Using geographic information systems to investigate the relationship between local health departments' workforce cuts and vulnerable populations

BACKGROUND: Since 2008, local health departments (LHDs) in the United States have cut 34,400 workers. It is unclear, however, how changes in the size of the LHD workforce due to cuts may have impacted the distribution of workers in geographic areas with the most vulnerable populations. PURPOSE: Exploring the relationship between LHD workforce cuts and sociodemographic characteristics (e.g. poverty and racial composition) across geographic areas is of particular relevance to research regarding LHD workforce, social determinants of health, and health disparities. The study will: 1) describe nationwide patterns of decline in the LHD workforce by mapping changes in full-time equivalents (FTEs) per capita, 2) examine the distribution of LHD FTE cuts relative to distributions of vulnerable populations (determined by poverty and racial composition), and 3) Determine whether there are significant clusters of changes in per capita LHD FTEs associated with changes in sociodemographic characteristics (e.g. poverty and racial composition) across selected contiguous states. METHODS: Retrospective, secondary data linking population characteristics with LHD data depicting workforce cuts will be examined through a panel time series design and through geographic information systems (GIS) visual and analytical portrayal of spatial patterns. RESULTS: Study findings will be presented regarding whether LHD workforce capacity is associated with “need” and how reductions in the workforce may disproportionately impact vulnerable populations. CONCLUSIONS: This research has the potential to inform critical decision-making and LHD resource allocation during times of economic hardship. Findings and related recommendations can be applied to policy, practice, and planning for reducing disparities.