NACCHO Report

ATTACHMENT – D: NACCHO report
[ SURVEY FINDINGS ]
March 2012

Local Health Department Job Losses and Program
Cuts: Findings from January 2012 Survey

ECONOMIC RECOVERY? NOT FOR MANY
LOCAL HEALTH DEPARTMENTS
Although the country as a whole shows signs of economic
recovery, the same is not true for many local health departments
(LHDs). During 2011, 57 percent of all LHDs reduced or eliminated
at least one program (Figure 1), a larger percentage than in
any 12-month period since the recession began in 2008 (not
shown). Emergency preparedness was among the hardest hit,
with 23 percent of LHDs reporting a reduction to this program.
An equal percentage of LHDs cut clinical health services, such as
comprehensive primary care and mental health services. Other
programs frequently cut include maternal child health, populationbased primary prevention, and immunization.

hiring freezes or budget cuts; the remaining 2,200 were staff
layoffs. When combined with loss estimates from previous
studies, nearly 40,000 jobs have been eliminated since 2008.
Figure 2. Estimated Number of LHD Job Losses (2008–2011)
and Job Losses and Additions (July–December 2011)
Job Losses (Layoffs and Attrition) (2008–2011)
2008

7,000

2009

16,000

2010

6,000

2011

10,600

Total

39,600

Figure 1. Percentage of LHDs that Reduced or Eliminated
Programs, Overall and by Program Area (Calendar Year 2011)
Program Area
At least one program

Percentage
of LHDs
57%

Emergency Preparedness

23%

Clinical Health Services

23%

Maternal and Child Health Services

21%

Population-based Primary Prevention

19%

Immunization

19%

Environmental Health

17%

Chronic Disease Screening and/or Treatment

16%

Communicable Disease Screening and/or
Treatment

10%

Food Safety

10%

Epidemiology and Surveillance

9%

n=590–633

NEARLY 40,000 JOBS LOST SINCE 2008
During the second half of 2011, LHDs throughout the country
collectively shed 5,200 jobs, more than three times as many
positions as they gained (Figure 2). Of the reductions, 3,000
were positions lost to attrition that were not replaced due to

Job Losses and Additions (July–December 2011)
Losses
Layoffs

2,200

Attrition

3,000

Total

5,200
Additions

New positions
Vacancies filled due to lift of hiring freeze
Total

1,200
500
1,700

Forty-four percent of all LHDs lost at least one staff person during
the second half of 2011, and more than one in every five (21
percent) either reduced staff work hours or imposed mandatory
furlough on existing staff (Figure 3). In total, more than half (51
percent) of all LHDs reported some type of reduced workforce
capacity between July and December 2011. These figures are
essentially unchanged since 2010.

BUDGETS CONTINUE TO DWINDLE
Forty-one percent of LHDs throughout the country said
their current fiscal year budget is less than the previous one,
compounding significant cuts made in prior periods (Figure 4).
About half (48 percent) said their budgets are holding steady,
and only 11 percent reported increases (not shown). Looking
ahead, 41 percent of LHDs expect cuts in the next fiscal year.

ATTACHMENT – E: NACCHO report
Figure 3. Percentage of LHDs Losing Workforce Capacity,
Overall and by Type (2010–2011)
51%
53%
52%

Any Reduction
in Workforce
Capacity

Figure 5. Percentage of LHDs Reporting Various Strategies to
Mitigate Negative Impact of Cuts on Service to Communities

44%
44%
44%

Lost Jobs
(Layoffs or
Attrition)
15%
14%
18%

Laid Off Staff
Cut Hours
or Imposed
Mandatory
Furlough

reduce workload, more than half (51 percent) identified other
providers in the community for client referrals, while 22 percent
contracted with another public health provider for services.

21%
22%
22%
0

Strategy

 July–December 2011 (n=628–650)
 January–June 2011 (n=630–666)
 Calendar Year 2010 (n=432–437)

20

60

40

Percentage of LHDs

Figure 4. LHDs with Budget Cuts (2008–2011) 
Percentage of LHDs Reporting Lower Budgets in the Current Fiscal Year
than
Prior Fiscal Year
 in theJul-Dec

Percentage of LHDs

2011
50

45%

45%

38%

40
30

44%

41%

27%

20

Cross-trained staff

82%

Increased staff workload

77%

Utilized technology to become more efficient
and/or reduce costs

60%

Pursued new funding opportunities

59%

Increased or began charging fees for service

55%

Identified other providers in the community for
client referrals

51%

Shared equipment or staff with another LHD

40%

Hired contract staff rather than regular employees

35%

Increased or began billing to insurance

35%

Merged departments within the LHD

23%

Contracted with another public health provider
for services

22%

Shared equipment or staff with a non-LHD
organization

17%

Increased work hours of existing staff

16%

Reduced employee pay

9%

n=657

10
0

Percentage
of LHDs

December
2008
n=1,079

August
2009
n=613

February November
2010
2010
n=696
n=1,891

July
2011
n=663

January
2012
n=651

Survey Date

41% expect a lower budget next fiscal year

PROTECTING THE COMMUNITY DESPITE
ONGOING CHALLENGES
LHDs used various strategies to minimize the negative impact of
cuts on service to their communities. Eighty-two percent reported
cross-training staff, one of the most common strategies. To offset
workforce reductions, health officials were much more likely to
increase the workload of their employees (77 percent) than to
increase work hours (16 percent). A large majority (60 percent)
reported increased use of technology as a means to reduce
expenses or increase efficiencies. Many employed measures to
increase revenues, including pursuing new funding streams (59
percent), originating or increasing fees for services (55 percent),
and originating or increasing insurance billing (35 percent). To

METHODOLOGY
In January and February 2012, NACCHO surveyed 960 LHDs,
selected as part of a statistically random sample designed to
provide both national and state-level estimates. A total of 663
LHDs distributed across 47 states participated for a response rate
of 69 percent. Data in this study were self-reported; NACCHO
did not independently verify the data provided by LHDs.
Technical documentation is posted on NACCHO’s website at
www.naccho.org/lhdbudget. Additional findings will be made
available here in the coming months.

ACKNOWLEDGMENTS
This document was supported by Award Number
5U38HM000449-04 from the Centers for Disease Control and
Prevention. Its contents are solely the responsibility of NACCHO
and do not necessarily represent the official views of the sponsors.
FOR MORE INFORMATION, PLEASE CONTACT:
Christine Brickman Bhutta, PhD
Senior Research Scientist
P 202-471-1206
[email protected]
The mission of the National Association of County and City Health Officials
(NACCHO) is to be a leader, partner, catalyst, and voice for local health
departments in order to ensure the conditions that promote health and
equity, combat disease, and improve the quality and length of all lives.

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