Vector Control Att C

A D V A N C E M E N T O F T H E PRACTICE

 D I R E C T F R O M C D C E N V I R O N M E N T A L H E A LT H S E R V I C E S B R A N C H

Jennifer Li,
MHS

Andrew Elligers,
MA, JD

Impact of Budget Cuts to
Environmental Health Services
at Local Health Departments:
Key Findings

E d i t o r ’s N o t e : NEHA strives to provide up-to-date and relevant
information on environmental health and to build partnerships in the
profession. In pursuit of these goals, we feature a column from the
Environmental Health Services Branch (EHSB) of the Centers for Disease
Control and Prevention (CDC) in every issue of the Journal.
In this column, EHSB and guest authors from across CDC will highlight
a variety of concerns, opportunities, challenges, and successes that we all
share in environmental public health. EHSB’s objective is to strengthen the
role of state, local, tribal, and national environmental health programs and
professionals to anticipate, identify, and respond to adverse environmental
exposures and the consequences of these exposures for human health.
The conclusions in this article are those of the author(s) and do not
necessarily represent the views of the CDC.
Jennifer Li is the director of Environmental Health and Health and
Disability at the National Association of County and City Health Officials.
Andrew Elligers is a senior program analyst for Environmental Health at the
National Association of County and City Health Officials.

sons. In addition, respondents indicated that
some environmental health services that were
not reduced or eliminated were still nega­
tively impacted by budgetary constraints.
Key findings from the survey are summa­
rized in the following categories.

Changes in Environmental
Health Revenue

T

he recent economic recession and its
aftermath negatively impacted many
local health departments (LHDs)
across the U.S. Seven surveys conducted by
the National Association of County and City
Health Officials (NACCHO) between August
2009 and February 2012 produced informa­
tive data (NACCHO, 2012). Each wave of the
study showed that in comparing the current
and prior fiscal years about 40% of LHDs na­
tionwide had lower budgets, about 50% cut
at least one program, and about 45% experi­
enced staff reduction. Since 2008, LHDs lost
almost 40,000 employees.

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According to one
respondent, personnel
reductions due to
budget cuts had “put
an enormous strain on
providing customary
environmental
health services.”

To learn specifically about changes to envi­
ronmental health funding and the impacts of
these changes on the environmental health
workforce and services at LHDs, NACCHO
surveyed a nationally representative sample
of LHDs in March and April 2012. The study
assessed changes between each respondent’s
most recently completed fiscal year and prior
fiscal year. The study data indicated that
environmental health revenue decreased for
a substantial percentage of LHDs and that
significant cuts to the environmental health
workforce and to valuable environmental
health services were made for budgetary rea-

• Of the 75% of LHDs that were able to sepa­
rate environmental health revenue from
overall LHD revenue, 34.5% realized lower
environmental health revenue than in the
previous fiscal year.
• Eighteen and a half percent of LHDs real­
ized higher environmental health revenue
in their most recently completed fiscal year
than in the previous fiscal year.

Impact on Environmental
Health Workforce
• Nearly three out of 10 (29.1%) LHDs expe­
rienced a reduction of their environmental
Reprinted with permission from NEHA

Volume 76 • Number 10

TABLE 1

Percentages of Local Health Departments That Reduced or
Eliminated Environmental Health Services for Budgetary Reasons
(N = 280–291)
Environmental Health Service
At least one service
Food safety
Vector control
Ground water
Surface water
Drinking water
Recreational water
Indoor air
Outdoor air
Pollution prevention
Land use
Hazardous material
Air pollution
Hazardous waste
Animal control
Climate change

Reduced or Eliminated (%)
33.7
12.8
12.7
10.7
8.5
10.0
8.3
7.8
3.2
5.3
5.6
2.6
1.6
5.3
6.8
1.5

TABLE 2
Percentages of Local Health Departments for Which Budgetary
Constraints Negatively Impacted Environmental Health Service
Outcomes (N = 289–307)
Environmental Health Service
Any service
Food safety
Vector control
Ground water
Surface water
Drinking water
Recreational water
Indoor air
Outdoor air
Pollution prevention
Land use
Hazardous material
Air pollution
Hazardous waste
Animal control
Climate change

health staff for budgetary reasons in the
form of layoffs or employee attrition where
employees were not replaced because of
hiring freezes or budget cuts.
Reprinted with permission from NEHA

Negative Impact (%)
39.6
20.7
16.8
14.9
13.5
15.6
13.6
8.9
3.2
6.9
7.1
3.5
1.8
5.9
8.8
1.1

• The number of job losses for the environ­
mental health workforce at LHDs nation­
wide was estimated to be 1,350 (550 were
laid off and 800 were lost to attrition and

not replaced because of hiring freezes or
budget cuts).
• LHDs reported that job losses negatively
affected their abilities to provide environ­
mental health services, increased stress on
the remaining workforce, and resulted in
low employee morale. According to one
respondent, personnel reductions due to
budget cuts had “put an enormous strain
on providing customary environmental
health services.”

Reduction and Elimination of
Environmental Health Services
• Many LHDs reduced or eliminated envi­
ronmental health services for budgetary
reasons (Table 1). Over one-third (33.7%)
of LHDs reduced or eliminated at least one
environmental health service.
• Environmental health services that were
reduced or eliminated by the largest per­
centages of LHDs included food safety
(12.8%) and vector control (12.7%).
• Environmental health services related to
water (ground, drinking, surface, and rec­
reational) were reduced or eliminated by
the next largest percentages of LHDs.
• Multiple respondents noted reduced
inspections of food establishments due to
budgetary constraints. For example, one
LHD “reduced food inspections from four
times per year to three.”
• Several respondents indicated reduced vec­
tor control services and described impacts
to mosquito control. Some examples
included eliminating mosquito surveil­
lance trapping, not spraying for mosqui­
toes as frequently, and not providing any
mosquito control services.

Environmental Health
Service Outcomes
• More than one-third (39.6%) of LHDs
reported that budgetary constraints nega­
tively impacted environmental health ser­
vice outcomes (Table 2).
• Food safety, vector control, and services
related to water were the top three areas for
which LHDs reported that budgetary con­
straints negatively impacted service outcomes.
• Some respondents described decreased qual­
ity of work in attempting to meet unchanged
or increasing workloads. Respondents also
indicated that budget constraints had led to
“reduced education and training.”

June 2014 • Journal of Environmental Health

39

A D V A N C E M E N T O F T H E PRACTICE

Moving Forward
With diminished resources, LHDs may be
less able to provide customary services and
respond to emergencies quickly and compre­
hensively. Recognizing the challenging con­
ditions illustrated by the survey data, NAC­
CHO supports staff at LHDs to advance the
practice of environmental health by provid­
ing innovative resources to address existing
and emerging issues and encourages LHDs to
consider the following actions (see Sidebar):
• learn from peers through NACCHO’s model
practices program;
• use and share existing tools and resources
developed by and for LHDs; and
• communicate, illustrate, and quantify the
impact of budget cuts on environmental
health service outcomes by telling their
stories to the public and policy makers.
For the full survey report, more information
about NACCHO’s environmental health work,
and links to additional resources, please visit
www.naccho.org/topics/environmental.
Corresponding Author: Jennifer Li, Director,
Environmental Health and Health and Disability, National Association of County and
City Health Officials, 1100 17th Street, NW,
7th Floor, Washington, DC 20036.
E-mail: [email protected].

Did You Know?

Quick Links: National Association of County and City Health Officials
(NACCHO) Resources to Support Environmental Health
NACCHO environmental health program: Environmental health–related tools,

publications, policy statements, and other resources.

http://www.naccho.org/topics/environmental

Toolbox: Free, online collection of local public health tools produced by members

of the public health community. Current examples of tools include case examples,

presentations, fact sheets, drills, evaluations, protocols, templates, reports, and

training materials. Check out environmental health–related toolkits on climate change,

environmental health in all policies, food safety, healthy community design, and Protocol

for Assessing Community Excellence in Environmental Health (PACE EH).

http://www.naccho.org/toolbox
Model practices database: Online, searchable collection of innovative, peer-reviewed
best practices across public health areas that allows users to benefit from their
colleagues’ experiences to learn what works, get strategies on how to implement
effective programs with good results, and save time and resources.
http://www.naccho.org/topics/modelpractices/
Stories from the field Web site: Web site that enables local health departments to share
their experiences and demonstrate the value of public health. Stories from the field can be
used to support advocacy, peer learning, and collaboration with state and federal partners.
http://www.nacchostories.org/

Reference
National Association of County and City Health
Officials. (2012). Local health department job
losses and program cuts: Findings from the Jan­

?

uary 2012 survey. Retrieved from http://www.
naccho.org/topics/infrastructure/lhdbudget/
upload/Research-Brief-Final.pdf

NEHA is coordinating with the Centers for Disease Control and Prevention
to offer four more Integrated Pest Management Workshops in the
upcoming months. Learn more at www.neha.org/research/irprogram.html.

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Volume 76 • Number 10

Reprinted with permission from NEHA