Washington, DC, June 12, 2025 — The National Association of County and City Health Officials (NACCHO), the voice of the country’s over 3,300 local health departments, released an analysis today in the American Journal of Public Health (AJPH) showing that while the local health department workforce grew during the COVID-19 pandemic, the gains were temporary, uneven across jurisdictions, and likely driven by short-term emergency funding. The analysis comes at a critical time, as federal funding cuts threaten the capacity of local health departments and raise urgent concerns about the stability and future readiness of the nation’s local public health system and workforce.
Using data from NACCHO’s National Profile of Local Health Departments (Profile) Study, researchers calculated changes in staffing levels from 2019 to 2022. During that period, the total number of local health department employees increased by 19%, and the total number of full-time equivalents (FTEs)—inclusive of part-time and full-time staff—rose by 20%. This is a notable shift after more than a decade of steady workforce decline since 2008.
However, most of the growth came from contractual and seasonal staff rather than long-term positions. While the number of full-time employees rose by just 7%, contract workers surged by 175%. Local health departments serving jurisdictions with more than 50,000 people saw significant increases in contract employees (up to 249%), while agencies serving smaller jurisdictions experienced little to no workforce growth.
“Our findings appear to indicate that local health departments were able to flex around these many limitations by bringing in temporary, contractual and seasonal labor in response to the explosive need driven by the COVID-19 response,” wrote researchers in AJPH. Researchers also noted that “contractual workers may not be able to transition to full-time positions or programmatic areas in need outside of COVID-19 given the expiration of pandemic supplemental funding in 2024.” They added that “despite this growth, it falls far short of the necessary workforce to provide infrastructure and public health services, which was estimated to be 80,000 or more FTEs.”
Without long-term, flexible, and disease-agnostic funding, local health departments, especially smaller agencies, will continue to struggle to build and sustain the workforce needed to keep our nation healthy and safe. With the unexpected claw back of pandemic-era supplemental funding, support for the local public health workforce through programs like the Public Health Infrastructure and Capacity grant are even more critical to ensuring our nation’s public health system is prepared to respond to ongoing and emerging threats.
“This is a pivotal moment,” said Lori Tremmel Freeman, NACCHO CEO. “The pandemic showed us what a stronger public health system could look like with more financial resources. Public health threats aren’t going away. Recent federal funding cuts have already set us back, and we are returning to an even more weakened system, just as chronic health challenges, opioid overdoses, maternal health issues, and future outbreaks demand more, not less, of our local public health workforce. Protecting the health of our communities requires a right-sized, well-supported, and permanent workforce.”
###
About NACCHO
The National Association of County and City Health Officials (NACCHO) represents the over 3,300 local governmental health departments across the country. These city, county, metropolitan, district, and tribal departments work every day to protect and promote health and well-being for all people in their communities. For more information, visit www.naccho.org.
