The National Association of County and City Health Officials, representing the country’s nearly 3,000 local health departments, has released updated findings from its National Profile Study exploring trends in workforce and financial capacity from 2008 to 2019, just months before the COVID-19 pandemic. This brief highlights two critical infrastructure components that enable local health departments (LHDs) to protect the health and wellbeing of the populations they serve.

Key findings:

• NACCHO data describe the impact of an economic downturn on local health department staffing capacity. NACCHO’s revised estimate reiterates that local health departments lost 20% of their workforce (37,000 jobs) after the 2008 recession.
• However, these new data also show that these cuts seem to have bottomed out in 2016. Between 2016 and 2019, local health departments had finally started to rebuild, if slowly, adding 3% of that lost workforce back (6,000 jobs) nationwide.
• Over the same period, the nation’s population increased by 8%. Since 2008, the number of full-time equivalent local health department workers has dropped from 5.2 per 10,000 population in 2008 to 4.1 per 10,000 population in 2019.
• Spending per capita is also concerning: While small local health departments have seen median per capita spending remain essentially flat in the last decade, after accounting for inflation, medium and large local health departments report 14% and 22% declines in median per capita, respectively.
• Health department budgets also continue to suffer from the effects of the 2008 recession. The majority of local health departments continue to experience flat funding, with a total of 67% experiencing stagnant (52%) or reduced budgets (15%) in 2019. This is despite inflation, population growth, and the increasing complexity of public health challenges.
• 24% of LHDs reported in 2019 that they expect next year’s budget to be greater relative to the current year; however, they may still not be making up for previous years of cuts. In addition, budgetary pressures resulting from the economic impact of the COVID-19 pandemic will likely result in far fewer seeing budgetary increases next year.
• Overall, 175 million Americans are living in communities that experienced stagnant or reduced local health department funding in 2019, impacting over half of the U.S. population.

“Overall, this new analysis points to what we continue to hear directly from local health departments across the country: they continue to be asked to do more with less, despite the increasing complexity and number of public health challenges, a growing population, and a larger proportion of older Americans,” said Lori Tremmel Freeman, NACCHO’s Chief Executive Officer.

“These data—even where some progress has been made in recent years—are even more concerning as we face the unknowns of the negative impact of the COVID-19 pandemic on the local and state budgets that support so much of local health departments’ work. We know that some local health departments have had to furlough staff mid-pandemic in order to absorb budgetary pressures, and many others are planning steep cuts for their next fiscal year. As these individuals work on the front lines to keep us safe from the pandemic, that same virus is directly eroding the funding that keeps them operational. We must do more to provide long-term, sustainable, predictable funding to local health departments, both now and in the future, to stabilize and rebuild this critical system before the next crisis.”

About the NACCHO Profile Study

The National Association of County and City Health Officials (NACCHO) has conducted the National Profile of Local Health Departments (Profile) study since 1989 to develop a comprehensive and accurate understanding of LHD infrastructure and practice.