By Frances Bevington, Senior Marketing and Communications Specialist and Stacy Stanford, MSPH, Program Analyst; Public Health Preparedness, NACCHO
On Jan. 21, NACCHO released the report of findings and data from the 2013 National Profile of Local Health Departments (Profile) study, demonstrating continued funding cuts across several programmatic areas at local health departments (LHDs), including emergency preparedness. According to NACCHO staff Carolyn Leep, Senior Director of Research and Evaluation, and Jan Wilhoit, Senior Project Management Specialist for the Profile, funding for emergency preparedness, particularly per capita funding, saw a significant drop in 2013, with LHDs reporting median per capita funding of $1.15 in 2013 compared to $2.07 per capita in 2010. This finding is consistent with continued decreases in overall federal funding for emergency preparedness, which has dropped more than 25 percent since 2007.
What is striking about the decrease in emergency preparedness funding is that LHDs are not reporting a corresponding decrease in staff. In fact, LHDs have increased emergency preparedness staff with 77 percent of all LHDs reporting a full time equivalent (FTE) in 2013, compared with 65 percent of all LHDs in 2010. Nationally, the number of emergency preparedness staff employed by LHDs grew to an estimated 2,900 FTEs in 2013 from 2,700 in 2010, an increase of approximately seven percent. While NACCHO has interviewed members who have anecdotally reported that decreases in funding have led to decreases in trainings, exercises, travel, and supplies because cuts in these areas precede staffing cuts, further research is needed to understand the full implications of funding cuts in emergency preparedness at the local level. Other findings of note regarding emergency preparedness include the following:
- Most LHDs have developed or updated a written emergency plan (87%) or provided emergency preparedness training to staff (84%).
- Since September 2010, more than half of all LHDs (55%) have responded to at least one all-hazards event, and almost all (93%) have participated in an emergency response drill or exercise.
- Natural disasters are the most common all-hazards event LHDs have responded to since September 2010 (41%), followed by an influenza outbreak (30%) and an outbreak of other infectious diseases (27%).
- LHDs also prepare for rare events; for example, few LHDs (6%) have responded to an exposure to a potential biological agent since September 2010, but 35 percent of LHDs have participated in drills/exercises to prepare for such an event.
Several findings that describe the overall state of personnel and practices at LHDs could have implications for emergency preparedness programs. For example, Profile data demonstrated a long-term decrease in LHD staff dating to the enactment of broad federal funding cuts in 2008. The total number of individuals employed at LHDs in 2013 was 162,000 as compared to 190,000 in 2008 and nearly one-half (48%) of all LHDs reduced or eliminated services in at least one program area. Less staff overall would likely result in less staff to respond to emergencies, regardless of whether or not those staff are emergency preparedness personnel. Findings also show that the top agency executives at LHDs are aging, with 25 percent of top executives over the age of 60 compared to 16 percent in 2005. As these top executives reach retirement age, knowledge acquired through responses to past emergencies may be lost. Also of note is the increasing level of LHDs who are engaging in formal quality improvement (QI) activities, most often in specific program areas, with 56 percent reporting a formal QI program compared to 45 percent in 2010. Participation in programs that emphasize quality improvement, such as NACCHO’s Project Public Health Ready, may be contributing to this increase.
NACCHO supports the Medical Reserve Corps (MRC), a national network of more than 200,000 volunteers in nearly 1,000 local units, through a cooperative agreement with the U.S. Department of Health and Human Services’ Office of the Surgeon General and encourages LHDs to engage MRC units in emergency preparedness activities. The 2013 Profile findings indicated that while only 16 percent of LHDs reported no engagement with volunteers, only 27 percent engage MRC volunteers specifically. This suggests that there is potential for increased collaboration between LHDs and MRC units. NACCHO is authoring a similar study of the MRC network that will be released in March 2014, “The 2013 Network Profile of the Medical Reserve Corps.” This study may offer LHDs more insight into how to best to engage with MRC units and volunteers.
The 2013 Profile expanded and added questions to measure changing practices at LHDs. The new data offer insights into policy activities that could be the first national-level data available on the policy work of LHDs. Most LHDs (90%) have been involved in some policy or advocacy areas in the past two years with 58 percent engaging in policy or advocacy specifically about emergency preparedness and response. The Profile also expanded the data collected about social media use at LHDs and found that, while LHDs are comparatively late adopters of social media, social media use is steadily increasing with 44 percent using Facebook in 2013 compared to 26 percent in 2010. The use of YouTube increased to 12 percent from six percent in 2010 and the use of Twitter increased to 18 percent from 13 percent in 2010. The 2013 Profile also asked about the use of social media for surveillance activities for the first time with results showing that ten percent of LHDs report this type of activity. However, the results are heavily skewed toward large LHDs that may have more resources and staff available for such activities. Profile data also show that large health departments serving populations greater than 500,000 are much more likely to have a Public Information Officer FTE, which recent research suggests may be correlated with capacity for social media activity. 
NACCHO has been collecting data through the Profile to inform a comprehensive picture of infrastructure and practice at LHDs since 1989. The 2013 Profile is the seventh version of this study and includes a collection of descriptive statistics of 2,000 respondents that is representative of the nation’s approximately 2,800 LHDs. For the study, an LHD is defined as an administrative or service unit of local or state government, concerned with health, and carrying some responsibility for the health of a jurisdiction smaller than the state. The study provides a fundamental basis for research on LHDs and represents a major investment of time on behalf of the LHDs who complete the Profile and a significant contribution by these LHDs to the knowledge base of public health.
- Harris, J., Choucair, B., Maier, R., Jolani, N., Bernhardt, J. (under review). Are public health organizations tweeting to the choir? Understanding LHD Twitter followership.