NACCHO recently undertook an initiative to identify themes across its national surveys to better direct national programmatic activities and resources. A few key survey trends highlight strengths and limitations faced by local health departments in fortifying their emergency response capacity. This is according to an examination of five of NACCHO’s nationally representative surveys: Are We Ready?, Preparedness Profile, Network Profile of the Medical Reserve Corps, National Profile of Local Health Departments, and Forces of Change. Opportunities also remain for federal agencies and national organizations to ensure local health departments are better equipped to handle diverse and evolving threats.
Local Health Departments (LHDs) Face Capacity Challenges
Local health departments (LHDs) are grappling with substantial capacity challenges, including workforce limitations. Preparedness coordinators spent less time on preparedness-specific job duties in 2022 compared to 2018. The share of preparedness coordinators that spent more than 75% of their time on preparedness job duties fell at or below 2016 levels after an increase in 2018 (See Figure 1). In 2022, the average percentage of job duties that LHD preparedness coordinators dedicated to preparedness was 25–49 percent.
Limited Resources Impact Preparedness
With constrained resources, LHDs have struggled to enhance their level of preparedness for several critical threats. These include environmental hazards like extreme temperature events, emerging threats such as opioid use and active shooter incidents, and cybersecurity events like medical supply chain disruptions and cyber-attacks (See Figure 2). Additionally, efforts to address health equity for at-risk populations have decreased since 2018, and only 40% of LHDs are currently tackling the public health effects of climate change.
Medical Reserve Corps Units Bolster Response Capacity
To bolster their response capabilities, more LHDs are engaging Medical Reserve Corps (MRC) units over time. MRC volunteers provide a range of emergency and non-emergency public health workforce capacity, with 56% of LHDs utilizing MRC units for preparedness activities. (See Figures 3 and 4).
Key Recommendations for National Support
Federal agencies and national organizations can help LHDs enhance their preparedness and resilience, ensuring local health departments are better equipped to handle the diverse and evolving threats they face by:
Strengthening the local preparedness workforce through targeted recruitment and retention efforts. This includes increasing the number of preparedness staff and their expertise in areas such as climate change and increasing staff time allotted to preparedness activities. These activities should align with the Public Health Response Readiness Framework.
Investing in and allocating resources to preparedness planning efforts that consider the diverse threats jurisdictions face. This includes addressing commonly recurring natural disasters exacerbated by climate change and newer threats like opioid overdoses and active shooter incidents.
Supporting and fostering partnerships between LHDs and MRC units to maximize the use of existing capabilities. This includes investing in MRC unit leaders and volunteers to ensure a trained and ready surge capacity workforce can support LHD capacity for response and recovery actions tailored to specific community needs.
This review of surveys was conducted by NACCHO with funding from the Administration for Strategic Preparedness and Response (ASPR).
