Forces of Change Surveys

Since 2008, the NACCHO has periodically surveyed a random sample of local health departments (LHDs) to assess the impact of the Great Recession.

In 2014, NACCHO expanded the survey to address more generally the forces that affect change in LHDs, including emerging public health threats and a growing need to focus on population health. This expanded assessment is called the Forces of Change survey. The Forces of Change survey helps to identify infrastructure challenges, as well as opportunities to strengthen public health capacity.

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2020 Forces of Change Survey Report

This report provides a compendium of results from the 2020 Forces of Change survey, which describe the mid-pandemic capacity and capabilities of LHDs.

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2020 Forces of Change Survey Report

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From the Frontline of Public Health Response

This infographic shares key findings from the 2020 Forces of Change survey.

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From the Frontline of Public Health Response

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Pandemic-Related Workplace Violence and Its Impact

This research article from JHU highlights impacts of harassment targeting LHDs during COVID-19.

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Pandemic-Related Workplace Violence and Its Impact

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Integration of Behavioral Health in Preparedness

This research article presents data from the 2020 Forces of Change survey on LHD involvement in behavioral health services during COVID-19.

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Integration of Behavioral Health in Preparedness

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Interoperability in LHD Information Systems

This research article presents 2020 Forces of Change data on the electronic infrastructure of LHDs, including local adoption of interoperable systems.

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Interoperability in LHD Information Systems

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Addressing Health Equity During COVID-19 Response

This article shares an interview with LHD leaders about 2020 Forces of Change data and their approach to integrating health equity into the response.

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Addressing Health Equity During COVID-19 Response

Use the following files to access our previous Forces of Change reports.

The 2020 Forces of Change survey assessed LHD capacity during the COVID-19 pandemic, including experiences of harassment, changes in services, pandemic preparedness activities, community recovery planning, information technology capacity, equity and preparedness, and interagency alignment and partnerships.

Findings are presented below:
2020 Forces of Change Survey Report

The following materials provide additional details on sampling design, survey administration, data cleaning, and analysis:
2020 Forces of Change Survey Instrument
2020 Forces of Change Survey Codebook
2020 Forces of Change Survey Technical Documentation

The 2018 Forces of Change survey assessed LHD opioid use prevention activities, population health efforts, influenza preparedness, informatics capacity, and environmental health activities.

Findings are presented below:
2018 Forces of Change Survey Report

The following materials provide additional details on sampling design, survey administration, data cleaning, and analysis:
2018 Forces of Change Survey Instrument
2018 Forces of Change Survey Codebook
2018 Forces of Change Survey Technical Documentation

The 2017 Forces of Change survey assessed LHD Zika prevention and response activities, multi-sectoral partnerships, and workforce recruitment efforts.

Findings are presented below:
2017 Forces of Change Survey Report

State Tables from the 2017 Forces of Change survey supplement national findings by providing information on cuts to local health department budgets and jobs for many states.

The following materials provide additional details on sampling design, survey administration, data cleaning, and analysis:
2017 Forces of Change Survey Instrument
2017 Forces of Change Survey Codebook
2017 Forces of Change Survey Technical Documentation

The 2015 Forces of Change survey assessed LHDs' changes in services, billing for clinical services, collaboration with non-profit hospitals and primary care providers, and workforce skills.

Findings are presented below:
2015 Forces of Change Survey Report
2015 Forces of Change Survey Infographic

State Tables from the 2015 Forces of Change survey supplement national findings by providing information on cuts to local health department budgets and jobs for many states.

The following materials provide additional details on sampling design, survey administration, data cleaning, and analysis:
2015 Forces of Change Survey Instrument
2015 Forces of Change Survey Codebook
2015 Forces of Change Technical Documentation

The 2014 Forces of Change survey assessed LHDs' changes in services, billing for clinical services, role as navigators, and accreditation efforts.

Findings are presented in five research briefs:
Local Health Department Budget Cuts and Job Losses
Changes in Health Department Services
Billing for Clinical Services
Role of Local Health Departments as Navigators
Local Health Department Accreditation

State Tables from the 2014 Forces of Change survey supplement national findings by providing information on cuts to local health department budgets and jobs for many states.

The following materials provide additional details on sampling design, survey administration, data cleaning, and analysis:
2014 Forces of Change Survey Instrument
2014 Forces of Change Survey Codebook
2014 Forces of Change Technical Documentation

ASTHO Forces of Change

The Association of State and Territorial Health Officials (ASTHO) publishes their own Forces of Change report, which complements NACCHO’s local-level data. Visit ASTHO’s website for the survey report.

Other NACCHO Research

NACCHO also publishes various other reports using information gathered from local health department surveys.

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2015 Local Board of Health National Profile

The Local Board of Health National Profile provides information about local board of health functions and characteristics.

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2015 Local Board of Health National Profile

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Job Loss & Program Cuts Surveys

NACCHO periodically surveyed local health departments to assess the impact of the recession on their budgets, programs, and workforce.

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Job Loss & Program Cuts Surveys

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1999-2000 Local Health Department Infrastructure Survey

NACCHO conducted a nationwide study of local public health agency funding, activities, and partnerships.

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1999-2000 Local Health Department Infrastructure Survey

NACCHO encourages researchers to apply for data from its studies on local health departments. Complete the form below to request data from either or both the National Profile of Local Health Departments and Forces of Change studies. By doing so, you agree to NACCHO’s Data Use Policy.

Profile and Forces of Change data are available at no charge through the Inter-University Consortium for Political and Social Research (ICPSR). Consult the ICPSR Data Use Agreement Form for instructions.

Thank you for your interest in data collected through NACCHO’s National Profile of Local Health Department and Forces of Change studies.

Please complete and submit the following form to submit a data request. You may also print the form and submit via email to ProfileTeam@naccho.org or mail to:

Profile Team, NACCHO
1201 Eye St. NW, Fourth Floor
Washington, DC 20005

By acquiring and use the dataset(s), you agree to NACCHO’s Data Use Policy.


Data Requested


Description of Planned Research

Provide a description of your planned research. Include specific hypotheses and/or research questions, and indicate how the work will benefit local public health practice. (Limit 3,000 characters)

Supporting Documents

If you would like to share any additional information related to your Profile or Forces of Change data request, please upload them here.


Plans for Disseminating Results

Briefly describe your plans for disseminating findings that feature data from the National Profile of Local Health Departments and Forces of Change studies. Please indicate an expected time frame for disseminating your findings.

Submit Your Form

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For more information about the National Profile of Local Health Departments, please reach out to our Research team at profileteam@naccho.org.

Research and Evaluation

Aaron Alford

Senior Director, Research & Evaluation

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Research and Evaluation

Timothy McCall

Director of Research

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Research and Evaluation

Margaret Cunningham

Senior R&E Specialist

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Research and Evaluation

Kellie Hall

Lead Analyst, Evaluation & Data Communications

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Research and Evaluation

Krishna Patel

Lead Survey & Research Analyst

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The 2008–2019 National Profile of Local Health Department studies and 2014–2020 Forces of Change surveys were supported by grants from the Robert Wood Johnson Foundation (RWJF) and cooperative agreements from the Centers for Disease Control and Prevention (CDC). All Profile studies prior to 2008 were supported through cooperative agreements with CDC.

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