Forces of Change Survey
NACCHO’s Forces of Change Survey assesses changes, at the national level, in local health department capacity and activities driven by public health trends. This survey has been conducted since 2008 — initially measuring the impact of the Great Recession on local health department budgets, staffing, and programs. In 2014, the survey was expanded to address broader social, political, and economic impacts. The Forces of Change Survey data show both point-in-time information, as well as longitudinal changes.
NACCHO’s 2023 Forces of Change survey assessed staffing and budget changes, billing practices for clinical services, the role of community health workers, programs and collaborations related to violence prevention and social determinants of health, and data modernization and outbreak analytics capacity.
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
2020 Forces of Change Survey Infographic
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
NACCHO encourages researchers to apply for data from its studies on local health departments. Profile and Forces of Change data are available at no charge through the Inter-University Consortium for Political and Social Research (ICPSR) at the University of Michigan. Consult the ICPSR website for instructions on submitting a request.
For questions about NACCHO's datasets, please contact the Research team at [email protected].
For more information about the National Profile of Local Health Departments, please reach out to our Research team at [email protected].
Research and Evaluation
Aaron Alford
Senior Director, Research & Evaluation
JavaScript is required to reveal this message. / Email
Research and Evaluation
Timothy McCall
Director of Research
JavaScript is required to reveal this message. / Email
Research and Evaluation
Margaret Cunningham
Lead Research Analyst
JavaScript is required to reveal this message. / Email
Research and Evaluation
Krishna Patel
Lead Survey & Research Analyst
JavaScript is required to reveal this message. / Email
Research and Evaluation
Chloe Garofalini
Research & Evaluation specialist
JavaScript is required to reveal this message. / Email
Research and Evaluation
Kellie Hall
Director of Data Communications
JavaScript is required to reveal this message. / Email
Research and Evaluation
Gwen Davis
Sr. R&E Specialist, Data Communication
JavaScript is required to reveal this message. / Email
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.