Latest NACCHO Economic Survey Reveals Local Health Departments Still Recovering from Recession

    • September 11, 2013

Washington, D.C.—A recent survey analysis found that despite modest improvement, America’s local health departments are still struggling to recover from the country’s economic recession, with 48 percent of survey respondents reporting reductions in, or elimination of, services in at least one program area and 27 percent reporting budget cuts in 2012.

Released today by the National Association of County and City Health Officials (NACCHO), the survey results reveal that local health departments have lost 43,900 jobs through layoffs or attrition since 2008. Although job losses and gains were roughly equal in 2012, with local health departments adding 4,000 positions and shedding 4,300 positions, 41 percent of departments nationwide experienced some type of reduction in workforce capacity. Others are still unable to rebuild their staff following previous rounds of budget cuts.  

Programs such as immunization, emergency preparedness, and maternal and child health have been particularly hard hit by budget cuts. For example, in 2012, 22 percent of local health departments reported cuts in immunization services, and 15 percent reported cuts to both emergency preparedness and maternal and child health services.

“While workforce reductions and program cuts may have slowed in some areas of the country in 2012, on the whole, the budgets of our nation’s local health departments are not keeping pace with the general recovery” said NACCHO Executive Director Robert M. Pestronk. “In fact, continuing annual draconian cuts associated with sequestration will further erode local health departments’ capacity to serve and respond. If keeping people healthy and safe is a priority, then we should rebuild local response capacity and health security, not keep cutting it.”

The impacts of local health department budget cuts are playing out in communities across the country. For instance, the Boston Public Health Commission (BPHC) was forced to limit its support of prenatal care due to a five percent cut in federal funds for the Healthy Start Initiative. Due to reduced funding, BPHC also has lost community health workers that provided home visits to young families, case management for children and teens at risk of truancy, and services at school-based health centers. And due to statewide budget cuts to local health departments in 2009, the Frederick County Health Department in Maryland was forced to eliminate one-third of its nurses. Before the nursing cuts, the health department conducted flu clinics in three locations simultaneously. Now they can only support one clinic location at a time which does not achieve the same mass vaccination clinic operation experience needed to advance the County’s public health emergency preparedness goals, and fewer residents are able to benefit from this important local health department service.

NACCHO administered the economic surveillance survey as part of the National Profile of Local Health Departments in 2012 and prior to the 2013 sequester cuts. The survey included questions about budget, staffing, and program cuts during 2012. All local health departments in the United States were asked to participate. A total of 2,000 local health departments completed the survey (a response rate of 79 percent). Data were weighted to adjust for non-response.

Learn more about local health department job losses and program cuts from 2008 through 2012 at

NACCHO’s economic survey and analyses is supported by the Centers for Disease Control and Prevention and by the Robert Wood Johnson Foundation.


About the Robert Wood Johnson Foundation

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to health and health care, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, measurable, and timely change. For more than 40 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime. For more information, visit Follow the Foundation on Twitter at or on Facebook at


About the National Association of County and City Health Officials

The National Association of County and City Health Officials (NACCHO) represents the nation's 2,800 local governmental health departments. These city, county, metropolitan, district, and tribal departments work every day to protect and promote health and well-being for all people in their communities.

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