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Frontiers in Public Health Services and Systems Research

An RWJF Collection

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The Resilient Local Health Department

Surviving the 2008 Economic Crisis

Three women walking between two buildings and a van; one is dressed in a lab_coat.

Researchers identify potential modifiable factors that can protect local health departments (LHDs) from job losses and budget cuts during periods of economic stress.


The Issue:
Public health financing is one of the four primary domains of the recently developed public health services and systems research agenda. It is arguably the most critical domain, as its relationships with both public health performance and health outcomes can have direct effects on the communities served by public health agencies.

In 2008, 27 percent of LHDs reported a decline in budgets compared to the previous year, with this figure increasing to 45 percent in August 2009 and again in July 2011. The financial crisis resulted in an estimated loss of almost 40,000 LHD jobs in those same years; equating to 21 percent of the estimated workforce size (184,000) in 2010. 

Key Findings

  • The outcome of interest–resiliency of the LHD–represented financial resiliency for maintaining budgets during the 2008 recession, and was based on the ratio of observed-to-predicted expenditures per capita for 2010.

  • LHDs which successfully weathered the economic recession of 2008 represented smaller populations and were better resourced in 2005; were less likely to have had a board of health with the authority to hire/fire; and were less likely to be dependent on local resources compared to LHDs which experienced significant losses in funding by 2010.

About the Study:

This retrospective cohort study was based on the 2005 and 2010 surveys of local health departments (LHDs) conducted by the National Association of County and City Health Officials. The study explored the financial situation of LHDs from a resilence standpoint, focusing specifically on two questions:

(1) What are the organizational characteristics of LHDs that weathered the economic crisis of 2008, and

(2) Are there potential modifiable factors, including public and private sources and uses of resources, that can protect LHDs from job losses and budget cuts during periods of future economic stress?


Excerpt from Frontiers in Public Health Services and Systems Research