This study seeks to quantify the impact of the economic recession on the budgets, workforce, and programs of Local Health Departments (LHDs) across the United States. The National Association of County and City Health Officials is conducting a series of four on-line surveys in 2008–2010, using nationally representative samples. Results of the third survey are under analysis and a fourth will be launched in July 2010. Findings of the first two surveys demonstrate that across the country, LHDs are experiencing substantial reduction in budgets, employees, and public health activities and services. In 2009, 45 percent of LHDs reported cuts in their budget, an increase from 27 percent in 2008. As of July 2009, only 14 percent of LHDs had received funding from the American Reinvestment and Recovery Act. Job losses increased during this time; in calendar year 2008 an estimated 7,000 LHD jobs were lost, while 8,000 staff positions were lost over six months in the first half of 2009 (January 1–June 30). From July 2008–June 2009, 55 percent of LHDs made cuts to important public health programs. Qualitative data provided by respondents suggests a variety of implications for the populations served. LHDs anticipate that these cuts will result in poor health outcomes ranging from preventable childhood disease to food borne illnesses that may increase public costs in the long term. The findings from this study show that LHDs are severely strained by increasing budget and workforce cuts, to the point that they are being forced to eliminate or reduce vital programs that protect the public's health. This is occurring even as LHDs are under increasing pressure to respond to public health emergencies such as H1N1 influenza and to provide a safety net for people affected by the economic recession.

LEARNING AREAS: Administration, management, leadership; Advocacy for health and health education

LEARNING OBJECTIVES: a) Describe trends in funding, workforce, and program cuts by local public health departments from 2008–2010 in the context of an economic recession; b) Discuss anticipated implications for health outcomes at the local level.