1. Trends in Local Health Department Programming and Funding Results from NACCHO’s National Profile of Local Health Departments and Job Losses and Program Cuts Surveys Sarah Newman, MPH Research and Evaluation Analyst Jan Wilhoit Program Manager

2. Presentation Outline What is NACCHO? Overview of NACCHO’s Data Collection: National Profile of Local Health Departments Survey and Job Losses and Program Cuts Survey Trends in Local Health Departments - Programs and Activities - Workforce - Budget Cuts Discussion

3. Local health departments are the first level of defense protecting the country’s health. NACCHO is the national non-profit membership association representing the nation’s 2,800 local health departments. - Leader, partner, catalyst, and voice for local health departments NACCHO supports local health departments by making information, practical field- tested tools, and innovative model practices easily accessible. What is NACCHO?

4. National Profile of Local Health Departments Examines funding, staffing, governance, and activities of local health departments NACCHO has conducted 7 National Profile of Local Health Department Studies: 1989- 1990, 1992, 1996, 2005, 2008, 2010, 2013 Response rates ranged from 79-83% NACCHO Data Collection Job Losses and Program Cuts Survey Developed in response to the economic downturn in 2008 NACCHO has conducted 8 Waves of the survey since 2008 Response rates ranged from 63-82% (excluding Wave 1)

5. Trends in Local Health Department Programming

6. Percent of Local Health Departments Providing Population-Based Primary Prevention Services (2013) Source: 2013 National Profile of Local Health Departments

7. Source: 2005, 2008, 2010, and 2013 National Profiles of Local Health Departments Percent of Local Health Departments Providing Select Clinical Services (2005 to 2013)

8. Source: 2005, 2008, 2010, and 2013 National Profiles of Local Health Departments Percent of Local Health Departments Involved in Outreach and Enrollment for Medical Insurance (2005 to 2013)

9. Source: NACCHO’s Job Losses and Program Cuts Surveys Percent of Local Health Departments with Program Cuts in at Least One Area (2008 to 2012)

10. Source: NACCHO’s Job Losses and Program Cuts Surveys Percent of Local Health Departments that Reduced or Eliminated Programs (2011 to 2012)

11. Source: NACCHO’s Job Losses and Program Cuts Surveys Percent of Local Health Departments that Reduced or Eliminated Programs (2011 to 2012)

12. Source: NACCHO’s Job Losses and Program Cuts Surveys Percent of Local Health Departments that Reduced or Eliminated Programs (2011 to 2012)

13. Source: NACCHO’s Job Losses and Program Cuts Surveys Percent of Local Health Departments Reporting Cuts in Clinical Health Services (2009 to 2012)

14. Trends in Local Health Department Workforce

15. Source: 2013 National Profile of Local Health Departments Occupations of Local Health Department Employees (2013)

16. Source: 2013 National Profile of Local Health Departments Occupations of Local Health Department Employees (2013)

17. Source: 2013 National Profile of Local Health Departments Occupations of Local Health Department Employees (2013)

18. Source: 1989, 2005, 2008, 2010, and 2013 National Profiles of Local Health Departments Percent of Local Health Departments Employing Public Health Physicians (1989 to 2013)

19. Source: 2013 National Profile of Local Health Departments Median Number of Public Health Physicians Employed in Local Health Departments (2013) Size of Population Served Median Number of Local Health Department FTEs Median Number of Public Health Physicians (FTEs) <10,00040 10,000–24,99990 25,000–49,999150 50,000–99,999280 100,000–249,999640.25 250,000–499,9991301 500,000–999,9992511.7 1,000,000+4533

20. Source: 2013 National Profile of Local Health Departments Median Number of Public Health Physicians Employed in Local Health Departments (2013) Size of Population Served Median Number of Local Health Department FTEs Median Number of Public Health Physicians (FTEs) <10,00040 10,000–24,99990 25,000–49,999150 50,000–99,999280 100,000–249,999640.25 250,000–499,9991301 500,000–999,9992511.7 1,000,000+4533

21. Source: 2013 National Profile of Local Health Departments Median Number of Public Health Physicians Employed in Local Health Departments (2013) Size of Population Served Median Number of Local Health Department FTEs Median Number of Public Health Physicians (FTEs) <10,00040 10,000–24,99990 25,000–49,999150 50,000–99,999280 100,000–249,999640.25 250,000–499,9991301 500,000–999,9992511.7 1,000,000+4533

22. Source: NACCHO’s Job Losses and Program Cuts Surveys Local Health Department Workforce Losses (2008 to 2012)

23. Source: NACCHO’s Job Losses and Program Cuts Surveys Percent of Local Health Departments Losing Workforce Capacity (2010 to 2012)

24. Source: 2008 and 2013 National Profiles of Local Health Departments Changes in Size of the Local Health Department Workforce (2008 to 2013) Estimated Workforce Size (FTEs) Percent Change 20082013 All Local Health Departments166,000146,000-12% Registered Nurse32,90027,700-16% Environmental Health Worker15,30013,300-13% Public Health Physician2,100 0% Health Educator4,4005,10016% Nutritionist4,2005,00019% Epidemiologist1,3001,80038%

25. Source: 2008 and 2013 National Profiles of Local Health Departments Changes in Size of the Local Health Department Workforce (2008 to 2013) Estimated Workforce Size (FTEs) Percent Change 20082013 All Local Health Departments166,000146,000-12% Registered Nurse32,90027,700-16% Environmental Health Worker15,30013,300-13% Public Health Physician2,100 0% Health Educator4,4005,10016% Nutritionist4,2005,00019% Epidemiologist1,3001,80038%

26. Source: 2008 and 2013 National Profiles of Local Health Departments Changes in Size of the Local Health Department Workforce (2008 to 2013) Estimated Workforce Size (FTEs) Percent Change 20082013 All Local Health Departments166,000146,000-12% Registered Nurse32,90027,700-16% Environmental Health Worker15,30013,300-13% Public Health Physician2,100 0% Health Educator4,4005,10016% Nutritionist4,2005,00019% Epidemiologist1,3001,80038%

27. Source: 2008 and 2013 National Profiles of Local Health Departments Changes in Size of the Local Health Department Workforce (2008 to 2013) Estimated Workforce Size (FTEs) Percent Change 20082013 All Local Health Departments166,000146,000-12% Registered Nurse32,90027,700-16% Environmental Health Worker15,30013,300-13% Public Health Physician2,100 0% Health Educator4,4005,10016% Nutritionist4,2005,00019% Epidemiologist1,3001,80038%

28. Source: 2008 and 2013 National Profiles of Local Health Departments Changes in Size of the Local Health Department Workforce (2008 to 2013) Estimated Workforce Size (FTEs) Percent Change 20082013 All Local Health Departments166,000146,000-12% Registered Nurse32,90027,700-16% Environmental Health Worker15,30013,300-13% Public Health Physician2,100 0% Health Educator4,4005,10016% Nutritionist4,2005,00019% Epidemiologist1,3001,80038%

29. Source: 2008 and 2013 National Profiles of Local Health Departments Changes in Size of the Local Health Department Workforce (2008 to 2013) Estimated Workforce Size (FTEs) Percent Change 20082013 All Local Health Departments166,000146,000-12% Registered Nurse32,90027,700-16% Environmental Health Worker15,30013,300-13% Public Health Physician2,100 0% Health Educator4,4005,10016% Nutritionist4,2005,00019% Epidemiologist1,3001,80038%

30. Trends in Local Health Department Budgets

31. Percent of Local Health Departments Reporting Lower Budgets (2008 to 2013) Source: NACCHO’s Job Losses and Program Cuts Surveys

32. Percent of Local Health Departments with Lower Budget than Previous Year (2009) More than half of local health departments reported budget cuts in 13 states

33. Percent of Local Health Departments with Lower Budget than Previous Year (Late 2010) More than half of local health departments reported budget cuts in 17 states

34. Percent of Local Health Departments with Lower Budget than Previous Year (2011) More than half of local health departments reported budget cuts in 15 states

35. Percent of Local Health Departments with Lower Budget than Previous Year (2012) More than half of local health departments reported budget cuts in 5 states

36. Local health departments provide essential programs and services to protect the health of the communities they serve. Effects of the economic downturn has remained with local health departments long after other sectors have seen improvement. Local health departments will only be able to better serve their communities by expanding programs, not merely avoiding further cuts. Conclusion

37. For more information about the National Profile Study of Local Health Departments, please visit our website: http://www.naccho.org/profile, or email us at profileteam@naccho.orghttp://www.naccho.org/profileprofileteam@naccho.org Questions? Comments?