2.  ASTHO: Who we are  Survey Research at ASTHO  Select findings  STPHIS: Online searchable database  Questions and comments

3.  ASTHO represents the public health agencies of the 50 states, territories, and DC, as well as the 120,000 public health professionals these agencies employ.  ASTHO members, the chief health officials of these jurisdictions, are dedicated to formulating and influencing sound public health policy and to assuring excellence in state-based public health practice.

4.  Members ◦ New State Health Official visit ◦ Technical Assistance  Other policymakers ◦ Health reform ◦ Appropriations  Public Health Systems and Services Research Community  Media  General public

5.  State and Territorial Public Health Survey ◦ Similar study done externally in 2001 ◦ ASTHO’s first S/TPHS conducted 2007 ◦ 2010 survey in field ◦ 2012 in planning phase ◦ Every two years thereafter  Budget Cuts Survey ◦ Started fall 2008 ◦ Every six months

6.  Launched in 2003  Follow-up survey in 2007  Folded into 2010 S/TPHS

7.  Environmental health survey  Minority health/health equity survey  H1N1 response  Use of funding formulas  Meaningful use in health information technology  Use of fiscal intermediaries  Evaluation of the Trust for America’s Health  Evaluation of America’s Health Rankings  Resource allocation study

11. Average Proportions for State Public Health Agency Revenue (FY09) ASTHO’s Budget Cuts Survey (November 2009)

12.  83% of health departments suffered job losses since July 2008. 1,564 state employees in central offices were lost 651 state employees assigned to local/regional offices were lost  76% of state/territorial health departments made cuts to the FY09 budget during FY09. Extent of Respondents’ Budget Reductions

13.  55% reported a FY10 budget that is smaller than FY09.  A third of states with larger budgets in fiscal year 2010 compared to fiscal year 2009, indicated that this is the result of federal stimulus and H1N1 funds and that their state general funds actually decreased.  28% reported a FY09 budget that was smaller than FY08.  At least 23% expect further cuts in FY10. Extent of Respondents’ Budget Reductions

14. Percent of State Health Agencies experiencing job losses and program reduction FY09: N= 49, FY10: N= 40, FY09 & FY10: N= 52

15. Cost-saving strategies Number of states using strategy (N=25)% Delayed retirement2080% Travel restrictions1976% Hiring freeze1664% Reduced training budget1352% Furloughs624% Alternative work schedules624% Early retirement416% Rehiring retirees28% Pre-retirement modifications00%

16.  Nurses make up the largest professional area*  Over 12,000 public health nurses working in state health departments  Public health nurses cited as top workforce shortage concern  Local health departments are experiencing similar shortages  States also cited shortages in other nursing sub- specialties such as certified nursing assistants, advanced practice nurses, nursing aids and nurse surveyors *largest is admin/clerical staff

17. Source: ASTHO 2007 Workforce Survey

18.  Workforce ◦ Number of public health nurses employed by state health agencies ◦ Salary range and benefits ◦ Degree of workforce shortage ◦ State-sponsored loan repayment programs to increase supply of nurses  State nursing home eligibility  Nursing home regulation  Quad Council competencies  Professional licensure

23. Katie Sellers, DrPH Senior Director, Survey Research ksellers@astho.org surveyresearch@astho.org (571) 527-3171