1. The National Connection for Local Public Health Local Health Department Funding Cuts and Impacts

2. Outline Background on NACCHOs Job Loss and Program Cuts Survey (Slide 3) Executive summary (Slide 4) Findings Budget cuts (Slide 6) Workforce cuts (Slide 17) Program cuts (Slide 23) Future of the survey (Slide 31) For more information (Slide 32) Acknowledgments (Slide 33)

3. Job Loss and Program Cut Survey Overview NACCHOs Job Loss and Program Cuts Survey was launched in November 2008 to quantify and describe the impact of the economic recession on the budget, workforce, and programs of local health departments (LHDs). The study design (census or stratified random samples) facilitates reliable estimates of job losses and program cuts at the national and state levels. Quick turn-around provides timely information for advocacy and policy decisions. Data are weighted to account for sampling and non-response, thus producing national-level estimates. Many SACCHOs are closely involved in helping to ensure a high response rate for their states. Three survey waves to date: November 2008 (Census design) July 2009 (Stratified random sample) January 2010 (Stratified random sample)

4. Executive Summary Budget Cuts In January 2010, 38 percent of LHDs reported that their budget in the current year is lower than their budget was in the previous year. If one-time funding, such as money from the American Recovery and Reinvestment Act (ARRA) or H1N1 Supplemental Appropriations, is excluded, an additional 15 percent of LHDs report a lower budget. Workforce Cuts Over a two-year period (January 2008 – December 2009), 23,000 LHD jobs were lost. This represents approximately 15 percent of the national LHD workforce. In the last six months of 2009, 46 percent of LHDs lost jobs to layoffs or attrition. Program Cuts In 2009, half of LHDs cut at least one program area. For example, a quarter of LHDs cut or eliminated services to pregnant women, new mothers, and children.

5. Voices from the Field Were the front line. Theres nobody else out here thats doing the things that need to be done. - Local health official, Midwest Region, September 2009

6. Budget Cuts

7. Percentage of LHDs with Lower Budget in Current Year than Previous Year Source: NACCHO Surveys of LHD Budget Cuts & Workforce Reduction (January 2009; September 2009; January 2010). Note that sampling design varied across surveys. Would have lower budget were it not for one- time funding such as that from ARRA or H1N1 supplemental appropriations. 53%

8. Budget Cuts - 2008 Percentage of LHDs with Lower Budget in December 2008 as Compared to Previous Year Source: NACCHO Survey of LHD Budget Cuts & Workforce Reduction (January 2010). Late 2008: More than half of LHDs have budget cuts in 7 states

9. Budget Cuts - 2009 Percentage of LHDs with Lower Budget in July 2009 as Compared to Previous Year Source: NACCHO Survey of LHD Budget Cuts & Workforce Reduction (July 2009). Mid-2009: More than half of LHDs have budget cuts in 20 states

10. Budget Cuts – 2010 (at first glance…) Percentage of LHDs with Lower Budget in January 2010 as Compared to Previous Year Source: NACCHO Survey of LHD Budget Cuts & Workforce Reduction (January 2010). Early 2010: More than half of LHDs have budget cuts in 14 states

11. Budget Cuts – 2010 (at second glance…) Percentage of LHDs with Lower Budget in January 2010 as Compared to Previous Year, Excluding One-Time Funding such as ARRA or H1N1 Funding Source: NACCHO Survey of LHD Budget Cuts & Workforce Reduction (January 2010). Early 2010: More than half of LHDs have cuts to core funding in 26 states

12. Budget Cuts - What does this mean? ARRA & H1N1 Supplemental Funding are helping to fill a gap, but LHDs continue to suffer from cuts to their core funding. To date, 42% of LHDs have received ARRA funds, either directly or as pass-through from states. Almost a third (32%) of LHDs have used reserve funds in order to cover expenses this year.

13. Voices from the Field We anticipate a 10 to 45 percent cut in many programs, with concurrent loss of federal funding because of the states inability to match federal dollars. - Local health official, Midwest Region, July 2009

14. Budget Cuts Source: NACCHO Surveys of LHD Budget Cuts & Workforce Reduction (January 2010). Percentage of LHDs with Lower Budget in Current Year, Excluding One-Time Funding, by Population Size Served and Governance Type

15. Budget Cuts Source: NACCHO Surveys of LHD Budget Cuts & Workforce Reduction (January 2010). Percentage of LHDs Receiving ARRA Funding, by Population Size Served and Governance Type

16. Budget Cuts Source: NACCHO Surveys of LHD Budget Cuts & Workforce Reduction (January 2010). Percentage of LHDs Anticipating Lower Budget for Next Year as Compared to This Year, by Population Size Served and Governance Type

17. Workforce Cuts

18. Jan.–Dec. 2008 Jan.–June 2009 July–Dec. 2009 Positions Lost to Layoffs or Attrition 7,0008,000 Staff with Reduced Hours or Mandatory Furlough --12,00013,000 % LHDs that lost staff 52%47%46% Source: NACCHO Surveys of LHD Budget Cuts & Workforce Reduction (January 2009; September 2009; January 2010). Note that sampling design varied across surveys. From Jan. 2008–Dec. 2009, LHDs lost a cumulative 23,000 jobs due to layoffs or attrition.

19. Workforce cuts Percentage of LHDs that Lost Jobs Due to Layoffs or Attrition (July–December 2009) Source: NACCHO Survey of LHD Budget Cuts & Workforce Reduction (January 2010). 46% of LHDs lost jobs to layoffs or attrition in the second half of 2009

20. Workforce Cuts Source: NACCHO Surveys of LHD Budget Cuts & Workforce Reduction (January 2010). Percentage of LHDs with Job Loss from Layoffs and Attrition, from July to December 2009, by Population Size Served and Governance Type

21. Workforce Cuts Source: NACCHO Surveys of LHD Budget Cuts & Workforce Reduction (January 2010). Percentage of LHDs with Cuts to Staff Time from Hours Cut or Mandatory Furlough, from July to December 2009, by Population Size Served and Governance Type

22. Voices from the Field The financial situation has hidden impacts. Attrition causes the agency to lose experience and knowledge that is not transferred to new employees. - Local health official, Southeast Region, July 2009

23. Voices from the Field Now we have three [mental health counselors], and... well have to lay off one, or even two. We are handling a case load of 175–200 people. The thought of one person trying to handle that is overwhelming. - Local health official, Midwest Region, September 2009

24. Program Cuts

25. Percentage of LHDs with Program Cuts in Calendar Year 2009 50% of LHDs made cuts to at least one program area during 2009 Source: NACCHO Survey of LHD Budget Cuts & Workforce Reduction (January 2010).

26. Program Cuts Percentage of LHDs with Program Cuts in Calendar Year 2009 due to Budget, by Program Area Source: NACCHO Survey of LHD Budget Cuts & Workforce Reduction (January 2010).

27. Workforce Cuts Source: NACCHO Surveys of LHD Budget Cuts & Workforce Reduction (January 2010). Percentage of LHDs with Cuts to at Least One Programmatic Area in 2009, by Population Size Served and Governance Type

28. Workforce Cuts Source: NACCHO Surveys of LHD Budget Cuts & Workforce Reduction (January 2010). Percentage of LHDs with Cuts to at Least Three Programmatic Areas in 2009, by Population Size Served and Governance Type

29. Voices from the Field Whats most alarming to me now is that if we cant provide these services, theres no one else that will be doing it. The people we serve and the needs they have dont go away. People will end up going to the police department or the emergency room–theyll be shifting to other service sectors that are not prepared to help them. In the end, that does not save money. - Local health official, Midwest Region, September 2009

30. Voices from the Field In two or three weeks, were going to have to make more reductions. Well close down services – like our lead poisoning prevention program, early diagnosis of developmental delays, and childrens immunizations. - Local health official, Northwest region, September 2009

31. Future of the Survey Current plans: Key questions integrated in 2010 National Profile of LHDs study (Profile) will also provide a more comprehensive understanding of budget, workforce, and program changes. Job Loss and Program Cuts survey is planned for January 2011. NACCHO is considering a long-term version of the survey that will measure reduction and growth of budgets, workforce, and programs.

32. For additional information… As results are available, they will be posted on NACCHO Web site at: www.naccho.org/advocacy/lhdbudgets.cfm For additional information or to provide feedback, please contact: Rachel Willard rwillard@naccho.org (202) 756-0164

33. Acknowledgments This document was supported by Award Number 5U38HM000449-02 from the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC.