1. The National Connection for Local Public Health Local Health Department Funding Cuts and Impacts Tuesday, March 16, 2010

2. Objectives 1.Describe and discuss most recent trends in budget, workforce, and program cuts at local health departments (LHDs). 2.Engage SACCHOs in discussion about utility and future of survey.

3. Tuesday, March 16, 2010 NACCHO Job Loss and Program Cut Survey NACCHO’s 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) This is the first public presentation of data from the Jan. 2010 survey.

4. Tuesday, March 16, 2010 Voices from the Field “We’re the front line. There’s nobody else out here that’s doing the things that need to be done.” - Local health official, Midwest Region, September 2009

5. Tuesday, March 16, 2010 Budget

6. Tuesday, March 16, 2010 Budget Cuts 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 the American Recovery & Reinvestment Act (ARRA) or H1N1. 53%

7. Tuesday, March 16, 2010 Budget Cuts Percentage of LHDs with Lower Budget in November 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

8. Tuesday, March 16, 2010 Budget Cuts 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

9. Tuesday, March 16, 2010 Budget Cuts 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

10. Tuesday, March 16, 2010 Budget Cuts 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

11. Tuesday, March 16, 2010 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 use reserve funds in order to cover expenses this year.

12. Tuesday, March 16, 2010 Voices from the Field “We anticipate a 10 to 45 percent cut in many programs, with concurrent loss of federal funding because of the state’s inability to match federal dollars.” - Local health official, Midwest Region, July 2009

13. Tuesday, March 16, 2010 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

14. Tuesday, March 16, 2010 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

15. Tuesday, March 16, 2010 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

16. Tuesday, March 16, 2010 Workforce

17. Tuesday, March 16, 2010 Workforce Cuts 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.

18. Tuesday, March 16, 2010 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

19. Tuesday, March 16, 2010 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

20. Tuesday, March 16, 2010 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

21. Tuesday, March 16, 2010 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 “ Now we have three [mental health counselors], and... we‘ll 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

22. Tuesday, March 16, 2010 Programs

23. Tuesday, March 16, 2010 Program Cuts 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).

24. Tuesday, March 16, 2010 Program Cuts Percentage of LHDs with Program Cuts in Calendar Year 2009, by Program Area Source: NACCHO Survey of LHD Budget Cuts & Workforce Reduction (January 2010).

25. Tuesday, March 16, 2010 Program Cuts – a different view… Percentage of LHDs With Services in Program Area that Made Program Cuts in Calendar Year 2009, by Program Area Source: NACCHO Survey of LHD Budget Cuts & Workforce Reduction (January 2010). This graphic is a better depiction of the vulnerability of existing program areas to cuts

26. Tuesday, March 16, 2010 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

27. Tuesday, March 16, 2010 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

28. Tuesday, March 16, 2010 Voices from the Field “What’s most alarming to me now is that if we can’t provide these services, there’s no one else that will be doing it. The people we serve and the needs they have don’t go away. People will end up going to the police department or the emergency room–they’ll 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

29. Tuesday, March 16, 2010 Voices from the Field “In two or three weeks, we’re going to have to make more reductions. We’ll close down services – like our lead poisoning prevention program, early diagnosis of developmental delays, and children’s immunizations.” - Local Health Official, Northwest region, September 2009

30. Tuesday, March 16, 2010 Utility of the survey How have you used the results of the Job Loss and Program Cuts Survey? What additional information would be helpful to you as you advocate for LHDs in your state?

31. Tuesday, March 16, 2010 Future of the Survey As the economic situation improves, should NACCHO consider implementing some long term version of the survey? What questions are most critical to monitoring the vitality and financial health of local health departments? Current plans: Key questions integrated in 2010 National Profile Study of LHDs – Profile will also provide a more comprehensive understanding of budget, workforce, and program changes Job Loss and Program Cuts survey run in January 2011

32. Tuesday, March 16, 2010 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. Tuesday, March 16, 2010 Supplemental Slides

34. Tuesday, March 16, 2010 Budget Cuts Population Size Lower Budget in Current Year, Excluding One- Time Funding Have Received ARRA Funding Less than 25,000 51%36% 25,000–49,999 50%37% 50,000–99,999 53%44% 100,000–499,999 58%56% 500,000 or more 74%69% OVERALL 53%42% Source: NACCHO Surveys of LHD Budget Cuts & Workforce Reduction (January 2010). Percentage of LHDs with Lower Budget in Current Year, Excluding One-Time Funding and Percentage Receiving ARRA Funding, by Population Size Served

35. Tuesday, March 16, 2010 Budget Cuts Unit of government that governs LHD Lower Budget in Current Year, Excluding One-Time Funding Have Received ARRA Funding Local 54%41% State 50%48% OVERALL 53%42% Source: NACCHO Surveys of LHD Budget Cuts & Workforce Reduction (January 2010). Percentage of LHDs with Lower Budget in Current Year, Excluding One-Time Funding and Percentage Receiving ARRA Funding, by Governance Type

36. Tuesday, March 16, 2010 Workforce Cuts Population Size Loss of Staff (Layoffs & Attrition) Reduced Staff Time (Hours Cut & Furlough) Less than 25,000 26%19% 25,000–49,999 43%21% 50,000–99,999 65%26% 100,000–499,999 76%29% 500,000 or more 84%31% OVERALL 46%23% Source: NACCHO Surveys of LHD Budget Cuts & Workforce Reduction (January 2010). Percentage of LHDs with Cuts to Workforce from July to December 2009, by Population Size Served

37. Tuesday, March 16, 2010 Workforce Cuts Unit of government that governs LHD Loss of Staff (Layoffs & Attrition) Reduced Staff Time (Hours Cut & Furlough) Local 44%26% State 59%5% OVERALL 46%23% Source: NACCHO Surveys of LHD Budget Cuts & Workforce Reduction (January 2010). Percentage of LHDs with Cuts to Workforce from July to December 2009, by Governance Type

38. Tuesday, March 16, 2010 Program Cuts Population Size Cuts to at least one program area Cuts to three or more program areas Less than 25,000 39%20% 25,000–49,999 51%30% 50,000–99,999 56%33% 100,000–499,999 65%36% 500,000 or more 69%54% OVERALL 50%28% Source: NACCHO Surveys of LHD Budget Cuts & Workforce Reduction (January 2010). Percentage of LHDs with Cuts to Programmatic Areas in 2009, by Population Size Served

39. Tuesday, March 16, 2010 Program Cuts Unit of government that governs LHD Cuts to at least one program area Cuts to three or more program areas Local 52%29% State 38%22% OVERALL 50%28% Source: NACCHO Surveys of LHD Budget Cuts & Workforce Reduction (January 2010). Percentage of LHDs with Cuts to Programmatic Areas in 2009, by Governance Type