Apr 6, 2010 (CIDRAP News) – A survey by the National Association of County and City Health Officials (NACCHO) shows that budget-squeezed local health departments (LHDs) shed 8,000 jobs in the second half of 2009, bringing the year's total to 16,000 and boosting the 2-year shrinkage in the local health workforce to 15%.
The NACCHO survey found that 46% of departments around the country lost jobs in the last 6 months of 2009. The survey was sent to 997 health departments in January and February and drew responses from 721 (72%) in 48 states.
The organization said a total of 23,000 jobs were lost to layoffs and attrition in 2 years—7,000 in 2008 in addition to the 16,000 in 2009—a reduction of 15% in the LHD workforce.
The reductions came more often through attrition than through layoffs, the results suggest. Sixteen percent of LHDs reported shrinking their staff through layoffs in the second half of 2009, while 46% said they lost positions through attrition in that period.
The cuts were unevenly distributed around the country, according to the survey. In 14 states, more than 75% of LHDs lost jobs, whereas a few states, including Iowa, Massachusetts, and North Dakota, had losses in 25% of LHDs or fewer. In most states the reductions involved between 25% and 75% of local health agencies. The sample of LHDs responding to the survey was small for some states, however.
Reduced hours, required furloughs
In addition to the thousands of staff who were laid off or not replaced on retirement, about 25,000 health workers faced reductions in their hours or had mandatory furloughs in 2009, according to the survey.
The job cuts were paralleled by budget reductions. Thirty-eight percent of LHDs reported a lower budget in 2010 than a year earlier, and another 15% would have had a lower budget but for federal stimulus money under the American Recovery and Reinvestment Act, pandemic flu funding, or both.
The staff and budget reductions forced cuts in many programs, NACCHO reported. The axe fell most frequently on programs to prevent chronic diseases and on maternal and child health programs, as 25% of departments reduced those activities.
The percentages of LHDs that made cuts in other programs are as follows: clinical health services, 21%; chronic disease screening and treatment, 19%; environmental health, 17%; immunization, 13%; communicable disease screening and treatment, 12%; food safety, 9%; epidemiology and surveillance, 9%; and emergency preparedness, 7%.
NACHHO illustrated the effects of the staff and program cuts by posting short reports that detail the situations affecting several LHDs around the country. For example, the health department in Lorain County, Ohio, took a 54% drop in local funding in 2009, on top of a nearly 30% drop in per-capita funding from the state over 2 years.
As a result, the department had to put all staff members on a 4-day week, and some programs will have to be shut down, said Health Commissioner Terrence Tomaszewski, according to the report. The department has no money to buy flu vaccine or staff to give the vaccinations, and it will have to cancel a program of flu vaccination clinics in low-income high-rise complexes.
Besides county and city health departments, the NACCHO survey respondents included 139 regional health departments that operate as subunits of state health departments, according to Rachel Willard, MPH, a senior analyst with the organization.
State health departments struggling, too
State health departments (SHDs) are struggling with staff and budget cuts that echo those at the local level, according to survey data released recently by the Association of State and Territorial Health Officials (ASTHO).
Surveys of state and territorial health departments show that 83% of the state departments have had job losses through attrition and layoffs since July 2008, according to an ASTHO report based on a series of semiannual surveys, the latest of which was conducted in January.
Fifty-five percent reported a lower budget for fiscal year 2010 than for 2009, and 23% said they expect further cuts this year. A third of the states have larger budgets for fiscal year 2010 than for 2009 but said this is the result of federal stimulus and pandemic funding.
Eighty-five percent of SHDs have reduced services, and 42% have dropped entire programs, ASTHO reported. In the infectious disease realm, some states have reduced HIV/AIDS medication purchases and services, children's vaccines, hepatitis C prevention, epidemiologic investigations, and laboratory tests.
The ASTHO findings come from a survey that was conducted in November 2008, January and July of 2009, and January 2010. Fifty-two of 57 state and territorial public health agencies responded to it.
NACCHO report on public health job cuts
Overview of NACCHO findings
NACCHO's state-level tables
NACCHO story on impact of cuts in Lorain County, Ohio
ASTHO report on impact of budget cuts on state health departments in 2008 and 09
March 2010 Trust for America's Health report on federal public health funds for states