Jun 21, 2011 (CIDRAP News) – Hard-pressed local health departments (LHDs) shed another 6,000 jobs through layoffs and attrition in 2010, bringing the total job losses over the past 3 years to 29,000, according to a survey report from the National Association of County and City Health Officials (NACCHO).
The new numbers, gathered in the latest of a series of surveys, mean the nationwide LHD work force has shrunk by 19% since 2008, the report says. As a result, many local departments have cut programs and suffered from higher workloads and low morale.
"Increased workloads, wage freezes and reductions, increased health insurance premiums, reduced benefits, restrictions on training and travel, and job insecurity contribute to low morale in many LHDs," the report states.
The findings come from a survey sent to all 2,568 LHDs in the nation from September to November 2010, with questions about budgets, staff, and programs from July 2009 through June 2010. The survey drew responses from 82% of the departments.
The 6,000 jobs lost through attrition and layoffs involved 44% of the LHDs. Another 18,000 positions were affected by reduced hours or mandatory furloughs, bringing the overall proportion of departments feeling a "negative job impact" to 52%, NACCHO officials report.
Job cuts were more common at larger departments than smaller ones: 10% of LHDs in communities of 25,000 or less laid off staff, versus 37% of departments in communities of 500,000 or more. But when small LHDs did cut jobs, they lost a bigger share of their workers than larger LHDs did.
LHD officials reported that the cutbacks meant more work for remaining staff members. "Our remaining employees are now expected to assume additional job duties due to positions being eliminated and the expectation that services delivery is not impacted," one official was quoted as saying.
Many departments said they had trouble keeping and recruiting qualified people as they were forced to lay off others, the report says. "We have not been able to offer raises, and the lagging salary scale we operate by has been a detriment in recruiting and retaining qualified people," one official commented.
Forty-two percent of LHDs, serving jurisdictions with 59% of the US population, said they reduced or dropped at least one program, according to NACCHO. Fourteen percent of the departments, serving 32% of the population, reported they cut three or more programs.
Maternal and child health programs were hit hardest, as 18% of LHDs said they reduced or eliminated services to pregnant women, new mothers, and children. In the infectious-disease realm, 8% of departments reduced immunizations, 7% cut back on communicable disease screening and treatment, 6% shrank food safety efforts, and 4% reduced epidemiology and surveillance.
"Armed with fewer resources, many LHDs have been forced to cut programs that are essential to protecting the health of their communities," the report says. "Other healthcare providers sometimes fill the void, but too often communities lose programs that are available nowhere else."
Staff and program cuts went hand-in-hand with budget reductions, the survey showed. Forty-four percent of LHDs said their operating budget in November 2010 was lower than in the previous year. When one-time money from the American Recovery and Reinvestment Act or H1N1 pandemic supplemental funding was excluded, a total of 56% of the departments reported cuts in their core funding, a higher percentage than seen in previous NACCHO surveys.
In addition, half of all the departments said in November 2010 that they expected a lower budget in the next fiscal year than in the current one.
The report notes that the type of governance influenced LHDs' staff levels and budgets. LHDs under state governance were less likely to report layoffs than those under local governance or shared state-local governance. Also, departments that had a local board of health were less likely to report a reduced budget than were those that didn't have a local board.
The NACCHO report was supported by the Centers for Disease Control and Prevention and the Robert Wood Johnson Foundation.
NACCHO report brief
NACCHO page with links to state-level and earlier reports