the national connection for local public health local health department funding cuts and impacts...

The National Connection for Local Public Health

Local Health Department Funding Cuts and Impacts

Tuesday, March 16, 2010


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.


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.


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


Budget


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%


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


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


Budget Cuts

Percentage of LHDs with Lower Budget in January 2010 as Compared to Previous Year


Early 2010: More than half of LHDs have budget cuts

in 14 states


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


Early 2010: More than half of LHDs have cuts to core

funding in 26 states


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.



“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


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


Budget Cuts


Percentage of LHDs Receiving ARRA Funding, by Population Size Served and Governance Type


Budget Cuts


Percentage of LHDs Anticipating Lower Budget for Next Year as Compared to This Year, by Population Size Served and Governance Type


Workforce


Workforce Cuts

Jan.–Dec. 2008

Jan.–June 2009

July–Dec. 2009

Positions Lost to Layoffs or Attrition 7,000 8,000 8,000

Staff with Reduced Hours or Mandatory Furlough -- 12,000 13,000

% 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.


Workforce cuts

Percentage of LHDs that Lost Jobs Due to Layoffs or Attrition (July–December 2009)


46% of LHDs lost jobs to layoffs or

attrition in the second half of

2009


Workforce Cuts


Percentage of LHDs with Job Loss from Layoffs and Attrition, from July to December 2009, by Population Size Served and Governance Type


Workforce Cuts


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



“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


Programs


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



Program Cuts

Percentage of LHDs with Program Cuts in Calendar Year 2009, by Program Area



Program Cuts – a different view…

Percentage of LHDs With Services in Program Area that Made Program Cuts in Calendar Year 2009, by Program Area


This graphic is a better depiction of the vulnerability of existing program

areas to cuts


Workforce Cuts


Percentage of LHDs with Cuts to at Least One Programmatic Area in 2009, by Population Size Served and Governance Type


Workforce Cuts


Percentage of LHDs with Cuts to at Least Three Programmatic Areas in 2009, by Population Size Served and Governance Type



“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



“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


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?


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


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

[email protected]

202/ 756-0164


Supplemental Slides


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%


Percentage of LHDs with Lower Budget in Current Year, Excluding One-Time Funding and Percentage Receiving ARRA Funding, by Population Size Served


Budget Cuts

Unit of government that governs LHD

Lower Budget in Current Year, Excluding One-Time

FundingHave Received ARRA Funding

Local 54% 41%

State 50% 48%

OVERALL 53% 42%


Percentage of LHDs with Lower Budget in Current Year, Excluding One-Time Funding and Percentage Receiving ARRA Funding, by Governance Type


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%


Percentage of LHDs with Cuts to Workforce from July to December 2009, by Population Size Served


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%


Percentage of LHDs with Cuts to Workforce from July to December 2009, by Governance Type


Program Cuts

Population SizeCuts to at least one

program areaCuts to three or

more program areasLess 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%


Percentage of LHDs with Cuts to Programmatic Areas in 2009, by Population Size Served


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%


Percentage of LHDs with Cuts to Programmatic Areas in 2009, by Governance Type

the national connection for local public health local health department funding cuts and impacts...

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