Online only: Tight economy putting the squeeze on local health departments ========================================================================== * Donya Currie Local health departments continue to fight an uphill battle to provide critical health services in the face of persistently tight economic times. A recent analysis of job losses released in May found that from January 2008 to December 2009, local health departments lost 23,000 jobs to layoffs and attrition, which was roughly 15 percent of the entire local health department work force. “Continued cuts to local health department budgets threaten Americans’ safety and health,” said APHA member Robert M. Pestronk, MPH, executive director of the National Association of County and City Health Officials, which conducted the analysis. “Although local health departments will continue to do the best job they can with the resources available to them, the cumulative effect of these budget cuts and job losses has taken a major toll on the ability of health officials to respond not only to large-scale emergencies and disease outbreaks like H1N1 influenza, but also to the everyday situations for which the health department is the first line of defense.” Nearly 75 percent of Americans lived in jurisdictions that lost at least one local health department worker in the last six months of 2009, the analysis said. In addition to job losses, an additional 13,000 employees experienced cuts to their working hours or mandatory furloughs. A wider look at the local health department work force, which was also released by NACCHO in May, found that the number of full-time employees remained constant between 2005 and 2008 at about 155,000 people. Larger local health departments serving populations of 250,000 to 499,000 were most likely to increase their staffing during that time period. Yet while the work force grew for 49 percent of health departments surveyed, it shrank for 34 percent of local health departments and remained the same at 17 percent of local health departments. Significant losses occurred within the ranks of the nursing work force, with the numbers of full-time nursing staff dropping by 10 percent. The nursing shortage and nursing vacancies are a “serious concern” for local health departments, the report said, especially as nurses make up a significant proportion of a local health department’s work force and the nation’s public health work force overall. On a more positive note, cultural competency is on the rise at larger local health departments. For example, agencies serving larger populations tend to employ higher proportions of staff who belong to racial or ethnic minority groups. Overall, the number of minority workers ranges from 5 percent at local health departments serving fewer than 25,000 people to 42 percent at agencies serving more than 1 million people, according to “Local Health Department Workforce: Findings from the 2008 National Profile of Local Health Departments.” “A local health department with a demographically diverse work force similar to the demographic diversity of the jurisdiction (served) supports cultural competence, the public good and personal rights,” the report stated. But while public health workers are increasingly diverse, they are also aging. Approximately 20 percent of local health department employees will be eligible for retirement in the next five years. As they depart, aging workers will take with them crucial skills honed over many years of service, historical knowledge of their agencies and the public health history of their communities. The intersection of jobs and public health was highlighted at a congressional briefing hosted by NACCHO in Washington, D.C., in July. Speaking at the Capitol Hill event, U.S. Rep. Robert Andrews, D-N.J., chair of the Health, Employment, Labor and Pensions Subcommittee of the U.S. House Committee on Education and Labor, emphasized the need to restore the tens of thousands of local public health jobs recently lost and pointed to the importance of the Local Jobs for America Act. The legislation, known in the House as H.R. 4812, would address the impacts of current local government budgetary shortfalls, potentially enabling local governments to provide local health departments with the resources necessary to reinstate laid-off personnel, return furloughed employees to full-time work and restore core public health services. “The mounting cuts to local public health departments are the beginnings of a national tragedy,” said APHA Executive Director Georges Benjamin, MD, FACP, FACEP (E). “Without robust, sustained investment in our public health infrastructure, the capacity and ability of this country to protect the public and prevent diseases is being severely eroded.” Both “Local Health Department Job Losses and Program Cuts: Findings from January/February 2010 Survey” and the “Local Health Department Workforce: Findings from the 2008 National Profile of Local Health Departments” are available at [www.naccho.org](http://www.naccho.org). ## Footnotes * Teddi Dineley Johnson contributed to this article. * Copyright The Nation’s Health, American Public Health Association