Local Health Departments Face the Threat of Budget Cuts During Pandemic

The economic fallout of the COVID-19 outbreak is worsening the strain on city and county health departments that have been tasked with doing more with less resources since the 2008 recession, an updated report from the National Association of County and City Health Officials says.

Over the past decade, the researchers found, the budgets of smaller local health departments had remained relatively stagnant; at the same time, medium to large local health departments saw their budgets decrease, the report said.

The majority of local health departments continue to experience flat funding, with a total of 67% experiencing stagnant (52%) or reduced budgets (15%) in 2019. This is despite inflation, population growth, and the increasing complexity of public health challenges.

As a result, the authors said, between 2008 and 2019, the recession resulted in local health departments laying off 37,000 of their employees. 

However, these new data also show that these cuts seem to have bottomed out in 2016. Between 2016 and 2019, local health departments had finally started to rebuild, if slowly, adding 3% of that lost workforce back (6,000 jobs) nationwide.

“Overall, this new analysis points to what we continue to hear directly from local health departments across the country,” said Lori Tremmel Freeman, the association’s chief executive officer.

Freeman said this reality is particularly worrisome now, “as we face the unknowns of the negative impact of the COVID-19 pandemic on the local and state budgets that support so much of local health departments’ work.”

Local health departments are vital for collecting and broadcasting information on public health threats and leading the effort to keep the public safe from them. 

Some local health departments could see a modest increase in funding next year, but not enough to make up for last year’s losses, the report said.

“We know that some local health departments have had to furlough staff mid-pandemic in order to absorb budgetary pressures, and many others are planning steep cuts for their next fiscal year,” Freeman said. 

Overall, 175 million Americans are living in communities that experienced stagnant or reduced local health department funding in 2019, impacting over half of the U.S. population.

Nationwide, local health departments shed about 16% of their full-time workers since the start of the 2008 recession.

“As these individuals work on the front lines to keep us safe from the pandemic, that same virus is directly eroding the funding that keeps them operational,” Freeman said. “We must do more to provide long-term, sustainable, predictable funding to local health departments, both now and in the future, to stabilize and rebuild this critical system before the next crisis.”