NACCHO’s 2013 National Profile of Local Health Departments Shows Continued Funding Cuts for Preparedness

By Frances Bevington, Senior Marketing and Communications Specialist and Stacy Stanford, MSPH, Program Analyst; Public Health Preparedness, NACCHO

On Jan. 21, NACCHO released the report of findings and data from the 2013 National Profile of Local Health Departments (Profile) study, demonstrating continued funding cuts across several programmatic areas at local health departments (LHDs), including emergency preparedness. According to NACCHO staff Carolyn Leep, Senior Director of Research and Evaluation, and Jan Wilhoit, Senior Project Management Specialist for the Profile, funding for emergency preparedness, particularly per capita funding, saw a significant drop in 2013, with LHDs reporting median per capita funding of $1.15 in 2013 compared to $2.07 per capita in 2010. This finding is consistent with continued decreases in overall federal funding for emergency preparedness, which has dropped more than 25 percent since 2007.


What is striking about the decrease in emergency preparedness funding is that LHDs are not reporting a corresponding decrease in staff. In fact, LHDs have increased emergency preparedness staff with 77 percent of all LHDs reporting a full time equivalent (FTE) in 2013, compared with 65 percent of all LHDs in 2010. Nationally, the number of emergency preparedness staff employed by LHDs grew to an estimated 2,900 FTEs in 2013 from 2,700 in 2010, an increase of approximately seven percent. While NACCHO has interviewed members who have anecdotally reported that decreases in funding have led to decreases in trainings, exercises, travel, and supplies because cuts in these areas precede staffing cuts, further research is needed to understand the full implications of funding cuts in emergency preparedness at the local level. Other findings of note regarding emergency preparedness include the following:

  • Most LHDs have developed or updated a written emergency plan (87%) or provided emergency preparedness training to staff (84%).
  • Since September 2010, more than half of all LHDs (55%) have responded to at least one all-hazards event, and almost all (93%) have participated in an emergency response drill or exercise.
  • Natural disasters are the most common all-hazards event LHDs have responded to since September 2010 (41%), followed by an influenza outbreak (30%) and an outbreak of other infectious diseases (27%).
  • LHDs also prepare for rare events; for example, few LHDs (6%) have responded to an exposure to a potential biological agent since September 2010, but 35 percent of LHDs have participated in drills/exercises to prepare for such an event.

Several findings that describe the overall state of personnel and practices at LHDs could have implications for emergency preparedness programs. For example, Profile data demonstrated a long-term decrease in LHD staff dating to the enactment of broad federal funding cuts in 2008. The total number of individuals employed at LHDs in 2013 was 162,000 as compared to 190,000 in 2008 and nearly one-half (48%) of all LHDs reduced or eliminated services in at least one program area. Less staff overall would likely result in less staff to respond to emergencies, regardless of whether or not those staff are emergency preparedness personnel. Findings also show that the top agency executives at LHDs are aging, with 25 percent of top executives over the age of 60 compared to 16 percent in 2005. As these top executives reach retirement age, knowledge acquired through responses to past emergencies may be lost. Also of note is the increasing level of LHDs who are engaging in formal quality improvement (QI) activities, most often in specific program areas, with 56 percent reporting a formal QI program compared to 45 percent in 2010. Participation in programs that emphasize quality improvement, such as NACCHO’s Project Public Health Ready, may be contributing to this increase.

NACCHO supports the Medical Reserve Corps (MRC), a national network of more than 200,000 volunteers in nearly 1,000 local units, through a cooperative agreement with the U.S. Department of Health and Human Services’ Office of the Surgeon General and encourages LHDs to engage MRC units in emergency preparedness activities. The 2013 Profile findings indicated that while only 16 percent of LHDs reported no engagement with volunteers, only 27 percent engage MRC volunteers specifically. This suggests that there is potential for increased collaboration between LHDs and MRC units. NACCHO is authoring a similar study of the MRC network that will be released in March 2014, “The 2013 Network Profile of the Medical Reserve Corps.” This study may offer LHDs more insight into how to best to engage with MRC units and volunteers.


The 2013 Profile expanded and added questions to measure changing practices at LHDs. The new data offer insights into policy activities that could be the first national-level data available on the policy work of LHDs. Most LHDs (90%) have been involved in some policy or advocacy areas in the past two years with 58 percent engaging in policy or advocacy specifically about emergency preparedness and response. The Profile also expanded the data collected about social media use at LHDs and found that, while LHDs are comparatively late adopters of social media, social media use is steadily increasing with 44 percent using Facebook in 2013 compared to 26 percent in 2010. The use of YouTube increased to 12 percent from six percent in 2010 and the use of Twitter increased to 18 percent from 13 percent in 2010. The 2013 Profile also asked about the use of social media for surveillance activities for the first time with results showing that ten percent of LHDs report this type of activity. However, the results are heavily skewed toward large LHDs that may have more resources and staff available for such activities. Profile data also show that large health departments serving populations greater than 500,000 are much more likely to have a Public Information Officer FTE, which recent research suggests may be correlated with capacity for social media activity. [1]

NACCHO has been collecting data through the Profile to inform a comprehensive picture of infrastructure and practice at LHDs since 1989. The 2013 Profile is the seventh version of this study and includes a collection of descriptive statistics of 2,000 respondents that is representative of the nation’s approximately 2,800 LHDs. For the study, an LHD is defined as an administrative or service unit of local or state government, concerned with health, and carrying some responsibility for the health of a jurisdiction smaller than the state. The study provides a fundamental basis for research on LHDs and represents a major investment of time on behalf of the LHDs who complete the Profile and a significant contribution by these LHDs to the knowledge base of public health.

What have been the consequences of cuts in preparedness funding to your LHD? Let us know in the comment section below.

  1. Harris, J., Choucair, B., Maier, R., Jolani, N., Bernhardt, J. (under review). Are public health organizations tweeting to the choir? Understanding LHD Twitter followership.


About Frances Bevington

Frances Bevington is the Senior Marketing and Communications Specialist for Public Health Preparedness at NACCHO. Her work includes emergency and risk communications planning, strategic messaging, and multichannel marketing for the adoption of best practices in public health preparedness. Twitter: @Wilkington

6 thoughts on “NACCHO’s 2013 National Profile of Local Health Departments Shows Continued Funding Cuts for Preparedness

  1. Theresa
    January 29, 2014 at 10:18 am

    Since our funding has been cut, we can no longer afford to do public outreach activites such as advertising campaigns, marketing materials including preparedness booklets and brochures and volunteer training.

  2. G
    January 29, 2014 at 11:03 am

    The cuts in funding are forcing us to spread out timelines for all projects, so now we’re not meeting objectives in our strategic plan. We had a RIF in 2013 which brought progress to a halt and current projects or plan updates didn’t occur, putting us way behind. We definately don’t have enough money to upgrade or replace equipment and systems. We’ve had to get real creative, but some things don’t have a work around. We are increasingly looking for volunteers, agencies and companies to provide services for free or EM interns to help us in the office, which has not been very successful. Private contract service outsourcing is decreasing due to strapped funding. I think the FY15 budget may force us cut more objectives. The administration talks about increasing national preparedness, but then doesn’t provide enough funding to make that happen. I don’t believe that the administration fully understands what is involved in emergency planning, logistics, volunteer recruitment, training & exercise, commuications, etc. To be effective, you need enough of the right kind of staff and the tools to make it happen….and it’s a long term endeavor that doesn’t produce a cost benefit until something hits the fan.

  3. January 29, 2014 at 12:04 pm

    Since funding cuts have been made staff has been reduced by more almost 60% making it harder to be at the table in all the locations we need to be as we plan, prepare, respond. mitigate etc. with community partners. We no longer can afford outreach materials to support training. Face to fase collaboration has greatly been reduced making us more vulnerable and less resilient as a community. Public Health effects all aspects of emergencies and disasters, realizing and educating about the impact poor public health would have on the community as disease spreads is vital. It is hard to share our message with all the funding reductions. I know the impact to life safety will be devastating with out our continued efforts.

  4. January 30, 2014 at 7:01 pm

    Echoing many of the other bloggers comments, the reduced funding has severely minimized our organization’s ability to effectively build sustaining relationships within communities. The funding cuts are enhancing the bureaucracy of public health preparedness. Completely being grant driven, public health preparedness professionals are spending more time in their offices, rather than developing capabilities and the capacity to become resilient during public health emergencies.

  5. Ntasiah
    January 31, 2014 at 1:17 pm

    The loss of government funding, for Public Health, will severely impact areas of Public Health that allow resources to be secured and/or purchased (including financing for fulfilling proposal contracts, etc…) with public and private partners and stakeholders. The loss of funding that maintains workforce positions and continual training will have a ‘domino’ effect within the Public Health infrastructure that can potentially create huge challenges with the various services which local Public Health agencies offer to the community. For example, the loss of the Emergency Preparedness program would have a devastating impact on the preparedness, prevention, mitigation, and recovery efforts in the event of a Public Health Emergency; not to mention the potentially injurious affect on the general public. The Emergency Preparedness funding is crucial to the Emergency Operations planning efforts in that: a) plans must be written specifically to a disaster-type (when possible) and specific to a population size and/or region, b) plans must be researched and continually exercised to learn the best possible practice and to be effective in the time of an emergency, c) partnerships for personnel, facilities, and resources (of all types) must be established, d) response planners and other team members must be current on their training and certifications in order to meet state and federal guidelines as well as to keep pace with the latest best practices, and e) funding aids in the resources it takes to have the capability to educate the workforce and the general public, on a consistent basis, and have the ability respond to/recover from Public Health emergencies.

  6. April 11, 2014 at 2:08 am

    I have been a MRC Coordinator for the last year in a HIGHLY disaster-prone area of the country. Our unit is 100% funded by the federal grant. My position is part-time with limited benefits. Our unit is significantly under-funded, IMHO. I am the 6th (or 7th coordinator, not real sure) for this very active MRC unit in the last 7 years. So sad, because we have such amazing, skilled, and generous volunteers! I really LOVE <3 this job, but I have no choice but to pursue other employment opportunities. It simply doesn't pay enough for me to meet my bills. In other MRC units in our state, they can't even find a person who will lead their unit. Now I know why. There is a very strong possibility that our unit will fold due to lack of financial support, and our area needs this unit so much.

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