Research ArticlesTough Choices in Tough Times: Enhancing Public Health Value in an Era of Declining ResourcesKuehnert, Paul L. MS, RN; McConnaughay, Karen S.Author Information Kane County Health Department (Mr Kuehnert) and County Board, Kane County Board of Health (Ms McConnaughay), Geneva, Illinois. Correspondence: Paul L. Kuehnert, MS, RN, Kane Country Health Department, 1240 N. Highland, Suite 26, Aurora, IL 60506 (KuehnertPaul@co.kane.il.us). This article is based in part on a presentations made to the final grantees' meeting of the Multistate Learning Collaborative in New Orleans in March, 2011, and the Institute of Medicine Committee on Public Health Strategies to Improve Health in May, 2011. The authors declare no conflicts of interest. The views expressed herein are those of the authors and do not necessarily reflect the views of the Kane County Board, Kane County Board of Health or the Kane County Health Department. Journal of Public Health Management and Practice: March/April 2012 - Volume 18 - Issue 2 - p 115-125 doi: 10.1097/PHH.0b013e3182303616 Buy SDC Metrics AbstractIn Brief The current economic recession is the deepest recession that the United States has experienced in more than 70 years. The convergence of severe economic conditions with the multiple population health and organizational challenges facing public health presents unprecedented demands on public health policymakers and executive leaders. This article reports a case study in which a Midwestern local health department intentionally realigned its structure and human resources to meet national public health accreditation standards while significantly reducing its budget in November 2010. The department transferred personal health care services that it previously provided to 3 federally qualified health centers in the community and reduced its workforce by 50%. The interrelated public policy and organizational management issues raised by the case study are reviewed, and questions and implications of the case for public health executive leaders, managers, policymakers, and researchers are identified. This article reports about a case study in which a midwestern local health department intentionally realigned its structure and human resources to meet national public health accreditation standards, thereby giving an example of enhancing public health value in an era of declining resources. © 2012 Lippincott Williams & Wilkins, Inc.