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Local Health Departments' Approaches to Deal With Recession

What Strategies Are Used to Minimize the Negative Impact on Public Health Services to Community?

Shah, Gulzar H. PhD, MStat, MS; Ye, Jiali PhD; Leep, Carolyn J. MS, MPH; Leider, Jonathon P. PhD

Journal of Public Health Management and Practice: November/December 2016 - Volume 22 - Issue 6 - p 537–541
doi: 10.1097/PHH.0000000000000260
Research Brief Report
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Context: Local health departments (LHDs) are crucial components in the public health system. As with their state counterparts, operating since the 2008 recession has proven financially difficult for the majority of the nation's 2800 LHDs. These health departments have elected to employ a variety of strategies to maintain operations and public-facing services and programs.

Objectives: This study aimed to assess strategies used by LHDs to minimize the negative impact on services to community and to examine variation in these strategies by the size of population in LHD jurisdiction.

Design and Participants: The design of this research brief report is observational, based on cross-sectional data from a nationally representative sample of 957 LHDs that enumerates and characterizes the nature of their responses to austerity.

Outcomes Measures: The main outcome measures included 19 strategies. We used descriptive and bivariate analyses to highlight our study findings.

Results: LHDs use a variety of strategies to mitigate negative impacts on the public health services in their communities, focusing on workforce, funding, service referral, and several other areas. The most frequently used strategies include cross-training staff, increasing work hours, pursuing new funding, resource sharing, and seeking fees for services provided. Some minor variation by the size of jurisdiction population existed in frequency of top 10 strategies used by LHDs.

Conclusions: Some of the LHD strategies to deal with the impact of recession address immediate issues caused by budget cuts and might be short-term fixes, including increasing workload of employees, and pay freezes. Other strategies, such as seeking new sources of revenues and resource sharing, can have potentially positive effects in the long run.

This study examines strategies used by local health departments (LHDs) to minimize the negative impact on services to community and to examine variation in these strategies by the size of population in LHD jurisdiction.

Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia (Dr Shah); and National Association of County & City Health Officials, Washington, District of Columbia (Drs Ye and Leep). Dr Leider is an independent consultant at JP Leider Research & Consulting, LLC in Minneapolis, Minnesota.

Correspondence: Gulzar H. Shah, PhD, MStat, MS, Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, 501 Forest Dr, Hendricks Hall, Bldg 303, Statesboro, GA 30460 (gshah@georgiasouthern.edu).

The authors declare no conflicts of interest. No financial disclosures were reported by the authors of this article.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (http://www.JPHMP.com).

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