Local health departments and the 2008 recession: characteristics of resiliency.
BACKGROUND
The 2008 recession had a significant impact on local health departments (LHDs), with more than half of such agencies experiencing job losses and program cuts.


OBJECTIVE
To identify potential modifiable factors that can protect LHDs from job losses and budget cuts during future economic crises.


METHODS
This retrospective cohort study used data from 2005 and 2010 surveys of LHDs. The outcome of interest was financial resiliency for maintaining budgets during the recession and was based on the ratio of observed to predicted expenditures (O/E) per capita for 2010. Logistic regression was used to model the resiliency of the LHD with independent variables grouped around domains of organization, revenues, and services, with stratification by size of the LHD jurisdiction. Data were analyzed in 2013.


RESULTS
Of the 987 LHDs in the final data set, 328 (33.2%) were categorized as resilient and 659 (66.8%) as non-resilient. Overall, resilient LHDs received a higher percentage of revenues from non-local sources compared to non-resilient LHDs (p<0.05) and had a more diversified service mix, with significantly (p<0.05) more treatment, population, and regulatory services. In the final regression models, findings differed substantially across the stratifications of LHD jurisdictional population size, with no single independent or control variable significantly associated with resiliency across all population categories.


CONCLUSIONS
Funding streams and service mix may be modifiable characteristics, suggesting possible means for LHDs to weather future economic stress; however, these characteristics may be unique to the size of the population served.
Department of Public Health, University of Tennessee, Knoxville, Tennessee. Electronic address: perwin@utk.edu.
Paul C
PC
Erwin
Jiann-Ping Hsu College of Public Health, Georgia South University, Statesboro, Georgia.
Gulzar H
GH
Shah
University of Kentucky College of Public Health, Lexington, Kentucky.
Glen P
GP
Mays
D015331:Cohort Studies; D057172:Economic Recession; D006801:Humans; D009111:Local Government; D016015:Logistic Models; D011635:Public Health Administration / Q000191:economics* / Q000639:trends; D012189:Retrospective Studies; D014478:Unemployment / Q000706:statistics & numerical data; D014481:United States