Forces of Change Report for Local Health Departments

NACCHO is excited to announce the release of our 2024 Forces of Change report! The Forces of Change Survey assesses changes, at the national level, in local health department capacity and activities driven by public health trends. The report highlights critical trends and challenges faced by local health departments across key areas such as workforce, finance, governance, fellowship and training programs, public health nursing, evaluation, and harm reduction. 

Key findings include 19% of LHDs reported job losses in 2023 – up from 14% in 2021 and 17% in 2022 – with the rate climbing to nearly 40% among large LHDs. These reductions may reflect the phase-out of temporary pandemic-related staffing, raising concerns about a shrinking public health safety net. Meanwhile, few LHDs hosted fellows or trainees, citing challenges such as limited supervisory capacity, high costs, and a lack of awareness. Nearly 70% reported insufficient funding to convert trainees into permanent staff, pointing to a gap between workforce interest and capacity. 

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