The Impact of Economic Downturn on Local Public Health: Qualitative Data Analysis of Decision Drivers

In this study, we examine qualitative data pertaining to programmatic cuts in local health departments (LHDs) resulting from adverse economic conditions. These data include detailed information about the nature of public health services eliminated, anticipated impacts on the health of communities, and drivers of decision-making about which services, programs or activities to reduce as a result of budget loss. This study involves analysis of qualitative data from two waves of Economic Surveillance Surveys (ESS) of LHDs – the first conducted in August of 2009 and the second to be conducted in January of 2010. Both of the ESSs are based on nationally representative stratified random samples. We have used QSR NVivo to organize, code, and synthesize qualitative data. Our preliminary analyses of the 2009 ESS show that budget reductions lead to reduction or elimination of a wide variety of public health services and activities, including essential public health functions that are not provided by other agencies. Consequently, LHDs reported that they expected serious community health impacts, including spread of infectious disease, negative MCH outcomes, unintended pregnancies, undetected chronic disease and cancers, and spread of food-borne illness. The results from the 2010 survey will provide additional information about decision drivers in service reduction due to budget loss by LHDs. These findings add to the evidence-base and provide valuable insights to local health department leaders and local government officials in a general economic downturn for understanding expected relative impact to their agency. The LHD leaders will also benefit from qualitative details concerning service-reduction decisions and factors to consider when making such decisions. The findings may allow state and federal public health leaders to make better decisions about resource allocation, particularly at times when budgets are declining.