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Budget cuts to health departments: is our health at risk?

For Immediate Release
Date: February 28, 2012
By: Ashley Wiggin, Communications and Marketing Officer, 206-221-2456,

Providing care for mothers and babies, preventing the spread of communicable diseases and responding to emergencies are among the services provided by local health departments, which have faced devastating cuts in the past several years. A 2011 National Association of County and City Health Officials (NACCHO) survey of local health departments nationwide found that more than half of all departments cut services in the first part of 2011, with maternal child health services the “hardest hit.” Since 2008, local health departments nationally have lost 34,400 out of a total 155,000 jobs due to layoffs and attrition[1]--a loss of capacity that is expected to threaten the health of the communities these agencies serve.

 In an effort to better understand what this means for the public, Betty Bekemeier, Assistant Professor, Department of Psychosocial and Community Health, has been funded to look at the impact of these cuts to county health departments. The grant will examine how cuts have affected the community—from the health of mothers and babies to infectious disease control. By investigating the types of cuts made to local health departments in the areas of maternal and child health (such as support for low income pregnant and parenting women in getting healthcare and information), environmental health (such as water supply and food safety monitoring), and communicable disease control (such as immunization programs and tuberculosis control), Bekemeier and her team of public health practice-oriented researchers hope to ultimately find what works best for improving health outcomes for the public, even in a time of diminishing budgets and cutting programs.

“As we have more evidence, we will be able to better inform policy makers about the impact that these services have on communities…and what happens when they go away,” said Bekemeier.  “But without adequate evidence of what each of these services do for the health of our communities and how to prioritize them, local public health leaders and policy makers are struggling to make very difficult decisions about what will best meet the needs of their communities—especially during these tough financial times.”

Bekemeier, alongside co-Investigator Michael Morris at the University of Arkansas for Medical Sciences, will use funding from The Robert Wood Johnson Foundation (RWJF) to look at six years of data from 305 health departments in four states (Washington, Florida, Minnesota and Ohio), related to changes in services and the impacts of this on the populations that are served. Using the health departments as a “living laboratory,” the project will study (2005-2010) data from health departments, from before and after budget cuts to services, and how these cuts are affecting people in the community. Cuts in health departments have included reducing and eliminating home visiting programs for new mothers, ending free immunization clinics, and slower responses to infectious disease outbreaks. She notes that these states were selected because they’ve all faced significant budget cuts, they all have a unique form of detailed data that support this type of study, and they each have existing Public Health Practice-Based Research Networks (PBRNs). Public Health PBRN partnerships between public health practitioners and researchers, make studies like this possible—as practitioners can make health data more accessible to researchers and researchers can be more responsive to the research questions that people in practice need answered.

With each health department handling cuts differently, Bekemeier notes that the overall impact to the populations served may be different across states and in rural versus urban communities. According to Bekemeier, nurses make up the majority of the workforce in city and county health departments, so they play an important role in understanding how the health departments are meeting the needs of those they serve.

“This financial crisis, awful as it is, is giving us an opportunity for a ‘natural experiment,’” She said. “These terrible cuts to services will give us that much better of a sense of how these services contribute to people’s health. Then we will need to use these findings as evidence to support programs and practices that meet the needs of our communities’ most vulnerable residents. Nurses are the backbone to our public health systems.  So we have a huge responsibility to be a part of understanding and providing leadership around these issues.”

The two-year $200,000 grant from The Robert Wood Johnson Foundation (RWJF) in conjunction with the National Network of Public Health Institutes (NNPHI) is one of 11 grants given to institutions across the country. The projects are part of a broad effort to support research that focuses on strategies to improve the quality and effectiveness of public health practice and policy.

“These are trying times in public health and any form of public service,” said F. Douglas Scutchfield, M.D., director of the National Coordinating Center of Public Health Systems and Services Research (PHSSR). “How best to cope with the changing environment at the state and local levels – in health departments generally and in specific programmatic areas such as maternal and child health – is the goal of these projects. The intent is to inform decision making in a rapidly evolving public health system.”

About the Funding agencies

As the nation’s largest philanthropy devoted exclusively to health and health care, The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. For more information about this project, visit, and

[1] National Association of County and City Health Officials, 2011.


The University of Washington School of Nursing is consistently the nation’s No. 1-ranked nursing school, according to U.S. News & World Report. Ranked No. 3 in research funding from the National Institutes of Health, the UW School of Nursing is a national and international leader in improving the health and well-being of individuals, families and communities. The school addresses society’s most pressing challenges in health care through innovative teaching, award winning research and community service. For more information, visit