The National Association of County and City Health Officials (NACCHO) has released its 2024 Forces of Change Survey report, revealing alarming trends regarding the workforce of local health departments across the United States.
The survey indicates that there is a notable increase in staff losses due to layoffs or attrition, which raises concerns about the public health safety net.
Of the 1,200 local health departments invited to participate in the survey from March to June 2024, 667 health departments, representing 56%, responded.
NACCHO stated in a news release that the findings underscore critical challenges local health departments face during uncertain times in public health.
In particular, the survey revealed that 19% of local health departments reported job losses in 2023, a significant uptick from 14% in 2021 and 17% in 2022.
The trend was particularly pronounced among large local health departments, where nearly 40% reported job losses.
Additionally, 17% of local health departments reported budget cuts for fiscal year 2024, with a further 23% anticipating cuts for fiscal year 2025.
The deterioration of staffing levels poses a serious risk, as 90% of local health departments stated that nurses are actively involved in health promotion and protection efforts.
Moreover, 72% reported nurse involvement in emergency preparedness and disaster recovery, while 41% indicated that nurses contribute to policy and advocacy work.
Despite the necessity of evaluation work in public health, nearly 60% of local health departments cited challenges stemming from insufficient staff time and capacity, undermining effective program evaluation.
NACCHO also warned that the future workforce development is at risk, as very few local health departments have individuals from training and fellowship programs assigned to their agencies.
NACCHO, which represents over 3,300 local health departments, continues to advocate for necessary support and resources to address these pressing issues.
In global health news, Cambodia’s health ministry announced another human case of H5N1 avian flu involving a 5-year-old boy from Kampot province, who is currently hospitalized in an intensive care unit.
This marks an uptick in human cases of H5N1 avian flu in Cambodia, with nine reported cases since early June and a total of twelve cases since the beginning of 2025.
Investigators revealed that the boy’s family has a flock of 40 chickens, some of which had been sick or had died.
The boy reportedly played with the chickens daily, revealing a clear link between human infections and contact with poultry.
Historically, human cases of H5N1 in Cambodia have often been severe or fatal, particularly those involving the older clade or the new reassortant strain that has emerged.
Simultaneously, NACCHO has announced it will award $356,000 to support local health departments in expanding wastewater monitoring programs as a means of tracking disease trends and emerging health threats.
This initiative, which benefits from support from the Centers for Disease Control and Prevention (CDC), marks the fourth year of the Wastewater Monitoring Mentorship Program.
In this year’s program, NACCHO is placing a specific emphasis on rural health departments that face unique barriers in analyzing wastewater.
The mentorship program pairs experienced local health departments with those in the early stages of developing their wastewater monitoring efforts.
Mentor departments include agencies from California, Massachusetts, Nebraska, and two from Texas, while mentee departments are based in Alaska, California, Iowa, Ohio, Missouri, Texas, and West Virginia.
The primary goal of the program is to ensure local health departments have adequate support to implement monitoring programs tailored to their communities’ health needs.
In other public health developments, recent reports from Africa show a decline in mpox cases in Sierra Leone, following a worrying surge that previously gave the virus a foothold in West Africa.
Yap Boum, PhD, MPH, deputy incident manager for Africa CDC’s mpox response, shared that the downward trend in case positivity reflects an increase in community healthcare worker involvement in identifying infections outside hospital settings.
Sierra Leone is achieving success through effective contact tracing paired with vaccination efforts.
However, Uganda has seen a slight increase in cases over the past three weeks, which Boum explained is expected as the country increases support for contact tracers.
Currently, Uganda, Sierra Leone, and Zambia account for 88% of all confirmed mpox cases in Africa.
Despite the availability of Bavarian Nordic mpox vaccines, a crucial challenge persists—there are insufficient funds for UNICEF and other providers to purchase additional doses.
Boum emphasized the urgency of addressing this situation, noting that the shortage of funds comes at a critical time in the fight against mpox when African countries are making progress and the vaccine uptake in affected populations is high.
This scenario represents a significant equity challenge in public health efforts to manage outbreaks effectively.
As NACCHO and various health officials work to address workforce shortages and emerging health threats, it is evident that a multipronged approach is required to bolster public health infrastructure both domestically and globally.
image source from：cidrap
