The National Association of County and City Health Officials (NACCHO) has released its 2024 Forces of Change Survey report, revealing a troubling trend among local health departments. The report indicates that an increasing number of these departments are experiencing staff reductions due to layoffs or attrition, which raises significant concerns about the shrinking public health safety net. The study encompasses a range of issues faced by health departments at the county, city, and district levels, including changes in staffing and budgets, governance structures, the utilization of public health fellowship and training programs, and the critical role of public health nurses.
Out of 1,200 local health departments surveyed between March and June 2024, 667 (or 56%) provided responses. The findings underscore the pressing challenges and trends affecting local health departments during a time of significant uncertainty in the public health landscape, according to NACCHO's news release.
The 2024 survey highlights that approximately 1 in 5 local health departments reported job losses in 2023, an increase from 14% in 2021 and 17% in 2022. Alarmingly, this rate surged to nearly 40% among larger local health departments. Additionally, 17% of these departments reported budget cuts for the fiscal year (FY) 2024, with 23% anticipating further cuts in FY2025. These findings illustrate the critical challenges local health departments face as they navigate an increasingly precarious funding environment.
Despite these challenges, the survey revealed that 90% of local health departments involve nurses in health promotion and protection activities. Furthermore, 72% of departments indicated that nurses participate in emergency preparedness, disaster recovery, and cross-sector collaboration, while 41% noted their involvement in policy and advocacy efforts. NACCHO's report also highlighted that in 2024, 84% of local health departments have programs with an evaluation component. However, nearly 60% of respondents cited challenges in conducting evaluations due to insufficient staff time or capacity, which raises further concerns about the effectiveness and sustainability of public health initiatives.
NACCHO added that a lack of participants from training and fellowship programs within local health departments jeopardizes future workforce development. This situation could potentially diminish the capacity of local health departments to respond to public health needs effectively.
In a separate public health development, Cambodia's health ministry reported another human case of H5N1 avian flu, involving a 5-year-old boy from Kampot province who is currently hospitalized in intensive care. This case is part of a concerning trend, as the country has seen an increase in human cases since late 2023, with nine reported since early June and twelve cases so far in 2025. Investigations revealed that the boy had daily contact with a flock of 40 chickens, several of which were sick or had died, illustrating the connection between poultry and human infections.
H5N1 is known to circulate among Cambodian poultry, with a new reassortant strain identified that combines genes from an older clade and the global 2.3.4.4b clade. Historical data indicates that human cases in Cambodia typically arise from direct contact with infected poultry, often resulting in severe or fatal outcomes.
In an effort to bolster local health departments, NACCHO, with support from the Centers for Disease Control and Prevention (CDC), has announced a $356,000 grant to support the implementation and expansion of wastewater monitoring programs. This initiative aims to track disease trends and emerging health threats within communities. In the 2025 Wastewater Monitoring Mentorship Program, NACCHO has selected five local health departments as mentors and eleven as mentees, focusing particularly on addressing the unique challenges faced by rural health departments.
The mentorship program is designed to ensure that local health departments receive the necessary support to develop or enhance their wastewater monitoring efforts, tailored to the specific needs of their communities. Mentor awardees include health departments from California, Massachusetts, Nebraska, and Texas, while mentees hail from states such as Alaska, California, Iowa, Ohio, Missouri, and West Virginia.
Additionally, following a spike in mpox cases in Sierra Leone, health officials have reported a decline in infections over the past six weeks. Dr. Yap Boum, deputy incident manager for the Africa CDC's mpox response, noted that increased involvement of community healthcare workers is effectively identifying cases outside of hospital settings. The integration of contact tracing with mpox vaccination efforts has also proven to be efficient.
Conversely, Uganda has experienced a slight rise in infections over the past three weeks, which is expected given the heightened support for contact tracers in the country. Infections from Uganda, Sierra Leone, and Zambia accounted for 88% of confirmed cases across Africa in the past week.
Despite the availability of the Bavarian Nordic mpox vaccine, a lack of funding poses a significant challenge to acquiring additional doses for African countries, hindering efforts to combat the outbreak effectively. Dr. Boum emphasized the urgency of addressing this crisis, highlighting the imperative of equity in public health response.
