Forces of Change Survey, United States, 2020

The National Association of County and City Health Officials' (NACCHO) Forces of Change Survey was developed as an evolution to NACCHO's Job Losses and Program Cuts Surveys (also known as the Economic Surveillance Surveys), which measured the impact of the economic recession on local health departments' (LHDs) budgets, staff, and programs.

The Forces of Change Survey continues to measure changes in LHD budgets, staff, and programs and assess more broadly the impact of forces affecting change in LHDs. For the 2020 Forces of Change survey, the core set of questions were distributed to a total of 2392 LHDs in the United States, with a stratified random sample of 905 LHDs receiving the module questionnaire.

More specifically, the survey collected information about LHD staffing levels, workforce reductions, and changes in budget sizes; provided services or functions; changes in the level of service delivery; billing for clinical services; efforts to help people enroll in health insurance from exchanges under the Affordable Care Act; awareness of and involvement in the State Innovation Models Initiative; participation in the Public Health Accreditation Board's national accreditation program for LHDs; and whether LHDs are part of a combined health and human services agency.