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The National Association of County and City Health Officials' (NACCHO) Forces of Change Survey is an evolution of 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' (LHD) 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 local health departments, such as health reform and accreditation. The 2018 Forces of Change survey was distributed to a stratified random sample of 966 LHDs in the United States.

The survey included six topics: (1) Budget Cuts and Job Losses, (2) Response to Opioid Use and Abuse, (3) Population Health Activities, (4) Influenza Preparedness and Response, (5) Informatics Capacity, and (6) Environmental Health Activities.

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

Beginning in 2014, NACCHO began conducting the Forces of Change survey yearly in years that the National Profile Study of Local Health Departments (Profile) was not fielded. The Forces of Change Survey continues to measure changes in LHD budgets, staff, programs, and assess more broadly the impact of forces affecting change in LHDs.

More specifically, the survey collected information about staffing and budget changes, agency governance, engagement with fellowship/training programs, public health nursing activities, evaluation capacity, and services to address the infectious disease consequences of the opioid crisis.