Forces of Change Survey, United States, 2024 (ICPSR 39672)

Version Date: Jun 2, 2026

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Principal Investigator(s):
Tim McCall, National Association of County and City Health Officials; Krishna Patel, National Association of County and City Health Officials; National Association of County and City Health Officials

Series:

https://doi.org/10.3886/ICPSR39672.v1

Version V1

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Summary

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.

Citation

McCall, Tim, Patel, Krishna, and National Association of County and City Health Officials. Forces of Change Survey, United States, 2024. Inter-university Consortium for Political and Social Research [distributor], 2026-06-02. https://doi.org/10.3886/ICPSR39672.v1

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Funding

Robert Wood Johnson Foundation (78802), United States Department of Health and Human Services. Centers for Disease Control and Prevention (NU38PW00037-01-01)

Subject Terms

Geographic Coverage

Smallest Geographic Unit

State

Restrictions

Access to the Restricted-Use Data is restricted. Users interested in obtaining these data must complete a Restricted Data Use Agreement and specify the reason for the request.

Distributor(s)

Inter-university Consortium for Political and Social Research
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Time Period(s)

2024

Date of Collection

2024-04-09 -- 2024-06-20

Data Collection Notes

  1. The Restricted-Use Data includes variables with local health department names (LHDNAME), a state variable (C0STATE), and a unique identifier (NACCHOID), while the Public-Use Data only includes a de-identified ID variable (DE_ID). For access to the restricted-use variables, apply for access to the Restricted-Use Data.
  2. Additional information about this study is available on the Forces of Change website.
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Study Design

NACCHO developed the questionnaire for the 2024 Forces of Change by first reviewing previous surveys conducted by NACCHO: Forces of Change (2014, 2015, 2017, 2018, 2020, 2023) and past Profile questionnaire (2005, 2008, 2010, 2013, 2016, 2019, 2022, 2023) to identify whether any topic areas should be repeated. Then subject matter experts within NACCHO determined which current public health topics should be included in the current questionnaire. An advisory group--comprising LHD leaders; staff from affiliate organizations including ASTHO, CDC, and RWJF; and researchers--and other subject matter experts within NACCHO provided input and feedback on questions.

NACCHO staff and a nationwide group of Forces of Change study advocates conducted follow-up with non-respondents using e-mail messages and telephone calls. NACCHO also offered technical support to survey respondents through an e-mail address and telephone hotline.

Sample

The 2024 Forces of Change study used a stratified random sampling design. A representative sample was used instead of a complete census design to minimize survey burden on LHDs while enabling the calculation of national-level estimates.

NACCHO randomly sampled 1,200 LHDs, stratified by size of population served. The population served measure had 7 population categories: LHDs serving less than 25,000 people, 25,000-49,999 people, 50,000-99,999 people, 100,000-249,999 people, 250,000-499,999 people, 500,000-999,999 people and more than 1,000,000 people served.

Time Method

Longitudinal: Trend / Repeated Cross-section

Universe

Local health departments (LHDs) in the United States. Rhode Island was excluded from the study because the state has no sub-state public health units.

Unit(s) of Observation

Organization

Data Type(s)

Mode of Data Collection

Response Rates

56%

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Original Release Date

2026-06-02

Version History

2026-06-02 ICPSR data undergo a confidentiality review and are altered when necessary to limit the risk of disclosure. ICPSR also routinely creates ready-to-go data files along with setups in the major statistical software formats as well as standard codebooks to accompany the data. In addition to these procedures, ICPSR performed the following processing steps for this data collection:

  • Checked for undocumented or out-of-range codes.

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Weight

For information on calculating weights, please see the section titled "Survey Weights and National Estimates" in the P.I. Codebook.

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Notes

  • The public-use data files in this collection are available for access by the general public. Access does not require affiliation with an ICPSR member institution.

  • ICPSR usually offers files in multiple formats for researchers to be able to access data and documentation in formats that work well within their needs. If you have questions about the accessibility of materials distributed by ICPSR or require further assistance, please visit ICPSR’s Accessibility Center.

  • One or more files in this data collection have special restrictions. Restricted data files are not available for direct download from the website; click on the Restricted Data button to learn more.

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This study is maintained and distributed by the Health and Medical Care Archive (HMCA). HMCA is the official data archive of the Robert Wood Johnson Foundation.