Postpandemic Shifts in Local Public Health: Structural Change, Motivations, and Perceived Impacts.

Abstract

Objective: To identify and characterize the motivations and perceived impacts of formal structural changes to local health departments (LHDs), with a specific focus on perceived impacts for the public health workforce.

Design: We conducted a systematic search of publicly available news articles, outreach to public health organizations, and 17 semistructured interviews with individuals involved in a formal LHD structural change between 2020 and 2025.

Setting: The exploratory study identified and examined structural changes in LHDs across the United States between 2020 and 2025.

Participants: Participants were individuals associated with a restructured LHD, including past or present staff or board members. We identified participants through structured search queries and systematic state outreach, followed by a review of LHD websites to obtain contact information.

Results: We identified 16 structural changes covering 12 states and all Census regions of the United States. Across these changes, 153 news articles were identified, ranging from 0 to 50 articles per change. Change classifications included regional health district dissolutions and splits, mergers and consolidations, formations, and closures or transfers of authority. The changes varied widely, although almost all occurred rapidly and carried a substantial administrative burden. COVID-19, cost-effectiveness, efficiency, and population change were among the key drivers reported. Participants reported notable impacts, including job losses and gains, changes in administrative processes, increased employee stress, and greater innovation and productivity.

Conclusions: Local public health restructuring occurs for many reasons and yields perceived benefits and challenges. Robust monitoring and guidance on restructuring may support LHDs during changes.