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Postpandemic Shifts in Local Public Health: Structural Change, Motivations, and Perceived Impacts
Kayla M Alvis1, Stephanie M Mathis, Michael Meit
1Author Affiliation: East Tennessee State University, Center for Rural Health and Research, Johnson City, TN (Alvis, Mathis, Meit, Leslie, Pelton, Dean, and Balio).
Journal of Public Health Management and Practice : JPHMP
|July 27, 2026
Summary
Local health department restructuring, driven by factors like COVID-19 and efficiency, impacts the public health workforce with both challenges and innovations. Guidance is recommended to navigate these changes effectively.
Area of Science:
- Public Health Policy
- Health Services Research
- Organizational Studies
Background:
- Local health departments (LHDs) are undergoing formal structural changes across the United States.
- These changes are often rapid and administratively burdensome, necessitating an understanding of their drivers and impacts.
Purpose of the Study:
- To identify and characterize the motivations behind formal structural changes in LHDs.
- To assess the perceived impacts of these structural changes, particularly on the public health workforce.
Main Methods:
- Systematic search of news articles and outreach to public health organizations.
- Conducted 17 semistructured interviews with individuals involved in LHD structural changes between 2020-2025.
- Exploratory study examining 16 structural changes in LHDs across 12 states.
Main Results:
- Identified various change classifications including mergers, dissolutions, formations, and closures.
- Key drivers reported include COVID-19, cost-effectiveness, efficiency, and population changes.
- Perceived impacts encompass job shifts, administrative process alterations, increased employee stress, and enhanced innovation.
Conclusions:
- Local public health restructuring is multifaceted, presenting both benefits and challenges.
- Effective monitoring and guidance are crucial for supporting LHDs through structural transitions.
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