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 LHDs, such as health reform and accreditation. 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. The collection is comprised of the public-use version (Restricted-Use Level 1) of the Forces of Change 2014 dataset, and includes 133 variables for 648 cases, with demographic variables related to LHD budgets, governance type, and number of employees.

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' budgets, staff, and programs. The Forces of Change Survey continues to measure changes in Local Health Department (LHD) budgets, staff, and programs and assess more broadly the impact of forces affecting change in LHDs, such as health reform and accreditation. 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 were part of a combined health and human services agency.

The collection is comprised of the public-use version (Restricted-Use Level 1) of the Forces of Change 2015 dataset, and includes 101 variables for 690 cases, with demographic variables related to LHD budgets.

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. This current iteration of the survey collected information about Zika response; local health departments involvement in multi-sectoral partnerships; and workforce recruitment. The collection is comprised of the public-use version (Restricted-Use Level 1) of the Forces of Change 2017 dataset, and includes 192 variables for 948 cases, with demographic variables related to LHD budgets.

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 LHDs, such as health reform and accreditation. This current iteration of the survey collected information about Zika response; LHDs involvement in multi-sectoral partnerships; and workforce recruitment. The collection is comprised of the restricted-use version (Restricted-Use Level 2) of the Forces of Change 2017 dataset, and includes 195 variables for 948 cases, with demographic variables related to LHD budgets.

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 LHDs, such as health reform and accreditation. 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.

The collection is comprised of the restricted-use version (Restricted-Use Level 2) of the Forces of Change 2014 dataset, and includes 140 variables for 648 cases, with demographic variables related to LHD budgets, governance type, and number of employees.

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' budgets, staff, and programs. The Forces of Change Survey continues to measure changes in Local Health Department (LHD) budgets, staff, and programs and assess more broadly the impact of forces affecting change in LHDs, such as health reform and accreditation. 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 were part of a combined health and human services agency. The collection is comprised of the restricted-use version (Restricted-Use Level 2) of the Forces of Change 2015 dataset, which includes 103 variables for 690 cases and demographic variables related to the size of population served and LHD budgets.

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.