Our new article, “Annual Survey of State and Territorial Chronic Disease Prevention and Health Promotion Capacity and Organizational Development Needs—United States, 2023,” just published in the May issue of the Journal of Public Health Management and Practice, shares findings from NACDD’s latest annual survey of Chronic Disease Directors. These public health leaders oversee chronic disease units in states and territories—and their insights offer an important look at the infrastructure supporting this essential work.

Each year, NACDD surveys Chronic Disease Directors to assess capacity, staffing, and organizational development needs. The 2023 survey had an 85% response rate (50 out of 59 jurisdictions), and the responses show a mixed picture: some signs of recovery from pandemic disruptions but also continued challenges—especially around workforce and funding.

Modest Workforce Gains, Lingering Challenges

Read Our Article in the May Issue of JPHMP

While staffing levels have increased slightly since 2020, many jurisdictions are still dealing with turnover, delayed hiring, and significant training needs. More than half of Chronic Disease Directors were new to their roles (three years or less), which shows how much leadership has turned over since the pandemic began.

Respondents cited difficulties recruiting and retaining experienced staff, challenges with government hiring processes, and a loss of institutional knowledge. Programs in smaller jurisdictions reported higher staffing ratios per capita, but that didn’t necessarily translate to more stability or resources.

And while raw staffing numbers may be higher than they were during the height of the pandemic, they don’t tell the full story. Many of those earlier positions were temporary or reassigned to COVID response—so teams were often rebuilding from a reduced baseline.

Some Areas Are Holding Steady, Others Need Attention

The good news: Directors generally felt their teams were doing well in areas like leadership, administration, and applying evidence-based practices. These are the building blocks of a strong public health program.

But workforce development stood out as a clear area of concern. Fewer than one in three rated their workforce development capacity as strong. Many said they plan to focus more on training and development in the year ahead—which tracks with broader calls for better support systems for the public health workforce, especially in chronic disease prevention.

Funding Instability Makes It Hard to Move Forward

It’s no surprise that funding came up as a major theme. Directors described the challenges of trying to hire or plan long-term when most funding is limited, inflexible, or temporary.

Several jurisdictions were trying to bring on new staff in 2023, while others were laying people off as COVID-era funds expired. This kind of boom-bust funding cycle makes it hard to build or sustain momentum—especially when you’re trying to strengthen systems over time, not just respond to immediate needs.

What’s Next

Even with these challenges, Chronic Disease Directors push ahead. Many are focusing on workforce development, internal systems, and partnerships as top priorities for 2024. Their experiences and insights help highlight where continued investment is most needed.

Read more in our full article, “Annual Survey of State and Territorial Chronic Disease Prevention and Health Promotion Capacity and Organizational Development Needs—United States, 2023,” available now in JPHMP.

Emily W. Lankau, MSSW, DVM, is an independent public health operations consultant supporting multiple government and non-profit clients with workforce development, quality improvement, data management and analysis, and technical writing.

Jeanne Alongi, DrPH, MPH, is Vice President for Public Health Leadership at NACDD, directing its Center for Public Health Leadership. Her work focuses on organizational effectiveness, evidence-based practice, and strategic leadership. She has held roles across sectors and received the HHS Secretary’s Award for Distinguished Service.