Departmental Highlights

Snapshot: Appropriation & Staffing Changes from 2025 Budget

	2025 Budgeted	2026 Proposed	Net Change	Percent Change	Average Annual Rate of Change (2011-2020)*	Inflation-adjusted Rate of Change (2011-2020)*
Appropriations	$689,641,355	$314,870,217	-$374,771,138	-54.3%	19.1%	20.0%
Positions & FTEs	1046	764	-282	-27.0%	0.4%	NA

*Historical comparisons are usually made from 2011-2025, however, in the case of CDPH, the pre-pandemic averages from 2011-2020 are presented for comparison. (The 2020 budget was set in late 2019, before the pandemic.) 

• This year’s budget sees an accelerated decline in CDPH’s budget, with appropriations down -54.4% from 2025, which had in turn declined -22.4% from 2024. Headcount in the 2026 proposal is down -27% from the previous year’s budget, itself a -10.6% from the 2024 high-water mark.
• The proposed 2026 budget reduces CDPH’s overall headcount by a net -282 positions, a -27% change. (25 of the eliminated positions are matched by equivalent titles/positions added at the expanded Department of Environment, however, as DoE takes over some of CDPH’s responsibilities.)
• Among the other eliminated positions, the largest reductions came across multiple public health administrator, project management, and epidemiologist titles, including: 
  • A net reduction of -41 Epidemiologist positions, more than half (54.7%) the positions budgeted for those titles, as well as the elimination of seven of the department’s 10 Infection Prevention Specialist positions.
  • A net reduction of -43 Public Health Administrator positions, -41.3% of the positions budgeted for those titles
  • A net reduction of -36 project manager, coordinator, and administrator positions, -40% of the positions budgeted for those titles
    The department saw a $23 million (-25%) decline in salaries and wages on payroll, reflected in its reduced headcount. Pass-through spending to delegate agencies and outside contracting under the professional and technical services appropriation are both down in this year’s CPDH budget proposal as well, -$11.5 million (-14.4%) in the delegate agencies category and -$7 million (-15.4%) in contracting.
• Despite the decline in budgeted positions and salaries, the Salary Provision appropriation category is up $7.5 million (359.8%), driven by appropriations from the Coronavirus Local Fiscal Recovery Fund ($4.4 million) and the Federal Grant Fund ($5.1 million).
  • According to the Grant Details supplement, the entire $4.4 million salary provision appropriation from the Coronavirus Local Fiscal Recovery Fund comes from ARPA.
  • Multiple grants from the Federal Grant Fund include salary provision appropriations, primarily CDC grants as well as $1.2 million from a U.S. Department of Health & Human Services grant for the national bioterrorism hospital preparedness program
• Reserve balance funds held over until the next year remained the health department’s largest appropriation category despite a -$304.6 million (-78.6%) decline. 

Historical Context

As the city’s point department for infectious disease response, the Department of Public Health’s responsibilities and budget increased dramatically during the COVID-19 pandemic. CDPH allocations more than quadrupled from 2020-2022, driven primarily by federal grants, before beginning to decline in 2023 and 2024 and dropping more precipitously in 2025. 

Prior to the pandemic, the department’s budget had averaged a 2011-2020 growth rate of 1.8% per year. Departmental budgets overall increased an average of 1.5% per year over the same time period, while the total city budget including Finance General appropriations grew at an average rate of 4.5% annually.

This year’s budget sees an accelerated decline in CDPH’s budget, with appropriations down -54.4% from 2025, which had in turn declined -22.4% from 2024. 

Local fund actuals are only a limited snapshot of CPDH’s overall expenditures, as the prior three budget years were all years in which the department was heavily grant-funded. With that caveat, CDPH spent an average 78.3% of its locally-funded budget from 2022-2024, compared to the citywide average 86.4% local fund spend:

Because much of the pandemic-era grant funding was passed through to delegate agencies or outside contractors, the department’s budgeted headcount did not expand as dramatically as its budget, but still saw multiple outlier years, with the workforce nearly doubling from 2020-2024 before beginning to decline in the 2025 budget. 

The department’s pre-pandemic budgeted workforce shrank at a rate of roughly -3.8% annually from 2011-2020. Overall budgeted positions for the city remained relatively flat across the same time periods, with minor year-to-year fluctuations averaging out to an overall growth rate of -0.002%.

Headcount in the 2026 proposal is down -27% from the previous year’s budget, itself a -10.6% from the 2024 high-water mark. 

From February through September of 2025, the months for which the city released full-time position vacancy data, CDPH averaged a 28.7% vacancy rate, one of the highest in the city, compared to the citywide average of 11.2%. 

214 of the department’s budgeted full-time positions were persistent vacancies, meaning that the same title/division/section/subsection combination was vacant for all eight months of available data.

Staffing

The proposed 2026 budget reduces CDPH’s overall headcount by a net -282 positions, a -27% change. (25 of the eliminated positions are matched by equivalent titles/positions added at the expanded Department of Environment, however, as DoE takes over some of CDPH’s responsibilities.)

Among the other eliminated positions, the largest reductions came across multiple public health administrator, project management, and epidemiologist titles, including: 

• A net reduction of -41 Epidemiologist positions, more than half (54.7%) the positions budgeted for those titles, as well as the elimination of seven of the department’s 10 Infection Prevention Specialist positions.
• A net reduction of -43 Public Health Administrator positions, -41.3% of the positions budgeted for those titles
• A net reduction of -36 project manager, coordinator, and administrator positions, -40% of the positions budgeted for those titles

Appropriations

CDPH is 27% locally-funded in this year’s budget proposal, up from the previous year’s 13.3% as grant funds continue to expire. 

Despite substantial declines, the Federal Grant fund remains the primary source of CDPH appropriations in 2026, representing 46.4% of the department’s appropriations. The corporate fund is the next-largest source at 18.2% of departmental appropriations. 

Fund	2025 Budgeted	2026 Proposed	Net Change from 2025	Percent Change from 2025	Percent of 2026 Recommended Funds
Federal Grant Fund	$252,037,072	$146,090,000	-$105,947,072	-42.0%	46.4%
Corporate Fund	$75,532,392	$57,413,178	-$18,119,214	-24.0%	18.2%
COVID-19 Grant Fund	$245,798,000	$44,798,000	-$201,000,000	-81.8%	14.2%
Coronavirus Local Fiscal Recovery Fund	$68,250,000	$16,137,000	-$52,113,000	-76.4%	5.1%
Community Safety Fund	$0	$14,526,625	$14,526,625	New Fund	4.6%
Entitlement Fund	$0	$13,467,000	$13,467,000	New Fund	4.3%
Opioid Settlement Fund	$13,471,733	$11,276,348	-$2,195,385	-16.3%	3.6%
State Grant Fund	$16,841,812	$7,607,000	-$9,234,812	-54.8%	2.4%
Vaping Settlement Fund	$1,919,276	$1,734,086	-$185,190	-9.6%	0.6%
Grants Management Fund	$0	$1,640,000	$1,640,000	New Fund	0.5%
Local Public and Private Grant Fund	$1,800,000	$150,000	-$1,650,000	-91.7%	0.0%
Construction and Demolition Debris Management Fund	$524,070	$30,980	-$493,090	-94.1%	0.0%
Community Development Block Grant Year LI	$13,467,000	$0	-$13,467,000	-100.0%	0.0%

Largest Appropriations

CDPH’s largest appropriations category, despite declines, is once again the Reserve Balance category, used for grant funds that the department does not plan to expend during the budget year. 

Setting aside that reserve, salaries and wages are the largest single-category appropriation, very nearly matched by pass-through spending to delegate agencies. Outside contracting under the professional and technical services category is the next-largest CDPH appropriation. 

In 2024, the most recent complete budget year for which local fund actuals and encumbrances data is available, CDPH spent only 70.9% of its locally-funded budget, with substantial underspend in the contracting, personnel services, and violence reduction program categories. (However, local funds for which actuals and encumbrances are available made up only 13.3% of CPDH’s budgeted appropriations in 2024.)

Change from Previous Year

Reserve balance funds held over until the next year remained the health department’s largest appropriation category despite a -$304.6 million (-78.6%) decline. 

The department also saw a $23 million (-25%) decline in salaries and wages on payroll, reflected in its dramatically reduced headcount. 

Despite the decline in budgeted positions and salaries, the Salary Provision appropriation category is up $7.5 million, a 359.8% increase, driven by appropriations from the Coronavirus Local Fiscal Recovery Fund ($4.4 million) and the Federal Grant Fund ($5.1 million). According to the Grant Details supplement, the entire $4.4 million salary provision appropriation from the Coronavirus Local Fiscal Recovery Fund comes from ARPA, while multiple grants from the Federal Grant Fund include salary provision appropriations, primarily CDC grants as well as $1.2 million from a U.S. Department of Health & Human Services grant for the national bioterrorism hospital preparedness program.

Pass-through spending to delegate agencies and outside contracting under the professional and technical services appropriation are both down in this year’s CPDH budget proposal as well, although not as dramatically as salaries or headcount, -$11.5 million (-14.4%) in the delegate agencies category and -$7 million (-15.4%) in contracting.