Abstract
OBJECTIVE: The National Association of Chronic Disease Directors (NACDD) is a nonprofit organization that supports state and territorial chronic disease prevention and health promotion efforts through capacity building and technical assistance. Each year, NACDD surveys health department leaders who oversee chronic disease prevention and health promotion work (hereafter, Chronic Disease Directors). In this paper, we report on the 2024 survey outcomes and place those findings into the broader public health policy context. DESIGN: Fifty-one Chronic Disease Directors completed the organizational capacity and development needs survey. Responses were summarized in aggregate and by jurisdiction size. RESULTS: State and territorial chronic disease units have varied responsibilities, but most address diabetes, cardiovascular diseases, and cancer screening and prevention. Chronic Disease Directors reported strong or improving capacity in most practice areas but ranked workforce development lower than other areas. Staffing decreased slightly during 2024 compared with 2023 (median of 1.1 and 1.3 employees per 100 000 jurisdiction population, respectively). Many Chronic Disease Directors expressed ongoing concerns about staff turnover and workforce development, funding limitations and stability, and the effects of the political climate on public health work. Despite these challenges, many respondents also conveyed success stories about program achievements, obtaining new funding, and building partnerships and collaborations. Looking forward to 2025, many Chronic Disease Directors expressed intentions to focus on leadership, policy, and technical training; on making structural and staffing changes within their units; and on continuing to build cross-sector relationships and collaborations. CONCLUSIONS: Continued concerns about staff turnover and workforce development underscore the need to better understand and remove barriers to capacity building in this area to support job satisfaction and employee retention. Changes to federal infrastructure are likely to have substantial impacts and may increase reliance on cross-sector partnerships to continue advancing chronic disease prevention and health promotion.