Study Identifies Need for Greater Investments in the Public Health Workforce

January 26, 2023

Recent investment in the public health workforce has been directly related to the COVID-19 pandemic, but whether that investment can be sustained is not clear, according to a new report, 
“The State of the U.S. Public Health Workforce: Ongoing Challenges and Future Directions.” Heather Krasna, PhD, adjunct assistant professor, health policy and management, and associate dean, career services at Columbia University Mailman School of Public Health, is a co-author of the study published in the Annual Review of Public Health.

Improving community health in a sustainable way—and making good use of the Centers for Disease Control and Prevention’s recent $3.2 billion investment in the public health workforce—will depend on the ability of health departments have to attract, train, and retain employees, the report finds.

“The public health workforce, specifically in our local, state, Tribal and territorial health departments, is the backbone of our public health system. This workforce lost 40,000 positions in the 2009 recession, most of which did not return,” said Krasna, who is co-author of 101+ Careers in Public Health, 3rd Edition, and author of Jobs That Matter: Find a Stable, Fulfilling Career in Public Service. “While there is some new investment in the workforce, it is temporary; and many of the underlying challenges with recruitment and retention have not been addressed. We must look at what has worked to build the workforce, and what remains to be addressed, in order for our communities to have the public health services they need to stay healthy.”

The current report synthesizes the evidence regarding major challenges that preceded the pandemic and remain now, including the lack of the field’s ability to define the governmental public health workforce as well as challenges with the recruitment and retention of public health workers. 

According to the key findings:

• Recruitment, diversity, and retention are key challenges in building the public health workforce. 
• The COVID-19 pandemic has taken a toll on the workforce, with high reported rates of burnout and symptoms of PTSD among public health employees. 
• The number of people enrolling in public health degree programs is rising, but relatively few graduates choose government public health employment, opting instead for private sector jobs. 
• Tracking the composition and the total number of people in the public health workforce remains a challenge because the federal government lacks a system for cataloging public health staff at the state , local, and Tribal government levels.  

To alleviate workforce shortages, the authors identify the following strategies that policymakers can adopt:

• Take proactive steps to increase the diversity of the workforce 
• Offer loan repayment programs for public health graduates 
• Make reforms to the government hiring process 
• Increase protections for public health workers 
• Ensure adequate, sustainable funding for the public health workforce

The authors make the point that while attention to the issue of the diversity of the workforce to date should be celebrated, next comes the important work of ensuring diversity among students in public health programs and supporting these trainees within all sectors and at all levels. “However, some of the challenges that governmental public health hiring managers face are well outside their sphere of control and will require broader reforms in public-sector hiring practices,” observes Krasna.

“Now is the time to invest in our public health workforce, not just through hiring new employees to meet immediate needs, but also retaining experienced employees to provide stability and to maintain and grow health departments’ collective knowledge,” said Brian C. Castrucci, DrPH, president and CEO of the de Beaumont Foundation, which focuses on public health workforce issues. 

In addition to Krasna from Columbia Mailman School of Public Health, the study was conducted by co-authors from the University of Minnesota School of Public Health, Indiana University, Fairbanks School of Public Health, the de Beaumont Foundation, and the Johns Hopkins Bloomberg School of Public Health. 

The report was supported by de Beaumont Foundation. (Read a press release by the de Beaumont Foundation here.