Research shows that public health agencies are critically understaffed

In March 2020, America’s public health workforce was in the midst of a years-long decline in staffing levels that left the country painfully unprepared as the World Health Organization declared the COVID-19 outbreak a pandemic. New research from the U of M School of Public Health (SPH), the de Beaumont Foundation and the Council on Public Health Accreditation shows that the number of people working in our nation’s public health sector is woefully insufficient to meet our basic public health needs.

Previous research has highlighted a significant need for new workers – at least 80,000 more full-time employees (FTE) at the state and local levels. In a new paper published in the Journal of Public Health Management and Practice, researchers also show:

  • The size of the nation’s public health workforce in state and local public health departments before the COVID-19 surge.
  • The level of staffing required to fully implement a minimum package of public health services (known as Essential Public Health Services).
  • The difference in staffing levels that currently exists between the two.

Researchers provide peer-reviewed evidence that to meet a minimum level of public health needs, local and state health departments across the country need to hire 80% more FTEs than pre-pandemic levels. Local health departments across the country need an estimated 54,000 more FTEs to provide basic public health services at pre-pandemic levels, while central offices of state health agencies need an estimated 26,000 more FTEs.

Barring the pandemic, public health staffing levels have been declining for many years. In the decade following the Great Recession, cuts in state and local public health funding forced agencies to cut staffing levels by 15% to 20% nationally—a loss of approximately 40,000 full-time employees.

“Despite the temporary increases we’ve seen in response to the COVID-19 pandemic, the overall trend remains dire,” said JP Leider, director of the Center for Public Health Systems at SPH and lead author of the study. “Transitioning the COVID-related surge in staff to a permanent workforce requires significant and sustained investment by federal and state governments to provide even minimal public health services.”

As the U.S. enters a period of recovery from COVID-19, researchers examined what the government’s post-pandemic public health system should look like and what resources are needed to make that happen. To achieve an 80,000-person increase in the public health workforce, the researchers point to two important policy considerations: how to hire and fill that workforce shortage, and how to pay for it.

  • Recruiting and maintaining a fully staffed public health workforce can lead to greater collaboration between public health educators and practitioners, which may include working with schools of public health to foster a pipeline of graduates into public health practice.
  • Public health funding is often severely limited through block grants or other restrictive funding streams. A sustainable long-term funding model for the public health workforce needs to be developed.

The research team also supported the creation of the Workforce Growth Calculator, which was released this month. It is a tool that allows individual health departments to create planning estimates of how many FTEs are needed to deliver essential public health services.

The research was supported by the Fondation de Beaumont.


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