Public Health's Looming Workforce Crisis

There is a storm on the horizon headed this way.

Experts in public health education warn of a looming workforce crisis with shortages already apparent in the highly trained personnel needed to meet today’s global health challenges. Meanwhile, an estimated 80 percent of America’s public health workforce lacks formal training.

“If you look at the H1N1 flu virus and all the issues that surround the pandemic, it’s hard to imagine people without a grounding in the many aspects of public health training—epidemiology, surveillance, vaccines, even public health finance—being able to effectively manage this crisis,” says Harrison Spencer, MD, MPH, CPH, president and CEO of the Association of Schools of Public Health (ASPH). “When the people on the front lines have no theoretical groundwork, there’s a problem here.”
In 2000 there were 50,000 fewer public health employees in the U.S. than there had been 20 years earlier. In many instances public health programs have been cut to help balance state and local budgets. And the success of public health efforts—measured by benchmarks ranging from the creation of safe drinking water systems to the elimination of polio in the Western Hemisphere—resulted in what many see as a dangerous sense of complacency.

After the terrorist attacks of September 11, 2001, the federal government dramatically expanded public health spending, but almost all of it was aimed at bioterrorism preparedness, and much of that money has gone into planning and orchestrating elaborate mock emergency exercises. Yet a 2004 survey by the Association of State and Territorial Health Officials found that more than half the states responding to the survey reported a lack of qualified employees to fill emergency preparedness needs.

According to the Center for State and Local Government Excellence (CSLGE), as many as 45 percent of public health workers are expected to retire within the next five years. Already some states have vacancy rates as high as 20 percent in key public health positions, with, for instance, a reported nationwide shortfall of 1,200 epidemiologists.

But change is in the air. According to the Pew Charitable Trusts’ Government Performance Project, virtually every state has been examining the workforce issue as a key means of ensuring critical public health functions. In the past decade there has been a surge in the creation of new schools of public health. The state of Arkansas, for example, set aside 5 percent of its tobacco settlement funds to create a college of public health to provide training in high-need areas, such as epidemiology. And public health is suddenly a “hot” major at undergraduate schools around the country: At Johns Hopkins University’s Homewood campus, it has become the fastest growing, and very nearly the largest, undergraduate major.

Perhaps not surprisingly, the solution to meeting the public health workforce crisis comes down to money. In a 2006 report “The Public Health Workforce Shortage: Left Unchecked Will We Be Protected?” by the American Public Health Association, author Courtney Perlino, MPP, concludes that “ultimately, there needs to be an increase in federal funding for all of public health, not just those issues capturing headlines today.”

The nonprofit Public Health Foundation estimates that an immediate infusion of approximately $10 billion is needed to shore up the nation’s public health infrastructure. Such an increase would not only help to alleviate workforce shortages; it would also, in the quietly understated language of Perlino’s report, “lead to public health constituting more than three cents for every dollar in the United States spent on health."