Based on survey data, the future of public health is looking pretty grim.
According to a March 2023 study in Health Affairs, local health departments could lose more than half their workforce by 2025. What's worse, after a 17% decline prior to the Covid pandemic, health departments already fall 80,000 workers short of the staffing levels needed to provide basic services, according to the de Beaumont Foundation.
As someone who's worked 20+ years in public health strategy and organizational capacity, I've never seen such high levels of anxiety in health departments of all sizes. I'll have much more to say about the workforce crisis in coming weeks, but first, I wanted some additional perspective on that Health Affairs study.
The study was co-authored by two experts at the de Beaumont Foundation: Rachel Hare Bork, Director of Research and Impact, and Moriah Robins, Senior Research Associate. They graciously agreed to answer five questions via email.
Ascendient: This study was full of alarm bells for anyone who cares about public health. As a researcher, what jumped out as the biggest surprises or concerns?
de Beaumont: The biggest concern is that if trends continue, by 2025 we could lose 130,000 of those working at health departments across the country today. This loss would be on top of the 80,000 employees that are already needed to fulfill basic public health services that each community needs to thrive.
This loss represents not just a loss of people, but also a loss of experience and institutional knowledge that was integral in responding to the COVID-19 pandemic and would be integral in responding to future public health challenges and crises.
Ascendient: Are pandemic-era patterns predictive of more "normal" times? For instance, among younger and/or less experienced workers, actual separations were much higher than planned separations (74% actual vs 43% planned for those 35 and under). Would you expect some stabilization moving forward?
de Beaumont: Intent to leave has historically been a good predictor of those who actually leave, but that predictive power can be affected by outside stressors, such as the pandemic. Among younger workers and less experienced workers, we saw that the proportion who left was much higher than the proportion who intended to leave. Additionally, among those age 65+ and those with more than 20 years of experience, the proportion who left is much lower than the proportion who intended to leave.
This suggests two things as we move forward: first, compared to the tumultuous 2017-2021 period, we will likely see some stabilization among younger and/or less experienced workers, with rates moving closer to their stated intent to leave; and second, we will likely see larger numbers of older and/or more experienced workers leave the workforce, with rates moving closer to their stated intent to leave.
Ascendient: You proposed some smart policy recommendations, but they'll likely take years to come to fruition. In the meantime, are you seeing any efforts to reorganize departments and/or leverage technology to improve efficiency with reduced staffing levels?
de Beaumont: The CDC Public Health Infrastructure Grant allots $3.1 billion to state and territorial jurisdictions to improve recruitment, retention, and overall public health infrastructure in public health departments; and $145 million to national organizations to provide communications and evaluation support as well as technical assistance. This funding provides health departments with much needed funding to invest in recruitment, hiring, and retention practices across governmental public health, as well as other pertinent workforce development strategies, over a five-year period.
We see from WINS that having the appropriate training to leverage technology is one area where staff need support. In the survey, nearly half of respondents (44%) disagreed or strongly disagreed with the statement, “Employees have sufficient training to fully utilize technology needed for their work.”
Looking for a smart way to leverage hiring? See our blog post on the need for administrative support.
Ascendient: What about partnerships? Are you seeing collaboration between health departments and other community partners (hospitals, social services, non-profits) to address these concerns and/or share staff?
de Beaumont: Partnerships between public health and other sectors are challenging, but have so much promise and are a real opportunity. Foundational research conducted by the de Beaumont Foundation and the Aspen Institute Health, Medicine and Society Program showed that other sectors, including Housing, Education, Health Systems, and Business, view health as different from public health, and they see public health professionals as book smart and lacking the necessary skills to meaningfully contribute to other sectors’ work. Preconceived notions like these, on all sides, create challenges for forming partnerships.
We are trying to bridge this gap through multi-sector programs like IMPACT in Public Health, which brings together businesses and governmental public health departments to support a shared vision of health, equity, and prosperity; and MADE for Health Justice, which supports non-profit organizations in creating local data ecosystems that connect data across sectors of local government, prioritize the needs and voices of communities oppressed by structural racism, and ultimately drive just and equity-centered decision making.
Ascendient: Finally, the PH WINS survey always includes forward-looking "intention" data. Do you see any signs for hope in those numbers?
de Beaumont: Despite all the challenges the governmental public health workforce faces, employees remain committed to their jobs and recognize the value of their work. The data show that 79% of state and local governmental public health employees are satisfied with their jobs and 68% are satisfied with their organizations. Additionally, 94% agree or strongly agree with the statement “the work I do is important,” and 93% are determined to give their best effort at work every day.
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