Public Health Workforce Gaps, Impacts, and Improvement Strategies from COVID-19

Meeting Gaps in the Public Health Workforce During Emergencies: How a Nongovernmental Organization Supported Critical Staffing Needs in the COVID-19 Response

The public health workforce continues to experience staff shortages, which hampered the ability of US state, tribal, local, and territorial health departments to respond to the COVID-19 pandemic. In April 2020, the US Centers for Disease Control and Prevention (CDC) awarded $45 million to the CDC Foundation to provide field assignees to support these health departments. To expand these efforts, the CDC provided an additional $20 million in May 2021 for vaccination efforts and $200 million in June 2021 to support COVID-19 response and general infrastructure support. The CDC Foundation worked with jurisdictions across the United States to develop job descriptions based on need and recruit nationally for positions. This expanded project, called the Workforce/Vaccine Initiative, hired 3,014 staff in 91 jurisdictions, with 2,310 (77%) hired by January 2022. Most assignments were fully remote (55%) or hybrid (28%). The largest number of staff (n=720) supported COVID-19 response work in schools. Other common functions included contact tracing/case investigation (n=456), program coordination (n=330), epidemiology (n=297), data and surveillance (n=283), and administrative support (n=220). To advance health equity and improve response efforts, 79 health equity staff were assigned to 30 jurisdictions. To support the needs of tribes, 76 field staff supported 22 tribal entities. This project demonstrated the important role of a flexible, centralized approach to rapid placement of staff in public health departments during an emergency response. While the goal of the Workforce/Vaccine Initiative was to meet short-term staffing needs, lessons learned could provide insights for building a sustainable and scalable public health workforce.

Minnesota Public Health Corps: A New Model For Building The Governmental Public Health Workforce

Governmental public health agencies in the US are understaffed, and ongoing shortages will have a detrimental effect on their ability to provide basic public health services and protections. Public Health AmeriCorps was established in 2022 to support efforts to create a stronger and more diverse public health workforce nationwide. The Minnesota Public Health Corps, one of the largest Public Health AmeriCorps models, is a capacity-building program that places AmeriCorps members directly into governmental public health settings across the state. We used data from the first year of the Minnesota Public Health Corps (2022-23) to describe the experiences of thirty-five sites participating in the program. We also examined preliminary findings about how it shaped AmeriCorps members' skills and prospects related to career development in public health. Corps members were younger and more diverse than the current public health workforce in Minnesota, and the majority said that they intended to pursue a public health career. Host sites reported improved capacity to deliver public health services and indicated that corps members helped them reach new populations. Our evaluation demonstrates that this statewide program may be a scalable model to address parts of the acute capacity gaps at public health agencies, as well as long-term efforts to revitalize the workforce.

When Money Is Not Enough: Reimagining Public Health Requires Systematic Solutions To Hiring Barriers

Public health departments in the US have experienced workforce shortages and challenges in recruiting new employees for decades. Reimagining the public health system will require sufficiently staffed health departments. This Commentary summarizes what is known about the issues that state and local health departments face during the hiring process, with a focus on civil service and merit-based hiring barriers. Although health departments have recently received funding to recruit new employees, they still struggle to hire them. Recommendations for change include tracking hiring process metrics; implementing formal quality improvement to strategically resolve delays; developing formal pathways for converting fellows, interns, and contractors into staff positions; and initiating workarounds in the short term and legal changes to hiring rules as necessary and feasible.

Public Health Nurses' Proficiencies and Training Needs in an Emergency Response: A Cross-Sectional Observational Study

OBJECTIVE

To address gaps in understanding the public health nursing workforce regarding competencies recognized as critical during an emergency response.

DESIGN, SETTING, AND PARTICIPANTS

A cross-sectional observational study using data with information on local health department staff- and organizational-level characteristics collected from across the United States in 2021. We used logistic regression to estimate the association between 2 binary nurse-specific predictors-(1) whether the staff person was a nurse and (2) whether the staff worked in a local health department that was "nurse-led" (directed by a nurse)-and reported proficiencies important to the COVID-19 response. Models controlled for relevant local health department and community characteristics.

RESULTS

In the sample, 19% were nurses and 37% were at nurse-led health departments. Nurse versus nonnurse staff had higher odds of reporting proficiencies in skills related to Justice, Equity, Diversity, and Inclusion and in the skill "identifying/applying evidence-based approaches to address public health issues." However, nurses, compared with their nonnurse peers, had higher odds of reporting training needs in domains related to community engagement, policy engagement, and cross-sectoral collaboration. Conversely, staff at nurse-led health departments, compared with non-nurse-led staff, had higher odds of reporting proficiencies in many of these same areas, including "collaborating across the public health system" and "influencing policies external to the organization that affect community health." There were no areas in which nurse-led staff had lower odds of reporting proficiencies or higher odds of identifying training needs.

CONCLUSIONS

Findings from this study highlight areas of strength for public health nurses, particularly strengths related to diversity, equity, and inclusion, as well as areas where more training is needed. Such findings can help guide future public health nurse workforce development as well as underscore the value of public health nursing leadership and staff at local health departments for supporting community health.

Estimating the Cost of the COVID-19 Response for Local Health Departments: Evidence From Ohio

This study assessed the staffing allocations and associated costs incurred by Ohio local health departments (LHDs) in response to the challenges posed by the COVID-19 pandemic. Data were extracted from the annual financial reports of Ohio LHDs for 2020 and 2021, encompassing a sample of 38 LHDs in 2020 and 60 LHDs in 2021. Descriptive analysis showed that Ohio LHDs committed substantial resources to responding to the COVID-19 pandemic. Although there was considerable variability across LHDs, median staffing and compensation collectively constituted 22% of total staffing and compensation. Multivariate regression analysis found minimal associations between the examined agency and community-level variables and the differences in staffing allocations and associated costs incurred by LHDs in response to the COVID-19 pandemic. After decades of underfunding and understaffing, securing sustainable funding will be crucial to equip LHDs across the country with the necessary resources to deliver comprehensive public health services in their communities.

Salary Disparities in Public Health Occupations: Analysis of Federal Data, 2021‒2022

Objectives. To assess salary differences between workers within key public health occupations in local or state government and workers in the same occupations in the private sector. Methods. We used the US Department of Labor's Occupational Employment and Wage Survey (OEWS). Referencing previous studies matching Standard Occupational Classification (SOC) codes with health department occupations, we selected 44 SOC codes. We contrasted median salaries in OEWS for workers in each occupation within state or local government with workers in the same occupations outside government. Results. Thirty of 44 occupations paid at least 5% less in government than the private sector, with 10 occupations, primarily in management, computer, and scientific or research occupations paying between 20% and 46.9% less in government. Inspection and compliance roles, technicians, and certain clinicians had disparities of 10% to 19%. Six occupations, primarily in social work or counseling, paid 24% to 38.7% more in government. Conclusions. To develop a sustainable public health workforce, health departments must consider adjusting their salaries if possible, market their strong benefits or public service mission, or use creative recruitment incentives such as student loan repayment programs for hard-to-fill roles. (Am J Public Health. 2024;114(3):329-339. https://doi.org/10.2105/AJPH.2023.307512).

Analysis of the Doctor of Public Health (DrPH) training and identity needs in the United States: a qualitative study

BACKGROUND

The Doctor of Public Health (DrPH) is the highest attainable degree in the field of public health, specifically designed to prepare professionals to address complex public health challenges in practical settings. This study was designed to explore the importance of achieving a shared and uniform understanding of DrPH education, assess the optimal direction for DrPH training, and investigate the specific curriculum requirements by gathering insights from current DrPH students and alumni in the United States.

METHODS

A total of 13 focus group discussions and two in-depth interviews (total participants: 50) were conducted through Zoom to see how DrPH students and alumni assessed their DrPH educational programs.

RESULTS

Three overarching findings emerged from the analysis of focus group discussions and in-depth interviews. First, participants expressed a preference against a national DrPH board examination, but advocated for a standardized common core curriculum that extends across the entire nation. Second, the ideal direction for DrPH training was perceived to involve a practice-based approach, emphasizing the importance of multi-, inter-, and trans-disciplinary instruction delivered by faculty with practical experience. Last, there was a demand for a DrPH-specific unique curriculum encompassing areas such as mixed method analysis, leadership and management, applied communication, crisis and change management, proficiency in addressing contemporary topics, and tailored applied and integrative learning requirements specific to the DrPH program.

CONCLUSIONS

We explored a range of DrPH training and identity needs among 50 participants, comprised of students and alumni who directly benefit from DrPH education. By considering these inputs, individuals from institutions that offer the DrPH degree can further enhance the quality of public health practice training and make significant contributions to the overall advancement of the field of public health.

Staffing Local Health Departments in Minnesota-Needs, Priorities, and Concerns

CONTEXT

The roles and responsibilities of local health departments (LHDs), as well as the hiring challenges they face, have changed since the pandemic started.

OBJECTIVES

To explore (1) staffing needs and priorities of LHDs in Minnesota, and (2) financial and community-level factors impeding health departments from maintaining optimal staffing.

DESIGN, SETTING, AND PARTICIPANTS

A cross-sectional online survey was administered via Qualtrics in July 2022 to city and county health departments in Minnesota (97% participation rate). It included both open- and close-ended questions concerning staffing needs and priorities of LHDs and challenges to hiring after the pandemic started.

RESULTS

Staffing priorities of LHDs included public health nurses, community health workers, and health planners/researchers/analysts. Hiring concerns included creating new permanent positions, offering competitive salaries, and filling open positions. Inadequate funds made it difficult to create new permanent positions and offer competitive salaries. External factors such as lack of affordable or reliable childcare, housing, and transportation also contributed to hiring challenges.

CONCLUSIONS

There is a need to increase staffing levels of the Minnesota public health enterprise by filling vacant positions and creating new positions. Increasing the public health workforce requires adequate sustainable funding along with creative solutions.