U.S. public health work force shortage in need of attention: APHA releases new brief on work force
The public health field has experienced a boom in recent years, thanks to enormous influxes of federal funding and a heightened awareness of its role in emergency preparedness. But despite the new attention, some say policy-makers missed the boat when it came to using the funds to address a fundamental concern: work force shortages.
According to new reports, if public health work force issues are not addressed adequately, the nation will be ill-prepared to face pending threats and health care challenges, ranging from pandemic influenza to natural disasters to the aging of the baby boomer generation. The situation is not hopeless, however, as long as certain policy and legislative initiatives are put in place, according to a new APHA policy brief, “The Public Health Workforce Shortage: Left Unchecked, Will We Be Protected?” which the Association released this month.
“The return on investing in the nation’s public health work force will not only save health care dollars in the long run and get us ready for any kind of emergency, it will translate into healthier families, children and communities,” said Courtney Perlino, MPP, a health policy analyst in APHA’s Center for Public Health Policy and author of the work force policy brief. “But the time to act is now.”
| | Kamille Lekhong, an Arizona public health scientist, conducts lab test for West Nile virus in Phoenix in 2004. Lab technicians are one of the public health fields now facing shortages. Photo by Jeff Topping, courtesy Getty Images |
The work force shortage is not a new concern to the public health landscape: Based on 2003 survey findings, the Association of State and Territorial Health Officials warned that the “most difficult challenge state and local public health agencies face in developing capacity to respond to terrorist events, emerging infectious diseases and other public health threats is assuring a qualified work force is available to carry out these functions.”
The ASTHO survey found that the average age of a public health worker is about 47, public health retirement rates may be as high as 45 percent in the coming years and current vacancy rates are up to 20 percent in some states. Key disciplines within public health that face more acute employment problems include public health nurses, epidemiologists, laboratory technicians and environmental health workers.
The APHA policy brief recommends solutions that target both students of public health as well as those already working in the field. One solution would be the passage of the federal Public Health Preparedness Workforce Development Act, which was introduced last year. The bill, also known as S. 506, would create a scholarship program for students who commit to serving at a federal, state, local or tribal public health agency after graduation. In addition, those who spent three years at an agency would qualify for a loan repayment program. The brief also calls for adequate federal funding for health professions grants managed by the U.S. Health Resources and Services Administration. The grants, which have recently been targeted for funding reductions, have proven effective in recruiting professionals to work in under-served regions and in recruiting under-represented minorities to the health field.
Sustainable and sufficient federal funding for the entire public health arena is key as well, especially when considering the grim budgetary outlook for many states and localities, the brief noted. In strapped financial times, many states have viewed the dramatic increase in federal public health preparedness funds, which began in 2002, as a way to replace state and local public health funding, instead of as a way to supplement and strengthen funding levels. Such funding shifts have actually decreased the number of state and local workers, according to Bernard Turnock, MD, MPH, co-author of a July/August article in Health Affairs on work force challenges.
“The overall net investment in public health is not what it should be had states and localities continued their investments,” said APHA member Turnock, director of the Division of Community Health Science at the University of Illinois-Chicago School of Public Health. “It’s an important (trend) that’s going on under the cover of all the progress that’s been made and its longtime implications are significant.”
According to the Health Affairs article, a steady increase of full-time public health workers had been documented from 1980 through 2003, reaching a peak of 556,000 full-time workers at federal, state and local health agencies in 2003. Increased bioterrorism funding from the federal government hasn’t led to a corresponding increase in the overall number of U.S. public health workers, however. Rather, it has just shifted state and local workers to the federal rolls, the article reported. In 2004, a decrease of about 6,000 state and local workers coincided with new federal bioterrorism funds used to support more than 6,000 public health positions — which led the authors to conclude that states and localities simply shifted existing staff into positions supported through federal grants. The end result was a reduction in public health workers at the state and local levels, but a corresponding increase at the federal level, Turnock said.
| | Cliff Sanchez, right, a public health worker with the Chicago Recovery Alliance, questions an intravenous drug user before administering an HIV test in May. Health workers such as Sanchez play a vital role in meeting community health needs. Photo by Scott Olson, courtesy Getty Images |
“Supplanting state and local resources with new federal bioterrorism sources certainly poses risks,” Turnock told The Nation’s Health. “If bioterrorism funds should start to really decline, we might actually see further reductions as states and localities are unable to kick the numbers back up again. (Federal funding levels) won’t continue forever…priorities do change, so there’s every reason to expect that this won’t always be the priority that it now is.”
Besides funding, efforts should also focus more on the needs of those already working in public health, and not just on potential workers or those in the “pipeline,” the Health Affairs article noted.
“The majority of those composing the public health work force don’t come through schools of public health — a lot of people come in through other routes,” said APHA member Kristine Gebbie, DrPH, RN, co-author of the Health Affairs article with Turnock. “Even if you come in with an MPH, the science changes, interests change. Paying attention to lifelong learning and sustainable work force development programs is as critical as debates about schools of public health.”
Gebbie said making the public as well as policy-makers more aware of the importance of a robust public health system will be a cornerstone of any successful drive to improve funding, development and scholarship programs. Building an effective public health work force can be an expensive endeavor for a local government, she said, so if officials don’t understand its importance, they may question the need for such a large commitment.
“It very much starts at the local level,” said Gebbie, the Elizabeth Standish Gill associate professor of nursing at Columbia University School of Nursing. “It involves developing a broader, citizen-wide level of public health literacy so that the average member of a community understands why they should have a public health system that can protect and support them.”
While both Gebbie and Turnock said the public health work force isn’t on the verge of caving in, they emphasized that new and long-term approaches are needed to continue moving in a positive direction.
“I don’t think that in the long or short run, that we’re going to collapse,” Gebbie said. “But I do think that based on what we know about demographics and shifts in employment, that we’re in for a particularly tight time.”
For a copy of the Health Affairs work force article, visit www.healthaffairs.org . To download APHA’s work force policy brief, visit www.apha.org .
For a related story on public health work force issues that appeared in The Nation's Health September 2006 issue, click below:
http://apha-test-redesign.apha.org/publications/tnh/archives/2006/09-06/National/2858.htm
» Back to Top
|