Public Health Workforce Position Statement

I. Statement

The Association of State and Territorial Health Officials (ASTHO) recognizes that the public health worker shortage, exacerbated by the current economic downturn, threatens the ability of public health departments to respond to major health threats and maintain essential public health responsibilities.

II. Within This Context ASTHO Recommends

States need sustained funding from Congress, federal government agencies and state legislatures to address the public health workforce crisis. To sustain and strengthen the public health workforce, ASTHO supports renewed federal and state investments (fiscally and programmatically) to:

• Prevent the further elimination of public health jobs.
• Enhance the awareness of federal agencies, legislators, policy makers, and the general public of the ramifications of a weakened public health system due to job loss.
• Provide sustained funding to HRSA’s Public Health Workforce Development Program and workforce programs introduced in PAHPA legislation.
• Create CDC funding streams for state and local workforce development.
• Encourage public health professionals, especially minorities, to enter or maintain employment at governmental public health agencies by offering salaries competitive with the private sector; loan repayment programs; scholarships; and internship programs, including opportunities for continuing education and training.
• Enhance and support diversity, so workforces reflect the community they serve.
• Support preparedness efforts by increasing the number of qualified laboratory and health information technology (HIT) workers.
• Recruit HIT workers to focus on key public health needs such as data exchange and system interoperability, and encourage staff to use public health IT training opportunities (i.e. certificate or graduate degree programs) to improve job performance.
• Provide funding to develop systems and training programs through partnerships with schools of public health and community colleges to increase access to formal training opportunities.
• Foster collaboration between academia and public health practice through fellowships, research partnerships, and community outreach.
• Encourage state health agencies to adopt public health professional competencies as recommended by existing public health associations.
• Develop and sustain the workforce necessary to achieve national public health department accreditation.
• Enumerate the governmental public health workforce.
• Track research trends, shortage projections, and best practices related to the public health workforce in a comprehensive national database.
• Expand HRSA’s definition of a healthcare worker to include public health professionals, particularly in non-clinical settings (i.e. dentists, physicians, etc). Public health nursing should also be a separate category of the nursing workforce to ensure inclusion in workforce research and recruitment incentives.
• Strengthen partnerships between public health and clinical practice.

For these reasons, ASTHO and its partners will continue to raise awareness and advocate on behalf of the public health workforce in order to address the public health worker shortage and enable the continued protection of the public’s health.

III. Background

Over 100,000 state workers and 165,000 local workers are responsible for improving the nation’s health and keeping the public secure.¹ The public health workforce encompasses wide-ranging specialties, such as public health physicians, public health nurses, first responders, scientists, social workers, laboratory workers, health educators, dentists, nutritionists, food inspectors, epidemiologists and environmental health workers to name a few. The public health workforce is the first line of prevention for the public when fighting against obesity, chronic diseases (i.e. diabetes, heart disease, and cancer), injuries, mental illness, infectious disease and the first line of defense when protecting the health of the environment, providing surveillance and conducting emergency preparedness. The nation needs a robust, well-trained public health workforce. However it is estimated that we will need 250,000 more public health workers by 2020.²

Historically, public health has been underfunded in comparison to total U.S. healthcare financing.³ The underinvestment in public health is underscored by the recent economic crisis. According to a 2009

ASTHO survey, 11,000 public health jobs will not be filled due to budget shortfalls and hiring freezes. Seventy-one percent of states expected budget cuts in FY09. At least 40% of states expect to lose staff through layoffs or attrition.⁴ To compensate for budget shortfalls states have been furloughing staff, restricting travel, and decreasing or eliminating critical services. These cost reduction measures are applied broadly across the state with no consideration to their impact, resulting in the reduction of critical programs, such as childhood immunization, disease prevention efforts and newborn screening. Health agency budgets are reduced further by the indirect consequences of state legislation. Health agencies loose invaluable revenue generated by indirect costs when states order widespread furloughs. Since 2003 ASTHO has reported on professional shortages affecting public health nurses, epidemiologists, environmental health workers, and laboratory workers- with public health physician shortages becoming a rising concern. Two major factors attributed to the state public heath workforce shortage are budget cuts and a lack of competitive salaries.⁵

Despite capacity challenges the public health workforce has risen to the occasion during various major events, such as the initial onset of the H1N1 pandemic, MRSA outbreaks, and Hurricane Katrina. However, many experts fear that without stable funding and significant investment in programs to attract professionals to governmental public health, an overburdened public health workforce will not be able to maintain and improve health outcomes or adequately handle a scenario involving multiple simultaneous health threats. An example of such an event could be a more virulent H1N1 outbreak coupled with any routine event such as a natural disaster or community outbreak.⁶

States have attempted to address the workforce shortage through strategic workforce planning, “the business process for ensuring that an organization has suitable access to talent to ensure future business success,” and recruitment and retention strategies.⁷  According to the 2007 State Public Heath Workforce Survey report, “nearly 2/3 of state health agencies had instituted workforce planning within the last two years.” States participated in several strategies, such as Web-based recruiting, job fairs and academic partnerships to market state public health careers.⁸

However during times of economic crisis, jobs and workforce development budgets are being cut. States need sustained funding from Congress and federal government agencies to adequately address the public health workforce crisis.

Approval History:

ASTHO position statements relate to specific issues that are time sensitive, narrowly defined, or are a further development or interpretation of ASTHO policy. Statements are developed and reviewed by appropriate policy committees and approved by the ASTHO Board of Directors.

Position statements are not voted on by the full ASTHO membership.

ASTHO Committee Review and Approval:

Performance Policy Committee - Review only on October 13, 2009.

Board of Directors Review and Approval on December 7, 2009.

Position Statement Expires on August 31, 2012.

For further information about this position statement, please contact ASTHO workforce development staff.

Related Documents:

ASTHO General Policy Statement

Performance Policy Statement

Notes

1. ASTHO. “2007 State Public Health Workforce Survey Results.” (2008).
2. ASPH. “ASPH Policy Brief: Confronting the Public Health Workforce Crisis” (Dec. 2008).
3. Draper, D., Hurley, R., and Lauer, J. “Public Health Workforce Shortages Imperil Nation’s Health.” Center for Studying Health System Change, No. 4 (April 2008).
4. ASTHO “Impact of Budget Cuts on State Public Health: Accelerating Job and Program Cuts Threaten the Public’s Health.” (2008).
5. ASTHO. “2007 State Public Health Workforce Survey Results.” (2008).
6. Testimony by Daniel Sosin on Strengthening State and Local Preparedness before the Committee on Oversight and Government Reform, U.S. House of Representatives.
7. Wikipedia definition of workforce planning Accessed on 9/21/09: “http://en.wikipedia.org/wiki/Workforce_planning.”
8. ASTHO. “2007 State Public Health Workforce Survey Results.” (2008), p.12.