State and Territorial Policies to Strengthen the Public Health and Healthcare Workforce

March 24, 2023 | Maggie Davis

hpu-office-workers-line-reading-docs.jpgChronic underfunding of public health prior to the pandemic resulted in insufficient staffing levels to maintain foundational public health services such as preventing and managing communicable disease outbreaks, ensuring food safety, and linking communities with clinical care. A 2021 study estimates that health departments needed to hire 80,000 additional staff to provide these foundational public health services.

Government public health agencies lost nearly half of all employees between 2017 and 2021, a figure that rises to approximately 75% of employees under age 35 with less than five years at the agency citing low pay, limited career advancement opportunities, work overload, and burnout. If the current attrition rate of public health professionals continues, state health agencies nationwide could more than half of the current workforce, draining these agencies of critical institutional knowledge and experience.

Three years into the COVID-19 pandemic, the courageous and beleaguered public health workforce continues to face staffing shortages, high turnover, burnout, and job-related stress. And in that time, a new stressor has also emerged—pandemic-related workplace violence.

In November 2022, CDC awarded $3.2 billion in grant funding over five years to 107 public health departments, including all 50 states, five territories, three freely associated states, and Washington, D.C. to support workforce recruitment, retention, and strengthen foundational public health capabilities. Accompanying the infusion of federal funding, states are considering several policy changes to strengthen the public health workforce and address challenges within the health care workforce.

Investing in the Government Public Health Workforce

Several state legislatures are considering ways to improve workforce recruitment, retention, and well-being for public health and other governmental agencies. The Maryland House passed HB 214 in February 2023, which would establish a public health commission to assess the state’s foundational public health capabilities and provide workforce recommendations.

Oregon’s legislature is considering HB 2773, which would enable the Oregon Health Authority to incentivize increasing recruitment and retention of diverse local public health professionals that reflect the communities they serve. These efforts include developing training programs for people interested in public health, providing support such as student loan forgiveness or repayment assistance, childcare subsidies for workers, retention bonuses and more. The Oregon Coalition of Local Health Officials submitted testimony in support of HB 2773, asserting that the bill’s $47 million investment will “ensure workers are adequately trained, departments are appropriately staffed, and will support sustainable growth for Oregon’s health and resilient communities.”

Workforce recruitment and retention challenges persist across many government agencies, with some states considering measures to generally support public service careers. Hawaii’s Senate recently passed SB 1569, which would establish a state workgroup to evaluate the feasibility of using telework to address long-term vacancies and applicability of allowing telework across departments. In February, the New Mexico House passed HJM 1, which would commission a governmentwide study of employee classification and compensation for the state government to remain a competitive employer.

Supporting the Broader Healthcare Workforce

Enabling equitable access to healthcare services is an essential public health service, with public health leaders often advocating for strengthening the healthcare system. Like public health, the healthcare system is experiencing significant challenges in recruiting and retaining qualified workers. Several state legislatures are considering ways to better support the healthcare workforce and address shortages of professionals in their communities.

One strategy many states have implemented is joining interstate licensing compacts that allow healthcare professionals licensed in one jurisdiction to practice in other jurisdictions participating in the compact. Many states are joining compacts for physicians, behavioral health, nurses, physical therapists, and more. In February 2023, Wyoming became the most recent state to join the Psychology Interjurisdictional Compact (SF 26) and Licensed Professional Counselor Compact (SF 10).

Another strategy is investing in education programs for healthcare professionals. Washington State’s Senate passed SB 5582 in March 2023, which would create new nursing training programs, including online curriculum and pathways, in community and technical colleges in the state. The proposal would also allow nursing students to participate in simulated learning environments to account for up to 50 required clinical hours.

New Jersey’s Assembly passed A 4615 in February 2023, which would direct the Commissioner of Human Services to amend the state Medicaid plan helping create additional medical residency spaces focused on behavioral healthcare. In 2022, Mississippi enacted HB 1006, dedicating funds from the American Rescue Plan Act creating the Accelerate Mississippi Workforce Development Program to provide education and training in nursing and healthcare related fields.

Several states have taken steps to more holistically assess their healthcare workforce. For example, as part of its annual budget, Virginia policymakers directed the Virginia Health Care Workforce Development Authority to conduct a study of primary care, behavioral, and nursing health care workforce issues. The workgroup’s initial report, published in January 2023, called for increased funding to train new physicians, reconsidering payment as incentives, and to consider expanding the scope of practices for various professions.

ASTHO’s Ongoing Support for the Public Health Workforce

In addition to monitoring policy updates that will support the public health workforce, ASTHO continues to directly support its members and public health professionals. CDC’s historic public health infrastructure grant funding, awarded in November 2022, included awards to ASTHO, National Network of Public Health Institutes, and Public Health Accreditation Board to support state, local, and territorial health departments’ workforce development, infrastructure, and data modernization needs.

ASTHO’s Public Health – Hope, Equity, Resilience, and Opportunity (PH-HERO) initiative, supports state and territorial public health agencies in addressing workforce burnout, moral injury, and aiding overall retention and recruitment. As part of this program, ASTHO has launched the PH-HERO Workforce Resource Center, which provides a curated collection of resources to support, connect, protect, and grow the well-being of the public health workforce.