New Data on State Health Agencies Shows Shrinking Workforce and Decreased Funding Leading Up to the COVID-19 Pandemic

September 24, 2020

ARLINGTON, VA—The Association of State and Territorial Health Officials (ASTHO) today released data from the ASTHO Profile of State and Territorial Public Health (Profile), the only source of comprehensive information on trends in state and territorial public health agency resources and infrastructure as well as the magnitude of work overseen by the public health workforce across all states, the District of Columbia, and the U.S. territories and Freely Associated States.

This year, data are presented in the Profile Dashboard—a set of interactive and customizable data visualizations that present data from the 2012, 2016, and 2019 surveys. The Dashboard allows for users to view national and agency-level data and explore trends over time. Monitoring changes in public health agency activities and resources over time is critical to understanding system capacity and supporting the state and territorial public health infrastructure.

“As public health has faced the unprecedented task of addressing the COVID-19 pandemic, our Profile provides important insight into the challenges states have experienced in their initial responses, including a shrinking public health workforce, decreased funding, and changes in the provision of services offered by state health agencies,” says Michael Fraser, ASTHO’s chief executive officer. “These data demonstrate the need for continued resources to support core public health work and to respond to this pandemic. As a nation, we have to commit to enhancing our public health capacity for the future, not continuing on a dangerous glide-path of decreases. We can be better prepared for the next pandemic by investing in our state and territorial public health workforce, our information technology systems, our laboratory infrastructure, and other programs that promote and protect the health of everyone in America.”

Key Findings:

  • The size of the public health workforce has been decreasing.

    In 2019, there were 91,540 full-time equivalents (FTE) working in state health agencies, down from 101,619 FTEs in 2012—a loss of almost 10%. Although certain categories of the workforce expanded over this period, numbers of clinical and preparedness professionals decreased or remained stagnant between 2012 and 2019 just as the COVID-19 pandemic fueled demands to expand public health emergency preparedness and response efforts.
  • Funding for public health agencies has declined.

    Between fiscal years 2010 and 2018, overall expenditures by public health agencies declined by 10.3% as funding levels from both federal (from $14,309.1M to $12,222.7M) and state (from $8,854.4M to $6,850.9M) sources fell. This downward trend may not have provided the necessary funding and stability to support routine public health activities alongside planning for public health crises.
  • Public health agencies have maintained core services despite shifting resources.

    In the face of these impacts to resources for preparedness and response, state and territorial health agencies maintained their capacity to conduct activities crucial to fighting COVID-19, such as infectious disease surveillance (performed by 97% of state and territorial agencies since 2016).

The Profile was supported by the Centers for Disease Control and Prevention and the Robert Wood Johnson Foundation. More in-depth information on Profile results can be found on the Dashboard, as well as in data briefs on public health agency activities, financial resources, and workforce at


ASTHO is the national nonprofit organization representing the public health agencies of the United States, the U.S. territories and freely associated states, and Washington, D.C., as well as the more than 100,000 public health professionals these agencies employ. ASTHO members, the chief health officials of these jurisdictions, are dedicated to formulating and influencing sound public health policy and to ensuring excellence in public health practice.