When the COVID-19 pandemic began in March of 2020, America’s public health workforce was in the midst of a years-long decline in staffing levels that left the country painfully unprepared to address this new public health crisis. New research from the U of M School of Public Health (SPH), the de Beaumont Foundation, and the Public Health Accreditation Board shows that the number of people working in our nation’s public health sector is woefully inadequate to meet our basic public health needs.

Previous research highlighted a substantial need for new workers – at least 80,000 more full time equivalent (FTE) employees at the state and local level. In a new paper published in the Journal of Public Health Management and Practice, researchers further show:

• The size of the nation’s public health workforce in state and local public health departments prior to the COVID-19 surge.
• The level of staffing needed to fully implement a bare minimum package of public health services (known as the Foundational Public Health Services).
• The gap in staffing levels that currently exists between the two. 

The researchers provide peer-reviewed evidence that to meet a minimum level of public health needs, local and state health departments across the country need to hire 80% more FTEs over pre-pandemic levels. Local health departments across the country require approximately 54,000 more FTEs to deliver baseline public health services at pre-COVID-19 levels, while state health agency central offices need approximately 26,000 more FTEs.

With the exception of the pandemic, public health staffing levels have been declining for many years. In the decade following the Great Recession, state and local public health funding reductions had forced agencies to reduce staffing levels by 15% to 20% nationally – a loss of approximately 40,000 full-time staff members.

“Despite the temporary increases we saw in response to the COVID-19 pandemic, the overall trend remains dire,” said JP Leider, Director of the Center for Public Health Systems at the University of Minnesota School of Public Health and lead author of the study. “Transitioning a COVID-related surge in staffing to a permanent workforce requires substantial and sustained investment from federal and state governments to deliver even the bare minimum of public health services.”

As the United States moves into a COVID-19 recovery period, the researchers examine what a post–COVID-19 governmental public health system ought to look like and what resources are needed to make that happen. To achieve an increase of 80,000 employees in the public health workforce, the researchers point to two important policy considerations: How to recruit and fill this workforce shortage, and how to pay for it. 

• Recruiting and sustaining a fully staffed public health workforce may entail greater collaboration between public health educators and practitioners, which could include working with public health schools to promote a pipeline of graduates into public health practice. 
• Public health funding is often categorically limited through block grants or other restrictive funding streams. There is a need to develop a sustainable long-term funding model for the public health workforce.

The Staffing Up team also supported the creation of the Staffing Up Workforce Calculator, which was released this month. It is a tool that allows individual health departments to create planning estimates for how many FTEs are needed to deliver the Foundational Public Health Services. 

The paper was co-authored by: J. Mac McCullough, School of Public and Population Health, Boise State University; Simone Rauscher Singh, Department of Health Management and Policy, University of Michigan School of Public Health; Annie Sieger, Sieger Consulting; Moriah Robins, de Beaumont Foundation; Brian C. Castrucci, de Beaumont Foundation; Jessica Solomon Fisher, Public Health Accreditation Board; and Paul Kuehnert, Public Health Accreditation Board. 

The research was supported by the de Beaumont Foundation.