The Impending Shortage in the State and Local Public Health Workforce


The State and Local Public Health Workforce: The Numbers

  • There are more than 500,000 individuals in the public health workforce, about two-thirds of whom work for state and local governments.
  • Nearly 300,000 of the more than 16 million people who work for state and local governments work for local or state health departments. The exact size of the public health workforce is often underestimated because government employees, including first responders such as firefighters and police, and housing and water authorities, also deliver public health services.
  • A majority of the public health workforce has specialized education or training.

A Workforce in Crisis

  • 45 to 50 percent of public health employees will become eligible to retire in the next five
    years.  This wave of retirements comes just as public health departments are assuming greater responsibility for threats such as pandemic influenza, bioterrorism, and drug resistant strains of common
  • Many governments are facing vacancy rates of up to 20 percent and turnover rates of about 14
    percent due to retirement, attrition, and expanded responsibilities.
  • The number of individuals ready to fill these vacancies continues to shrink. More capacity to
    train public health workers is needed.

The Public’s Opinion

  • Though one in three people (36 percent) believes the primary responsibility for responding to
    public health emergencies lies with the federal government, the fact is that state and local health departments are, and will continue to be,
    the first line of response and the primary source of public health services for the vast majority of Americans.
  • A recent survey showed that a majority of people would be interested in a state or local government
    job (56 and 58 percent, respectively) and many would like to work in public health. However, many say that applying for state and local
    government jobs is too complicated.

Hardest Hit Professions

Public health nurses

  • The largest group of public health professionals — about a quarter of the local health department
    (LHD) workforce.
  • 59 percent of LHDs anticipate having problems hiring qualified nurses in 2008.


  • Increasingly important profession with the reemergence and proliferation of infectious
    diseases such as tuberculosis and drug resistant staph, as well as concerns over bioterrorism.
  • State health departments say they need nearly 1,200 new epidemiologists, a 47 percent increase, to
    meet increasing demand.
  • Of the LHDs that employ epidemiologists, 38 percent anticipate having difficulties hiring
    qualified candidates in 2008.

Environmental health

  • The second largest segment (10 percent) of the public health workforce.
  • These professionals monitor air and water quality, help control the use of toxic substances such as
    pesticides, inspect restaurants, and enforce housing and land use codes.
  • In 2008, 39 percent of LHDs anticipate having problems hiring qualified environmental health

Why are there shortages in these professions?

  • Attrition and retirement.
  • The proliferation of infectious diseases and other new public health issues have increased demand for epidemiologists and IT experts.

The barriers to hiring qualified candidates

  • Lack of competitive pay and benefits
  • Budgetary restrictions
  • Geographic desirability.


  • The Public Health Preparedness Workforce Development Act (S. 1882), sponsored by Senator Chuck Hagel (R-NE) and Richard Durbin (D-IL), would establish loan repayment and grant programs for those pursuing degrees or training in public health preparedness or bio-defense. Such programs have helped build the public health workforce in prior generations, and have proven effective more recently for recruiting doctors and dentists to underserved areas. The Act is viewed as a first step toward more ambitious loan repayment and grant programs for a wider variety of public health workers.
  • Training for various public health professionals under Title VII of the Public Health Services Act is effective, but is limited due to reductions in federal funding. Increased support for Title VII programs is needed to support an adequately prepared public health workforce.
  • Increasing the visibility of public health workers in the community and providing more competitive salaries and benefits help attract people to state and local health public health careers.
  • Most graduates of the 36 U.S. accredited schools of public health do not initially work in government health agencies. Better coordination between schools of public health and health departments can ensure that effective training is available.
  • Innovative human resources practices, such as flexible work hours and telecommuting, can help attract and retain personnel in certain positions.
  • Recruiting diverse populations, including African Americans and Latinos, to public health careers may help address health disparities in the population. Underrepresented groups comprise about 25 percent of the U.S. population, yet they account for only 10 percent of the public health workforce.
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