Contributor: A Crisis in Public Health—Addressing the Exodus From Our Essential Workforce

The COVID-19 pandemic revealed not only vulnerabilities in our health care system but also cracks in the fabric of our public health infrastructure. Although the physical and social toll of the disease is evident in statistics and headlines, an equally alarming trend is emerging: an accelerating exodus of professionals from state and local health departments.

This exodus, precipitated in part by undue criticism, exhaustion, and lack of public understanding, threatens the integrity of our nation’s response to future health crises and the core foundation of daily public health practices. It is imperative that we reinforce the narrative around the critical value of public health and civil service, advocate for their indispensable roles in our society, and take urgent actions to prevent a talent drain that could jeopardize our nation's health.

Perry N. Halkitis, PhD, MS, MPH | Image Credit: Rutgers School of Public Health

Laura Magaña, PhD | Image Credit: Association of Schools and Programs of Public Health

The findings of a study on governmental public health workforce retention in the United States, published in Health Affairs, found that public health professionals are leaving their positions at state and local health departments and other governmental agencies at an astonishing rate. The de Beaumont Foundation–funded study indicated that if separation trends continue, by 2025, as much as half of the governmental public health workforce will have left their positions.

With reports of bullying, threats, and harassment, more than 1 in 4 state and local public health employees are considering leaving the workforce. Exacerbating existing shortages will unduly impact the health of people and populations, particularly those most vulnerable to health disparities. Further, although the $3.2 billion investment in public health, including workforce development, funded by the CDC, is heralded, one-time funds won’t be enough to change the trajectory. Ongoing support from states is needed.

What keeps getting lost from the conversation is that members of the public health workforce are the unsung heroes of the overall health, well-being, and safety of the nation. Often behind the scenes, they are responsible for the health of populations by coordinating life-saving efforts, providing critical risk management, mitigating the spread of infectious disease, and overseeing emergencies and disaster preparation. The public health workforce is uniquely trained to provide communication, conduct outreach, investigate health crises, mobilize communities, create effective health connections and partnerships, deploy resources, and translate procedures, policies, actions, and regulations that if not followed correctly could result in fatal outcomes, eminent danger, or life-long suffering. Imagine the recent health crises without these vital public health workers.

Speaking openly about the falsehood of the attacks on public health and its workers that were created during the last few years, advocating for the importance of public health to all of us, legitimizing the place of public health alongside the clinical health professions, and educating the public about the role of the public health workforce are all necessary steps for the future of public health and the endurance of a robust public health infrastructure.

Our nation’s health depends on having public health experts in these roles—as the recent COVID-19 pandemic and mpox outbreak demonstrated. As the leading voice of academic public health, the Association of Schools and Programs of Public Health (ASPPH) has created a Center for Public Health Workforce Development that focuses on growing a diverse workforce for the future. We know that we can and must do more to guide students and graduates into civil service work in meaningful state and local governmental public health roles.

As ASPPH’s member schools and programs of public health, we advocate addressing recruitment and retention issues for the governmental public health workforce—issues including wage stagnation, student debt burden, and chronic underinvestment in public health infrastructure and civil service. We agree with the authors of the Health Affairs article that the exodus of the governmental public health workforce “has enormous societal impact and speaks directly to the nation’s continued readiness to respond to future pandemics.”

ASPPH-member schools and programs of public health play a vital role in advancing health in their communities. They are collaborating with state and local public health partners on a concerted, multipronged approach to increase the governmental public health workforce The ASPPH Center for Public Health Workforce Development Advisory Committee has identified strategies to address governmental public health workforce shortages:

Invest in federal programs incentivizing public health graduates to serve in governmental public health, such as the Public Health Workforce Loan Repayment Program. Congress recently reauthorized this critical program in the PREVENT Pandemics Act to help governmental public health departments address their multiple workforce challenges, but this program still needs to be funded.Student loan debt is a significant obstacle to students seeking careers. Loan repayment will allow our nation to strengthen the capacity of the public health workforce with the next generation of professionals who have educational training in public health.

Increase collaboration between academia and our colleagues in governmental public health. This should include investments by the federal government in partnerships between academic institutions and local health departments. This could include more paid internships in health departments, which increases student interest in government public health; postgraduate 1-year public health residencies in health departments, which lowers entry barriers; and faculty-in-residence programs in health departments.

Introduce new federal initiative to bring applied research, evaluation, and training to the practice field through grant support mechanisms that combine the expertise of academic public health with frontline leadership and staff from the public health practice field.

Improve data collection and analysis to better understand the career trajectory of public health degree seekers, the governmental public health workforce, and barriers to entry into civil service jobs so that we can usher students into governmental public health and keep them there throughout their careers.

The mass exodus of professionals from state and local health departments is a public health crisis that we cannot ignore anymore, because the societal implications are immense. We must take swift action to stop the hemorrhaging of this invaluable workforce. To stem this alarming trend, a comprehensive approach is necessary. This would require changing public perceptions of public health professionals, supporting their roles and contributions, and taking substantive steps to address system-level challenges.

Public health professionals are the backbone of our health system, and their contributions are vital to the well-being of our communities. In this highly complex and technologically advancing world, we need to rely on trained public health professionals who have expertise and experience in public health. As a society, we must value their work, provide the support they need, and ensure that public health remains a rewarding and viable career choice. Together, we can build a resilient public health infrastructure that is prepared to respond effectively to future health crises and continues to protect and promote the health and well-being of all people every day