Strengthening the Public Health Work Force to Address Current and Future Challenges

Recognizing that the nation entered the 21st century facing a myriad of diverse public health challenges like chronic diseases or conditions (e.g., diabetes, heart disease, obesity, stroke and cancer), birth defects and developmental disabilities (e.g., autism), infectious diseases (including emerging and remerging diseases), environmental and occupational exposures, terrorism, injuries, mental illness, health disparities, and an increasing uninsured population;^1-2 and that the overall public health approach of identification, implementation, and evaluation of prevention and control efforts will continue to be the foundation of evidence-based public health practice now and in the future;³ and 

Recognizing that during the 21st century the U.S. population will increasingly become older, more racially and ethnically diverse^2,4-5 and that there is sufficient, scientific evidence to support a greater diversity among health professionals with several reports indicating that greater diversity is associated with improved access to care for racial and ethnic minority patients, greater patient choice and satisfaction, and better provider communication; and 

Recognizing that to assure the health of an increasingly diverse population in the United States, and to achieve the Healthy People 2010 goal to eliminate health disparities, a strong and an effective public health work force is needed that is adequate, trained, diverse and culturally competent;^2,6 and 

Knowing that the governmental public health work force is the foundation for our public health system, as the first line of defense against natural and man-made public health emergencies and as the principal provider of essential public health services;^2,6 and 

Knowing that a survey of state public health offices in 2003 revealed high vacancy rates, high turnover rates, increased aging of the work force, and high retirement eligibility that may lead to a crisis in the governmental public health work force,^7-10 with up to 45 percent of the work force of a state government retiring in the next five years7 and similarly high retirements in some federal public health agencies;¹¹ and 

Acknowledging that this is a major concern because less than 20 percent of public health graduates go into government service;¹² and fields suffering most from work force shortages include nursing, epidemiology, laboratory services, and environmental health;⁸ and 

Realizing that if current work force trends are not reversed a shortage in the size and composition of the public health work force is imminent, affecting a current work force of approximately 450,000 individuals working in salaried public health positions and trained in a multitude of disciplines, including biological, medical and nursing sciences, biostatistics, epidemiology, laboratory science, administration, business, behavioral science, computer science, dentistry, public health education and promotion, environmental engineering, ethics, law, nutrition, psychology, political science, public affairs, sociology and urban planning;^11-12 and 

Recognizing that there are effective recruitment, retention, and training strategies to strengthen the work force,¹³ and that these strategies include strengthening the career ladder of current public health workers (and the career paths of prospective workers from other fields), advocating for increased funding for competitive salaries, raising public awareness about public health and career opportunities, engaging retired public health workers in teaching and advising roles, examining perceptions of students and potential employees of working in a government setting15 and cross training workers to be skilled in a range of public health settings and tasks; and that these strategies are not widely used or completely funded; and 

Recognizing that APHA has developed a number of policies that address specific aspects of the work force (policies 20032, 200210, 20004, 9613, 9414, 8102 and Guiding Principles for Public Health Response to Terrorism)^14-20 and that these policies call for: improved recruitment and retention of public health nurses to strengthen the public health infrastructure, enhancement and expansion of the maternal and child health work force in response to the National Action Agenda (particularly in translating quality data into decisions), a strengthened public health work force as a guiding principle for the public health response to terrorism and emergencies, strengthened funding and traineeships for minority midwifery students in support of access to midwifery services in the United States, targeted recruitment and retention of Hispanics to be leaders in their field, adequate funding for graduate training programs for public health professionals by governmental entities, and improved occupational health and safety of minority workers through the education of minority health professions, and others that serve minority communities;^14-20 and 

Recognizing that APHA supports legislation to improve the public health work force; and 

Acknowledging that some state and other governmental agencies and professional organizations are taking short-and long-term approaches to remedy the shortage;⁸ 

Therefore, the American Public Health Association urges that:

1. Congress provide adequate funding for a comprehensive national database of the public health work force, including race, ethnicity, gender, disability status and other characteristics comparable to those available for the health care work force.
2. Congress provide adequate funding to make long-range projections for public health work force needs and training at the state and local level.
3. Develop, fund, implement and evaluate best practices for recruitment, retention, and training of the public health work force. Best practices should include those that have a substantial impact on increasing the recruitment, retention and training of minorities. Elements of this effort should include:
   1. Collaboration among federal, state, tribal and local government and non-governmental organizations.
   2. Funding for scholarships and loan forgiveness programs to recruit, train, and retain the public health work force, especially minorities.
   3. Promotion of efforts to provide competitive salaries and benefits for the public work force.
   4. Development and dissemination of tools and resources to increase awareness of public health career opportunities, including those most effective in recruiting minorities.
   5. Increased funding for programs designed to improve the training of public health leaders and managers to provide a supportive and satisfying work environment that contributes to work force retention. 

References

1. Institute of Medicine. Understanding population health and its determinants. In: The Future of the Public's Health in the 21st century. Washington, D.C.: The National Academies Press; 2003:1-18.
2. Institute of Medicine. Executive summary. In: The Future of the Public's Health in the 21st century. Washington, D.C.: The National Academies Press; 2003:1-18.
3. Haddix AC, Teutsch SM, Shaffer PA, Dunet DO. Prevention Effectiveness: A Guide to Decision Analysis and Economic Evaluation. New York, N.Y.: Oxford University Press 2003.
4. Institute of Medicine. In the Nations Compelling Interest: Ensuring Diversity in the Health-Care Work force. Washington, D.C.:The National Academies Press;2004:1-409.
5. The Sullivan Commission. Missing persons: Minorities in the Health Professions. 2004;1-200. http://www.sullivancomission.org.
6. Institute of Medicine. Summary. In: Who Will Keep the Public Healthy: Educating Public Health Professionals for the 21st century. Washington, D.C.:The National Academies Press;2003:3-26.
7. Association of State and Territorial Health Officials. State Public Health Employer Worker Shortage Reports: A Civil Service Recruitment and Retention Crises. http://www.astho.org, 2004.
8. Council of State Governments. Public Health Worker Shortage: Trends Alert, Critical Information for State Decision Makers. http://www.csg.org, 2004.
9. Centers for Disease Control and Prevention, unpublished data.
10. Association of State and Territorial Health Officials. http://www.astho.org. 
11. Institute of Medicine. The governmental public health infrastructure. In: The Future of the Public's Health in the 21st century. Washington, D.C.:The National Academies Press;2003:96-177.
12. Institute of Medicine. History and current status of public health education in the United States. In: Who Will Keep the Public Healthy: Educating Public health Professionals for the 21st century. Washington, D.C.:The National Academies Press;2003:41-60.
13. Council on Linkages Between Academia and Public Health Practice. Public Health Worker Recruitment and Retention. http://www.phf.org/Link/tools.htm#Recruitment.
14. American Public Health Association Policy Statement 20032. The Impact of a Public Health Nursing Shortage on the Nation's Public Health Infrastructure. APHA Policy Statements , 1948 to Present, Cumulative. Washington, D.C.: American Public Health Association; current volume. 
15. American Public Health Association Policy Statement 2002-10. Maternal and Child Health (MCH) Data Capacity through the National Action Agenda. APHA Policy Statements, 1948 to Present, Cumulative. Washington, D.C.: American Public Health Association; current volume.
16. American Public Health Association Policy Statement 20004. Supporting Access to Midwifery services in the United States (Position Paper). APHA Policy Statements , 1948 to Present, Cumulative. Washington, DC: American Public Health Association; current volume. 
17. American Public Health Association Policy Statement 9613. Addressing Hispanic Underrepresentation in the Health Professions. APHA Policy Statements , 1948 to Present, Cumulative. Washington, D.C.: American Public Health Association; current volume. 
18. American Public Health Association A Policy Statement 9414. Federal and State Financial Support for Training of Public Health Professionals. APHA Policy Statements, 1948 to Present, Cumulative. Washington, DC: American Public Health Association; current volume.
19. American Public Health Association Policy Statement 8102. Occupational Health and Safety Services for Minority Workers. APHA Policy Statements , 1948 to Present, Cumulative. Washington, D.C.: American Public Health Association; current volume. 
20. American Public Health Association. Guiding Principles for a Public Health Response to Terrorism. http://www.apha.org.

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