THE PUBLIC HEALTH WORKFORCE CRISIS: THE NEED FOR A MORE PUBLIC-HEALTH-EDUCATED WORKFORCE

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THE PUBLIC HEALTH WORKFORCE CRISISTHE NEED FOR
A MORE PUBLIC-HEALTH-EDUCATED WORKFORCE

• Presentation by the ASPH Taskforce on the
• Public Health Workforce
• Dean Rosenstock, Chair
• June 29, 2007

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Definitions of the Public Health Workforce

• The public health workforce
• includes all those responsible for providing the
  services identified in the Public Health in
  America statement regardless of the organization
  in which they work. This expansive definition
  does not include those who occasionally
  contribute to the effort in the course of
  fulfilling other responsibilities
• focuses broadly on assurance, assessment and
  policy development, with activities including
  health surveillance, protection, promotion,
  planning, regulation, and health services
  organization, delivery, and evaluation
• works in governmental public health agencies,
  community-based service organizations, academic
  and research institutions, private organizations,
  and hospitals, health plans and medical groups
• is comprised of clinicians, occupational and
  environmental health specialists,
  epidemiologists, biostatisticians, health program
  administrators and educators, health economists,
  planners and policy analysts.
• Public Health Workforce Employment Settings
  (2000)
• 19 Federal government
• 33 State government (some may be local-level
  workers)
• 34 Local government (some may be state-level
  workers)
• 14 Other settings (including academia)

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Changing Roles and Responsibilities of Public
Health Professionals

• Originally focused on prevention of transmission
  of communicable diseases, occupational health,
  environmental health
• Later, added reproductive health, chronic disease
  prevention, and injury prevention
• Currently, more additions genetics, preventing
  bioterrorism and violence, handling and disposal
  of hazardous waste
• Shift from providing personal health services to
  population based services
• Increase in privatization of public services
• Implementation of performance standards for
  public health departments

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The Fundamental Shortage

• The public health workforce is doing more today
  (and likely in the future), with less people than
  in 1980, and with a smaller workforce-to-populatio
  n ratio. In 2000, there were over 50,000 fewer
  public health employees than in 1980
• or, seen another way, 62 per 100,000 fewer
• To have the same ratio in 2000 as in 1980 (220
  per 100,000), there would need to have been
  619,128 public health workers, or 170,874 more PH
  workers than the most recent count of 448,254 in
  2000.
• In 2020, to have the same ratio (220 to 100,000),
  the public health workforce would need to number
  738,771, or 290,517 more than the most recent
  count.

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Educational Capacity

• Current estimates indicate that accredited
  programs graduate approximately 800 students per
  year and schools of public health graduate nearly
  6,700.
• To reach 290,000 additional trained public health
  workers, production of graduates would have to
  increase three-fold over the next 13 years
• 7,500 graduates per year 97,500, x 3 292,500

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Addressing the Projected Public Health Workforce
Crisis Retirement of the Baby Boomers

• Impending Decrease in the Workforce Retirement
• 19 of local public health workers eligible for
  retirement in 5 years (from 2005)
• 24 of state public health workers eligible for
  retirement (2004)
• 44 of the CDCs workforce will be eligible to
  retire within 5 years (from 2003)
• If we assume that the public health workforce
  numbered 450,000 in the years when the each of
  the retirement waves will occur (2003, 2008,
  2010), then by 2010 a total of 102,330 public
  health workers will retire 23 of the current
  workforce.

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Rectifying the Training Gap Providing Formal
Training for the Current Public Health Workforce

• In 2001, the CDC estimated that up to 80 of the
  public health workforce does not have formal
  public health education or training.
• If the public health schools and programs were to
  address this deficit in the public sector alone,
  they would need to develop training programs for
  up to 309,600 current public health workers
  (minus those that retire and are replace by
  formally-educated workers).

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Training a Portion of the International Public
Health Workforce

• In 1995, SPH graduated 778 foreign nationals.
  Along with the increase in the number of SPH, the
  number of foreign national graduates increased to
  1,075 in 2005, an increase of 297 graduates, or
  38 percent.
• The size and capacity of the public health
  workforce outside of the United States and Europe
  is worse off, and multifaceted efforts are needed
  to increase the capacity of these countries
  workforces, for both their own health and safety
  and, given the increasingly easy cross-country
  transmission of disease, for our own.

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Public Health Physicians

• The IOM committee, Training Physicians for Public
  Health Careers, recently released its
  prepublication. Based on numbers and sizes of
  agencies at all levels of government, the
  staffing patterns both reported and known to
  members of the committee and indications from the
  agencies at the level of vacancies, the
  committees estimate is that there are currently
  10,000 public health physicians.
• The current ratio of public health physicians to
  US population is 3.5 per 100,000. The committee
  estimates that 20,000 physicians are currently
  needed in public health careers (7.1 per
  100,000).

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Areas Where Sufficient Data Are Not Available

• Addressing cultural competence and racial/ethnic
  parity
• Addressing need for public health workers in
  rural/underserved areas
• Others???

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Feedback for Deans and the Committee

• Deans and the Committee would like feedback on
• General approach
• Significant gaps or omissions in the general
  approach
• What can be done to strengthen the basic argument