SHORTAGE IN PUBLIC HEALTH WORKERS IMPERILS STATES’ RESPONSE TO DISASTERS

Volume 29, Issue 512 March 31, 2008

Tara Lubin

It’s a matter of when, not if, a disaster will strike. A calamity such as a bioterrorism attack or influenza pandemic will test the capacity of a state’s public health system. In the event of an influenza pandemic, for example, states will have to help track the flu’s evolution and try to prevent its spread, administer vaccines, run clinical labs, and ensure that water and food supplies are safe. Accomplishing such tasks requires a crack public health workforce.

But there’s a problem: there simply aren’t enough workers in the public health workforce. New surveys by the Association of State and Territorial Health Officials (ASTHO) and the Center for State and Local Government Excellence indicate that most state and local governments—which employ two-thirds of the public health workforce—are experiencing an increasingly dire shortage of public health nurses in particular, as well as epidemiologists, lab technicians and environmental health workers.

According to the ASTHO study, by 2012 more than 50 percent of state health agency workers will be eligible for retirement. The average age of a public health worker in state government is 47, and the average age of new hires is 40.

“Human resource capital is the main tool for state public health,” said Jim Pearsol, chief program officer of public health performance at ASTHO. “Finding folks with the proper expertise and knowledge has been a challenge now for many years, and it’s just getting worse in terms of availability of workforce.” As a consequence, many states are pursuing a variety of strategies to shore up their public health staffs.

Some State Strategies

Alabama is using funds from the federal Preventive Health and Health Services Block Grant to support such efforts as leadership training, internships and recruitment of new employees through Alabama schools and universities.

Alabama also emphasizes training and mentoring for its existing public health workforce, most notably with a five-month-old project called Public Health TEAM Academy. TEAM, which stands for Training and Experience to Advance Managers, is a week-long intensive program that offers hands-on, true scenario-driven learning and training. Based on feedback from participants, the state’s goals of boosting morale and better performance are starting to be accomplished.

According to Michele Jones, workforce development director of the Department of Public Health, this is the largest investment Alabama has made in its public health workforce. The initiative is being funded mostly by the block grant, but state funds are used as well.

“I think one of the best things (states can do), from my experience, is make that investment up-front with your workers,” says Jones. “It’s one of the best, most beneficial things, both short-term and more importantly, long-term. I just don’t think you can do enough preparing and mentoring employees.”

Other State Actions

Colorado’s Department of Health and Environmental Control uses job sharing, succession planning and formal mentoring programs to bolster its workforce. The department also rehires retirees to preserve the institutional knowledge of older staff, and recruits online and at colleges and universities.
In Indiana, the Department of Health has, among other efforts, a youth corps program to generate interest in public health careers.
The Public Health Division in Oregon offers flexible hours, a telecommuting option and job rotation (which provides cross-training) to retain current staff. They also created a formal succession planning program and provide numerous opportunities for staff development.
Incentives like referral bonuses for new hires, tuition loan repayment programs and flexible work options are provided by the South Carolina Department of Health and Environmental Control. The department also pools resources with other state agencies to recruit for government positions, particularly for public health nurses.

Congress has taken some steps to help mitigate the public health workforce shortage. For example, the 2006 Pandemic and All-Hazards Preparedness Act authorizes loan repayment programs for the recruitment and training of a stronger public health workforce. So far, Congress has yet to appropriate funds for the act.

For more information on the public health workforce, please contact NCSL’s Tara Lubin at (202) 624-3558 or at Tara.Lubin@ncsl.org.