Billions of federal dollars to bolster public health departments nationwide may not have a lasting impact when the pool of cash dwindles, officials worry.
President Joe Biden outlined a plan to create thousands of new public health jobs, a vision Democrats sought to make reality as part of the American Rescue Plan (
But health departments must compete with hospitals and other private enterprises for high-demand workers like epidemiologists and nurses. They’re often offering less money for tougher jobs — and ones that may disappear in a year or two, public health leaders say.
That has raised fears many of these departments will end up where they were before 2020: short-staffed and unprepared for a pandemic.
“The issue we face isn’t as much the number of dollars we see today, as sustainability,” said Umair Shah, secretary of health for Washington state.
What the public health sphere needs is a long-term commitment by Congress to expand their workforce, officials say.
Public health departments were already shrinking heading into the Covid-19 pandemic: there were 91,540 full-time positions at state health agencies in 2019, down from 101,619 in 2012—a drop of almost 10%, according to data from the Association of State and Territorial Health Officials.
Since then, health departments have been stretched thin trying to track the spread of Covid-19 and distribute vaccines to protect people from the virus. This lack of staff made it hard for health agencies to properly assess how many people have the virus, and complicated response times.
One analysis from the de Beaumont Foundation, which advocates for a larger public health system, recommended the federal government fund 80,000 new public health workforce jobs to prepare for the next pandemic.
A source familiar with the government’s plan to distribute the funds said about $2 billion of of the pledged $7.4 billion has been handed out so far to state and local health agencies, as well as to school districts to hire school nurses.
The Centers for Disease Control and Prevention is the agency tapped to distribute much of these funds. Jude Fulce, a spokesperson, said data on how many workers have been hired with the money in 2021 or 2022 isn’t available. She said the agency expects to see some preliminary figures later in the year.
When asked how much money has been distributed so far, Fulce pointed to a notice from the White House announcing the plan to spend $7.4 billion.
The Association of State and Territorial Health Officials will update its data on the public health workforce later this year, said Stephanie Rhodes, a spokeswoman for the group.
‘Stretched Incredibly Thin’
Health department leaders say they’re bringing on new staff, but many of them can’t be promised jobs beyond 2023.
In Washington state, the health department has expanded since the beginning of 2020. It had 1,880 workers before the outbreak of Covid, and now has 2,715, according to department data. About 40% of those new hires are temporary staff.
The department has also seen an 18% turnover rate, meaning they’ve replaced nearly a fifth of the staff since 2020. Many of these new workers have less public health experience than their predecessors, Shah said.
Health departments are dealing with burnout: their workers are entering a third year of tracking a virus that’s been killing at least 1,000 Americans every week since the beginning of October—and often triple that number.
“It’s cliche at this point but it’s true: we’re stretched incredibly thin,” said Mike DeRose, human resources director for the Michigan Department of Health and Human Resources.
‘Competing With Ourselves’
In Houston, the health department had about 1,200 regular workers pre-pandemic, all but 100 being permanent staff, said the department’s director, Stephen Williams. Now, the department has about 1,600 workers, with 400 of them in temporary positions.
Williams said the department has been recruiting disease prevention specialists, microbiologists, and outreach workers to bolster their Covid response. So have surrounding health departments and hospitals, he said.
“We’re competing with ourselves for some of these employees,” Williams said.
The high demand for epidemiologists—public health workers who investigate patterns and causes of disease and injury—and nurses is set to remain for the next decade, Bureau of Labor Statistics data show. Employment of epidemiologists is projected to grow 30% from 2020 to 2030, compared to an 8% average for all occupations. That’s 900 job openings for epidemiologists each year, for the next eight years.
For nurses, with a larger workforce size, the demand is also high: 194,500 openings for registered nurses are projected each year until 2030, a 9% growth rate, according to BLS data.
Competition for workers means employers pay higher wages, Rachel Greszler, a research fellow at the Heritage Foundation think tank, told lawmakers Thursday. She said the massive influx of public money going into various sectors of the economy in recent years has distorted markets, driving up costs and wages.
“When it’s simply employers having to pay more to do the same thing, that translates to higher prices,” Greszler said.
Even with the new hires, Williams, in Houston, said he’s shifting existing staff away from activities like chronic disease prevention.
“Really, we needed close to the level of staff we have now before Covid,” Williams said. “We’re doing a lot with what we have.”
Public health advocates also say the federal funds aren’t yet reaching many local health departments. States and counties that have received CDC funds decide how to distribute the money, and some smaller health departments don’t have the expertise to get grants directly from the agency.
Administrative and bureaucratic hurdles can make it almost impossible for small health departments to tap into federal programs, said David Harvey, executive director of the National Coalition of STD Directors.
“There’s a disruption in hiring everywhere; public health is no different,” Harvey said. “The administrative hurdles at the CDC are not helping.”
To stretch these short-term personnel gains into a long-term expansion of the health workforce will require dedicated, year-to-year federal funding, said Justin Mendoza, who leads advocacy for Partners in Health, a group that works to strengthen public health.
Mendoza’s group wants appropriators in Congress to increase the CDC’s annual budget by $1 billion starting in fiscal 2023 to accommodate regular investments in the public health workforce. The fiscal 2021 enacted budget for the CDC was about $8 billion.
“The money we have right now isn’t enough, that was a down payment,” he said.
Health department leaders are also arguing for regular federal investments so they don’t have to shrink again when the American Rescue Plan funds dry up.
“I’m concerned we’re going to forget the lessons we learned from this pandemic and just try to move on to whatever is next,” Shah, in Washington, said. “Then the next emergency comes up and we’re not ready for it.”