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Managing Editor Scott Harris sharris@aamc.org Staff Writer Elissa Fuchs efuchs@aamc.org

Viewpoint: We Must Strengthen Our Public Health Workforce

I'm generally not one for New Year's resolutions. The time spent deciding on how we'll commit to improving our lives is often longer than our follow-through. By Valentine's Day, there's little left of our resolve but faint memory. Often missing from these well-intentioned goals are strategic objectives and long-term investment.

By Georges C. Benjamin, Executive Director, American Public Health Association

To this I offer a challenge facing us in the New Year and beyond, one which we must all muster resolve to address. We face a workforce crisis in public health, which poses serious risks to the health of our nation.

Since the advent of the field of public health nearly a century and a half ago, public health workers have helped protect the necessities of life: ensuring our food is safe to eat, our water is safe to drink, and our air is safe to breathe. Core public health services protect against infectious disease, prevent the onset of chronic disease, promote healthy life-styles and protect against workplace and environmental hazards. Due largely to the success of public health, our nation's average lifespan has increased some 30 years since 1900.

Despite this record of achievement, public health has been chronically underfunded for decades. Experts have been warning us that our nation's public health infrastructure is in disarray. Our laboratory capacity and communications networks are insufficient. There are serious gaps in our disease surveillance systems. Above all, we lack adequate personnel and training. These and other shortcomings have been known to public health leaders for some time but have also been more recently documented by the Institute of Medicine, the General Accounting Office, and others as current pressures on the public health system make these failings more visible.

Perhaps never before has it been so important to repair the foundation of our public health system. This foundation is being asked to support our response to some of the most threatening emerging diseases of our time and to prepare for diseases yet unknown. In this age when biological and chemical terrorism is added to the portfolio of public health threats, we need to be assured that the system works and works well. This begins with the public health workforce.

The landscape within which we practice - where we prepare for an "all hazards" approach - is expanding and evolving. Modern technologies continue to push the bounds of the practice. Translating scientific breakthroughs into healthy outcomes will require new tools, expertise, and people working in emerging fields such as genomics and informatics.

Both in size and training, our workforce was insufficient even before the new responsibilities of bioterrorism preparedness were assigned to it. Assessments of our current workforce indicate that nearly half lack formal academic training in public health, and few opportunities exist to assist workers in obtaining training.

To complicate matters, 50 percent of the federal public health workforce and 25 percent of the state public health workforce will retire in the next five years. This massive attrition in personnel will create a critical shortage of workers that clearly cannot be remedied through existing training programs and recruitment efforts.

What is clear is that the public health workforce must be revitalized if we hope to avert a looming crisis. We must focus on three areas: Retention-We need to find ways to retain qualified, skilled professionals currently employed in public health. We need to assist workers in career development by fostering growth opportunities and developing career ladders to grow workers in their profession.

We need to find ways to improve compensation. Public sector salaries have not kept pace with the private sector. Creative solutions may involve utilizing more homeland security dollars to support our workforce.

Recruitment-We need to develop more programs to introduce and advance public health as a career option during all phases of education, from primary and secondary school curriculum through the university level. Part of this may involve a massive marketing campaign to rally students and other professionals to consider joining the cause of public health.

Training and education-We need to increase the exposure of students to public health and encourage dual degrees with other health sciences but also with new partners in fields such as law, engineering, and law enforcement. We should build on our collaborations with schools of medicine. With improvements in technology, we should expand distance learning opportunities and online training to better equip workers already in the field.

The public health workforce is overburdened and under trained. The increasing demands and expectations placed upon it have only stretched the workforce thinner, and the coming mass exodus of personnel creates a dire situation. Without zealous New Year's resolve to strengthen the public health work force, and a strategic plan and investment to back it up, we place the health of the public at risk.

(For more information, please visit www.apha.org )

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