On Linkages: Confronting the Public Health Workforce Crisis: Asph Statement on the Public Health Workforce

University of California-Los Angeles, School of Public Health, CA 90095, USA.
Public Health Reports (Impact Factor: 1.55). 06/2008; 123(3):395-8.
Source: PubMed


FORECASTAs a result, today's public health workforce, faced with daunting public health challenges, has been forced to do more with fewer people. For example, in the U.S. in the year 2000, there were about 50,000 fewer public health employees than in 1980.5,6 While the 1980 workforce ratio (220 per 100,000) may in fact be an underestimate of the ideal number of public health workers, it provides a benchmark for estimating current and future needs.2 And although technological advances may to some extent mitigate the impact of the decrease in the size of the public health workforce, this trend cannot continue without drastically compromising the public's health.To have the same public health workforce-to-population ratio in 2000 as existed in 1980, there would have had to have been more than 600,000 public health workers, or an additional 150,000 on top of the 450,000 that existed at the time. In 2020, to have the same ratio (220:100,000), the public health workforce would need to number 700,000+, or 250,000+ workers more than the most recent count.More than 50% of states cite the lack of trained personnel as a major barrier to our nation's preparedness.7 Additionally, a recent Institute of Medicine (IOM) report states that there is a shortage of 10,000 public health physicians—double the amount estimated to be practicing currently.8 Other reports have documented and forecast shortages among public health nurses, epidemiologists, health-care educators, and administrators. Moreover, there are demonstrated disparities in the public health workforce related to racial and ethnic parity, as well as geographic maldistribution. As stated by the Sullivan Commission on Diversity in the Healthcare Workforce: “Today's physicians, nurses, and dentists have too little resemblance to the diverse populations they serve, leaving many Americans feeling excluded by a system that seems distant and uncaring. The fact that the nation's health professions have not kept pace with changing demographics may be an even greater cause of disparities in health access and outcomes than the persistent lack of health insurance for tens of millions of Americans.”9Public health workforce shortages are even more critical in much of the developing world. For example, despite representing 11% of the world's population and 24% of the global burden of disease, sub-Saharan Africa has only 3% of the world's health workers and commands less than 1% of the world's health expenditures.10 The 2006 World Health Report states that there is a “major mismatch” between population needs and the available public health workforce in terms of overall numbers, relevant training, practical competencies, and sufficient diversity to serve all individuals and communities. Multifaceted efforts are needed to increase the capacity of the global public health workforce, given the increasingly easy cross-country transmission of disease.11Retirement projections of public health professionals are not available for most private-sector positions. However, for the public sector, the estimated retirement potential is sobering (Table 2). If we assume that the public health workforce numbered 450,000 in the years when each of the retirement waves is projected (2003, 2010, 2012), then by 2012 a total of more than 100,000 public health workers (or 23% of the current workforce) will retire, leaving a large void of expertise to be filled. Of note, this projected retirement wave will place an added burden on the looming workforce shortage of 250,000 estimated for 2020.Table 2Percent of public health workers eligible to retire by 2012 (n=450,000)

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    • "Zywiak (2010) reported that, according to the Paraprofessional Healthcare Institute, 1.1 million additional direct-care workers will be needed. In addition, the Association of Schools of Public Health (ASPH) projects a shortage of 250,000 public health workers by 2020 (Rosenstock, et al., 2008). Moreover, the American Geriatrics Society (2013) reported increasing demand for geriatricians , estimating a need for 36,000 by 2030. "
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