Incredible shrinking public health system

An aging workforce, budget cuts and the inability to financially compete with the private sector in recruiting qualified health care professionals are some of the factors stressing state and local government health care systems. The situation is so serious that two senators might re-introduce legislation as early as this month that would create a loan repayment and scholarship program to help entice epidemiologists, nurses, laboratory scientists and other health care professionals to work in state, city and county health departments.

“We consider [recruiting] to be the number one problem facing public health officials,” says George Hardy Jr., executive director of the Washington-based Association of State and Territorial Health Officials (ASTHO). “This is an incredibly huge problem.”

Hardy’s organization conducted a survey in 2003 that spotlights the problem for a profession that is all but forgotten except during times of national emergencies and disasters. The most startling news from the survey of 37 state health care departments is that the average age of the public health employee is 46.6 years old, and some states have vacancy rates of up to 20 percent.

Nebraska and New York rank as the No. 1 and No. 2 states with the highest percentage of workers eligible for retirement, according to the ASTHO survey. Nearly 46 percent of the public health care workers in Nebraska and 45 percent in New York qualify for retirement. “We are going to lose a lot of years of experience,” says Richard Raymond, Nebraska’s senior public health official and ASTHO president. “The new [health care workers] coming in are not going to have that experience and risk making mistakes that could have been avoided.”

The ASTHO survey confirms the similar results of a 2002 study conducted by two local government groups that warned that public health care agencies nationwide were dangerously close to being understaffed. The Washington-based National Association of County and City Health Officials will begin a similar assessment focusing on staffing in local health departments this month. Pat Libbey, executive director for the organization, says he expects comparable results.

The need for a skilled public health workforce is intensified as federal authorities rely on local officials to help with homeland security duties, such as identifying disease outbreaks and educating the public on avoiding exposure to diseases. Raymond suggests public health departments need to reinforce their recruitment process by educating high school students about careers in public health, as well as increasing pay to attract qualified individuals. “We can be our own worst enemies or best recruiters,” he says.

The federal legislation would help recruit a new generation of workers. The legislation, proposed by Sen. Chuck Hagel, R-Neb., and Senate Minority Whip Richard Durbin, D-Ill., would authorize $35 million per year for scholarships and another $195 million to help graduates repay their loans in exchange for agreeing to work in the public health sector. They offered a similar bill last year, but Congress did not act on it.

“It only takes a casual look at recent headlines about mad cow disease, flu vaccine shortages and bioterrorism to see that public health threats are of real concern in this country,” Durbin says. “As we look to the future, it is clear that protecting the public’s health must continue to be a top priority. If we don’t take steps soon to boost the number of public health professionals, our nation could see existing shortages become a real crisis at the national, state and local levels.”
— Mark Preston is the Washington correspondent for American City & County.