GAO: Public-health workforce shortage undermines ability to respond to outbreaks, other emergencies

Public health nurse with patient

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A new US Government Accountability Office (GAO) report identifies a shortage of public health workers across multiple occupations and locations that restricts the ability to perform essential functions such as disease investigation and mitigation, hazard detection, and emergency response.

The US Department of Health and Human Services (HHS) and other organizations have taken actions (eg, job training and placement, better pay) to alleviate the shortages, which began with the 2008-2009 recession and worsened during public health emergencies such as the COVID-19 pandemic, the authors said.

Tracking outbreaks, communicating with public

The GAO reviewed 69 public-health workforce research studies and reports and interviewed officials from HHS and 11 stakeholder organizations such as those representing jurisdictions, public health professionals, or education; public health policy and research; and public health practice and population health.

FAO officials also interviewed officials in 11 jurisdictions (4 states, 1 territory, 2 tribes, and 4 local governments) with different structures, funding, and proportion of population living in rural areas.

Public health workers perform key functions such as tracking disease outbreaks, monitoring water quality, and communicating with the public about health threats, the report noted.

"Nonfederal jurisdictions within the U.S. (states, territories, Tribes, and localities, such as counties and cities) have primary responsibility for public health in their geographic areas, and these jurisdictions employ most of the public health workforce—more than 200,000 workers," the authors wrote. "The federal government, particularly the Department of Health and Human Services (HHS), supports these jurisdictions' workforces and also employs its own public health workforce."

Gaps in critical skills, rural public health

The GAO identified shortages in occupations such as nursing, epidemiology, and operations; skills such as leadership and informatics; locations such as rural areas; and times such as public health emergencies.

Public health funding can be restricted to limited time frames or specific activities, which makes it difficult to use the funding for hiring.

Contributing factors include worker recruitment and retention challenges, which the authors said are difficult to solve and likely to be long-term. "For example, public health funding can be restricted to limited time frames or specific activities, which makes it difficult to use the funding for hiring," they wrote.

Employers also face stiff market competition for workers from other entities that can offer higher pay and better job security and flexibility, a more manageable workload, and less stress. Jurisdictions may also have cumbersome hiring processes due to difficult-to-change state or local civil-service requirements, the GAO said.

In response to these challenges, HHS has offered employers more flexibility in using some grant funds for hiring and support, and some organizations have provided financial incentives and made hiring processes more efficient. Maine, for instance, increased pay for public health nurses and expedited hiring processes, which helped the state fully meet its workforce needs.

"The public health workforce encompasses numerous jurisdictions within the U.S., many of which face various persistent challenges in recruiting and retaining public health workers," the authors concluded. "However, the HHS and jurisdictional actions we have described, among others, have helped enable jurisdictions to deal with the challenges, and helped begin to address gaps in the public health workforce."

 

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