Public Health Workforce Reductions: What Losing Capacity Means for Communities

Public health agencies at all levels of government have faced workforce pressures in recent years, including direct workforce reductions, budget constraints, and departures driven by workplace changes. The consequences of reduced public health capacity are not immediately visible in the way that hospital closures or medication shortages are, but they are documented in slower outbreak response, reduced chronic disease prevention programs, weaker surveillance, and diminished community health infrastructure. The public health workforce is highly specialized and takes years to develop. Public health professionals include epidemiologists who design and analyze disease surveillance systems, laboratorians who identify pathogens, public health nurses and community health workers who deliver programs, environmental health specialists who investigate contamination, and public health emergency preparedness professionals who coordinate responses to disasters and outbreaks. These are not interchangeable positions, and workforce losses in specific specialties cannot be quickly filled. The COVID-19 pandemic revealed both the strengths and limitations of the US public health workforce. The pandemic required rapid scaling of contact tracing, vaccination programs, testing, and data analysis at a scale that exceeded existing capacity in many jurisdictions. The response also depleted public health workers, who experienced burnout, harassment, and working conditions that drove many experienced professionals out of the field. Surveys conducted during and after the pandemic documented high rates of reported intent to leave public health careers among the workforce. State and local public health agencies bore primary responsibility for pandemic response and had to dramatically expand their operations, often with temporary federal funding through emergency supplemental appropriations. As that temporary funding has ended, many state and local health departments have had to reduce programs and staff that were added during the pandemic. The result in many jurisdictions is a public health workforce that is smaller and less experienced than at the pandemic's start. Federal public health workforce reductions at agencies including CDC, FDA, NIH, and other HHS components have been implemented through a combination of voluntary separation programs, reductions in force, and contractor terminations. The specific programs affected vary by agency, and the consequences are being assessed by both internal agency evaluations and external observers including former agency officials, academic public health researchers, and congressional oversight. The economic case for public health investment has been documented in research showing substantial returns on public health spending relative to the cost of treating preventable conditions. Studies of specific public health programs, including tobacco control, childhood immunization, and injury prevention, consistently find that prevention is substantially cheaper than treatment when program costs are compared to the costs of treating the conditions they prevent. A workforce that cannot effectively deliver prevention programs shifts costs from prevention to treatment in ways that increase overall healthcare spending. The geographic distribution of public health capacity matters for understanding the consequences of workforce reductions. Jurisdictions that rely most heavily on federal funding for public health programs, often rural areas and states with limited fiscal capacity, are most affected by federal program cuts. Urban jurisdictions with diversified funding sources are somewhat more insulated, though federal program cuts affect them as well. Rebuilding public health workforce capacity after reductions is a slow process. Training pipelines for epidemiologists, laboratorians, and other specialized public health professionals are measured in years, and institutional knowledge held by experienced professionals who leave the field cannot be quickly replaced. The public health community and academic experts have argued that the workforce reductions occurring in the current policy environment will have consequences for public health capacity that will be felt for years, particularly if new health threats emerge during a period of diminished capacity.