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policy, local public health agencies, public health infrastructure, public health workforce, research needs



  1. Fraser, Michael R.


There is a paucity of information about the nation's local governmental public health agency (LPHA) workforce. Without additional research, crucial questions about the individuals providing front-line public health services remain unanswered. Current national efforts to develop a public health workforce research agenda must include strategies for collecting basic data on local governmental public health workers. The work of enumerating and classifying LPHA staff is complicated, but not impossible. Projects to improve LPHA performance and discussions of the certification of public health workers are incomplete without current and accurate data on the individuals comprising our nation's public health system. The need to describe basic facets of the LPHA workforce is not trivial. As city and county budgets are cut and LPHAs are left scrambling to cover lost positions, data are needed to inform important decisions about what kinds of LPHA staff are needed to keep a community healthy.


At the front line of our nation's public health system are approximately 3,000 local public health agencies (LPHAs) carrying out the important business of protecting and improving the health of communities nationwide. Earlier research on LPHAs demonstrates that LPHAs are structured in a variety of ways and provide a number of different services in their jurisdictions, ranging from conducting restaurant inspections to staffing sexually transmitted disease clinics and everything in between.1 The diversity of LPHA structures has led to the development of a popular adage to describe America's local governmental public health system: "If you've seen one local health department, you've seen one local health department." Corresponding to the diversity of LPHA size, services provided, and regulatory authority is the diverse composition of the local public health workforce.


Given that LPHAs represent a very large, if not the largest, segment of the public health practice workforce nationwide, one might expect to find a sizeable body of research on the individuals that are daily involved in strengthening and improving the public's health. Unfortunately, if one looks to the literature for answers on even the most basic facets of the local governmental public health workforce there are little data to be found on the people who work in LPHAs and their professional qualifications. No state or national system is in place to track local public health workers in any way. Thus, we have no data on when they enter the workforce, when they leave, their average age, their years of education, and other important characteristics of public health professionals. Additionally, while the nation recently invested almost $1 billion in preparing the nation's public health system to respond to bioterrorism and other public health threats and emergencies, including specific attention to workforce development and training, no one can accurately identify how many public health workers will benefit from the training this funding may support (current thinking is "about half a million" individuals practice public health nationwide), what kinds of occupations they represent (conventional wisdom is that "most are public health nurses, sanitarians, and administrative staff") or their professional preparation (it is often cited that "most don't have master's degrees in public health"). Given the lack of knowledge on the LPHA workforce, we clearly have a lot more to learn and this information is very much needed for critical workforce planning and professional development activities at all levels of government.