Over the past decade, there has been increased interest by many stakeholders in more closely aligning the efforts of general local governments with their local, regional, and state public health department counterparts. There are a variety of reasons for this, from weaving health considerations into all local policies to reducing duplication found within distinct budgets to the sharing of expertise across organizational silos, among others.

For these efforts to succeed, one central challenge that public employers must address is the recruitment and retention of professionals with essential skill sets, a need that will continue to be particularly acute for those in public health roles as governments work to mitigate the short- and longer-term effects of the COVID-19 pandemic.

With an eye toward implementing effective workforce development strategies,¹ it is essential that the similarities and differences between the state and local public health sector and the state and local government workforce overall are known. To this end, in March 2020, with the support of the de Beaumont Foundation (DBF), the Center for State and Local Government Excellence (SLGE) released a first-of-its-kind study, “How Does the Public Health Workforce Compare with the Broader Public Sector?”²

As outlined in this report, in 2017, according to the Bureau of Labor Statistics (BLS), there were slightly less than 20 million state and local employees; 5.1 million at the state level, 14.4 million at the local level. While BLS projections will likely be impacted in the wake of the 2020 global public health crisis, state employment is expected to contract by 1.7 percent between 2018 and 2028, while local employment is expected to increase by 3.1 percent during this timeframe. In 2017, there were around one million public servants working as healthcare practitioners and in technical occupations and support roles, two groups projected to increase by approximately 5.5 percent between 2018 and 2028. While these health care occupations cover many public health positions, they also include others that are not in public health roles such as home health aides and massage therapists, while excluding others such as animal control and health educators. According to two leading state and local public health associations (ASTHO and NACCHO), there are 244,230 public professionals in core public health roles.

To understand gender, race/ethnicity, age, educational attainment, and salary demographics of the public health and overall state and local workforce, data sets from BLS and the Public Health Workforce Interests and Needs Survey (PH WINS) were analyzed and compared. Below are some of the key, topline findings:

Gender

In 2017, 60 percent of the state and local workforce was female, while 40 percent was male. The public health workforce was 77 percent female and 21 percent male. The remaining two percent identified themselves as other or did not answer.³

Race/Ethnicity

In 2017, the public health workforce was more diverse than the state and local sector overall. While 57 percent of the public health workforce was white, 67 percent of the state and local government workforce was white. Much of the increased diversity in the public health workforce comes from higher percentages of workers that listed themselves as Black/African American, Asian, and two or more races.

Age

The age distributions of both the public health workforce and state and local sector overall follow the same general distribution patterns, with the public health workforce skewing slightly older with an average age of 48, relative to 44 for state and local workers overall.

Educational Attainment

As one might expect given the knowledge-based roles of many state and local workers, the majority of all state and local workers (67 percent) and public health workers (81 percent) have completed some type of post-secondary education. This higher percentage for the public health workforce is likely a function of the specialized training, certifications, or degrees that are required by statute or organizational policy for many positions, such as epidemiologists, nurses, and health officers.

Salary

Similar to the age distribution, the salary distribution of both the state and local workforce overall and the public health workforce generally follow similar patterns, but the mid-range for public health is $55,000–$65,000, while it is $45,000–$55,000 for state and local government generally. This differentiation, in part, is linked to 14 percent of state and local workers making less than $25,000 (e.g., recreation workers, cafeteria workers, and facilities cleaners), relative to approximately 1 percent in the public health sector.

In the summer of 2020, SLGE, with the support of DBF, and in coordination with ICMA, will be releasing the findings of a survey and case studies that explore how general local governments and public health departments are coordinating to address today’s greatest population health challenges, focusing especially on providing safe stable affordable housing, implementing healthy community design, and reducing substance misuse and prescription drug overdose.

 

 JOSHUA FRANZEL, PHD, is president and CEO of the Center for State and Local Government Excellence (jfranzel@slge.org).

 

 

Endnotes and Resources

¹  See: Workforce of the Future: Strategies to Manage Change, https://slge.org/assets/uploads/2018/10/workforce-of-the-future-oct-2018.pdf] and Innovations in the Health and Human Services Workforce [https://slge.org/assets/uploads/2019/11/innovations-in-hhs-workforce.pdf

²  https://www.slge.org/assets/uploads/2020/03/public-health-workforce.pdf

³  An ‘other’ or ‘did not answer’ option is not available for state and local workforce overall.