Policy and Position Statements


Public Health Workforce Position Statement

I. ASTHO Supports a Robust Public Health Workforce

The Association of State and Territorial Health Officials (ASTHO) recognizes that a skilled state public health workforce is essential for protecting and improving the health and wellness of the public and responding to major health threats. The public health community must improve its ability to assess the needs of the current public health workforce, communicate the value of the public health workforce, and equip future public health leaders with the skills necessary to carry out essential public health responsibilities and respond to the changing landscape of the U.S. public health system.

II. Within This Context, ASTHO Recommends that State and Territorial Health Agencies:

Communicate to federal agencies, legislators, policymakers, and the general public the importance of a strong public health system for health promotion and prevention of disease.

Track research trends, best practices, and shortages related to the public health workforce in a comprehensive national database.

  • Enumerate the governmental public health workforce.
  • Create standardized job descriptions for common public health positions to allow for clearer delineation of training needs and salary comparison.
  • Encourage HRSA to expand its definition of a healthcare worker to include public health professionals, particularly in non-clinical settings (i.e., program managers and directors, policy advocates, health educators, etc.). Public health nursing should also be a separate category of the nursing workforce to ensure inclusion in workforce research and recruitment incentives.

Build the infrastructure to develop public health leaders.

  • Foster collaboration between academia and public health practice through fellowships, research partnerships, training opportunities, the establishment of academic health centers, and community outreach. Strengthen connections with departments that do not traditionally teach public health, such as law, finance, and public administration.
  • Provide support for career ladders from entry level to senior management to encourage professional development training for public health workers.
  • Adopt public health professional competencies as recommended by existing public health associations.
  • Utilize and strengthen existing learning management systems, such as TRAIN (TrainingFinder Real-Time Affiliate Integrated Network), as tools to strengthen competencies.
  • Explore methods of developing knowledge, skills, and attitudes to build the capacity of the future public health workforce in the following areas: communicating persuasively, working with diverse populations, informatics, problem solving, systems thinking, and change management.
  • Provide funding to support workforce development. Encourage HRSA to sustain public health workforce development programs and workforce programs introduced in the Pandemic and All-Hazards Preparedness Act. Create CDC funding streams for state and local workforce development.

Strengthen partnerships between public health and clinical practice.

  • Facilitate inter-professional education to help the clinical and public health workforce develop a broad view of health and a collaborative spirit.
  • Incorporate a population health focus and measures into healthcare systems, such as accountable care organizations.
  • Utilize the nonprofit hospital community benefit requirement as an entry point for the collaboration between government public health agencies and hospitals.

Use incentives developed in collaboration with health agency human resources divisions, such as offering salaries competitive with the private sector, flexible work hours, telework options, loan repayment programs, scholarships, internship programs, and opportunities for continuing education and training, to encourage public health professionals, especially minorities, to enter or maintain employment at governmental public health agencies.

Enhance and support diversity, so workforces reflect the communities they serve.

Support preparedness efforts by increasing the number of qualified laboratory and health information technology (HIT) workers.

Recruit HIT workers to focus on key public health needs such as health data exchange, clinical and claims data interpretation, utilization of electronic health records, and systems interoperability, and encourage staff to participate in public health informatics training opportunities (i.e., certificate or graduate degree programs) to improve job performance.

Adopt and maintain a workforce development plan and other activities that align with national public health accreditation standards and measures.

  • Develop and sustain the workforce necessary to achieve national public health department accreditation through leadership support, agency-wide planning, and dedicated staff (i.e., accreditation coordinators, workforce development directors, etc.).

ASTHO and its partners will continue to raise awareness and advocate on behalf of the public health workforce to develop strong public health leaders, address the worker shortage, and enable the continued protection of the public's health.

III. Background

More than 100,000 state workers1 and 160,000 local workers2 are responsible for improving the nation's health and keeping the public secure. The public health workforce encompasses wide-ranging specialties, such as public health physicians, public health nurses, first responders, social workers, community organizers, advocacy specialists, laboratory workers, health educators, nutritionists, epidemiologists, and environmental health workers, to name a few. The public health workforce is the first line of prevention for the public when fighting against obesity, chronic disease (i.e., diabetes, heart disease, and cancer), injuries, mental illness, infectious disease, and the first line of defense when protecting the health of the environment, providing surveillance, and conducting emergency preparedness activities. Due to the growing U.S. population and a substantial portion of the current workforce reaching retirement in the next few years, it is estimated that we will need 250,000 more public health workers by 2020.3

Domain eight of the Public Health Accreditation Board's Standards and Measures is "Maintain a competent public health care workforce."4 The Institute of Medicine recommends periodically assessing the public health workforce to develop and implement professional development and training programs to prepare it for the country's future public health needs.5

Public health issues include disease and natural disasters, but the public health system is also affected by social, political, and economic forces. For example, the Affordable Care Act brings new opportunities, as well as challenges, to the public health system. The law emphasizes the role of prevention in the U.S. health system and may be the impetus for a potential shift in responsibility for providing and financing clinical care. Another challenge facing state and territorial health agencies is significant budget cuts; 50 agencies (46 states, 3 territories, and DC) have reported budget cuts since July 2008. In that same period, more than 46,000 jobs in state and local public health agencies have been lost.6 An adaptive workforce with an interdisciplinary perspective is necessary to protect and promote the public's health and respond to forces that may threaten it.

A number of initiatives are helping to fill critical gaps in the public health workforce. States have attempted to address the workforce shortage through strategic workforce planning-"the business process for ensuring that an organization has suitable access to talent … to ensure future business success," according to Wikipedia-and recruitment and retention strategies.7 According to the 2010 Profile of State Public Heath, 17 percent of states and territories identified "infrastructure/capacity/IT/workforce" as one of their top five priorities. States used several strategies, such as web-based recruiting, job fairs, and academic partnerships, to market state public health careers.8

Public health organizations and federal agencies can augment the workforce development efforts of state health agencies. A workforce assessment project funded by the de Beaumont Foundation aims to work across all ASTHO affiliate organizations to determine cross-cutting training needs for the public health workforce for the next five years. The Association of Schools of Public Health Framing the Future project aims to create a new interdisciplinary vision for public health education from the undergraduate to the doctorate level to develop informed citizens and advanced professionals. CDC has worked with the Employment and Training Administration (ETA) of the U.S. Department of Labor (DOL) to designate CDC's Public Health Informatics Fellowship Program as a DOL/ETA Registered Apprenticeship, which brings more visibility to the program. The Scientific Education and Professional Development Program Office (SEPDPO) in CDC's Office of Surveillance, Epidemiology, and Laboratory Services has convened a public health workforce summit of more than 90 participants representing more than 40 organizations. SEPDPO will continue to engage stakeholders to move forward with workforce development strategies that were prioritized at the summit.

Approval History:

ASTHO position statements relate to specific issues that are time sensitive, narrowly defined, or are a further development or interpretation of ASTHO policy. Statements are developed and reviewed by appropriate policy committees and approved by the ASTHO Board of Directors. Position statements are not voted on by the full ASTHO membership.

Performance Policy Committee Review and Approval: August 2013
ASTHO Board of Directors Review and Approval: September 2013
Policy Expires: September 2016

For further information about this position statement, please contact ASTHO workforce development staff at infocenter@astho.org.

Related Documents:

ASTHO Performance Policy Statement


  1. ASTHO. ASTHO Profile of State Public Health, Volume 2. 2010. Available at http://www.astho.org/profiles/. Accessed 08-12-2013.
  2. NACCHO. 2010 National Profile of Local Health Departments. 2010. Available at http://www.naccho.org/topics/infrastructure/profile/resources/2010report/upload/2010_Profile_main_report-web.pdf. Accessed 08-12-2013.
  3. Association of Schools of Public Health. “ASPH Policy Brief: Confronting the Public Health Workforce Crisis.” 2008. Available at http://www.asph.org/UserFiles/WorkforceShortage2010Final.pdf. Accessed 08-12-2013.
  4. Public Health Accreditation Board. “Public Health Accreditation Board Standards: An Overview.” Available eat http://www.phaboard.org/wp-content/uploads/PHAB-Standards-Overview-Version-1.0.pdf. Accessed 08-12-2013.
  5. Institute of Medicine. “The Future of the Public’s Health in the 21st Century.” 2002.
  6. ASTHO. “Budget Cuts Continue to Affect the Health of Americans.” ASTHO Budget Cuts Brief. 2012. Available at http://www.astho.org/budget-cuts-Dec-2012/. Accessed 08-12-2013.
  7. Wikipedia. “Workforce planning.” Available at http://en.wikipedia.org/wiki/Workforce_planning. Accessed 08-12-2013. 
  8. ASTHO. ASTHO Profile of State Public Health, Volume 2. 2011. p.9.