There is an ongoing crisis within the public health system in the Inland Empire (and beyond). 

Part of the problem is that most of us are unaware of the role that public health plays when it is working well. As Riverside County Public Health Director Kim Saruwatari noted recently, “If we’re doing our jobs right, nobody knows we’re doing our jobs because we’re preventing disease, we’re preventing illness, we’re preventing emergencies related to the food supply. We do our job quietly in the background and we don’t tell our story well.”

It’s time to tell the story of public health, and it’s time to work as a community to build a pipeline of public health workers for the future. The consequences of inaction will ensure that public health becomes a focus of awareness for every single citizen, because we will all be affected to some degree. 

In this article, we’ll be shedding light upon: 

  • The startling decline in public health workers
  • Why public health workers are leaving
  • How the shortage in public health workers will affect us
  • Solving the problem with a coordinated regional effort
  • The bottom line: fixing the exposure and messaging problem

The Startling Decline in Public Health Worker Numbers

How large is California’s public health workforce gap?

Put simply, the gap is huge. A study published in March 2023 noted: “Nearly half of all state and local public health employees left their jobs between 2017 and 2021. An additional 80,000 workers are needed to provide a minimum set of public health services to citizens.”

While most of us have heard about shortages in clinical staff, particularly nursing, on the heels of the Covid-19 pandemic, what you might not realize is that non-clinical workers make up a significant part of the public health workforce. 

How many public health workers will we need by 2030?

Projecting the future needs of the public health workforce is made all the more difficult by the reality that data is incredibly fragmented. Presently, due to the lack of a central data source, it is nearly impossible to keep tabs on the whole of the public health workforce or plan for upcoming gaps, since there is “no single source of data that encompasses all workers in the public health workforce.” That said, it’s easy to gain a clearer picture of the whole by considering anecdotal information that can be found easily in any public health department within the Inland Empire. In Riverside County, as an example, a posting for an epidemiologist was open for three months without a single qualified applicant found.

This leaves public health across the country in a purely reactive state. Needless to say, we are unprepared to face another pandemic, and the academic consensus is that we are not wondering if there will be another global pandemic, but instead are contemplating when. 

The Root Causes: Why are public health workers leaving?

Retirement of Lifelong Employees

One of the key contributors to the upcoming departure of many of our public health employees currently is age. According to Dr. Jeff Leung, Riverside County Public Health Officer: “Many people who join public health stay in public health for their whole career.” That means that when they leave after 20 or even 40 years, they take a wealth of knowledge along with them, creating a vacancy that is very difficult to fill. 

While many people immediately think of doctors and nurses when the term “public health” is mentioned, the shortages extend beyond clinical settings. 

Positions facing severe shortages include: 

  • Health and medical managers
  • Hospital and healthcare administrators
  • Biostatisticians
  • Management consultants specializing in healthcare
  • Epidemiologists
  • Occupational health and safety specialists
  • Social and community services managers
  • Health education specialists

Covid-19 Burnout

The pandemic had a profound effect on the state of public health in this country. When it began, those in the field were put under extreme pressure, partially fueled by the fear gripping citizens around the globe. That pressure, coupled with the longevity of the pandemic, led to a significant portion of the workforce citing burnout and departing. 

Beyond the pandemic’s direct effects, Covid-19 also swung a spotlight onto a field that typically operates, as Saruwatari said, behind the scenes. The public had opinions on the way the pandemic was being handled on a variety of levels, thanks in part to the politicization of the issue, and public health departments took a lot of criticism. This lack of public support for what is a fundamental and under appreciated function of society created a hesitancy for those who might have been considering careers in the public health field. 

Lack of An Established Career Pipeline 

Because public health has often operated under the radar of most peoples’ awareness, the career options within the field are not the kinds of things that children grow up planning to pursue. Without exposure to the wide range of career opportunities available, those rising through our schools choose alternative paths instead. 

A Slow-Moving Government Engine

The nature of the public health field–that it is a government job–is part of the issue in several ways. For one thing, government careers don’t offer the reliable benefits and pensions that once led so many to opt for the security of a government job over higher salaries in the private sector. With pensions disappearing, government positions are being forced to compete on salary, where private organizations often have the upper hand. 

For new graduates facing student loan debt, these numbers matter. According to a recent future workforce study, “the top three reasons that upcoming and recent grads would turn down a job include low pay, poor work-life balance, and unattractive benefits.”

Government departments are further burdened by a notoriously laborious hiring process that often takes months. It is unrealistic to expect that graduates can put off making rent, car, and loan payments for months at a time in order to compete for a job that most likely pays less than the private sector can. 

How will the shortage in public health workers affect us? 

Good question. It will affect every single citizen living in the United States if this problem isn’t solved in the near future, even more so in the Inland Empire, given that so many qualified candidates move to bigger cities in California to work, like Los Angeles, San Francisco, or San Diego, exacerbating the shortages faced in our region. The current shortages make it difficult for departments to handle routine community care, and impossible to mount a surge response like that which would be needed for another pandemic. 

Public health addresses many of the things that make up our communities, things we take for granted. According to the 2022 book, Public Health: “Common public health issues and concerns include environmental quality (clean air, water, and food), sanitation, climate change, health equity, health reform, access to healthcare, tobacco use and exposure, mental health, injury and violence, physical activity, nutrition, obesity, and vaccination.”

The current crisis should be top of mind for all of us, but particularly: 

  • Policymakers who deal with the overall health of their communities and create legislation in the event of public health emergencies
  • Hospitals, which are on the front lines of any public health outbreak or crisis and are dealing with shortages of their own
  • Schools who can look at this as an excellent opportunity to create candidates ripe for positions in an eager market

Solving the Problem with a Coordinated, Regional Effort

It is clear that the diverse Inland Empire needs more highly skilled, cross-culturally competent public health workers. We need to attract them and make it worthwhile for them to stay. 

The good news is that there are ways to accomplish this and many efforts underway to put these ideas into action, but it is a community effort that will take proactivity, collaboration, and deep coordination across organizations like ours, public health departments, universities, and school districts.

1. Expanding Health Pathways Funding

Students don’t necessarily understand what jobs exist in public health, and it is up to those seeking applicants to change this. Private companies attend job fairs and set up tables on campuses during career week, but public health is not usually there. In order to plan for a career, students need to know it exists. They need to understand what the jobs are, what the titles are, and what kind of preparation goes into securing them. They need to know what these jobs pay and what they can expect for their futures if they embark on a career in public health. 

Assembly Bill 1695 – a bill that would provide funding for a Nursing Pathway Program, which would provide an Associates in Nursing from any of California’s community colleges at several schools serving ninth through twelfth graders – is an excellent start.

However, we need similar funding and support for nonclinical pathways including management, administration, and education within the public health field, and we need to expand these into middle schools if we truly want to instill interest early on. Building pathways that increase exposure to career possibilities in public health creates a new generation of motivated and prepared applicants to enter the field. But funding is needed, and programs should start as early as possible in the schools.

2. Enhancing Collaborative, Project-Based Curriculum Design

Our workforce shortage isn’t just a factor of quantity. Equally important to the livelihood of our region’s public health is the quality of candidates we’re attracting and hiring. Public health departments often cite that candidates they’re recruiting – many of whom come from leading public health schools – still are not equipped with all of the soft and hard skill sets needed to excel in a modern public health environment.

Some skill sets traditionally missing in applicants include:

  • Grant writing: since 90% of health departments are funded by grants, writing applications is critical.
  • Budgetary competency: understanding how budgets are built and how to monitor them.
  • Complex data skills: applicants need to know how to mine data for insights and how to turn those insights into actionable strategy to direct limited resources for the most impact.
  • Technology and software: the tools have changed and will continue to evolve. The workforce needs to be adept at learning new tech and implementing it quickly. 
  • Grassroots interactions: with so many applicants having come up through remote education and relying on screens, many are unsure how to connect within their communities.
  • Written communication: training in proper and professional communication is crucial. 
  • Public speaking: the ability to motivate and mobilize groups is important, as is presenting recommendations and findings in order to inspire action. 

By increasing collaboration between public health departments, middle and high school CTE departments, and the schools of public health within our region, up-to-date training can be created to ensure that graduates are ready to step into active roles on day one, and are equipped with the skills needed to add value to a modern public health department. Collaborative, project-based curriculum design is one way to ensure that these programs meet the needs of the schools and also of the public health departments they ultimately funnel to. 

3. Rethinking HR Practices to Fit the New Workforce

Digitizing & Streamlining the Hiring Process

The current process takes far too long and has too many steps to be an effective way to fill critical -need positions. Though government agencies are notoriously slow to move, this is one area where accepting the status quo will cost us immensely, both in the near and long term.

Re-assessing Compensation Packages

The best talent will not settle for lower compensation, and when inflation is at record highs, graduates will not accept less than they would make in the same job in the private sector. The ongoing lack of funding to make salaries competitive continues to deter talent. It is critical that government agencies assess pay in comparison to industry benchmarks, knowing that for many of those who do choose a role in public health, it’s a choice they maintain for life, making them extremely valuable workers. 

More On-the-Job Training & Room for Promotions

Another way to offset the burden those in this field often feel is by investing in on-the-job training to ensure those new to the field can ramp up rapidly. Finally, job pathways must be identified for those who are interested in up-leveling inside the field. Many people leave because they have no upward trajectory.  

4. Addressing the Storytelling Problem in Public Health

Public health is an opportunity that has not been properly represented, especially as a generation rises that has demonstrated a desire to impact the world in a positive way. Students today are more invested in working for the greater good than any generation in recent memory, and public health is a very concrete way to ensure your work life has a real community impact. 

“In public health, we’re not impacting one person,”  Saruwatari noted. “It’s neighborhoods, communities, cities, entire counties.” 

 Saruwatari went on to talk about what inspires her to remain in the field and to do her best to recruit interested graduates to public health: 

“The thing that keeps me going is the desire to really get upstream and get people healthy so we can prevent the chronic diseases that are making them sick and keeping them home, keeping them from doing the things they love. I want Riverside County to be the healthiest county in the country. I want people to move here because they know we have an environment where they’re going to thrive.”

There is a lot of talk about the desire to work in a role that has a real impact on the world, and there is no question that public health offers such a place. For those coming out of corporate positions who have potentially felt empty or less than meaningful, public health makes a great second career. The field is eager for those with experience in tech, management consulting, strategy, marketing, change management, and more. 

The Bottom Line 

We’ve highlighted four major issues contributing to the need within public health, but what we really require is more forums and collaborative groups convening to hammer out the issues and find solutions. Some of this work is taking place, for instance in the Public Health Leadership Consortium led by Reach Out, where we are bringing together public health departments and public health colleges, along with workforce development boards and some funders to discuss how to approach the very real shortages within this critical field. We’re also part of Thrive Inland SoCal, which is discussing this issue along with others impacting our communities and economic development initiatives. 

It’s not enough, though. For this work to have the impact the Inland Empire needs it to have, more funding and more involvement from the K-12 community is needed. In order to build exposure pipelines to attract the bright young minds from within our community to take on this work, this crisis needs to be front of mind for those with the funds to help elevate it. Our kids deserve the awareness that K-12 exposure pipelines bring to the kinds of opportunities available to them, and our communities deserve to have fully staffed public health departments to ensure their well being. 

Without programmatic, coordinated exposure – and the funding required to deliver those programs – we’re one mass outbreak away from a recurrence of 2020, something our region and our people cannot afford. It’s due time – as policymakers, educators, funders, and community leaders – that we recognize the gravity of this challenge, while at the same time, not missing the profound opportunity to set the next generation of health workforce professionals up for success, while revitalizing the face of a profession that is ripe with opportunity to serve and enact change amidst a generation that is searching for an outlet to do so.

__________________

To learn more about Reach Out’s Public Health Leadership Consortium and our Work-Based Learning programs, or to inquire about funding initiatives for the public health workforce, contact Dr. Shermineh Davari: shermineh at we-reachout.org