Data differ considerably regarding the number of people employed in the nation’s 57 state and territorial health departments and nearly 2,900 local health departments. According to a 2007 survey by the Association of State and Territorial Health Officials (ASTHO, 2008), more than 100,000 individuals work in state public health agencies, 34 percent of whom are administrative and clerical personnel. According to a 2005 survey, local health departments employ approximately 160,000 public health workers, again approximately 34 percent of whom are administrative and clerical personnel (NACCHO, 2006).4

State and local health department workers are “graying” (Tilson and Berkowitz, 2006), and replacements—if they can be found—too often lack public health training and adequate science backgrounds. Public health careers are unattractive to new recruits because of “low salaries, poor benefits, adverse working conditions, and low status” (Tilson and Berkowitz, 2006). Severely constrained state budgets and rigid hiring practices pose additional barriers to recruitment (Gebbie and Turnock, 2006).

Having a sufficient number of employees is not enough; they also need the right education and skills to carry out their vital functions (Salinsky and Gursky, 2006). The public health workforce—federal, state, and local—continues to be widely criticized for lacking basic science preparation and appropriate public health knowledge and skills, prompting a previous IOM committee to recommend that public health workers should “demonstrate mastery of the core public health competencies appropriate to their jobs” (IOM, 2002). In local public health agencies, “Skill deficits are less apparent than worker shortages but may be more consequential in adversely affecting the quantity and quality of public health services” (Draper et al., 2008). Aware of these problems, public health schools are moving toward credentialing their graduates through the new National Board of Public Health Examiners, which may help public health agencies identify more qualified job candidates. (The two national organizations representing public health departments—ASTHO and National Association of County and City Health Officials [NACCHO]—hope to launch accreditation programs for public health agencies, as well.)

State and local health departments, like the health care system generally, lack racial and ethnic diversity among their employees. The


These survey results report data from, in the former instance, 43 states and the District of Columbia, and, in the latter case, 80 percent of local departments, so the figures do not represent a complete accounting.

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