Understanding and Supporting the Public Health Workforce: Why it Matters
The COVID-19 pandemic was the single most cataclysmic health event since the great influenza pandemic of 1918–1919. By the end of 2023 in the United States alone, the pandemic had resulted in hundreds of millions of illnesses, 6.5 million hospitalizations, and more than 1 million deaths.
Working within a coordinated public health system, the unsung public health workforce helped mitigate the health impacts of the pandemic by providing day-to-day surveillance data, educating the public on control measures like isolation and physical distancing, and administering almost 200 million doses of COVID-19 vaccine in 3 months in 2021. The vaccination effort alone is estimated to have prevented 2.2 million deaths and 17 million hospitalizations — and saved $1 trillion in healthcare costs.
Advocating for the Public Health Workforce
Although the critical role that public health nurses, epidemiologists, and emergency preparedness workers played on the front lines of the COVID-19 pandemic raised awareness of the role of public health, the pandemic also brought attention to inadequate staffing levels at state and local health departments. Furthermore, select public health recommendations and activities evoked outright hostility from some political leaders and community members — who in some cases directly threatened public health workers for doing their jobs.
The public health workforce’s determination to protect and improve the health and safety of the population through collective efforts of society is usually not so visible. Despite the important contribution public health workers make to the health status and quality of life of the individuals, families, and communities they serve, careers in public health still do not receive appropriate recognition or respect. This is due in part to the fact that when public health efforts are successful, nothing happens.
In addition, the current political environment is threatening funding for — and questioning the value of — public health efforts. This increases stress on public health leaders and their teams. For all these reasons, it is essential that we advocate for the public health workforce, and importantly why The Future of Public Health Starts Here: Strengthening the Public Health Workforce is a key priority for National Public Health Week 2025.
Defining the Public Health Workforce
Efforts to define the public health workforce take into account three important aspects of public health practice: work setting, work content, and the workers themselves.
The Work Setting
Public health workers are employed by organizations that promote, protect and preserve the health of a defined population group. Such organizations may be public (i.e., federal, state, tribal, local, tribal and territorial governmental public health agencies) or private (i.e., hospitals, health insurers, and community-based organizations).
Public health objectives may be primary or subsidiary to the organization’s principal objectives. For example, school nurses working for the local school district, researchers working for the American Cancer Society, and community health educators employed by the local hospital can be viewed as part of the public health workforce.
Organizations such as the Association of State and Territorial Health Officials and the National Association of City and County Health Officials conduct regular surveys that help describe workers who are employed in state and local health departments, while the Public Health Workforce Interests and Needs Survey provides information on the size and composition of the governmental public health workforce and its changes over time.
The Work Content
Multidisciplinary public health teams perform work addressing one or more of the 10 Essential Public Health Services (EPHS). Examples of an essential service (ES) are:
- Environmental health technicians assess and monitor population health status related to environmental health issues (ES 1).
- Epidemiologists investigate, diagnose and address root causes of diseases (ES 2).
- Public health educators communicate to inform and educate about health (ES 3).
- Attorneys take legal and regulatory actions to protect the community (ES 6).
- Community health workers enable equitable access to health and other services (ES 7).
To achieve programmatic success, it’s important to have a diverse public health workforce that corresponds with the populations it serves (ES 8). A focus on populations, as opposed to individuals, is a distinguishing characteristic of these job descriptions. For example, an individual trained as a health educator who works for a community-based teen pregnancy prevention program is clearly a public health worker.
The Workers
Public health workers are defined by the completion of formal education and, in some cases, licenses to practice. Public health workers may earn degrees in public health, in other fields, or hold degrees in both public health and another profession. For example, the public health workforce includes physicians, dentists, nurses, social workers, engineers, and lawyers.
Public health workers can also be defined by the skill areas or core competencies they have mastered, such as epidemiology, health education, sanitation, statistics, or nutrition. However, a worker’s educational and training background might not coincide with their profession or job function. For example, a local health department nurse might be trained to investigate cases in a disease outbreak, performing as an epidemiologist with demonstrated competency but not formal education in epidemiology.
The Public Health Workforce of the Future
Despite the remarkable achievements of the last 125 years, public health has much to do. Potential barriers to ongoing progress include global environmental threats, the disruption of vital ecosystems; population overload; persistent and, in some cases, widening social injustice and health inequity; and lack of access to affordable, effective care. These are just a few in a long list of lingering health problems from the 20th century. Further gains in health status may be less related to science than to social policies.
Public health practitioners need to aspire to stay true to the principles of public health practice. These principles include focusing on the social-ecologic model of health, addressing health inequities, promoting human rights and social justice, advancing evidence-based programs, and effectively moving from a government-dominated public health system to engaging collaboratively with the larger public health system.
Explaining the value of public health to decision makers and the public — and gaining their support — are important and ongoing challenges. The focus of National Public Health Week 2025 on the public health workforce has never been more important.
About the authors: The writers of this article are the authors of The Essentials of Public Health (5th edition, 2026), published by Jones & Bartlett Learning.
Guthrie S. Birkhead, MD, MPH, is a professor emeritus in the Department of Epidemiology and Biostatistics, State University of New York at Albany School of Public Health. He worked for the New York State Department of Health for 27 years and served as Deputy Commissioner for Public Health from 2007 to 2015. He is a past member of the Advisory Committee on Immunization Practices and past member and chair of the National Vaccine Advisory Council.
Cynthia B. Morrow, MD, MPH, is an assistant professor in the Department of Interprofessionalism at Virginia Tech Carilion School of Medicine. Dr. Morrow also teaches at Hollins University in Roanoke, Va. She previously served as the Lerner Chair for Health Promotion at Maxwell School of Public Administration at Syracuse University (2014-2017) and the Commissioner of Health for Onondaga County (2005-2014).
Sylvia Pirani, MS, MPH, is a public health practice consultant who provides support to the Region 2 Public Health Training Center hosted by the Columbia University Mailman School of Public Health. She also serves as a site visitor for the national Public Health Accreditation Board. For 25 years, she worked at the New York State Department of Health, where she directed the Office of Public Health Practice.
Essentials of Public Health (5th edition)
Essentials of Public Health (5th edition) is a thorough introduction to the field of public health, blending public health practice concepts, government public health, and careers in public health.
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