Public Health Workforce Bills Address Growing Staffing Crisis

January 25, 2022

Senate health committee chair Patty Murray (D-WA) and ranking Republican Richard Burr (NC) Tuesday (Jan. 25) released a discussion draft of their future pandemic response legislation that includes provisions to revitalize the Public Health Workforce Loan Repayment Program.

The bipartisan legislation focuses on strengthening the nation’s public health and medical preparedness and response systems in the wake of the COVID-19 pandemic. It includes a provision to repay loans to public health workers in exchange for their work in a state, territorial, tribal or local public health department. The provision is meant to counter a rising workforce crisis in the public health sector, which mirrors a similar shortage in other health care sectors.

“We’ve all seen how damaging it is when communities can’t get tests, health care facilities can’t get masks, public health experts can’t get comprehensive data, and families can’t get clear, reliable information,” Murray said. “We’re painfully aware of how the trauma of a pandemic can worsen a mental health crisis, and magnify damaging health inequities in communities. After everything our nation has been through these past two years, we owe it to everyone who worked so hard to get us through this crisis to take every step we can to make sure we are never in this situation again, and that’s what this bill will help us get done.”

The new bill also includes direct funds -- though the total amount is not included -- meant to shore up the public health workforce.

Direct funds would be used “to recruit, hire, and train community health workers; support community health workers in providing education and outreach in their communities; address social determinants of health and eliminate health disparities; and to educate community members,” the bill says.

Beyond funding and loan forgiveness, the new bill would require the Government Accountability Office to conduct a thorough evaluation of the state of the public health sector to determine a course of action. It also would reauthorize a community health worker program, which would extend community health workers’ education efforts in medically underserved communities to promote healthy behaviors and outcomes.

Murray and Burr’s new legislation, Prepare for and Respond to Existing Viruses, Emerging New Threats, and Pandemics Act, joins a handful of other bills aimed at supporting the public health workforce, which has suffered serious losses during the COVID-19 public health emergency.

Sens. Cory Booker (D-NJ), Susan Collins (R-ME), Lisa Murkowski (R-AK) and Tina Smith (D-MN) on Jan. 13 reintroduced the Strengthening the Public Health Workforce Act, a bipartisan bill aimed at recruiting young health professionals into public health roles in state and local public health departments.

Public health stakeholders applaud the bill’s reintroduction, which would provide $35,000 in student loan assistance for each year served in a public health role. It was designed to respond to an ongoing workforce crisis in the public health sector, which began in the mid 2000s and has since escalated, particularly at the state and local level.

Though the new bills are specifically focused on supporting public health workers, the overall implications of a bolstered public health workforce could also have significant benefits for other health care sectors.

Stakeholders including the American Academy of Family Physicians have emphasized the importance of a community-oriented care system that integrates primary care with public health.

“We are supportive of efforts to ensure state and local health departments are adequately staffed and resourced to ensure public health needs of the community are met,” AAFP said in an email. “Family physicians play a critical role in the integration of primary care-public health, and can continue to contribute through inclusion of local, regional, state, and national public health partners within the medical neighborhood.”

The bill was initially introduced in the Senate in May 2020, but stalled. Omicron rates have stretched health care providers and public health officials to a breaking point, however.

During a Jan. 11 Senate health committee hearing, Rochelle Walensky, director for the Centers for Disease Control and Prevention, said America is facing a workforce shortage of over 80,000 jobs, leading to workforce burnout and rising turnover of those who remain.

The crisis could worsen if left unaddressed. Nearly a quarter of public health staffers are eligible for retirement this year, and over 55% of staff are over age 45, meaning rates of retirement could increase in the coming years.

“Local and state health departments have lost nearly a quarter of their workforce since 2008 and many more public health workers are set to retire in the coming years,” Booker said.

In a 2020 position paper, AAFP says family medicine must align with the public health sector to promote community-oriented primary care and a "whole-person concept of health,” especially for broad systemic change to be successful.

“Evaluating and measuring how primary care and public health work together may assist physicians, practices, and policymakers as they align local resources to improve population health,” the paper says.

Beyond the two new bills, workforce strain has prompted the introduction of several other pieces of federal legislation, including the BIO-Preparedness Workforce Act -- a bill designed to recruit and retain infectious disease clinicians and health care providers -- and the Strengthening the Public Health Workforce Act, which is a complementary bill geared specifically toward recruiting and retaining public health workers.

“This bipartisan legislation would help rebuild our public health capacity, mitigate the spread of COVID-19 and future pandemics, and provide much needed relief to health care workers who have shouldered the burden of understaffing throughout the pandemic,” Smith said in a statement.

The National Association of County and City Health Officials applauded legislators for reintroducing the bill. Adriane Casalotti, NACCHO’s chief of government and public affairs, said NACCHO hopes loan forgiveness will help public health departments retain staffers who have entered public health to assist with public health emergency response efforts.

“Every day counts -- for as long as this is still a great idea and not an implemented program, we are leaving opportunities on the table to recruit and retain top talent into public health departments where we need them,” Casalotti said.

Casalotti said the federal government’s recruiting initiatives for health care providers have been widely successful; NACCHO’s goal for the Strengthening the Public Health Workforce Act is to create a similarly strong recruiting initiative for public health roles.

“Public health departments are always working behind the scenes, to try and address multiple challenges, whether or not we’re actually paying attention to them,” Casalotti said. “The investments that the bill could bring are not just needed during a pandemic response -- this is needed every day for their work, whether it be keeping the water safe in your community, inspecting restaurants, getting your kids their vaccines on time, there’s a host of things that health departments do every day that they don’t get a lot of attention for."

The administration is also taking steps to address the public health workforce issue. Peter Sinclair, a spokesperson for the Health Resources and Services Administration, said HRSA will begin accepting applications for two new programs, funded by the American Rescue Plan, beginning in February. The Community Health Worker and Paraprofessional Training Program and the Public Health Scholarship Program will support training to expand the public health workforce, he said.

“The first will provide nearly $240 million to create a pipeline program for 13,000 community health workers and paraprofessionals from underserved communities,” Sinclair said in an email. “HRSA will also invest nearly $39 million to support organizations for developing scholarship programs that incentivize individuals to pursue careers in public health.” -- Bridget Early (