A lack of healthcare workers leaves the US vulnerable to emerging health crisis

We might be even less prepared for the next public health emergency than we were for the last one.

After all the billions of dollars on pandemic era upgrades to labs and data and surveillance, after all the studies and convenings and white papers about emergency preparedness, the U.S. still lacks two crucial things in the public health arsenal.

People. And trust.

Without an adequate public health workforce, and without trust in those people and the work they do, the U.S. could get caught flat-footed once again.

Two research papers published this week in the journal Health Affairs quantify what we more or less already knew. America’s public health workforce is depleted. And Americans are a skeptical bunch; they don’t have a huge amount of trust in public health nor its messengers, although the trust deficit may not be quite as deep as you’ve heard.

Unless something changes and fast, “our health departments will be empty and no one will be paying attention until it is way too late,” said Brian Castrucci, a lead author of the workforce study and the president and CEO of the de Beaumont Foundation, which focuses on public health.

Amid low pay, long hours, cumbersome bureaucracy and, nowadays, abuse and threats so severe that researchers found huge numbers of public health workers had at least some symptoms of PTSD, public health workers are quitting in droves — and the exodus began even before Covid-19 made everything harder. Nearly half quit between 2017 and the end of 2021, and it’s not just pandemic-exhausted older workers choosing early retirement. The under 35s are also fleeing. That means not just a loss of workers for now, but no pipeline for leaders of the future, pointed out a worried Georges Benjamin, executive director of the American Public Health Association. “That knowledge base is going out the door,” he said.

The shortages in the public health sector aren’t getting anywhere near as much attention as labor challenges in the health care system. Doctors and nurses and others who take care of patients are of course important, said Castrucci. But letting public health erode leaves us vulnerable in different ways.

“It’s like opening the gates that protect the army,” he said. “If we don’t have a strong public health system, there’s no way we can have enough hospital beds to make up for the problems.”