Abby Vogel

Context: A new tool, the Public Health Workforce Calculator (“Workforce Calculator”), was developed near the onset of the COVID pandemic to help agencies estimate the staffing they would need to fully implement the Foundational Public Health Services (FPHS). The data underlying the Workforce Calculator algorithm was from pre-pandemic time periods. Objective: To assess whether the Workforce Calculator continues to reliably estimate staffing need in a peri-COVID context. Design: Local health departments participated in the National Association of County and City Health Officials Profile survey, which for a random half of agencies, stratified by jurisdiction size, contained a module that asked them to estimate the FTE they would need to fully implement FPHS. For each of the 108 valid responding agencies, these data were compared with the Workforce Calculator output that the agency would have received to assess whether the Workforce Calculator was concordantly estimating staffing needs. Main Outcome Measure: We assessed concordance between the reported staffing needs and the Workforce Calculator’s estimates, both graphically and quantitatively, using Lin’s concordance correlation coefficient. Results: For most FPHS categories, the Workforce Calculator systematically underestimated the amount of staffing needed for full implementation relative to agencies’ reported needs. Conclusions: Post-COVID staffing needs systematically appear more substantial than the pre-COVID data on which the Workforce Calculator was based. An update to the Workforce Calculator using post-COVID data would benefit end users.

Objectives. To understand the landscape of the nonfederal governmental public health workforce and to identify replicable methods for future enumerations. Methods. This enumeration of the state and local public health workforce was conducted from 2023 to 2024 and triangulated the National Association of County and City Health Officials (NACCHO) Profile 2022 and the Association of State and Territorial Health Officials (ASTHO) Profile 2022. We utilized Public Health Workforce Interests and Needs Survey (PH WINS) data from 2021 to assess demographic distributions across Department of Health and Human Services (HHS) regions in the United States. Results. A total of 239 000 staff were employed in state and local health departments in 2022, a 2% increase since 2012. Sixteen states—including 6 in the Southeast—lost staff relative to population growth. Conclusions. An uneven landscape of public health workforce density reflects chronic underinvestment in public health. The process of enumeration itself was also fraught with pitfalls and data limitations. Public Health Implications. We recommend building on federal investments to develop dedicated funding streams for state and local public health. We also recommend amending federal efforts around enumeration to include governmental public health at all levels. ( Am J Public Health. 2025;115(5):716–725. https://doi.org/10.2105/AJPH.2024.307964 )

Objectives. To expand on previous enumerations by assessing the size and composition of the governmental public health workforce in the wake of the COVID-19 pandemic, identifying workforce trends, occupational distributions, and potential gaps in staffing. Methods. From 2023 to 2024, using 2022 data in the United States, we conducted 3 distinct analyses: (1) estimating the total workforce size, (2) profiling occupation-specific distributions, and (3) evaluating the role and prevalence of public health nurses using novel data sources. For total counts, we used multiple imputation by chained equations to develop robust agency-level estimates and address missingness from multiple data sets. Results. State and local public health agencies grew to approximately 239 000 staff in 2022, up from an estimated 206 500 in 2019. The largest occupation groups included office and administrative support workers (37 576) and public health or community health nurses (29 387). We found that 73 478 (1.8%) of registered nurses nationwide served in governmental public health roles. Conclusions. The size of the workforce during the COVID-19 response has returned to 2008 levels although temporary staff largely constitute the increase. Public Health Implications. An undersized workforce leaves the United States vulnerable to future disasters and current challenges. ( Am J Public Health. 2025;115(5):707–715. https://doi.org/10.2105/AJPH.2024.307960 )

The public health workforce (PHW) counts a great variety of professionals, and how services are delivered differs in every country. The complexity and the diversity of PHW professions also reflect structural problems of supply and demand of PHW in various organizations and health care systems. Therefore, credentialing, regulation, and formal recognition are essential for a competent and responsive PHW to address public health challenges. To ensure comparability of the credentialing and regulation systems for the PHW and to enable its collective action at the macro level in the event of a health crisis, we systematically analyzed documented evidence on the PHW. A systematic review was selected to answer the research questions: (1) what are the most effective aspects and characteristics in identified programs (standards or activities) in professional credentialing and regulation of the PHW and (2) what are common evidence-based aspects and characteristics for the performance standards to support a qualified and competent PHW? The identification of professional credentialing systems and available practices of the PHW was performed systematically using a systematic review of international resources in the specialized literature published in English. The PRISMA framework was used to verify the reporting of combined findings from three databases: Google Scholar (GS), PubMed (PM), and Web of Science (WoS). The original search covered the period from 2000 until 2022. Out of 4839 citations based on the initial search, 71 publications were included in our review. Most of the studies were conducted in the US, UK, New Zealand, Canada, and Australia; one study was conducted in an international context for professional credentialing and regulation of the PHW. The review presents specific professional regulation and credentialing approaches without favoring one of the proposed methods. Our review was limited to articles focused on professional credentialing and regulation of the PHW in the specialized literature published in English and did not include a review of primary PHW development sources from international organizations. The process and requirements are unique processes displaying knowledge, competencies, and expertise, regardless of the field of practice. Continuous education, self-regulatory, and evidence-based approach can be seen as common characteristics for the performance standards on both community and national levels. Certification and regulation standards should be based on competencies that are currently used in practice. Therefore, answering questions about what criteria would be used, what is the process operation, what educational background the candidate should have, re-examination, and training are essential for a competent and responsive PHW and could stimulate the motivation of the PHW.