The wide range of activities subsumed under the rubric of public health practice is provided by a large and diverse workforce. Assessing the size and composition of the public health workforce facilitates information necessary to identify workforce gaps, forecast trends and needs, and guide workforce development policies. In sum, enumerating the public health workforce is a crucial step toward strengthening the workforce infrastructure. Despite the value in enumerating the public health workforce, this is no easy task as there is no standard system of monitoring the public health workforce or standard worker title or classification scheme. Further, public health includes diverse employment settings (federal, state, and local) entailing highly varied roles and disciplines across these settings. In the most recent effort to enumerate governmental public health workers in the United States, an estimated 290,988 were identified in federal, state, and local public health agencies.1 This chapter presents insights about the makeup of the governmental public health workforce and its disciplines, public health practice settings and evolving system changes, educational backgrounds of the workforce and training programs, and ongoing challenges for the public health workforce. (See Chapter 9: Public Health Practice in the United States.)
THE DISCIPLINES OF PUBLIC HEALTH
The two largest groups of professionals identified in public health practice are public health nurses (47,270) and environmental health professionals (23,838).1 In addition to these two professions, physicians, health educators, laboratory scientists, epidemiologists, and public health officials are most likely to be mentioned as important contributors to public health. In the early history of public health, it was professionals with an environmental focus, including engineers, who made some of the most striking contributions, assuring that drinking water was safe, sewage systems installed, and waste products appropriately handled. As the specific causes of diseases became known in the first half of the twentieth century, physicians with public health training became more prominent, and measures of disease prevention such as isolation of infected persons, tracing of individual contacts, and vaccination became important public health tools. The complete list of professions associated with public health practice includes all of those associated with medical care (dentist, pharmacist, physical and occupational therapist, psychologist, social worker), others less frequently seen in patient-care settings (occupational health and industrial hygiene, law, veterinary medicine), and many with important analytic and data skills (biostatistics, economics, informatics). Much like the healthcare workforce, the public health workforce is overwhelmingly professional (individuals with baccalaureate or higher degrees), enriched by a wide range of technicians (in laboratory, environment, and informatics, to name a few areas) and critical support staff in administrative, data entry, and other tasks.
The professions in public health are supported by an impressive array of technicians and paraprofessionals as well. Laboratory technicians, dental technicians, computer technicians, community outreach workers, and environmental technicians are all represented. In addition, because much of public health depends on documentation and communication, there is ...