During the 20th century, the United States' public health workforce has been of sufficient interest to policy makers that regular efforts have been made to enumerate it. Limited enumeration is found as early as 1908; the last direct federal survey occurred in 1964. After 1964, workforce size was estimated. The ratio of public health workers to population reached an estimated 220/100,000 in 1980. Data collected in 2000 yielded a ratio of 158/100,000—a 10 percent decrease. In the absence of a system to reliably collect public health workforce data such information is problematic to interpret or use for infrastructure planning and development.
During the 20th century, the size, scope and composition of the public health workforce in the United States have been of sufficient interest to policy makers that regular efforts have been made to enumerate it. Government agencies have taken the lead in most enumeration efforts, notably assisted by private foundations in the early part of the century. These endeavors have included attention to workforce location, occupations, education, and public health practice, as well as numbers of workers. Public health workforce enumerations have been published irregularly from 1926 through 2000. The most consistent episode of reporting occurred from 1947 through 1963. Workforce information, gathered from current and historical records, has been organized into tables for this study. For the years 1915–1935 and for 1946, we calculated ratios of workers to the served population from data provided in the original source. After 1946, we calculated ratios of workers to the total population using the reported data and historical national population estimates from the U.S. Census Bureau. 1
Table 1 displays five elements: the data source; the year for which each source provides workforce counts; which workers each source counted; how each source counted; and the population basis that was used for ratio calculations. Table 2 lists the number of public health workers in ratio to 100,000 persons in the population in the years referenced.
Jacqueline Merrill, MPH, RN, C, is a Project Manager, Center for Health Policy, Columbia University School of Nursing, New York.
Rula Btoush, RN, MSN, is a Research Assistant at the Center for Health Policy, Columbia University School of Nursing, New York.
Meera Gupta, MPH, is a Data Manager at the Center for Health Policy, Columbia University School of Nursing, New York.
Kristine Gebbie, DrPH, RN, is the Elizabeth Standish Gill Associate Professor of Nursing and Director of the Center for Health Policy, Columbia University School of Nursing, New York
Corresponding author: Jacqueline Merrill, MPH, RN, C, Project Manager, Center for Health Policy, Columbia University School of Nursing, 630 W. 168th Street, Mailbox #6, New York, NY 10032.
The authors thank and acknowledge the work of Robert Gerzoff of the Centers for Disease Control and Prevention. The extensive annotated bibliography of public health workforce historical documents that he has assembled provided the impetus for this study.