The crisis with the public health workforce is not a new threat. Reports over many years warned of this imminent danger.1–4 The average age of a state public health worker is 47 years and by 2012, greater than 50 percent will be eligible for retirement.5 It is estimated that an additional 250000 workers need to be trained by 2020,6 creating a daunting challenge for current educational structures. A 2004 report by the Council of State and Territorial Epidemiologist noted that 48 percent of epidemiologists in state and local public health agencies were not academically trained.7 Twenty-nine percent of local health departments experience difficulties in recruiting epidemiologists.8 Other acute shortages exist in nursing, laboratory science, and environmental health.9 Across most sectors of public health, wages are noncompetitive8 and potentially contribute to the current shortages and low educational attainment rates of the workforce. In one state health department, more than 60 percent of the workforce lacked a college degree.10 Also, the workforce in 68 percent of local health department jurisdictions is less diverse than the populations that they serve,8 potentially limiting capacity to address health disparity issues. A methodical, long-term plan of action in response to this predicament is needed.
Traditionally, entry into the field of public health is at the graduate level with a master of public health degree. Advancements have been made to increase the number of bachelor's degree programs focused on public health but, historically, graduate studies are seen as the “gold standard”6(p4) in public health education. There are roughly 25 undergraduate public health–related degree programs in accredited programs and schools of public health across the country.11 Historically though, because the traditional path to a career in public health was at the graduate level, there was limited opportunity to attract and educate entry-level workers who did not have an undergraduate degree.
Given the dire public health workforce crisis, solutions must be formulated to attract more students to this field in addition to educating the existing workforce. Following the lead of other industries and sectors of healthcare, collaboration with the nation's community college systems is an option that should be considered by public health systems. Allied health education for decades has represented a sizable portion of community college programs. Other professions such as pharmacy, dentistry, and engineering have utilized the nation's community college system to attract undergraduate students as a means of building a strong and competent workforce. Many industries also utilize the community college system to market their professions as well as for creating structures for life-long learning experiences.
There are close to 1200 community colleges in the United States. Half of all undergraduates in the nation are educated at community colleges.12 Many community colleges exist in a system with campuses scattered throughout states similar to some state public health systems. Articulation agreements between community colleges and 4-year graduate degree granting institutions create opportunities for seamless educational experiences for students starting with the first year of college through a graduate or even a terminal degree, if desired. As an illustration, Tulsa Community College has an agreement with the University of Oklahoma that begins with 2 years at Tulsa Community College and culminates for students 4 years later with a doctorate in pharmacology from the University of Oklahoma.13 The institutions developed the agreement in 2002 as a proactive response to estimates of severe shortages of pharmacists in the region. The public health workforce is undereducated at all levels; so, a similar public health model should allow students to take career paths at various intervals and not solely at the doctorate level. But simply raising their awareness to that opportunity is a positive step, because many students may never have considered a terminal degree as an option.
The dental profession collaborates with community colleges to reach out to students from vulnerable populations. They view community colleges as feeder institutions, especially for students who have been marginalized.14 Forty-seven percent of all African American and 56 percent of all Hispanic undergraduate students attend community colleges.12 Reports show that high school students interested in entering an occupational field are more likely to attend a community college.15 Fifty-nine percent of new nurses and the majority of other new healthcare workers are educated at community colleges.15 In addition, when addressing the issue of retention of professionals in public health, it is worth noting that 61 percent of community college students who earned an occupational associates degree were in jobs related to their fields, the highest for any category of community college graduate.15
The community-focused mission of community colleges fosters an intimate bond between them and their service regions. This orientation has synergy with the population health mission of public health. Given the focus on community, community colleges are an excellent platform to promote public health service-learning opportunities. Service-learning programs create intense learning experiences and educational institutions and professions are taking note of that.16 The dental profession embraced this concept by rotating students in community dental care facilities,16 a model that fits well with the delivery of public health services. Attracting students from vulnerable populations to work in service-learning programs in undeserved communities could have benefits that extend across society. For that reason, philanthropic and corporate entities seeking to fund strategies that reduce social inequities should consider this model, given the potential for achieving short-term wins that translate into profound long-term impacts.
An astute educator asserted that higher education was in fact an issue of public health, given its impact on improving “the very quality of human life.”17 (pB16) Educational attainment levels and the associated ability to increase income are directly related to achieving health equity. Partnerships between the public health and community college systems would increase these opportunities for Americans while creating environments for segments of the population to live healthier and more productive lives. This approach should be embraced by public health and combined with more traditional programs to address the workforce crisis. This strategy will educate the workforce to market the field of public health, while also increasing opportunities to elevate the socioeconomic status of students, which has a positive impact on individual and community health status.
1. Draper DA, Hurley RE, Lauer J. Public health workforce shortages imperil nation's health. Center for Studying Health System Change, research Brief no. 4.http://www.hschange.org/CONTENT/979/
. Published April 16, 2008. Accessed February 8, 2008.
2. Association of State and Territorial Health Officials. State Public Health Employee Workforce Shortage Report: A Civil Service Recruitment and Retention Crisis
. Arlington, VA: Association of State and Territorial Health Officials; 2004.
3. Gebbie K, Rosenstock L, Hernandez LM, eds. Who Will Keep the Public Healthy? Educating Public Health Professionals for the 21st Century
. Washington, DC: Institute of Medicine of the National Academies; 2003.
15. Adelman C. Moving Into Town—and Moving on: The Community College in the Lives of Traditional-Age Students
. Washington, DC: Office of Vocational and Adult Education, US Dept of Education; February 2005.
16. Yoder KM. A framework for service-learning in dental education. J Dent Educ