Linda Rosenstock: Nation needs more public health workers

As presidential politics shine a light on our very expensive – $2 trillion and growing – fragmented and inefficient health care system, a critical component with implications for all of us is at risk in the shadows.

By 2020 we will require an additional 250,000 public health care professionals in this country, about one-third of the number of workers needed to meet our vital public health care functions.

A new report, "Confronting the Public Health Workforce Crisis" by the Association of Schools of Public Health, builds upon the widespread consensus that there are insufficient and inadequately trained public health professionals to address current and future needs.

Our current public health work force – including physicians, nurses, epidemiologists, environmental and infectious disease specialists – is struggling to keep up with an increasingly complex array of challenges. These professionals are at the forefront working to ensure clean air and water, safe food and workplaces, and preventing infectious and chronic diseases. But even more important, they are relied on to confront dramatic new threats, many brought about by globalization, including emerging infectious diseases, health effects of climate change and threats of disasters ranging from a terrorist act to another hurricane the magnitude of Katrina.

The estimates of this looming crisis are sobering at face value, yet do not reflect that 23 percent of the current public health work force will be eligible to retire in the next five years. Nor do they include the increased need for American public health professionals to address the global public health work force crisis faced by the developing world.

For California, it is estimated that the current public health work force will need to increase by nearly 50 percent, adding 27,000 new workers. Just last year the University of California system recognized its critical role in addressing this shortage. Unfortunately, the plan for the UC system to double its capacity to educate graduate-level public health professionals in the next decade was abandoned – the latest casualty of state budget woes.

Despite the alarm bells sounded in this work force projection, there is an affordable solution.

We know public health interventions – whether prevention of disease through vaccines or population efforts to combat smoking and obesity – are a wise investment. The health advantages generated per dollar simply dwarf the costly medical care interventions that otherwise follow. For that reason alone we know that public health needs to work hand in hand with our broader health care system.

Current college students are enthusiastic about the benefit of working in public health, with an opportunity to help save lives not just one at a time, but thousands and even millions at a time. These are the same students turned away from existing schools of public health because programs are at capacity. Students have the will, our nation has the need, yet we aren't making advances to reconcile the two.

To address this work force shortage we need to be bold – we need something like a National Public Health Emergency Plan to tap into remarkable interest for public health careers through recruitment, financial support and incentives to direct professionals where the need is greatest.

Recently, Rep. Doris Matsui, D-Sacramento, joined Senate colleagues in introducing the "Public Health Preparedness Workforce Development Act," an essential first step.

Projections indicate that an initial investment of about $30 million annually at the federal level would put the country on the right track to satisfy the demand for highly skilled public health professionals. After all, this work force crisis isn't really about the "public" – it is a threat to each of us as individuals, our families and our communities. Fortunately, this one can be solved, and at the cost of tens of millions of dollars, it is a relative bargain.

About the writer:

• Dr. Linda Rosenstock is the dean of the UCLA School of Public Health.