NACE Journal, February 2022

Because of COVID-19, public health has been in the news. However, even now, most people are not aware of what public health is, what their local or state health department does, or what kinds of careers exist in the field. If a student asked you what careers exist in public health or how to find them, would you be able to guide them in the right direction?

The answer to this question is more important than ever as $7.4 billion is being spent over the next few years to bolster the underfunded, understaffed local, state, tribal, and territorial health departments around the United States. As a result, there are new career opportunities for every major and degree level, ranging from associate degree graduates to Ph.D.s.

What Is Public Health?

One way to understand the nature of public health is to imagine a doctor who takes care of one patient at a time. Public health professionals are like that doctor, except that their patient is a whole neighborhood, city, county, state, or even nation. Rather than diagnosing an individual’s disease, a public health professional diagnoses and treats the underlying causes that make a whole community more likely to have higher infant mortality, higher rates of lung cancer, or more opioid overdoses. These causes, or “upstream” factors, could include lack of access to prenatal care or nutritious food, exposure to dangerous air pollution from a nearby chemical plant, or even high rates of unemployment.¹ The “treatment” could range from a nutrition program to a new clean air law to a community-based intervention to reduce underlying social or economic inequities.

Until COVID-19, public health efforts were often invisible. It’s easy to see how a doctor fixed your broken arm after a car crash, but it’s harder to see how a public health effort prevented you from being hurt because of a seatbelt law. It’s easy to see how a doctor can treat you for food poisoning and harder to see how public health conducts food and restaurant inspections or requires nutrition labeling, preventing you, and millions of other people, from getting sick.
Public health efforts may be invisible, but every day we benefit from public health policies, programs, and research initiatives.

Who Provides Public Health Services?

Public health programs are delivered by a broad range of organizations, including government agencies, nonprofits, academia, and even for-profit corporations. However, certain functions of public health are delivered only by government agencies. These agencies include the 50+ state and territorial health departments and the 2,800 local (city and county) health departments, as well as tribal health departments and the broad range of federal government agencies involved with public health. These are spearheaded by the U.S. Department of Health and Human Services, which is the parent agency of the Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, the Food and Drug Administration, and the U.S. Public Health Service. Additionally, the U.S. Environmental Protection Agency and even the U.S. Department of Defense play important roles.

Some of the essential services provided by government health departments include restaurant inspections; licensing and inspection of day care centers; environmental inspections of beaches, swimming pools, and septic systems; immunization programs and registries; health education and screenings; and screening of sexually transmitted infections. Health departments also provide emergency response, newborn genetic screenings, birth and death records, laboratory testing, disease surveillance, tobacco cessation programs, maternal-child health, and nutrition programs. On the federal level, agencies ensure drugs and medical devices are safe for use, provide funding for research on public health, oversee regulation of toxic chemicals, and more.

Importance of Public Health

Government public health agencies, especially local and state health departments, have been drastically short staffed for decades. Many suffered budget cuts from the 2009 recession and never recovered.² While spending on medical treatments has risen astronomically, investments in public health have declined. It is estimated that 80,000 new people are needed to join government health departments—and that is not counting those needed to respond to the pandemic.³ That’s a big increase considering that state and territorial health departments employ around 91,500 people and local health departments have around 136,000 full-time equivalent staff as of 2019.^{4, 5} Even these numbers are likely to be overestimated, because many more staff have left health departments in the last two years due to the stress and burnout caused by COVID-19 response.

Unfortunately, due to this lack of understanding of the importance (and cost savings) of public health, health departments in many parts of the country did not have the technology or staff to respond to the pandemic, leaving the country far less prepared for a public health disaster than other countries with stronger public health systems. In response, new investments are now being made to bolster the public health workforce.

Benefits of Working in Public Health

Beyond the meaningfulness of a career where students can see that they have made a positive impact on their community, public health has other benefits.

For example, especially in government agencies, there is often more job security and better benefits than in other fields. In addition, public health professionals can access ongoing, free trainings through public health training centers throughout the country. There are also student loan forgiveness programs, such as the Public Service Loan Forgiveness program and, for individuals in certain fields—including medicine, nursing, and social work—there may be loan repayment via the National Health Service Corps program for those who work in health departments. There also are new initiatives to create loan forgiveness programs specifically for public health workers.^{6, 7}

Careers in the Field

Considering the broad range of services provided by health departments, there is a huge range of career opportunities in the field. While many other careers exist in public health outside of government, here is a snapshot of the key types of careers in local and state government health departments:

• There are 21,200 registered nurses in local health departments (LHDs), and 7,170 in state health departments (SHDs), as well as 573 nurse practitioners in SHDs and 3,600 licensed practical or vocational nurses in LHDs, with a total number of nurses at 32,500+. Public health nurses make up the backbone of local and state public health departments, but most nursing students do not hear about the career pathways they can have in public health.
• More than 20,500 staff work in the business and financial operations in public health: 8,900 (LHD) and 11,684 (SHD). People with business, accounting, or finance skills, and especially contracting and grants management, are greatly needed.
• There are more than 20,000 individuals serving as environmental health workers: 14,500 (LHD) and 5,978 (SHD). Environmental health workers conduct inspections of a broad range of public facilities, e.g., restaurants and swimming pools to ensure they are safe for public use. They may also be involved in efforts like mosquito control when an insect-borne disease outbreak occurs. There are also environmental engineers and hydrologists whose work includes ensuring the water supply is healthy. A background in biology, ecology, environmental health, or other sciences is important for these roles.
• Nearly 15,000 people serve as behavioral health staff—6,700 in LHDs and 8,278 in SHDs—provide mental health services, especially in public hospitals or carceral facilities. There are also public health social workers that provide services that prevent mental health issues on the population level.
• Health educators—7,500 in LHDs and 2,313 in SHDs—provide community-wide outreach and education programs to teach the public about healthy eating, prevention of injuries, and other health topics. They also conduct outreach to community members at events, conduct surveys, provide trainings, and create educational handouts and materials. A bachelor’s degree in public health or health education, and often a Master of Public Health degree (M.P.H.), is needed in this field.
• There are also roles in agency leadership. Senior leaders include health commissioners and department or program directors. Often requiring education and experience in public health, business, or management, these leaders are needed to supervise staff and set the direction of programs and initiatives. Currently, there are 5,800 in LHDs and 1,598 in SHDs, but with many leaders retiring, people with leadership and management experience can find opportunities in public health.
• Epidemiologists/statisticians (2,900 in LHDs, 3,939 in SHDs) are “disease detectives,” finding patterns in diseases or deaths to identify the root causes using statistical analysis that is specific to the field of epidemiology. Epidemiologists exist in a broad range of sub-disciplines, not just in infectious disease. There are cancer epidemiologists, injury epidemiologists, psychiatric epidemiologists, social epidemiologists, and others. Most epidemiologists need an M.P.H. with a specialization in epidemiology or biostatistics.
• Nearly 7,000 public health nutritionists (5,100 in LHDs, 1,610 in SHDs) provide education on healthy food and nutrition to the public and often manage services such as the WIC supplemental nutrition program. Being a registered dietitian is important but not always required for these roles, depending on the position.
• Laboratory workers (2,100 in LHDs and 4,072 in SHDs) may conduct genomic surveillance to determine when a new COVID variant of concern has arrived, find the origin of a salmonella outbreak, or test tissue or blood samples for a range of different pathogens, such as rabies. Lab workers can range from technicians with a basic biology or science background to those with advanced degrees in microbiology, virology, bacteriology, or other sciences.
• Community health workers (5,600 in LHDs) come from the communities they serve and provide an important link between their community and the services and programs that ensure community members can have the best health. These roles are often open to people without specific degrees in public health or related fields.
• Emergency and disaster preparedness and response staff (2,300 in LHDs and 1,102 in SHDs) play a crucial role in the public health infrastructure. They engage in a range of activities during emergencies or disasters, including ensuring there is safe water to drink, putting out alerts, and working with the healthcare system. A background in emergency management, public administration, or other related fields is helpful.
• Information systems specialists (2,200 in LHDs and 734 in SHDs) are critical for handling the huge volumes of data gathered by health departments. People with strong computer and data management skills are needed for this role.
• Oral healthcare professionals (2,200 in LHDs and 306 in SHDs) can provide dental health education, community screenings, and preventive services offered to community members through schools or community clinics.
• Public health physicians (1,300 in LHDs and 587 in SHDs) provide leadership and program management in a broad range of public health settings. Besides their M.D. or D.O. credential, these physicians often also have an M.P.H. or a preventive medicine residency.
• Animal control workers (1,000 in LHDs) can also be part of a local health department.
• Public information professionals (600 in LHDs and 297 in SHDs) provide communications and information that is accessible for members of the public. Special training, strong writing skills, and some background in public health are needed for this role.
• Quality improvement professionals (628 in SHDs) are needed to ensure public health and healthcare services meet regulations and requirements and continuously improve in quality.
• Other roles in health departments include office and administrative support staff (23,100 [LHD], 12,832 [SHD], total 35,932), and nursing aides and home health aides (2,200 [LHD]). There is also a need for disease intervention specialists to provide care and follow-up to people who have illnesses such as HIV/AIDS, and contact tracers to provide support for individuals who must isolate or quarantine to prevent the spread of a contagious illness. Beyond these, there are more than 100 roles in public health, including health policy analyst, advocacy director, and geographic information systems mapper.

New Opportunities

With new investments from the American Rescue Plan to bolster the public health workforce, many new career opportunities are now available for students from a broad range of areas, including:⁸

• Public Health AmeriCorps, a new program funded with $400 million in new investments over five years, will help introduce thousands of people to the field of public health, especially in “state, local, tribal, and territorial public health departments or in service to public health departments.”⁹ The program will provide “pathways to good quality public health-related careers by providing exposure through onsite experience, training, and more, with a focus on recruiting AmeriCorps members who reflect the communities in which they will serve.”
• Centers for Disease Control and Prevention Epidemic Intelligence Service will be expanded through a multi-million dollar investment. This program is a globally recognized fellowship for physicians, veterinarians, nurses, physician assistants, doctoral-level healthcare professionals, e.g., Pharm.D.s, and doctoral-level scientists, allowing participants to “work in diverse topical areas such as infectious diseases, chronic diseases, injury prevention, environmental health, and occupational health, either at CDC or at state, tribal, local, or territorial health departments.”¹⁰
• Building Laboratory Workforce and Capacity “to strengthen the public health laboratory workforce pipeline to respond to future public health emergencies” is an investment of $337 million. A related program includes the Association of Public Health Laboratories Fellowships for paid fellowships for students in a range of science and math-focused majors, including programs in bioinformatics, bio risk management, environmental health, food safety, infectious disease, informatics, quality management, and newborn screening.¹¹
• Public Health Informatics & Technology Workforce Development Program (PHIT Workforce Program) includes $80 million “to strengthen U.S. public health informatics and data science” especially through partnerships with Historically Black Colleges and Universities, Tribal Colleges and Universities, Hispanic-Serving Institutions, and Asian American and Native American Pacific Islander-Serving Institutions.¹² Opportunities may be available for computer science and data-related majors.
• There is additional funding to state and local health departments to hire community health workers for COVID response through the National Initiative to Address COVID-19 Health Disparities Among Populations at High-Risk and Underserved; and $3.4 billion in grants to support the COVID response, including contact tracing, testing, and vaccination outreach, and $500 million for school nurses. These programs will likely be advertised on the state or local level through new initiatives such as the New York State Public Health Corps Fellows program.
• CDC’s Public Health Associates Program is a two-year, paid fellowship providing excellent experience in public health, especially for new college graduates.¹³

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For students who are motivated by public service, career services professionals can be a key link to help them explore the many career paths and opportunities available in public health.

Endnotes

¹ Social Determinants of Substance Use & Overdose Prevention. Minnesota Department of Health. Retrieved from  www.health.state.mn.us/communities/opioids/prevention/socialdeterminants.html.

² Leider, J.P. (May 20, 2020). New Workforce Estimates Show Public Health Never Recovered From the Great Recession. JPHMP Direct. Retrieved from  https://jphmpdirect.com/2020/05/20/new-workforce-estimates-show-public-health-never-recovered-from-the-great-recession-then-came-covid-19/.

³ Public Health Departments Need 80,000 New Employees. But That’s Not Enough for a New Pandemic. Route Fifty, October 13, 2021. Retrieved from www.route-fifty.com/health-human-services/2021/10/80000-public-health-employees-needed/186077/.

⁴ Association of State and Territorial Health Officials. Workforce Capacity: All States. Retrieved from www.astho.org/profile/#openModal3.

⁵ National Association of County and City Health Officials. National Profile of Local Health Departments. Retrieved from www.naccho.org/resources/lhd-research/national-profile-of-local-health-departments.

⁶ Public Service Loan Forgiveness. Federal Student Aid. Retrieved from https://studentaid.gov/manage-loans/forgiveness-cancellation/public-service

⁷  Loan Repayment. National Health Services Corps. Retrieved from https://nhsc.hrsa.gov/.

⁸ Association of State and Territorial Health Officials, (May 19, 2021). Issue Brief: Public Health Workforce Funding Available Through the American Rescue Plan and CARES Act. Retrieved from www.astho.org/COVID-19/Public-Health-Workforce-Funding-Available-Through-CARES-ARP/.

⁹ FY 2022 Americorps State and National Public Health. Americorps. Retrieved from https://americorps.gov/funding-opportunity/fy-2022-americorps-state-national-public-health-americorps.

¹⁰ Welcome EIS Class of 2021. Centers for Disease Control and Prevention. Retrieved from www.cdc.gov/eis/index.html.

¹¹ Association of Public Health Laboratories. Laboratory Fellowships. Retrieved from www.aphl.org/fellowships/Pages/default.aspx.

¹² HHS Announces $80 Million in American Rescue Plan Funding (June 17, 2021). U.S. Department of Health & Human Services. Retrieved from www.hhs.gov/about/news/2021/06/17/hhs-announces-80-million-in-arp-funding-to-bolster-underrepresented-communities-in-public-health-it-workforce.html.

¹³ Centers for Disease Control and Prevention. Public Health Professionals Gateway. Retrieved from www.cdc.gov/phap/index.html.