Sustainability of the Growth of the Local Public Health Workforce During the COVID-19 Pandemic, 2019-2022

Krishna Patel, At the time of this study, all of the authors were with the National Association of County and City Health Officials, Washington, DC. Timothy C. McCall is also with the Department of Clinical Research and Leadership, The George Washington University, Washington, DC.
Timothy C. McCall, At the time of this study, all of the authors were with the National Association of County and City Health Officials, Washington, DC. Timothy C. McCall is also with the Department of Clinical Research and Leadership, The George Washington University, Washington, DC.
Margaret Cunningham, At the time of this study, all of the authors were with the National Association of County and City Health Officials, Washington, DC. Timothy C. McCall is also with the Department of Clinical Research and Leadership, The George Washington University, Washington, DC.
Chloe Garofalini, At the time of this study, all of the authors were with the National Association of County and City Health Officials, Washington, DC. Timothy C. McCall is also with the Department of Clinical Research and Leadership, The George Washington University, Washington, DC.
Joi Lee, At the time of this study, all of the authors were with the National Association of County and City Health Officials, Washington, DC. Timothy C. McCall is also with the Department of Clinical Research and Leadership, The George Washington University, Washington, DC.
Aaron A. Alford, At the time of this study, all of the authors were with the National Association of County and City Health Officials, Washington, DC. Timothy C. McCall is also with the Department of Clinical Research and Leadership, The George Washington University, Washington, DC.

Document Type

Journal Article

Publication Date

6-12-2025

Journal

American journal of public health

DOI

10.2105/AJPH.2025.308096

Abstract

To explore whether and how the local health department (LHD) workforce shifted during the COVID-19 pandemic given the large influx of supplemental funding to public health. We used data from the National Association of County and City Health Officials National Profile of Local Health Departments, the main source of comprehensive data collected from LHDs across the United States. Total numbers of employees, total numbers of full-time equivalents (FTEs), and employee types (full time, part time, contractual, and seasonal) were used to estimate the total LHD workforce in 2022, changes in the LHD workforce from 2019 to 2022, and changes in the LHD workforce from 2019 to 2022 by employee type. In 2022, the estimated LHD workforce consisted of 182 100 employees or 163 200 FTEs. Between 2019 and 2022, there was a 19% increase in the total LHD workforce, but the size of the workforce varied according to jurisdiction size and rurality. The largest increase was among contract workers (175%), whereas the full-time workforce grew by approximately 7%, indicating that the permanent workforce was predominantly unchanged. With the surge in temporary and contract workers in 2022, there are concerns regarding the sustainability of the LHD workforce. Without continued strategic and sustained funding across jurisdiction types, the workforce may be in jeopardy. (Am J Public Health. Published online ahead of print June 12, 2025:e1-e7. https://doi.org/10.2105/AJPH.2025.308096).

Department

Clinical Research and Leadership

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