Enumeration and Composition of the Public Health Workforce: Challenges and Strategies

The field of public health needs a comprehensive classification data system that provides a better assessment of the size and composition of its workforce. Such a data system is necessary for understanding the capacity, trend projections, and policy development critical to the future workforce.Previous enumeration and composition studies on the public health workforce have been helpful, but the methodology used needs further improvements in standardization, specificity, data storage, and data availability. Resolving this issue should follow a consensus-based course of action that includes public and private stakeholders at the national, state, and local level.This prime issue should be addressed now, particularly in the current environment of comprehensive health care reform.THE FIELD OF PUBLIC HEALTH and its workforce have been persistently challenged by an unclear definition of boundaries of knowledge, expertise, and practice. These attributes lead to a corresponding lack of clarity of the public health workforce size (enumeration) and composition. Furthermore, other information on the public health workforce such as education and training, wages, turnover rates, and mobility across states is not regularly collected and available for comprehensive and comparative analysis and policy development.Central to this issue is the lack of a consensus-based, comprehensive, standardized classification (taxonomic) data system that provides a relevant and validated characterization of the public health workforce.1–4 Although there have been significant efforts to enumerate and garner a better characterization of the public health workforce, multiple gaps remain in specificity of the public health workforce and in the placement of this information in a suitable data repository for common use. Moreover, current circumstances—that is, alerts of workforce shortages in public health and other health professions (some based on limited estimated data), fears surrounding formidable rising health care costs, and recent passage by Congress of comprehensive health care reform initiatives—are provoking an escalating need to examine the public health apparatus and, in particular, the supply and needs or demands of the public health workforce.I examine these challenges in developing a valid classification data system that could be a significant tool to understand, monitor, and provide direction to the workforce. An underlying purpose is to stimulate a sense of urgency and call for leadership to bring consensual action to bear in this matter.