New study explores staffing priorities and challenges at local public health departments

The COVID-19 pandemic drew attention to the critical need to invest in our nation's public health infrastructure and rebuild local public health departments, many of which have been losing staff for years. Although there's been an infusion of new grants and funding from the Centers for Disease Control and Prevention and the federal Coronavirus Aid, Relief and Economic Security (CARES) Act, among other sources, little research has been conducted to identify strategies to invest these funds optimally, or to help health departments determine best practices for addressing their staffing needs.

A new study from the University of Minnesota School of Public Health (SPH) helps fill this gap, analyzing the staffing priorities of local health departments (LHD) in Minnesota—and exploring the barriers Minnesota's LHDs are confronting to achieving adequate staffing levels.

In the study, which was published in the Journal of Public Health Management and Practice, researchers surveyed 97% of the 72 county and city health agencies throughout Minnesota in June and July of 2022. The study examined three key areas of concern to LHDs—staffing needs and priorities, financial constraints to hiring and external barriers to recruitment.

They found:

• LHD staffing priorities include vacant positions that must be filled and new positions that must be created.
• Priority positions include public health nurses (PHN), community health workers (CHW) and health planner/researcher/analysts (HPRA).
• There is a high need to fill vacant PHN, public health educator (PHE), and administrative support positions, and a need to receive authorizations to create new PHN, CHW, HPRA, communications, public health informaticians and epidemiologist positions.
• Inadequate funding and other financial constraints, including restrictions on how funds can be used, pose a barrier both to filling vacant positions and creating new positions.
• LHDs' inability to offer competitive wages impedes their ability to recruit and retain employees, as does the fact that LHDs often cannot hire staff without approvals from other public officials.

External factors contributing to hiring challenges include lack of affordable child care, housing and transportation options.

"As local health departments seek to take advantage of new funding opportunities to staff up, this research will help guide governmental public health leaders as they identify staffing needs and priorities, as well as identify barriers to maintaining optimal staffing levels," said Harshada Karnik, SPH researcher and lead author of the study. "We believe this is a roadmap local health departments can use to identify emerging needs that reflect their new roles and responsibilities, and to attract, and retain staff."

The researchers also emphasized that agencies that are able to offer benefit programs that address external factors—such as child care, housing and transportation—may be better positioned to retain staff.

Karnik is a researcher at SPH's Center for Public Health Systems.