The backbone of the nation’s public health workforce is buckling.

A recent study has raised alarms with its dire prediction of a mass exodus of governmental public health workers—considered the “backbone” of public health efforts in the United States—if current trends hold.¹ “In our analytic sample, nearly half of all employees in state and local public health agencies left between 2017 and 2021, a proportion that rose to three-quarters for those ages 35 and younger or with shorter tenures,” the study’s authors wrote. “If separation trends continue, by 2025 this would represent more than 100,000 staff leaving their organizations, or as much as half of the governmental public health workforce in total.”

Based on data from the Public Health Workforce Interests and Needs Surveys in 2017 and 2021, the study has raised troubling questions about the country’s health priorities and the ability of local and state governments to recruit and retain new talent to help fill a yawning gap. “If you saw half or three quarters of firefighters or police indicating that they were planning to quit, much less retire, I think that would be pretty concerning. That’s kind of where we are right now in public health,” says lead author Jonathon Leider, PhD, an associate professor of public health and the director of the Center for Public Health Systems at the University of Minnesota in Minneapolis.

Many of the public health jobs lost during the Great Recession of 2008–2009 never returned and left governments with a workforce deficit, Dr Leider says. Then, older employees who had delayed retirement during the recession started to leave during the economic recovery. Their departure was compounded by what some demographers have dubbed the “silver tsunami,” or the wave of baby boomers reaching retirement age.

“We’ve been investing in this short-age for a long time,” adds study coauthor Brian Castrucci, DrPH, MA, president and chief executive officer of the de Beaumont Foundation in Bethesda, Maryland, which focuses on improving community health and public health systems. By the start of the COVID-19 pandemic, he notes, a lack of attention to filling the available positions and increasing low pay rates had already contributed to a shortage of 80,000 full-time equivalents.

The pandemic then led to “unprecedented levels of bullying, politicization, and political attacks on the public health workforce,” he charges. Amid that hostile environment, employees were pulled from other health department divisions to bolster short-staffed pandemic response teams, which added to the stress. “This is just a recipe for burnout,” he says. “The pandemic was an accelerant, but the fire was already burning.”

国家公共卫生队伍的骨干力量正在崩溃。

最近的一项研究敲响了警钟，其可怕的预测是，如果目前的趋势持续下去，政府公共卫生工作人员（被认为是美国公共卫生工作的“支柱”）将大规模外流。¹该研究的作者写道：“在我们的分析样本中，2017 年至 2021 年间，州和地方公共卫生机构的所有员工中有近一半离职，而对于 35 岁及以下或任期较短的员工来说，这一比例上升到四分之三。” “如果离职趋势持续下去，到 2025 年，将有超过 10 万名工作人员离开其组织，相当于政府公共卫生人员总数的一半。”

该研究基于 2017 年和 2021 年公共卫生劳动力兴趣和需求调查的数据，对国家的卫生优先事项以及地方和州政府招募和留住新人才以帮助填补巨大缺口的能力提出了令人不安的问题。“如果你看到一半或四分之三的消防员或警察表示他们计划退出，更不用说退休，我认为这将是相当令人担忧的。这就是我们目前在公共卫生领域的处境，”主要作者、明尼阿波利斯明尼苏达大学公共卫生副教授兼公共卫生系统中心主任 Jonathon Leider 博士说。

莱德博士说，2008-2009 年大衰退期间失去的许多公共卫生工作再也没有回来，导致政府出现劳动力短缺。然后，在经济衰退期间推迟退休的老员工在经济复苏期间开始离职。一些人口学家所称的“银色海啸”，即婴儿潮一代达到退休年龄的浪潮，加剧了他们的离开。

研究报告合著者布赖恩·卡斯特鲁奇 (Brian Castrucci) 补充道：“我们长期以来一直在针对这一短缺问题进行投资。”卫生系统。他指出，到新冠肺炎 (COVID-19) 大流行开始时，由于缺乏对填补空缺职位的重视以及不断降低的工资率，已经导致 80,000 名全职员工短缺。

他指控说，这场大流行导致“公共卫生人员遭受前所未有的欺凌、政治化和政治攻击”。在这种充满敌意的环境中，卫生部门其他部门的员工被抽调出来，以加强人手短缺的流行病应对团队，这加剧了压力。“这只会导致倦怠，”他说。“疫情是一种助燃剂，但火已经在燃烧。”