Bolstering the public-health workforce

Nov. 1, 2009
As Congress negotiates the parameters of a comprehensive healthcare reform bill, American families, medical professionals, and members of Congress are discussing how best to improve America’s healthcare delivery and health insurance systems. From lab room to dining room to hearing room, conversations are ongoing in nearly every corner of the country that will influence the future of American healthcare for generations to come.

There exists a wide and diverse array of plans and
proposals for how to reform our healthcare system. Though the final
shape this historic piece of legislation will take is not yet known,
what is certain is that any healthcare reform proposal must include a
real investment in our public-health workforce. Protecting and improving
public health is critical for us to achieve our goals of a highly
functional, affordable healthcare system in this country; a strong
public-health workforce is the key to this endeavor.

Unfortunately, our public-health workforce is aging
into retirement, and the system lacks the means to compete with
private-sector positions for the best public-health graduates. Nearly a
quarter of the current public-health workforce will be eligible to
retire by 2012, and there were 50,000 fewer public-health workers in the
United States in 2000 than in 1980. Unless policymakers take bold steps
to reverse this trend, state and local public-health departments will
continue to be undermanned and outgunned by the many threats and
challenges they face.

As we have seen most recently in the H1N1 virus, this
country cannot afford to let its public-health system decay any further.
The diseases we fight are too virulent, and the specter of a mass
outbreak is too terrifying. America’s public-health workforce provides
an essential component of our nation’s efforts to ensure safety and
security for Americans at home and abroad; without this robust
workforce, we are vulnerable.

Public-sector salaries are part of the problem.
Higher salaries and signing bonuses in private industry make it
difficult for public-health departments to fill their positions with
qualified professionals. At a time when millions of Americans have been
forced into unemployment because of the economic downturn, 11% of state
public-health positions still await qualified candidates. We must train
more public-health workers, and we must provide them with the right
incentives to serve the public good.

The time is now to develop a pipeline of qualified people,
so public-health laboratories can compete to attract the best personnel available.

Another part of the problem is the mounting level of
student loan debts facing public-health graduates in the United States.
Students typically face thousands of dollars of debt by the time they
finish school, at which point they are forced to choose between working
in settings like public-health labs or taking more lucrative positions
for pharmaceutical companies or other industries.

An increasingly large number of these graduates are
foregoing employment in public-health labs for the “greener pastures” of
private industry. In my home state of California, we are proud to have
leading research universities and a vibrant network of laboratories that
are a vital part of the state’s public-health infrastructure. Of the 39
public-health laboratories in California, however, there are currently
15 facilities operating without a director, and even more vacancies are
expected to occur in the next 10 years as present directors retire.

To address these many problems, I introduced
legislation earlier this year that would rebuild and bolster the
dwindling community of public-health workers. The Public Health
Workforce Investment Act, HR 2231, creates a new program of scholarships
and loan repayments as incentives for public-health graduates to enter
the public-health workforce. Much of my language in HR 2231 was
incorporated into the comprehensive healthcare reform bill, America’s
Affordable Health Choices Act, as the Public Health Workforce Corps.
This program will foster and support the medical professionals who serve
on the front lines of disease prevention and treatment.

By offering federal subsidies for the cost of
education in exchange for service in public-health departments,
laboratories, and community health centers, my legislative language will
enable public-health laboratories to compete on a level playing field
with private entities for the best and brightest graduates.
Public-health laboratories are responsible for some of the most
important tasks in protecting the lives and health of our friends and
families: managing the health system’s response to biological and
chemical attacks; fighting food-borne illnesses; preventing the spread
of communicable diseases and pandemics; assisting communities in
preparing for disasters; and promoting best health practices. It is
imperative that we make an investment in our public safety and health by
making it easier for the next generation of public-health workers to
earn a decent living in public laboratories. The Public Health Workforce
Corps must be a part of this solution.

The time is now to develop a pipeline of qualified people, so
public-health laboratories can compete to attract the best personnel
available. The Public Health Workforce Corps will strengthen our
country’s system of public-health laboratories, and our health system as
a whole. An investment in the public-health workforce is truly an
investment in the health and wealth of our nation.

Doris Matsui represents California’s 5th congressional district in the U.S. House of Representatives.