1. October 23, 2001 Enumeration of the Public Health Workforce in the United States, 2000 Kristine Gebbie, RN, DrPH, Jacqueline Merrill, MPH, RN,C Center for Health Policy Columbia University School of Nursing

2. October 23, 2001 Center for Health Policy Columbia University School of Nursing The Question What is the size and composition of the public health workforce?

3. October 23, 2001 Center for Health Policy Columbia University School of Nursing The Answer 448,254 workers in salaried positions

4. October 23, 2001 Center for Health Policy Columbia University School of Nursing 1970 vs. 2000 1970 1970 500,000 PH Workers 1: 457 workers to persons Estimated by different method 2000 2000 448,254 PH Workers 1: 635 workers to persons Include federal employees, salaried staff of limited volunteer agencies Supplemented by at least 2,864,825 volunteers

5. October 23, 2001 Center for Health Policy Columbia University School of Nursing Historic comparison 1923 27 workers/100,000 population 1933 22 workers/100,000 population 1958 32 workers/100,000 population 1979 219 workers/100,000 population(est) 2000 158 workers/100,000 population

6. October 23, 2001 Center for Health Policy Columbia University School of Nursing Public Health Worker Density PH Workers to 100,000 Population 140 to566 (16) 77 to140 (17) 37 to77 (17)

7. October 23, 2001 Center for Health Policy Columbia University School of Nursing Who are they? Commonly identified health professions, many technical w/ backgrounds, some trained on the job. Unidentified by education--advanced education, or a high school diploma and a willingness to learn

8. October 23, 2001 Center for Health Policy Columbia University School of Nursing National Summary 448,254 salaried workers by occupational category Clerical/Support 13% Category Unreported 25% Administrative 4% Professional 44% Technical 14%

9. October 23, 2001 Center for Health Policy Columbia University School of Nursing National Summary (cont’d) Local 34% Federal 19% Other 14% State 33% Percentage of 448,254 PH Workers by Location

10. October 23, 2001 Center for Health Policy Columbia University School of Nursing National Summary (cont’d) The location of the workforce distributed within OPM occupational categories OPM CATEGORY LOCAL 16,495 33,857 3,975 8,454 89,970 10,045 11,410 56,958 38,331 29,217 11,902 58,897 1,152 13,360 443201 50,313 748 10,313 2,213 0 10000 20000 30000 40000 50000 60000 70000 80000 90000 100000 AdministrativeProfessional TechnicalClerical/Support Category Unreported Number Employed STATE FEDERAL OTHER

11. October 23, 2001 Center for Health Policy Columbia University School of Nursing National Summary (cont’d) Select professionals by location 533 655 1,304 14,543 6,101 888 3,975 4,207 10,045 9,935 7,043 4,055 1,152 4,311 126 20,443 2,080 532 748 145 0 5000 10000 15000 20000 25000 Officials and Administrators PH PhysicianPH NurseEnvironmental Professional PH Educator Number Employed LOCAL STATE FEDERAL OTHER

12. October 23, 2001 Center for Health Policy Columbia University School of Nursing National Summary (cont’d) Estimated ratios of workers /100,000 population in DHHS Regions 118 128 174 179 76 116 77 90 187 200 IIIIIIIVVVIVIIVIIIIXX DHHS Region Mean State and Territorial Ratios National Ratio 158

13. October 23, 2001 Center for Health Policy Columbia University School of Nursing National Summary (cont’d) Range of workers to 100,000 population Must understand PH systems to interpret PA lowest—why? SC highest—why? National includes federal Estimated Ratios of Public Health Workers per 100,000 Population 37 158 566 PennsylvaniaNationalSouth Carolina

14. October 23, 2001 Center for Health Policy Columbia University School of Nursing Public Health Worker/Population Region IV 1:500 1:177 1:895 1:1096 1:1355 1:712 1:685 1:1003

15. October 23, 2001 Center for Health Policy Columbia University School of Nursing Worker distribution by Occupational Category -Region IV STATE 9% 5% 9% 45% 20% 46% 27% 59% 52% 41% 13% 16% 14% 26% 11% 4% 7% 11% 23% 17% 29% 52% 12% 4% 1% 2% 47% 33% 1% 2% 20% 28% 19%.01%.04% 73% 2% ALFLGAKYMSNCSCTN Percentage of Workers Category Unreported Clerical/Support Technical Professional Administrative

16. October 23, 2001 Center for Health Policy Columbia University School of Nursing Wisconsin vs. Arizona Distribution of workers by occupational category at three Locations Wisconsin OPM Workers by Location 6% 7% 1% 2% 41%.05% 7% 4% 5% 22%.05%.7% 4% Administrative Professional Technical Clerical/Support Category Unreported OPM CATEGORY Number Employed State Local Other Administrative Arizona OPM Workers by Location 60% 2% 29% 0.06% 6% 3% Professional Technical Clerical/Support Category Unreported OPM CATEGORY Number Employed State Local Other

17. October 23, 2001 Center for Health Policy Columbia University School of Nursing Wisconsin Percentage of PH Workers by Agency Source Wisconsin Department of Agriculture, Trade & Consumer Protection 9% Wisconsin Department of Natural Resources 16% Wisconsin State Lab of Hygiene 7% ASTPHND Survey* 5% March of Dimes 0.05% Wisconsin Department of Health and Family Services 63% * Association of State and Territorial Public Health Nutrition Directors 1994 Survey Data-file.

18. October 23, 2001 Center for Health Policy Columbia University School of Nursing About PH workforce data Data are descriptive Interpretation demands understanding PH system in each state Different basis for analysis than general health workforce statistics

19. October 23, 2001 Center for Health Policy Columbia University School of Nursing Issues Difference in PH structures resulted in varying types of information states w/ centralized systems states w/ decentralized systems combination of both centralized and decentralized

20. October 23, 2001 Center for Health Policy Columbia University School of Nursing Issues Data differed from jurisdiction to jurisdiction Inconsistent time period Individual workers vs. full-time equivalents Detail --some included every job title, others provided less detail

21. October 23, 2001 Center for Health Policy Columbia University School of Nursing Audience Leadership of public health agencies Evaluators of public health programs Schools of public health, other health professions schools Policy analysts in legislatures and executive branch policy offices Workforce researchers, including Department of Labor

22. October 23, 2001 Center for Health Policy Columbia University School of Nursing Uses Basis for developing policy for future enumeration Distribution of workers compared w/ caution to other state’s or agencies Specific program areas comparative analysis (nutritionists, PH educators)

23. October 23, 2001 Center for Health Policy Columbia University School of Nursing Workforce Database Public Health Community Consensus HRSA CDC ASTHO NALBOHNACCHO IdeaPlayersPractical Decisions APHA Reality Who, Where, How to Count? Official PH + ? Partners How specific? Details on professions? Data Source? Time Limits? Public Health Workforce Database

24. October 23, 2001 Center for Health Policy Columbia University School of Nursing Moving Forward Range of governmental public health to include? Range outside governmental public health to include? What level of specificity? Should any public health professions be reported in detail? Who will provide data to the database? What time period should be used to limit information?

25. October 23, 2001 Center for Health Policy Columbia University School of Nursing The Public Health Workforce: Enumeration 2000 online Website: http://cpmcnet.columbia.edu/dept/nursing/ institute-centers/chphsr/EnumMain.html