Public & Social Sector Practice

Building the US public-

health workforce of
the future
State and local health departments have an imperative to invest in their
workforces as they build toward endemic COVID-19 and improving
other health outcomes. Here are six strategies to act on now.

by Pooja Kumar, Emily Lurie, and Ramya Parthasarathy

© Feodora Chiosea/Getty Images

February 2022
 US public-health agencies have been fighting
on the front line to protect Americans against
COVID-19 for almost two years. To respond to the
pandemic, public-health departments across the
country have had to assume new and expanded
responsibilities while continuing to deliver their
core responsibilities and services as part of the
public-health system.
As new COVID-19 variants hit the country and
case rates surge, the rapid scale-up and shift in
responsibilities continue to cause serious strain
on the public-health system, which was already
grappling with workers approaching retirement and
staffing shortages before the pandemic (Exhibit 1).
Over the past decade alone, the public-health
workforce has shrunk by more than 15 percent.1
Stagnant funding and cumbersome hiring processes
have left departments struggling to attract the
specialized and diverse talent they need to better
reach, serve, and reflect their communities.2
As public-health departments face more attrition
from pandemic-related burnout and resignations,
such labor-market pressures are unlikely to abate. In
May 2021, the US White House announced plans to
invest $7.4 billion from the American Rescue Plan to
recruit and train public-health workers.3
With that funding, state and local public-health
departments have a unique opportunity to invest in
the public-health workforce and build for the future.
It is difficult in the throes of a COVID-19 surge to
think about anything other than the acute pandemic
response, but rebuilding the public-health
workforce in parallel is critical to ensuring that

Web <2022>
<Building the US public health workforce of the future>
Exhibit
Exhibit <1>1 of <3>

Stateand
State andlocal
localpublic-health
public-healthdepartments
departmentswere
wereexperiencing
experiencingworkforce
workforce
declines even prior to the COVID-19 pandemic.
declines even prior to the COVID-19 pandemic.
Number of US public-health workers Share of US public-health
workers with plans to leave the
250,000 workforce or retire in the next
–16% 5 years, %
1

200,000

150,000

100,000
47
50,000

0
2008 2010 2013 2016 2019

1
Survey data from 2017.
Source: Public Health Workforce Interests and Needs Survey 2017, de Beaumont Foundation, Association of State and Territorial Health Officials (ASTHO),
National Association of County and City Health Officials (NACCHO), Big Cities Health Coalition, 2019; Brian C. Castrucci and Monica Valdes Lupi, “When we
need them most, the number of public health workers continues to decline,” de Beaumont Foundation, May 19, 2020

1
Brian C. Castrucci and Monica Valdes Lupi, “When we need them most, the number of public health workers continues to decline,” de Beaumont
Foundation, May 19, 2020.
2
Yira Natalia Alfonso et al., “US public health neglected: Flat or declining spending left states ill equipped to respond to COVID-19,” Health
Affairs, April 2021, Volume 40, Number 4, pp. 664–71.
3
“Fact sheet: Biden-Harris administration to invest $7 billion from American Rescue Plan to hire and train public health workers in response to
COVID-19,” White House, May 13, 2021.

2 Building the US public-health workforce of the future

health outcomes are on the path to improvement
over the longer term. In this article, we outline
six strategies that state and local public-health
departments could consider to build the public-
health workforce of the future (Exhibit 2).
or jurisdiction size. Put another way, this is the first
time in the current generation—and potentially in
several—that the United States is having a societal
conversation about the role of the public-health
workforce as a part of the country’s necessary
healthcare fabric and infrastructure.

Six strategies to consider for building The complexity of the US public-health

the US public-health workforce of
the future
While states and localities will need to tailor
interventions to the unique needs of their
constituents, each could consider focusing on six
workforce development strategies.
1. Reassess capabilities and roles
By some estimates, the US public-health workforce
will need to grow by 80 percent to provide a
minimum set of health services in the country
today.4 Despite broad recognition of the current
workforce shortages, there is no consensus on how
optimal staffing should look in roles, capabilities,
infrastructure, which spans 50 state health
departments, 2,800 local health departments,
and 300 regional and district offices, complicates
attempts to define future staffing needs.5
Each locality has distinct mandates, programs,
capabilities, governance structures, and operating
models to serve its unique population.
In addition, much of public health has historically
been funded through categorical (or vertical)
financing streams for specific programs, disease
areas, and initiatives, such as communicable-
disease control and maternal and pediatric
healthcare.6 There has been little disease-

Web <2022>
<Building the US public health workforce of the future>
Exhibit <2>
Exhibit 2 of <3>
Six strategies
Six strategiescan
canhelp
helpto
tobuild
buildthe
theUS
USpublic-health
public-healthworkforce
workforceof
ofthe
thefuture.
future.

Reassess Share resources Overhaul the Invest in Cultivate Promote

capabilities and engage recruitment employees strong leaders diversity, equity,
and roles partners process Ensure that the Re-create the ranks and inclusion
Invest in a system- Leverage momen- Build innovative workforce feels well of public-health Prioritize health
atic exercise to tum gained through recruitment plat- supported with leadership through equity to ensure
identify competen- partnerships during forms that stream- clear paths for internal upskilling that the workforce
cies needed for the the COVID-19 line processes, development and and external reflects the com-
future, assess response to rede- broaden talent advancement, recruitment, espe- munity being
current competen- fine state–local pipelines, and especially given the cially given the served; potential
cies and staffing collaboration and increase accessi- extreme burnout exodus of public- initiatives can
levels, and create the role of external bility to combat the experienced during health leaders in include creative
tailored, role- partners “Great Resignation” the pandemic the past 19 months recruitment efforts,
specific workforce- refreshed job
expansion plans classifications,
and trainings
focused on DE&I

4
Efforts to create national standards in the sector are under way, including a workforce calculator from the Center for State, Tribal, Local, and
Territorial Support; the de Beaumont Foundation; and the Public Health National Center for Innovations (PHNCI) expected in summer 2022.
For more, see “Staffing up: Workforce levels needed to provide basic public health services for all Americans,” de Beaumont Foundation and
PHNCI, October 2021.
5
ASTHO profile of state and territorial public health, volume 4, Association of State and Territorial Health Officials, 2017.
6
Institute of Medicine Committee on Public Health Strategies to Improve Health, For the Public’s Health: Investing in a Healthier Future,
Washington, DC: National Academies Press, 2012.

Building the US public-health workforce of the future 3

 agnostic funding for staffing in foundational
areas such as communications, emergency
preparedness, and executive management or for
staffing to tackle new challenges, such as climate
change. The injection of the American Rescue Plan
and other funding offers states an opportunity to
address needs in overall workforce shortages and
to assess the capabilities required to meet those
specific needs.
In one large US state, we conducted a systematic
capacity and capabilities assessment of more
than 50 local health jurisdictions. The results
highlighted the variation in self-reported core
technical competencies and exposed gaps in areas
that have historically been underfunded, such as
bioinformatics and health economics (Exhibit 3).
They also showed sizable variations in capability
and capacity among jurisdictions of different sizes,

Web <2022>
<Building the US public health workforce of the future>
Exhibit <3> of <3>
Exhibit 3
Capability and capacity among local health jurisdictions vary greatly depending
Capability and capacity among local health jurisdictions vary greatly
on the area of expertise.
depending on the area of expertise.
Share of local health jurisdictions reporting sufficient capability and
Low High
capacity, by jurisdiction size, case example from US state,1 % (n = 51)

Very Large and

small Small Medium extra large

Health education Higher

reported
capability and
Maternal, child, and family health capacity

Emergency preparedness

Environmental public health

Communicable-disease control

Chronic-disease and -injury prevention

Epidemiology

Laboratory science

Health equity

Bioinformatics/population health data science

IT development and implementation Lower

reported
capability and
Health economics capacity

1
Share of respondents within each size category who have responded with “Agree” or “Strongly agree” to the question: “The department/program has sufficient
capacity and capabilities in each of the following areas of technical expertise.”
Source: Workforce Capabilities Assessment, Aug 2021

4 Building the US public-health workforce of the future

emphasizing the potential need to tailor workforce
augmentation efforts.
Instead of a one-size-fits-all approach to staffing,
state and local health departments can consider
conducting a systematic assessment. They can
identify the competencies needed in a future public-
health system, assess current competencies and
staffing levels, and create a plan to hire, train, and
design the workforce for the future. And they can
incorporate lessons learned during the COVID-19
pandemic, including the pros and cons of using
temporary and contracted staff and transferring
full-time employees among roles.
2. Share resources and engage partners
The COVID-19 pandemic has forced public-health
systems to find talent creatively through internal
transfers and rotations, temporary staffing, cross-
jurisdictional collaboration, and engagement with
partners and nongovernmental organizations.
Public-health entities can use this moment in time to recruitment timelines, complex and sometimes
consider how to redefine their resourcing needs.
For example, states and jurisdictions can jointly
examine which roles need to be local, regional,
or remote. Public educators and direct clinical
providers may need to be local, while laboratory
technicians may be able to provide services
regionally. Bioinformatic and data science
professionals may be able to work remotely. And
creative models of shared service can broaden
access to top talent, especially in rural and hard-to- scratch: they can borrow from platforms and
reach areas.
sector businesses, and government partners
have provided vital support during the COVID-19
pandemic.7 For example, community-based
organizations created safe spaces for quarantine
and isolation, academic institutions built testing
capacity, and faith-based organizations promoted
vaccine uptake. States and localities can be creative
about volunteer and surge staffing. Individuals
can be trained, certified, and available on “warm
standby” as a reserve corps for acute crises, and
they can work as disease investigators, contact
tracers, and public-health educators, as needed.
3. Overhaul the recruitment process
According to the US Bureau of Labor and Statistics,
job resignation rates in the country hit a record high
of 3 percent in November 2021, with more than
4.5 million people quitting their jobs. For public-
health departments, the staffing challenges of the
“Great Resignation” are exacerbated by common
hiring challenges in the public sector, such as long
restrictive job descriptions, and compensation
packages below industry standards.8
Public-health departments can capitalize on the
opportunity to rebrand by launching modernized
and innovative recruitment platforms that attract
prospective hires. Such efforts can be digitally
enabled and analytically driven, tracking talent
gaps to inform recruiting and reducing turnaround
times. Departments do not have to build from
approaches in other sectors.

Public-health departments can also consider
expanding their networks to partners with adjacent
capabilities, especially for part-time, surge, and
temporary staff. Healthcare providers, community-
based organizations, academic institutions, private-
With a renewed public focus on and appreciation
for public health, agencies can broaden their talent
pipelines and reach more diverse applicant pools.
They can restructure job descriptions to emphasize
capabilities over experience and offer remote- and

7
For example, Homelessness and Health Response Group for Equity created a coalition with more than 100 members (including hospitals,
federally qualified health centers, shelter operators, and housing advocates) to establish dedicated quarantine and isolation sites; the
University of California, San Francisco, partnered with community organizations to test all residents of San Francisco’s mission district as well
as Bolinas; North Carolina partnered with Medicaid programs to hire and train staff to augment local health department contact-tracing efforts;
and Black pastors are promoting vaccine uptake in New York through hosting vaccination events and speaking out, targeting the 45 percent of
Black adults who have not received a COVID-19-vaccine dose. For more, see Lloyd Michener et al., “Engaging with communities—lessons (re)
learned from COVID-19,” Preventing Chronic Disease: Public Health Research, Practice, and Policy, July 2020, Volume 17; Liam Stack, “‘A safe
space’: Black pastors promote vaccinations from the pulpit,” New York Times, October 13, 2021.
8
The average public-health nurse salary was reported to be around $60,000 in August 2021, compared with the median registered-nurse salary
of around $75,000. For more, see “Public health nurse salary guide,” NurseJournal, November 11, 2021.

Building the US public-health workforce of the future 5

 hybrid-working practices. Public-health systems
can also spark interest in potential candidates
earlier in the pipeline. For example, organizations
such as the Public Health Foundation’s HOSA-
Future Health Professionals target secondary
and postsecondary students, introducing them
to public-health concepts at a preprofessional
stage. Additional innovative recruitment efforts
could include targeted programs, such as large-
scale virtual and in-person job fairs, academic
partnerships, rotational programs, internship
programs, and community partnerships.
4. Invest in employees
A 2017 survey by the de Beaumont Foundation
of public-health workers revealed that nearly
half were planning to leave or retire within five
years.9 Employees cited inadequate pay, lack
of advancement opportunities, the workplace
environment, job satisfaction, and lack of support
as their primary reasons. The COVID-19 pandemic
seems to have only made matters worse. A
more recent US Centers for Disease Control
and Prevention survey revealed that 53 percent
of workers had symptoms of at least one
mental-health condition; 23 percent felt bullied,
threatened, or harassed because of work; and
72 percent were overwhelmed by their workload or
family–work balance.10
Providing better support for public-health workers
may require leadership and management teams
to clearly define and actively cultivate their
organizations’ culture, routinely reassess and
address employees’ needs, and fund programs
to contribute to a more sustainable working
environment. In the immediate term, public-health
systems can consider following some of their
private-sector counterparts, offering extended
sabbaticals, mental-health services, and additional
at-home support (for example, childcare services)
for their employees as they recover from the
effects of the COVID-19 pandemic. Organizations
can also invest in developing and advancing
employees’ abilities. In a McKinsey Global Survey
on future workforce needs, respondents often
said that skill building, rather than hiring, is the
most effective way to close skills gaps in the next
five years.11 Capability-building programs can
teach employees critical technical and strategic
skills, such as bioinformatics, IT development, and
healthcare economics.
Skill building can go beyond training courses.
Organizations can foster a culture of learning
and development that includes role modeling,
apprenticeship, flexible training (including virtual
and self-paced options), and incentives such as
paid time off and stipends. Capability building can
empower employees to pursue long-term careers
in public health. Employers can help employees
understand, from the start of their careers, how they
can advance professionally and use the employers’
resources, mentorship programs, and rotational
programs to do so.
5. Cultivate strong leaders
The COVID-19 pandemic has not only exacerbated
the burden on frontline workers but also contributed
to additional scrutiny of public-health leaders. They
are challenged by more than 100 new laws that have
implications for state and local public-health powers
and face increased personal and public threats.12
Over the past 19 months, more than 500 public-
health leaders have left their jobs, a significant loss
of executive leadership and experience. As public-
health departments look to rebuild for the future,
they will need to replenish their leadership ranks.
That would likely require internal upskilling and
external recruitment. In evaluating potential
leadership candidates, public-health departments

9
2017 national findings: Public Health Workforce Interests and Needs Survey, a joint report from Association of State and Territorial Health
Officials, de Beaumont Foundation, and National Association of County and City Health Officials, January 2019.
10
Jonathan Bryant-Genevier et al., “Symptoms of depression, anxiety, post-traumatic stress disorder, and suicidal ideation among state, tribal,
local, and territorial public health workers during the COVID-19 pandemic—United States, March–April 2021,” Morbidity and Mortality Weekly
Report, July 2021, Volume 70.
11
“Beyond hiring: How companies are reskilling to address talent gaps,” McKinsey, February 12, 2020.
12
Mike Baker and Danielle Ivory, “Why public health faces a crisis across the U.S.,” New York Times, October 18, 2021.

6 Building the US public-health workforce of the future

have an opportunity to build a cadre that reflects
the diversity of the population they serve. That
may require adjusting role descriptions to suit
candidates based on their capabilities and
competencies rather than specific educational
qualifications or work experience.
States and jurisdictions can redouble their efforts
to grow leaders internally. They can provide training
opportunities for strategic management skills, such
as change management, decision making, and
consumer centricity. McKinsey surveys have found
that just 28 percent of public-sector managers are
qualified to support employees’ development and
that fewer than 33 percent of leaders have been
trained in change leadership.13
6. Promote diversity, equity, and inclusion
The COVID-19 pandemic has highlighted long-
standing inequities in public health: compared
with White, non-Hispanic people, minorities have
experienced more than one and a half times the
case rate, three times the hospitalization rate, and
two times the death rate.14 A January 2022 study
by the Kaiser Family Foundation showed that
COVID-19-vaccination uptake has followed suit,
with racial and ethnic minorities experiencing
substantially higher vaccine hesitancy.15 Those
disparities underscore the importance of health
equity, not just in outcomes but also in the diverse
workforces serving communities.
One way for public-health departments to rebuild
trust and serve the communities that need the
most support is to foster more diversity in their
workforces, which survey results indicate are
roughly 80 percent women and 60 percent
White workers today.16 Possible initiatives include
apprenticeship programs to recruit a diverse
workforce, redefined minimum requirements for
entry-level jobs, hiring from alternative pathways,
and loan forgiveness and subsidy programs. Beyond
hiring, public-health departments could also take
initiatives to encourage an inclusive culture and
require diversity, equity, and inclusion training for
their workforces.
Investing today to prepare
for tomorrow
The McKinsey Global Institute estimates that every
$1 invested in healthcare improvements leads to
a $2 to $4 economic return.17 Realizing this value
will require states and localities to strengthen their
public-health systems. Public-health departments
can simultaneously build capacity and capabilities
by investing in diversity and talent, creating
opportunities for learning and development, and
promoting a flexible, innovative, and inclusive
environment. Modernization of the public-health
workforce has been a “tomorrow problem” for many
years. Tomorrow has arrived.

Pooja Kumar is a partner in McKinsey’s Philadelphia office, Emily Lurie is a specialist in the New York office, and Ramya
Parthasarathy is an associate partner in the Bay Area office.

Designed by McKinsey Global Publishing

Copyright © 2022 McKinsey & Company. All rights reserved.

13
Martin Checinski, Roland Dillon, Solveigh Hieronimus, and Julia Klier, “Putting people at the heart of public-sector transformations,” McKinsey,
March 5, 2019.
14
“Risk for COVID-19 infection, hospitalization, and death by race/ethnicity,” US Centers for Disease Control and Prevention, November 2021.
15
Across 42 US states, 60 percent of White people, compared with 54 percent of Black people, had received at least one dose of COVID-19
vaccine as of January 2022. For more, see Nambi Ndugga et al., “Latest data on COVID-19 vaccinations by race/ethnicity,” Kaiser Family
Foundation, November 2021.
16
2017 national findings, January 2019.
17
“Prioritizing health: A prescription for prosperity,” McKinsey Global Institute, July 8, 2020.

Building the US public-health workforce of the future 7