Boulder County Public Health knows that the department is no exception to the workforce challenges plaguing most industries.
A shrinking workforce and inconsistent funding are just some of the challenges facing Boulder County Public Health and public health agencies across the country, which the Boulder County Board of Health discussed on Monday.
“This is not a new challenge,” Chief Medical Officer Dr. Bob Belknap said. “The public health workforce was changing and there were challenges even prior to the pandemic.”
In 1980, there were 220 public health workers per 100,000 people in the U.S. That dropped to 158 by 200 and 147 in 2020. At the same time, public health preparedness funding nationwide dropped by about a third from 2002 to 2019.
Belknap cited a study from last year that found that nationally, the public health workforce needs to increase by about 80% to meet its core responsibilities. For perspective, that would translate to an increase of 84 full time employees for Boulder County Public Health.
Additionally, public health has long navigated inadequate and unpredictable funding. Before COVID, public health was allocated just 0.5% of the state’s budget, Belknap said. Local per capita spending on public health came out to just $1.50 per person per year.
These slim funds mean public health agencies have to search for and compete against one another for grants, which often change in amounts year to year. Temporary emergency funding, like COVID or monkeypox spending, tends to be transient, reactive and inflexible.
“It’s really hard to staff and plan and implement strategies to address important health issues when funding is this unpredictable,” Belknap said.
There is a 250,000 public health worker deficit nationwide, while one in three public health workers are considering leaving the field in the next year and one in two are considering departing in the next five, Belknap said. At Boulder County Public Health, 30 staff members are at or near their 20-year service mark which makes them much more likely to consider retirement.
Locally, the dissolution of the Tri-County Health Department and San Juan Basin Public Health also creates regional competition for the limited number of public health workers as new health departments are established.
Some of the main stressors for employees include low pay, work overload and burnout, a lack of opportunities for advancement, stress and organizational climate and culture. Mental health is a big stressor for the national workforce right now, with 56% of workers reporting at least one PTSD symptom.
The health department cited the fact that public health workers have navigated multiple county emergencies without rest, dealt with frustrations with outdated systems and processes, moved through ongoing leadership transitions, all with a need for more competitive salaries.
Boulder County Public Health said the department is investing in retention but expects to see these challenges for a while including continued turnover. It was noted that burnout recovery takes time, and sometimes it may not be enough to keep an employee.
The health department is looking at how it can be proactive in planning for needs during a public health emergency, which is impacted by a baseline workforce. Along with employees, public health agencies in Colorado and nationwide are looking at what can change in financing, data and information technology, governance and law, relationship building and cross-sector partnerships to modernize the departments.
Boulder County Public Health is planning on initiating a workforce study, which will include an assessment of the agency’s current structuring. The health department emphasized to its board that without funding public health on the front end and investing in prevention, money is instead spent after the harm is done on treatment — something that costs a lot more and is less efficient.
