More than a dozen members of the Governor's Public Health Commission met Thursday to discuss workforce issues facing the statewide system, but they faced challenges analyzing anything because of limited data.
“I could go on and on about what we know about national public health workers but, to be specific to Indiana, we have a problem,” said Dr. Valerie A. Yeager, with the Indiana University Richard M. Fairbanks School of Public Health. “[Some of] this data is really limited, and it’s probably too limited to be actionable.”
Yeager urged the commission to be cautious in using available data, as it only partially represents the current public health workforce, partly due to low response rates to surveys. She said that approximately 70% of the state’s 94 local health departments served populations of less than 50,000 people in rural settings.
On average, those departments had five full-time employees, but many had zero full-time workers and relied on part-time employees. Just 39 agencies had a full-time local health official, and 55 had part-time health officials.
“The vast majority of public health workers — nationally four out of five — do not have formal training in public health,” Yeager said. “Some positions within a public health agency may not require public health expertise, but this is important because cross-training, especially in small agencies, is really crucial.”
Despite the limitations of data on Indiana workforce training and characteristics, Yeager outlined a capacity problem in the state, where the majority of Hoosiers live in areas with healthcare worker shortages.
“In particular, we are missing epidemiological expertise and emergency preparedness expertise,” Yeager said, noting that both fields had managed much of the public health response for the last 18 months of the coronavirus pandemic.
The shortage of workers comes even as the number of public health graduates grew from 214 in 2011 to 591 graduates in 2020, a 176% increase. Researcher Courtney Medlock, with the Bowen Center for Health Workforce Research and Policy at IU School of Medicine, said there was no available data to indicate where those students had gone.
Additionally, salaries for local health departments are set by county councils, which may not regularly review any below-market rate salaries and can clash with local health departments. After those clashes, the state legislature passed a law letting local governing bodies overturn local health department mandates.
Commission members made vague references to counties that denied federal grants aimed at hiring new employees, possibly referring to the Elkhart County Council’s unanimous rejection of a $1 million grant Sept. 11.
The Elkhart County Health Officer shortly announced her resignation, citing the public political battles.
Asked about her concerns with the politicization of public health officers, Yeager noted that local health departments usually operated without public attention, certifying and inspecting restaurants and investigating localized outbreaks. The lack of public support could hurt public health, and its attempt to recruit more employees, in the future.
“When we’re not in the middle of an emergency, people don’t see public health in action. Now that people are aware of the role of public health and its overlap with preventive restrictions in the pandemic … the politicization could be detrimental,” Yeager said. “Public health is a foundational element to a society’s well-being.
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