54: PH Workforce Crisis

Dr. Brian Castrucci, President and CEO of the non-profit de Beaumont Foundation, considers the public health workforce crisis; Dr. Kristina Box, Indiana’s State Health Commissioner, says public health departments can help reduce stigma for pregnant...

Spotify podcast player badge
Apple Podcasts podcast player badge
Amazon Music podcast player badge
Google Podcasts podcast player badge

Dr. Brian Castrucci, President and CEO of the non-profit de Beaumont Foundation, considers the public health workforce crisis; Dr. Kristina Box, Indiana’s State Health Commissioner, says public health departments can help reduce stigma for pregnant people with substance use disorders; ASTHO publishes a new blog article examining the growing number of legal fights over masks in schools; and a webinar to discuss leadership among the community health workforce is scheduled for next month.

New York Times: Why Public Health Faces a Crisis Across the U.S.

de Beaumont Foundation webpage: “Staffing Up” Research – Health Departments Need to Grow by 80% to Provide Basic Services

The Commonwealth Fund webpage: “It’s Really, Truly Everywhere”- How the Opioid Crisis Worsened with COVID-19

ASTHO Experts Blog Article: Courts Considering Challenges to States Blocking School Mask Requirements

ASTHO Event: Promoting Community Health Worker Leadership

ASTHO logo



This is Public Health Review Morning Edition for Tuesday, October 26th, 2021. I'm Robert Johnson.

Here's today's news from the Association of State and Territorial Health Officials.


Public health departments across the nation told the New York Times they were shorthanded. Now, the de Beaumont Foundation tells us just how many people are needed to fill those open positions. The number is 80,000 and that's not even enough to staff another pandemic.

Dr. Brian Castrucci is president and CEO of the non-profit de Beaumont Foundation. He talks about the problem in today's morning conversation.

What's been the reaction to your analysis that we need 80,000 public health workers just to deliver basic public health services in the U.S.?


I think people have been surprised. I don't think that most Americans realize how starved for resources the public health system is.

This quantifies it—it's 80,000 people, it's an 80% increase.

And so, that lets us know just how vulnerable we are—not just in this pandemic, but in future pandemics—if we don't do something to make up this gap.


Does this qualify as a crisis in your mind?


It's been a crisis for a long time. COVID just finally punctuated the crisis for us.

We've been losing public health people for decades; and really anybody, any elected official that has defunded public health in some ways, shares in the accountability for what's happened during COVID.


Let's talk about elected officials. They control the budgets.

How are we doing communicating with them the needs of the industry?


I think the 80,000 number's a great first step in this.

Typically, we say things in public health like, "We are underfunded and understaffed." And now, people are believing us and they're listening to us and they're asking them, "Well, how many people do you need and how much money?" And I don't know that we have a good evidence base and a research base to say, "We need this much money and this many people in these places."

And so, we need that backup, and we need to get to a point where there's a minimum acceptable standard in every state for public health. Because the future safety, security, and economic prosperity of our nation relies on us rebuilding a robust public health system.


Is the solution just about money or is it more than that?


Well, it's always going to be more than that because we have a federated public health system; and so, we need to find commonality and unity amongst all states.

I mean, unfortunately, there are those elected leaders who have been antagonistic to public health throughout this pandemic. Those are the same people responsible for rebuilding this public health system.

And so, we need to agree that public health isn't one side of the aisle or the other—it's the ground on which those aisles are built. And if we don't have public health, then our nation's foundation is cracked.


Later this week, we examined de Beaumont's work with ASTHO on the PH Workforce survey.

Dr. Castrucci's comments about the survey are coming up Friday.


The number of people who died from a drug overdose since the pandemic is setting a record. It's believed 90,000 people died last year, the resulting isolation and depression driving more people to use drugs.

Stigma prevents many of them from getting treatment, including pregnant people who often fear the consequences for themselves and their children if they try to get help.

Dr. Kristina Box is an OB-GYN. She's also the Indiana state health commissioner.


I think that, number one, you have to reduce the stigma associated with saying, "I have a substance use disorder issue." We need to normalize that as healthcare professionals and as a society; to say substance use disorder, just like having diabetes or high blood pressure, is an underlying medical disorder that needs to be treated.

We need to recognize that a lot of those substance use disorders are treating underlying anxiety and depression, and actually evaluate and identify those underlying mental health issues that are a problem.


Dr. Box discusses Indiana's plan to improve substance use treatment for pregnant people in an interview for the Public Health Review podcast, coming soon everywhere you stream audio.


Also today, the courts are getting involved in the debate over mask orders in schools. Across the country, they're considering disputes about whether states can pass laws or impose orders to prevent mask wearing among students and staff during school days.

A new ASTHO blog article reports that many of the legal challenges seek federal protection for students with disabilities.


Finally this morning, ASTHO plans a webinar next month to share how some members are engaging community health workers. The focus is on leadership within this workforce.


Visit the show notes for links to the workforce webinar and the new blog article about mask legal challenges.


Also, remember to follow us on Apple Podcasts or Spotify, or listen on Alexa or Google assistant.

And, if you have a minute, please take time to leave us a rating and a review.


Join us tomorrow morning for more ASTHO news and information.

I'm Robert Johnson. You're listening to Public Health Review Morning Edition.

Kristina Box MD FACOG

State Health Commissioner, Indiana Department of Health

Brian Castrucci DrPh MA

President and CEO of the de Beaumont Foundation