As the United States continues to grapple with increasingly complex public health challenges, a new perspective is emerging on how we define the public health workforce. In a paper published in the American Journal of Public Health (AJPH), Heather Krasna, PhD, EdM, MS, of Columbia University Mailman School of Public Health, urges a fundamental shift in our understanding of who comprises this workforce.
Krasna argues that the traditional view—one that focuses mainly on government-employed professionals—is too narrow for today’s reality. While federal, state, and local health departments still play a crucial role in delivering public health services, many vital contributors operate outside these government institutions. For example, simply tallying the number of nurses in the country doesn’t clarify how many are actively involved in public health work.
To address this gap, Krasna proposes a two-tiered, intersectional framework for categorizing the public health workforce. The first tier is the core public health workforce, made up of employees within government health departments at all levels, including federal, state, local, tribal, and territorial agencies. The second tier is the wider public health workforce, which includes individuals in other sectors and industries who spend at least 50% of their work time delivering services that align with the CDC’s 10 Essential Public Health Services or the Foundational Public Health Services.
The 10 Essential Public Health Services offer a comprehensive roadmap for promoting and protecting community health, while the Foundational Public Health Services define the minimum services all governmental public health departments should provide. According to Krasna, these frameworks can help identify non-government professionals who still play critical roles in public health—an important step toward building a more complete picture of the workforce.
Expanding the definition has several benefits. It allows for more accurate workforce assessments, reveals potential gaps or inefficiencies—such as costly outsourcing of core services—and enables better planning of education and training initiatives. Importantly, this broader approach could help strengthen the nation’s ability to respond effectively to crises such as pandemics or natural disasters.
Krasna concludes that without a clearer, more inclusive understanding of who constitutes the public health workforce, efforts to plan, prepare, and respond to future health emergencies will remain incomplete and potentially ineffective.
