As COVID-19 raged, roughly 4,000 highly skilled epidemiologists, communications specialists and public health nurses were joined by a nonprofit from the Centers for Disease Control and Prevention to help battered public health departments on the front lines defects can be removed.
But over the past few months, most of the CDC Foundation’s contracts for those public health workers in local and state departments have expired as the group has spent nearly all of its $289 million in Covid relief funds. The CDC Foundation, an independent nonprofit that supports CDC’s work, estimates that no more than about 800 of its 4,000 employees will eventually work in those jurisdictions, said spokesman Piers Nelson.
This has led many local and state health departments to face staffing shortages as the country grapples with a possible winter spike in COVID cases and the ongoing threat of monkeypox, the caseload of sexually transmitted infections and other public health issues. Exploding.
A 2020 Associated Press-KHN investigation found that the public health workforce in the US remains underfunded for decades – just before the start of the pandemic, only 28% of local health departments had an epidemiologist or statistician. Then, after the pandemic began, public health officials quit in large numbers as they were reprimanded for enforcing COVID regulations, blamed for the economic downturn, and were battling burnout.
According to new research in the Journal of Public Health Management and Practice, even if funding were available to retain all 4,000 foundation staff, public health staff needs could not be met. Research says that at least 80,000 new employees are needed for state and local public health departments to implement a minimum package of public health services.
However, the funding for the foundation’s jobs was always time-limited because it was intended to help with the emergency response to COVID. And although the American public’s COVID concerns have subsided, public health experts warn that this is yet another example of a failure to properly finance the public health sector with annual, guaranteed money – a risk to the country from outbreaks. Being unable to stop and fight properly.
“So the boom and bust cycle continues despite the loss of a million American lives to Covid,” said Brian Castrucci, co-author of the report and head of the De Beaumont Foundation. “How many more American deaths are going to happen until we fix this problem?”
Unlike the thousands of inexperienced contact tracers hired to follow up with COVID patients to stop the spread amid the surge, this CDC Foundation staffer generally had public health expertise that could also fill pre-existing gaps. Was. The head of the foundation, Dr. Judy Monroe, said that while local and state officials liked the foundation’s ability to cut through red tape through hiring, “it showed up like cavalry.”
In Chicago, CDC Foundation employees make up one-tenth of the city’s public health workforce, said Dr. Allison Arwadi, commissioner of the city’s Department of Public Health. Although he furloughed 26 of those 66 employees in December, he said it would hurt to lose the rest. They have contributed to everything from public health nursing to giving Chicagoans the latest guidance about the pandemic.
CDC Foundation leader Kayne Levores, who helped organize the foundation’s response in Ohio until the contract expired in October, said her staff of 20 not only had to set up COVID projects, but also provided local health departments with cancer groups, It was supposed to help track rural health disparities and the environment. health problems.
“Those jobs are just sitting there, all that work left unfinished,” he said.
Five people hired for CDC Foundation COVID contracts told KHN that they were under the impression that their contracts could be extended or that they would be hired by local or state governments that would be flooded with COVID dollars. Only one of them had a contract till 8 November.
Senior epidemiologist Katie Schenk, who has a doctorate in public health, conducts COVID surveillance for the CDC Foundation at the Illinois and Washington, DC, departments of health. Both contracts expired, and she was left without a job this summer.
“How do you explain there is no funding for jobs in our sector when there is clearly so much work to be done?” He asked. “It is damaging to the public health system, which is shedding staff like there is no tomorrow.”
Sometime in November, state and local health officials are expecting $3 billion in targeted Covid relief to bolster the public health workforce. But that money is coming after most of the CDC Foundation’s contracts have expired and those employees have moved on with their lives.
While the amount is substantial and will help close the 80,000-worker gap, many public health officials and experts stressed the cash is short-term and set to last five years — which could make it harder to fill positions. Because candidates want job stability. It is also divided among the 50 states, US territories, and several large health departments. And some state and local officials, such as those in Missouri and Michigan, have refused to spend COVID dollars on public health departments amid backlash against the pandemic response.
Munro said state and local governments sometimes have limits on hiring full-time employees, even when federal funds are available to do so. He said some localities have wage freezes or are unwilling to spend more on health officials than other government employees, making it harder to hire highly skilled workers such as epidemiologists. Monroe said the pay and benefits at the CDC Foundation are sometimes better than those available at local and state level jobs. Many of the foundation’s employees may face pay cuts if they choose to remain in local departments.
“You certainly don’t go into public health to get rich,” said epidemiologist Susan Knoll, who took a private-sector job as a health consultant after working for the CDC Foundation in Ohio. “You get a grant-funded job. And then you’re always looking for another job.
“That’s the reality of how we fund public health in this country,” said Chrissy Juliano, executive director of the Health Coalition for Big Cities.
“We ramp up, and we ramp down, and we don’t think about routine work,” she said. “We as a sector should not lose qualified people who are committed to working in public health. These are the people who need to be protected.
At least 38,000 public health jobs were lost from the 2008 recession to 2019. AP-KHN was detected in the probe.
The few remaining employees have their eyes on the door. Lisa Macon Harrison, director of North Carolina’s Granville Vance Public Health Department, said that even after instituting flexible benefits, she’s seeing 15% to 20% turnover, which she blames on burnout.
Levores said epidemiologists and other workers with advanced degrees have student loans to pay and worry about losing health insurance every time the grants expire.
Arwadi of Chicago said the lack of a steady source of money year after year is jeopardizing health department programs. He estimates that in two years the city will lose 86% of its current grant funding, putting wastewater tracking, some of his department’s IT staff and community-based outreach on a potential chopping block.
“We won’t be able to do a half-dozen things that the City of Chicago clearly expects us to be able to do. Forget ‘Can I bring the vaccine to your house?’ It’s ‘Can I even stand like a vaccine clinic in your neighborhood?'” she said. “That’s the level I’m afraid we’re going to slide to.”
Harrison said she’s seen it all before: Money flooded in for pandemic preparedness after 9/11, and then money for staffing went away, leaving departments flat-footed for COVID.
De Beaumont Foundation’s Castrucci pointed to how the current funding structure ensures that the public health sector, which exists to contain outbreaks and disease, will not be staffed to do so unless an emergency arises.
“You’re basically saying, ‘We’ll wait for the fire to burn until we hire firefighters,'” he said.
KHN (Kaiser Health News) is a national newsroom that does in-depth journalism about health issues. Along with policy analysis and polling, KNN is one of the three major operational programs in KFF (Kaiser Family Foundation). KFF is a thriving non-profit organization that provides information on health issues to the nation.
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