We need to rebuild California’s public health workforce

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With the death of almost a million Americans in just two years, we are experiencing how important public health workers are to public safety.

Contagious diseases like COVID-19 not only take lives from families and neighborhoods, but also steal jobs and money from businesses and interrupt our children’s education. 

This pandemic has demonstrated how much we have neglected critical public safety workers in public health, and how much we need strong public health departments to protect our communities.

Unfortunately, we have taken for granted the vital work of public health workers in preventing dangerous diseases. The normality we enjoyed prior to COVID was the result of dedicated public health professionals who keep diseases at bay, but their numbers have declined for more than a decade. Outbreaks of diseases like measles, Valley fever, pertussis and syphilis, and preparation for Ebola and Zika taxed public health departments; then a five-alarm crisis hit with COVID; the responding departments were not staffed sufficiently for a pandemic.  

To bring COVID under control and address other ongoing public health emergencies, we need a skilled and organized army of public health workers. That is why we called for a $300 million annual commitment to rebuild California’s public health infrastructure, and we appreciate the governor’s leadership in providing these vital funds in his recent budget proposal.

But if we are to build a more robust defense against disease, we must reinforce our depleted front lines. 

There are jurisdictions with shuttered public health laboratories, closed for want of being able to hire a skilled lab director. Our corps of public health nurses — certified registered nurses who go into communities to promote health and prevent disease and disability — has been dangerously thinned. Epidemiologists who investigate patterns and causes of disease are unavailable. 

We must reverse course in order to successfully transition to a future where COVID is controlled and preventable deaths avoided.

That is why we are proposing the Public Health Equity and Readiness Opportunity (PublicHERO) Initiative. This plan commits part of the state budget surplus to make impactful one-time investments over three to four years to recruit and retain the epidemiologists, public health nurses, laboratory directors and other skilled professionals needed on the front lines.

The day-to-day work of local public health departments — controlling sexually transmitted diseases, chronic disease prevention, HIV/AIDS testing and treatment, and preventing the spread of infectious diseases — must also continue. Expanding our workforce to reflect the diversity of California communities and the languages Californians speak is crucial to reaching California’s health equity goals to protect all Californians.

The PublicHERO Initiative includes a one-time investment of $120 million for public health agencies to bolster their workforce by funding stipends including student-loan forgiveness, signing bonuses, and other recruitment and retention efforts, with a specific allocation for rural and Central Valley counties that face the most acute staffing challenges.

In addition, the initiative establishes internships, fellowships and other pathway programs to encourage entry into public health careers, especially in diverse communities.

Public health nurses in the community are required to have advanced education, including special certification, yet are typically paid less than nurses in health care, despite their additional qualifications. The PublicHERO Initiative funds payment of certification fees for public health nurses for three years to be more competitive.

The initiative also builds capacity and improves retention by providing education grants for career development for current public health workers so they can earn advanced degrees required for promotion to more highly skilled positions.

In total, the PublicHERO Initiative’s targeted plan to provide California with a pipeline of trained public health professionals seeks $186.4 million.

Our overextended public health workers are struggling on the front lines of the COVID pandemic to defend our neighborhoods, and they need to know that we have their back and that reinforcements are coming. We can no longer neglect this vital public safety workforce; California needs to fund the PublicHERO Initiative. 

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Dr. Richard Pan has also written about California needing to recognize racism as a public health crisis, restarting a greener Sacramento economy, and Asian American and Pacific Islanders who are ready to lead.

Assemblymember Cecilia Aguiar-Curry has also written about exploring ideas for stimulating our depressed economy.