Public health transformation requires reimagining and developing a common vision to ensure the mindsets, capacity, resources, and workforce necessary to provide equitable Foundational Public Health Services (FPHS) and 10 Essential Public Health Services (EPHS), to advance health, wellbeing, and equity. It occurs through a fundamental shift in the way a public health system(s) is structured, functions and interacts through continuous quality improvement, innovation, partnerships, community-led efforts, and systems change.

Simply put, it requires sustaining what is working, building on what can be improved, and reimagining what could be so that all people and communities can thrive[i].

Public health transformation is reliant on a public health workforce that looks different than the past – we must do things differently if we want an infrastructure that facilitates improved health outcomes for all. Health departments must implement strategies to address a wide range of workforce development, retention, and recruitment challenges. Members of the 21st Century Learning Community (21C) shared how they are transforming their governmental public health workforce and provided examples of what strategic implementation looks like in their state.

Setting the Stage: Public Health Systems Transformation Requires a Transformed Workforce

While each state and its health departments are unique, some trends have emerged in conversations and practice to attract and retain a workforce that is prepared to meet current and future needs.

  • Equitable recruitment practices are necessary to diversify applicants and staff.
  • Data-driven tools, such as the FPHS Capacity and Cost Assessment or PHAB Readiness Assessment, should be used to identify priority areas that need additional workforce support.
  • Employees value a workforce culture that is flexible, supports healing, and offers opportunities to grow.
  • The workforce is made of people who are still experiencing high levels of trauma and burnout from the COVID-19 pandemic, centuries of systemic racism, and longstanding health inequities.

All states are operating within a public health system that has room for improvement; through transformation, states are intentionally and strategically shifting how their public health system operates and serves their community.

Strategies to Transform the Public Health Workforce

Workforce development, retention, and recruitment are all separate yet interrelated workforce areas; as such, it is important to identify specific strategies for each and to explore how they do, or do not, relate to each other. Workforce policies and practices often outlast the workforce that developed them, requiring a forward-thinking approach to prepare for the future public health workforce.

The strategies below are not exhaustive and may cross workforce areas. We encourage health departments to utilize innovation and quality improvement processes, like Lean principles, to develop additional strategies. If your health department has a new strategy to share, please email [email protected].

Workforce Development Strategies

Action: Use the FPHS Capacity and Cost Assessment, Public Health Workforce Calculator, PHAB Readiness Assessment, or a combination of tools for transformation.

Example: Wisconsin is currently using the FPHS Capacity and Cost Assessment to understand gaps within their public health system. The state health department and local health departments are completing the Assessment separately, and data will be analyzed to help develop a data-driven approach.

Action: Include tuition reimbursement as a benefit.

Action: Collaborate with local schools of public help to develop a scholarship program specific to educating your current public health workforce.

  • Example: Colorado has also developed an innovative pipeline model that combines their apprenticeship and Public Health AmeriCorps program. This allows participants to receive funding, education, and resources from both programs. Additionally, there are increasing number of paths to transfer apprenticeship completions to credit at community colleges and universities.
  • Example: The Indiana’s Governor’s Public Health Commission Report 2022 recommended that a comprehensive local and state public health workforce assessment be performed to collect and analyze job descriptions, salary ranges, full-time equivalent counts, training, and services delivered. The assessment found that the public health workforce had gotten substantially smaller since the 1970s; recruitment, diversity, and retention are key barriers; the COVID-19 pandemic took a toll on the workforce; tracking the composition and total number of people in the public health workforce is a challenge; and enrollments in public health degrees are rising but many graduates opt for private sector jobs.
  • Example: The Kentucky Resources and Services Administration (HRSA) provides grants for universities to pay for scholarships in public health. View an example at the University of Kentucky College of Public Health.
  • Example: At the Minnesota Department of Health (MDH), a Public Health Traineeship partnership program between the University of Minnesota School of Public Health (SPH) and MDH provides scholarship assistance to students seeking a Master of Public Health from SPH. Funded by HRSA, the program focuses on addressing inequities in our public health system, improving emergency preparedness and response, and increasing the size of the public health workforce. Tuition and fees for 45 scholarships annually will be awarded during the initial 3 years.
  • Example: The Minnesota Department of Health is a community based-training (CBT) partner to the Region V Public Health Training Center. This partnership means we participate in the training center’s advisory board and special interest groups, allowing the opportunity to provide input and direction for knowledge and skills needed across the state. The training center develops training materials which we then promote across our public health system through multiple communication channels.

Action: Use workforce development plans developed as part of the PHAB accreditation process to develop priorities.

  • To successfully implement, this plan should be co-created with health department employees that are performing the work.
  • Complete a workforce development planning assessment.
  • Revise competency assessment based on the core competencies to look at workforce needs across the state.

Example: RESTORE: The Colorado Blueprint for Innovative Public Health Workforce Development was developed to support the state’s workforce development goals. They are currently focused on action planning and engaging partners, including their state school of public health, medical association, SACCHO, and local public health agencies.

Action: Use evidence-based job descriptions and attractive job postings that can be easily adapted by local and state health departments.

Action: Engage current staff to learn their experiences and reflections on what core competencies and Foundational Capabilities are needed to do their jobs.


  • Use learnings to implement tiered training to create a clear path for professional development based on gaps in needed training.


Example: The California Department of Public Health invited employees to join a sharing session. 160 volunteers shared their experiences and provided feedback on the core competencies needed to perform their role and the process to get there. For example, an employee shared that it would be valuable to have clear communications about the steps to take for an intern or entry level professional to take to become an epidemiologist. Employees also share that if training is important, managers need to make space in workloads for their team to attend.

Example: The Public Health Model Job Descriptions Project, an initiative of the Region V Public Health Training Center at the University of Michigan School of Public Health and the Center for Public Health Systems at the University of Minnesota School of Public Health, created evidence-based job descriptions and attractive job postings that can be easily adapted by local and state health departments.

Action: Ask employees what workforce development options they are interested in, that align with your strategic plan, and engage them in developing opportunities that they believe add value to their work and professional growth.

Example: In Ohio, to qualify for a job at the state level employees need supervisory experience. In response to this challenge, they are working on an internal project, ODHU, that will create a practicum where employees can act as a team leader to gain supervisory experience. Upon completion, the practicum will count as one year of supervisory experience.

Action: Map core competencies to job descriptions and train managers on how the map relates to employee roles and responsibilities.

Example: Jefferson County Health Department in Missouri is rewriting employee job descriptions and performance metrics to add alignment to the Missouri FPHS model. This work is being performed to more clearly demonstrate the connection between the FPHS and individual roles.

Action: Build mutually beneficial academic partnerships to develop curriculum and training around science, informatics, intelligence, and other public health concepts.

Example: At Minnesota Department of Health (MDH), the Summer Public Health Institute at the University of Minnesota is held in collaboration with MDH and offers a course for everyone practicing in or studying public health or fields related to public health. Participants can expand their professional expertise, broaden career options, network with other professionals, or explore a new area of interest. The institute takes place in late May-early June.

Action: Research has found that feeling supported by managers is the most important aspect of job satisfaction[ii]. Foster a supportive environment by providing managers with training on what it looks like to meet the diverse range of employee needs.

Action: Embed racial and health equity principles into education and training during onboarding and continuing education opportunities.

  • Example: Massachusetts is embedding racial and health equity through offering Racial Equity 101 training to Local Boards of Health and public health professionals. They are continuing this through the creation of Racial Equity 102.
  • Example: The State of Minnesota offers the opportunity for Tribal State Relations Training to state employees (at a fee to the employee’s home agency).
  • Example: The Minnesota Department of Health is embedding a cohort of health equity strategists throughout the agency. These health equity strategists will spend part of their time as a cohort and the other part of their time with their respective Division within the agency to align and challenge the status quo of how we do our work.

Action: Onboard new employees in cohorts to develop cross-division relationships from the start.

Action: Create a buddy system to connect new employees to someone with historical knowledge, experience getting to know the health department, and a friendly face.

  • Example: Jefferson County Health Department in Missouri has realigned their program staff into cross-disciplinary teams based on the components of the FPHS model.

Retention Strategies

Action: Perform regular salary surveys within your state; this can serve as data for health departments to make informed decisions and be used to create a statewide salary base to decrease salary competition between the state and local health department as well as local health department to local health department.

Action: Encourage human resources to develop a plan to adjust salaries, as needed, to account for potential changes to health department budgets on a consistent basis.

  • Example: The SACCHO in Ohio completes a salary survey every other year. The aim is to better understand salaries across the state and avoid situations where they bring new employees in at a higher wage than existing employees without making adjustments.

Action: Dedicate resources to build a supportive workforce culture through incorporating healing and HEART (healing, equity, anti-racism, response, and trauma training), bringing in partners to lead wellness trainings, responding to employee burnout, and identifying priority areas to focus on.

  • Example: At Minnesota Department of Health, Behavioral Health Consultants provide consultation and guidance based on subject matter expertise to local public health, Tribal health, and their community advisory committees, and emergency response staff in assessing needs, and developing and implementing approaches to increase local and regional disaster behavioral health capacity.
  • Example: Oregon is investing in workforce wellness through employee resource groups, staff of color support groups, career development paths, communities of practice for professional development, and more.

Action: Benefits may include retention bonuses, flexible hours, education reimbursement, adult orthodonture, “Paw”ternity leave, remote options for all, a four-day work week, etc.

  • Example: Pine County Public Health, a small rural health department in Minnesota, has a 100% retention rate. Staff credit the workplace culture, which focuses on well-being. They offer a wellness schedule, which includes a four-day work week option for full-time employees. This has led to less stress, even during vaccine roll outs during Summer 2021. They began the program with a pilot, and it has since spread to other divisions in their government.
  • Example: At Minnesota Department of Health, for many positions depending on the business need, staff may choose a flexible schedule (9 or 10-hour days). Additionally, there are many positions that may telework from across Minnesota or neighboring states.

Action: Dedicate time to share your knowledge and experience with employees who you hope will be in your/similar positions one day.

Action: Ask employees what you can provide that would add value to their career journey.

Action: Encourage leaders to communicate availability so that they are more approachable to newer staff.

Recruitment Strategies

Action: Promote jobs in a breadth of diverse places (virtual and in person) within the community your health department serves (e.g., historically black colleges and universities).

Action: Invest in a regional representative for college fairs that has information and opportunities from all health departments in the region, eliminating the need for all local health departments to send staff.

Action: Update your health department’s hiring website to be easy to navigate and to include language that help potential applicants outside of government or public health understand if they are eligible for a role.

  • Identify if specific roles/classifications are entry level, mid-level, management level, etc.

Example: Colorado developed a pathway for public health careers website to demonstrate the range of roles in public health, their responsibilities, and additional information to help current and future employees see how they can grow in public health.

Example: Columbia-Boone County in Missouri centers human resources around health equity. This includes advertising directly to populations within their program’s targeted audience. They have revised their job opportunities postings and interview panels and techniques to include health equity and inclusion practices as well.

Example: Local health departments in Ohio are often unable to send staff to the numerous college fairs. The Ohio SACCHO worked with the state to invest in regional representatives so that one person can go to the college fairs and share information on all state and local job postings.

Action: Develop campaigns for specific classifications that allow applicants to apply for more than one role at once.

Action: Use, with permission, classification levels from different government offices to hire for roles that do not fit within your classification system.

  • Example: At Minnesota Department of Health (MDH), a new job classification, Communication Specialist, was developed to create a more comprehensive structure for existing and new roles.
  • Example: The Nevada state division of human resource management is creating a pipeline/trainee program for specific classifications. This program will hire people with interest in a specific path and work with them to ensure they receive licensure and training in one to years. This trainee to employee program will hopefully create a workforce for classifications that are often hard to fill.

Action: Use interagency agreements for hard to fill positions to increase salary opportunities (e.g., hire through state university system).

Action: Map your pipeline/pathways for current and future employees, then assess areas to improve to attract a more diverse applicable pool, strengthen your workforce infrastructure, and provide additional workforce development opportunities.

  • Example: Minnesota’s 2024-2025 Governor’s Biennial Budget Recommendations includes support for funding to pay AmeriCorps volunteers a living wage.
  • Example: North Carolina has fellowships and internships with local HBCUs, but these experiences have historically not counted as work experience to meet the requirements for state jobs. The state is piloting a program that will make these fellows or interns eligible for hard to fill positions.

Action: Include Equity, Diversity, and Inclusion Commitment Statement on all job postings; internally, determine the action steps the organization will take to fulfill this commitment.

Action: Redact some applicant information (e.g., names) before sharing applications with hiring managers.

Action: Evaluate the impact of minimum requirements (e.g., years of experience) to determine if they still reflect current roles.

  • Consider how nontraditional education can be counted or how internships may be used to fulfill experience requirements.

Action: Provide support navigating your health department’s/government’s hiring system.

Example: At Minnesota Department of Health, temporary staff who were hired to support COVID-19 have been encouraged and supported by their hiring supervisor to apply to open roles. *This is not a coordinated system throughout the entire agency though is seen among hiring managers eager to retain talented staff.

Action: Use Lean principles to streamline the hiring workflow process and decrease the time it takes to hire new staff.

Action: Create Equity Lead positions throughout all divisions and offices to examine how equity is embedded in new positions and existing work, particularly as it relates to policies.

  • Offer opportunities for interested staff to serve as Equity Leads; provide training, as needed, and allocate time to perform associated work.

Looking to the Future: A Transformed Public Health System

Implementing these workforce transformation strategies will not be without challenges to overcome. Health department leadership must intentionally shift the culture away from emergency operations. To achieve this culture change, health departments should:

  • Prioritize current needs and focus on intentional steps to transform their system (without taking on too much at once).
  • Implement knowledge management systems to have a process in place so that health department efforts do not get lost during turnover or transitions.
  • Improve communications with the public and policymakers to rebuild trust and better combat politicization and polarization in public health.
  • Examine any improvements that can be made to your benefits package to attract the future workforce, decrease competition amongst other local health departments, and create an environment for employees to thrive.

Thank you to the 2023 21C Workforce Affinity Group participants for their contributions to Strategies to Transform the Public Health Workforce.

We will continue to add to the list of workforce transformation strategies and examples. If you or your health department have an example to share, please email Naomi Rich, Program Specialist at [email protected].