UNIVERSITY
OF
CALIFORNIA

Healthforce
Center at ucsr

Public Health Workforce and Education in California

INTRODUCTION

This report presents an overview of current and
future supply and demand for California's public
health workforce. Public health professionals
perform a wide range of services aimed at
creating the conditions in which people can be
healthy. Some public health professionals
provide services to individuals, such as
vaccination and education about healthy
behaviors (e.g., education about the risks
associated with consuming tobacco or alcohol).
Others address community needs, such as
investigating and treating outbreaks of
communicable disease, providing access to
nutritious foods and safe places to exercise, and
enforcing safety standards in workplaces and
sanitary standards in restaurants.'
Epidemiologists conduct research at a
population level to identify risk factors and
trends in the incidence and prevalence of
disease. Still other public health professionals
develop, implement and evaluate programs,
systems and policies to improve health.

The COVID-19 pandemic has highlighted the
importance of the public health workforce and
revealed a critical need for reinvestment in it.
For example, California needs to substantially
increase the number of contact tracers working
with people who test positive for COVID-19 and
those with whom they have had close contact to
ensure that they have access to testing, medical
care and other services that can reduce the
spread of the virus.

The public health workforce is usually defined in
one of two ways. One definition encompasses
all people who work for local, state or federal
agencies that provide public health services,
regardless of whether they have degrees in
public health. The other definition includes all
those who have bachelor's, master's or doctoral
degrees in public health, regardless of whether
they work for public health agencies. Neither
definition is optimal. Many jobs for public health
agencies do not require public health degrees,
and many people with public health degrees do
not work for organizations that provide public

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health services. For example, people with
master's degrees in public health who work for
health systems or health plans.

SUMMARY

No single source of data exists that
encompasses all workers in the public
health workforce.

The majority of employees of state and local
health departments in the United States
were female (79%) and non-Hispanic white
(59%) in 2017.

Over one-fourth (27.78%) of employees of
state and local public health departments in
2017 were older than 55 years.

Only 14% of state and local public health
department employees in the United States
had any public health degree in 2017,

Nationwide, the number of graduate degrees
awarded in public health grew by 300%
between 1992 and 2016.

Twenty-eight colleges and universities in
California award bachelor's, master's or
doctoral degrees in public health, including 4
schools of public health and 16 public health
programs accredited by the Council on
Education for Public Health (CEPH).

A survey of 36 local health departments and
41 state health agencies across the United
States found that state health agencies most
frequently reported high need for
epidemiologists and laboratory workers,
while local health departments reported high
need for disease intervention specialists,
nurses, and administrative support.

The COVID-19 pandemic is increasing
demand for the public health workforce.

UNIVERSITYOFCALIFORNIA.EDU 01
CURRENT SUPPLY

While there is no single estimate of the number
of individuals in the workforce with degrees in
public health, the Public Health Workforce
Interests and Needs Survey (PH WINS),
conducted in 2014 and 2017, offers useful data
on state and local health department workers
nationwide.

The total number of people in California's public
health workforce is unknown. The California
Department of Public Health (CDPH) employed
approximately 3,600 people in 2017. At that
time, 61% of the CDPH's permanent managers
and supervisors were eligible for retirement, as
were 44% of permanent non-supervisory
employees.?

Demographic Characteristics

The 2017 survey, which had 47,756
respondents, found that the majority of the
workforce in state and local health departments
was female (79%) and non-Hispanic white
(59%) (Table 1).3 Black and Asian workers
constituted similar proportions of the workforce
in these departments as in the U.S. population
overall. Latinos were underrepresented relative
to their proportion of the U.S. population. Non-
Hispanic white employees were more likely to be
in supervisory, managerial or executive
positions.4

Table 1. State and Local Public Health
Workforce in the United States by
Race/Ethnicity, 2017

Racial/Ethnic Group Percentage
White 59%
Black/African American 15%
Hispanic/Latino 13%
Asian 6%
Other 1%
Two or More Races 6%

Source: de Beaumont Foundation. PH WINS Survey,
2017

The 2017 PH WINS survey found that 20.2% of
state or local health department employees were
age 35 years or younger, 52% were age 36 to

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55 years, 25% were age 56 to 65 years, and
2.8% were age 66 years or older. ® Twenty-two
percent of respondents indicated that they had
worked in public health for over 20 years.

Sixty-seven percent of respondents to the 2017
PH WINS survey reported that they had at least
a bachelor's degree in any field. Twenty-five
percent had a master's degree in addition to a
bachelor's degree. Five percent had a doctorate
(and possibly a master's degree) in addition to a
bachelor's degree. Only 14% had any type of
public health degree.®

EDUCATION
Educational Programs in the United States

Colleges and universities in the United States
offer public health degrees at undergraduate,
master's and doctoral levels. There are two
types of doctoral degrees in public health. PhD
programs prepare students for careers as
advanced researchers and academicians, while
DrPH programs are designed to prepare
"leaders with expertise in evidence-based public
health practice and research",'"

The Council on Education for Public Health
(CEPH), the accrediting body for public health
schools and programs, was formed in 1974 to
promote consistent training, learning objectives
and national standards. The first programs
accredited by CEPH were master's degrees in
public health, followed in 2003 by undergraduate
public health programs at universities that
offered master's degrees in public health, and in
2013, by stand-alone undergraduate public
health programs (i.e., undergraduate public
health programs at universities that do not offer
graduate programs in public health).

The number of institutions offering
undergraduate public health degrees increased
between 2003 and 2016, from 83 institutions in
2003 (with a mean of 17 degrees per institution
and a maximum of 120 degrees per institution)
to 271 in 2016 (with a mean of 48 degrees per
institution and a maximum of 536 degrees per
institution). The number of undergraduate
public health degrees awarded per year

UNIVERSITYOFCALIFORNIA.EDU 02
increased dramatically during this period, from
1,448 in 2003 to 12,895 in 2016. More than half
of all degrees awarded between 2003 and 2016
were awarded between 2011 and 2016. In 2016,
degrees from accredited undergraduate
programs accounted for 6,834 (53%) of the
12,895 undergraduate public health degrees
conferred.°

According to a survey conducted by the
Association of Schools and Programs of Public
Health (ASPPH), 75% of recipients of bachelor's
degrees in public health in 2014-2015 were
employed following graduation and 12% were
pursuing further education (13% did not respond
to the survey). Among those who were
employed, 34% were employed by for-profit
institutions, 20% by health care organizations,
and 11% by governmental organizations (35%
worked elsewhere or did not respond). 1°

The number of graduate degrees awarded in
public health quadrupled between 1992 and
2016, from 4,481 graduate degrees awarded in
1992 to 19,124 in 2016. During this time, the
number of institutions granting at least one
graduate degree in public health increased from
74 to 310. Master's degrees accounted for
between 90% and 92% of these degrees
awarded each year, while doctorate degrees
accounted for 8% to 10%. In 2016, 83% of
public health graduate degrees were awarded
by CEPH-accredited institutions.

The proportion of graduate public health
degrees by program area remained consistent
from 1992 to 2016, with 40% to 50% of graduate
degree recipients having a concentration in
general public health or health policy and
management. A smaller percentage obtained
degrees in the basic public health sciences. In
2016, 11% of degrees were awarded in
epidemiology, 10% in health
education/behavioral science, 6% in
environmental health sciences and 5% in
biostatistics. Other specializations in which
degrees were awarded include global health,
maternal child health and program
management. '2

According to ASPPH data, the number of
accredited schools and programs of public

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health with students in DrPH programs
increased from 18 in 2000 to 38 in 2015. Since
2002, the number of students in DrPH programs
has more than doubled, growing from 605 to
1,526 students in 2015. During the 2014-2015
academic year, 204 graduates received a DrPH
degree."

Geographic Distribution of
Educational Programs

Of the 12,895 undergraduate public health
degrees conferred by U.S. schools in 2016,
institutions in the Southeast and Western United
States accounted for the largest share of
degrees. Institutions in New England and the
Plains states conferred the fewest degrees. '4

An assessment of 85 institutions offering CEPH-
accredited public health programs at the
certificate, master's, and doctoral level in 2014
found that 22% (19) were located in
Northeastern states, followed by 16% (14) in
Eastern states, 14% (12) in Southern states,
14% (12) in Central states, and 12% (10) in
Western states. ® These estimates do not
include colleges and universities that have
public health degree programs not accredited by
CEPH.

Demographic Characteristics of Public
Health Students

The percentage of undergraduate degrees in
public health awarded to women increased
between 2003 and 2016, from 73% to 78% of
degrees awarded. The percentage of graduate
degrees in public health awarded to women also
increased, rising from 63% in 1992 to 73% in
2016. 16

The proportion of Asian/Pacific Islander and
Hispanic students in undergraduate public
health programs increased between 2003 and
2016 from 5% to 13% and from 6% to 14%,
respectively. At the same time, the proportions
of non-Hispanic white students and non-
Hispanic Black students decreased, from 62% to
50% and from 23% to 16%, respectively. 1"
Asian/Pacific Islander, Hispanic and non-
Hispanic Black students accounted for a higher

UNIVERSITYOFCALIFORNIA.EDU 03
share of undergraduate degrees received in
public health than across all other disciplines.

The racial/ethnic composition of individuals
awarded graduate degrees in public health also
changed in the last several decades. The
ASPPH reports that the percentage of graduate
degrees awarded to white students decreased
from 75% in 1992 to 53% in 2016, while the
percentage of graduate degrees awarded to
Asian/Pacific Islander students increased from
6% to 14%, to Black/African American students
from 6% to 11%, and to Hispanic/Latino
students from 8% to 10%. 18

Educational Programs in California

As of 2016, California had the most colleges and
universities conferring undergraduate public
health degrees in the United States (20
institutions, 1,699 degrees). '? Of these, 15 were
public (California State University or University
of California) and five were private, not-for-
profit.2

California has 24 universities that offer master's
degree programs in public health. Sixteen of
these universities are public (California State
University or University of California), six are
private, not-for-profit, and two are private, for-
profit.

There are six California universities with doctoral
programs in public health. Four are public
(University of California) and two are private,
not-for-profit. All six universities award PhD
degrees. One offers a general PhD in public
health, whereas the others offer PhDs in public
health specialties, including biostatistics,
environmental science, epidemiology, global
health, health policy, health promotion,
infectious disease and nutrition. Three of these
universities (Claremont Graduate University,
Loma Linda University, and University of
California, Berkeley) award DrPH degrees.

There are currently four CEPH-accredited
schools of public health in California: Loma
Linda University, San Diego State University,
University of California, Berkeley, and University
of California, Los Angeles.2' The Regents of the
University of California have approved the

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establishment of a School of Public Health at the
University of California, San Diego that is not yet
accredited by CEPH. In addition, there are 16
CEPH-accredited public health programs in the
state, nine at public universities and seven at
private, not-for-profit universities. There are also
seven California universities that have
unaccredited public health degree programs.

Public health degree programs are located
across California, but are concentrated in
Southern California and in the Bay Area. There
are no doctoral programs in the San Joaquin
Valley or in the Central Coast region, and no
institutions north of Sacramento that have
graduate degree programs in public health.

Figure 1. Public Health Degree Programs by
Degree Type, California, 2018

30
25
z=
20 6 = Private For-
5 .
15 Profit
10 Private Not for
Profit
2
m@ Public
3 4
45 i) »
Noy e -
we ¥ &
es » Ss

Source: National Center for Education Statistics, College
Navigator. Some institutions award more than one type of
degree in public health.

There are also nine programs in California that
are exclusively online or offer an online/in-
person hybrid format. These include three
programs at public universities: CSU Northridge
(MPH), San Jose State University (MPH), and
UC Berkeley (MPH). There are five programs at
private, not-for-profit universities: Loma Linda
University (MPH), National University
(bachelor's and MPH), University of San
Francisco (MPH), University of Southern
California (MPH), and Touro University (MPH).
There is one program at a private, for-profit
university, Ashford University (MPH).22

UNIVERSITYOFCALIFORNIA.EDU 04
FUTURE SUPPLY AND DEMAND

A survey of 41 state health agencies and 36
local health departments found that state health
agencies most frequently reported high-priority
workforce needs for epidemiologists and
laboratory workers.?% Local health departments
reported high need for disease intervention
specialists, nurses, and for administrative
support, management and leadership personnel.
Both state and local health departments
indicated that their ability to recruit and retain
qualified employees was constrained by an
inability to offer competitive salaries.

Several recent trends will increase demand for
public health professionals. First, California's
aging population will require public health
professionals with expertise in the challenges
faced by senior citizens, including chronic
disease, disability and impaired mobility.
Successfully addressing these challenges will
require a public health approach that goes
beyond treatment of specific medical or
cognitive conditions to encompass social
determinants of health, including access to food,
housing and transportation.

Second, there is increasing recognition that
social determinants of health affect mental
health. This recognition will increase demand for
public health professionals who can work
alongside mental health professionals to
address the needs of those with mental health
conditions. The movement to shift resources
away from law enforcement may increase the
resources available to implement such
approaches to improving mental health.

Third, climate change will increase demand for
public health professionals. In particular,
California will need public health professionals
with expertise in emergency response and
disaster management to respond to wildfires.

Finally, the COVID-19 pandemic has increased
demand for public health personnel. Large
numbers of contact tracers are needed to
connect with individuals who test positive for

07.31.20 UC Health

COVID-19 and to ensure that they and their
close contacts have access to testing, medical
care, and other services to reduce the spread of
the virus. Public health professionals also need
skills to persuade skeptical members of the
public that preventive measures such as
wearing masks and immunization (when a
vaccine is available) are effective and safe. In
addition, the disproportionate impact of COVID-
19 on Black and Latino Californians will increase
demand for Black and Latino public health
professionals, and those with the skills,
knowledge and cultural and linguistic
competency to improve health equity.

Regardless of the needs that public health
professionals address, they will need expertise
in analysis and interpretation of quantitative data
from multiple streams, including environmental
monitoring, electronic medical records and
mobile and wearable devices.

No quantitative estimates of future supply and
demand for public health professionals in
California have been published. The large
growth in the number of recipients of bachelor's
and graduate degrees in public health in
California and the U.S. overall suggests that the
future supply of public health professionals may
be adequate to replace those who retire.
However, little is known about the extent to
which persons with public health degrees are
working for government agencies or not-for-
profit organizations that provide public health
services. Better information about graduates'
career paths is needed to estimate the fraction
who go on to complete degrees in clinical fields
(e.g., medicine, dentistry) or to work for for-profit
health care organizations. Public health
education programs also need to assess the
extent to which their curricula prepare graduates
to address aging, social determinants of health,
climate change, and COVID-19.

UNIVERSITYOFCALIFORNIA.EDU 05
 

1 American Public Health Association. What is
Public Health? Retrieved from
https://www.apha.org/what-is-public-health

2 California Department of Public Health (2017).
State Leadership Accountability Act Report.
Retrieved from
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pdf/SLAA cdph 2017.pdf

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4 Sellers, K., Leider, J. P., Gould, E., Castrucci, B. C.,
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7 Association of Schools and Programs in Public
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https://www.aspph.org/ftf-reports/the-drph

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The Landscape of US Undergraduate Public Health
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628. Retrieved from

https: //doi.org/10.1177/0033354918784911

9 Resnick, B., Leider, J. P., & Riegelman, R. (2018).
The Landscape of US Undergraduate Public Health
Education. Public Health Reports, 133(5), 619-
628. Retrieved from

https: //doi.org/10.1177/0033354918784911

10 Resnick, B., Leider, J. P., & Riegelman, R. (2018).
The Landscape of US Undergraduate Public Health
Education. Public Health Reports, 133(5), 619-
628. Retrieved from

https: //doi.org/10.1177/0033354918784911

11 Leider, J. P., Plepys, C. M., Castrucci, B. C., Burke,
E. M., & Blakely, C. H. (2018). Trends in the
Conferral of Graduate Public Health Degrees: A

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Triangulated Approach. Public Health Reports,
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12 Leider, J. P., Plepys, C. M., Castrucci, B. C., Burke,
E. M., & Blakely, C. H. (2018). Trends in the
Conferral of Graduate Public Health Degrees: A
Triangulated Approach. Public Health Reports,
133(6), 729-737. Retrieved from
https://doi.org/10.1177/0033354918791542

13 Sherman, B. R., Hoen, R., Lee, J. M., & Declercq, E.
R. (2017). Doctor of Public Health Education and
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14 Resnick, B., Leider, J. P., & Riegelman, R. (2018).
The Landscape of US Undergraduate Public Health
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628. Retrieved from
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15 Joshi A, Amadi CT. (2016, Jan 27). Assessment of
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16 Resnick, B., Leider, J. P., & Riegelman, R. (2018).
The Landscape of US Undergraduate Public Health
Education. Public Health Reports, 133{5), 619-
628. Retrieved from

https: //doi.org/10.1177/0033354918784911

17 Resnick, B., Leider, J. P., & Riegelman, R. (2018).
The Landscape of US Undergraduate Public Health
Education. Public Health Reports, 133(5), 619-
628. Retrieved from

https: //doi.org/10.1177/0033354918784911

18 Leider, J. P., Plepys, C. M., Castrucci, B. C., Burke,
E. M., & Blakely, C. H. (2018). Trends in the
Conferral of Graduate Public Health Degrees: A
Triangulated Approach. Public Health Reports,
133(6), 729-737. Retrieved from
https://doi.org/10.1177/0033354918791542

19 Resnick, B., Leider, J. P., & Riegelman, R. (2018).
The Landscape of US Undergraduate Public Health
Education. Public Health Reports, 133(5), 619-
628. Retrieved from
https://doi.org/10.1177/0033354918784911

20 National Center for Education Statistics, College
Navigator. Retrieved from
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s=CA&p=51.2299+51.2201&xp=1

UNIVERSITYOFCALIFORNIA.EDU 06
 

23 Beck, A. J., Leider, J. P., Coronado, F., & Harper, E.

21 National Center for Education Statistics, College (2017). State Health Agency and Local Health
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22 National Center for Education Statistics, College https://doi.org/10.2105/AJPH.2017.303875

Navigator. Retrieved from

http://nces.ed.gov/collegenavigator/default.aspx?
s=CA&p=51.2299+51.2201&xp=1

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