Community and Public Health Practice: Workforce, Access and Service Delivery Report

Summary

Community and public health practice covers population-focused work delivered by governmental public health agencies, community health workers (CHWs) and community-oriented workers, alongside primary care. The latest available data show a large global health workforce, which the World Health Organization (WHO) estimated at 65 million health workers ¹ and later described as exceeding 70 million ². Evidence specific to community and public health roles is thinner. A peer-reviewed study describes community-oriented workers in governmental public health as a critical but understudied segment ³. The main finding is workforce instability. CHW intent to leave US local and state health departments rose from 25% to 28% ⁴, and government public health departures surged amid federal workforce reductions and program cuts ⁸. Access pressure is significant, with about 92 million people living in US primary care shortage areas ⁷. Shortage forecasts are large but are projections, not observed counts ⁶. Comparable data on spending, reimbursement, waiting times, outcomes and digital adoption was not found in the source pack.

Key findings

1. 1

   The global health workforce is estimated at 65 million

   WHO reported an estimated 65 million health workers using data from 194 Member States, and the first WHO reporting of community health worker stock ¹. This is a broad health workforce figure, not a count of community health roles.

   Confidence: High
2. 2

   CHW intent to leave US health departments is rising

   The share of CHWs intending to leave local and state health departments rose from 25% to 28% over the period studied. The authors link retention to organizational support, pay satisfaction and job security ⁴.

   Confidence: Medium
3. 3

   Government public health departures surged recently

   Researchers report a surge in government health workforce departures amid federal workforce reductions and program cuts. The source does not give a full figure in the extract, so the scale is described qualitatively ⁸.

   Confidence: Qualitative
4. 4

   About 92 million Americans live in primary care shortage areas

   As of a recent federal count, approximately 92 million people lived in a primary care Health Professional Shortage Area in the United States ⁷.

   Confidence: High
5. 5

   Shortage projections are large but are forecasts

   The national projection workforce center forecasts a shortage of 141,160 physicians and 245,950 licensed practical nurse full-time equivalents, and a 58% physician shortage in nonmetro areas versus 5% in metro areas ⁶. These are modeled projections, not observed counts.

   Confidence: Medium
6. 6

   Fewer than 10% of CHWs work for health departments

   A review reports that fewer than 10% of CHWs work for health departments. The figure is an upper bound and its period is not stated, so it should be treated as indicative only ⁵.

   Confidence: Medium

1Industry definition and scope

This report treats community and public health practice as population-level and community-based work. It includes governmental public health agencies at state and local levels, CHWs and other community-oriented workers, and the public health roles that connect them with primary care. The source pack does not give a formal definition of the field, so this boundary is an interpretation made for analysis.

Terminology varies across sources. WHO uses the broad term health workers ¹ and separately encourages a diverse skills mix that includes community-based and mid-level workers in primary care teams ². US studies use community-oriented workers ³, community health workers ⁴⁵, and promotores de salud in national surveys ⁹. These terms are not interchangeable, and figures built on different definitions cannot be compared directly.

The geographic scope is global, with United States evidence used where sources are US-specific. The reporting period is the latest available data in the source pack. Several extracts do not state their survey or measurement periods, which limits trend analysis.

Terminology differences are reported as found in each source. No single definition is imposed across sources.

2Market size, structure and value chain

The source pack contains no verified market size in currency, no revenue figures and no growth rate for community and public health services. Market value cannot be estimated from these sources, so this section uses workforce and program indicators as proxies for scale.

Workforce scale is the clearest indicator. WHO estimates the global health workforce at 65 million ¹ and later states that the stock exceeds 70 million ². These figures come from different reporting points and may use different bases, so they should not be read as a growth rate. In US state government public health, community-oriented workers rose from 4,900 to 9,786 over the study period ³. In local public health, the number of community-oriented workers grew 136% and then fell 40% in a later period ³. The pattern suggests that the workforce expanded quickly and then contracted, though the source does not explain the causes in detail.

Structure and value chain are shaped by public funding. Government public health workers deliver care in public hospitals, local health departments and federal systems such as the Veterans Health Administration ⁸. Federal pandemic relief funds were used to establish the Illinois Pandemic Health Navigator Program with more than 650 CHWs ⁵. The source pack does not describe reimbursement or billing models for these services.

• Global health workforce (estimated) 65million health workers Observed Global (194 Member States), Latest available data [1]
• State government community-oriented workers 9,786workers Observed United States, state government public health, Latest available data in study period [3]
• Local public health community-oriented workers, later change 40percent decline Observed United States, local public health, Study period [3]
• Population in primary care shortage areas 92million people Observed United States, Latest available data [7]

Figures from different sources and dates are shown side by side for context only and are not combined into a total.

3Customers, demand and adoption

End users include residents of communities with limited access to primary care, people who receive public health services, and employers such as health departments and federal systems. The source pack does not measure service utilization or patient satisfaction for these groups directly.

Demand indicators point to access gaps. About 92 million people lived in US primary care shortage areas ⁷. The national projection center forecasts that nonmetro physician shortages will be 58% against 5% in metro areas ⁶. This is a forecast and should be read as a modeled expectation, not an observed gap. Among respondents who had been helped by CHWs, 60.8% encountered them in health care settings, while 21% encountered them in their community or place of worship ⁹. The survey period is not stated, and the extract does not show how representative the sample is. The result suggests that CHW contact is concentrated in clinical settings, though this is an interpretation of two survey shares.

Purchasing and employment criteria center on the stability of the workforce. The authors of a national public health workforce survey conclude that improving organizational support, pay satisfaction and job security can improve CHW retention ⁴. The intent to leave rose from 25% to 28% over the study period ⁴. WHO also encourages countries to use a diverse skills mix that includes community-based and mid-level workers ², which may widen demand for these roles. Barriers include workforce loss and funding changes ⁸, although the pack does not quantify their effect on service demand.

• Helped respondents who encountered CHWs in health care settings 60.8percent Observed United States, Survey period not stated [9]
• CHWs intending to leave local and state health departments 28percent Observed United States, local and state health departments, Study period, later measurement [4]

The pack does not support a demand volume estimate. Demand is described through access indicators and workforce retention.

4Competitive landscape and key players

Community and public health practice does not have a commercial competitive market in the pack in the usual sense. Providers are largely public or publicly funded bodies, with some community and clinical settings. The sources do not provide market shares, revenue or firm-level comparisons, so concentration cannot be assessed.

Public providers are represented by state and local public health departments ³⁸, the Veterans Health Administration ⁸ and state programs such as the Illinois Pandemic Health Navigator Program ⁵. This program was funded with federal pandemic relief money and used more than 650 CHWs ⁵. Its funding was time-limited, which makes it an example of an emerging or temporary model rather than an established one, as an interpretation of the pack.

Nursing facilities illustrate competitive labor pressure. A Pennsylvania survey by provider associations found a shortage of nearly 2,600 care providers against state staffing ratio requirements ¹⁰. Survey authors project an additional shortage of more than 20,000 per year in nursing facilities ¹⁰. These figures come from an industry association and reflect the interests of the sector, so they should be weighed accordingly. The sources do not compare private, community and public providers on quality or cost, so a fair cross-sector comparison is not possible from this pack.

Comparable examples were limited. Only three named examples are available in the pack and they cover different settings.

5Technology, operations and workforce

The source pack does not cover digital health adoption among community and public health providers, so technology adoption cannot be assessed. Operational change is evident in workforce models. WHO supports a diverse skills mix that includes community-based and mid-level workers in primary care teams ². The Illinois program shows CHWs deployed at scale through public funds ⁵. A review of CHW integration in health departments describes this integration as a developing practice, not as a fully standard one (interpretation).

Workforce capacity is the central constraint. The national projection center forecasts a shortage of 245,950 licensed practical nurse full-time equivalents and 141,160 physicians ⁶. These are forecasts. Retention is also a concern because CHW intent to leave rose from 25% to 28% ⁴. The authors of the workforce study recommend organizational support, pay and job security as levers ⁴. Community-oriented workers in governmental public health are described as understudied ³, so skills and productivity data for this group are limited.

Productivity measures, training pipelines and automation impact are not in the source pack. The gaps are significant, and no productivity claim is made in this report.

Established and emerging practice is distinguished by interpretation only, based on whether programs are standing or time-limited.

6Regulation, standards, risk and sustainability

Jurisdiction matters. WHO's Global Strategy on Human Resources for Health is a global strategy, and its recommendations on skills mix are encouragements to countries ². These are voluntary or non-binding guidance for member countries, not enforceable rules. In the United States, the pack describes state staffing ratio requirements for nursing facilities in Pennsylvania ¹⁰. These requirements are binding state rules as described in the source, though the extract does not cite the statute. The federal workforce projections ⁶ are forecasts and do not set requirements.

Risks include workforce loss tied to federal cuts and program changes ⁸, the staffing gap in nursing facilities ¹⁰ and access gaps in shortage areas ⁷. The pack does not cover privacy rules, safety incident data or quality standards for community and public health services. Privacy is relevant because survey and program data describe people, so analysis should stay at population level and should not be treated as individual medical advice.

Environmental and sustainability factors are not covered in the source pack and are not assessed here. Equity is the clearest social dimension: the gap between nonmetro and metro shortage forecasts ⁶ and the concentration of CHW contact in clinical settings ⁹ both bear on who receives services. These equity points are interpretations of the source figures.

This section is for analysis and is not professional medical, legal or engineering advice.

7Challenges, opportunities and case examples

The main challenge is sustaining a stable workforce in public health. Departures have surged in government health work ⁸, and CHW intent to leave is rising ⁴. Shortage pressure is documented in primary care areas ⁷ and in nursing facilities ¹⁰. Access is also limited by geography, as shown by the metro and nonmetro forecast gap ⁶.

Opportunities include the WHO call for a diverse skills mix ² and the reach of CHWs beyond clinics. The CDC survey shows that a sizeable share of CHW contact occurs in health care settings (60.8%), while 21% occurs in community or places of worship ⁹. Expanding community-based contact is an interpretation and would need more evidence on cost and outcomes, which the pack does not provide.

Case example 1: the Illinois Pandemic Health Navigator Program used federal pandemic relief funds to employ more than 650 CHWs ⁵. Case example 2: the Veterans Health Administration is one of the federal systems where government public health workers deliver care ⁸. Case example 3: Pennsylvania nursing facilities face a shortage of nearly 2,600 care providers against state staffing ratios ¹⁰. The examples differ in setting and funding and are not directly comparable.

Outcome, cost and waiting-time evidence for these programs was not found in the pack.

8Outlook and strategic implications

In the near term, workforce instability is the most evidence-based concern. Departures from government public health work ⁸ and rising CHW intent to leave ⁴ suggest continued pressure on public health capacity. Shortage forecasts for physicians and nurses ⁶¹⁰ point to continued pressure on primary care and long-term care capacity, though these are projections and their timing is uncertain.

In the medium term, WHO's push for a diverse skills mix ² may shift more care to community-based and mid-level workers. Whether that happens depends on funding that the pack does not describe. Data gaps create uncertainty: the community workforce is understudied ³, and key definitions and periods vary across sources.

Practical implications: employers should prioritize organizational support, pay and job security to retain CHWs ⁴. Funders should consider the time-limited nature of pandemic-era programs ⁵ when planning sustained services. Researchers and public agencies need consistent definitions and published counts of community-oriented workers ³⁵ to support planning and comparison.

Projections are reported as forecasts and are not treated as observed outcomes.

9Conclusion

The latest available evidence shows a large health workforce and substantial access gaps, but it does not support a full market size or a cross-sector comparison of quality and cost. The most defensible takeaways are that community and public health capacity is vulnerable to workforce loss ⁴⁸, that shortage projections are large but remain forecasts ⁶, and that better definitions and data are needed before performance can be judged ³.

How this was built

Sources

1. 1

   Global Strategy on Human Resources for Health: Workforce Reporting at Seventy-fifth World Health Assembly

   World Health Organization Official statistics

   who.int
2. 2

   Community-based health workers (CHWs) and Health workforce pages

   World Health Organization Official statistics

   who.int
3. 3

   Community-Oriented Workers in Local and State Public Health

   Journal of Public Health Management & Practice Peer-reviewed

   ovid.com
4. 4

   Retention of Community Health Workers in the Public Health Workforce: Public Health Workforce Interests and Needs Survey

   American Journal of Public Health Peer-reviewed

   ajph.aphapublications.org
5. 5

   A Review of Community Health Worker Integration in Health Departments

   PMC (National Library of Medicine) Peer-reviewed

   pmc.ncbi.nlm.nih.gov
6. 6

   Health Workforce Projections

   Health Resources and Services Administration, National Center for Health Workforce Analysis Official statistics

   bhw.hrsa.gov
7. 7

   State of US Health Care Workforce

   HRSA National Center for Health Workforce Analysis Official statistics

   bhw.hrsa.gov
8. 8

   Government health workforce departures surge

   University of Minnesota School of Public Health Peer-reviewed

   sph.umn.edu
9. 9

   Public Understanding of and Engagement With Community Health Workers and Promotores de Salud: Findings From Two National Surveys

   Centers for Disease Control and Prevention, Preventing Chronic Disease Peer-reviewed

   cdc.gov
10. 10

    Health Care Workforce Shortages Strain Access to Care

    Hospital and Healthsystem Association of Pennsylvania, LeadingAge PA and Pennsylvania Health Care Association Industry association

    phca.org