How Health Departments Need to Play Catch-up to the Private Sector

Many roles in the state and local health department workforce are comparatively underpaid, and job requirements are often lower compared to the private sector, according to a new study by researchers at Columbia University Mailman School of Public Health. This situation potentially creates recruitment and retention challenges and produces a workforce that may be less prepared for public health crises. The findings are published in the Journal of Public Health Management and Practice.

The study is among the first to provide detailed data on salary differences between jobs in state and local health departments compared to similar jobs in other sectors, using a dataset of missions of job postings for comparison. Until now, federal data on salaries for local and state health department employees were limited.

“Our findings can begin to inform health departments seeking to benchmark salaries to improve recruitment and retention of key staff.,” said Heather Krasna, PhD, EdM, MS, associate dean of Career and Professional Development at Columbia Mailman. “Health departments experience significant challenges with recruitment and retention, especially for leadership and management positions as well as computer/IT roles, and nurses are especially underpaid, contributing to workforce gaps and challenges meeting public health needs.

“Job postings for workforce research provide an alternative, real-time method to assess job requirements and salaries,” Krasna added. “Our goal was to utilize data from job postings to determine if there were significant differences in salary, education, or experience requirements when comparing jobs in local or state government health departments with the same types of jobs posted in other sectors.”

Using Lightcast, a large-scale and comprehensive database of job postings, with up to 3.5 million U.S. postings from 160 000 online sources, the researchers gathered real-time data on salary, education, and experience requirements for 44 public health occupations, contrasting those in state and local health departments (SLHDs) with those in all other sectors. They also assessed salary differences and contrasted minimum education and experience levels. A unique feature of Lightcast is its ability to collect close to the “full universe” of job postings rather than a random sample.

A total of 16,284 job postings were collected for state and local government health departments (SLHDs), and 12, 609, 441 in the private sector. Twenty-seven occupations paid significantly less in SLHDs, and six paid significantly more. For 37 occupations, SLHDs were less likely to require a Master’s degree than the private sector. Certain SLHD positions require less education and/or experience, while also paying less.

“Consistent findings that many occupations are relatively lower paying in health departments create implications for sustainability in the workforce,” said Krasna. “Health departments should consider using data from job postings to benchmark their salaries and advocate for more competitive wages, especially for ‘hard-to-fill’ positions, and to better advertise their benefits to attract candidates.”

SLHDs are short-staffed by at least 80,000 workers., according to recent estimates.  Temporary post-pandemic funding such as the Public Health Infrastructure Grant had been made available to hire public health workers, but such funds do not necessarily increase salaries. 

It is noteworthy that many key positions in health departments, especially management and leadership roles, computer occupations, and scientific and surveillance roles such as statisticians, engineers, environmental scientists, or policy analysts (with the title of Political Scientists), require only a Bachelor’s degree; by comparison, the private sector requires a Master’s or higher degree.

These occupations can serve in frontline roles in disease surveillance and public safety, and considering the many calls to modernize the public health data infrastructure, the lower education level required for Epidemiologists, Statisticians, and computer occupations raises questions about whether government workers are well-prepared for their roles.

“It is possible that for many of these occupations, government might require less education because their salaries are too low to be able to attract applicants with more education. Alternately, health departments may be relying on ‘on-the-job training,’ or they may be flexible on education requirements in order to attract a more diverse candidate pool, including individuals with less access to higher education or graduate degrees,” observed Krasna. “Future research about differences in education or experience between SLHD and similar workers in other sectors could help illuminate whether such differences have an impact on the health of the communities SLHDs serve.”

While SLHDs may offer better benefits than the private sector to make up for lower salaries, disparities of 25 percent and higher are likely to make hiring extremely difficult for certain roles and contribute to recruitment and retention difficulties, according to Krasna. Health departments may have little control over the salaries offered to their staff due to regulations and civil service requirements, but gathering more information about salary disparities may help health departments make the case to policymakers that wage increases are needed for certain positions in health departments.

“Columbia Mailman School degree programs give students the tools to think creatively for tackling the complex issues in their future workplaces, and addressing the many multidimensional challenges in an ever-changing world. Through cutting-edge research by our faculty and exposure to experts from a wide range of experiences and disciplinary backgrounds our students are prepared for a full range of healthcare careers in government as well as non-profit organizations and the private sector,” said Krasna.

Co-authors are Isabella Patino, and Malvika Venkataraman, Columbia Mailman School; and Sezan Ozcan Onal, University of Minnesota.

The study was supported by the Centers for Disease Control and Prevention and the Health Resources and Services Administration (grants U81HP47167, UR2HP47371).

The Columbia Mailman Office of Career Services serves an enrollment of approximately 1,750 students and 11,000 alumni who receive lifetime career services access. Each year since 2017 the office has provided between 1,500 and 2,000 individual student advising appointments.