Public Health Students and Grads Advocate for Loan Repayment

In August and September, more than 100 public health students and graduates—including dozens from Columbia Mailman School—organized meetings with offices of 21 members of the U.S. House of Representatives and Senate as part of the nation’s first-ever National Public Health Students and Graduates Hill Week. Their message: support loan repayment for public health graduates working in health departments.

The effort was co-organized by Heather Krasna, Associate Dean, Career and Professional Development, at Columbia Mailman, and Eric Coles, President of the DrPH Coalition, a public health advocacy organization. Volunteers from this grassroots effort had organized petition letters with over 2,500 signatures in the previous months. Heather also worked with the Association of Schools and Programs of Public Health (ASPPH), to have the loan repayment program be a top legislative priority for ASPPH. The Association helped train the students before they participated in Hill Week, presented on the issue at various meetings, and actively cross-promoted these efforts.

“Public health student loan repayment is urgently needed,” says Krasna. “Local, state, and Tribal public health departments are finally receiving new funding to replenish their depleted ranks in response to decades of underfunding brought to light by the COVID-19 pandemic. However, many potential new hires with the special training needed by these health departments can’t afford to work in local and state government due to their need to pay off high student loans, combined with the relatively low wages in government.”

During National Public Health Students and Graduates Hill Week, public health advocates voiced support for House bill H.R. 3297, “Public Health Workforce Loan Repayment Act,” and Senate Bill S.3506, “Strengthening the Public Health Workforce Act,” which would authorize loan repayment programs for working in state, local, and Tribal public health departments to graduates of fields such as public health, epidemiology, or statistics. Though a similar program was authorized in 2006, and again in 2010, the program was never funded. This year the U.S. House Appropriations committee included $25 million in the FY’23 budget, which still must pass the full Congress.

“The potential loan repayment program is incredibly meaningful to me, as I worked in my local health department’s COVID-19 response,” says Nancy Le, MPH first-year student at Columbia Mailman School of Public Health. This funding would help ensure they provide indispensable public health services across the nation. According to a recent study, the U.S. public health workforce is short at least 80,000 people, or nearly 80 percent of current staffing levels.

Strengthening the public health workforce is a great investment, according to multiple studies. For every dollar spent upstream on public health, taxpayers save up to $27 in downstream costs in healthcare and other social services.

Despite serious interest in working in government, public health degree graduates face financial barriers. There are far fewer scholarships in public health compared to medical schools, leading many to take out student loans. The median debt of a public health graduate student was about $52,000, according to a study co-authored by Krasna in the American Journal of Public Health.

Current loan repayment programs for working in public health departments are not available to public health degree graduates. Programs, like HRSA’s National Health Service Corps, are only available to other degrees, namely clinical degrees, like the medical doctorate, nursing and physical therapy. Even though a degree in public health provides training specifically designed for government health departments not covered in medical training (and includes unique competencies in epidemiology, public health policy, health equity, and health communications) government health departments have no easy way to attract trained public health graduates to work for them.

The last two years have clearly shown the need to strengthen the U.S. public health system. With salaries that are often lower compared to the private or even nonprofit sector, local health departments have significant difficulty recruiting new talent.

“A study I led showed that training in public health, especially epidemiology, is in high demand by other sectors like pharmaceuticals and health insurance,” says Krasna. “The country continues to witness the results of this workforce mismatch—monkeypox, polio, food poisoning, preventable chronic illnesses like diabetes and lung cancer, and opioid overdoses, all of which have caused Americans’ life expectancy to drop to its lowest level since 1996.”

Ensuring specially trained staff—those who actually study public health—are hired is a great first step to resolving these problems. The specific training of public health graduates is vital. “This loan repayment program would relieve that burden and get more of us working where we’re needed, which is on the ground and within our communities,” says Le.