New Federal Support for the Public Health Workforce: Analysis of Funding by Jurisdiction

Key Takeaways

• New federal investment of $3 billion equipped to well being departments from the American Rescue Plan is designed to construct and bolster what has been a depleted public well being personnel in the USA.
• The investment, disbursed throughout the CDC’s Public Well being Infrastructure Grants (PHIG) program, has been equipped to 107 other jurisdictions, together with state, county, town, and territorial well being departments.
• Via area, well being departments within the South have won the biggest percentage of investment (39%), adopted by means of the ones within the West (23%), Midwest (20%) and Northeast (17%).
• State well being departments have won the best percentage of personnel investment (70.6%) adopted by means of counties (17.1%), towns (10.4%), and territories (1.9%).
• Amongst states, Florida won the biggest quantity of personnel reinforce ($141.4 million), adopted by means of Texas ($140.8 million), and New York ($107.8 million). In combination the highest ten funded states accounted for 47% of all state investment and 33% of investment total.
• Jurisdictions record that they plan to make use of PHIG personnel price range to rent or retain greater than 6,000 body of workers over the five-year grant length, with maximum deliberate hires/retentions in Texas, Florida, and Missouri by means of the top of the grant.
• The dimensions, scope, and versatility of this investment is unparalleled, because it exceeds any investment equipped for the personnel up to now, reaches many extra jurisdictions, and extends over a five-year length.
• Information on results and affects will take longer to materialize, and demanding situations stay, together with the remainder hole between estimated personnel wishes and deliberate body of workers hires and retentions, and questions on personnel sustainability after the five-year grant length ends. 

Creation

COVID-19 highlighted and exacerbated present weaknesses within the U.S. public well being gadget, in particular within the public health workforce, which had already been depleted. Public well being departments in any respect ranges – together with states, counties, huge towns, and territories – confronted a large number of demanding situations in mounting a reaction to the pandemic because of a loss of body of workers, restricted investment, and old-fashioned knowledge and conversation features, amongst different problems, and considerations stay about preparedness for long term pandemics. In reaction, Congress equipped $7.7 billion throughout the American Rescue Plan to lend a hand shore up the public health workforce, which incorporated price range to be directed to public well being departments. In flip, the Facilities for Illness Keep an eye on and Prevention used a few of these price range to create a brand new, five-year, $3 billion Public Health Infrastructure Grants (PHIG) program to lend a hand public well being departments recruit, retain, and train employees, together with to raised get ready for long term pandemics (the PHIG additionally contains an extra $140 million for “foundational features” and $200 million for “knowledge modernization”). PHIG introduced in 2022 with the $3 billion in personnel price range awarded to well being departments within the first yr of the grant. The PHIG program is essential for a number of causes:

• This can be a “non-categorical and cross-cutting” grant mechanism, by contrast to maximum federal public health funding which is typically targeted to specific sicknesses, actions, or populations;
• It supplies investment for a multi-year length – on this case, 5 years – versus maximum public well being investment which is typically equipped yearly (or at maximum over a two- to three-year length, as was once achieved with different ARPA investment);
• The selection of native jurisdictions eligible for investment is significantly greater than different CDC investment mechanisms, together with others funded via ARPA; and
• The quantity of investment made to be had for public well being jurisdictions to enlarge their personnel exceeds any prior grant mechanism; for instance, the following biggest quantity was once $2 billion in ARPA funds awarded in 2021 for a two-year length basically to deal with COVID (even if the ones price range may well be used for preparedness).

The usage of newly available data from the CDC, this factor transient analyzes the distribution of PHIG personnel investment by means of jurisdiction, in addition to jurisdictional plans for reinforcing the personnel (knowledge on foundational capacities and knowledge modernization don’t seem to be incorporated), to offer an preliminary snapshot of the way this new investment shall be used. Information are as of September 30, 2023.

Review of PHIG Group of workers Investment

As described within the grant announcement, PHIG personnel price range are meant to “improve and enlarge the general public well being personnel by means of hiring, conserving, supporting, and coaching the personnel and by means of strengthening related personnel making plans, methods, processes, and insurance policies.” Jurisdictions can use those price range to fill vacancies and create new positions, in addition to put money into employee well-being and engagement, together with different actions. Key traits and necessities of the grant come with:

• As many as 111 jurisdictions, together with state, county, town, and territorial well being departments, are eligible to obtain PHIG price range. Counties serving a inhabitants of two,000,000 or extra and towns serving a inhabitants 400,000 or extra are eligible as direct recipients.
• A investment formulation in keeping with the scale of the inhabitants served by means of a jurisdiction in addition to an adjustment issue for “group vulnerability”, the use of the U.S. Census’s Community Resilience Estimates, is used to decide allocations. The bottom investment quantity for all awards is about at $2.5 million and the ceiling at $150 million.
• Jurisdictions are anticipated to focal point their personnel efforts on six key actions and feature some flexibility to select amongst those (see Desk 1). Whilst inspired to incorporate all six actions of their plans, they’re required to incorporate #1 (recruit and rent new public well being body of workers) and #6 (support reinforce for implementation). Beneath #6, recipients should rent a Group of workers Director to lend a hand oversee implementation and a minimum of one body of workers member to behavior analysis.

Key Task	Examples
1. Recruit and rent new public well being body of workers	Habits personnel wishes exams, enlarge recruitment efforts, revise process pay scales, be offering hiring incentives, determine internships and fellowships
2. Retain public well being body of workers	Be offering retention incentives akin to mortgage compensation and transferring bills, revise phrases for present jobs to permit for extra pay or advantages, maximize hybrid paintings alternatives
3. Strengthen and maintain the general public well being personnel	Undertake place of work techniques for body of workers well-being, support worker engagement, behavior body of workers point of view surveys, percentage and use worker enter in strategic making plans and different place of work projects
4. Teach new and present public well being body of workers	Upload coaching choices, determine or revise coaching tracks or certificates techniques, reinforce body of workers who sign up in outdoor trainings
5. Beef up personnel making plans, methods, processes, and insurance policies	Create or revise a personnel construction technique, catalyze the gathering and use of personnel knowledge, refresh on-line recruitment and hiring portals, behavior high quality growth on present methods
6. Beef up reinforce for implementation of this grant	Rent a Group of workers Director to control the grant, body of workers to behavior program analysis and function dimension, and a Information Modernization Director.
SOURCE: HHS/CDC PHIG Grant Opportunity – “U.S. Public Infrastructure, Group of workers, and Information Programs” June 2022.

Findings

PHIG personnel investment has been awarded to 107 public well being departments around the nation, with maximum channeled to state jurisdictions, and the biggest percentage to the South, in large part reflecting the scale of a jurisdiction’s inhabitants.

• The 107 well being division recipients come with the ones in all 50 states and Washington D.C., 27 counties, 21 towns, and 8 territories (see Determine 1).
• State well being departments have won the biggest percentage of investment (70.6%), adopted by means of counties (17.1%), towns (10.4%), and territories (1.9%) (see Determine 2).
  • The highest ten funded states accounted for 47% of all state investment and 33% of investment total. Amongst states, Florida won the biggest quantity ($141.4 million), adopted by means of Texas ($140.8 million), and New York ($107.8 million) (see Determine 3).
  • The highest ten funded counties accounted for 61% of all county investment and 10% of investment total. Amongst counties, Los Angeles County, California won the biggest quantity ($79.8 million), adopted by means of Maricopa County, Arizona ($38.0 million), and Miami-Dade County, Florida ($27.8 million).
  • The highest ten funded towns accounted for 71% of all town investment and seven% of investment total. Amongst towns, New York Town won the biggest quantity ($84.6 million), adopted by means of Chicago ($27.1 million), and Houston ($23.3 million).
  • The 8 territories won 2% of investment total. Amongst territories, Puerto Rico won the biggest quantity ($34.9 million), adopted by means of Guam ($4.3 million), and the U.S. Virgin Islands ($3.6 million).
• Via area, well being departments within the South have won the biggest percentage of investment (39%), adopted by means of the West (23%), Midwest (20%) and Northeast (17%) (see Determine 4).

Investment according to capita for all recipients mixed was once $8.95, with vital variation in some instances. For instance, according to capita investment for territories was once virtually two times that of states. This in part displays the truth that there’s a base investment quantity for all jurisdictions, without reference to inhabitants dimension.

• Consistent with capita investment was once $8.95 total, even though it ranged amongst all jurisdictions from a low of $7.49 for the state of Utah to a prime of $125.69 for the territory of Palau.
• Evaluating throughout jurisdiction sorts, states had the bottom according to capita investment ($8.57), adopted by means of counties ($9.10) and towns ($11.00). Territories, which typically have the bottom inhabitants dimension of any jurisdiction, won $15.91 according to capita.
• Inside states, investment according to capita ranged from $7.49 in Utah to $11.75 in Wyoming. In counties, it ranged from $8.03 in King County, Washington to $11.87 in Douglas County, Nebraska. Amongst town recipients according to capita investment quantities ranged from $9.43 in Columbus to $13.88 in Lengthy Seaside, and in territories it ranged from $11.27 in Puerto Rico to $125.69 in Palau (see Determine 5).

Maximum personnel investment is being channeled to the 2 required personnel actions underneath the grant – “strengthening grant implementation” and “recruitment and hiring” – even if there may be variation throughout jurisdictions.

• Greater than a 3rd ($1.1 billion or 36%) of investment is to “Beef up reinforce for implementation of this grant”, which contains hiring a Group of workers Director and analysis body of workers. The following biggest class is recruitment and hiring of body of workers ($613 million or 20%) adopted by means of body of workers retention ($342 million or 11%). The rest 33% is split amongst 4 different actions (see Determine 6).
• There’s some variation by means of jurisdiction stage. For instance, states have been much more likely to make use of price range for strengthening grant implementation (38%) than counties (28%), and counties have been much more likely to make use of investment for recruitment and hiring (23%) than territories (11%) (see Determine 7).
• Most effective seven jurisdictions didn’t channel maximum personnel investment to the 2 required classes. For instance, in two jurisdictions (Washington and Fulton County, Georgia), “Strengthen and maintain the general public well being personnel” was once the highest funded class and in two jurisdictions (Austin and Dallas County, Texas), “Retain public well being body of workers” was once the highest class.

Jurisdictions record that they plan to rent or retain greater than 6,000 body of workers over the five-year grant length, with the biggest percentage anticipated to reinforce organizational competencies.

• In yr 1, jurisdictions plan to rent or retain 3,862 body of workers, emerging to six,152 by means of yr 5.
• State jurisdictions plan to rent the best selection of body of workers (2,471 body of workers in yr 1 and three,822 by means of yr 5), adopted by means of counties (800 and 1,207), towns (377 and 754), and territories (214 and 369). The common selection of body of workers to be employed/retained throughout all jurisdictions is 36.4 in yr 1 and 58.0 in yr 5, even though this varies by means of well being division stage.
• The jurisdictions making plans to rent/retain essentially the most body of workers in yr 1 are Texas (433), Los Angeles County (189), and Florida (186); by means of yr 5, it’s Texas, Florida, and Missouri.
• When requested for anticipated hiring/retention numbers throughout ten defined public health program areas, jurisdictions reported the biggest percentage of anticipated hires/retained body of workers by means of yr 5 in “Organizational competencies” (38% of all body of workers hires and retentions), adopted by means of “Overview and surveillance” (14%) and “Different” (14%). This system spaces with the smallest stocks of deliberate hires/retained body of workers are “Maternal, kid, and circle of relatives well being” (2%), “Persistent illness and damage prevention (3%), and “Environmental public well being” (4%). There’s some variation by means of well being division stage. For instance, by means of yr 5, 42% of body of workers employed/retained by means of states are anticipated in organizational competencies in comparison to 31% by means of territories in that class. Territories plan for a better percentage of body of workers in overview and surveillance (25%) in comparison to different jurisdiction sorts (see Determine 8).

Dialogue

New federal investment of $3 billion equipped to well being departments from the American Rescue Plan is designed to construct and bolster what has been a depleted public well being personnel in the USA. The dimensions, scope, and versatility of the investment is unparalleled, because it exceeds any investment equipped for the personnel up to now, reaches many extra jurisdictions, and extends over a five-year length. This research of preliminary knowledge from the CDC supplies an early take a look at how investment has been disbursed around the nation and what jurisdictions plan to do with this reinforce. As proven right here, states have won the biggest percentage of investment, (70.6%), adopted by means of counties (17.1%), towns (10.4%), and territories (1.9%), reflecting the scale of the populations they serve. Jurisdictions plan to make use of price range to rent or retain greater than 6,000 body of workers by means of the top of the five-year length, with states main the way in which on this house. Maximum investment shall be channeled to the 2 required spaces of the grant, strengthening reinforce for implementation via hiring key team of workers and recruitment and hiring of body of workers, adopted by means of body of workers retention extra typically. Throughout these types of spaces there may be notable variation amongst recipients, which seems to mirror the design of the PHIG in permitting flexibility to deal with the original wishes of various jurisdictions.

Nonetheless, whilst those knowledge supply an early snapshot of the way this investment shall be used, knowledge on results and affects will take a for much longer time to materialize. Additionally, in spite of the scale of the grant and multi-year nature of the investment, there are demanding situations that stay. First, the deliberate selection of body of workers hires and retentions constitute just a fraction of estimates of the need for a public well being personnel within the U.S.  Moreover, whilst investment is equipped for a five-year length, longer than maximum jurisdictional grants, there are questions concerning the sustainability of hiring past this era, with jurisdictions already expressing considerations concerning the long term. Extra extensively, the level to which this investment can lend a hand plug the very deep hollow, even briefly, within the public well being personnel that might be required to adequately get ready and reply to long term threats is still noticed. Tracking the affect of those investments, together with how enduring they could also be, shall be essential for assessing the power of the country’s public well being infrastructure and its talent to deal with new demanding situations going ahead.