Aging and the Public Health Workforce
Moore, Jean, McGinnis, Sandra, Continelli, Tracey, Annual Review of Gerontology & Geriatrics
The expected growth of the older adult population aged 65 years and older in the United States over the next 50 years will have an unprecedented impact on the country's health care system as well as on its workforce. Caused by a confluence of two factors-declining birth rate and increasing life expectancy-the aging of the U.S. population will have substantial impacts on both the supply of health care workers and the demand for health services. The supply of health care workers may decline as large numbers of them retire or reduce their working hours. At the same time, older adults consume a disproportionate share of health care services in the United States, so that demand for such services will increase.
There are a number of important demographic trends related to this growing cohort of elderly. The cohort will
* increase dramatically in number over the next 50 years,
* be more racially and ethnically diverse than previous cohorts of older adults,
* be better educated and less likely to be poor than in the past,
* have a smaller pool of potential family caregivers than their parents,
* have different health care needs than younger age groups (e.g., more chronic diseases; more need for ADL assistance),
* consume more health care services than younger age groups, and
* have a greater range of health care models to choose from (e.g., interdisciplinary care teams; assisted living facilities).
The aging of the population will affect the supply of health workers, the nature of the skills and services that health care workers must be equipped to provide, the settings in which this care is provided, and the strategies used to keep people healthy. While much attention has been given to the effects of the aging of the country on a number of health professions, there has been little discussion about the impact of aging on the public health workforce.
The public health system is a network of public and private agencies across the country that provides population-based health services, health education, clinical services, and prevention programs. Its workforce draws from a wide array of professions both within and outside of health care. Some members of the workforce have had formal training in public health, but many have not. National data on the size and composition of the public health workforce are limited. The lack of clear definitions and good data make it difficult to measure and assess the impact of the aging of the U.S. population on the public health workforce.
It is clear, however, that the public health workforce is already facing shortages, especially of public health nurses, epidemiologists, laboratory scientists, and environmental health specialists (Association of State and Territorial Health Officials [ASTHO], 2003; Institute of Medicine [IOM], 2002a; U.S. Department of Health and Human Services [HHS], 2005). Reasons given include recent state budget cuts, high retirement rates, and a rapidly aging public health workforce. The mean age for public health workers in 2003 was 47 years, compared to a mean age of 44 years for all state government workers and a mean age of 40 years for the entire U.S. workforce (ASTHO, 2003). It appears that too few new workers are currently entering the field to replace retiring professionals (IOM, 2002b).
This chapter will examine public health nurses and public health physicians in terms of aging, retirement, geographic variation in these trends, and the potential impact on current shortages. Further, the chapter will discuss the importance of expanding the focus of public health to include keeping older Americans healthy.
* Public health nurses (PHNs) are older than other RNs and are aging more rapidly.
* Preventive medicine physicians are older than other physicians and are aging more rapidly.
* Some health departments currently report difficulty recruiting new PHNs, although retention is generally high. …