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Small but Essential: Understanding Rural Public Health Workforce Challenges and Strengths From the 2024 Public Health
Casey P Balio1, Stephanie M Mathis, Michael B Meit
1Author Affiliations: Center for Rural Health and Research, East Tennessee State University, Johnson City, Tennessee (Drs Balio, Mathis, and Meit); Department of Health Services Management and Policy, East Tennessee State University, Johnson City, Tennessee (Drs Balio and Mr Meit); Department of Community and Behavioral Health, East Tennessee State University, Johnson City, Tennessee (Dr Mathis); and Department of Child, Family, and Population Health, School of Nursing, University of Washington, Seattle, Washington (Dr Bekemeier).
Objective:
Describe key characteristics of the rural local public health workforce on a national level, including in comparison to both the overall and urban local public health workforce.
Design:
Cross-sectional analysis of the 2024 Public Health Workforce Interests and Needs Survey (PH WINS) data.
Setting:
Local health departments (LHDs) serving rural and urban jurisdictions across the United States.
Participants:
The study sample included 172 679 weighted responses from individuals working in LHDs, and 33 214 of them were from rural-serving LHDs.
Main Outcome Measures:
Descriptive and bivariate statistics for measures across 4 areas, both overall and by rurality: demographic characteristics, educational background, position information, and intentions to stay or leave.
Results:
Greater portions of the rural local public health workforce were female and White relative to their urban counterparts. Compared to the urban workforce, the portions of the rural workforce without a public health degree and with clinical training were both greater. Tenure in position, agency, and public health practice also differed by rurality, with 19.6% of the rural workforce reporting the greatest tenure in public health practice (21 years or above) compared to 17.8% of the urban workforce. Intentions to stay, leave, or retire also differed by rurality, with 15.4% of the rural workforce reporting intentions to leave in the next year for reasons outside of retirement, compared to 21.6% of the urban workforce.
Conclusions:
Characteristics of the local public health workforce vary by rurality, extending prior research demonstrating differences between rural- and urban-serving LHDs across the nation. Findings should guide rural-focused strategies aimed at strengthening and sustaining the public health workforce.
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