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Addressing Gaps in Public Health Workforce Data: The Inclusion of US Territories and Freely Associated States in the
Rachel Hare Bork1, Haley L Cash McGinley1, Dulce Mendoza1
1Rachel Hare Bork and Kay Schaffer are with the de Beaumont Foundation, Bethesda, MD. Haley L. Cash McGinley is with LuGu Consulting LLC, Kailua, HI. Dulce Mendoza and Alex Wheatley are with the Association of State and Territorial Health Officials, Arlington, VA.
Abstract:
US territories and freely associated states (T/FAS) deliver critical public health services to approximately 3.7 million people but have historically been excluded from national public health workforce assessments. Structural differences, such as smaller workforces, wide geographic distribution, and unique governance, have made it challenging to include T/FAS in public health workforce data systems. In 2025, the Public Health Workforce Interests and Needs Survey expanded to include the 8 T/FAS in the Islands Pilot. Between February 2025 and May 2025, survey invitations were sent to 8913 staff, resulting in 2556 responses for an overall response rate of 29% (19% in the Caribbean, 47% in the Pacific Islands). Findings reveal that the T/FAS workforce is younger and more racially and ethnically diverse and has higher job satisfaction and lower burnout despite differences in education, formal public health training, and benefits. Training needs were highest in the Pacific Islands, especially for policy engagement and systems and strategic thinking. The Public Health Workforce Interests and Needs Survey Islands Pilot highlights the value of culturally informed workforce assessments and provides data to support workforce planning, policy, and capacity building in underrepresented areas. (Am J Public Health. 2026;116(S5):S453-S462. https://doi.org/10.2105/AJPH.2026.308702).
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