{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T11:04:28Z","timestamp":1786446268647,"version":"build-2736575974"},"reference-count":17,"publisher":"American Public Health Association","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Public Health"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:p> Objectives. To expand on previous enumerations by assessing the size and composition of the governmental public health workforce in the wake of the COVID-19 pandemic, identifying workforce trends, occupational distributions, and potential gaps in staffing. <\/jats:p><jats:p> Methods. From 2023 to 2024, using 2022 data in the United States, we conducted 3 distinct analyses: (1) estimating the total workforce size, (2) profiling occupation-specific distributions, and (3) evaluating the role and prevalence of public health nurses using novel data sources. For total counts, we used multiple imputation by chained equations to develop robust agency-level estimates and address missingness from multiple data sets. <\/jats:p><jats:p> Results. State and local public health agencies grew to approximately 239\u2009000 staff in 2022, up from an estimated 206\u2009500 in 2019. The largest occupation groups included office and administrative support workers (37\u2009576) and public health or community health nurses (29\u2009387). We found that 73\u2009478 (1.8%) of registered nurses nationwide served in governmental public health roles. <\/jats:p><jats:p> Conclusions. The size of the workforce during the COVID-19 response has returned to 2008 levels although temporary staff largely constitute the increase. <\/jats:p><jats:p> Public Health Implications. An undersized workforce leaves the United States vulnerable to future disasters and current challenges. ( Am J Public Health. 2025;115(5):707\u2013715. https:\/\/doi.org\/10.2105\/AJPH.2024.307960 ) <\/jats:p>","DOI":"10.2105\/ajph.2024.307960","type":"journal-article","created":{"date-parts":[[2025,3,20]],"date-time":"2025-03-20T20:07:42Z","timestamp":1742501262000},"page":"707-715","source":"Crossref","is-referenced-by-count":10,"title":["Enumeration 2024: What We Know and What We Wish We Knew About the Governmental Public Health Workforce in a COVID-19 Recovery Landscape"],"prefix":"10.2105","volume":"115","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9905-476X","authenticated-orcid":false,"given":"Jonathon P.","family":"Leider","sequence":"first","affiliation":[{"name":"Jonathon P. Leider, Nicole M. Weiss, Abby Vogel, Sezen O. Onal, Xiao Zang, Harshada Karnik, Bibin Joseph, and Morgan Pak are with the Center for Public Health Systems, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis. Casey P. Balio and Nathan Dockery are with the Center for Rural Health Research, Department of Health Services Management and Policy, East Tennessee State University, Johnson City. Rachel Hogg-Graham is with the College of Public Health, University of Kentucky, Lexington. Paula Kett and Betty Bekemeier are with the Center for Health Workforce Studies, University of Washington, Seattle. Joyce Edmonds is with the Harvard T.\u2009H. Chan School of Public Health, Boston, MA. Amy Belflower Thomas is with the Public Health Accreditation Board, Alexandria, VA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2987-4268","authenticated-orcid":false,"given":"Casey P.","family":"Balio","sequence":"additional","affiliation":[{"name":"Jonathon P. Leider, Nicole M. Weiss, Abby Vogel, Sezen O. Onal, Xiao Zang, Harshada Karnik, Bibin Joseph, and Morgan Pak are with the Center for Public Health Systems, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis. Casey P. Balio and Nathan Dockery are with the Center for Rural Health Research, Department of Health Services Management and Policy, East Tennessee State University, Johnson City. Rachel Hogg-Graham is with the College of Public Health, University of Kentucky, Lexington. Paula Kett and Betty Bekemeier are with the Center for Health Workforce Studies, University of Washington, Seattle. Joyce Edmonds is with the Harvard T.\u2009H. Chan School of Public Health, Boston, MA. Amy Belflower Thomas is with the Public Health Accreditation Board, Alexandria, VA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0555-4902","authenticated-orcid":false,"given":"Rachel","family":"Hogg-Graham","sequence":"additional","affiliation":[{"name":"Jonathon P. Leider, Nicole M. Weiss, Abby Vogel, Sezen O. Onal, Xiao Zang, Harshada Karnik, Bibin Joseph, and Morgan Pak are with the Center for Public Health Systems, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis. Casey P. Balio and Nathan Dockery are with the Center for Rural Health Research, Department of Health Services Management and Policy, East Tennessee State University, Johnson City. Rachel Hogg-Graham is with the College of Public Health, University of Kentucky, Lexington. Paula Kett and Betty Bekemeier are with the Center for Health Workforce Studies, University of Washington, Seattle. Joyce Edmonds is with the Harvard T.\u2009H. Chan School of Public Health, Boston, MA. Amy Belflower Thomas is with the Public Health Accreditation Board, Alexandria, VA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1704-3536","authenticated-orcid":false,"given":"Nicole M.","family":"Weiss","sequence":"additional","affiliation":[{"name":"Jonathon P. Leider, Nicole M. Weiss, Abby Vogel, Sezen O. Onal, Xiao Zang, Harshada Karnik, Bibin Joseph, and Morgan Pak are with the Center for Public Health Systems, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis. Casey P. Balio and Nathan Dockery are with the Center for Rural Health Research, Department of Health Services Management and Policy, East Tennessee State University, Johnson City. Rachel Hogg-Graham is with the College of Public Health, University of Kentucky, Lexington. Paula Kett and Betty Bekemeier are with the Center for Health Workforce Studies, University of Washington, Seattle. Joyce Edmonds is with the Harvard T.\u2009H. Chan School of Public Health, Boston, MA. Amy Belflower Thomas is with the Public Health Accreditation Board, Alexandria, VA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5783-221X","authenticated-orcid":false,"given":"Abby","family":"Vogel","sequence":"additional","affiliation":[{"name":"Jonathon P. Leider, Nicole M. Weiss, Abby Vogel, Sezen O. Onal, Xiao Zang, Harshada Karnik, Bibin Joseph, and Morgan Pak are with the Center for Public Health Systems, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis. Casey P. Balio and Nathan Dockery are with the Center for Rural Health Research, Department of Health Services Management and Policy, East Tennessee State University, Johnson City. Rachel Hogg-Graham is with the College of Public Health, University of Kentucky, Lexington. Paula Kett and Betty Bekemeier are with the Center for Health Workforce Studies, University of Washington, Seattle. Joyce Edmonds is with the Harvard T.\u2009H. Chan School of Public Health, Boston, MA. Amy Belflower Thomas is with the Public Health Accreditation Board, Alexandria, VA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sezen O.","family":"Onal","sequence":"additional","affiliation":[{"name":"Jonathon P. Leider, Nicole M. Weiss, Abby Vogel, Sezen O. Onal, Xiao Zang, Harshada Karnik, Bibin Joseph, and Morgan Pak are with the Center for Public Health Systems, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis. Casey P. Balio and Nathan Dockery are with the Center for Rural Health Research, Department of Health Services Management and Policy, East Tennessee State University, Johnson City. Rachel Hogg-Graham is with the College of Public Health, University of Kentucky, Lexington. Paula Kett and Betty Bekemeier are with the Center for Health Workforce Studies, University of Washington, Seattle. Joyce Edmonds is with the Harvard T.\u2009H. Chan School of Public Health, Boston, MA. Amy Belflower Thomas is with the Public Health Accreditation Board, Alexandria, VA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5722-8255","authenticated-orcid":false,"given":"Xiao","family":"Zang","sequence":"additional","affiliation":[{"name":"Jonathon P. Leider, Nicole M. Weiss, Abby Vogel, Sezen O. Onal, Xiao Zang, Harshada Karnik, Bibin Joseph, and Morgan Pak are with the Center for Public Health Systems, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis. Casey P. Balio and Nathan Dockery are with the Center for Rural Health Research, Department of Health Services Management and Policy, East Tennessee State University, Johnson City. Rachel Hogg-Graham is with the College of Public Health, University of Kentucky, Lexington. Paula Kett and Betty Bekemeier are with the Center for Health Workforce Studies, University of Washington, Seattle. Joyce Edmonds is with the Harvard T.\u2009H. Chan School of Public Health, Boston, MA. Amy Belflower Thomas is with the Public Health Accreditation Board, Alexandria, VA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8524-6493","authenticated-orcid":false,"given":"Paula","family":"Kett","sequence":"additional","affiliation":[{"name":"Jonathon P. Leider, Nicole M. Weiss, Abby Vogel, Sezen O. Onal, Xiao Zang, Harshada Karnik, Bibin Joseph, and Morgan Pak are with the Center for Public Health Systems, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis. Casey P. Balio and Nathan Dockery are with the Center for Rural Health Research, Department of Health Services Management and Policy, East Tennessee State University, Johnson City. Rachel Hogg-Graham is with the College of Public Health, University of Kentucky, Lexington. Paula Kett and Betty Bekemeier are with the Center for Health Workforce Studies, University of Washington, Seattle. Joyce Edmonds is with the Harvard T.\u2009H. Chan School of Public Health, Boston, MA. Amy Belflower Thomas is with the Public Health Accreditation Board, Alexandria, VA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joyce","family":"Edmonds","sequence":"additional","affiliation":[{"name":"Jonathon P. Leider, Nicole M. Weiss, Abby Vogel, Sezen O. Onal, Xiao Zang, Harshada Karnik, Bibin Joseph, and Morgan Pak are with the Center for Public Health Systems, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis. Casey P. Balio and Nathan Dockery are with the Center for Rural Health Research, Department of Health Services Management and Policy, East Tennessee State University, Johnson City. Rachel Hogg-Graham is with the College of Public Health, University of Kentucky, Lexington. Paula Kett and Betty Bekemeier are with the Center for Health Workforce Studies, University of Washington, Seattle. Joyce Edmonds is with the Harvard T.\u2009H. Chan School of Public Health, Boston, MA. Amy Belflower Thomas is with the Public Health Accreditation Board, Alexandria, VA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1687-8849","authenticated-orcid":false,"given":"Harshada","family":"Karnik","sequence":"additional","affiliation":[{"name":"Jonathon P. Leider, Nicole M. Weiss, Abby Vogel, Sezen O. Onal, Xiao Zang, Harshada Karnik, Bibin Joseph, and Morgan Pak are with the Center for Public Health Systems, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis. Casey P. Balio and Nathan Dockery are with the Center for Rural Health Research, Department of Health Services Management and Policy, East Tennessee State University, Johnson City. Rachel Hogg-Graham is with the College of Public Health, University of Kentucky, Lexington. Paula Kett and Betty Bekemeier are with the Center for Health Workforce Studies, University of Washington, Seattle. Joyce Edmonds is with the Harvard T.\u2009H. Chan School of Public Health, Boston, MA. Amy Belflower Thomas is with the Public Health Accreditation Board, Alexandria, VA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9398-9280","authenticated-orcid":false,"given":"Nathan","family":"Dockery","sequence":"additional","affiliation":[{"name":"Jonathon P. Leider, Nicole M. Weiss, Abby Vogel, Sezen O. Onal, Xiao Zang, Harshada Karnik, Bibin Joseph, and Morgan Pak are with the Center for Public Health Systems, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis. Casey P. Balio and Nathan Dockery are with the Center for Rural Health Research, Department of Health Services Management and Policy, East Tennessee State University, Johnson City. Rachel Hogg-Graham is with the College of Public Health, University of Kentucky, Lexington. Paula Kett and Betty Bekemeier are with the Center for Health Workforce Studies, University of Washington, Seattle. Joyce Edmonds is with the Harvard T.\u2009H. Chan School of Public Health, Boston, MA. Amy Belflower Thomas is with the Public Health Accreditation Board, Alexandria, VA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1506-8459","authenticated-orcid":false,"given":"Bibin","family":"Joseph","sequence":"additional","affiliation":[{"name":"Jonathon P. Leider, Nicole M. Weiss, Abby Vogel, Sezen O. Onal, Xiao Zang, Harshada Karnik, Bibin Joseph, and Morgan Pak are with the Center for Public Health Systems, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis. Casey P. Balio and Nathan Dockery are with the Center for Rural Health Research, Department of Health Services Management and Policy, East Tennessee State University, Johnson City. Rachel Hogg-Graham is with the College of Public Health, University of Kentucky, Lexington. Paula Kett and Betty Bekemeier are with the Center for Health Workforce Studies, University of Washington, Seattle. Joyce Edmonds is with the Harvard T.\u2009H. Chan School of Public Health, Boston, MA. Amy Belflower Thomas is with the Public Health Accreditation Board, Alexandria, VA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0894-7503","authenticated-orcid":false,"given":"Morgan","family":"Pak","sequence":"additional","affiliation":[{"name":"Jonathon P. Leider, Nicole M. Weiss, Abby Vogel, Sezen O. Onal, Xiao Zang, Harshada Karnik, Bibin Joseph, and Morgan Pak are with the Center for Public Health Systems, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis. Casey P. Balio and Nathan Dockery are with the Center for Rural Health Research, Department of Health Services Management and Policy, East Tennessee State University, Johnson City. Rachel Hogg-Graham is with the College of Public Health, University of Kentucky, Lexington. Paula Kett and Betty Bekemeier are with the Center for Health Workforce Studies, University of Washington, Seattle. Joyce Edmonds is with the Harvard T.\u2009H. Chan School of Public Health, Boston, MA. Amy Belflower Thomas is with the Public Health Accreditation Board, Alexandria, VA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1871-9034","authenticated-orcid":false,"given":"Amy Belflower","family":"Thomas","sequence":"additional","affiliation":[{"name":"Jonathon P. Leider, Nicole M. Weiss, Abby Vogel, Sezen O. Onal, Xiao Zang, Harshada Karnik, Bibin Joseph, and Morgan Pak are with the Center for Public Health Systems, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis. Casey P. Balio and Nathan Dockery are with the Center for Rural Health Research, Department of Health Services Management and Policy, East Tennessee State University, Johnson City. Rachel Hogg-Graham is with the College of Public Health, University of Kentucky, Lexington. Paula Kett and Betty Bekemeier are with the Center for Health Workforce Studies, University of Washington, Seattle. Joyce Edmonds is with the Harvard T.\u2009H. Chan School of Public Health, Boston, MA. Amy Belflower Thomas is with the Public Health Accreditation Board, Alexandria, VA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9034-2746","authenticated-orcid":false,"given":"Betty","family":"Bekemeier","sequence":"additional","affiliation":[{"name":"Jonathon P. Leider, Nicole M. Weiss, Abby Vogel, Sezen O. Onal, Xiao Zang, Harshada Karnik, Bibin Joseph, and Morgan Pak are with the Center for Public Health Systems, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis. Casey P. Balio and Nathan Dockery are with the Center for Rural Health Research, Department of Health Services Management and Policy, East Tennessee State University, Johnson City. Rachel Hogg-Graham is with the College of Public Health, University of Kentucky, Lexington. Paula Kett and Betty Bekemeier are with the Center for Health Workforce Studies, University of Washington, Seattle. Joyce Edmonds is with the Harvard T.\u2009H. Chan School of Public Health, Boston, MA. Amy Belflower Thomas is with the Public Health Accreditation Board, Alexandria, VA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"844","reference":[{"key":"bib1","doi-asserted-by":"publisher","DOI":"10.1097\/00124784-200311000-00005"},{"key":"bib2","doi-asserted-by":"publisher","DOI":"10.1002\/hpm.3128"},{"key":"bib3","volume-title":"Public Health Service. A Report on Public and Community Health Personnel.","author":"US Department of Health, Education, and Welfare","year":"1980"},{"key":"bib4","volume-title":"The Public Health Workforce Enumeration 2000.","author":"Gebbie KM.","year":"2000"},{"key":"bib5","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2014.07.018"},{"key":"bib6","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.publhealth.25.102802.124357"},{"key":"bib7","doi-asserted-by":"publisher","DOI":"10.1097\/00124784-200701000-00012"},{"key":"bib8","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-publhealth-071421-032830"},{"key":"bib13","volume-title":"Flexible Imputation of Missing Data.","author":"Rubin DB.","year":"2018","edition":"2"},{"key":"bib14","doi-asserted-by":"publisher","DOI":"10.1002\/mpr.329"},{"issue":"3","key":"bib20","first-page":"927","volume":"16","author":"Hall P.","year":"1988","journal-title":"Ann Stat."},{"key":"bib21","first-page":"e1","author":"Bekemeier B","year":"2025","journal-title":"Am J Public Health."},{"key":"bib22","doi-asserted-by":"publisher","DOI":"10.1097\/PHH.0000000000000690"},{"key":"bib23","volume-title":"Public Health Nursing: Scope and Standards of Practice.","author":"American Nurses Association","year":"2022","edition":"3"},{"key":"bib24","doi-asserted-by":"publisher","DOI":"10.1097\/PHH.0000000000001614"},{"key":"bib26","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2023.1306274"},{"key":"bib29","unstructured":"Centers for Disease Control and Prevention. Public health infrastructure grant. May 16, 2024. Available at: https:\/\/www.cdc.gov\/infrastructure-phig\/about\/index.html. Accessed May 30, 2024."}],"container-title":["American Journal of Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ajph.aphapublications.org\/doi\/pdf\/10.2105\/AJPH.2024.307960","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,9]],"date-time":"2025-04-09T20:02:27Z","timestamp":1744228947000},"score":1,"resource":{"primary":{"URL":"https:\/\/ajph.aphapublications.org\/doi\/full\/10.2105\/AJPH.2024.307960"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5]]},"references-count":17,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,5]]}},"alternative-id":["10.2105\/AJPH.2024.307960"],"URL":"https:\/\/doi.org\/10.2105\/ajph.2024.307960","relation":{},"ISSN":["0090-0036","1541-0048"],"issn-type":[{"value":"0090-0036","type":"print"},{"value":"1541-0048","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5]]}}}