Workforce Challenges in Public Health Preparedness

Submitted By

Pete Baril
Western Upper Peninsula Health Department, Michigan
November 7, 2013

Its mid-February in Michigan’s Upper Peninsula. Pete Baril, the emergency preparedness coordinator for the Western Upper Peninsula Health Department, arrives at the office. He sets off across the freshly plowed parking lot, pondering the task before him. “Three deep,” he says as he scrapes the remainder of last night’s snowfall away from the entrance.

The Western Upper Peninsula Health Department serves the northernmost and westernmost reaches of Michigan, with 70,000 residents scattered across 5,000 rugged square miles. As the public health emergency preparedness coordinator, it is Baril’s responsibility to ensure plans are in place, and staff are trained to tackle public health threats such as disease outbreaks, natural disasters, or terrorist attacks.

In his office, Baril pulls out an organizational chart showing each of the emergency functions associated with a pandemic flu response. These functions are to be staffed “three deep” each, meaning three unique staff members should be listed below each function. The Western Upper Peninsula Health Department is a small rural agency, so “three deep” has never been a reality, though at times they have been close. Baril pulls out a red pen and draws an “X” through the first staff member’s name, smiling at first as this individual was a friend and coworker who recently retired. The smile doesn’t last long, as Baril knows this individual will not be replaced.

The organizational chart has a lot of “X’s”. The agency has seen its staffing drop from 112 to 45 since 2009, a 60 percent reduction. The reduction is due in part to some program losses, a changing healthcare market, and declining revenue sources. All of these resources are important in an emergency. “Two deep” staffing is a distant memory these days. Baril has been resourceful in planning and relies upon community partners just to staff each position with one person, though that is changing too.

It’s reality check time, as Baril wheels a white board into his office, focused on redrawing the agency staffing model he begins to sketch positions and staff. The face of public health is changing; agencies all across the country are shrinking; and service delivery models in all programs have to shift accordingly. At day’s end, as Baril scrapes the snow and ice from his truck, he is not pleased, and the weather has nothing to do with it. If you were to take a peek at the white board in his office, you would see that public health emergency response is beginning to shift from doing more with less, to doing less with less. In the event of an emergency, this is unacceptable.

The reality is, as public health agencies shrink, so too does their ability to respond in a crisis. Every nurse, clerk, and inspector has a role, and as those staff numbers dwindle, planners such as Baril struggle to fill gaps. In order to maintain preparedness on the public health front, we must invest in a well-equipped, well-trained public health workforce, in numbers capable of truly serving our communities.

Leave a Reply

Your email address will not be published. Required fields are marked *