Public Health Pathways: Preparing the Next Generation of Public Health Leaders

Underscoring the Importance of the Public Health Workforce The public health workforce is critical for maintaining the health and safety of the country. Skilled professionals monitor outbreaks, track diseases, implement primary prevention strategies, and provide many other essential services. They help ensure our air and water are clean, our food is safe, and that there is proper care for populations disproportionately burdened with poor health, in both urban and rural areas. Often serving as a bridge between communities and the health care system, public health is the first line of defense against many health conditions. Public health usually exists in the shadows. When it is working well, most people don’t recognize it; however, when the system breaks down, it affects everyone. Current Workforce Challenges To meet the ever-changing health needs of communities, a well-trained, adequately sized, and diverse workforce is necessary.1 The number of seasoned public health workers leaving the field has accelerated faster than the number of those entering it. Between 2017 and 2021, nearly half of all employees in US state and local public health agencies left their jobs.2 Following the pandemic, thousands of public health workers lost their jobs, and thousands of others have retired or left the field, citing burnout and/or stress. This decrease in workforce is further augmented by the long-standing trend where public health operates in a cycle of “neglect, panic, repeat.”3 In the event of an emergency, such as an outbreak or other health threat, public health receives funding to address the issue. Once the crisis has abated, attention diverts, and funding often evaporates. The culmination of these funding and staffing issues has resulted in a public health workforce crisis. There is a need for at least an additional 80 000 public health workers to fill vacant positions and staff up.4 Additionally, results from the 2024 Public Health Workforce Interests and Needs Survey (PH WINS) highlight that young professionals lack the key strategic skills to plan and implement public health programs, such as budgeting and fiscal management, policy engagement, and change management.5 Strategies are necessary to bring new energy into public health and ensure the next generation of public health leaders are prepared to address the needs of communities. Pathways as a Solution Public health pathway programs have been established to address these current workforce challenges and have shown to influence the career choices of many students. When programs incorporate hands-on learning, meaningful tasks, and responsibilities, both students and agencies benefit. Students develop a realistic understanding of the day-to-day work of public health, and agencies gain enthusiastic temporary workers, who, after graduation, are more likely to receive a permanent position at the agency (or similar ones) than those with no practical experience. Example of a Successful Pathway Program In 2025, ASTHO partnered with the National Association of Offices of Minority Health (NASOMH) to pilot the Vivian Lasley Bibbs (VLB) Fellowship, named in honor of the trailblazing leader, Vivian Lasley Bibbs, whose public health career spanned over 30 years of governmental service, and included serving as the former president of NASOMH. The fellowship placed Master of Public Health (MPH) students in state health departments for an 8-week intensive experience. In structuring this pathway program, the following key components—believed to be most crucial for success—were incorporated. Components of Successful Pathway Programs Partnerships with academic institutions with public health programs For this initial pilot, ASTHO partnered with a select group of accredited MPH programs to identify strong students interested in participating in the pilot. Students were required to submit their academic transcripts and letters of recommendation and complete an essay application that highlighted their interest in this opportunity. All completed applications underwent a comprehensive review process, resulting in the selection of 5 students as the inaugural VLB fellows. Hands-on experiential learning Fellows were assigned meaningful programmatic work by their site supervisors, who were in State Offices of Minority Health or partnering agencies, based on the organizational needs. They participated in planning and strategy sessions, worked closely with community partners, completed assigned tasks, and formally presented their deliverables upon program completion. Fellows also engaged in the collective writing of a high-quality white paper. Incorporation of mentoring and career coaching Each fellow met one-on-one with fellowship leadership, as well as with their site supervisors, on multiple occasions. Weekly virtual sessions focused on key public health issues with subject matter experts from ASTHO and NASOMH. These interactive sessions ranged from data modernization in public health to mentoring and networking, as well as the benefits of peer networks. Leadership and professional skill development As young professionals on the verge of entering the workforce, the fellows were introduced to Boundary Spanning Leadership6 and the importance of public health accreditation. They were challenged on aspects of critical thinking, team dynamics, and workplace negotiations. Through these activities, they developed early leadership skills and gained valuable experience. Continuous feedback and bidirectional evaluations An anonymous survey was administered to the fellows after each virtual session, at the midpoint of the fellowship, and again at the conclusion of the fellowship. Evaluations were also collected from site supervisors on their experience with the program and their assessment of the individual fellows. All data were analyzed and synthesized into a final report for fellowship leadership and funders. The recommendations will inform changes to the next cohort, enabling it to better address the needs of the fellows and the sites. An example of this is the feedback on the collective white paper: Several comments focused on the new skills and sense of accomplishment from completing it and emphasized its importance for future cohorts. Outcomes and Key Takeaways The fellows who completed the evaluations overwhelmingly agreed that the fellowship increased their knowledge and capabilities, and that having the opportunity to participate in a program like this would help them succeed in future career opportunities. The skills gained, including strategic problem-solving, relationship building, and data evaluation, become more relevant when practiced in real-life situations rather than relying only on knowledge from the classroom and materials. They emphasized their increased understanding of governmental public health, including the roles of offices such as those focused on minority health within public health agencies and how they work to improve the health of populations disproportionately burdened with poor health outcomes. Fellows also highlighted the increase in their knowledge of the role that policy plays in public health system change. Finally, all fellows praised the high quality of the experience and were likely or very likely to apply the information learned to their public health practice in their future careers and upcoming classwork. Conclusion Pathway programs are one strategy to address the need to grow the governmental public health workforce for the future. Providing well-orchestrated opportunities for interested students to explore and experience public health practice enhances their understanding of the field and opens their eyes to potential career opportunities. Replacing public health workers as they leave the government by establishing pathway programs and ensuring new public health professionals have fundamental skills to meet the needs of communities is crucial to building a resilient and effective public health system.