Enumerating the State and Local Public Health Workforce During the COVID-19 Response

<b>Objectives.</b> To understand the landscape of the nonfederal governmental public health workforce and to identify replicable methods for future enumerations. <b>Methods.</b> This enumeration of the state and local public health workforce was conducted from 2023 to 2024 and triangulated the National Association of County and City Health Officials (NACCHO) Profile 2022 and the Association of State and Territorial Health Officials (ASTHO) Profile 2022. We utilized Public Health Workforce Interests and Needs Survey (PH WINS) data from 2021 to assess demographic distributions across Department of Health and Human Services (HHS) regions in the United States. <b>Results.</b> A total of 239 000 staff were employed in state and local health departments in 2022, a 2% increase since 2012. Sixteen states-including 6 in the Southeast-lost staff relative to population growth. <b>Conclusions.</b> An uneven landscape of public health workforce density reflects chronic underinvestment in public health. The process of enumeration itself was also fraught with pitfalls and data limitations. <b>Public Health Implications.</b> We recommend building on federal investments to develop dedicated funding streams for state and local public health. We also recommend amending federal efforts around enumeration to include governmental public health at all levels. (<i>Am J Public Health</i>. 2025;115(5):716-725. https://doi.org/10.2105/AJPH.2024.307964).