Community-Oriented Workers in Local and State Public Health

ABSTRACT Context: Local and state public health agencies increasingly rely on community-oriented workers to strengthen connections with the populations they serve. This workforce, which includes community health workers, health educators, peer counselors, and health navigators, plays a crucial role in health promotion, disease prevention, and care coordination, especially among underserved populations. Despite their importance, limited national data exist on their size, distribution, and job quality within governmental public health. Objective: To describe the size, distribution, and job quality of community-oriented workers employed in governmental public health agencies and compare job quality indicators to counterparts working outside public health. Design: Cross-sectional descriptive study combining nationally representative administrative and survey data. Setting: Local and state health agencies across the United States. Participants: Community-oriented public health workers, including community health workers, health educators, peer counselors, and health navigators, identified through the American Community Survey (2019–2023) and respondents to the Public Health Workforce Interests and Needs Survey (2021, 2024). Main Outcome Measures: Workforce size and distribution across settings: measures of job quality including wages, earnings trends, job satisfaction, and intent to leave. Results: Employment in community-oriented public health roles grew substantially during the COVID-19 pandemic but declined sharply after 2021, particularly at the state level. Earnings peaked in 2021 before falling to levels comparable to non–public health counterparts by 2023. Although job satisfaction modestly increased during this period, intent-to-leave rates remained persistently high (20%–30%). Conclusions: This study provides the first national evidence on the distribution and job quality of community-oriented workers in governmental public health. Findings highlight growth in this essential workforce after the pandemic and underscore the need for sustained investment in compensation, career development, and retention strategies to strengthen public health capacity.