The current traditional conception of the public health workforce is largely centered on government-operated agencies and departments at various administrative levels—federal, state, local, tribal, and territorial. This conventional framework inadequately captures the breadth of the workforce actively engaged in public health functions. Counting all healthcare professionals such as nurses or epidemiologists regardless of their role or sector fails to differentiate those working directly on public health services from those practicing clinical or other forms of individual care. This limitation presents a significant challenge to accurately assessing workforce capacities and addressing gaps.

Dr. Krasna proposes an innovative intersectional model which redefines the public health workforce by separating it into two distinct yet interrelated tiers. The “core” public health workforce remains composed of individuals employed within government health departments, reflecting the traditional backbone of public health service delivery. However, the “wider” public health workforce is newly conceptualized to include professionals who may be employed outside government agencies yet whose work directly involves at least half of their time in delivering services consonant with the Centers for Disease Control and Prevention’s (CDC) 10 Essential Public Health Services or the Foundational Public Health Services framework. This broader workforce encompasses a vast array of individuals working in hospitals, academia, non-profit organizations, and even private sector entities, all contributing to the public health mission.

The framework of the 10 Essential Public Health Services, first developed in the 1990s and periodically updated, delineates the core functions necessary to protect and promote community health. These services include monitoring health status, diagnosing health problems, informing and educating the public, mobilizing community partnerships, developing policies, enforcing laws, linking individuals to needed services, ensuring a competent workforce, evaluating health services, and conducting research. The Foundational Public Health Services, by contrast, specify the baseline capacities necessary at the governmental level to ensure equitable and effective public health infrastructure, setting a minimum standard that no jurisdiction should fall below.

What is particularly compelling in Krasna’s model is the shift in defining the workforce through an outcome-oriented lens. Rather than classifying workers by job titles or organizational affiliations, this method “reverse engineers” workforce identification by starting with the essential public health services themselves. By mapping who delivers these services regardless of their official role or employer, policymakers and researchers can gain a more accurate and impactful understanding of workforce composition and dynamics. This approach aligns closely with systems thinking in public health, where the ecosystem of actors and relationships is appreciated in its full complexity.

The implications of this redefinition are far-reaching. It empowers public health systems to better identify workforce gaps, including areas where essential services might be outsourced to sectors that may not maintain the same cost-effectiveness or public accountability as government agencies. Additionally, such delineation can sharpen the focus on workforce development, guiding more tailored training programs that prepare a wider spectrum of professionals to meet evolving public health needs. The ability to capture the contributions of this expansive workforce helps ensure more resilient public health infrastructures capable of responding to emergent crises such as pandemics.

Moreover, Dr. Krasna’s framework encourages a more equitable valuation of public health practitioners working outside traditional roles. Many of these professionals provide critical surveillance, education, policy advocacy, and clinical preventive services that directly support population health. Their inclusion broadens the workforce narrative and highlights collaborative, cross-sectoral efforts essential in today’s interconnected public health environment where challenges like climate change, health disparities, and global infectious diseases call for multi-dimensional responses.

This expanded concept of the public health workforce also intersects with pressing policy concerns. Understanding the composition and capacity of both the core governmental and wider non-governmental workforce aids in the strategic allocation of resources. It informs funding decisions, workforce planning, and emergency preparedness strategies, ensuring that jurisdictions can maintain essential services during disruptions. Without such clarity, there is a risk that critical public health functions may be left understaffed or uncoordinated, undermining population health outcomes during both routine and crisis periods.

The importance of accurate workforce surveillance is further underscored by the ongoing COVID-19 pandemic which unveiled stark deficiencies in public health infrastructure, especially in staffing capacities. Many jurisdictions struggled to mobilize sufficient and appropriately trained personnel swiftly. By adopting Krasna’s model, health departments and allied organizations can systematically map and mobilize an inclusive workforce capable of robust response, effectively leveraging untapped potential across sectors such as academia, healthcare delivery, emergency management, and community organizations.

Furthermore, this framework aligns well with contemporary trends toward interdisciplinary collaboration and integration in health. It fosters recognition of how sectors traditionally deemed outside public health—such as education, social services, and private enterprises—play vital roles in the public health mission. This holistic vision supports not only preparedness but also sustained promotion of health equity and the social determinants of health, acknowledging the complex web of influences on population well-being.

Dr. Krasna’s research emerges from the Columbia University Mailman School of Public Health, an institution known for its leadership in advancing public health knowledge and workforce development. Founded in 1922, the school boasts a dynamic global faculty and student body engaged in a spectrum of critical health challenges, from infectious disease control to climate change impacts. The school’s contribution to this discourse exemplifies its commitment to aligning research with real-world public health transformation.

The proposed workforce model serves as a clarion call for researchers, policymakers, and public health practitioners to reconsider entrenched assumptions and adopt more nuanced, service-driven frameworks. By doing so, it promises to catalyze stronger collaborations, more comprehensive workforce assessments, and the development of innovative training initiatives that prepare the full spectrum of public health professionals to meet contemporary and future challenges. This shift also enhances transparency and accountability in how public health resources are utilized across sectors.

Ultimately, embracing this redefined public health workforce model allows for a more precise and functional approach to workforce planning and evaluation. It holds potential not only to fortify response capacities in emergencies but also to advance routine public health functions that improve community health outcomes. As public health continues to evolve in complexity and scale, frameworks like these provide the conceptual infrastructure required to ensure its workforce is robust, diverse, and aligned with the imperative to safeguard the health of all populations.

Subject of Research: Public health workforce redefinition and capacity assessment beyond government health departments
Article Title: The Public Health Workforce Beyond Government Health Departments: Proposing a New Definition
News Publication Date: Not specified in the source
Web References: Columbia University Mailman School of Public Health
Keywords: Public health, health workforce, government health departments, 10 Essential Public Health Services, Foundational Public Health Services, workforce assessment, health policy, health systems, pandemic preparedness, health equity

The study, led by researchers Hunt, Marks, Hameed, and their colleagues, utilized qualitative methods including interviews and focus groups to capture lived experiences of individuals with disabilities amidst the pandemic’s challenges. Across diverse cultural, economic, and infrastructural contexts, barriers to accessing critical information, healthcare services, and social support systems emerged as recurring themes. Many participants reported feeling excluded from mainstream communication channels that disseminated health directives, highlighting profound shortcomings in the inclusivity of urgent public health messaging.

One significant concern arises from the design and implementation of preventive strategies such as social distancing, mask mandates, and hygiene protocols. For many individuals with physical, sensory, or cognitive disabilities, adhering to these recommendations was intricately complicated by additional obstacles. For example, visually impaired participants described difficulties in navigating public spaces with safety measures in place, while individuals reliant on personal assistants faced challenges in maintaining physical distance without losing crucial support. Such findings underscore the inadequacy of “one size fits all” approaches to pandemic prevention.

From a technical standpoint, the research emphasizes the need to incorporate universal design principles within epidemic preparedness frameworks. This involves creating communication materials accessible in multiple formats—braille, sign language, audio descriptions—and ensuring healthcare and social services are physically and cognitively accessible. The study documents cases where exclusionary practices not only heightened risks for people with disabilities but also exacerbated social isolation and mental health issues, compounding the pandemic’s toll.

The interplay between socioeconomic factors and disability status featured prominently in the analysis. In resource-constrained settings, healthcare infrastructure often lacks the capacity to prioritize vulnerable groups. The survey revealed wide disparities in access to COVID-19 testing, treatment, and vaccination programs for people with disabilities. In many instances, lack of transportation, limited caregiver availability, and systemic discrimination impeded timely and effective care, amplifying health inequities during the crisis.

Moreover, the research elaborates on the policy-level neglect of disability-inclusive approaches within national responses. Although international guidelines by bodies such as the World Health Organization advocate for accessible public health strategies, implementation inconsistencies were widespread. Policy documents frequently overlooked the requirements of people with disabilities, resulting in absence of targeted interventions, funding allocations, and data disaggregation necessary to monitor equity outcomes.

An important contribution of this work is its comparative cross-country analysis that elucidates contextual enablers and barriers. Countries that integrated disability rights organizations and stakeholders into pandemic planning demonstrated higher levels of inclusivity. These participatory approaches facilitated tailored solutions such as specialized helplines, home-based service delivery, and adapted informational campaigns, proving that meaningful engagement is vital for responsive health governance.

Technically, recommendations put forth include the urgent adoption of intersectional frameworks in epidemic response mechanisms. Intersecting axes of vulnerability, such as disability combined with gender, age, or socioeconomic deprivation, must inform tailored interventions. This requires systematic collection of disaggregated data and embedding inclusive metrics within public health monitoring systems. Failure to do so risks perpetuating invisibility and marginalization during health emergencies.

The psychosocial dimensions investigated reveal that many people with disabilities experienced heightened anxiety and uncertainty due to inadequate communication and social support during lockdowns. Lack of accessible mental health services compounded these issues. The study highlights successful instances where community-based organizations bridged gaps by delivering psychosocial aid and practical assistance, offering vital lessons for future crisis preparedness.

In light of the digital divide prevalent in LMICs, reliance on online platforms for health promotion and vaccination registration inadvertently excluded many. The study details how technological accessibility barriers affected remote consultations and information dissemination, calling for multimodal approaches that prioritize offline and community-based modalities in future public health strategies.

A particularly technical challenge examined is in adapting infection prevention protocols in institutional settings such as schools and rehabilitation centers. These environments cater to high concentrations of vulnerable individuals but often lacked tailored guidance early in the pandemic. Training of staff on disability-sensitive practices and ensuring physical accessibility of hygiene infrastructure were identified as critical gaps requiring urgent redress.

The research also scrutinizes how international aid and funding mechanisms addressed disability inclusion within pandemic responses. Findings suggest inconsistency and often superficial integration of disability considerations in funding criteria. The study argues for explicit disability-inclusive conditionalities to ensure equitable resource allocation and program design.

From an ethical perspective, the study reinforces that health equity mandates intentional inclusion of marginalized populations in epidemic planning. The exclusion of people with disabilities contravenes principles of justice and human rights enshrined in global frameworks like the UN Convention on the Rights of Persons with Disabilities. Embedding these values concretely into practice requires advocacy, education, and systemic change.

Importantly, this comprehensive qualitative inquiry contributes empirical evidence to a field historically dominated by epidemiological modelling and biomedical data, offering a nuanced understanding of social determinants of health during pandemics. By centering voices of people with disabilities, it challenges dominant narratives and calls for transformative approaches that prioritize inclusivity, accessibility, and dignity.

In conclusion, the COVID-19 pandemic exposed and exacerbated longstanding inequities faced by people with disabilities in LMICs. Inclusive public health strategies are not merely ethical imperatives but necessary for effective disease control and societal resilience. This research charting successes and failures provides a roadmap for building more inclusive health systems capable of protecting all citizens in future global health emergencies.

Subject of Research: How inclusive were strategies to prevent the spread of COVID-19 for people with disabilities in low- and middle-income countries.

Article Title: How inclusive were strategies to prevent the spread of COVID-19 for people with disabilities? Evidence from qualitative research in eight low- and middle-income countries.

Article References:
Hunt, X., Marks, S., Hameed, S. et al. How inclusive were strategies to prevent the spread of COVID-19 for people with disabilities? Evidence from qualitative research in eight low- and middle-income countries. Int J Equity Health 24, 121 (2025). https://doi.org/10.1186/s12939-025-02482-7

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