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EXECUTIVE SUMMARY
For more than a year, the COVID-19 pandemic has revealed the cracks in our health infrastructure and pushed
our systems to the breaking point. It has exacerbated underlying inequities and disproportionately impacted
communities of color. The United States needs a systemic investment in public and community health jobs focused
on serving the most marginalized.
Over the last decade, the nation has lost at least 38,000 public health jobs, while state and local public health
budgets have dropped by 16% and 18% per capita, respectively. Systemic underfunding since 1980 has slashed
the state and local public health workforce from nearly 500,000 jobs to under 200,000 today. Especially hard hit
are poor communities and communities of color, which have been continually passed over and neglected due to
entrenched inequities. This undermines health in all communities. As a result, hospitalization rates of Black people
in the U.S. due to COVID-19 are almost three times those of white people in the U.S., while COVID-19 related death
rates were twice that of white people in the U.S.
President Biden signed into law the American Rescue Plan Act (ARP), a $1.9 trillion relief bill, in March 2021 and
issuing the “Executive Order On Advancing Racial Equity and Support for Underserved Communities Through the
Federal Government” (“Equity Executive Order”) on his first day in oce. In the ARP, Congress provided $7.66
billion for a Public Health Workforce (ARP Section 2501).
On March 25, 2021, labor unions, community-and faith-based organizations, public health experts, and advocates
gathered for a roundtable discussion on how the ARP might build the public and community health workforce
the country desperately needs. The roundtable participants identified the needs of community and public health
workforces to address COVID-19 discrepancies and build more equitable public health responses in the U.S. Critical
findings about elements necessary for the success of the ARP workforce emerged in four categories: targeted
funding, who we hire, the quality of the jobs, and building community capacity.
On May 4, 2021 the Biden administration announced the first allocation of Section 2501 through investments in
grants for community-based organizations (CBOs); this was followed up by a May 13 announcement investing the
rest of Section 2501 funds in local and state public health departments and long-term funding to improve public
health systems. These funds included a distinct focus on hiring from and investing in training programs within
communities aected by COVID-19 and minority-serving academic institutions.
COVID-19 IS THE SPRINT,
EQUITY IS THE MARATHON:
Key elements for building a public health and community health workforce
JUNE 2021
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The May announcements focused exclusively on funds made available under Section 2501 of the ARP, but the
legislation made additional allocations for workforce investments: including $7.6 billion in funding for vaccines
(Section 2301); $47.8 billion allocated for testing, contact tracing, and mitigation (Section 2401); and $7.6 billion
provided for community health centers and community care (Section 2601). The ARP arms and has laid the
foundation for the Administration’s commitment to building an equitable health force of more than 100,000 public
health workers and 150,000 community health workers (CHWs) capable of addressing the interlocking crises of
health and social inequity.
In this white paper, we highlight recommendations that build on these announcements, and suggest policies for
the administration to consider while building the public health and community health workforces.
• Smart investments can build the community and public health workforce for the long-haul.
• Addressing racial inequities in health requires a workforce that can address dicult, deep-set issues.
This is more than the work of a single year or a crisis response: it requires building a workforce that can
run a marathon.
• ARP funds should be strategically deployed to fund a large, multi-year commitment to the public and
community health workforce.
• Workers must be hired from the communities they will serve—those hit hard by the COVID-19 pandemic
and health inequities.
• To achieve this, targeted hiring is critical; a new recruitment plan is a good first step towards actualizing
this.
• Funded training can teach key skills, and ensure that the qualifications that matter most—embeddedness
in a community and cultural competence—drive who gets hired.
• This workforce will be made of a variety of jobs—navigators, CHWs, social support specialists, and more.
• Ensuring good jobs for public health and community health.
• Living wages and benefits will help recruit a talented workforce.
• With targeted hiring, good benefits will ensure that communities facing both the COVID-19 pandemic
and recession get the jobs they need to drive an equitable recovery.
• Community coordination can drive eective public and community health strategy, hiring, and funding.
• The U.S. Department of Health and Human Services (HHS) should structure grants to create an analogue
to the Ryan White Act’s community planning councils.
• Grants should be awarded to ensure that small CBOs have the opportunity to grow alongside the public
and community health workforce. Two new grant opportunities demonstrate initial eorts.
Together, these recommendations can drive an equitable recovery from this pandemic and advance progress
against deep health disparities throughout America.
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TABLE OF CONTENTS
EXECUTIVE SUMMARY
I. SMART INVESTMENTS TO BUILD THE PUBLIC AND COMMUNITY HEALTH WORKFORCE
Recommendations
Long-term funding is essential for equity
Smart investments from the ARP can have a large impact
North Carolina’s Approach to COVID-19 Through Community Health
II. WHO WE HIRE: RECRUITMENT AND TRAINING
Recommendations
Recruit from the communities most aected by COVID-19
Train for a broad set of skills
Allow for a wide range of job functions
Health workforce members should be trained with skills that enable them to address both
immediate and longer-term health needs
Trusted Messengers in Chicago
III. ALL JOBS CREATED THROUGH ARP SHOULD BE GOOD-PAYING JOBS
Recommendations
Strong pay and benefits are necessary to advance health equity and build back better
Pathways for advancement create a workforce that can take on large health disparities
IV. BUILDING CAPACITY IN COMMUNITIES
Recommendations
HHS can structure grants to build capacity for small, localized CBOs right now
Community coordination is essential to combat COVID-19 and address local needs
HHS should structure funding opportunities to ensure small CBOs with a strong track
record have a shot at meaningful funding
Planning Councils Can Empower Communities
V. FOLLOWING UP ON THIS DOWN PAYMENT
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I. SMART INVESTMENTS TO BUILD THE PUBLIC AND COMMUNITY HEALTH WORKFORCE
Multiple funding streams in the American Rescue Plan (ARP) are necessary to fund the community and public health
workforce that can meet President Biden’s pledges to advance racial equity, combat health disparities, and hire 100,000
public health workers and 150,000 community health workers (CHWs).
The Biden administration began to address this goal when, on May 13, 2021, they announced how the majority of the $7.6
billion in funding for Section 2501 of the ARP will be allocated.
Recommendations
• The U.S. Department of Health and Human Services (HHS) should use funds throughout the ARP to build the
largest and most lasting public and community health workforce possible.
• Smart and transparent funding criteria, timelines, and grant disbursements made in advance are critical for rapid
scale up.
• The public and community health workforce needs to be built for the long-haul with targeted hiring to advance
equity. While some roles may include AmeriCorps jobs or stipend-based fellowship opportunities, they must also
look beyond short-term funding programs to build a sustainable long-term pipeline. ARP funds should continue to
focus on recruiting, training, and expanding the public and community health workforce.
• While $250 million is a meaningful start, funding should continue to go directly to community-based organizations
(CBOs) to expand long-term capacity and address health inequities in every community.
• HHS should create a centralized tracking tool (like the one provided in 2009 at recovery.gov) that gives granular
information on where ARP funds are going to help ensure funds are used eectively and build long-term support
for this critical work.
Long-term funding is essential for equity
The public and community health workforce should be funded with a longer-term (2+ year) time horizon to eectively
tackle COVID-19 and other disease burdens. This will create an investment in a workforce that can make progress on
President Biden’s racial equity Executive Order.
Long-term jobs are important for attracting a talented and stable public and community health workforce. Guaranteed
funding beyond the immediate term will ensure the workforce can grow to become even more eective on the job.
The administration’s announcement includes a $3 billion investment to modernize the public health workforce and
build toward health equity. Funds will be distributed through a new grant program—designed by various federal, state,
local, and territorial public health experts—aimed to support health departments in lower-income and under-resourced
communities. This grant program may increase hiring of CHWs and provide an opportunity to continue in their role
beyond COVID-19.
Nevertheless, the timeline of investing beyond the pandemic is unclear, and should be outlined and clarified—with health
equity at its center—to ensure the public health workforce is sustained beyond the pandemic.
Longer-term funding will allow state and local health departments and CBOs the opportunity to build capacity, plan for
the future, and strategize together. The public and community health workforce can best “build back better” if they’re
recruited and trained with an eye on addressing underlying health inequities, as called for by the National Community-
Based Workforce Alliance.
Volunteer Service Corps positions are often antithetical to the goal of building long term jobs due to the temporary nature
of the role, as well as the often inequitable support and incentives provided. The CDC has introduced a partnership with
AmeriCorps to establish surge capacity and training programs for young people. This program aims to “focus on building
a diverse pipeline for the public health workforce and providing direct service to communities across the country.” As
the launch of the Public Health AmeriCorps is not the administration’s only investment in a public health workforce, this
program seems additive to the goals of the ARP, however we caution that it should not take priority over more long-term
career pathways.
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Smart investments from the ARP can have a large impact
HHS should draw on all relevant funding streams to support the community and public health workforce. President
Biden’s historic goal of hiring 100,000 public health workers and 150,000 CHWs is only achievable if dierent funding
streams from ARP are used to build the workforce. This scale is necessary to meet the pandemic moment and President
Biden’s goal to “improve quality of care and reduce hospitalization for low-income and underserved communities” over
the long-term.
ARP Section 2501 appropriates $7.66 billion through HHS to health departments and CBOs for public and community
health workforce growth. Sections 2401, 2406 (testing, tracing, and mitigation) and 2601 (community health centers
and community care) provide a total of $53.6 billion which can and must be used, in part, for the public and community
health workforce. Section 3041 appropriates $240 million for workforce development through the Indian Health Service.
In addition to the administration’s announcement of $500 million from Section 2501 allocated to hiring school nurses,—
critical members of the community health workforce—Section 2001 can also be used to fund school nurses.
We estimate that Section 2501 could fund as many as 150,000 public health and community health jobs for one year
(assuming $50,000 annual salaries, and accounting for benefits and overhead). However, Section 2501 falls short
of President Biden’s ambitious goal to create 100,000 public health workers and 150,000 CHW jobs. To reach this
milestone, HHS must draw on other ARP funding streams, as highlighted above. Because health workers will use the
same skills needed to mitigate the pandemic to address longer-term inequities, they should be funded to achieve the
Biden Administration’s short-, medium-, and long-term goals. Importantly, these roles will need to be hired at multiple
levels, going beyond federal programs or state funding alone. Each funding stream should have a plan and each should
require targeted hiring, as is outlined in the announcement of the Section 2501 funds.
HHS should focus a portion of funds in Sections 2401 and 2406 on funding community and public health workers whose
first, essential tasks will be focused on guiding their communities through the COVID-19 pandemic. In a May 2021
letter to Secretary Xavier Becerra, Senator Elizabeth Warren, along with Representatives Barbara Lee, Judy Chu, Karen
Bass, Pramila Jayapal, Robin Kelly, Lisa Blunt Rochester, Kaiali’i Kahele, Nanette Diaz Barragán, Marilyn Strickland, Mark
DeSaulnier, Adam Smith, and Earl Blumenauer, calls for these funds, among others, to be directed toward CBOs that
work within medically underserved areas.
Smart funding requires flexibility so that states can coordinate funds to local public health departments to expand
capacity at every level. Sens. Kirsten Gillibrand, Michael Bennett, Tina Smith, Amy Klobuchar, Chris Van Hollen, and Cory
Booker recommended one possible formula in their letter of intent to Secretary Xavier Becerra and Director Rochelle
Walensky.
When thinking about the local level, the National Association of County and City Health Ocials (NACCHO) has
released a set of guidelines. NACCHO clarifies that local health departments must be engaged in conversations about
how to best resource their communities in the ongoing response, and recovery from, the COVID-19 pandemic. EO 13996
specifically requires “the Secretary of HHS and the Secretary of Labor [to] promptly consult with State, local, Tribal, and
territorial leaders to understand the challenges they face in pandemic response eorts, including challenges recruiting
and training sucient personnel to ensure adequate and equitable community-based testing, and testing in schools and
high-risk settings.”
Local health departments operate under a variety of governance structures, the majority of which are independent from
the state health department. Direct local input is key for developing a tailored strategy, and in some jurisdictions is
essential to be included in grant applications due to the lack of county health departments in the governance structure.
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N C’ A COVID-19 T C H
The North Carolina Department of Health and Human
Services (NCDHHS) took early advantage of CARES
Act funding to provide wraparound care to people
infected and aected by COVID, which should serve as
a model for other states. With $14.7 million in CARES
Act funding from August-December 2020 and $16
million in state and CDC funding from January-June
2021, NCDHHS was able to hire and manage over 400
CHWs and pay them living wages. Fulfilling a wide range
of roles, CHWs help connect individuals to testing,
provide general COVID and vaccine-related education,
facilitate vaccination, screen for social determinants of
health, and refer to necessary social supports.
Because these CHWs came from the communities they
worked in and are employed by CBOs with longstanding
local ties, they brought with them existing trusted
relationships, and were able to create an “ecosystem”
of support in the most vulnerable counties in the
state. This system helped to ensure that referrals for
social supports via the CARES Act-funded Support
Services Program (financial relief, food assistance,
PPE, transportation) and additional state mechanisms
(housing support, rent/utility assistance, child care,
etc.) were fulfilled by the appropriate funding streams
and that technology solutions were accompanied
by a person-centered workforce. Of over 39,000
households served from September 2020 through
April 2021, almost all referrals via the Support Services
Program received food assistance and 70% received
financial relief (up to $800). With all of these eorts,
North Carolina has largely avoided becoming one of the
U.S. states hardest hit by COVID-19. This is no doubt
due to the state’s promotion of safe quarantine and
isolation for COVID-19 in marginalized populations,
and resource coordination done by the NC CHW and
Support Services Programs.
Community health workers at a local food distribution event hosted by La Semilla, a non-profit organization serving
Latinx communities and partnering with Spanish-speaking CHW vendor Curamericas Global in Durham, North Carolina
and the surrounding area. Photo courtesy of Curamericas
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II. WHO WE HIRE: RECRUITMENT AND TRAINING
For a successful and equitable new public and community health workforce, the recruitment, hiring, and training of
people whose experiences and competencies can best serve communities in need are crucial. To hire for lived experience,
recruitment and hiring must target those most aected, and accessible training programs must be employed to ensure
the long-term sustainability of the program.
The Biden administration announced that the CDC will use $3.4 billion of Section 2501 of the ARP towards “new hiring
for state and local public health departments to quickly add sta to support critical COVID-19 response eorts.” Coupled
with the announcement of $250 million to help CBOs hire community outreach workers, including social support
specialists, it is clear that the administration is promoting equity as a top priority in the response to COVID-19. This is a
great first step, and should not be the last.
Recommendations
• The public and community health workforce should be recruited from the communities they serve—those which
have faced the highest rates of COVID-19 due to pre-existing health inequities.
• Recruitment for the expanded public and community health workforce should supplement, not replace, state and
local public health funding streams.
• ARP funds should be used to support robust trainings for the public and community health workforce, and capacity
building for state and local health departments and CBOs to ensure the workforce has the support and coordination
it needs to succeed.
• The workforce should be structured around a variety of dierent job functions, be embedded in community
organizations, and be built around skills that will continue to improve health equity after the COVID-19 pandemic.
Recruit from the communities most aected by COVID-19
To best serve the communities that face the greatest inequities, HHS should ensure that recruitment and hiring empower
those very communities. This is critical because the workforce plays two distinct roles: a means of delivering services to
communities, and a jobs program for communities grappling with multiple, intersecting crises.
The public health workforce needs workers with the linguistic and cultural competence and lived experience to build
trust with most-impacted communities, as they are most representative of the community since they live, pay taxes,
raise children, and spend their wages there. This trust, in turn, is essential to delivering eective and racially equitable
public health services. Hiring from these communities is essential for the ARP to achieve its ends—a workforce that
comes from, and deeply understands, a specific community will be better able to serve it. ARP Section 2501(B)(ii)
directs HHS to ensure that needs of these communities are being met, specifying that money for hiring should go to
organizations “particularly in medically underserved areas.” This point is also referenced in the aforementioned Sen.
Warren and Rep. Lee letter.
Public health workers need to understand and build trust with those they serve. For CHWs to operate most eectively,
for instance, they need to learn peoples’ lived experiences and understand the complex interactions of social needs at
an individual and community level. For communities that speak languages other than English, the workforce will need
linguistic capability. An HHS report on minority health underscored the importance of workers’ linguistic capability,
while other research has found that language and communication barriers reduce the eectiveness of care.
Moreover, this approach is urged by President Biden’s January 20, 2021 Executive Order on Equity. In that Executive
Order, President Biden announced that it was the policy of his Administration to pursue a “comprehensive approach to
advancing equity for all, including people of color and others who have been historically underserved, marginalized, and
adversely aected by persistent poverty and inequality.” Accordingly, the President directed “heads of agencies, study
strategies, consistent with applicable law, for allocating Federal resources in a manner that increases investment in
underserved communities, as well as individuals from those communities.” HHS can make good on this policy statement
by ensuring that ARP grants flow to underserved communities through targeted recruitment and hiring. Such policies will
ensure that money goes to those who have too-often been unjustly denied opportunities and benefits.
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Targeted hiring helps mitigate the pandemic’s economic impact by providing an influx of federal investment in people,
places, and communities disproportionately harmed by the ongoing health crisis. The COVID-19 pandemic has
exacerbated longstanding social inequalities, with people of color experiencing a outsized burden of COVID-19 cases,
hospitalizations and deaths. Moreover, unemployment for Black and Latinx communities is still increasing to 10% and
8.8%, respectively. Low-wage workers, in general, have faced both financial and health insecurity, and Black workers in
particular face two compounding preexisting conditions, racism and economic inequality. The ARP can thereby serve as
a vital step in building a better workforce.
Train for a broad set of skills
Public health workers should be recruited and trained to foster a broad skill set, so they can transition from addressing
acute COVID-19 concerns to addressing the social determinants of health, which have driven the inequitable impact
of COVID-19. The skills that allow the workforce to contain COVID-19 will be critical to advancing health equity over
the longer term.Partnerships with public health apprenticeship programs that have strong connections to impacted
communities, health departments, and CBOs should be strongly encouraged to enable cross-cutting training.
There are several working models for training a competent public health and community health workforce. For instance,
the New Jersey Department of Health has collaborated with the New Jersey Department of Labor and Workforce
Development to create the NJ Community Health Worker Institute to increase the number of CHWs in general, with
a particular focus on hiring women, people from low-income communities, and communities of color. SEIU 721 has
partnered with the City of Los Angeles for an eective joint hiring and apprenticeship program. These programs oer
pathways that enable workers to develop and advance their careers, benefiting the worker, the workforce, and the
communities they serve.
As the acute phase of the COVID-19 pandemic subsides, CHWs will go from talking to community members about social
supports needed for isolation and COVID-19 vaccines, to helping their neighbors navigate social supports needed to get
to school; manage chronic pain, mental health, or diabetes; find a job; and secure better housing. Much of the COVID-19
support system is the same support system our communities need to improve health long-term. This is true for traditional
public health jobs as well—the epidemiologist who is now evaluating contact tracing data will not suddenly switch to
a dierent line of work. She will apply the skills that helped track the spread of new variants to addressing outbreaks of
HIV, tuberculosis, or the flu, and can adapt these tools to help track and respond to other urgent health needs, such as
the opioid epidemic.
The White House’s allocation of Section 2501 funds towards a grant program that “will oer community health workers
and others hired for the COVID-19 response an opportunity to continue their careers beyond the pandemic as public
health professions,” indicates the administration is beginning to think about the importance of building and investing in
the public health workforce past the pandemic. This eort must remain central to the strategy in order to build programs
that respond to local needs.
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Allow for a wide range of job functions
1 Section 2501(b), “use of funds for public health departments,” gives HHS the power to: [Provide funds related to the recruiting,
hiring, and training of individuals] to serve as case investigators, contact tracers, social support specialists, community health workers,
public health nurses, disease intervention specialists, epidemiologists, program managers, laboratory personnel, informaticians,
communication and policy experts, and any other positions as may be required to prevent, prepare for, and respond to COVID–19.
The ARP allows for a wide range of job functions to be hired under Section 2501
1
. This is a feature—not a bug—that
ensures that the community and public health workforce can address the social determinants of health from multiple
directions. HHS may use the funds to either hire people for the roles enumerated in the ARP or to prevent, prepare for,
and respond to COVID-19.
Congress intended for HHS to provide a wide array of jobs because it not only listed many dierent jobs, but it also
enabled HHS to hire “any other positions” related to the pandemic. In other words, HHS has authority to tackle the broad
social determinants of health according to this language, and should not be limited to those called out directly in this
Section. Due to concurrent impacts of the pandemic on homelessness, jobs programs, and increased need for family
care, HHS should consider roles that navigate social support networks, conduct targeted homelessness outreach, and
integrate legal support when drafting guidance. This has yet to be outlined in the White House’s allocation of Section
2501 funds.
HHS should also use this leeway to support the hiring of a broadly defined workforce that is united by its ability to
address the health inequities that have made COVID-19 so devastating. While the workforce section of the ARP is broad
and has allowed flexibility for many roles, it falls short of explicitly funding legal aid attorneys who can help resolve issues
that aect health and drive COVID-19 spread like eviction, unsafe workplace conditions, incarceration, or unresolved
immigration issues. This broad mix of skills and roles is critical to ensuring that the overall workforce is eective and built
to last.
Health workforce members should be trained with skills that enable them to address both immediate
and longer-term health needs
Many of the essential skills and roles needed to finish combatting the COVID-19 pandemic are also essential for
addressing the underlying and persistent health inequities that have made the pandemic so deadly for impoverished
regions and communities of color. In addition to expanding capacity, leadership, and training in state and local public
health departments, the community-facing workforce, such as CHWs and social support specialists, should be
structured around key workforce design principles. Their duties should be structured around improving behavioral
health, expanding access to preventative screening, immunizations, connections to social support systems, and chronic
disease management.
CHWs are the core of the expanded community and public health workforce. During the COVID-19 pandemic, global
health leaders, health providers, legislators, policy makers and funders have called for the rapid scale up and integration
of CHWs to strengthen public health and local and state COVID-19 response plans. On March 19, 2020, the U.S.
Department of Homeland Security Cybersecurity and Infrastructure Security Agency (CISA) demonstrated the urgency
to engage CHWs when it issued guidance to states, tribes, and territories that classified CHWs as essential critical
infrastructure workers during COVID-19.
The Community Health Worker Consensus project has defined ten core competencies for eective CHWs, ranging from
cultural competence and mediation to patient advocacy and navigation. Building on this work, the National Community-
Based Workforce Alliance has created a playbook for eective CHW COVID-19 response strategies to help design a
robust CHW workforce. HHS should require that grantees commit to the Community-Based Workforce Principals to
ensure local recruitment and continuous training and professional development, in line with these thorough and robust
recommendations.
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T M C
Latinx and Black communities in Chicago, IL have
suered a disproportionate impact from COVID-19.
While 29% of Chicago residents identify as Latinx,
they account for 44% of COVID cases, based on
conservative estimates. Death rates among Black
Chicagoans are nearly double than that of white
residents. To address the specific mistrust in the
Chicago community around the COVID-19 vaccine, a
group of dynamic and like-minded organizations are
collaborating with CBOs to form a vaccine partnership
of credible messengers: individuals indigenous to and
respected by the community where they work or live,
to support COVID-19 vaccination eorts and related
health messaging.
The Chicagoland Vaccine Partnership is utilizing the
trusted messenger model to build a public health
workforce of tens of thousands of individuals that will
educate community members about the value and safety
of vaccination, connect them to healthcare sites where
they can access the vaccine, and link them to other key
socioeconomic supports. These trusted messengers
are vital for the immediate COVID-19 response and
vaccine rollout, but also in the long-term, given other
public health failures that disproportionately aect
Latinx and Black communities all over the country.
Partners In Health estimates that at least 540,000 new CHWs are needed across the country to advance a more
equitable approach to care and community engagement. By building on the existing CHW workforce across the country,
a portion of Section 2501 funds can be used to the greatest eect. CHWs are best positioned to help consumers
navigate technological gaps in vaccine platforms, serve as trusted messengers for COVID-19 vaccine outreach and case
investigation, and guide care and resources for other major health concerns in their communities.
In addition, evidence from the Contact Tracing Collaborative in Massachusetts, and contact tracing eorts elsewhere,
have shown that a focus on social support specialists is essential for COVID-19 response. Sometimes called care resource
coordinators or navigators, these individuals ensure that a COVID-19 case or contact has the social, material, and other
supports they need to safely isolate or quarantine. Connecting individuals and families to these essential resources has
been remarkably eective at helping contain the spread of COVID-19.
The CDC defines social support specialists as essential for COVID epidemic control, because contact tracing’s ecacy
in decreasing disease spread relies on the ability of cases and their contacts to safely isolate and quarantine to avoid
infecting others. Unfortunately, many families with limited resources struggle to isolate and quarantine eectively. In
Massachusetts, 15-20% of new cases report needing support to isolate and quarantine. Many individuals must take
unpaid time o from their jobs or may live in situations where safe isolation or quarantine is dicult or even impossible
without assistance. Individuals sometimes need deliveries of food, cleaning supplies, or medication, assistance with
child or elder care, or support with communicating with their employers so they do not lose their jobs. Social support
specialists can also help people secure housing support or health care enrollment.
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III. ALL JOBS CREATED THROUGH ARP SHOULD BE GOOD-PAYING JOBS
Consistent with other eorts by the Biden administration to establish a higher minimum wage, as well as meeting the
objectives of the ARP, all public and community health jobs should be good jobs, backed by strong labor standards.
Building o the letter of intent from Senators Gillibrand, Bennett, and others, workforce members should be well-
compensated and hired to build upon and extend existing public health workforce capabilities.
Recommendations
• Workforce members should be paid not less than the higher of $15/hr or prevailing wage in accordance with the
McNamara-O’Hara Service Contract Act (SCA).
• Workforce members should receive benefits, including health, retirement, and paid family and medical leave.
• Workforce members should have anti-displacement protections and rights to recall.
• The workforce should be structured in ways that are amenable to labor organizing to help build eective training,
retention, and political power to support future funding.
Strong pay and benefits are necessary to advance health equity and build back better
Decent job standards are critical for our essential workers. Public health workers are essential to the well-being of our
society during the pandemic, as well as post-pandemic. Too often, however, our policies have undervalued and devalued
their vital work, causing community and public health workers to earn below living wages. Securing good wages, benefits,
and working conditions for public health workers is essential for the longevity of this workforce. Moreover, because the
workforce members will be recruited from the most-aected communities, investment in a strong, well resourced, and
protected workforce is also an investment in those communities.
A strong wages-and-benefits package will enable the community health workforce to more readily achieve the objectives
laid out in the ARP. As ARP Section 2501(a) tasks HHS with the responsibility of “establishing, expanding, and sustaining
a public health workforce,” the agency should ensure that wages and benefits are at a sucient level to recruit and retain
workers. Failure to provide sucient labor standards could lead to the deterioration of the workforce for several reasons:
• Hiring entities might find it dicult to recruit people of requisite competence, experience, and background without
oering prevailing wages.
• Prevailing wages will create lower turnover, which improves the quality of services. High turnover, by contrast, is
“expensive, results in loss of expertise, and negatively aects organizational performance.”
• Providing for the health of these workers, who must also attend to their own health and wellness, will enable them
to be successful in their jobs. Low wages adversely aect physical and mental health of workers through a variety of
mechanisms, ranging from stress and lack of access to goods and services, to the feeling from workers that neither
they nor their work is valued. A sucient wage-and-benefit floor can ensure that workers are economically secure,
motivated, and ready and able to do the important work the country needs.
Pathways for advancement create a workforce that can take on large health disparities
Once workers are hired, pathways for career development are critical to recruit, retain, and expand the community health
workforce. Accordingly, all funds distributed under Section 2501 should require a strategic plan for developing public
health careers. The current language in the recent allocation of funds is vague.
These provisions can both serve as an eective initial recruitment tool and help retain workers, enabling the workforce
to draw on their expertise and experience to best serve communities in need. Before the pandemic, experts warned of
supply shortages of CHWs, a trend that will likely worsen as an aging population places a greater burden on existing
systems. These career ladders will help retain workers, thereby building a more sustainable workforce and increasing
the quality of care it will provide.
HHS should clarify that Section 2501 funds cannot be subgranted to for-profit organizations, used to contract out to for-
profit organizations, or used for any purpose other than employment, PPE, and administration by health departments
and nonprofit private or public organizations.
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PARTNERS IN HEALTH | YALE GLOBAL HEALTH JUSTICE PARTNERSHIP
In addition, HHS should seek clarity on student loan assistance for public health workers out of other funds in the ARP,
executive authority for loan forgiveness/forbearance, or updated guidance for the Federal Student Loan Forgiveness
Program. These options would ensure that the public health workforce utilize existing programs, rather than divert funds
from Section 2501.
IV. BUILDING CAPACITY IN COMMUNITIES
To address systemic, underlying health inequities, it is critical that the public and community health workforce be driven
by priorities set at the community level. Local responses are better able to adapt to the needs of communities, bring
linguistic and cultural competency, and build trust. However, local communities are often under-staed in terms of
responsibilities and roles, and smaller CBOs are often under-funded, in part due to a lack of capacity, unclear guidance,
or connections with public health systems.
To this end, HRSA has announced $250 million in awards for CBOs. One opportunity lays out up to 10 awards for
intermediary organizations to serve as a pass through for CBOs, and another which directly funds up to 121 CBOs. Half
of the $250 million for CBOs to work with those hardest hit by COVID-19 have recently been allocated to 14 nonprofit
organizations, with the other half expected to be allocated to 121 smaller CBOs by July 1. These opportunities are a first
step toward empowering communities to address COVID-19 and health equity. Here we lay out considerations that build
upon this eort.
Recommendations
• Job requirements should focus on skills, shared life experiences (especially for CHWs), and cultural fluency—rather
than academic credentials.
• Ensure indirect measures of workforce readiness (criminal legal record, eviction record, credit score, or immigration
status) are not primary considerations for roles.
• HHS should allow undocumented persons who serve as CHWs a pathway to citizenship.
• Use community-driven processes, paired with state-led needs assessments, like structures in the Ryan White Program.
• HHS should rely on local intermediaries to ensure that community knowledge informs the development of the
public and community health workforce.
HHS can structure grants to build capacity for small, localized CBOs right now
There are a number of actions HHS can take immediately to begin building capacity for small CBOs to ensure a smooth
and eective expansion of the public and community health workforce. Capacity development grants similar to those
under Ryan White Part C would promote organizational infrastructure development for smaller CBOs. In response to the
HIV/AIDS crisis, federal programs aim to strengthen eorts around rapid antiretroviral therapy (ART), CHWs, integration
of HIV/AIDS primary care with oral health and/or behavioral health, and transitioning youth into adult HIV/AIDS care.
HHS should also require that grantees not use excessive degree, licensure, or certification requirements that might
exclude qualified candidates, particularly for community-based roles. Candidates can be assessed for basic literacy,
numeracy, and data collection skills. Where applicable, training programs, as described above, should be paired with
state-mandated accreditation. Degree requirements in particular threaten to exclude candidates with the community
knowledge and critical people skills needed to reach marginalized communities.
Nearly one in three American adults have some sort of a criminal legal record. Black men disproportionately bear the
burden of discrimination based on criminal legal involvement. The community and public health workforce is designed to
address the underlying health disparities within communities—barring those who have been convicted from meaningful
legal employment undermines these goals by excluding people with important lived experience from the workforce.
HHS must ensure that legal records, particularly for charges that disproportionately aect communities of color, do not
automatically bar candidates from consideration.
The argument for undocumented persons is comparable. HHS should allow undocumented individuals who serve as
CHWs to expedite applications for immigration, where applicable. Such action is in line with calls to reform the existing
immigration system and will help undocumented individuals, who are predominantly uninsured and reliant on emergency
rooms for medical attention, to access culturally competent care.
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PARTNERS IN HEALTH | YALE GLOBAL HEALTH JUSTICE PARTNERSHIP
Community coordination is essential to combat COVID-19 and address local needs
As grants are allocated, HHS should require states and all grantees to coordinate health strategy and implementation
with community voices. As a core condition of funding under ARP Section 2501 grants, states should lead a needs
assessment, planning, and community planning council process.
To do this, HHS should help states coordinate a locality- and CBO-involved needs assessment to understand priorities
for urgent and long-term workforce positions. State health departments should then develop an implementation plan
while they chart a roadmap for communities to create local implementation councils.
We suggest that HHS require a community consultation similar to the Ryan White planning council model. This
community-led planning and implementation model can ensure that the funds from the ARP are used in an appropriate
and ecient way to address communities’ needs. HHS should consider giving priority to grantees that have councils in
place, which should be designed to give CBOs, labor organizations, and community members the ability to contribute to
plans that implement ARP workforce funds at the local level.
Such a requirement would empower CBOs that know their community well and ensure that their knowledge is shaping
state and local health department strategy. Small CBOs are often the most eective in reaching local communities
because they have a nuanced understanding of needs in the community. This advantage helps drive equity in hiring and
program goals. However, small CBOs tend to be at a disadvantage in gaining funds, and are sometimes entirely excluded
from planning processes. A community planning council model would give CBOs a seat at the table, and potentially help
smaller CBOs contribute to and serve their communities without the burden of grant reporting and other constraints on
capacity.
P C C E C
The Ryan White Act is a powerful example of how a federal program can incorporate community-level representation
into the funding allocation process and support the work of CBOs by improving their organizational infrastructure.
Part A of Ryan White requires that community-based planning bodies, known as planning councils, conduct a needs
assessment and develop a comprehensive plan for the delivery of services in that region based on its findings.
These planning councils must reflect the demographics of the local population, with particular consideration given
to disproportionately aected and historically underserved groups and subpopulations. Part A further promotes
accountability to local communities by requiring that all planning council meetings and minutes are publicly accessible.
Planning Council Needs Assessment Example:
In 2016, the San Francisco HIV Planning Council found disparate rates of PreP utilization in its service
area. The needs assessment revealed that mostly college-educated, cisgender white men with private
health insurance utilized PreP while other high-risk populations were not accessing PreP at comparable
rates. These findings subsequently informed the planning council’s comprehensive plan to expand PreP
outreach and education campaigns to include dierent languages and targeted outreach to people of color,
transgender persons, injection drug users, and cisgender women over the next 5 years.
While planning councils ensure that federal funding is responsive to community-specific needs, the capacity
development grants in Part C of Ryan White allow CBOs to access the funds necessary to develop the organizational
infrastructure to respond to that need. Through the Capacity Development Program, CBOs and other nonprofit
entities can apply for grants administered by HRSA to improve organizational capacity in either of two ways: care
innovation or infrastructure development projects. In 2020, these grants allowed non-profit entities to apply for
funding to expand their organizational capacity to implement, enhance, or expand CHW services to serve the
eligible populations identified in their needs assessment.
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V. FOLLOWING UP ON THIS DOWN PAYMENT
The investment aorded by the ARP has provided our health infrastructure with the first seeds of funding it has desperately
needed for decades. With billions on the table to start the process of rebuilding, HHS has the opportunity to begin to
address both the immediate exigencies of the pandemic and the longer-term challenges of creating sustainable health
equity. The principles and recommendations that emerged from the roundtable on March 25, 2021 can serve as vital first
steps in ensuring that money flows to communities in need, hires the workers who can best serve those communities,
and builds capacity for the short- and long-term.
The Biden Administration’s decision to invest $7.4 billion from the ARP towards a public health workforce, and $250
million towards CBOs, is a laudable first step in rebuilding the U.S. health infrastructure.
It is essential to recognize that the funds from the ARP are a down payment on what must be a broader, sustainable
investment in our public health infrastructure. Eorts in the American Jobs Plan, American Families Plan, and future
priorities of the administration must build on these investments. As the pandemic has underscored, our systems of
support and care are insucient for equitably meeting the needs of our people. While the ARP has provided a vital
lifeline, it must be the first of many steps towards building the public health workforce and system we need. This coalition
of stakeholders looks forward to the long-term project of making that aspiration a reality.
For additional information, contact Justin Mendoza, U.S. Advocacy Manager, Global Policy and Program,
Partners In Health, U.S. Public Health Accompaniment Unit, at [email protected]
Authors (listed alphabetically):
Kyle Bigley, JD expected 2022**; Alison Bloomgarden, MA*; Morgan N.V. Buchanan, MPH**;
Amy Kapczynski, JD**; Justin Mendoza, MPH*; Briana Moller, JD**;
Megan Stellini, MPH expected 2022**; Evan Walker-Wells, JD expected 2022**
Aliations: * Partners In Health, ** Yale Global Health Justice Partnership
© 2021 Partners In Health. All rights reserved.
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