The Price of Dedication: An Analysis of Wage Trajectories in State and Local Public Health From 2017 to 2024

Abstract

Context: Salary plays a crucial role in recruiting and retaining employees in public health; however, information about trends in compensation is limited. Objective: To analyze trends in earnings among state and local governmental public health workers between 2017 and 2024. Methods: Data used are from the Public Health Workforce Interests and Needs Survey for the years 2017, 2021, and 2024. The analytic sample comprised 34 379 full-time permanent employees with complete salary data in 2017, 32 862 in 2021, and 45 241 in 2024, representing state health agency (SHA) and local health department (LHD) public health workers in each respective year. We performed a multi-cross-sectional analysis using descriptive and bivariate analyses and interval-based regression techniques to explore relationships between annualized earnings and key individual and agency-level characteristics. Results: Earning patterns in 2024 were largely consistent with historical patterns. Individual and agency-level characteristics continued to play a significant role in shaping salary. Higher salaries remained associated with higher supervisory status, longer tenure, higher educational attainment, salaried (versus hourly) employment, union/bargaining unit representation, and employment setting within SHAs versus LHDs. Between 2017 and 2024, annual earnings for full-time permanent employees increased from $57 817 in 2017 to $73 299 in 2024, representing a 27% average increase of $15 482. However, when adjusted for inflation, annual wages showed no real growth, indicating that earnings remained largely stable in terms of purchasing power during this timeframe. Subgroups that experienced declines in inflation-adjusted salaries between 2017 and 2024 include executives, employees with longer tenures, employees with doctoral degrees, and employees with public health degrees versus degrees in other fields. Conclusions: The continued decline in inflation-adjusted earnings for certain groups and persistent gender and racial pay gaps indicate that without targeted interventions, public health agencies may face challenges in retaining experienced professionals, attracting new talent, and ensuring workforce stability.