Building a stronger public health workforce: insights from a study on salaries in urban health departments

In collaboration with BCHC, Drexel’s Urban Health Collaborative analyzed pay structures in 11 large urban health departments to understand workforce needs and challenges. Despite some difficulties comparing across departments, the study reveals trends that can inform future improvements in pay, benefits, and competitive hiring practices.

Governmental public health departments can only meet the needs of the populations they serve if they have a fully staffed, competent, and qualified workforce. No matter the sector, public or private, employees are attracted to and remain in jobs and at organizations that provide a competitive advantage through a combination of pay, benefits, and organizational practice. Challenges to achieving these ideals are numerous for health departments because they are often underfunded, understaffed, and competing with similar organizations and institutions for the same workforce.

In the winter of 2023–2024, in partnership with the Big Cities Health Coalition (BCHC), our team at the Drexel Urban Health Collaborative (UHC) reviewed the salaries, pay determinants, and pay progressions of 11 large, primarily urban, health departments that are local recipients of CDC’s Public Health Infrastructure Grant (PHIG). Our shared goal was to better understandjob compensation structures across grantees to support their workforce/hiring needs and inform future standardization of job salaries, pay determinants, and pay progressions to aid in improving their competitive advantage in hiring. Below we share the process and findings of that undertaking and the inherent challenges in doing this work.

What we did and the challenges we faced

Working with BCHC’s PHIG Local Workforce Director Peer Network to establish the focus and scope of research and information gathering, we were able to collect data from 11 local PHIG recipients (10 BCHC health departments and 1 non BCHC member), We explored salary ranges for a variety of positions; pay determinants (whether the health department or city/county regulate pay), civil service positions, and union presence; and pay progressions (cost of living adjustments, merit, bonuses, and promotions).

The main sources of information we used were city and county government fiscal reports, compensation and classification studies, salary ordinances, salary/payroll/pay rate charts and spreadsheets, civil service rules, union rules and other regulations. This was supplemented by interviews with two BCHC member health departments, one informal survey sent to all 49 local PHIG recipients, and email requests for salary ranges due to the lack of information found online.

While a major goal of this analysis was to create a comparable data set across jurisdictions, this proved to be elusive. Relying primarily on publicly available information limited our analysis when it came to comparing one health department with another in the following ways.

1. Limited transparency of salary information

2. Difficulty identifying health department salaries, perhaps due to:

3. Variation between classification of positions

4. Variation among salary/hourly positions, union/non-union positions, and civil service/non-civil service positions within departments

5. Difficulty of calibrating titles for positions across departments, within a city and across cities

What we were able to learn

Despite the many challenges discussed above, we gleaned some useful information about trends and outliers across salaries, pay determinants, and pay progression mechanisms, recognizing that there are variations based on geographic location, county, city, and/or health department size, local economies and competition therein.

Salary ranges

Salary ranges for the positions we studied are wide due in part to the variations described above. For example, the pay range for a medical examiner is between $71,000 and $356,000, while a health educator can make anywhere from $38,000 to $100,000. These ranges make it difficult to identify norms and standards for cities.

Pay determinants – What and who decide how much someone is paid?

A variety of organizational structures can determine the pay range for a position, including whether a health department or city/county has authority, whether a job is classified as a civil service position, whether a job is part of a union, and whether the job is salaried or hourly. Of the 11 departments we reviewed, ten have their pay regulated by the city/county. Ten of the 11 health departments have staff who are classified as civil service positions. Union jobs exist in nine of the 11 health departments. Management positions are not typically civil service positions or union jobs. And while salaried positions are the norm for most jobs within health departments, ten of the 11 also have staff that are paid hourly pay.

Pay progressions

Pay progressions are the mechanisms used to increase the rate of pay for health department employees. For this project we looked at cost of living adjustments (an increase to wages to reflect increases in the cost of living), promotions, bonuses, and merit (a raise given in recognition of an employee’s contributions). Cost of living and promotions are the most common pay progressions across health departments while merit and bonuses are offered by about half (six of 11) for each.

For future exploration

We encourage further exploration on the following topics: