# Aggregated 50-State, Regional, and State-Level Trends in State and Local Government Health Employees in the U.S. From 2000 Through 2023

## TL;DR

This study analyzed U.S. state and local government health employment trends from 2000 to 2023, finding stability overall but regional and temporal variations.

## Contribution

The study provides a detailed, aggregated analysis of health employment trends across U.S. states and regions over a 23-year period.

## Key findings

- U.S. state and local government health employment remained stable from 2000 to 2023.
- Most states saw employment decreases during the Great Recession (2007–2009) and increases during the pandemic (2020–2023).
- Regional trends varied, with the South showing a decline and the Midwest showing growth in health employment.

## Abstract

•Joinpoint regression was used to examine U.S. government health employment trends.•U.S. state and local government health employees remained stable from 2000 to 2023.•State and local government health employment decreased in most states (2007–2009).•State and local government health employment increased in many states (2020–2023).

Joinpoint regression was used to examine U.S. government health employment trends.

U.S. state and local government health employees remained stable from 2000 to 2023.

State and local government health employment decreased in most states (2007–2009).

State and local government health employment increased in many states (2020–2023).

The authors investigated trends in U.S. state and local government health employees per million persons at the aggregated 50-state, regional, and state levels.

The authors used repeated cross-sectional data from the Annual Survey of Public Employment & Payroll. Joinpoint regression was used to estimate average annual percentage changes and annual percentage changes from 2000 through 2023. State and local full-time and part-time government health employees included public health and several other categories of health workers.

State and local government health employees per million persons remained stable in the U.S. from 2000 through 2023. Heterogeneous trends in state and local government health employees were observed by region: Northeast (average annual percentage change=0.5% increase, 95% CI=0.3%, 0.7%), Midwest (average annual percentage change=0.9% increase, 95% CI=0.6%, 1.1%), South (average annual percentage change= −0.7% decrease, 95% CI= −0.9%, −0.5%), and West (average annual percentage change=0.1% increase, 95% CI= −0.1%, 0.2%). The authors observed further variation in state-stratified analyses.

Most U.S. states experienced decreasing trends during the Great Recession (2007–2009) and increasing trends during the COVID-19 pandemic (2020–2023). Stable and long-term funding streams are essential to support consistent recruitment, training, and retention of state and local government health employees. Health policies should account for regional variations in health needs and employment trends when planning the state and local government health hiring.