Government public health has long depended on people willing to accept some financial sacrifice in exchange for serving their communities; while few entered government expecting wealth, they could count on stability and a pathway to a decent life. But today, that compact is eroding.
Many public health workers now face a growing financial strain: significant student loan debt paired with wages that are not keeping pace with inflation. Increasingly, we are asking people to finance their education at market rates while compensating them below market rates for work that is essential to the nation’s health and safety. In effect, we are financially penalizing people for choosing public service.
Recent research using data from the 2024 Public Health Workforce Interests and Needs Survey (PH WINS) shows how student debt and stagnant wages are threatening recruitment and retention across government public health.
The Numbers Behind the Debt
The 2024 survey asked respondents how much student loan debt they had for either themselves or their children. The data is clear: Student debt is not the exception in public health; it’s the norm. More than 40% of state and local public health workers carry student loan debt, and among those who do, their average balance is $48,000.
These numbers reflect the educational expectations of the field. Many roles require advanced degrees such as a Master of Public Health or other graduate training, which often come with substantial financial costs. And the burden is not evenly distributed — loan balances vary by age, race and ethnicity, and level of education, compounding existing inequities within the workforce. The analysis found that 35% of Black/African American government public health employees had loan balances above $40,000, compared with 11%–17% of White, Asian, Hispanic, American Indian/Alaska Native, and Middle Eastern/North African employees.
Wages That Aren’t Keeping Up
At the same time, related research found that while public health salaries have increased nominally from 2017 to 2024, those gains disappear when adjusted for inflation. In real terms, wages have remained flat or even declined for some groups, including highly educated and experienced staff.
Even as the demands on the workforce grow, compensation is not keeping pace with either the cost of living or the cost of entering the profession. Significant student loan debt combined with stagnant wages makes government public health increasingly difficult to sustain as a long-term career.
A Workforce Under Financial Strain
While student debt affects many professions, the challenge is particularly acute in government public health, where salaries often lag behind private-sector opportunities requiring similar levels of education. Workers burdened by debt are more likely to leave government public health for higher-paying sectors or avoid entering the field altogether. Financial stress contributes to burnout and turnover in a workforce already under strain.
It’s especially acute for early- and mid-career professionals. Many younger public health workers are entering public service carrying educational debt while earning salaries that are often insufficient to keep pace with rising housing, childcare, and living costs. For workers earning $55,000 or less, the average student loan burden remains staggering relative to income. For many early-career professionals, the combination of educational debt and stagnant wages can delay major financial milestones such as homeownership and family formation while also raising questions about the long-term financial sustainability of remaining in government public health.
These pressures also threaten efforts to build a workforce that reflects the communities it serves. Debt burdens are not equally distributed. The financial barriers associated with public service careers may disproportionately discourage individuals from historically underrepresented communities from entering or staying in government public health. A workforce that does not reflect its communities is less equipped to understand and respond to their needs effectively.
Why Loan Relief Matters
Student loan relief and repayment programs can play a critical role in reducing financial inequities and strengthening the workforce. Policies such as loan forgiveness or employer-supported repayment can help offset the cost of required education, making public sector roles more financially viable. These policies can also improve recruitment and retention, especially among early-career professionals. At the very moment government public health faces workforce shortages, federal policy changes threaten to make entry into the profession even harder. Proposed restrictions on federal loan availability for certain professional programs, including public health, may push students toward less favorable private loans or discourage them from pursuing government public health careers altogether.
As the nation faces increasing threats from infectious disease, natural disasters, misinformation, and chronic illness, weakening the pipeline into government public health is shortsighted. If public health agencies are expected to compete for highly trained talent, the pathway into the profession cannot become more financially precarious.
What’s at Stake
A weakened public health workforce is not merely a workforce problem — it is a national vulnerability. It is felt in slower outbreak detection, fewer inspections, weakened maternal and child health services, delayed emergency response, and diminished preparedness when agencies cannot recruit and retain qualified staff. When entering the field requires taking on tens of thousands of dollars in debt for jobs whose wages are often too low to support repayment, we are gambling with the nation’s health, safety, security, and economic prosperity.
