Such anonymity causes a problem when the organizations try to replace their nurses, epidemiologists and laboratory technicians. Those roles fail to spark the imagination of college students and other potential workers—even while demand for health services rises because of worries about pandemic viruses and bioterrorism.

“We are facing a crisis in our public health workforce,” says Michelle Gourdine, former deputy secretary for public health services in Maryland.

Nearly half of the 500,000 people who work in public health nationwide will be eligible to retire over the next five years, according to the Center for State and Local Government Excellence in Washington. Health departments are reporting that 20 percent of their jobs are unfilled and the turnover rate is 14 percent.

Low salaries and competition from private-sector labs and hospitals deplete the potential labor pool. So does the lack of creative marketing by health agencies.

“It’s exciting work; it’s challenging,” says Patrick Libbey, executive director of the National Association of County & City Health Officials. “It’s often invisible, we hope, because it’s often successful. We in public health don’t know how to sell it.”

This lack of interest endures despite the increased emphasis on the field following the terrorist attacks of September 11, 2001.

“If you could spell epidemiologist, you could be one,” Libbey says.

Some states have implemented programs to help increase the number of people who are entering the field, according to Jim Pearsol, chief program officer for public health performance at the Association of State and Territorial Health Officials.

Alabama has set up a partnership with public health schools at state universities. Colorado has established mentoring programs and tries to rehire retirees. In Indiana, medical residents go through a rotation in a public health department, and doctoral candidates can complete their dissertations after being hired.

On the federal level, Sens. Dick Durbin, D-Illinois, and Chuck Hagel, R-Nebraska, have introduced a bill that would fund scholarships and loan repayment assistance for students seeking a public health job. It also would provide midcareer training for people in the field.

During the last week of February, a House companion measure was introduced for the first time by Rep. Doris Matsui, D-California.

That breakthrough notwithstanding, generating momentum for legislation can be difficult.

“We’re working against a philosophy that the market will take care of workforce shortages,” says Donna Brown, government affairs counsel at the health officials association.

With declining tax revenue caused by the economic downturn, there’s also an attitude at the federal level that state and local governments must do more.

“That’s not a realistic expectation,” Brown says, because they are under their own fiscal pressure.

Operating effectively in those conditions has created another problem for public health agencies.

“We are able to do a lot with limited resources,” Gourdine says. “That may be our Achilles heel.”