The public health workforce

Defining, illustrating and reflecting on logic analysis with an example from a professional development program

Program designers and evaluators should make a point of testing the validity of a program's intervention theory before investing either in implementation or in any type of evaluation. In this context, logic analysis can be a particularly useful option, since it can be used to test the plausibility of a program's intervention theory using scientific knowledge. Professional development in public health is one field among several that would truly benefit from logic analysis, as it appears to be generally lacking in theorization and evaluation. This article presents the application of this analysis method to an innovative public health professional development program, the Health Promotion Laboratory. More specifically, this paper aims to (1) define the logic analysis approach and differentiate it from similar evaluative methods; (2) illustrate the application of this method by a concrete example (logic analysis of a professional development program); and (3) reflect on the requirements of each phase of logic analysis, as well as on the advantages and disadvantages of such an evaluation method. Using logic analysis to evaluate the Health Promotion Laboratory showed that, generally speaking, the program's intervention theory appeared to have been well designed. By testing and critically discussing logic analysis, this article also contributes to further improving and clarifying the method.

Training the workforce in evidence-based public health: an evaluation of impact among US and international practitioners

INTRODUCTION

The Prevention Research Center in St. Louis developed a course on evidence-based public health in 1997 to train the public health workforce in implementation of evidence-based public health. The objective of this study was to assess use and benefits of the course and identify barriers to using evidence-based public health skills as well as ways to improve the course.

METHODS

We used a mixed-method design incorporating on-site pre- and post-evaluations among US and international course participants who attended from 2008 through 2011 and web-based follow-up surveys among course participants who attended from 2005 through 2011 (n = 626). Respondents included managers, specialists, and academics at state health departments, local health departments, universities, and national/regional health departments.

RESULTS

We found significant improvement from pre- to post-evaluation for 11 measures of knowledge, skill, and ability. Follow-up survey results showed at least quarterly use of course skills in most categories, majority endorsement of most course benefits, and lack of funding and coworkers who do not have evidence-based public health training as the most significant barriers to implementation of evidence-based public health. Respondents suggested ways to increase evidence-based decision making at their organization, focusing on organizational support and continued access to training.

CONCLUSION

Although the evidence-based public health course is effective in improving self-reported measures of knowledge, skill, and ability, barriers remain to the implementation of evidence-based decision making, demonstrating the importance of continuing to offer and expand training in evidence-based public health.

Labour market outcomes of public health graduates: evidence from Australia

Little information is available on the public health workforce. This study contributes to the gap in the literature and examines the demographic characteristics, career destinations and earnings of Masters in Public Health (MPH) graduates in Australia, using data from the 1999–2009 waves of the Graduate Destination Survey. It was found that public health graduates had a high amount of female representation and very low proportions of indigenous representation. Public health graduates experienced a relatively low unemployment rate and 85% were employed within 120 days of graduation. However, close to half of the graduates did not work in the health industry or in health-related roles. The mean salaries of public health graduates working in public health roles were relatively low compared to those in other occupations, but they had a range comparable to that observed for public health professionals in the USA and were higher than those of other Masters graduates in some other health fields. The results indicate strong demand and positive employment prospects for public health graduates in Australia. Strategies to target recruitment and/or retention of female or indigenous graduates in the public health workforce should be a priority. Mapping of public health graduate destinations and employment prospects should might be prioritised, given its strong potential to facilitate workforce planning and provide potential public health workers with more comprehensive career trajectories.

In-depth interviews with state public health practitioners on the United States National Physical Activity Plan

BACKGROUND

The United States National Physical Activity Plan (NPAP; 2010), the country's first national plan for physical activity, provides strategies to increase population-level physical activity to complement the 2008 physical activity guidelines. This study examined state public health practitioner awareness, dissemination, use, challenges, and recommendations for the NPAP.

METHODS

In 2011-2012, we interviewed 27 state practitioners from 25 states. Interviews were recorded and transcribed verbatim. Transcripts were coded using a standard protocol, verified and reconciled by an independent coder, and input into qualitative software to facilitate development of common themes.

RESULTS

NPAP awareness was high among state practitioners; dissemination to local constituents varied. Development of state-level strategies and goals was the most frequently reported use of the NPAP. Some respondents noted the usefulness of the NPAP for coalitions and local practitioners. Challenges to the plan included implementation cost, complexity, and consistency with other policies. The most frequent recommendation made was to directly link examples of implementation activities to the plan.

CONCLUSIONS

These results provide early evidence of NPAP dissemination and use, along with challenges encountered and suggestions for future iterations. Public health is one of eight sectors in the NPAP. Further efforts are needed to understand uptake and use by other sectors, as well as to monitor long-term relevance, progress, and collaboration across sectors.

Promoting an occupational perspective in public health

Background

Although the value of occupation for health and well-being is fundamental to the occupational therapy profession, this view is not well recognized in the field of public health.

Purpose

In this article, we argue that occupational therapists have a unique and valuable perspective to bring to the field of public health, particularly with respect to the importance of occupational engagement in promoting the health and well-being of Canadians.

Key Issues

There are many compelling reasons for public health advocacy, including the need to increase awareness of the health benefits and risks of occupational engagement for individuals and communities. Challenges that lie ahead, however, include issues related to terminology, the complexity of occupation, the need to consider multidimensional outcomes, and diversity of evidence.

Implications

To move forward, the profession of occupational therapy in Canada needs to position health promotion messaging in a way that clearly captures the complexity and value of occupation and resonates with Canadians of all ages and abilities.

How can both the intervention and its evaluation fulfill health promotion principles? An example from a professional development program

The emergence over the past 20 years of health promotion discourse poses a specific challenge to public health professionals, who must come to terms with new roles and new intervention strategies. Professional development is, among other things, a lever for action to be emphasized in order to meet these challenges. To respond to the specific training needs of public health professionals, a team from the Direction de santé publique de Montréal (Montreal Public Health Department) in Quebec, Canada, established in 2009 the Health Promotion Laboratory, an innovative professional development project. An evaluative component, which supports the project's implementation by providing feedback, is also integrated into the project. This article seeks to demonstrate that it is possible to integrate the basic principles of health promotion into a professional development program and its evaluation. To this end, it presents an analytical reading of both the intervention and its evaluation component in light of the cardinal principles in this field. Initiatives such as the Health Promotion Laboratory and its evaluation are essential to consolidate the foundations of professional development and its assessment by concretely integrating health promotion discourse into these practices.

Translating cancer prevention and control research into the community setting: workforce implications

A gap exists between cancer prevention research and its translation into community practice. Two strategies to reduce this gap are community-based participatory research (CBPR) and dissemination research. CBPR offers an avenue to engage academic and community partners, thereby providing mechanisms for joint learning and application of knowledge. Dissemination research examines the movement of evidence-based public health and clinical innovations to practice settings. While applying these approaches may reduce the gap between research and practice, the cancer prevention workforce may be inadequate in size, insufficiently trained, lack resources and incentives, or face structural barriers to effectively participate in CBPR and disseminate evidence-based research findings into practice. Information on translating cancer prevention information to communities and workforce implications was obtained from a panel of experts and through a review of the literature on CBPR and dissemination research. The expert panel and literature review identified major barriers to successfully conducting CBPR and dissemination research in community settings. Barriers included inadequate policies; insufficient networking and communication infrastructures; unsupportive research cultures, climates, and mindsets; inadequate researcher and practitioner education; and limited CBPR and dissemination research with adequate study designs. No specific estimates of the cancer prevention workforce were found; however, indirect evidence for a shortfall were identified. We recommend expanding CBPR training for academic and community partners; increasing funding for dissemination research and practice; supporting proven partnerships; and providing strategic coordination for government agencies, research institutions, nongovernmental organizations, and the private sector to foster better dissemination of information and integration of community-based cancer prevention and control programs and practices. Specific challenges and needs that must be addressed to improve the translation of cancer prevention research into community settings were identified.

Building an effective workforce: a systematic review of public health workforce literature

CONTEXT

The Robert Wood Johnson Foundation commissioned a systematic review of public health workforce literature in fall 2010. This paper reviews public health workforce articles published from 1985 to 2010 that support development of a public health workforce research agenda and address four public health workforce research themes: size and composition, effectiveness and health impact, demand, and policy.

EVIDENCE ACQUISITION

PubMed, ERIC, and Web of Science databases were used to search for articles; Google search engine was used to identify gray literature. The study used the following inclusion criteria: (1) the document was published in the U.S.; (2) the main theme(s) of the article address public health workforce research or relate to at least one of the four workforce research themes; and (3) the article focuses on the domestic workforce.

EVIDENCE SYNTHESIS

A total of 126 public health workforce articles and gray literature documents were analyzed in this review, including 34 related to effectiveness and health impact, 32 summary articles, 30 articles on size and composition, 20 articles about demand, and 10 policy articles. The primary sources for identifying articles were PubMed (66%); Google (28%); and Web of Science (6%).

CONCLUSIONS

The majority of public health workforce articles are descriptive in nature; few empirical studies about the public health workforce have been published in the peer-reviewed literature. Future research should consider use of organizational theories to develop workforce capacity models for public health and development of quantifiable output measures on which to base models that incorporate workforce demand.

A survey tool for measuring evidence-based decision making capacity in public health agencies

BACKGROUND

While increasing attention is placed on using evidence-based decision making (EBDM) to improve public health, there is little research assessing the current EBDM capacity of the public health workforce. Public health agencies serve a wide range of populations with varying levels of resources. Our survey tool allows an individual agency to collect data that reflects its unique workforce.

METHODS

Health department leaders and academic researchers collaboratively developed and conducted cross-sectional surveys in Kansas and Mississippi (USA) to assess EBDM capacity. Surveys were delivered to state- and local-level practitioners and community partners working in chronic disease control and prevention. The core component of the surveys was adopted from a previously tested instrument and measured gaps (importance versus availability) in competencies for EBDM in chronic disease. Other survey questions addressed expectations and incentives for using EBDM, self-efficacy in three EBDM skills, and estimates of EBDM within the agency.

RESULTS

In both states, participants identified communication with policymakers, use of economic evaluation, and translation of research to practice as top competency gaps. Self-efficacy in developing evidence-based chronic disease control programs was lower than in finding or using data. Public health practitioners estimated that approximately two-thirds of programs in their agency were evidence-based. Mississippi participants indicated that health department leaders' expectations for the use of EBDM was approximately twice that of co-workers' expectations and that the use of EBDM could be increased with training and leadership prioritization.

CONCLUSIONS

The assessment of EBDM capacity in Kansas and Mississippi built upon previous nationwide findings to identify top gaps in core competencies for EBDM in chronic disease and to estimate a percentage of programs in U.S. health departments that are evidence-based. The survey can serve as a valuable tool for other health departments and non-governmental organizations to assess EBDM capacity within their own workforce and to assist in the identification of approaches that will enhance the uptake of EBDM processes in public health programming and policymaking. Localized survey findings can provide direction for focusing workforce training programs and can indicate the types of incentives and policies that could affect the culture of EBDM in the workplace.

Enumeration and composition of the public health workforce: challenges and strategies

The field of public health needs a comprehensive classification data system that provides a better assessment of the size and composition of its workforce. Such a data system is necessary for understanding the capacity, trend projections, and policy development critical to the future workforce. Previous enumeration and composition studies on the public health workforce have been helpful, but the methodology used needs further improvements in standardization, specificity, data storage, and data availability. Resolving this issue should follow a consensus-based course of action that includes public and private stakeholders at the national, state, and local level. This prime issue should be addressed now, particularly in the current environment of comprehensive health care reform.

Assessing state substance abuse prevention infrastructure through the lens of CSAP's Strategic Prevention Framework

Although the organizational structures and operating procedures of state substance abuse prevention systems vary substantially across states, there is scant empirical research regarding approaches for rigorous assessment of system attributes and which attributes are most conducive to overall effectiveness. As one component of the national cross-site evaluation of the SPF State Incentive Grant Program (SPF SIG), an instrument was developed to assess state substance abuse prevention system infrastructure in order to measure infrastructure change and examine the role of state infrastructure in achieving prevention-related outcomes. In this paper we describe the development of this instrument and summarize findings from its baseline administration. As expected, states and territories were found to vary substantially with respect seven key characteristics, or domains, of state prevention infrastructure. Across the six domains that were assessed using numeric ratings, states scored highest on data systems and lowest on strategic planning. Positive intercorrelations were observed among these domains, indicating that states with high capacity on one domain generally have relatively high capacity on other domains as well. The findings also suggest that state prevention infrastructure development is linked to both funding from state government and the presence of a state interagency coordinating body with decision-making authority. The methodology and baseline findings presented will be used to inform the ongoing national cross-site evaluation of the SPF SIG and may provide useful information to guide further research on state substance abuse prevention infrastructure.

Training for public information officers in communication to reduce health disparities: a needs assessment

Government public information officers and risk communicators bear the burden for reaching all Americans with public health and emergency messages. To assess needs specifically regarding communication to reduce health disparities, an Internet survey is made available to members of the National Public Health Information Coalition. Respondents are asked to rate their own needs at their level of organizational responsibility as well as the needs of staff whom they may be supervising on 25 communication and cultural competencies. Multicultural understanding, culturally appropriate message development, and ways to better collaborate with diverse populations are identified as communication competencies in which more training is especially needed.

Studying an ill-defined workforce: public health workforce research

This article describes challenges, issues, and strategies associated with public health workforce research. The factors that contribute to workforce supply and demand imbalances are reviewed, and the unique difficulties encountered with studies of public health workers are identified. Two case studies of previous public health workforce research conducted by the New York Center for Health Workforce Studies are used to illustrate how different levels of analyses can be used to better understand recruitment and retention issues of public health workers and to inform programs and policies designed to ensure a well-sized and competent public health workforce. Case study 1, conducted in 2005, assessed supply and demand gaps in state and local health departments in six states and helped estimate the scope of recruitment and retention problems in these agencies. Case study 2, conducted in 2006, provided a detailed examination of the current public health workforce in local health departments in New York. Data drawn from this study were used to identify specific workforce challenges faced by these agencies. Findings from these case studies, conducted at different levels of analyses (multistate vs single state) and using different research methods (qualitative vs quantitative), are reviewed, highlighting differences based on scope and methods. Finally, suggested areas for future studies about the public health workforce are considered.

Perspectives on public health workforce research

The Centers for Disease Control and Prevention Office of Workforce and Career Development is committed to developing a competent, sustainable, and diverse public health workforce through evidence-based training, career and leadership development, and strategic workforce planning to improve population health outcomes. This article reviews the previous efforts in identifying priorities of public health workforce research, which are summarized as eight major research themes. We outline a strategic framework for public health workforce research that includes six functional areas (ie, definition and standards, data, methodology, evaluation, policy, and dissemination and translation). To conceptualize and prioritize development of an actionable public health research agenda, we constructed a matrix of key challenges in workforce analysis by public health workforce categories. Extensive reviews were conducted to identify valuable methods, models, and approaches to public health workforce research. We explore new tools and approaches for addressing priority areas for public health workforce and career development research and assess how tools from multiple disciplines of social sciences can guide the development of a research framework for advancing public health workforce research and policy.

Examining the role of training in evidence-based public health: a qualitative study

The use of evidence-based public health (EBPH) approaches is generally recognized as essential to changing public health outcomes. However, using an EBPH decision-making process requires public health practitioners to have the skills to review the evidence and pick the most workable strategy to address the problem at hand for their population of interest and the local context. Although there has been a growing body of academic literature examining the skills needed to translate evidence-based programs in local settings, many public health practitioners have not had the opportunity to learn or develop these skills. This article reports on qualitative interviews conducted to evaluate the process and impact of an EBPH course. The course has been found to assist participants in integrating new and existing skills to make evidence-based decisions. However, participants emphasize that factors external to the course influence their ability to engage in the EBPH process they learned.

Geographic variation in public health spending: correlates and consequences

OBJECTIVES

To examine the extent of variation in public health agency spending levels across communities and over time, and to identify institutional and community correlates of this variation.

DATA SOURCES AND SETTING

Three cross-sectional surveys of the nation's 2,900 local public health agencies conducted by the National Association of County and City Health Officials in 1993, 1997, and 2005, linked with contemporaneous information on population demographics, socioeconomic characteristics, and health resources.

STUDY DESIGN

A longitudinal cohort design was used to analyze community-level variation and change in per-capita public health agency spending between 1993 and 2005. Multivariate regression models for panel data were used to estimate associations between spending, institutional characteristics, health resources, and population characteristics.

PRINCIPAL FINDINGS

The top 20 percent of communities had public health agency spending levels >13 times higher than communities in the lowest quintile, and most of this variation persisted after adjusting for differences in demographics and service mix. Local boards of health and decentralized state-local administrative structures were associated with higher spending levels and lower risks of spending reductions. Local public health agency spending was inversely associated with local-area medical spending.

CONCLUSIONS

The mechanisms that determine funding flows to local agencies may place some communities at a disadvantage in securing resources for public health activities.

Evidence-based public health: a fundamental concept for public health practice

Despite the many accomplishments of public health, a greater attention to evidence-based approaches is warranted. This article reviews the concepts of evidence-based public health (EBPH), on which formal discourse originated about a decade ago. Key components of EBPH include making decisions on the basis of the best available scientific evidence, using data and information systems systematically, applying program-planning frameworks, engaging the community in decision making, conducting sound evaluation, and disseminating what is learned. Three types of evidence have been presented on the causes of diseases and the magnitude of risk factors, the relative impact of specific interventions, and how and under which contextual conditions interventions were implemented. Analytic tools (e.g., systematic reviews, economic evaluation) can be useful in accelerating the uptake of EBPH. Challenges and opportunities (e.g., political issues, training needs) for disseminating EBPH are reviewed. The concepts of EBPH outlined in this article hold promise to better bridge evidence and practice.

Public health workforce employment in US public and private sectors

OBJECTIVES

The purpose of this study was to describe the number and distribution of 26 administrative, professional, and technical public health occupations across the array of US governmental and nongovernmental industries.

METHODS

This study used data from the Occupational Employment Statistics program of the US Bureau of Labor Statistics. For each occupation of interest, the investigator determined the number of persons employed in 2006 in five industries and industry groups: government, nonprofit agencies, education, healthcare, and all other industries.

RESULTS

Industry-specific employment profiles varied from one occupation to another. However, about three-fourths of all those engaged in these occupations worked in the private healthcare industry. Relatively few worked in nonprofit or educational settings, and less than 10 percent were employed in government agencies.

CONCLUSIONS

The industry-specific distribution of public health personnel, particularly the proportion employed in the public sector, merits close monitoring. This study also highlights the need for a better understanding of the work performed by public health occupations in nongovernmental work settings. Finally, the Occupational Employment Statistics program has the potential to serve as an ongoing, national data collection system for public health workforce information. If this potential was realized, future workforce enumerations would not require primary data collection but rather could be accomplished using secondary data.

Public health delivery systems: evidence, uncertainty, and emerging research needs

The authors review empirical studies published between 1990 and 2007 on the topics of public health organization, financing, staffing, and service delivery. A summary is provided of what is currently known about the attributes of public health delivery systems that influence their performance and outcomes. This review also identifies unanswered questions, highlighting areas where new research is needed. Existing studies suggest that economies of scale and scope exist in the delivery of public health services, and that key organizational and governance characteristics of public health agencies may explain differences in service delivery across communities. Financial resources and staffing characteristics vary widely across public health systems and have expected associations with service delivery and outcomes. Numerous gaps and uncertainties are identified regarding the mechanisms through which organizational, financial, and workforce characteristics influence the effectiveness and efficiency of public health service delivery. This review suggests that new research is needed to evaluate the effects of ongoing changes in delivery system structure, financing, and staffing.

Using a community-based participatory research approach to improve the performance capacity of local health departments: the Kansas Immunization Technology Project

BACKGROUND

Building the capacity of local health departments (LHDs) in the use of health data is critical. Unlike community-based health agencies or private healthcare providers, LHDs serve as public health officials for their communities. Thus, LHDs' ability to use technology, electronically access and distribute up-to-date health information, and to measure population-based health outcomes for their communities is crucial.

PROCEDURES

Using feedback obtained from various sources, groundwork efforts in Kansas indicated that few LHDs had the skills to utilize and interpret immunization data in a way that would allow them to effectively assess, screen, treat, and monitor infectious diseases in their communities. In response to the need for a well-trained LHD workforce, and using a community-based participatory research (CBPR) approach, team members developed and delivered training to enhance immunization data skills among LHDs. The goal of the training was to improve LHDs' capacity to identify, obtain, analyze and present immunization data.

RESULTS

Training was provided to LHD staff representing 46 counties. Satisfaction survey results indicated the overwhelming majority of participants found the training beneficial. Results indicated that approximately 93% acquired new knowledge and skills they could apply to their jobs.

DISCUSSION

The project renders a model for providing ongoing trainings in stepwise fashion to a particular workforce. The willingness of the project partners to be innovative and inclusive in addressing the training needs of the state's public health professionals is noted. Similar training should be considered for other public health programmatic areas.

Directions for disaster nursing education in the United States

Because of their diverse education, experience, and practice settings, nurses are uniquely qualified to be first receivers, care givers, and leaders in any large-scale public health emergency. Many nurses, however, continue to feel inadequately prepared to function effectively in these types of situations. Great strides have been made since 2001, but much work remains to be accomplished. This article focuses on newer approaches used to teach nurses the principles of disaster preparedness. It also addresses the need to incorporate mass casualty care and disaster management skills into undergraduate curricula, continuing nurse education, and advanced degree programs for nurses in the United States.

Credentialing for Public Health Nurses: Personally Valued … But Not Well Recognized

OBJECTIVE

This study examined the extent to which public health nurses (PHNs) see value in credentialing and perceive specific barriers related to a community/public health nursing (C/PHN) credential.

DESIGN

A cross-sectional exploratory survey was used to examine the perceived value of credentialing for PHNs and the perceived barriers to obtaining or maintaining the C/PHN credential as the primary variables of interest.

SAMPLE

Data were collected from 655 PHN members of national public health nursing organizations who participated in an online survey.

MEASUREMENT

Responses related to the perceived value of credentialing were analyzed using factor analysis and descriptive statistics. Data regarding perceived barriers to the C/PHN credential were analyzed through descriptive statistics and through the Borda Count Method for analysis of ranked data (Tannenbaum, 1995).

RESULTS

Similar to nurses in other specialties, study participants perceived that credentialing has a high personal value for PHNs, but that certification provides less value in terms of extrinsic recognition. Respondents identified issues related to the lack of external recognition as particular barriers to the C/PHN credential.

CONCLUSIONS

These findings provide guidance to public health nursing leaders and inform discussions regarding the development of credentialing systems within the field of public health.

Using Principles of Community-based Participatory Research to Enhance Health Data Skills Among Local Public Health Community Partners

In a prior statewide health disparities assessment, local community public health and social service professionals indicated a need for technical capacity growth in order to understand and effectively utilize health data. Using a community-based participatory research approach in addressing this need, health data training was provided to 26 individuals with the primary goals being to provide capacity to identify health disparities that result in higher morbidity and mortality, and to provide the skills needed to access, interpret, and utilize health data. Satisfaction surveys showed that an overwhelming majority of participants were extremely pleased with the training. Follow-up telephone interviews (100% response rate) conducted 2 months after the training indicated positive results, with participants discussing how they felt empowered to find, interpret, and use data as a result of the training. Results of a 6-month follow-up questionnaire (54% response rate) further supported the program's desired outcome to expand participants' knowledge and use of health data. This pilot project illustrated how utilizing a community-level partnership approach to program development not only enhances the utilization of such programs but also helps sustain participants' knowledge and skills.

Relative effectiveness of worker safety and health training methods

OBJECTIVES

We sought to determine the relative effectiveness of different methods of worker safety and health training aimed at improving safety knowledge and performance and reducing negative outcomes (accidents, illnesses, and injuries).

METHODS

Ninety-five quasi-experimental studies (n=20991) were included in the analysis. Three types of intervention methods were distinguished on the basis of learners' participation in the training process: least engaging (lecture, pamphlets, videos), moderately engaging (programmed instruction, feedback interventions), and most engaging (training in behavioral modeling, hands-on training).

RESULTS

As training methods became more engaging (i.e., requiring trainees' active participation), workers demonstrated greater knowledge acquisition, and reductions were seen in accidents, illnesses, and injuries. All methods of training produced meaningful behavioral performance improvements.

CONCLUSIONS

Training involving behavioral modeling, a substantial amount of practice, and dialogue is generally more effective than other methods of safety and health training. The present findings challenge the current emphasis on more passive computer-based and distance training methods within the public health workforce.

Simulating Public Health Response to a Severe Acute Respiratory Syndrome (SARS) Event

In response to recent public health threats and disasters, greater emphasis has been placed on the use of exercises and drills to improve individual performance and enhance capacity of the public health workforce. However, despite the increased application of these exercises, rigorous research regarding their appropriate development and relative effectiveness in improving public health preparedness is limited. The present study attempted to fill this void by presenting a detailed account of a comprehensive and integrated approach to developing, implementing, and evaluating a tabletop exercise designed to enhance emergency preparedness and response of public health workers. Following a comprehensive training systems model, a tabletop exercise was developed to simulate worker recognition and response to a Severe Acute Respiratory Syndrome event among public health workers in Arkansas. Forty-nine individuals participated in the tabletop exercise, including public health workers and their external partners. Results demonstrated the effectiveness of this tabletop exercise in increasing participants' competency-related knowledge and skills. The flexibility afforded by creating a standardized competency-based process can extend to other state and local health departments and provides evidence of the reciprocal relationship between research and practice needed to advance the areas of emergency preparedness training and workforce development initiatives in public health.

The public health infrastructure and our nation's health

Threats to Americans' health-including chronic disease, emerging infectious disease, and bioterrorism-are present and growing, and the public health system is responsible for addressing these challenges. Public health systems in the United States are built on an infrastructure of workforce, information systems, and organizational capacity; in each of these areas, however, serious deficits have been well documented. Here we draw on two 2003 Institute of Medicine reports and present evidence for current threats and the weakness of our public health infrastructure. We describe major initiatives to systematically assess, invest in, rebuild, and evaluate workforce competency, information systems, and organizational capacity through public policy making, practical initiatives, and practice-oriented research. These initiatives are based on applied science and a shared federal-state approach to public accountability. We conclude that a newly strengthened public health infrastructure must be sustained in the future through a balancing of the values inherent in the federal system.

The south central center for public health preparedness training system model: a comprehensive approach

The South Central Center for Public Health Preparedness (SCCPHP) is a collaboration among the schools of public health at Tulane University and the University of Alabama at Birmingham and the state health departments in Alabama, Arkansas, Louisiana, and Mississippi. The SCCPHP provides competency-based training via distant delivery methods to prepare public health workers to plan for and rapidly respond to public health threats and emergency events. This article presents the training system model used by the SCCPHP to assess, design, develop, implement, and evaluate training that is both competency driven and practice based. The SCCPHP training system model ensures a standardized process is used across public health occupations and geographic regions, while allowing for tailoring of the content to meet the specific training needs of the workforce in the respective state and local health departments. Further, the SCCPHP training system model provides evidence of the reciprocal nature between research and practice needed to advance the area of emergency preparedness training and workforce development initiatives in public health.