National Public Health Performance Standards: workforce development and agency effectiveness in Florida

Making a Living in Governmental Public Health: Variation in Earnings by Employee Characteristics and Work Setting

CONTEXT

This article examines factors related to earnings in the context of the governmental public health system's urgent need to recruit and retain trained public health workers as many in the existing workforce move toward retirement.

METHODS

This article characterizes annualized earnings from state and local public health practitioners in 2017, using data from the 2017 Public Health Workforce Interests and Needs Survey (PH WINS), which was fielded in fall/winter 2017 to more than 100 000 state and local public health practitioners in the United States. The response consisted of 47 604 public health workers for a response rate of 48%.We performed descriptive statistics, bivariate analyses, and interval-based regression techniques to explore relationships between annualized earnings, supervisory status, gender, years of experience, highest degree (and whether it was a public health degree), job classification, race/ethnicity, union/bargaining unit, paid as salary or hourly wage, setting, and region.

RESULTS

Higher supervisory status, higher educational attainment, white non-Hispanic race/ethnicity, male gender, salaried employment, bargaining unit (labor union) position, certain geographic regions, having a clinical/laboratory/other scientific position, and working in either a state health agency (SHA) or a large local health department (LHD) setting are all associated with higher salary. Having a public health degree versus a degree in another area did not appear to increase earnings. Being a person of color was associated with earning $4000 less annually than white peers (P < .001), all else being equal. The overall regression model showed a gender wage gap of about $3000 for women (P = .018). Supervisors, clinical and laboratory staff, public health sciences staff, and union staff also earned more than their counterparts.

DISCUSSION

As multiple factors continue to shape the public health workforce, including increasing racial/ethnic diversity, continued retirements of baby boomers, and the growth of bachelor's-level public health education, researchers should continue to monitor the gender and racial/ethnic pay gaps. This information should help the field of governmental public health as it endeavors to rebuild its capacity while current workers, many at the highest level of leadership, move on to retirement or other jobs. Public health leaders must prioritize equitable pay across gender and race/ethnicity within their own departments as they build their organizations' capacity to achieve health equity.

The Methods Behind PH WINS

Supplemental Digital Content is Available in the Text.

This article outlines the conceptualization, development, and implementation of the Public Health Workforce Interests and Needs Survey, as well as considerations and limitations.

The Public Health Workforce Interests and Needs Survey (PH WINS) has yielded the first-ever nationally representative sample of state health agency central office employees. The survey represents a step forward in rigorous, systematic data collection to inform the public health workforce development agenda in the United States. PH WINS is a Web-based survey and was developed with guidance from a panel of public health workforce experts including practitioners and researchers. It draws heavily from existing and validated items and focuses on 4 main areas: workforce perceptions about training needs, workplace environment and job satisfaction, perceptions about national trends, and demographics. This article outlines the conceptualization, development, and implementation of PH WINS, as well as considerations and limitations. It also describes the creation of 2 new data sets that will be available in public use for public health officials and researchers—a nationally representative data set for permanently employed state health agency central office employees comprising over 10 000 responses, and a pilot data set with approximately 12 000 local and regional health department staff responses.

From service provision to function based performance - perspectives on public health systems from the USA and Israel

If public health agencies are to fulfill their overall mission, they need to have defined measurable targets and should structure services to reach these targets, rather than offer a combination of ill-targeted programs. In order to do this, it is essential that there be a clear definition of what public health should do- a definition that does not ebb and flow based upon the prevailing political winds, but rather is based upon professional standards and measurements.The establishment of the Essential Public Health Services framework in the U.S.A. was a major move in that direction, and the model, or revisions of the model, have been adopted beyond the borders of the U.S.This article reviews the U.S. public health system, the needs and processes which brought about the development of the 10 Essential Public Health Services (EPHS), and historical and contemporary applications of the model. It highlights the value of establishing a common delineation of public health activities such as those contained in the EPHS, and explores the validity of using the same process in other countries through a discussion of the development in Israel of a similar model, the 10 Public Health Essential Functions (PHEF), that describes the activities of Israel's public health system. The use of the same process and framework to develop similar yet distinct frameworks suggests that the process has wide applicability, and may be beneficial to any public health system.Once a model is developed, it can be used to measure public health performance and improve the quality of services delivered through the development of standards and measures based upon the model, which could, ultimately, improve the health of the communities that depend upon public health agencies to protect their well-being.

Examination of the relationship between public health statute modernization and local public health system performance

OBJECTIVES

Wide variation in performance of public health (PH) systems, coupled with national interest in improving PH system quality, makes it a priority to identify factors associated with performance. One factor may be congruence between a state's PH enabling statutes and the obligations outlined in Public Health in America-the collaboratively developed framework that defines the mission and essential services (ESs) of PH.

SUBJECTS

This research examined the relationship between (1) the degree to which language in a state's PH enabling statutes reflects PH's mission and ESs and (2) the performance of local public health systems in delivering ESs, measured by National Public Health Performance Standards scores in 207 local jurisdictions.

METHODS

Binary logistic regression demonstrated that a high degree of congruence between statutory language and public health's mission increased the odds of above-average system performance for 5 of 10 ESs.

RESULTS

High levels of congruence between statutory language and the ESs themselves increased odds of above-average system performance for 6 of 10 ESs. Results yielded modest odds ratios (<2.0).

CONCLUSIONS

Limitations of the data make it impossible to draw firm conclusions; however, these modest results suggest that statutory language may account for little of the variation in local public health system performance.

State of emergency preparedness of Kentucky's rural public health workforce: assessing its ability to identify community health problems

OBJECTIVE

The author examined the emergency preparedness readiness of all workgroups within Kentucky's rural public health departments as it related to the 10 Essential Public Health Services. This article describes the results related to the three emergency preparedness competencies for the first Essential Public Health Service: the ability to monitor health status to identify community health problems.

METHODS

Onsite surveys were conducted in one urban and 93 rural Kentucky public health agencies during 2005 and 2006. Categorical data were analyzed using univariate and multivariate analysis techniques. The author compared responses to the level of confidence (LOC) and need for training (NFT) among the seven workgroup classifications.

RESULTS

One thousand nine hundred ninety-four public health workers completed the surveys. Of these, 1,813 workers represented 55% of the state's rural local public health workforce. Kentucky's rural public health workforce can be described as predominantly Caucasian, female, and not planning to retire within the next five years. There were significant differences among workgroups for LOC and NFT for each competency examined. Across all workgroups, there was a mean LOC (58%) in the ability to describe the actions to take and procedures to follow in an emergency. There was a correspondingly higher mean perceived NFT (73%) for this competency.

CONCLUSION

This study raises the question of whether we are adequately prepared to monitor our communities' health status. Further research that minimizes the limitations of self-reports and, instead, requires the worker to demonstrate the competency may provide a more accurate assessment of emergency preparedness.

Calidad en salud pública

Based on the concepts of quality and public health and of public health organizations as service organizations, the advisability of establishing a reference model for quality in public health, incorporating objective criteria, indicators and standards, is discussed. The 2 main models of quality management in the field of service organizations, ISO 9001-2000 and EFQM, are reviewed and their advantages and disadvantages with respect to their application in public health services are contrasted. Based on the Institute of Medicine's definition of the functions of public health, we followed the approach of the Delphi study of the World Health Organization and the Assessment Protocol for Excellence in Public Health (APEX PH) model. The NPHPSP of the Centers for Disease Control is described in detail. We propose the use of this model as the reference model for quality management and improvement in public health organizations. Finally, we conclude that the approval of the Law of Cohesion and Quality of the National Health System by the Spanish parliament, which lays out the eight main health services that the National Health System should provide, would allow the NPHSPS to be adapted to our environment as a tool for quality management of Spanish public health services.

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.