The State of the US Governmental Public Health Workforce, 2014-2017

Assessing Diversity, Equity, and Inclusion in the US Environmental Health Workforce: Challenges and Opportunities

CONTEXT

Environmental health (EH) professionals play a critical role in the US public health workforce, performing a wide range of duties aimed at safeguarding community health. As the US population diversifies, the EH workforce needs to be culturally competent and reflective of this diversity. Current data show a predominantly White EH workforce, which may hinder the effectiveness and equity of public health interventions.

OBJECTIVE

The aims of this study were to assess EH professionals' perceptions of organizational commitment to diversity, equity, and inclusion (DEI), identify influencing factors, and examine the relationship between these perceptions and job satisfaction, engagement, and retention.

METHODS

This study utilized data from the 2021 Public Health Workforce Interests and Needs Survey (PH WINS), targeting 137 447 public health workers with a response rate of 35% (n = 44 732). The survey included Likert scale questions to measure workplace satisfaction, awareness of DEI concepts, confidence in addressing DEI issues, and perceptions of organizational effectiveness in DEI.

RESULTS

Significant demographic disparities between BIPOC and White EH workers were identified. BIPOC workers were more prevalent in lower salary brackets and non-permanent roles, while White workers dominated supervisory and executive positions. Workplace satisfaction was similar across groups, but BIPOC workers reported lower pay satisfaction and job security. Awareness of DEI concepts was high among both groups, but BIPOC workers showed greater confidence in addressing health equity and structural racism. Perceptions of organizational effectiveness in DEI varied, with BIPOC workers perceiving a lower organizational commitment to DEI.

CONCLUSIONS

These findings underscore the need for targeted DEI training, equitable workplace policies, and an inclusive organizational culture. Longitudinal research is recommended to track DEI progress and its impact on public health outcomes. Addressing DEI disparities within the EH workforce is critical for enhancing public health interventions and outcomes.

Public Health Simulation-Infused Program (PHSIP) for Nursing Education

INTRODUCTION

Recent health crises, like COVID-19, have increased the need for nurses with public health competencies, but students lack knowledge and are unconvinced of the importance of the field.

METHODS

Pre-licensure nursing students (n = 341) engaged with a public health simulation-infused program (PHSIP) that scaffolded throughout the curriculum. Public health knowledge was tested pre- and post-simulation-based education (SBE), and the simulation effectiveness tool-modified (SET-M) was used to evaluate Learners' perception of the SBE experience.

RESULTS

Learners' overall mean SET-M scores were 47.1/57 (83%), ranging from 49.5 to 54 out of 57. Post-test knowledge scores were found to be significantly higher than pre-test (p < 0.001), with an average overall mean knowledge score of 70% (±0.25) and an effect size of 0.82.

DISCUSSION

Scaffolding public health SBEs across the curriculum allowed continuous exposure to public health content. Lessons learned include the need to chunk pre-SBE training to prevent cognitive overload, and the time and resources needed to create a PHSIP.

CONCLUSION

Nursing educators should embrace the PHSIP curriculum to provide an opportunity for students to gain an appreciation for the field and gain the knowledge, skills, and resources needed to care for the public's health.

Annual Survey of State and Territorial Chronic Disease Prevention and Health Promotion Capacity and Organizational Development Needs-United States, 2023

OBJECTIVE

The National Association of Chronic Disease Directors (NACDD) is a nonprofit organization that supports state and territorial chronic disease prevention and health promotion efforts through capacity building and technical assistance. Each year, NACDD surveys health department leaders who oversee chronic disease prevention and health promotion (hereafter, Chronic Disease Directors). We have previously used the annual survey results to inform strategic planning and resource allocation but have not historically published key findings in the peer-reviewed literature. In this paper, we report on NACDD's 2023 survey outcomes and place those findings into the broader public health policy context.

DESIGN

State Chronic Disease Directors completed a survey about their organizational capacity and development needs. Responses were summarized in aggregate and by jurisdiction size.

RESULTS

State chronic disease units have varied staffing and responsibilities, but most address diabetes, cardiovascular diseases, and cancer screening and prevention. Chronic Disease Directors generally reported strong or improving capacity in most practice areas but ranked workforce development lower. Staffing increased slightly during 2023 compared with the 2020 baseline (median of 1.3 and 1.1 employees per 100 000 jurisdiction population, respectively). However, Chronic Disease Directors expressed ongoing concerns about turnover, hiring, and training of inexperienced staff, as well as about funding limitations and uncertainty. Looking forward to 2024, many Chronic Disease Directors expressed intentions to focus on supporting their workforce with training and development opportunities and addressing health equity.

CONCLUSIONS

During this period of pandemic recovery, turnover, hiring, and training-particularly of the many new public health staff-remain key areas of concern for many chronic disease units. Continued stabilization of public health funding and increased prioritization of organizational capacity development-particularly workforce development, chronic disease data systems, and tools for addressing health equity-could help ensure chronic disease units can better address current and emerging challenges in chronic disease prevention and health promotion.

Trends and inequality of human resource in centers for disease control and prevention in China from 2019 to 2023

Background

The public health workforce plays a crucial role in the development of health systems, particularly in enhancing the capacity of public health infrastructure. Understanding the current status of human resources in the Centers for Disease Control and Prevention (CDC) is essential for establishing future development goals. This study aims to assess the quantity and equity of the human resources in China's CDCs since the outbreak of COVID-19, with the goal of promoting a more equitable distribution of the CDC workforce and enhancing the capacity to respond effectively to major public health emergencies.

Methods

Using nationwide administrative data from China CDC (2019-2023), we conducted a two-stage analysis: First, we conducted a descriptive analysis of the current status and trends of the CDC workforce. Second, we performed an equity assessment through multilevel decomposition (1) Calculated Gini coefficients across three dimensions (geography, Gross Domestic Product per capita, population density); (2) Applied Theil T/L index to partition inequalities into within-region and between-region components.

Results

Between 2019 and 2023, the CDC workforce in China increased to 230,594 employees, with workforce density rising from 1.3 to 1.64 per 10,000 residents, 76.26% being health professionals, a majority of whom were female, and the 25-34 age group comprising the largest segment (29.06%). Additionally, while the proportion with less than 5 years of service grew, staff with over 30 years of service formed the largest tenure group (30.69%). The Gini coefficient revealed extreme spatial inequality, indicating that geographic distribution was significantly exceeding those based on economic and population distributions, with values of 0.5815, 0.3866, and 0.1843, respectively, in 2023. Decomposition of inequality indicated that both general staff and health professionals were primarily affected by within-region disparities, with an increasing trend of within-region inequity from 2019 to 2023. In 2023, Theil T analysis showed that within-region inequality accounted for 76.67% of staff disparities, while for health professionals, this figure was 64.21%.

Conclusion

The human resource landscape in China's CDCs faces challenges related to both underfunding and an aging workforce. Inequities in workforce distribution persisted from 2019 to 2023, with significant disparities within regions. Strengthening the CDC workforce, particularly in underdeveloped and sparsely populated areas, is essential for addressing these challenges.

Experiences and Lessons Learned From Surging the Governmental Public Health Workforce During the COVID-19 Pandemic

CONTEXT

During the COVID-19 pandemic, the United States relied on the public health workforce to control the spread of COVID-19 while continuing to provide foundational public health services. Facing longstanding staffing shortages, state, tribal, local, and territorial (STLT) public health agencies (PHAs) used various strategies and supports to surge the workforce in response to the pandemic.

OBJECTIVES

The study explored (1) the types of strategies and supports STLT PHAs used to surge the public health workforce during the pandemic, (2) assessments of surge strategies and supports, and (3) approaches to using the range of surge strategies available.

DESIGN

We conducted 27 semi-structured interviews in 2023 and performed thematic analysis.

PARTICIPANTS

Interviewees included STLT public health officials, leaders of organizations that directly supported the COVID-19 workforce surge, and public health workforce experts indirectly involved in the workforce surge.

RESULTS

To surge the workforce, interviewees relied on partnerships, staffing agencies, the National Guard, the Centers for Disease Control and Prevention Foundation's COVID-19 Corps, the Medical Reserve Corps, and other strategies. Interviewees valued strategies that rapidly engaged staff and volunteers at no cost to their PHA and flexible funding from the federal government to support surge efforts but noted shortcomings in the strategies and supports available. Interviewees described using multiple strategies simultaneously but noted challenges in implementing these strategies due to inadequate planning and insufficient staff and resources.

CONCLUSION

The study underscores the need for STLT PHAs to establish mechanisms to surge the workforce as part of ongoing planning for emergency preparedness. Focus areas include building administrative and hiring capacity within STLT PHAs and sustaining partnerships and contractual agreements that helped fill staffing gaps during the pandemic. To support efforts to build workforce capacity to meet future surge management needs, STLT PHAs should consider creative solutions to attract and retain staff, as well as opportunities to engage students in public health work.

Accredited Public Health Department Characteristics Associated With Workforce Gaps Identified in Workforce Development Plans

OBJECTIVE

When pursuing accreditation by the Public Health Accreditation Board, local health departments (LHDs) must submit a workforce development plan (WDP). The purpose of this study was to examine LHD characteristics associated with workforce gaps identified and strategies implemented by LHDs.

DESIGN

We conducted a qualitative content analysis of all WDPs submitted to the Public Health Accreditation Board between March 2016 and November 2021.

SETTING

We examined WDPs from all accredited LHDs (n = 183) at the time of data collection in January 2022. A majority of LHDs had more than 50 staff members (n = 106, 57.9%), had a decentralized governance structure (n = 164, 89.6%), had county-level jurisdictions (n = 99, 54.1%), and served rural populations (n = 146, 79.8%).

MAIN OUTCOME MEASURES

For each overarching theme, we constructed 2 binary variables indicating whether the LHD identified a workforce gap or strategy among any subthemes within each overarching theme. Logistic regressions were used to examine relationships between LHD characteristics and identification of a workforce gap or strategy for each theme.

RESULTS

Few LHD characteristics were significantly associated with gaps identified or strategies implemented by LHDs. LHDs applying for reaccreditation had higher odds (adjusted odds ratio [AOR], 2.44; confidence interval [CI], 1.04-5.83) of identifying a leadership gap and of identifying a recruitment gap (AOR, 2.94; CI, 1.11-7.52) compared to LHDs applying for accreditation for the first time. LHDs serving urban populations had higher odds (AOR, 2.83; CI, 1.32-6.25) of identifying a recruitment strategy compared to LHDs that only served suburban/rural populations.

CONCLUSIONS

Overall, many workforce gaps reported by LHDs were universally observed irrespective of LHD characteristics. While most LHDs identified strategies to address gaps, our findings also reveal workforce areas where LHDs reported gaps without an accompanying strategy, indicating areas where LHDs could use more technical assistance and support.

Minnesota Public Health Corps: A Qualitative Assessment of AmeriCorps' Members Experiences

CONTEXT

Long-standing gaps in public health capacity exist due to extensive workforce shortages, particularly in governmental public health (GPH); these gaps were worsened during and after the COVID-19 pandemic. In response, the federal government established Public Health AmeriCorps (PHA), which supported the integration of AmeriCorps members in public health systems. Minnesota Public Health Corps (MNPHC) prioritized placing members in GPH agencies to increase GPH capacity. Initial evaluation results (2022-2023) suggest that program members were well-integrated into agencies. This article reports on the contextual information offered by MNPHC members throughout their service, including the specific programs and activities members implemented, to better explain how members were successful at extending agencies' capacity.

OBJECTIVES

Activities, challenges, and successes of members during their service are described to better explain how members were successful at extending their sites' capacity.

DESIGN

Descriptive qualitative methods using data reported each month by 60 members.

SETTING

GPH agencies with at least one AmeriCorps member.

PARTICIPANTS

MNPHC members and GPH agencies.

INTERVENTION

MNPHC members at GPH agencies across Minnesota who implemented service plans.

MAIN OUTCOME MEASURE

Outcomes of interest included salient themes within MNPHC members' (1) activities, (2) encountered challenges and barriers, (3) successes.

RESULTS

MNPHC members implemented public health activities that helped bolster the capacity at host sites. The most common activities were related to public health communications, community engagement, and data analysis. Reported successes were largely concerned with progress made on the different activities being implemented by members. Members also reported few challenges; however, most reported challenges related to common issues encountered in public health, such as difficulty working with community partners or finding available data.

CONCLUSIONS

MNPHC offers a compelling model that provides support to the GPH workforce while also offering those considering a career in GPH an opportunity to experience a range of public health activities.

Racial and Ethnic Composition of Departments of Health Policy & Management and Health Education & Behavioral Sciences

The diversity of racial/ethnic representation in the health services and policy research (HSPR) workforce plays a crucial role in addressing the health needs of underserved populations. We assessed changes (between 2012 and 2022) in the racial/ethnic composition of students and faculty from departments of Health Policy & Management (HPM) and Health Education & Behavioral Sciences (HEBS) among the Association of Schools and Programs of Public Health member institutions. We analyzed annual data from over 40 institutions that reported student and faculty data in 2012 and 2022 within each department. Racial/ethnic populations included American Indian/Alaska Native (AI/AN), Asian, Hispanic, Native Hawaiian/Pacific Islander (NH/PI), Black, White, Unknown, and Multiracial. We conducted analyses by department and examined racial/ethnic composition by student status, degree level, faculty rank, and tenure status. We found statistically significant increases in Black assistant professors (HPM and HEBS) and tenured faculty (HPM), Hispanic graduates and tenure-track faculty (HPM), Asian professors (HPM: full and tenured, HEBS: associate and tenured), and Multiracial students and graduates (HPM and HEBS). Statistically significant decreases were observed in White professors (HPM: assistant and full, HEBS: all ranks) and tenure-track faculty (HPM and HEBS), AI/AN associate professors and tenured faculty (HEBS), Hispanic associate professors (HPM), Asian assistant professors (HEBS), and NH/PI students (HPM and HEBS). Our findings highlight the importance of increasing racial/ethnic representation. Strategies to achieve this include facilitating workshops to raise awareness about the structural barriers encountered by Hispanic faculty, providing research support, evaluating promotion processes, establishing more pathway programs, and fostering interdisciplinary academic environments studying AI/AN or NH/PI populations.

Nurse practitioner program enrollment trends and predictions

BACKGROUND

As the fastest growing segment of the healthcare workforce, understanding NP enrollment is vital.

PURPOSE

This work aimed to guide healthcare workforce forethought, academic planning, and policy initiatives.

METHOD

This secondary data analysis investigated nurse practitioner (NP) program enrollment trends from 2013 to 2022, including sub-analyses of master's versus doctoral enrollment, clinical tracks (acute care, primary care, psychiatric mental health), and enrollment status (part-time vs. full-time). An autoregressive integrated moving average (ARIMA) projection modeling is used to forecast enrollment for four years, 2023-2026.

RESULTS

CONCLUSION: Increased enrollments in doctoral NP programs, visible in DNP NP program and enrollment growth, may offer advantages for the healthcare workforce. Part-time enrollment prevalence requires attention in workforce planning due to the potential for extended graduation timelines. These findings hopefully will lead to an effective healthcare response to meet the demand for high-quality care in a changing landscape.

Factors influencing the turnover intention for disease control and prevention workers in Northeast China: an empirical analysis based on logistic-ISM model

PURPOSE

This study aimed to determine the current turnover intention among workers at Centers for Disease Control and Prevention (CDCs) in Northeast China and to investigate the factors contributing to this phenomenon.

MATERIALS AND METHODS

The cross-sectional study was conducted in May 2023 across four northeastern provinces of China. The study included a total of 11,912 valid participants who were CDC workers selected using a stratified cluster sampling method. The study assessed demographics, turnover intention, work resources, work perceptions, and psychological support through online questionnaires. The binary logistic regression analysis identified the factors associated with turnover intention for CDC workers, while the Interpretative Structural Modelling (ISM) revealed the hierarchical relationship between the influencing factors.

RESULTS

The study found that 28.8% of the respondents reported high turnover intention. The binary logistic regression suggested that the risk factors of turnover intention among employees included gender, age, education, and several work-related, organizational, and psychological factors. The work-related factors were daily working hours, job burnout, and role overload. The organizational factor was unit support for training, unit's infrastructure conditions, leadership style, remuneration package and performance appraisal and promotion system. The psychological support factors were family support, professional identity, and organizational commitment. The ISM analysis results showed that the primary factors influencing CDC workers' intention to leave were internally connected and grouped into four categories according to their level of impact: surface, transition, deep, and essential factors. Notably, the essential factors were professional identity and organizational commitment.

CONCLUSION

Nearly one-third of the respondents expressed a strong desire to resign from their employment. Turnover intention among CDC workers was subject to diverse influences. Early identification, detection, and targeted multidisciplinary interventions should be introduced to address the array of factors that affect staff, with particular emphasis on boosting the professional identity and organizational commitment of CDC workers.

Development of a University-Government Partnership for Public Health Response and Workforce Development in the State of Oregon

The COVID-19 pandemic exposed and exacerbated a public health workforce shortage and national strategies have called for the development of clear occupational pathways for students to enter the public health workforce and meaningful public health careers. In response to the immediate need for public health workers during the pandemic, several universities and academic hospitals rapidly mobilized students and employees and partnered with local or state health departments. However, many of those partnerships were based on short-term volunteer effort to support critical COVID-19 public health efforts. In this article, we document the development of Oregon's Public Health Practice Team, a student, staff, and faculty workforce developed at the Oregon Health & Science University-Portland State University (OHSU-PSU) School of Public Health in close collaboration with the Oregon Health Authority (OHA). This project contributed significant effort to several phases of Oregon's statewide public health response to COVID-19, and over time developed into a lasting, multi-purpose, inter-agency collaborative public health practice program. Health equity has been centered at every stage of this work. We describe the phases of the partnership development, the current team structure and operations, and highlight key challenges and lessons learned. This provides a case-study of how an innovative and flexible university-government partnership can contribute to immediate pandemic response needs, and also support ongoing public health responses to emerging needs, while contributing to the development of a skilled and diverse public health workforce.

Evaluating a contact tracing course: How universities can develop the public health workforce

OBJECTIVES

To describe the participants of a university-based COVID-19 contact tracing course and determine whether the course changed knowledge, attitudes, and intention to participate in contact tracing.

PARTICIPANTS

Faculty, staff, and students were eligible.

METHODS

Surveys evaluated the impact of the course on participant intentions to engage in contact tracing. Logistic regression identified characteristics associated with increased likelihood of participating in contact tracing.

RESULTS

Nearly 800 individuals participated, of whom 26.2% identified as Hispanic/Latino and 14.0% as Black. Nearly half (48.8%) planned to conduct contact tracing. While attitudes did not change, knowledge improved (67.9% vs. 93.8% scores on assessments; p < 0.001). Younger participants and Black individuals were more more likely to be confident that they would participate in contact tracing.

CONCLUSIONS

Course completion was associated with increased knowledge. Participants were racially and ethnically diverse, highlighting how universities can partner with health departments to develop workforces that reflect local communities.

Factors Associated with COVID-19 Public Health Workforce Pipeline

Public health entities nationwide conducted historic hiring to mitigate the COVID-19 pandemic. Post-pandemic recovery has seen recognition and investment in the need for public health infrastructure including workforce. This case study presents a descriptive analysis of COVID-19 case investigators and contact tracers who were part of the COVID-19 workforce in Michigan and associated factors in their ongoing interest in the field. The majority of these respondents have continued their public health career.

Hispanic-Serving Institutions Contributing to the Training and Diversity of the Public Health and Health Care Workforce

The University of Texas at El Paso (UTEP), a Hispanic Serving and Carnegie R1 institution, serves as a pathway for socioeconomically diverse Hispanic/Latino (H/L) health profession students via equal-access strategies. The Center for Institutional Evaluation, Research, and Planning data illustrates UTEP's success in graduating H/L health professionals (i.e., allied health, nursing, pharmacy, and psychology) students between 2014 and 2023. Nearly 90% of these graduates are employed in Texas one year after graduation, and 85% remain employed after 10 years. (Am J Public Health. 2024;114(S6):S472-S477. https://doi.org/10.2105/AJPH.2024.307655) [Formula: see text].

Minnesota Public Health Corps: A New Model For Building The Governmental Public Health Workforce

Governmental public health agencies in the US are understaffed, and ongoing shortages will have a detrimental effect on their ability to provide basic public health services and protections. Public Health AmeriCorps was established in 2022 to support efforts to create a stronger and more diverse public health workforce nationwide. The Minnesota Public Health Corps, one of the largest Public Health AmeriCorps models, is a capacity-building program that places AmeriCorps members directly into governmental public health settings across the state. We used data from the first year of the Minnesota Public Health Corps (2022-23) to describe the experiences of thirty-five sites participating in the program. We also examined preliminary findings about how it shaped AmeriCorps members' skills and prospects related to career development in public health. Corps members were younger and more diverse than the current public health workforce in Minnesota, and the majority said that they intended to pursue a public health career. Host sites reported improved capacity to deliver public health services and indicated that corps members helped them reach new populations. Our evaluation demonstrates that this statewide program may be a scalable model to address parts of the acute capacity gaps at public health agencies, as well as long-term efforts to revitalize the workforce.

Spatial distribution and influencing factors of CDC health resources in China: a study based on panel data from 2016-2021

Background

Measuring the development of Chinese centers for disease control and prevention only by analyzing human resources for health seems incomplete. Moreover, previous studies have focused more on the quantitative changes in healthcare resources and ignored its determinants. Therefore, this study aimed to analyze the allocation of healthcare resources in Chinese centers for disease control and prevention from the perspective of population and spatial distribution, and to further explore the characteristics and influencing factors of the spatial distribution of healthcare resources.

Methods

Disease control personnel density, disease control and prevention centers density, and health expenditures density were used to represent human, physical, and financial resources for health, respectively. First, health resources were analyzed descriptively. Then, spatial autocorrelation was used to analyze the spatial distribution characteristics of healthcare resources. Finally, we used spatial econometric modeling to explore the influencing factors of healthcare resources.

Results

The global Moran index for disease control and prevention centers density decreased from 1.3164 to 0.2662 (p < 0.01), while the global Moran index for disease control personnel density increased from 0.4782 to 0.5067 (p < 0.01), while the global Moran index for health expenditures density was statistically significant only in 2016 (p < 0.1). All three types of healthcare resources showed spatial aggregation. Population density and urbanization have a negative impact on the disease control and prevention centers density. There are direct and indirect effects of disease control personnel density and health expenditures density. Population density and urbanization had significant negative effects on local disease control personnel density. Urbanization has an indirect effect on health expenditures density.

Conclusion

There were obvious differences in the spatial distribution of healthcare resources in Chinese centers for disease control and prevention. Social, economic and policy factors can affect healthcare resources. The government should consider the rational allocation of healthcare resources at the macro level.

Salary Disparities in Public Health Occupations: Analysis of Federal Data, 2021‒2022

Objectives. To assess salary differences between workers within key public health occupations in local or state government and workers in the same occupations in the private sector. Methods. We used the US Department of Labor's Occupational Employment and Wage Survey (OEWS). Referencing previous studies matching Standard Occupational Classification (SOC) codes with health department occupations, we selected 44 SOC codes. We contrasted median salaries in OEWS for workers in each occupation within state or local government with workers in the same occupations outside government. Results. Thirty of 44 occupations paid at least 5% less in government than the private sector, with 10 occupations, primarily in management, computer, and scientific or research occupations paying between 20% and 46.9% less in government. Inspection and compliance roles, technicians, and certain clinicians had disparities of 10% to 19%. Six occupations, primarily in social work or counseling, paid 24% to 38.7% more in government. Conclusions. To develop a sustainable public health workforce, health departments must consider adjusting their salaries if possible, market their strong benefits or public service mission, or use creative recruitment incentives such as student loan repayment programs for hard-to-fill roles. (Am J Public Health. 2024;114(3):329-339. https://doi.org/10.2105/AJPH.2023.307512).

Lessons learned from implementing a diversity, equity, and inclusion curriculum for health research professionals at a large academic research institution

Objective

Despite advances in incorporating diversity and structural competency into medical education curriculum, there is limited curriculum for public health research professionals. We developed and implemented a four-part diversity, equity, and inclusion (DEI) training series tailored for academic health research professionals to increase foundational knowledge of core diversity concepts and improve skills.

Methods

We analyzed close- and open-ended attendee survey data to evaluate within- and between-session changes in DEI knowledge and perceived skills.

Results

Over the four sessions, workshop attendance ranged from 45 to 82 attendees from our 250-person academic department and represented a mix of staff (64%), faculty (25%), and trainees (11%). Most identified as female (74%), 28% as a member of an underrepresented racial and ethnic minority (URM) group, and 17% as LGBTQI. During all four sessions, attendees increased their level of DEI knowledge, and within sessions two through four, attendees' perception of DEI skills increased. We observed increased situational DEI awareness as higher proportions of attendees noted disparities in mentoring and opportunities for advancement/promotion. An increase in a perceived lack of DEI in the workplace as a problem was observed; but only statistically significant among URM attendees.

Discussion

Developing applied curricula yielded measurable improvements in knowledge and skills for a diverse health research department of faculty, staff, and students. Nesting this training within a more extensive program of departmental activities to improve climate and address systematic exclusion likely contributed to the series' success. Additional research is underway to understand the series' longer-term impact on applying skills for behavior change.

Public health workforce survey data (2016-2021) related to employee turnover: proposed methods for harmonization and triangulation

Introduction

Public health workforce numbers are unsustainable at best and dire at worst: based on 2017 and 2019 data, 80,000 FTEs needed to be hired by health departments to provide basic public health foundational services before COVID-19 hit, suggesting that the situation is worse after the mass exodus of public health officials due to the pandemic. As such, a better understanding of public health workforce turnover is critical to improving recruitment and retention in the discipline.

Methods

This methods report details how the authors harmonized four public health workforce surveys-the Public Health Workforce Interests and Needs Survey (PH WINS), the National Association of County and City Health Officials (NACCHO) Profile, the NACCHO Forces of Change survey, and the Association of State and Territorial Health Officials (ASTHO) Profile-in order to examine employee turnover.

Results

We found that 31% of the public health workforce reported considering leaving their positions at some time in the future. Furthermore, the majority of agencies reported that zero vacancies had been filled in both 2018 and 2019.

Discussion

These findings suggest that retention, recruitment, and onboarding may be areas upon which to focus evaluation and quality improvement endeavors, allowing public health organizations to better attract and retain the most qualified candidates.

Facilitated Asynchronous Online Learning to Build Public Health Strategic Skills

CONTEXT

The COVID-19 pandemic spurred significant government investments for hiring public health workers. There are clear opportunities to help build capacities among both current and incoming public health workers, closing well-elucidated skill gaps.

OBJECTIVE

To report on the development process, methods used, and outcomes seen from a point-in-time public health workforce capacity-building initiative, Public Health Essentials (PHE) .

DESIGN

Capacity-building outcomes evaluation using pre/postintervention measures.

SETTING

The United States.

PARTICIPANTS

A total of 512 learners working in roles (government or adjacent to) that support public health.

INTERVENTION

PHE, a cohort-based facilitated asynchronous online course comprising 5 units, 18 modules, 54 learning outcomes, and 266 teaching and applied assessment elements designed to build public health strategic skills.

MAIN OUTCOME MEASURES

Two outputs and 3 outcomes were used to assess and improve progress in achieving our goal of building generalizable and transferrable public health ability and confidence among diverse public health workers: Use of PHE , PHE completion rate , Learner competence , Change in self-assessed ability , and Benefits of PHE.

RESULTS

From September 2021 to December 2022, 4 agencies used PHE for fellowship training or employee capacity building. Some 79% (n = 512) of learners completed the training, demonstrating competence in all 54 areas assessed by expert course facilitators. Of those, 79% (n = 321) completed both optional pre- and post-PHE surveys, reporting statistically significant gains in all strategic skill domains assessed (n = 9), regardless of demographics and public health experience. Learners gained new skills and knowledge (92%), developed a better understanding of public health (86%), and broadened their public health skill base (84%). A majority can apply the knowledge and skills gained directly to their work (94%), which benefits their team (92%), and have increased their confidence as public health practitioners (49%).

CONCLUSIONS

PHE can significantly improve learners' ability across 9 strategic skill areas in as few as 15 weeks, regardless of their demographics, training, or experience.

What Are Public Health Agencies Planning for Workforce Development? A Content Analysis of Workforce Development Plans of Accredited Public Health Departments

OBJECTIVE

Recruiting and retaining public health employees and ensuring they have the skills necessary to respond are vital for meeting public health needs. As the first study examining health department (HD) workforce development plans (WDPs), this study presents gaps and strategies identified in WDPs across 201 accredited HDs (168 initial/33 reaccreditation plans).

DESIGN

This cross-sectional study employed qualitative review and content analysis of WDPs submitted to the Public Health Accreditation Board (PHAB) between March 2016 and November 2021.

MAIN OUTCOME MEASURES

Eight overarching workforce themes were examined: planning/coordination, leadership, organizational culture, workplace supports/retention, recruitment, planning for departmental training, delivery of departmental training, and partnership/engagement. Within each theme, related subthemes were identified. Coders indicated whether the WDP (1) identified the subtheme as a gap; (2) stated an intent to address the subtheme; and/or (3) identified a strategy for addressing the subtheme.

RESULTS

The most common gaps identified included prepare workforce for community engagement/partnership (34.3%, n = 69), followed by resource/fund training (24.9%, n = 50). The subtheme that had the most instances of an identified strategy to address it was assess training needs (84.1%, n = 169), followed by foster quality improvement (QI) culture/provide QI training (63.2%, n = 127). While both of these strategies were common among the majority of HDs, those subthemes were rarely identified as a gap. Secondary findings indicate that increase recruitment diversity/recruit from a more diverse applicant pool was rarely identified as a gap (6.0%, n = 12) and rarely had an identified strategy for addressing the subtheme (9.0%, n = 18).

CONCLUSION

While HDs recognized many workforce gaps, HDs did not always propose a strategy for addressing them within the WDP. Conversely, some WDPs proposed strategies for subthemes that did not reflect recognized gaps. Such discrepancies between identified gaps and strategies in WDPs may suggest areas where HDs could use additional support and guidance.

A Strategy for Strengthening: Implementation of the Capabilities Opportunities Assessment Tool for the Public Health Workforce

CONTEXT

Strengthening the national public health infrastructure is crucial to ensure provision of necessary public health services in all jurisdictions. Public health agencies and their governing bodies need an evidence-based understanding of workforces' capabilities to operationalize this effort.

PROGRAM

The Capabilities Opportunities Assessment Tool for the Public Health Workforce (COAT-PH) is an assessment of workforce foundational capabilities (FCs), based on the Foundational Public Health Services (FPHS) framework. The COAT-PH provides data on employees' capabilities to health departments to help them improve and operationalize the FPHS.

IMPLEMENTATION

This article describes the development and pilot testing of the COAT-PH in a convenience sample of 8 health departments in Texas of various sizes and accreditation statuses. Participating leadership teams were provided easily interpretable reports to deliver clear evidence of division and organization-level workforce capability gaps and strengths. Follow-up semistructured interviews were conducted with leaders to capture insights into the tool and the usefulness of the findings.

EVALUATION

Eighty-eight percent of pilot health departments reported successfully appraising employee capability deficits, and 83% of small and medium health departments successfully assessed division or organizational FC strengths and gaps. All participating departments identified ways they could use their findings in future improvement efforts. Instrument psychometrics included the Cronbach α of internal reliability using a small test-retest sample (n = 6) of 0.956. Item test-retest reliability using Cohen's κ revealed 89% of items demonstrated at least slight reliability and 43% demonstrated moderate to substantial reliability. Content validity was established through review by 15 subject matter experts in the field of public health.

DISCUSSION

To provide the FPHS, health department leadership teams need a strong, prepared workforce and an effective method to demonstrate employee capabilities and provide evidence of health department workforce strengths and gaps to their governing bodies in the form of data that are clear and easy to understand. Early results demonstrated the usefulness of the COAT-PH in this effort.

Modernizing the United States' Public Health Infrastructure: A Position Paper From the American College of Physicians

The United States' public health sector plays a crucial role in preventing illness and promoting health. Public health drove massive gains in life expectancy during the 20th century by supporting vaccination campaigns, promoting motor vehicle safety, and preventing and treating tobacco use. However, public health is underfunded and underappreciated, forcing the field to do more with fewer resources. In this position paper, the American College of Physicians (ACP) updates its 2012 policy recommendations on strengthening the nation's public health infrastructure. ACP calls for effective coordination of public health activities, robust and stable year-to-year funding of public health services, a renewed and well-supported public health workforce, action to address health-related dis- and misinformation, modernized public health data systems, and greater coordination between public health and medical sectors.

Staffing Up and Sustaining the Public Health Workforce

OBJECTIVES

Estimate the number of full-time equivalents (FTEs) needed to fully implement Foundational Public Health Services (FPHS) at the state and local levels in the United States.

METHODS

Current and full implementation cost estimation data from 168 local health departments (LHDs), as well as data from the Association of State and Territorial Health Officials and the National Association of County and City Health Officials, were utilized to estimate current and "full implementation" staffing modes to estimate the workforce gap.

RESULTS

The US state and local governmental public health workforce needs at least 80 000 additional FTEs to deliver core FPHS in a post-COVID-19 landscape. LHDs require approximately 54 000 more FTEs, and states health agency central offices require approximately 26 000 more.

CONCLUSIONS

Governmental public health needs tens of thousands of more FTEs, on top of replacements for those leaving or retiring, to fully implement core FPHS.

IMPLICATIONS FOR POLICY AND PRACTICE

Transitioning a COVID-related surge in staffing to a permanent workforce requires substantial and sustained investment from federal and state governments to deliver even the bare minimum of public health services.

Characteristics of Public Health Registered Nurses and Advanced Practice Registered Nurses: Lessons Learned From the 2018 National Sample Survey of Registered Nurses

OBJECTIVES

Little research has compared the demographic and practice characteristics of registered nurses (RNs) who work in public health (PH RNs) with other RNs and advanced practice registered nurses (APRNs) who work in public health (PH APRNs) with other APRNs. We examined differences in characteristics between PH RNs and other RNs and between PH APRNs and other APRNs.

METHODS

Using the 2018 National Sample Survey of Registered Nurses (N = 43 960), we examined demographic and practice characteristics, training needs, job satisfaction, and wages of PH RNs compared with other RNs and PH APRNs compared with other APRNs. We used independent sample t tests to determine significant differences between PH RNs and other RNs and between PH APRNs and other APRNs.

RESULTS

On average, PH RNs and PH APRNs earned significantly less than other RNs ($7082 difference) and APRNs ($16 362 difference) (both P < .001). However, their job satisfaction was comparable. PH RNs and PH APRNs were also significantly more likely than other RNs and APRNs to report the need for more training in social determinants of health (20 [P < .001] and 9 [P = .04] percentage points higher, respectively), working in medically underserved communities (25 and 23 percentage points higher, respectively [P < .001 for both]), population-based health (23 and 20 percentage points higher, respectively [P < .001 for both]), and mental health (13 and 8 percentage points higher, respectively [P < .001 for both]).

CONCLUSIONS

Efforts that expand public health infrastructure and workforce development must consider the value of a diverse public health nursing workforce to protect community health. Future studies should include more detailed analyses of PH RNs and PH APRNs and their roles.

Improving Foodborne Disease Surveillance and Outbreak Detection and Response Using Peer Networks-The Integrated Food Safety Centers of Excellence

CONTEXT

Foodborne disease surveillance and outbreak investigations are foundational to the prevention and control of foodborne disease in the United States, where contaminated foods cause an estimated 48 million illnesses, 128 000 hospitalizations, and 3000 deaths each year. Surveillance activities and rapid detection and investigation of foodborne disease outbreaks require a trained and coordinated workforce across epidemiology, environmental health, and laboratory programs.

PROGRAM

Under the 2011 Food Safety Modernization Act, the Centers for Disease Control and Prevention (CDC) was called on to establish Integrated Food Safety (IFS) Centers of Excellence (CoEs) at state health departments, which would collaborate with academic partners, to identify, implement, and evaluate model practices in foodborne disease surveillance and outbreak response and to serve as a resource for public health professionals.

IMPLEMENTATION

CDC designated 5 IFS CoEs in August 2012 in Colorado, Florida, Minnesota, Oregon, and Tennessee; a sixth IFS CoE in New York was added in August 2014. For the August 2019-July 2024 funding period, 5 IFS CoEs were designated in Colorado, Minnesota, New York, Tennessee, and Washington. Each IFS CoE is based at the state health department that partners with at least one academic institution.

EVALUATION

IFS CoEs have built capacity across public health agencies by increasing the number of workforce development opportunities (developing >70 trainings, tools, and resources), supporting outbreak response activities (responding to >50 requests for outbreak technical assistance annually), mentoring students, and responding to emerging issues, such as changing laboratory methods and the COVID-19 pandemic.

Staffing Local Health Departments in Minnesota-Needs, Priorities, and Concerns

CONTEXT

The roles and responsibilities of local health departments (LHDs), as well as the hiring challenges they face, have changed since the pandemic started.

OBJECTIVES

To explore (1) staffing needs and priorities of LHDs in Minnesota, and (2) financial and community-level factors impeding health departments from maintaining optimal staffing.

DESIGN, SETTING, AND PARTICIPANTS

A cross-sectional online survey was administered via Qualtrics in July 2022 to city and county health departments in Minnesota (97% participation rate). It included both open- and close-ended questions concerning staffing needs and priorities of LHDs and challenges to hiring after the pandemic started.

RESULTS

Staffing priorities of LHDs included public health nurses, community health workers, and health planners/researchers/analysts. Hiring concerns included creating new permanent positions, offering competitive salaries, and filling open positions. Inadequate funds made it difficult to create new permanent positions and offer competitive salaries. External factors such as lack of affordable or reliable childcare, housing, and transportation also contributed to hiring challenges.

CONCLUSIONS

There is a need to increase staffing levels of the Minnesota public health enterprise by filling vacant positions and creating new positions. Increasing the public health workforce requires adequate sustainable funding along with creative solutions.

Local health department engagement with workplaces during the COVID-19 pandemic—Examining barriers of and facilitators to outbreak investigation and mitigation

Objectives

To document local health department (LHD) COVID-19 prevention or mitigation activities at workplaces in the United States and identify facilitators for and barriers to these efforts.

Methods

We conducted a web-based, cross-sectional national probability survey of United States LHDs (n = 181 unweighted; n = 2,284 weighted) from January to March 2022, collecting information about worker complaints, surveillance, investigations, relationships and interactions with employers/businesses, and LHD capacity.

Results

Overall, 94% LHD respondents reported investigating workplace-linked COVID-19 cases; however, 47% reported insufficient capacity to effectively receive, investigate and respond to COVID-19-related workplace safety complaints. Prior relationships with jurisdiction employers and LHD personnel with formal occupational health and safety (OHS) training were predictors of proactive outreach to prevent COVID-19 spread in workplaces (p &lt; 0.01 and p &lt; 0.001). LHD size predicted OHS personnel and sufficient financial resources to support workplace investigation and mitigation activities (p &lt; 0.001).

Conclusions

Differences in LHD capacity to effectively respond to communicable disease spread in workplaces may exacerbate health disparities, especially between rural and urban settings. Improving LHD OHS capacity, especially in smaller jurisdictions, could facilitate effective prevention and mitigation of workplace communicable disease spread.

Practices Among Local Public Health Agencies to Support Evidence-Based Decision Making: A Qualitative Study

OBJECTIVES

Evidence-based decision making (EBDM) capacity in local public health departments is foundational to meeting both organizational and individual competencies and fulfilling expanded roles. In addition to on-the-job training, organizational supports are needed to prepare staff; yet, less is known in this area. This qualitative study explores supportive management practices instituted as part of a training and technical assistance intervention.

DESIGN

This qualitative study used a semistructured interview guide to elicit participants' descriptions and perceptions via key informant interviews. Verbatim transcripts were coded and thematic analyses were conducted.

SETTING

Local public health departments in a US Midwestern state participated in the project.

PARTICIPANTS

Seventeen middle managers and staff from 4 local health departments participated in remote, audio-recorded interviews.

INTERVENTION

Following delivery of a 3½-day in-person training, the study team met with health department leadership teams for department selection of supportive agency policies and procedures to revise or newly create. Periodic remote meetings included collaborative problem-solving, sharing of informational resources, and encouragement.

MAIN OUTCOME MEASURES

Included management practices instituted to support EBDM and impact on day-to-day work as described by the interview participants.

RESULTS

Leadership and middle management practices deemed most helpful included dedicating staff; creating specific guidelines; setting expectations; and providing trainings, resources, and guidance. Health departments with a preexisting supportive organizational culture and climat e were able to move more quickly and fully to integrate supportive management practices. Workforce development included creation of locally tailored overviews for all staff members and onboarding of new staff. Staff wanted additional hands-on skill-building trainings. Several worked with partners to incorporate evidence-based processes into community health improvement plans.

CONCLUSIONS

Ongoing on-the-job experiential learning is needed to integrate EBDM principles into day-to-day public health practice. Management practices established by leadership teams and middle managers can create supportive work environments for EBDM integration.

Overcoming barriers and improving public health nursing practice

Public health nurses (PHN) are critical to ensuring the health of communities. Absent the most basic information on the PHN workforce in our state, we conducted interviews with 21 PHN and school health nurse (SHN) leaders and an online survey of PHNs and SHNs practicing in Maryland (N = 491). Our study identified an older, very experienced, and well-educated workforce. Both the interviews and survey identified similar barriers: low salaries, recruitment and hiring challenges, limited funding for public health programs, and no opportunities for education or career advancement. Survey participants also identified barriers of inadequate leadership, recognition, and communication including PHNs not being represented at decision-making tables or at the state leadership level. Strategies to promote public health nursing from leaders and survey participants were similar: increasing awareness about what public health and PHNs do and their value; improving advocacy and stakeholder engagement; improving access and availability of services; improving PHN leadership representation at the state level; a improving PHN salaries and benefits including tuition reimbursement. Although results were similar to national studies, comprehensive, granular workforce data is critical to ensure the public health workforce can meet current and emerging public health needs and that public health infrastructure and services are appropriately funded.

Comparative Evaluation of 2 Work Experience Approaches for Predominantly Black Youth in a Rural Community: Implications for Public Health Workforce Development

CONTEXT

In order to create a more diverse workforce, there is a need to involve historically excluded youth in public health-related work. Youth involvement in asset-based work experience approaches is especially relevant for rural areas with workforce shortages.

OBJECTIVE

To explore the public health workforce development implications of community-based career exploration and asset mapping work experience from the perspective of Black youth.

DESIGN

We used qualitative in-depth interviews with youth, aged 14 to 22 years, who participated in a work experience program anchored in several rural counties in southeastern United States. A phenomenological lens was applied for qualitative analyses with iterative, team-based data coding. Participants were also surveyed pre- and postprogram to supplement findings.

PROGRAM

A rural community-based organization's work experience program consisted of 2 tracks: (1) Youth Connect-a career exploration track that included work placement within community agencies; and (2) MAPSCorps-a track that employs youth to conduct asset mapping for their community.

RESULTS

We interviewed 28 of 31 total participants in the 2 tracks. We uncovered 4 emergent profiles in how youth described shifts in their perceptions of community: (1) Skill Developers; (2) Community Questioners; (3) Community Observers; and (4) Community Enthusiasts. In comparing between tracks, youth who participated in work experience that involved asset mapping uniquely described increased observation and expanded view of community resources and had greater increases in research self-efficacy than youth who participated only in career exploration.

CONCLUSION

Asset mapping work experience that is directly placed in rural communities can expose Black youth to and engage them in essential public health services (assessing and mobilizing community assets) that impact their community. This type of program, directly integrated into rural communities rather than placed near academic centers, could play a role in creating a more diverse public health workforce.

Public Health Workforce Perceptions About Organizational Commitment to Diversity, Equity, and Inclusion: Results From PH WINS 2021

OBJECTIVE

In response to calls to achieve racial equity, racism has been declared as a public health crisis. Diversity, equity, and inclusion (DEI) is an approach public health organizations are pursuing to address racial inequities in health. However, public health workforce perceptions about organizational commitment to DEI have not yet been assessed. Using a nationally representative survey of public health practitioners, we examine how perceptions about supervisors' and managers' commitment to DEI and their ability to support a diverse workforce relate to perceptions of organizational culture around DEI.

METHODS

Data from the 2021 Public Health Workforce Interests and Needs Survey (PH WINS) to examine the relationship between public health employees' perceptions about their organization's commitment to DEI and factors related to those perceptions. PH WINS received 44 732 responses (35% response rate). We calculated descriptive statistics and constructed a logistic regression model to assess these relationships.

RESULTS

Findings show that most public health employees perceive that their organizations are committed to DEI; however, perceptions about commitment to DEI vary by race, ethnicity, gender identity, and organizational setting. Across all settings, White respondents were more likely to agree with the statement, "My organization prioritizes diversity, equity, and inclusion" (range, 70%-75%), than Black/African American (range, 55%-65%) and Hispanic/Latino respondents (range, 62.5%-72.5%). Perception that supervisors worked well with individuals with diverse backgrounds had an adjusted odds ratio (AOR) of 5.37 ( P < .001); organizational satisfaction had an AOR of 4.45 ( P < .001). Compared with White staff, all other racial and ethnic groups had lower AOR of reporting their organizations prioritized DEI, with Black/African American staff being the lowest (AOR = 0.55), followed by Hispanic/Latino staff (AOR = 0.71) and all other staff (AOR = 0.82).

CONCLUSIONS

These differences suggest that there are opportunities for organizational DEI commitment to marginalized public health staff to further support DEI and racial equity efforts. Building a diverse public health workforce pipeline will not be sufficient to achieve health equity if staff perceive that their organization does not prioritize DEI.

Public Health Workforce Gaps, Impacts, and Improvement Strategies from COVID-19

The public health workforce has been instrumental in protecting residents against population health threats. The COVID-19 pandemic has highlighted the importance of the public health workforce and exposed gaps in the workforce. Public health practitioners nationwide are still coming to understand these gaps, impacts, and lessons learned from the pandemic. This study aimed to explore Minnesota's local public health practitioners' perceptions of public health workforce gaps, the impacts of these workforce gaps, and the lessons learned in light of the COVID-19 pandemic. We conducted seven concurrent focus groups with members of the Local Public Health Association of Minnesota (LPHA; n = 55) using a semi-structured focus group guide and a survey of the local agencies (n = 70/72 respondents, 97% response rate). Focus group recordings were transcribed verbatim and analyzed using deductive and inductive coding (in vivo coding, descriptive coding), followed by thematic analysis. The quantitative data were analyzed using descriptive analyses and were integrated with the qualitative data. Participants indicated experiencing many workforce gaps, workforce gaps impacts, and described improvement strategies. Overall, many of the workforce gaps and impacts resulting from COVID-19 discussed by practitioners in Minnesota are observed in other areas across the nation, making the findings relevant to public health workforce nationally.

Managing an ageing healthcare workforce: a systematic literature review

PURPOSE

The aim of this paper is to review research conducted on managing the ageing healthcare workforce and identify gaps for further research.

DESIGN/METHODOLOGY/APPROACH

A systematic literature search of studies in the English language was carried out in Scopus and Web of Science databases.

FINDINGS

The study consists of an analysis of 75 published articles. The majority of the papers were published in recent years, indicating a growing interest in the field. The authors specified the following inclusion criteria: all years, articles/reviews, English language and full text in the Web of Science and Scopus databases. The authors of the paper illustrated seven major categories with different topics that were suggested for future research. It included: challenges of labor market in the healthcare field, age-related changes and their influence on work ability, training opportunities and lifelong learning among ageing health workforce, motives of early retirement, ageing and its relationship to Occupational Health and Safety. Longitudinal studies and case study strategy with mixed-methods approaches were suggested for future research by the authors.

ORIGINALITY/VALUE

The paper summarizes knowledge related to the management of ageing health workforce, describes topics researched and as a result, presents findings on and conclusions about the most important future implications of the ageing workforce for management in the healthcare field providing lines for further research. To the authors' knowledge, no holistic systematic literature reviews have been published in academic journals targeted specifically to ageing healthcare workers.

Examining Factors Associated With Minority Turnover Intention in State and Local Public Health Organizations: The Moderating Role of Race in the Relationship Among Supervisory Support, Job Satisfaction, and Turnover Intention

CONTEXT

There is a need to understand minority governmental public health workforce turnover to ensure the retention of public health minority workers, capitalize on diversity benefits, and enhance public health's capacity to serve diverse populations.

OBJECTIVE

This study assesses the moderating effect of minority health workers' race on (1) the relationship between the workforce environment, particularly employees' perceptions of their pay and supervisory support on job satisfaction, and (2) the relationship between job satisfaction and turnover intentions.

DESIGN

Using the 2017 Public Health Workforce Interests and Needs Survey (PH WINS), a cross-sectional survey of the public health workforce, a hierarchical logistic regression modeling technique was used to assess the moderating role of race on the relationship between supervisory support, pay and job satisfaction, and turnover intentions.

SETTING AND PARTICIPANTS

The PH WINS survey data from state and local health department employees.

MAIN OUTCOME MEASURE

Job satisfaction, pay, supervisory support, and turnover intention.

RESULTS

Job satisfaction was found to mediate the relationship between the work environment factors of pay satisfaction and supervisory support and turnover. Our findings also suggest that while race moderates the influence of compensation and supervisory support on job satisfaction, race has no moderating effect on the job satisfaction-turnover intentions relationship.

CONCLUSIONS

A focus on boosting job satisfaction, particularly through pay equity and perceived support, may reduce turnover among minority public health personnel.

Training the MCH workforce: the Time for Change is now

Introduction

Maternal and child health (MCH) services are critical for vulnerable populations. Workforce shortages, poor retention, and gaps in necessary trainings impede the capacity of public health systems to address needs. This manuscript characterizes the current MCH workforce, MCH program applicants and graduates, and describe findings within a national context to devise elements of a recruitment and retention strategy.

Methods

Data were obtained for public health program applicants, first-destination employment outcomes, and worker perceptions and demographics. Data were stratified according to the MCH and total public health workforce and by local, state, and national totals. Data were characterized by degree type, discipline, demographics, and employment outcomes.

Results

MCH staff constitute 11% of the state and local governmental public health workforce. MCH staff are approximately as diverse, have higher educational attainment, and are more likely to hold nursing degrees than the rest of the public health workforce. Yet, just 14% of MCH staff hold any type of public health degree. The MCH pipeline from academia appears modestly sized, with approximately 5% of applicants between 2017 and 2021 applying to a MCH master’s degree.

Discussion

The MCH workforce has a lower proportion of formal training or degrees in public health, though trends seem to indicate improvements. However, it is critical that a multi-faceted recruitment and retention strategy be coordinated by a broad range of stakeholders. These efforts will serve to improve the capability and capacity of the public health system to address critical needs of increasingly diverse MCH populations.

Significance

In order to modernize and reimagine the academic-public health pipeline, it is critical to better understand how many applicants and graduates exist within Maternal and Child Health programs across the US, and their characteristics. This manuscript connects that information with the most recently available public health workforce information on demographics, workplace perceptions, and intent to leave among staff at state and local health departments. Data presented in this paper allow the most comprehensive characterization of the MCH academia->practice pipeline to-date, identifies a fundamental disconnect in those career pathways, and offers options to repair that break.

Community Health Resources, Globalization, Trust in Science, and Voting as Predictors of COVID-19 Vaccination Rates: A Global Study with Implications for Vaccine Adherence

The COVID-19 global pandemic requires, not only an adequate supply of, but public adherence to safe and effective vaccinations. This study analyzes the human and economic resources and political and public attitudinal factors that influence widely varying country-level coronavirus vaccination rates. Using data on up to 95 countries, we found that countries’ strength of community health training and research (CHTR), education index, globalization, and vaccine supply are associated with a greater COVID-19 vaccination rate. In a separate analysis, certain political factors, and public attitudes (perceived government effectiveness, government fiscal decentralization, trust in science, and parliamentary voter turnout) predicted vaccination rates. Perceived corruption and actual freedoms (political rights and civil liberties) related to vaccination rates in prior studies were not significantly predictive when controlling for the above factors. The results confirm our prior findings on the importance of CHTR resources for increasing COVID-19 vaccination rates. They also suggest that to motivate vaccine adherence countries need, not only an adequate vaccine supply (which depends on a country having either its own resources or effective global political, social, and economic connections) and community health workforce training and research, but also a population that trusts in science, and is actively engaged in the political process.

Estimating Public Health Workforce Efforts Toward Foundational Public Health Services

CONTEXT

The Foundational Public Health Services (FPHS) include a core set of activities that every health department should be able to provide in order to ensure that each resident has access to foundational services that protect and preserve health. Estimates of the public health workforce necessary to provide the FPHS are needed.

OBJECTIVE

This study assessed the potential use of an FPHS calculator to assess health department workforce needs.

DESIGN AND SETTING

Qualitative interviews were conducted via Zoom in December 2020-January 2021.

PARTICIPANTS

Seventeen state and local public health leaders.

MAIN OUTCOME MEASURES

Qualitative insights into the potential use of an FPHS calculator.

RESULTS

Almost all participants expressed that a reliable estimate would help them justify requests for new staff and that a calculator based on the FPHS would help organizations to critically assess whether they are meeting the needs of their communities and the core expectations of public health. Although participants expected that a tool to calculate full-time equivalent needs by the FPHS would be helpful, some participants expressed concerns in regard to using the tool, given ongoing workforce issues such as recruitment challenges, hiring freezes, and funding restrictions. An anticipated positive consequence of using this tool was that it may lead to cross-training the workforce and result in more diverse expertise and skills among existing workers. The other unintended consequences were that an FPHS calculator would require a substantial amount of time assessing the current FPHS efforts of existing staff and the results of the FPHS gap estimate could become the bar rather than the minimum needed.

CONCLUSIONS

The current public and political focus on public health infrastructure as a result of the COVID-19 pandemic has created a window of opportunity to create change. An FPHS-based staffing tool may help transform public health and initiate a new era.

Ensuring Food Safety for Americans: The Role of Local Health Departments

(1) Background: Several agencies in the United States play a primary role in ensuring food safety, yet foodborne illnesses result in about 3000 deaths and cost more than USD 15.6 billion each year. The study objectives included analyzing local health departments’ (LHDs) level of engagement in food safety and other related services, and LHDs’ characteristics associated with those services. (2) Methods: We used data from 1496 LHDs that participated in the 2019 National Profile of Local Health Departments Survey, administered to all 2459 LHDs in the United States. Logistic regression analyses were performed to model multiple dichotomous variables. (3) Results: An estimated 78.9% of LHDs performed food safety inspections, 78.3% provided food safety education, 40.7% provided food processing inspections, and 48.4% engaged in policy and advocacy. The odds for LHDs to directly provide preventive nutrition services were 20 times higher if the LHDs had one or more nutritionists on staff (Adjusted Odds Ratio or AOR = 20.0; Confidence Interval, CI = 12.4−32.2) compared with LHDs with no nutritionists. Other LHD characteristics significantly associated with the provision of nutrition services (p < 0.05) included population size, state governance (rather than local), and LHD having at least one registered, licensed, practical, or vocational nurse. The odds of providing food processing services were lower for locally governed than state-governed LHDs (AOR = 0.5; CI = 0.4−0.7). The odds of performing food safety inspections varied by LHD’s population size, whether a nutritionist was on staff, whether it was state-governed (vs. locally), and whether it completed a community health assessment (CHA) within 5 years. (4) Conclusions: LHDs play a critical role in ensuring safe food for Americans, yet variations exist in their performance based on their specific characteristics. Adequate funding and a competent workforce are essential for LHDs to utilize evidence-based practices and engage in policymaking and advocacy concerning food safety.

A multisectoral approach to advance health equity in rural northern Arizona: county-level leaders' perspectives on health equity

BACKGROUND

Multisectoral and public-private partnerships are critical in building the necessary infrastructure, policy, and political will to ameliorate health inequity. A focus on health equity by researchers, practitioners, and decision-makers prioritizes action to address the systematic, avoidable, and unjust differences in health status across population groups sustained over time and generations that are beyond the control of individuals. Health equity requires a collective process in shaping the health and wellbeing of the communities in which we live, learn, work, play, and grow. This paper explores multisectoral leaders' understanding of the social, environmental, and economic conditions that produce and sustain health inequity in northern Arizona, a geographically expansive, largely rural, and culturally diverse region.

METHODS

Data are drawn from the Southwest Health Equity Research Collaborative's Regional Health Equity Survey (RHES). The RHES is a community-engaged, cross-sectional online survey comprised of 31 close-ended and 17 open-ended questions. Created to assess cross-sectoral regional and collective capacity to address health inequity and inform multisectoral action for improving community health, the RHES targeted leaders representing five rural northern Arizona counties and 13 sectors. Select open-ended questions were analyzed using an a priori coding scheme and emergent coding with thematic analysis.

RESULTS

Although leaders were provided the definition and asked to describe the root causes of inequities, the majority of leaders described social determinants of health (SDoH). When leaders described root causes of health inequity, they articulated systemic factors affecting their communities, describing discrimination and unequal allocation of power and resources. Most leaders described the SDoH by discussing compounding factors of poverty, transportation, housing, and rurality among others, that together exacerbate inequity. Leaders also identified specific strategies to address SDoH and advance health equity in their communities, ranging from providing direct services to activating partnerships across organizations and sectors in advocacy for policy change.

CONCLUSION

Our findings indicate that community leaders in the northern Arizona region acknowledge the importance of multisectoral collaborations in improving health equity for the populations that they serve. However, a common understanding of health equity remains to be widely established, which is essential for conducting effective multisectoral work to advance health equity.

Pandemic-Related Workplace Violence and Its Impact on Public Health Officials, March 2020‒January 2021

Objectives. To characterize the experience and impact of pandemic-related workplace violence in the form of harassment and threats against public health officials. Methods. We used a mixed methods approach, combining media content and a national survey of local health departments (LHDs) in the United States, to identify harassment against public health officials from March 2020 to January 2021. We compared media-portrayed experiences, survey-reported experiences, and publicly reported position departures. Results. At least 1499 harassment experiences were identified by LHD survey respondents, representing 57% of responding departments. We also identified 222 position departures by public health officials nationally, 36% alongside reports of harassment. Public health officials described experiencing structural and political undermining of their professional duties, marginalization of their expertise, social villainization, and disillusionment. Many affected leaders remain in their positions. Conclusions. Interventions to reduce undermining, ostracizing, and intimidating acts against health officials are needed for a sustainable public health system. We recommend training leaders to respond to political conflict, improving colleague support networks, providing trauma-informed worker support, investing in long-term public health staffing and infrastructure, and establishing workplace violence reporting systems and legal protections. (Am J Public Health. 2022;112(5):736-746. https://doi.org/10.2105/AJPH.2021.306649).

Strengthening institutions for public health education: results of an SWOT analysis from India to inform global best practices

BACKGROUND

Developing public health educational programs that provide workers prepared to adequately respond to health system challenges is an historical dilemma. In India, the focus on public health education has been mounting in recent years. The COVID-19 pandemic is a harbinger of the increasing complexities surrounding public health challenges and the overdue need to progress public health education around the world. This paper aims to explore strengths and challenges of public health educational institutions in India, and elucidate unique opportunities to emerge as a global leader in reform.

METHODS

To capture the landscape of public health training in India, we initiated a web-based desk review of available offerings and categorized by key descriptors and program qualities. We then undertook a series of in-depth interviews with representatives from a purposively sample of institutions and performed a qualitative SWOT analysis.

RESULTS

We found that public health education exists in many formats in India. Although Master of Public Health (MPH) and similar programs are still the most common type of public health training outside of community medicine programs, other postgraduate pathways exist including diplomas, PhDs, certificates and executive trainings. The strengths of public health education institutions include research capacities, financial accessibility, and innovation, yet there is a need to improve collaborations and harmonize training with well-defined career pathways. Growing attention to the sector, improved technologies and community engagement all hold exciting potential for public health education, while externally held misconceptions can threaten institutional efficacy and potential.

CONCLUSIONS

The timely need for and attention to public health education in India present a critical juncture for meaningful reform. India may also be well-situated to contextualize and scale the types of trainings needed to address complex challenges and serve as a model for other countries and the world.

Building the MCH Public Health Workforce of the Future: A Call to Action from the MCHB Strategic Plan

Introduction

In 2021, the Maternal and Child Health Bureau (MCHB) released a new strategic plan to guide its work over the next 10–15 years. The plan highlights four goals—access, equity, workforce capacity, and impact—that are essential to achieving MCHB’s vision.

Methods

We present 13 recommendations to highlight opportunities for ongoing and new activities aligned with Goal 3 of the plan—“Strengthen Public Health Capacity and Workforce for MCH.”

Results

Recommendations 1–3 highlight the need to support pathways into state and local MCH public health (PH) positions, to offer accessible and high-quality training for the practicing workforce, and to build capacity to address health and social inequities. Recommendations 4–7 discuss the need to build a racially and ethnically diverse workforce, ensure equity and anti-racism are foundational concepts in training, and strengthen engagement of community members and those with lived experience as part of the MCH PH workforce. Recommendations 8–10 outline opportunities to enhance MCH workforce data and measurement frameworks, and support practice-based research. Recommendations 11–12 discuss the importance of academic-practice partnerships and the need to spur innovation. Recommendation 13 highlights the need to define and amplify the unique skillset of the MCH PH workforce.

Conclusions

The release of the MCHB strategic plan comes at a time of critical need to build and sustain a MCH PH workforce to achieve equity for MCH populations. We encourage the field to engage in dialogue around the recommendations presented in this paper, and to offer additional actions to build and support the MCH PH workforce.

We must practice what we preach: a framework to promote well-being and sustainable performance in the public health workforce in the United States

The COVID-19 pandemic, along with efforts to address systemic racism and social injustice, has required the public health workforce to mobilize an unprecedented and extensive frontline response while simultaneously delivering core services and addressing natural disasters and other emergent threats. Research conducted among health care professionals during the COVID-19 pandemic indicates an increase in anxiety, depression, and burnout, but mental health effects of the pandemic on the public health workforce are less well understood. Left unaddressed, secondary traumatic stress resulting from exposure to the trauma of those we serve, as well as burnout stemming from work-related factors, may hinder our ability to fulfill our mission to serve the population at large. This Viewpoint provides a framework for shifting our culture to prioritize the well-being and sustainable performance of the public health workforce to foster resilience and mitigate stressors.

Training Networks of Local Health Departments: A Regional Assessment

OBJECTIVE

The public health system faces major challenges in 2020, including an aging workforce, reductions in funding, and 2 simultaneous major threats to public health-the coronavirus pandemic and racial injustice. To effectively harness promising new technologies and address these and other public health challenges ahead, public health professionals must be trained on evidence-based practices for protecting and improving public health. This project sought to understand the network of health departments and organizations that provide training in order to inform strategic efforts to fill training gaps and improve access to training for local health departments (LHDs), thereby strengthening the public health system.

DESIGN/SETTING/PARTICIPANTS

We conducted a Web-based survey of 501 LHDs in the 6 states constituting Region V of the Department of Health & Human Services. The survey focused on the training relationship between LHDs and state and national organizations that provide public health training, allowing for a social network analysis. We used data visualization and descriptive statistics to examine the network.

RESULTS

Of 290 participating health departments (58% response rate), 248 had monthly or more frequent contact with at least 1 organization for the purpose of training. Altogether, the 248 LHDs were connected to 47 state-level organizations and 10 national-level organizations. In 5 of 6 states, more LHDs were connected to the state health department for training than to any other organization type. Universities, national nonprofits, and national membership organizations provided training to the fewest LHDs. Local health department characteristics did not have a clear relationship with its number of training connections.

CONCLUSIONS

State health departments may benefit from the support of universities, national nonprofits, and national membership organizations by partnering to offer training or by recommending training from these organizations to LHDs. Additional qualitative information from local and state health departments would be useful to determine the best strategies for universities, national nonprofits, and national membership organizations to participate in training local practitioners to improve LHD capacity.

Postgraduate Employment Outcomes of Undergraduate and Graduate Public Health Students : A Scoping Review

OBJECTIVES

A key goal of schools and programs of public health is to prepare graduates for careers in the public health workforce after graduation, but are they achieving this goal? We assessed how the employment outcomes of students earning public health degrees are collected and described in the literature.

METHODS

Using the Kirkpatrick model of training evaluation as a framework, we conducted a 6-step scoping review: (1) formulating the research question, (2) identifying relevant studies, (3) selecting studies, (4) charting the data, (5) collating and summarizing the results, and (6) consulting stakeholders. We included articles published from January 1, 1993, through July 4, 2020, that provided data on employment status, employment sector/industry, job function, or salary of public health graduates. We excluded articles that were not written in English and were about dual-degree (ie, doctor of medicine-master of public health) students. We found and reviewed 630 articles.

RESULTS

We found 33 relevant articles. Most articles focused on a single school and combined multiple graduating classes, focused on subspecializations of public health, or focused on graduates' satisfaction with their curriculum but not employment outcomes. Data were inconsistently categorized, and studies were difficult to compare.

CONCLUSIONS

Research on public health graduates' employment outcomes is scarce and does not follow consistent protocols. New standards should be adopted to systematize the collection of data on employment outcomes of public health graduates.

Core Competency Gaps Among Governmental Public Health Employees With and Without a Formal Public Health Degree

OBJECTIVES

To examine the role of a formal public health degree as it relates to core competency needs among governmental public health employees.

DESIGN

This cross-sectional study utilizes the 2017 Public Health Workforce Interests and Needs Survey (PH WINS). Bivariate relationships were analyzed by conducting χ tests of respondents' supervisory level and reported skill gaps. Multivariate logistic regressions of reported skill gaps were performed holding gender, age, race/ethnicity, highest degree attained, current employer, role type, tenure in current agency, and public health certificate attainment constant.

SETTING

Nationally representative sample of government public health employees.

PARTICIPANTS

A total of 30 276 governmental public health employees.

MAIN OUTCOME MEASURE

Self-reported competency skills gaps.

RESULTS

Among nonsupervisors, those with a public health degree had significantly lower odds of reporting a competency gap for 8 of the 21 skills assessed. Among supervisors/managers, those who had a formal public health degree had significantly lower odds of reporting a competency gap in 3 of the 22 skills assessed. Having a degree in public health was not significantly related to an executive's likelihood of reporting a skill gap across any of the 22 skills assessed. Regardless of supervisory level, having a public health degree was not associated with a reduced likelihood of reporting skill gaps in effective communication, budgeting and financial management, or change management competency domains.

CONCLUSIONS

Possessing a formal public health degree appears to have greater value for skills required at the nonsupervisor and supervisor/manager levels than for skills needed at the executive level. Future work should focus on longitudinal evaluations of skill gaps reported among the public health workforce as changes in public health curricula may shift over time in response to newly revised accreditation standards. In addition, public health education should increase emphasis on communication, budgeting, systems thinking, and other management skills among their graduates.