Reconciling Supply and Demand for State and Local Public Health Staff in an Era of Retiring Baby Boomers

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.

The Urgent Need for Disaster Education as a Core Competency in Accredited Schools and Colleges of Public Health by the Council on Education for Public Health

Public Health is essential to disaster preparedness, mitigation, response, and recovery. This has never been more evident than during the COVID-19 pandemic when public health was the disaster response lead. However, students are graduating from accredited schools and colleges of public health with limited or no education in disaster management. This is a crisis unto itself, and it is incumbent upon The Council on Education for Public Health (CEPH) to take immediate action. Public health preparedness should be recognized as a core element in public health curricula, and practical experiences, such as drills and simulations, are necessary to equip students with the confidence and competencies needed in high-stress situations. The need for such preparedness education extends beyond the COVID-19 pandemic. It is a crucial step for creating a resilient and competent public health workforce capable of safeguarding community health in the face of complex and emerging challenges.

Exploring the geospatial variations in the public health workforce: implications for diversifying the supply of potential workers in governmental settings

The US public health workforce has markedly declined, falling from 500 000 individuals in 1980 to 239 000 by 2022, a trend exacerbated by economic instability and an aging demographic. There was a temporary surge in staffing through emergency hires during the COVID-19 pandemic, but the permanence of these positions remains uncertain. Concurrently, public health degree conferrals have sharply increased, creating a mismatch between the growing number of graduates and the actual needs of health departments. This study analyzes the distribution of the potential public health labor supply within a 50- and 150-mile radius of health departments, revealing a significant regional imbalance. Most regions experience substantial differences in the concentration of public health graduates when accounting for population size, reflecting geographic disparities in workforce distribution. These findings underscore the necessity for structured partnerships between health departments and educational institutions and advocacy for adaptive policy changes to align educational outputs with labor market demands, essential for a resilient public health workforce.

Implementation of climate adaptation in the public health sector in Europe: qualitative thematic analysis

BACKGROUND

Adaptation, to reduce the health impacts of climate change, is driven by political action, public support and events (extreme weather). National adaptation policies or strategies are limited in addressing human health risks and implementation of adaptation in the public health community is not well understood.

AIM

To identify key issues in climate change adaptation implementation for public health in Europe.

METHODS

Key informant interviews with decision-makers in international, national and local city governments in 19 European countries. Participants were recruited if a senior decision-maker working in public health, environmental health or climate adaptation.

INTERVIEWS ADDRESSED

Barriers and levers for adaptation, policy alignment, networks and evidence needs.

RESULTS

Thirty-two interviews were completed between June and October 2021 with 4 international, 5 national and 23 city/local government stakeholders. Respondents reported inadequate resources (funding, training and personnel) for health-adaptation implementation and the marginal role of health in adaptation policy. A clear mandate to act was key for implementation and resource allocation. Limited cross-departmental collaboration and poor understanding of the role of public health in climate policy were barriers to implementation.

CONCLUSIONS

Across Europe, progress is varied in implementation of climate adaptation in public health planning. Providing appropriate resources, training, knowledge mobilization and supporting cross-departmental collaboration and multi-level governance will facilitate adaptation to protect human health.

Expanding the Public Health Pipeline Through the Public Health Influencers Summer Institute

The need for a robust public health system in the United States is critical for safeguarding population health. However, current data suggest an insufficient number of individuals entering or staying in the governmental public health workforce. Expanding the public health pipeline requires creative thinking about recruitment and training activities. To attract students to public health and other health-related fields, including medicine, one institution in the Southeast recently initiated the Public Health Influencers Summer Institute (PHISI), a program that addresses the beginning of the career development continuum: recruitment of high school students. For this investigation, we reviewed evaluation data of the PHISI and provided descriptive analyses and selected quotes to reflect student learning. Participants reported increased familiarity with all public health topics after participating in the program, with the greatest increases in public health policy and social determinants of health. In addition, all participants reported increased or significantly increased understanding of public health after participating in the program. While interest in the field of public health increased due to the COVID-19 pandemic, there are not enough individuals entering or staying in the public health workforce, leaving a critical shortfall. Introducing high school students to the field of public health may increase their interest in entering the public health workforce in the future, thereby strengthening the overall public health infrastructure. We propose that the PHISI may be an innovative strategy for increasing both the number and diversity of students interested in pursuing a career in public health.

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.

Burnout among public health workers in Canada: a cross-sectional study

BACKGROUND

This study presents the prevalence of burnout among the Canadian public health workforce after three years of the COVID-19 pandemic and its association with work-related factors.

METHODS

Data were collected using an online survey distributed through Canadian public health associations and professional networks between November 2022 and January 2023. Burnout was measured using a modified version of the Oldenburg Burnout Inventory (OLBI). Logistic regressions were used to model the relationship between burnout and work-related factors including years of work experience, redeployment to pandemic response, workplace safety and supports, and harassment. Burnout and the intention to leave or retire as a result of the COVID-19 pandemic was explored using multinomial logistic regressions.

RESULTS

In 2,079 participants who completed the OLBI, the prevalence of burnout was 78.7%. Additionally, 49.1% of participants reported being harassed because of their work during the pandemic. Burnout was positively associated with years of work experience, redeployment to the pandemic response, being harassed during the pandemic, feeling unsafe in the workplace and not being offered workplace supports. Furthermore, burnout was associated with greater odds of intending to leave public health or retire earlier than anticipated.

CONCLUSION

The high levels of burnout among our large sample of Canadian public health workers and its association with work-related factors suggest that public health organizations should consider interventions that mitigate burnout and promote recovery.

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.

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.

Master of Public Health Education in the United States Today: Building Leaders of the Future

OBJECTIVES

For decades, there have been calls to action to change the status quo of public health education in the United States to respond to workforce needs and help reinforce capacity. During the last 10 years, schools and programs of public health have planned and implemented programmatic and curricular changes. This study explored the focus of master of public health (MPH) education in the United States today.

METHODS

We used a 3-phase mixed-methods study to compile data to describe the current state and focus of MPH education in the United States via survey data collection (November-December 2019), semistructured interviews (January-February 2020), and document reviews.

RESULTS

Survey responses represented at least 43% (93/215) of eligible MPH programs in the United States. Most respondents (86%, 99/115) reported that the primary focus of MPH education in the United States is to prepare graduates for public health practice and employment linked to public health, and 54% (59/109) reported that their MPH programs adopted this focus in the last 5 years. MPH programs invested in student learning, competence development, and supporting workforce readiness, including a focus on leadership abilities. Programs noted that they seek to develop strategic thinkers and engaged leaders with abilities to understand and address emergent public health needs.

CONCLUSIONS

Public health education in the United States is in a period of change. MPH programs reported responding to workforce needs by closing gaps in workforce capacity and developing compassionate and professional leaders who can understand needs, collaborating with communities, and facilitating action that will ameliorate health disparities and promote social injustice by practicing public health in new ways.

Barriers and facilitators to state public health agency climate and health action: a qualitative assessment

BACKGROUND

As the health implications of climate change become more apparent, agencies and institutions across the United States are developing recommendations for state and territorial health agencies (S/THAs) to implement evidence-informed climate and health adaptation strategies. The CDC established the Building Resilience Against Climate Effects (BRACE) framework in 2010 to encourage local and state public health engagement in climate change adaptation. However, even after a decade of the BRACE initiative, the elements that affect the adoption and implementation of climate and health programming by S/THAs are not well understood.

METHODS

Using an implementation science framework, this study sought to further understand and define the barriers and facilitators that determine the breadth and success of climate change and health activities undertaken by state health agencies (SHAs). We conducted focus groups with representatives from SHAs with and without climate and health programs, and analyzed data using the framework method for qualitative research.

RESULTS

This study identified funding, state and agency-level prioritization, staff capability and capacity, and political will and polarization as factors that influence the readiness for implementation and implementation climate for climate and health activities.

CONCLUSIONS

As the impacts of climate change intensify, S/THAs will need to expand resources and capacity, and seek advocacy and assistance from external organizations in order to support the level of engagement required to strengthen climate resilience. Findings from this study have implications for public health policy and highlight potential pathways to expand support for climate and health activities in S/THAs in the U.S.

Recovery and Resiliency in 29 Big Cities: Results From the 2021 Public Health Workforce Interests and Needs Survey

CONTEXT

Big Cities Health Coalition member health departments (BCHC HDs) serve more than 61 million people across their jurisdictions, nearly 20% of the US population. As such, they have particular challenges and opportunities in how they do their work. This article focuses on BCHC HDs that participated in the 2021 Public Health Workforce Interests and Needs Survey (PH WINS) and describes workplace perceptions, training needs, COVID-19 efforts, and well-being.

OBJECTIVE

To describe key characteristics of the governmental public health workforce among BCHC HDs, including demographics, perceptions, and needs.

DESIGN

Using a subsample of data from the 2021 PH WINS that included 29 BCHC HDs, descriptive statistics on many of the topics covered by the 2021 PH WINS were analyzed and compared with the 2017 PH WINS.

SETTING

Twenty-nine BCHC HDs in cities across the United States.

PARTICIPANTS

In total, 7922 of 29 661 staff members (response rate of 27%) from participating BCHC HDs.

RESULTS

Most BCHC HD respondents self-identified as a woman (76%, 95% confidence interval [CI]: 75%-77%), and as Black, Indigenous, and people of color (69%, 95% CI: 68%-70%), similar to findings from the 2017 PH WINS (75%, 95% CI: 74%-76%; 67%, 95% CI: 66%-69%, respectively). Most respondents believe that their organization prioritizes diversity, equity, and inclusion (70%, 95% CI: 69%-72%). Thirty percent (95% CI: 29%-32%) intend to leave their organizations within 1 year, and 18% (95% CI: 17%-19%) plan to retire within 5 years. Staff connect their work with agency goals and priorities (86%, 95% CI: 85%-87%) and are determined to give their best effort every day (91%, 95% CI: 90%-91%).

CONCLUSION

As the need for an all-encompassing focus on COVID-19 lessons, BCHC HDs should continue to focus on prioritizing staff retention, enhancing communication between senior staff and employees, and fostering an environment where innovation and creativity are rewarded.

Turnover, COVID-19, and Reasons for Leaving and Staying Within Governmental Public Health

BACKGROUND AND OBJECTIVES

Public health workforce recruitment and retention continue to challenge public health agencies. This study aims to describe the trends in intention to leave and retire and analyze factors associated with intentions to leave and intentions to stay.

DESIGN

Using national-level data from the 2017 and 2021 Public Health Workforce Interests and Needs Surveys, bivariate analyses of intent to leave were conducted using a Rao-Scott adjusted chi-square and multivariate analysis using logistic regression models.

RESULTS

In 2021, 20% of employees planned to retire and 30% were considering leaving. In contrast, 23% of employees planned to retire and 28% considered leaving in 2017. The factors associated with intentions to leave included job dissatisfaction, with adjusted odds ratio (AOR) of 3.8 (95% CI, 3.52-4.22) for individuals who were very dissatisfied or dissatisfied. Odds of intending to leave were significantly high for employees with pay dissatisfaction (AOR = 1.83; 95% CI, 1.59-2.11), those younger than 36 years (AOR = 1.58; 95% CI, 1.44-1.73) or 65+ years of age (AOR = 2.80; 95% CI, 2.36-3.33), those with a graduate degree (AOR = 1.14; 95% CI, 1.03-1.26), those hired for COVID-19 response (AOR = 1.74; 95% CI, 1.49-2.03), and for the BIPOC (Black, Indigenous, and people of color) (vs White) staff (AOR = 1.07; 95% CI, 1.01-1.15). The leading reasons for employees' intention to stay included benefits such as retirement, job stability, flexibility (eg, flex hours/telework), and satisfaction with one's supervisor.

CONCLUSIONS

Given the cost of employee recruitment, training, and retention of competent employees, government public health agencies need to address factors such as job satisfaction, job skill development, and other predictors of employee retention and turnover.

IMPLICATIONS

Public health agencies may consider activities for improving retention by prioritizing improvements in the work environment, job and pay satisfaction, and understanding the needs of subgroups of employees such as those in younger and older age groups, those with cultural differences, and those with skills that are highly sought-after by other industries.

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.

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.

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.

A Qualitative Study of the COVID-19 Response Experiences of Public Health Workers in the United States

The mental health impacts of the COVID-19 pandemic on frontline, patient-facing healthcare staff have been described in several studies, but the effects of the COVID-19 response on the US public health workforce have not been well characterized. In early 2021, we conducted interviews with a subset of public health practitioners in the United States who participated in a cross-sectional survey and indicated their willingness to participate in a follow-up interview. An interview guide was developed to collect information about professional roles since the start of the pandemic, aspects of the individual COVID-19 response that impacted mental health, and aspects of the organizational/institutional COVID-19 response that impacted mental health, as well as the strengths and weaknesses of, opportunities for, and threats to public health professionals and organizations going forward. Interviews were transcribed and inductively coded to identify themes. Of the 48 people invited to participate, 24 completed an interview between January 28 and February 23, 2021. Five key themes were identified through inductive coding of interview transcripts: (1) teamwork and workplace camaraderie, (2) potential for growth in the field of public health, (3) considerations for adaptive work environments (eg, remote work, work out of jurisdiction, transition to telework), (4) politicization of response, and (5) constrained hiring capacity and burnout. After more than a year of public health emergency response to the COVID-19 pandemic, it is critically important to understand the detrimental and supportive factors of good mental health among the public health workforce.

Voluntary Separations and Workforce Planning: How Intent to Leave Public Health Agencies Manifests in Actual Departure in the United States

OBJECTIVES

To ascertain levels of turnover in public health staff between 2014 and 2017 due to retirement or quitting and to project levels of turnover for the whole of the state and local governmental public health in the United States nationally.

DESIGN

Turnover outcomes were analyzed for 15 128 staff from public health agencies between 2014 and 2017. Determinants of turnover were assessed using a logit model, associated with actually leaving one's organization. A microsimulation model was used to project expected turnover onto the broader workforce.

RESULTS

Between 2014 and 2017, 33% of staff left their agency. Half of the staff who indicated they were considering leaving in 2014 had done so by 2017, as did a quarter of the staff who had said they were not considering leaving. Staff younger than 30 years constituted 6% of the workforce but 13% of those who left (P < .001).

CONCLUSIONS

Public health agencies are expected to experience turnover in 60 000 of 200 000 staff positions between 2017 and 2020.

IMPLICATIONS

As much as one-third of the US public health workforce is expected to leave in the coming years. Retention efforts, especially around younger staff, must be a priority. Succession planning for those retiring is also a significant concern.

The impact of the COVID-19 response on the provision of other public health services in the U.S.: A cross sectional study

Introduction

Funding and staff formerly dedicated to routine public health tasks (e.g., responding to communicable and non-communicable diseases, investigating foodborne outbreaks, conducting routine surveillance) and services (e.g., environmental health, substance abuse, maternal-child health) may no longer be available in many public health departments due to the COVID-19 response. The objective of this study was to assess the extent to which staffing for essential public health services has been redirected to the COVID-19 response.

Materials and methods

This is a cross-sectional study using a survey distributed through the Qualtrics platform. Individuals (N = 298) working in public health across governmental and academic public health departments in the U.S. during the ongoing COVID-19 pandemic response were surveyed. Survey items measured multiple domains including professional experience (i.e., training, years of experience, content expertise, job functions, hours worked), mental and physical health status (i.e., generalized anxiety, depression, burnout), and career plans (i.e., pre-pandemic vs. current career plans).

Results

The total number of content expertise areas and programmatic functions covered by individual public health workers increased between January and September of 2020, with 26% (73 of 282) of respondents reporting an increase in both. The total number of respondents working in infectious disease and preparedness remained constant, while declines were reported in program evaluation (-36%) and health education (-27%) and increases were reported in disease investigation (+35%).

Conclusions

The provision of many essential public health functions and tasks have been limited or eliminated while the U.S. public health workforce responds to the COVID-19 pandemic. These findings highlight opportunities for funding and professional development of public health systems, both during and after the COVID-19 response, to help ensure the continuity of essential public health services, staffing sustainability, and preparedness for future public health emergencies in the U.S.

Developing the public health workforce through community-based fieldwork

A skilled public health workforce is critical to assure the public's health. Recent scholarship has highlighted the benefits of practice-based fieldwork to train the public health workforce. This scholarship has highlighted these benefits primarily through quantitative evaluation. DePaul University's Master of Public Health (MPH) Program provides practice-based education and training to enable students to develop key competencies in public and community health. A key component of the MPH Program is a 9-month practicum experience. This practicum experience requires students to (1) Complete at least 250 h of fieldwork at a local health organization and (2) write a capstone thesis about their practicum project. In this themed issue, seven MPH Program students provide empirical papers, describing their practicum project and the competencies they gained. These empirical papers build upon existing scholarship on practice-based fieldwork and aim to advance academic and community efforts to assure a skilled public and community health workforce.

Determinants of workplace perceptions among federal, state, and local public health staff in the US, 2014 to 2017

Background

The governmental public health workforce in the United States comprises almost 300,000 staff at federal, state, and local levels. The workforce is poised for generational change, experiencing significant levels of retirement. However, intent to leave for other reasons is also substantial, and diversity is lacking in the workforce.

Methods

Workforce perception data from 76,000 staff from Health and Human Services (HHS) including 14,000 from the Centers for Disease Control and Prevention were analyzed across 2014 and 2017. Additionally, data from 32,000 state and local health department staff in 46 agencies reporting in both years. Estimates were constructed accounting for survey design and non-response.

Results

In 2017, women made up 43% of the total US government workforce and 33% of supervisors or higher, compared to 73 and 68% generally in State Health Agencies (p < .0001); and 62% vs 52% in HHS (p < .0001). Among state staff, intent to leave increased from 22 to 31% (p < .0001), but fell in 2017 from 33 to 28% for HHS (p < .0001). Correlates of intent to leave included low job satisfaction, pay satisfaction, and agency type. Federal entities saw the highest proportion respondents that indicated they would recommend their organization as a good place to work.

Conclusions

While intent to leave fell at federal agencies from 2014 to 2017, it increased among staff in state and local health departments. Additionally, while public health is more diverse than the US government overall, significant underrepresentation is observed in supervisory positions for staff of color, especially women.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11703-x.

What Can You Do With a Bachelor's in Public Health? A Case Study of Graduate Outcomes From the University of Hawai'i

Since the development of a Bachelor of Arts in public health, a common question among prospective students, faculty, and community members has been asked: “What will students do after graduation?” While national data on graduates are abundant, community inquiries sought more detailed profiles of local graduates. To address this need, data on 224 graduates of the Bachelors of Arts in Public Health (BAPH) degree at the University of Hawai‘i at Mānoa were collected through alumni outreach efforts and professional online profile searches. Data were compiled into a summary presentation and program “resume”. Findings indicated roughly 30% of BAPH graduates pursued graduate-level education and 43% were employed within a year of graduation. Employment in local NGOs and healthcare organizations was common, while bureaucratic challenges limited hiring at public agencies. A review of job titles suggested graduates were employed in program coordination or support staffing. Local program profiles, such as this one, complement national employment data. Moreover, these efforts may foster interest among prospective students and support from faculty, administrators, and employers.

Public Health Workforce Burnout in the COVID-19 Response in the U.S

While the health impacts of the COVID-19 pandemic on frontline health care workers have been well described, the effects of the COVID-19 response on the U.S. public health workforce, which has been impacted by the prolonged public health response to the pandemic, has not been adequately characterized. A cross-sectional survey of public health professionals was conducted to assess mental and physical health, risk and protective factors for burnout, and short- and long-term career decisions during the pandemic response. The survey was completed online using the Qualtrics survey platform. Descriptive statistics and prevalence ratios (95% confidence intervals) were calculated. Among responses received from 23 August and 11 September 2020, 66.2% of public health workers reported burnout. Those with more work experience (1-4 vs. <1 years: prevalence ratio (PR) = 1.90, 95% confidence interval (CI) = 1.08-3.36; 5-9 vs. <1 years: PR = 1.89, CI = 1.07-3.34) or working in academic settings (vs. practice: PR = 1.31, CI = 1.08-1.58) were most likely to report burnout. As of September 2020, 23.6% fewer respondents planned to remain in the U.S. public health workforce for three or more years compared to their retrospectively reported January 2020 plans. A large-scale public health emergency response places unsustainable burdens on an already underfunded and understaffed public health workforce. Pandemic-related burnout threatens the U.S. public health workforce's future when many challenges related to the ongoing COVID-19 response remain unaddressed.

Public Health Student Response to COVID-19

To understand the role public health students play in response to COVID-19 despite cuts in funding for graduate student emergency response programs (GSERPs), we reviewed the websites of the Association of Schools and Programs of Public Health, Council on Education in Public Health, and individual schools and programs to identify student participation in COVID-19 response activities. Thirty schools and programs of public health are supporting public health agencies in response to COVID-19, primarily through the provision of surge capacity (n = 20, 66.7%), contact tracing (n = 19, 63.3%), and training (n = 11, 36.7%). The opportunity to participate in formal and informal applied public health experiences like practica, service-learning, and field placements can benefit both public health students and agency partners. Although recent publications have identified gaps in academic public health response to COVID-19, in part due to the cessation of funding for workforce development and other university-based programs in public health preparedness, schools and programs of public health continue to support public health agencies. Future funding should explicitly link public health students to applied public health activities in ways that can be measured to document impacts on public health emergency response and the future public health workforce.

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.

First-Destination Outcomes for 2015-2018 Public Health Graduates: Focus on Employment

Objectives. To improve understanding of the future public health workforce by analyzing first-destination employment outcomes of public health graduates.Methods. We assessed graduate outcomes for those graduating in 2015-2018 using descriptive statistics and the Pearson χ2 test.Results. In our analysis of data on 53 463 graduates, we found that 73% were employed; 15% enrolled in further education; 5% entered a fellowship, internship, residency, volunteer, or service program; and 6% were not employed. Employed graduates went to work in health care (27%), corporations (24%), academia (19%), government (17%), nonprofit (12%), and other sectors (1%). In 2018, 9% of bachelor's, 4% of master's, and 2% of doctoral graduates were not employed but seeking employment.Conclusions. Today's public health graduates are successful in finding employment in various sectors. This new workforce may expand public health's reach and lead to healthier communities overall.Public Health Implications. With predicted shortages in the governmental public health workforce and expanding hiring because of COVID-19, policymakers need to work to ensure the supply of public health graduates meets the demands of the workforce.

Using Public Health Workforce Surveillance Data to Prioritize Retention Efforts for Younger Staff

INTRODUCTION

The public health enterprise has a people problem. An aging workforce coupled with a sustained, strong economy and healthcare sector has made the recruitment and retention of young, educated staff challenging. Approximately one third of public health staff aged 33 years and younger are considering leaving their organization in the next year. Their reasons for leaving, and considerations for staying, are not well characterized within public health.

METHODS

Data were drawn from the Public Health Workforce Interests and Needs Survey, a nationally representative survey of state and local governmental public health employees across the U.S. In 2017, a total of 43,701 staff responded. Descriptive statistics across age groups were examined, and reasons for leaving were characterized. A latent class model and an intent-to-leave logit model were fit in 2019.

RESULTS

Pay and lack of opportunities for advancement were most frequently selected as reasons for considering leaving. Results of a logit model showed that being somewhat or very dissatisfied (versus somewhat or very satisfied) was associated with higher odds of intending to leave (AOR=4.4, p<0.0001), as was pay dissatisfaction (AOR=2.0, p<0.0001). Scoring higher than the agency median on a construct measuring perceived lack of organizational support (AOR=1.8, p<0.0001) and on a scale measuring burnout (AOR=2.6, p<0.0001) was also associated with higher odds of intending to leave.

CONCLUSIONS

Many factors associated with an increased intent to leave are present among all age groups. However, support is needed for managers as they attempt to develop and implement solutions that seek to retain the younger workforce in particular. Creating paths for promotion, competitive pay practices, organizational support, and engagement are all critical for retention in this group.

Public Health Has an Equity Problem: A Latinx's Voice

Public health has an equity problem. One of the main pillars of our public health system, schools and academic programs of public health, are under the control of white (heterosexual) faculty. They continue to exclude brown, black, and indigenous people from their faculty and leadership ranks. This racism pervades institutional policies and culture and is a major fault in the quest for health equity. In this essay, I center on the experience of Latinx faculty to examine the roots of this inequity and the arguments for diversity and inclusion. I also propose avenues for change and argue for institutional transformation that goes beyond adding people of color to faculty and leadership roles.

"The hardest job you will ever love": Nurse recruitment, retention, and turnover in the Nurse-Family Partnership program in British Columbia, Canada

Background

Nurse turnover is a significant issue and complex challenge for all healthcare sectors and is exacerbated by a global nursing shortage. Nurse-Family Partnership is a community health program for first-time pregnant and parenting girls and young women living in situations of social and economic disadvantage. In Canada, this program is delivered exclusively by public health nurses and only within a research context. The aim of this article is to explore and describe factors that contribute to recruitment, retention, and turnover of public health nurses delivering Nurse-Family Partnership in British Columbia, Canada between 2013 and 2018.

Methods

Interpretive description was used to guide sampling, data collection and analytic decisions in this qualitative component drawn from the British Columbia Healthy Connections Project mixed methods process evaluation. Semi-structured, individual interviews were conducted with 28 public health nurses who practiced in and then exited Nurse-Family Partnership.

Results

Nurses were motivated to join this program because they wanted to deliver an evidence-based program for vulnerable young mothers that fit with their personal and professional philosophies and offered nurse autonomy. Access to program resources attracted nursing staff, while delivering a program that prioritizes maintaining relationships and emphasizes client successes was a positive work experience. Opportunities for ongoing professional development/ education, strong team connections, and working at full-scope of nursing practice were significant reasons for nurses to remain in Nurse-Family Partnership. Personal circumstances (retirement, family/health needs, relocation, career advancement) were the most frequently cited reasons leading to turnover. Other factors included: involuntary reasons, organizational and program factors, and geographical factors.

Conclusions

Public health organizations that deliver Nurse-Family Partnership may find aspects of job embeddedness theory useful for developing strategies for supporting recruitment and retention and reducing nurse turnover. Hiring nurses who are the right fit for this type of program may be a useful approach to increasing nurse retention. Fostering a culture of connectivity through team development along with supportive and communicative supervision are important factors associated with retention and may decrease turnover. Many involuntary/external factors were specific to being in a study environment. Program, organizational, and geographical factors affecting nurse turnover are modifiable.

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.

Changes in the State Governmental Public Health Workforce: Demographics and Perceptions, 2014-2017

Context:

Workforce is a critical cog in the governmental public health enterprise in the United States. Until 2014, workforce research was largely conducted at the organizational level. However, the fieldings of the Public Health Workforce Interests and Needs Survey allow for nationally representative comparisons with individual respondents.

Objective:

Using data from agencies that participated in 2014 and 2017, we conducted multi–cross-sectional comparisons of the Public Health Workforce Interests and Needs Survey data.

Design:

The Public Health Workforce Interests and Needs Survey participants at the State Health Agency Central Offices were surveyed using a Web-based platform. Balanced repeated replication weights were used to account for differential designs between 2014 and 2017.

Setting:

Thirty-three state health agency central offices that participated in both 2014 and 2017.

Participants:

Permanently employed governmental public health staff.

Main Outcome Measures:

We examined changes in perceptions of the workplace environment, job and pay satisfaction, intent to leave, awareness of emerging concepts in public health, and demographic/worker characteristics. Pearson and Rao-Scott–adjusted χ² analyses were used to compare changes between 2014 and 2017.

Results:

The percentage of staff who are people of color increased from 29% (95% confidence interval, 28%-30%) to 37% (95% confidence interval, 36%-38%) from 2014 to 2017 across 33 states. Approximately 26% of staff were younger than 40 years in 2014 compared with 29% in 2017 (P < .001). Job satisfaction increased in 17 states overall (P < .05, n = 5) and decreased in 16 states (P < .05, n = 5) but did not change in aggregate. Overall, the percentage of staff considering leaving the organization in the next year or retiring within 5 years is up from 44% to 48% (P < .001).

Conclusions:

Global measures of satisfaction are relatively high and consistent between 2014 and 2017. Demographics are shifting toward a marginally younger workforce as many retire, and a significant portion of staff indicates that they are considering leaving their organization or planning to retire.

The Public Health Workforce Interests and Needs Survey (PH WINS 2017): An Expanded Perspective on the State Health Agency Workforce

Context:

Workforce surveillance efforts have long been called for in public health: the Public Health Workforce Interests and Needs Survey (PH WINS) answers that call.

Objective:

To characterize the state of the governmental public health workforce among State Health Agency-Central Office (SHA-CO) staff across the United States.

Design:

The SHA leadership were contacted and invited to have their agency participate in PH WINS 2017 as a census-based fielding. Participating agencies provided staff lists, and staff were then directly invited by e-mail to participate in a Web-based survey. Pearson and Rao-Scott χ² analyses are employed in descriptive analyses. Balanced repeated replication weights account for design and nonresponse.

Setting and Participants:

SHA-CO staff.

Main Outcome Measures:

The PH WINS focuses on 4 primary domains: perceptions of workplace environment and job satisfaction, training needs, national trends, and demographics. In addition, measures of intent to leave and employee burnout are analyzed.

Results:

The state governmental public health workforce is primarily female (72%), non-Hispanic white (64%), and 46 years of age or older (59%). Nearly one-third (31%) of the workforce is older than 55 years, with 9% aged 30 years or younger. Overall, 74% of respondents indicated that they had at least a bachelor's degree, and 19% indicated having a public health degree of some kind. Seventy-nine percent of the respondents indicated that they were somewhat/very satisfied with their jobs. Approximately 47% of SHA-CO staff say that they are considering leaving or are planning to retire. With respect to training needs, the largest overall gaps for the state health agency workforce were observed in budget and financial management, systems and strategic thinking, and developing a vision for a healthy community.

Conclusions:

PH WINS represents the first nationally representative survey of governmental public health staff in the United States. It holds potential for wide usage from novel workforce research to identifying and helping address practice-based needs.

The Methods of PH WINS 2017: Approaches to Refreshing Nationally Representative State-Level Estimates and Creating Nationally Representative Local-Level Estimates of Public Health Workforce Interests and Needs

Supplemental Digital Content is Available in the Text.

Context:

The Public Health Workforce Interests and Needs Survey (PH WINS) was first fielded in 2014 and is the largest public health workforce survey in the nation. This article elucidates the methods used for the 2017 PH WINS fielding.

Program or Policy:

PH WINS was fielded to a nationally representative sample of State Health Agency Central Office (SHA-CO) staff, as well as local health department (LHD) staff. The instrument largely mirrored 2014, though the training needs section was revised, and a validated item measuring burnout in staff was added.

Implementation:

Staff lists were collected directly from all participating state and local agencies. Forty-seven state health agencies (SHAs), 26 large LHDs, and 71 midsize LHDs participated. All SHAs were surveyed using a census approach. The nationally representative SHA-CO frame is representative of all central office staff members. The nationally representative local frame was a complex survey design, wherein staff from LHDs were randomly sampled across 20 strata, based on agency size and geographic region. Staff were also contributed with certainty from large LHDs in nondecentralized states. The frame is representative of staff at LHDs serving more than 25 000 people and with 25 or more staff members. Other LHDs are excluded, and so PH WINS is not representative of smaller LHDs. Balanced repeated replication weights were used to adjust variance estimates for the complex design.

Evaluation:

Overall, 47 604 people responded to PH WINS in 2017 across all frames. PH WINS 2017 achieved a response rate of 48%. The design effect for the SHA-CO frame was 1.46 and was 16.42 for the local frame.

Discussion:

PH WINS now offers a nationally representative sample of both SHA-CO and LHD staff across 4 major domains: workplace environment, training needs, emerging concepts in public health, and demographics. Both practice and academia can use PH WINS to better understand the perceptions and needs of staff, address training gaps, and work to recruit and retain quality staff.

The Governmental Public Health Workforce in 26 Cities: PH WINS Results From Big Cities Health Coalition Members

Context:

More than 80% of Americans live in urban areas. Over the past 20 years, an increasing number of local governmental public health departments, particularly those in big cities, have taken pioneering action to improve population health. This article focuses on members of the Big Cities Health Coalition (BCHC) who participated in the 2017 Public Health Workforce Interest and Needs Survey (PH WINS). If the impact of these health departments is to be sustained, they will require a workforce prepared for the challenges of 21st-century public health practice.

Objective:

To characterize workforce interests and needs among staff in 26 large, urban health departments who are BCHC members.

Design:

Administered PH WINS survey to staff in BCHC member health departments to assess perceptions about the workplace environment and job satisfaction; training needs; awareness of national trends; and demographics.

Setting:

In total, 26 of 30 BCHC member health departments, United States.

Participants:

In total, 7453 of 17 613 staff members (response rate 43.4%) from participating departments.

Results:

The workforce consists predominantly of women (75%) and people of color (68%). Staff is satisfied with their job (81%), the organization (71%), and pay (59%), but more than a quarter are considering leaving within the year. The agency's mission drives staff, but it lacks an environment fostering creativity and innovation. Training needs include budgeting/financial management, change management, and strategic thinking.

Conclusions:

BCHC departments must improve retention, provide opportunities for advancement, enhance communication between leadership and staff, foster creativity and innovation, and align labor allocation with disease burden in local communities. Findings from the second iteration of PH WINS allow a comprehensive, comparable analysis of the workforce across the 26 BCHC member health departments that participated. These data expand upon the ability to assess and monitor improvement in the workforce environment, job satisfaction, awareness of national trends, and training needs.

Regional Training Needs Assessment: A First Look at High-Priority Training Needs Across the United States by Region

Supplemental Digital Content is Available in the Text.

Context:

Although core scientific skills remain a priority to public health, preventing and responding to today's leading causes of death require the workforce to build additional strategic skills to impact the social, community-based, and economic determinants of health. The 2017 Public Health Workforce Interests and Needs Survey allows novel regional analysis of training needs, both individually and across 8 strategic skill domains.

Objective:

The purpose of this article is to describe the training needs of public health staff nationally, across the 10 Department of Health and Human Services Regions.

Design:

The Public Health Workforce Interests and Needs Survey was a Web-based survey fielded to 100 000 staff nationwide across 2 major frames: state health agency-central office and local health department. State-based respondents were fielded on a census approach, with locals participating in a more complex sampling design. Balanced repeated replication weights were used to address nonresponse and sampling.

Setting:

State and local health departments.

Participants:

Respondents from state and local health departments.

Main Outcome Measures:

This article draws from the training needs portion of Public Health Workforce Interests and Needs Survey. Descriptive statistics are generated, showing training needs gaps. Inferential analyses pertain to gaps across Region and supervisory status, using Pearson χ² test and Rao-Scott design–adjusted χ² test.

Results:

Training needs varied across regions and work setting. Certain strategic skills tended to see larger, consistent gaps regardless of Region or setting, including Budgeting & Finance, Change Management, Systems Thinking, and Developing a Vision for a Healthy Community.

Conclusions:

Overall, the data suggest substantial interregional variation in training needs. Until now, this picture has been incomplete; disparate assessments across health departments, Regions, and disciplines could not be combined into a national picture. Regionally focused training centers are well situated to address Region-specific needs while supporting the broader building of capacity in strategic skills nationwide.

Considering Leaving, But Deciding to Stay: A Longitudinal Analysis of Intent to Leave in Public Health

Context:

Public health has been hit by the first wave of the “silver tsunami”—baby boomers retiring en masse. However, thousands of staff members say they are considering voluntarily leaving for other reasons as well.

Objective:

To identify characteristics of staff who said they were planning on leaving in 2014 but stayed at their organizations through 2017.

Design:

Data from the 2014 and 2017 Public Health Workforce Interests and Needs Survey (PH WINS) were linked by respondent, and characteristics associated with intent to leave were analyzed. Longitudinal logistic models were fit to examine correlates of intent to leave, with job and pay satisfaction, demographic variables, and workplace engagement perceptions as independent variables.

Setting and Participants:

Respondents from state health agency–central offices and local health departments that participated in the PH WINS in 2014 and 2017.

Main Outcome Measures:

Intent to leave (excluding retirement), demographic measures, and changes in the perceptions of workplace engagement.

Results:

Among all staff members responding in 2014 and 2017, 15% said they were considering leaving in 2014, excluding retirement, compared with 26% in 2017 (P < .001). Overall, 21% of those who were not considering leaving in 2014 indicated they were doing so in 2017. Comparatively, 57% of those considering leaving in 2014 said they were still considering it in 2017. The regressions showed those who were somewhat or very satisfied were significantly more likely to indicate they were not (or were no longer) considering leaving.

Conclusions:

Among staff members who have been considering leaving but have not yet left their organization, improvements to workplace engagement perceptions and job satisfaction were highly associated with not considering leaving their job.

COVID-19 and US Health Financing: Perils and Possibilities

While the COVID-19 pandemic presents every nation with challenges, the United States’ underfunded public health infrastructure, fragmented medical care system, and inadequate social protections impose particular impediments to mitigating and managing the outbreak. Years of inadequate funding of the nation’s federal, state, and local public health agencies, together with mismanagement by the Trump administration, hampered the early response to the epidemic. Meanwhile, barriers to care faced by uninsured and underinsured individuals in the United States could deter COVID-19 care and hamper containment efforts, and lead to adverse medical and financial outcomes for infected individuals and their families, particularly those from disadvantaged groups. While the United States has a relatively generous supply of Intensive Care Unit beds and most other health care infrastructure, such medical resources are often unevenly distributed or deployed, leaving some areas ill-prepared for a severe respiratory epidemic. These deficiencies and shortfalls have stimulated a debate about policy solutions. Recent legislation, for instance, expanded coverage for testing for COVID-19 for the uninsured and underinsured, and additional reforms have been proposed. However comprehensive health care reform – for example, via national health insurance – is needed to provide full protection to American families during the COVID-19 outbreak and in its aftermath.

Monetary and Nonmonetary Costs and Benefits of a Public Health Master's Degree in the 21st Century

As postsecondary tuition and debt levels continue to rise, the value proposition of higher education has been increasingly called into question by the popular media and the general public. Recent data from the National Center for Education Statistics now show early career earnings and debt, by program, for thousands of institutions across the United States. This comes at an inflection point for public health education-master's degrees have seen 20 years of growth, but forecasts now call for, at best, stagnation.Forces inside and outside the field of public health are shifting supply and demand for public health master's degrees. We discuss these forces and identify potential monetary and nonmonetary costs and benefits of these degrees.Overall, we found a net benefit in career outcomes associated with a public health master's degree, although it is clear that some other master's degrees likely offer greater lifetime earning potentials or lower lifetime debt associated with degree attainment. We outline the issues academic public health must engage in to successfully attract and train the next generation of public health graduates.

Perspectives on program mis-implementation among U.S. local public health departments

BACKGROUND

Public health resources are limited and best used for effective programs. This study explores associations of mis-implementation in public health (ending effective programs or continuing ineffective programs) with organizational supports for evidence-based decision making among U.S. local health departments.

METHODS

The national U.S. sample for this cross-sectional study was stratified by local health department jurisdiction population size. One person was invited from each randomly selected local health department: the leader in chronic disease, or the director. Of 600 selected, 579 had valid email addresses; 376 completed the survey (64.9% response). Survey items assessed frequency of and reasons for mis-implementation. Participants indicated agreement with statements on organizational supports for evidence-based decision making (7-point Likert).

RESULTS

Thirty percent (30.0%) reported programs often or always ended that should have continued (inappropriate termination); organizational supports for evidence-based decision making were not associated with the frequency of programs ending. The main reason given for inappropriate termination was grant funding ended (86.0%). Fewer (16.4%) reported programs often or always continued that should have ended (inappropriate continuation). Higher perceived organizational supports for evidence-based decision making were associated with less frequent inappropriate continuation (odds ratio = 0.86, 95% confidence interval 0.79, 0.94). All organizational support factors were negatively associated with inappropriate continuation. Top reasons were sustained funding (55.6%) and support from policymakers (34.0%).

CONCLUSIONS

Organizational supports for evidence-based decision making may help local health departments avoid continuing programs that should end. Creative mechanisms of support are needed to avoid inappropriate termination. Understanding what influences mis-implementation can help identify supports for de-implementation of ineffective programs so resources can go towards evidence-based programs.

Mapping the healthcare chaplaincy workforce: a baseline description

Changing U.S. demographics and the growing emphasis on diversity in the healthcare workforce requires professional healthcare chaplains to examine the characteristics of its own workforce. Previous research suggested that chaplains were mainly Caucasian/White and Mainline Protestant. To explore further, this paper presents a baseline sketch of the workforce and identifies important differences among board-certified chaplains (BCCs), certified educators, certified educator candidates (CECs), and clinical pastoral education (CPE) students. Although missing data quickly became the central story of the analysis and thus requires caution in comparison, the preliminary results suggest BCCs and Certified Educators are older and Whiter/more Caucasian than CECs and CPE students. At least one-third of chaplains and Certified Educators identify as Mainline Protestant, but students and CECs reported greater variation in religious affiliation. Chaplains may be similar to users of healthcare and hospitalized persons in terms of gender and race/ethnicity. Recommendations include suggestions for improving the data infrastructure of professional chaplaincy organizations.

The Public Health Workforce Taxonomy: Revisions and Recommendations for Implementation

Public health workforce size and composition have been difficult to accurately determine because of the wide variety of methods used to define job title terms, occupational categories, and worker characteristics. In 2014, a preliminary consensus-based public health workforce taxonomy was published to standardize the manner in which workforce data are collected and analyzed by outlining uniform categories and terms. We summarize development of the taxonomy's 2017 iteration and provide guidelines for its implementation in public health workforce development efforts. To validate its utility, the 2014 taxonomy was pilot tested through quantitative and qualitative methods to determine whether further refinements were necessary. Pilot test findings were synthesized, themed by axis, and presented for review to an 11-member working group drawn from the community of experts in public health workforce development who refined the taxonomy content and structure through a consensus process. The 2017 public health workforce taxonomy consists of 287 specific classifications organized along 12 axes, intended for producing standardized descriptions of the public health workforce. The revised taxonomy provides enhanced clarity and inclusiveness for workforce characterization and will aid public health workforce researchers and workforce planning decision makers in gathering comparable, standardized data to accurately describe the public health workforce.

Succession Planning in State Health Agencies in the United States: A Brief Report

OBJECTIVE

Approximately 25% of the public health workforce plans to retire by 2020. Succession planning is a core capability of the governmental public health enterprise; however, limited data are available regarding these efforts in state health agencies (SHAs).

METHODS

We analyzed 2016 Workforce Gaps Survey data regarding succession planning in SHAs using the US Office of Personnel Management's (OPM's) succession planning model, including 6 domains and 27 activities. Descriptive statistics were calculated for all 41 responding SHAs.

RESULTS

On average, SHAs self-reported adequately addressing 11 of 27 succession planning activities, with 93% of SHAs adequately addressing 1 or more activities and 61% adequately addressing 1 or more activities in each domain.

CONCLUSIONS

The majority of OPM-recommended succession planning activities are not being addressed, and limited succession planning occurs across SHAs. Greater activity in the OPM-identified succession planning domains may help SHAs contend with significant turnover and better preserve institutional knowledge.

A Review of Public Health Training Needs Assessment Approaches: Opportunities to Move Forward

CONTEXT

Assessing training needs of the public health workforce is crucial for creating professional development opportunities to improve knowledge, competence, and effectiveness of this workforce.

DISSEMINATION

Regional Public Health Training Centers (RPHTCs) assess workforce training needs and deliver training based on identified needs. To determine training priorities, several needs assessment surveys have been administered by RPHTCs and national public health member organizations.

EVALUATION

This study identified the types of training questions being asked to public health practitioners in the various assessment surveys implemented by RPHTCs and national membership organizations. Although the surveys measured similar overarching constructs, multiple approaches with limited consistency were used to measure training needs.

DISCUSSION

Although successful in responding to the needs of their targeted constituents, the limited consistency among survey types makes generalization of findings difficult. Disseminating common metrics and aggregate survey findings would increase efficiency in determining workforce training needs and developing targeted training.