Beyond the Status Quo: 5 Strategic Moves to Position State and Territorial Public Health Agencies for an Uncertain Future

Rapid evidence review: Policy actions for the integration of public health and health care in the United States

Objective

To identify policy actions that may improve the interface of public health and health care in the United States.

Methods

A rapid review of publicly-available documents informing the integration of public health and health care, and case examples reporting objective measures of success, with abstraction of policy actions, related considerations, and outcomes.

Results

Across 109 documents, there were a number of recurrent themes related to policy actions and considerations to facilitate integration during peace time and during public health emergencies. The themes could be grouped into the need for adequate and dedicated funding; mandates and shared governance for integration; joint leadership that has the authority/ability to mobilize shared assets; adequately staffed and skilled workforces in both sectors with mutual awareness of shared functions; shared health information systems with modernized data and IT capabilities for both data collection and dissemination of information; engagement with multiple stakeholders in the community to be maximally inclusive; and robust communication strategies and training across partners and with the public.

Conclusion

While the evidence does not support a hierarchy of policies on strengthening the interface of public health and health care, recurrent policy themes can inform where to focus efforts.

Learning to Lead: 3 Models to Support Public Health Leadership Development

CONTEXT

The current public health system is underresourced and understaffed, which has been exacerbated by the coronavirus pandemic. In addition, there has been a decline in the public health workforce at both state and local levels during the last decade. While workforce numbers dwindle, public health systems have to address increasingly complex challenges-such as climate change, chronic diseases, and health equity-challenges that require skilled, adaptive leaders. This article describes the importance of leadership development and how 3 public health training centers (PHTCs) are building leadership skills in the public health workforce.

PROGRAM

To address the need for public health leadership training, the PHTCs in the Health & Human Services (HHS) Regions 4, 7, and 10 all offer public health leadership institutes (PHLIs).

IMPLEMENTATION

The 3 PHLIs discussed in this article vary in longevity (3-18 years), cohort length (8-12 months), and format (virtual, in-person, and hybrid); yet, all 3 emphasize adaptive leadership through a health equity lens and intentional opportunities to apply skills in practice.

EVALUATION

Each PHLI conducts extensive evaluation based on Kirkpatrick's levels of evaluation and collects common metrics collected by all PHTCs. Data from the PHLIs illustrate high levels of satisfaction with learning, presentation of data, identification of workplace actions, and improvement of subject matter understanding. Each PHLI also has numerous stories of impact.

DISCUSSION

With public health leaders leaving the workforce and the complexities of practice increasing, leadership training is critical to the current workforce and succession planning. These PHTCs provide a significant, enduring resource toward the development of our nation's public health leaders, as well as meeting the unique needs of their regions' workforces.

Regarding Investment in a Healthier Future: Impact of the 2012 Institute of Medicine Finance Report

CONTEXT

Governments at all levels work to ensure a healthy public, yet financing, organization, and delivery of public health services differ across the United States. A 2012 Institute of Medicine Finance report provided a series of recommendations to ensure a high-performing and adequately funded public health infrastructure.

OBJECTIVES

This review examines the influence of the Finance report's 10 recommendations on public health policy and practice.

DESIGN

This review utilized peer-reviewed and gray literature published since 2012.

ELIGIBILITY CRITERIA

Documents that address at least one of the Finance report's 10 recommendations and contain information on either official actions taken in response to the Finance report or evidence of the report's influence on the practice community.

RESULTS

Of 2394 unique documents found, a total of 56 documents met the eligibility criteria. Review of these 56 documents indicated that the most substantial activity related to the recommendations was focused on the "minimum package of public health services" concept and establishment of a uniform chart of accounts.

DISCUSSION

Progress has been mixed on the Finance report recommendations. Improved tracking and auditing of public health activity appears to be advancing, yet financial benchmarks remain unmet. Challenges remain in determining actual investment in public health and equitable resource allocation approaches. State and local health department use of cost estimation methodology and a uniform chart of accounts tool has contributed to an increase in understanding and improvement in public health spending.

CONCLUSIONS

The Finance report has served as a strong impetus for advocating for an increased investment in governmental public health. Efforts are bolstered by informed public health practitioners and stakeholders but often stymied by policy makers who must balance complex competing issues and priorities. Although many successes have occurred, further work is needed toward improving investment in the nation's public health.

The Most Important Skills Required by Local Public Health Departments for Responding to Community Needs and Improving Health Outcomes

In 2017, Public Health 3.0 was introduced, providing recommendations that expand traditional public department functions and programs. Operationalizing the framework requires that local health departments invest in the requisite professional skills to respond to their community's needs. The purpose of this paper is to determine the professional skills that are most important for local health departments to respond to large public health issues and challenges that are having a major impact on their communities. The study used a cross-sectional assessment of the education and training needs of local public health departments in Nebraska following the principles of practice-based systems research. The assessment was designed to assess the training and education needs of local health department staff members. The questions measured the perceived importance of and respondent's capacity across 57 core competencies for public health professionals modified from the Council on Linkages Between Academia and Public Health Practice. A total of 104 staff members from seven local health departments were requested to complete the assessment and 100% of the individuals responded to and completed the assessment. Twenty-eight skills were identified as the most important skills needed for local health departments. The skills were themed and categorized into four domains. (1) Data, Evaluation, and Quality Improvement, (2) Community Engagement and Facilitation, (3) Systems Thinking and Leadership, and (4) Policy and Advocacy. The results from this analysis provide direction to strengthen and transform the public health system into one that is connected, responsive, and nimble. Additionally, it also highlighted a glaring omission that Equity, Diversity, and Inclusion should be included as the fifth domain.

Toward an Understanding of Public Health Entrepreneurship and Intrapreneurship

This paper describes a framework used to understand public health entrepreneurship and intrapreneurship for the purpose of pedagogy and practice. To ground this framework in the academic literature, a scoping review of the literature was conducted with application of a snowball method to identify further articles from the bibliographies of the search results. Recurring themes were identified to characterize common patterns of public health entrepreneurship and intrapreneurship. These themes were design thinking, resource mobilization, financial viability, cross-disciplinary collaboration, and systems strengthening. Case examples are provided to illustrate key themes in both intrapreneurship and entrepreneurship. This framework is a starting point to further the discourse, teaching, and practice of entrepreneurship and intrapreneurship in public health. More research is needed to understand implications for power and privilege, capacity building, financing, scaling, and policy making related to entrepreneurship and intrapreneurship in public health.

Unleashing the Creativity and Innovation of Our Greatest Resource-The Governmental Public Health Workforce

Context:

Creativity and innovation in the governmental public health workforce will be required to generate new ideas to solve complex problems that extend beyond traditional public health functions such as disease surveillance and monitoring. Creativity and innovation can promote and advance necessary organizational transformation as well as improve organizational culture and workplace environment by motivating employees intrinsically. However, there is little empirical evidence on how rewarding creativity and innovation in governmental public health departments is associated with organizational culture and workplace environments.

Objective:

This study describes (1) the degree to which creativity and innovation are rewarded in governmental public health agencies and (2) associations between rewarding creativity and innovation and worker satisfaction, intent to leave, and workplace characteristics.

Design:

The cross-sectional Public Health Workforce Interests and Needs Survey (PH WINS) was administered using a Web-based platform in fall 2017.

Settings and Participants:

Data used for these analyses were drawn from the 2017 PH WINS of governmental health department employees. This included state health agency and local health department staff. PH WINS included responses from 47 604 staff members, which reflected a 48% overall response rate. PH WINS excludes local health departments with fewer than 25 staff or serving fewer than 25 000 people.

Results:

Fewer than half of all workers, regardless of demographic group and work setting, reported that creativity and innovation were rewarded in their workplace. Most measures of worker satisfaction and workplace environment were significantly more positive for those who reported that creativity and innovation were rewarded in their workplace.

Conclusion:

This research suggests that promoting creativity and innovation in governmental public health agencies not only could help lead the transformation of governmental public health agencies but could also improve worker satisfaction and the workplace environment in governmental public health agencies.