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.

What Predicts Graduate Public Health Student Success? Evidence for Admission Committees in a Post-Affirmative Action Landscape

OBJECTIVE

A severe staff shortage and a dearth of professionals from underrepresented backgrounds in the public health workforce are contributing to poor health outcomes in the United States. Schools and programs can mitigate these problems by admitting more graduate public health students overall and from underrepresented backgrounds. We identified predictors of foundational graduate public health course grades and graduate grade point average (GPA), sharing evidence to remove application factors that are admission barriers and do not predict student outcomes.

METHODS

We conducted a linear regression analysis on demographic and academic factors from 564 graduate public health applications for students at the University at Buffalo who received their degree from January 1, 2016, to February 1, 2021, analyzing age, race and ethnicity, sex, income, undergraduate degree, verbal and quantitative Graduate Record Examination (GRE) percentiles, and undergraduate GPA. Outcomes were grades in foundational public health courses and cumulative graduate GPA.

RESULTS

Undergraduate GPA was the best predictor of graduate public health student success, explaining nearly 7% of foundational public health course grades and 29% of graduate GPA. Higher undergraduate GPA contributed to higher course grades and graduate GPA. GRE scores explained <1% of student outcomes.

CONCLUSIONS

Our findings add to the growing body of research showing that standardized test scores may not predict graduate student outcomes and provide further evidence for the field of public health to consider removing this admission barrier. By doing so, institutions could admit more students to graduate public health programs who can bring needed skills to the market, further diversifying the workforce and public health faculty, to better meet population health needs.

Public Health in the Public Eye: Experiences of Ohio's Public Health Workforce During COVID-19

The COVID-19 pandemic was uniquely challenging for public health workers charged with enforcing recommendations. In the United States, media reports highlight frequent outbursts and threats from community members and elected officials regarding masking protocols, vaccine mandates, and other public health measures such as isolation/quarantining recommendations. Given this backdrop, the purpose of this study was to better understand the lived experiences of this critical workforce in the context of COVID-19. We conducted in-depth phone interviews with public health workers in Ohio (N = 11). Questions were designed to illicit workers' experiences and sense-making of the pandemic experience. We analyzed results using the techniques of interpretive phenomenological analysis. Five major themes focused on how workers experienced public perceptions of COVID-19 and the public health response. Three themes highlight the role of media and social media in polarizing public perceptions. These we note as: Dealing with Deadlock, Feeling Misunderstood and Misrepresented, and The Rollercoaster of Public Opinion. Getting on With the Work reveals strategies used to navigate public perceptions and misperceptions. This ranged from aggressive education and information sharing, to setting boundaries around the controversial or disputed aspects of the pandemic. Finally, After the Dust Settles comments on hopes for postpandemic transformations of public health and public perceptions thereof. These results can inform new pathways for public health. Paramount among these are effective strategies that address public knowledge, values, and worldviews. Such messaging must promote nuanced understanding and customized approaches for local realities, rather than relying on rigid dichotomies that further polarization and distrust.

Federal Student Loan Debt in Public Health and the Opportunities for Loan Repayment Programs

OBJECTIVES

A need persists for graduates with public health training in government public health roles; however, earnings for these positions tend to be lower when compared with earnings for people with undergraduate or graduate training who are working in other sectors, such as private health care or pharmaceuticals. This study assessed federal student loan debt associated with education for public health, with an aim to quantify the need that may be met through the federal Public Health Workforce Loan Repayment Program (PHWLRP), which is one tool that policy makers have proposed to incentivize people with public health training to pursue employment in government public health.

METHODS

We analyzed federal student loan data provided by the National Center for Education Statistics College Scorecard for the 2018-2019 academic year. We merged these data with the Integrated Postsecondary Education Data System to estimate the number of degrees awarded. We used Spearman rank correlation to compare associations between debt and annual earnings by award level (bachelor's, master's, and doctoral degrees).

RESULTS

Across all award levels, the median level of federal student loan debt associated with education for public health was $33 366. The median annual earnings 1 year after graduation were $80 687 for graduates with doctoral degrees and $33 279 for graduates with bachelor's degrees.

CONCLUSIONS

As policy makers attempt to strengthen the public health workforce with a focus on funding and implementing the PHWLRP, the existing levels of student debt should be considered to ensure that programs such as the PHWLRP are funded and reflect the needs of graduates and government public health employers.

Conducting a Comprehensive Assessment of the Public Health Workforce: Lessons Learned and Opportunities for the Future

Indiana was one of the earliest states to conduct a comprehensive public health workforce assessment in preparation for the use of federal funds for infrastructure strengthening. Experiences from this assessment provide insights that may be useful to other public health agencies and partners. This brief summarizes key lessons and highlights opportunities for improved workforce assessments. For example, the lack of standardized job titles within local health departments (LHDs) can be mitigated by collecting the top 3 job tasks employees engage in daily and reassigning standardized titles based on nationally collected workforce data. This facilitates comparisons across LHD employees nationally. In addition, many employees felt their job tasks did not align well with the Foundational Public Health Services (FPHS) areas and capabilities, which contributed to the likely overestimation of effort. Further consideration of how to better align and/or integrate FPHS assessment within current practice is needed in addition to improved ways of assessing efforts toward FPHS.

Application of COVIDTracer to Inform Public Health Workforce Planning in Alaska During the COVID-19 Pandemic

The COVID-19 pandemic has caused social and economic disruption worldwide and spurred numerous mitigation strategies, including state investments in training a large contact tracing and case investigation workforce. A team at the University of Alaska Anchorage evaluated implementation of the COVID-19 contact tracing and case investigation program of the State of Alaska Department of Health and Social Services, Division of Public Health, Section of Public Health Nursing. As part of that evaluation, the team used COVIDTracer, a spreadsheet modeling tool. COVIDTracer generated projections of COVID-19 case counts that informed estimates of workforce needs and case prioritization strategies. Case count projections approximated the reported epidemiologic curve with a median 7% difference in the first month. The accuracy of case count predictions declined after 1 month with a median difference of 80% in the second month. COVIDTracer inputs included previous case counts, the average length of time for telephone calls to cases and outreach to identified contacts, and the average number of contacts per case. As each variable increased, so too did estimated workforce needs. Decreasing the average time from exposure to outreach from 10 to 5 days reduced case counts estimated by COVIDTracer by approximately 93% during a 5-month period. COVIDTracer estimates informed Alaska's workforce planning and decisions about prioritizing case investigation during the pandemic. Lessons learned included the importance of being able to rapidly scale up and scale down workforce to adjust to a dynamic crisis and the limitations of prediction modeling (eg, that COVIDTracer was accurate for only about 1 month into the future). These findings may be useful for future pandemic preparedness planning and other public health emergency response activities.

Enhancing Workforce Pathways: Insights From a Paid Internship Pilot Program Linking Public Health Students and Local Health Departments

The persistent understaffing of the governmental public health workforce has led to program cutbacks, staff burnout at local health departments (LHDs), and an urgent need to replenish staffing. To build recruitment pathways into LHDs and build their workforce capacity, we introduced a paid internship initiative connecting Master's in Public Health students from a Midwestern university with LHDs in the state. This article presents the pilot program developed and the insights gained from it. Program participants included nine LHDs that hosted 10 students for 12-week internships. Internship projects were developed by LHDs with support from the state's association of county and city health officials. All students completed their internship projects satisfactorily. The experience highlighted that while students contributed to LHDs through short-term projects, with sustained backing and minor adjustments, this model can serve to reinforce the governmental public health sector's existing and future capacity in the long term.

The Impacts of Politicization on Public Health Workers: The COVID-19 Pandemic in Oregon and Montana

CONTEXT

The contributions from the field of public health to human society are numerous and are often taken for granted. The COVID-19 pandemic thrust the largely invisible public health workforce into the public eye. Like other career civil servants at the intersection of the citizen-state encounter, reports of uncooperative, hostile, and even violent confrontations between public health workers and those they serve are on the rise. This study explores the attitudes of public health professionals in two states in the American West.

METHODS

The authors conducted an anonymous web-based survey of public health professionals in Montana and Oregon one year into the COVID-19 pandemic.

FINDINGS

Public health workers who responded to the survey reported beliefs that the COVID-19 pandemic was politicized by actors in the government, both major political parties, the media, and the public broadly. This politicization affected workers' abilities to do their jobs, with respondents in Montana experiencing more negative impacts than those in Oregon.

CONCLUSIONS

Public health workers face growing antagonism from the public and pressure from political leaders, which poses a significant concern for the public health workforce and for communities as they prepare to address and overcome future public health challenges.

Exploring Job Stress Among Public Health Workforce in Northeastern Malaysia

Introduction Job stress is recognized as a significant concern across various occupational settings which have profound implications for both individuals and organizations. During the COVID-19 pandemic, job stress among the public health workforce (PHW) has been a significant concern, as they face a significantly increased risk of infection and mortality due to excessive COVID-19 exposure. This study presents a descriptive exploration of key job stress-related factors among PHW in Terengganu, Malaysia. Methodology This is a cross-sectional study conducted from May 2022 to April 2023, encompassing all eight District Health Offices (DHO) and government health clinics in Terengganu. Data collection involved a Malay version of the Job Content Questionnaire (M-JCQ), which assesses job characteristics based on Karasek's demand-control-support model and consists of four main domains: decision latitude, psychological job demands, physical job demands, and social support. Data was collected from 1044 participants, and statistical analysis was performed using SPSS version 27 (IBM Corp., Armonk, NY, USA). Findings Of the 1044 participants, 18.9% experienced job stress. The highest percentage of job stress was observed among nurses (24.3%), followed by medical assistants (18.3%) and physicians (16.0%). In contrast, the public health assistant (PKA) group had the lowest rate of job stress. Job types based on Karasek's model also showed variations, with doctors having the highest percentage of active jobs (46.4%), while medical assistants had the highest percentage of low job strain (17.9%), and PKAs had the highest percentage of passive job types (44.7%). Conclusion This study offers significant insights into the work-related challenges faced by the public health workforce in Terengganu, Malaysia, especially during the COVID-19 pandemic. Job stress is a substantial concern, and understanding its underlying factors is essential for improving the well-being of PHWs. Decision latitude, job demands, and social support play critical roles in shaping job stress among PHWs. Strategies and interventions are needed to mitigate job stress, improve working conditions, and enhance the effectiveness of PHWs in public health initiatives. This study highlights the importance of addressing job stress in this sector, with potential benefits for both the mental and physical health of PHW.

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.

"Seems Like There Is No Stopping Point at All Whatsoever": A Mixed-Methods Analysis of Public Health Workforce Perception on COVID-19 Pandemic Management and Future Needs

OBJECTIVE

The COVID-19 pandemic, caused by a highly contagious novel virus called SARS-CoV-2, has led to significant global morbidity and mortality, with disproportionate burden among frontline workers. While the current empirical body of evidence highlights reported depression, burnout, moral injury, compassion fatigue, and post-traumatic stress among healthcare workers, similar assessment among the public health workforce is limited. Given work-related pressure of rapid pandemic management strategies, risk of exposure, potential fatigue, etc., understanding the caregiver burden of the public health workforce is critical. Methods: This study used a convergent parallel mixed-methods design. Participants were recruited using a mix of both convenience and snowball sampling. All data were collected virtually and kept anonymous. All statistical analyses were conducted using SPSS version 28, and all qualitative results were thematically analyzed using the grounded theory approach. Results: Among the study participants, nearly 65% reported that their personal lives were impacted due to providing COVID-19 related services. Furthermore, a majority (88%) reported poor sleep health, including low daytime wakefulness, while 24% reported serious psychological distress. Qualitative analysis demonstrated several emergent themes, with central themes indicative of the need for paradigm shift in capacity building for public health emergency preparedness that integrates caregiver support. Conclusions: Results highlight the importance of addressing the caregiver burden experienced by public health and related workforces during public health emergencies.

Using Grand Rounds to Train and Prepare a Local Public Health Workforce To Manage COVID-19 Outbreaks During the 2020-2021 Pandemic Winter Upsurge

In response to the coronavirus disease 2019 (COVID-19) pandemic, the Los Angeles County Department of Public Health (DPH) expanded its workforce by >250 staff during Fall 2020 to manage the expected volume of outbreaks, which ultimately peaked. The workforce included reorganized groups of physicians, nurses, outbreak investigators from several DPH programs, and a 100+ member data science team tasked with designing and operating a data system and information flow process that became the backbone infrastructure of support for field investigation and outbreak management in real-time. The accelerated workforce expansion was completed in 3 months. To prepare new and reassigned permanent staff for fieldwork, DPH and several faculty from the Emory University Rollins School of Public Health adopted a flexible, skills-based series of medical Grand Rounds. These 16 sessions were grounded in practice- and problem-based learning principles using case studies, interactive scenarios, and didactic presentations based on scientific and public health practice information to teach knowledge and skills that were needed to manage COVID-19 outbreaks in different sectors. The evaluation suggests positive experience with the training series as well as impact on job performance.

Understanding Low Utilization of Employee Assistance Programs and Time Off by US Public Health Workers During the COVID-19 Pandemic

OBJECTIVE

Despite high rates of reported mental health symptoms among public health workers (PHWs) during the COVID-19 pandemic, utilization of employer-offered resources was low. Our objective was to understand what barriers and deterrents exist for PHWs accessing employer-offered resources.

METHODS

Four national public health organizations disseminated a national online survey of public health department employees during March-April 2021; 26 174 PHWs completed the survey. We examined 5164 write-in survey responses using thematic analysis to identify key reasons why PHWs were not accessing time off and employee assistance programs (EAPs) and to understand what resources PHWs would like to see their employers offer.

RESULTS

The top reasons that PHWs reported for not taking time off during the COVID-19 pandemic were financial concerns (24.4%), fear of judgment or retaliation (20.8%), and limitations in the amount of time off offered or available (11.0%). The top reasons that PHWs reported for not using EAPs during the COVID-19 pandemic were difficulty accessing EAPs (53.1%), use of external services (21.5%), and a lack of awareness about EAPs or motivation to initiate their use (11.3%). While desired employer-offered resources varied widely, PHWs most frequently listed financial incentives, paid time off, flexible scheduling, and organizational change.

CONCLUSION

Organizations can best help their employees by organizing the workforce in a way that allows PHWs to take time off, creating a positive and supportive organizational climate, regularly assessing the needs of PHWs, clearly communicating the availability of employer-offered benefits, and emphasizing the acceptability of using those benefits.

A Systematic Review on Professional Regulation and Credentialing of Public Health Workforce

The public health workforce (PHW) counts a great variety of professionals, and how services are delivered differs in every country. The complexity and the diversity of PHW professions also reflect structural problems of supply and demand of PHW in various organizations and health care systems. Therefore, credentialing, regulation, and formal recognition are essential for a competent and responsive PHW to address public health challenges. To ensure comparability of the credentialing and regulation systems for the PHW and to enable its collective action at the macro level in the event of a health crisis, we systematically analyzed documented evidence on the PHW. A systematic review was selected to answer the research questions: (1) what are the most effective aspects and characteristics in identified programs (standards or activities) in professional credentialing and regulation of the PHW and (2) what are common evidence-based aspects and characteristics for the performance standards to support a qualified and competent PHW? The identification of professional credentialing systems and available practices of the PHW was performed systematically using a systematic review of international resources in the specialized literature published in English. The PRISMA framework was used to verify the reporting of combined findings from three databases: Google Scholar (GS), PubMed (PM), and Web of Science (WoS). The original search covered the period from 2000 until 2022. Out of 4839 citations based on the initial search, 71 publications were included in our review. Most of the studies were conducted in the US, UK, New Zealand, Canada, and Australia; one study was conducted in an international context for professional credentialing and regulation of the PHW. The review presents specific professional regulation and credentialing approaches without favoring one of the proposed methods. Our review was limited to articles focused on professional credentialing and regulation of the PHW in the specialized literature published in English and did not include a review of primary PHW development sources from international organizations. The process and requirements are unique processes displaying knowledge, competencies, and expertise, regardless of the field of practice. Continuous education, self-regulatory, and evidence-based approach can be seen as common characteristics for the performance standards on both community and national levels. Certification and regulation standards should be based on competencies that are currently used in practice. Therefore, answering questions about what criteria would be used, what is the process operation, what educational background the candidate should have, re-examination, and training are essential for a competent and responsive PHW and could stimulate the motivation of the PHW.

The Shifting Public Health Landscape and Virtual Learning Environment: The Effectiveness of Practice-Based Teaching Delivered In-Person, Virtual, and Hybrid

The pandemic necessitated teaching competencies that allow public health (PH) students to be immediately workforce ready. The shift to virtual learning provided an ideal time to consider pedagogies focused on applied learning opportunities, such as practice-based teaching (PBT). This multi-year, post-test evaluation of one PBT course explored differences in students' competency achievement immediately post-course with different modalities of delivery: fall 2019 in-person (n = 16), summer 2020 virtual (n = 8), and fall 2020 hybrid (n = 15). Using a variety of methods to assess across semesters, the study found virtual and hybrid learning environments resulted in equally high levels of competency achievement as in-person delivery. Regardless of course delivery, students reported, with no difference across semesters, PBT directly contributed to their workforce readiness, helped with acquisition of essential workforce skills such as problem-solving, leadership, and teamwork, and led to skill and knowledge acquisition they would not have achieved in a non-PBT course. The increased emphasis on virtual learning changed the higher education landscape and the need for students to be workforce-ready with the technical and professional skills demanded by the field and offered opportunity to redesign courses with an emphasis on applied opportunities. Virtually delivered PBT is an effective, adaptable, and sustainable pedagogy worth the investment.

The Opportunity Cost of COVID for Public Health Practice: COVID-19 Pandemic Response Work and Lost Foundational Areas of Public Health Work

This article has been temporarily removed by the publisher, Wolters Kluwer, due to a data quality issue. We regret any confusion this may have caused. This article will be published once production is complete on the Public Health Workforce Interest and Needs Survey supplemental issue.

CONTEXT

There is little empirical evidence regarding the magnitude of the COVID-19 response across the public health workforce and the extent to which other public health programs were called upon to contribute to the response, potentially leading to less work being done in other public health programs during the COVID-19 pandemic.

OBJECTIVES

To assess the composition of the workforce that contributed to the COVID-19 pandemic response during 2020-2022.

DESIGN

A large, cross-sectional, nationally representative survey of the state and local public health agency workforce through the Public Health Workforce Interest and Needs Survey (PH WINS).

SETTING

Nearly all state health agency-central offices (SHA-COs) and Big City Health Coalition (BCHC) member public health departments as well as a nationally representative sample of other local health departments (LHDs) with more than 25 staff members and serving more than 25 000 people participated in fall 2021.

PARTICIPANTS

A sample of all individuals working at each SHA-CO or LHD as part-time or full-time employees, contractors, or other employee types was used. A total of 44 732 responses (35% of eligible respondents) were received.

MAIN OUTCOME MEASURE

Main outcomes included the proportion of full-time equivalent (FTE) effort devoted to COVID-19 response work by quarter (Q) from Q1 2020 through Q1 2022. Predictors of interest included individual- and agency-level demographics, most notably an individual's self-reported public health program area.

RESULTS

Staffing and hiring for the COVID-19 pandemic response was an ongoing effort that began in 2020 and lasted through 2022. During the pandemic, all public health program areas contributed at least 20% of their workforce time to COVID-19 response, peaking at 47-83% of the staff time, depending on the program area.

CONCLUSIONS

There was a considerable public health opportunity cost to the public health systems' large and prolonged COVID-19 response. Persistent understaffing in the public health system remains an important issue.

Qualitative Insights From Governmental Public Health Employees About Experiences Serving During the COVID-19 Pandemic, PH WINS 2021

OBJECTIVE

The purpose of the current study was to examine governmental public health employee experiences during the COVID-19 pandemic.

DESIGN AND SETTING

A total of 5169 responses to a PH WINS 2021 open-ended question were qualitatively coded. The question asked employees to share their experiences during the COVID-19 response. The 15 most common themes are discussed.

PARTICIPANTS

Responses from governmental public health employees in state health agencies (SHAs), big cities (Big City Health Coalition or BCHC agencies), and local health departments (LHDs) across all 50 states were included.

RESULTS

The most frequently identified theme was pride in public health work and/or the mission of public health (20.8%), followed by leadership (17.2%), burnout or feeling overwhelmed (14%), communication (11.7%), and overtime/extra work (9.7%). Among the top 15 themes identified, comments about pride in public health work and/or the mission of public health (95.9%), teamwork (81.5%), and telework (61%) were predominantly positive. Co-occurring themes for responses that expressed pride in public health work and/or the mission of public health were often countered with explanations of why respondents remain frustrated, including feeling burned out or overwhelmed , disappointment with the community's sense of responsibility or trust in science , and feeling unappreciated either by the community or their agency. All of these co-occurring themes were predominantly negative.

CONCLUSIONS

Employees are proud to work in public health and value teamwork but often felt overworked and unappreciated during the COVID-19 pandemic. Reviewing existing emergency preparedness protocols in the context of lessons learned during the COVID-19 pandemic and listening to employees' experiences with teleworking and task sharing may better prepare agencies for future challenges. Creating channels for clear communication during a period of changing information and guidelines may help employees feel more prepared and valued during an emergency response.

The Institute of Medicine's call to action revisited: assuring access to public health education for U.S. college students

The Educated Citizen and Public Health initiative promotes that an understanding of public health issues is a principal component of an educated population and is necessary to develop social responsibility and promote civic dialog. This initiative supports the Institute of Medicine's (now the National Academy of Medicine) recommendation that "all undergraduates should have access to education in public health." The purpose of our work is to examine the extent to which 2- and 4-year U.S. state colleges and universities offer and/or require a public health course. Select indicators identified include the presence and type of public health curriculum, public health course requirement, presence of public health graduate program offering, pathways to public health, Community Health Worker training, as well as demographic information for each institution. An analysis was also conducted for the historically Black colleges and universities (HBCUs), and the same select indicators were examined. The data suggest that there is an imperative need for a public health curriculum across the nation's collegiate institutions with 26% of 4-year state institutions lacking a full undergraduate public health curriculum; 54% of 2-year colleges not offering a pathway to public health education; and 74% of HBCUs not offering a public health course or degree. In the age of COVID-19, syndemics, and considering the post-pandemic phase, we argue that expanding public health literacy at the associate and baccalaureate level can help prepare an educated citizenry who is both public health literate and one that can demonstrate resilience in the face of public health challenges.

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.

Seven Years, 3 Surveys, a Changed World: The State Public Health Workforce 2014-2021

CONTEXT

The COVID-19 pandemic and other public health challenges have increased the need for longitudinal data quantifying the changes in the state public health workforce.

OBJECTIVE

To characterize the state of governmental public health workforce among state health agency (SHA) staff across the United States and provide longitudinal comparisons to 2 prior fieldings of the survey.

DESIGN

State health agency leaders were invited to have their workforce to participate in PH WINS 2021. As in prior fieldings, participating agencies provided staff lists used to send e-mail invitations to employees to participate in this electronic survey.

SETTING AND PARTICIPANTS

State health agency staff.

MAIN OUTCOME MEASURES

PH WINS 2021 maintains the 4 primary domains from 2014 and 2017 (ie, workplace engagement, training needs assessment, emerging public health concepts, and demographics) and includes new questions related to the mental and emotional well-being; the impact of the COVID-19 pandemic on staff retention; and the workforce's awareness of and confidence in emerging public health concepts.

RESULTS

The percentage of SHA staff who self-identify as Black, Indigenous, and people of color increased from 30% (95% confidence interval [CI]: 29%-32%) to 35% (95% CI: 35%-37%) between 2014 and 2021. Staff younger than 31 years accounted for 11% (95% CI: 10%-12%) of the SHA workforce in 2021 compared with 8% in 2014 (95% CI: 8%-9%). From 2014 to 2021, staff who self-identify as a woman increased from 72% (95% CI: 71%-74%) to 76% (95% CI: 75%-77%). Overall, 22% (95% CI: 21%-23%) of the SHA workforce rated their mental health as poor/fair.

CONCLUSION

The 2021 PH WINS results represent unique and current perspectives on the SHA workforce and can inform future public health infrastructure investments, research, and field practice to ensure a strong public health system.

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.

The Effectiveness and Flexibility of Practice-Based Teaching: A Long-term, Cross-disciplinary Evaluation

OBJECTIVES

Schools of public health (SPHs) must train students through real-world situations. Practice-based teaching (PBT) uses immediate application for skill development through multiple modes of delivery including virtual collaborations. PBT provides short-term benefits but is less understood long term. We sought to understand the longer-term impacts of PBT on students, public health agencies, faculty, and SPH administration and determine if the reported benefits of PBT outweigh the challenges.

METHODS

We used a mixed-methods pre-post-test evaluation to assess short-term outcomes in spring 2015 and long-term outcomes 3 years later using quantitative and qualitative assessments. The evaluation included 4 PBT courses spanning disciplines in 1 SPH. Participants included students (n = 56), collaborating agencies (n = 9), teaching faculty (n = 7), and SPH administrators (n = 8).

RESULTS

Students reported acquisition of competencies, application at follow-up, and being workforce ready (91.0%) with greater appreciation 3 years post-semester (78.6%). Collaborating agencies reported successful implementation of deliverables (77.8%) and enhanced networks (88.7%) with cost savings and better outcomes for the communities served. Faculty recognized beneficial outcomes to students including workforce preparation (71.4%), and administration recognized the benefits and worth of PBT to the school for teaching (100%) and research opportunities (87.5%).

CONCLUSIONS

Given the shifting higher education landscape as a result of the pandemic, public health courses are being redesigned to provide opportunities for skill development, regardless of delivery mode, and enhanced connections to the field are essential. PBT is a flexible pedagogy that results in lasting and innovative resources to agencies and prepares public health students with technical skills and professional competencies to be workforce ready.

Identifying the Gaps Between Public Health Training and Practice: A Workforce Competencies Comparative Analysis

Objectives: The study aimed to generate insights on how best to enhance the compatibility between Public Health training program competencies and the implementation of competencies required by employers to address current and emerging public health needs. Methods: A survey adapted from the WHO-ASPHER Competency Framework for the Public Health Workforce was conducted online among Israeli public health managers from August to November 2021. The survey was formulated to mirror Essential Public Health Operations. Forty-nine managers participated (37.6% response rate) in an assessment of 44 public health competencies and the core organizational public health operations. Results: Analysis of Essential Public Health Operations revealed a notably high deficiency reported for Advocacy Communication and Social Mobilization for health competencies. Collaborations and Partnership and, Leadership and System Thinking were the most reported insufficient competencies, particularly in health departments and research institutes. Governmental offices reported Organizational Literacy and Adaptability competencies being deficient. Deficiencies were more impactful as the level of expertise increased. Conclusion: There is a clear need for public health professionals to acquire versatile and innovative competencies in response to the ever-changing health threats.

Landscape Analysis of Public Health Jobs in India to Develop an Evidence-Based Public Health Curriculum

The increase in communicable and non-communicable disease incidence and prevalence, changing population demographics, along with concerns about pandemics, natural disasters, and wars, have highlighted the challenges faced by health systems. The study aims to identify data on publicly posted public health jobs available to applicants eligible to work in India to identify the public health and allied fields workforce needs, skills, and expertise in India. A cross-sectional study was done in June-July 2021. The data was collected from eleven common job portals in India. Descriptive and content analysis was done to identify the most common job titles, educational level preferred/desired, skills, and experience required in the public health jobs in India. In total 382 unique public health and related fields jobs were analyzed. Job postings were most commonly classified as manager (n = 68), officer/lead (n = 61), analyst (n = 49), and consultant (n = 44). Around one-fifth of the jobs were based in Delhi (n = 98, 24%). About a quarter of the job postings required more than 8 years of experience (26%, n = 100). More than half of the job postings mentioned having the knowledge and understanding of data analysis and statistical approaches (n = 116, 64%). Around 15% (n = 193) of the job posting wanted the candidate to have expertise in communication. Skills were classified into various types such as software, technical, and language. Timely assessment of the curriculum should be done to impart skills related to the needs of the employers and prepare a skilled and competent public health workforce to address the 21st century public health challenges.

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.

Modern public pealth problems and solutions: An undergraduate capstone course to prepare the next generation of public health practitioners to enhance health equity

With a growing emphasis on health equity in public health practice and research, ensuring a competent and skilled public health workforce is critical to advancing the public health mission of a healthier nation. The expansion of undergraduate public health programs provides a unique opportunity for more extensive training and education of the next generation of public health professionals and to center undergraduate public health education around the need to be competent in addressing health disparities to achieve health equity. Following national accreditation standards set by the Council on Education for Public Health (CEPH), undergraduate Bachelor of Public Health (BSPH) students at the University at Buffalo (UB) must complete a capstone course before graduation. This course focuses on integrating and synthesizing knowledge acquired from the BSPH core curriculum through analysis, explanation, and addressing public health problems via an interdisciplinary approach. We designed the most recent iterations of the capstone class based on the model that includes cross-cutting skills as defined by CEPH, evidence-based decision-making skills, established learning objectives of the course, and centering on health equity. This course also builds on the students' previously acquired knowledge with an ultimate goal to prepare the graduating seniors for the "real world" health equity-related public health activities. As a part of the coursework, students complete case studies, article reviews, and active learning group activities that target each component of the model. The final products of the course are a synthesis paper and oral presentation based on a public health problem as identified through surveillance data, analyzing causes of this problem, identifying critical stakeholders, creating an evidence-based solution to the problem, and explaining how health inequities may be addressed through the proposed solution. Centering the culminating course for BSPH undergraduate students on health equity will help ensure a competent and skilled workforce, informed by accreditation standards and prepared to lead our national public health goal of improved and equitable population health.

Prevalence and characteristics of advocacy curricula in Australian public health degrees

BACKGROUND

Public health advocacy is a fundamental part of health promotion practice. Advocacy efforts can lead to healthier public policies and positive impacts on society. Public health educators are responsible for equipping graduates with cross-cutting advocacy competencies to address current and future public health challenges.

PROBLEM

Knowledge of the extent to which students are taught public health advocacy is limited. To determine whether advocacy teaching within public health degrees matches industry needs, knowledge of pedagogical approaches to advocacy curricula is required. This study sought to understand the extent to which advocacy is taught and assessed within Australian public health degrees.

METHODOLOGY

Australian public health Bachelor's and Master's degrees were identified using the CRICOS database. Open-source online unit guides were reviewed to determine where and how advocacy was included within core and elective units (in title, unit description or learning outcomes). Degree directors and convenors of identified units were surveyed to further garner information about advocacy in the curriculum.

RESULTS

Of 65 identified degrees, 17 of 26 (65%) undergraduate degrees and 24 of 39 (62%) postgraduate degrees included advocacy within the core curriculum, while 6 of 26 (23%) undergraduate and 8 of 39 (21%) postgraduate offered no advocacy curriculum.

IMPLICATIONS

Australian and international public health competency frameworks indicate advocacy curriculum should be included in all degrees. This research suggests advocacy competencies are not ubiquitous within Australian public health curricula. The findings support the need to advance public health advocacy teaching efforts further.

What Factors Influence the Interest in Working in the Public Health Service in Germany? Part I of the OeGD-Studisurvey

As in many European countries, the Public Health Service (PHS) in Germany has had considerable difficulties in attracting well-qualified personnel for decades. Despite ongoing political and societal debate, limited empirical research on possible causes and explanations is available. To identify areas of action, we explored reasons for the (lack of) interest in working in the PHS by conducting two cross-sectional surveys among 3019 medical students (MS), public health students, and students from other PHS-relevant fields (PH&ONM) in Germany right before (wave 1, 2019/2020) and during the COVID-19 pandemic (wave 2, 2021). While interest in working in the PHS among MS was low, it was considerably higher among PH&ONM. The prevalent underestimation of the importance of public health and low levels of knowledge about the PHS were identified as potential barriers. Although core activities of the PHS were often considered attractive, they were repeatedly not attributed to the PHS. A negative perception of the PHS (e.g., it being too bureaucratic) was prevalent among students with and without PHS interest, indicating that both a negative image and potentially structural deficits need to be overcome to increase attractiveness. Based on the findings, we propose approaches on how to sustainably attract and retain qualified personnel.

How to Increase the Attractiveness of the Public Health Service in Germany as a Prospective Employer? Part II of the OeGD-Studisurvey

The Public Health Service (PHS) in Germany has had difficulties in recruiting enough qualified staff for years, but there is limited research on what factors drive decisions to (not) join the PHS workforce. We explored reasons for this perceived (lack of) attractiveness. We conducted two cross-sectional surveys among medical students (MS), public health students and students from other PHS-relevant fields (PH&ONM) in Germany before (2019/2020) and during the COVID-19 pandemic (2021). Both waves surveyed self-reported reasons for why students did (not) consider working in the PHS as attractive and how this could be improved, using open-question items. Qualitative and quantitative content analyses were conducted according to Mayring. In total, 948 MS and 445 PH&ONM provided valid written responses. Reasons for considering the PHS as attractive were, among others, the perception of a good work-life balance, high impact, population health focus, and generally interesting occupations. Suggestions to increase attractiveness included reducing bureaucracy, modernization/digitalization, and more acknowledgement of non-medical professionals. Among MS, reasons against were too little clinical/patient-related activities, low salary, and occupations regarded as boring. Our findings indicate areas for improvement for image, working conditions in, and institutional structures of the PHS in Germany to increase its attractiveness as an employer among young professionals.

Emerging lessons from the COVID-19 pandemic about the decisive competencies needed for the public health workforce: A qualitative study

The global COVID-19 crisis exposed the critical need for a highly qualified public health workforce. This qualitative research aimed to examine public health workforce competencies needed to face COVID-19 challenges and identify the gaps between training programs and the competency demands of real-world disasters and pandemics. Through a sample of thirty-one participant qualitative interviews, we examined the perspectives of diverse stakeholders from lead public health organizations in Israel. Grounded Theory was used to analyze the data. Six themes emerged from the content analysis: public health workforce's low professional status and the uncertain future of the public health workforce; links between the community and Higher Education institutions; the centrality of communication competencies; need to improve health promotion; the role of leadership, management, and partnership, and innovation in public health coherence. Increasing the attractiveness of the profession, professional and financial support, and improving the working conditions to ensure a sustainable and resilient PH system were deemed necessary. This paper describes and cultivates new knowledge and leadership skills among public health professionals, and lays the groundwork for future public health leadership preparedness programs.

Multi-, Inter-, and Transdisciplinarity within the Public Health Workforce: A Scoping Review to Assess Definitions and Applications of Concepts

In light of the current public health challenges, calls for more inter- and transdisciplinarity in the public health workforce are increasing, particularly to respond to complex and intersecting health challenges, such as those presented by the climate crisis, emerging infectious diseases, or military conflict. Although widely used, it is unclear how the concepts of multi-, inter-, and transdisciplinarity are applied with respect to the public health workforce. We conducted a scoping review and qualitative content analysis to provide an overview of how the concepts of multi-, inter-, and transdisciplinarity are defined and applied in the academic literature about the public health workforce. Of the 1957 records identified, 324 articles were included in the review. Of those, 193, 176, and 53 mentioned the concepts of multi-, inter-, and transdisciplinarity, respectively. Overall, 44 articles provided a definition. Whilst definitions of multidisciplinarity were scarce, definitions of inter- and transdisciplinarity were more common and richer, highlighting the aim of the collaboration and the blurring and dissolution of disciplinary boundaries. A better understanding of the application of multi-, inter-, and transdisciplinarity is an important step to implementing these concepts in practice, including in institutional structures, academic curricula, and approaches in tackling public health challenges.

Evaluation of a Contact Tracing Training Program and Field Experience

Introduction

The study objective was to evaluate a contact tracing training program and the role of contact tracing on volunteers' professional development.

Methods

A COVID-19 contact tracing program was conducted at an urban academic medical center, in collaboration with the local health department, between March 2020 and May 2021. Contact tracers, most of whom were health professions students, completed pretraining and post-training surveys to assess knowledge and self-efficacy to conduct contact tracing, plus an 18-month follow-up survey regarding career impacts.

Results

We observed statistically significant post-training increases in knowledge and self-efficacy to conduct contact tracing. Contact tracers described benefiting from training regarding cultural humility, empathy, and trauma-informed interviewing. They also expressed a deeper understanding of COVID-19 inequities and their structural causes and reported that the work was emotionally demanding.

Conclusions

Key to pandemic preparedness is having a trained and supported workforce. This study showed how contact tracing training and field experience strengthened students' education in the health professions by sharpening interpersonal skills and structural competency and by generating insights regarding current gaps in both public health infrastructure and support for vulnerable populations.

Real World Feedback: How Well Did the Virtual Training Academy Prepare California's COVID-19 Contact Tracing Workforce?

To effectively respond to the COVID-19 pandemic, California had to quickly mobilize a substantial number of case investigators (CIs) and contact tracers (CTs). This workforce was comprised primarily of redirected civil servants with diverse educational and professional backgrounds. The purpose of this evaluation was to understand whether the weeklong, remote course developed to train California's CI/CT workforce (i.e., Virtual Training Academy) adequately prepared trainees for deployment. From May 2020 to February 2021, 8,141 individuals completed the training. A survey administered ~3 weeks post-course assessed two measures of overall preparedness: self-perceived interviewing proficiency and self-perceived job preparedness. Bivariate analyses were used to examine differences in preparedness scores by education level, career background, and whether trainees volunteered to join the COVID-19 workforce or were assigned by their employers. There were no significant differences in preparedness by education level. Compared to trainees from non-public health backgrounds, those from public health fields had higher self-perceived interviewing proficiency (25.1 vs. 23.3, p < 0.001) and job preparedness (25.7 vs. 24.0, p < 0.01). Compared to those who were assigned, those who volunteered to join the workforce had lower self-perceived job preparedness (23.8 vs. 24.9, p = 0.02). While there were some statistically significant differences by trainee characteristics, the practical significance was small (<2-point differences on 30-point composite scores), and it was notable that there were no differences by education level. Overall, this evaluation suggests that individuals without bachelor's degrees or health backgrounds can be rapidly trained and deployed to provide critical disease investigation capacity during public health emergencies.

Preparing Students for the Public Health Workforce: The Role of Effective High-Impact Educational Practices in Undergraduate Public Health Program Curricula

There are several institutions of higher learning in the United States that award degrees in public health to undergraduate students. While these institutions serve as potential pipelines for the public health workforce, it is unclear if the curricula and training students receive from these institutions, really prepare them for the public health workforce or higher education. The questions sometimes asked are whether the programs offered by these institutions exist to provide students with a good understanding of public health issues so they can become good citizens for building a responsible society, or if it is to prepare students for graduate school. Regardless of what the goals are, students in undergraduate public health programs need to be exposed to curricula that adequately prepare them to enter well-defined careers in public health. Thus, institutions of higher learning offering degrees in public health to undergraduate students need to understand the market, assess, and understand the needs of public health agencies, and tailor course curricula to match those needs. Georgia State University established its undergraduate public health program in 2016. Since then, over 200 students have graduated from the program. The purpose of the study was to assess student perception of the role of high impact educational practices such as study abroad, signature experience, and undergraduate research curricula in preparing them for careers in public health.

The New to Public Health Residency Program Supports Transition to Public Health Practice

Training and retaining a competent public health workforce are challenging. Residency programs for new and transitioning professionals are effective in other fields but rare in governmental public health. The New to Public Health Residency Program is a residency program for professionals entering public health practice. On the basis of the Foundational Public Health Services model, the program was designed using adult learning principles and best practices from nurse residency programs. Content created by public health experts is delivered over 12 months through online course sessions that include interactive learning activities. Additional program components include monthly synchronous online discussions and support from a mentor. Residents apply their learning through implementation of an evidence-based practice project at their workplace. The program is accredited for continuing professional development contact hours. Agencies with limited resources to support new public health employees may find the New to Public Health Residency Program a vital training resource.

A Multilevel Workforce Study on Drivers of Turnover and Training Needs in State Health Departments: Do Leadership and Staff Agree?

OBJECTIVES

To characterize agreement between senior governmental public health staff and their subordinates concerning drivers for staff turnover, and skill importance and ability.

DESIGN

Data were combined from 2 national surveys conducted in 2017; one was a nationally representative, individual-level survey of public health workers, and one was an individual-level survey of their leadership.

SETTING

State health agencies.

PARTICIPANTS

Respondents who held scientific, nonsupervisory positions at state health agency central offices (n = 3606) were matched with leadership (n = 193) who provided programmatic area oversight.

MAIN OUTCOME MEASURES

Drivers of turnover and training needs are the primary outcomes examined in this article.

RESULTS

Leaders and their staff agreed on the main 2 drivers of turnover (low salary and lack of opportunities for advancement), but discordance was observed for other major drivers of turnover. Substantial discordance was observed between leaders and their staff in terms of perceived staff proficiency with selected skills.

CONCLUSIONS

This multilevel assessment of workplace perceptions offers evidence around training needs and drivers of turnover in state health agencies. Although staff and leaders agree on some major drivers of turnover, other potential reasons for leaving cited by staff, and the difference in perceptions of skills, can help target job satisfaction, training, and retention efforts in state health agencies.

Factors Associated with Intention of Serbian Public Health Workers to Leave the Job: A Cross-Sectional, Population-Based Study

Recruitment and retention of public health workers (PHWs) is crucial for the optimal functioning of the public health system at a time of budget cuts and the threat of a pandemic. Individual and job-related variables were examined by univariate and multivariate logistic regression to identify predictors of the intention to leave a job during the COVID-19 outbreak among Serbian PHWs in 25 institutes of public health (n = 1663 respondents, of which 73.1% were female). A total of 20.3% of PHWs intended to leave their current job within the next five years. Males and persons aged younger than 55 years who had additional practice were more likely to report an intention to leave their job than females, those older than 54 years and those without additional work. While uncertainty and fear of infection during the COVID-19 pandemic were almost perceived as job attractiveness, other job-related characteristics were identified as significant barriers to maintaining the sufficient capacity of qualified PHWs in the future. Authorities need to address these factors, including the following: the feeling of tension, stress or pressure, and unavailability of information during the COVID-19 pandemic, as well as dissatisfaction with respect, valuation, and the job in general.

Addressing Workforce Disparities by Improving the Academic Resilience and Professionalism of Health Science Students Through Structured and Targeted Supports

Background: The undergraduate program in Public Health of Saint Catherine University is the second most popular major of the institution, drawing students from diverse racial, economic, cultural, and educational backgrounds. This has presented significant opportunities and challenges with regard to providing students and faculty with the needed academic and professional development to ensure graduates embody the skills needed for Public Health workforce of today. The objective of this study was to identify potential structured institutional supports to graduate Public Health professionals from diverse communities to advance health equity. A secondary objective was to determine whether the needed supports for Public Health students might differ from peers in other health programs, specifically Nursing.

Methods: Using a mixed methods approach and a convenience sample, data were gathered from Public Health students, nursing students, faculty, and staff from November 2019 through July 2020. The survey assessed stress, grit, and demographic factors. Focus group topics included: academic resilience and professionalism, supports and gaps in the current institutional structure with respect to mitigating student stressors, and opportunities for programmatic solutions.

Results: In total, 53 Public Health and 32 in Nursing students completed the survey. Nursing students tended to be farther along in their undergraduate careers, less likely to have failed a class, and more likely to have recently been laid off from a job. Public Health students reported more support from parents, but less support from friends and classmates than their Nursing peers. Most Nursing and Public Health students reported unmanaged stress, and similar average grit scores (3.51 vs. 3.41, p = 0.43), respectively. In focus groups, students described a series of stressors including working full time while attending school, family expectations, difficulty with time management, and learning how to acclimate to college norms. University staff and faculty identified financial pressures as a primary student stressor in addition to complex lives including managing family crises.

Conclusions: Study findings are being used to identify or adapt professional development supports in undergraduate Public Health programs. Through supporting a diverse undergraduate student population in Public Health, a future workforce from communities most impacted by health disparities will emerge.

The Containment Scouts: First Insights into an Initiative to Increase the Public Health Workforce for Contact Tracing during the COVID-19 Pandemic in Germany

The COVID-19 pandemic in Germany has demanded a substantially larger public health workforce to perform contact tracing and contact management of COVID-19 cases, in line with recommendations of the World Health Organization (WHO). In response, the Robert Koch Institute (RKI) established the national “Containment Scout Initiative” (CSI) to support the local health authorities with a short-term workforce solution. It is part of a range of measures for strengthening the public health system in order to limit the spread of SARS-CoV-2 in Germany. The CSI is an example of how solutions to address critical health system capacity issues can be implemented quickly. It also demonstrates that medical or health-related backgrounds may not be necessary to support health authorities with pandemic-specific tasks and fulfil accurate contact tracing. However, it is a short-term solution and cannot compensate for the lack of existing qualified staff as well as other deficits that exist within the public health sector in Germany. This article describes the structure and process of the first phase of this initiative in order to support health policymakers, public health practitioners, and researchers considering innovative and flexible approaches for addressing urgent workforce capacity issues.

The Future Public Health Workforce in a Changing World: A Conceptual Framework for a European-Israeli Knowledge Transfer Project

Health services quality and sustainability rely mainly on a qualified workforce. Adequately trained public health personnel protect and promote health, avert health disparities, and allow rapid response to health emergencies. Evaluations of the healthcare workforce typically focus on physicians and nurses in curative medical venues. Few have evaluated public health workforce capacity building or sought to identify gaps between the academic training of public health employees and the needs of the healthcare organizations in which they are employed. This project report describes the conceptual framework of "Sharing European Educational Experience in Public Health for Israel (SEEEPHI): harmonization, employability, leadership, and outreach"-a multinational Erasmus+ Capacity Building in Higher Education funded project. By sharing European educational experience and knowledge, the project aims to enhance professionalism and strengthen leadership aspects of the public health workforce in Israel to meet the needs of employers and the country. The project's work packages, each jointly led by an Israeli and European institution, include field qualification analysis, mapping public health academic training programs, workforce adaptation, and building leadership capacity. In the era of global health changes, it is crucial to assess the capacity building of a well-qualified and competent workforce that enables providing good health services, reaching out to minorities, preventing health inequalities, and confronting emerging health challenges. We anticipate that the methods developed and the lessons learned within the Israeli context will be adaptable and adoptable by other countries through local and cultural adjustments.

Aligning Best Practices: A Guiding Framework as a Valuable Tool for Public Health Workforce Development with the Example of Ukraine

Background: At present, in Ukraine, there is an insufficient capacity for up-to-date surveillance of the health status of the general population; public health (PH) promotion and disease prevention activities are scarce. Additionally, there is an urgent need to ensure, develop and support an efficient public health workforce (PHW) and appropriately address existing health issues. Ukraine currently introduces PH system reforms in line with its current burden of disease, the epidemiological profile and the Essential Public Health Services (EPHOs). This analysis aims to propose a pragmatic framework to provide guidance and recommendations related to the development, support and planning of the PHW in Ukraine. Methods: We constructed a framework based on a previously published scoping review and analyzed various policy analysis approaches. In line with the recommendations found in the literature and the best practices used elsewhere, this method enabled the construction of a framework for facilitating successful PHW development. In addition, an expert workshop was held, serving as a reality check for identifying crucial areas of the PH system in Ukraine. Results: The proposed framework includes a country’s background, the evidence and available policy options, such as the health system (including core functions, organizational resources, regulations and norms), health system capacities (including human resources; PH capacity assessment; datasets and databases; forecasting strategies; licensing, accreditation and quality assurance) and capacity building (including PH education, training, core competencies and ethical and professional codes of conduct). To facilitate and support effective implementation of the framework, we propose (1) implementing strategies to facilitate changes in attitude, behavior and practices among the citizens; (2) implementing strategies to facilitate the necessary behavioral changes in the PHW; (3) implementing strategies to facilitate the necessary organizational and institutional changes; (4) implementing strategies to facilitate system changes and (5) identification of potential barriers and obstacles for the implementation of these strategies. Conclusion: The report highlights the practical tactics and best practices for providing suggestions for PHW support and planning. The employment of prominent analytical tools and procedures in policymaking processes suggests an effective strategy for PHW development in Ukraine.

Rapid Development, Training, and Implementation of a Remote Health Profession's Student Volunteer Corps During the COVID-19 Pandemic

Public health in the United States has long been challenged by budget cuts and a declining workforce. The COVID-19 pandemic exposed the vulnerabilities left by years of neglecting this crucial frontline defense against emerging infectious diseases. In the early days of the pandemic, the University of Texas Medical Branch and the Galveston County Health District (GCHD) partnered to bolster Galveston County's public health response. We mobilized interprofessional teams of students and provided training to implement projects identified by GCHD as necessary for responding to the pandemic. We provided a safe outlet for students to contribute to their community by creating remote volunteer opportunities when students faced displacement from clinical rotations and in-person didactics converted to virtual formats. As students gradually returned to clinical rotations and didactic demands increased, it became necessary to expand volunteer efforts beyond what had initially been mostly hand-selected student teams. We have passed the initial emergency response phase of COVID-19 in Galveston County and are transitioning into more long-term opportunities as COVID-19 moves from pandemic to endemic. In this case study, we describe our successes and lessons learned.