Critical Components Of The Public Health Infrastructure

The Public Health Workforce

The governmental public health infrastructure at the federal, state, and local levels consists of physical resources (e.g., laboratories), information networks, and human resources (the public health workforce). An adequately sized and appropriately trained workforce performing competently is an essential element of the public health infrastructure. The public health workforce at the federal, state, and local levels must be prepared to respond to an array of needs, such as the assurance of health-related environmental safety, the interpretation of scientific data that can influence health outcomes, or the clarification of vast amounts of highly technical information after a community emergency. In addition to meeting the scientific and technical requirements of public health practice, state and local public health officials are often expected to provide community leadership, manage community reactions, and communicate about risk, protection, and prevention.

Current estimates indicate that approximately 450,000 individuals are working in salaried public health positions, with many more contributing to this mission through nongovernmental organizations or on a voluntary basis (HRSA, 2000). Public health practitioners have training in a variety of disciplines, including the biological and health sciences, psychology, education, nutrition, ethics, sociology, epidemiology, biostatistics, business, computer science, political science, law, public affairs, and urban planning.

Recent studies have shown, however, that the current public health workforce is unevenly prepared to meet the challenges that accompany the practice of public health today. An estimated 80 percent of the current workforce lacks formal training in public health (CDC-ATSDR, 2001). Moreover, the major changes in technology, biomedical knowledge, informatics, and community expectations will continue to challenge and redefine the practice of public health, requiring that current public health practitioners receive the additional, ongoing training and support they need to update their existing skills (Pew Health Professions Commission, 1998).

Training and Education for the Public Health Workforce

Competency-Based Training

Given that early public health efforts in the United States were aimed at improving sanitation, controlling infectious diseases, assuring the safety of food and water supplies, and immunizing children, it is hardly surprising that public health workers at that time were predominantly graduates of schools of medicine, nursing, and the biological sciences. Today, however, the public health workforce has broader responsibilities and must be much more diverse. For example, as part of the performance of essential services, members of the public health workforce must be prepared to engage the community in effective actions to promote mental, physical, environmental, and social health. Advances in biomedical and genomics research and technologies have the potential to change the way public health practitioners think about population-level disease risk and how disease prevention and health promotion activities might be practiced. Moreover, rapidly evolving computer and information technologies and the use of mass media and social marketing have the potential to revolutionize health departments' access to up-to-date surveillance information, disease databases, and communications networks as well as to enhance worker productivity.

The need to strengthen the public health workforce was recognized by IOM in 1988 and has been the focus of a variety of efforts since then. Some of these activities will be discussed in the chapter on the role of academia in the public health system (Chapter 8). A few key efforts focusing on the current workforce (rather than training new workers) are also covered here. In particular, the report The Public Health Workforce: An Agenda for the 21st Century (USPHS, 1997) called for greater leadership on workforce issues from national, state, and local public health agencies; use of a standard taxonomy to better assess and monitor workforce composition; competency-based curriculum development; and greater use of new technologies for distance learning. The Taskforce for Public Health Workforce Development, established in 1999 by CDC and ATSDR, recommended six broad strategies for a national public health workforce development agenda (CDC, 2000e):

1. Monitor current workforce composition and project future needs.

2. Identify competencies and develop curricula.

3. Design integrated learning systems.

4. Use incentives to promote public health practice competencies.

5. Conduct and support evaluation and research.

6. Assure financial support for a lifelong learning system in public health.

An almost universal priority for workforce development is ensuring that all public health practitioners have mastery over a basic set of competencies involving generalizable knowledge, skills, and abilities that allow them to effectively and efficiently function as part of their public health organizations or systems (CDC-ATSDR, 2000; DHHS, 2000; CDC, 2001d) (see Appendix E for an extended list of competencies for public health workers). Many experienced public health professionals require a variety of cross-cutting competencies to help them meet the routine and emergent



Health Educators 13%

FIGURE 3-2 Public health occupations most needed in 5 years.

IT Specialists

Environmental Specialists 21%

Public Health Nurses 28%

Health Educators 13%

FIGURE 3-2 Public health occupations most needed in 5 years.

challenges of public health, as well as specialized skills and abilities in areas such as maternal and child health, community health, and genomics. In addition, a recent survey of the local public health infrastructure found that several specific public health occupations are projected to be the most needed in the coming 5 years (NACCHO, 2001e). These occupations included public health nurses, epidemiologists, and environmental specialists (NACCHO, 2001e) (see Figure 3-2).

The Council on Linkages between Academia and Public Health Practice8 has developed a list of 68 core public health competencies in eight domains (see Box 3-2), with different levels of competency expectations for frontline public health workers, senior professional staff, program specialists, and leaders (Council on Linkages between Academia and Public Health Practice, 2001). An expert panel convened by CDC, ATSDR, and HRSA has recommended adoption of this list as the basis for competency-based training of the public health workforce (CDC, 2000e). Use of this list as the basis for training and continuing education for the public health workforce

8 The Council on Linkages between Academia and Public Health Practice is composed of leaders from national organizations representing the public health practice and academic communities. The council grew out of the Public Health Faculty/Agency Forum, which developed recommendations for improving the relevance of public health education to the demands of public health in the practice sector. The council and its partners have focused attention on the need for a public health practice research agenda.

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