Workforce

by

Jean Moore

• LAST REVIEWED: 21 October 2016
• LAST MODIFIED: 28 May 2013
• DOI: 10.1093/obo/9780199756797-0093

Introduction

The public health system is a complex network of organizations that works to promote, protect, and preserve the health of the population as a whole. While governmental public health agencies (i.e., federal, state, and local) play a critical role in the planning and delivery of public health services, many other private and nonprofit organizations make up the public health system, including health and human services agencies, faith-based organizations, businesses, and schools. Recent concerns about natural disasters and threats of biological, chemical, and nuclear terrorism, as well as infectious diseases such as West Nile virus and Lyme disease, have raised public awareness about the need for an effective public health system. Well-prepared public health professionals are essential to an effective public health system in the United States. However, concern exists about the adequacy of the supply of public health workers and their skills and competencies. Public health draws its workforce from a wide array of professions both within and outside of health care. Health professionals in the public health workforce include registered nurses, social workers, health educators, nutritionists, physicians, and dentists, among others. Additional public health professionals include epidemiologists, sanitarians, and other environmental health workers. Some members of the workforce have had formal training in public health, but many have not. National data on the size and composition of the public health workforce are limited. The lack of clear definitions and good data make it difficult to fully assess the sufficiency of the supply of public health workers in relation to the demand for them. These issues are common threads found in public health workforce literature. This article identifies references on a variety of topics related to the public health workforce, including key areas for consideration in public health workforce research, workforce enumeration strategies, workforce recruitment and retention, and education and training of public health professionals. The author wishes to acknowledge the assistance provided by Maria A. MacPherson, RN, MPH, and Lyrysa Smith to complete this work.

General Overviews

Key reports released since the 1990s provide critical context about public health and the adequacy of this workforce to provide vital services aimed at maintaining the health of the population. The Institute of Medicine 1988 highlights the critical challenges faced by the public health system, including the lack of an adequately sized and trained workforce. Given emerging priorities in public health, US Department of Health and Human Services 1994 recommends the addition of new content to the curricula used to train public health professionals. Association of Schools of Public Health 1999 encourages the development of stronger ties between public health education and practice. Association of State and Territorial Health Officials 2004 is one of the first national reports to document concerns about health workforce shortages by state public health agencies.

• Association of Schools of Public Health (ASPH), Council of Public Health Practice Coordinators. 1999. Demonstrating excellence in academic public health practice. Washington, DC: Association of Schools of Public Health.

  Highlights concerns about the lack of strong ties between public health education and practice, particularly governmental public health. Identifies strategies for schools of public health to consider for bridging the gap between academia and practice; an emphasis is placed on practice-based research.

• Association of State and Territorial Health Officials (ASTHO). 2004. State public health employee worker shortage report: A civil service recruitment and retention crisis. Washington, DC: Association of State and Territorial Health Officials.

  Results of a 2003 workforce survey of senior health officials in all states and territories are reported with a focus on concerns about a rapidly aging public health workforce and high rates of anticipated retirements. Survey respondents cite a variety of strategies aimed at recruiting and retaining public health workers.

• Institute of Medicine. 1988. The future of public health. Washington, DC: National Academies.

  Identifies the issues that contribute to a weak and fragmented public health system, including those with clear implications for the public health workforce. The report urges an immediate call to action and identifies the steps necessary to restore an effective public health system, including the development of a better educated public health workforce.

• US Department of Health and Human Services (DHHS), Public Health Service. 1994. The public health workforce: An agenda for the twenty-first century: A report of the public health functions project. Washington, DC: US Government Printing Office.

  Describes emerging challenges in public health and recommends the addition of new content areas in the curricula used to educate public health professionals, including informatics, genomics, communication, cultural competence, community-based participatory research, global health policy and law, and public health ethics.