Strategies for Enhancing Governmental Public Health Workforce Well-being and Retention.

Governmental public health (GPH) agencies need a diverse, skilled, and motivated workforce to advance health and well-being, but they face a number of recruitment challenges. While there has been massive growth in public health degree programs and graduates, those with a degree in public health are underrepresented in the GPH workforce. This study evaluates potential reasons undergraduate and graduate public health degree holders are underrepresented in the GPH workforce, assesses student awareness of and interest in GPH jobs, and identifies strategies for improved recruitment. We conducted pilot focus groups to explore public health students' interest in working for GPH agencies, obstacles to employment, and how this career path could be better promoted. Eight focus groups were conducted with a total of 33 participants at 3 universities and at the Annual Meeting of the American Public Health Association. Participants were enrolled full-time in or graduated within the last year from a public health bachelor's degree program or a public health master's degree program. Undergraduates had declared a public health major and were in their senior year; graduate students were in their second year and actively job seeking; or participants graduated within the past 12 months. The focus groups sought to capture students' perspectives of GPH agencies and how they believe recruitment can be improved. Participants described attractive job attributes including fulfilling, meaningful work; a position at a mission-driven organization; and the opportunity to make an impact on their community. Governmental public health agencies were viewed as bureaucratic, lacking innovation, and underresourced. Participants reported difficulties accessing and finding relevant job postings. Key to effectively recruiting and retaining new graduates is understanding their perceptions about/experiences with GPH agencies. While GPH jobs have desired attributes, participants reported that health departments are not effectively recruiting them.

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. 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. 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. 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. 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.

In an era of diminished resources, public health agencies are being asked to do more with less. Evidence suggests that while revenues at the state and local levels have been flat or increased slightly since 2010, a large number of governmental public health agencies in the United States have been forced to cut programs and/or staff to compensate for the relative paucity of funds at their disposal. At the same time, these agencies have been challenged to effectively deploy diminished resources to develop and implement multi-level interventions in their communities and to address the many determinants of complex chronic diseases, such as diabetes mellitus and heart disease. Infectious diseases like influenza still pose significant threats to public health, placing an additional strain on departmental resources. One way many health departments are addressing the challenge posed by diminished resources is through collaborating with other partners in the public health system to protect community health.

This chapter focuses on employees in the public health workforce, specifically employee engagement, in a moment of national reckoning on racism and racial injustice that has had significant impact on governmental public health agencies. Beyond the long-standing work of public health agencies to address the long-term health impacts of racism, there is a need for agencies to make systemic changes internally in addressing discrimination, inequity, and exclusion. While employee engagement and motivation are important during typical operations, the COVID-19 pandemic illustrates the specific challenge and need to address these factors while responding to an extended worldwide crisis. Governmental public health leaders can increase employee engagement and unlock employee motivation by leveraging the important purpose and meaningful work of governmental public health as well as pay. While there are barriers in governmental systems that make extrinsic motivation challenging, leaders can create cultures that build upon intrinsic motivators to keep employees engaged.

Regional Public Health Training Centers: An Essential Partner in Workforce Development.

SPECIALTY GRAND CHALLENGE article Front. Public Health, 18 July 2013Sec. Public Health Education and Promotion https://doi.org/10.3389/fpubh.2013.00020

Given challenges to recruiting nurses to public health and the growth in national policies focused on population health, it is crucial that public health agencies develop strategies to sustain this important group of employees. The objective of this study was to examine factors that influence nurses' decisions to work in public health agencies. This cross-sectional study examined perspectives of nurses who worked in state and local public health departments and responded to the 2010 Council on Linkages Between Academia and Public Health Practice's survey of public health workers. We calculated the mean rating of each recruitment and retention factor for nurses and non-nurses separately and compared differences by using t tests. We then used multivariate regression analysis to examine differences in ratings by role (ie, nurse or non-nurse). After controlling for personal and organizational characteristics, the influence of 5 recruitment factors was significantly stronger among nurses than among non-nurses: flexibility of work schedule ( P < .001), autonomy/employee empowerment ( P < .001), ability to innovate ( P = .002), specific duties and responsibilities ( P = .005), and identifying with the mission of the organization ( P = .02). The influence of 5 retention factors was stronger among nurses than among non-nurses : autonomy/employee empowerment ( P < .001), flexibility of work schedule ( P < .001), specific duties and responsibilities ( P < .001), opportunities for training/continuing education ( P = .03), and ability to innovate ( P = .008). Some factors that influence nurses to begin and remain working in local governmental public health agencies, such as flexible schedules and employee autonomy, are factors that governmental public health agencies can design into positions and highlight when recruiting from health care organizations, private industry, and academia.

Health care systems in countries around the world are focused on improving the health of their populations. Many countries face common challenges related to capturing, structuring, sharing and acting upon various sources of information in service of this goal. Information science, in combination with information and communications technologies (ICT) such as online communities and cloud-based services, can be used to address many of the challenges encountered when developing initiatives to improve population health. This presentation by RTI International will focus on the development of the Public Health Quality Improvement Exchange (www.phqix.org), where informatics and ICT have been used to develop new approaches to public health quality improvement; a challenge common to many nations. The presentation will also identify lessons learned from this effort and the implications for Gulf Cooperation Council (GCC) countries. This presentation addresses two of Qatar's Cross-cutting Research Grand Challenges; "Managing the Transition to a Diversified, Knowledge-based Society," and "Developed modernized Integrated Health Management." The first grand challenged is addressed by our research on the use of social networks and their relationship to public health practice environments. The second is addressed through our research in the development of taxonomies that align with the expectations of public health practitioners to facilitate information sharing [1]. Health care systems aim to have the most effective practices for detecting, monitoring, and responding to communicable and chronic conditions. However, national systems may fail to identify and share lessons gained through the practices of local and regional health authorities. Challenges include having appropriate mechanisms for capturing, structuring, and sharing these lessons in uniform, cost-effective ways. The presentation will explore how a public health quality improvement exchange, where practitioners submit and share best practices through an online portal, help address these challenges. This work also demonstrates the advantages of a user-centered design process to create an online resource that can successfully accelerate learning and application of quality improvement (QI) by governmental public health agencies and their partners. Public health practitioners, at the federal, state, local and tribal levels, are actively seeking to promote the use of quality improvement to improve efficiency and effectiveness. The Public Health Quality Improvement Exchange (PHQIX) was developed to assist public health agencies and their partners in sharing their experiences with QI and to facilitate increased use of QI in public health practice. Successful online exchanges must provide compelling incentives for participation, site design that aligns with user expectations, information that is relevant to the online community and presentation that encourages use. Target audience members (beneficiaries) include public health practitioners, informatics professionals, and officials within health authorities. This discussion aims to help audience members understand how new approaches and Web-based technologies can create highly reliable and widely accessible services for critical public health capabilities including quality improvement and data sharing. 1. Pina, J., et al., Synonym-based Word Frequency Analysis to Support the Development and Presentation of a Public Health Quality Improvement Taxonomy in an Online Exchange. Stud Health Technol Inform, 2013. 192: p. 1128.

Discipline-specific workforce development initiatives have been a focus in recent years. This is due, in part, to competency-based training standards and funding sources that reinforce programmatic silos within state and local health departments. National leadership groups representing the specific disciplines within public health were asked to look beyond their discipline-specific priorities and collectively assess the priorities, needs, and characteristics of the governmental public health workforce. The challenges and opportunities facing the public health workforce and crosscutting priority training needs of the public health workforce as a whole were evaluated. Key informant interviews were conducted with 31 representatives from public health member organizations and federal agencies. Interviews were coded and analyzed for major themes. Next, 10 content briefs were created on the basis of priority areas within workforce development. Finally, an in-person priority setting meeting was held to identify top workforce development needs and priorities across all disciplines within public health. Representatives from 31 of 37 invited public health organizations participated, including representatives from discipline-specific member organizations, from national organizations and from federal agencies. Systems thinking, communicating persuasively, change management, information and analytics, problem solving, and working with diverse populations were the major crosscutting areas prioritized. Decades of categorical funding created a highly specialized and knowledgeable workforce that lacks many of the foundational skills now most in demand. The balance between core and specialty training should be reconsidered.

Every day in communities across the nation, our public health system and public health workforce are striving to help everyone get and stay healthy.Our public health workforce has worked overtime during the COVID-19 pandemic to protect our communities, and while we are grateful for the temporary emergency funding provided by Congress to help state and local health departments, we know that we must ensure our public health system and workforce

Public health practitioners, policy makers, and researchers alike have called for more data on individual worker's perceptions about workplace environment, job satisfaction, and training needs for a quarter of a century. The Public Health Workforce Interests and Needs Survey (PH WINS) was created to answer that call. Characterize key components of the public health workforce, including demographics, workplace environment, perceptions about national trends, and perceived training needs. A nationally representative survey of central office employees at state health agencies (SHAs) was conducted in 2014. Approximately 25,000 e-mail invitations to a Web-based survey were sent out to public health staff in 37 states, based on a stratified sampling approach. Balanced repeated replication weights were used to account for the complex sampling design. A total of 10,246 permanently employed SHA central office employees participated in PH WINS (46% response rate). Perceptions about training needs; workplace environment and job satisfaction; national initiatives and trends; and demographics. Although the majority of staff said they were somewhat or very satisfied with their job (79%; 95% confidence interval [CI], 78-80), as well as their organization (65%; 95% CI, 64-66), more than 42% (95% CI, 41-43) were considering leaving their organization in the next year or retiring before 2020; 4% of those were considering leaving for another job elsewhere in governmental public health. The majority of public health staff at SHA central offices are female (72%; 95% CI, 71-73), non-Hispanic white (70%; 95% CI, 69-71), and older than 40 years (73%; 95% CI, 72-74). The greatest training needs include influencing policy development, preparing a budget, and training related to the social determinants of health. PH WINS represents the first nationally representative survey of SHA employees. It holds significant potential to help answer previously unaddressed questions in public health workforce research and provides actionable findings for SHA leaders.

The public health (PH) workforce shortage poses a significant threat to the US population. Despite an increase in PH programs attracting students, there is a need to enhance diversity within local and state PH departments. While internships are recognized as valuable entry points into the PH field, research on the effectiveness of such pathway programs for recruiting diverse candidates is limited. Sponsored by the Connecticut (CT) Department of Public Health and supported by the CDC Crisis Response Cooperative Agreement: COVID-19 Public Health Workforce Supplemental Funding, the CT Public Health Fellowship Program (PHFP) aims to generate interest in PH careers by placing students in high-quality fellowship positions in CT. Third- or fourth-year undergraduates and graduate students enrolled in PH programs receive administrative support, one-on-one coaching, orientation, and a $3500 stipend to facilitate their internships. From January 2023 to May 2024, 97 out of 205 applicants were admitted to the PHFP. Acceptance was on a rolling basis, accommodating academic schedules, personal limitations such as work/family obligation or transportation access, and host agency capacities. We analyzed program data from PHFP applications. Chi-square tests and t-tests were conducted to assess differences between PHFP fellows and non-fellows. The results were not statistically significant. Additionally, fellows were compared to a representative sample of PH students from the US, New England, and CT. The PHFP has a strong potential to help replenish and diversify the PH workforce and enhance health equity. Future research should examine the long-term impacts of such PH experiential learning initiatives on a large scale.

Context:Workforce surveillance efforts have long been called for in public health: the Public Health Workforce Interests and Needs Survey (PH WINS) answers that call.Objective:To characterize the state of the governmental public health workforce among State Health Agency-Central Office (SHA-CO) staff across the United States.Design:The SHA leadership were contacted and invited to have their agency participate in PH WINS 2017 as a census-based fielding. Participating agencies provided staff lists, and staff were then directly invited by e-mail to participate in a Web-based survey. Pearson and Rao-Scott χ2 analyses are employed in descriptive analyses. Balanced repeated replication weights account for design and nonresponse.Setting and Participants:SHA-CO staff.Main Outcome Measures:The PH WINS focuses on 4 primary domains: perceptions of workplace environment and job satisfaction, training needs, national trends, and demographics. In addition, measures of intent to leave and employee burnout are analyzed.Results:The state governmental public health workforce is primarily female (72%), non-Hispanic white (64%), and 46 years of age or older (59%). Nearly one-third (31%) of the workforce is older than 55 years, with 9% aged 30 years or younger. Overall, 74% of respondents indicated that they had at least a bachelor's degree, and 19% indicated having a public health degree of some kind. Seventy-nine percent of the respondents indicated that they were somewhat/very satisfied with their jobs. Approximately 47% of SHA-CO staff say that they are considering leaving or are planning to retire. With respect to training needs, the largest overall gaps for the state health agency workforce were observed in budget and financial management, systems and strategic thinking, and developing a vision for a healthy community.Conclusions:PH WINS represents the first nationally representative survey of governmental public health staff in the United States. It holds potential for wide usage from novel workforce research to identifying and helping address practice-based needs.

Background During the past decades, the growth of knowledge to prevent disease on the one hand and the growth of public acceptance to prevent disease on the other hand led to form public health systems. Soon after, health was no longer considered as an individual responsibility only, and more effective interventions against health threats and communicable diseases were developed. As a result, public agencies and authorities were established to implement newly discovered interventions against health threats and to prevent non-communicable diseases. Though, the orientation of public health agencies and authorities shifted from prevention of disease to promotion of health in almost all countries, their public health systems are developed widely differently. While some countries look back to traditionally established public health systems, others are pursuing different approaches to achieve Health in All Policies through policy and legislation in Wales or are now evaluating their public health policies after a ten-years-strategy, like Sweden and still others have only recently (2015) introduced a new Preventive Health Care Act and follow a bottom up approach called “Future Forum Public Health”, like Germany. Objectives This workshop aims at presenting the very different perspectives on the achievement of public health and different systems around Europe. Both, the disparity of the approaches and their different forms, and different stages of their development will be addressed by each presentation. Despite differences of the public health systems in each context, the workshop will focus on identifying shared features and common challenges of the countries with the goal of identifying inspiring examples and discussing criteria of transferability. During the discussion that will follow, different possibilities of cooperation and exchange will be assessed and debated. In particular, the workshop will encompass a presentation from Wales on “the future generation’s act” and will include information on the requirements to turn the legislation into practice. The Swedish input will focus on the Swedish national public health policy and its achievements after ten years. France will give an overview of the structural developments during the last ten years. The presentation from Germany will consist of contrasting a top-down and a bottom-up approach, namely the act to strengthen health promotion and prevention in Germany on the one hand and the future forum public health on the other hand. And last but not least, we will hear about the particular success of the Slovenian example with a newly shaped and largely developed public health system. Key messages Acquiring insight into different approaches to achieve improvements in public health based on alternative systems is important to identify inspiring examples, shared features and common challenges. Identification of criteria of transferability of public health strategies, legislation and policies between countries, and requirements for implementation are crucial for learning from best practice.

Undergraduate public health education: a workforce perspective.