When the Association of State and Territorial Health Officials (ASTHO) and the de Beaumont Foundation set out to conduct the first ever nationally representative survey of state public health agency employees, we had a very specific goal. We wanted to learn about the needs of both the current public health workforce and the challenges of building the public health workforce of the future. The field of public health is experiencing transformational change, but government bureaucracy is not known for its flexibility and agility. We knew the workforce was facing limitations in addressing the current health needs of the population in the current public health system—we wanted to identify those challenges in specific, actionable terms and to learn more about the demands the workforce will face in the coming years, given the predicted shifts in the population, the environment, threats to health, developments in technology, and the transforming health system.
One of the key ways we sought to identify the future needs of the public health workforce was to convene public health leaders from across the spectrum of public health practice. In April 2013, ASTHO and the de Beaumont Foundation engaged 31 organizations and networks in a consensus-building process, including, among others, the ASTHO affiliates, the National Association of County & City Health Officials, the American Public Health Association, the Public Health Foundation, the Centers for Disease Control and Prevention, and the Health Resources and Services Administration. The participants identified the top challenges the public health workforce would face in the next 3 to 5 years and what competencies workers would need to effectively address those challenges. They prioritized systems thinking, communicating persuasively, change management, information and analytics, problem solving, and working with diverse populations as the top 6 competencies needed.1 But this process only reflected the expert opinion of public health leaders, not necessarily the opinions of workers in the trenches. We needed to hear from public health workers directly.
With the Public Health Workforce Interests and Needs Survey (PH WINS), we studied the issue from an entirely different perspective—that of a representative sample of all state health agency workers, regardless of their area of practice, place in the organizational hierarchy, or tenure in the field of public health. This was important, given that certain groups, such as young workers and racial and ethnic minorities, are traditionally underrepresented in executive and leadership positions.
We learned that there are some remarkable successes and some important challenges faced by public health agencies. State health agency workers report a high level of satisfaction with their jobs (79% are somewhat or very satisfied with their job).2 Most are mission-driven (91% joined public health to “make a difference”) and find the work meaningful (85% report knowing how their work relates to the agency's goals and priorities). They are fully engaged with their work (92% report being determined to give their best effort at work every day), and most (64%) would recommend their organization as a good place to work. Despite these encouraging numbers, however, the average age of the workforce is 48 years and approximately 38% are planning on or considering leaving governmental public health before 2020.2 This means state health agencies will lose critical experience and institutional memory. It also presents a potential opportunity to hire workers who will excel in skills necessary for the transformed health system of the future.
There are also successes and challenges with regard to the demographics of the current workforce. The current public health workforce reflects the general population with respect to the proportion of African American and Asian workers.2 Women are overrepresented and the Hispanic/Latino and young adult populations are underrepresented.2 Going forward, as we approach a majority-minority nation, as some states already are, we will need to continue to diversify our workforce and services to reflect the population we serve.
Faced with an older group of workers rapidly approaching retirement, state public health agencies will need to recruit more millennials and people of color to join government service. To retain the new, younger, and more diverse workers, state health agency leaders will need to create an environment that is welcoming, inclusive, and as satisfying for the new workers as it has been for the current workforce. Only 38% of the current workforce believes creativity and innovation are rewarded.2 To be responsive to emerging threats and the transformation of the system, as well as to create a workplace environment that keeps a younger, more diverse workforce engaged, public health leaders are going to have to transform our agencies to foster and reward creativity and innovation in the workplace. This is a tall order in the governmental context, but we should learn from entrepreneurs and technology firms and adapt their best practices to flourish within the constraints of government. We can leverage the fact that our mission to protect and improve the health of the population is appealing to the socially conscious younger generation.
The US Department of Health and Human Services vision for public heath quality defines quality as “the degree to which policies, programs, services and research for the population increase desired health outcomes and conditions in which the population can be healthy.”3 PH WINS holds great promise for deepening our understanding of workforce perspectives and needs, as well as monitoring trends and progress over time. Most importantly, PH WINS provides information that can drive our action toward improving public health agencies and our workforce. We are already using the findings to help state health agencies meet current challenges and evolve into organizations that will be even more effective in addressing the issues we will face in the future.
1. Kaufman NJ, Castrucci BC, Pearsol J, et al. Thinking beyond the silos: emerging priorities in workforce development for state and local government public health agencies. J Public Health Manag Pract. 2014;20(6):557–565.
2. Sellers K, Leider JP, Harper E, Castrucci BC. Highlights from the Public Health Workforce Interests and Needs Survey: the first nationally representative survey of state health agency employees. J Public Health Manag Pract. 2015;21(suppl 6):S13–S27.