One infectious disease can change everything, at any time: Ebola. One storm can change anything, at any time: Hurricane Katrina. One technological innovation can change how people relate to one another, learn, and connect: smartphones. One tipping point in social vigilance can result in the resurgence of a disease once controlled: measles. One policy can catalyze transformation: the Affordable Care Act.
How do we recruit, train, support, and retain a public health workforce capable of working in this highly connected, fast-changing environment? This is an important question for governmental public health across all levels and jurisdictions.
It is imperative to have data for action, including trend data about workforce demographics, needs, gaps, impact, and programs and tools. This information is essential to planning, implementing, and evaluating workforce development programs and activities and for ensuring that workforce investments are well spent.
Examples of surveys that are tracking public health workforce trends include the profiles of state and local health departments conducted by the Association of State and Territorial Health Officials (ASTHO) and the National Association of County & City Health Officials (NACCHO), with some support from the Centers for Disease Control and Prevention (CDC) and the Robert Wood Johnson Foundation. Collectively, these profiles provide system-level information about the health department workforce, such as numbers, occupations, salaries, vacancies, projected retirements, tenure, qualifications, and other demographics. The profiles also provide information about the health department working environment, such as governance structure and factors affecting system change, including economic forces and health reform. In addition, ASTHO, NACCHO, and CDC are collaborating on improving enumeration of the public health workforce at the federal, state, and local levels.
In 2014, the de Beaumont Foundation and ASTHO partnered on the Public Health Workforce Interests and Needs Survey (PH WINS), which is the first nationally oriented survey of individual public health practitioners at the state and local health agency levels. The aims of the survey were to (1) inform future investments in workforce development; (2) establish a baseline of key workforce development metrics; and (3) explore workforce attitudes, morale, and climate. This information will be a valuable contribution to our data for action and is similar to the surveys for assessing the federal workforce. PH WINS also provides more information for making public health a more competitive and attractive sector to individuals choosing where to apply their skills and for fully developing, utilizing, and retaining those hired.
As with the results of the ASTHO, NACCHO, and other public health workforce surveys, first, CDC will use the PH WINS data to inform the creation, implementation, and evaluation of CDC's workforce development activities both within the agency and in the support CDC provides to the field. For example, the PH WINS data can inform follow-up on the priorities and action items identified through the 2012 Public Health Workforce Summit, Modernizing the Workforce for the Public's Health: Shifting the Balance, and the resulting National Public Health Workforce Strategic Roadmap.1 , 2 The roadmap depicts the key elements needed to strengthen the public health and health care workforce. To meet today's public health demands, we need professionals capable of bridging the worlds of public health and health care and embracing and utilizing innovative communication strategies and tools, and information technology, in addition to employing time-honored skills in surveillance, epidemiology, and laboratory science.
Second, CDC and others can use the PH WINS data to inform training programs (including training needs and curriculum), recruiting and mentoring trainees, and assisting trainees in transitioning to permanent jobs within public health. CDC and others need to know when and how to change or improve these activities according to current and emerging workforce needs. CDC supports a number of public health training fellowships,3 including the Epidemic Intelligence Service and the Public Health Associate Program, which provide individuals with on-the-job experience in the field. Recognizing that new skills are needed in public health practice, the CDC has developed new fellowships, for example in informatics and laboratory leadership.
Third, CDC and others can use the PH WINS data to inform training materials and products. CDC provides access to a number of free online workforce development resources, including CDC TRAIN.4 , 5 It partnered with the Public Health Foundation to develop CDC TRAIN, vastly expanding access to education and training resources for professionals who protect the public's health. As of September 2014, more than 6600 high-quality learning products were available.
Fourth, CDC and its national public health and academic partners can use the data to improve workforce development, including across sectors. These partners range from academic associations, such as the American Association of Colleges of Nursing, the Association of American Medical Colleges, the Association of Schools and Programs of Public Health, and the Association for Prevention Teaching and Research, to national public health professional associations such as the Council of State and Territorial Epidemiologists and the Association of Public Health Laboratories, to ASTHO and NACCHO. Cross-sector collaboration is essential to enhancing the teaching of population health concepts within other disciplines such as health care and to aligning approaches (curricula, teaching materials, or methods) and field experiences with ground-level public health priorities and practice needs.
Fifth, PH WINS and other public health workforce data are important in terms of shaping best practices and standards. Domain 8 of the Public Health Accreditation Board's standards and measures for accreditation of health departments is focused on maintaining a competent public health workforce.6 PH WINS is providing information relevant to this domain that can be used at a national level to inform the standards and measures over time. In turn, health departments can use these standards and measures to assess and improve their own activities and performance in this domain.
Finally, PH WINS and other public health environment surveys provide information about current and emerging health issues and needs, priorities, and factors influencing system changes that impact the public health profession and practice. CDC and others use this information to develop products and tools that support the public health workforce in conducting their work as effectively and efficiently as possible. These tools and products include guidelines, recommendations, national strategies, data about health status and trends, reports that track progress toward goals and performance improvement tools.
It is very clear that data such as those provided by PH WINS and other workforce development surveys are essential to the success of recruiting, training, and retaining a capable, sustainable, and fulfilled public health workforce. The results of these surveys will continue to be the foundation for the continuous quality improvement that is needed. These data tell the story of where we are today, where we can improve, and how to get there. We want to be able to tell a story that inspires and supports others in picking up and carrying the torch for protecting and improving population health.