Secondary Logo

Share this article on:

Rebooting Our Boots on the Ground

Hunter, Edward L. MA

Journal of Public Health Management and Practice: November/December 2015 - Volume 21 - Issue - p S1–S2
doi: 10.1097/PHH.0000000000000315

Supplemental Digital Content is Available in the Text.

de Beaumont Foundation, Bethesda, Maryland.

Correspondence: Edward L. Hunter, MA, de Beaumont Foundation, 7501 Wisconsin Ave, Ste 1310E, Bethesda, MD 20814 (

The author is President and CEO of the de Beaumont Foundation.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

If the state and local public health workforce represents the “boots on the ground” that protect and promote our health, we may be heading for a significant rebooting. With public health budgets stabilizing after losses1 associated with the Great Recession, we can focus discussion of how to rebuild and retool the workforce to match the needs of the future. Importantly, our goal is not to stabilize or preserve static organizations—rather, we need institutions that move forward, adapt, and transform to meet new needs.

The reemergence of Ebola and measles is a reminder of the continuing urgency of traditional governmental public health functions as well as the need to improve foundational systems and capacities. At the same time, the work of public health takes place amid multiple transformations in the US health system, stimulating an evolution in the role of public health agencies. These transformations include:

  • implementation of the Patient Protection and Affordable Care Act (ACA) and the introduction of new players (eg, Accountable Care Organizations and other delivery system models) with vested interests in “population health”;
  • an increasing emphasis on partnerships (eg, between primary care and public health) and policy solutions to advance a public health agenda as well as new demands for evidence to support these efforts;
  • accreditation of public health agencies as part of efforts to improve quality, performance, and accountability;
  • the development of new leadership roles across communities, including the involvement of governmental public health with health care delivery systems in community health needs assessments and the investment of community benefit dollars; and
  • greater public policy attention to social determinants of health.

These transformations contribute to the demand for a public health workforce that is increasingly skilled in areas such as informatics, community and multisector partnerships, and business-related analytics that are currently underrepresented in governmental agencies. Cutting across specific skill sets and program areas, leadership and staff will need to be politically savvy, innovative, adaptive, and motivated.

Even as we forecast a period of comparative stability in aggregate employment numbers in state and local governmental public health agencies, we can anticipate significant churn in which unprecedented numbers of workers retire or transition to other jobs.2–4 This places priority on maintaining continuity in core capacities as experience, leadership, and skills are lost. At the same time, it is an opportunity to reload and refresh the workforce by elevating existing talent, retooling for underrepresented skill sets (such as informatics),5 and diversifying demographics and talents.

Addressing this coming changeover in the workforce presents multiple imperatives and opportunities, including the following:

  • Prioritizing efforts associated with job satisfaction and retention—including training.6 Funders can help support training by making it an allowable expense under federal and private grants.
  • Rethinking approaches to learning in place (both formal training and experiential learning), including improvements in e-learning, certificate programs, and other ways to quickly address skill gaps.
  • Building on the Association of Schools and Programs of Public Health's Governmental Public Health Workforce Development Expert Panel report7 to evaluate academic public health curricula to ensure that the governmental public health workforce has a pipeline of well-equipped staff. Schools can also encourage programs that connect students to health agencies as potential employers that are aligned with the values that brought them into public health schools.
  • Focusing on approaches to preparing existing mid-level staff for leadership, including skills in informatics, business management, public-private and cross-sector partnerships, and systems thinking.
  • Building a greater sense of community around the mission of public health. This is a significant factor in satisfaction and retention and can be a powerful competitive edge in recruitment. Keeping a strong sense of mission is particularly important in challenging political environments, and as we consider nontraditional partnerships to amplify our impact.
  • Establishing programs that encourage existing leaders to focus on mentoring those who will fill their shoes. This is rewarding to both mentor and mentee, and can sustain a legacy after a career in governmental public health.
  • Developing mechanisms to understand where younger workers, who now typically experience shorter tenures at a single agency, move for their next jobs. Rather than considering them lost to the public health mission, we can develop strategies to ensure that they will be equipped with skills and attitudes toward governmental public health that will make them effective partners or ambassadors in new settings.
  • Building stronger alumni networks that can help turn former staff into effective public health champions or partners once they leave government.

The Public Health Workforce Interests and Needs Survey (PH WINS) provides an important window into the governmental public health workforce as these agencies face critical transitions. In some cases, it puts numbers around challenges we had already sensed, allowing us to confront them more directly.

PH WINS shows the enormity of our challenge as well pointing to opportunities. This undertaking allows us to document and assess the workforce in ways not previously attempted. PH WINS has many and varied uses, only a fraction of which are documented in this supplement. Ideally, the availability of these results—and the availability of public use files for further analysis—will stimulate not only further research but also action. This supplement points to promising and practical steps that can be taken, including by federal officials (as outlined in the Centers for Disease Control and Prevention and Health Resources and Services Administration commentaries) as well as at the state and local levels and in academia.

The talent and commitment of those at the front lines of public health are critical assets in improving our nation's health. In recent decades, this workforce has delivered dramatic improvement in health and life expectancy, enabling improved quality of life and economic prosperity. Empowered with new tools and approaches, public health agencies are poised for even greater impact—but they must address the workforce challenges that could undermine their success.

Helping transform the practice of public health is the principal focus of the de Beaumont Foundation, and we are committed to supporting strategies to better equip governmental public health agencies and their leaders to address these challenges. PH WINS was developed as part of this focus, as are our other initiatives in workforce and infrastructure development. We look forward to continuing our work with partners in the public health and academic communities to use PH WINS to move forward on practical solutions (see Supplemental Digital Content available at

Back to Top | Article Outline


1. National Association of County & City Health Officials. Local Health Department Budget Cuts and Job Losses: Findings From the 2014 Forces of Change Survey. Washington, DC: National Association of County & City Health Officials; 2014. Accessed August 11, 2015.
2. Liss-Levinson R, Bharthapudi K, Leider JP, Sellers K. Loving and leaving public health: predictors of intentions to quit among state health agency workers. J Public Health Manag Pract. 2015;21(suppl 6):S91–S101.
3. Sellers K, Leider JP, Harper M, et al. Highlights from the Public Health Workforce Interests and Needs Survey: the first nationally representative survey of state health agency employee. J Public Health Manag Pract. 2015;21(suppl 6):S13–S27.
4. Porshaban D, Basurto-Davila R, Shih M. Building and sustaining strong public health agencies: determinants of workforce turnover. J Public Health Manag. Pract. 2015;21(suppl 6):S80–S90.
5. Baker EL. Addressing urgent public health workforce needs: building informatics competency and strengthening management and leadership skills. J Public Health Manag. Pract. 2015;21(suppl 6):S5–S6.
6. Harper E, Castrucci BC, Bharthapudi K, Sellers K. Job satisfaction: a critical, understudied facet of workforce development in public health. J Public Health Manag Pract. 2015;21(suppl 6):S46–S55.
7. Association of Schools and Programs of Public Health, Association of State and Territorial Health Officials. Framing the Future: Governmental Public Health Workforce Development Expert Panel. Washington, DC: Association of Schools and Programs of Public Health; 2015. Accessed August 11, 2015.

Supplemental Digital Content

Back to Top | Article Outline
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.