In 2017, the Centers for Disease Control and Prevention (CDC) celebrated 10 Achievements in Public Health in the 20th century; policies, practices, and interventions that improved outcomes and lengthened life by 25 years.1 However, in the discussion of these achievements, something was noticeably absent—any recognition for the governmental public health workforce, which was essential in achieving each of these victories (Figure). From the quarantine and isolation measures in the 18th century to today, the diseases plaguing our nation have changed from flu to polio to HIV to diabetes. The one constant through all the years has been the governmental public health workforce, the critical members of the US workforce who have committed their life's work to ensuring the health of our nation.
Woltring and Novick are right, “The workforce is the most essential element in our collective efforts in assuring the public's health.”2 But it is also often the most neglected. Our nation's state and local health departments receive grant after grant that pay budget items like supplies, salaries, and purchased services, but what of the people who are tasked with achieving improved health outcomes? Somehow we believe that we will have an evolving, strengthening workforce without investing the time, energy, and thought that are truly needed to develop the workforce. If we want to be a healthy nation, we must invest in the individuals who make up our workforce and we must support agency cultures, policies, and practices that unleash innovation and creativity. Developing our workforce is the best strategy we have toward achieving the outcomes we collectively desire.
The 1988 Institute of Medicine (IOM) report, The Future of Public Health, found the public health system to be in disarray and inappropriately politicized and unnecessarily fragmented, making deliberate action difficult.3 In response, core competency sets were developed for public health generally and for specific disciplines within the field of public health (eg, epidemiology, public health nursing, or preparedness) or specific degree types (eg, the master of public health).4–9 Schools and programs of public health, public health institutes and training centers, national associations, federal agencies, foundations, and others developed a wide range of programs and trainings for emerging and existing public health professionals, which strengthened the discipline-specific knowledge and technical skills of the governmental public health workforce. However, this nearly singular focus on specialized skills, reinforced by decades of categorical funding, created a governmental public health workforce characterized by an overreliance on discipline-specific competencies and frameworks lacking in many of the skills now most in demand to address the complex and emerging problems we face.
The need for strategic skills in the public health workforce is not new. Scholars, practitioners, and policy makers have called for a continued focus on systemwide workforce for nearly 2 decades.10–17 Thirty years after the IOM called for broad, cross-cutting skills and competencies for public health practitioners,3 there is renewed emphasis and increased recognition that the governmental public health workforce requires strategic skills that allow them to transcend traditional public health disciplines to meet the evolving needs of the public.18 These strategic skills complement the workforce's existing discipline-specific expertise by increasing the reach of its expertise to other disciplines and influence factors that affect health in communities that are increasingly outside the traditional sphere of public health influence such as transportation, housing, and public safety.
While there has never been a scarcity of visions for governmental public health workforce development, implementation and execution have been uneven. Governmental public health workforce development can be best described as fractured and scattershot driven by available funding more than any strategic plan. The proliferation of competency sets has created expansive lists of needed skills, from which discerning priorities has proven difficult.19 Standards and requirements among the governmental public health workforce vary state to state without a unifying national framework. Surveys conducted by membership organizations and academia use different methods, at different times, and for different purposes, leaving the existing data unable to be combined to build a comprehensive understanding of the development and training needs of the entire public health workforce. Even when federal funders aligned to develop a national workforce agenda, the plan was not implemented and generally unheeded by the field.
We need to come together as a field, as a community, to align toward a common workforce goal. We need to recognize and leverage our existing workforce assets—like the national network of training centers funded by the Health Resources and Services Administration, the catalogue of existing trainings, the Public Health Workforce Interests and Needs Survey, the Public Health Accreditation Board, the Council on Linkages between Academia and Public Health—and identify and address the gaps and needs. We need to identify, understand, and align federal funds that support workforce development. We need a national workforce agenda with the support of public health leaders and the practitioner community—state, local, tribal, and territorial health officials; philanthropic and federal funders; academic institutions and others—and an accountability mechanism to ensure implementation. We need to align information to create one single source of information and resources on workforce development. Unless we commit to this agenda, the development of the governmental public health workforce will not improve, and, eventually, existing progress on health outcomes will erode and needed progress on emerging issues will slow.
Thanks to the Journal of Public Health Management and Practice and others, we have more knowledge about the workforce than at any previous point in the history of the governmental public health system. Knowledge, however, is not the problem. It is alignment, implementation, and a commitment to collaborate rather than duplicate. The governmental public health workforce can wait no longer and must prioritize strategic skill development. With this renewed interest in strategic skills for the governmental public health workforce, the question is whether we will act now or wait another 30 years before advancing this agenda.
1. Centers for Disease Control and Prevention. Ten great public health achievements—United States, 2001-2010. MMWR Morb Mortal Wkly Rep. 2011;60(19):619–623.
2. Woltring CS, Novick LF. Public health workforce: infrastructure's keystone. J Public Health Manag Pract. 2003;9(6):438–439.
3. Institute of Medicine (US) Committee for the Study of the Future of Public Health. The Future of Public Health. Washington, DC: National Academies Press; 1988.
4. Allegrante JP, Moon RW, Auld ME, Gebbie KM. Continuing-education needs of the currently employed public health education workforce. Am J Public Health. 2001;91(8):1230–1234.
5. Barry MM, Allegrante JP, Lamarre MC, Auld ME, Taub A. The Galway Consensus Conference: international collaboration on the development of core competencies for health promotion and health education. Glob Health Promot. 2009;16(2):5–11.
6. Calhoun JG, Ramiah K, Weist EM, Shortell SM. Development of a core competency model for the master of public health degree. Am J Public Health. 2008;98(9):1598–1607.
7. Gebbie K, Merrill J. Public health worker competencies for emergency response. J Public Health Manag Pract. 2002;8(3):73–81.
8. Gebbie KM, Qureshi K. Emergency and disaster preparedness: core competencies for nurses. Am J Nurs. 2002;102(1):46–51.
9. Markenson D, DiMaggio C, Redlener I. Preparing health professions students for terrorism, disaster, and public health emergencies: core competencies. Acad Med. 2005;80(6):517–526.
10. Baker EL Jr, Stevens RH. Linking agency accreditation to workforce credentialing: a few steps along a difficult path. J Public Health Manag Pract. 2007;13(4):430–431.
11. Cioffi JP, Lichtveld MY, Tilson H. A research agenda for public health workforce development. J Public Health Manag Pract. 2004;10(3):186–192.
12. Gebbie K, Merrill J, Tilson HH. The public health workforce. Health Aff (Millwood). 2002;21(6):57–67.
13. Gebbie KM, Turnock BJ. The public health workforce, 2006: new challenges. Health Aff (Millwood). 2006;25(4):923–933.
14. Institute of Medicine Committee on Educating Public Health Professionals for the 21st, C., in Who Will Keep the Public Healthy? Educating Public Health Professionals for the 21st Century. Washington, DC: National Academies Press; 2003.
15. Lichtveld MY, Cioffi JP. Public health workforce development: progress, challenges, and opportunities. J Public Health Manag Pract. 2003;9(6):443–450.
16. Ogolla C, Cioffi JP. Concerns in workforce development: linking certification and credentialing to outcomes. Public Health Nurs. 2007;24(5):429–438.
17. Tilson H, Gebbie KM. The public health workforce. Annu Rev Public Health. 2004;25:341–356.
18. National Consortium for Workforce Development. Building Skills for a More Strategic Public Health Workforce: A Call to Action. Washington, DC: National Consortium for Workforce Development; 2017.
19. 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.