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«Strategies for Enumerating the U.S. Government Public Health Workforce A Joint Report of the Center of Excellence in Public Health Workforce Studies, ...»

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Strategies for Enumerating

the U.S. Government

Public Health Workforce

A Joint Report of the Center of Excellence

in Public Health Workforce Studies,

School of Public Health, University of Michigan,

and the Center of Excellence

in Public Health Workforce Research and Policy,

College of Public Health, University of Kentucky

February 2012

This report was commissioned in partial fulfillment of contracts with the Centers for Disease Control and

Prevention and the Health Resources and Services Administration, awarded through a cooperative agreement with the Public Health Foundation [University of Michigan No. DRDA 10-PAF-1243 and University of Kentucky No. 3048107810].

Suggested Citation: University of Michigan/Center of Excellence in Public Health Workforce Studies, University of Kentucky/Center of Excellence in Public Health Workforce Research and Policy. Strategies for Enumerating the U.S. Government Public Health Workforce. Washington, DC: Public Health Foundation; 2012. Available at: http://www.phf.org.

Prepared by Center of Excellence in Public Health Workforce Studies School of Public Health, University of Michigan Principal Investigator: Matthew L. Boulton, MD, MPH Senior Research Specialist: Angela J. Beck, MPH, CHES 1415 Washington Heights, M5224 SPH II Ann Arbor, MI 48109-2029 Phone: 734-615-6041 E-mail: mboulton@umich.edu or ajbeck@umich.edu Center of Excellence in Public Health Workforce Research and Policy College of Public Health, University of Kentucky Principal Investigators: F. Douglas Scutchfield, MD, and Cynthia D. Lamberth, MPH, CPH Project Manager: Susan C. Webb, MSW, MPH 121 Washington Ave., Suite 212 Lexington, KY 40536-0003 Phone: 859-218-2024 E-mail: scutch@uky.edu or cdlamb2@uky.edu Project Officers Centers for Disease Control and Prevention Scientific Education and Professional Development Program Office Mehran S. Massoudi, PhD, MPH CAPT, US Public Health Service Associate Director for Science Fátima Coronado, MD, MPH Deputy Associate Director for Science Health Resources and Services Administration Bureau of Health Professions Edward Salsberg Director, National Center for Health Workforce Analysis Nadra Tyus, DrPH, MPH Public Health Analyst, National Center for Health Workforce Analysis

The authors gratefully acknowledge the assistance of the following:

Robin P. Pendley, MPH, CPH, and Tourette Jackson, DrPH, Research Assistants, Center for Public Health Systems and Services Research, College of Public Health, University of Kentucky Ron Bialek, MPP, President, Public Health Foundation Carol Gotway Crawford, PhD, Centers for Disease Control and Prevention The National Advisory Committee to the Centers of Excellence Peter I. Buerhaus, PhD, RN, FAAN, Vanderbilt University Claude Earl Fox, MD, MPH, Florida Public Health Institute, University of Miami C. William Keck, MD, MPH, Northeastern Ohio Universities College of Medicine David Meltzer, MD, PhD, University of Chicago Jacqueline A. Merrill, RN, MPH, DNSC, Columbia University J. Henry Montes, MPH, American Public Health Association Education Board Debra Perez, PhD, MPA, MA, Robert Wood Johnson Foundation George Stamas, MA, Bureau of Labor Statistics Hugh H. Tilson, MD, DrPH, University of North Carolina Gillings School of Global Public Health Former Members Linda T. Bilheimer, PhD Kristine M. Gebbie, DrPH, RN Darrell Landreaux, Lt Col, USAF Roger Straw, PhD Enumerating the Public Health Workforce

–  –  –




Public Health Workforce Research Summary

Centers of Excellence Objectives


Case Definition Used by the 2010–2011 COE Project

Public Health Workers Not Included in the Project Case Definition

Public Health Workers Included in the Case Definition Who Are Undercounted or Not Counted

Public Health Workers Who Are Overcounted or Double-Counted

Defining the Public Health Workforce for Long-Term Activities


Data Sources Available for Immediate Use

Data Sources with Potential for Future Use — Additional Research Required

Data Sources Not Recommended for Enumeration/Workforce Surveillance



Administrative or Clerical Personnel

Behavioral Health Professional

Emergency Preparedness Staff

Environmental Health Worker


Health Educator

Laboratory Worker


Public Health Dentist

Public Health Informatics Specialist

Public Health Manager

Public Health Nurse

Public Health Physician

Public Information Specialist

Other Public Health Professional/Uncategorized Public Health Workers


State and Territorial Health Department Workforce

Local Health Department Workforce

Enumerating the Public Health Workforce




Developing a National Public Health Workforce Enumeration Study

Implementing a National Public Health Workforce SLS





–  –  –

ABPM American Board of Preventive Medicine ACPM American College of Preventive Medicine ACS American Community Survey APHL Association of Public Health Laboratories ASPH Association of Schools of Public Health ASTHO Association of State and Territorial Health Officials ASTPHND Association of State and Territorial Public Health Nutrition Directors BLS Bureau of Labor Statistics CDC Centers for Disease Control and Prevention CEPH Council on Education for Public Health CHP Center for Health Policy (Columbia University) CHWs Community Health Workers COEs Centers of Excellence CPDF Central Personnel Data File CPS Current Population Survey CSTE Council of State and Territorial Epidemiologists DHHS U.S. Department of Health and Human Services DHS U.S. Department of Homeland Security DoD U.S. Department of Defense ECAs Epidemiology Capacity Assessments EMS emergency medical services EPA U.S. Environmental Protection Agency FTEs full-time equivalents HRSA Health Resources and Services Administration IHS Indian Health Service IOM Institute of Medicine NACCHO National Association of County and City Health Officials NAICS North American Industry Classification System NEHA National Environmental Health Association NHTSA National Highway Traffic Safety Administration NIHB National Indian Health Board NSF National Science Foundation NSSRN National Sample Survey of Registered Nurses OES Occupational Employment Statistics OPM Office of Personnel Management RNs registered nurses RWJF Robert Wood Johnson Foundation SLS surveillance-like system SOCs Standard Occupational Classifications TRAIN TrainingFinder Real-Time Affiliate Integrated Network USDA U.S. Department of Agriculture VA U.S. Department of Veterans Affairs WIC Women, Infants, and Children

–  –  –

Introduction: Developing and maintaining a competent and effective public health workforce is an important goal for the U.S. Department of Health and Human Services (DHHS), as outlined in its Healthy People initiative (Available at: http://www.healthypeople.gov/2020/ topicsobjectives2020/overview.aspx?topicid=35). Enumeration and surveillance are key strategies for analyzing data regarding the size and composition of the public health workforce, and the continual monitoring of these data is essential to determining how to improve and maintain workforce competency and effectiveness. The Centers for Disease Control and Prevention and the Health Resources and Services Administration jointly funded a 1-year project through a cooperative agreement with the Public Health Foundation to have two Centers of Excellence, one at the University of Michigan and the other at the University of Kentucky, to address the following objectives: (1) outline options for developing a sustainable, systematic, and replicable plan for enumerating and characterizing the nation’s public health workforce on an ongoing basis; (2) determine desired data elements required to provide useful information about the nation’s public health workforce; (3) review available data sources regarding the public health workforce; assess usability of data for national enumeration purposes; and determine information or elements that are missing or unavailable; (4) develop formal recommendations for a proposed surveillance-like system for ongoing enumeration of the public health workforce; and (5) work with stakeholders to build consensus for developing an enumeration plan. This activity will be an ongoing, long-term element aimed at achieving a desired, useful system that can assist with evidence-based policy development regarding public health workforce concerns.

Methods: To meet these objectives, a case definition of the public health workforce was developed that focuses on a subset of workers employed in nontribal local, state, and federal government agencies. A comprehensive review of available public health workforce data sources was completed to determine whether existing data sources can be used to implement an enumeration study and to establish a surveillance-like system for long-term monitoring of the public health workforce. Finally, recommendations for public health workforce enumeration and surveillance were developed.

Results: Fifteen distinct data sources were reviewed and evaluated on the basis of specific criteria, including reliability, validity, frequency of data collection, and accessibility. No one data source has the breadth and specificity to provide adequate information regarding the size and composition of the entire public health workforce as outlined in the case definition for this project. Data from multiple sources have the potential to be used collectively to provide the information necessary for public health workforce enumeration and surveillance; however, all data sources have limitations, and some might require greater modification than others to be rendered more useful for these purposes. The required minimum data elements identified for use in public health workforce surveillance focus on demographic characteristics of the workforce (e.g., age, sex, race/ethnicity, and income); education and training characteristics (e.g., academic degrees, licensure/certification, and years of experience in current position); and job characteristics (e.g., full-time equivalent level, agency type [public health department or other], employment type [regular versus contract employee], job classification, job function, and service area zip code). These elements assume organizational-level data collection; additional elements can be added if primary data collection is undertaken at the individual worker level, although this is correspondingly more complex and resource-intensive than data collected at the organizational level.

Enumerating the Public Health Workforce

Recommended Actions: The next steps for implementing a public health workforce enumeration study and surveillance-like system should include (1) identifying a working group of workforce researchers and stakeholders; (2) developing, though the working group, a consensus regarding key concerns, chief among them being development of a common public health workforce taxonomy, identification of methods for implementing additional or modified data collection with the help of national public health professional organizations, and defining strategies for modifying national data sources (e.g., data generated from the Bureau of Labor Statistics); (3) working with federal partners to refine federal public health workforce estimates further; (4) assisting public health organizations with data collection and analysis as necessary;

(5) producing an enumeration estimate; and (6) developing a test model of a public health workforce surveillance-like system in a subset of states.

–  –  –

Developing and maintaining a competent and effective public health workforce is a crucial goal for the U.S. Department of Health and Human Services (DHHS), as outlined in its Healthy People initiative.1 Although progress has been made toward achieving this goal, much remains to be done as a result of inconsistencies in defining the persons the public health workforce comprises and the lack of consensus regarding workers’ training. No standards or benchmarks exist that specify the ideal mix of education, experience, and diversity needed to produce an effective workforce.

Public Health Workforce Research Summary

Although research is being conducted on staffing patterns of health departments, cultural competence, and other workforce competencies, these efforts have been hampered by a considerable lack of data about the public health workforce.2–4 Knowledge is limited regarding the workers the workforce comprises — how many workers populate it, what disciplines are represented, where workers deliver essential services, or how effective they are at doing so.

Perhaps even less is known about the demographic composition of the workforce — their sex, race/ethnicity, educational backgrounds, reasons for entering public health, reasons for staying, or how they adapt to new demands as disease and population trends change and unstable funding affects their job security and future career prospects.

More attention has been focused recently on answering these critical questions regarding the public health workforce. In 2007, recognizing renewed interest in workforce research, Carol Gotway Crawford, PhD, then the Associate Director of Science in the Office of Workforce and Career Development at the Centers for Disease Control and Prevention (CDC), convened a stakeholders’ meeting. An outgrowth of that workshop was a seminal workforce research article published by Crawford et al.5 To advance the public health workforce research agenda, Crawford et al. recommended eight

broad research themes, as follows:

1. workforce size and composition;

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