The public health workforce

Defining the public health workforce and specifying its performance requirements present equal challenges as the nation anticipates public health needs for the twenty-first century. The core group of professionals employed by government public health agencies works in close partnership with a wide range of public, private, and voluntary organizations. The wider circle includes almost all physicians, dentists, and nurses, plus many other health, environmental, and public safety professionals. The task of ensuring that this workforce is prepared with skills and knowledge to face both identified and emerging public health challenges is immense.     

Migrant health: new challenges for European public health research

This issue of the European Journal of Public health containsa number of important contributions on socioeconomic inequalitiesin health. These clearly illustrate the     

Mapping the public health workforce I: a tool for classifying the public health workforce

We aimed to develop a tool to identify members of the public health workforce and classify them using categories developed for the Chief Medical Officer's project to strengthen the public health function. The tool was developed to gain a picture of London's public health workforce, and needed to be reliable and easy to use in many settings inside and outside the health service. We needed to be able to classify posts from brief information without interrogation of postholders, so that the entire workforces of large organisations could be classified from information provided by only a few key informants. Key questions and decision rules were defined by presenting interviewees in public health with brief information on nine jobs and discussing with them the process by which they determined whether each post was in the public health workforce, and if so, in which category. The questions and decision rules were refined into a classification tool which was presented as a flow diagram and a questionnaire. Application of the tool revealed that it was understood by key informants and resulted in classifications which were accepted by the researchers. The tool has now been applied extensively in London and yielded useful results. Many other applications in public health workforce planning and development are anticipated.     

Immigration and aging: new challenges in public health

Foreign migration in Spain is at present a priority in the social and demographic context the country. At a worldwide level, trends in the evolution of population and social, political and economical indicators, appear to maintain for the coming years, the present trends on migrations from poor countries to the rich ones. In the health area, considering migration as a relatively recent phenomena in Spain, and considering that is mainly constituted by young and healthy population, there are not still data available on the main health needs of migrants related to aging. Data from other countries with a longer migrant tradition, shows mental health disorders and social and cultural barriers for adaptation, as basic health determinants for older migrants. Related to the effects in the health system, the inclusion of the aging factor in general population and migrant needs, offer an optimistic panorama for future planning. Migrant aging in Spain, despite of its middle and long term perspective, do require a progressive adaptation of knowledge and resources to cover future needs. Considering this coming future, health professionals do need to be trained in intercultural skills and knowledge.     

Public health workforce: challenges and policy issues

This paper reviews the challenges facing the public health workforce in developing countries and the main policy issues that must be addressed in order to strengthen the public health workforce. The public health workforce is diverse and includes all those whose prime responsibility is the provision of core public health activities, irrespective of their organizational base. Although the public health workforce is central to the performance of health systems, very little is known about its composition, training or performance. The key policy question is: Should governments invest more in building and supporting the public health workforce and infrastructure to ensure the more effective functioning of health systems? Other questions concern: the nature of the public health workforce, including its size, composition, skills, training needs, current functions and performance; the appropriate roles of the workforce; and how the workforce can be strengthened to support new approaches to priority health problems.The available evidence to shed light on these policy issues is limited. The World Health Organization is supporting the development of evidence to inform discussion on the best approaches to strengthening public health capacity in developing countries. WHO's priorities are to build an evidence base on the size and structure of the public health workforce, beginning with ongoing data collection activities, and to map the current public health training programmes in developing countries and in Central and Eastern Europe. Other steps will include developing a consensus on the desired functions and activities of the public health workforce and developing a framework and methods for assisting countries to assess and enhance the performance of public health training institutions and of the public health workforce.     

Public health workforce development: progress, challenges, and opportunities.

The public health workforce is key to strengthening public health infrastructure. National partners have articulated a vision of a sustainable and competent workforce prepared to deliver essential public health services. Six strategic elements provide a framework for action: monitoring workforce composition; identifying competencies and developing related curriculum; designing an integrated life-long learning delivery system; providing individual and organizational incentives to ensure competency development; conducting evaluation and research and assuring financial support. Partners convened in January 2003 to review progress and to re-evaluate strategies in light of the recently released Institute of Medicine reports on infrastructure and workforce issues. Although significant challenges remain, there is convergence on priorities for competency development, research questions to be addressed and next steps in the national dialogue on certification and credentialing in public health.     

Undergraduate public health education: a workforce perspective

OBJECTIVE: To describe the career paths of students who majored in public health at the undergraduate level and to assess the skills and knowledge these graduates believed were most useful to them in the public health workforce. METHOD: A telephone survey was conducted of all graduates from Adelaide University's Bachelor of Health Sciences degree from 1992-99 who had majored in public health (124 graduates). RESULTS: The response rate to the graduate survey was 71%. Using the definition of public health functions from the National Delphi Study on Public Health Functions to delineate the public health workforce, 59% of respondents were employed in public health. Graduates working in public health valued generic skills such as communication and collaboration more highly than more specific public health skills and knowledge areas. However, they also believed their undergraduate course would have been improved by a more practical orientation. CONCLUSIONS: A high proportion of graduates from this generalist degree who major in public health find employment in the public health workforce. They greatly value the generic skills associated with their undergraduate public health education and believe their entry into the workforce would have been further facilitated by stronger links between their academic program and the working environment of public health professionals. Implications: Studies of workforce training programs in public health must differentiate between the educational needs of undergraduate and postgraduate students. In particular, strategies need to be developed to provide stronger links between undergraduate students and the public health workforce.     

公共卫生医师定位的思考

国家治理现代化进程中实现“健康中国”有赖于健全的公共卫生体系,其关键在于一支技术过硬、数量充足、能适应时代需要的公共卫生医师队伍。然而我国各界对于公共卫生医师的认知很少,公共卫生医师队伍目前存在着严重的身份危机问题。公共卫生医师的身份危机主要表现在两个方面。一是公共卫生医师的“医师”身份缺失的危机,二是公共卫生医师的功能角色模糊,存在可替代性的危机。建议应首先明确我国公共卫生医师是否为预防医学医师,重新定位设计“公共卫生医师”的角色,将预防医学本科学历作为公共卫生医师准入的基本条件,适度拓宽临床医学专业医学生考取公共卫生医师的途径,改革预防医学与公共卫生教育培养体系。     

Schools, health literacy and public health: possibilities and challenges

Health literacy is a concept that can be widely embraced by schools. Schools throughout the world contribute to the achievement of public health goals in conjunction with their educational commitments. In this paper, the interface between a school's core business of education and public health goals is identified, and examples provided in the area of nutrition demonstrating how these links can operate at school level. The structure and function of the health promoting school is described and the author proposes that there is a very close connection between the health promoting school and the enabling factors necessary in achieving health literacy. Major findings in the literature that provide evidence of good practices in school health education and promotion initiatives are described. Also, those factors that make schools effective and which facilitate learning for students are identified. There is a substantial overlap between the successful components of a health promoting school and effective schools. This enables schools to potentially achieve all three levels of health literacy, including level 3-critical health literacy. However, there are three challenges that must be addressed to enable schools to achieve this level: the traditional structure and function of schools, teachers practices and skills, and time and resources. Strategies are proposed to address all three areas and to reduce the impediments to achieving the goals of health literacy and public health using the school as a setting.     

The local public health workforce in rural communities.

This work describes the public health workforce and training needs of rural local public health agencies (LPHAs) in comparison with suburban and metropolitan LPHA jurisdictions. A survey was sent to 1,100 LPHAs nationwide. The rural urban commuting area codes (RUCAs) defined LPHAs as rural or urban, and the Standard Occupational Classification system enumerated the workforce. Most occupational classifications had significantly fewer staff in rural LPHAs. Public health nurses ranked as the most needed staff and serve in various important capacities in rural LPHAs. In terms of training, job-specific or programmatic continuing education was identified as the most important training need. Developing leadership and public health workforce capacity within rural public health is an essential agenda item for rural America. Decision makers may need to consider different organizational structures while balancing the need for local input and control. Regionalization and collaborative approaches to difficult workforce issues may present potential solutions to workforce challenges.     

The public health workforce in the year 2000.

It has been 20 years since the last estimate of the public health workforce's size and composition. This study provides a best estimate through secondary analysis of existing workforce reports, summaries, and information gathered from chief health officials in 50 states and 6 territories, public health organizations, and federal agencies. Results indicate that the workforce consists of some 448,254 persons in salaried positions as follows: 44.6 percent professionals, 4 percent officials/administrators, 14 percent technicians, and 13 percent clerical/support. Workforce size may have decreased by as much as 10 percent over the last 20 years, despite a 25 percent increase in population and rising health hazards.