Contemporary Public Health: Principles, Practice, and Policy

3. Public Health Workforce and Education in the United States

3 Public Health Workforce and Education in the United States Connie J. Evashwick The public health workforce is a highly diverse collection of personnel representing multiple disciplines with a wide variety of career paths and employment settings, numerous types of formal and informal training, and a broad range of job functions. In the United States formal education in public health is offered by schools of public health, master’s degree programs, clinical professionals ’ programs with specialties in public health, and colleges and universities . In addition, many of those working in public health come from other disciplines and have no formal training in public health. On-the-job training and continuing education for the workforce are provided by government public health departments, nonprofit organizations, medical centers and health systems, commercial educational enterprises, and various other organizations. This chapter presents an overview of the public health workforce and its education , emphasizing the heterogeneity and related complexities and outlining key considerations for shaping the public health workforce of the twenty-first century. For many of the relevant issues, however, the data required for precise analysis are lacking. Background The United States’ Healthy People initiative recognizes the importance of public health manpower to the nation’s health. One of the Healthy People 2020 goals is “to ensure that Federal, State, Tribal, and local health agencies have the necessary infrastructure to effectively provide essential public health services.” The report continues: 64   Connie J. Evashwick Public health infrastructure is fundamental to the provision and execution of public health services at all levels. . . . Public health infrastructure includes 3 key components that enable public health organizations . . . to deliver public health services. These components are: A capable and qualified workforce Up-to-date data and information systems Public health agencies capable of assessing and responding to public   health needs.1 Similarly, the Institute of Medicine opened its 2003 report Who Will Keep the Public Healthy? as follows: “In a world where health threats range from AIDS and bioterrorism to an epidemic of obesity, the need for an effective public health system is as urgent as it has ever been. An effective public health system requires well-educated public health professionals” (p. 1).2 Clearly, a workforce that is adequate in quantity and satisfactory in quality is essential to a wellfunctioning public health system. The Affordable Care Act of 2010 (ACA) reinforces the importance of the workforce by including a lengthy list of provisions pertaining to the supply and training of health care, including public health professionals.3 These provisions focus on direct training; infrastructure with education and training components ; and workforce analysis, planning, and enumeration, among others. Elements of the ACA also reflect the public health workforce issues for which there is a consensus on national priorities for the coming years. In summary, the public health workforce is one of the foundations of a healthy society. Despite its significance, counting and characterizing that workforce can be problematic. Definition and Enumeration The public health workforce in the United States can be described as a multidimensional mosaic of positions, functions, disciplines, degrees, and licenses . Enumerating and characterizing the public health workforce are elusive tasks. Job descriptions vary from setting to setting. Public health professionals come from an array of disciplines and formal education programs. Educational backgrounds vary widely, as do professional certifications. In an effort to capture this diversity, the Institute of Medicine defines a public health professional as follows: a person educated in public health or a related discipline who is employed to improve health through a population focus (p. 4).2 The most recent detailed, comprehensive enumeration of the U.S. public Public Health Workforce and Education in the United States   65 health workforce was done in 2000 (see box).4 The taxonomy of jobs constituting the public health workforce was based on categories used by the U.S. Bureau of Labor Statistics, refined by the Bureau of Health Professions of the Health Resources and Services Administration (HRSA). This list of occupations may be revised at a future date, but it offers a baseline. The study concluded that there were nearly 450,000 people working in public health jobs, primarily for government agencies.4 Of these, 34 percent worked at the local level, 33 percent at the state level, and 19 percent at the federal level. About 14 percent worked outside of government settings, including those employed by schools of public health, such as faculty, researchers, and...