Do Public Health Professionals Want to Address Their Gaps in Competency? It Depends on Job Level

Public health professionals are expected to engage in trainings to address competency gaps in core public health domains, but among professionals in non-management positions, gaps in competency often predicted disinterest in ameliorative training. 

Experts agree that competency in multiple core domains (analysis, leadership, communication, etc.) is desirable for public health professionals. Nevertheless, research indicates that the majority lack such competency. Why? Limited access to training doesn’t explain it. Free trainings on core public health domains are widely available. Numerous organizations produce them, including 10 federally funded training centers, one of which I work at. Other factors, consequently, appear to be at play. With this in mind, I examined whether a job skills pattern known in organizational psychology might be one such factor.

Organizational psychology studies report that broad skill sets often hold importance mainly for higher level employees. This follows from the fact that upper level roles in an organization often require performance of a multiplicity of tasks. It might be expected, then, that high level public health employees would want to achieve competency in an array of public health domains.

In contrast, lower level employees often specialize. Lower level public health professionals, the bulk of the public health workforce, tend to specialize as data analysts, epidemiologists, nurses, safety inspectors, and so on. They, consequently, might have limited interest in achieving competency in multiple domains.


To examine this proposition, I used data from a training preferences and domain competency survey of professionals at 14 public health departments/organizations in the US Southwest: upper managers (n = 69), middle managers (n = 332), and nonmanagers (n = 790). Support staff (receptionists, secretaries, drivers, etc.) were not included. Respondents were administered a competency assessment questionnaire that asked them to rate their skills on each of 70+ items in 8 core public health domains (Financial Planning and Management, Analysis/Assessment, Communication, Cultural Competency, Leadership/Systems Thinking, Policy Development/Program Planning, Public Health Sciences, and Community Dimensions of Practice). Respondents were also asked whether they wanted training in 25 domain-related topics (budgeting, program evaluation, community assessment, systems thinking, etc.). I examined the association of competency in core domains overall with the number of training topics desired. I also compared competency in individual core domains with desire for specific related training topics.


Overall competence and number of training topics desired

As can be seen in the Figure below, upper managers who did not have overall competence in the 8 core domains desired sharply more training topics than their competent counterparts (median of 12 topics vs 5, P = .02). But nonmanagers who lacked overall competence in the 8 domains desired fewer topics than their competent counterparts (4 vs 6, P < .001)—the opposite of the upper managers. For middle managers, a statistically significant association between lack of overall competence and interest in number of training topics was not found.

Figure. Overall Competency and Median Number of Training Topics Desired by Public Health Professionals: Upper Managers, Middle Managers, and Nonmanagers

Individual domains and specific training topics

The study’s findings for competency in individual domains (eg, the association of competency in the domain of Financial Planning and Management with desire for training in the topic of budgeting) mirrored those in the Figure. Upper managers with lesser competency in an individual domain often had significantly higher odds of desiring training related to the domain. The opposite was found for nonmanagers. And little association was indicated for middle managers.


The findings are consistent with the organizational psychology-based proposition discussed above. Additional factors, however, could help explain why upper managers were the only group for which gaps in competency predicted desire for training. For example, upper managers may be more aware of the oft-repeated message that competence in multiple domains is needed. They might also be motivated to set an example for their employees.


There appears to be a need for efforts to bring public health employees into sync with the idea that competency is needed in an array of domains. Or maybe, we need to reconsider this view of competency.

Efforts to bring more employees into sync with the idea of competency in an array of domains could include:

  • enhanced information campaigns to better educate the workforce
  • competency requirements in the workplace
  • credentialing/certification programs for employees
  • fiscal rewards for employee improvement in competency
  • public health department accreditation programs that help motivate interest in employee competency.

Alternatively, perhaps we need to move away from the idea that public health professionals generally need competency in a range of domains (eg, the 8 domains used in this study, all recommended by the Council on Linkages). It might be more useful to focus on the relative importance of domains to a professional’s job.

For instance, finance professionals in a public health department might be encouraged to first have competency in the domain of Financial Planning and Management. Then achieving competency in selected other domains (eg, Leadership/Systems Thinking and Policy Development/Program Planning) could be planned in order of importance. And some domains (eg, Public Health Sciences) could be viewed as having limited relevance. Such tailoring would likely seem more intuitive and doable to many public health professionals and their supervisors.

Consistent with this, competency assessment surveys could use assessments specific to an employee’s role: epidemiologic competency assessments for epidemiologists, nursing competency assessments for nurses, and so on. Such assessments probably would be more sensitive to change in an employee’s skills, and thus may better position public health departments to show skill growth in their workforce. If needed, some general public health competency assessment items could be included to round out the surveys.

Recommendations on public health competency and course training development have typically come from experts, often groups of experts—a top-down approach. This study looked at the competencies and training interests of employees to help inform such recommendations—more of a bottom-up approach. By doing so, it provides new information about how competency and training interests relate in public health departments, information that raises questions about decades-old recommendations regarding competency and training.

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Author Profile

James K. Cunningham
James K. Cunningham, PhD, conducts systems, policy, and workforce development research related to health. He has worked as a nonmanager and manager in public health agencies. He is a faculty member at The University of Arizona’s College of Medicine and College of Public Health and directs evaluation services for the Western Region Public Health Training Center. 

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