Changing Competency Gaps and Modernization of the Public Health Workforce

In most areas, more than 20% of the public health workforce has competency gaps, although odds of gaps differ by demographic and position characteristics.

The public health workforce plays a vital role in health and well-being of populations. In recent years, the workforce has faced challenges in underfunding and high rates of turnover. Most recently, the COVID-19 pandemic shed unprecedented light onto the public health system and workforce and further exposed some of the challenges and strengths of the system.

Studies prior to the pandemic have described the changing dynamics of the workforce and skills and gaps of the workforce. In the 2017 Public Health Workforce Interests and Needs Survey (PH WINS), financial management, systems and strategic thinking, change management, and developing a vision for a healthy community were identified as top training needs. Further, an impending large-scale retirement of the workforce has been on the horizon. Those in leadership positions, with long careers in public health and institutionalized knowledge of the field, may leave the field and take this knowledge with them. During the COVID-19 pandemic, public health workers were faced with new responsibilities and added pressure to keep their communities safe. In addition to the pandemic, there have been shifts in what we as a society expect from the health and public health sectors, with added emphasis on understanding disparities, addressing health equity, and collaborating across sectors. With the evolving workforce, changing demands, and the pandemic, there was a need to characterize competency gaps in the current workforce.

What we did:

Using the most recent iteration of PH WINS, we compare gaps in competencies of the “traditional” public health workforce, those who were not hired for COVID-19 response, with gaps among the COVID-19 response workforce. “Gaps” are competency areas which respondents described as of “high importance” to their job and their own skill level as “low.” We specifically focused on competencies related to data, evidence-based approaches, health equity and social justice, environmental drivers of health, social determinants of health and related policies, and community health assessments, although analyses on all competency areas can be found in the supplemental materials included with our article in this special issue of the Journal of Public Health Management and Practice.

What we found:

  • For most competency areas, more than 20% of the workforce had a gap.
  • There were inconsistent changes in gaps between 2017 and 2021.
  • Tenure in public health and higher levels of education were associated with lower odds of gaps in most areas.
  • In most areas, respondents who identified as female had significantly greater odds of gaps than those who identified as male.
  • In many areas, the COVID-response workforce had significantly fewer gaps than the traditional workforce.

Other considerations:

  • Gaps are the product of the individual’s perceptions of their work requirements and skill levels. These are subjective measures.
  • Approximately three-quarters of the workforce identifies as female.
  • Those hired as COVID-19 response workers may have more specific job responsibilities, making gaps less frequent.
  • Those hired for the COVID-19 response are more likely to have recently entered the field and are more likely to have formal public health training, which may also impact the odds of having competency gaps.

What this means for public health:

Read: Public Health Workforce Interests and Needs Survey 2021 (PH WINS)

The workforce is continuing to evolve but perhaps has experienced one of the most dramatic shifts during the COVID-19 pandemic. This most recent iteration of PH WINS has found that the workforce is becoming more diverse, younger, and less likely to have formal public health training. During the pandemic, the workforce faced similar rates of intention to leave or retire as seen prior to the pandemic but with a substantial toll on their mental health and well-being. The findings from our study may help to better target training areas for the current workforce and inform competencies and curricula for schools and programs of public health to prepare the next generation.

Read Our Article in the Journal of Public Health Management and Practice:

Learn More about the 2021 PH WINS Findings:

Casey P. Balio, PhD, is a research assistant professor at the East Tennessee State University (ETSU) College of Public Health’s Center for Rural Health Research and Department of Health Services Management & Policy. Balio’s research focuses on variations in public health systems and Medicaid programs.

Nicole Galler, MPH, is a doctoral student in Department of Health Services Management & Policy at the ETSU College of Public Health. Galler has worked for the CDC Foundation and completed an internship with the National Rural Health Association. Her research interests relate to rural health and aging populations.

Michael Meit, MA, MPH, is a research associate professor at the ETSU College of Public Health and co-director of the Center for Rural Health Research. Meit has worked in rural public health research for many years.

Nathan Hale, PhD, MPH, is an associate professor in Department of Health Services Management & Policy. Hale’s research focuses on access to care for vulnerable populations and public health systems.

Kate BeattyKate E. Beatty, PhD, MPH, is an Associate Professor in the Department of Health Services Management & Policy and Center for Rural Health Research at ETSU. Beatty’s research focuses on rural health and public health systems including issues of access to public and health care services and health disparities.