Schools and programs of public health are key allies in rebuilding and strengthening America’s public health workforce.

Background

The public health system in the United States provides essential services to prevent disease and injury, and to promote wellbeing. For decades, however, the public health system was under-funded, limiting the number of public health workers and public health services available to communities. Though there were calls to action to change the status through the late 1900s and early 2020s, changes in public health investments were not seen. The impacts of low investment in prevention, preparedness, and resilience were evident during the COVID-19 pandemic: many lives were lost. Facilitated by an unprecedented influx of funding, many public health units quickly scaled up their workforce to be able to meet needs.  We are now faced with the question: what comes next. Our work published in the Journal of Public Health Management and Practice, “Levers of Change: How to Help Build the Public Health Workforce of the Future,” provides some ideas and strategies for action.

Building the Public Health Workforce

Schools and programs of public health (SPPH) were established to develop interdisciplinary skilled workers to support and advance the public’s health. Over the last century, the number of SPPH has increased dramatically, and the focus of and approach to workforce development via Master of Public Health (MPH) training has shifted to keep up with current and emergent needs. Over the last decade, major shifts have occurred in SPPH’s curriculum and pedagogical approaches, with aims to support diversity of future workers, bolster workforce readiness, and develop public health leaders who collaborate with communities to facilitate movement toward social justice. Key elements to develop a robust public health workforce are in place. However, despite these shifts, gaps in the current workforce persist. To help inform ways to close these gaps quickly, we explored the factors that influence MPH program changes to then propose how MPH programs may be further engaged to help address current and future public health workforce needs.

Layers of Influence

Based on input from leadership within 43% of the accredited/applicant MPH programs in the US we found that multi-layered factors influence MPH program changes, including national-level accreditation standards, community and constituent input, organizational level strategic planning, individual/team-focused capacity building opportunities (eg, learning from peers via conferences, publications, webinars), and an individual and organizational tendency towards innovation and optimism. However, SPPH leadership noted that program-level change is best seeded from a higher level, including national initiatives and constituent (eg, workforce pipeline) input. In the last decade, national public health initiatives were perhaps the strongest influence on SPPH-change process as they gave key guidance, helped to normalize it, and gave peers a place to learn from each other. Particularly important to note is that respondents shared that it’s not just policy that guides action, but rather the engaged processes used to develop and implement calls to action. Engagement helped to seed and support the change, helping actors understand when, how, and why.

Future Actions

As we look to re-build the public health system, and the public health workforce that facilitates health equity, national public health leaders can and should take a lead role, but our research suggests that their impact can be augmented by also engaging SPPH and their constituents. Together, they wield complementary influence that can accelerate action. Four steps are suggested:

1. Support Connections

MPH program leaders express a desire to have greater connections with the public health workforce, and a deeper understanding of needs and gaps they experience. To support this, national public health leaders can redouble their efforts to create collaborative working groups, and document and disseminate needs, priorities, and successes and lessons learned. This should include publications (journal articles, reports, white papers), as well as webinars and meetings to support discussion and the development of a shared understanding and shared priorities, as MPH program leaders value learning from each other.

2. (Re-)define Who Comprises the Public Health Workforce to Acknowledge Impacts

SPPH programs are producing more graduates than ever, and yet relatively few are filling roles in the governmental public health workforce. While this trend might be good for inter-sectoral public health, it may slow government public health rebuilding efforts. National public health leaders should work with SPPH to collectively design methods to track where SPPH graduates are going, why there, and to fill what public health role. This initiative could inform a refined definition of who and what comprise “the public health workforce,” inclusive of the various roles and fields that contribute to public health. As exemplified by the COVID-19 response, public health happens at many levels and by many types of organizations. SPPH are developing graduates that fill many types of roles, developing potential for Public Health 3.0, but this workforce is not yet defined, making it hard to measure the impacts of revitalized approaches to MPH education.

3. Refine Professional Training Pathways to Best Fit Workforce Needs

With a renewed definition of the public health workforce, position-specific gaps in the government, clinical, community-based, and private-sector public health workforce should be enumerated to develop an understanding of how many people, in what types of roles, are needed, and what level or type of education is needed to support effective function. In line with shifts that other allied health professions and service professions have taken, this expanded workforce enumeration and task analysis could strategically inform future public health credentialing efforts, as well as SPPH planning, including refinement training focus and measures of success for professional bachelors and masters and doctoral-level public health training.

4. Work Locally to Develop Build Pipelines

Many sectors use competitive internship programs to both train prospective workers and develop a pipeline of skilled workers. Public health education has components of such a model, but due to limited funding and flexibility in government public heath offices, internships/applied practice experiences may be un-paid or low-wage and may not have a clear pathway to a future job, or a job with competitive wages. With the influx of federal dollars for public health systems strengthening, SPPH and government public health offices should look to develop structured and paid internship opportunities, leading to fellowships and/or employment with room for growth. Concurrently, SPPH might look to expand their partnerships with public health practitioners, government public health, and community-based organizations, both to support deeper, real-world-type learning, and to support coordinated and collaborative public health improvement. MPH programs are doing this, but there is evidence that they want even more of this, and they want help from national public health leaders to make connections.

Public health education in the US is changing to help develop a strong public health workforce. SPPH, and their faculty, staff, students, and partners are key stakeholders and that inform and catalyze action. With continued attention, advocacy, and a commitment to monitoring, evaluation, and adaptation of approaches, we can activate Levers of Change: To Help Build the Public Health Workforce of the Future.

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Genevive Meredith, DrPH, MPH, OTR, is Professor of Practice at Cornell University Department of Public & Ecosystem Health and Associate Director of the Cornell University Master of Public Health Program.