Rising to Meet the Moment: What Does the Public Health Workforce Need to Modernize?

OBJECTIVE: This study uses findings from the most recent iterations of the Public Health Workforce Interest and Needs Survey (PH WINS) to describe importance, skill level, and gaps of key public health competencies as well as characteristics associated with gaps. DESIGN: Repeated cross-sectional analysis of the 2017 and 2021 PH WINS data. SETTING: State and local health departments. PARTICIPANTS: Nationally representative population of state and local governmental public health workers. MAIN OUTCOME MEASURES: Gaps of key public health competencies related to data, evidence-based approaches, health equity and social justice, factors that affect public health, cross-sectoral partnerships, and community health assessments and improvement plans. Gaps reflect areas of high importance and low skill level. Differences in gaps among the traditional public health workforce and those hired specifically for COVID-19 response. RESULTS: For most competency areas, more than 20% of the public health workforce perceived a gap. Gaps related to environmental factors that affect public health, social determinants of health and cross-sector partnerships, and community health assessments and improvement plans were the largest. Tenure in public health practice, highest level of education, and having formal public health training were associated with lower odds of gaps in most areas. In a secondary analysis of traditional public health workforce compared with those hired specifically for COVID-19 response, those hired for COVID-19 response reported significantly fewer gaps for all but one competency considered. CONCLUSIONS: A substantial proportion of the public health workforce perceives gaps in competency areas that are of high importance to the evolving role of public health. As public health continues to adjust and modernize in response to the COVID-19 pandemic and other historic changes, understanding and addressing training needs of the workforce will be instrumental to public health's ability to respond to the needs of the public.

Tracking the Impact of Diseases of Despair in Appalachia—2015 to 2018

Introduction: This study provides an update on mortality due to diseases of despair within the Appalachian Region, comparing 2015 to 2018. Methods: Diseases of despair include: alcohol, prescription drug and illegal drug overdose, suicide, and alcoholic liver disease/cirrhosis of the liver. Analyses are based on National Vital Statistics System (NVSS) mortality data for individuals aged 15-64. Results: Between 2015 and 2017, the diseases of despair mortality rate increased in both Appalachia and the non-Appalachian U.S., and the disparity grew between Appalachia and the rest of the county. In 2018, the disease of despair mortality rate declined by 8 percent in Appalachia, marking the first decline for the Region since 2012. Diseases of despair continue to impact the working-age population, and while males experience a higher burden of mortality due to diseases of despair, the disparity between Appalachia and the rest of the United States is greater for females. Overdose mortality rates in Appalachia increased between 2015 and 2017, followed by a decline in 2018. During this same time frame, suicide also increased notably within the Appalachian region, and the disparity between Appalachia and the non-Appalachian U.S. increased by 50 percent. Implications: These findings document that the diseases of despair continue to have a greater impact in the Appalachian Region than in the rest of the United States. While the declining trends between 2017 and 2018 are promising, data has shown that these rates are likely to increase again, particularly as a result of the COVID-19 pandemic.

Rural Appalachia Battling the Intersection of Two Crises: COVID-19 and Substance-Use Disorders.

During the COVID-19 pandemic, rural Appalachia is at great risk of unforeseen side effects including increased mortality from substance use disorders (SUDs). People living with SUDs are at increased risk for both exposure to and poor outcomes from COVID infection. The economic impacts of COVID-19 must also be considered. As rural Appalachia combats the substance use crisis amidst the COVID-19 pandemic, the geographic economic, health and social inequities within our region must be considered. As a national recovery is sought, we should reimagine federal policies that center the economic and public health of rural Appalachia addressing the two crises.