Not Only How Much But How: The Importance Of Diversifying Funding Streams In A Reimagined Public Health System.

Revenue diversification may be a synergistic strategy for transforming public health, yet few national or trend data are available. This study quantified and identified patterns in revenue diversification in public health before and during the COVID-19 pandemic. We used National Association of County and City Health Officials' National Profile of Local Health Departments study data for 2013, 2016, 2019, and 2022 to calculate a yearly diversification index for local health departments. Respondents' revenue portfolios changed fairly little between 2016 and 2022. Compared with less-diversified local health departments, well-diversified departments reported a balanced portfolio with local, state, federal, and clinical sources of revenue and higher per capita revenues. Less-diversified local health departments relied heavily on local sources and saw lower revenues. The COVID-19 period exacerbated these differences, with less-diversified departments seeing little revenue growth from 2019 to 2022. Revenue portfolios are an underexamined aspect of the public health system, and this study suggests that some organizations may be under financial strain by not having diverse revenue portfolios. Practitioners have ways of enhancing diversification, and policy attention is needed to incentivize and support revenue diversification to enhance the financial resilience and sustainability of local health departments.

Contemporary Public Health Finance: Varied Definitions, Patterns, and Implications.

The financing of public health systems and services relies on a complex and fragmented web of partners and funding priorities. Both underfunding and "dys-funding" contribute to preventable mortality, increases in disease frequency and severity, and hindered social and economic growth. These issues were both illuminated and magnified by the COVID-19 pandemic and associated responses. Further complicating issues is the difficulty in constructing adequate estimates of current public health resources and necessary resources. Each of these challenges inhibits the delivery of necessary services, leads to inequitable access and resourcing, contributes to resource volatility, and presents other deleterious outcomes. However, actions may be taken to defragment complex funding paradigms toward more flexible spending, to modernize and standardize data systems, and to assure equitable and sustainable public health investments.

Enhancing Workforce Pathways: Insights From a Paid Internship Pilot Program Linking Public Health Students and Local Health Departments.

The persistent understaffing of the governmental public health workforce has led to program cutbacks, staff burnout at local health departments (LHDs), and an urgent need to replenish staffing. To build recruitment pathways into LHDs and build their workforce capacity, we introduced a paid internship initiative connecting Master's in Public Health students from a Midwestern university with LHDs in the state. This article presents the pilot program developed and the insights gained from it. Program participants included nine LHDs that hosted 10 students for 12-week internships. Internship projects were developed by LHDs with support from the state's association of county and city health officials. All students completed their internship projects satisfactorily. The experience highlighted that while students contributed to LHDs through short-term projects, with sustained backing and minor adjustments, this model can serve to reinforce the governmental public health sector's existing and future capacity in the long term.

What Are Public Health Agencies Planning for Workforce Development? A Content Analysis of Workforce Development Plans of Accredited Public Health Departments.

OBJECTIVE: Recruiting and retaining public health employees and ensuring they have the skills necessary to respond are vital for meeting public health needs. As the first study examining health department (HD) workforce development plans (WDPs), this study presents gaps and strategies identified in WDPs across 201 accredited HDs (168 initial/33 reaccreditation plans). DESIGN: This cross-sectional study employed qualitative review and content analysis of WDPs submitted to the Public Health Accreditation Board (PHAB) between March 2016 and November 2021. MAIN OUTCOME MEASURES: Eight overarching workforce themes were examined: planning/coordination, leadership, organizational culture, workplace supports/retention, recruitment, planning for departmental training, delivery of departmental training, and partnership/engagement. Within each theme, related subthemes were identified. Coders indicated whether the WDP (1) identified the subtheme as a gap; (2) stated an intent to address the subtheme; and/or (3) identified a strategy for addressing the subtheme. RESULTS: The most common gaps identified included prepare workforce for community engagement/partnership (34.3%, n = 69), followed by resource/fund training (24.9%, n = 50). The subtheme that had the most instances of an identified strategy to address it was assess training needs (84.1%, n = 169), followed by foster quality improvement (QI) culture/provide QI training (63.2%, n = 127). While both of these strategies were common among the majority of HDs, those subthemes were rarely identified as a gap. Secondary findings indicate that increase recruitment diversity/recruit from a more diverse applicant pool was rarely identified as a gap (6.0%, n = 12) and rarely had an identified strategy for addressing the subtheme (9.0%, n = 18). CONCLUSION: While HDs recognized many workforce gaps, HDs did not always propose a strategy for addressing them within the WDP. Conversely, some WDPs proposed strategies for subthemes that did not reflect recognized gaps. Such discrepancies between identified gaps and strategies in WDPs may suggest areas where HDs could use additional support and guidance.

COVID-19 Revealed Shortcomings Of The US Public Health System And The Need To Strengthen Funding And Accountability.

The US governmental public health system, which includes federal, state, and local agencies, is seen by many observers as having a money problem, stemming from a lack of resources. During the COVID-19 pandemic, this lack of resources has had unfortunate consequences for the communities that public health practice leaders are expected to protect. Yet the money problem is complex and involves understanding the nature of chronic public health underinvestment, identifying what money is spent in public health and what the country gets for it, and determining how much money is needed to do the work of public health in the future. This Commentary elucidates each of these issues and provides recommendations for making public health services more financially sustainable and accountable. Well-functioning public health systems require adequate funding, but a modernized public health financial data system is also key to the systems' success. There is a great need for standardization and accountability in public health finance, along with incentives and the generation of research evidence demonstrating the value of and most effective delivery for a baseline of public health services that every community should expect.

Staffing Local Health Departments in Minnesota-Needs, Priorities, and Concerns.

CONTEXT: The roles and responsibilities of local health departments (LHDs), as well as the hiring challenges they face, have changed since the pandemic started. OBJECTIVES: To explore (1) staffing needs and priorities of LHDs in Minnesota, and (2) financial and community-level factors impeding health departments from maintaining optimal staffing. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional online survey was administered via Qualtrics in July 2022 to city and county health departments in Minnesota (97% participation rate). It included both open- and close-ended questions concerning staffing needs and priorities of LHDs and challenges to hiring after the pandemic started. RESULTS: Staffing priorities of LHDs included public health nurses, community health workers, and health planners/researchers/analysts. Hiring concerns included creating new permanent positions, offering competitive salaries, and filling open positions. Inadequate funds made it difficult to create new permanent positions and offer competitive salaries. External factors such as lack of affordable or reliable childcare, housing, and transportation also contributed to hiring challenges. CONCLUSIONS: There is a need to increase staffing levels of the Minnesota public health enterprise by filling vacant positions and creating new positions. Increasing the public health workforce requires adequate sustainable funding along with creative solutions.

A Systematic Review on Professional Regulation and Credentialing of Public Health Workforce.

The public health workforce (PHW) counts a great variety of professionals, and how services are delivered differs in every country. The complexity and the diversity of PHW professions also reflect structural problems of supply and demand of PHW in various organizations and health care systems. Therefore, credentialing, regulation, and formal recognition are essential for a competent and responsive PHW to address public health challenges. To ensure comparability of the credentialing and regulation systems for the PHW and to enable its collective action at the macro level in the event of a health crisis, we systematically analyzed documented evidence on the PHW. A systematic review was selected to answer the research questions: (1) what are the most effective aspects and characteristics in identified programs (standards or activities) in professional credentialing and regulation of the PHW and (2) what are common evidence-based aspects and characteristics for the performance standards to support a qualified and competent PHW? The identification of professional credentialing systems and available practices of the PHW was performed systematically using a systematic review of international resources in the specialized literature published in English. The PRISMA framework was used to verify the reporting of combined findings from three databases: Google Scholar (GS), PubMed (PM), and Web of Science (WoS). The original search covered the period from 2000 until 2022. Out of 4839 citations based on the initial search, 71 publications were included in our review. Most of the studies were conducted in the US, UK, New Zealand, Canada, and Australia; one study was conducted in an international context for professional credentialing and regulation of the PHW. The review presents specific professional regulation and credentialing approaches without favoring one of the proposed methods. Our review was limited to articles focused on professional credentialing and regulation of the PHW in the specialized literature published in English and did not include a review of primary PHW development sources from international organizations. The process and requirements are unique processes displaying knowledge, competencies, and expertise, regardless of the field of practice. Continuous education, self-regulatory, and evidence-based approach can be seen as common characteristics for the performance standards on both community and national levels. Certification and regulation standards should be based on competencies that are currently used in practice. Therefore, answering questions about what criteria would be used, what is the process operation, what educational background the candidate should have, re-examination, and training are essential for a competent and responsive PHW and could stimulate the motivation of the PHW.

Voluntary Separations and COVID-19: A Snapshot of Turnover Intention in the Federal Workforce in the First Year of the Pandemic.

Voluntary separations can exact heavy tolls on organizations that affect their efficiency or effectiveness. This historical retrospective investigates how the COVID-19 pandemic may have influenced federal employees' intention to leave for reasons other than retirement. We examined the 2020 Federal Employee Viewpoint Survey (FEVS) with a particular focus on agencies likely heavily impacted by the pandemic, including the Departments of Agriculture (USDA), Health and Human Services (HHS), Homeland Security (DHS) and the US Environmental Protection Agency (EPA). We used inferential statistics and a logistic model to identify correlations for intent to leave, considering changes related to the pandemic. Intentions to leave notably increased after the pandemic for most respondents, and overall intentions to leave were lower for USDA, HHS, and EPA staff than for all federal employees. Reasons included perceived unavailability of protections from COVID-19 exposure, disruptions to work by the pandemic, and increased work demands due to the pandemic.

Public Health Workforce Gaps, Impacts, and Improvement Strategies from COVID-19.

The public health workforce has been instrumental in protecting residents against population health threats. The COVID-19 pandemic has highlighted the importance of the public health workforce and exposed gaps in the workforce. Public health practitioners nationwide are still coming to understand these gaps, impacts, and lessons learned from the pandemic. This study aimed to explore Minnesota's local public health practitioners' perceptions of public health workforce gaps, the impacts of these workforce gaps, and the lessons learned in light of the COVID-19 pandemic. We conducted seven concurrent focus groups with members of the Local Public Health Association of Minnesota (LPHA; n = 55) using a semi-structured focus group guide and a survey of the local agencies (n = 70/72 respondents, 97% response rate). Focus group recordings were transcribed verbatim and analyzed using deductive and inductive coding (in vivo coding, descriptive coding), followed by thematic analysis. The quantitative data were analyzed using descriptive analyses and were integrated with the qualitative data. Participants indicated experiencing many workforce gaps, workforce gaps impacts, and described improvement strategies. Overall, many of the workforce gaps and impacts resulting from COVID-19 discussed by practitioners in Minnesota are observed in other areas across the nation, making the findings relevant to public health workforce nationally.

Training the MCH workforce: the Time for Change is now.

INTRODUCTION: Maternal and child health (MCH) services are critical for vulnerable populations. Workforce shortages, poor retention, and gaps in necessary trainings impede the capacity of public health systems to address needs. This manuscript characterizes the current MCH workforce, MCH program applicants and graduates, and describe findings within a national context to devise elements of a recruitment and retention strategy. METHODS: Data were obtained for public health program applicants, first-destination employment outcomes, and worker perceptions and demographics. Data were stratified according to the MCH and total public health workforce and by local, state, and national totals. Data were characterized by degree type, discipline, demographics, and employment outcomes. RESULTS: MCH staff constitute 11% of the state and local governmental public health workforce. MCH staff are approximately as diverse, have higher educational attainment, and are more likely to hold nursing degrees than the rest of the public health workforce. Yet, just 14% of MCH staff hold any type of public health degree. The MCH pipeline from academia appears modestly sized, with approximately 5% of applicants between 2017 and 2021 applying to a MCH master's degree. DISCUSSION: The MCH workforce has a lower proportion of formal training or degrees in public health, though trends seem to indicate improvements. However, it is critical that a multi-faceted recruitment and retention strategy be coordinated by a broad range of stakeholders. These efforts will serve to improve the capability and capacity of the public health system to address critical needs of increasingly diverse MCH populations. SIGNIFICANCE: In order to modernize and reimagine the academic-public health pipeline, it is critical to better understand how many applicants and graduates exist within Maternal and Child Health programs across the US, and their characteristics. This manuscript connects that information with the most recently available public health workforce information on demographics, workplace perceptions, and intent to leave among staff at state and local health departments. Data presented in this paper allow the most comprehensive characterization of the MCH academia->practice pipeline to-date, identifies a fundamental disconnect in those career pathways, and offers options to repair that break.

Regarding Investment in a Healthier Future: Impact of the 2012 Institute of Medicine Finance Report.

CONTEXT: Governments at all levels work to ensure a healthy public, yet financing, organization, and delivery of public health services differ across the United States. A 2012 Institute of Medicine Finance report provided a series of recommendations to ensure a high-performing and adequately funded public health infrastructure. OBJECTIVES: This review examines the influence of the Finance report's 10 recommendations on public health policy and practice. DESIGN: This review utilized peer-reviewed and gray literature published since 2012. ELIGIBILITY CRITERIA: Documents that address at least one of the Finance report's 10 recommendations and contain information on either official actions taken in response to the Finance report or evidence of the report's influence on the practice community. RESULTS: Of 2394 unique documents found, a total of 56 documents met the eligibility criteria. Review of these 56 documents indicated that the most substantial activity related to the recommendations was focused on the "minimum package of public health services" concept and establishment of a uniform chart of accounts. DISCUSSION: Progress has been mixed on the Finance report recommendations. Improved tracking and auditing of public health activity appears to be advancing, yet financial benchmarks remain unmet. Challenges remain in determining actual investment in public health and equitable resource allocation approaches. State and local health department use of cost estimation methodology and a uniform chart of accounts tool has contributed to an increase in understanding and improvement in public health spending. CONCLUSIONS: The Finance report has served as a strong impetus for advocating for an increased investment in governmental public health. Efforts are bolstered by informed public health practitioners and stakeholders but often stymied by policy makers who must balance complex competing issues and priorities. Although many successes have occurred, further work is needed toward improving investment in the nation's public health.

Funding Public Health: Achievements and Challenges in Public Health Financing Since the Institute of Medicine's 2012 Report.

OBJECTIVE: The purpose of this study was to review changes in public health finance since the 2012 Institute of Medicine (IOM) report "For the Public's Health: Investing in a Healthier Future." DESIGN: Qualitative study involving key informant interviews. SETTING AND PARTICIPANTS: Purposive sample of US public health practitioners, leaders, and academics expected to be knowledgeable about the report recommendations, public health practice, and changes in public health finance since the report. MAIN OUTCOME MEASURES: Qualitative feedback about changes to public health finance since the report. RESULTS: Thirty-two interviews were conducted between April and May 2019. The greatest momentum toward the report recommendations has occurred predominantly at the state and local levels, with recommendations requiring federal action making less progress. In addition, much of the progress identified is consensus building and preparation for change rather than clear changes. Overall, progress toward the recommendations has been slow. CONCLUSIONS: Many of the achievements reported by respondents were characterized as increased dialogue and individual state or local progress rather than widespread, identifiable policy or practice changes. Participants suggested that public health as a field needs to achieve further consensus and a uniform voice in order to advocate for changes at a federal level. IMPLICATIONS FOR POLICY AND PRACTICE: Slow progress in achieving 2012 IOM Finance Report recommendations and lack of a cohesive voice pose threats to the public's health, as can be seen in the context of COVID-19 emergency response activities. The pandemic and the nation's inadequate response have highlighted deficiencies in our current system and emphasize the need for coordinated and sustained core public health infrastructure funding at the federal level.