Katie Sellers

The Public Health Workforce Interests and Needs Survey: The First National Survey of State Health Agency Employees.

This article describes a nationally representative survey of central office employees at state health agencies to characterize key components of the public health workforce.

Thinking beyond the silos: emerging priorities in workforce development for state and local government public health agencies.

Supplemental Digital Content is Available in the Text. This study focuses on the existing public health workforce, with the results aiming at informing the revisions public health academic programs and standards are experiencing nationally.

Quality improvement and accreditation readiness in state public health agencies.

OBJECTIVE There were 3 specific objectives of this study. The first objective was to examine the progress of state/territorial health assessment, health improvement planning, performance management, and quality improvement (QI) activities at state/territorial health agencies and compare findings to the 2007 findings when available. A second objective was to examine respondent interest and readiness for national voluntary accreditation. A final objective was to explore organizational factors (eg, leadership and capacity) that may influence QI or accreditation readiness. DESIGN Cross-sectional study. SETTING State and Territorial Public Health Agencies. PARTICIPANTS Survey respondents were organizational leaders at State and Territorial Public Health Agencies. RESULTS Sixty-seven percent of respondents reported having a formal performance management process in place. Approximately 77% of respondents reported a QI process in place. Seventy-three percent of respondents agreed or strongly agreed that they would seek accreditation and 36% agreed or strongly agreed that they would seek accreditation in the first 2 years of the program. In terms of accreditation prerequisites, a strategic plan was most frequently developed, followed by a state/territorial health assessment and health improvement plan, respectively. CONCLUSIONS Advancements in the practice and applied research of QI in state public health agencies are necessary steps for improving performance. In particular, strengthening the measurement of the QI construct is essential for meaningfully assessing current practice patterns and informing future programming and policy decisions. Continued QI training and technical assistance to agency staff and leadership is also critical. Accreditation may be the pivotal factor to strengthen both QI practice and research. Respondent interest in seeking accreditation may indicate the perceived value of accreditation to the agency.

Public Health Workforce Taxonomy

Thoroughly characterizing and continuously monitoring the public health workforce is necessary for ensuring capacity to deliver public health services. A prerequisite for this is to develop a standardized methodology for classifying public health workers, permitting valid comparisons across agencies and over time, which does not exist for the public health workforce. An expert working group, all of whom are authors on this paper, was convened during 2012–2014 to develop a public health workforce taxonomy. The purpose of the taxonomy is to facilitate the systematic characterization of all public health workers while delineating a set of minimum data elements to be used in workforce surveys. The taxonomy will improve the comparability across surveys, assist with estimating duplicate counting of workers, provide a framework for describing the size and composition of the workforce, and address other challenges to workforce enumeration. The taxonomy consists of 12 axes, with each axis describing a key characteristic of public health workers. Within each axis are multiple categories, and sometimes subcategories, that further define that worker characteristic. The workforce taxonomy axes are occupation, workplace setting, employer, education, licensure, certification, job tasks, program area, public health specialization area, funding source, condition of employment, and demographics. The taxonomy is not intended to serve as a replacement for occupational classifications but rather is a tool for systematically categorizing worker characteristics. The taxonomy will continue to evolve as organizations implement it and recommend ways to improve this tool for more accurate workforce data collection.

Job Satisfaction: A Critical, Understudied Facet of Workforce Development in Public Health.

This article explores the relationship between general employee satisfaction and specific characteristics of the job and the health agency and provides recommendations regarding what health agencies can do to support recruitment and retention.

Changes in Public Health Workforce Composition: Proportion of Part-Time Workforce and Its Correlates, 2008-2013

BACKGROUND State and local public health department infrastructure in the U.S. was impacted by the 2008 economic recession. The nature and impact of these staffing changes have not been well characterized, especially for the part-time public health workforce. PURPOSE To estimate the number of part-time workers in state and local health departments (LHDs) and examine the correlates of change in the part-time LHD workforce between 2008 and 2013. METHODS We used workforce data from the 2008 and 2013 National Association of County and City Health Officials (n=1,543) and Association of State and Territorial Health Officials (n=24) profiles. We employed a Monte Carlo simulation to estimate the possible and plausible proportion of the workforce that was part-time, over various assumptions. Next, we employed a multinomial regression assessing correlates of the change in staffing composition among LHDs, including jurisdiction and organizational characteristics, as well measures of community involvement. RESULTS Nationally representative estimates suggest that the local public health workforce decreased from 191,000 to 168,000 between 2008 and 2013. During that period, the part-time workforce decreased from 25% to 20% of those totals. At the state level, part-time workers accounted for less than 10% of the total workforce among responding states in 2013. Smaller and multi-county jurisdictions employed relatively more part-time workers. CONCLUSIONS This is the first study to create national estimates regarding the size of the part-time public health workforce and estimate those changes over time. A relatively small proportion of the public health workforce is part-time and may be decreasing.

Public health spending in 2008: on the challenge of integrating PHSSR data sets and the need for harmonization.

In recent years, state and local public health department budgets have been cut, sometimes drastically. However, there is no systematic tracking of governmental public health spending that would allow researchers to assess these cuts in comparison with governmental public health spending as a whole. Furthermore, attempts to quantify the impact of public health spending are limited by the lack of good data on public health spending on state and local public health services combined. The objective of this article is to integrate self-reported state and local health department (LHD) survey data from 2 major national organizations to create state-level estimates of governmental public health spending. To create integrated estimates, we selected 1388 LHDs and 46 states that had reported requisite financial information. To account for the nonrespondent LHDs, estimates of the spending were developed by using appropriate statistical weights. Finally, funds from federal pass-through and state sources were estimated for LHDs and subtracted from the total spending by the state health agency to avoid counting these dollars in both state and local figures. On average, states spend

Job Satisfaction and Expected Turnover Among Federal, State, and Local Public Health Practitioners

106 per capita on traditional public health at the state and local level, with an average of 42% of spending occurring at the local level. Considerable variation exists in state and local public health funding. The results of this analysis show a relatively low level of public health funding compared with state Medicaid spending and health care more broadly.

Budgetary decision making during times of scarcity.

OBJECTIVES To use data on the governmental public health workforce to examine demographics and elucidate drivers of job satisfaction and intent to leave ones organization. METHODS Using microdata from the 2014 Federal Employee Viewpoint Survey and 2014 Public Health Workforce Interests and Needs Survey, we drew comparisons between federal, state, and local public health staff. We fitted logistic regressions to examine correlates of both job satisfaction and intent to leave ones organization within the coming year. RESULTS Correlates of job satisfaction included pay satisfaction, organizational support, and employee involvement. Approximately 40% of federal, state, and local staff said they were either considering leaving their organization in the next year or were planning to retire by 2020. CONCLUSIONS Public health practitioners largely like their jobs, but many are dissatisfied with their pay and are considering working elsewhere. More should be done to understand the determinants of job satisfaction and how to successfully retain high-quality staff. PUBLIC HEALTH IMPLICATIONS Public health is at a crossroads. Significant turnover is expected in the coming years. Retention efforts should engage staff across all levels of public health.

Structure and Functions of State Public Health Agencies in 2007

Public health is often defined by the sciences on which it is based (eg, epidemiology, tropical medicine, biostatistics) or the programs a health department operates. Far too often the critical role of the health official in garnering political support, financial resources, and public support is not recognized when defining the scope of our system. Because most state health officials are political appointees, their work is sometimes considered to be separate from public health, as if politics and public health were distinct. But the state health official’s interface with the political system and with the state budget office is critical to all aspects of public health. Without political support from the governor and financial support from the legislature, the public health agency cannot effectively protect and improve the health of the population. As is reported at some length in this issue and the March issue of this journal, state and local health departments have seen major budget reductions over the past several years. However, to date there has not been much information regarding the context and decision-making processes around these budget cuts. This column presents select initial findings from a collaborative study with the Johns Hopkins Bloomberg School of Public Health that seeks to provide context and deeper understanding around issues of budgetand priority-setting processes, introduces components of a framework for budgetary decision making identified at the December 2011 ASTHO (Association of State and Territorial Health Officials) Winter Meeting, and links these ideas to the recently released Institute of Medicine (IOM) report For the Public’s Health: Investing in a Healthier Future. The Johns Hopkins-ASTHO study consisted of both qualitative and quantitative research: semistruc-