Public health in the 21st century

As the U.S. healthcare system evolves and communities gain more access to care, diverse forces are driving change, and the practice of public health is adapting. Given the challenges to the public health system and those faced as a nation -- including urgent health threats (e.g., antibiotic resistance, prescription drug use and overdose, global health security) and decreased funding for addressing public health concerns -- having trust in public health practitioners, their scientific knowledge, and particularly the public health system, has never been more important.

"The public health workforce is now not only required to take a lead in protecting citizens' health, but it also must provide the evidence base needed for linking public health information with clinical services and activities; offer targeted, scalable public health interventions; and support clinical services in a way that affects populations at large," notes Guest Editor Fátima Coronado, MD, MPH, Deputy Associate Director for Science, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA. "This supplement is both timely and important because it reviews some of the critical challenges faced by the public health workforce, discusses selected changes under way, and highlights data-driven research to advance the field of public health services and systems research."

This groundbreaking supplement, The Public Health Workforce, includes 22 articles from more than 30 institutions, agencies, foundations and public companies and covers two major areas: public health workforce capacity building and public health workforce size and composition.

Key topics in the Supplement include:

• How to clearly define the public health workforce challenges using cause-and-effect diagrams and a concise roadmap.
• Use of Massive Open Online Courses (MOOCs) by the School of Public Health at Harvard and concerns about retention of the knowledge gained using that method of instruction.
• How the CDC conducts workforce development within its own organization.
• Do students who receive adequate training in Public Health and Community Medicine tend to practice in areas with physician shortages?
• How do we count public health workers? In the first study since 2000, 50% of all public health workers are employed at the local level, with 30% and 20% at the state and federal levels, respectively.
• How can we define public health workers properly? A taxonomy has been developed which is a necessary step to continuously monitor the size and composition of the workforce to ensure sufficient capacity to deliver essential public health services.
• Data show that part-time public health workers are a low percentage of the total workforce and the percentage has decreased over the last 5 years.
• Despite relatively uncompetitive pay, local health departments experience lower rates of employee turnover than state health agencies and lower rates than state and local government in general.
• How can we align public health workforce competencies with population health improvement goals?
• How the Public Health Accreditation Board (PHAB) developed the standards and measures to encourage health departments to strengthen the current public health workforce and strategically develop the workforce of tomorrow.
• Do Internal Medicine Residency Programs develop public health competencies?
• How a training program for racial and ethnic minorities for careers in public health sciences has resulted in 60% of the students entering public health careers.
• Will epidemiology education change rapidly enough to keep up with trends in communications and computing?
• How the growth of cities, "Big Data," and cognitive computing will change the public health workforce.
• Building a Culture of Health -- How the public health workforce will not only provide medical care but will help to establish a Culture of Health.
• Nursing as a critical driver of the Culture of Health.

Guest Editors Dr. Coronado and Denise Koo, MD, MPH, Office of Public Health Scientific Services, CDC, Atlanta, GA, and Kristine Gebbie, DrPH, RN, Faculty of Health Sciences, Flinders University, Adelaide, South Australia, write that "we are buoyed by the increased efforts to meet workforce challenges and the valuable contribution of researchers and practitioners to strengthen the public health workforce. Efforts to strengthen the public health workforce should be a continuing priority involving well-planned, evidence based, and coordinated actions from decision makers undaunted by the mission of transforming public health and improving the population's health while facing the complex landscape of the 21st century."

The special supplement can be found online at: http://www.ajpmonline.org/issue/S0749-3797%2814%29X0016-4