AJPH201719234_Beck XXXXXXXXXX
State Health Agency and Local Health Department
Workforce: Identifying Top Development Needs
Angela J. Beck, PhD, MPH, Jonathon P. Leider, PhD, Fatima Coronado, MD, MPH, and Elizabeth Harper, DrPH
Objectives.To identify occupationswith high-priorityworkforce development needs at
public health departments in the United States.
Methods. We surveyed 46 state health agencies (SHAs) and 112 local health de-
partments (LHDs). We asked respondents to prioritize workforce needs for 29 occu-
pations and identify whether more positions, more qualified candidates, more
competitive salaries for recruitment or retention, or new or different staff skills were
needed.
Results. Forty-one SHAs (89%) and 36 LHDs (32%) participated. The SHAs reported
having high-priority workforce needs for epidemiologists and laboratory workers; LHDs
for disease intervention specialists, nurses, and administrative support, management,
and leadership positions. Overall, the most frequently reported SHA workforce needs
were more qualified candidates and more competitive salaries. The LHDs most fre-
quently reported a need for more positions across occupations and more competitive
salaries. Workforce priorities for respondents included strengthening epidemiology
workforce capacity, adding administrative positions, and improving compensation to
ecruit and retain qualified employees.
Conclusions. Strategies for addressing workforce development concerns of health agencies
includeprovidingadditional trainingandworkforcedevelopmentresources,and identifyingbest
practices for recruitment and retention of qualified candidates. (Am J Public Health. 2017;107:
1418–1424. doi:10.2105/AJPH XXXXXXXXXX)
Public health workforce research is an areain which more evidence is needed to
etter understand how to organize, finance,
and effectively deliver public health services.1
Public health workforce studies have pri-
marily focused on enumerating governmental
public health workers2–5; assessing worke
characteristics and educational attainment6–8;
identifying occupational trends9–11; de-
veloping worker competencies12–15; analyz-
ing factors associated with recruitment,
etention, and retirement16,17; and identify-
ing co
elates of job satisfaction.18
Three national surveys periodically collect
data on governmental public health work-
force characteristics: the profile studies
conducted by the Association of State and
Te
itorial Health Officials (ASTHO)10 and
the National Association of County and City
Health Officials (NACCHO),11 and the
Public HealthWorkforce Interests andNeeds
Survey.19 Collectively, these studies have
eported a reduction in workforce size since
2008, a shift in the types of occupations
employed in state health departments,
and limited formal public health training,
with an estimated 17% holding a public
health degree.8,10,11 However, the field
continues to seek definitive answers con-
cerning the number of workers required
to deliver public health services and recog-
nizes certain knowledge gaps, including the
types of skills, educational backgrounds,
and occupations needed for core tasks and
functions required by public health de-
partments.20 Ongoing national public health
eform efforts, including the Foundational
Public Health Services approach and Public
Health 3.0, also have a strong workforce
focus.21,22
To identify public health workforce needs
and determine areas requiring workforce
development, the University of Michigan
Center of Excellence in Public Health
Workforce Studies implemented the Public
Health Workforce Gaps Study in collabo-
ation with ASTHO and with support from
the Centers for Disease Control and Pre-
vention. The goals of this study were to (1)
identify occupations with perceived work-
force development needs, (2) determine the
types of workforce development needs by
occupation, and (3) gain knowledge re-
garding workforce turnover and succession
planning. This report focuses on state and
local health department workforce develop-
ment needs by occupation.
METHODS
We designed the Public Health Work-
force Gaps Study as an explanatory mixed
methods23 project that included an agency-
level survey of state health agencies (SHAs)
and local health departments (LHDs) in
the United States, conducted in summe
2016. Although not included in this article,
we also conducted follow-up interviews
with select survey respondents. Survey
ABOUT THE AUTHORS
Angela J. Beck is with the Center of Excellence in Public Health Workforce Studies, University of Michigan School of Public
Health, Ann A
or. Jonathon P. Leider is with JP Leider Research and Consulting, Minneapolis, MN. Fatima Coronado is
with Center for Surveillance Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA.
Elizabeth Harper is with Association of State and Te
itorial Health Officials, Arlington, VA.
Co
espondence should be sent to Angela J. Beck, PhD, MPH, Clinical Assistant Professor of Health Behavior and Health
Education, Associate Director, Center of Excellence in Public Health Workforce Studies, University of Michigan School of Public
Health, 1420 Washington Heights, Ann A
or, MI XXXXXXXXXXe-mail: XXXXXXXXXX). Reprints can be ordered at http:
www.
ajph.org by clicking the “Reprints” link.
This article was accepted April 18, 2017.
doi: XXXXXXXXXX/AJPH XXXXXXXXXX
1418 Research Peer Reviewed Beck et al. AJPH September 2017, Vol 107, No. 9
AJPH RESEARCH
mailto: XXXXXXXXXX
http:
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development began during fall 2015 and
included pretesting with ASTHO staff and
2 sets of cognitive interviews with 7 public
health practitioners. We distributed the
online survey to human resource personnel
and senior deputies in 46 SHAs and senio
leadership in a random sample of 112
LHDs across the US human resource staff,
and we encouraged senior leadership to
complete the organizational survey together.
We considered the LHD study segment
a pilot to test this methodology in local set-
tings. The sample included a mix of geo-
graphical, organizational, and governance
status characteristics but was not designed to
e nationally representative. Approximately
two thirds of the LHDs sampled served
communities with XXXXXXXXXXor more persons
and one third served fewer than XXXXXXXXXX
persons. Ninety-four sample LHDs were
locally governed, 13 were governed by the
state health agency, and 5were under a shared
governance structure. The LHDs were
sampled evenly geographically.
We offered respondents a list of 29 oc-
cupations selected from the Public Health
Workforce Taxonomy24 and workforce
needs were assessed (Table A, available as
a supplement to the online version of this
article at http:
www.ajph.org, for occupa-
tion definitions). Because we did not wish to
constrain respondents to needs that were only
within the agency’s cu
ent financial
wherewithal to address, we asked the fol-
lowing: “If your agency had sufficient funds
to address workforce needs, which occupa-
tions would you consider to have relatively
higher priority and lower priority needs?”
Respondents grouped the occupations into 3
categories, on the basis of their own set of
criteria: higher priority, lower priority, o
“not applicable” (i.e., occupations not
employed by and not needed by the agency).
For all occupations categorized as higher o
lower priority, we asked respondents to
identify whether the following workforce
need categories were applicable: more posi-
tions, more qualified candidates, more
competitive salaries for recruitment or re-
tention, new or different skills, “other”
workforce development needs, or no
workforce development needs. We collected
additional information on training needs if
“new or different skills” was selected and
“other” needs if selected.
To better characterize SHA responses, we
added variables used in previous studies10,11 to
the state data set: type of governance structure
(i.e., decentralized, centralized, shared, o
mixed); population size of the jurisdiction
served (i.e., small: £ XXXXXXXXXX; medium:
XXXXXXXXXX– XXXXXXXXXX; large: > XXXXXXXXXX);
and geographical regions coded as follows:
New England= states in US Department of
Health and Human Services (HHS) Regions
1 and 2; Mid-Atlantic/Great Lakes=HHS
egions 3 and 5; South =HHSRegions 4 and
6;Mountains/Midwest=HHSRegions 7 and
8; and West=HHS Regions 9 and 10. We
did not include US te
itories in this study.
We conducted analyses of LHD and SHA
descriptive statistics in aggregate. We also
analyzed SHA data by geographical region,
population size, and governance structure
emphasizing the occupations most fre-
quently identified as having high work-
force priority needs as a means fo
summarizing the occupations of highest
priority. We managed quantitative data in
Microsoft Excel 2016 (Microsoft Corpora-
tion, Redmond, WA) and analyzed them
in Stata 13.1 (StataCorp LP, College Station,
TX).
RESULTS
Forty-one of 46 SHAs (89%) responded to
the survey, as did 36 of 112 LHDs (32%). One
SHA did not report workforce needs, leaving
40 SHA responses for these analyses. The
SHA respondents collectively included
24 human resource personnel, 17 senio
deputies, 2 health agency directors, and 8
other staff. The majority of respondents were
from SHAs with decentralized governance
structures (n = 23), followed by centralized
(n = 9), and mixed or shared (n = 8), and
served communities with small (n = 13),
medium (n= 13), and large (n = 14) pop-
ulation size. The SHA respondents most
frequently represented the Mid-Atlantic
Great Lakes region (n= 10), followed by the
South and Mountains/Midwest regions
(n = 9 each), New England (n= 7), and the
West (n = 5). The LHD respondents included
19 local health officials, 15 senior deputies,
4 human resource personnel, and 9 others.
Twenty-six LHDs served communities of
XXXXXXXXXXor more persons; 10 served com-
munities of fewer than XXXXXXXXXXpersons.
The SHA respondents most frequently
identified the highest-priority workforce
needs in the following occupations: epide-
miologists (88%); laboratory workers (73%);
public health informatics specialists (72%);
licensure, regulatory, or enforcement staff
(68%); program managers (65%); environ-
mental health workers (65%); disease in-
tervention specialists (63%); information
systems specialists (63%); public health
and community health nurses (63%); and
department directors (60%; Table 1).
Overall, the most frequently reported
workforce need types were more qualified
candidates and more competitive salaries;
fewer respondents reported need for more
TABLE 1—State Health Agency Workforce Development Needs by Top High-Priority
Occupations: Public Health Workforce Gaps Study, United States, 2016
Workforce Need Priority, No. (%)
Occupation No. Higher Priority Lower Priority Not Applicable
Epidemiologist XXXXXXXXXX (0)
Laboratory worker XXXXXXXXXX1 (3)
Public health informatics specialist XXXXXXXXXX0 (0)
Licensure, regulatory, or enforcement worker XXXXXXXXXX1 (3)
Public health or program manager XXXXXXXXXX0 (0)
Environmental health worker XXXXXXXXXX1 (3)
Disease intervention specialist XXXXXXXXXX2 (5)
Information systems specialist XXXXXXXXXX5 (13)
Public health or community health nurse XXXXXXXXXX3 (8)
Program or department director XXXXXXXXXX3 (8)
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September 2017, Vol 107, No. 9 AJPH Beck et al. Peer Reviewed Research 1419
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www.ajph.org
positions or need for workers to learn new o
different skills.
However, the specific workforce needs
differed by occupations. At least 80% of SHA
espondents reported a need for more com-
petitive salaries to recruit and retain epide-
miologists (89%), laboratory workers (86%),
public health managers (85%), disease in-
tervention specialist (85%), information sys-
tems specialists (84%), and public health
informatics specialists (81%). A need for more
qualified candidates was reported for every
occupation by at least half of SHAs, with
public health informatics specialist (85%),
information systems specialist (80%), and
programor department director (74%) among
themost frequently reported. Furthermore, at
least half