Abstract
Interest in and awareness of public health in the United States has grown due to COVID-19; however, state and local health departments have seen a mass exodus of leadership since the beginning of the pandemic. Based on the results of the de Beaumont Foundation’s most recent Public Health Workforce Interests and Needs Survey (PH WINS), nearly one in three public health employees say they are considering leaving the profession due to stress, burnout, and low pay. One viable strategy for ensuring a diverse and competent public health workforce is the national network of Public Health Training Centers (PHTCs). This commentary describes the Public Health Training Center Network, with a specific focus on Region IV, and discusses challenges and opportunities for advancing the public health agenda in the United States. The national PHTC Network continues to provide invaluable services in terms of training, professional development, and experiential learning for the current and future public health workforce. However, increased funding would allow PHTCs to have a greater impact and reach through bridge programs for public health workers and others, additional field placement experiences, and expanded outreach to non-public health professionals in training activities. PHTCs have shown great adaptability over time and can once again pivot to meet the needs of a rapidly changing public health landscape demonstrating that PHTCs are truly more relevant than ever.
Public health in the United States has reached an inflection point. On one hand, interest in and awareness of public health has grown due to COVID-19 (Smith & Young, 2020). On the other hand, state and local health departments have seen a mass exodus of leadership since the beginning of the pandemic. Reasons for leaving include interference with public health measures, efforts to diminish public health authority, and threats to personal safety (Hall, 2022). Moreover, departures have not been limited to senior management. According to the de Beaumont Foundation’s National Survey of the Public Health Workforce (2022), nearly one in three public health employees say they are considering leaving the profession due to stress, burnout, and low pay.
Considering recent and ongoing national public health issues (e.g., vaccine hesitancy due to mistrust, fear, and lack of information; lack of investment in public health infrastructure; and disparate health outcomes), the need for a robust public health system in the United States is more critical than ever for safeguarding population health. One viable strategy for ensuring a diverse and competent public health workforce is the national network of Public Health Training Centers (PHTCs). In this commentary, we describe the Region IV PHTC and discuss challenges and opportunities for advancing the public health agenda in the United States.
Overview of Public Health Training Centers
In the late 1990s, the Health Resources and Services Administration (HRSA) funded a network of PHTCs to address accreditation standards for the public health workforce at the state, local, and tribal levels (Bigley, 2016). More recently, PHTCs have focused on competency-based trainings and practice-based opportunities to advance the current and future public health workforce (Alperin & Bekemeier, 2022). HRSA funds 10 Regional PHTCs, one in each U.S. Department of Health and Human Services region (HRSA, 2022). The Region IV PHTC (R-IV PHTC) comprises eight states in the southeast United States: Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee.
Region IV Public Health Training Center
The R-IV PHTC is located at Emory University’s Rollins School of Public Health; its mission is to build the capacity of the current and future public health workforce to protect and promote the health of communities in the southeastern United States. This mission aligns with the HRSA PHTC Program’s purpose of increasing the number of people in the public health workforce, enhancing the quality of this workforce, and improving the ability of the workforce to meet national, state, and local health care needs (HRSA, 2022). The primary areas of focus for the R-IV PHTC include professional development for the current workforce, experiential learning for the future workforce, and consulting and technical assistance for health departments. State and regional training needs guide the work of the R-IV PHTC.
Training Needs
In 2021, the de Beaumont Foundation and the Association of State and Territorial Health Officials (ASTHO) fielded the Public Health Workforce Interests and Needs Survey (PH WINS) to gauge interests and needs of the state and local governmental public health workforce in the United States. The top five areas of training needs across all supervisory levels at the national level included budget and financial management; systems and strategic thinking; community engagement; change management; and justice, equity, diversity, and inclusion (JEDI) (de Beaumont, 2022). Many of these same training priorities were reflected in the 2017 R-IV PHTC multimodal training needs assessment as well as subsequent key informant interviews with state leaders in 2021. In response, R-IV PHTC has added programs and activities specifically designed to address key priority areas, such as health equity and racial justice as well as communication with diverse audiences.
These needs have also been addressed by the national PHTC Network (PHTCN). For example, PHTCN, in partnership with the National Network of Public Health Institutes, has developed a set of racial justice competencies for public health professionals that can be used in developing educational offerings. This strategy coincides with the release of the updated Essential Public Health Services Framework (The Public Health Center for Innovations [PHNCI], 2022). Furthermore, Dr. Richard Hofrichter, senior director of health equity and social initiatives at the National Association of City and County Health Departments, has encouraged the entire public health enterprise to move toward transformative dialogues about issues like structural racism to address root causes of inequity.
Similarly, based on key informant interviews, state leaders in R-IV expressed the need for further guidance about how to effectively communicate public health messages with audiences that may not share the same values or beliefs regarding science and science-informed policies. Individuals noted that it is imperative but difficult to engage in meaningful, productive discussions about protecting population health in states where these topics may be seen as controversial or divisive. As a starting point, the R-IV PHTC has developed a comprehensive training catalog of live and on-demand training topics which includes training topics such as how to address difficult dialogues; communicate with diverse populations; and debunk misinformation, disinformation, and false claims about COVID-19 and vaccines. In addition, the R-IV PHTC has created several leadership and management trainings, including an eight-month leadership institute for emerging public health and primary care leaders.
Opportunities
The national PHTC Network, including R-IV PHTC, has strived to meet the growing demands of an increasingly complex public health landscape. Nevertheless, there may be opportunities to increase the reach and potency of this network by exploring new strategies to recruitment, training, and professional development of the current and future public health workforce. We offer the following ideas for consideration by HRSA and the leadership of the PHTC Network.
Bridging Experience and Education
One of the most fertile grounds for recruiting new public health professionals and promoting individuals to leadership positions is within local and state health departments. Based on the latest findings from PH WINS (de Beaumont, 2022), the vast majority (86%) of the governmental public health workforce does not have a degree in public health. This finding suggests that there is tremendous opportunity to grow public health leaders from within. Moreover, this statistic confirms comments from state leaders in R-IV who requested more training opportunities for entry level and administrative support staff on Public Health 101 foundational skills to address gaps in knowledge.
One way for PHTCs to play an integral role in expanding the pool of potential public health leaders is to market and financially support continuing education for governmental public health employees. More specifically, PHTCs could create bridge programs to prepare employees with a bachelor’s degree in a field other than public health to transition into an accredited Master of Public Health (MPH) degree program. Similar programs could be designed to support employees with associate degrees to move into comparable undergraduate degree programs in public health.
Traditionally, bridge programs have been designed to ease high school student transition to college by providing academic skills and resources needed to succeed in a college environment. These same concepts could be applied to support entry- and mid-level public health workers. Moreover, if successful, public health bridge programs could support traditional (e.g., high school to bachelor’s to MPH) or nontraditional (e.g., military service or veteran status to bachelor’s to MPH) pathways. A bridge program to governmental public health would not only expand the numbers but also the diversity of individuals entering the public health pipeline.
Increase the Number of Applied Practice Experiences
Currently, PHTCs offer field placement experiences for MPH students to gain practical experience by working with or on behalf of underserved communities or populations (Fifolt et al., 2020). The R-IV PHTC collaborates with state/local public health departments, the Area Health Education Centers program, and other partners to direct students completing field placement experiences to rural and medically underserved areas. However, the overall number of field placement experiences is limited per region; R-IV currently offers 32 placements per year across the eight-state region.
PHTCs would have greater impact and reach if HRSA budgeted for an increased number of applied learning experiences. Based on the recently approved funding announcement, field placement opportunities have been extended to a wider range of students, including undergraduate juniors and seniors, doctoral students enrolled in a health professions degree program, and preventive medicine residents. However, funding for this expanded pool of candidates has not kept pace with the potential demand.
Furthermore, only half of field placement experiences in R-IV are with local or state health departments; the other half are primarily with local, health-adjacent nonprofits. At times, efforts to place students with health departments have been thwarted due to personnel board rules about the types of work students can perform or regulations regarding how students are paid and by whom. These barriers limit student exposure to careers in governmental public health and further constrain the public health pipeline.
Students who participate in field placement experiences receive a modest stipend through the PHTC. However, even with financial assistance, students still bear the cost of housing in the location of their field placement experience. Likewise, students who work full- or part-time to pay for school forgo anticipated earnings to participate in a requirement for degree completion. Finally, since field placements are designed to serve medically underserved populations and communities, students may have the added burden of finding available housing in rural or geographically remote areas (Fifolt et al., 2020). To minimize these barriers, we suggest that the leadership of PHTCs and local and state health departments work together to ensure the availability of adequate and stable housing beyond the current arrangement which places the onus of responsibility solely on the student.
Expand target audience for public health training opportunities
The national PHTC Network has been exceptionally responsive to assessing and meeting the needs of the public health workforce through professional development training. This was especially true for R-IV when evaluators conducted a rapid needs assessment in response to the COVID-19 pandemic. However, the primary audience for trainings is the governmental public health workforce. To fully heed the call of Public Health 3.0 to “engage multiple sectors and community partners to generate collective impact” (DeSalvo et al., 2017, p. 3), PHTCs must intentionally design and promote training opportunities for a wide range of professionals across various disciplines.
One of the clearest examples of this multidisciplinary approach to complex problem-solving can be seen in the field of health care through Interprofessional Collaborative Practice (IPCP). IPCP is defined as “practice and education where individuals from two or more professional backgrounds meet, interact, learn together, and practice with the client at the center of care” (Prentice et al., 2015, p. 1). In the context of public health practice, the term client would be replaced with community and the term care would be replaced by the phrase public health intervention.
As outlined in Public Health 3.0, improving the health conditions of vulnerable populations and addressing social determinants of health will require “vibrant, structured, cross-sector partnerships designed . . . (for) collective action” (DeSalvo et al., 2017, p. 4). Therefore, public health partners must include a range of non-public health professionals such as traditional and social media experts and influencers, city planners, emergency medical services (EMS), transportation managers, first responders, and more.
Conclusion
In the United States, there are significant demands for a highly skilled and diverse public health workforce; therefore, we, as a society, must invest in the public health infrastructure. As demonstrated in this article, the national PHTC Network continues to provide invaluable services in terms of training, professional development, and experiential learning. Increased funding, however, would allow PHTCs to have a greater impact through bridge programs for public health workers and others, additional field placement experiences, and expanded outreach to non-public health professionals in training activities. Adopting an IPCP mind-set requires us to engage non-public health professionals in collaborative training sessions. PHTCs have shown great adaptability over time and can once again pivot to meet the needs of a rapidly changing public health landscape demonstrating that PHTCs are truly more relevant than ever.
Footnotes
Authors’ Note:
This work is sponsored by the Region IV Public Health Training Center, which is supported by the Health Resources and Services Administration of the U.S. Department of Health and Human Services under Grant Number 6 UB6HP31680, Affordable Care Act (ACA) Public Health Training Centers.
