HRSA's Investment in Public Health Training Centers.

Abstract

The COVID-19 pandemic has demonstrated the relevance, importance, and value of the nation's public health workforce. Although not as easily defined or demarcated as other health professions, public health is a critical health workforce specialty, just as primary care physicians, nurses, dentists, and other health professions whose training is supported by the Health Resources and Service Administration's (HRSA's) Bureau of Health Workforce. Comprising both the Preventive Medicine Residency program and the Public Health Training Centers (PHTCs), the Bureau's public health workforce portfolio, although relatively small, is a unique and critical component of the federal government's overall public health efforts. A previous supplement in the Journal of Public Health Management and Practice discussed the activities of the Preventive Medicine Residency program.1 In this volume, we focus on the PHTCs and their role in training the US public health workforce. Public Health Training Unlike most health professions supported by HRSA's Bureau of Health Workforce programs, the PHTC program is unique because of the field that it supports. There is no singular career path into the field of public health. Since there is no standardized career pathway for those entering public health, there is no standard training curriculum required for entry into the field. Unlike nursing, dentistry, or medicine, there is no limitation on who can enter the public health workforce at most levels (although some jurisdictions may require a physician to lead their health departments). Still, public health can be defined as a unique profession. As stated in a seminal treatise on public health education, “The ordinary medical training does not qualify a person to be a health officer any more than the training suitable for public health service would qualify a man to practice medicine.”2(p794) Although public health may be a unique body of study, the 2017 Public Health Workforce Interests and Needs Survey (PH WINS) found that only 14% of the public health workforce has formal degrees in public health.3 And although formal training in the science of public health may include the core disciplines of epidemiology and biostatistics, environmental and behavioral health, and health policy and management, survey respondents still believed public health workers needed training in budgeting and financial management, systems and strategic thinking, and change management and developing a vision for a healthy community. The Art of Public Health Just as there is an art to direct clinical care, we must acknowledge that there is an art to public health. Akin to the “bedside manner” of clinicians, the art consists of a set of skills for the public health practitioner that transcends the science of public health and has significant implications in the success of the practitioner. If the art of clinical care can be summarized as using soft skills of communication and persuasion to achieve health outcomes in patients, the art of public health could be considered soft skills such as sound management and problem solving, which are essential to the health of populations. In fact, if effective bedside manner requires a deep understanding of the patient, the same can be said of public health and an understanding of the community to be served. The beginnings of formal public health education in the 20th century acknowledged the same: “With these points in view, the next matter requiring our attention is that since the education is to be for service, it must be practical, but a practical art based on sound science.”2(p794) Even the Welch-Rose report indicated in its requirements for modern public health education, The mere assembling of such courses does not constitute a school of hygiene. The great need of the country today ... is the establishment of well equipped and adequately supported institutes or laboratories of hygiene, where ... opportunities are afforded for thorough training in both the science and the art.4(p6) The Bureau's experience with health professional training shows that the most effective training occurs with the patients to be served: if we expect clinicians to succeed in rural areas or with underserved populations, their training should take place in the same areas. Public health training should be no exception. And thus, the PHTCs endeavor to provide practical training within communities with public health needs. Training the Public Health Workforce The PHTC program began in 1999 to support the accreditation movement among local health departments and the defining of competencies among public health workers. The program has changed to meet public health needs over the ensuing 2 decades. Just as the PHTCs' transformation in 2013 allowed them to provide rapid response training during the 2014 Ebola crisis,5 the program has an opportunity now to address public health workforce needs that have been exposed in the wake of the COVID-19 pandemic. To provide a flavor of HRSA-funded PHTCs' activities, during academic year 2019-2020, PHTCs oversaw experiential field placements at 278 sites across 48 states and Puerto Rico, which included state, local, and tribal health departments, Federally Qualified Health Centers and community health centers, hospitals, community-based organizations, and other settings; 74% of sites were located in medically underserved communities, 29% were in primary care settings, and 26% were in rural areas. In addition, PHTCs provided 2779 continuing education courses that reached 307 750 individuals, a quarter of whom worked in medically underserved communities. The projects collected in this supplement demonstrate the wide range of training activities funded through the HRSA-funded PHTCs: from an overview of PHTCs as a partner in workforce development to assessments of adaptive leadership and various modes of training; from systems thinking and issues in equity to an evaluation of a national pilot and an appraisal of COVID-19 activities across the PHTCs. The PHTCs are dynamic and spirited hubs of programmatic activity, looking to match the present and future needs of the public health workforce. In 1991, HRSA's then-Administrator Robert Harmon wrote of HRSA's role in public health, “It is essential that HRSA identify major weaknesses in the system and assist in correcting them.” He continued, “Filling the gaps in health care infrastructure ... is a responsibility unique to HRSA.”6(p7) We, the authors, agree wholeheartedly, and it is with this charge that we look toward future iterations of the PHTC program. Future Directions of the Public Health Training Centers After more than 20 years, the PHTCs remain a vibrant and vital program dedicated to training a public health workforce responsive to the needs of the nation. The need for a strong public health workforce will continue past the COVID-19 pandemic, and HRSA's PHTC program will continue to evolve and adapt to the needs of the workforce, keeping the art of the practice at the forefront of our training goals.