Governmental Public Health Agencies Research Articles

Strategies for Enhancing Governmental Public Health Workforce Well-being and Retention.

Strategies for Enhancing Governmental Public Health Workforce Well-being and Retention.

The Emerging Leaders in Public Health Initiative: Leadership Development to Advance Public Health Practice.

Effective leadership is essential for governmental public health agencies to promote and protect the health of their communities. The Emerging Leaders in Public Health Initiative, a program of The Kresge Foundation, was implemented to strengthen leadership in governmental public health. We seek to examine lessons from the initiative to contribute to the field a better understanding of leadership development practices. An external evaluator conducted a retrospective analysis of participant responses postinitiative to assess the overall impact of the initiative and explore which components were most valuable. United States. Directors and other staff from governmental public health agencies were recruited in 2-person teams to participate in 3 successive cohorts. Drawn from adaptive leadership principles, a framework was developed to guide the selection and implementation of educational and experiential activities. Participants were challenged to develop a new role for their public health agency, which provided a learning laboratory to practice individual and team leadership skills. The Kresge Foundation provided participants with a resource grant and a National Program Office offered convenings, webinars, coaching, and technical assistance over the 18 months of the developmental experience. Satisfaction, perceived value of components, and future intentions were assessed from participants in cohorts II and III (n = 70). The overall response rate was 93%. One hundred four diverse leaders from 52 agencies, representing 30 states participated in the initiative. Participants were extremely satisfied with the program (94%) and indicated a strong likelihood of recommending it to a colleague (96%). Unrestricted grant funding, peer learning, and in-person learning sessions were the program components rated most highly valuable. This initiative offers insights into principles and processes to be considered for future public health leadership development.

Proposing a Code of Ethics for Public Health Professionals in Europe

Context: Public health practitioners are involved in a wide array of contexts. Local and national government public health agencies; domestic and international nongovernmental organizations (NGOs); and academic institutions are just a few examples of the settings where public health practitioners work. Acting ethically and meeting ethical commitments in a practical and transdisciplinary endeavor as complicated as public health necessitates careful consideration. Ethical practice ensures that public health institutions work properly and that individual public health practitioners maintain their integrity. There is little debate about the importance of ethics in public health professional practice and, as a result, the necessity for a corresponding professional code of ethics. 
 Policy Options: Only an US-American code of public health ethics has been created so far. Since ethical considerations in public health are heavily dependent in contexts, the aim of this document is to initiate a discussion surrounding the establishment of a Code of Ethics for Public Health Professionals in Europe.
 Recommendations:
 
 Stimulate the discussion on a European code of public health ethics.
 Make a clear distinction between public health ethics and medical ethics.
 Recognize public health as a profession and not just a medical specialty.
 Recognize the need for a common code of ethics among public health professionals in Europe.
 Use Kotter's Model based on the Theory of Change as a roadmap when creating the European public health code of ethics.
 Treat the European code of ethics as a "living document".
 Encourage further research on a European code of ethics.
 

Health Departments' Role in Addressing Social Determinants of Health in Collaboration With Multisector Community Partnerships.

Multisector community partnerships (MCPs) are key component of the public health strategy for addressing social determinants of health (SDOH) and promoting health equity. Governmental public health agencies are often members or leaders of MCPs, but few studies have examined the role of health departments in supporting MCPs' SDOH initiatives. We engaged 42 established MCPs in a rapid retrospective evaluation to better understand how MCPs' SDOH initiatives contribute to community changes that promote healthy living and improved health outcomes. As part of this work, we gained insights into how health departments support MCPs' SDOH initiatives, as well as opportunities for enhanced collaboration. Results indicate that health departments can support MCPs' SDOH initiatives through the provision of funding and technical assistance, data sharing, and connecting community organizations with shared missions, for example. Findings can be used to inform the development of funding opportunities and technical assistance for MCPs and health department partners.

A Uniform Chart of Accounts: Strengthening Public Health Practice and Research Through Standardized Financial Data.

The COVID-19 pandemic made the long-standing need for a national uniform financial reporting standard for governmental public health agencies clear, as little information was available to quantify state and local public health agencies' financial needs during the pandemic response. Such a uniform system would also inform resource allocation to underresourced communities and for specific services, while filling other gaps in practice, research, and policy making. This article describes lessons learned and recommendations for ensuring broad adoption of a national Uniform Chart of Accounts (UCOA) for public health departments. Leveraging previous efforts, the UCOA for public health systems was developed through collaboration with public health leaders. The UCOA allows state and local public health agencies to report spending on activities and funding sources, along with practice-defined program areas and capabilities. To date, 78 jurisdictions have utilized the UCOA to crosswalk financial information at the program level, enabling comparisons with peers. Jurisdictions participating in the UCOA report perceptions of substantial up-front time investment to crosswalk their charts of accounts to the UCOA standard but derive a sense of valuable potential for benchmarking against peers, ability to engage in resource allocation, use of data for accountability, and general net positive value of engagement with the UCOA. The UCOA is considered a need among practice partners. Implementing the UCOA at scale will require government involvement, a reporting requirement and/or incentives, technical assistance, financial support for agencies to participate, and a means of visualizing the data.

Turnover, COVID-19, and Reasons for Leaving and Staying Within Governmental Public Health.

Public health workforce recruitment and retention continue to challenge public health agencies. This study aims to describe the trends in intention to leave and retire and analyze factors associated with intentions to leave and intentions to stay. Using national-level data from the 2017 and 2021 Public Health Workforce Interests and Needs Surveys, bivariate analyses of intent to leave were conducted using a Rao-Scott adjusted chi-square and multivariate analysis using logistic regression models. In 2021, 20% of employees planned to retire and 30% were considering leaving. In contrast, 23% of employees planned to retire and 28% considered leaving in 2017. The factors associated with intentions to leave included job dissatisfaction, with adjusted odds ratio (AOR) of 3.8 (95% CI, 3.52-4.22) for individuals who were very dissatisfied or dissatisfied. Odds of intending to leave were significantly high for employees with pay dissatisfaction (AOR = 1.83; 95% CI, 1.59-2.11), those younger than 36 years (AOR = 1.58; 95% CI, 1.44-1.73) or 65+ years of age (AOR = 2.80; 95% CI, 2.36-3.33), those with a graduate degree (AOR = 1.14; 95% CI, 1.03-1.26), those hired for COVID-19 response (AOR = 1.74; 95% CI, 1.49-2.03), and for the BIPOC (Black, Indigenous, and people of color) (vs White) staff (AOR = 1.07; 95% CI, 1.01-1.15). The leading reasons for employees' intention to stay included benefits such as retirement, job stability, flexibility (eg, flex hours/telework), and satisfaction with one's supervisor. Given the cost of employee recruitment, training, and retention of competent employees, government public health agencies need to address factors such as job satisfaction, job skill development, and other predictors of employee retention and turnover. Public health agencies may consider activities for improving retention by prioritizing improvements in the work environment, job and pay satisfaction, and understanding the needs of subgroups of employees such as those in younger and older age groups, those with cultural differences, and those with skills that are highly sought-after by other industries.

Workplace Perceptions and Experiences Related to COVID-19 Response Efforts Among Public Health Workers - Public Health Workforce Interests and Needs Survey, United States, September 2021-January 2022.

The COVID-19 pandemic has strained many essential frontline professionals, including public health workers*; however, few studies have evaluated the specific challenges facing public health workers during this period. Data from the 2021 Public Health Workforce Interests and Needs Survey (PH WINS), a nationally representative survey of individual state and local governmental public health agency workers, provide insight into public health workers' demographic characteristics and experiences during the COVID-19 pandemic, tenure, and intention to leave their organization† (1). Surveyed governmental public health workers identified predominantly as non-Hispanic White (White), women, and aged >40 years; however, workforce characteristics differed by agency type. Overall, 72% of respondents reported working fully or partially in a COVID-19 response role at any point during March 2020-January 2022. An estimated 44% of workers reported that they were considering leaving their jobs within the next 5 years for retirement or other reasons. Of those considering leaving, 76% began thinking about leaving since the start of the COVID-19 pandemic. When asked what was needed, besides funding, to respond to the COVID-19 pandemic, 51% selected additional staff capacity. Survey findings highlight the importance of focused attention on recruitment and retention that promotes diversity (2) and workers with public health experience, which will be critical as the workforce rebuilds as the COVID-19 pandemic evolves.

Evaluation of individual and ensemble probabilistic forecasts of COVID-19 mortality in the United States.

Short-term probabilistic forecasts of the trajectory of the COVID-19 pandemic in the United States have served as a visible and important communication channel between the scientific modeling community and both the general public and decision-makers. Forecasting models provide specific, quantitative, and evaluable predictions that inform short-term decisions such as healthcare staffing needs, school closures, and allocation of medical supplies. Starting in April 2020, the US COVID-19 Forecast Hub (https://covid19forecasthub.org/) collected, disseminated, and synthesized tens of millions of specific predictions from more than 90 different academic, industry, and independent research groups. A multimodel ensemble forecast that combined predictions from dozens of groups every week provided the most consistently accurate probabilistic forecasts of incident deaths due to COVID-19 at the state and national level from April 2020 through October 2021. The performance of 27 individual models that submitted complete forecasts of COVID-19 deaths consistently throughout this year showed high variability in forecast skill across time, geospatial units, and forecast horizons. Two-thirds of the models evaluated showed better accuracy than a naïve baseline model. Forecast accuracy degraded as models made predictions further into the future, with probabilistic error at a 20-wk horizon three to five times larger than when predicting at a 1-wk horizon. This project underscores the role that collaboration and active coordination between governmental public-health agencies, academic modeling teams, and industry partners can play in developing modern modeling capabilities to support local, state, and federal response to outbreaks.

Traditional Postpartum Care Among Women of Korean Descent in the United States.

Traditional postpartum care practices in East Asia have been recognized as non-functional by some government public health agencies. This study examined the perception of traditional postpartum care practice among families of Korean descent in the United States. In addition to pragmatic health care issues, the research was designed to contribute to cross-cultural understanding of hot-cold theory of reproductive behavior. A descriptive survey study and follow-up interviews were conducted among women of Korean descent living in the United States (n = 141). A questionnaire was used to explore the variation in women's beliefs about traditional postpartum care and the extent to which they or their relatives practiced this care. In the follow-up interview, the participants freely described the different ways of postpartum care practice. Compared to women from other Asian and immigrant populations, women of Korean descent maintained similar or higher rates of believing the functionality of temperature maintenance care practice, and believed that the associated forms of traditional care will continue in the future. Traditional postpartum care practices are broadly shared and practiced in Asian immigrant populations, even in highly industrialized and modernized settings. Furthermore, from their own experience of somatic pain and its functionality, women called for better implementation of traditional care as an alternative or supplement to modern medical care. Health-care systems need to improve understanding and accommodation of cultural beliefs about possible benefits of temperature maintenance after childbirth in Asian ethnic populations.

Attracting New Talent to the Governmental Public Health Workforce: Strategies for Improved Recruitment of Public Health Graduates.

Governmental public health (GPH) agencies need a diverse, skilled, and motivated workforce to advance health and well-being, but they face a number of recruitment challenges. While there has been massive growth in public health degree programs and graduates, those with a degree in public health are underrepresented in the GPH workforce. This study evaluates potential reasons undergraduate and graduate public health degree holders are underrepresented in the GPH workforce, assesses student awareness of and interest in GPH jobs, and identifies strategies for improved recruitment. We conducted pilot focus groups to explore public health students' interest in working for GPH agencies, obstacles to employment, and how this career path could be better promoted. Eight focus groups were conducted with a total of 33 participants at 3 universities and at the Annual Meeting of the American Public Health Association. Participants were enrolled full-time in or graduated within the last year from a public health bachelor's degree program or a public health master's degree program. Undergraduates had declared a public health major and were in their senior year; graduate students were in their second year and actively job seeking; or participants graduated within the past 12 months. The focus groups sought to capture students' perspectives of GPH agencies and how they believe recruitment can be improved. Participants described attractive job attributes including fulfilling, meaningful work; a position at a mission-driven organization; and the opportunity to make an impact on their community. Governmental public health agencies were viewed as bureaucratic, lacking innovation, and underresourced. Participants reported difficulties accessing and finding relevant job postings. Key to effectively recruiting and retaining new graduates is understanding their perceptions about/experiences with GPH agencies. While GPH jobs have desired attributes, participants reported that health departments are not effectively recruiting them.

COVID-19 Case Investigation and Contact Tracing: Early Lessons Learned and Future Opportunities.

Case investigation and contact tracing are fundamental public health strategies for controlling and preventing the spread of infectious diseases. Although the principles behind these strategies are not new, the capacity and operational requirements needed to support disease investigation during the SARS-CoV-2 (COVID-19) pandemic are unprecedented. This article analyzes the implementation of case investigation and contact tracing in controlling COVID-19 transmission during the early stages of the US pandemic response (January 20 through August 31, 2020). Governmental public health agencies mobilized to expand case investigation and contact tracing programs in the early months of the pandemic. In doing so, they encountered a range of challenges that included rapidly scaling up the workforce; developing and subsequently revising guidance and protocols specific to COVID-19 as more was learned about the virus over time; defining job functions; encouraging public acceptance of and participation in case investigation and contact tracing; and assessing the utility of these activities during both the containment and mitigation phases of outbreak response. COVID-19 case investigation and contact tracing programs presented an array of opportunities for health departments to innovate, especially around technology to support public health efforts, as well as opportunities to address health equity and advance community resilience. Lessons learned from disease intervention specialists, guidance and resources from federal agencies and national partners, and peer-to-peer exchange of promising practices can support jurisdictions encountering early implementation challenges. Further research is needed to assess COVID-19 case investigation and contact tracing program models and innovations, as well as strategies for implementing these activities during containment and mitigation phases.

Moving Upstream: Health and Prosperity During the COVID-19 Pandemic

According to Lisa Miller and Deborah Deatrick, everyone everywhere was unprepared for a disruption of the magnitude caused by the COVID-19 pandemic. As COVID-19 spread, new fissures emerged. Early efforts by government public health agencies stumbled, revealing system weaknesses from decades of neglect and underfunding. They go on to describe the efforts of Maine public health advocates to form the Maine Alliance to Health and Prosperity and outline the Alliance's plans for the future.

Applied Public Health Informatics: An eHealth Discipline Focused on Populations

The discipline of public health informatics, part of the broader eHealth field, brings methods, knowledge, and theories from computer science and information science to support population health and well-being. This branch of informatics is most often found in governmental public health agencies that focus on population-level activities, including surveillance of disease as well as disease prevention. There are several specialised public health information systems used to prevent or mitigate disease, including syndromic surveillance, electronic laboratory reporting, and population health dashboards. This article defines and describes public health informatics and its role in eHealth. The article further discusses the role of public health information systems and challenges they face for the future. Strengthening public health will require greater investment in interoperability as well as analytics and the workforce. Disease outbreaks like COVID-19, Ebola, and H1N1 demonstrate the need for robust public health informatics applications and methods. Yet there is much work to be done to evolve existing tools and methods to strengthen the public health infrastructure for the next pandemic.

Containing COVID-19 Through Contact Tracing

Containing coronavirus disease 2019 (COVID-19) through case investigation and contact tracing is a crucial strategy for governmental public health agencies to control the spread of COVID-19 infection in the United States. Because of the recency of the pandemic, few examples of COVID-19 contact-tracing models have been shared among local, state, and federal public health officials to date. This case study of the Anne Arundel County Department of Health (Maryland) illustrates one model of contact-tracing activity developed early in the outbreak. We describe the contact-tracing effort’s place within the broader county health agency Incident Command System, as well as the capabilities needed, team composition, special considerations, and major lessons learned by county health officials. Other local, state, tribal, territorial, and federal health officials and policy makers can use this case study to innovate, iterate, and further refine contact-tracing efforts to prevent the spread of COVID-19 infection and support community members in isolation or quarantine.

Building a Sustainable Governmental Public Health Workforce: A Look at the Millennial Generation.

Millennials have had a profound impact on society, the economy, and the US workforce. This study used generational definitions published by the Pew Research Center. Millennials includes respondents who reported an age between 21 and 36 years (born in 1981-1996) at the time the 2017 Public Health Workforce Interests and Needs Survey (PH WINS) was administered. Generation X includes respondents who reported an age between 37 and 52 years (born in 1965-1980), and the baby boom generation (baby boomers) includes respondents between 53 and 71 years of age (born in 1946-1964). Public sector agencies, including governmental public health, are increasingly interested in figuring out how to attract and retain millennials. As the governmental public health workforce anticipates upcoming retirements, knowledge about the motivations and organizational characteristics that appeal to millennials is crucial to understanding the millennial workforce and workplace dynamics for decades to come. In 2017, millennials made up 22% of the governmental public health workforce, Generation X 40%, and baby boomers 37%. This study examined opinions, expectations, and important workplace environment factors of millennials working in governmental public health compared with other generations. We performed bivariate analyses and fit a logistic regression model to evaluate the association of generation with responses to a set of satisfaction and engagement PH WINS survey questions. Data were drawn from the 2017 PH WINS of governmental health department employees, including state health agency and local health department staff. PH WINS excludes local health departments with fewer than 25 staff members or serving fewer than 25 000 people. PH WINS included responses from 47 604 staff members, which reflected a 48% overall response rate. The generations that were examined (millennials, Generation X, and baby boomers) were similarly satisfied with their jobs, organizations, and pay security, and millennials intended to leave their jobs for similar reasons as other generations. Millennials reported more strongly than other generations that their supervisors treated them with respect, that they had sufficient training to utilize technology, that their training needs are assessed, and that creativity and innovation were rewarded. They, however, reported less strongly that they were completely involved in their work and determined to give their best every day. Millennials in governmental public health agencies (excluding local health departments with <25 staff members or serving <25 000 people) may not be as different from other generations as previously thought. Governmental public health agencies should focus on highlighting workplace environment factors rated highly by millennials and on showcasing how careers in governmental public health could be attractive career options for millennials.

18.M. Workshop: Institutional barriers and support influencing the health and well-being of LGBT individuals

Abstract Research studies from many parts of the world have demonstrated significantly elevated risk of poor mental health among lesbian, gay, bisexuals, and transgender (LGBT) individuals compared to cisgender and heterosexual individuals. A growing body of evidence suggests that the elevated risk of poor mental health among LGBT people can be partly attributed to greater exposure to stigma-related stress and institutional barriers, such as, limited access to adequate health care, discriminatory legislation (e.g., regarding recognition of same-sex unions), and limitations in open expression of identity. Today many governmental public health agencies call for policy and intervention programs addressing specific needs of LGBT individuals. Still, the public health consequences of discrimination towards LGBT individuals have only recently been a topic of investigation and current knowledge in the area is limited. This workshop will include presentations of studies on strategies to reduce healthcare inequalities including the barriers LGBT individuals face when they access care and give examples of how institutional support can be provided. Laetitia Zeeman and Nigel Sherriff from University of Brighton, will present results from a European Union funded pilot project. Dr Corina Lelutiu-Weinberger from Rutgers University will present results from a study of the influence of gender affirmation and discrimination on transgender individuals mental health in a large US sample. Next, Daniel Hagen from New York University will present data analysing the protective effects of legal same-sex unions on the mental health of lesbian and gay couples. Lovro Markovic will present a study of predictors of being open with an LGBT identity in the workplace among employees in Austria. Key messages Although encouraging promising practices to reduce LGBT healthcare inequalities have been initiated in many parts of the world, much remains to be done to ensure equal access to care for all. Barriers to social integration in the form of discriminatory marriage legislation and work-place discrimination can have a negatively influence on LGBT individual's health and well-being.

Public Health Is Essential: COVID-19's Learnable Moment for Medical Education.

The COVID-19 pandemic, an unprecedented challenge for this generation of physicians and for the health care system, has reawakened calls to strengthen the United States’ public health systems. This global event is also a “learnable moment” for medical education—an opportunity to decisively incorporate public health, including public health systems, through the continuum of medical education. Although medical educators have made progress in integrating public health content into medical curricula, “public health” is not a phrase that is consistently used in curricular standards, and public health colleagues are not identified as unique and essential partners to improve and protect health. The COVID-19 crisis has demonstrated how a strong public health system is necessary to support the health of patients and populations, as well as the practice of medicine. Partnerships between medical and public health communities, through individual- and population-based interventions, can also more effectively combat more common threats to health, such as chronic diseases, health inequities, and substance abuse.To achieve a more effective medicine–public health relationship in practice, curricula across the continuum of medical education must include explanations of public health systems, the responsibilities of physicians to their local and state governmental public health agencies, and opportunities for collaboration. Medical education should also prepare physicians to advocate for public health policies, programs, and funding in order to improve and protect the health of their patients and communities. Pandemic COVID-19 demonstrates with laser focus that all physicians are part of public health systems and that public health content has a distinct and critical place across the continuum of medical education to prepare physicians to participate in, collaborate with, and advocate for public health systems.

Applying the Ready, Willing, and Able Framework to Assess Agency Public Health Emergency Preparedness: The CDC Perspective.

Public health emergencies in the United States have been complex, frequent, and increasingly costly in the past decade, at times overwhelming government agencies that are primarily resourced for routine, nonemergency health functions. Emergencies are not always predictable, and adequate resources are not always available to prepare staff in advance for emergency response roles and to mobilize them quickly when a new threat emerges. Additionally, real-world data that connect preparedness levels to response outcomes may be difficult to obtain, further limiting continuous quality improvement efforts by public health officials. In this article, we apply the Ready, Willing, and Able (RWA) framework to identify areas for improvement related to organizational and staff readiness, willingness, and ability to respond during a public health emergency. We share emergency response deployment, training, and personnel data collected as part of emergency response activations (2008 to 2018) at the Centers for Disease Control and Prevention to illustrate how the framework may be applied at government agencies to improve response processes and effectiveness. Additionally, we propose potential metrics aligned with the framework constructs that may help emergency managers consistently assess agency preparedness and, over time, be incorporated into broader standardized measurement methods. We conclude that the RWA framework is a practical tool that can complement other preparedness approaches currently in use at government public health agencies.

State Health Official Career Advancement and Sustainability Evaluation-Description of the Methods Used in the SHO-CASE Study.

State health officials (SHOs) lead state governmental public health agencies, playing an important role in their states. However, little comprehensive research has examined SHOs or characteristics of these leaders, limiting evidence about ways to improve SHO selection and subsequent performance. This brief describes the methods of the SHO-CASE study focused on current and former SHOs in state public health agencies. Methods used include qualitative components that informed the development of survey questions, survey administration, and survey response. A total of 147 SHOs responded to the SHO survey representing every state and Washington, District of Columbia. The SHO-CASE study survey database represents the most comprehensive database of its kind regarding a range of attributes of current and former SHOs. These data can be used to explore factors contributing to SHO success including valuable insights into effectively working with the states' elected officials.

Workshop: Addressing the mental health needs of lesbian, gay, bisexual, and transgender populations

Abstract Today a large number of studies from different parts of the world clearly show that compared with heterosexuals lesbian, gay, bisexual, and transgender (LGBT) individuals have an increased risk of mental health problems, especially depression, anxiety and suicidal behaviour. To meet this increased risk of mental health problems, many governmental public health agencies call for policy and intervention programs addressing specific needs of LGBT individuals. Despite the clear need for evidence-based care, prevention, and treatment specifically tailored to LGBTQ people, there are currently few such programmes due to lack of sufficient research. This workshop will give examples of studies on mental health care needs among LGBT individuals and effect of evidence-based training for mental health providers, as well as, studies showing improvements of mental health after treatments. Dr. Corina Lelutiu-Weinberger (Rutgers University, USA) will present results from a newly conducted study of LGBT-affirmative mental health training for health care providers in Romania. Dr. John Pachankis (Yale University, USA), will present results showing improvements in mental health among transgender individuals after receiving gender-affirmative surgical treatment, using a total population dataset from Sweden. Dr. Igor Grabovac (Medical University of Vienna, Austria) will present health and well-being disparities based on sexual orientation among older LGBT individuals in England. The situation for LGBT individuals varies greatly across Europe. The level of acceptance for minority sexual orientations differs greatly by country, and in many countries, LGBT people are also subject to legal discrimination concerning basic civil rights, e.g. regarding recognition of same-sex unions. During the workshop, Dr. Richard Bränström (Karolinska Institutet, Sweden) will present data on experiences of discrimination in health care settings and openness with sexual and gender identity to mental health providers among LGBT populations across all 28 European Union Countries. Key messages Today a large number of studies from different parts of the world clearly show that compared to heterosexuals LGBT individuals have an increased risk of mental health problems. Access to supportive mental health care for LGBT individuals varies greatly across Europe and dissemination of targeted LGBT-affirmative evidence-based interventions needed.