Journal of Public Health Management and Practice最新文献

This study examined the relationship between the comprehensiveness of nonprofit hospitals' health equity strategies and their community benefit spending. Health equity strategies were measured using data from the American Hospital Association's Annual Survey and included indicators of equitable and inclusive organizational policies; systematic and shared accountability for health equity; diverse representation in hospital leadership and governance; community engagement; collection and use of segmented data to drive action; and culturally appropriate patient care. Community benefit spending was measured using data from Internal Revenue Service (IRS) Form 990 Schedule H. Among 984 hospitals with complete data for the year 2022, those with the most comprehensive health equity strategies dedicated more resources to traditional clinical community benefits-including charity care and Medicaid payment shortfalls-while spending less on subsidized health services. These hospitals also consistently invested more in population health-related community benefits, such as community health improvement programs, community building activities, and cash or in-kind contributions. These findings suggest that robust health equity strategies are linked to greater investment in both clinical needs and broader determinants of community health.

From 2005 to 2024, the Centers for Disease Control and Prevention's port health stations (PHSs) received 37 reports of travelers with suspected or confirmed cholera. Most reports (29/37, 78%) occurred before 2012, with the majority linked to the 2010 Haiti outbreak. The median age of travelers was 34 years (interquartile range: 21-59 years), and nearly all (35/37, 95%) arrived by air. Seventeen (46%) cases were laboratory-confirmed as toxigenic Vibrio cholerae O1, serotype Ogawa; 16 (94%) patients with confirmed cholera were hospitalized. No deaths were reported. Following the publication in 2011 of notification criteria for communicable diseases in travelers, health department notifications to PHSs of cholera cases declined. Continued coordination with public health partners is important to ensure timely evaluation and follow-up of travelers with suspected cholera. Clinicians should obtain travel histories and consider cholera in recent travelers with severe watery diarrhea who have been in outbreak or endemic areas.

Context: The public health (PH) workforce shortage poses a significant threat to the US population. Despite an increase in PH programs attracting students, there is a need to enhance diversity within local and state PH departments. While internships are recognized as valuable entry points into the PH field, research on the effectiveness of such pathway programs for recruiting diverse candidates is limited.

Program: Sponsored by the Connecticut (CT) Department of Public Health and supported by the CDC Crisis Response Cooperative Agreement: COVID-19 Public Health Workforce Supplemental Funding, the CT Public Health Fellowship Program (PHFP) aims to generate interest in PH careers by placing students in high-quality fellowship positions in CT. Third- or fourth-year undergraduates and graduate students enrolled in PH programs receive administrative support, one-on-one coaching, orientation, and a $3500 stipend to facilitate their internships.

Implementation: From January 2023 to May 2024, 97 out of 205 applicants were admitted to the PHFP. Acceptance was on a rolling basis, accommodating academic schedules, personal limitations such as work/family obligation or transportation access, and host agency capacities.

Evaluation: We analyzed program data from PHFP applications. Chi-square tests and t-tests were conducted to assess differences between PHFP fellows and non-fellows. The results were not statistically significant. Additionally, fellows were compared to a representative sample of PH students from the US, New England, and CT.

Discussion: The PHFP has a strong potential to help replenish and diversify the PH workforce and enhance health equity. Future research should examine the long-term impacts of such PH experiential learning initiatives on a large scale.

Context: The 2024 Public Health Workforce Interests and Needs Survey (PH WINS) offers important data on the composition, well-being, and training needs of the public health workforce in the post-COVID-19 era.

Objective: To characterize the state governmental public health workforce in 2024 and provide a comparison to the 2021 survey.

Design: State health agency leaders were invited to have their workforce participate in PH WINS 2024. Participating agencies provided staff lists used to send e-mail invitations to employees to participate in this electronic survey.

Setting: State health agencies.

Participants: State health agency central office staff.

Main outcome measure: PH WINS 2024 maintains the domains from previous fieldings (ie, workplace engagement, training needs assessment, emerging public health concepts, well-being, and demographics).

Results: The proportion of staff aged 35 and under increased approximately 4% from 20% in 2021 (95% CI: 20%-21%) to 24% in 2024 (95% CI: 23%-24%). State health agency central office staff with 5 or fewer years in their current agency increased from 49% (95% CI: 48%-50%) in 2021 to 55% (95% CI:54%-56%) in 2024. Self-reported mental health improved with the proportion of those rating their mental and emotional health as poor or fair in 2021, 5% (95% CI:4%-5%) and 18% (95% CI: 17%-19%), respectively, decreasing to 3% (95% CI: 3%-3%) and 15% (95% CI: 14%-15%), respectively, in 2024. The top 3 strategic skill training needs in 2024 were budget and financial management (48%; 95% CI: 47%-49%), policy engagement (38%; 95% CI: 37%-39%), and systems and strategic thinking (34%; 95% CI: 33%-34%).

Conclusion: The 2024 PH WINS results indicate demographic shifts toward a state health agency central office workforce that is younger in age and tenure and positive improvements in key workforce well-being indicators that can inform future public health infrastructure investments and field practices to ensure a robust public health system.

Over the last 25 years, our communities have seen many growing and emerging challenges that have required the public health workforce to be nimble and well-trained in a wide range of areas, making national initiatives such as the Public Health Workforce Interests and Needs Survey (PH WINS) critical to assessing the needs of the public health workforce. As the de Beaumont Foundation prepared to field PH WINS in 2024, the 10 regional Public Health Training Centers (PHTCs), funded by the Health Resources and Services Administration and collectively known as the PHTC Network, were a natural partner to assist in the expansion of PH WINS to local health departments (LHDs). In 2024, due to having the first nationally representative sample of small LHDs, 1178 LHDs were included in the national sample of LHDs, up from 431 LHDs in 2017 and 439 LHDs in 2021. The purpose of this paper is to illustrate the PHTCs' role in bridging gaps between national public health initiatives and achieving the regional reach needed to help ensure engagement among individual states and local communities.

Context: Preventable gaps in health care access and health outcomes persist in the United States, linked to a range of complex, multilevel factors. Social capital is often considered a health-promoting resource that can facilitate improved health outcomes across communities. However, critiques of social capital highlight potential drawbacks, including unequal benefits across groups.

Objective: This research examines the relationship between social capital and health outcomes across 2 racial groups within the same communities in the United States.

Design: This research leverages a unique county-level dataset to analyze how social capital may be associated with divergent health outcomes across different racial groups within the same counties. We estimate our models using ordinary least squares regression with errors clustered by state. For 2 different health outcomes, we compare regression coefficients across the Black and White models using the seemingly unrelated post-estimation procedure.

Setting: Our dataset includes county-level data on social capital, health outcomes, and socioeconomic factors from more than 1000 US counties where aggregated health data are reported by racial subgroup.

Main outcome measures: We analyze whether social capital is health-protective for both Black and White populations, considering 1 health behavior (influenza vaccination) and 1 health outcome (life expectancy).

Results: Our findings suggest that county-level structural social capital is associated with higher White influenza vaccination rates and higher life expectancy. However, the same levels of social capital within a county are not associated with higher Black influenza vaccination rates or higher life expectancy.

Conclusions: Our analysis suggests that the current conceptualization of structural social capital captures health-promoting resources for White populations but not for Black populations. Addressing disparate impacts of social capital requires both acknowledging unequal levels of structural social resources and reconceptualizing social capital to better capture resources Black individuals leverage for health.

Objective: To describe how pandemic-era changes to enteric disease staff and resources impacted investigations and program needs post-COVID-19-emergency and to develop recommendations for maintaining capacity during future emergencies and periods of resource shortages.

Context: The federal COVID-19 public health emergency declaration ended in May 2023; however, pandemic-era changes continue to disrupt public health capacity and routine enteric disease activities. The Integrated Food Safety Centers of Excellence (Food Safety CoEs) assessed the ongoing impacts of the pandemic on enteric disease epidemiologists and developed recommendations for maintaining capacity during future emergencies and periods of resource shortages.

Setting and participants: The Food Safety CoEs conducted 53 interviews with 135 enteric disease epidemiologists at public health agencies in 48 states, 2 cities, and 3 territories. Interviews occurred using bidirectional video conferencing software between April and June 2023; one interview occurred in October 2023.

Design: A structured data extraction was performed by assigning emergent descriptive codes to transcript excerpts. Comprehensive topic summaries were used to summarize participant perspectives and experiences.

Main outcomes: Nine topic summaries emerged: work culture, remote work, innovation, competition for qualified epidemiologists, novice workforce, increasing workload and responsibilities, relationships, end of COVID-19 funding, and recommendations for future public health emergencies.

Results: While many epidemiologists transitioned back to pre-pandemic roles, disparities in staffing, funding, and retention remained. Programs with strong leadership and team cohesion demonstrated greater resilience. Participants emphasized the need for sustainable funding, improved hiring mechanisms, and expanded surge capacity plans, including student interview teams and knowledge-transfer protocols.

Conclusion: The pandemic exacerbated preexisting workforce challenges and revealed ongoing public health vulnerabilities. Structural changes, such as flexible funding, remote work policies, and centralized interview teams, can enhance workforce sustainability. Addressing these issues proactively will strengthen public health capacity and preparedness for the future.

Introduction: Conceptualization of the COVID-19 response burden on the state and local government public health workforce is complicated as it continuously evolved and called upon nearly every aspect of the workforce. This study aims to catalog the scale of COVID-19 response among the state and local public health workforce by assessing the role of overtime in the delivery of public health services during pandemic response and shifts in agency size and program area distribution since the height of the pandemic.

Methods: This study uses detailed state and local workforce survey data from the Public Health Workforce Interests and Needs Survey 2021 and 2024 administrations. The analytic sample includes the 72.2% of employees that served in a COVID-19 response role at any time during the pandemic (n = 30 914; N = 136 591) and 214 state and local agencies that participated in both years (n = 65 144 unduplicated responses).

Results: In total, overtime equated for the equivalent of 25 000 FTE COVID-19 response employees, one-quarter (25%) of the total FTE COVID-19 response workforce. Of the 214 agencies that participated in both the Public Health Workforce Interests and Needs Survey 2021 and 2024, 41% of agencies (88) saw decreases in staff size overall between those 2 points in time. Shifts in primary program area between 2021 and 2024 are largely driven by changes in the proportion of non-full-time permanent employees.

Conclusion: This analysis magnifies the strain on the existing capacity of the public health workforce during the COVID-19 pandemic. These challenges stem from a chronically underfunded and understaffed workforce that was not prepared for surge capacity beyond existing employees. Given that many state and local public health agencies are smaller post-pandemic, it is reasonable to conclude that without large infrastructural changes, the workforce would likely face the same challenges if another pandemic-like crisis were to occur.

Context: High turnover rates in the public health workforce pose ongoing challenges to maintain essential services and institutional knowledge. Recent studies indicate that job dissatisfaction, burnout, and structural barriers have intensified following the COVID-19 pandemic. While prior studies have identified key predictors of turnover intention, the potential of machine learning (ML) to improve predictive accuracy and guide targeted interventions remains underexplored.

Objective: This study applied ML techniques to examine the predictors of turnover intent and to simulate the impact of workplace satisfaction improvements among state health agency employees.

Methods: We used data from 4 waves of the nationally representative Public Health Workforce Interests and Needs Survey: 2014, 2017, 2021, and 2024. Focusing on state health agency central office staff, we trained 3 ML models-Lasso Regression, Random Forest, and Gradient Boosting-to predict intent to leave one's organization within the next year. Models were trained separately by year using cross-sectional data and evaluated. Variable importance was assessed, and a simulation was conducted to evaluate the potential reduction in predicted turnover following targeted improvements in job satisfaction, organizational satisfaction, and pay satisfaction.

Results: All models demonstrated strong performance, with area under the receiver operating characteristic curve values ranging from 0.78 to 0.85. Job satisfaction consistently emerged as the most important predictor across all models and years, followed by organizational and pay satisfaction. Lasso Regression generally achieved the highest sensitivity and accuracy. Simulation results showed that modest improvements in satisfaction variables could substantially reduce predicted turnover intent, particularly among early- and mid-career staff.

Conclusion: This study highlights the value of ML for identifying key predictors of turnover intention. Findings reinforce the importance of job satisfaction, organizational climate, and compensation in retaining public health staff. ML-driven tools can support more proactive, data-informed retention strategies in the governmental public health system.