Journal of Public Health Management and Practice最新文献

In response to the COVID-19 pandemic, the US government funded voluntary school-based testing to support safe, in-person learning. In Alabama, this effort led to over 925 000 tests across 814 schools. This Practice Brief Report outlines implementation challenges and adaptive strategies used by the Alabama COVID-19 Testing and Prevention program, led by School of Public Health faculty and staff at the University of Alabama at Birmingham School of Public Health. Key informant interviews revealed 4 main challenges: lack of buy-in, limited capacity, unclear program scope, and short lead time. The team responded by building relationships, offering incentives, engaging School Liaisons, hiring adaptable staff, and ensuring strong leadership. These efforts built trust, increased participation, and reduced staff burden. Findings highlight the importance of local engagement, flexibility, and trust-building in public health work. Lessons learned offer guidance for future school-public health partnerships, especially in politically conservative and resource-limited settings.

Background and objectives: The United States is experiencing a public health workforce shortage, elevating the importance of workplace initiatives that support employee retention. In recent years, state health agencies (SHAs) have increasingly implemented diversity, equity, and inclusion (DEI) policies to promote fairness in the workplace, which have been associated with employee satisfaction and intentions to stay. SHAs have also increased investments in health equity infrastructure, aiming to address population health inequities. Less is known about the connection between these 2 forms of equity investment, specifically, if SHA investments in health equity infrastructure are associated with employee perceptions of organizational commitment to DEI. This research fills this gap by exploring individual- and agency-level characteristics associated with SHA employee perceptions of organizational commitment to DEI.

Methods: This study utilized data from the 2022 Profile of State and Territorial Public Health and the 2021 Public Health Workforce Interests and Needs Survey. The study sample includes responses from 12 978 nontemporary employees of 38 state public health agencies. Multilevel logistic regression was used to analyze predictors associated with positive perception of organizational commitment to DEI.

Results: Findings indicate that SHA investments in health equity infrastructure and top prioritization of health equity initiatives (ie, increasing workforce diversity, increasing cultural competency/health literacy, and data collection and tracking of demographics and disparities) are associated with agency employees' positive perceptions of organizational commitment to DEI.

Conclusion: This study shows that investing in health equity infrastructure is a strategic decision that strengthens agency culture and capacity. By embedding equity into operations and leadership, public health agencies can improve workforce retention, organizational climate, and their ability to serve communities fairly.

Context: The COVID-19 pandemic required a major response from local public health to reduce infections and manage inequities in COVID-19 outcomes. It is important to consider lessons learned from the COVID-19 pandemic response across local public health in order to prepare for future public health emergencies.

Objective: This study examined how local public health units (PHUs) in Ontario, Canada, addressed inequities in COVID-19 outcomes in their pandemic response.

Design: We contacted all 34 Ontario PHUs to participate in a survey on priorities, actions, and barriers to address health inequities in their COVID-19 response and conducted inductive content analysis on responses to identify themes.

Setting: Ontario, Canada.

Participants: A total of 25 out of 34 local Ontario PHUs completed the survey.

Main outcome measure: Public health unit-reported priorities and actions in addressing health inequities in their COVID-19 response.

Results: PHUs reported varied priorities in addressing health inequities. PHUs played a key role in coordinating an equity-focused response, including data analysis and reporting, engaging with community groups, and making cross-sector connections. However, important barriers remained, including a lack of community trust, frequent changes in guidance, lack of access to data on the social determinants of health, and a shortage of staffing and resources.

Conclusion: Findings suggest ways to prioritize health equity in a public health emergency, including through properly resourcing PHUs, early planning and trust building, and improved equity-based data collection.

Big Cities Health Coalition member health departments (BCHC HDs) serve more than 60 million people across 35 jurisdictions nearly 20% of the US population. This brief focuses on BCHC HDs that participated in the 2024 Public Health Workforce Interests and Needs Survey (PH WINS), highlighting key workforce indicators during a period of historic investments in public health infrastructure. Results for BCHC HDs from the 2024 PH WINS survey show a positive change in recruitment and retention and strong job satisfaction. These changes correspond with historic financial investments, particularly through the Centers for Disease Control and Prevention (CDC) Public Health Infrastructure Grant (PHIG), suggesting that this substantial investment has played a role in the gains observed among the BCHC HD workforce.

Objective: The purpose of this study is to describe individual and organizational characteristics among those who report working remotely and examine how concordance between public health employees' work preferences and their actual work situations relates to burnout, satisfaction, and intention to leave.

Design: This cross-sectional study utilizes the 2024 Public Health Workforce Interests and Needs Survey (PH WINS). Bivariate relationships were analyzed by conducting chi-squared tests of individual and organizational characteristics by respondents' reported work situation, work preference, and concordance between work situation and work preference. Multivariate logistic regression models of workforce outcomes were performed holding race/ethnicity, gender, age, education level, public health degree attainment, role classification, tenure at current agency, current employer, current employment status, full-time employee, supervisory status, setting, and governance constant.

Setting: A nationally representative sample of government public health employees.

Participants: 55 742 government public health employees.

Main outcome measures: Job satisfaction, burnout, and intention to leave.

Results: Among respondents, most worked in-person, and 52.2% reported that their work situation matched their preference. Job satisfaction was high for the majority of respondents. Nearly 20% reported burnout, and 24.8% reported that they intended to leave their organization within a year. Work situation and preference varied significantly by age, education, tenure, employment status, and organizational setting. Older and less educated staff were more likely to work in their preferred setting (in-person). Multivariate models showed that concordance between work situation and preference was significantly associated with higher satisfaction and lower burnout and intent to leave.

Conclusions: Findings show that employees whose work situations align with their work preferences report higher job satisfaction, lower burnout, and decreased intention to leave their organizations. These effects are most pronounced among younger and highly educated workers, who experience more difficulty in achieving this alignment.

Objective: Describe key characteristics of the rural local public health workforce on a national level, including in comparison to both the overall and urban local public health workforce.

Design: Cross-sectional analysis of the 2024 Public Health Workforce Interests and Needs Survey (PH WINS) data.

Setting: Local health departments (LHDs) serving rural and urban jurisdictions across the United States.

Participants: The study sample included 172 679 weighted responses from individuals working in LHDs, and 33 214 of them were from rural-serving LHDs.

Main outcome measures: Descriptive and bivariate statistics for measures across 4 areas, both overall and by rurality: demographic characteristics, educational background, position information, and intentions to stay or leave.

Results: Greater portions of the rural local public health workforce were female and White relative to their urban counterparts. Compared to the urban workforce, the portions of the rural workforce without a public health degree and with clinical training were both greater. Tenure in position, agency, and public health practice also differed by rurality, with 19.6% of the rural workforce reporting the greatest tenure in public health practice (21 years or above) compared to 17.8% of the urban workforce. Intentions to stay, leave, or retire also differed by rurality, with 15.4% of the rural workforce reporting intentions to leave in the next year for reasons outside of retirement, compared to 21.6% of the urban workforce.

Conclusions: Characteristics of the local public health workforce vary by rurality, extending prior research demonstrating differences between rural- and urban-serving LHDs across the nation. Findings should guide rural-focused strategies aimed at strengthening and sustaining the public health workforce.

Context: Government public health agencies are navigating challenging changes in funding, policy, and shifting priorities. Now more than ever, agencies must address the training needs of their multigenerational workforce in order to sustain and strengthen the public health ecosystem.

Objectives: This paper identifies the patterns in perceived training needs and strategic strengths across generational groups within state and local government public health agencies, and examines whether differences in formal public health education affect the training needs across those generations, utilizing data from the Public Health Workforce Interests and Needs Survey (PH WINS).

Setting: 48 state- and 1,178 local- public health departments.

Participants: 56,595 eligible employees from state and local public health departments.

Results: Nationally, the top three training needs were Budget and Financial Management (51%; 95% CI: 50%-51%), Policy Engagement (40%; 95% CI: 39%-41%), and Systems and Strategic Thinking (34%; 95% CI: 34%-35%). These are fairly consistent within each age group, except for Change Management, which is a top need for the youngest age group (36%; 95% CI: 35%-38%). Formal public health training plays a role in decreasing perceived training needs and bolstering strategic strengths.

Conclusions: The perceived training needs of the state and local public health workforce indicate a changing relationship between generational dynamics, lived experiences, and formal public health education. Public health agencies should promote and support intergenerational learning and collaboration among all age groups within the workforce. This approach can enhance workforce development initiatives, leading to a more robust workforce.

Context: The Public Health Workforce Interests and Needs Survey (PH WINS) was fielded in 2014, 2017, and 2021. In the last 10 years, it has provided participating health departments and the field with data to improve recruitment and retention, strengthen workforce development efforts, guide strategic planning, and raise critical funds to improve public health infrastructure. It captures individual perspectives on engagement and satisfaction, intention to leave, training needs, and workplace infrastructure. This article describes the methods used for the 2024 administration of PH WINS.

Ph wins: PH WINS 2024 was fielded to a nationally representative sample of staff in State Health Agency Central Offices (SHA-CO) and local health departments (LHDs) from September 9, 2024, to January 17, 2025. The instrument was revised to improve the actionability of the results, reduce respondents' cognitive burden, and align with existing standards or survey questions. PH WINS 2024 had 12 sampling frames, compared with the 3 in previous years: SHAs, members of the Big Cities Health Coalition (BCHC), and LHDs in each of the 10 Health and Human Services (HHS) Regions. All participating agencies were surveyed using a census approach.

Participation: Overall, staff lists for 48 SHAs, 1,178 LHDs were collected, and the survey was sent to 159 627 individuals. PH WINS received a total of 56 595 responses, a 37% of eligible respondents. The SHA frame received responses from 29% of eligible respondents, BCHC members received 33%, and all other LHDs received 51%. The nationally representative SHA-CO frame included a total of 18 110 individuals, and the nationally representative LHD frame included 38 485 individuals from all 1178 LHDs. For the first time, the national sample of LHDs included small LHDs.

Reflections: With the 2024 administration of PH WINS, all state and local public health departments in the United States had the opportunity to participate, yielding a nationally representative sample of small LHDs for the first time. State and local health department leaders should be empowered to use the results for workforce development and other planning. Questions were modified to become more action-oriented, rigorous, and stable over time to maximize the utility of PH WINS for years to come. Given the changing public health landscape associated with new outbreaks, disasters, and the political environment, these changes are critical.

Context: Salary plays a crucial role in recruiting and retaining employees in public health; however, information about trends in compensation is limited.

Objective: To analyze trends in earnings among state and local governmental public health workers between 2017 and 2024.

Methods: Data used are from the Public Health Workforce Interests and Needs Survey for the years 2017, 2021, and 2024. The analytic sample comprised 34 379 full-time permanent employees with complete salary data in 2017, 32 862 in 2021, and 45 241 in 2024, representing state health agency (SHA) and local health department (LHD) public health workers in each respective year. We performed a multi-cross-sectional analysis using descriptive and bivariate analyses and interval-based regression techniques to explore relationships between annualized earnings and key individual and agency-level characteristics.

Results: Earning patterns in 2024 were largely consistent with historical patterns. Individual and agency-level characteristics continued to play a significant role in shaping salary. Higher salaries remained associated with higher supervisory status, longer tenure, higher educational attainment, salaried (versus hourly) employment, union/bargaining unit representation, and employment setting within SHAs versus LHDs. Between 2017 and 2024, annual earnings for full-time permanent employees increased from $57 817 in 2017 to $73 299 in 2024, representing a 27% average increase of $15 482. However, when adjusted for inflation, annual wages showed no real growth, indicating that earnings remained largely stable in terms of purchasing power during this timeframe. Subgroups that experienced declines in inflation-adjusted salaries between 2017 and 2024 include executives, employees with longer tenures, employees with doctoral degrees, and employees with public health degrees versus degrees in other fields.

Conclusions: The continued decline in inflation-adjusted earnings for certain groups and persistent gender and racial pay gaps indicate that without targeted interventions, public health agencies may face challenges in retaining experienced professionals, attracting new talent, and ensuring workforce stability.