The local health department (LHD) workforce is the backbone of the nation’s public health infrastructure. While healthcare issues have historically overshadowed the public health tenets of prevention and population health, LHD leaders and staff are truly on the front lines of keeping U.S. residents healthy and safe. Despite its critical importance, the LHD workforce is facing numerous challenges that the nation must confront to ensure the health and well-being of our communities.
One key challenge is the changing nature of LHD work. LHDs are increasingly being incentivized to shift away from traditional services and instead develop cross-cutting capacities and lead cross-sector partnerships to improve population health. This shift requires that LHD leaders and staff develop new skillsets to support the evolving nature of their work.
While the scope of LHD work is shifting and broadening, most LHDs are still contending with the job losses of the last decade. Data from NACCHO’s 2016 Profile of Local Health Departments (Profile) study suggests that the decline in the number of LHD jobs may be decreasing; however, LHDs have lost 22% of their workforce—from 190,000 employees in 2008 to 147,000 in 2016. It will likely take a generation to rebuild the workforce to its pre-Great Recession strength. LHDs also face the impending retirement of a large portion of their staff. Currently, almost a third of public health professionals are between the ages of 51 and 60.1 LHDs are grappling with how to prepare for a mass exodus of employees who will soon retire.
NACCHO’s Workforce Development Efforts
NACCHO has committed significant resources to supporting the development and training of the LHD workforce. In 2016 alone, NACCHO hosted more than 4,000 total participants at its three major educational conferences. NACCHO also provided 66 travel scholarships to build workforce competencies, hosted 64 informative workshops and webinars, and provided more than 420 hours of one-on-one technical assistance to LHD staff.
In 2015, NACCHO launched the Management Essentials for New Local Health Officials training series. This program helps new local health officials prepare for LHD leadership through rigorous modules in strategic planning, successful people management, and financial management. Since the development of NACCHO’s virtual learning community in 2016, over 200 LHD staff have participated in information-sharing among colleagues. Since its launch in July 2015, more than 450 local health officials and their staff have participated in the Web-based series. In 2016, NACCHO successfully launched a virtual learning community to enhance information-sharing among participants. To date, more than 200 LHD staff participated in the forum. The program builds upon NACCHO’s Survive and Thrive training for new and aspiring local health officials, which concluded in 2013. More than 180 people participated in the three cohorts, which paired new leaders with seasoned mentors to help bolster their ability to resolve challenges unique to local health officials.
Last year, NACCHO hosted its second cohort of Roadmap to Ready, a training and mentoring program to help new emergency preparedness coordinators navigate the complex landscape of public health preparedness. The first two cohorts of Roadmap to Ready engaged more than 100 LHD preparedness coordinators representing over 20 states including a staff member from our department. Throughout the year, participants received knowledge, skills, connections, and resources to successfully prepare their local jurisdictions for new and emerging threats.
NACCHO’s Web-based Roots of Health Inequity course is also more relevant than ever as LHDs are compelled to address the social determinants of health. The online course offers health department staff a place to investigate the relationship between social injustice—the fundamental cause of health inequities—and everyday public health practice.
How LHDs are Addressing Workforce Development
LHDs are taking a variety of approaches to ensuring their agencies are equipped with the staff they need to be successful in the next era of local public health. The Salt Lake County Health Department (SLCHD) in Utah has developed and implemented a succession plan to prepare for the approaching retirement of nearly 30% of its staff. The project aimed to train staff in the skills that staff close to retirement possessed. After identifying key positions that were essential to the department’s overall functioning and their responsibilities and skillsets, SLCHD began to recruit employees to participate in the year-long project. A survey that was conducted after the project showed a notable increase in knowledge in key areas.
Similarly, the Kent County Health Department (KCHD) in Michigan developed a three-year workforce development plan to help it meet the requirements of both accreditation through the Public Health Accreditation Board (PHAB) and NACCHO’s Project Public Health Ready program for emergency preparedness. Evaluation results of the program have shown overwhelming staff increases in knowledge, skills, and abilities. For example, data from 2013–2014 indicates that 84% of staff reported significant or some change in knowledge and skills associated with communication; 82% of staff reported significant or some change in knowledge and skills associated with cultural competency; 75% of staff reported significant or some change in knowledge and skills associated with public health science; 77% of staff reported significant or some change in knowledge and skills associated with leadership and systems thinking skills; and 92% of staff reported significant or some change in knowledge and skills associated with emergency preparedness. The workforce development plan created by KCHD successfully met requirements for both national accreditation through PHAB and recognition through PPHR. National accreditation through PHAB was conferred in September 2014 and PPHR recognition was awarded in January 2015.
At my health department, the Cambridge Public Health Department, we’re cultivating the next generation of LHD leaders by engaging students in local schools of public health. We invite students to complete a field practicum in our agency, which exposes them to the work of LHDs and shows them first-hand the breadth and depth of our work. Students participate in a variety of ways, including shadowing nurses, creating outreach strategies for our health campaigns, and analyzing public health data. In addition to exposing students to our programs and day-to-day work, each year we host a symposium for graduate students during National Public Health Week, which enables them to learn about the inner-workings of the health department. Finally, on a more personal note, I find it incredibly important to serve as a mentor to up-and-coming local public health professionals. Mentors have been very valuable to me in my own career so I make it a point to give back. And I find it’s a two-way relationship—they benefit from my 20 years of experience and I gain insights about the challenges and opportunities that face future leaders and healers to our discipline.
Our workforce is our most important asset for improving health outcomes in our communities. We must continue to invest our time and resources to ensure that tomorrow’s generation of leaders is prepared to take the helm.
NACCHO’s Workforce Development Webpage
NACCHO Workforce Resource Center
NACCHO’s Roots of Health Inequity Course
NACCHO’s Model Practices Database (search for the Workforce category)
NACCHO’s Profile of Local Health Departments Study
CDC’s Workforce Development Resources
- The deBeaumont Foundation and the Association of State and Territorial Health Officials. (2015). Public Health Workforce Interests and Needs Survey. Retrieved April 11, 2017, from http://www.debeaumont.org/phwins/