The Public Health Workforce:

An Agenda for the 21st Century

A Report of the Public Health Functions Project

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

TABLE OF CONTENTS

Executive Summary .............................................................................................................. v

Acknowledgments ............................................................................................................... vii

Introduction .......................................................................................................................... 1

Context .................................................................................................................................3

Composition of the Public Health Workforce ................................................................... 4

Competency-Based Curriculum ...................................................................................... 7

Distance Learning System Development .......................................................................... 8

Future Directions ................................................................................................................ 11

National Leadership ...................................................................................................... 11

State and Local Leadership........................................................................................... 12

Workforce Composition ............................................................................................... 12

Curriculum Development............................................................................................... 13

Distance Learning ......................................................................................................... 16

Implementation ................................................................................................................... 17

Appendix A: The Public Health Functions Project ............................................................ 19

Appendix B: Public Health in America .......................................................................... 21

Appendix C: Revision of the Federal Standard Occupational Classification (SOC) System:

New Occupational Categories Recommended for the Field of Public Health 23

Appendix D: Descriptions of Selected Public Health Workforce Assessment Studies ........ 27

Appendix E: Competencies for Providing Essential Public Health Services ....................... 29

Appendix F: Healthy People 2000 Consortium .............................................................. 43

Appendix G: The Faculty/Agency Forum Competencies by Discipline .............................. 47

Appendix H: Competencies Reviewed by the Competency-Based Curriculum

Work Group............................................................................................... 49

Appendix I: Public Health Functions Steering Committee and Working Group;

Subcommittee on Public Health Workforce, Training, and Education and

Work Group Member Lists......................................................................... 51

References ......................................................................................................................... 57

Bibliography ....................................................................................................................... 61

Today our Nation faces a widening gap between

challenges to improve the health of Americans and

the capacity of the public health workforce to meet

those challenges. Deeply concerned with this trend,

the Public Health Functions Steering Committee in

September 1994 commissioned the Subcommittee

on Public Health Workforce, Training, and Education, charged to:

provide a profile of the current public health

workforce and make projections regarding

the workforce of the 21st century. The

Subcommittee should also address training

and education issues including curriculum

development to ensure a competent

workforce to perform the essential functions

of public health now and in the future.

Minority representation should be analyzed

and the programs to increase representation

should be evaluated. Distance learning

should be explored. The Subcommittee

should examine the financing mechanisms for

curriculum development and for strengthening the training and education infrastructure.

The plan presented here builds on work already in

place with a call to practical action of Federal, State,

and local public health agencies; academic public

health departments; community health coalitions and

organizations; philanthropies; and all others concerned with the health of Americans.

This report uses as an analytic framework the

statement Public Health in America, with its

enumeration of 10 essential services of public health,

incorporating and building upon previous discussions

of public health functions. The public health

workforce includes all those providing essential

public health services, regardless of the nature of the

employing agency. The report endorses individual

and organizational excellence as the only standard

acceptable to the public and decisionmakers who

EXECUTIVE SUMMARY

must play a vital role in realizing the vision of

“Healthy People in Healthy Communities.” The

Subcommittee divided its efforts into:

• Enumerating the current workforce in public

 health function positions and assessing future

 changes in workforce roles and the impact of

 these changes on the workforce composition;

• Identifying training and education needs for core

 practices/essential public health services; and

• Developing a strategic plan for using distance

 learning approaches to provide high-priority

 public health education and training.

The specified action items listed below, and elaborated upon in the full report, represent essential first

efforts and will require the concerted attention of all

partners on the Public Health Functions Steering

Committee and many others if they are to have the

desired impact. These steps are not sequential,

and work on all of them should proceed concurrently. The necessary actions include:

1. National Leadership

The Public Health Functions Steering Committee

should continue to serve as the locus for oversight

and planning for development of a public health

workforce capable of delivering the essential public

health services across the Nation, including support

for any legislative authorization or financing mechanisms needed to fully implement this report and a

commitment to ensure that current workforce

development resources are wisely invested in

achieving identified goals. Each partner organization

is encouraged to develop specific plans and policies

that complement this collaborative effort.

2. State and Local Leadership

In order to ensure that programs are appropriately

tailored to the unique configuration of needs and

resources in each State and in each local jurisdiction,

a mechanism to develop State public health

v

*By “Federal, State, and local public health agencies” this report means any health, substance abuse, environmental

health and protection, or public health agency charged with some portion of the roles encompassed in the statement

Public Health in America.
The Public Health Workforce: An Agenda For The 21st Century

workforce planning and training should be developed and implemented. This mechanism should

include not only development of identified leaders,

but also cultivation of leadership qualities throughout

the workforce. The State, or where appropriate,

regional, efforts should emphasize possible partnerships among practice and academic entities involved

in public health. These efforts should be responsive

to and provide input into those at the national level.

In addition, these efforts must involve local public

health entities and be responsive to their needs.

3. Workforce Composition

A standard taxonomy should be used to identify the

size and distribution of the public health workforce in

official agencies (health, environmental health and

protection, mental health and substance abuse; local,

State, and national) and private and voluntary

organizations. This effort should be coordinated

with the Bureau of Labor Statistics to enhance

uniformity in occupational classification reporting.

To the extent possible, the taxonomy should be

consistent with Public Health in America,

recognizing that specific occupational titles will

vary across organizations.

Using the same taxonomy, the Steering Committee

should recommend and support a mechanism to

quantify the future demand for public health workers, paying particular attention to issues of diversity

and changing demographics in the workforce.

4. Curriculum Development

The statement of competencies for the public health

workforce developed by the Subcommittee should

be refined and validated, identifying the subset(s) of

competencies associated with each of the various

professions that make up the workforce.

Basic, advanced, and continuing education curricula

to train current and future public health workers in

the identified competencies should be supported

(where existing) and developed (where not yet in

place). Implementation should be coordinated with

the State planning efforts (above) and make maximum use of new technologies (below).

Improved methods (such as certification) of identifying practitioners who have achieved competency

should be identified and implemented if demonstrated effective.

5. Distance Learning

All partners in the effort to strengthen the public

health workforce should make maximum use of

evolving technologies such as distance learning.

A structure should be established to develop an

integrated distance learning system building on

existing public and private networks and making

information on best practices readily available.

The agenda presented in these recommendations

only partially fulfills the original charge to the Subcommittee. In its continuing leadership role, the

Steering Committee should identify other tasks that

need continuing attention and make plans for their

completion. With the continued attention of the

Public Health Functions partners, the public health

workforce will be strengthened to contribute

even more to the health of communities in the

21st century.

vi
It is difficult to acknowledge all the individuals who

have contributed to the development of this complex

and detailed report. The major contributors were

the members of the Subcommittee on Public Health

Workforce, Training, and Education and they are

listed in Appendix I. In addition, members of the

Public Health Functions Working Group and Steering Committee provided important comments on

earlier drafts of this report and their input has been

greatly appreciated and valued.

The Subcommittee would like to recognize the

specific efforts of the staff, Alex Ross, Health

Resources and Services Administration; D.W. Chen,

Health Resources and Services Administration;

Nona Gibbs, Centers for Disease Control and

Prevention; Nicole Cumberland, Office of Disease

ACKNOWLEDGMENTS

vii

Prevention and Health Promotion; Kristine Gebbie,

Office of Disease Prevention and Health Promotion;

the workgroup chairs, Doug Lloyd, Health Resources and Services Administration; Neil Sampson,

Health Resources and Services Administration; Dick

Lincoln, Centers for Disease Control and Prevention; Dennis McDowell, Centers for Disease Control

and Prevention; and specific contributors and

reviewers, Jerre Jensen, Public Health Training

Network; Susanne Caviness, Indian Health Service;

Valerie Welsh, Office of Minority Health; Faye

Malitz, University of Maryland; Anthony Moulton,

Centers for Disease Control and Prevention;

Herbert Traxler, Health Resources and Services

Administration; and Michael Weisberg, National

Library of Medicine.

1

Today our Nation faces a widening gap between

challenges to improve the health of Americans and

the capacity of the public health workforce to meet

those challenges. The public health community is

actively engaged in a wide range of activities to keep

the current workforce up to date and to anticipate

future needs. As a leadership forum for action on

public health infrastructure issues, the Steering

Committee of the Public Health Functions Project

(see Appendix A) in September 1994 commissioned the Subcommittee on Public Health

Workforce, Training, and Education to review

factors related to workforce challenges and to make

recommendations for an action plan. Their charge

was as follows:

To further an understanding of the public health

workforce, a Subcommittee . . . is charged with providing

a profile of the current public health workforce and

making projections regarding the workforce of the 21st

century. As a part of this effort, the Subcommittee should

examine the current and future shortfalls in the public

health workforce, looking broadly at Federal, State and

local levels, in public health departments as well as

mental health, substance abuse, and environmental

health agencies and at the emerging need for public

health competencies in managed care systems, health

plans, and in other governmental agencies such as

departments of agriculture, education, and justice. The

Subcommittee should also address training and

education issues including curriculum development for

graduate training in public health and ongoing training

and development activities to ensure a competent

workforce to perform the essential functions of public

health now and in the future. Minority representation in

public health disciplines should be analyzed and the

programs to increase representation should be reviewed and evaluated. Distance learning and other

advanced technology training methods should be

explored to ensure that training and education activities

are carried out in the most efficient and cost-effective

manner. Therefore, the Subcommittee shall examine the

financing mechanisms for curriculum development and

for strengthening the training and education infrastructure, as well as explore the feasibility of establishing a

Council on Graduate Public Health Education.

The Public Health Functions Steering Committee

also developed a consensus statement, entitled

Public Health in America, in 1994 (see Appendix

B). Building further upon the core functions of

public health (assessment, policy development, and

assurance) identified by the Institute of Medicine

(IOM) in its 1988 study The Future of Public

Health, the consensus statement describes what

public health does and what services are essential to

achieving healthy people in healthy communities.

Successful provision of these essential services

requires collaboration among public and private

partners * within a given community and across

various levels of government. The Subcommittee

used these essential services as a framework for

their respective activities.

INTRODUCTION

*The partnership must include all agencies and private or voluntary organizations in the areas of health, mental health,

substance abuse, environmental health and protection, and public health responsible for fulfilling Public Health

in America.
The Public Health Workforce: An Agenda For The 21st Century

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3

As the American health care system evolves, a

variety of forces are driving changes in the practice

of public health. In addition to other dynamics, the

continually changing ethnic, racial, immigrant, age,

and economic groupings within our society require

an increasingly skilled body of public health professionals. Accompanying these changes are shifts in

the roles of public health practitioners and other

health care workers within the various public health

disciplines and in their need for training, continuing

education, and related skill development.

One of the major training and education challenges

results from the movement of some public health

agencies away from a primary role directly providing

personal health services to underserved populations

toward greater emphasis on providing populationfocused services to entire communities (Baker, et al.,

1994). This transition is accelerating as more States

mandate the enrollment of Medicaid populations into

managed care arrangements; however, many public

health systems will continue to provide direct care

to some populations, including the growing number

of uninsured.

Medicaid and other contracts between government

agencies and managed care organizations (MCOs)

establish new roles and relationships, which in turn

affect the public health workforce. Also, new

community-wide collaboration to achieve objectives

of Healthy People 2000 or other goals requires

strong participation from health departments.

Governmental health agencies will continue to

oversee basic public health concerns such as ensuring clean water and environmental safety. Furthermore, the public looks to the Government for

leadership in times of “health emergencies”

such as hurricanes, floods, and communicable

disease outbreaks.

The public health workforce requires up-to-date

knowledge and skills to deliver quality essential

public health services. To meet the training and

continuing education needs of an evolving

workforce, a clearer understanding is required

concerning the functions and composition of the

public health workforce both now and in the future.

This information should be communicated clearly to

legislators and other government leaders so that

policy can be based on an understanding of the

current demand for public health services and the

supply of trained professionals required to meet that

demand. Furthermore, because this is a geographically dispersed and demographically diverse

workforce, new strategies for presenting efficient

and effective training must be developed.

Based on a review of previously published reports, ** barriers to strengthening the public health

workforce can be summarized as:

• Inadequate knowledge about the competencies

 the workforce will need to meet future challenges

 and about new training and education resources

 that will be needed to develop those

 competencies;

• Lack of formal training in public health and in the

 application of broad public health competencies

 to emerging new functions, e.g., constituency

 building, leadership, and use of electronic

 information systems;

• Limited public health professional certification

 requirements that can serve as incentives for

 participation in training and education;

• Indecision about workforce development across

 multiple public health and health financing

 agencies;

• Absence of stable funding for public health and

 the fragmentation imposed by categorical

 funding streams; and

• Failure to use advanced technology to its full

 potential, e.g., to provide training.

CONTEXT

** Individual reports are cited in the body of this report as appropriate and are included in the References.
The Public Health Workforce: An Agenda For The 21st Century

4

The following sections present background on the

three interrelated topics addressed by the Subcommittee on Public Health Workforce, Training, and

Education. The first section explores what is known

about the composition of the public health workforce and focuses on methods of identifying who

carries out which public health functions. The

impact of the changing role of public health on the

future composition of the workforce is also examined. The next section addresses the public health

education and (re)training challenges in an evolving

health care system. In the third section, the use of

distance learning strategies to meet the training and

education needs of a widely dispersed population of

working health professionals is discussed. The

report then details the recommendations (Future

Directions) of the Subcommittee to address these

issues, and implementation.

COMPOSITION OF THE PUBLIC HEALTH

WORKFORCE

Current changes in the public health system necessitate planning for organizational change (Nelson et

al., 1994, 1995). This process emphasizes the

importance of knowing the composition of the

present workforce and being able to describe the

workforce providing essential public health services

to community members. Knowing which professionals are currently performing specific public health

functions is integral to projecting what types of

public health professionals will be required in the

future. Effectively and efficiently providing training

and education for an evolving public health

workforce requires a clear understanding of the

composition of that workforce. The landmark IOM

study (1988) on public health noted that although

public health workers had adequate technical

preparation in specific fields, many may lack training

in management, political skills, and community

organization and diagnosis, all of which are essential

for leadership in complex multifaceted public health

activities. The IOM study further emphasized the

challenge facing public health personnel to update

their knowledge and skills in light of the continuous

evolution of the public health field.

Definition of the Public Health Workforce

The public health workforce has frequently been

defined as those individuals employed by local,

State, and Federal government health agencies. Use

of this definition is limiting; for example, individuals in

academia who educate, train, or perform research in

public health should be considered part of the public

health workforce. As private sector health care

delivery organizations provide more communitybased public health services, their employees also

should be considered part of the workforce. Furthermore, current models of the determinants of

health (Evans and Stoddard, 1994) suggest that

individuals from many sectors of a community (e.g.,

education, economic development) must be involved

to produce health and well-being.

For purposes of this discussion, the public health

workforce includes all those responsible for providing the services identified in the Public Health in

America statement (see Appendix B) regardless of

the organization in which they work. As an example, all members of the U.S. Public Health

Service Commissioned Corps, whether currently

assigned to the Department of Health and Human

Services (DHHS) or elsewhere are included. At the

State level, many workers in environment, agriculture, or education departments have public health

responsibilities and are included. This expansive

definition does not include those who occasionally

contribute to the effort in the course of fulfilling

other responsibilities.

Given this breadth, identifying organizations where

public health is operationalized is a challenge. In the

public sector, responsibilities for public health

functions are shared among multiple agencies. For

example, in the six States visited by the IOM Future

of Public Health Committee, six different public

health systems were observed. The committee

found that States varied in their concept of public

health and in the importance they placed on public

health activities. The health agencies in each of these

States were diverse in organization, authority,

activities, and resources (IOM, 1988). At each
5

level of government, agencies charged with public

health, environmental health and protection, mental

health, and substance abuse services must be

included in the process. As an increasing proportion

of essential public health services are provided by

the private and voluntary sectors, the difficulties in

classification will be exacerbated.

Identifying, Classifying, and Enumerating the

Public Health Workforce

Over the past 25 years, assessing the composition,

size, function, and adequacy of the public health

workforce has been the subject of numerous studies.

Many of these initiatives have confronted myriad

barriers in their attempts to track the workforce.

The studies continuously encountered the following

three problems as they sought to assess the public

health workforce:

• Lack of clear, concise, mutually exclusive

public health profession classification

schemes/categories;

• An absence of consistent public health

professional credentialing requirements; and

• A professional workforce educated in

specific disciplines such as medicine, nursing, dentistry, or administration but lacking

formal public health training.

As a further problem, support staff (e.g., receptionists, clinic assistants, laboratory assistants) often are

not effectively oriented to the public health goals of

the organization and are limited in the contributions

they are able to make to the overall effort.

For example, the American Public Health Association (APHA) has 31,000 members actively engaged

in public health practice and can enumerate them by

their self-selected area of expertise or interest by the

Association section with which they affiliate. With

funding from the Bureau of Health Professions of the

Health Resources and Services Administration,

APHA actively pursued a comprehensive workforce

enumeration in the mid-1980s, investigating methods

of counting the workforce. The APHA Workgroup

found that there was neither clear differentiation

between persons trained at a given level nor between persons trained at different levels within the

same occupational category. The Workgroup

concluded that using professional titles to define

function was inadequate since localities in each State

could define the functions of specific personnel titles

differently (APHA, 1983). The APHA group

proposed a functionally based classification system

based on three criteria—type of work setting, type

of work performed, and type of position. One

application of this approach is discussed below.

In 1989, the Bureau of Health Professions organized

a Public Health Workforce Consortium that developed a series of position papers on the public health

workforce (Public Health Workforce Consortium,

1989). The Consortium suggested that many of the

difficulties encountered in gathering workforce data

were the result of shortcomings in classification

schemes for public health work, work settings, and

workers. These inadequacies were traced to a lack

of standardized methods for categorizing public

health professionals and their work that often

resulted in ambiguous classifications. Existing

occupational classifications failed to consistently

identify the duties and qualifications expected of the

incumbents (Moore and Hall, 1989). The Consortium also cited the lack of clear boundaries between

public health occupations as problematic. For

example, the knowledge base, skills, and tasks

required in epidemiology and biostatistics overlap

extensively; there is no single defining characteristic

that unequivocally places a professional in one

category as opposed to the other. Absolute clarity

and consistency may never be possible, given the

nature of public health. However, failure to describe

the workforce clearly hampers efforts to assist

decisionmakers to make appropriate investment in

the entry level and continuing education of public

health workers.

In 1996, the Standard Occupational Classification

(SOC) Revision Policy Committee convened by the

Bureau of Labor Statistics, Department of Labor,

and the Bureau of Census, Department of Commerce, sought the DHHS’s assistance in revising and

Context
The Public Health Workforce: An Agenda For The 21st Century

6

updating the health occupation categories used in

regular tabulations of the entire U.S. workforce.

Drawing on the earlier work of APHA and the

Workforce Consortium discussion, some additional

categories were identified and forwarded to the

SOC Revision Policy Committee. Adoption of

these changes (see Appendix C) will enhance

uniformity in occupational classification and data

collection activities within the Departments of Health

and Human Services, Labor, and Commerce and

with their State, local, and private sector partners.

Estimates of Workforce Composition

and Supply

The objectives of a recently completed study by The

George Washington University Medical Center,

Center for Health Policy Research (Solloway et al.,

1996) were to assess the size and composition of

the government agency public health workforce in

five States, examining the changing patterns of public

health practice and linking the workforce to the

essential public health services. The study also

sought to identify education and training needs of

public health personnel as well as barriers to meeting

those needs. In meeting these objectives, the study

highlighted difficulties in developing a national

workforce data set (Solloway et al., 1996). Investigators found that the detail needed to classify the

workforce was typically not available in existing

State personnel data systems and needed agency

input. Applying a standard public health occupational taxonomy in the five States proved to be labor

intensive and time consuming. Investigators reported that by the completion date of the report the

data were no longer valid, because of reductions or

turnovers in personnel, although the magnitude of

error was not clear.

Study findings also suggest that the aggregation of

data into a standard occupational taxonomy obscures variations in workforce activities. The

investigators felt that aggregated workforce data

were not useful in understanding the functions

of the workforce, identifying personnel shortages,

or addressing training and educational issues

(Solloway et al., 1996).

The Center for Health Policy Studies of The University of Texas, Houston Health Science Center, used

the methodology developed by the APHA

Workgroup in the mid-1980’s to assess the professional public health workforce in Texas (Kennedy et

al., 1996). Using a two-staged survey, the Texas

Public Health Workforce Study Group first surveyed

employers and potential employers of health personnel and then focused on individual employees. The

study provides an estimate of the supply of public

health professionals and identifies shortage areas in

Texas. A description of this and other selected

public health workforce assessment studies is found

in Appendix D, presenting study objectives, methods, and information available for each project.

In addition to these efforts, the DHHS Data Council

has been asked by the Public Health Council to

consider mechanisms for improving public health

workforce reporting; no action date for a reply has

been set. Proxy measures of the workforce could

be used to further the enumeration. Possibilities

include reported graduations from schools and

programs in public health, reported certifications as

public health specialists within professions such as

medicine, nursing, or health education, and reported

position vacancies or association membership trends

over time. Each of these approaches has significant

shortcomings but might be used to supplement or

clarify other data.

This discussion has illustrated a number of methodological concerns that have hampered the ability of

policymakers to accurately enumerate the level of

public health personnel across the country. Among

the more notable concerns for data collection are:

• Occupational classifications in use rarely

reflect the duties and qualifications currently

expected of the incumbents;

• Boundaries between public health occupational categories often are not delineated;

categories are not mutually exclusive and
7

overlap extensively with regard to knowledge base, skills, and tasks;

• Classification systems lack consistency;

some occupations are defined by what

people do, while others are defined by the

populations they serve or by the required

underlying skills;

• Position descriptions/job titles for public

health professions lack uniformity across

States and organizations; and

• No comprehensive public health professional licensure or certification requirement

provides categories for data collection.

COMPETENCY-BASED CURRICULUM

As the entire health system changes, major training

and continuing education challenges will emerge.

Training and retraining in the public, private, and

voluntary sectors are needed to prepare the

workforce for new challenges and responsibilities.

Six priority areas for a competency-based curriculum are cultural competency, health promotion skills,

leadership development, program management, data

analysis, and community organizing (Joint Council of

Governmental Public Health Agencies, 1995).

It is clear that the public health workforce must be

competent in the latest approaches to traditional

public health skills (e.g., epidemiology, health policy

development, and health education) and must

understand the impact of efforts to manage care and

integrate delivery systems on health, the changing

role of government, the building of community

partnerships, the use of new information technologies, and the uses of data in policy development and

decisionmaking (Nelson et al., 1996a, 1996b). In

addition, to be an effective participant at the community level, the public health workforce must be

conversant with continuous quality improvement, the

strengths and challenges of diversity, and system

development. If the public health organization

provides personal care services, they must be of the

highest quality as well. Current projects such as the

SAMHSA Mental Health Managed Care and

Workforce Training Project focus on these concerns. No one worker or profession will master all

knowledge, but an agency’s entire workforce should

encompass the full range of public health competencies identified by the Competency-Based Curriculum Work Group (see Appendix E).

Education and Training: Reassessment and

Retooling

The Pew Health Professions Commission report

(1995), entitled Critical Challenges: Revitalizing

the Health Professions for the Twenty-First

Century, observed: “The needs of the integrated

systems will not be met simply by hiring [new] public

health professionals [but by] substantial and ongoing

retraining of nurses, physicians, allied health personnel, and managers . . . [who are] required to apply

the skills in new contexts.” The report calls for

creative and risk-accepting leadership in providing

training and education, a “renaissance” for educating

public health professionals. The training and

retraining for public health should be based in

competencies, that is, in what people should be

able to do, rather than what they should know

(Lane et al., 1994).

What is needed, then, is a reassessment and a

retooling of the entire public health education and

training enterprise. The goal is to make efficient and

effective use of scarce resources so they will be

responsive to emerging health systems (Lincoln et

al., 1996). This educational “renaissance” will be

distinguished by several features. First, it will involve

a stronger role of partnerships and collaborations

between groups from the public, voluntary, and

private sectors—MCOs, business and industry,

schools of public health and other health professions,

State and local health departments, professional

associations, community-based organizations,

foundations, Federal Government, and other key

stakeholder groups. Partnerships and collaborations

will enhance the relevance of education and training

and provide potential financial support resulting in a

more effective and efficient educational program.

The potential range of partnerships can be appreciated by considering the array of interested bodies

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The Public Health Workforce: An Agenda For The 21st Century

8

participating in the Healthy People 2000 Consortium (see Appendix F).

Another distinguishing feature will be the recognition

that traditional approaches to delivering instruction

(e.g., classroom settings) are no longer the sole

method of adequately preparing students to enter

practice or for providing continuing education to a

widely dispersed public health workforce. Fieldbased learning experiences that take full advantage

of state-of-the-art learning technologies, such as

those involved in distance learning, must be implemented. Care and creativity will be required to

effectively use these technologies in situations

traditionally done face-to-face such as internships in

mental health or substance abuse. As the workforce

becomes more diverse, methods should be adapted

to meet the needs of each student.

Finally, the educational “renaissance” will be characterized by continuing movement from the conventional approach of teaching a curriculum based on

subject matter areas toward the teaching of performance-based competencies. The new emphasis will

be on demonstrated skills and behavior. Focusing

on measurable learner-centered competencies

provides the additional benefit of accountability and

facilitates consideration of issues surrounding

performance improvement at the organizational and

individual employee levels (Nelson et al., 1997),

licensure, certification, and enumeration.

The previous work of the Faculty/Agency Forum

and the Council on Linkages Between Academia

and Public Health Practice and the competencies

identified by a number of public health disciplines

(see Appendix G) provide an excellent beginning for

this effort, as does the report Taking Training

Seriously, issued by the Joint Council of Governmental Public Health Agencies. Other disciplinespecific competencies that helped to inform the

recommendations in the Future Directions section of

this report are presented in Appendix H.

DISTANCE LEARNING SYSTEM

DEVELOPMENT

As noted in the previous section, compelling and

urgent programmatic forces are making enhanced

training and education opportunities for public health

professionals a necessity. Public health professionals

are “knowledge workers,” professionals who

interpret and apply information to create and provide “value added” solutions and who make informed recommendations in continuously changing

work environments (Winslow and Bramer, 1994).

Public health workers require the ability to acquire

and apply theoretical and analytical knowledge and

the habit of continuous lifelong learning to remain

viable and productive.

The emergence of a world interconnected by

networks of computers, satellite downlinks, and

telecommunications technologies represented by the

Internet, World Wide Web, and corporate and

private intranets offers great potential for the lifelong

training and education of public health workers. In

combination with traditional classroom learning,

networked computers and telecommunications

technologies provide distance learning systems that

enable diverse groups of geographically dispersed

individuals to access information for training and

education anytime, anywhere. These same technologies also provide an infrastructure for integrating

national efforts with local community needs and

concerns. Local networks of electronic information

resources further stimulate and provide opportunities

for involvement across all segments of a community:

education, health care, local government, business,

and individual citizens. Blacksburg Electronic

Village (Virginia) and Smart Valley (California) are

exemplary demonstrations of such community

involvement. Care is needed, however, to ensure

that access to such resources is equitable across

communities and populations.
9

Organizations responsible for public health programs

and training have a unique opportunity to participate

in the creation and utilization of the National Information Infrastructure. There is an opportunity to

leverage the enormous intellectual efforts, products,

and services that already exist to achieve cost

efficiencies and to explore new and exciting ways to

provide education and training that emphasize

individual differences, collaborative learning, experimentation, learner responsibility, skills for lifelong

learning, freedom from constraints of time and place

for learning, immediacy of information, a multiplicity

of distributed learning environments, enhanced role

for teachers/trainers as facilitators, and a renewed

sense of responsibility for learning outcomes.

Distance learning is a system and a process that

connects learners with distributed learning resources

characterized by:

• Separation of place and/or time between

instructor and learner, among learners,

and or between learners and learning

resources; and

• Interaction between the learner and the

instructor, among learners, and/or between

learners and learning resources conducted

through one or more media; use of electronic media is not necessarily required

(American Council for Education, 1996).

Federal agencies currently using distance learning

systems include: Defense, Agriculture, Education,

Veterans Affairs, Federal Aviation Administration,

Environmental Protection, and Social Security

Administration and within DHHS—Centers for

Disease Control and Prevention, Food and Drug

Administration, Health Care Financing Administration, and Health Resources and Services Administration. Schools of public health, State health

agencies, the American Hospital Association, and

others also have used distance learning systems,

often with award-winning success.

 Additional success in public health is cited in a

recent study by Solloway, et al. (1996), which

concludes that distance learning: (1) provides a

consistent message to a large number of people

within a short time period; (2) overcomes barriers to

training such as time away from the job and travel

restrictions; (3) promotes collaborative relationships

among colleagues as well as communities, and

provides increased opportunities for information

exchange; and (4) provides an excellent vehicle for

disseminating information, updating scientific knowledge, and teaching technical skills.

To develop an effective competency-based curriculum requires accurate information concerning the

composition, functions, and education needs of the

public health workforce. After developing curricula

to meet the workforce’s needs, the use of such

strategies as distance learning are critical in providing

training to a geographically dispersed and diverse

public health workforce. An effort to improve

vaccine coverage for preschool children initiated by

the Clinton Administration 3 years ago serves as an

example of the interrelationships between workforce

composition, education, and the delivery of training.

To meet the new vaccination goals, the National

Immunization Program (NIP) staff had to develop a

curriculum and training program on vaccine-preventable diseases. Equally important was identifying the

sector of the workforce requiring training—nurses

and other prevention personnel. Traditionally,

training for NIP was delivered in a 5-day workshop

for 50 students. NIP staff realized that it would

need to greatly increase the number of public health

practitioners receiving training in order to meet the

program’s goals. Using distance learning strategies,

a series of satellite video conferences on vaccine

preventable diseases was designed and produced to

successfully train 25,000 participants nationwide

through the first series.

Context
The Public Health Workforce: An Agenda For The 21st Century

10
11

Public health is integral to the well-being of the

Nation’s communities. It is time to take a serious

and deliberate look at the composition, activities,

and education needs of the public health workforce.

Completing and fulfilling the charge made to this

Subcommittee will require the coordinated and

collaborative effort of the Public Health Functions

Steering Committee partners and others. In order to

move this agenda forward, the Steering Committee

makes five major recommendations in the areas of:

• National Leadership

• State and Local Leadership

• Workforce Composition

• Curriculum Development

• Distance Learning

These steps are not sequential. Work on all of

them should proceed concurrently. Using a

consensus process involving groups of individuals

representing over 20 public-health-related organizations (see Appendix I), the Subcommittee puts

forward the following proposed action steps for

each of the identified recommendations. Ultimately

the goal is to develop a seamless approach to

enhancing the workforce: identifying the workforce

and assessing individual skills, examining changes in

the evolving public health environment to identify

areas requiring additional skill development, determining how best to obtain those skills, and finally,

using strategies such as distance learning to provide

the necessary training and education.

NATIONAL LEADERSHIP

The Public Health Functions Steering Committee

should continue to serve as the locus for oversight

and planning for development of a public health

workforce capable of delivering the essential services of public health across the Nation. This

includes maintaining support for any legislative

authorization or financing mechanisms needed to

fully implement the recommendations of this report

and a commitment to ensure that current workforce

development resources are wisely invested in

achieving identified goals. Each partner organization

and others are encouraged to develop specific

plans and policies that complement this

collaborative effort.

Workforce policies and funding priorities for public

health workforce training must be responsive to both

the supply of public health workers and the demand

for their skills. Meeting the public health needs of

individual communities requires an understanding of

the types of public health professionals needed to

provide required services, the actual positions

available (the demand), and an understanding of

who currently provides these services and their skills

(the supply). The Federal role of (1) providing

standards and guidelines; (2) conducting research

and disseminating its findings; (3) ensuring equity

across States; and (4) developing priorities for the

Nation (APHA Policy Statement, 1996) should be

appropriately incorporated into the national effort.

Proposed Action Steps

A. Organize a national forum of key stakeholders from both the public and private sectors

to examine human resource allocation and

trends in public health. Potential forum

participants in addition to the Public Health

Functions Steering Committee members

include the American Association of Health

Plans, Health Care and Financing Administration, State Medicaid directors, social

workers, substance abuse and mental health

professionals, nurses, professional organizations, and the business community in general.

B. Develop and implement modules for Leadership Training Institutes that enable public

health leaders to better assess their roles in

providing public health services in a changing

environment.

C. Involve frontline public health practitioners

from all types of organizations in the efforts

FUTURE DIRECTIONS
The Public Health Workforce: An Agenda For The 21st Century

12

to enumerate, plan for, and educate the

public health workforce.

STATE AND LOCAL LEADERSHIP

To ensure that programs are appropriately tailored

to the unique configuration of needs and resources in

each State and in each local jurisdiction, a mechanism for development of State public health

workforce planning and training should be developed and implemented. This mechanism should

include not only development of identified leaders,

but also cultivation of leadership qualities throughout

the workforce. The State, or where appropriate,

regional, efforts should emphasize possible partnerships among practice and academic entities involved

in public health. These efforts should be responsive

to and provide input into those at the national level.

In addition, these efforts must involve local public

health entities and be responsive to their needs.

Proposed Action Steps

A. Ensure that workforce planning takes place

in all appropriate jurisdictions. Allocation of

human resources should be determined by

State and local governments or on a regional

basis when appropriate due to resources,

geography, or other factors.

B. Within each jurisdiction encourage the

participation of medical care delivery

systems and others with public health

responsibilities to achieve mutual goals in

workforce development.

C. Develop a partnership with States to quantify the supply and demand of personnel

providing essential public health services at

the State, local, and private sector levels.

WORKFORCE COMPOSITION

A standard taxonomy should be used to regularly

identify the size and distribution of the public health

workforce in official agencies (health, environmental

health and protection, mental health, and substance

abuse; local, State, and national) and private and

voluntary organizations. This effort should be

coordinated with the Bureau of Labor Statistics to

enhance uniformity in occupational classification

reporting. To the extent possible, the taxonomy

chosen should be consistent with the Public Health

in America statement, recognizing that specific

occupational titles will vary across organizations.

It is in the public’s interest to have a public health

workforce that is ethnically and culturally diverse

and is adequately trained and deployed to provide

essential public health services. Using the same

taxonomy, the Steering Committee should recommend and support a mechanism to quantify the

future demand for public health workers, paying

particular attention to issues of diversity and changing demographics in the workforce.

Proposed Action Steps

A. Identify a lead agency or organization to

provide leadership in continuing efforts to

assess the size, composition, and distribution

of the workforce as related to essential

services of public health.

B. Examine methods used by professional

organizations such as American Nurses

Association, American Medical Association,

American Psychological Association,

American Dental Association, and National

Environmental Health Association to classify

their respective workforces and incorporate

where helpful.

C. Develop a standard taxonomy based on the

10 essential public health services to qualitatively characterize the public health

workforce. This classification scheme must

be derived through collaboration and

consensus of the entire public health community.

D. Use the SOC System of the workforce and

data from the Bureau of Labor Statistics and

census surveys to track shifts in the staffing

mix of personnel among the governmental,

private, and voluntary sectors.

E. Identify and take action steps to ensure that

the public health workforce is ethnically and

culturally diverse.
13

F. Work with the Office of Management and

Budget to include appropriate public health

entries in the SOC System to facilitate

identification of public health worksites, such

as local health departments and other

organizations providing essential public

health services.

CURRICULUM DEVELOPMENT

Preparation of the current and future workforce

requires clarifying essential competencies, making

associated curriculum revisions, and identifying

methods to keep both current.

Part I. Competencies

The statement of competencies for the public health

workforce developed by the Competency-Based

Curriculum Work Group (Appendix E) should be

refined and validated, with the subset(s) of competencies associated with each of the various disciplines identified.

The competencies needed to meet the public health

challenges of today and tomorrow should form the

foundation for all future efforts to train and educate

the workforce. Competency specification is a vital

step for two reasons: (1) During the process of

curriculum planning and development, it provides a

central focus for the providers of training and

education—schools of public health, medicine,

nursing, dentistry, and the allied and associated

health professions, as well as other academic

institutions, public sector agencies, and private

sector organizations; and (2) By determining competencies that will be needed, it is possible to examine

the current capabilities and qualifications of the

workforce, to identify gaps in the workforce, and to

design and support systems for training/education of

the workforce to fill those gaps.

Proposed Action Steps

A. Verify that identified competencies are

indeed necessary for efficient and effective

practice of public health. Validations of

these competencies should be provided

by a panel of practice-based experts

who are in public health organizations,

including employers.

B. Identify competencies critical to all public

health practitioners and those critical to

successful practice in specific organizational

settings. The competencies presented in

Appendix E should be viewed as “organizational” competencies, those required for the

entire workforce deployed within a given

public health setting. (Although all public

health practitioners should be familiar with

the essential services of public health, few, if

any, individuals will be equally competent in

all areas.) Categorizing competencies

should be conducted by a review panel of

experts including practitioners and employers from all practice settings.

C. Improve long-range planning. Public health

competencies are evolutionary. They are

affected by changes in responsibilities and

the practice of public health. There must be

a formal mechanism to update competencies

to reflect changing demands. A mechanism

for assuring current and accurate competencies may take the form of an institute, task

force, or other entity supported by government, foundations, and/or the academic

community. Responsibilities will include

monitoring trends in the demand for public

health services and interpreting those

demands in terms of the skill and knowledge

needed to provide the 10 essential services

of public health.

Future Directions
The Public Health Workforce: An Agenda For The 21st Century

14

Part II. Curriculum Development

The curriculum development process should be

guided by attention to key competencies that are

adequately addressed within existing curriculum

offerings and those that are deficient. This process

of development or enhancement of curricula focusing

on competencies, rather than content, is a challenging task. Competencies are derived from an analysis

of the performance of proficient practitioners with

concentration on skills and abilities rather than on

activities. A primary function of competency-based

curricula in public health is that they can provide

both educators and employers of public health

personnel guidance and structure in the allocation of

effort and resources.

Basic, advanced, and continuing education curricula

to train current and future public health personnel in

the identified competencies should be supported

(where existing) or developed (where not yet in

place). Implementation should be coordinated with

State planning efforts and make maximum use of

new technologies.

Improved methods (such as certification) of identifying practitioners who have achieved competency

should be implemented if demonstrated effective.

Because the public health workforce is characterized

by a diverse range of experiences, education background, and ethnicity, any program for systematically

addressing the training and education needs of the

workforce must direct its resources toward meeting

the most important skill enhancement areas,

especially considering the needs of communities

and populations currently underserved by public

health programs.

Proposed Action Steps

A. Ensure that the practice community has a

substantial role in the curriculum development process. Examine existing models that

link the academic and practice communities

as a first step in facilitating practitioner

involvement and target efforts and resources

in their replication.

B. Determine the current status of “competency” of the workforce. Develop and

implement a methodology (survey, direct

observation, etc.) to assess the current level

of proficiency in the practice of the competencies. This research effort will include an

evaluation of how the competencies have

been acquired (on-the-job training, formal

education, mentoring, continuing education,

etc.) and the perceived adequacy of these

approaches in the context of the communities being served.

C. Develop measurable performance indicators

for identified competencies.

D. Survey public health training/education

institutions to assess the extent to which

competencies are currently being employed

to structure the curriculum.

E. Conduct an analysis of the competency

statements (Appendix E) and make revisions

for their most effective use in curriculum

development. Education and training

specialists should conduct this analysis.

F. Identify gaps between high-priority competencies that are needed and those competencies already present in the workforce.

The competencies proposed by the Competency-Based Curriculum Workgroup

incorporate projections of competencies

needed now and in the future (5 years

hence). After additional review, these

projections can serve as a baseline. Identification and prioritization between the actual

and the needed profile of competencies may

best be accomplished by a panel composed

of practice association representatives,

academic institutions, and Federal agencies.
15

G. Translate competencies into discrete didactic

and field-based learning experiences and

activities.

H. Create a matrix of addressed and unaddressed competencies based on public

health organizational needs with the results

of the instructional provider survey (data

collected during the needs assessment

activity) by cross-referencing each element

in the competency listing.

I. Support a curriculum development process

that is sensitive to the needs of local communities in order to be responsive to the local

priorities of each agency, State, or local

community relating to the essential services

of public health.

J. Recommend to the Council for Education in

Public Health and other organizations within

the accreditation community that competency-based approaches be incorporated

into the standards for educational institution

accreditation and into the standards for

professional certification and/or licensure.

K. Develop criteria for identifying providers

of public health training and education that

are “models of excellence” and support

these providers through grants and

other forms of support. Implement the

operation of a “clearinghouse” to promote

sharing of exemplary teaching approaches

among institutions.

Part III. Curriculum Update and Maintenance

Public health practitioner competencies are evolutionary in nature; hence, a curriculum to support

the establishment of such competencies must

include a formal mechanism for keeping them

current and accurate.

Proposed Action Steps

A. Create and support an organizational entity

with responsibility for conducting an ongoing

“environmental scan” at the national, State,

local, business, and industry levels to assess

the demand for specific essential public

health services. As shifts in essential services are detected, accompanying “corrections” in the competencies need to be

reflected within curricula. The organizational

entity may take the form of an institute,

task force, or other entity supported by

government, foundations, and/or the academic community.

B. Follow up graduates of competency-based

training and education programs on a regular

basis to determine the extent to which they

are using the competencies they have

previously acquired.

C. Maintain close liaisons with organizations

sharing an interest in public health

competencies to facilitate input from all

key stakeholders.***

D. If judged to be appropriate, establish a

national “competency assessment system”

for public health practice. The system will

(1) establish standards of practice based on

approved competencies; (2) develop a

mechanism for assessing whether these

standards are being met; and (3) administer

a nationwide program for assessing competencies on an individual basis and for the

potential credentialing of “competent” public

health practitioners.

Future Directions

***Examples of these key organizations include: The Council on Linkages Between Academia and Public Health Practice;

schools of the health professions; Federal, State, and local governments; professional organizations; MCOs; The Robert

Wood Johnson and W.K. Kellogg Foundations; and the Pew Charitable Trust.
The Public Health Workforce: An Agenda For The 21st Century

16

DISTANCE LEARNING

All partners in the effort to strengthen the public

health workforce should make maximum use of

evolving technologies such as distance learning.

A structure should be established to develop an

integrated distance learning system building on

existing public and private networks and making

information on best practices readily available.

Distance learning presents tremendous potential to

accelerate and expand training opportunities, but it

also represents a paradigm shift in most agencies’

training strategies. Therefore, public health leaders

must drive this change in their organizations.

Proposed Action Steps

A. Establish a formal structure to advocate for

the integration of distance learning techniques into practice and academic

entities involved in public health

strategies for training, education, and

communication. Actions necessary for

this to proceed include:

• Evaluate previous studies that document

distance learning resources among partners.

• Develop a strategy for participant registration that is compatible across agencies and

that is supported by a technology that allows

for orders of magnitude expansion and

comparability of data.

• Establish a standard practice and methodology for stakeholder’s evaluation of distance

learning results.

• Institute a common practice for program

promotion and marketing.

• Develop a strategy to facilitate sharing

resources across organizational lines (e.g.,

interagency agreements, cooperative

agreements, grants, memorandums

of understanding).

• Initiate standards for distance learning

technology that permit system integration

across agencies.

• Encourage and support the use of public/

private assignments to promote collaboration in training.

• Share innovative and effective procurement

mechanisms for distance learning services

(e.g., task order contracts and other procurement mechanisms).

• Assist in identifying and developing distance

learning faculty and subject matter experts

and establishing incentives for their support.

• Provide grant assistance for development of

distance learning programs at regional and

local levels.

B. Directly link distance learning systems and

program development priorities to the

information generated by the Workgroups

on Workforce Composition and Competency-Based Curriculum.

C. Routinely gather input from key

partners regarding training needs and

technological capabilities.

D. Develop agency expertise in distance

learning; participate in relevant organizations

such as the United States Distance Learning

Association (USDLA) and Government

Alliance for Training and Education (GATE).

E. Provide access to information about public

health distance learning programs and

resources through mechanisms such as

FedWorld Training Mall and the Public

Health Training Network web site.

F. Organize a mechanism for pooling and

accessing resources and expertise on

distance learning across all of public health.
17

Due to the multiplicity of responsibilities within public

health, no single agency or organization has the

responsibility of addressing the workforce composition, training, and education needs of a diverse

public health workforce. Focusing the attention

of a broad array of organizations on the priority

issues presented in this paper will be critical to

the success of any proposed followup. Enhancing the feedback loop between public health

employers, communities, and training institutions will be one of the most important links in

responding to the need for a well-trained

workforce. Harnessing the varied interests of

IMPLEMENTATION

governmental, private, and voluntary public health

organizations and creating a body with appropriate

levels of resources allocated to this activity will be

critical to the success of any proposed public health

workforce initiative. The agenda presented in these

recommendations only partially fulfills the original

charge to the Subcommittee. In its continuing

leadership role, the Steering Committee should

identify other tasks needing continued attention and

make plans for their completion. With the energetic

and sustained attention of the Public Health Functions partners, the public health workforce will

contribute even more to the health of communities in

the 21st century.
The Public Health Workforce: An Agenda For The 21st Century

18
19

Background: Several recent analyses of the status

of public health activities in the United States indicate the fragility of the public health infrastructure

(Public Health Foundation, 1994; Prevention

Report, 1995; Schade, 1995). The Public Health

Functions Project was created to help clarify the

issues and develop strategies and tools to address

the matters identified. Special emphasis will be

given to: marshaling consensus on the essential

services of public health; quantifying the investment

in those services at the Federal, State, and local

levels; assessing the current capacity and needs for

public health workforce in various areas; developing

guidelines for sound practices in public health; linking

with activities to characterize the information system

elements necessary for the conduct of public health

services, including the relationship of those elements

to the personal health services information systems;

and developing strategies for enhancing public and

professional awareness of the nature and impact of

public health activities.

Project: To address these issues, the following

tasks will be undertaken as part of the Public Health

Functions Project:

1. Develop a taxonomy of the essential services of public health that can be readily

understood and widely accepted for use by

the public health community.

2. Using the taxonomy developed, assess the

public health infrastructure and document the

Federal, State, and local expenditures on

essential services of public health.

3. Propose a mechanism to ensure account

ability for outcomes related to the delivery of

essential public health services at the State

and local levels, in return for greater flexibilty in administration of Federal grants to

support public health.

4. Develop a strategy for communicating to the

general public and key policymakers the

nature and impact of essential public

health services.

5. Document and publish analyses of the health

and economic returns on investments in

essential public health services.

6. Identify the key categories of public health

personnel necessary to carry out the essential services of public health, assess the

Nation’s current capacity and shortfalls, and

establish a mechanism for ongoing monitoring of workforce strength and capability.

7. Develop and publish a full set of evidencebased guidelines for sound public

health practice.

8. Collaborate with the PHS Data Policy

Committee to identify the information and

data needs for the effective implementation

of the essential services of public health and

develop a strategy for the interface between

the personal services and population-wide

systems, ensuring the availability of information necessary to both.

9. Develop a process to ensure the appropriate

collaboration of the public health community

and adequate inclusion of public health

perspectives in the development of

national health goals and objectives for the

year 2010.

10. Develop a strategy for regular communication among interested parties at the national,

State, and local levels on progress related to

these activities.

Project Coordination: The project will be coordinated by a Steering Committee chaired by the

Assistant Secretary for Health and the Surgeon

General, and composed of the PHS agency heads

and the presidents of the American Public Health

Association, the Association of Schools of Public

Health, the Association of State and Territorial

Health Officials, the Environmental Council of the

States, the National Association of County and City

Health Officials, the National Association of Local

Boards of Health, the National Association

of State Alcohol and Drug Abuse Directors,

the National Association of State Mental

Appendix A:

The Public Health Functions Project
The Public Health Workforce: An Agenda For The 21st Century

20

Health Program Directors, Partnership for

Prevention, and the Public Health Foundation.

Execution of activities will be overseen by a

Staff Working Group co-chaired by the

Deputy Assistant Secretary for Health

(Disease Prevention and Health Promotion)

and the Director of the Centers for Disease

Control and Prevention, and composed of

designees from each of the organizations

represented on the Steering Committee.

Each specific activity undertaken within this project

will have identified leadership and staff support from

PHS. Wherever possible, existing structures and

communication devices will be used as the basis for

Public Health Functions efforts (e.g., the Public

Health Service Data Policy Committee, the Joint

Council of Governmental Public Health Agencies,

the Council on Linkages between Academia and

Public Health Practice).
21

PUBLIC HEALTH IN AMERICA

Vision:

Healthy People in Healthy Communities

Mission:

Promote Physical and Mental Health and Prevent Disease,

Injury, and Disability

Public Health

• Prevents epidemics and the spread of disease

• Protects against environmental hazards

• Prevents injuries

• Promotes and encourages healthy behaviors

• Responds to disasters and assists communities in recovery

• Assures the quality and accessibility of health services

Essential Public Health Services

• Monitor health status to identify community health problems

• Diagnose and investigate health problems and health hazards in the community

• Inform, educate, and empower people about health issues

• Mobilize community partnerships to identify and solve health problems

• Develop policies and plans that support individual and community health efforts

• Enforce laws and regulations that protect health and ensure safety

• Link people to needed personal health services and assure the provision of health care when

otherwise unavailable

• Assure a competent public health and personal health care workforce

• Evaluate effectiveness, accessibility, and quality of personal and population-based health

services

• Research for new insights and innovative solutions to health problems

Appendix B

Adopted: Fall 1994, Source: Public Health Functions Steering Committee, Members (July 1995):

American Public Health Association • Association of Schools of Public Health • Association of State and Territorial Health Officials • Environmental Council of the

States • National Association of County and City Health Officials • National Association of State Alcohol and Drug Abuse Directors • National Association of State

Mental Health Program Directors • Public Health Foundation • U.S. Public Health Service—Agency for Health Care Policy and Research • Centers for Disease Control

and Prevention • Food and Drug Administration • Health Resources and Services Administration • Indian Health Services • National Institutes of Health • Office of

the Assistant Secretary for Health • Substance Abuse and Mental Health Services Administration
The Public Health Workforce: An Agenda For The 21st Century

22
23

Definitions are provided for each new occupational

category; examples of job “titles” (i.e., “index”

items) are provided in parentheses

(1) Epidemiologist

Investigates and describes the determinants and

distribution of disease, disability, and other health

outcomes and develops the means for their preven

tion and control.

(2) Environmental Engineer (e.g., Water

Supply/Waste Water Engineer, Solid Waste Engineer, Air Pollution Engineers, Sanitary Engineer)

Applies engineering principles to control, eliminate,

ameliorate, and/or prevent environmental health

hazards.

(3) Environmental Engineering Technician

and Technologist (e.g., Air Pollution Technician,

Water/Waste Water Plant Operator and Testing

Technician)

Assists Environmental Engineers and other environmental health professionals in the control, elimination, amelioration, and/or prevention of environmental health hazards. May collect data and implement

procedures or programs developed by Environmental Engineers and other environmental

health professionals.

(4) Environmental Scientist and Specialist

(e.g., Environmental Researcher, Environmental

Health Specialist, Food Scientist, Soil and Plant

Scientist, Air Pollution Specialist, Hazardous Materials Specialist, Toxicologist, Water/Waste Water

Solid Waste Specialist, Sanitarian, Entomologist)

Applies biological, chemical, and public health

principles to control, eliminate, ameliorate, and/or

prevent environmental health hazards.

Appendix C:

Revision of the Federal Standard Occupational

Classification (SOC) System: New

Occupational Categories Recommended for the Field of Public Health

 (Still pending, August 1997)

(5) Environmental Science Technician and

Technologist (e.g., Air Pollution Technicians,Vector

Control Workers)

Assists Environmental Scientists and Specialists and

other environmental health professionals in the

control, elimination, and/or prevention of environ

mental health hazards.

(6) Occupational Safety and Health

Specialist (e.g., Industrial Hygienists, Occupational

Health Specialists, Radiologic Health Inspectors,

Safety Inspectors)

Reviews, evaluates, and analyzes workplace envi

ronments and exposures and designs programs and

procedures to control, eliminate, ameliorate, and/or

prevent disease and injury caused by chemical,

physical, biological, and ergonomic risks to workers.

(7) Occupational Safety and Health Technician and Technologist

Collects data on workplace environments and

exposures for analysis by Occupational Safety and

Health Specialists. Implements programs and

conducts evaluation of programs designed to limit

chemical, physical, biological, and ergonomic risks

to workers.

(8) Health Educator (e.g., Public Health

Educator, Community Health Educator, School

Health Educator)

Designs, organizes, implements, communicates,

provides advice on and evaluates the effect of

educational programs and strategies designed to

support and modify health-related behaviors of

individuals, families, organizations, and communities.
The Public Health Workforce: An Agenda For The 21st Century

24

(9) Public Health Policy Analyst

Analyzes needs and plans for the development of

health programs, facilities, and resources; analyzes

and evaluates the implications of alternative policies

relating to health care.

(10) Health Service Manager/Health Service

Administrator

Plans, organizes, directs, controls, and/or coordinates health services, education, or policy in establishments such as hospitals, clinics, public health

agencies, managed care organizations,industrial and

other types of businesses, or related entities.

(11) Public Health and Community Social

Worker (e.g., Community Organizer, Outreach and

Education Social Worker, Public Health Social

Worker)

Identifies, plans, develops, implements, and/or

evaluates programs designed to address the social

and interpersonal needs of populations in order to

improve the health of a community and promote the

health of individuals and families.

(12) Mental Health and Substance Abuse

Social Worker (e.g., Alcoholism Worker, Clinical

Social Worker, Community Health Worker, Crisis

Team Worker, Drug Abuse Worker, Marriage and

Family Social Worker, Psychiatric Social Worker,

Psychotherapist Social Worker)

Provides services for persons having mental, emotional, or substance abuse problems. May provide

such services as individual and group therapy, crisis

intervention, and social rehabilitation. May also

arrange for supportive services to ease patients’

return to the community.

NOTE: Social Worker occupations proposed (#11 and #12)

are distinct from, and in addition to, social worker occupations already proposed, including “Medical Social

Worker”; “Child, Family, and School Social Worker”; and

“Social Worker, other.”

(13) Psychologist, Mental Health Provider

(e.g., Clinical Psychologist, Counseling Psychologist,

Marriage Counselor Psychologist, Psychotherapist)

Diagnose and treat mental disorders by using

individual, child, family, and group therapies. May

design and implement behavior modification programs. (Requires doctoral degree.)

NOTE: Psychologist occupation proposed (#13) is distinct

from, and in addition to, Psychologist occupations already

proposed, including “School Psychologist”; “Industrial/

Organizational Psychologist”; and “Psychologists, except

Mental Health Providers.”

(14) Alcohol and Substance Abuse

Counselor, including Addiction Counselor (e.g.,

Substance Abuse Counselor, Certified Substance

Abuse Counselor, Certified Alcohol Counselor,

Certified Alcohol and Drug Counselor, Certified

Abuse and Drug Addiction Counselor, Drug Abuse

Counselor (Associates Degree or higher), Drug

Counselor (Associates Degree or higher), Alcoholic

Counselor (Associates Degree or above)

Assesses and treats persons with alcohol or drug

dependency problems. May counsel individuals,

families, or groups. May engage in alcohol and drug

prevention programs.

(15) Mental Health Counselor (e.g., Clinical

Mental Health Counselor, Mental Health Counselor)

Emphasizes prevention and works with individuals

and groups to promote optimum mental health. May

help individuals deal with addictions and substance

abuse; family, parenting, and marital problems;

suicidal tendencies; stress management; problems

with self-esteem; and issues associated with aging,

and mental and emotional health. Excludes psychiatrists, psychologists, social workers, marriage and

family therapists, and substance abuse counselors.
25

• Public Health Physician (e.g., General

Preventive Medicine/Public Health, Occupational Medicine, Epidemiologist, Physician

Executive, Clinician)

• Public Health Nurse (e.g., Occupational

Nurse, School Nurse, Community Health

Nurse, Nurse Practitioner, Clinician)

• Public Health Dentist (e.g., Dental Public

Health Clinician)

• Public Health Dental Worker (e.g.,

Dental Hygienist, Dental Assistant)

• Public Health Veterinarian

• Public Health Nutritionist (e.g., Community Nutritionist, Registered Dietician,

Nutrition Scientist, Clinician)

• Public Health Pharmacist

Appendix C

• Public Health Laboratory Scientist

(e.g., Microbiologist, Chemist, Physicist,

Entomologist)

• Public Health Laboratory Technician

and Technologist (e.g., Medical Laboratory Technician, Medical Technologist,

Histologic Technician and Technologist,

Cytotechnologist)

• Public Health Attorney or Hearing

Officer

• Health Information System/

Computer Specialist

• Public Relations/Public Information/

Health Communications/Media

Specialist

• Biostatistician

Revision of the Federal Standard Occupational

Classification (SOC) System: Public Health Occupational

 Categories Already Listed Under Pre-Existing

Occupational Subcategories

(e.g., Physician, Nurse, Dentist, Veterinarian, Attorney, Statistician)
The Public Health Workforce: An Agenda For The 21st Century

26
27

Appendix D:

Descriptions of Selected Public Health Workforce Assessment Studies

Investigator(s) Study Objectives Methods Type of Information

Public Health

Foundation, 1992

Provide information

on workforce engaged

in public health activities

within State

health agencies

Analyze trends in

staffing patterns

FTE data collected by

occupational categories in

all 50 States by survey

mailed to State

Health Agency

Number and types of

vacancies by

occupational categories

Perceived workforce

recruitment problems

Environmental Health Data

Workshop

(ASPH, L.J.

Gordon, 1991)

Provide estimate

of number of professional

and technical staff

employed in

environmental health

Identify areas of

personnel shortages

Examine educational and

training levels of environmental health workforce

Available data, estimates by

workshop participants

Number of personnel in

environmental health

positions

Level of formal

education in field

Areas of personnel

shortages in

environmental health

Bureau of Health

Professions, Report to

Congress, 1992 & 1994

Provide detailed report on

status of health personnel in

the United States

Available data, expert

panels and focus groups

Shortages of public health

personnel in specific

categories

National Association of

City and County Health

Officials (NACCHO), 1990

& 1995

Gain a comprehensive,

accurate description of

activities, capacities, and

needs of local health departments

Survey of local

health departments

Estimates of number

of professionals in

health departments

National Association of

State Mental Health

Program Directors,

1994 & 1996

Obtain comparable

data about mental

health systems

Survey of State Mental

Health Authorities

Staffing levels of

State-operated or Statefunded mental health

provider organizations

Information on minority

workforce issues

Client/staff ratios

Recruitment, training, and

staff retention data

Salary levels

FTE physicians in

State hospitals
The Public Health Workforce: An Agenda For The 21st Century

28

Descriptions of Selected Public Health Workforce Assessment Studies

Investigator(s) Study Objectives Methods Type of Information

The George Washington

Medical Center,

Center for Health

Policy Research,

(Solloway et al., 1996)

University of Texas, School

of Public

Health, Center for Health

Policy Studies

(Kennedy et al., 1996)

An Update on Human

Resources in Mental Health

(Peterson et al., 1996)

Develop methodology and

assess size and composition

of public health workforce in

5 States

Examine changing patterns

of public health practice and

link workforce to the

essential public health

services. Identify educational and training needs of

public health personnel as

well as barriers to meeting

needs

Recommend approaches to

address educational training

needs of State public health

workers

Estimate size of professional

public health workforce in

Texas

Describe workforce composition

Identify personnel shortages

by occupation as well as

perceived education and

training needs

To update information from

previous Mental Health,

United States reports

To add information on

disciplines incorporated in

the work groups since 1990

To present comparable

information on the size and

characteristics of each of the

eight disciplines

Using personnel data from

States, organizational

charts were used to

identify workers by job

title, organizational unit,

and department. Job titles

were matched to workforce

typology developed by

the Bureau of Health

professions.

Study also conducted site

visits, key-informant

interviews, and focus

groups and examined 3

training and education

models to identify education and training needs

and barriers.

Two-stage mailed survey;

first stage surveyed

employers of professional

public health workers;

second stage focused on

individual employees

Utilized methodology

developed by APHA

Workgroup in mid- 1980’s

that classifies workforce

by 3 criteria: type of work

setting, type of work

performed, and type of

position

Data sources include:

AMA’s Physician Characteristics and Distribution in

the United States (1996);

the 1996 membership

records of the APA; the

1994 APA Membership

Directory Survey; the

1988-89 APA Professional

Activities Survey; NASW

membership; ANA’s

national certification

program

Classification in public

health workforce in

these 5 States

Level of formal education or

training in the field of public

health

Training and educational

needs of workforce in the 5

States

Methods of delivering

educational and training

programs to public health

personnel

Estimate of supply of public

health professionals in Texas

Identified shortage areas

Assessment and identification of employee perceived

education and training needs

Classification of public

health workforce by work

activity

Assessment of capacity and

geographic

distribution of workforce

Number of personnel in eight

select disciplines and

professional activities

Level of education

Information on minority

workforce issues

Recruitment, training, and

staff retention data

(continued)
29

Appendix E:

Competencies for Providing Essential Public Health Services

Essential Service #1: Monitor health status to identify community health problems.

Competencies:

Analytic Skills

• Define a problem

• Determine appropriate use of data and statistical methods for problem identification and resolution and

program planning, implementation, and evaluation

• Select and define variables relevant to defined public health problems

• Evaluate the integrity and comparability of data and identify gaps in data sources

• Understand how the data illuminate ethical, political, scientific, economic, and overall public

health issues

• Understand basic research designs used in public health

• Make relevant inferences from data

Communication Skills

• *Communicate effectively both in writing and orally (unless a handicap precludes one of these forms

of communication)

• Present accurately and effectively demographic, statistical, programmatic, and scientific information

for professional and lay audiences

• Solicit input from individuals and organizations

• Advocate for public health programs and resources

• Lead and participate in groups to address specific issues

• Use the media to communicate public health information

Policy and Development/Program Planning Skills

• Collect and summarize data relevant to an issue

Basic Public Health Sciences Skills

• Define, assess, and understand the health status of populations, determinants of health and illness,

factors contributing to health promotion and disease prevention, and factors influencing the use of

health services

• Apply the basic public health sciences, including behavioral and social sciences, biostatistics, epidemiology, environmental public health, and prevention of chronic and infectious diseases and injuries

New

• Understand risk assessment and risk communication skills

• Understand how to use public health software packages such as Epi-Info to track, analyze, and

present findings of community health problems

(continued)

(These lists of organizational competencies for providing essential public health services were done by the CompetencyBased Curriculum Work Group of the Subcommittee on Public Health Workforce, Training, and Education. The Work

Group began with the universal competencies developed by the Faculty/Agency Forum, divided them into the 10

essential services of public health framework, and added new competencies. Those marked with a * are universal

competencies that have been modified.)
The Public Health Workforce: An Agenda For The 21st Century

30

• Design and operate a surveillance system

• Understand analytic skills for survey development and administration

• Understand the role and importance of vital statistics

• Understand computer/information technology applications

• Know existing sources of data

• Describe problems in terms of time (persistence), magnitude/severity (scope), dispersion/location

(place), and co-occurrence/co-morbidity

• Demonstrate ethical (including sensitive, confidential) conduct in practice, research, data collection and

storage, and program management

• Effectively function in culturally diverse settings, assess cross-cultural relations, adapt professional

behavior to unique needs, assess and promote cultural competence of employee/organization

(These lists of organizational competencies for providing essential public health services were done by the CompetencyBased Curriculum Work Group of the Subcommittee on Public Health Workforce, Training, and Education. The Work

Group began with the universal competencies developed by the Faculty/Agency Forum, divided them into the 10

essential services of public health framework, and added new competencies. Those marked with a * are universal

competencies that have been modified.)
31

Essential Service #2: Diagnose and investigate health problems and health hazards in the community.

Competencies:

Analytic Skills

• Define a problem

• Determine appropriate use of data and statistical methods for problem identification and resolution, and

program planning, implementation, and evaluation

• Select and define variables relevant to defined public health problems

• Evaluate the integrity and comparability of data and identify gaps in data sources

• Understand how the data illuminate ethical, political, scientific, economic, and overall public

health issues

• Understand basic research designs used in public health

• Make relevant inferences from data

Communication Skills

• *Communicate effectively both in writing and orally (unless a handicap precludes one of these forms

of communication)

• Present accurately and effectively demographic, statistical, programmatic, and scientific information

for professional and lay audiences

• Solicit input from individuals and organizations

• Lead and participate in groups to address specific issues

• Use the media to communicate public health information

Policy and Development/Program Planning Skills

• Collect and summarize data relevant to an issue

• State policy options

• Articulate the health, fiscal, administrative, legal, social, and political implications of each policy option

• State the feasibility and expected outcomes of each policy option

Cultural Skills

• Understand the dynamic forces contributing to cultural diversity

• Interact sensitively, effectively, and professionally with persons from diverse cultural, socioeconomic,

educational, and professional backgrounds and with persons of all ages and lifestyle preferences

• Identify the role of cultural, social, and behavioral factors in determining disease, disease prevention,

health promoting behavior, and medical service organization and delivery

• Develop and adapt approaches to problems that take into account cultural differences

Basic Public Health Sciences Skills

• Define, assess, and understand the health status of populations, determinants of health and illness,

factors contributing to health promotion and disease prevention, and factors influencing the use of

health services

• Understand research methods in all basic public health sciences

(continued)

Appendix E

(These lists of organizational competencies for providing essential public health services were done by the CompetencyBased Curriculum Work Group of the Subcommittee on Public Health Workforce, Training, and Education. The Work

Group began with the universal competencies developed by the Faculty/Agency Forum, divided them into the 10

essential services of public health framework, and added new competencies. Those marked with a * are universal

competencies that have been modified.)
The Public Health Workforce: An Agenda For The 21st Century

32

• Apply the basic public health sciences including behavioral and social sciences, biostatistics, epidemiology, environmental public health, and prevention of chronic and infectious diseases and injuries

New

• Understand environmental health issues and environmental morbidity factors

• Establish ties with nontraditional public health providers such as school health clinics and occupational

safety office in industry

• Utilize risk assessments (i.e., identifying hazardous exposure and health effects)

• Apply laboratory science skills

• Understand study design, including outbreak/cluster investigation

• Facilitate interview (including cultural competence) and qualitative survey methods

• Utilize public relation skills

• Know existing network of consultants and technical assistance and community-based assets to collect

and analyze community health data

• Understand relevant legal and regulatory information

• Identify the scientific underpinnings and ascertain strength of evidence from literature, including

effectiveness of interventions

• Prepare and interpret data from vital statistics, census, surveys, service utilization, and other relevant

special reports

(These lists of organizational competencies for providing essential public health services were done by the CompetencyBased Curriculum Work Group of the Subcommittee on Public Health Workforce, Training, and Education. The Work

Group began with the universal competencies developed by the Faculty/Agency Forum, divided them into the 10

essential services of public health framework, and added new competencies. Those marked with a * are universal

competencies that have been modified.)
33

Essential Service #3: Inform, educate, and empower people about health issues.

Competencies:

Communication Skills

• *Communicate effectively both in writing and orally (unless a handicap precludes one of these forms

of communication)

• *Present accurately and effectively demographic, statistical, programmatic, and scientific information

for professional and lay audiences (i.e., risk communication)

• Solicit input from individuals and organizations

• Advocate for public health programs and resources

• Lead and participate in groups to address specific issues

• *Use the media and advanced technologies to communicate public health information

Cultural Skills

• Understand the dynamic forces contributing to cultural diversity

• Interact sensitively, effectively and professionally with persons from diverse cultural, socioeconomic,

educational, and professional backgrounds and with persons of all ages and lifestyle preferences

• Identify the role of cultural, social, and behavioral factors in determining disease, disease prevention,

health promoting behavior, and medical service organization and delivery

• Develop and adapt approaches to problems that take into account cultural differences

New

• Understand psychosocial and behavioral theories (e.g., health belief model)

• Establish measurable goals/objectives

• Understand how public and private agencies within a community operate

• Understand risk assessment and health risk assessment methodologies

• Translate education information into compelling sound “bites”

• Know how to use the legal and political system to effect change

• Understand different theories on education and learning

Appendix E

(These lists of organizational competencies for providing essential public health services were done by the CompetencyBased Curriculum Work Group of the Subcommittee on Public Health Workforce, Training, and Education. The Work

Group began with the universal competencies developed by the Faculty/Agency Forum, divided them into the 10

essential services of public health framework, and added new competencies. Those marked with a * are universal

competencies that have been modified.)
The Public Health Workforce: An Agenda For The 21st Century

34

Essential Service #4: Mobilize community partnerships to identify and solve problems.

NOTE: Competencies needed to identify and solve problems are included in essential services #1, 2, and 5.

Therefore, the competencies listed below reflect those needed to mobilize community partnerships.

Competencies:

Communication Skills

• *Communicate effectively and persuasively both in writing and orally (unless a handicap precludes one

 of these forms of communication)

• Present accurately and effectively demographic, statistical, programmatic, and scientific information

 for professional and lay audiences

• Solicit input from individuals and organizations

• Advocate for public health programs and resources

• Lead and participate in groups to address specific issues

• Use the media to communicate public health information

Cultural Skills

• Understand the dynamic forces contributing to cultural diversity

• Interact sensitively, effectively, and professionally with persons from diverse cultural, socioeconomic,

educational, and professional backgrounds and with persons of all ages and lifestyle preferences

• Identify the role of cultural, social, and behavioral factors in determining disease, disease prevention,

health promoting behavior, and medical service organization and delivery

• Develop and adapt approaches to problems that take into account cultural differences

New

• Establish ties with nontraditional health providers (such as businesses, managed care organizations

and other health care providers, schools, other government agencies, volunteer, and nonprofit organizations, advocacy groups, community groups, hospitals, physicians, insurers, faith and church groups)

• Understand the existing network of consultants and technical assistance and community-based assets

to collect and analyze community health data

• Utilize leadership, team building, negotiation, and conflict resolution skills to build community

partnerships

• Foster community empowerment, involvement, and power sharing whenever possible in the design,

implementation, and research aspects of programs and systems

(These lists of organizational competencies for providing essential public health services were done by the CompetencyBased Curriculum Work Group of the Subcommittee on Public Health Workforce, Training, and Education. The Work

Group began with the universal competencies developed by the Faculty/Agency Forum, divided them into the 10

essential services of public health framework, and added new competencies. Those marked with a * are universal

competencies that have been modified.)
35

Essential Service #5: Develop policies and plans that support individual and community health efforts.

Competencies:

Communication Skills

• Use the media and advanced technologies to communicate public health information

Policy and Development/Program Planning Skills

• *Collect and summarize data relevant to an issue and test its reliability

• State policy options

• Articulate the health, fiscal, administrative, legal, social, and political implications of each policy option

• State the feasibility and expected outcomes of each policy option

• *Utilize current techniques in decision analysis

• Write a clear and concise policy statement

• Develop a plan to implement the policy, including goals, outcome and process objectives, and implementation steps

• Translate policy into organizational plans, structures, and programs

• Identify public health laws, regulations, and policies related to specific programs

• Develop mechanisms to monitor and evaluate programs for their effectiveness and quality

Cultural Skills

• Understand the dynamic forces contributing to cultural diversity

• Interact sensitively, effectively, and professionally with persons from diverse cultural, socioeconomic,

educational, and professional backgrounds and with persons of all ages and lifestyle preferences

• Identify the role of cultural, social, and behavioral factors in determining disease, disease prevention,

health promoting behavior, and medical service organization and delivery

• Develop and adapt approaches to problems that take into account cultural differences

Financial Planning and Management Skills

• Develop and present a budget

• Manage programs within budgetary constraints

• Develop strategies for determining budget priorities

• Monitor program performance

• Prepare proposals for funding from external sources

• Apply basic human relations skills to the management of organizations and the resolution of conflicts

• Manage personnel

• Understand the theory of organizational structure and its relation to professional practice

New

• Utilize and integrate strategic planning processes, including assessment methodology and modeling

when developing policies or community-health plans

• Conduct cost-effectiveness, cost-benefit, and cost-utility analyses

Appendix E

(These lists of organizational competencies for providing essential public health services were done by the CompetencyBased Curriculum Work Group of the Subcommittee on Public Health Workforce, Training, and Education. The Work

Group began with the universal competencies developed by the Faculty/Agency Forum, divided them into the 10

essential services of public health framework, and added new competencies. Those marked with a * are universal

competencies that have been modified.)
The Public Health Workforce: An Agenda For The 21st Century

36

Essential Service #6: Enforce laws and regulations that protect health and ensure safety.

Competencies:

Communication Skills

• *Communicate effectively both in writing and orally (unless a handicap precludes one of these forms

of communication)

• *Present accurately and effectively demographic, statistical, programmatic, and scientific information

for professional and lay audiences (i.e., risk communication)

• *Use the media and advanced technologies to communicate public health information

Policy and Development/Program Planning Skills

• *Collect and summarize data relevant to an issue, including adequate interpretation of historical experiences, activities, and outcomes

• *Identify, interpret, and implement public health laws, regulations, and policies related to

specific programs

Cultural Skills

• Interact sensitively, effectively, and professionally with persons from diverse cultural, socioeconomic,

educational, and professional backgrounds and with persons of all ages and lifestyle preferences

New

• Utilize creative methods for achieving enforcement and regulation of laws that protect health

• Collaborate with other public agencies and organizations (e.g., law enforcement)

• Manage and monitor the enforcement process (including enforcement personnel, compliance, and

development of inspection indicators)

• Understand risk assessment and health risk assessment methodologies

(These lists of organizational competencies for providing essential public health services were done by the CompetencyBased Curriculum Work Group of the Subcommittee on Public Health Workforce, Training, and Education. The Work

Group began with the universal competencies developed by the Faculty/Agency Forum, divided them into the 10

essential services of public health framework, and added new competencies. Those marked with a * are universal

competencies that have been modified.)
37

Essential Service #7: Link people to needed personal health services and ensure the provision of health care when otherwise unavailable.

Competencies:

Analytic Skills

• Define a problem

• Make relevant inferences from data

Policy and Development/Program Planning Skills

• Collect and summarize data relevant to an issue

• State policy options

• Articulate the health, fiscal, administrative, legal, social, and political implications of each policy option

• State the feasibility and expected outcomes of each policy option

• Decide on the appropriate course of action

• Write a clear and concise policy statement

• Develop a plan to implement the policy, including goals, outcome and process objectives, and implementation steps

• Translate policy into organizational plans, structures, and programs

• Develop mechanisms to monitor and evaluate programs for their effectiveness and quality

Cultural Skills

• Understand the dynamic forces contributing to cultural diversity

• Interact sensitively, effectively, and professionally with persons from diverse cultural, socioeconomic,

educational, and professional backgrounds and with persons of all ages and lifestyle preferences

• Identify the role of cultural, social, and behavioral factors in determining disease, disease prevention,

health promoting behavior, and medical service organization and delivery

• Develop and adapt approaches to problems that take into account cultural differences

Basic Public Health Sciences Skills

• Define, assess, and understand the health status of populations, determinants of health and illness,

factors contributing to health promotion and disease prevention, and factors influencing the use of

health services

Financial Planning and Management Skills

• Develop and present a budget

• Manage programs within budgetary constraints

• Develop strategies for determining budget priorities

• Monitor program performance

• Prepare proposals for funding from external sources

• Apply basic human relations skills to the management of organizations and the resolution of conflicts

• Manage personnel

• Understand the theory of organizational structure and its relation to professional practice

(continued)

Appendix E

(These lists of organizational competencies for providing essential public health services were done by the CompetencyBased Curriculum Work Group of the Subcommittee on Public Health Workforce, Training, and Education. The Work

Group began with the universal competencies developed by the Faculty/Agency Forum, divided them into the 10

essential services of public health framework, and added new competencies. Those marked with a * are universal

competencies that have been modified.)
The Public Health Workforce: An Agenda For The 21st Century

38

New

• Negotiate contracts for personal health services

• Identify health needs of special and vulnerable populations

• Utilize case management skills to coordinate care

• Coordinate public health and medicine for optimal care

• Provide or ensure provision of comprehensive personal health services, including primary and specialty

medical and dental care and clinical preventive services

• Prepare and implement emergency response plans

(These lists of organizational competencies for providing essential public health services were done by the CompetencyBased Curriculum Work Group of the Subcommittee on Public Health Workforce, Training, and Education. The Work

Group began with the universal competencies developed by the Faculty/Agency Forum, divided them into the 10

essential services of public health framework, and added new competencies. Those marked with a * are universal

competencies that have been modified.)
39

Essential Service #8: Assure a competent public health and personal health care workforce.

Competencies:

Analytic Skills

• Determine appropriate use of data and statistical methods for problem identification and resolution and

program planning, implementation, and evaluation

Policy and Development/Program Planning Skills (policy = privileging, licensing, quality assurance,

credentialing, and accreditation of health professionals and health professions education)

• Collect and summarize data relevant to an issue

• State policy options

• Articulate the health, fiscal, administrative, legal, social, and political implications of each policy option

• State the feasibility and expected outcomes of each policy option

• Decide on the appropriate course of action

• Write a clear and concise policy statement

• Develop a plan to implement the policy, including goals, outcome and process objectives, and implementation steps

• Translate policy into organizational plans, structures, and programs

Cultural Skills

• Interact sensitively, effectively, and professionally with persons from diverse cultural, socioeconomic,

educational, and professional backgrounds and with persons of all ages and lifestyle preferences

• Develop and adapt approaches to problems that take into account cultural differences

Basic Public Health Sciences Skills

• Understand the historical development and structure of State, local, and Federal public health agencies

Financial Planning and Management Skills

• Understand the theory of organizational structure and its relation to professional practice

New

• Persuasively express to organizational leaders the value and need for training and education

• Know and use contemporary learning technologies

• Understand different theories on education and learning

(These lists of organizational competencies for providing essential public health services were done by the CompetencyBased Curriculum Work Group of the Subcommittee on Public Health Workforce, Training, and Education. The Work

Group began with the universal competencies developed by the Faculty/Agency Forum, divided them into the 10

essential services of public health framework, and added new competencies. Those marked with a * are universal

competencies that have been modified.)

Appendix E
The Public Health Workforce: An Agenda For The 21st Century

40

Essential Service #9: Evaluate effectiveness, accessibility, and quality of personal and

population-based health services.

Competencies:

Analytic Skills

• Evaluate the integrity and comparability of data and identify gaps in data sources

• Understand how the data illuminate ethical, political, scientific, economic, and overall public

health issues

• *Understand basic research methodologies used in public health and health services research

• Make relevant inferences from data

Communication Skills

• *Communicate effectively both in writing and orally (unless a handicap precludes one of these forms

of communication)

• Present accurately and effectively demographic, statistical, programmatic, and scientific information

for professional and lay audiences

• Solicit input from individuals and organizations

• Advocate for public health programs and resources

Policy and Development/Program Planning Skills

• Collect and summarize data relevant to an issue

• Identify public health laws, regulations, and policies related to specific programs

• Develop mechanisms to monitor and evaluate programs for their effectiveness and quality

• Understand analytic skills for survey development and administration

Cultural Skills

• Understand the dynamic forces contributing to cultural diversity

• Interact sensitively, effectively, and professionally with persons from diverse cultural, socioeconomic,

educational, and professional backgrounds and with persons of all ages and lifestyle preferences

• Identify the role of cultural, social, and behavioral factors in determining disease, disease prevention,

health promoting behavior, and medical service organization and delivery

• Develop and adapt approaches to problems that take into account cultural differences

Basic Public Health Sciences Skills

• Define, assess, and understand the health status of populations, determinants of health and illness,

factors contributing to health promotion and disease prevention, and factors influencing the use of

health services

• Understand research methods in all basic public health sciences

• Apply the basic public health sciences, including behavioral and social sciences, biostatistics, epidemiology, environmental public health, and prevention of chronic and infectious diseases and injuries

• Understand the historical development and structure of State, local, and Federal public health agencies

(continued)

(These lists of organizational competencies for providing essential public health services were done by the CompetencyBased Curriculum Work Group of the Subcommittee on Public Health Workforce, Training, and Education. The Work

Group began with the universal competencies developed by the Faculty/Agency Forum, divided them into the 10

essential services of public health framework, and added new competencies. Those marked with a * are universal

competencies that have been modified.)
41

Financial Planning and Management Skills

• Monitor program performance

New

• Understand analytic skills for survey development and administration

• Monitor quality of personal health services provided

• Conduct cost-effectiveness, cost-benefit, and cost-utility analyses

Appendix E

(These lists of organizational competencies for providing essential public health services were done by the CompetencyBased Curriculum Work Group of the Subcommittee on Public Health Workforce, Training, and Education. The Work

Group began with the universal competencies developed by the Faculty/Agency Forum, divided them into the 10

essential services of public health framework, and added new competencies. Those marked with a * are universal

competencies that have been modified.)
The Public Health Workforce: An Agenda For The 21st Century

42

Essential Service #10: Research for new insights and innovative solutions to health problems.

Competencies:

Analytic Skills

• Define a problem

• Determine appropriate use of data and statistical methods for problem identification and resolution and

program planning, implementation, and evaluation

• Select and define variables relevant to defined public health problems

• Evaluate the integrity and comparability of data and identify gaps in data sources

• Understand how the data illuminate ethical, political, scientific, economic, and overall

public health issues

• Understand basic research designs used in public health

• Make relevant inferences from data

Communication Skills

• *Use the media to communicate and disseminate results of research findings

Cultural Skills

• Understand the dynamic forces contributing to cultural diversity

• Interact sensitively, effectively, and professionally with persons from diverse cultural, socioeconomic,

educational, and professional backgrounds and with persons of all ages and lifestyle preferences

• Identify the role of cultural, social, and behavioral factors in determining disease, disease prevention,

health promoting behavior, and medical service organization and delivery

• Develop and adapt approaches to problems that take into account cultural differences

Basic Public Health Sciences Skills

• Define, assess, and understand the health status of populations, determinants of health and illness,

factors contributing to health promotion and disease prevention, and factors influencing the use of

health services

• Understand research methods in all basic public health sciences

• Apply the basic public health sciences, including behavioral and social sciences, biostatistics, epidemiology, environmental public health, and prevention of chronic and infectious diseases and injuries

• Understand the historical development and structure of State, local, and Federal public health agencies

New

• Identify specific research methodologies relevant to each of the previous nine essential services

• Conduct collaborative research across multiple disciplines

• Understand budget processes in order to lobby for resources to investigate innovative approaches to

health problems

(These lists of organizational competencies for providing essential public health services were done by the CompetencyBased Curriculum Work Group of the Subcommittee on Public Health Workforce, Training, and Education. The Work

Group began with the universal competencies developed by the Faculty/Agency Forum, divided them into the 10

essential services of public health framework, and added new competencies. Those marked with a * are universal

competencies that have been modified.)
43

Organizations:

Academy of General Dentistry

Aerobics and Fitness Association of America

Alcohol and Drug Problems Association

Alliance for Aging Research

Alliance for Health

Amateur Athletic Union of the United States

American Academy of Child and Adolescent

 Psychiatry

American Academy of Family Physicians

American Academy of Nursing

American Academy of Ophthalmology

American Academy of Orthopedic Surgeons

American Academy of Otolaryngology, Head and

 Neck Surgery, Inc.

American Academy of Pain Management

American Academy of Pediatric Dentistry

American Academy of Pediatrics

American Alliance for Health, Physical Education,

 Recreation and Dance

American Art Therapy Association

American Association for Clinical Chemistry

American Association for Dental Research

American Association for Health Education

American Association for Marriage and Family

 Therapy

American Association for Respiratory Care

American Association for the Advancement of

 Science

American Association of Certified Orthoptists

American Association of Colleges of Nursing

American Association of Colleges of Osteopathic

 Medicine

American Association of Colleges of Pharmacy

American Association of Dental Schools

American Association of Family and Consumer

 Services

American Association of Health Plans

American Association of Homes for the Aging

American Association of Occupational Health Nurses

American Association of Pathologists’ Assistants

American Association of Public Health Dentistry

American Association of Public Health Physicians

American Association of Retired Persons

American Association of School Administrators

American Association of Suicidology

American Association of University Affiliated

 Programs

American Association on Mental Retardation

American Cancer Society, Inc.

American College Health Association

American College of Acupuncture

American College of Cardiology

American College of Clinical Pharmacy

American College of Emergency Physicians

American College of Gastroenterology

American College of Health Care Administrators

American College of Health Care Executives

American College of Nurse-Midwives

American College of Nutrition

American College of Obstetricians and Gynecologists

American College of Occupational and Environmental

 Medicine

American College of Physicians

American College of Preventive Medicine

American College of Radiology

American College of Sports Medicine

American Correctional Health Services Association

American Council on Alcoholism, Inc.

American Council on Exercise

American Counseling Association

American Dental Association

American Dental Hygienists’ Association

American Diabetes Association

American Dietetic Association

American Federation of Teachers

American Geriatrics Society

American Heart Association

American Highway Users Alliance

American Hospital Association

American Indian Health Care Association

American Institute for Preventive Medicine

American Kinesitherapy Association

American Liver Foundation

American Lung Association

American Meat Institute

American Medical Association

American Medical Student Association

American Nurses Association

Appendix F:

HEALTHY PEOPLE 2000 Consortium
The Public Health Workforce: An Agenda For The 21st Century

44

American Occupational Therapy Association

American Optometric Association

American Orthopedic Society for Sports Medicine

American Osteopathic Academy of Sports Medicine

American Osteopathic Association

American Osteopathic Health care Association

American Pharmaceutical Association

American Physical Therapy Association

American Podiatric Medical Association

American Psychiatric Association

American Psychiatric Nurses Association

American Psychological Association

American Public Health Association

American Red Cross

American Rehabilitation Association

American Rehabilitation Counseling Association

American Running and Fitness Association

American School Food Service Association

American School Health Association

American Society for Clinical Nutrition

American Society for Gastrointestinal Endoscopy

American Society for Microbiology

American Society for Nutritional Sciences

American Society for Parenteral and

 Enteral Nutrition

American Society for Pharmacology and

 Experimental Therapeutics

American Society of Addiction Medicine

American Society of Health System Pharmacists

American Society of Human Genetics

American Society of Ocularists

American Speech-Language-Hearing Association

American Spinal Injury Association

American Statistical Association

American Thoracic Society

American Trauma Society

American Veterinary Medical Association

Aquatic Exercise Association

Arthritis Foundation

Asian and Pacific Islander American Health Forum

Asociacion Nacional Pro Personas Mayores

ASPO/Lamaze Association

Association for Applied Psychophysiology and

 Biofeedback

Association for Hospital Medical Education

Association for Professionals in Infection Control and

 Epidemiology

Association for the Advancement of Automotive

 Medicine

Association for the Care of Children

Association for Worksite Health Promotion

Association of Academic Health Centers

Association of American Indian Physicians

Association of American Medical Colleges

Association of Community Health Nursing Educators

Association of Food and Drug Officials

Association of Maternal and Child Health Programs

Association of Occupational and Environmental

 Clinics

Association of Pediatric Oncology Nurses

Association of Rehabilitation Nurses

Association of Schools of Allied Health Professions

Association of Schools of Public Health

Association of State and Territorial Chronic Disease

 Program Directors

Association of State and Territorial Dental Directors

Association of State and Territorial Directors of

 Health Promotion and Public Health Education

Association of State and Territorial Directors of

 Nursing

Association of State and Territorial Health Officials

Association of State and Territorial Public Health

 Laboratory Directors

Association of State and Territorial Public Health

 Nutrition Directors

Association of State and Territorial Public Health

 Social Workers

Association of Teachers of Preventive Medicine

Association of Technical Personnel in Ophthalmology

Association of Women’s Health, Obstetric, and

 Neonatal Nurses

Asthma and Allergy Foundation of America

Black Congress on Health, Law, and Economics

Blue Cross and Blue Shield Association

Boy Scouts of America

Brain Injury Association, Inc.

Business Roundtable

Camp Fire

Cardiovascular Credentialing International

Catholic Health Association of the United States

Center to Prevent Handgun Violence

Chamber of Commerce of the United States of

 America

Coalition for Consumer Health and Safety

College of American Pathologists

Consortium of Social Science Associations

Council for Responsible Nutrition

Council of Medical Specialty Societies

Emergency Nurses Association

Employee Assistance Professionals Association

Environmental Council of the States

Eye Bank Association of America
45

Federation of American Societies for Experimental

 Biology

Federation of Behavioral, Psychological, and

 Cognitive Sciences

Food Marketing Institute

Future Homemakers of America

General Federation of Women’s Clubs

Gerontological Society of America

Girl Scouts of the United States of America

Grocery Manufacturers of America

Health Industry Manufacturers Association

Health Insurance Association of America

Health Ministries Association

Health Sciences Communications Association

Healthier People Network

Healthy Mothers, Healthy Babies

Institute for Child Health Policy

Institute of Food Technologists

International Hearing Society

International Lactation Consultant Association

International Life Sciences Institute

La Leche League International

Learning Disabilities Association of America

March of Dimes Birth Defects Foundation

Maternity Center Association

Midwives Alliance of North America

Migrant Clinicians Network

Mothers Against Drunk Driving

National 4-H Council

National AIDS Fund

National PTA

National Alliance for the Mentally Ill

National Alliance of Black School Educators

National Alliance of Nurse Practitioners

National Alliance of Senior Citizens, Inc.

National Asian and Pacific American Families

 Against Substance Abuse

National Association for Family and Community

 Education

National Association for Home Care

National Association for Human Development

National Association for Music Therapy

National Association for Public Health Statistics and

 Information Systems

National Association for Public Worksite Health

 Promotion

National Association for Sport and Physical

 Education

National Association of Biology Teachers

National Association of Childbearing Centers

National Association of Children’s Hospitals and

 Related Institutions

National Association of Community Health Centers

National Association of Counties

National Association of County and City

 Health Officials

National Association of Elementary School

 Principals

National Association of Governor’s Councils on

 Physical Fitness and Sports

National Association of Neighborhoods

National Association of Neonatal Nurses

National Association of Optometrists and

 Opticians, Inc.

National Association of Pediatric Nurse Associates

 and Practitioners

National Association of RSVP Directors

National Association of School Nurses

National Association of Secondary School Principals

National Association of Social Workers

National Association of State Alcohol and Drug

 Abuse Directors

National Association of State Boards of Education

National Association of State Mental Health

 Program Directors

National Association of State Nutrition Education

 and Training Coordinators

National Association of State School

 Nurse Consultants

National Athletic Trainers’ Association

National Black Nurses Association

National Board of Medical Examiners

National Civic League

National Coalition Against Sexual Assault

National Coalition of Hispanic Health and Human

 Services Organizations

National Commission Against Drunk Driving

National Committee to Prevent Child Abuse

National Community Pharmacists Association

National Conference of State Legislatures

National Consumers League

National Council for Adoption

National Council for International Health

National Council of Community Hospitals

National Council of La Raza

National Council on Alcoholism and Drug

 Dependence

National Council on Patient Information

 and Education

National Council on the Aging

Appendix F
The Public Health Workforce: An Agenda For The 21st Century

46

National Dairy Council

National Education Association Health Information

 Network

National Environmental Health Association

National Family Planning and Reproductive

 Health Association

National Federation for Specialty Nursing

 Organizations

National Federation of State High School

 Associations

National Food Processors Association

National Health Council

National Health Lawyers Association

National Hispanic Council on Aging

National Institute for Fitness and Sports

National Kidney Foundation

National League for Nursing

National Lesbian and Gay Health Association

National Medical Association

National Mental Health Association

National Minority AIDS Council

National Minority Health Association

National Nurses Society on Addictions

National Organization for Women

National Organization on Adolescent Pregnancy,

 Parenting and Prevention

National Osteoporosis Foundation

National Pediculosis Association

National Pest Control Association

National Recreation and Park Association

National Restaurant Association

National SAFE KIDS Campaign

National Safety Council

National School Boards Association

National Strength and Conditioning Association

National Stroke Association

National Wellness Institute, Inc.

National Women’s Health Network

Network of Employers for Traffic Safety

Nursing Network on Violence Against Women

Oncology Nursing Society

Opticians Association of America

Oral Health America

Partnership for Prevention

People’s Medical Society

Pharmaceutical Researchers and Manufacturers

 of America

Physicians for a Violence-Free Society

Planned Parenthood Federation of America

Poison Prevention Week Council

Population Association of America

Prevent Blindness America

Produce for Better Health Foundation

Produce Marketing Association

Public Health Institute

Road Runners Club of America

Salt Institute

Salvation Army

Sexuality Information and Education Council

 of the U.S.

Society for Academic Emergency Medicine

Society for Adolescent Medicine

Society for Healthcare Strategy and Market

 Development

Society for Hospital Epidemiology of America

Society for Nutrition Education

Society for Public Health Education

Society of Behavioral Medicine

Society of General Internal Medicine

Society of Prospective Medicine

Society of State Directors of Health, Physical

 Education and Recreation

State Family Planning Administrators

The Arc

The International Health, Racquet and

 Sportsclub Association

The Sugar Association

The United States Conference of Mayors

Think First Foundation

Unitarian Universalist Seventh Principle Project

United States Eye Injury Registry

United Way of America

VHA, Inc.

Visiting Nurse Association of America

Washington Business Group on Health

Wellness Councils of America

Western Consortium for Public Health

Women’s Sports Foundation

Wound, Ostomy and Continence Nurses Society

YMCA of the USA

State Agencies:

Public Health

Mental Health

Substance Abuse

Environment
47

Appendix G:

The Faculty/Agency Forum Competencies by Discipline

In addition to the Universal Competencies, competencies were developed for the following specific disciplines by the Public Health Faculty/Agency Forum:

Public Health Administration

Epidemiology and Biostatistics

Behavioral Sciences

Environmental Public Health

For details refer to:

Sorensen, Andrew A., and Ronald G. Bialek, eds. 1993. The public health faculty/agency forum:

Linking graduate education and practice. Gainesville, FL: Florida University Press.
The Public Health Workforce: An Agenda For The 21st Century

48
49

Appendix H:

Competencies Reviewed by

the Competency-Based Curriculum Work Group

 Competency Set Lead Organization Date

 Universal Competencies The Public Health Faculty/Agency Forum 1989

 Competencies for Education in Association of Teachers of Maternal & 1993

 Maternal and Child Health Child Health

Association of Schools of Public Health

MCH Council

 Public Health Leadership Competencies for State The National Public Health Leadership Draft

 Regional Programs Development Network version

 1996

 Community-Based Public Health Competencies Johns Hopkins University School of Health 1996

 A Competency-Based Framework for Professional The National Commission for Health 1996

 Development of Certified Health Education Specialists Education Credentialing, Inc.

 Addiction Counselor Competencies Curriculum Review Committee of the 1995

Addiction Training Center Program

 Educating Environmental Health Science and Protection Association of Schools of Public Health 1991

 Professionals: Problems, Challenges, Larry J. Gordon

 and Recommendations

 Competency Objectives for Dental Public Health American Public Health Association: 1990

Dental Section
The Public Health Workforce: An Agenda For The 21st Century

50
51

CO-CHAIRS

Jo Ivey Boufford, M.D.

Acting Assistant Secretary for Health

U.S. Department of Health and Human Services

Audrey F. Manley, M.D., M.P.H.

Acting Surgeon General

U.S. Department of Health and Human Services

MEMBERS

Lisa Simpson, M.B., B.Ch.

Acting Administrator

Agency for Health Care Policy and Research

E. Richard Brown, Ph.D.

President

American Public Health Association

Allan Rosenfield, M.D.

President

Association of Schools of Public Health

Jack Dillenberg, D.D.S., M.P.H.

President

Association of State and Territorial Health Officials

David Satcher, M.D., Ph.D.

Director

Centers for Disease Control and Prevention

Harold Reheis, P.E.

President

The Environmental Council of the States

David A. Kessler, M.D.

Commissioner of Food and Drugs

Food and Drug Administration

Ciro Sumaya, M.D., M.P.H.T.M.

Administrator

Health Resources and Services Administration

Michael H. Trujillo, M.D., M.P.H.

Director

Indian Health Service

Mary des Vignes-Kendrick, M.D., M.P.H.

President

National Association of County and City

 Health Officials

Luceille Fleming

President

National Association of State Alcohol and Drug

 Abuse Directors

Stuart B. Silver, M.D.

President

National Association of State Mental Health

 Program Directors

Edwin Pratt, Jr.

Past President

National Association of the Local Boards of Health

Appendix I:

Public Health Functions Steering Committee and Working Group

Subcommittee on Public Health Workforce, Training, and Education:

Competency-Based Curriculum Work Group

Distance Learning Systems Work Group

Workforce Composition Work Group

PUBLIC HEALTH FUNCTIONS STEERING COMMITTEE

MEMBERS (MARCH 1997)
The Public Health Workforce: An Agenda For The 21st Century

52

Harold E. Varmus, M.D.

Director

National Institutes of Health

Maurice Mullet, M.D.

Chairman of the Board

Public Health Foundation

Honorable Richard S. Schweiker

Chair

Partnership for Prevention

Nelba R. Chavez, Ph.D.

Administrator

Substance Abuse and Mental Health

 Services Administration

PUBLIC HEALTH FUNCTIONS

WORKING GROUP

MEMBERS (MARCH 1997)

CO-CHAIRS

David Satcher, M.D., Ph.D.

Director

Centers for Disease Control and Prevention

Claude Earl Fox, M.D., M.P.H.

Deputy Assistant Secretary for Health

(Disease Prevention and Health Promotion)

MEMBERS

Raymond Seltser, M.D.

Center for Primary Care Research

Agency for Health Care Policy and Research

Katherine S. McCarter, M.H.S.

Acting Executive Director

American Public Health Association

Michael K. Gemmell, C.A.E.

Executive Director

Association of Schools of Public Health

Cheryl Beversdorf, R.N., M.H.S., C.A.E.

Executive Vice President

Association of State and Territorial Health Officials

Edward Baker, M.D., M.P.H.

Director

Public Health Program Practice Office

Centers for Disease Control and Prevention

Charles Gollmar

Acting Director, Office of Program Planning

 and Evaluation

Centers for Disease Control and Prevention

Jeffery R. Harris, M.D., M.P.H.

Associate Director for Policy, Planning,

 and Evaluation

Centers for Disease Control and Prevention

Gary Hogelin, M.A.

Assistant Director for Policy and Planning

Office of Surveillance and Analysis

Centers for Disease Control and Prevention

Ray M. Nicola, M.D.

Associate Director, Division of Public Health

Public Health Program Practice Office

Centers for Disease Control and Prevention

Reverend Samuel Nixon

Director, Affiliate Relations Department

Congress of National Black Churches

Robbie Roberts

Executive Director

The Environmental Council of the States

Peter Rheinstein, M.D.

Director, Medicine Staff, Office of Health Affairs

Food and Drug Administration

Ronald Carlson

Associate Administrator for Planning Evaluation

 and Legislation

Health Resources and Services Administration

Douglas S. Lloyd, M.D., M.P.H.

Associate Administrator for Public Health Practice

Health Resources and Services Administration
53

Audrey H. Nora, M.D.

Director, Maternal and Child Health

Health Resources and Services Administration

Stephen B. Permison, M.D.

Deputy Director, Quality Assurance Division

Bureau of Health Professions

Health Resources and Services Administration

Neil H. Sampson

Acting Director, Division of Associated Dental and

 Public Health Professions

Bureau of Health Professions

Health Resources and Services Administration

CDR Susanne Caviness, Ph.D.

Chief, Patient Registration, Quality Management

Indian Health Service

Nancy Rawding

Executive Director

National Association of County and City

 Health Officials

Edwin Pratt, Jr.

Past President

National Association of Local Boards of Health

John Gustafson

Executive Director

National Association of State Alcohol and

 Drug Abuse Directors

Robert Glover, Ph.D.

Executive Director

National Association of State Mental Health

 Program Directors

William Harlan, M.D.

Associate Director for Disease Prevention

National Institutes of Health

Eric Goosby, M.D.

Director

Office of HIV/AIDS Policy

Roscoe M. Moore, Jr., D.V.M., Ph.D., D.Sc.

Associate Director

Office of International and Refugee Health

Valerie Welsh

Office of Minority Health

Thomas Kring

Acting Deputy Assistant Secretary for Health

Office of Population Affairs

RADM Stephen B. Corbin

Chief of Staff

Office of the Surgeon General

Susan Blumenthal, M.D.

Deputy Assistant Secretary on Women’s Health

Office on Women’s Health

Jud Richland

Executive Director

Partnership for Prevention

Christine G. Spain, M.A.

Director, Research, Planning and Special Projects

President’s Council on Physical Fitness and Sports

Ronald Bialek, M.P.P.

Executive Director

Public Health Foundation

Duiona Baker, M.P.H.

Senior Policy Analyst

Office of Policy and Program Coordination

Substance Abuse and Mental Health

 Services Administration

STAFF

Kristine Gebbie, Dr.P.H., R.N.

Senior Advisor, Public Health Functions

Office of Disease Prevention and Health Promotion

Nicole Cumberland

Operations Coordinator, Public Health Functions

Office of Disease Prevention and Health Promotion

Appendix I
The Public Health Workforce: An Agenda For The 21st Century

54

COMPETENCY-BASED CURRICULUM

WORK GROUP

CO-CHAIRS

Dick Lincoln

Public Health Program Practice Office

Centers for Disease Control and Prevention

 (until October 1996)

Association of Schools of Public Health

Neil H. Sampson

Bureau of Health Professions

Health Resources and Services Administration

MEMBERS

Raymond Seltser

Center for Primary Care Research

Agency for Health Care Policy and Research

Catherine Kordek

American Public Health Association

Wendy Katz

Association of Schools of Public Health

Alison Wojciak

Association of Schools of Public Health

Jane C. Nelson

Center for Public Health Practice

Emory University School of Public Health

Mary Haack

George Washington Center for Health Policy

Michelle Solloway

George Washington Center for Health Policy

Rosemary Duffy

Bureau of Health Professions

Health Resources and Services Administration

Alexander F. Ross

Health Resources and Services Administration

Rick Bothwell

Division of Clinical and Preventive Services

Indian Health Service

Lee Bone

Department of Health and Policy Management

Johns Hopkins School of Public Health/Kellogg

 Community-Based Public Health

Jeanne Wehage

Department of Health Policy and Management

Johns Hopkins School of Public Health

Jerre Jensen

Public Health Training Network

Elaine Auld

Society for Public Health Education

Janice Taylor

State of Washington Department of Health

Susanne Rohrer

Center for Substance Abuse Treatment Substance

Abuse and Mental Health Services Administration

Major Bruno Petrucelli

Walter Reed Army Institute of Research

Division of Preventive Medicine

U.S. Department of Defense

Susan Conrath

Internal Environments Division

U.S. Environmental Protection Agency

STAFF

D.W. Chen

Bureau of Health Professions

Health Resources and Services Administration

Nicole Cumberland

Office of Disease Prevention and Health Promotion

SUBCOMMITTEE ON PUBLIC HEALTH WORKFORCE, TRAINING, AND EDUCATION
55

DISTANCE-BASED LEARNING SYSTEMS

WORK GROUP

CHAIR

Dennis McDowell

Division of Media and Training Services

Public Health Program Practice Office

Centers for Disease Control and Prevention

MEMBERS

Lynn Kazemekas

Center for Information Dissemination

Agency for Health Care Policy and Research

James G. Hill

Director, Office of Rural Health

American Psychological Association

Tom Kubisyn

Assistant Executive Director

Policy and Advocacy in the Schools

American Psychological Association

Scott Becker

Association of Schools of Public Health

Nona Gibbs

Public Health Program Practice Office

Centers for Disease Control and Prevention

Robert Fatula

Television Design and Development Branch

Food and Drug Administration

Gary German

Division of Human Resource Service

Food and Drug Administration

Michelle Solloway

George Washington Center for Health Policy

Pam Vocke

Surveyor Training Improvement Team

Health Care Financing Administration

D.W. Chen

Bureau of Health Professions

Health Resources and Services Administration

Ronald Merrill

Health Resources and Services Administration

Alexander Ross

Health Resources and Services Administration

Neil H. Sampson

Bureau of Health Professions

Health Resources and Services Administration

Alan Lee Myers

Training Officer

Indian Health Service

Michael Weisberg

National Library of Medicine

Rita Kelliher

Public Health Foundation

Steve Seitz

Public Health Advisor

Center for Substance Abuse Prevention

Substance Abuse and Mental Health

 Services Administration

Lisa Nelson

U.S. Environmental Protection Agency

Ruth Salinger

Office of the Secretary

U.S. Department of Health and Human Services

STAFF

Jerre Jensen

Senior Advisor

Public Health Training Network

Nicole Cumberland (Part-time)

Office of Disease Prevention and Health Promotion

Appendix I
The Public Health Workforce: An Agenda For The 21st Century

56

WORKFORCE WORK GROUP

CHAIR

Douglas S. Lloyd

Health Resources and Services Administration

MEMBERS

Carolyn Clancy

Agency for Health Care Policy and Research

Karen VanLandeghem

Association of Maternal and Child Health Programs

Wendy Katz

Association of Schools of Public Health

David Manning

Association of State and Territorial Health Officials

Mary Haack

George Washington Center for Health Policy

Michelle Solloway

George Washington Center for Health Policy

D.W. Chen

Bureau of Health Professions

Health Resources and Services Administration

Madeleine Golde

National Association of Social Workers

Jim Baxendale

National Association of State

 Alcohol and Drug Abuse Directors

Bruce Emery

National Association of State

Mental Health Program Directors

Valerie Welsh

Office of Minority Health

Kay Eilbert

Public Health Foundation

Duiona Baker

Substance Abuse and Mental Health

 Services Administration

Richard House

School of Public Health

University of North Carolina at Chapel Hill

STAFF

Alexander F. Ross

Health Resources and Services Administration

Nicole Cumberland

Office of Disease Prevention and Health Promotion
57

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