Genomic Workforce Competencies: Background on Public Health Workforce Development

Public Health in the United States began during the mid-1880s and focused on sanitation. Initial statutes, which mandated clean water, proper sanitation and safe food, led to the elimination of approximately 80% of prevalent disease. By the early 1900s, public health led the campaign for mass immunization and primary preventive health care that focused on the individual. The Institute of Medicine (IOM) in 1987 convened an expert committee to examine public health in the United States.

The highly critical report, “The Future of Public Health,” published in 1988, outlined the dilemma facing all of public health in the nation, and recommended that public health return to its population base, with the community as the unit of focus. The report laid out and defined three primary core functions for public health: Assessment, Policy Development, and Assurance. “Assessment” is the regular collection and analysis of data on community health status, identification of community resources, identification and targeting of community problems and needs, and identification of opportunities to engage communities. “Policy Development” is the ability to respond to community needs by applying scientific knowledge, political acumen, and leadership ability to develop sound public health policy by establishing agreed upon community health goals and objectives. Finally, “Assurance” demands that public health agencies assure the availability of necessary services by encouraging the action of others, regulating the actions of others, and/or providing necessary services directly, in addition to developing a constituency to support community health goals.

In response to the IOM challenge, public health began to mobilize and develop programs to support “The Future of Public Health.” In 1992 the practice and academic communities created the Council on Linkages Between Academia and Public Health Practice and the Faculty-Agency Forum. Public health capacity issues were addressed through the Assessment Protocol for Excellence in Public Health. In addition, the National Public Health Leadership Institute was created to provide advanced skills to key leaders in the public health workforce. Public health organizations, (1992-1995) created such documents as “Core Public Health Functions” by the National Association of County and City Health Officials (NACCHO), “Blueprint for a Healthy Community: A Guide for Local Health Departments by NACCHO and CDC, and “The Public Health Workforce: An Agenda for the 21st Century” by the Public Health Functions Project of the United States Public Health Service Commissioned Corps (USPHS). These documents began laying out the groundwork, often rudimentary, to create an effective public health operation, using a competency-based workforce. Finally, the Public Health Functions Steering Committee comprising the broadest array of practice, academic, specialty and professional organizations developed a common vision and mission for public health in the nation and a statement of purpose expanding the three core functions into ten essential services.

The vision, Healthy People in Healthy Communities, and the mission, To promote physical and mental health and to prevent disease, injury, and disability, enunciated the population and community focus for the “new” public health. “Assessment” was defined as the monitoring of health status to identify community health problems, the diagnosis and investigation of health problems and health hazards in the community, and the evaluation of the effectiveness, accessibility, and quality of personal and population-based health services. “Assurance” was enforcing laws and regulations that protect health and ensure safety, linking people to needed personal health services and ensuring the provision of health care when otherwise unavailable, and ensuring a competent public health and personal healthcare workforce. “Policy Development” required mobilization of community partnerships to identify and solve health problems, and the development of policies and plans that supported individual and community health efforts. The last essential service stated that public health should pursue research for new insights and innovative solutions to health problems and cut across other essential services.

The essential services assure a competent public health and personal healthcare workforce, was critical to the success of recreating public health in the United States. A public health worker would need an array of “new” competencies to have the knowledge, skills, and behaviors to change public health, maintain it, and respond to future challenges. Assuring a competent workforce within a competent health department was considered so critical that the planners of the 2010 health objectives for the nation developed a series of public health infrastructure goals and objectives. Healthy People 2010: Objectives for the Nation, stated:

“All public health services depend on the presence of basic infrastructure. Every categorical public health program – childhood immunizations, infectious disease monitoring, cancer and asthma prevention, drinking water quality, injury prevention and many others – requires health professionals who are competent in cross-cutting and technical skills, public health agencies with the capacity to assess and respond to community health needs, and up-to-date information systems.”

“In public health, a strong infrastructure provides the capacity to prepare for and respond to both acute and chronic threats to the Nation’s health, whether they are bioterrorism attacks, emerging infections, disparities in health status, or increases in chronic disease and injury rates. Such an infrastructure serves as the foundation for planning, delivering and evaluating public health. The public health infrastructure comprises data and information systems, the workforce, and public health organizations.”

As the nation’s prevention research agency, CDC has a long and proud tradition of training the public health workforce. In alignment with their missions, CDC / ATSDR-sponsored training focuses on developing highly technical skills for specific public health programs or tasks. Over the past decade, distance and e-learning technologies expanded access to this valuable training. External training reached approximately 665,000 people in FY99 at an estimated cost of $55 million. Most of the estimated 500,000 frontline public health workers have no formal public health training. In June 1999, CDC/ATSDR convened a task force of internal and external partners to create a strategic plan for workforce development. Workforce competencies describe a vision: “an integrated life long learning system for the development of the public health workforce” whose goal is a competent workforce able to deliver the essential public health services.

Background on Public Health Competencies

Competencies can be defined as the knowledge, skills, and abilities demonstrated by organization or system members that are critical to the effective and efficient function of the organization or system. The function of the public health system is the promotion of health and the prevention of disease. Competencies addressed by people in public health must inform and enable public health system organizations and individuals as they transition to a population-based prevention focus.

The competencies must be identified, validated, assessed and developed in the context of the essential public health services and in the relation of these services to positive health outcomes. Broadly defined, competencies are actions, describable in behavioral terms, and observable in the performance of individual or system components. Measuring competency (individual or organizational) is part of a system for continuous improvement in public health.