The Public Health Workforce

Abstract

Defining the public health workforce and specifying its performance requirements present equal challenges as the nation anticipates public health needs for the twenty-first century. The core group of professionals employed by government public health agencies works in close partnership with a wide range of public, private, and voluntary organizations. The wider circle includes almost all physicians, dentists, and nurses, plus many other health, environmental, and public safety professionals. The task of ensuring that this workforce is prepared with skills and knowledge to face both identified and emerging public health challenges is immense.

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At the Intersection of Health, Health Care and Policy
doi: 10.1377/hlthaff.21.6.57
, 21, no.6 (2002):57-67Health Affairs
The Public Health Workforce
Kristine Gebbie, Jacqueline Merrill and Hugh H. Tilson
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The Public Health Workforce
Without a competent workforce, a public health agency is as useless
as a new hospital with no health care workers.
by Kristine Gebbie, Jacqueline Merrill, and Hugh H. Tilson
ABSTRACT: Defining the public health workforce and specifying its performance require-
ments present equal challenges as the nation anticipates public health needs for the
twenty-first century. The core group of professionals employed by government public health
agencies works in close partnership with a wide range of public, private, and voluntary orga-
nizations. The wider circle includes almost all physicians, dentists, and nurses, plus many
other health, environmental, and public safety professionals. The task of ensuring that this
workforce is prepared with skills and knowledge to face both identified and emerging public
health challenges is immense.
Public health, a deceptively simple phrase, encompasses all ac-
tivities undertaken by communities to assure the conditions within which
people can be healthy.1To accomplish this, public health practice is at its
heart interdisciplinary, weaving together the various skills, knowledge, attitudes,
and worldviews of the multiple professions involved. Many partners contribute to
this effort, which is distinguished from medical care by its focus on populations
and communities rather than individuals.2Communities are made up of individu-
als, however, and lack of care does diminish a community’s health. Thus public
health services include some provision of care, especially to vulnerable groups.
Public health also reaches beyond medicine or health. Achieving healthier com-
munities requires collaboration with educators, child welfare workers, adult em-
ployment counselors, transportation experts, recreation specialists, public safety
engineers, housing planners, and emergency responders, among others. Public
health professionals respect each contribution and collaborate across organiza-
tional lines, such as in making epidemiological information useful to emergency,
fire, and police commanders responding to emergencies.
nRange of public health partners. Recent events highlight the crucial role of
partnerships. During the anthrax crises of 2001–02 the public health community
provided expert information on the disease agent, public information on the risks of
exposure, and treatment guidelines to government agencies and private health care-
givers and to the public via information hotlines. Partners in response included law
Workforce Issues
HEALTH AFFAIRS ~ Volume 21, Number 6 57
©2002 Project HOPE–The People-to-People Health Foundation, Inc.
Kristine Gebbie is Elizabeth Standish Gill Associate Professor of Nursing and directs the Center for Health Policy
at Columbia University School of Nursing in New York City. Jacqueline Merrill is project manager at the center.
Hugh Tilson is senior adviser to the dean, University of North Carolina School of Public Health, in Chapel Hill.
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enforcement and other public safety agencies, the hospital and community health
systems, office-based physicians, and the media.
Both the terrorist hijacking and anthrax events required public health profes-
sionals to cooperate across governmental levels as well. In New York City the re-
sponse involved the FBI, the U.S. Public Health Service, the Environmental Protec-
tion Agency, and the Air National Guard, among others. New York State provided
additional staff to multiple local agencies, as well as specialized laboratory assis-
tance. Local hospitals and physicians participated in public education, screening for
potential disease cases, and distribution of preventive drugs. In the first two weeks
of October 2001 collaborators such as these responded not only to actual anthrax
exposures but to more than 2,300 false alarms and hoaxes nationwide.3
nMore than emergencies. Beyond the public health response to emergencies
and urgent health threats, public health workers prevent disease and promote
health through collaboration with a growing circle of partners. For example, poor
nutrition and lack of physical activity have combined to create a heavier population
at increased risk of many chronic diseases. Effective community action to change the
risk factors and rear a generation of leaner, more fit adults might be accomplished by
the combined efforts of the entire health community, educators, recreation special-
ists, transportation professionals, grocery and restaurant workers, employers, union
officials, and civic leaders. It is unlikely that any one of these groups alone could
make and sustain the change.4
The systemic underfunding of public health has become a part of public dis-
course in Congress and elsewhere at a level not heard in recent memory. Within
public health, however, dialogue about the need for infrastructure support began
in earnest more than a decade ago with a 1988 Institute of Medicine (IOM) study
of the U.S. public health system.5Healthy People 2010 set specific public health in-
frastructure objectives to improve public health data and information, public
health systems and relationships, and the public health workforce.6Activities tar-
geting the Healthy People 2010 workforce objectives include development of com-
petencies for public health practice, identifying opportunities for and examples of
collaboration between public health and traditional medical practice, and clarify-
ing the composition of the workforce.7This paper summarizes recent efforts by
the public health workforce to describe itself and to define its complex knowledge
needs. It further identifies research questions and challenges to current policy and
resource allocation that must be addressed, if the professionals needed by the na-
tion’s public health infrastructure are to be provided.
Who Is A Public Health Worker?
Public health workers are defined as all those responsible for providing the es-
sential services of public health regardless of the organization in which they
work.8The essential services provided by these workers include the following: (1)
Monitor health status to identify community health problems; (2) diagnose and
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investigate health problems and health hazards in the community; (3) inform, edu-
cate, and empower people about public health issues; (4) mobilize community
partnerships to identify and solve health issues; (5) develop policies and plans
that support individual and community health efforts; (6) enforce laws and regu-
lations that protect health and ensure safety; (7) link people to needed personal
health services and ensure the provision of health care when otherwise unavail-
able; (8) ensure a competent public health and personal health care workforce; (9)
evaluate effectiveness, accessibility, and quality of personal and population-based
health services; and (10) conduct research for new insights and innovative solu-
tions to health problems.9Some of these workers are obvious: The epidemiologist
working for a city health department investigating outbreaks of foodborne disease
is clearly a public health worker, as is the restaurant inspection sanitarian or the
immunization nurse. But so is a hospital-based nurse investigating nosocomial in-
fections and the office-based physician assistant reporting a notifiable condition
to the health department.
Official public health agencies are the most common employers of the nearly
500,000 identifiable public health workers. In 2000 official federal agencies em-
ployed 19 percent of this workforce; state agencies, 33 percent; and local public
health agencies, 34 percent. Other settings such as schools of public health ac-
counted for the remaining 14 percent.10
The public health workforce definition encompasses many others who have not
been counted. These include persons responsible for occupational safety and
health in industry, unions, and government; those doing population-focused
health education on behalf of voluntary organizations (heart disease, cancer, or di-
abetes) and large health care systems; and those reducing environmental hazards,
employed by both governmental agencies and other enterprises.11
nRange of definitions. Public health workers may be defined on three major
dimensions: specific profession (the worker), place of employment (the work set-
ting), or focus of concern (the work).12 A combination of labor market, civil service,
and salary dynamics makes the choice of any one of these problematic.
The worker. Professional categories define workers by formal educational attain-
ment and in some cases a state-issued license to practice. Those in public health
may have initial preparation in one of many professions: dentistry, medicine, nurs-
ing, social work, engineering, or law; they may hold a master’s or doctoral degree
specifically in public health; some hold both public health and other degrees.
Fields include epidemiology, sanitation, statistics, nutrition, and health educa-
tion. Job titles are frequently an inaccurate reflection of the educational prepara-
tion or the work done by an individual. In smaller organizations and rural areas,
for example, a registered nurse (RN) with no specialized public health education
may be both the community’s epidemiologist and its health educator. Public
health practitioners possessing only on-the-job preparation in outreach and edu-
cation also make important contributions to programs such as HIV prevention,
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reproductive health, or chronic disease management.
The work setting. Place-of-employment definitions include separating govern-
mental from nongovernmental public health activities and indicating the level at
which the work occurs (local, state, or national). Essential services of public
health, the main criteria for defining public health work, are performed in govern-
mental public health agencies and in private-sector settings such as hospitals and
community agencies. Examples of non–health department services include
HIV/AIDS education, smoking-cessation programs, maternal/child health promo-
tion, or drinking water systems. Essential public health work is accomplished by
using a range of public or voluntary agencies such as surveillance for reportable
diseases or community education about health problems such as lead poisoning,
pest infestations, or domestic violence. Volunteers augment the activities of gov-
ernmental public health, including the American Red Cross, the American Lung
Association, and others. In 2000, a limited assessment identified close to three
million such volunteers.13
The work. Work descriptions separate workers by the goal of their function or re-
sponsibility. Programmatic labels such as infection control, lead poisoning pre-
vention, child health promotion, or injury prevention may be the common ap-
proach to budget structures, although they provide little information on work-
force. Numbers of people involved are usually reported as full-time equivalents
(FTEs), with or without specification by level or qualifications. Workforce analy-
sis and planning based on FTE information is flawed because a number such as “3
FTE” may represent a partial commitment of as many as ten different workers,
each of whom needs access to resources and lifelong developmental opportunities.
nSnapshot of public health workforce numbers. Accessible information on
public health workers is primarily about those in the fifty-six state and territorial
public health agencies and nearly 3,000 local agencies. These vary widely in size and
composition, from one or two professionals acting as generalists to several thousand
with great internal specialization (Exhibit 1).
In 2000, 50,000 public health nurses served in a variety of roles in governmental
public health agencies, nearly 10 percent of the total workforce, the largest profes-
sional group in public health.14 Other estimates place the number of RNs in both
public health and community health (including home health) at 400,000 out of a
total of 2,186,900 RNs in all settings.15 National projections indicate the need for
more than one million additional nurses within the decade.16 Public health agen-
cies will be at a disadvantage during this period, because they frequently offer
lower wages than private organizations do and will experience intense competi-
tion in hiring and retaining these essential workers.
More than 20,000 environmental health professionals and technicians were re-
ported by governmental public health agencies in 1999, but their number may be
closer to 60,000, as estimated by their leading professional organization.17 The
variance reflects the evolving nature of this profession. Environmental agencies
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independent from local public health agencies are common, and the private sector
realizes the importance of environmental services. Many sanitarians, for example,
are employed in various parts of the food supply and food service industries.
Workforce Issues
HEALTH AFFAIRS ~ Volume 21, Number 6 61
EXHIBIT 1
Summary Of U.S. Public Health (PH) Professionals, By Occupational Title, 2000
Occupation
Federal
agencies
Select
voluntary
agencies
State and
territorial
agencies Total
Administrators
Health administrator 1,152 – 14,768 15,920
Professionals
Administrative/business professional
Attorney/hearing officer
Biostatistician
3,133
351
684
–
–
–
1,592
250
480
4,725
601
1,164
Clinical, counseling, and school psychologist
Environmental engineer
Environmental scientist and specialist
Epidemiologist
1
3,092
3,951
5
–
–
–
–
1
1,457
10,931
922
2
4,549
14,882
927
Health economist
Health planner/researcher/analyst
Infection control/disease investigator
Licensure/inspection/regulatory specialist
86
2,074
2
9,625
–
–
–
–
19
1,499
781
4,155
105
3,573
783
13,780
Marriage and family therapist
Medical and public health social worker
Mental health/substance abuse social worker
Mental health counselor
–
170
–
113
–
–
–
–
–
2,006
–
673
–
2,176
–
786
Occupation/safety and health specialist
PH dental worker
PH educator
PH laboratory professional
3,619
1,240
126
9,603
–
–
–
–
1,974
792
2,104
4,485
5,593
2,032
2,230
14,088
PH nurse
PH nutritionist
PH optometrist
PH pharmacist
4,311
269
5
1,180
8,000
–
–
–
36,921
6,411
4
316
49,232
6,680
9
1,496
PH physical therapist
PH physician
PH program specialist
PH student
12
4,055
3,836
37
–
–
–
–
60
1,953
3,984
14,996
72
6,008
7,820
15,033
PH veterinarian/animal control specialist
Psychiatric nurse
Psychiatrist
Psychologist
1,929
–
–
688
–
–
–
–
108
4
1
67
2,037
4
1
755
Public relations/media specialist
Substance abuse and behavioral disorders
counselor
448
2
12
–
115
36
575
38
55,799 8,012 113,865 177,676
SOURCE: Bureau of Health Professions, National Center for Health Workforce Information and Analysis, The Public Health
Workforce: Enumeration 2000 (Rockville, Md.: Health Resources and Services Administration, 2000).
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Public health physicians form a relatively small part of the practicing public
health workforce (3 percent) but serve in crucial roles, often as chief health official
or senior clinician in epidemiology, disease control, or maternal and child health.18
Recent attention has focused on the need to retain and strengthen the physician’s
voice in interdisciplinary public health practice and on the need for all physicians
to understand and contribute to public health. Neither can happen if physicians
are employed by public health programs only for a limited number of clinical
hours, or if the public health component of medical education is not strengthened.
Public health laboratory workers support public health surveillance and epide-
miology. In governmental agencies they are estimated to number more than 20,000
professionals and technicians.19 These workers require skills to recognize the pub-
lic health significance of findings in ways that differ from those of the clinical labo-
ratory. One hallmark is their readiness to respond quickly to surge demands asso-
ciated with outbreak investigations. Any complete count of these workers,
however, would include the staff in other clinical and environmental laboratories
such as those that perform testing for hazardous exposure in the workplace.
nSupply of professionals. Workforce analysis in public health is challenging
because of the complexities described above; it has been complicated by shifts in
public policy, public interests, and funding. There has not been a national system of
public health workforce studies for at least twenty years, yet other national policies
have a large impact on the workforce. There are no long-term recruitment and edu-
cation strategies to fill the workforce pipeline under even routine conditions. For
example, federal legislation enacted in response to the threat of bioterrorism has re-
sulted in approximately 2,300 new jobs in public health at the state level and addi-
tional positions in local agencies, with no specific funds to increase the overall pool
of prepared workers.20 At the same time, an economic downturn has lowered tax
revenues, leading to cuts in agency budgets and associated staff reductions.
In 2000, thirty-two U.S. schools of public health graduated approximately
16,000 individuals.21 In addition, fourteen accredited graduate programs of com-
munity health education and thirty-five accredited graduate programs of commu-
nity health/preventive medicine supplied approximately 800 more graduates with
a master of public health, health administration, or health educator degree.22
Most of these graduates find employment outside governmental public
health.23 For example, Columbia University documents that among public health
graduates of the past three years, fewer than half have found employment in public
health agencies (Exhibit 2). Also, the routine turnover associated with retirement,
family relocations, and career changes in all sectors of public health will absorb
many graduates, with no increase in overall capacity.
One policy challenge is setting human resources/personnel practices that sup-
port adequate staffing of health departments. Within the public health commu-
nity there is advocacy for development of a competency-based personnel system
and reform of civil service systems, hiring practices, and related salary structures.
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These were effective in increasing professionalism when they were created but to-
day are unable to react quickly to change and conspire to permit hiring of incom-
pletely qualified persons, paying them less than earned in positions of comparable
responsibility in other sectors.
Public Health Knowledge
nCore areas of public health. The core areas of public health required in grad-
uate public health degree programs are health services administration, biostatistics,
epidemiology, behavioral sciences, and environmental health sciences. These core
areas may be the entire focus of study, or another area such as international/global
health, public health dentistry, laboratory practice, nutrition, public health practice
and program management, maternal and child health, or occupational safety and
health may be added.24 The Public Health Workforce Collaborative, representing
federal public health agencies, state and local public health agencies, and academic
public health associations, has affirmed that the sciences on which public health is
based have expanded to include genomics and informatics, with an increased focus
on risk communication and community leadership in environmental and behavioral
sciences.
Effective public health practice requires attainment of additional analytic, com-
munication, and cultural skills. Those with more organizational responsibility
also need facility in management and financial planning.25 Some of this knowledge
may be part of a professional curriculum, meaning that even a nonspecialized
practitioner has rudimentary skills and knowledge. However, only advanced
study can lead to mastery of the full range of public health. Those entering a
school of public health without a health-related education may need additional
basic education in these subjects.
Disparities in worker qualifications raise policy issues in preparation, continu-
ing education, recruitment, and retention. A National Strategic Plan for the Devel-
opment of the Public Health Workforce has been developed with support from
the Centers for Disease Control and Prevention (CDC) and the active participa-
Workforce Issues
HEALTH AFFAIRS ~ Volume 21, Number 6 63
EXHIBIT 2
Employment Settings Of Graduates Of Mailman School Of Public Health, Columbia
University, Class Of 1999–2001
Public health agencies
Academic and research institutions
Other nonprofits (including NGOs, PVOs)
41%
19
11
Profit-making entities other than consulting and pharmaceutical but including managed care
Consulting firms
Pharmaceutical companies
16
7
6
SOURCE: Columbia University, Mailman School of Public Health, Office of Career Services.
NOTES: NGOs are nongovernmental organizations. PVOs are private voluntary organizations.
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tion of the Workforce Collaborative. Key recommendations include support for a
national lifelong distance-learning system; credentialing of public health officials;
and development of competencies in public health and specialty areas.
Continuing education and distance learning. Even for individuals with the current
skills today, continuing education is essential as the field changes.26 The disper-
sion of a large proportion of public health workers in small organizations with lit-
tle backup and limited budgets makes it challenging for these workers to remain
current.27 Expanded availability of distance-learning approaches, including Web-
based learning, satellite downlink broadcasts, CD-ROM learning modules, and
telephone conference-call courses, eases some of these problems. The Public
Health Practice Program Office at the CDC and the Bureau of Health Professions
at the Health Resources and Services Administration (HRSA) have funded
workforce development and preparedness training centers in close to thirty aca-
demic centers, with a strong evaluation component poised to address many of the
challenges described here.28 Individuals must accept responsibility to take advan-
tage of what is offered, and employers must support regular access to these re-
sources.
Credentialing and certification. For the past five years public health leaders have ex-
plored the question of whether there should be certification for public health
practice.29 Some states have already moved in this direction. New Jersey requires
licensure as a public health administrator for anyone employed to run a local
health department; Illinois is moving to certify directors of local health depart-
ments.30 Many states stipulate credentials for state health officials, such as a medi-
cal license, or specialized training in preventive medicine or public health.31 Con-
fusion exists even among those health professionals who are credentialed, because
many physicians who are active and effective in public health may have board certif-
ication in preventive medicine, but others may come from other specialty areas.32
If professional certification were based on having a master of public health
(MPH) degree, a majority of today’s workforce would not qualify, and recruitment
would be impossible in many areas.33 Certification by examination or experience
beyond the MPH or other professional degree might be redundant for profession-
als who have specialty certification such as preventive medicine or a graduate de-
gree in public health nursing. National certification for health educators and
sanitarians already exists. The number of unresolved issues suggests that it will be
some time before there is a well-developed national program.
Competency development. At the same time, the increasing clarity about the compe-
tencies needed to practice public health means that desired outcomes can be
stated and incorporated into position descriptions or program specifications. The
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Elements Of Public Health
“Public health workers lacking adequate training can cause immense
harm that will be measured in illness or death years later.”
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Council on Linkages between Public Health Practice and Academia has provided
an excellent framework of core competencies for front-line professionals, ad-
vanced practitioners, and leaders in public health.34 Grouped in eight domains,
these competencies provide a foundation from which more-specific competencies
such as those in emergency preparedness and genomics have been built. The eight
domains are analytic assessment, policy development/program planning, commu-
nication, cultural competency, community dimensions of practice, basic public
health sciences, financial planning and management, and leadership and systems
thinking.35 Additional competency sets identify needed capacities in genomics,
emergency response, bioterrorism readiness, law, and informatics.
nIntegrating public health into all health education. Accompanying the
movement toward better preparation of the public health workforce is an interest in
assuring that all health professionals learn rudimentary public health skills. This
work includes such activities as expected public health competencies for baccalau-
reate nursing graduates and the development of basic public health curriculum
units suitable for use in any baccalaureate or graduate health professional program.36
If effectively done, this activity would mean that when those in public health organi-
zations reach out for collaboration, they find a larger pool of partners.
Challenges To Workforce Development
Public health has both a day-to-day sustaining role and a pivotal emergency role
in every community; this role can only be assured when the workforce has proper
resources, allowing official health agencies to partner with the wider circle of
public health workers.37 Thus, the nation faces a basic public policy challenge: to
balance this investment with the other high priorities in today’s faltering economy
and in the face of the imminent dangers in a terrorized world.
The improvements cannot wait; they must be made without all the answers.
The gaps in our knowledge base require a vigorous, comprehensive, and immedi-
ate research agenda to support policy decisions. That so many questions remain
unanswered, when systems research is already seen as an essential service of pub-
lic health, only provides further testimony to a long-term lack of resources.
Among the unanswered questions are (1) What is the “right” balance of part-
nership efforts between governmental public health and other professionals or
volunteers? (2) How do the core public health competencies translate into effec-
tive professional output? (3) What should be tested, how, and on whom before a
credential is issued? (4) What evidence relates the MPH or other degree to pro-
ductivity in the workplace?
The Academy for Health Services Research and Health Policy has created a new
public health systems research focus, which convened for the first time in 2002.38
This will provide a platform for the dissemination and encouragement of needed
public health workforce studies. The nation has made education in other profes-
sions a matter of national priority, with standards, targets, and funding. The fund-
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ing of public health traineeships and support for educational programs and insti-
tutions is equally important.
The public health workforce is a complex mixture of health profes-
sionals and others. While the core of this workforce is relatively easy to
identify, the edges merge with many other groups having overlapping or
congruent missions. For policy purposes, more important than crisply defining
the limits of the workforce is the need for continuing development of a knowledge
base for defining competency, and for establishing the workforce contribution to
an effective public health infrastructure. More important yet is the need to staff
each local and state public health agency and partner organization in the commu-
nity with competent, dedicated public health professionals. Without a competent
workforce, a public health agency is as useless as a new hospital with no physi-
cians, nurses, or technicians. Indeed, public health workers lacking adequate
training or preparation and regular upgrading of skills have the potential to cause
immense harm that will only be measured in illness or death many years later.
The authors acknowledge the members of the Public Health Workforce Collaborative for their seminal work.
NOTES
1. Institute of Medicine, The Future of Public Health (Washington: National Academy Press, 1988).
2. IOM, Committee on Public Health for the Twenty-first Century, unpublished committee proceedings.
3. U.S. Department of Justice, “Campaign against Terrorism: FBI, U.S. Justice Department Investigate An-
thrax Threats,” Press Release, 16 October 2001, www.embajadausa.org.ve/wwwh841.html (24 July 2002).
4. L. Green, M. Daniel, and L. Novick, “Partnerships and Coalitions for Community-Based Research,” Public
Health Reports 1, no. 116 (2001): 20–31.
5. See IOM, The Future of Public Health.
6. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion,
Healthy People 2010 (Washington: DHHS, 2000).
7. Council on Linkages between Academia and Public Health Practice, “Core Competencies for Public
Health Professionals,” www.trainingfinder.org/competencies/list.htm (20 May 2002); and R.D. Lasker
and the Committee on Medicine and Public Health, Medicine and Public Health: ThePower of Collaboration (Chi-
cago: Health Administration Press, 1997).
8. DHHS, Public Health Service, The Public Health Workforce: An Agenda for the Twenty-first Century (Washington:
U.S. Government Printing Office, 1994), 4.
9. Public Health Functions Steering Committee, Public Health in America, 28 November 2000, web.health.gov/
phfunctions (7 July 2002).
10. DHHS, Health Resources and Services Administration, The Public Health Workforce: Enumeration 2000
(Rockville, Md.: HRSA, December 2000).
11. G.P. Mays, P.K. Halverson, and R. Stevens, “The Contributions of Managed Care Plans to Public Health
Practice: Evidence from the Nation’s Largest Local Health Departments,” Public Health Reports 116 (2001):
50–67.
12. V. Kennedy and F. Moore, “A Systems Approach to Public Health Workforce Development,” Journal of Pub-
lic Health Management and Practice 7, no. 4 (2001): 17–22.
13. See DHHS, The Public Health Workforce: Enumeration 2000.
14. Ibid.
15. E. Spratley et al., The Registered Nurse Population: Findings from the National Sample Survey of Registered Nurses
(Rockville, Md.: HRSA, Bureau of Health Professions, Division of Nursing, 2000); and U.S. Department of
66 November/December 2002
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Labor, Bureau of Labor Statistics, “2000 National Occupational Employment and Wage Estimates: 29-1111
Registered Nurses,” 15 November 2001, www.bls.gov/oes/2000/oes291111.htm (24 July 2002).
16. D. Hecker, “Occupational Employment Projections to 2010,” Monthly Labor Review (November 2001).
17. DHHS, The Public Health Workforce: Enumeration 2000; and Nelson Fabian, executive director, National Envi-
ronmental Health Association, personal communication, 11 November 1999.
18. DHHS, The Public Health Workforce: Enumeration 2000.
19. Ibid.
20. Emergency Supplemental Act, 2002, P.L. 107-117, 20 December 2001, and Amendments, 10 January 2002; and
Public Health Threats and Emergencies Act, 2000, Title I, P.L. 106-505, Sec. 2731, 13 November 2000.
21. Association of Schools of Public Health, Annual Data Report (Washington: ASPH, 1996).
22. Sheila Smythe, dean of graduate studies, New York Medical College School of Public Health, personal
communication, April 2002.
23. Edward Baker, assistant surgeon general, Centers for Disease Control and Prevention, personal communi-
cation, April 2002.
24. ASPH, “What Is Public Health? Core Areas of Public Health,” www.asph.org/aa-section.cfm/3/53 (15 July
2002).
25. A.A. Sorenson and R.G. Bialek, eds., The Public Health Faculty/Agency Forum: Linking Graduate Educationand Prac-
tice, Final Report (Gainesville: University Press of Florida, 1991).
26. Centers for Disease Control and Prevention, Office of Workforce Policy and Planning, Proceedings from
the Public Health Workforce Development Expert Panel Workshop, 1–2 November 2000.
27. R.B. Gerzoff, C.K. Brown, and E.L. Baker, “Full-Time Employees of U.S. Local Health Departments,
1992–1993,” Journal of Public Health Management and Practice 5, no. 3 (1999): 1–9; and K.M. Gebbie and I.
Hwang, Preparing Currently Employed Public Health Professionals for Changes in the Health System (New York: Co-
lumbia University School of Nursing, 1998).
28. CDC, Public Health Practice Program Office, Office of Workforce Policy and Planning, “Centers for Pub-
lic Health Preparedness (CPHP),” www.phppo.cdc.gov/owpp/CPHPLocations.asp (20 May 2002); and
HRSA, Bureau of Health Professions, “Public Health Training Centers,” www.bhpr.hrsa.gov/publichealth/
phtc.htm (20 May 2002).
29. M. Akhter, “Professionalizing the PH Workforce: The Case for Certification,” Journal of Public Health Man-
agement and Practice 7, no. 4 (2001): 46–49.
30. B.J. Turnock, “Competency-Based Credentialing of Public Health Administrators in Illinois,” Journal ofPub-
lic Health Management and Practice 7, no. 4 (2001): 74–82.
31. Association of State and Territorial Health Officials, “The Recruitment, Selection, and Retention of a State
Health Official: A Guide for the Appointing Authority” (Brochure) (Washington: ASTHO, 2000).
32. H. Tilson and K.M. Gebbie, “Public Health Physicians: An Endangered Species,” American Journal of Preven-
tive Medicine 21, no. 3 (2001): 233–240.
33. S. Dandoy, “Educating the Public Health Workforce,” American Journal of Public Health 91, no. 3 (2001):
467–468.
34. See Council on Linkages, “Core Competencies.”
35. CDC, Public Health Practice Program Office, Core Competencies in Emergency Preparedness for All Public Health
Worke r s (New York: Columbia University School of Nursing, 2001); and CDC, “Genomic Competencies for
the Public Health Workforce at Any Level in Any Program,” 28 June 2001, www.cdc.gov/genomics/
training/competencies/comps.htm#workforce (20 May 2002).
36. American Association of Colleges of Nursing, The Essentials of Baccalaureate Education for Professional Nursing
Practice (Washington: AACN, 1998); and South Carolina Area Health Education Consortium, “Health Ed-
ucation,” www.ahec.net (20 May 2002).
37. CDC, Office of Workforce Policy and Planning, Public Health’s Infrastructure: A Status Report (Washington:
DHHS, 2002).
38. Academy for Health Services Research and Health Policy, 2002 Annual Research Meeting, “The First Pub-
lic Health Systems Research Meeting: Transferring Research into Preparedness,” 22 June 2002, www.
academyhealth.org/2002/cdc/agenda.htm (7 August 2002).
39. IOM, “Clinical Research Roundtable,” www.iom.edu/iom/iomhome.nsf/pages/clinical+research+
roundtable (7 August 2002).
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