A Workforce in Transition: Understanding Public Health Skill Gaps

by Jon Scaccia October 14, 2024

In recent years, public health has become an area of intense focus, with local health departments (LHDs) emerging as critical players in managing both routine and crisis healthcare needs. From the COVID-19 pandemic to long-standing issues like resource management and community health, these departments are the backbone of public health infrastructure across the country.

However, a troubling trend has surfaced—gaps in essential skills across the public health workforce, particularly among frontline workers. A new study based on the 2021 Public Health Workforce Interests and Needs Survey (PH WINS) reveals that smaller local health departments face unique challenges, such as fewer staff with advanced degrees and more pronounced gaps in critical skills like resource management, systems thinking, and change management. These findings provide vital insights into how we can strengthen this essential workforce.

The Silent Struggles of Small Health Departments

Small health departments, especially those in rural or underserved areas, are often asked to do more with less. These departments typically lack the resources and staffing of their larger counterparts, meaning employees are stretched thin, taking on multiple roles. The result? Significant skill gaps affect their ability to manage resources, engage with the community, and think strategically about the future.

Imagine a small town’s local health department. One employee might be responsible for managing budgets, responding to community health crises, and planning public health campaigns. Without the proper training and support, these workers face overwhelming challenges, which can directly impact the health outcomes of the communities they serve.

The study highlighted that small LHDs have significantly fewer employees with graduate degrees or public health specializations, particularly when compared to state health agencies and larger LHDs. In fact, only 12% of employees in small LHDs had a graduate degree, compared to 43% in state health agencies. This lack of advanced education correlates with greater gaps in crucial public health skills.

Experience vs. Education: On-the-Job Learning

Interestingly, the study found that while advanced degrees were associated with fewer skill gaps, tenure in public health was a stronger predictor of a well-rounded skill set. In other words, the longer someone works in public health, the more they learn on the job and the better they become at filling these skill gaps.

This highlights an important point: while formal education is undoubtedly valuable, real-world experience can be just as—if not more—critical in shaping a competent public health workforce. Many small health departments rely on hiring local community members who may not have advanced degrees but who bring valuable life experience and a deep understanding of their communities’ unique needs.

Strategic Skills in Crisis

One of the most striking findings of the study was the pervasive skill gap in crosscutting strategic skills—those that aren’t tied to technical knowledge but are crucial for managing resources, systems thinking, and leading change. These skills are often more difficult to teach and require a broader understanding of public health systems and the ability to think on a macro level.

For example, resource management was a top concern, with 65% of workers in small LHDs reporting gaps in this area. As public health continues to face budget constraints and growing demands, effectively managing resources is more critical than ever. Systems thinking, or the ability to understand and manage the broader systems that influence public health, was another area of concern, with 60% of small LHD employees reporting gaps in this skill.

These skill gaps aren’t just theoretical—they have real-world implications. Without the ability to think strategically and manage resources effectively, local health departments may struggle to respond to public health crises or plan for the future, leaving their communities vulnerable.

The Role of Regional Training Centers

Given the unique challenges faced by small LHDs, how can we bridge these skill gaps? The study suggests that regional training centers can play a crucial role in providing accessible, targeted training for public health workers, especially in smaller departments with fewer resources.

Training that focuses on strategic skills, such as systems thinking and resource management, could significantly improve the capabilities of public health workers. Moreover, it’s important to customize these training programs to meet the specific needs of different health departments. For example, a small rural LHD might need training in resource management and community engagement, while a larger urban department might benefit more from advanced epidemiology or data analytics.

By focusing on the needs of small LHDs and offering tailored, no-cost training programs, regional training centers can help close the skill gaps and ensure that all communities, regardless of size or resources, have access to well-trained public health professionals.

A Workforce in Flux

The public health workforce is undergoing a significant transformation. As baby boomers retire and the demands on local health departments continue to grow, it’s more important than ever to understand the educational characteristics and skill gaps of frontline workers. These employees, who make up about 75% of the public health workforce, are the backbone of our public health system. They respond to health emergencies, run vaccination campaigns, and engage with their communities on a daily basis.

However, without proper support and training, they cannot do their jobs effectively. The COVID-19 pandemic brought to light the critical role that public health workers play, but it also revealed the cracks in the system. Now, with renewed attention and funding for public health, we have an opportunity to address these issues head-on.

Practical Takeaways for Public Health Leaders

For public health leaders, these findings should serve as a call to action. First, it’s important to recognize that education alone isn’t enough. While advanced degrees are valuable, on-the-job experience is equally critical. Leaders should invest in mentorship programs and peer learning opportunities that allow less experienced workers to learn from their more seasoned colleagues.

Second, training should be tailored to the specific needs of different health departments. Small LHDs, in particular, face unique challenges that require targeted solutions. Regional training centers can play a key role in developing and delivering these solutions. Still, public health leaders must also advocate for the funding and resources necessary to make this training accessible to all.

Finally, public health leaders should prioritize strategic skills development. The ability to manage resources, think critically about systems, and lead change is crucial for the future of public health. Without these skills, even the most well-intentioned efforts will fall short.

Join the Conversation

What challenges have you seen in public health training and workforce development? How can we better support small local health departments in bridging these critical skill gaps? Share your thoughts and experiences in the comments or on social media using #PublicHealthWorkforce.

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