Center of Excellence in Public Health Workforce Studies Counting and Characterizing the Public Health Workforce: Enumeration 2012 Matthew L. Boulton, MD, MPH University of Michigan School of Public Health

Center of Excellence in Public Health Workforce Studies U.S. Public Health Workforce Initial effort to count public health workers Approximately 450,000 paid public health workers in U.S. in % local 33% state 19% federal 14% other

Center of Excellence in Public Health Workforce Studies Institute of Medicine Report 80% public health workforce inadequately trained 40% of workforce will retire within 10 years Recommended certification or credentialing of all public health workers Eight core training areas: Informatics Genomics Communication Cultural competence CBPR Global health Policy & Law Ethics

Center of Excellence in Public Health Workforce Studies Why is the Public Health Workforce so Difficult? Workers have extremely diverse training and educational backgrounds Public health activities occur in a wide array of settings Represented by many professional groups No commonly used workforce job classification No repeatable, affordable, standardized, and highly acceptable workforce monitoring system in place

Center of Excellence in Public Health Workforce Studies Numerous data sources for public health workforce enumeration extending over years Data largely from periodic surveys issued at varying intervals using different methodologies No standardized job classifications across surveys; occupational classifications may not accurately reflect job function Few surveys collect individual level information Little data on worker demographics, training & educational background, licensure & certification CDC/HRSA Public Health Workforce Enumeration Report

Center of Excellence in Public Health Workforce Studies Data Sources 1. ASTHO Profile Survey9. National Sample Survey of Registered Nurses 2. NACCHO Profile Survey10. ASTPHND Public Health Nutritionist Workforce Data 3. OPM Federal Employment Statistics11. ASPH Annual Data Report 4. Agency-level Personnel Data12. TRAIN 5. BLS Occupational Employment Statistics 13. ACPM Workforce Testimony 6. American Community Survey14. ASTDD Data 7. APHL Workforce Capacity Assessment 15. Professional organization/association membership lists 8. CSTE Epidemiology Capacity Assessment Immediate Use Future Use Not Recommended for Use

Center of Excellence in Public Health Workforce Studies Workers by Case Definition Occupation *Weighted Estimates

Center of Excellence in Public Health Workforce Studies National Laboratory Capacity Assessment, 2011 Public Health, Environmental & Agricultural Lab Workforce Organizational data from 80 laboratories & individual level data on approximately 2000 laboratorians Over 50% of labs report little or no capacity to provide education and training to their workers Laboratorians self-evaluate low competence in many core areas Lack of training opportunities was barrier to worker recruitment for 26% of labs and to retention for 38% of labs

Center of Excellence in Public Health Workforce Studies The number of epidemiologists in state health departments decreased by 10% between 2006 and 2009 assessments Approximately 14% of epidemiologists have had no formal training in epidemiology More than 1/3 rd of states indicated a need for additional staff training in 23 of the 27 applied epidemiology competencies 17% of the epidemiology workforce anticipates retirement, resignation or release from workforce within next 5 years CSTE National Epidemiology Assessment, 2009

Center of Excellence in Public Health Workforce Studies Public Health Nurse Workforce Survey Organizational survey launched July 23 rd ; data collection taking place through mid-September (50 state health departments and 328 local health departments in sample) Individual survey being piloted (~7500 nurses in sample) Preliminary study findings will be presented at APHA (October 30; 2:30-4:00 pm)

Center of Excellence in Public Health Workforce Studies Bureau of Labor Statistics Data Occupational Employment Statistics (OES) program produces employment and wage estimates for over 800 occupations Data collection methods Semi-annual mail survey of establishments: 200,000 establishment surveyed every 6 months; 1.2M surveyed over 3 years BLS draws sample and produces survey materials; State Workforce Agencies collect the data National estimates produced based on responses

Center of Excellence in Public Health Workforce Studies Sample Public Health Occupational Classifications : Community health workers : Environmental engineering technicians : Environmental engineers : Environmental science and protection technicians : Environmental scientists and specialists : Epidemiologists : Health Educators : Medical and public health social workers : Medical scientists, except epidemiologists : Mental health counselors : Substance abuse and behavioral disorder counselors

Center of Excellence in Public Health Workforce Studies National Profile of Epidemiologists NACCHO ASPH, other University data Hospital and Industry data ASTHO BLS Local Government Epidemiologists State Government Epidemiologists Epidemiology Faculty Hospital/ Pharmaceutical Epidemiologists Applied Epidemiologists Research Epidemiologists Federal Government Epidemiologists Self-employed, Consultant Epidemiologists CSTE

Center of Excellence in Public Health Workforce Studies Other Enumeration Challenges and Limitations State governance structure (e.g. centralized/decentralized) may impact whether duplicate data are reported to ASTHO and NACCHO National data sources (e.g., BLS, ACS) lack the specificity required to disaggregate public health workers from the publicly available data Enumeration is only addressing number of workers; workforce characteristics are also important but often not collected No consensus for minimum data elements to collect Depending on the data source, many workers uncategorized

Center of Excellence in Public Health Workforce Studies Where Do We Go? CDC working to refine federal workforce estimates Enumeration Work Group assisting with: Refining national enumeration estimate for 2012 Discussing methods for addressing duplicate counts between surveys Classifying uncategorized workers Establishing minimum data elements to collect Recommending BLS SOC modifications Developing a workforce classification schema

Center of Excellence in Public Health Workforce Studies New Classification Schema Multi-axial listing to create a common language for workforce classifications which organizations can map to 10 Axes under development Job title Job setting/venue Education Licensure/certification Job Tasks Program area Specialization area/expertise Funding source Condition of employment Demographics

Center of Excellence in Public Health Workforce Studies

Center of Excellence in Public Health Workforce Studies Contact Information Center of Excellence in Public Health Workforce Studies University of Michigan School of Public Health Department of Epidemiology 1415 Washington Heights Ann Arbor, MI (734)

Center of Excellence in Public Health Workforce Studies Job Classifications Administrative or Clerical Personnel Behavioral Health Professional Emergency Preparedness Staff Environmental Health Worker Epidemiologist Health Educator Laboratory Worker Nutritionist Public Health Dentist Public Health Manager Public Health Nurse Public Health Physician Public Health Informatics Specialist Public Information Specialist Other Public Health Professional or Uncategorized Workers

Center of Excellence in Public Health Workforce Studies Project Case Definition Individuals providing Essential Public Health Services employed in: Traditional state, territorial and local governmental public health agencies/departments Federal agencies with a clear mandate to provide public health services Non-public health state, local, or federal governmental agencies providing environmental health services Non-public health state, local or federal governmental agencies providing public health laboratory services Used 15 occupational classifications from the ASTHO and NACCHO Profile Surveys Based on data availability

Center of Excellence in Public Health Workforce Studies Learning Management Systems May be a source of individual-level worker data in the future Significant challenges with using LMS for enumeration: Duplication of workers across LMS Data may not be updated Most systems not built for research purposes- extracting comparable data from a variety of systems is difficult

Center of Excellence in Public Health Workforce Studies Challenges and Limitations Varied data collection methods makes comparison of survey data difficult Lack of definitions/descriptions of job functions for some job titles made grouping difficult Federal occupational classifications did not group well within ASTHO/NACCHO Profile Survey occupations Occupational classifications may not accurately reflect job function