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Vast health inequities persist in cities across the United States. Although recommendations exist to guide governmental public health institutions seeking to advance population health equity, local contexts are likely to influence how these pursuits take shape. We review recommendations for pursuing equity that were developed from an environmental scan conducted in the city of New Orleans. The recommendations, which are based on perspectives provided by city and state public health leaders, leaders from other city governmental departments, and community-based health department partners, center around the enduring impact of systemic racism, working across sectors, and prioritizing community engagement.

Context Creativity and innovation in the governmental public health workforce will be required to generate new ideas to solve complex problems that extend beyond traditional public health functions such as disease surveillance and monitoring. Creativity and innovation can promote and advance necessary organizational transformation as well as improve organizational culture and workplace environment by motivating employees intrinsically. However, there is little empirical evidence on how rewarding creativity and innovation in governmental public health departments is associated with organizational culture and workplace environments. Objective This study describes (1) the degree to which creativity and innovation are rewarded in governmental public health agencies and (2) associations between rewarding creativity and innovation and worker satisfaction, intent to leave, and workplace characteristics. Design The cross-sectional Public Health Workforce Interests and Needs Survey (PH WINS) was administered using a Web-based platform in fall 2017. Settings and participants Data used for these analyses were drawn from the 2017 PH WINS of governmental health department employees. This included state health agency and local health department staff. PH WINS included responses from 47 604 staff members, which reflected a 48% overall response rate. PH WINS excludes local health departments with fewer than 25 staff or serving fewer than 25 000 people. Results Fewer than half of all workers, regardless of demographic group and work setting, reported that creativity and innovation were rewarded in their workplace. Most measures of worker satisfaction and workplace environment were significantly more positive for those who reported that creativity and innovation were rewarded in their workplace. Conclusion This research suggests that promoting creativity and innovation in governmental public health agencies not only could help lead the transformation of governmental public health agencies but could also improve worker satisfaction and the workplace environment in governmental public health agencies.

Context Workforce development in governmental public health has historically focused on discipline-specific skills. However, as the field of public health has evolved, crosscutting skills have become critical. The 2017 fielding of the Public Health Workforce Interests and Needs Survey (PH WINS) provides a national benchmark for gaps in crosscutting skills in state and local health departments. Objective The purpose of this article is to identify top areas of training needs in the governmental public health workforce using data from PH WINS 2017. Design PH WINS participants in state and local health departments were surveyed in fall 2017 using a Web-based platform. Balanced repeated replication weights were used to account for complex sample design. Setting Forty-seven state health agencies, 26 large city health departments, and a nationally representative sample of mid-to-large local health departments. Participants Permanently employed governmental public health staff. Main outcome measures Training needs were determined by combining self-reported skill importance and proficiency. Skills reported to be of high importance, and low levels of proficiency were coded as training needs. Focus area gaps were defined as having a training need in at least one skill in the focus area. Results The largest area of training need, regardless of supervisory status, was in budgeting and financial management (55%; 95% confidence interval [CI], 53-56), with a large gap also identified in systems and strategic thinking (49%; 95% CI, 47-50). There was some variation by supervisory status, with training needs for nonsupervisors in change management and in developing a vision for a healthy community for management. Conclusions The PH WINS training needs assessment provides the first nationally representative data on training needs for the state and local health department workforce. Across state and local health departments, there are common critical training needs essential for the current and future practice of public health.

Context: Workforce is a critical cog in the governmental public health enterprise in the United States. Until 2014, workforce research was largely conducted at the organizational level. However, the fieldings of the Public Health Workforce Interests and Needs Survey allow for nationally representative comparisons with individual respondents. Objective: Using data from agencies that participated in 2014 and 2017, we conducted multi–cross-sectional comparisons of the Public Health Workforce Interests and Needs Survey data. Design: The Public Health Workforce Interests and Needs Survey participants at the State Health Agency Central Offices were surveyed using a Web-based platform. Balanced repeated replication weights were used to account for differential designs between 2014 and 2017. Setting: Thirty-three state health agency central offices that participated in both 2014 and 2017. Participants: Permanently employed governmental public health staff. Main Outcome Measures: We examined changes in perceptions of the workplace environment, job and pay satisfaction, intent to leave, awareness of emerging concepts in public health, and demographic/worker characteristics. Pearson and Rao-Scott–adjusted χ2 analyses were used to compare changes between 2014 and 2017. Results: The percentage of staff who are people of color increased from 29% (95% confidence interval, 28%-30%) to 37% (95% confidence interval, 36%-38%) from 2014 to 2017 across 33 states. Approximately 26% of staff were younger than 40 years in 2014 compared with 29% in 2017 (P < .001). Job satisfaction increased in 17 states overall (P < .05, n = 5) and decreased in 16 states (P < .05, n = 5) but did not change in aggregate. Overall, the percentage of staff considering leaving the organization in the next year or retiring within 5 years is up from 44% to 48% (P < .001). Conclusions: Global measures of satisfaction are relatively high and consistent between 2014 and 2017. Demographics are shifting toward a marginally younger workforce as many retire, and a significant portion of staff indicates that they are considering leaving their organization or planning to retire.

Supplemental Digital Content is Available in the Text., Context: Although core scientific skills remain a priority to public health, preventing and responding to today's leading causes of death require the workforce to build additional strategic skills to impact the social, community-based, and economic determinants of health. The 2017 Public Health Workforce Interests and Needs Survey allows novel regional analysis of training needs, both individually and across 8 strategic skill domains. Objective: The purpose of this article is to describe the training needs of public health staff nationally, across the 10 Department of Health and Human Services Regions. Design: The Public Health Workforce Interests and Needs Survey was a Web-based survey fielded to 100 000 staff nationwide across 2 major frames: state health agency-central office and local health department. State-based respondents were fielded on a census approach, with locals participating in a more complex sampling design. Balanced repeated replication weights were used to address nonresponse and sampling. Setting: State and local health departments. Participants: Respondents from state and local health departments. Main Outcome Measures: This article draws from the training needs portion of Public Health Workforce Interests and Needs Survey. Descriptive statistics are generated, showing training needs gaps. Inferential analyses pertain to gaps across Region and supervisory status, using Pearson χ2 test and Rao-Scott design–adjusted χ2 test. Results: Training needs varied across regions and work setting. Certain strategic skills tended to see larger, consistent gaps regardless of Region or setting, including Budgeting & Finance, Change Management, Systems Thinking, and Developing a Vision for a Healthy Community. Conclusions: Overall, the data suggest substantial interregional variation in training needs. Until now, this picture has been incomplete; disparate assessments across health departments, Regions, and disciplines could not be combined into a national picture. Regionally focused training centers are well situated to address Region-specific needs while supporting the broader building of capacity in strategic skills nationwide.

This study ascertains the levels of educational attainment among state health agency employees as well as the correlates of attainment., Context: Educational attainment is a critical issue in public health workforce development. However, relatively little is known about the actual attainment of staff in state health agencies (SHAs). Objective: Ascertain the levels of educational attainment among SHA employees, as well as the correlates of attainment. Design: Using a stratified sampling approaching, staff from SHAs were surveyed using the Public Health Workforce Interests and Needs Survey (PH WINS) instrument in late 2014. A nationally representative sample was drawn across 5 geographic (paired adjacent HHS) regions. Descriptive and inferential statistics were analyzed using balanced repeated replication weights to account for complex sampling. A logistic regression was conducted with attainment of a bachelor's degree as the dependent variable and age, region, supervisory status, race/ethnicity, gender, and staff type as independent variables. Setting and Participants: Web-based survey of SHA central office employees. Main Outcome Measure: Educational attainment overall, as well as receipt of a degree with a major in public health. Results: A total of 10 246 permanently-employed SHA central office staff participated in the survey (response rate 46%). Seventy-five percent (95% confidence interval [CI], 74-77) had a bachelor's degree, 38% (95% CI, 37-40) had a master's degree, and 9% (95% CI, 8%-10%) had a doctoral degree. A logistic regression showed Asian staff had the highest odds of having a bachelor's degree (odds ratio [OR] = 2.8; 95% CI, 2.2-3.7) compared with non-Hispanic whites, and Hispanic/Latino staff had lower odds (OR = 0.6; 95% CI, 0.4-0.8). Women had lower odds of having a bachelor's degree than men (OR = 0.5; 95% CI, 0.4-0.6). About 17% of the workforce (95% CI, 16-18) had a degree in public health at any level. Conclusions: Educational attainment among SHA central office staff is high, but relatively few have formal training of any sort in public health. This makes efforts to increase availability of on-the-job training and distance learning all the more critical.

Based on a model of bureaucrat politicking, this study investigates how local health officials, as political actors, secure financial resources to ensure their local health departments can meet the needs of their constituents. The model draws from theories of bureaucracies, public administration, and community power and describes administrating, advocating, co-learning, and politicking behaviors bureaucrats employ as leaders of local government agencies. The model of bureaucrat politicking generates a series of hypotheses that describe how bureaucrat behavior can affect elected official budget appropriations. I hypothesize that politicking will result in more resources for bureaucrats than administrating, advocating, or co-learning. Secondarily, I hypothesize that co-learning will result in more resources than advocating or administrating. Co-learning is predicted to have a greater affect than advocating because a bureaucrat will be leveraging electoral pressures via constituent engagement. In addition, administrating behavior will result in the fewest resources of the four behavior types. I examine the behaviors of local health officials to uncover how the model of bureaucrat politicking plays out in practice. Results from in-depth interviews with ten local health officials from around the country illustrate how local bureaucrats demonstrate administrating, advocating, co-learning, and politicking behaviors. Ordinary least square regression analyses using survey data mainly from the National Association of County and City Health Officials' National Profile of Local Health Departments study support my hypotheses.