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Bureau of Health Professsions - Environmental Health

The Public Health Work ForceEnumeration 2000 Bureau of Health ProfesssionsNational Center forHealth Workforce Informationand AnalysisA Message from HRSA s AdministratorThe Health Resources and Services Administration is pleased to offer this pub-lication -- The Public Health Workforce Enumeration 2000 -- that details thevery latest information on the composition and distribution of the publichealth workforce by the National Center for Health Workforce Information andAnalysis in HRSA s Bureau of Health professions in collaboration with theCenter for Health Policy, Columbia University School of Nursing, this publi-cation is the answer to a call from Federal, State and local officials for morecomprehensive local Health information. Collected from state and local pub-lic Health authorities in 57 States and territories, the data includes informationon public Health workers in eight occupational categories and 55 occupationaltitles.

Analysis in HRSA’s Bureau of Health Professions in collaboration with the Center for Health Policy, Columbia University School of Nursing, this publi- cation is the answer to a call from Federal, State and local officials for more

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Transcription of Bureau of Health Professsions - Environmental Health

1 The Public Health Work ForceEnumeration 2000 Bureau of Health ProfesssionsNational Center forHealth Workforce Informationand AnalysisA Message from HRSA s AdministratorThe Health Resources and Services Administration is pleased to offer this pub-lication -- The Public Health Workforce Enumeration 2000 -- that details thevery latest information on the composition and distribution of the publichealth workforce by the National Center for Health Workforce Information andAnalysis in HRSA s Bureau of Health professions in collaboration with theCenter for Health Policy, Columbia University School of Nursing, this publi-cation is the answer to a call from Federal, State and local officials for morecomprehensive local Health information. Collected from state and local pub-lic Health authorities in 57 States and territories, the data includes informationon public Health workers in eight occupational categories and 55 occupationaltitles.

2 Included are ratios of public Health workers to residents, along withdescriptions of the unique attributes of each local public Health tracking the current workforce, we improve our chances to identify andfill the gaps in local, state, and national public Health . It is our hope that thisdocument will increase understanding of issues involving the public healthworkforce, help local communities do a better job of monitoring their ownworkforce needs, and give policymakers a valuable tool to improve fundingdecisions at the local Earl Fox, MD, MPHC enter for Health PolicyColumbia University School of NursingPrepared byCenter for Health Policy, Columbia University School of NursingHRSA/ATPM Cooperative Agreement # U76 AH Gebbie, DrPH, RNPrincipal InvestigatorDecember 2000 The Public Health Work ForceEnumeration 2000 AcknowledgementsThe Public Health Workforce: Enumeration 2000 wasprepared by the Center for Health Policy, Columbia University School ofNursing, supported by Health Resources and Services Administration(HRSA) and Association of Teachers of Preventive Medicine (ATPM)Cooperative Agreement # U76 AH Gebbie, DrPH, RNElizabeth Standish Gill Associate Professor of NursingDirector, Center for Health PolicyColumbia University School of NursingPrincipal InvestigatorJacqueline Merrill, BSN, RN,CProject ManagerProject StaffRula B toushManuel CortazalEric GebbieMeera GuptaInseon HwangMaryann KingMonte WagnerThe authors wish to thank Christine Curran of the ColumbiaSchool of Nursing, Robert Gerzoff of the Public Health Practice ProgramOffice, CDC, Gerald McClendon of the Bureau of Health professions ,HRSA (retired)

3 , and the staff of the Health Resources and Services Admin-istration, the Association of State and Territorial Health Officials, and theNational Association of County and City Health Officials for their consul-tation and special note of appreciation goes to the many state, territorial and localofficials, and their staffs, who assisted us in collecting information and whosupported us with their time, cooperation and photo: CDC Image LibraryACKNOWLEDGEMENTS 7 INTRODUCTION 11A NATIONAL PERSPECTIVE 23 THE PUBLIC Health WORKFORCE IN THE STATES AND TERRITORIES 29 THE STATE AND TERRITORIAL PUBLIC Health WORKFORCE 31 REGION IConnecticut 33 Maine 37 Massachusetts 41 New Hampshire 45 Rhode Island 49 Vermont 53 REGION IINew Jersey 57 New York 61 Puerto Rico 65 Virgin Islands 69 REGION IIID elaware 73 Maryland 77 Pennsylvannia 81 Virginia 85 West Virginia 89 District of Columbia 93 Contents8 REGION IVAlabama 97 Florida 101 Georgia 105 Kentucky 109 Mississippi 113 North Carolina 117 South Carolina 121 Tennessee 125 REGION VIllinois 129 Indiana 133 Michigan 137 Minnesota 141 Ohio 145 Wisconsin 149 REGION VIArkansas 153 Louisiana 157 New Mexico 161 Oklahoma 165 Texas

4 169 REGION VIIIowa 173 Kansas 177 Missouri 181 Nebraska 185 REGION VIIIC olorado 189 Montana 193 North Dakota 197 South Dakota 201 Utah 205 Wyoming 209 Contents9 REGION IXArizona 213 California 217 Hawaii 221 Nevada 225 American Samoa 229 Guam 233 Micronesia 237N. Mariana Islands 241 REGION XAlaska 245 Idaho 247 Oregon 253 Washington 257 THE FEDERAL PUBLIC Health WORKFORCE 261 VOLUNTARY ASSOCIATIONS AND ORGANIZATIONS 267 SUMMARY 271 TECHNICAL NOTES 275 BIBLIOGRAPHY 279 APPENDICES 289 APPENDIX APUBLIC Health IN AMERICA 291 APPENDIX BA HISTORY OF PUBLIC Health ENUMERATION 295 APPENDIX CDEFINITION AND DECISION RULES 301 Part 1 OPM Definitions 301 Part 2 EEO Definitions 305 Part 3 CHP/BHPr+ Definitions and Rules 307 Contents11 IntroductionThe public Health workforce in this current best estimate is composed of 448,254persons in salaried positions or one public Health worker for every 635 persons,supplemented by at least 2,864,825 volunteers.

5 This community is large and Health organizations form a network linked by common interest and in somecases, by law, in pursuit of improved Health for all. The workers come from commonlyidentified Health professions , from many technical backgrounds, or have been trainedon the job. Entry to this workforce may require advanced education and board certifica-tion in a specialty requiring a dozen years of advanced education, or a high schooldiploma and a willingness to learn. The size and composition of this workforce shouldbe identified, and should be tracked over time in order to develop appropriate plans forworkforce development, recruitment and retention. Such analysis is possible for somecomponents of the nation s Health workforce such as physicians and nurses, some ofwhom work in public Health . It has not been realistic for the public Health workforce asa whole, because there has been no systemic accumulation of the necessary may come as a surprise that the current estimated number of public Health workers isless than the oft-cited half-million number developed in the 1970's.

6 At the time thatnumber was developed, it represented a public Health worker to population ratio of oneworker to each 457 persons, a ratio noticeably better than the current estimate. Given thenew public Health challenges of the intervening decades, the change represents substan-tial erosion in public Health among leaders of the public Health community during the 1993-4 nationalhealth reform debates focused on ways to improve communication within the publichealth community and between that community and policy-makers at all levels. A keyproduct of those discussions was the statement Public Health in America (PHA) [SeeAppendix A]. This document developed the broad discussion of core functions ofpublic Health presented earlier by the Institute of Medicine into a more complete presen-tation of the mission, vision, responsibilities and essential services of public of the essential services public Health was charged with was to assure a competentpublic Health .

7 Workforce. The Public Health Functions Steering Committee, authorof PHA, subsequently commissioned a group to develop specific plans for meeting thiscommitment to the public Health work group on public Health workforce was charged with providing a profile of thecurrent public Health workforce and making projections regarding the workforce of the21st century. [See Appendix B for a summary of public Health workforce enumerationefforts.] The subsequent report, The Public Health Workforce: an Agenda for the 21stCentury (PH Workforce) made a number of important points regarding the workforce12 Introductionthat influenced this project. For example, the report attempted to clarify who should beconsidered a part of the public Health workforce:For purposes of this discussion, the public Health workforce includes allthose responsible for providing the services identified in the Public Healthin America statement regardless of the organization in which they an example, all members of the Public Health Service Commis-sioned Corps, whether currently assigned to the Department of Healthand Human Services (DHHS) or elsewhere are included.

8 At the Statelevel, many workers in environment, agriculture, or education depart-ments have public Health responsibilities and are included. This expan-sive definition does not include those who occasionally contribute to theeffort in the course of fulfilling other report offered no profile of the workforce, however. It did include a discussion ofenumeration that highlighted the following methodological concerns: occupational clas-sifications in use have rarely reflected the duties and qualifications expected of the in-cumbents; boundaries between public Health occupational categories have not beendelineated; available categories are not mutually exclusive and overlap extensively withregard to knowledge base, skills, and tasks; existing classification systems lack consis-tency, with some occupations defined by what people do, and others defined by thepopulations they serve or by the required underlying skills; the many position descrip-tions/job titles used to employ public Health professions lack uniformity across Statesand organizations; and there is no comprehensive public Health professional licensureor certification requirement for public Health workers.

9 The report ended the discussionof workforce enumeration with this recommendation:A standard taxonomy should be used to regularly identify the sizeand distribution of the public Health workforce in official agencies( Health , Environmental Health and protection, mental Health , andsubstance abuse; local, State, and national) and private and volun-tary organizations. [emphasis added]The decision to develop this enumeration, a current best estimate of the size andcomposition of the public Health workforce at the local, state and national level, is onlya first step toward a comprehensive, accessible and current data source on the publichealth PH Workforce was being published, work was also underway on a new edition ofHealthy People 2010, the national statement of Health objectives that has driven muchpublic Health investment in recent decades. Healthy People 2010 included a new chapteron public Health infrastructure, demonstrating recognition that if the infrastructure wasnot in place, accomplishments of all other objectives were in jeopardy.

10 The public healthinfrastructure chapter identified workforce as one of the three essential components ofinfrastructure, the other two being data/information and systems/relationships. Threeobjectives relate specifically to the public Health workforce:13 IntroductionObjective 23-8. (Developmental) Increase the proportion of Federal,Tribal, State, and local agencies that incorporate specific competencies inthe essential public Health services into personnel 23-9. (Developmental) Increase the proportion of schools forpublic Health workers that integrate into their curricula specific content todevelop competency in the essential public Health 23-10. (Developmental) Increase the proportion of Federal,Tribal, State, and local public Health agencies that provide continuingeducation to develop competency in essential public Health services fortheir none of these specifically require the enumeration of the public Health workforce,knowledge of the size and composition of the workforce would enhance our under-standing of the scope of work needed to accomplish each, and would facilitate monitor-ing success.


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