PH WINS 2021 Methodology Report

Context: Understanding the extent to which equity-focused work is occurring in public health departments (eg, in chronic disease programs) can identify areas of success and what is needed to move the needle on health equity. Objective: The study objective was to characterize the patterns and correlates of equity-related practices in US state and territorial public health practice. Design: The design was a multimethod (quantitative and qualitative), cross-sectional study. Setting: The setting included US state and territorial public health departments. Participants: Chronic disease prevention practitioners (N = 600) completed self-report surveys in July 2022 through August 2022 (analyzed in September 2022 through December 2022). Main Outcome Measures: Health equity data were obtained across 4 domains: (1) staff skills, (2) work unit practices, (3) organizational priorities and values, and (4) partnerships and networks. Results: There was a wide range in self-reported performance across the health equity variables. The highest values (those agreeing and strongly agreeing) were related to staff skills (eg, the ability to describe the causes of inequities [82%]). Low agreement was reported for multiple items, indicating the lack of systems for tracking progress on health equity (32%), the lack of hiring of staff members who represent disadvantaged communities (33%), and limited use of principles for community engagement (eg, sharing decision-making authority with partners [34%]). Qualitative data provided tangible examples showing how practitioners and their agencies are turning an array of health equity concepts into actions. Conclusions: There is urgency in addressing health equity and our data suggest considerable room for enhancing health equity practices in state and territorial public health. To support these activities, our findings provide some of the first information on areas of progress, gaps in practice, and where to target technical assistance, capacity building efforts, and accreditation planning.

Section: Discussionsupporting

confidence: 79%

Section: Discussionsupporting

confidence: 79%

Understanding Health Equity in Public Health Practice in the United States

Brownson

Mazzucca-Ragan

Jacob

et al. 2023

“…The PH WINS methodologies are described in more detail elsewhere (Robins et al 2022, in this issue). 17 Briefly, using employee rosters from participating departments, PH WINS was sent to 137 446 individuals in the governmental public health workforce representing 47 state health agencies (SHAs) and 288 decentralized local health departments (LHDs) across the United States. Decentralization refers to the governance structure of a health department and describes the relationship an SHA has to the LHDs in the state.…”

Section: Methodsmentioning

confidence: 99%

The Opportunity Cost of COVID for Public Health Practice: COVID-19 Pandemic Response Work and Lost Foundational Areas of Public Health Work

McCullough

Robins

2022

Self Cite

This article has been temporarily removed by the publisher, Wolters Kluwer, due to a data quality issue. We regret any confusion this may have caused. This article will be published once production is complete on the Public Health Workforce Interest and Needs Survey supplemental issue. Context: There is little empirical evidence regarding the magnitude of the COVID-19 response across the public health workforce and the extent to which other public health programs were called upon to contribute to the response, potentially leading to less work being done in other public health programs during the COVID-19 pandemic. Objectives: To assess the composition of the workforce that contributed to the COVID-19 pandemic response during 2020-2022. Design: A large, cross-sectional, nationally representative survey of the state and local public health agency workforce through the Public Health Workforce Interest and Needs Survey (PH WINS). Setting: Nearly all state health agency-central offices (SHA-COs) and Big City Health Coalition (BCHC) member public health departments as well as a nationally representative sample of other local health departments (LHDs) with more than 25 staff members and serving more than 25 000 people participated in fall 2021. Participants: A sample of all individuals working at each SHA-CO or LHD as part-time or full-time employees, contractors, or other employee types was used. A total of 44 732 responses (35% of eligible respondents) were received. Main Outcome Measure: Main outcomes included the proportion of full-time equivalent (FTE) effort devoted to COVID-19 response work by quarter (Q) from Q1 2020 through Q1 2022. Predictors of interest included individual-and agency-level demographics, most notably an individual's self-reported public health program area. Results: Staffing and hiring for the COVID-19 pandemic response was an ongoing effort that began in 2020 and lasted through 2022. During the pandemic, all public health program areas contributed at least 20% of their workforce time to COVID-19 response, peaking at 47-83% of the staff time, depending on the program area.Conclusions: There was a considerable public health opportunity cost to the public health systems' large and prolonged COVID-19 response. Persistent understaffing in the public health system remains an important issue.

“…Balancerepeated replication weights were constructed to account for the complex design and adjust for nonresponse. Complete details of the 2021 PH WINS methodology can be found in another article in this issue, 17 and the 2014 and 2017 methodologies are available elsewhere. 18,19 This descriptive study uses data from the 2017 and 2021 PH WINS to examine changes in the BCHC governmental public health workforce.…”

Section: Methodsmentioning

confidence: 99%

“…Balance-repeated replication weights were constructed to account for the complex design and adjust for nonresponse. Complete details of the 2021 PH WINS methodology can be found in another article in this issue,17 and the 2014 and 2017 methodologies are available elsewhere 18,19…”

Section: Methodsmentioning

confidence: 99%

Recovery and Resiliency in 29 Big Cities: Results From the 2021 Public Health Workforce Interests and Needs Survey

Juliano

Schaffer

Gambatese

2022

Self Cite

Context: Big Cities Health Coalition member health departments (BCHC HDs) serve more than 61 million people across their jurisdictions, nearly 20% of the US population. As such, they have particular challenges and opportunities in how they do their work. This article focuses on BCHC HDs that participated in the 2021 Public Health Workforce Interests and Needs Survey (PH WINS) and describes workplace perceptions, training needs, COVID-19 efforts, and well-being. Objective: To describe key characteristics of the governmental public health workforce among BCHC HDs, including demographics, perceptions, and needs. Design: Using a subsample of data from the 2021 PH WINS that included 29 BCHC HDs, descriptive statistics on many of the topics covered by the 2021 PH WINS were analyzed and compared with the 2017 PH WINS. Setting: Twenty-nine BCHC HDs in cities across the United States. Participants: In total, 7922 of 29 661 staff members (response rate of 27%) from participating BCHC HDs.Results: Most BCHC HD respondents self-identified as a woman (76%, 95% confidence interval [CI]: 75%-77%), and as Black, Indigenous, and people of color (69%, 95% CI: 68%-70%), similar to findings from the 2017 PH WINS (75%, 95% CI: 74%-76%; 67%, 95% CI: 66%-69%, respectively). Most respondents believe that their organization prioritizes diversity, equity, and inclusion (70%, 95% CI: 69%-72%). Thirty percent (95% CI: 29%-32%) intend to leave their organizations within 1 year, and 18% (95% CI: 17%-19%) plan to retire within 5 years. Staff connect their work with agency goals and priorities (86%, 95% CI: 85%-87%) and are determined to give their best effort every day (91%, 95% CI: 90%-91%). Conclusion:As the need for an all-encompassing focus on COVID-19 lessons, BCHC HDs should continue to focus on prioritizing staff retention, enhancing communication between senior staff and employees, and fostering an environment where innovation and creativity are rewarded.