Building a New Generation of Public Health Leaders Forged in a Public Health Crisis.

The COVID-19 pandemic presented wide-ranging leadership challenges to public health leaders and public health organizations. In its wake, as the necessity of reconstructing public health and modernizing the Centers for Disease Control and Prevention (CDC) is considered, we reviewed reports from the Commonwealth Fund and the CDC and other leadership-focused literature to identify common themes for a new generation of public health leaders. We posit that this new generation must have the ability to communicate (build and maintain trust and accountability); forge, facilitate, and promote partnerships; connect public health and health care systems; build information systems that provide accessible, actionable data; engage in systems and strategic thinking and action; center equity and inclusivity and understand structural racism as a fundamental driver and creator of health inequities; and achieve and maintain resilience and self-care. For each of the 7 abilities, we offer a description, assess what COVID-19 taught us about the necessity of the ability for public health leaders, and offer suggestions for developing (or honing) one's skill set, mindset, and tool set in this regard. (Am J Public Health. 2024;114(6):626-632. https://doi.org/10.2105/AJPH.2024.307633).

Using National Public Health Accreditation to Explore Quality Improvement and Performance Management in Small Local Health Departments.

CONTEXT: This article focuses on 4 small local health departments (LHDs) that were in the process of seeking Public Health Accreditation Board (PHAB) reaccreditation or Pathways Recognition using PHAB Standards & Measures Version 2022. OBJECTIVE: The objective of this study was to explore the experiences of 4 small LHDs related to Quality Improvement (QI) and Performance Management (PM) in their pursuit of PHAB reaccreditation or Pathways Recognition. DESIGN: A team of researchers conducted 22 qualitative interviews with health department leaders and staff. Findings relative to QI/PM represent an embedded case study since they were part of a larger investigation. SETTING: The research team conducted interviews remotely with health departments located in the West and Midwest. PARTICIPANTS: Participants included adults at least 18 years old and employed in 1 of 4 health departments. MAIN OUTCOME MEASURES: Emergent themes from this qualitative investigation included using QI/PM tracking systems, building staff buy-in for QI/PM, integrating QI/PM into daily work, and advice for other health departments regarding QI/PM. RESULTS: Participants suggested that tracking systems helped them manage QI/PM processes. Staff buy-in for QI/PM was strengthened by building a sense of ownership of the process and connecting improvement processes to outcomes. Health departments integrated QI/PM into daily work by leadership modeling and communicating expectations. Advice for other health departments included finding a QI system that was easy to follow and recognizing the role of QI/PM in improving performance to better support the wellbeing of the community. CONCLUSIONS: QI/PM are important tools for health department effectiveness. Participants affirmed that the primary purposes of QI/PM are to enhance internal processes and improve community health outcomes. Study findings demonstrate how 4 small health departments integrated QI/PM into their public health practice.

Equipping the Public Health Workforce of the Future: Evaluation of an Evidence-Based Public Health Training Delivered Through Academic-Health Department Partnerships.

OBJECTIVE: Maintaining a skilled public health workforce is essential but challenging given high turnover and that few staff hold a public health degree. Situating workforce development within existing structures leverages the strengths of different organizations and can build relationships to address public health challenges and health equity. We implemented and evaluated an innovative, sustainable model to deliver an established evidence-based public health (EBPH) training collaboratively among Prevention Research Centers (PRC), local and state health departments, and Public Health Training Centers (PHTC). DESIGN: Quantitative data: quasi-experimental, 1-group pre-post. Qualitative data: cross-sectional. Data were collected between December 2021 and August 2022. SETTING: Four US sites, each a partnership between a PRC, local or state health department, and a PHTC. PARTICIPANTS: Governmental public health staff and representatives from other organizations that implement public health programs in practice settings. MAIN OUTCOME MEASURES: Course participants completed a pre- and postcourse survey self-rating 14 skills on a 5-point Likert scale. Differences were analyzed using mixed effects linear models. In-depth interviews (n = 15) were conducted with course faculty and partners to understand: (1) resources contributed, (2) barriers and facilitators, (3) benefits and challenges, and (4) resources needed to sustain this model. Interviews were transcribed verbatim, and a thematic analysis identified themes. RESULTS: Statistically significant increases in all skills were observed from pre- to postcourse (n = 241 at post, 90% response). The skills with the largest increases were understanding economic evaluation enough to inform decision-making (mean change = 1.22, standard error [SE] = 0.05) and developing an action plan (mean change = 1.07, SE = 0.07). Facilitators to delivering the course included having a shared goal of workforce development, existing course curricula, and dedicated funding for delivering the course. CONCLUSIONS: Collaborative delivery of the EBPH training can ameliorate the effects of high staff turnover, strengthen academic-practice relationships, and promote population-wide health and health equity.

The Value and Impacts of Academic Public Health Departments.

The academic health department (AHD) is a partnership between an academic institution and a governmental health agency. These partnerships are meant to provide mutual benefits that include opportunities for student field placements and internships, practice-informed curriculum, and practice-based research. The term academic health department dates back only to 2000, although there are several examples of academic-practice partnerships prior to that date. In addition to AHDs that have been established over the past two decades, other forms of academic-practice engagement provide similar mutual benefits, such as prevention research centers and public health training centers. Current research on AHDs explores how these partnerships matter regarding the outputs, outcomes, and impacts of the units that comprise them. This review also considers the most recent perspectives on how AHDs have responded to the COVID-19 pandemic and how they might advance public health's efforts to address structural racism and promote health equity.

Exploring the Preliminary Steps of One County Health Department to Manage the COVID-19 Pandemic.

This case study describes how one county health department in Alabama used the best available evidence to address the needs of its citizens during the first 6 months of the COVID-19 pandemic. The authors explore issues of scope of authority by government officials, individual freedom versus population health, and challenges of health communication during a disease outbreak. Despite the availability of vaccines, boosters, and access to vaccines by children as young as 5 years, COVID-19 cases are on the rise across the United States more than 2 years after the official news broke out of Wuhan, China. Health officials have expressed concerns that backlash against governmental public health during the pandemic will limit public health authorities from responding to the traditional challenges that were present pre-COVID-19 and will remain in a post-COVID-19 world.

COVID-19 Vaccine Knowledge, Attitudes, and Practices in Alabama: The Case for Primary Health Care Providers.

OBJECTIVE: To examine knowledge, attitudes, and practices about COVID-19 in Alabama, with a primary focus on vaccination perception and utilization. DESIGN: We used a COVID-19 Knowledge, Attitudes, and Practices survey and recruited adult Alabama residents in April-May 2021. PARTICIPANTS: Initial surveys from 1324 Alabamian participants were considered for analysis; after careful review of incomplete responses, 953 were ultimately included for analysis. MAIN OUTCOME MEASURE: Vaccine behavior and hesitancy comprise a self-reported response contained in the survey instrument. Three primary vaccine groups were used to assess differences in demographic characteristics, health status, perception of susceptibility and severity of COVID-19, sources of information, and trust about COVID-19. RESULTS: Of the 953 survey participants included for analysis, 951 had self-identified vaccine status in which 153 (16.1%) reported to have received the vaccine at the time of the survey, 375 (39.4%) were very likely or somewhat likely to get an approved COVID-19 vaccine if it was offered, and 423 (44.5%) were somewhat unlikely or very unlikely to get an approved COVID-19 vaccine. Health care providers were the most trusted sources of information, regardless of vaccine status. For participants unlikely to receive a vaccine, social media and local news sources were consistently more trusted and utilized than those who were vaccinated or were likely to be. CONCLUSIONS: The perceptions among unvaccinated participants are actionable and provide teachable opportunities to decrease vaccine apprehension.

Comparing the COVID-19 Responses in Cuba and the United States.

The purpose of this analytic essay is to contrast the COVID-19 responses in Cuba and the United States, and to understand the differences in outcomes between the 2 nations. With fundamental differences in health systems structure and organization, as well as in political philosophy and culture, it is not surprising that there are major differences in outcomes. The more coordinated, comprehensive response to COVID-19 in Cuba has resulted in significantly better outcomes compared with the United States. Through July 15, 2021, the US cumulative case rate is more than 4 times higher than Cuba's, while the death rate and excess death rate are both approximately 12 times higher in the United States. In addition to the large differences in cumulative case and death rates between United States and Cuba, the COVID-19 pandemic has unmasked serious underlying health inequities in the United States. The vaccine rollout presents its own set of challenges for both countries, and future studies can examine the comparative successes to identify effective strategies for distribution and administration. (Am J Public Health. 2021;111(12):2186-2193. https://doi.org/10.2105/AJPH.2021.306526).

COVID-19's Impact on Women: A Stakeholder-Engagement Approach to Increase Public Awareness Through Virtual Town Halls.

Women face unprecedented challenges imposed by the COVID-19 pandemic. Emerging evidence suggests that women are unduly burdened by inequitable access to economic, health, and social resources during the pandemic. For many women, COVID-19 has presented new urgency to challenges and illuminates unique issues long encountered. Gendered roles such as family caregiving and frontline occupations increase women's exposure to COVID-19 infections and critical outcomes. To increase dialogue around COVID-19's impact on women, the University of Alabama at Birmingham School of Public Health convened a moderated virtual town hall on April 25, 2020, with 2 sexual and reproductive health experts. The town hall was the second in a series to increase public awareness of COVID-19's impact on vulnerable populations. This report highlights policy and practice implications that are particularly relevant for engaging key populations and delivering information to increase public awareness of COVID-19.

The State of the US Governmental Public Health Workforce, 2014-2017.

Public health workforce development efforts during the past 50 years have evolved from a focus on enumerating workers to comprehensive strategies that address workforce size and composition, training, recruitment and retention, effectiveness, and expected competencies in public health practice. We provide new perspectives on the public health workforce, using data from the Public Health Workforce Interests and Needs Survey, the largest nationally representative survey of the governmental public health workforce in the United States. Five major thematic areas are explored: workforce diversity in a changing demographic environment; challenges of an aging workforce, including impending retirements and the need for succession planning; workers' salaries and challenges of recruiting new staff; the growth of undergraduate public health education and what this means for the future public health workforce; and workers' awareness and perceptions of national trends in the field. We discussed implications for policy and practice.

Challenges and Innovations in Surveying the Governmental Public Health Workforce.

Surveying governmental public health practitioners is a critical means of collecting data about public health organizations, their staff, and their partners. A greater focus on evidence-based practices, practice-based systems research, and evaluation has resulted in practitioners consistently receiving requests to participate in myriad surveys. This can result in a substantial survey burden for practitioners and declining response rates for researchers. This is potentially damaging to practitioners and researchers as well as the field of public health more broadly. We have examined recent developments in survey research, especially issues highly relevant for public health practice. We have also proposed a process by which researchers can engage with practitioners and practitioner groups on research questions of mutual interest.