public health infrastructure, public health practice, public health workforce



  1. Lichtveld, Maureen Y.
  2. Cioffi, Joan P.


The public health workforce is key to strengthening public health infrastructure. National partners have articulated a vision of a sustainable and competent workforce prepared to deliver essential public health services. Six strategic elements provide a framework for action: monitoring workforce composition; identifying competencies and developing related curriculum; designing an integrated life-long learning delivery system; providing individual and organizational incentives to ensure competency development; conducting evaluation and research and assuring financial support. Partners convened in January 2003 to review progress and to re-evaluate strategies in light of the recently released Institute of Medicine reports on infrastructure and workforce issues. Although significant challenges remain, there is convergence on priorities for competency development, research questions to be addressed and next steps in the national dialogue on certification and credentialing in public health.


The workforce is a foundation element of public health infrastructure as conceptualized in Figure 1. The capacity and readiness of a public health system is defined, in part, by both the governmental agency workforce and the community partners. A strong infrastructure enables the public health system to prepare for, and respond to, both acute and chronic threats to the nation's public health, whether the threats are from terrorism, emerging infections, disparities in health, or increases in chronic diseases and injury rates. Of the nation's estimated 400,000 to 500,000 public health professionals, few report formal graduate level public health education. Public health workforce development is chronically underfunded. The current national focus on preparedness highlights the importance of a system to ensure the ongoing competency development of the front line to deliver essential services and respond to public health threats and emergencies.


Criticism of workforce training and preparation was strong in the 1988 Institute of Medicine (IOM) report on public health.1 Schools of public health, employers, federal agencies, and professional groups were called upon to remedy the situation. In response, federal, state, and local initiatives were developed with some success. Newly released IOM reports2,3 suggest that although some progress has been made, much work remains. Table 1 shows the competency and content requirements for the public health workforce described in major documents from 1988 to 2002.