Abstract
The Partnership for the Public's Health work in supporting partnerships between local health departments and community-based organizations has offered important insights into the difficulties of changing public health practice to a more community-based model. Keys to these difficulties are workforce issues: availability, appropriateness of initial training, recruitment, retention, and issues of continuing education. These challenges and some positive examples are discussed.
Managed care has been dominating the California marketplace for many years, and the transition from primarily nonprofit health plans to for-profit ones was most significant here. When the California Blue Cross plan changed its status from a nonprofit health service to a for-profit plan by creation of the investor-owned Wellpoint Health Networks, California law (Health and Safety Code, [S]1399.72-1399.76, 2003) required that a significant portion of the assets on which it had not been taxed be returned to serve the public good. This led to the creation, in 1998, of two well-endowed health-related foundations, of which the California Endowment is the largest. (The second is the California Healthcare Foundation.)
The California Endowment's interests in looking at strategies for community health improvement coincided with many of California's local health departments' desires to find ways to better serve their communities. In collaboration with the Public Health Institute, an independent nonprofit organization devoted to promoting health, well being, and quality of life through research, training, and community building, the Partnership for the Public's Health (PPH) was created.
The initiative paired 14 local health departments that had applied to be part of the project with a minimum of two community-based organizations in their respective service areas. The objective was that these partnerships would offer new insights into the challenges and opportunities inherent in a complex, statewide, multi-year effort to improve community health, broadly defined. These local partnerships were asked to work together on several areas of community-based public health:
* internal capacity development for both the local health departments and the community groups;
* partnership development; joint selection of community health improvement goals to work on together; and related policy and systems change activities.
A similar initiative called Turning Point, was launched several years earlier with funding from the W.K. Kellogg and Robert Wood Johnson Foundations. Turning Point took a similar collaborative approach to community health improvement, but it focused primarily on state health departments, although some local health departments were involved. Turning Point is committed to understanding the components of the larger public health system and promoting the community-based approach.
It quickly became apparent that one of the most critical components of this renewed focus on communities was the public health workforce. Meetings with public health department leaders readily identified recruiting, retaining, and retraining personnel as among the highest priorities for attention. Internal and external forces, as described below, have driven this focus on the public health workforce.