workforce gaps and decrease performance deficiencies; and assurance of educational course work to enhance the skills of the workforce of local public health systems. State public health agencies, working in collaboration with local public health systems, can develop incentives that support workforce development activities.

  • Evaluation and quality improvement of the statewide system for workforce development. To be successful in this area, the state public health agency would periodically and consistently review the state’s activities to assure that a competent public and personal care workforce uses the results from reviews to improve the quality and outcome of its efforts. These reviews would include current and future workforce distribution and continuing education needs as well as public health system assessment for its success in meeting those needs.

The public health system in the United States has been described as being ill-prepared, in disarray, and under-funded to meet the current (much less the future) needs of the population (IOM, 1988). Attention is being paid to the development of multiple strategies to strengthen the public health infrastructure. If these strategies are to be successful in the future, the developmental and educational needs of the public health workforce must be addressed. If the historic underfunding of public health human resource development continues, the public health system as a whole will be further weakened. State public health agencies, working in partnership with local public health systems and the federal government, must take the lead in strengthening the quality of the public health workforce.

FEDERAL PUBLIC HEALTH AGENCIES

Federal agencies are important to the development of the public health workforce generally, and specifically to the education of public health professionals. The roles of these agencies have included developing the research base that provides education; testing educational approaches; helping schools develop infrastructure; supporting faculty development; and providing funding for students. Key agencies include the National Institutes of Health (NIH), the Health Resources and Services Administration (HRSA), CDC, the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Agency for Healthcare Research and Quality (AHRQ), and their predecessors. They are located within the Department of Health and Human Services (DHHS), but the size of the department and the diversity of missions of the component units makes it critical that the discussion be specific to the individual agency.

From the broadest public health education perspective, HRSA and CDC have been central and will be the focus of this discussion. HRSA



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