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While academic programs prepare public health graduates for the technical challenges of practice, many professionals new to the field also need training in the cross-cutting strategic skills required for successful leadership and management of health agencies. Successful practitioners blend subject matter expertise with administrative and leadership acumen to ensure that improvements in public health reach the communities they serve. 'Building Strategic Skills for Better Health' offers a dynamic guide for implementing and developing leadership, management, and advocacy skills to transform public health work across disease-focused services toward integrated population health initiatives.

The COVID-19 pandemic has emphasized the need for health professionals to communicate more clearly about what public health is and why it matters. In comparison to health care, public health is underfunded, undervalued, and misunderstood, and that is partly because of the unclear and inconsistent way that health leaders talk about it. This book is intended to help public health professionals and anyone else who communicates about public health to do so more effectively-whether they need to reach policymakers, the media, or the public. Many people who are trained in medicine or public health have never had to "sell" ideas or policies to uninformed or skeptical partners. The insights, tools, and resources included in this book can provide a first step toward better communications and stronger partnerships. The book is based on original research and insights by social scientists and seasoned communications professionals at the FrameWorks Institute and Hattaway Communications. In addition to sharing perspectives from leading experts, the book also provides practical tools, including tested messaging, effective metaphors, and tips for using storytelling and data. These tools can help professionals avoid messages that backfire, answer challenging questions, reframe public health assumptions, and draw on the power of anecdotes while sharing important data. For anyone who is ready to change how public health is viewed and valued in our nation, Talking Health is a practical and powerful starting point.

"For those who seek to improve health through policy change, this book is intended to be your companion. It is written by practitioners, elected officials, and other policymakers who have firsthand experience with the complex dynamics of policymaking through their professional careers. Its chapters share perspectives on the power of policy from the federal, state, and local levels; demonstrate several evidence-based policy packages developed by leading public health organizations; provide perspectives not only on legislative policy but on the roles of litigation and regulation; and reveal the existing threats to using policy to impact health. We hope that this book will inspire current and future public health practitioners and pMolicymakers to use policy to achieve optimal and equitable health for all"--

The Time is Now for Leading Systems Change in Public Health Practice / by Eve C. Pinsker, Christina R. Welter, and Kristina Y. Risley -- Racial Justice and Power-Sharing : The Heart of Leading Systems Change / by Lili Farhang and Solange Gould -- Readiness for Change / by Amy Mullenix, Rebecca Wells, and Karen Trierweiler -- Personal Leadership / by Kristina Y. Risley and Renée Branch Canady -- Interpersonal Leadership / by Patricia Moten Marshall, Christina R. Welter, and Samantha Cinnick -- Organizational Leadership / by Mary F. Morten and Geneva Porter -- Team and Cross-Sector Leadership / by Jeannine Herrick, Christina R. Welter, and Patricia Moten Marshall -- Leading Change Through Partnership : Community Organizing, Coalition-Building, and Engaging Nontraditional Partners / by Jonathan Webb -- Articulate the Root Challenge / by Christina R. Welter, Eve C. Pinsker, and Kristen Hassmiller Lich -- Leveraging the Lessons of Implementation Science to Serve Systems Change / by W. Oscar Fleming -- Sustainability and Effective Public Health : A Committed Relationship / by Gillian Gawne-Mittelstaedt -- Challenges and Opportunities in Leading Systems Change / by Jonathan Webb, Brian C. Castrucci, Grace Castillo, and Kristina Y. Risley -- Public Health Systems Change in Action / by Jeannine Herrick and Ray Dlugolecki -- Community Leadership / by Dorothy Cilenti and Lacy Fehrenbach -- Using Systems Thinking to Build Preparedness and Response Readiness / by Gina Massuda Barnett, Millka Baetcke, Christina R. Welter, and Grace Castillo.

Why a practical playbook for partnerships between public health and primary care? / Denise Koo, J. Lloyd Michener, James B. Sprague, Brian C. Castrucci -- The value of public health and primary care partnerships / Brian C. Castrucci, J. Lloyd Michener, Densie Koo, James B. Sprague -- Primary care and public health: partners for population health / Julie K. Wood -- The value of integration : public health, primary care, and beyond / Paul E. Jarris, Katie Sellers -- Principles of partnerships between public health and primary care / J. Lloyd Michener, Brian C. Castrucci, Denise Koo -- Stages of partnerships between public health and primary care / J. Lloyd Michener, Brian C. Castrucci -- How to have difficult conversations / Justine Strand de Oliveira -- Group dynamics / Mina Silberberg, Seamus Bhatt-Mackin -- Pitching your project / Justine Strand de Oliveira -- Positioned for sustainability / Karen J. Minyard, Amanda Phillips Martinez, Tanisa Adimu -- The role of early wins in long-term success / Frederick S. Johnson -- The value of early wins in be well Lake County / Christina Arnold -- Challenges of working together / Lara Snyder -- Starting off on the right foot: a communication strategy is essential / Karen Remley -- Leveraging media / Kate Reuterswärd -- The practice of public health and how it is changing / Brian C. Castrucci, Hugh H. Tilson, Denise Koo, Jonathon P. Leider -- The changing landscape of primary care / Andrew Bazemore, Russell Phillips, Robert L. Phillips, Jr -- Addressing social determinants of health / Mina Silberberg, Brian C. Castrucci -- Creating a culture of health in Cambridge, MA / Claude-Alix Jacob, Susan Feinberg -- Community health assessments : past, present, and future / Kevin Barnett, Sara Rosenbaum -- Community health needs assessments benefit communities and hospitals alike / Philip Alberti, Ivy Baer -- Leveraging the affordable care act for population health / Eduardo Sanchez -- Partnering with Medicaid, Medicare, public health, and primary care to improve health outcomes / Sharon G. Moffatt, Monica Valdes Lupi, Kathleen Nolan -- Working with accountable care organizations / Joanne M. Conroy, Clese Erikson, Coleen Kivlahan -- Local health departments and a primary care safety net / Robert M. Pestronk -- Co-locating primary care and public health services / Michelle J. Lyn -- Return on investment and economic evaluation / Steven M. Teutsch, Denise Koo, Scott D. Grosse -- The promise and power of using data together / Brian C. Castrucci, Hugh H. Tilson, David A. Ross -- Working with data / Mina Silberberg, Denise Koo, Raymond J. King -- Metrics : how to select them, how to use them / Mina Silberberg, Denise Koo -- Use of electronic health records for population health / Denise Koo, Raymond J. King, Seth Foldy -- Electronic health records : forging common ground for primary care and public health / Dave Ross -- Public and population health it in the age of EHRS and the ACA : expert perspectives on current trends / John W. Loonsk -- Using geographic health information systems (GHIS) for population health / Joshua L. Tootoo, Brian C. Castrucci, Pamela Maxson, Michele Casper, Marie Lynn Miranda -- Shared space : using geography to identify relationships and increase understanding in primary care and public health / Robert L. Phillips, Jr, Andrew Bazemore -- Data and the future of public health / Jeffrey Engel -- San Diego, CA, promotes healthy weight to improve community health / Shaila Serpas, Christina Khaokham, Sharon Hillidge, Virginia Watson -- Indiana reduces the burden of asthma / Virginia Watson -- "Top-down" and "bottom-up" initiatives create a comprehensive prescription drug overdose prevention program in North Carolina / Virginia Watson

CONTEXT: Creativity and innovation in the governmental public health workforce will be required to generate new ideas to solve complex problems that extend beyond traditional public health functions such as disease surveillance and monitoring. Creativity and innovation can promote and advance necessary organizational transformation as well as improve organizational culture and workplace environment by motivating employees intrinsically. However, there is little empirical evidence on how rewarding creativity and innovation in governmental public health departments is associated with organizational culture and workplace environments. OBJECTIVE: This study describes (1) the degree to which creativity and innovation are rewarded in governmental public health agencies and (2) associations between rewarding creativity and innovation and worker satisfaction, intent to leave, and workplace characteristics. DESIGN: The cross-sectional Public Health Workforce Interests and Needs Survey (PH WINS) was administered using a Web-based platform in fall 2017. SETTINGS AND PARTICIPANTS: Data used for these analyses were drawn from the 2017 PH WINS of governmental health department employees. This included state health agency and local health department staff. PH WINS included responses from 47 604 staff members, which reflected a 48% overall response rate. PH WINS excludes local health departments with fewer than 25 staff or serving fewer than 25 000 people. RESULTS: Fewer than half of all workers, regardless of demographic group and work setting, reported that creativity and innovation were rewarded in their workplace. Most measures of worker satisfaction and workplace environment were significantly more positive for those who reported that creativity and innovation were rewarded in their workplace. CONCLUSION: This research suggests that promoting creativity and innovation in governmental public health agencies not only could help lead the transformation of governmental public health agencies but could also improve worker ...

Purpose. To assess the association between the presence of international board-certified lactation consultant (IBCLC) services at a delivery hospital and the breastfeeding practices of women whose infants required neonatal intensive care unit (NICU) admission. Design. Cross-sectional study using population-level data. Setting. Philadelphia, Pennsylvania. Subjects. 2132 infants admitted to the NICU. Measures. Breastfeeding at hospital discharge was measured with the question, "Is the infant being breastfed?" Delivery hospitals were dichotomized as to the presence or absence of an IBCLC on staff. Analysis. Logistic regression was used to assess the relationship between breastfeeding at discharge and the presence of an IBCLC at the delivery facility while adjusting for maternal characteristics and birth outcomes. Results. Among mothers of infants admitted to the NICU, breastfeeding rates among mothers who delivered at hospitals with an IBCLC were nearly 50% compared with 36.9% among mothers who delivered at hospitals without an IBCLC. The adjusted odds of breastfeeding initiation prior to hospital discharge were 1.34 (95% confidence interval = 1.03, 1.76) times higher for women who delivered at a facility with an IBCLC. Conclusions. To increase breastfeeding rates among the NICU population, these findings support the need for universal availability of IBCLCs at delivery facilities that have NICUs.

CONTEXT: Workforce is a critical cog in the governmental public health enterprise in the United States. Until 2014, workforce research was largely conducted at the organizational level. However, the fieldings of the Public Health Workforce Interests and Needs Survey allow for nationally representative comparisons with individual respondents. OBJECTIVE: Using data from agencies that participated in 2014 and 2017, we conducted multi–cross-sectional comparisons of the Public Health Workforce Interests and Needs Survey data. DESIGN: The Public Health Workforce Interests and Needs Survey participants at the State Health Agency Central Offices were surveyed using a Web-based platform. Balanced repeated replication weights were used to account for differential designs between 2014 and 2017. SETTING: Thirty-three state health agency central offices that participated in both 2014 and 2017. PARTICIPANTS: Permanently employed governmental public health staff. MAIN OUTCOME MEASURES: We examined changes in perceptions of the workplace environment, job and pay satisfaction, intent to leave, awareness of emerging concepts in public health, and demographic/worker characteristics. Pearson and Rao-Scott–adjusted χ(2) analyses were used to compare changes between 2014 and 2017. RESULTS: The percentage of staff who are people of color increased from 29% (95% confidence interval, 28%-30%) to 37% (95% confidence interval, 36%-38%) from 2014 to 2017 across 33 states. Approximately 26% of staff were younger than 40 years in 2014 compared with 29% in 2017 (P < .001). Job satisfaction increased in 17 states overall (P < .05, n = 5) and decreased in 16 states (P < .05, n = 5) but did not change in aggregate. Overall, the percentage of staff considering leaving the organization in the next year or retiring within 5 years is up from 44% to 48% (P < .001). CONCLUSIONS: Global measures of satisfaction are relatively high and consistent between 2014 and 2017. Demographics are shifting toward a marginally younger workforce as many ...

CONTEXT: A changing public health landscape requires local governmental health departments (LHDs) to have a workforce prepared to meet complex challenges. While previous assessments looked at organizational data on the LHD workforce, the Public Health Workforce Interests and Needs Survey (PH WINS) is the first nationally representative survey to examine individual perceptions of training needs, workplace environment, job satisfaction, and awareness of emerging concepts in public health. OBJECTIVES: Characterize key interests and needs of the local governmental public health workforce. DESIGN: Survey invitations were sent to individual LHD employees on the basis of a stratified sampling approach. The LHDs had to employ a minimum of 25 staff and serve a population of 25 000 or greater to be eligible for inclusion. SETTING: 399 LHDs across the United States. PARTICIPANTS: A total of 26 533 LHD employees completed the survey (59% response rate). RESULTS: The majority of local public health workers are female (81%, 95% confidence interval [CI]: 78%-84%) and white non-Hispanic (68%, 95% CI: 64%-72%). Of the nearly quarter of workers who declared an intent to leave within the next year excluding retirement (22%, 95% CI: 19%-25%), the most common reasons included pay (46%, 95% CI: 42%-50%), lack of opportunities for advancement (40%, 95% CI: 38%-50%), and workplace environment (30%, 95% CI: 27%-32%). Across jurisdiction size and supervisory level, skills gaps were noted in budget and financial management, systems and strategic thinking, developing a vision for a healthy community, and change management. CONCLUSIONS: As the first nationally representative sample of the local governmental public health workforce, these data create a national benchmark against which LHDs can measure their workforce. Given the similarities found across LHDs serving different jurisdiction sizes, a unified approach to workforce development should be employed across all LHDs. The LHD leadership should address retention, reward creativity and ...

OBJECTIVES: To ascertain levels of turnover in public health staff between 2014 and 2017 due to retirement or quitting and to project levels of turnover for the whole of the state and local governmental public health in the United States nationally. DESIGN: Turnover outcomes were analyzed for 15 128 staff from public health agencies between 2014 and 2017. Determinants of turnover were assessed using a logit model, associated with actually leaving one's organization. A microsimulation model was used to project expected turnover onto the broader workforce. RESULTS: Between 2014 and 2017, 33% of staff left their agency. Half of the staff who indicated they were considering leaving in 2014 had done so by 2017, as did a quarter of the staff who had said they were not considering leaving. Staff younger than 30 years constituted 6% of the workforce but 13% of those who left (P < .001). CONCLUSIONS: Public health agencies are expected to experience turnover in 60 000 of 200 000 staff positions between 2017 and 2020. IMPLICATIONS: As much as one-third of the US public health workforce is expected to leave in the coming years. Retention efforts, especially around younger staff, must be a priority. Succession planning for those retiring is also a significant concern.

OBJECTIVES: More than 16 000 graduate degrees in public health are awarded annually. Yet only 14% of the governmental public health workforce has formal public health training of any kind, and 8% has a master of public health (MPH) degree. We characterized the differences among governmental staff members with master's degrees across US health departments. METHODS: We used data from the 2017 Public Health Workforce Interests and Needs Survey, a national survey of state and local public health departments (43 669 responses; response rate, 48%). We examined the characteristics of the workforce by educational attainment and compared respondents who had obtained a "terminal" (ie, highest degree obtained) MPH degree with respondents who had obtained a terminal non–public health (non-PH) master's degree. RESULTS: Respondents who had a non-PH master's degree were as likely as respondents who had an MPH degree to hold a supervisory role (43% vs 41%; P = .67). We found only 1 significant difference between the 2 groups: respondents aged ≤40 with a terminal MPH degree were significantly less likely than respondents aged ≤40 with a non-PH master's degree to earn more than the national average salary (adjusted odds ratio = 0.67; 95% CI, 0.47-0.97; P = .03). CONCLUSIONS: We found only marginal differences in career outcomes for people working in governmental public health who had a terminal MPH degree vs a terminal non-PH master's degree. This finding does not necessitate a full reconsideration of the MPH as it relates to governmental public health practice but a greater recognition that there are multiple paths into practice.

CONTEXT: Workforce development in governmental public health has historically focused on discipline-specific skills. However, as the field of public health has evolved, crosscutting skills have become critical. The 2017 fielding of the Public Health Workforce Interests and Needs Survey (PH WINS) provides a national benchmark for gaps in crosscutting skills in state and local health departments. OBJECTIVE: The purpose of this article is to identify top areas of training needs in the governmental public health workforce using data from PH WINS 2017. DESIGN: PH WINS participants in state and local health departments were surveyed in fall 2017 using a Web-based platform. Balanced repeated replication weights were used to account for complex sample design. SETTING: Forty-seven state health agencies, 26 large city health departments, and a nationally representative sample of mid-to-large local health departments. PARTICIPANTS: Permanently employed governmental public health staff. MAIN OUTCOME MEASURES: Training needs were determined by combining self-reported skill importance and proficiency. Skills reported to be of high importance, and low levels of proficiency were coded as training needs. Focus area gaps were defined as having a training need in at least one skill in the focus area. RESULTS: The largest area of training need, regardless of supervisory status, was in budgeting and financial management (55%; 95% confidence interval [CI], 53-56), with a large gap also identified in systems and strategic thinking (49%; 95% CI, 47-50). There was some variation by supervisory status, with training needs for nonsupervisors in change management and in developing a vision for a healthy community for management. CONCLUSIONS: The PH WINS training needs assessment provides the first nationally representative data on training needs for the state and local health department workforce. Across state and local health departments, there are common critical training needs essential for the current and future practice of public ...

CONTEXT: Ensuring adequate and appropriate training of the workforce is a crucial priority for governmental public health. This is particularly important, given the diverse backgrounds of the public health workforce; the vast majority (approximately 83%) do not have formal training in public health, and those that do have formal training in public health have limited training in management and other essential organizational skills. OBJECTIVE: The purpose of this article is to identify training needs among public health workers in specific job types and settings. DESIGN AND PARTICIPANTS: This cross section study used 2014 data from the Public Health Workforce Interests and Needs Survey. Qualitative analyses were used to code open-ended responses to questions about training needs. Needs are stratified across job types and jurisdiction. RESULTS: Eight main themes or skill areas were identified with the largest proportion indicating a need for management/leadership skills (28.2%). The second most frequent need was communication skills (21.3%). Across the 9 job types examined, general management skills were either the first or second training need for 7 job types. Among individuals who already have leadership/management positions, budgeting was the most common training need. CONCLUSIONS: Findings from this study can inform targeted strategies to address training needs for specific types of employees. Such strategies can influence the efficiency and effectiveness of public health efforts and employee satisfaction. As new public health frameworks–like Public Health 3.0 and the Chief Health Strategist–are advanced nationally, it is necessary to ensure that the workforce has the skills and abilities to implement these frameworks.

CONTEXT: More than 80% of Americans live in urban areas. Over the past 20 years, an increasing number of local governmental public health departments, particularly those in big cities, have taken pioneering action to improve population health. This article focuses on members of the Big Cities Health Coalition (BCHC) who participated in the 2017 Public Health Workforce Interest and Needs Survey (PH WINS). If the impact of these health departments is to be sustained, they will require a workforce prepared for the challenges of 21st-century public health practice. OBJECTIVE: To characterize workforce interests and needs among staff in 26 large, urban health departments who are BCHC members. DESIGN: Administered PH WINS survey to staff in BCHC member health departments to assess perceptions about the workplace environment and job satisfaction; training needs; awareness of national trends; and demographics. SETTING: In total, 26 of 30 BCHC member health departments, United States. PARTICIPANTS: In total, 7453 of 17 613 staff members (response rate 43.4%) from participating departments. RESULTS: The workforce consists predominantly of women (75%) and people of color (68%). Staff is satisfied with their job (81%), the organization (71%), and pay (59%), but more than a quarter are considering leaving within the year. The agency's mission drives staff, but it lacks an environment fostering creativity and innovation. Training needs include budgeting/financial management, change management, and strategic thinking. CONCLUSIONS: BCHC departments must improve retention, provide opportunities for advancement, enhance communication between leadership and staff, foster creativity and innovation, and align labor allocation with disease burden in local communities. Findings from the second iteration of PH WINS allow a comprehensive, comparable analysis of the workforce across the 26 BCHC member health departments that participated. These data expand upon the ability to assess and monitor improvement in the workforce environment, ...