Turning the Focus to Workforce Surveillance
A Workforce Data Set We Can Count On
Hugh H. Tilson, MD, DrPH
T
his collection of reports on the public health
workforce embodies and amply demonstrates the
value of the workforce component of the public
health services and systems research (PHSSR) agenda.1
Building and maintaining—and continuously improving
—the public health infrastructure requires concerted
efforts at enhancing public health programs, organiza-
tion, finance, and, of course, the public health workforce.
To be most successful, these efforts will be based on
rigorous and ongoing collection of the evidence and
formulation of evidentiary frameworks within which to
frame them. Let us celebrate together the publication of
this supplement issue, signaling the “coming of age” of
public health workforce research to provide this much-
needed evidence base.
Ad hoc efforts at workforce research will always be
important to answer particular questions or respond to a
time-sensitive issue; many of the papers here fit this
description. However, fundamental to the field of work-
force research is the ongoing collection of nationwide
public health workforce data using a consistent termi-
nology and methods that ensure unduplicated numbers.
The surveillance approach to public health workforce
data begins as all surveillance does, with agreement on
the terminology and taxonomy, followed by agreement
on the sampling frame for its collection and where the
combined data will be housed. Finally, a long-term
investment in regular, periodic surveys of the workforce
using these agreed classifications and samples to provide
reliable evidence is needed—“data we can count on!”
Such data will elucidate the evolving pattern of the
public health workforce and allow demonstration of
potential contributing factors within the public health
system, which may drive/change the workforce. This
data-based understanding is essential to effective
evidence-based advocacy for educating, building, and
maintaining an effective workforce. In short, the sector
has needed a shift in the paradigm of workforce data
collection from occasional and ad hoc surveys to the
time-honored public health approach of ongoing
surveillance.
From the Public Health Leadership Program, University of North Carolina
Gillings School of Global Public Health, Chapel Hill, North Carolina.
0749-3797/$36.00
http://dx.doi.org/10.1016/j.amepre.2014.07.041
S278 Am J Prev Med 2014;47(5S3):S278–S279 & 2014 Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).
The U.S. is the richer for the long-term concerted
efforts of the National Association of County and City
Health Officials (NACCHO), Association of State and
Territorial Health Officials (ASTHO), and their collabor-
ating members to provide reliable workforce data. The
NACCHO and ASTHO periodic surveys form the basis
of several articles/analyses in this issue.2–5 Particularly
important is the report on a national effort at improving
and aligning the classification systems and taxonomy for
public health workforce research.5
With full participation from ASTHO, NACCHO, CDC,
the Health Resources and Services Administration, the
University of Michigan Center of Excellence in Public Health
Workforce Studies, and health systems/PHSSR researchers, a
method for consistent data collection at the population level
has been developed to ensure alignment of workforce
research activities conducted by NACCHO, ASTHO, and
others. These efforts can better ensure that the field is
provided data that adequately and accurately depict the
status of the public health workforce in each of the cross-
sectional surveys and the dynamic nature of that workforce,
measured consistently across serial surveys. In short, the field
has reached the required agreement on taxonomy!
There are two consistent supporters of this effort that
are worth singling out: CDC and the Robert Wood
Johnson Foundation (RWJF). Against often very frus-
trating bias against finding funds for such “administra-
tive” and definitely non–disease-specific efforts, CDC has
provided ongoing cooperative agreement funding for the
NACCHO and ASTHO profile surveys. The ongoing
advocacy for and support of the field of PHSSR, notably
the public health workforce research agenda,1 appears to
have provided the sustainable support required for
effective, reliable surveillance.
Likewise, RWJF has provided support for ASTHO and
NACCHO profile surveys since 2008, as well as the
Public Health Practice Based Research network, which is
a much-needed infrastructure of prepared minds to
harness the data generated by these ongoing workforce
surveillance efforts. RWJF has also supported the Public
Health Accreditation Board (PHAB), joining CDC in
building the expectation that the public health agencies
will be measured against an agreed-upon standard, which
requires their use of evidence-based approaches to
continuous quality improvement. As outlined in the
paper by Bender et al.,6 these standards appear in
 Tilson / Am J Prev Med 2014;47(5S3):S278–S279
PHAB’s workforce and infrastructure requirements
(Domains 8 and 11, respectively)7 and the expectation
that accreditation will always include focus on Domain
10, advancing the research efforts critical to continuous
improvement.
In the face of financial pressures to address the high
visibility and identify politically “sellable” efforts of
public health, the courage and vision of these strong
collaborators and supporters and the scholars committed
to understanding the workforce cannot be over-
recognized. Hence, it is all the more important to
celebrate this supplement issue of the American Journal
of Preventive Medicine for providing the opportunity to
demonstrate the return on this much-needed investment
in public health workforce research and the reliable
surveillance data upon which to base it!
It is wonderful to be able to “count” on such
leadership!
Publication of this article was supported by the U.S. Centers for
Disease Control and Prevention (CDC), an Agency of the
Department of Health and Human Services, under the
Cooperative Agreement with the Public Health Foundation
and University of Michigan Center of Excellence in Public
Health Workforce Studies (CDC RFA-OT13-1302). The ideas
expressed in the articles are those of the authors and do not
necessarily reflect the official position of CDC.
Dr. Tilson is National Association of County and City
Health Officials Past President, 1976–1978; and Member,
November 2014
S279
Association of State and Territorial Health Officials Alumni
(NC 1978–1981).
Dr. Tilson served as a senior advisor for public health
workforce to HRSA and a consultant to the National Associa-
tion for County and City Health Officials during the develop-
ment of this project.
No financial disclosures were reported by the author of
this paper.
References
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