Building an Effective Workforce

This systematic literature review reveals most articles regarding the public health workforce are descriptive; there are few empirical studies. But health reform, through provisions to increase the public health workforce and strengthen quality measurement, may provide opportunities to improve research.

This systematic review, one of several commissioned by the Robert Wood Johnson Foundation on public health services and systems research (PHSSR), encompasses articles from 1985–2010 concerning “people who provide essential public health services” in the United States. Specifically, this review includes 126 articles identified through PubMed, Google, and Web of Science, and related to the themes of workforce size and composition; workforce effectiveness and health impact; demand for public health workforce; and public health workforce policy. (A companion review covers the themes of diversity; recruitment, retention, separation and retirement; education, training, and credentialing; and pay, promotion, performance, and job satisfaction.)

Key Findings:

  • There were few evidence-based findings. Only one-quarter of the articles were based on research studies—the balance described aspects of the workforce—but nearly all data analysis was limited to descriptive statistics.
  • Nearly half of the peer reviewed articles came from the same journal, and nearly one-third of all references in the literature arise from non-peer reviewed technical reports.
  • Fewer than five of the articles mentioned any theory, despite the fact that organizational and systems theories, as well as workforce and capacity studies in medicine and nursing, are all relevant.

While acknowledging the historical lack of reliable funding, the authors note the “general paucity” of research on the public health workforce, which, as public health leaders have repeatedly stated, is the “backbone” of the public health system. The authors hope that health care reform, with its focus on increasing this workforce and measuring care quality, may provide better funding, but also better opportunities for data collection. They hope this will improve academic interest in and respect for PHSSR, and thus attract more researchers.