Do public health professionals want to fill their skills gaps? It depends on job level

Public health professionals are expected to engage in training to address skills gaps in key areas of public health, but among professionals in non-managerial positions skills gaps are often expected disinterestedness in advanced training.

Experts agree that competence in several core areas (analysis, leadership, communication, etc.) is desirable for public health professionals. Nevertheless, research indicates that the majority lack this skill. Why? Limited access to training does not explain it. Free training in key areas of public health is widely available. Many organizations produce them, including 10 federally funded training centers, which I work for. Therefore, other factors seem to be at play. With this in mind, I examined whether a known professional skill model in organizational psychology could be one of these factors.

Organizational psychology studies report that broad skill sets often matter primarily to higher-level employees. This stems from the fact that higher level roles in an organization often require performing a multiplicity of tasks. One might therefore expect that senior public health employees would want to acquire skills in a range of public health areas.

In contrast, lower-level employees often specialize. Lower-level public health professionals, the bulk of the public health workforce, tend to specialize as data analysts, epidemiologists, nurses, safety inspectors, etc. Therefore, they might have a limited interest in acquiring skills in several areas.


To examine this proposition, I used data from a survey of training preferences and domain competencies of professionals from 14 public health departments/organizations in the Southwestern United States: senior managers (n = 69), middle managers (n = 332) and non-managers (n = 790). Support staff (receptionists, secretaries, drivers, etc.) were not included. Respondents were given a skills assessment questionnaire that asked them to rate their skills on each of over 70 elements in 8 core areas of public health (financial planning and management, analysis/evaluation, communication, cultural competence, leadership/systems thinking, policy development/program planning, public health sciences and community dimensions of practice). Respondents were also asked if they would like training on 25 topics related to the field (budgeting, program evaluation, community evaluation, systems thinking, etc.). I examined the association of competence in core areas overall with the number of desired training topics. I also compared competence in individual core areas with desire for specific related training topics.


Overall competence and number of training topics desired

As can be seen in the figure below, senior managers who did not have overall competence in the 8 key areas strongly wanted After training subjects than their competent counterparts (median of 12 subjects vs 5, P = .02). But non-managers who lacked overall competence in the 8 desired areas less of subjects than their competent counterparts (4 vs 6, P .001) – the opposite of senior executives. For middle managers, a statistically significant association between lack of overall competence and interest in the number of training topics was not found.

Figure. Overall competence and median number of training topics desired by public health professionals: senior managers, middle managers and non-managers

Individual areas and specific training topics

The study results for competence in individual domains (for example, the association of competence in the domain of financial planning and management with the desire for training in the domain of budgeting) mirrored those of the figure. Senior managers with lower skills in an individual domain often had significantly higher odds of desiring domain-related training. The opposite was observed for non-executives. And little association was indicated for middle managers.


The results are consistent with the organizational psychology-based proposition discussed above. However, other factors could help explain why senior managers were the only group for which skills gaps predicted the desire for training. For example, senior managers may be more aware of the oft-repeated message that competence in multiple areas is needed. They might also be motivated to set an example for their employees.


There appears to be a need for efforts to synchronize public health employees with the idea that competence is needed across a range of domains. Or maybe we need to reconsider this view of competence.

Efforts to get more employees in sync with the idea of ​​competence in a range of areas could include:

  • enhanced information campaigns to better educate the workforce
  • workplace skill requirements
  • accreditation/certification programs for employees
  • tax rewards for improving employee skills
  • public health service accreditation programs that help motivate interest in employee skills.

Alternatively, perhaps we should move away from the idea that public health professionals generally need skills in a range of domains (e.g. the 8 domains used in this study, all recommended by the Council on Linkages ). It might be more useful to focus on the relative importance of domains to a professional’s work.

For example, finance professionals in a public health service might be encouraged to have skills in the area of ​​financial planning and management first. Then, skills acquisition in other selected areas (eg, leadership/systems thinking and policy development/program planning) could be planned in order of importance. And some areas (eg, public health sciences) might be considered of limited relevance. Such an adaptation would likely seem more intuitive and feasible to many public health professionals and their supervisors.

In line with this, competency assessment surveys could use assessments specific to an employee’s role: epidemiological competency assessments for epidemiologists, nursing competency assessments for nurses, etc. Such assessments would likely be more sensitive to the evolution of an employee’s skills and therefore could better position public health departments to show growth in the skills of their workforce. If necessary, some general public health competency assessment items could be included to complement the surveys.

Public health competency recommendations and course development typically come from experts, often from expert panels – a top-down approach. This study looked at employee skills and training interests to help inform these recommendations – a more bottom-up approach. In doing so, it provides new insights into the relationship between competence and training interests in public health services, insights that raise questions about decades-old recommendations regarding competence and training.

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James K. Cunningham

James K. Cunningham, PhD, conducts research on health-related systems, policies, and workforce development. He has worked as a non-manager and manager in public health agencies. He is a faculty member of the University of Arizona College of Medicine and College of Public Health and directs the evaluation services of the Western Region Public Health Training Center.

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