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How to measure
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No licensure or job title readily defines the workforce. No pre-requisite educational degree to work in PH. Diverse training modalities exist for learning PH competencies, skills, and perspectives. Functional activities may not match training nor job title. Part time and full time roles, permanent and temporary roles vary in benefits and career advancement and measurement.
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Self-identification may over and undercount workforce. Individuals could self-identify as part of the PHW (or not) because of their activities or training or place or work (eg, at DOH).
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Where to measure
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The government sector is core but only part of the plausible PHW. Nonprofits and academia have longstanding PH roles. Newly emerging roles in clinical care and health insurance with a population health focus could be considered.
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Wide scope may make measurement too complex to be comprehensive. Narrow scope may miss workforce. How to decide what to include and who decides.
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Dynamic consideration
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The pandemic impacted the roles of increased need for, and loss of, governmental PH workers. COVID-19 resulted in creation of PH positions which were temporary and thus don’t represent sustained improvement. PHW must be elastic to respond to emergencies as well as responsive to changing long-term demographic and population health needs. Short term grant funding, in non-emergency times, often necessitates temporary or contracted PH workers. Intermittent grant funding is a long-standing feature of PH. Temporary workers are part of the baseline landscape of the PHW but vary and may be missed in PHW enumeration.
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Global considerations
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Federal, regional, and even international entities may be relevant in PHW enumeration. Strength of PH is in the scale, scope, and cross-sector, interdisciplinary approach to support population health. This complicates not only measurement but also advocacy and ownership of measurement.
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Who advocates for counting this workforce? Who defines the boundaries (government vs. academia vs other)? Complexity of blurry boundaries may complicate a distinct PH identity and reduce advocacy and funding.
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Hawai‘i considerations
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Calculators designed for local PH departments are not designed to be useful to centralized structures (like that of the Hawai‘i Department of Health).21,22 Behavioral health services fall under the umbrella of PH.
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Could try to modify output from calculators. Calculation data useful to prioritize hires. There is a complexity delineating clinical services in core PH, but it is important to understand this nuance.
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