Competency Gaps Among Governmental Public Health Employees With and Without a Certification in Public Health

Abstract

Objective:

The purpose of this study is to examine competency gaps among governmental public health workers with and without the Certified in Public Health (CPH) credential, specifically among the majority of the workforce without a formal public health degree.

Design:

This cross-sectional study uses 2021 Public Health Workforce Interests and Needs Survey (PH WINS) data. Multivariate logistic regressions of reported skill gaps were performed while controlling for gender, age, race/ethnicity, public health degree attainment, role type, current employer, and tenure in public health practice.

Setting:

A nationally representative sample of governmental public health employees.

Participants:

36 752 US governmental public health employees across local and state health agencies representing 47 states.

Main Outcome Measures:

Self-reported competency gaps.

Results:

Among nonsupervisors without a formal public health degree, those with a CPH had lower odds of reporting competency gaps in 3 of the 23 skills assessed compared to those without a CPH. Among supervisors/managers without a formal public health degree, those with a CPH had lower odds of reporting competency gaps in 6 of the 24 skills assessed compared to those without a CPH. Among executives without a formal public health degree, those with a CPH had no significant differences in reporting competency gaps in any of the 24 skills assessed compared to those without a CPH. When looking at the public health workforce as a whole, both with and without formal public health degrees, there were few significant competency gap differences between workers with and without the CPH.

Conclusions:

Having a CPH is associated with fewer self-reported competency gaps, specifically among the 85% of governmental public health employees without a public health degree. Thus, the CPH may be valuable to the sizable governmental public health workforce that does not have a formal education in public health. The CPH seems to be less impactful for executives compared to other supervisory levels.

Introduction

A competent public health workforce is an essential part of the public health infrastructure. In the workplace, competency commonly refers to the ability to proficiently perform job-related tasks.¹ In general, higher competency levels are typically expected among individuals with formal post-secondary education; however, only 15% of the public health workforce have either a bachelor’s or master’s degree in public health or a related field.^2–4 Given the generally low level of formal public health education within the governmental public health workforce, the Certified in Public Health (CPH) credential provides an opportunity to credential and validate workforce competencies.

The CPH credential was first introduced in 2008 through the work of the National Board of Public Health Examiners (NBPHE), with a goal of standardizing the skills across the workforce, enhancing the hiring standards for public health professionals, and improving salaries in the field of public health.⁵ The CPH exam was first administered to graduates of the Association of Schools and Programs of Public Health (ASPPH)-member schools in 2008 but has since been expanded to allow public health professionals with at least 5 years of experience to sit for the exam, regardless of whether they have a formal public health education.⁶ One potential outcome of the CPH credential is the reduction in core competency gaps within the public health workforce. The NBPHE developed the initial content for the CPH exam based on the Master of Public Health core competencies as outlined by ASPPH and later refined this content to model introductory-level core courses taught across various CEPH-accredited schools and programs of public health.⁷ However, to date, little empirical work has been published that examines outcomes associated with the CPH credential. Prior studies have examined who is taking it,^6,8 why they are taking it,^6,9 why they are not taking it,^5,6 and recertification metrics,^5,6 but studies examining the implications of the CPH are limited. While core competency gaps among individuals with formal, post-secondary public health training have been previously described,^4,10 no peer-reviewed studies have examined the relationship between a CPH credential and perceived competency gaps among the public health workforce. Therefore, it remains unknown whether having a CPH credential is associated with fewer competency gaps overall.^11–16 Furthermore, it may be valuable to know more about the competency gaps specifically among individuals without a formal public health education but who have a CPH credential, as the CPH may be associated with fewer skill gaps specifically for these individuals.

The purpose of this study is to examine core competency gaps among individuals in the governmental public health workforce with and without the CPH credential. Furthermore, this study will extend the literature by also examining competency gaps among those without a formal public health degree and the extent to which having a CPH mitigates any gaps. Findings from this work may provide insight for the NBPHE regarding gaps in skills and knowledge among individuals who are CPH credentialed. In addition, employers in public health agencies can use this information to inform hiring decisions and continuing education for their current workforce. Finally, this study will contribute to the ongoing discussion about ways to strengthen the role of the CPH for the public health workforce.

Methods

Data

PH WINS is a nationally representative survey of governmental public health workers in the US. PH WINS is conducted every 3 to 4 years providing longitudinal information about the public health workforce since 2014. It is administered and supported by the de Beaumont Foundation and the Association of State and Territorial Health Officials (ASTHO). Detailed survey design and sampling methods have been previously described by Robins et al.¹⁷ This study utilizes the 2021 iteration of the PH WINS survey and focuses on the questions related to self-reported training needs among governmental public health workers. Respondents were asked to rate their proficiency and the day-to-day importance of 23–24 public health skill items, specific to each supervisory level (eg nonsupervisor, supervisor/manager, or executive). These skills cover nine strategic skill domains that are considered critical to public health: effective communication; data-based decision making; justice, equity, diversity, and inclusion (JEDI); budget and financial management; change management, systems, and strategic thinking; community engagement; cross-sectoral partnerships; and policy engagement.

Inclusion/exclusion criteria

This study focused on full-time governmental public health workers whose job roles would require the use of public health core competencies/skills (eg epidemiologist, community health worker, health educator, etc.). Respondents who were part-time employees (n = 3464, 7.7%) and those who reported their job roles as “other” (n = 778, 1.7%), “custodial” (n = 49, 0.1%), “clerical” (n = 3564, 8.0%), or undefined (n = 125, 0.3%) were excluded from analyses.

Dependent variables

For each of the 23–24 public health skill items, respondents were asked to use a Likert scale to rate both their perception of the importance of the skill to their current position (“not important,” “somewhat unimportant,” “somewhat important,” or “very important”) and their perceived proficiency in that particular skill (“unable to perform,” “beginner,” “proficient,” “expert,” or “not applicable”). The specific questions about skills that were provided to respondents differed by supervisory status, with separate sets of questions asked of nonsupervisors, supervisors/managers, and executives. If the respondent perceived a skill to be “somewhat important” or “very important” to their current job and also reported they were “unable to perform” the skill or were at a “beginner” level of proficiency for that skill, this was considered a “skill gap” or competency gap. We created a binary indicator to identify public health workers’ skill gaps, similar to previously published methodology.^4,10

Independent variables

The main explanatory variable of interest in this study was a binary indicator of whether or not the respondent had a certificate in public health (yes or no).

Control variables

Control variables included a binary indicator of whether or not the individual had ever obtained a formal degree in public health (yes or no), role classification (administrative, public health sciences, clinical and laboratory, and social sciences/other), current employer (local or state government), tenure in public health practice (0–5, 6–15, 16 or more years), female (yes or no), race/ethnicity (white, black/African American, Hispanic/Latino, or other), and age (35 years and younger, 36–45 years, 46–55 years, 56 years or older).

Analysis

Unweighted and weighted descriptive statistics were calculated for all respondents included in this study. Bivariate relationships were analyzed by conducting χ² tests of public health workers’ self-reported skill gaps by respondents’ supervisory level. Next, we used multivariate logistic regression models to examine self-reported skill gaps for each supervisory group controlling for formal public health degree attainment, role type, current employer, and tenure in public health practice, which have historically been controlled for when examining skill gaps in the public health workforce.^4,10 We include gender, race/ethnicity, and age as control variables. We accounted for the complex sampling design of PH WINS by using the survey and balanced repeated replication weights provided by de Beaumont. Because of our study’s large number of comparisons, our α value of significance was adjusted according to the Bonferroni correction and set at .02 for all bivariate and multivariate analyses. Findings were considered marginally significant if P values were between .05 and .02. All data were analyzed using Stata, Version 18 (College Station, Texas).

Results

Demographics

In 2021, 36 752 individuals responded to the 2021 iteration of PH WINS, representing approximately 155 361 public health government workers. Demographic characteristics of this sample are displayed in Table 1. Approximately, 3% (n = 986) of respondents had a certificate in public health. The majority of respondents were nonsupervisors (n = 25 696; 69.9%), females (n = 27 875; 76.9%), white (n = 21 110; 59.0%), and did not have a formal degree in public health (n = 31 167; 84.8%). All age categories and tenure categories were represented equally. Table 2 displays bivariate analyses of demographic characteristics by supervisory status. An estimated 3% of nonsupervisors, 4% of supervisors/managers, and 6% of executives have certificates in public health.

TABLE 1.

Unweighted and Weighted Descriptive Statistics among Respondents to PHWINS

	2021
Characteristic	N (%)	Weighted N (%)
Total	36 752	155 361
PH Certificate
Yes	986 (3.3)	4 279 (3.4)
No	28 957 (96.7)	121 939 (96.6)
PH Degree
Yes	5585 (15.2)	25 044(16.1)
No	31 167 (84.8)	130 317 (83.9)
Supervisory Level
Nonsupervisor	25 696 (69.9)	107 852(69.4)
Supervisory/manager	10 074(27.4)	43 392 (27.9)
Executive	982 (2.7)	4117 (2.7)
Role
Administrative	7147 (19.6)	30 226 (19.6)
Clinical and laboratory	10 543 (29.0)	44 008 (28.6)
Public health services	17 748 (48.7)	75 390 (49.0)
Social services	986 (2.7)	4373 (2.8)
Current Employer
Local government	13 086 (37.0)	64 999 (43.6)
State government	22 262 (63.0)	84 081 (56.4)
Tenure in Public Health Practice
0–5 years	12 499 (35.6)	52 143 (35.2)
6–15 years	11 522 (32.9)	49 311 (33.3)
≥16 years	11 051 (31.5)	46 806 (31.6)
Gender
Female	27 875 (76.9)	117 967 (76.9)
Male/other	8383 (23.1)	35 436(23.1)
Race/ethnicity
White	21 110 (59.0)	82 631 (54.6)
Black/African American	4572(12.8)	22 109 (14.6)
Hispanic or LatinX	5843 (16.3)	26 480(17.5)
Other	4236 (11.9)	20 007 (13.2)
Age
<35 years	8618 (25.9)	35 941 (25.5)
36–45 years	8295 (24.9)	35 857 (25.5)
46–55 years	8435 (25.3)	35 744 (25.4)
≥56 years	7944 (23.9)	33 224 (23.6)

Source: Public Workforce Interests and Needs Survey, 2021.

Notes: Weighted using national survey weights provided by the de Beaumont Foundation. The full analytical sample size is 36 752 or 155 361 (weighted). The sample size of each characteristic represents just those respondents who answered the corresponding question.

TABLE 2.

Bivariate Relationship between Sample Characteristics and Supervisory Level (N = 155 361)^a,b

Characteristic	Nonsupervisor (n = 87 315; 69.4%) N (%)	Supervisor/Manager (n = 35 479; 27.9%) N (%)	Executive (n = 3426; 2.7%) N (%)	P
CPH Certificate				.01
Yes	2828 (3.2)	1243 (3.5)	202 (5.9)
No	84 487 (96.8)	34 236 (96.5)	3224 (94.1)
PH Degree				< .001*
Yes	14 672 (13.6)	9151 (21.1)	1224 (29.7)
No	93 184 (87.2)	34 238 (78.9)	2896 (70.3)
Role				< .001*
Administrative	21 282 (19.9)	7462 (17.3)	1483 (36.3)
Clinical and laboratory	33 574 (31.4)	10 072 (23.4)	360 (8.8)
Public health services	48 365 (45.3)	24 787 (57.5)	2235 (54.8)
Social services and other	3569 (3.3)	796 (1.8)	3 (0.1)
Current Employer				< .001*
Local government	44 192 (42.9)	18 633 (44.4)	2178 (54.0)
State government	58 857 (57.1)	23 365 (55.6)	1858 (46.0)
Tenure in Public Health Practice				< .001*
0–5 years	43 232 (42.3)	8326 (19.8)	590 (14.6)
6–15 years	32 878 (32.2)	15 278 (36.3)	1155 (28.6)
≥16 years	25 997 (25.5)	18 516 (44.0)	2292 (56.8)
Gender				< .001*
Female	82 786 (77.8)	32 487 (75.6)	2695 (66.1)
Male/other	23 594 (22.2)	10 460 (24.4)	1384 (33.9)
Race/Ethnicity				< .001*
White	54 528 (52.0)	25 432 (60.2)	2671 (66.5)
Black/African American	15 697 (15.0)	6018 (14.2)	399 (9.9)
Hispanic/Latino	19 981 (19.0)	5985 (14.2)	516 (12.8)
Other	14 743 (14.0)	4836 (11.4)	430 (10.7)
Age				< .001*
<35	29 411 (30.2)	6295 (15.9)	242 (6.4)
36–45	23 586 (24.2)	11 305 (28.6)	966 (25.7)
46–55	22 410 (23.0)	12 011 (30.4)	1331 (35.5)
≥56	22 086 (22.7)	9929 (25.1)	1214 (32.4)

^aDifferences by supervisory level were calculated using χ² tests.

^bPublic Health Workforce Interests and Needs Survey, 2021.

^*Significance (P ≤ .05).

Notes: Weighted using national survey weights provided by the de Beaumont Foundation.

Key findings (Respondents without a formal public health degree)

Among nonsupervisor respondents without a formal PH degree, those with a CPH had significantly lower odds of reporting a competency gap in 1 of the 23 assessed skills and marginally significant lower odds of reporting a competency gap for 2 additional skills compared to those without a CPH (see Table 3). Specifically, nonsupervisors with a CPH were significantly less likely to report a skill gap in identifying “evidence-based approaches to address public health issues” (AOR = 0.68, 95% CI = 0.51–0.92, P = .01; Domain: Data-Based Decision-Making) compared to those without a CPH. They also had marginally significant lower odds of reporting a skill gap in 1) describing “the importance of engaging community members in the design and implementation of programs to improve health in a community” (AOR = 0.78, 95% CI = 0.62–0.98, P = .03; Domain: Community Engagement) and 2) collaborating “with public health personnel across the agency to improve the health of the community” (AOR = 0.74, 95% CI = 0.58–0.95, P = .02; Domain: Cross-Sectoral Partnerships) compared to their counterparts without a CPH.

TABLE 3.

Multivariate Analysis of Reported Skill Gaps among Nonsupervisor Level Respondents With/Without a Certificate in Public Health (CPH) but No Formal Public Health Degree in 2021^a,b

	2021 PHWins
Focus Area – Skill Gap	AOR	CI	p-valuec
Effective communication
Communicate in a way that different audiences can understand	1.09	0.78–1.51	.62
Communicate in a way that persuades others to act	1.03	0.72–1.47	.86
Data-based decision-making
Identify appropriate sources of data and information to assess the health of a community	0.80	0.57–1.14	.21
Collect valid data for use in decision-making	1.05	0.72–1.54	.79
Identify evidence-based approaches to address public health issues	0.68	0.51–0.92	.01d
JEDI
Describe the value of a diverse public health workforce	0.78	0.54–1.12	.17
Support inclusion of health equity and social justice principles into planning for program and service delivery	0.82	0.59–1.14	.23
Deliver socially, culturally, and linguistically appropriate programs and customer service	0.98	0.74–1.30	.88
Budgeting and financial management
Describe financial analysis methods applicable to program and service delivery	1.14	0.83–1.58	.41
Describe how public health funding mechanisms support agency programs and services	1.04	0.79–1.38	.76
Describe the value of an agency business plan	0.99	0.71–1.39	.95
Change management
Describe the influence of internal changes on organizational practices	1.17	0.95–1.46	.14
Assess the external drivers in your environment that may influence your work	1.01	0.84–1.21	.95
Systems and Strategic Thinking
Describe how social determinants of health impact the health of individuals, families, and the overall community	0.98	0.76–1.27	.89
Participate in quality improvement processes	0.90	0.72–1.13	.35
Describe your agency’s strategic priorities, mission, and vision	0.92	0.70–1.21	.55
Community Engagement
Describe the value of community strategic planning that results in a community health assessment or community health improvement plan	0.90	0.70–1.16	.40
Describe the importance of engaging community members in the design and implementation of programs to improve health in a community	0.78	0.62–0.98	.03e
Describe your role in improving the health of the community served by the agency	0.82	0.56–1.19	.28
Cross-Sectoral Partnerships
Engage community assets and resources to improve health in a community	0.85	0.62–1.15	.27
Collaborate with public health personnel across the agency to improve the health of the community	0.74	0.58–0.95	.02e
Policy Engagement
Describe the relationship between a policy and many types of public health problems	1.05	0.87–1.27	.59
Collect and summarize information to inform the development of policies external to the organization that affect the health of the community	1.81	0.74–1.59	.68

Abbreviations: AOR, adjusted odds ratio; CI, confidence interval.

Notes: Weighted using national survey weights provided by the de Beaumont Foundation.

^aData source: Public Workforce Interests and Needs Survey, 2021.

^bResults are individual logistic regressions for each skill gap, holding constant gender, race/ethnicity, age, education level, employer, role type, and tenure in public health practice.

^cBonferroni correction adjustment (significance level set at P ≤ .02).

^dSignificance (P ≤ .02).

^eMarginal significance (P ≤ .05).

Among supervisor/manager respondents with no formal PH degree, those with a CPH had significantly lower odds of reporting a competency gap in 1 of the 24 skills assessed and marginally significantly lower odds of reporting a competency gap for five additional skills compared to their counterparts without a CPH (see Table 4). Specifically, supervisors/managers with a CPH were significantly less likely to report a skill gap in identifying and assessing “options for policies external to the organization that affect the health of the community” (AOR = 0.43, 95% CI = 0.26–0.73, P = < .01; Domain: Policy Engagement). Marginally significant lower odds of reporting skill gaps were observed among supervisors/managers with a CPH compared with their counterparts without a CPH in the following areas: (1) “examine the feasibility of a policy and its relationship to many types of public health problems” (AOR = 0.60, 95% CI = 0.37–0.98, P = .04; Domain: Policy Engagement), (2) “implement an organizational strategic plan” (AOR = 0.66, 95% CI = 0.45–0.96, P = .03; Domain: Systems and Strategic Thinking), (3) “build cross-sector partnerships to address social determinants of health” (AOR = 0.49, 95% CI = 0.25–0.95, P = .04; Domain: Systems and Strategic Thinking), (4) “incorporate health equity and social justice principles into planning for programs and services” (AOR = 0.58, 95% CI = 0.36–0.94, P = .03; Domain: JEDI), and (5) “identify appropriate sources of data and information to assess the health of a community” (AOR = 0.49, 95% CI = 0.25–0.97, P = .04; Domain: Data-Based Decision-Making).

TABLE 4.

Multivariate Analysis of Reported Skill Gaps among Supervisor/Manager Level Respondents with/without a Certificate in Pubic Health (CPH) but No Formal Public Health Degree in 2021^a,b

	2021 PHWins
Focus Area – Skill Gap	AOR	CI	p-valuec
Effective Communication
Communicate in a way that different audiences can understand	0.40	0.13–1.26	.11
Communicate in a way that persuades others to act	0.66	0.33–1.31	.23
Data-Based Decision-Making
Identify appropriate sources of data and information to assess the health of a community	0.49	0.25–0.98	.04e
Use valid data to drive decision making	0.67	0.35–1.29	.23
Apply evidence-based approaches to address public health issues	0.87	0.51–1.48	.59
JEDI
Support development of a diverse public health workforce	0.71	0.32–1.59	.40
Incorporate health equity and social justice principles into planning for programs and services	0.58	0.36–0.94	.03e
Implement socially, culturally, and linguistically appropriate policies, programs, and services that reflect the diversity of individuals and populations in a community	0.65	0.37–1.16	.14
Budgeting and Financial Management
Use financial analysis methods in managing programs and services	0.78	0.32–1.92	.58
Identify funding mechanisms and procedures to develop sustainable funding models for programs and services	0.96	0.57–1.61	.88
Implement a business plan for agency programs and services	0.68	0.38–1.19	.17
Change Management
Modify programmatic practices in consideration of internal and external changes	0.80	0.40–1.61	.53
Assess the drivers of your environment that may influence public health programs and services	0.67	0.41–1.08	.10
Systems and Strategic Thinking
Integrate current and projected trends into strategic planning for programs and services	0.85	0.51–1.43	.54
Build cross-sector partnerships to address social determinants of health	0.49	0.25–0.95	.04e
Apply quality improvement processes to improve agency programs and services	0.89	0.49–1.61	.69
Implement an organizational strategic plan	0.66	0.45–0.96	.03e
Community Engagement
Apply findings from a community health assessment or community health improvement plan to agency programs and services	0.99	0.61–1.61	.98
Engage community members in the design and implementation of programs to improve health in a community	1.06	0.54–2.07	.87
Assess how agency policies, programs, and services advance population health	0.83	0.47–1.45	.50
Cross-Sectoral Partnerships
Identify and engage assets and resources that can be used to improve health in a community	0.68	0.37–1.24	.20
Engage in collaboration within the public health system, including traditional and nontraditional partners to improve the health of a community	0.82	0.46–1.46	.48
Policy Engagement
Examine the feasibility of a policy and its relationship to many types of public health problems	0.60	0.37–0.98	.04e
Identify and assess options for policies external to the organization that affect the health of the community	0.43	0.26–0.73	<.01d

Abbreviations: AOR, adjusted odds ratio; CI, confidence interval.

Notes: Weighted using national survey weights provided by the de Beaumont Foundation.

^aData source: Public Workforce Interests and Needs Survey, 2021.

^bResults are individual logistic regressions for each skill gap, holding constant gender, race/ethnicity, age, education level, employer, role type, and tenure in public health practice.

^cBonferroni correction adjustment (significance level set at P ≤ .02).

^dSignificance (P ≤ .02).

^eMarginal significance (P ≤ .05).

Among executive respondents without a PH degree, those with a CPH had no significant differences in reporting a competency gap in any of the 24 skills assessed compared to those without a CPH (see Table 5).

TABLE 5.

Multivariate Analysis of Reported Skill Gaps among Executive Level Respondents With/Without a Certificate in Public Health (CPH) but No Formal Public Health Degree in 2021^a,b

	2021 PHWins
Focus Area – Skill Gap	AOR	CI	p-valuec
Effective Communication
Communicate in a way that different audiences can understand	1.04	0.44–2.44	.92
Communicate in a way that persuades others to act	1.86	0.31–11.07	.43
Data-Based Decision-Making
Ensure the use of appropriate sources of data and information to assess the health of a community	1.26	0.31–5.04	.74
Use valid data to drive decision making	0.85	0.26–2.83	.73
Ensure the application of evidence-based approaches to address public health issues	1.45	0.62–3.41	.38
JEDI
Develop a diverse public health workforce	0.38	0.06–2.43	.30
Incorporate health equity and social justice principles into across the agency	0.84	0.22–3.22	.79
Ensure the implementation of socially, culturally, and linguistically appropriate policies, programs, and services that reflect the diversity of individuals and populations in a community	0.61	0.08–4.55	.62
Budgeting and Financial Management
Use financial analysis methods in making decisions about programs and services across the agency	0.84	0.10–6.94	.86
Leverage funding mechanisms and procedures to develop sustainable funding models for the agency	0.78	0.11–5.54	.80
Design a business plan for the agency	0.99	0.24–4.01	.99
Change Management
Manage organizational change in response to evolving internal and external circumstances	0.70	0.16–3.07	.63
Assess the drivers of your environment that may influence public health programs and services across the agency	1.64	0.31–8.58	.55
Systems and Strategic Thinking
Integrate current and projected trends into organizational strategic planning	0.64	0.15–2.77	.54
Influence policies external to the organization that address social determinants of health	1.62	0.45–5.77	.45
Create a culture of quality improvement at the agency or division level	0.59	0.14–2.53	.47
Ensure the successful implementation of an organizational strategic plan	0.69	0.22–2.16	.51
Community Engagement
Ensure health department representation in a collaboration process resulting in a community health assessment or community health improvement plan	0.78	0.17–3.68	.76
Ensure community member engagement in the design and implementation of programs to improve health in a community	0.74	0.19–2.90	.66
Advocate for needed population health services and programs	1.76	0.39–8.04	.46
Cross-Sectoral Partnerships
Negotiate with multiple partners for the use of assets and resources to improve health in a community	0.78	0.10–5.90	.80
Build collaborations within the public health system among traditional and nontraditional partners to improve the health of a community	0.82	0.31–1.97	.46
Policy Engagement
Determine the feasibility of a policy and its relationship to many types of public health problems	0.71	0.22–2.29	.55
Prioritize and influence policies external to the organization that affect the health of the community	0.60	0.17–2.16	.42

Abbreviations: AOR, adjusted odds ratio; CI, confidence interval.

Notes: Weighted using national survey weights provided by the de Beaumont Foundation.

^aData source: Public Workforce Interests and Needs Survey, 2021.

^bResults are individual logistic regressions for each skill gap, holding constant gender, race/ethnicity, age, education level, employer, role type, and tenure in public health practice.

^cBonferroni correction adjustment (significance level set at P ≤ .02).

^dSignificance (P ≤ .02).

^eMarginal significance (P ≤ .05).

Secondary findings (all respondents regardless of public health degree status)

Among all nonsupervisor respondents, both with and without a formal public health degree, those with a CPH had no significant differences in reporting a competency gap in any of the 23 skills assessed compared to those without a CPH (see Supplemental Digital Content, Appendix 1, available at http://links.lww.com/JPHMP/B544).

Among all supervisor/manager respondents, both with and without a formal public health degree, those with a CPH had significantly lower odds of reporting a competency gap in 1 of the 24 skills assessed compared to those without a CPH (see Supplemental Digital Content, Appendix 2, available at http://links.lww.com/JPHMP/B544). Supervisors/Managers with a CPH were significantly less likely to report a skill gap in identifying “appropriate sources of data and information to assess the health of a community” (AOR = 0.58, 95% CI = 0.38–0.81, P = < .01; Domain: Data-Based Decision Making) compared to those without a CPH.

Among all executive respondents, both with and without a formal public health degree, those with a CPH had significantly lower odds of reporting a competency gap in 1 of the 24 skills assessed and marginally significantly lower odds of reporting a competency gap in one additional skill compared to those without a CPH (see Supplemental Digital Content, Appendix 3, available at http://links.lww.com/JPHMP/B544). Executives with a CPH were significantly less likely to report a skill gap in ensuring “the application of evidence-based approaches to address public health issues” (AOR = 0.12, 95% CI = 0.05–0.27, P − = < .001; Domain: Data-Based Decision Making) and marginally significantly less likely to report a skill gap in communicating “in a way that different audiences can understand” (AOR = 0.26, 95% CI = 0.08–0.88, P = .03; Domain: Effective Communication) compared to executives without a CPH.

Discussion

A competent public health workforce is a crucial part of the public health infrastructure. Typically, individuals with formal post-secondary education are expected to exhibit higher levels of competency within their respective fields. However, within the US governmental public health workforce, formal public health degrees are only held by approximately 15% of the workforce.^2–4 Given the small proportion of employees with formal public health training in the governmental public health workforce, the CPH credential offers a valuable opportunity to recognize and validate workforce competencies. This study examined competency gaps among individuals in the governmental public health workforce with and without the CPH credential, specifically examining gaps among those without a formal public health degree to explore whether having a CPH relates to bridging any gaps.

Overall, findings suggest that the CPH is not closing competency gaps beyond what a public health degree already offers in training the workforce.^4,10 However, among those without a public health degree, which is 85% of the workforce, the CPH appears to be beneficial in terms of reducing self-reported competency skill gaps. Since the CPH exam was modeled after courses taught in CEPH-accredited schools and programs, when public health employees with no formal education in public health attain a CPH credential, they are showing that they have mastered some of the material commonly taught across public health programs.⁷ Thus, the uptake and maintenance of the CPH offers measurable value for the sizable governmental public health workforce that does not have a formal education in public health.

Supporting the CPH certification and the associated processes and ongoing credentialing may be meaningful for employers and employees in terms of reducing competency gaps. While many governmental agencies have tuition remission benefits for formal degree programs, providing support toward CPH certification costs and continuing education for maintaining the CPH may be valuable. Given that the cost of the CPH exam has been cited as a barrier to the uptake and maintenance of the CPH, employers could also consider covering initial exam costs and the biennial recertification fee as a means to strengthen and maintain the skills of their workforce.⁶

While the CPH was primarily beneficial for those without a public health degree, we did observe an associated benefit of the CPH among executives with and without a public health degree. Specifically, we observed a lower likelihood of executives reporting competency gaps in effective communication, a key workforce skill domain. Executives with a CPH were less likely to report a competency gap in the skill: “communicate in a way that different audiences can understand,” an area of historical gaps among those with a public health degree and one that was crucial for leaders during the COVID-19 pandemic.^4,10 This finding suggests that executives with a CPH perceive themselves as more equipped to communicate in ways that foster stronger stakeholder engagement. By enhancing their ability to adapt messages to different cultural, educational, and professional contexts, CPH-certified leaders may be able to bridge the divide between technical knowledge and the understanding of public health practices and initiatives among key stakeholders.

The CPH credential and public health degrees provide opportunities to gain and validate the skills necessary for job-related tasks in public health. However, findings from this study suggest that there are competency gaps that continue to persist even among individuals with these credentials. Regardless of supervisory level, CPH, or public health degree, governmental public health employees are equally as likely to report a skill gap in “delivering/implementing socially, culturally, and linguistically appropriate programs and customer service” within the JEDI domain.^4,10 Furthermore, nonsupervisors and supervisors/managers are equally as likely to report a skill gap in “describing/using financial analysis methods applicable to program and service delivery” within the budgeting and financial management domain, regardless of whether they have any formal public health education or a CPH.^4,10 Thus, the NBPHE and ASPPH should consider ways to continue strengthening these areas as they update competency frameworks within the CPH and provide guidance for public health degrees. Addressing these gaps through enhanced trainings and educational content can help ensure that public health professionals are better equipped to meet the demands of their roles.

While having the CPH credential was associated with a lower likelihood of competency gaps, it is unclear whether this certification has long-term benefits for public health professionals. Future research should examine CPH timing (eg initial certification and length of certification maintenance) and whether obtaining the CPH once is sufficient or if maintaining the certification provides added value. Several factors may be hindering CPH recertification among public health professionals. Notably, there is a lack of evidence that the CPH credential factors into hiring or salary decisions in both private and public settings.⁵ Furthermore, recertification requires an additional fee and continuing education requirements. Incentivizing recertification may be hampered if individuals do not personally recognize the benefits and when the evidence regarding benefits is limited. Examining whether there is personal and workforce training value in maintaining the CPH credential is needed to inform both employers and employees as they make decisions on expanding competency skill sets.

Strengths and limitations

This study has several strengths and weaknesses worth noting. First, this is the first study to examine competency gaps among governmental public health employees with and without a CPH. It draws on a nationally representative national sample of public health employees from large and mid-sized governmental agencies at both the state and local levels, providing new insights that may inform workforce development by the NBPHE and public health. However, some limitations should be noted. Given that all data were self-reported, respondents may have exhibited social desirability bias in over-reporting their perceived “good behaviour” (eg, skills) or under-reporting their “bad behaviour” (eg, skill gaps). Additionally, we were unable to account for any other professional or public health training outside of CPH or public health degree attainment, which may confound observed associations. The small proportion of respondents who reported holding a CPH (3%) also reduces the statistical power to detect meaningful differences and may result in less stable estimates. To improve the accuracy of standard errors and confidence intervals, we applied balanced repeated replication weights, which account for the complex survey design and the variability associated with rare outcomes. While this method does not correct for the potential underestimation of predicted probabilities associated with holding a CPH, it enhances the representativeness and reliability of the estimates. Still, findings should be interpreted with caution. Furthermore, given the number of comparisons in our analysis, we may have identified false relationships between having a CPH and reporting skill gaps. To mitigate this risk, we applied a more conservative significance level using the Bonferroni correction. Finally, while this cross-sectional study provides new insights, we are unable to establish causal relationships between the CPH and self-reported skill gaps among governmental public health workers.

Conclusion

Using 2021 PH WINS data, we found that having a CPH was associated with fewer competency gaps, particularly among public health workers without a formal public health degree which is 85% of the workforce. As more data on the US public health workforce is collected and educational objectives are updated, longitudinal analysis should continue to evaluate how these competency gaps change over time. Future research should explore the relationship between maintaining the CPH and competency gaps over time.

Supplementary Material

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal’s Website (http://www.JPHMP.com).

Implications for Policy & Practice.

• Governmental employers should consider supporting CPH certification for their employees as there is an association with fewer competency gaps, particularly among their employees without a formal degree in public health.

• Findings suggest that NBPHE and ASPPH should prioritize ways to ensure skill development in describing/using financial analysis methods applicable to program and service delivery and delivering/implementing socially, culturally, and linguistically appropriate programs and customer service to reduce competency gaps among all supervisory levels.