Professionalization of the public health workforce: scoping review and call to action

Abstract

Background

The ‘WHO-ASPHER Roadmap to Professionalizing the Public Health Workforce in the European Region’ provides recommendations for strategic and systematic workforce planning around professionalization levers including: (i) competencies, (ii) training and education, (iii) formal organization, (iv) professional credentialing and (v) code of ethics and professional conduct as well as taxonomy and enumeration. It was based on a literature review till 2016. This scoping review aims to explore how the professionalization was documented in the literature between 2016 and 2022.

Methods

Following the Joanna Briggs Institute guidelines, we searched Medline via PubMed, Web of Science, ERIC via EBSCO and Google Scholar and included studies on professionalization levers. Four critical appraisal tools were used to assess qualitative, quantitative, mixed methods studies and grey literature. The PRISMA Extension for Scoping Reviews (PRISMA-ScR) was used for reporting.

Results

Eleven articles included in this review spanned 61 countries, targeting undergraduate, master’s, doctoral degrees and continuing professional development. Most of these documents were reviews. About half provided a definition of the public health workforce; more than half covered the taxonomy and included information about competences, but the use of frameworks was sporadic and inconsistent. Formal organization and the necessity of a code of conduct for the public health workforce were acknowledged in only two studies.

Conclusions

In spite of some efforts to professionalize the public health workforce, this process is fragmented and not fully recognized and supported. There is an urgent need to engage policymakers and stakeholders to prioritize investments in strengthening the public health workforce worldwide.

Introduction

The ‘WHO-ASPHER Roadmap to Professionalizing the Public Health Workforce (PHW) in the European Region’ was published in 2022, delivering recommendations for a range of stakeholders, including governments, ministries, health authorities at all levels, public health training institutions, professional organizations and employers.¹ These recommendations are relevant for strategic and systematic workforce planning and are encapsulated in a conceptual model in line with definitions of professionalization as a social process with a set of qualifications (and therefore an education and training structure), a professional organization, professional standards and competencies, accredited training pathways and professional registration. The model outlines the levers and measures of professionalization including: (i) competencies, (ii) training and education, (iii) formal organization, (iv) professional credentialing and (v) code of ethics and professional conduct¹ [p. 17] (table 1).

Table 1.

Glossary of concepts including professionalization levers according to the WHO-ASPHER Road Map to Professionalization of the Public Health Workforce in the European Region

No.	Key terms	Definitions	References
1	Code of ethics and professional conduct	A document offering guidance on the moral norms and values considered relevant to guide the conduct of the members of a profession. A code of ethics and professional conduct can also function as a policy document, a decision aid and aide memoire or as a foundation for disciplinary measures within (including exclusion from) a professional association or professional body	1 [p. 61]
2	Competencies	Individual attributes (knowledge, skills and attitudinal or personal aspects) that represent context-bound productivity and are important for defining the role a person plays within an organization or system	1 [p. 61]
3	Credentialing for public health professionals	The process of obtaining, verifying and assessing the qualifications of public health professionals to provide services or operations for a public health organization or system; credentials constitute documented evidence of education or training, certification or licensure and experience	1 [p. 61]
4	Professionalization	The necessary steps needed to professionalize the core public health workforce in a given country. The visualization of the Roadmap incorporates: (i) four considerations, including leadership, country context, stakeholders and intersectorality of public health, including core and wider public health workforce and other health related professions; (ii) the conceptual model, which constitutes the core of the Roadmap and presents necessary levers that inform measures of professionalization and linking them with three governance levels responsible for the implementation process: government and policy, organizations and institutions and professions; and (iii) the country assessment tool, which establishes a logical and practical approach, including major questions countries should ask when undergoing the assessment leading to the professionalization of the public health workforce, including ‘why’, ‘what’ and ‘how’	1 [p. 14]
5	Public health professionals	Individuals trained and working in providing public health services and operations, most typically as employees of a public health organization. Ideally, they should be designated a set of activities reserved under provision of an agreement based on education and training prerequisites or the equivalent.	1 [p. 62]
6	Public health training	traditional education and training of public health degree programmes (such as doctorate, master and specialty training for physicians) as well as continuing professional development, public health courses within other specialty degree programmes (such as nursing, pharmacy, law, journalism and architecture) and short courses for professionals working in all fields that affect the health of the population.	1 [p. 62]
7	Public health workforce	Individuals engaged in providing public health services and operations who identify public health as being the primary part of their role (core public health workforce) but also those who contribute to public health only as part of their job as well as other individuals whose work can improve population health (wider public health workforce)	1 [p. 62]
8	Taxonomy	A standardized method for classifying public health workers, enabling valid comparisons across agencies and institutions and within a given organization and over time.	1 [p. 63]
9	Workforce planning	Identifies and analyses what an organization is going to need in terms of the size, type and quality of workforce to achieve its objectives. It determines what mix of experience, knowledge and skills is required and sequences steps to get the right number of right people in the right place at the right time.	1 [p. 63]

One of the measures is the PHW taxonomy, which enumerates the size and type of the workforce and facilitates comparisons within and between countries. Brown and Roddy² proposed six guiding principles for PHW development in USA in 2001. These encompass competencies, education, training, credentialing and certification. They introduced the concept of PHW enumeration, a prerequisite for analysing the composition and distribution of this workforce. In 2004, Tilson and Gebbie³ declared that the development of a ‘fully competent PHW is a key component of the nation’s public health infrastructure and should become a focus of increasing attention’. They recognized the challenges facing public health, which align with those outlined in the WHO-ASPHER Roadmap, including:

• Defining, classifying and enumerating existing and needed workforce;

• understanding required competencies and specifying those competencies;

• building programs to use these competencies to train the workforce;

• documenting and assuring the competency of the workforce through efforts at formal credentialing; and

• grappling with the enormous legacy of neglect in conducting formal public health systems research including workforce research, sorely needed to advance the evidence base upon which policy in building the PHW must rest’.³ [p. 342]

In 2006, Gebbie and Turnock⁴ called for addressing health necessities in USA by organizing workforce development around competencies including core competencies, competency-based, training, credentialing and accrediting public health agencies. In 2014, Drehobl presented two visual tools to promote a system-based approach to face PHW challenges.⁵ The first, a fishbone diagram, shed light on the factors affecting the PHW, such as workforce composition, numbers and competences. The second tool, a strategic PHW roadmap, was designed around four goals: (i) enhancing the educational system at various levels, (ii) amplifying the capabilities of the existing workforce, (iii) refining pathways for public health careers and (iv) bolstering systems and organizational capacity to support the workforce. These ambitious goals were backed by 16 specific strategies. For instance, to attain the first goal, the roadmap suggests influencing decision-making boards, introducing certifications and promoting the licensure of individuals and accreditation of educational institutions. To realize the second goal, it recommends defining target skills and competencies across different disciplines. As for the final goal, it proposes a strategy that involves specifying the numbers and types of workers needed.

The recent work by Leider provides the methodology to develop the Public Health Workforce Interests and Need Survey (PH WINS),⁶ conducted in 2014, 2017 and 2021 in USA.⁷ In 2021, PH WINS surveyed 44 732 from 137 447 individuals working in the governmental public health departments, and gathered information about their training needs and demographics.⁷ Training needs included strategic skills such as effective communication, systems and strategic thinking, change management and policy engagement.⁸ The demographic questions asked to ‘indicate which degrees you have attained’ or ‘indicate which credentials you have attained’.⁹

The findings and recommendations included in the WHO-ASPHER Road Map resonate with the previous work in the field. The roadmap was supported by an extensive literature review until 30 October 2016 under the initiative of the WHO Coalition of Partners to support the transformation of public health systems.^1,10 Since then, the PHW has faced tremendous pressure stemming from the highly politicized and polarized COVID-19 response, profound challenges of natural disasters, growing health inequalities and other health emergencies. These factors were adding up to an already stressed and chronically underfunded workforce¹¹ causing an exodus and massive resignations. Therefore, there is a need to find out what has been done to support and develop the PHW after the publication of the WHO-ASPHER Road Map. This scoping review explores how the professionalization of the PHW has been documented in the literature between 2016 and 2022 and critically discusses the need for action, including attention to new competences.

Methods

The review followed the Joanna Briggs Institute guidelines¹² including:

1. Identifying the research question: which was based on the population, concept and context (PCC) where the PHW is the population, professionalization is a concept, and public health is a context.

2. Identifying relevant studies: Medline via PubMed, Web of Science, Education Resources Information Centre (ERIC) via EBSCO, and Google Scholar were used (Supplementary material S1) following the PCC approach as a two-step process (Supplementary material S2). The search strategy contained index terms, keywords truncation and Boolean operators. The last search was done on 23 May 2022.

3. Study selection: the Rayyan software¹³ was used for collecting hits, eliminating duplications and including or excluding hits based on titles, abstracts and full text. We included the studies, which reported on either one professionalization lever in case of reviews or on two or more in case of other studies. Four critical appraisal tools were used to assess the quality of each paper including qualitative,¹⁴ quantitative,¹⁵ mix methods¹⁶ and grey literature¹⁷ (Supplementary material S3).

4. Charting the data: was based on the following headings: reference in Vancouver, corresponding author, study objective, location, the definition of professionalization, definition of the PHW, design and methods, professionalization lever(s) covered for example taxonomy and enumeration. In the case of education, we specified the level (bachelor, master, post-graduate, DrPH or PhD).

5. The PRISMA Extension for Scoping Reviews (PRISMA-ScR) was used for reporting.¹⁸

6. Consultation between the authors was based on the information obtained from the literature.

Results

We identified 3255 documents. After reviewing the titles and excluding most of the papers because they did not meet the criteria, 34 documents were fully reviewed (figure 1). Twenty-three did not meet the inclusion criteria (Supplementary material S4), leaving eleven that met the requirements^19–29 (Supplementary material S5). The findings are presented in the following order: (i) year of publication, location and learners’ level (applicable to studies where education was a professionalization lever), (ii) methodologies used, (iii) definitions, taxonomy and enumeration of the PHW and (iv) five leavers to professionalize the PHW, as outlined in the WHO-ASPHER Road Map including competencies, education and training, formal organization, professional credentialing and code of ethics and professional conduct.

Figure 1.

PRISMA 2020 flow diagram for new systematic reviews which included searches of databases, registers and other sources

Year of publication, location and learner’s level

The number of documents published in consecutive years included: 2021(n = 2/11),^19,20 2020 (n = 5/11)^21–24,29 and 2018 (n = 4/11).^25–28 Five articles reported on public health professionalization in one country^{20,21,26–28} and other six covered multiple countries.^{19,22–25,29} Research on public health professionalization was documented in 61 countries (Supplementary material S6). Two documents focused on Europe,^25,29 one on the European Member States (MS-28)²² and one targeted cities or administrative regions such as Jerusalem and Hong Kong.²⁵

The professionalization of the PHW related to undergraduate (n = 1/11)²⁸ and postgraduate education including master (n = 3/11)^19,26,27 and doctoral degrees (1/11)²⁰; e.g. Master of Public Health (MPH), Master of Science in Public Health (MsPH)^19,26,27 and Doctor of Public Health (DrPH) or PhD. Notably, PhD is designed for a career in research, most often in academia, while a DrPH is for practitioners who seek to work in leadership positions in ‘the field’. Others focused on continuing professional development (CPD) (n = 6/11).^16–25,29

Methodologies to study professionalization of the PHW

Six studies were literature reviews^19,23–28 including scoping reviews^24,25 and a systematic review.²³ Three reviews focused on documents included in the websites of specific institutions, such as the Association of Arab Universities, Association of Schools and Programs of Public Health, the National Centre for Education Statistics, Council on Education for Public Health and Academic Public Health Institutions.^19,20,28 One article used two cross-sectional surveys within the European Schools and Departments of Public Health (SDPH) to analyse education and training in public health.²⁹ Other studies used two or more methods to study the professionalization of the PHW: Park et al.²⁰ used a review and interviews, Khatri et al.²¹ used interviews and focus groups, Mansholt et al.²² used a scoping review, focus groups and expert interviews, and Zeeshan et al.²⁶ conducted a review and interviews.

Public health workforce: definitions

Five studies provided a definition of the PHW^20–23,25 (table 2 and Supplementary material S5). Watts et al. analysed 82 studies to define the PHW and divided these definitions into four categories: employer type, workers’ function, occupation and training. Their definition also included time factor, which is more than 0.5 h per week.²³

Table 2.

Overview of public health workforce professionalization (2016–22) (n = 11)

No.	References	Public health workforce: definition	Public health workforce: taxonomy/enumeration	Professionalization: definition	Competencies—1st lever	Training and education—2nd lever	Formal organization—3rd lever	Professional credentialing—4th lever	Code of ethics and professional conduct—5th lever
1	17	No	No/out of the scope	No/out of the scope	No/out of the scope	Yes	No/out of the scope	Yes	No/out of the scope
2	18	Yes	No/out of the scope	No/out of the scope	No/out of the scope	Yes	No/out of the scope	Yes	No/out of the scope
3	19	Yes	No/out of the scope	No/out of the scope	Yes	Yes	No/out of the scope	No/out of the scope	No/out of the scope
4	20	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
5	21	Yes	Yes	No/out of the scope	No/out of the scope	No/out of the scope	No/out of the scope	No/out of the scope	No/out of the scope
6	22	No/Out of the scope	No/out of the scope	No/out of the scope	Yes	Yes	No/Out of the scope	No/out of the scope	No/out of the scope
7	23	Yes	Yes	No/out of the scope	No/out of the scope	Yes	No/out of the scope	Yes	No/out of the scope
8	24	No/Out of the scope	No/out of the scope	No/out of the scope	Yes	Yes	No/out of the scope	Yes	No/out of the scope
9	25	No	Yes	No/out of the scope	Yes	Yes	Yes	No/out of the scope	No/out of the scope
10	26	No	Yes	No/out of the scope	No/out of the scope	Yes	No/out of the scope	No/out of the scope	No/out of the scope
11	27	No/Out of the scope	Yes	No/out of the scope	Yes	Yes	No/out of the scope	Yes	Yes
Total (yes)		5/11	6/11	1/11	6/11	10/11	3/11	6/11	2/11

Park et al.²⁰ defined the PHW in relation to training, time and occupation: ‘professionally trained, dedicated full-time public health practitioner’. Mansholt et al., in their definition included multi-disciplinarity, professionalism and impact on population health.

‘The PHW is multidisciplinary and multi-professional in character, encompassing a core PHW that identifies with a primary public health role and a wider PHW including health professionals and others who impact population health’²² [p. 3].

Public health workforce: taxonomy/enumeration

Six studies covered the taxonomy.^{22,23,25,27–29} Watts et al. used the International Standard Classification of Occupations (ISCO-08) with two digits to map occupations in their systematic review. The results show the PHW composition in six countries: England, Germany, The Netherlands, New Zealand, Slovenia and USA. The most common occupations were: (i) nursing and midwifery, (ii) medical doctors, (iii) health associate professionals, (iv) health professionals and (v) legal, social and cultural professionals. Classifying some occupations was challenging as they could fall into more than one category. For instance, nursing roles often overlap with community health nurses, public health nurses, or school nurses. Further, it was very difficult to provide a definition of the PHW, which would resonate well internationally as there was not a definitive set of occupations which could be called the PHW or universal PHW taxonomy. Lastly, comparing the PHW globally, as its composition varried across countries, and tranfering competencies between countries was not obvious.²³

Watts et al.²³ found that 25 out of 82 studies provided information about the methodology to study PHW taxonomy, including: (i) expert opinions, (ii) historical workforce data, (iii) current workforce data, (iv) using the growth of health expenditure indicator and (v) service-target based model. They also noticed that USA and UK had a national process to study the PHW enumeration. This is helpful to determine the coverage of necessary workers, their sustainability and the methodology to reproduce the PHW enumeration, as it is in case of the Association of State and Territorial Health Officials (ASTHO), and the National Association of County & City Health Officials (NACCHO) in USA.

Tao et al. studied the education of the PHW. They found that the most common disciplines were public health (n = 168/350 studies), public health with a speciality (n = 60/350 studies) including biostatistics, emergency preparedness, environmental health, epidemiology, informatics, health education and nutrition, nursing (n = 13/350 studies), dentistry (n = 8/350 studies), veterinary medicine (n = 4/350 studies), social work (n = 4/350 studies) and pharmacy (n = 2/350 studies).²⁵ Tiwari et al.²⁷ described the PHW as those who have public health training and studied sociology, economics, anthropology, or communications. Laaser et al.²⁹ found that the profiles of SDPH were university-based and part of other programmes, e.g. medicine, nursing, sociology.

WHO/ASPHER ROADMAP: professionalization levers

Competencies

Six studies mentioned competencies.^{21,22,24,26,27,29} Archer et al.²⁴ reviewed 33 articles to determine the frameworks that were used to educate the PHW. Less than half of the articles mentioned using frameworks and competencies (n = 12/33) and common frameworks were developed by the Centres for Disease Control and Prevention in USA and the Public Health Agency of Canada. Mansholt et al.²² conducted a review to determine the competencies to professionalize the PHW in the European MS, and found that the WHO and ASPHER created the Competency Framework for Public Health Workforce in the European Region. Laaser et al.²⁹ mapped the SDPH graduates’ performance based on the ten Essential Public Health Operations (10 EPHOs) and 450 competencies that were grouped and matched with each EPHOs.

Three articles expressed the need to establish educational frameworks for the PHW in Nepal (2020),²¹ Pakistan (2019)²⁶ and India (2018).²⁷ Such frameworks should include communication and writing skills, health management, leadership, financial planning, analytical skills and policy planning and development.^21,26,27 They should be intertwined with key public health areas such as maternal and child health, nutrition, communicable diseases, disasters and emergency management, health systems, health care financial management, policy and strategy development.²⁶ [p. 816].

Training and education

Ten studies examined education and training.^{19–22,24–29} Laaser et al. explored undergraduate and postgraduate education among SDPH and found 170 Bachelor, Master and Doctoral programmes meeting the minimum European Credit Transfer System (ECTS) criterion, according to surveys conducted in 2011 and 2015–16. Meanwhile, Resnick et al. investigated undergraduate public health degrees in USA from 2003 to 2016²⁸ and reported that the focus of education and training was predominantly on exercise science/kinesiology/athletic training, health services administration, health promotion/health education, public health/community health, nutrition, health science and environmental health.

Nuwayhid et al.,¹⁹ Mansholt et al.,²² Zeeshan et al.²⁶ and Tiwari et al.²⁷ studied training and education at master level. Zeeshan et al.²⁶ found that Masters of Public Health (MPH) were not reporting sufficiently their content, the mode of delivery and the assessment in Pakistan (n = 9/17). Nuwayhid et al. considered 22 countries in the Middle East and found 26 MPH programs, which offered: social and behavioural sciences, environmental health, epidemiology, health management and biostatistics. Similarly, in Pakistan, MPH offered epidemiology, biostatistics, communicable disease control, health education/promotion, health management/health administration and accounting, occupational/environmental health and reproductive health.²⁶ Park et al.²⁰ studied training and education in DrPH in USA and reported 28 campus-based (n = 24/28) and distance-based (n = 4/28) programmes. These required leadership courses. Theuniversities offered three to five leadership courses (n = 15/28) per programme.

Archer et al. mentioned that education and training was often provided in blended learning format, which is a mix of online tutorials and in-person training. The number of participants ranged from 12 to 4000 individuals. The online sessions lasted from 20 minutes to 20 hours per module. The format of the courses ranged from one day workshop to one year or longer.²⁴

Tao et al.,²⁵ in their scoping review, considered 350 studies carried out in 38 countries. They stated that universities did not consider the job market to plan educational programs, including the content and degrees that they offer. Similarly, Katri et al.²¹ reported a disconnection between the theory and practise to which the PHW was exposed in real life scenarios in Nepal. On the other hand, Laaser et al.²⁹ looked at the performance of public health graduates of the SDPH who were members of ASPHER in relation to the WHO EURO 10 EPHOs, using a 5-point likert to assess the competency level: the performace was between three and four in the two surveys. They emphasized that English language should be used in the PHW’s training in the European Region and called the SDPHs to update their websites, share experiences of best practices and modernize and standardize curricula, including global and environmental health as well as adding courses on how public health organizations maintain networks with political decision-makers.

Formal organization

Two documents mentioned the importance of formal organizations,^22,27 acknowledging the necessity to create a body for enhancing self-governance of the PHW to create a roadmap to professionalize this workforce in India and the European member states.^22,27

Professional credentialing and accreditation

Seven documents referred to professional credentialing.^{19,20,22,25–27,29} In 2018, Tao et al. studied accreditation, licensure, or certification of the PHW. They found that a few studies covered this topic (n = 3/350). For example study surveyed alumni to study who prepared them for their jobs.²⁵ Laaser et al.²⁹ mapped the bachelor, master and PhD programmes in SDPH in two periods and found 20 vs. 24 bachelor programs, master 38 vs. 48 and PhD 11 vs. 18. The bachelor’s contained between 132–240 ECTS, master’s between 60 and 180 ECTS and PhD’s from 120 to 460 ECTS. Zeeshan et al. revealed a gap in the structure, standardization and needs-based public health education across the PHW education programmes in Pakistan, highlighting a need for a public health accreditation body to enforce the use of competency-based approaches. According to Nuwayhid et al., few MPH programmes in the Middle East had national accreditation (n = 5/24), and three programmes were accredited in USA by the Council on Education for Public Health (CEPH)²⁰ and in Europe by the Agency for Public Health Education Accreditation.¹⁹

Code of ethics and professional conduct

Two studies mentioned the need to have a code of conduct for employers and employees working on public health.^22,29 Laaser et al. claimed that this area would strengthen the PHW’s profile and status and this could be done by establishing, teaching and training public health ethics, population ethics and PHW’s perception about its profession.

Discussion

This review offers a comprehensive overview of the international literature on the professionalization of the PHW from 2016 to 2022. Eleven articles included in this review spanned 61 countries, targeting three levels of study (undergraduate, master’s and doctoral degree) and CPD.^{19,20,26–28} Most of these documents were reviews,^23–25 and about half provided a definition of the PHW.^20–23,25 More than half covered the taxonomy of the PHW.^{22,23,25,27–29} Formal organization and the necessity of a code of conduct for the PHW were acknowledged in only two studies.^22,27,29 The notion of professional credentialing and accreditation was recognized in many of the analysed documents.^{19,20,22,25–27,29} More than half of the documents included information about competencies,^{21,22,24,26,27,29} but the use of frameworks was sporadic and inconsistent. Our analysis suggests that the call by Gebbie and Turnock⁴ in 2006 for the organization of the PHW around competencies has not been sufficiently implemented in many countries, leading to a mismatch between job opportunities and the qualifications of the PHW, thereby jeopardizing the objectives of public health systems. Despite numerous innovations and best practices, there is a need for significant improvement and strengthening of the competence profile of public health graduates by for instance adapting and operationalizing competency frameworks within the national/sub-national context and benchmarking processes. Moreover, the system-based approach to the PHW proposed by Drehobl and colleagues³ in 2014 does not appear to be effectively implemented, particularly in the European Region. The development of the PHW is a complex process that has been influenced by recent events such as the COVID-19 pandemic, man-made disasters, political instability such as Russian war in Ukraine, conflicts in Syria and Sudan or natural disasters including climate change crisis. These events underscore the critical role of public health professionals in disease prevention, health protection, safety and security. The development of the PHW is further impacted by the diversity in program formats and the number of graduates from SDPH.²⁹

The development of the PHW has become even more crucial due to the urgent need for a coordinated One Health approach.³⁰ It calls for a competent PHW able to demonstrate a systemic understanding of ‘green’ competencies and the interconnected role public health plays in addressing the environmental determinants of health including unifying, and sustainable approach, essential for achieving a balance in the health of people, animals and ecosystems.³⁰ Recent initiative of the WHO called ‘Building the public health and emergency workforce: a roadmap’ is a constructive response to the call to professionalize the PHW³¹ including the operationalization of competencies, public health functions and methods to enumerate the PHW.

These new demands for integrated and coordinated approaches to the PHW highlight more general challenges embedded in professionalization processes³² that were historically based on exclusionary strategies, hierarchy and dominance of one professional group over another profession, including the gendered dimensions. It is currently not fully clear what a more inclusive approach might look like and, most importantly, how it might be implemented successfully in the healthcare system and the governance architecture. One major challenge of developing recommendations for the PHW is that much of the existing literature is still shaped by exclusion and ‘silo’ approaches to professionalization. Although there are some efforts to professionalize the PHW globally, this process is fragmented and not fully recognized and supported. Therefore, there is an urgent need to engage policymakers and stakeholders to prioritize investments in strengthening the PHW worldwide and support the implementation of the roadmaps to professionalize and build the public health and emergency workforce.

 

This paper is submitted on behalf of the ASPHER Task Force on Professionalization of the Public Health Workforce in the European Region.

Supplementary data

Supplementary data are available at EURPUB online.

Author contributions

Conceptualization, review and writing (KC), review, screening, critical appraisal, review methodology (PRF and GB), critical review and writing (EK), critical review (PK), review (LM, JG, GS, OA and NP). All authors read and agreed on the final version of the manuscript.

Funding

The authors did not receive funding to carry out this research.

Conflicts of interest: None declared.

Key points.

• The ‘WHO-ASPHER Roadmap to Professionalizing the Public Health Workforce in the European Region’ provides recommendations for strategic and systematic workforce planning around professionalization levers including: (i) competencies, (ii) training and education, (iii) formal organization, (iv) professional credentialing and (v) code of ethics and professional conduct as well as taxonomy and enumeration.

• The development of a competent PHW is a key component of the nation’s public health infrastructure and should become a focus of increasing attention especially in view of recent challenges and events, which underscore the critical role of public health professionals in disease prevention, health protection, safety and security.

• In spite of efforts to professionalize the PHW, this process is fragmented and not fully recognized and supported.

• There is an urgent need to engage policymakers and stakeholders to prioritize investments in strengthening the PHW worldwide.

Data availability

The data underlying this article are available in the article and in its online supplementary material, which can be accessed via a DOI link. Any additional questions concerning the data underlying this article will be shared on reasonable request to the corresponding author.