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Public Health Workforce in Times of Global Transformations: Past, Present, and Future Developments

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (31 May 2022) | Viewed by 30043

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Special Issue Editors

Dr. Florian Fischer

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Guest Editor

1. Institute of Public Health, Charité – Universitätsmedizin Berlin, 10117 Berlin, Germany
2. Bavarian Research Center for Digital Health and Social Care, Kempten University of Applied Sciences, 87437 Kempten, Germany
Interests: evidence-based public health; global health; digital health; health communication
Special Issues, Collections and Topics in MDPI journals

Ms. Laura Arnold

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Guest Editor

Academy of Public Health Services, Düsseldorf, Germany
Interests: social epidemiology; teaching epidemiology; health reporting and planning; evidence-based decision-making processes

Dr. Franziska Hommes

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Guest Editor

Institute of Tropical Medicine and International Health, Charité – Universitätsmedizin Berlin, 13353 Berlin, Germany
Interests: social determinants of health; global health education; tropical medicine

Dr. Kerstin Sell

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Guest Editor

1) Pettenkofer School of Public Health, Ludwig-Maximilians University Munich, 80539 München, Germany
2) Chair of Public Health and Health Services Research, IBE, Ludwig-Maximilians University Munich, 80539 München, Germany
Interests: evidence-based public health; knowledge translation; global health; sexual and reproductive health

Special Issue Information

Dear Colleagues,

Assuring a sufficient and competent public health workforce is one of the ten essential public health operations (EPHOs) as defined by the World Health Organization. The core group of public health professionals includes positions exclusively or substantially focused on issues related to population health in public health research, practice, policy, or education.

Public health, an interdisciplinary and interprofessional area of research and practice, encompasses various skills, knowledge, and attitudes of the multiple professions involved. All of these professions have to deal with major transformations and challenges, such as demographic change, rising social inequalities, globalization, digitalization, as well as impacts of climate change and biodiversity loss. Furthermore, the public health workforce is faced with a rapidly changing working environment due to higher professionalization, international collaboration, and personnel mobility.

Despite the advantages achieved in past decades, several challenges for public health workforce development and training remain. Public health workforce crises have been observed almost worldwide. Among other things, this is due to heterogeneous, often underfunded or insufficient public health structures and activities, lack of interprofessional exchange, brain drain, and missing definitions of core competencies. Strategies and evidence to overcome these challenges shall be illustrated and discussed in empirical (qualitative, quantitative or mixed-methods approaches, systematic literature reviews or meta-analyses) or conceptual papers (e.g., discussion) in this Special Issue. We welcome contributions highlighting local, national or global perspectives on developments and future trends in the core public health workforce in view of challenges related to ongoing global transformations.

Dr. Florian Fischer
Ms. Laura Arnold
Dr. Franziska Hommes
Dr. Kerstin Sell
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2300 CHF (Swiss Francs). Authors may apply for a waiver or discount of the Article Processing Charge. For doing so, please send an abstract (about 300 words) of the planned contribution (including a list of authors including their affiliations) to [email protected] until 28 February 2021. After the abstract submission deadline, you will be informed about the possibility of receiving a waiver or discount - in case the manuscript successfully passes external peer-review. Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

public health
population health
workforce
training
employment
interprofessionality
professionalism
interdisciplinarity

Published Papers (10 papers)

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Research

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32 pages, 1313 KiB

Open AccessArticle

What Factors Influence the Interest in Working in the Public Health Service in Germany? Part I of the OeGD-Studisurvey

by Laura Arnold, Lisa Kellermann, Florian Fischer, Sophie Gepp, Franziska Hommes, Laura Jung, Amir Mohsenpour, Dagmar Starke and Jan M. Stratil

Int. J. Environ. Res. Public Health 2022, 19(18), 11838; https://doi.org/10.3390/ijerph191811838 - 19 Sep 2022

Cited by 3 | Viewed by 2621

Abstract

As in many European countries, the Public Health Service (PHS) in Germany has had considerable difficulties in attracting well-qualified personnel for decades. Despite ongoing political and societal debate, limited empirical research on possible causes and explanations is available. To identify areas of action, we explored reasons for the (lack of) interest in working in the PHS by conducting two cross-sectional surveys among 3019 medical students (MS), public health students, and students from other PHS-relevant fields (PH&ONM) in Germany right before (wave 1, 2019/2020) and during the COVID-19 pandemic (wave 2, 2021). While interest in working in the PHS among MS was low, it was considerably higher among PH&ONM. The prevalent underestimation of the importance of public health and low levels of knowledge about the PHS were identified as potential barriers. Although core activities of the PHS were often considered attractive, they were repeatedly not attributed to the PHS. A negative perception of the PHS (e.g., it being too bureaucratic) was prevalent among students with and without PHS interest, indicating that both a negative image and potentially structural deficits need to be overcome to increase attractiveness. Based on the findings, we propose approaches on how to sustainably attract and retain qualified personnel. Full article

(This article belongs to the Special Issue Public Health Workforce in Times of Global Transformations: Past, Present, and Future Developments)

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47 pages, 647 KiB

Open AccessArticle

How to Increase the Attractiveness of the Public Health Service in Germany as a Prospective Employer? Part II of the OeGD-Studisurvey

by Laura Arnold, Lisa Kellermann, Florian Fischer, Franziska Hommes, Laura Jung, Amir Mohsenpour and Jan M. Stratil

Int. J. Environ. Res. Public Health 2022, 19(18), 11733; https://doi.org/10.3390/ijerph191811733 - 17 Sep 2022

Cited by 3 | Viewed by 1972

Abstract

The Public Health Service (PHS) in Germany has had difficulties in recruiting enough qualified staff for years, but there is limited research on what factors drive decisions to (not) join the PHS workforce. We explored reasons for this perceived (lack of) attractiveness. We conducted two cross-sectional surveys among medical students (MS), public health students and students from other PHS-relevant fields (PH&ONM) in Germany before (2019/2020) and during the COVID-19 pandemic (2021). Both waves surveyed self-reported reasons for why students did (not) consider working in the PHS as attractive and how this could be improved, using open-question items. Qualitative and quantitative content analyses were conducted according to Mayring. In total, 948 MS and 445 PH&ONM provided valid written responses. Reasons for considering the PHS as attractive were, among others, the perception of a good work-life balance, high impact, population health focus, and generally interesting occupations. Suggestions to increase attractiveness included reducing bureaucracy, modernization/digitalization, and more acknowledgement of non-medical professionals. Among MS, reasons against were too little clinical/patient-related activities, low salary, and occupations regarded as boring. Our findings indicate areas for improvement for image, working conditions in, and institutional structures of the PHS in Germany to increase its attractiveness as an employer among young professionals. Full article

(This article belongs to the Special Issue Public Health Workforce in Times of Global Transformations: Past, Present, and Future Developments)

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16 pages, 366 KiB

Open AccessArticle

Experiences Shared by the (Future) Public Health Workforce during the COVD-19 Pandemic in Germany: Results of a Survey on Workload, Work Content, and Related Challenges among Students and Young Professionals

by Florian Fischer, Julia Wicherski, Myriam Tobollik and Timothy McCall

Int. J. Environ. Res. Public Health 2022, 19(18), 11444; https://doi.org/10.3390/ijerph191811444 - 11 Sep 2022

Viewed by 1562

Abstract

Although previous studies have focused on the adverse effects of the COVID-19 pandemic on various professional groups (particularly in the health and nursing care sector), this study aims to close a research gap by assessing perspectives of students and young professionals in epidemiology and public health in Germany in terms of shifts in workload, work content, and related challenges caused by the pandemic. We conducted a cross-sectional survey between mid-February and mid-March 2022. Quantitative data were analyzed via standardized mean differences. Qualitative data based on answers to open-ended questions were analyzed via a qualitative content analysis. Overall, 172 individuals participated in this survey. Results indicate that students felt burdened the most by lack of exchange with other students and lecturers. Study participants employed in public health experienced changes in their employment because they had changes in their work content- and administration, which was accompanied by a high burden due to the workload. Multiple demands that can have an impact on both acquired skills and mental health during the professional qualification phase were mentioned by the participants. Therefore, more in-depth analyses are needed to investigate the impact the pandemic will have on the (future) public health workforce in the long run. Full article

(This article belongs to the Special Issue Public Health Workforce in Times of Global Transformations: Past, Present, and Future Developments)

17 pages, 696 KiB

Open AccessArticle

Stakeholders’ Perception of the Palestinian Health Workforce Accreditation and Regulation System: A Focus on Conceptualization, Influencing Factors and Barriers, and the Way Forward

by Shahenaz Najjar, Sali Hafez, Aisha Al Basuoni, Hassan Abu Obaid, Ibrahim Mughnnamin, Hiba Falana, Haya Sultan, Yousef Aljeesh and Mohammed Alkhaldi

Int. J. Environ. Res. Public Health 2022, 19(13), 8131; https://doi.org/10.3390/ijerph19138131 - 2 Jul 2022

Cited by 2 | Viewed by 2176

Abstract

The Health Workforce Accreditation and Regulation (HWAR) is a key function of the health system and is the subject of increasing global attention. This study provides an assessment of the factors affecting the Palestinian HWAR system, identifies existing gaps and offers actionable improvement solutions. Data were collected during October and November 2019 in twenty-two semi-structured in-depth interviews conducted with experts, academics, leaders, and policymakers purposely selected from government, academia, and non-governmental organizations. The overall perceptions towards HWAR were inconsistent. The absence of a consolidated HWAR system has led to a lack of communication between actors. Environmental factors also affect HWAR in Palestine. The study highlighted the consensus on addressing further development of HWAR and the subsequent advantages of this enhancement. The current HWAR practices were found to be based on personal initiatives rather than on a systematic evidence-based approach. The need to strengthen law enforcement was raised by numerous participants. Additional challenges were identified, including the lack of knowledge exchange and salary adjustments. HWAR in Palestine needs to be strengthened on the national, institutional, and individual levels through clear and standardized operating processes. All relevant stakeholders should work together through an integrated national accreditation and regulation system. Full article

(This article belongs to the Special Issue Public Health Workforce in Times of Global Transformations: Past, Present, and Future Developments)

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14 pages, 365 KiB

Open AccessArticle

Factors Associated with Intention of Serbian Public Health Workers to Leave the Job: A Cross-Sectional, Population-Based Study

by Katica Tripković, Milena Šantrić-Milićević, Milena Vasić, Mirjana Živković-Šulović, Marina Odalović, Vesna Mijatović-Jovanović and Zoran Bukumirić

Int. J. Environ. Res. Public Health 2021, 18(20), 10652; https://doi.org/10.3390/ijerph182010652 - 11 Oct 2021

Cited by 8 | Viewed by 1918

Abstract

Recruitment and retention of public health workers (PHWs) is crucial for the optimal functioning of the public health system at a time of budget cuts and the threat of a pandemic. Individual and job-related variables were examined by univariate and multivariate logistic regression to identify predictors of the intention to leave a job during the COVID-19 outbreak among Serbian PHWs in 25 institutes of public health (n = 1663 respondents, of which 73.1% were female). A total of 20.3% of PHWs intended to leave their current job within the next five years. Males and persons aged younger than 55 years who had additional practice were more likely to report an intention to leave their job than females, those older than 54 years and those without additional work. While uncertainty and fear of infection during the COVID-19 pandemic were almost perceived as job attractiveness, other job-related characteristics were identified as significant barriers to maintaining the sufficient capacity of qualified PHWs in the future. Authorities need to address these factors, including the following: the feeling of tension, stress or pressure, and unavailability of information during the COVID-19 pandemic, as well as dissatisfaction with respect, valuation, and the job in general. Full article

(This article belongs to the Special Issue Public Health Workforce in Times of Global Transformations: Past, Present, and Future Developments)

13 pages, 599 KiB

Open AccessArticle

Aligning Best Practices: A Guiding Framework as a Valuable Tool for Public Health Workforce Development with the Example of Ukraine

by Olga Gershuni, Katarzyna Czabanowska, Genc Burazeri, Vesna Bjegovic-Mikanovic, Grzegorz Juszczyk, Anna Cichowska Myrup and Volodymyr Kurpita

Int. J. Environ. Res. Public Health 2021, 18(17), 9246; https://doi.org/10.3390/ijerph18179246 - 1 Sep 2021

Cited by 2 | Viewed by 2667

Abstract

Background: At present, in Ukraine, there is an insufficient capacity for up-to-date surveillance of the health status of the general population; public health (PH) promotion and disease prevention activities are scarce. Additionally, there is an urgent need to ensure, develop and support an efficient public health workforce (PHW) and appropriately address existing health issues. Ukraine currently introduces PH system reforms in line with its current burden of disease, the epidemiological profile and the Essential Public Health Services (EPHOs). This analysis aims to propose a pragmatic framework to provide guidance and recommendations related to the development, support and planning of the PHW in Ukraine. Methods: We constructed a framework based on a previously published scoping review and analyzed various policy analysis approaches. In line with the recommendations found in the literature and the best practices used elsewhere, this method enabled the construction of a framework for facilitating successful PHW development. In addition, an expert workshop was held, serving as a reality check for identifying crucial areas of the PH system in Ukraine. Results: The proposed framework includes a country’s background, the evidence and available policy options, such as the health system (including core functions, organizational resources, regulations and norms), health system capacities (including human resources; PH capacity assessment; datasets and databases; forecasting strategies; licensing, accreditation and quality assurance) and capacity building (including PH education, training, core competencies and ethical and professional codes of conduct). To facilitate and support effective implementation of the framework, we propose (1) implementing strategies to facilitate changes in attitude, behavior and practices among the citizens; (2) implementing strategies to facilitate the necessary behavioral changes in the PHW; (3) implementing strategies to facilitate the necessary organizational and institutional changes; (4) implementing strategies to facilitate system changes and (5) identification of potential barriers and obstacles for the implementation of these strategies. Conclusion: The report highlights the practical tactics and best practices for providing suggestions for PHW support and planning. The employment of prominent analytical tools and procedures in policymaking processes suggests an effective strategy for PHW development in Ukraine. Full article

(This article belongs to the Special Issue Public Health Workforce in Times of Global Transformations: Past, Present, and Future Developments)

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16 pages, 6947 KiB

Open AccessArticle

What Do Public Health Graduates Do and Where Do They Go? An Analysis of Job Destinations and Mismatch in Australian Public Health Graduates

by Rory David Watts, Devin C. Bowles, Colleen Fisher and Ian W. Li

Int. J. Environ. Res. Public Health 2021, 18(14), 7504; https://doi.org/10.3390/ijerph18147504 - 14 Jul 2021

Cited by 5 | Viewed by 2854

Abstract

Background: It is not well understood what occupations public health graduates have after graduation, nor is it well known whether their education provides them with the relevant knowledge and skills to feel well matched to their occupations. Furthermore, it is commonly presumed that public health graduates work in government, and investments in education would bolster this workforce. Methods: We aimed to describe the common occupations of Australian public health graduates, describe the heterogeneity of graduate destinations, describe the level of mismatch that graduates report, and compare these results with other fields of study. We used eight years of Australian graduate survey data (2008–2015) from the Graduate Destinations Survey, examining outcomes data from 8900 public health graduates from four levels of education. We compared occupation and industry heterogeneity, and level of occupational mismatch between public health graduates, and graduates from other fields of education. Results: Public health graduates report having a broad set of occupations in a broad set of industries after graduation, and this breadth is dissimilar to most health degrees. Furthermore, public health graduates tend to have average or lower-than-average rates of mismatch. Conclusions: Despite going into a broad set of occupations and industries, graduates from public health tend to report being well prepared given their education. Given that both occupation and industry outcomes are heterogeneous for graduates, an investment in public health education does not guarantee an increase in the governmental public health workforce. Full article

(This article belongs to the Special Issue Public Health Workforce in Times of Global Transformations: Past, Present, and Future Developments)

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Review

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23 pages, 1445 KiB

Open AccessReview

Multi-, Inter-, and Transdisciplinarity within the Public Health Workforce: A Scoping Review to Assess Definitions and Applications of Concepts

by Kerstin Sell, Franziska Hommes, Florian Fischer and Laura Arnold

Int. J. Environ. Res. Public Health 2022, 19(17), 10902; https://doi.org/10.3390/ijerph191710902 - 1 Sep 2022

Cited by 14 | Viewed by 3990

Abstract

In light of the current public health challenges, calls for more inter- and transdisciplinarity in the public health workforce are increasing, particularly to respond to complex and intersecting health challenges, such as those presented by the climate crisis, emerging infectious diseases, or military conflict. Although widely used, it is unclear how the concepts of multi-, inter-, and transdisciplinarity are applied with respect to the public health workforce. We conducted a scoping review and qualitative content analysis to provide an overview of how the concepts of multi-, inter-, and transdisciplinarity are defined and applied in the academic literature about the public health workforce. Of the 1957 records identified, 324 articles were included in the review. Of those, 193, 176, and 53 mentioned the concepts of multi-, inter-, and transdisciplinarity, respectively. Overall, 44 articles provided a definition. Whilst definitions of multidisciplinarity were scarce, definitions of inter- and transdisciplinarity were more common and richer, highlighting the aim of the collaboration and the blurring and dissolution of disciplinary boundaries. A better understanding of the application of multi-, inter-, and transdisciplinarity is an important step to implementing these concepts in practice, including in institutional structures, academic curricula, and approaches in tackling public health challenges. Full article

(This article belongs to the Special Issue Public Health Workforce in Times of Global Transformations: Past, Present, and Future Developments)

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Other

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10 pages, 6766 KiB

Open AccessProject Report

The Containment Scouts: First Insights into an Initiative to Increase the Public Health Workforce for Contact Tracing during the COVID-19 Pandemic in Germany

by Dunja Said, Simon Brinkwirth, Angelina Taylor, Robby Markwart and Tim Eckmanns

Int. J. Environ. Res. Public Health 2021, 18(17), 9325; https://doi.org/10.3390/ijerph18179325 - 3 Sep 2021

Cited by 11 | Viewed by 4307

Abstract

The COVID-19 pandemic in Germany has demanded a substantially larger public health workforce to perform contact tracing and contact management of COVID-19 cases, in line with recommendations of the World Health Organization (WHO). In response, the Robert Koch Institute (RKI) established the national “Containment Scout Initiative” (CSI) to support the local health authorities with a short-term workforce solution. It is part of a range of measures for strengthening the public health system in order to limit the spread of SARS-CoV-2 in Germany. The CSI is an example of how solutions to address critical health system capacity issues can be implemented quickly. It also demonstrates that medical or health-related backgrounds may not be necessary to support health authorities with pandemic-specific tasks and fulfil accurate contact tracing. However, it is a short-term solution and cannot compensate for the lack of existing qualified staff as well as other deficits that exist within the public health sector in Germany. This article describes the structure and process of the first phase of this initiative in order to support health policymakers, public health practitioners, and researchers considering innovative and flexible approaches for addressing urgent workforce capacity issues. Full article

(This article belongs to the Special Issue Public Health Workforce in Times of Global Transformations: Past, Present, and Future Developments)

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9 pages, 1308 KiB

Open AccessConcept Paper

The Future Public Health Workforce in a Changing World: A Conceptual Framework for a European–Israeli Knowledge Transfer Project

by Osnat Bashkin, Keren Dopelt, Zohar Mor, Lore Leighton, Robert Otok, Mariusz Duplaga, Fiona MacLeod, Jascha De Nooijer, Yehuda Neumark, Stephanie Paillard-Borg, Theodore Tulchinsky, Shira Zelber-Sagi and Nadav Davidovitch

Int. J. Environ. Res. Public Health 2021, 18(17), 9265; https://doi.org/10.3390/ijerph18179265 - 2 Sep 2021

Cited by 11 | Viewed by 3143

Abstract

Health services quality and sustainability rely mainly on a qualified workforce. Adequately trained public health personnel protect and promote health, avert health disparities, and allow rapid response to health emergencies. Evaluations of the healthcare workforce typically focus on physicians and nurses in curative medical venues. Few have evaluated public health workforce capacity building or sought to identify gaps between the academic training of public health employees and the needs of the healthcare organizations in which they are employed. This project report describes the conceptual framework of “Sharing European Educational Experience in Public Health for Israel (SEEEPHI): harmonization, employability, leadership, and outreach”—a multinational Erasmus+ Capacity Building in Higher Education funded project. By sharing European educational experience and knowledge, the project aims to enhance professionalism and strengthen leadership aspects of the public health workforce in Israel to meet the needs of employers and the country. The project’s work packages, each jointly led by an Israeli and European institution, include field qualification analysis, mapping public health academic training programs, workforce adaptation, and building leadership capacity. In the era of global health changes, it is crucial to assess the capacity building of a well-qualified and competent workforce that enables providing good health services, reaching out to minorities, preventing health inequalities, and confronting emerging health challenges. We anticipate that the methods developed and the lessons learned within the Israeli context will be adaptable and adoptable by other countries through local and cultural adjustments. Full article

(This article belongs to the Special Issue Public Health Workforce in Times of Global Transformations: Past, Present, and Future Developments)

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