Introduction

Preparing the public health care workforce to address potential terrorist attacks and other health emergencies is challenging because of the diversity of the professions and the multitude of task assignments. The public health workforce is that group of professionals who serve to ensure the conditions for the health of populations. This is a broad group of professionals: nurses and physicians, environmental scientists and technicians, laboratory workers, epidemiologists, health educators, biostatisticians, administrators, infectious disease specialists, legal and regulatory specialists, occupational health specialists, and others. These professionals are educated and trained in skills unique to their disciplines. However, in the public health care system, they are called upon not only to practice their unique skills, but also to work as a member of a multidisciplinary team.

This workforce is employed not only in state and local health departments, but also in hospitals, ambulatory care facilities, community-based organizations, academia, and private industry, often in partnerships with governmental agencies. The anthrax outbreak in 2001 focused attention on the workings of several health departments in the country and provides an example of the need for educating and training the public health workforce to more effectively respond to such emergency events. The New Jersey Department of Health and Senior Services (DHSS), without warning, became the pivotal agency in responding to this outbreak. The public health workforce was expected to establish surveillance systems to detect cases of anthrax; to alert the medical community to recognize and diagnose cases; to answer questions from the medical community, the media, and the public; to obtain specimens and conduct tests for proper laboratory confirmation; to screen for anthrax in both human and environmental samples; to investigate and follow suspected and confirmed cases; and to provide guidance for those providing prophylactic antibiotics. The dhss had to map the contaminated environment of the Trenton Postal Processing and Distribution Center in Hamilton Township. Other locations, potentially contaminated by anthrax, required environmental sampling as well. In addition to seeing to all of the above, the dhss was in constant communication with other governmental agencies, (e.g., the CDC, the FBI, and the postal service)

In retrospect, it became apparent that meeting the demands of a terrorist attack, or of any other public health emergency, requires, “an integrated, synchronized, responsive, and focused health-preparedness- and-response capability using highly trained and educated health professionals.”² To meet this need, the public health care workforce must be educated and trained to apply their diverse, profession-specific knowledge and skills and to act as a multidisciplinary team. The importance of this type of training did not go unnoticed by the 9/11 Commission. Referring to the attacks on September 11, 2001, the Commission noted that, teamwork, collaboration, and cooperation at an incident site are critical to a successful response. Key decision makers who are represented at the incident command level help to ensure an effective response, the efficient use of resources, and responder safety. Regular joint training at all levels is, moreover essential to ensuring close coordination during an actual incident.³ Broadly speaking, the responsibilities of the state and local health departments illustrate the variety of activities in which public health professionals may be involved and the importance of public health in planning for and responding to emergencies. The health departments are charged with preventing epidemics and the spread of disease, protecting the community against environmental hazards, preventing injuries, promoting and encouraging healthy behaviors, and responding to disasters and assisting communities in recovery.⁴

Workplace Competence

An organizing model that can serve public health professionals and organizations in planning, applying skills, and assessing outcomes is described by the following ten essential public health services.^5,6

1. monitor health status to identify community problems;
2. diagnose and investigate health problems and hazards;
3. inform, educate, and empower communities about health issues;
4. mobilize community partnerships to identify and resolve problems;
5. develop policies and plans that support community health efforts;
6. enforce laws and regulations that protect health and provide safety;
7. link those in need to personal health and health care services when not otherwise available;
8. assure a competent public health workforce;
9. evaluate effectiveness, accessibility, and quality of health services; and
10. investigate and employ innovative solutions to health problems.

These essential services were initially identified in 1994 by a blue-ribbon panel, chaired by the U. S. surgeon general, David Satcher, MD, PhD, that was commissioned to focus federal efforts to improve a depleted public health infrastructure. They are intended to identify a common mission within which the diverse public health professions can coordinate activities and to guide capacity assessment, infrastructure improvement, and outcome evaluation of the public health care system. Many in public health recommend that education and training be based in broad public health workplace competencies that identify the professional knowledge and skills needed within an organization to accomplish the essential services.^7,8,9 The Council on Linkages between Academia and Public Health Practice sought advice from more than a thousand key informants in developing a set of core competencies and attitudes.¹⁰ They are intended to guide the development of educational content and curriculum, and are organized into eight domains.

1. analytic and assessment;
2. policy development and program planning;
3. communication;
4. cultural competency;
5. community dimensions of practice;
6. public health science;
7. financial planning and management; and
8. leadership and system thinking.

Because these domains only capture the cross-cutting competencies for public health practice, they may not contain abilities specific to disciplines within the field. They are suggested as a starting point and a guide.

The Center for Disease Control and Prevention (CDC) and the Agency for Toxic Substances and Disease Registry (ATSDR) have written a strategic plan for developing this public health workforce that will be able to deliver the essential public health services.¹¹ This plan mandates the utilization of core competencies in developing curriculum. Despite this mandate, however, the evidence that general core competencies enhance the delivery of essential services remains ambiguous.^12,13