Presented by Cynthia Lamberth, MPH, CPH APHA Mid-Year Meeing, June 2011

1. The Impact of ACA on the
Public Health Workforce
June 24, 2011
APHA Mid-year meeting
Chicago, Illinois
Cynthia D. Lamberth, MPH, CPH
Associate Dean, Workforce Development
University of Kentucky College of Public Health
Center for Public Health Systems & Services Research

2. Increase in Demand for PH Services?
• ACA may increase demand for PH services
– Emphasis on prevention and thus activities related to
prevention (not just preventive care)
• School Based Health Centers
• Community Transformation Grants
• MCH Visit programs
• Epidemiology/Lab Capacity Grants
• Healthy Living/Aging Well
• Incentives for Prevention of Chronic Disease
• May lead to increased need for PH workers in
certain areas

3. Decrease in Demand for PH Services?
• Increased insurance coverage in previously
uninsured
– Drive users of PH clinical servicers to private
providers
• Decrease in reimbursement to PH depts.
• Decrease demand for clinical services in LHDs
• May result in decreased demand for PH
workers in certain areas

4. The Net Result?
• Net loss or gain of PH workers?
• Shift in workforce away from clinical services
• Opportunities to collaborate with community
health centers FQHC’s
• The final outcome is uncertain and it may vary
from state to state

5. Enumeration
The public health workforce is The size and composition of this
composed of individuals whose workforce should be identified,
major work focus is delivery of and should be tracked over time
one or more of the essential in order to develop appropriate
services of public health, whether plans for workforce
development, recruitment and
or not those individuals are on the retention.
payroll of an official, voluntary, or
not-for-profit public health
agency. The Public Health Work Force
Public Health Functions Enumeration 2000
Project, 1997 HRSA

6. Enumeration of PH workforce
• Need to know how many workers to know if
we need more or less of them to respond to
impact of ACA
• Need to know composition to know if we need
more or less in certain areas to satisfy changes
from ACA

7. UK Center of Excellence
in Workforce Research & Policy
 Gather information about relevant databases; post on NLM
website
 Technical assistance to PH workforce researchers
 Explore TRAIN and other LMS data elements as research
resource
 Map literature to 8 research themes
 Study BLS data inputs for characterizing the PH workforce
 Sponsor scientific session at annual CPHSSR Keeneland
Conference
 Support National Advisory Committee

8. What we’re finding
• Much discipline-specific research; not much re:
public health workforce as a whole
• Organizations often reluctant to share data; but
researchers very willing to discuss work
• Data usually not comparable. Data Harmonization
efforts addressing this issue
• HHS agencies, other federal agencies (e.g., BLS) eager
to collaborate
• The call for a common taxonomy is still needed today

9. Enumeration Activity to Date
• UK and UM developed case definition to guide work
• UK and UM determined there is no one existing
system that can be easily adapted for enumeration;
same problems Gebbie, et al encountered
• Agreed upon “family of systems” approach to guide
thinking

10. US Public
OPM Health CDC/
CSTE Service HRSA
NIHB APHL
ASPH
NEHA
FACULTY
BUREAU of
LABOR ATPM
STATISTICS
TRAIN ASTPHND
NACCHO NSSRN
CHARACTERIZING
the PUBLIC
ASTHO HEALTH ASTDD
WORKFORCE
A FAMILY OF SYSTEMS

11. Enumeration Activity to Date
• Agreed upon “family of systems” approach to guide
thinking
– Envisioned system will make use of multiple,
currently available streams of data to characterize
the workforce
• We have the specs ready for a trial of this sentinel type
approach, however the funding for the COE is no
longer in place.
• Working with Data Harmonization Workgroup to
understand various surveys and comparable data

12. Research to Examine Impact of ACA
• PHSSR funding to examine impact of ACA
• PBRN RFP
• RWJF PHSSR Solicitation

13. Impact of ACA on Academia
• How does it impact the production of PH
workers?
– Different competencies necessary?
– Different training (e.g. focus on H.I.T. may
necessitate technical proficiency)
– Need more or less workers?
– Change in settings: Governmental, private,
community health workers, local public health

14. UKCPH Response to ACA
• Increase in enrollment and emphasis on
serving most vulnerable populations through
practical experiences
• Change in curriculum to include ACA scenarios
in classroom training
• Increased interest in certificate and degree
programs in gerontology
• Overall increase in Schools of Public Health
and accredited programs

15. For more information contact:
Cynthia D. Lamberth, MPH, CPH
cynthia.lamberth@uky.edu
121 Washington Avenue, Suite 212
Lexington, KY 40517
859-257-5678
www.publichealthsystems.org