Exercise 4

Individual Exercise #4: Human Resources Management in the Public Health Sector

The COVID–19 pandemic has called attention to persistent workforce shortages in state and local health departments across the U.S. Managing human resources within the public health sector is made difficult by the lack of consistent data and evidence–based guidelines concerning the number and types of workers needed for a robust public health system. Managers within hospitals, nursing homes, primary care clinics, and other medical institutions use recommended staff–to–patient ratios to manage human resources for key occupations such as physicians, nurses, and therapists. At the population level, recommended staff–to–population ratios are used to identify geographic areas that have inadequate numbers of physicians, nurses, dentists, and mental health professionals. This information is used to manage workforce recruitment and retention programs, as well as education and training programs for health professionals. Unfortunately, these types of data and guidelines largely do not exist for major components of the public health workforce. Recently a national committee sponsored by the de Beaumont Foundation conducted a study of the U.S. public health workforce in order to help the public health sector assess its current and future workforce needs. A summary of this study’s findings is available by clicking here. Many state and local public health agencies want to be able to estimate their own workforce needs, but currently there are no such state and local estimates available in the literature.
In this exercise, we will use some of the results from this recent national study along with data from the 2020 U.S. Census to make projections about human resources needs in Colorado’s pub lic health system. The answers we identify in this exercise might be used as reasonable management goals and targets for workforce recruitment and retention for public health agencies within the state. For example, these answers might be used to develop budgets for hiring new workers, and to design education and training pipeline programs to prepare these new workers. As is often the case in managerial decision –making, this exercise requires you to work with imperfect information that contains uncertainty and many possible sources of error. For example, the Census data are an important tool for public health professionals yet are inherently uncertain. As you work through this exercise, you will want to reflect on the reasonableness of the answers you obtain, and how you might refine and improve these answers in the future.

Instructions
Go to the U.S. Census website that lists total U.S. population: https://www.census.gov/quickfacts Search “Colorado” in the search bar, which will reveal population data for the state of Colorado as well. The website should now have two columns of data: one column for the U.S. and one for the state of Colorado. The most accurate U.S. Census is conducted every 10 years because the U.S. population is surveyed extensively, while during individual years, the U.S. Census only surveys smaller areas of the U.S. and relies on predictions for un–surveyed areas that tend to overestimate population in urban areas and underestimate in rural areas. Only use population data from April 1, 2020 for this assignment.

Use decimal form for answers. If the ratio is 10:4 or 10/4, the decimal form is 2.5. For the sake of this exercise, round up your final answer to a whole number to reflect a whole person. An answer of 2.5 will round up to 3. An answer of 2.1 will round up to 3. Please come to office hours if in need of assistance understanding the math. This is also a great resource from the Centers for Disease Control and Prevention (CDC) that provides a refresher on understanding ratios and proportions: https://www.cdc.gov/csels/dsepd/ss1978/lesson3/section1.html

Question 1 (0 points)
This assignment is to be completed individually. You may discuss the assignment with classmates and consult course materials and other reference materials in order to develop your individual responses to the assignment. However, the answers you submit for the assignment must represent your o wn individual work, and you may not submit answers obtained from others. By selecting “Yes” below, you are affirming that you have complied with these requirements and with the Honor Code of the Colorado School of Public Health.
• o Yes
• o No

Question 2 (20 points)
The de Beaumont report estimates that a total of 183,500 workers are needed at state and local public health agencies across the U.S. Use this result along with an estimate of the total number of people who reside in the U.S. as of 2020 (from the U.S. Census Bureau as of April 1, 2020) to calculate a worker–to– population ratio that indicates how many public health workers are needed per 100,000 residents in the U.S.
________ public health workers are needed per 100,000 residents of the U.S.

Question 3 (20 points)
Let’s assume that Colorado requires the same ratio of public health staffing as the U.S. that was found in #2. If so, we can apply the U.S. worker–to–population ratio to Colorado’s resident population in order to estimate how many public health workers are needed in Colorado. To do this, find the estimate of the total number of people who reside in the state of Colorado as of 2020 (from the U.S. Census Bureau). Then you can apply this estimate to the worker–to–population ratio in #2 in order to estimate how many public health workers may be needed in Colorado. Make sure to round your final answer up to a whole number.

Using the ratio in #2, I estimate that ________ public health workers are needed in Colorado based on the number of state residents in 2020.

Question 4 (20 points)

The de Beaumont study estimates that approximately 70% of the public health workers needed in the U.S. are needed to work in local health departments, and 30% are needed to work in state health
departments. Let’s apply these estimates to your answer in question # 3 above in order to estimate how many local health department workers are needed in Colorado. Make sure to round your final answer up to a whole number.
Using the final answer in #3, I estimate that ________ workers are needed for staffing local health departments in Colorado.

Question 5 (20 points)
Now let’s take the answer in #4 above and convert it into a worker–to–population ratio specifically for local health departments in Colorado. To do this, use the information about the total resident population in Colorado that you used in #3 above.
Using the final answer in #4, I estimate that ________ local health department workers are needed per 100,000 residents of Colorado.

Question 6
Studies indicate that rural areas require public health worker–to–population ratios that are approximately 20% larger than the worker–to–population ratios needed in urban areas due to less efficiency in performing public health functions for smaller and less geographically compact populations. Let’s use this information together with the final answer to question # 4 to determine how many of
Colorado’s local health department workers should be allocated into rural vs. urban areas of the state. To do this, let’s first assume that approximately 14% of the residents of Colorado currently reside in rural areas, with the remaining 86% residing in urban areas. Based on the research cited above, we know that the staffing ratio for rural areas must be 1.2 times (20% larger) the staffing ratio of urban areas. In reverse, the staffing ratio for urban areas is 20% less than rural areas, or 0.83 times that of rural areas ((20/120)*100%). We can estimate the number of local health department workers needed in rural areas of Colorado by working through some simple arithmetic. Calculate A through D step by step. Caution: Use your final answer for #4, but do not round intermediate numbers to whole numbers as this will affect the precision of the final number. Round the final answer up to a whole number. Calculations:
A. A. Rural population in 100,000s = [0.14 * (Total Colorado Population)] / 100,000
B. B. Urban population in 100,000s = [0.86 * (Total Colorado Population)] / 100,000
C. C. Rural staffing ratio = (#4 Answer) / [(A) + 0.83*(B)]
D. D. Rural local health department workers needed in Colorado = (C) * (A)

Submit your final answer for (D): I estimate that ________ local health department workers are needed in rural areas of Colorado. Make sure to round your final answer up to a whole number.
Extra Credit 5 extra credit points will be given for answering the following questions. Keep your answer to 1–2 paragraphs. There is no one right answer, but it is possible to have a completely wrong answer. You must make one strong argument that has some kind of real–world evidence to back up your response to get full points (include a resource citation if needed). You can use reading material in class or information outside of class.

Question 7 (Extra Credit)
Contact tracing is a crucial process for abating the spread of a contagious disease. The inability to conduct sufficient contact tracing during the COVID–19 pandemic highlighted staffing shortages of local and state public health departments. Reflect on the full–time worker–to–population ratios you calculated  or public health departments as a floor and not a ceiling. Suggest one way health departments can be prepared to temporarily expand their workforce as needed during epidemics/outbreaks so that they can continue to carry out routine tasks and also add extra needed services to contain epidemics.