Public Health Administration
Public health administration is the component of the field of public health that concentrates on management of people and programs. On a day-to-day basis, administration is needed to ensure that organizations operate efficiently and with success. Programs must be guided. The field of administration is concerned with theory and techniques derived from a variety of fields, mainly management.
The work of a public health administrator is at the same time similar to and different from that of persons engaged in administration in other fields. The administrative elements are similar. These include supervising employees, coordinating programs, preparing budgets, monitoring programs, and evaluating results and outcomes. Other aspects that are germane to the field of public health are different from other fields. Public health administrators are concerned with health and disease prevention programs. They administer educational campaigns and try to keep the people they serve healthy. Other health professionals have similar aims of maintaining health but often are restorative or curative rather than preventive.
There are 10 core public health functions with which an administrator must be familiar. There is a specialized body of public health law. Data are constantly being generated. They must be sorted, classified, stored, and interpreted. There are systems to keep track of diseases, vital events, waste materials, insects and a host of other aspects of public health. Data that are developed must be organized and presented to such various constituencies as members of the public, governmental agencies and professionals. The overall health of the public being served must be periodically assessed. Intervention programs must be created, implemented and evaluated. Other forms of research are conducted.
The day-to-day activities of a public health administrator include human resources management; finance; performance measurement and improvement; communications and marketing; and maintaining relations with members of the media and local government. A public health administrator must build relationships with such various constituencies as consumer groups, health providers and legislators. Leadership is an important aspect of public health administration.
The most common work setting for a public health administrator is an office within a local health department or public health agency. There are approximately 3,300 local boards of health in the United States. Their size varies from a single municipality to an entire state. Many consist of one or more counties. Each employs a staff of professionals who provide specialized services. Each provider has a supervisor; larger organizations have more than one layer of supervision. In addition, there are public and private organizations that provide public health services. Governments also employ public health administrators. The number of persons who provide some administrative services within the realm of public health is thus extensive. A conservative estimate for the United States would exceed 20,000 persons.
The majority of public health administrators work in offices. However, this is not universally the case. Using data from a study conducted by the National Association of Local Boards of Health, as of 1997 approximately 70% of all health boards had access to computers, but only 18% had access to the Internet. Among public health employees, as of 2001 about 5% lacked access to computers. This number is declining with passing time. Most administrators have and regularly use electronic tools. Many administrators who work in the field routinely use laptop communication devices.
Education and training
Basic preparation for a career in public health administration usually begins with a college degree. There are persons currently in the work force with less formal education. These people have been typically been
working in the public health system for many years, having started at a time when formal training in public health or administration was uncommon and largely unavailable. However, their numbers are decreasing. As these people retire, their replacements are entering with more formal training and credentials.
It is possible to learn administration from experience on the job but the time required is increasing each year. As of 2001, a college degree is the functional minimum level of education for admission into the field of public health administration. The actual field of study can vary but an undergraduate degree in management, public health, nursing, community health, applied health, allied health or a related discipline is useful. An optimal undergraduate curriculum should include course work in the following subject areas: management, accounting, finance, economics, biology, environmental health or science, marketing, business, health law, and budgeting. These courses will most likely be supplemented by advanced formal education and practical on the-job training.
Initial training begins with job orientation. This is relatively similar for most entry-level positions in the field. During orientation, the structure and reporting relationships of an organization are described. Basic laws and other legal requirements are outlined. Job duties of a particular position are explained. Organizational regulations and requirements are reviewed.
Ongoing training occurs at two levels. The first is specific to a particular working agency or environment. It consists of office and organizational updates, program changes, and information pertaining to other local issues. The second is specific to the field of public health. These updates typically occur at professional conferences and through articles in the secondary literature of public health. They consist of changes in programs that have been proposed or imposed by federal or other funding agencies. They also include new findings related to theories or practice that have been developed by researchers. Changes in reporting procedures are in this category.
Advanced education and training
Advanced training in public health administration can be obtained from a formal graduate degree program
There are some differences among the degree courses described. These are typically related to the focus afforded by the training. For example, an MPH degree is specifically concentrated on public health. An MBA provides more general training. While both are useful, the MPH is focused on health. In an analogous manner, MHSA course work focuses on issues related to managing health service providers and organizations. MPA focuses on administration in a public or not for profit environment. The MHA is geared for hospital administrators while the MM is very general. An MPH degree curriculum includes courses in epidemiology and environmental health. The others typically substitute additional courses in economics, accounting, or labor relations.
Some workers in public health administration require continuing education units to maintain a license or certification. Examples of such workers include nurses, social workers, health officers, sanitarians, and physicians. The rules for many of these professionals are not set by federal or national agencies but rather may be specific to the state that has issued the credential. Professionals earning continuing education credits may include courses and seminars that cover aspects of public health administration. In this way, they acquire new and updated knowledge.
Public health administration as a profession does not require practitioners to be certified as of 2001. There is a movement to require certification for public health administrators. If this trend becomes law, more individuals will be seeking advanced education credits in the future. A likely degree option is the MPH.
The future outlook for persons seeking employment in public health administration is quite favorable. With the advent of managed care, prevention and public health have assumed new emphasis in the mainstream practice of medicine. Demand for persons with training in public health administration is likely to increase. In addition, as of 2001, performance standards are being instituted within the field of public health. This trend will increase the demand for people with advanced and specific training in public health administration. With increased requirements for training and preparation, salaries for public health administrators are also likely to rise. As the baby boomer generation ages and retires, the number of agencies and organizations providing services is expected to increase. These demands, too, are likely to drive up salaries for public health administrators.
All persons seeking to enter the field of public health administration will require professional training and preparation. This requirement will translate into opportunities for teachers of this subject. As of 2001, there are not enough people with appropriate professional experience and training to meet the demand for teachers in schools and programs of public health. With demand for trained persons increasing, the demand for teachers is likely to increase over the demand in the recent past.
Halverson, Paul K., Arnold D. Kaluzny, and Curtis P. McLaughlin, Managed Care and Public Health. Gaithersburg, MD: Aspen Publishers, 1998.
Health Administration Press. Back to Basics: Foundations of Healthcare Management. Chicago, IL: Health Administration Press, 2000.
Kilpatrick, Anne O., and James A. Johnson, Handbook of Health Administration and Policy. New York: Marcel Dekker, 1998.
Novick, Lloyd F. and Glen P. Mays, Public Health Administration: Principles for Population-Based Management. Gaithersburg, MD: Aspen Publishers, 2000.
Rakich, Jonathan S., Kurt Darr, and Beaufort B. Longest, Managing Health Services Organizations and Systems, 4th ed. Baltimore. MD: Health Professions Press, 2000.
Atchison, C., M. A. Barry, N. Kanarek, and K. Gebbie. "The quest for an accurate accounting of public health expenditures." Journal of Public Health Management and Practice 6, no. 5 (2000): 93-102.
Hall-Long, B. A., G. B. Perez, and P. K. Allbright. "A public health-academic education partnership." Journal of
Public Health Management and Practice 7, no. 1 (2001): 60-66.
Neuberger, R. J. "Where's the evidence? Making the case for public health." Journal of Epidemiology and Community Health 55, no. 2 (2001): 77-78.
Upshaw, V. M. "The National Public Health Performance Standards Program: Will it strengthen governance of local public health?" Journal of Public Health Management and Practice 6, no. 5 (2000): 88-92.
American Hospital Association. One North Franklin, Chicago, IL 60606-3421. (312) 422-3000. <http://www.aha.org/index.asp>.
American Public Health Association. 800 I Street, NW, Washington, DC 20001-3710. (202) 777-2742. Fax: (202) 777-2534. <http://www.apha.org/>. firstname.lastname@example.org.
Association of State and Territorial Health Officials. 1275 K Street NW, Suite 800, Washington, DC 20005-4006. (202) 371-9090. Fax: (202) 371-9797. <http://www.astho.org/>. email@example.com.
Health Resources and Services Administration. 5600 Fishers Lane, Room 8-103, Rockville, MD 20857. (301) 443-0062. Fax: (301) 443-1164. <http://www.hrsa.gov/>. firstname.lastname@example.org.
National Association of County and City Health Officials. 1100 17th Street, Second Floor, Washington, DC 20036. (202) 783-5550. Fax: (202) 783-1583. <http://www. naccho.org/>.
National Association of Local Boards of Health. 1840 East Gypsy Lane, Bowling Green, OH 43402. (419) 353-7714. Fax: 352-6278. <http://www.nalboh.org/>. email@example.com.
Maryland Community and Public Health Administration. <http://mdpublichealth.org/>.
Medical Library Association. <http://www.phha.mlanet.org/>.
Sun Library. <http://sunlibrary.is.rpslmc.edu/library/pubhealth.html>.
University of South Carolina Library. <http://www.libsci.sc.edu/bob/class/clis734/webguides/PHealth.htm>.
Epidemiology—The study of patterns and distribution of disease in large groups of people.
Vital event—An occurrence for which a certificate is typically issued. Examples of vital events include births, deaths, marriages and adoptions.
L. Fleming Fallon, Jr., MD, PhD, DrPH