The public health professional core competencies, in my opinion, have not adequately reflected or prepared people for critical elements of their jobs-to-be-done: improving health behaviors of individuals and in communities, increasing the adoption and use of evidence-based practices by public health and allied organizations, and promoting and strengthening environmental and policy changes to improve and sustain public health. The Council on Linkages Between Academia and Public Health Practice (Council on Linkages) is in the process of reviewing and revising the current Core Competencies for public health professionals. As part of this process, the Council on Linkages is collecting feedback on the Core Competencies from the public health community. Please consider the following observations and suggestions for how they could be improved to be more relevant to the practice of public health as I have observed and participated in it over the past 30 years. If you agree with these, and have other opinions about competencies for public health professionals, you have until December 31st to submit them. Feel free to copy and paste these comments, edit them, and add to them in the comments section of their feedback form.
In reviewing the current core competences, only three - rather weak - competencies touch on the jobs-to-be-done by public health professionals as outlined above: 2A6 - 2B7 - 2B8: participates, develops and implements plans and programs consistent with policies (Policy Development/Program Planning Skills). A second one in that domain, 2A8 - 2B9 - 2C10, mentions the need for program monitoring and evaluation skills. Finally, 3A4 -3B4 - 3C4 address using a variety of approaches to disseminate public health information (e.g., social networks, media, blogs). These isolated competencies stand in marked contrast to the more detailed 6-7 'Communication skills' and an equal number of 'Cultural competency skills' currently identified in the Core Competencies.
Despite the existence of the Core Competencies and others (for example, for MPH and DrPH programs), there have been few investigations of what is needed for success in the context of practice, not academics. And when one turns to whether characteristics of the public health workforce are associated with improved effectiveness and changes in population health outcomes, a recent survey of the public health workforce literature found no published study that had investigated the question (Beck & Boulton, 2012). My point here is that we need to pay more attention to what is needed in the real world of public health practice; not theories and fashions.
The needs for competencies in communication and marketing in the public health workforce have been consistently voiced. In the context of reducing health disparities, Golding & Rubin (2011) noted that the success of any expansion of programs and services to close gaps in health status rests on the effectiveness of the information and communication that is provided by health communicators and health marketers. In their survey of members of the National Public Health Information Coalition, 66% of respondents identified the planning, development and implementation of interventions, and marketing and advertising as major job responsibilities. The leading training topic survey respondents identified for themselves – and for other staff in their state or local health department – was to “understand how to tailor and target campaigns that will improve the well-being of diverse individuals and communities.” Social marketing has been identified as part of the continuing education competencies for the currently employed public health education workforce, and public health leadership training initiatives include marketing as part of their curriculum (Allegrante, Moon, Auld & Gebbie, 2000; Hawley, Romain, Molgaar & Kabler, 2011). Harris et al (2012) note that the marketing discipline can significantly contribute to the frameworks that are used, and the dissemination and implementation strategies that are selected, to bring more evidence to the daily practice of public health.
Consistent with these views, Healthy People 2020 included social marketing among the objectives for the Nation to achieve over the course of the next decade. Specifically, Healthy People 2020 Objectives HC/HIT – 13.2 and HC/HIT-13.3 are:
Increase the proportion of schools of public health and accredited master of public health (MPH) programs that offer one or more courses in social marketing.
Increase the proportion of schools of public health and accredited master of public health (MPH) programs that offer workforce development activities in social marketing for public health practitioners.
Just this past week the Federal Interagency Workgroup for National Health Objectives for 2020 met and approved revisions to the other related HC/HIT objective that now reads:
[13.1] Increase the number of State health departments that report using social marketing in health promotion and disease prevention programs.
Social marketing is a systematic process for developing behavior and social change programs with documented successes for many public health issues, across many different population groups and in many different contexts (see Lefebvre, 2013). The strategies and tools, discussed below, are a foundation for the best in public health change programs, whether it is truth®, Verb™ or the current TIPS campaign. Indeed, when read alongside a social marketing textbook such as Lefebvre (2013), the discussion of the "six components necessary for public health intervention" by the Director of the CDC (Frieden, 2014) includes many of the key features and ideas that characterize a marketing orientation and approach to public health.
A set of tiered competencies, recently approved by the International Social Marketing Association's Board of Directors, for the Council to consider are:
Tier 1: Entry level professionals
Explains and differentiates a social marketing approach and demonstrates the appropriate application of social marketing approaches and tools (audience segmentation, behavior selection, consumer research, application of evidence-based theories and models, use of integrated marketing strategies, behavior change evaluation) to support development of health promotion and disease prevention programs and policies.
Tier 2: Individuals with management and/or supervisory responsibilities
Manages and leads the development of health promotion and disease prevention programs and policies using a social marketing strategic planning approach and community input.
Tier 3: Senior managers and/or leaders
Communicates, encourages and ensures professional, organizational and community support for the ethical development of health promotion and disease prevention programs and policies based on social marketing approaches.
These competencies might be considered for inclusion under a broader domain of competencies.
I propose to the Council to consider what if they developed a separate set of competencies under the domain of Public Health Change skills (or behavior, community and social change skills)? For people in the field, this is what they have to do to be successful. And for many students entering public health, this is what they want to do, change the world - or at least their corner of it. They should be prepared by public health education and training programs to be as good as they can be at it. For a more articulated vision of what a set of competencies for Public Health Change Skills could be, I propose starting with:
1. Describe social marketing to colleagues and other professionals, differentiate it from other approaches to behavior and social change, advocate for its appropriate application to social policy development and implementation.
2. Work with colleagues and stakeholders to identify community or national priorities and identify those to which a social marketing approach may be usefully applied.
3. Identify affected populations and select appropriate segments to give the greatest priority to in program planning.
4. Prioritize and select measurable behaviors, organizational practices, environments or policies to influence.
5. Design and conduct a situational analysis, evidence reviews and formative research needed to understand the perspectives on the problem and its possible solutions by people affected by it and stakeholders, and identify their perceived value (benefits) for the change objective as compared to the alternatives.
6. Apply appropriate behavioral and social science theories and models to the development of a framework to describe the problem and its potential solution.
7. Analyze, synthesize and apply theory, evidence and research insights to create an integrated marketing strategy and plan.
8. Develop and test the relevance and potential effectiveness of marketing strategies (e.g., concepts and approaches) and tools (e.g., products, services and messages) with representatives of priority groups and stakeholders.
9. Implement, manage and lead social marketing interventions.
10. Design and implement a program evaluation plan, including a monitoring system to assure programs are on track to achieve goals.
11. Apply ethical principles to conducting research, and developing and implementing a social marketing plan.
12. Communicate the results of the program and its evaluation to colleagues, stakeholders, communities and other relevant organizations and groups.
Again, we can debate whether 'social marketing' needs to be incorporated into every competency listed above (for example, #1, 2, 9 and 11). However, I think few seasoned public health program planners would argue against the importance of each of these items in any well developed and implemented public health program - whether it is aimed at individual, organizational or policy change.
Finally, I recommend that the framers of the Council on Linkages' revised competencies give special attention to their role in fostering evidence-based public health. As Brownson, Fielding & Maylahn (2009) have noted, the development of an evidence-based approach to public health practice involves more than a knowledge of the science of what works with what identified problem, when, under what circumstances and with whom. There is also a need to have frameworks that can serve to translate this scientific knowledge into effective, efficient, equitable and sustainable programs in real-world settings. And there must also be broad and consistent dissemination and implementation of proven interventions at both the state and local level of public health practice. I believe that incorporating the concepts and tools of social marketing into the next version of public health competencies is a significant step in that direction.
Allegrante JP, Moon RW, Auld E, Gebbie KM. Continuing-education needs of the currently employed public health education workforce. Am J Public Health; 2000; 91:1230-1234.
Beck AJ, Boulton ML. Building an effective workforce: A systematic review of public health workforce literature. Am J Prev Med. 2012; 42:S6-S16.
Brownson RC, Fielding JE, Maylahn CM. (2009). Evidence-based public health: A fundamental concept for public health practice. Annu Rev Publ Health. 2009;30:175-201.
Frieden TR. Six components necessary for effective public health program implementation. Am J Public Health; 2014: 104:17-22. Abstract
Golding L, Rubin D. Training for public information officers in communication to reduce health disparities: A needs assessment. Health Promot Pract. 2011; 12:406-413. Abstract
Hawley SR, St. Romain T, Orr SA, Molgaar CA, Kabler BS. Competency-based impact of a statewide public health leadership training program. Health Promot Pract. 2011; 12:202-208. Abstract
Harris JR, Cheadle A, Hannon PA, Forehand M, Lichiello P, Mahoney E, Snyder S, Yarrow J. A framework for disseminating evidence-based health promotion practices. Prev Chron Dis. 2012; 9:E22 PMCID: PMC3277406
Lefebvre RC. Social marketing and social change: Strategies and tools for improving health, well-being and the environment. San Francisco, CA: Jossey-Bass; 2013.