Matern Child Health J (2015) 19:240–243 DOI 10.1007/s10995-014-1621-x
COMMENTARY
Workforce Crisis in MCH Leadership Nan Streeter
Published online: 28 October 2014 Ó Springer Science+Business Media New York 2014
Why Do We Need Maternal and Child Health (MCH) Leadership Now? We have a crisis facing us! The aging workforce, the impending challenges of implementing the Affordable Care Act (ACA), and the need to redefine the role of Title V (of the Social Security Act) in light of ACA implementation require uniquely skilled and knowledgeable leaders. Since its inception in 1935, Title V has served a critical need for healthy mothers and children in the nation. From then to the present time, the workforce needs, especially in leadership, have changed dramatically due to the shift of focus from the individual health to the health of the entire population. Early in its history, Title V faced problems of poorly immunized children, infectious diseases, and high infant mortality rates. These issues have shifted at present to the current challenges of rapidly rising rates of obesity among all populations, unmet treatment needs for mental health disorders, and addressing the underlying social determinants which contribute to health status, to list just a few contemporary issues. The numbers of the public health workforce eligible for retirement are overwhelming, estimated at almost 25 % for 2014 [1]. The loss of experienced and skilled staff to retirements is further complicated by the fact that approximately 12 % of state public health agency positions are vacant. More troublesome, agencies are recruiting for only 24 % of vacancies, presumably due to budget cuts and hiring freezes [1, 2]. Agencies report shrinking numbers of qualified candidates for vacancies due to lack of N. Streeter (&) Utah Department of Health, PO Box 142001, Salt Lake City, UT 84114-2001, USA e-mail: [email protected]
123
experience, training, and knowledge of public health in general. Decreased funding, lower public sector salaries and shrinking benefits contribute to difficulty in hiring and retaining health professionals who are able to secure much higher salaries in the private sector. Filling public health positions requiring a physician, nurse or psychologist is exceptionally difficult. The pending retirement of many public health professionals will create significant gaps in the workforce, especially in leadership roles. Historically, there has been a concern that public health workers in the United States lack formal public health training. [3] Indeed, even today few Schools of Public Health in the United States offer a focus, concentration, certificate, or degree in MCH Public Health. Of the 47 accredited Schools of Public Health, 19 schools offer an MPH in MCH, 5 offer a DrPH in MCH, 3 offer PhD programs in MCH, and 4 offer MSPH or MHS. The federal Maternal and Child Health Bureau currently supports 13 MCH programs in schools of public health. [4]. The lack of MCH-specific public health programs and educational opportunities presents a challenge to developing the current MCH workforce and future leaders in MCH. The MCH public health workforce has few opportunities to learn about planning to address the issues and challenges in the MCH public health field. Further, the complexities of planning for implementation of new technologies also pose a serious challenge to work groups which are underfunded and understaffed. These factors together paint a grim future for the federal, state and local MCH public health workforce, particularly in leadership capacity and succession of upcoming leaders. With the impending retirement of large numbers of experienced public health professionals, the current workforce may be less prepared to take on leadership roles. To carry forward the mission of MCH public health to improve the
Matern Child Health J (2015) 19:240–243
health of women and children in this country, we need to ensure we have strong leaders with exceptional skills and knowledge gained through MCH leadership development and educational opportunities.
Evolution of MCH Leadership Today’s MCH workforce members are the future MCH leaders who will bring tomorrow’s visions and who will develop innovative strategies to achieve better health for mothers and children. We cannot wait to recognize this great need—we have to address the leadership needs both for the present and for the future. MCH leadership requires a unique set of skills and competencies to guide the national, state and local efforts to impact the health of our mothers, children and families. MCH leadership development assures that the MCH public health workforce has the competencies necessary to meet current and future MCH needs. To better understand the critical need for MCH leadership development, one must understand the tremendous shifts in leadership focus that have occurred over course of history of Title V [5, 6], from the creation of the Children’s Bureau in 1912 and Title V of the Social Security Act in 1935. These laws reflected the need to address critical health issues for mothers and children in those times, such as life-threatening infections, high infant mortality rates (86 per 1,000 live births in 1920), high maternal mortality rates (681.8 per 100,000 live births) and other issues such as child labor with threats to children’s safety and health [7, 8]. Investigation of infant mortality, birth rates, orphanages, orphan trains, juvenile courts, desertion, dangerous occupations, accidents and diseases of children, and child labor were foci for the early Children’s Bureau [5]. As a country we have made great strides in reducing mortality and improving the lives of mothers and children, though more work remains. Today’s MCH leaders have built capacity in: data collection, analysis and application; linkages of data sets; development of the field of MCH epidemiology; evidence based practices; and policy development. Today’s MCH world is increasingly complicated. Tomorrow will bring even greater challenges. I am confident that future MCH leaders will need new skills and knowledge to address these challenges, and to develop innovative strategies to achieve even better health for mothers and children. Leadership development takes place in a variety of ways, including on the job training as many of us have experienced during our careers, formal training, and continuing education. Leaders can emerge from these efforts with experience, skills and knowledge. Important in our planning for succession is the need to provide junior staff with the opportunity to develop leadership skills and experience
241
through mentorship by senior staff before retirement. This facilitates passing on some of the pearls of experience, knowledge, skills that have been acquired over many years of work in the field. Some consider workforce development as a luxury or as something that is not that important, especially in times of budgets cuts, sequestration, and furloughs. Yet, don’t we, as MCH leaders, owe it to those we serve and those who work with us to ensure that we purposefully assist in their leadership development?
Need for MCH Public Health Leaders We cannot wait to fulfill this great need as evidenced by the recently released 2013 United Health Foundation America’s Health Rankings Report which indicates that all four of the National Challenges for Long Term Changes are related to the health of our nation’s children [9]. The percentage of children in poverty, at 21.3 % of those under 18 years of age, is above 20 % for the fourth straight year, far above the 23-year low of 15.8 % in 2002. Although the percentage of uninsured individuals has remained relatively stable the last 4 years, children are impacted by these numbers. Nationally, among children aged 19–35 months, only 68.4 % are fully immunized according to the recommendations of the Advisory Committee on Immunization Practices (ACIP). And, lastly, the rate of low birth weight increased from 7.0 to 8.1 % during the last 20 years. Although the rates appear to be leveling off, as a nation, we have yet to decrease the rate to the 1990 level. These challenges point to the great need for MCH leadership development to effectively reverse factors that impact the health of mothers and children, such as the poor rates of poverty, immunizations, low birth weight and insurance coverage. MCH leaders who are planning retirement in the next several years are concerned about who will come after us, not from the perspective of thinking we are irreplaceable, but rather from the perspective of staff having leadership opportunities and training. Without formal trainings such as leadership institutes, staff promoted to leadership positions in MCH will struggle with the many challenges of today’s public health and health care system. We need experienced and skilled MCH leaders now more than ever to address the increasing challenges in promoting healthy mothers and children and reducing morbidities among children and youth with special health care needs. But, from where will these leaders come?
Role of Title V in MCH Leadership Development Title V has supported states’ efforts to address the health care needs of mothers and children, including those with
123
242
special needs, for decades. The law has been amended several times to account for the changing needs of these vulnerable populations in our nation. Now, the nation is faced with the critical issues that impact the very core of well-being of mothers, children and families with the largest expansion of health care in the nation’s history, the growing epidemic of obesity, and increasing proportions of children living in poverty, as a few examples. By enhancing the knowledge and skills of the workforce, we will ensure that leaders will arise with competencies to face the future MCH challenges. We need to assess the competencies of current workers to ensure that they are properly prepared for the future through opportunities for leadership development and experience. HRSA has a long history of supporting programs to address shortages of health professionals and workforce development through training and loan programs. The focus on maternal and child health leadership development has been spearheaded by the federal Maternal and Child Health Bureau (MCHB), which has been a leader in MCH workforce development. MCHB defined a set of core competency areas for MCH leadership which includes a broad array of skills and knowledge for leadership development [10]. These competencies help frame the skills, knowledge and abilities needed to ensure that tomorrow’s MCH leaders have an understanding of the public health issues related to maternal and child health in our country, the ability to identify and communicate the needs of the MCH populations, the expertise in negotiation, conflict resolution, mentoring, team building and understanding of key concepts, such as cultural awareness/competency and family-focused care. The next 10 years will be vital for development of MCH leadership due to the ever changing environment in health care and evolving new roles for federal, state and local public health, including Title V. While traditional public health focuses on epidemiology, and infectious and chronic diseases, the critical concept of life course, that is health beginning before conception and impacting the health of the child throughout life on to the next generations, could reframe the entire field of public health and its approach to prevention of chronic diseases and morbidity associated with conditions such as hypertension, obesity, diabetes, etc. MCH leaders have focused on the concept of life course to gain better understanding of the scope and impact of intergenerational health. Life course recognizes the interconnectedness of genetic, environmental (stress, toxic exposures) risk factors with an individual’s protective factors that influence health throughout life. The biological relationship between a mother and child is so intertwined and life course helps explain fetal origins of chronic diseases of adulthood. In 2002, Halfon and Holstein introduced the concept of life course related to health development over one’s lifetime, a concept that now has
123
Matern Child Health J (2015) 19:240–243
become a prominent framework for conceptualizing health [11]. The following year, 2003, Lu and Halfon [12] proposed a new approach to examining disparities in birth outcomes based on the life course perspective. Looking at health from the life course perspective will change how public health as a field will view its role, its focus and the prevention of chronic diseases much earlier than it currently approaches reduction in chronic diseases that disable, lead to poor health and higher rates of death [13, 14]. Life course becomes the underlying theme of health promotion and disease prevention. For several years, MCH leaders have framed their public health work in this way which stresses the importance of MCH leadership development all the more. Leadership development education and opportunities strengthen one’s ability to lead effectively. Leadership ability grows as the knowledge, skills, and experience of the individual expand and deepen. According to the Institute of Medicine report, The Future of the Public’s Health in the 21st Century, ‘‘we must be led by those who have mastery of the skills to mobilize, coordinate and direct broad collaborative actions within the complex public health system, these skills need constant refinement and honing’’ [15]. But, how can ‘the student’ learn from the ‘master’ if there are no masters? And, maternal and child health is not specifically addressed in this document or others related to future workforce challenges. With the increased focus on the life course perspective, maternal and child health is vital to our public’s health, yet not considered as a core focal area in educational programs for the workforce. As current leaders in MCH retire, we need to ensure that we are assisting our successors by building on their career experiences and opportunities to learn from the ‘‘masters’’. Leadership development clearly needs to be formalized and regionalized throughout the country to ensure access to all states and territories. Without national MCH leadership programs, leadership ‘‘development’’ becomes an ‘‘on the job’’ training process, which is less than optimal. National MCH leadership programs are vital to ensuring adequate training for those in public health who are serving the most vulnerable in our society—women, children and adolescents, especially those with special health care needs. These programs specifically target development of new leaders so that they can better advocate for mothers, children and their families, implement effective evidence-based practices and strategies to address identified needs for these populations provide quality services, and educate and conduct research. Leadership development ensures that new leaders are able to effectively drive change, contribute to scientific evidence and impact improved health of the population. To ensure that we have successful MCH leaders, we have to invest in the development of leadership capacity within the current workforce. We need to ensure that they have the
Matern Child Health J (2015) 19:240–243
appropriate education, background, experience, skills and training. Leadership development is a process of experience, acquisition of skills and education on principles and methods for leadership. Leaders transform visions into reality. They set goals and directions for programs and take steps to ensure an effective and cohesive team. The federally funded MCH Leadership Institutes have enabled many evolving MCH leaders to learn from current MCH leaders to have opportunities to explore a deeper knowledge and enhanced skills to become better prepared leaders of the future. State agencies, and certainly local agencies, do not have the capacity to provide leadership development for new and upcoming leaders since most public health agencies are working with fewer and fewer resources. State and local MCH workers value these leadership trainings because they provide them with (1) formal education on MCH public health in a way that most have not experienced in their educational career, (2) opportunities to learn from ‘‘experts’’ in the field, and (3) opportunities to learn from their peers.
What Can We Do? We have to act now to ensure that the next generation of younger and less experienced public health professionals is adequately prepared to assume leadership in MCH. If not, MCH as we know it today will be severely diminished in capacity to address national, state and local issues related to the health of our mothers, infants, children and adolescents, especially those with special health care needs. We have a responsibility as MCH leaders to mentor emerging MCH leaders and support succession planning. We have to ensure that MCH leadership programs continue to develop skills in the next generation of leaders. We have to provide opportunities to teach and equip future leaders with tools and the skills to deal with the many upcoming challenges in public health. We have to let national leaders know the importance of MCH Leadership development; we have to let national leaders know of the dearth of MCH public health programs. We have to act NOW!
243
References 1. Association of State and Territorial Health Officials. ASTHO profile of state public health. Vol. 3. Retrieved from http://www. astho.org/Profile/Volume-Three. 2. Association of State and Territorial Health Officials. State health agency budget cuts. Retrieved from http://www.astho.org/budgetcuts-Nov-2013. 3. Institute of Medicine. (1988). The future of public health. Washington DC: The National Academy Press. 4. Council on Education for Public Health. Accredited schools & programs. Retrieved October 3, 2013, from http://ceph.org/ accredited. 5. Bradbury, D., & Elliot, M. (1956). Four decades of action for children: A formal history of the children’s bureau. Retrieved from https://ia600508.us.archive.org/12/items/fourdecadesofact 00brad/fourdecadesofact00brad.pdf. 6. Walker, D. K. (2003). Public health strategies to promote healthy children, youth and families. In R. M. Lerner, F. Jacobs, & D. Wertlieb (Eds.), Handbook of applied developmental science enhancing the life chances of youth and families. Thousand Oaks: Sage. 7. Association of Schools of Public Health. (1896–1970). Public Health Reports (Vols. 11–85, p. 2680) October 28, 1921. 8. CDC. (2007). Maternal Mortality and Related Concepts. Retrieved from http://www.cdc.gov/nchs/data/series/sr_03/sr03_033.pdf. 9. United Health Foundation. (2013). America’s Health Rankings Report. Retrieved December 12, 2013, from http://www.amer icashealthrankings.org. 10. MCH Leadership Competencies Workgroup (Eds). (2009). Maternal and child health leadership competencies, version 3.0. Retrieved December 12, 2013, http://devleadership.mchtraining. net/mchlc_docs/mch_leadership_comp_3-0.pdf. 11. Halfon, N., & Hochstein, M. (2002). Life-course health development: An integrated framework for developing health, policy, and research. Milbank Quarterly, 80, 433–479. 12. Lu, M. C., & Halfon, N. (2003). Racial and ethnic disparities in birth outcomes: A life course perspective. Maternal and Child Health Journal, 7(1), 13–30. 13. Kuh, D., & Ben-Shlomo, Y. (2004). A life course approach to chronic disease epidemiology (2nd ed.). Oxford: Oxford University Press. 14. Fine, A., Kotelchuck, M., Adess, N., & Pies, C. Policy brief: A new agenda for MCH policy and programs: Integrating a life course perspective. Family, Maternal and Child Health Programs, Contra Costa County, CA. Retrieved from www.cchealth. org/groups/lifecourse. 15. Committee on Assuring the Health of the Public in the 21st Century. (2003). The future of the public’s health in the 21st century. Washington, DC: The National Academy Press.
123
COMMENTARY
Workforce Crisis in MCH Leadership Nan Streeter
Published online: 28 October 2014 Ó Springer Science+Business Media New York 2014
Why Do We Need Maternal and Child Health (MCH) Leadership Now? We have a crisis facing us! The aging workforce, the impending challenges of implementing the Affordable Care Act (ACA), and the need to redefine the role of Title V (of the Social Security Act) in light of ACA implementation require uniquely skilled and knowledgeable leaders. Since its inception in 1935, Title V has served a critical need for healthy mothers and children in the nation. From then to the present time, the workforce needs, especially in leadership, have changed dramatically due to the shift of focus from the individual health to the health of the entire population. Early in its history, Title V faced problems of poorly immunized children, infectious diseases, and high infant mortality rates. These issues have shifted at present to the current challenges of rapidly rising rates of obesity among all populations, unmet treatment needs for mental health disorders, and addressing the underlying social determinants which contribute to health status, to list just a few contemporary issues. The numbers of the public health workforce eligible for retirement are overwhelming, estimated at almost 25 % for 2014 [1]. The loss of experienced and skilled staff to retirements is further complicated by the fact that approximately 12 % of state public health agency positions are vacant. More troublesome, agencies are recruiting for only 24 % of vacancies, presumably due to budget cuts and hiring freezes [1, 2]. Agencies report shrinking numbers of qualified candidates for vacancies due to lack of N. Streeter (&) Utah Department of Health, PO Box 142001, Salt Lake City, UT 84114-2001, USA e-mail: [email protected]
123
experience, training, and knowledge of public health in general. Decreased funding, lower public sector salaries and shrinking benefits contribute to difficulty in hiring and retaining health professionals who are able to secure much higher salaries in the private sector. Filling public health positions requiring a physician, nurse or psychologist is exceptionally difficult. The pending retirement of many public health professionals will create significant gaps in the workforce, especially in leadership roles. Historically, there has been a concern that public health workers in the United States lack formal public health training. [3] Indeed, even today few Schools of Public Health in the United States offer a focus, concentration, certificate, or degree in MCH Public Health. Of the 47 accredited Schools of Public Health, 19 schools offer an MPH in MCH, 5 offer a DrPH in MCH, 3 offer PhD programs in MCH, and 4 offer MSPH or MHS. The federal Maternal and Child Health Bureau currently supports 13 MCH programs in schools of public health. [4]. The lack of MCH-specific public health programs and educational opportunities presents a challenge to developing the current MCH workforce and future leaders in MCH. The MCH public health workforce has few opportunities to learn about planning to address the issues and challenges in the MCH public health field. Further, the complexities of planning for implementation of new technologies also pose a serious challenge to work groups which are underfunded and understaffed. These factors together paint a grim future for the federal, state and local MCH public health workforce, particularly in leadership capacity and succession of upcoming leaders. With the impending retirement of large numbers of experienced public health professionals, the current workforce may be less prepared to take on leadership roles. To carry forward the mission of MCH public health to improve the
Matern Child Health J (2015) 19:240–243
health of women and children in this country, we need to ensure we have strong leaders with exceptional skills and knowledge gained through MCH leadership development and educational opportunities.
Evolution of MCH Leadership Today’s MCH workforce members are the future MCH leaders who will bring tomorrow’s visions and who will develop innovative strategies to achieve better health for mothers and children. We cannot wait to recognize this great need—we have to address the leadership needs both for the present and for the future. MCH leadership requires a unique set of skills and competencies to guide the national, state and local efforts to impact the health of our mothers, children and families. MCH leadership development assures that the MCH public health workforce has the competencies necessary to meet current and future MCH needs. To better understand the critical need for MCH leadership development, one must understand the tremendous shifts in leadership focus that have occurred over course of history of Title V [5, 6], from the creation of the Children’s Bureau in 1912 and Title V of the Social Security Act in 1935. These laws reflected the need to address critical health issues for mothers and children in those times, such as life-threatening infections, high infant mortality rates (86 per 1,000 live births in 1920), high maternal mortality rates (681.8 per 100,000 live births) and other issues such as child labor with threats to children’s safety and health [7, 8]. Investigation of infant mortality, birth rates, orphanages, orphan trains, juvenile courts, desertion, dangerous occupations, accidents and diseases of children, and child labor were foci for the early Children’s Bureau [5]. As a country we have made great strides in reducing mortality and improving the lives of mothers and children, though more work remains. Today’s MCH leaders have built capacity in: data collection, analysis and application; linkages of data sets; development of the field of MCH epidemiology; evidence based practices; and policy development. Today’s MCH world is increasingly complicated. Tomorrow will bring even greater challenges. I am confident that future MCH leaders will need new skills and knowledge to address these challenges, and to develop innovative strategies to achieve even better health for mothers and children. Leadership development takes place in a variety of ways, including on the job training as many of us have experienced during our careers, formal training, and continuing education. Leaders can emerge from these efforts with experience, skills and knowledge. Important in our planning for succession is the need to provide junior staff with the opportunity to develop leadership skills and experience
241
through mentorship by senior staff before retirement. This facilitates passing on some of the pearls of experience, knowledge, skills that have been acquired over many years of work in the field. Some consider workforce development as a luxury or as something that is not that important, especially in times of budgets cuts, sequestration, and furloughs. Yet, don’t we, as MCH leaders, owe it to those we serve and those who work with us to ensure that we purposefully assist in their leadership development?
Need for MCH Public Health Leaders We cannot wait to fulfill this great need as evidenced by the recently released 2013 United Health Foundation America’s Health Rankings Report which indicates that all four of the National Challenges for Long Term Changes are related to the health of our nation’s children [9]. The percentage of children in poverty, at 21.3 % of those under 18 years of age, is above 20 % for the fourth straight year, far above the 23-year low of 15.8 % in 2002. Although the percentage of uninsured individuals has remained relatively stable the last 4 years, children are impacted by these numbers. Nationally, among children aged 19–35 months, only 68.4 % are fully immunized according to the recommendations of the Advisory Committee on Immunization Practices (ACIP). And, lastly, the rate of low birth weight increased from 7.0 to 8.1 % during the last 20 years. Although the rates appear to be leveling off, as a nation, we have yet to decrease the rate to the 1990 level. These challenges point to the great need for MCH leadership development to effectively reverse factors that impact the health of mothers and children, such as the poor rates of poverty, immunizations, low birth weight and insurance coverage. MCH leaders who are planning retirement in the next several years are concerned about who will come after us, not from the perspective of thinking we are irreplaceable, but rather from the perspective of staff having leadership opportunities and training. Without formal trainings such as leadership institutes, staff promoted to leadership positions in MCH will struggle with the many challenges of today’s public health and health care system. We need experienced and skilled MCH leaders now more than ever to address the increasing challenges in promoting healthy mothers and children and reducing morbidities among children and youth with special health care needs. But, from where will these leaders come?
Role of Title V in MCH Leadership Development Title V has supported states’ efforts to address the health care needs of mothers and children, including those with
123
242
special needs, for decades. The law has been amended several times to account for the changing needs of these vulnerable populations in our nation. Now, the nation is faced with the critical issues that impact the very core of well-being of mothers, children and families with the largest expansion of health care in the nation’s history, the growing epidemic of obesity, and increasing proportions of children living in poverty, as a few examples. By enhancing the knowledge and skills of the workforce, we will ensure that leaders will arise with competencies to face the future MCH challenges. We need to assess the competencies of current workers to ensure that they are properly prepared for the future through opportunities for leadership development and experience. HRSA has a long history of supporting programs to address shortages of health professionals and workforce development through training and loan programs. The focus on maternal and child health leadership development has been spearheaded by the federal Maternal and Child Health Bureau (MCHB), which has been a leader in MCH workforce development. MCHB defined a set of core competency areas for MCH leadership which includes a broad array of skills and knowledge for leadership development [10]. These competencies help frame the skills, knowledge and abilities needed to ensure that tomorrow’s MCH leaders have an understanding of the public health issues related to maternal and child health in our country, the ability to identify and communicate the needs of the MCH populations, the expertise in negotiation, conflict resolution, mentoring, team building and understanding of key concepts, such as cultural awareness/competency and family-focused care. The next 10 years will be vital for development of MCH leadership due to the ever changing environment in health care and evolving new roles for federal, state and local public health, including Title V. While traditional public health focuses on epidemiology, and infectious and chronic diseases, the critical concept of life course, that is health beginning before conception and impacting the health of the child throughout life on to the next generations, could reframe the entire field of public health and its approach to prevention of chronic diseases and morbidity associated with conditions such as hypertension, obesity, diabetes, etc. MCH leaders have focused on the concept of life course to gain better understanding of the scope and impact of intergenerational health. Life course recognizes the interconnectedness of genetic, environmental (stress, toxic exposures) risk factors with an individual’s protective factors that influence health throughout life. The biological relationship between a mother and child is so intertwined and life course helps explain fetal origins of chronic diseases of adulthood. In 2002, Halfon and Holstein introduced the concept of life course related to health development over one’s lifetime, a concept that now has
123
Matern Child Health J (2015) 19:240–243
become a prominent framework for conceptualizing health [11]. The following year, 2003, Lu and Halfon [12] proposed a new approach to examining disparities in birth outcomes based on the life course perspective. Looking at health from the life course perspective will change how public health as a field will view its role, its focus and the prevention of chronic diseases much earlier than it currently approaches reduction in chronic diseases that disable, lead to poor health and higher rates of death [13, 14]. Life course becomes the underlying theme of health promotion and disease prevention. For several years, MCH leaders have framed their public health work in this way which stresses the importance of MCH leadership development all the more. Leadership development education and opportunities strengthen one’s ability to lead effectively. Leadership ability grows as the knowledge, skills, and experience of the individual expand and deepen. According to the Institute of Medicine report, The Future of the Public’s Health in the 21st Century, ‘‘we must be led by those who have mastery of the skills to mobilize, coordinate and direct broad collaborative actions within the complex public health system, these skills need constant refinement and honing’’ [15]. But, how can ‘the student’ learn from the ‘master’ if there are no masters? And, maternal and child health is not specifically addressed in this document or others related to future workforce challenges. With the increased focus on the life course perspective, maternal and child health is vital to our public’s health, yet not considered as a core focal area in educational programs for the workforce. As current leaders in MCH retire, we need to ensure that we are assisting our successors by building on their career experiences and opportunities to learn from the ‘‘masters’’. Leadership development clearly needs to be formalized and regionalized throughout the country to ensure access to all states and territories. Without national MCH leadership programs, leadership ‘‘development’’ becomes an ‘‘on the job’’ training process, which is less than optimal. National MCH leadership programs are vital to ensuring adequate training for those in public health who are serving the most vulnerable in our society—women, children and adolescents, especially those with special health care needs. These programs specifically target development of new leaders so that they can better advocate for mothers, children and their families, implement effective evidence-based practices and strategies to address identified needs for these populations provide quality services, and educate and conduct research. Leadership development ensures that new leaders are able to effectively drive change, contribute to scientific evidence and impact improved health of the population. To ensure that we have successful MCH leaders, we have to invest in the development of leadership capacity within the current workforce. We need to ensure that they have the
Matern Child Health J (2015) 19:240–243
appropriate education, background, experience, skills and training. Leadership development is a process of experience, acquisition of skills and education on principles and methods for leadership. Leaders transform visions into reality. They set goals and directions for programs and take steps to ensure an effective and cohesive team. The federally funded MCH Leadership Institutes have enabled many evolving MCH leaders to learn from current MCH leaders to have opportunities to explore a deeper knowledge and enhanced skills to become better prepared leaders of the future. State agencies, and certainly local agencies, do not have the capacity to provide leadership development for new and upcoming leaders since most public health agencies are working with fewer and fewer resources. State and local MCH workers value these leadership trainings because they provide them with (1) formal education on MCH public health in a way that most have not experienced in their educational career, (2) opportunities to learn from ‘‘experts’’ in the field, and (3) opportunities to learn from their peers.
What Can We Do? We have to act now to ensure that the next generation of younger and less experienced public health professionals is adequately prepared to assume leadership in MCH. If not, MCH as we know it today will be severely diminished in capacity to address national, state and local issues related to the health of our mothers, infants, children and adolescents, especially those with special health care needs. We have a responsibility as MCH leaders to mentor emerging MCH leaders and support succession planning. We have to ensure that MCH leadership programs continue to develop skills in the next generation of leaders. We have to provide opportunities to teach and equip future leaders with tools and the skills to deal with the many upcoming challenges in public health. We have to let national leaders know the importance of MCH Leadership development; we have to let national leaders know of the dearth of MCH public health programs. We have to act NOW!
243
References 1. Association of State and Territorial Health Officials. ASTHO profile of state public health. Vol. 3. Retrieved from http://www. astho.org/Profile/Volume-Three. 2. Association of State and Territorial Health Officials. State health agency budget cuts. Retrieved from http://www.astho.org/budgetcuts-Nov-2013. 3. Institute of Medicine. (1988). The future of public health. Washington DC: The National Academy Press. 4. Council on Education for Public Health. Accredited schools & programs. Retrieved October 3, 2013, from http://ceph.org/ accredited. 5. Bradbury, D., & Elliot, M. (1956). Four decades of action for children: A formal history of the children’s bureau. Retrieved from https://ia600508.us.archive.org/12/items/fourdecadesofact 00brad/fourdecadesofact00brad.pdf. 6. Walker, D. K. (2003). Public health strategies to promote healthy children, youth and families. In R. M. Lerner, F. Jacobs, & D. Wertlieb (Eds.), Handbook of applied developmental science enhancing the life chances of youth and families. Thousand Oaks: Sage. 7. Association of Schools of Public Health. (1896–1970). Public Health Reports (Vols. 11–85, p. 2680) October 28, 1921. 8. CDC. (2007). Maternal Mortality and Related Concepts. Retrieved from http://www.cdc.gov/nchs/data/series/sr_03/sr03_033.pdf. 9. United Health Foundation. (2013). America’s Health Rankings Report. Retrieved December 12, 2013, from http://www.amer icashealthrankings.org. 10. MCH Leadership Competencies Workgroup (Eds). (2009). Maternal and child health leadership competencies, version 3.0. Retrieved December 12, 2013, http://devleadership.mchtraining. net/mchlc_docs/mch_leadership_comp_3-0.pdf. 11. Halfon, N., & Hochstein, M. (2002). Life-course health development: An integrated framework for developing health, policy, and research. Milbank Quarterly, 80, 433–479. 12. Lu, M. C., & Halfon, N. (2003). Racial and ethnic disparities in birth outcomes: A life course perspective. Maternal and Child Health Journal, 7(1), 13–30. 13. Kuh, D., & Ben-Shlomo, Y. (2004). A life course approach to chronic disease epidemiology (2nd ed.). Oxford: Oxford University Press. 14. Fine, A., Kotelchuck, M., Adess, N., & Pies, C. Policy brief: A new agenda for MCH policy and programs: Integrating a life course perspective. Family, Maternal and Child Health Programs, Contra Costa County, CA. Retrieved from www.cchealth. org/groups/lifecourse. 15. Committee on Assuring the Health of the Public in the 21st Century. (2003). The future of the public’s health in the 21st century. Washington, DC: The National Academy Press.
123
