Outline ONLY for a research paper. (will post for paper later)

O R I G I N A L P A P E R

Engaging Local Public Health System Partnerships to Educate the Future Public Health Workforce

Rosemary M. Caron • Marc D. Hiller •

William J. Wyman

Published online: 1 September 2012

� Springer Science+Business Media, LLC 2012

Abstract The Institute of Medicine concluded that

keeping the public healthy required a well-educated public

health workforce, thus leading to its recommendation that

‘‘all undergraduates should have access to education in

public health’’ [2]. In response to this call, the authors

examined the current practice, feasibility, and value in

strengthening (or building) a functional collaborative model

between academic institutions and practitioners from local

health departments to educate tomorrow’s public health

workforce. Local and regional health departments in New

England were surveyed to: (1) establish a baseline of

existing working relationships between them and nearby

academic institutions; (2) examine the barriers that inhibit

the development of collaborations with academic partners;

(3) assess how they jointly promote public health workforce

development; and (4) analyze which essential public health

services their partnership addresses. Despite the lack of

financial resources often cited for the absence of academic-

local health department collaborations, some New England

states reported that their academic institution and local

public health department partnerships were valued and

productive. The authors discuss how effective academic-

community collaborations have the potential to facilitate a

broad-based appreciation of public health among students

via a wide array of public health curricula and applied

experiential learning opportunities in public health settings.

The authors propose a model for how to combine basic

public health lessons with practical experience and leader-

ship offered by local health departments, in order to foster a

real understanding of public health, its importance, practice,

and relevance in today’s society from a public health

workforce perspective.

Keywords Local health department � Public health workforce � Public health partnership � Public health system � Public health education

Introduction

A strong public health infrastructure that hopes to address

the wide range of needs within a community requires sound

relationships and active collaboration between academia

and the current, as well as, future public health workforce.

In 1988, the Institute of Medicine (IOM) outlined some

distressing failures of the public health infrastructure in its

report The Future of Public Health. In particular, the IOM

determined that unlike other health professions, ‘‘schools

of public health have in recent years become somewhat

isolated from the field of public health practice’’ [1]. The

IOM further concluded that ‘‘all undergraduates should

have access to education in public health’’ to ensure a well-

educated public health workforce [2].

Partnerships and collaborations between public health

practitioners and public health educators are important

exercises in developing an educated citizenry in public

health, posited as a necessary requirement of a liberal arts

undergraduate education by Riegelman and Albertine in

their report, Recommendations for Undergraduate Public

Health Education [3]. Providing students with ‘‘real life’’

R. M. Caron (&) � M. D. Hiller Department of Health Management and Policy,

College of Health and Human Services, University of New

Hampshire, #319 Hewitt Hall, 4 Library Way,

Durham, NH 03824, USA

e-mail: [email protected]

W. J. Wyman

Department of Biomedical Science, University of New

Hampshire, Durham, NH, USA

123

J Community Health (2013) 38:268–276

DOI 10.1007/s10900-012-9610-8

practical exposure and experiences in public health is likely

to make students more aware, and therefore, more sensitive

to the role of public health in their community. In this way,

educators and practitioners can help promote a stronger

understanding of public health, both in a general sense and

within special areas, as well as a more meaningful appre-

ciation of public health citizenship among students by

engaging them with their community.

Students who work with public health practitioners are

also likely to be better prepared to address the health needs

of their communities upon their entry into the workforce.

With exposure to real world applications of public health,

students may become more aware of public health career

choices and the educational opportunities available, as well

as the social connections and professional networks that

will help them enter the workforce. In addition, their first-

hand observation of the commitments and social values

held by working public health professionals provides them

the opportunity to experience that which Turnock refers to

as ‘‘Unique Images of Public Health, namely its basis in

social justice, its inherent political nature, its dynamic,

ever-expanding agenda, its link with government, its

grounding in the sciences, its use of prevention as a prime

strategy, and its uncommon culture and bond’’ [4]. The

description of these images and values can be read in an

academic textbook but we propose that they require being

observed and experienced in the workplace and in the

practitioner for them to hold meaning and appreciation.

Similarly, agencies that provide internships, practicums,

or other partnerships will have better access to public health

educated new hires who may already be familiar with the

operations and organization of the agency. Collaborations

between academia and the community can also be beneficial

in addressing the limited access of many community agen-

cies to the expertise needed to assess and respond to the

changing demands for service [5]. Furthermore, these types

of collaborations can enable academics to bring rich, real-life

experiences into the classroom and provide students with a

well-rounded educational experience.

A critical component of a public health system in the

community is the local health department (LHD). LHDs

are established by their respective state government either

as a product of state legislature or by executive authority

granted to a particular state governmental agency, such as a

state health department. In turn, they are governed by the

respective state and local laws. As such, they cannot be

considered separately from the state network in which they

operate [6]. They exist for the common good and are

responsible for providing leadership and services aimed at

improving health and well-being, and preventing illness,

disease, injury, premature death, and health disparities [7].

A number of different factors, such as the governance

structure, level of legal authority, infrastructure, functional

capacity and resources of the LHD, all contribute to the

range of services and levels of collaboration it may offer.

An understanding of the current baseline of working part-

nerships between a LHD and its nearby academic institu-

tion(s) may provide valuable insights into the education of

our future public health workforce.

The purpose of this study was to survey LHDs in New

England, given their diverse organization, to: (1) establish

a baseline of their existing working relationships with

neighboring academic institutions; (2) examine perceived

or existing barriers that inhibit the development of col-

laborations with academic partners; (3) assess how they

jointly promote or engage in public health workforce

development; and (4) analyze which essential public health

services are embodied in their efforts or those that may be

reflected within their existing collaborative partnerships.

The authors discuss how effective academic-LHD part-

nerships have the potential to facilitate a broad-based,

universal appreciation of public health among students via

a wide array of public health curricula, educational

resources, and applied experiential learning opportunities

in public health settings. The authors provide recommen-

dations for combining basic public health lessons with

practical experiences, expertise, and leadership offered by

LHDs, in order to foster a real, stronger understanding of

public health, its importance, practice, and relevance in

today’s society from a public health workforce perspective.

Local Health Departments

In some ways, it is difficult to compare and contrast LHDs

as they differ significantly with regard to functional

authority, size, organization, and form. While this is true

among LHDs nationally, it is equally true with regard to

the New England states. Nationally speaking, they tend to

fall into one of four general formative arrangements as

described in Table 1.

As individual organizational units, not necessarily being

viewed specifically within any of the four common models

described in Table 1, the most common local public health

organization responsible for providing public health ser-

vices at the local level, is the county health department. In

this form, local county health departments function as

agents of the state granting them this authority and bear the

responsibilities delegated to them in assuring the health of

their respective population. Four out of five LHDs,

nationally, are organized at the county level, though this is

not the most common local public health unit found in the

New England states [7].

As illustrated in the above discussion, there is a lack of a

single operational definition for what constitutes a local

health agency, a realization that contributes to the variation

among such agencies, particularly within New England.

J Community Health (2013) 38:268–276 269

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The National Association of County and City Health

Officials (NACCHO) is the professional organization for

the 2,700 local health departments in the United States [9].

‘‘NACCHO’s mission is to be a leader, partner, catalyst,

and voice for local health departments in order to ensure

the conditions that promote health and equity, combat

disease, and improve the quality and length of all lives’’

[10]. NACCHO has been funded by the Robert Wood

Johnson Foundation to develop an ‘‘operational definition’’

to which all local public health entities might at least

concur. Additionally, a new effort is afoot toward provid-

ing the more fully functional local public health depart-

ments the opportunity to seek accreditation as a means of

validating their meeting or excelling in a defined set of

performance standards [8].

In this study, the authors defined local health department

broadly and as a result, included both fully functioning local

health departments (comprised of multiple public health

professionals), as well as local health officers (who

provided a much more limited range of services and often

did not constitute a professionally-educated public health

professional). Often, in the latter case, single full-, or

part-time, health officers constituted local town officials

(e.g., town managers, select-persons, building inspectors,

plumbers, or sanitarians) or voluntary citizens (often

retired) who had professional or personal interest/expertise

in public health (e.g., college professor in a health-related

area such as microbiology, physician, nurse, epidemiolo-

gist, pollution control expert). Hence, while the latter

represented the ‘‘local public health entity’’ included within

this survey, they did not necessarily represent or reflect the

same capacity or level of expertise that was reflected among

the former.

Methods

Survey Sample and Design

The Department of Health Management and Policy at the

University of New Hampshire (UNH), developed and

conducted a formal online and anonymous survey of all

LHDs in New England. Specifically, the directors of the

LHDs were surveyed after being identified from the

NACCHO Program Directory. Six hundred and sixty-three

LHDs were surveyed in the New England states (Con-

necticut, Maine, Massachusetts, New Hampshire, Rhode

Island, and Vermont). Based on an extensive literature and

website review of public health curricula in academic

institutions and educational services of a LHD, survey

questions were developed regarding how such public health

system partnerships between academia (defined as two- and

four-year undergraduate colleges and universities) and

LHD practitioners can facilitate public health education

and contribute to the public health workforce. The survey

was pilot tested nationally among a small group of LHD

directors and public health faculty. The survey was subse-

quently revised where appropriate for clarification purposes.

Table 1 Description of the formative structure of local health departments (LHDs) in the United States

Type of local health

department

Description

1. Centralized This model (exemplified in New England, e.g., Vermont, Rhode Island) of LHDs is one in which the local health

agencies are directly operated by the state. In this highly centralized arrangement, there are no local health

departments and the state provides local health services, typically through local state offices distributed across the

state. Staff of these LHDs are state government employees

2. Decentralized This model (exemplified in New England, e.g., Massachusetts) appears to be the most popular and has LHDs formed

and managed by local government (counties, cities, or towns). Such a decentralized arrangement of different and

unique LHD structures, organizations, and priorities may lead to greater difficulty when seeking to provide a

generic description or make specific comparisons, yet it offers each a potential ability to more specifically address

local concerns, as well as ensuring a greater degree of local control

3. Shared This is the least common model and allows the state to hold some control over the local health agency/department,

such as appointing the health officer or requiring budgets/plan to be submitted annually. This structure is

exemplified in New England by Connecticut

4. Mixed This model (exemplified in New England, e.g., New Hampshire, Maine) constitutes one in which elements of both

centralized and decentralized arrangements co-exist in various communities throughout the state. In some larger

communities, local government has been granted greater legal authority from the state to operate the local health

agency/department with little, if any involvement by the state (unless specifically called upon). In other, often

smaller communities with less infrastructure, local governments choose not to form a local agency and remain

dependent upon the state to assure whatever level of public health services are provided and available

Source National Association of County and City Health Officials (NACCHO). (2010). National Profile of Local Health Departments. Retrieved July 1, 2011 from http://www.naccho.org/topics/infrastructure/profile/resources/2010report/upload/2010_Profile_main_report-web.pdf

270 J Community Health (2013) 38:268–276

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NACCHO supported the research effort given that this study

paralleled many of their interests as well with regard to

strengthening the public health workforce.

Sampling Methodology

An electronic database of LHD directors in New England

was created utilizing the NACCHO Directory of Programs

[9]. The survey was created by employing an electronic

survey tool developed by the University of New Hampshire

(UNH) called SurveyCat. SurveyCat is UNH’s online

survey system. The invitation letter to participate in the

survey was e-mailed to the LHD director. The invited

respondent was asked to access the survey by clicking on a

hyperlink to open the electronic survey. The participant’s

responses were saved directly to space designated on the

UNH server. In general, the survey sought demographic

and general health department information, as well as

details of any existing partnerships/relationships with aca-

demic institutions (or faculty members) and specific edu-

cational activities. The survey took 10–15 min to complete

and participation was entirely voluntary. The instrument

used skip logic to allow respondents to not answer all

questions. Therefore, the denominator for responses to each

question only reflects respondents that chose to answer that

question.

The survey remained accessible for respondents to

complete for 8 weeks due to the time period in which the

survey was implemented which included holidays. Follow-

up reminder e-mails were sent to LHD directors every

other week seeking completion by non-respondents and

thanking those who had previously completed the survey.

Survey Instrument

The study was approved by the UNH Institutional Review

Board. The survey was comprised of various question types

including multiple-answer, open-ended, matched respon-

ses, and Likert-scale questions. The survey for LHD

directors was comprised of 33 questions, organized into

five sections: (1) demographic and general information; (2)

presence and extent of a partnership with academia; (3)

barriers to the establishment of an academic-LHD part-

nership; (4) specific collaborative efforts and support of

essential public health services; and (5) perceived public

health threats facing local communities in the twenty first

century.

Data Analysis

Data were entered into and analyzed using Microsoft Excel

for Mac 2011, version 14.1.4. Quantitative responses were

evaluated using descriptive statistics. Qualitative analyses

were used to evaluate open-ended response questions. The

texts from these responses were entered and quantified

using content analysis software, QSR NVivo, version 9.

Nueundorf briefly defines content analysis ‘‘as the sys-

tematic, objective, quantitative analysis of message char-

acteristics.’’ This method codes the text into manageable

categories by theme [11].

Results

Of the 663 LHD directors surveyed in New England, 124

responded with completed instruments generating a 19 %

response rate. The ranking of the New England states with

the most responses was as follows: Connecticut (n = 29,

4.4 %), Maine (n = 7, 1.1 %), Massachusetts (n = 53,

8.0 %), New Hampshire (n = 33, 5.0 %), Rhode Island

(n = 0, 0.0 %), and Vermont (n = 2, 0.30 %). Each of

these LHDs, although operationally functioning under

different models, serves a minimum of 5,000–24,999

people, with many serving populations larger than 100,000,

with the exception of Vermont. All LHDs have been in

operation for at least 10–25 years, with some operating for

100 years or more (e.g., Massachusetts and Connecticut).

The most commonly reported professional positions

currently employed at the LHD in each of the New England

states that responded to the survey included the following:

health educators, sanitarians, physicians, public health

nurses, school nurses, epidemiologists, statisticians, and

public health preparedness planners. Other employed

positions included community health administrators, social

workers, nutritionists, housing case workers, and food

inspectors.

Cross-tab analysis was done to examine of those New

England states that have an established LHD, how many

collaborated with an academic institution. The responses

varied by state with Connecticut and Massachusetts

reporting the highest number of collaborations (Table 2).

These two states also reported a distance of 10–24 miles

between their LHDs and their respective college/university

partners. Furthermore, the LHDs located in Massachusetts

and Connecticut reported more than other New England

states that they viewed increasing the professional capacity

of its employees as part of their mission.

Survey respondents were requested to identify barriers

that prevent their pursuit of a partnership with an educa-

tional institution (Table 3). LHD directors who reported an

existing partnership with an educational institution, as well

as LHD directors who did not report a partnership

responded to this question. The content of the responses

were coded and themes of barriers were identified: lack of

time, lack of adequate funding, and a lack of adequate

staffing. The LHDs without an academic partnership also

J Community Health (2013) 38:268–276 271

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identified a ‘‘lack of interest’’ on the part of LHD employees

and on the part of the nearby educational institution. Other

barriers included politics and an absence of policies to

govern such partnerships. For those LHDs with an academic

partnership, they most often classified their level of

engagement as ‘‘moderate’’ and rated their partnership with

academia as ‘‘very valuable’’ on a Likert scale.

The LHDs with an established partnership with acade-

mia reported the following themes of collaborative activi-

ties that promote public health education and public health

workforce development (Table 4): providing internships to

students from undergraduate programs; presenting guest

lectures on selected topics to colleges; providing informa-

tion, data, statistics to students working on community

health-oriented projects; providing job shadowing oppor-

tunities; mentoring students as trainees, or volunteers;

collaborating on a research project with an academic

institution; serving as an adjunct professor for a specific

class; acting as a thesis advisor for an undergraduate stu-

dent; service learning opportunities (such opportunities

were defined broadly as working on projects that benefit

communities.)

The ‘‘Ten Essential Public Health Services,’’ as devel-

oped by the Centers for Disease Control and Prevention,

detail the activities that should be undertaken to prevent

disease and promote health in all communities [12]. Survey

respondents were asked about which of these essential

public health services were reflected in their partnerships

(Table 5). Respondents identified the following: Inform,

educate, and empower people about health issues; monitor

health status to identify community health problems;

diagnose and investigate health problems and health haz-

ards in the community; mobilize community partnerships

to identify and solve health problems; develop policies and

plans that support individual and community health efforts.

These essential public health services developed from the

IOM’s three core functions of public health and serving as

a core to its 1988 Report characterize the unique role of

public health in society. They are defined as follows:

1. ‘‘Assessment calls for public health to regularly and

systematically collect, assemble, analyze, and make

available information on the health of the community…’’ 2. ‘‘Policy development calls for public health to serve

the public interest in the development of comprehen-

sive public health policies by promoting the use of the

scientific knowledge base in decision making…’’ 3. ‘‘Assurance calls for public health to assure their

constituents that services necessary to achieve agreed-

on goals are provided…’’ [1].

LHD directors responded that their partnerships with

academia would best be classified as fulfilling the policy

development core function, followed by assurance, and

assessment.

Survey respondents were asked to comment on their

opinions of what public health threats they perceived as

facing local communities as society progresses into the

twenty first century. This was an optional, open-ended

question. The content of the responses were coded and

themes from the responses were identified. Respondents

identified that a lack of funding; a shortage of competent

public health workers; and a lack of understanding of what

public health is and does on the part of the community were

the main threats. Additional perceived public health threats

included emerging infectious diseases, chronic disease,

obesity, climate change, homelessness and unemployment.

Discussion

Partnerships are fundamental to successful public health

practice [4]

Partnerships between academia and community organi-

zations, such as with local health departments, can be

viewed as critical elements of the system needed to

improve a community’s quality of life and well-being.

These public health system partnerships hold the potential

to address local public health concerns by engaging mul-

tiple stakeholders and accessing varied resources, such as

Table 2 The number of academic-LHD partnerships reported by New England LHDs

State Number of collaborations

Connecticut 22

Maine 6

Massachusetts 23

New Hampshire 8

Rhode Island 0

Vermont 2

Table 3 Identified themes of barriers that prevent partnership development between LHDs and academic institutions

Barrier Number of

LHDs

that identified

this barrier

Lack of time 63

Lack of funding 58

Lack of staff 64

Lack of nearby educational institutions 10

Lack of interest of LHD employees

to engage in partnership development

12

Lack of educational institutions to engage in

partnership development

17

272 J Community Health (2013) 38:268–276

123

funding, expertise, and infrastructure. Zahner states that

‘‘interorganizational collaboration aimed at community

health improvement is an expectation of local public health

systems’’ [13]. Furthermore, the IOM and the Council on

Linkages between Academia and Public Health Practice

recommend that partnerships between academia and public

health practice are essential to educating a public health

workforce [14, 15]. Our work examined not only the extent

to which partnerships between academia and LHDs were

established in New England but we assessed what activities

these collaborations are engaged in that contribute to public

health education and public health workforce development,

as well as what essential public health services their col-

laboration addressed.

The peer-reviewed literature cites evidence that academic

institution-health department partnerships can be successful

in addressing local public health issues. For example, Petroro

et al. [16] report on a successful partnership between aca-

demia and a state health department that addressed the

incidence of vancomycin-resistant enterococci infections in

the community. The authors also identified challenges

experienced by their collaboration, such as scheduling con-

flicts among partners and data availability issues [16].

However, they concluded that despite these challenges,

‘‘…faculty should strongly consider developing partnerships with public health practice in order to contribute to important

public health surveillance and other functions, and to provide

relevant experiences for students [16]. In addition, Lovelace

examined the collaboration between local health depart-

ments in North Carolina and other community groups and

organizations [17]. The authors’ results indicated a positive

correlation between the extent of the LHD’s collaboration

with community-based organizations and public health

performance [17]. Similarly, Livingood et al. [18] assessed

the status of academic institution-public health agency

partnerships in Florida and concluded that ‘‘…the partner- ships were perceived to enhance the local health system’s

capacity’’.

Of our survey respondents, approximately half of the

LHD directors reported an ongoing collaboration with an

Table 4 Identified themes of collaborative activities conducted by LHD and academic partnerships

Provide internships to students from undergraduate and graduate programs

Present guest lectures on selected topics to high school, college, and professional programs

Provide information, data, statistics to students working on community health-oriented projects

Provide job shadowing opportunities

Mentor students as trainees, or volunteers

Collaborate on a research project with an academic institution

Serve as an adjunct professor for a specific class

Serve as a thesis advisor for a graduate student

Provide service learning opportunities (service learning opportunities were defined as working on projects that benefit communities)

Table 5 Ten essential public health services

1. Monitor health status to identify and solve community health problems

2. Diagnose and investigate health problems and health hazards in the community

3. Inform, educate, and empower people about health issues

4. Mobilize community partnerships and actions to identify and solve health problems

5. Develop policies and plans that support individual and community health efforts

6. Enforce laws and regulations that protect health and ensure safety

7. Link people to needed personal health services and assure provision of healthcare when otherwise unavailable

8. Assure a competent public health and personal healthcare workforce

9. Evaluate the effectiveness, accessibility, and quality of personal and population-based health services

10. Research for new insights and innovative solutions to health problems

The Essential Public Health Services that were reflective of the LHD and academic partnerships in New England:

Inform, educate, and empower people about health issues

Monitor health status to identify community health problems

Diagnose and investigate health problems and health hazards in the community

Mobilize community partnerships to identify and solve health problems

Develop policies and plans that support individual and community health efforts

Source Centers for Disease Control and Prevention. (1994). The Core Public Health Functions Steering Committee, National Public Health Performance Standards Program. http://www.cdc.gov/od/ocphp/nphpsp/EssentialPHServices.htm

J Community Health (2013) 38:268–276 273

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academic partner. LHDs located in Massachusetts and

Connecticut reported the most collaborations. We speculate

the reason for this finding is the rather large number of

academic institutions specializing in public health educa-

tion, as well as the type of LHDs in these locales. Geo-

graphic location for the academic institutions and LHDs in

these two states was noted to be close which could foster

the development of stronger working collaborations as

compared to other, more rural New England states.

On the other hand, in addition to the barriers identified

by survey respondents that prevented their pursuit of a

partnership with an educational institution, we speculate

that organizational culture could also be a significant

inhibitor of pursuing such relationships. Academic insti-

tution-health department partnerships are recommended as

an advantageous collaboration that can address a capacity-

constrained community and contribute to training the cur-

rent and future public health workforce [19]. However, we

argue that it can take significant time and effort to develop

such a partnership and that both partners need to be willing

to engage in the process and commit to the time it will take

to develop mutual respect, trust, and open communication

[20]. These are working principles common to community-

based participatory research that is conducted between

partners that traditionally operate in very different orga-

nizational cultures and environments [21]. Covich et al.

[22] report similar working principles for their academic-

health department partnership that worked to improve

public health preparedness.

In an effort to expand the role of LHDs in advancing the

meaningful education of students preparing to enter the

public health workforce, an evolving concept of the ‘‘aca-

demic health department’’ has emerged through efforts of

the Council on Linkages between Academia and Public

Health Practice. This effort has produced a growing, yet

relatively small, number of more formal organizational

affiliations between local (and some state) health depart-

ments and academic institutions in about a dozen states

[5, 23]. We encourage this initiative to be examined more

closely by local health departments wishing to establish or

further support current relationships with their academic

collaborators as it appears to progress the educated citizen

and public health workforce movements. Further, it may

be time for the leaders of academic public health programs

to seek more meaningful educational (active learning)

opportunities for their students by promoting closer inter-

actions and involvement of public health professionals

working in LHDs.

Based on our exploratory analysis, we propose that

greater emphasis needs to be made to build and strengthen

linkages between LHDs and academic institutions

throughout New England and nationally, especially con-

sidering the public health threats anticipated in the twenty

first century as perceived by LHD directors in New Eng-

land. In an effort to facilitate a more seamless and effective

model for collaborations between academic institutions and

LHDs, we propose the development of a Public Health

Exchange (PHx) housed within state university systems

with a public health undergraduate and/or graduate pro-

gram. The PHx would be a central coordinating entity to

consolidate the informal collaborative arrangements that

often currently exist in a community or to initiate the

development of such where they do not already exist. The

PHx would operate via a website within universities where

public health practitioners and public health educators

could virtually unite in achieving the public health mission.

We envision that an interested faculty member could ini-

tially lead the project by receiving requests and identifying

appropriate faculty for the project, and helping to coordi-

nate the recruitment of undergraduate and/or graduate

students. If it appears that some form of a mutually

meaningful collaboration is feasible, a project coordinator

would be identified from both the university and the local

or state health department to determine project workflow,

budget issues, scheduling, and other needed structural,

organizational, or administrative arrangements.

The benefit of such a proposal would be the develop-

ment of an environment where collaboration between

academia and local or state health departments could be

fostered, regardless of geographic distance, to maximize

varied expertise, and supplement limited human and

funding resources. This creative system would assist with

productivity in improving community health while assur-

ing students the invaluable opportunity to bridge the public

health knowledge obtained in their academic environments

with the practical applications of these principles in the

‘‘real world’’ of public health practice. A similar univer-

sity-state agency relationship is already in practice in the

form of the Technology Transfer Center at UNH which

bridges academia with civil engineering projects around

the state [24]. By creating an entity whose mission is to

develop collaborations, the idea can be more easily circu-

lated throughout the state that there is an existing system to

facilitate partnerships between academia and public health.

Figure 1 illustrates the proposed PHx Model. Specifi-

cally, the PHx could serve as a two-way exchange of

information and resources between academic and LHD

partners that include the following:

1. Undergraduate and graduate student workforce for

LHD projects and initiatives

2. Experiential learning opportunities for the future

public health workforce

3. Educational and practice partnerships between LHD

employees and faculty that allows for new course and/

or curricula development

274 J Community Health (2013) 38:268–276

123

4. Joint public health seminar series for LHD officials

and faculty so there is an opportunity for knowledge

and practice to be shared

Benefits of the PHx might include:

1. Reducing costs to implement or initiate new projects

due to the centralization of resources

2. Accessing and preparing new hires for LHDs more

readily and effectively

3. Retaining state funding within state organizations by

recruiting undergraduate and graduate students from

the respective state university to work as contract

employees

4. Centralizing the process for identifying interested and

relevant collaborators from a range of disciplines

5. Addressing the primary barriers (time, funding, and

staff) that often limits collaborations

6. Reducing redundancy and duplication of efforts;

maximizing limited resources; presenting potential

applicability on a statewide or regional scale

Disadvantages, or limits, of the PHx might include:

1. Identifying a champion for specific projects

2. Consuming valuable time to initiate projects

3. Securing initial start-up costs to develop and maintain

websites

Although our findings provide valuable insight into the

extent of working partnerships between LHDs and aca-

demic institutions in New England, several limitations to

this work should be noted. The sampling bias associated

with a non-probability sampling technique limits the gen-

eralizability of the findings from this study to other aca-

demic-LHD partnerships. Missing data occurred randomly

across the surveys. In addition, the results were limited by

the cross-sectional study design and compliance to the

authenticity of self-reported information. Similar to other

studies, our work was challenged by collecting data that

pertained, in many instances, to the perceptions of indi-

vidual respondents. The multiple classifications of LHDs

also complicated comparative analyses. Despite these

limitations, the findings resulting from this study have been

appropriately qualified and we propose that the results

provide valuable insights into the work of academic-LHD

partnerships that address public health issues and educate

the public health workforce.

While academic public health programs provide mean-

ingful education about public health and seek to assure the

understanding of its historical and theoretical foundation,

and introduce students to its scientific basis vis-a-vis

courses in epidemiology and biostatistics, for example,

most are somewhat limited in their abilities to expose

students to the ‘‘hands on’’ field of public health practice.

Hence, many types of formal and informal organizational

and structural relationships between academia and LHDs

can be developed to provide such practical experience and

expand a LHD’s ability to provide the essential public

health services via a better, more educated and experienced

public health workforce. The authors propose one such

model in the Public Health Exchange described herein. The

dynamic benefits that may be attributed to stronger and

even more creative means of collaboration seem almost

unlimited. For academics seeking to provide the most

meaningful public health education and preparation for

their students and for LHDs seeking public health workers

prepared to ‘‘hit the ground running’’ who already embody

the core values of public health, such collaborations should

simply appear as common sense. Hence, future work in this

area should be directed at examining academia’s experi-

ence in partnerships with LHDs, as well as determining the

effectiveness of the new, innovative, and effective part-

nerships in educating the public health workforce and

improving the community’s health.

Acknowledgments This work received no financial support. The authors would like to express their gratitude to the directors of local

health departments in New England who took the time to participate

in the survey, as well as Ms. Margaret Lewis for her assistance with

database development. In addition, the authors thank the National

Association of County and City Health Officials (NACCHO) for their

insights and past and ongoing efforts related to this work

Fig. 1 Proposed model for a Public Health Exchange (PHx) that would foster collaborations between academic institutions and local/

state health departments

J Community Health (2013) 38:268–276 275

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