The Promise of Student Pathway Programs in Diversifying and Replenishing the Public Health Workforce: The Connecticut Public Health Fellowship Program

<p dir="ltr"><b>Context:</b> The ongoing public health workforce shortage poses a significant threat to the United States population. The COVID-19 pandemic has highlighted this crisis, drawing attention to the lack of critical diversity within the public health workforce, which is necessary to address health equity. Despite the proliferation of public health programs attracting graduate students, there has not been a corresponding increase in the number or diversity of employees within local and state public health agencies, which are the backbone of the public health infrastructure. While internships are generally recognized as valuable experiences for individuals seeking to enter public health, there is limited research on the effectiveness of pathway programs (initiatives designed to help students transition from undergraduate or graduate school to the workforce) in recruiting diverse candidates and ultimately meeting and sustaining public health workforce demand. Therefore, it is essential to examine internship models not only as avenues for sustaining the public health workforce but also as mechanisms for attracting and serving historically marginalized populations.</p><p dir="ltr"><b>Case Study:</b> Sponsored by the Connecticut Department of Public Health and supported by the Centers for Disease Control and Prevention’s (CDC) Crisis Response Cooperative Agreement COVID-19 Public Health Workforce Supplemental Funding, the Connecticut Public Health Fellowship Program (CT PHFP) “aims to build interest in public health careers by supporting college and graduate students in high-quality public health fellowship placements throughout Connecticut” (Yale School of Public Health, n.d.). The CT PHFP provides third- or fourth-year undergraduate or graduate-level students enrolled in any accredited academic institution and in any degree program relevant to public health with administrative support, coaching, program orientation, and a $3,500 stipend to support their internship experience. From July 2022 through June 2024, 97 fellows have been supported through the CT PHFP and placed with local and state public health agencies and community organizations across Connecticut. Acceptance into the CT PHFP was on a rolling basis, accommodating academic schedules, personal limitations such as work/family obligations or transportation access, and host agency capacities.</p><p dir="ltr"><b>Methods:</b></p><ul><li><b>Quantitative Component:</b> Using the CT PHFP as an exemplary case, program data from CT PHFP applications were analyzed to assess demographic differences between fellows and non-fellows using chi-square tests and t-tests, where applicable. Fellows were also compared to a representative sample of PH students from the U.S., New England, and Connecticut.</li><li><b>Qualitative Component:</b> Interviews were conducted with 13 out of the 97 CT PHFP alumni to assess barriers and facilitators of access and participation, using a modified framework analysis approach. Additionally, two meetings were held with New England preceptors (n=27) as a form of member checking to review findings and generate recommendations for future programming.</li></ul><p dir="ltr"><b>Evaluation:</b> Analysis of the program data did not yield statistically significant differences between CT PHFP fellows and non-fellows. Facilitators to access and participation included clear application processes, stipends, alignment of tasks with career goals, program flexibility, mentoring, networking opportunities, inclusive cultures, and accessible sites. Barriers included financial constraints, limited awareness of opportunities, logistical challenges, training scheduling, limited leadership diversity, lack of project structure, and task misalignment.</p><p dir="ltr"><b>Discussion:</b> The CT PHFP has the potential to serve as a promising model for addressing the adaptive challenge of public health workforce shortages and diversity gaps. Reducing barriers and enhancing facilitators can attract and retain diverse talent, strengthening public health infrastructure. Continued support and improvement are crucial for building a robust, well-prepared public health workforce capable of meeting future health challenges. Findings provide valuable insights into the effectiveness of internship models in promoting diversity within the public health workforce. These insights will be crucial not only for Connecticut but also for national and statewide programs aiming to address similar challenges. The results will be utilized in the creation of a pathway program toolkit through the New England Public Health Training Center (NEPHTC) network, providing a structured approach for other regions to implement similar initiatives. Future research should examine the long-term impacts of such public health experiential learning initiatives on a large scale, ultimately enhancing the capacity to address health equity and improve public health outcomes nationwide.</p><p><br></p>