My daughter just graduated from college and is starting work on a presidential campaign this summer. I’m incredibly proud of her, wistful about the long-gone little-kid days, and hopeful in a way I really need to feel. With the steady drumbeat of bad news and a seemingly broken political system, this smart, energetic, and passionate woman gives me hope in a way nothing else can.
She is going to be a field organizer in Iowa, because that’s where the magic of a successful bid for the presidency starts. As she takes all her youthful optimism and civic engagement to Iowa, I have the typical worries of a mother, but a few things I don’t worry about are her having access to healthy food, a safe place to live, and protection against preventable disease. That’s because of something most Americans take for granted – the day-to-day work of state and local public health agencies.
Imagine a community with no restaurant inspections, making food poisoning an expectation rather than a rarity. Imagine a city that doesn’t inspect rental housing for mold and pests, meaning more children grow up with asthma that could have been prevented and managed. Imagine a school district with rampant measles outbreaks because there’s no credible voice sharing science-based information one about the need and the safety of vaccinations.
This may sound like post-apocalyptic hyperbole, but public health is severely threatened by a lack of funding, a rising rate of turnover, and a loss of critical skills needed to protect the public. In fact, the May 2019 issue of the American Journal of Public Health posed this question on its cover: “Is the public health workforce threatened by mass extinction?” The issue includes several articles reporting on the most recent Public Health Workforce Interests and Needs Survey (PH WINS), which found that more than 40 percent of the current workforce is planning to leave within the next five years.
That new vision is possible only with a strong, committed workforce, but the workforce is showing cracks. PH WINS data show that as the nation becomes more diverse, the public health workforce is not as diverse as the population it serves. At the same time, public health departments struggle to create a truly inclusive environment that embraces diversity and ensures that workers of all backgrounds can be satisfied with their jobs, organizations, and pay. Our analysis also suggests that public health professionals are eager to pursue health equity, but many don’t feel equipped or empowered to do so.
The public health workforce may not be facing extinction, but it is facing a wave of retirements, especially among senior leaders with valuable institutional knowledge and experience. Unfortunately, younger workers are increasingly considering leaving their governmental public health jobs as well. We were concerned when we conducted PH WINS in 2014, because in addition to the 25 percent of workers surveyed who were planning to retire in the next five years, another 16 percent were considering leaving their organization in the next year. Between 2014 and 2017, that proportion of workers intending to leave in the next year increased by 41 percent!
Researchers also explored how salary may impact health departments’ ability to recruit and retain the workers they need. We learned that analysis of salary differentials between public health professionals in the public versus the private sector may mask important gaps in salary in certain positions and in certain geographic areas. Another group of researchers took a deep dive into the increasingly popular undergraduate public health major, and what the impact of the newly minted bachelors of public health graduates may be on the public health system.
Some of the findings from PH WINS, like much of the news generally, can take away the glimmer of hope we feel when we encounter idealistic, talented, and motivated young people. But the AJPH articles offer practical solutions that health departments and others with a stake in the public health system can take. But the larger call to arms is critical: if we keep spending just 2.5 percent of our national health spending on public health, sinking the other 97.5 percent into medical care, the public health system will continue to crumble, and food poisoning, opioids, and measles will be just a few of the myriad health problems that will replace optimism with disease and despair.
Read the articles:
“Public Health WINS Is a Call to Arms as Well as a Roadmap for All Who Care About a Thriving, Healthy Nation”
“The State of the US Governmental Public Health Workforce, 2014–2017”
“Mass Exodus of State Health Department Deputies and Senior Management Threatens Institutional Stability”
“The Role of Salary in Recruiting Employees in State and Local Governmental Public Health: PH WINS 2017”