Like many other federal agencies, the public health workforce is dangerously close to crisis mode. Between 2017 and 2021, nearly half of all employees in state and local public health agencies in the U.S. left their jobs. And studies show that, if such workforce conditions continue, more than 100,000 public health staff could leave their jobs by 2025.
Accelerating the crisis is an older workforce with many approaching retirement, and a lack of young talent entering the public sector to replace them. At the same time, mid-level talent is flocking to the private sector, in favor of a higher paycheck and better benefits. The cracks in the foundation are showing, exacerbated by what federal health employees and their counterparts at state and local levels perceive as a lack of appreciation for their work protecting public health and safety.
As attrition rates continue to rise, health agencies together with policymakers must take a critical look at their workforce, recognize key challenges faced by workers, and devise strategic, tangible solutions to amend these concerns.
Identifying root causes
While the Covid-19 pandemic underscored the critical role the public health workforce plays, it also inflamed existing issues plaguing workers – key reasons many are departing the field. Among them:
- Burnout: To keep up with the magnitude of Covid cases, public health workers endured long, grueling hours in the first two years of the pandemic. However, even as the pandemic waned, an exhaustive pace continued, especially amidst the mass exodus of public health employees. Today, to get bandwidth back to an acceptable level, it is estimated that the public health workforce needs to add 80,000 more employees. Given these conditions, agencies should anticipate burnout to continue to rise – with others resigning their roles as a result.
- Mental health concerns: Between witnessing the horrors of the pandemic and grappling with burnout, mental health concerns are on the rise within the public health workforce. A recent CDC survey found 53% of state and local public health workers had recently experienced anxiety, depression, suicidal ideation, or another behavioral health diagnosis, and burnout makes it more likely for workers to develop these disorders. Despite these troubling numbers, 75.5% of workers report that their employers have not increased mental health support since March 2021
- Salaries and benefits: Younger public health workers are more likely to leave the public sector and take jobs in the better paying private sector. A staggering 75% of the employees ages 35 or younger left their jobs in public health in the last several years. Among their most frequently cited reasons are salary level, fringe benefits and lack of opportunities for advancement.
Addressing key concerns
While each of these challenges have their own complexities, it is imperative that policymakers and health agency leaders take steps to help support and retain their workforce. Addressing the issues will take time, but there are a few key steps that should be taken to drive positive momentum and support public health workers.
– Invest in training and education: Public health agencies should strive to expand their investment in training and education programs that will prepare the next generation of public health workers. Presenting staff with consistent growth or upskilling opportunities is an effective way to not only retain existing teams, but scale agencies’ overall capabilities. This can take the form of work-based learning and apprenticeships, as well as on-the-job training, where workers can learn by doing in a controlled space. Agencies can also increase certificate programs, and ensure that curricula are geared towards building essential skills needed in public health or preparing employees for leadership opportunities.
Training opportunities not only help workers bolster their skill set and maintain a competitive edge but can increase both employee and overall organizational morale. As a result, investing in employees’ growth can yield higher productivity and retention.
CDC has made admirable strides, expanding training opportunities with the assistance of Covid funding. However, these efforts need additional resources and support to ensure they are accessible, affordable, and sustainable. Congressional support for the use of tuition remission options for those entering the field would be a valuable step.
– Improve working conditions: Policymakers should support steps that improve working conditions for public health employees. This includes providing them with competitive salaries and benefits, developing career ladders, and creating a more supportive work environment. Some local communities and states are already taking steps to do that. For example, in Georgia, elected officials recently earmarked millions of dollars for salary increases for public health workers, to make them more competitive with salaries at hospitals.
This mindset can also extend to investing in technology systems that make workers’ jobs easier and more efficient. Low-code/no-code technology, for example, has been crucial in addressing the talent gap with federal health agencies, enabling non-programmers to fulfill basic programming duties using simple drag-and-drop interfaces. This, in turn, frees up those with more robust experience, empowering them to focus on more complex, interesting projects.
Increasingly, federal agencies are also turning to AI to optimize and streamline workflows. For example, AI can augment the decision-making process by automating repetitive or time-consuming tasks. Health agencies can also explore utilizing AI-powered chatbots to help the public schedule vaccines and medical screenings, or answer questions about wellness or prevention. AI can not only uplevel experiences for the public but can also free up value bandwidth for public health workers.
– Promote diversity in the public health workforce: To improve workplace effectiveness and better serve all members of the public, health agencies must work to deepen diversity. This includes recruiting staff from all gender, racial, and socio-economic backgrounds, reaching out to underrepresented groups and providing them with the proper support to succeed in public health careers. The creation of a Public Health AmeriCorps Program was an important advance in creating a diverse entry-level pipeline. This CDC-funded effort hires residents from communities with elevated health risks, provides them with onsite work experience and customized training and links them to the local public health agencies for potential employment.
Retaining a diverse workforce is just as important as recruitment. Federal health agencies should strive to create employee resource groups and diversity equity, inclusion and accessibility programs to create a culture of support, and allyship. Any special training geared toward diverse employees can also help upskill these workers and strengthen retainment efforts.
Together, these efforts can improve the morale of the public health workers while future-proofing the workforce. Instituting these changes is a marathon, not a sprint, and it will take sustainable support from elected officials as well as continuous effort and refinement from the leaders of health agencies to get it right.
It is only by supporting the public health workers, and making their jobs more appealing that health agencies can strengthen the workforce to prevent and respond to future public health threats.
Photo: Angelina Bambina, Getty Images
