By Brian C. Castrucci, DrPH
When the de Beaumont Foundation first launched the Public Health Workforce Interests and Needs Survey (PH WINS) in 2014, we didn’t know what to expect, but with the release of our 2017 survey, two themes have become clear: 1) the workforce is composed of dedicated, skilled professionals who want to make a difference and 2) the field is threatened by a high rate of turnover. If governmental public health professionals leave, who will be left to protect the public’s health?
The de Beaumont Foundation and ASTHTO created PH WINS to fill a notable knowledge gap in national data on the governmental public health agency workforce. Before PH WINS, data were collected only at the agency level or within specific health departments, so it wasn’t possible to identify national trends, gaps, or opportunities. For the 2017 survey, we expanded the data collection to a representative sample of local governmental public health agencies, giving us an even more thorough picture of the workforce.
From 2014 to 2017, the number of people who said they plan to leave their organization within the next five years increased by 41 percent. Nearly half the workforce could leave – by retiring or leaving the field of public health entirely – and that loss of specialized skills and experience could be devastating to American communities.
Our hope is that health agencies and other leaders will use this data to invest in the workforce – to improve retention, attract new talent, and expand training to prepare today’s workforce for the needs of the future. See the report for information on demographics, training needs, and intent to leave.
The public health field needs support and investment, but making governmental public health a priority must begin by educating Americans about the role and value of the workforce. The work they do touches lives in every community across the country, but few people understand that.
However, research shows that Americans overwhelmingly value public health services protections. In a recent survey commissioned by the de Beaumont Foundation, two-thirds of Americans said they believe every community should enjoy basic public health services, including protection against communicable diseases, emergency response, clean air and water, and maternal and child health services. A full 57 percent of voters said they’d be willing to pay more in taxes to ensure communities have access to these and other basic public health services. But when asked about which organizations play an important role in creating healthy communities, respondents ranked public health departments behind hospitals, schools, fire departments, and police departments.
When there’s a natural disaster or outbreak, our ability to mitigate the impact will be dictated by the strength of the governmental public health workforce. As PH WINS shows, that means our nation, states, and communities must prioritize and support the workforce. We now know the challenges. The question is, what will we do about them?
By Kris Risley, de Beaumont Foundation, and Jennifer McKeever, National Network of Public Health Institutes
Public health professionals understand the vital role the government workforce plays in improving the health of communities nationwide. But the new Public Health Workforce Interests and Needs Survey (PH WINS) shows that the field faces a high rate of turnover, making it even more important to retain professionals and build the skills that will be needed in the future.
“Our hope is that health agencies and other leaders will use these data to invest in the workforce – to improve retention, attract new talent, and expand training to prepare today’s workforce for the needs of the future,” said Brian C. Castrucci, DrPH, CEO of the de Beaumont Foundation, which first conducted the survey with Association of State and Territorial Health Officials (ASTHO) in 2014. The 2017 survey was expanded to include more local health departments, giving an even richer snapshot of trends, gaps, and opportunities.
It is incumbent on public health leaders to shine a light on the workforce, highlight one another’s successes, and advocate for additional investments in training and other types of support. Working together, we can ensure that public health professionals can successfully shape the direction of our nation’s health and well-being.
The public health field is not alone in our desire to support our people. Across sectors, individuals and organizations are looking at ways to invest in and strengthen their workforce. From our education colleagues, we are learning that people generally have a strong desire to grow and develop. This includes students, young professionals, our youngest and newest, mid-career professionals, and our senior leaders. In their book An Everyone Culture: Becoming a Deliberatively Developmental Organization, Robert Kegan and Lisa Laskow Lahey share their research on unleashing the potential in people so that their work can have the greatest impact. From our business colleagues, including those at Case Western Reserve (@caseweatherhead, @dlc6David) and the University of Michigan (@PositiveOrg), we know that people and organizations grow and develop in the direction where they place their attention. Of course, psychologists, philosophers, and spiritual teachers across the ages have taught us this as well.
Understanding the Needs for Professional Growth
The 2017 Public Health Workforce Interests and Needs Survey (PH WINS) highlights some of the areas where public health professionals say they want and need to grow. These include developing leadership capacity, particularly in the areas of:
- systems and strategic thinking
- leading change
- developing cross-sector partnerships
- improved communications; and
- working with diverse cultures.
There is also a desire to enhance skills related to budget and finance as well working with data for better decision-making.
See the training needs identified in PH WINS 2017.
Supporting Professional Growth through the Public Health Learning Navigator
To facilitate opportunities for growth in these areas, the National Network of Public Health Institutescollaborated with theAssociation for State and Territorial Health Officials (ASTHO) and the de Beaumont Foundationto identify high-quality online courses that address the needs identified through PH WINS. These courses are being offered on the Public Health Learning Navigator, a community-sourced tool developed by the Public Health Learning Network (PHLN).
To select the featured courses, NNPHI solicited and screened nominations from across the field of public health, and the trainings were then peer-reviewed using the Quality Standards for Training Design and Delivery. Seventy-five online trainings were reviewed, and 26 are now available on the Learning Navigator. See the courses.
This is the first step of an ongoing commitment to identify relevant training and development opportunities for the public health workforce. Over time, more courses will be available; individuals and organizations are encouraged to submit nominations for inclusion or sign up to be a peer reviewer. Other online training opportunities can be found on the TRAIN Learning Network and the Maternal and Child Health Navigator.
The workforce has indicated ways they want to learn and grow, and leaders in the field have created and or curated relevant trainings. There is always more that can be done and more that can be learned. Together we can continue to learn in ways that support our need to grow and effectively act on passion for public health.
Kris Risley, DrPH, CPCC, is the Managing Director for Workforce at the de Beaumont Foundation. Jennifer McKeever, MSW, MPH, is the Director of Public Health Practice and Training at the National Network of Public Health Institutes.
Are America’s states and cities prepared for the next health epidemic? Not according to new survey research that shows a rise in job turnover among public health professionals. This is despite high levels of job satisfaction.
As states and communities work to address health risks, including natural disasters and disease outbreaks, they face significant disruption of their public health workforce and a major loss of specialized skills needed to protect, promote, and improve health. A new survey of professionals in state and local health departments, the 2017 Public Health Workforce Interests and Needs Survey (PH WINS), shows that nearly half the workforce could leave their organizations within the next five years, including people who will retire and many who may leave the public health field altogether. This is particularly troubling because local health departments have eliminated 56,360 jobs since 2008.
PH WINS, the only nationally representative survey of state and local public health workers, was first conducted in 2014 and has consistently revealed a high rate of job satisfaction. But the results suggest that agencies need to do more to retain skilled employees, as the number of employees who are planning to leave increased 41% from 2014 to 2017. Key findings:
- Nearly half the workforce is considering leaving their organizations in the next five years, including 22% who plan to retire and 25% who plan to leave within one year for other reasons.
- Among those planning to leave, the top five reasons are inadequate pay (46%), lack of advancement (40%), workplace environment (31%), job satisfaction (26%), and lack of support (26%).
- Several populations that are already underrepresented in the workforce are poised to leave in large numbers – Millennials (32% considering leaving), employees with a degree in public health (34%), men (31%), and women executives (24%).
- Professionals in public health departments work to prevent and respond to major crises, including infectious disease outbreaks, surges in chronic disease, and natural disasters. A decline in the public health workforce could threaten the health and safety of communities, especially when combined with rising health threats, including more frequent disease outbreaks, the opioid epidemic, and increases in chronic diseases.
“Health departments are already understaffed and underfunded,” said Brian Castrucci, CEO of the de Beaumont Foundation. “The consequences of losing nearly half of an already-strapped workforce would put our country at great risk. These professionals do important work that most people don’t even realize is happening, preventing major diseases and outbreaks before they even happen. They also play an essential role in keeping communities healthy and safe, every day.”
- Public health professionals are motivated by their mission, with 95% saying the work they do is important and they are determined to give their best efforts every day.
- Generally, public health employees are satisfied with their jobs (81%), but only 48% are satisfied with their salary.
- The public health workforce is aging. Millennials represent 22% of the workforce, compared with 35% of the national workforce.
- There is a gap between leadership and line staff. A total of 67% of executives say creativity and innovation are rewarded in their agency, but only 41% of non-supervisory staff say this is so. A total of 69% of executives say communication among leadership and staff is good, but only 48% of non-supervisory staff agree.
- Women are underrepresented at the executive level. The public health workforce is 79% female (compared with 51% of the national workforce), but for every 100 men, 4 reach the highest level of leadership, compared with only 2 of every 100 women.
Michael Fraser, CEO of ASTHO, said: “We hope that health officials, policymakers, and other stakeholders concerned with the nation’s health will consider these trends when formulating budgets, policies, and regulations that may help address the country’s need for safe, healthy communities.”
Lori Tremmel Freeman, CEO of NACCHO, said: “A skilled public health workforce is essential for protecting and improving the health and wellness of the public and responding to major health threats. We need to address the needs of the current workforce, communicate the value of public health, and equip future public health leaders with the skills necessary to carry out essential responsibilities.”
Chrissie Juliano, executive director of Big Cities Health Coalition, said: “These professionals are on the front lines of emergencies like the Ebola and Zika virus outbreaks, as well as efforts to contain the opioid epidemic, the surge in chronic disease that drives up health costs, and the sharp rise in teen e-cigarette use. These findings show us that this nation needs to get serious about building its health system by investing in the people who protect and promote the public’s health.”
Read the report, learn more, and see the data.
In a 2018 wrap-up in Modern Healthcare, Steven Ross Johnson quotes de Beaumont Foundation CEO Brian Castrucci on the efforts of health providers to meet patients’ social needs. Highlighting the trend of healthcare organizations prioritizing wellness and prevention — including addressing patient needs in areas like housing, poverty, and food security — Johnson writes:
“But as interest in addressing social determinants has grown, action on broader public health issues has not kept up with the pace.”
“Healthcare moved from downstream interventions to what I would call mid-stream interventions, but we have still failed to go upstream,” said Brian Castrucci, CEO of the de Beaumont Foundation, an organization that supports local and state public health programs to advance public health.
And on the lack of federal government support for public health issues:
Castrucci said making progress on any of the major public health concerns came down to a matter of political will. He felt such an effort would ultimately require the kind of resources to successfully lobby for better health in the same way industries have lobbied for years on issues that have been detrimental to health.
“Alcohol has a lobby, soda has a lobby, guns have a lobby,” Castrucci said. “They’re all really well funded. Where’s the health lobby?”
Read the article (free registration required).
Did you know that millennials make up 35 percent of the workforce in the United States, but only about 24 percent of state and local health departments? This is despite a 300 percent growth in public health degrees over the past two decades. So where are the millennials, and what do these numbers mean for the future of public health?
Public health’s greatest asset is its people, but the workforce is rapidly aging and facing tremendous turnover. In fact, according to the Public Health Workforce Needs and Interests Survey (PH WINS), as many as 41 percent of public health employees in state and local health are considering leaving in the next five years.
At the recent annual meeting of the American Public Health Association, the de Beaumont Foundation hosted a session on millennials in the public health workforce that revealed important trends, challenges, and opportunities. Moderated by Brian C. Castrucci, DrPH, MA, CEO of the de Beaumont Foundation, the panel discussion featured four millennial leaders:
- Elizabeth (Lizzie) Corcoran, MPH, CPH, Special Assistant to the CEO, de Beaumont Foundation
- Brittany K. Marshall, DrPH, CPH, CHES-Evaluation Specialist, CDC Foundation
- Ryan Tingler, MPH, Research Project Manager, University of Pennsylvania, School of Nursing
- Colleen Healy Boufides, JD, Senior Attorney, National Network for Public Health Law
In dialogue with each other and the audience, four key insights emerged.
- Millennials are cause-driven and motivated to work for many of the fundamental principles that underpin public health.
Citing research by The Millennial Impact Report, Colleen Healy Boufides highlighted one of the key characteristics of the millennial workforce: millennials are motivated to work for causes they feel passionately about, not by loyalty to institutions or the way things have traditionally been done. Social justice issues like LGBTQ rights, income inequality, minimum wage debates, and affordable housing / gentrification compel millennials to spend their most precious asset – their time – in service of causes that make the world a better place.
Public health, and especially the focus on the social determinants of health, is a natural fit for cause-driven millennials. Looking at how “the distribution of money, power, and resources at global, national, and local levels” influences the health of individuals and communities falls squarely within the lexicon of the millennial generation and can serve as a clarion call to this group.
Healy Boufides’ own story reflects this trend. After reading about Paul Farmer’s work in Mountains Beyond Mountains, she was inspired to pursue a career focused on health inequities. While her intended field of work shifted several times, from healthcare to public health to law, her desire to work on health inequities remained a constant.
“I started out moving toward a healthcare career,” she said, “but then I realized I wanted to work on the causes rather than the symptoms of health inequities. I started focusing on public health, and then I realized all of those causes could be changed through law and were affected by law, so I decided to go to law school specifically to work on public health.”
Before you can be motivated to pursue a career in public health, you have to be aware of the opportunities – which leads to the next key insight.
- Millennials see networking and mentorship relationships as valuable both for career opportunities and professional development – and older generations should see this as a critical path to engaging young talent in the public health workforce.
The importance of networking and mentorship was the subject of Ryan Tingler’s presentation, and a recurring theme of the other panelists. Tackling a common misconception about mentoring, he emphasized that mentoring is a two-way street, with benefits for both the mentor and the mentee.
Brian Castrucci, Lizzie Corcoran, Brittany Marshall, Ryan Tingler, and Colleen Healy Boufides
For the mentee, the benefits are obvious: a mentor can share valuable professional skills, provide career insights, and open doors to new opportunities. The mentor also stands to benefit from engaging deeply in this professional relationship. The mentee may bring new knowledge or approaches to longstanding problems, and the mentor may garner new insights into how his or her younger colleagues see the world around them.
“It’s a two-way street,” said Tingler, “and it’s not just about the technological side of it. It’s about recognizing generational and cultural changes.”
For career public health officials, mentoring is also an invaluable tool for recruiting new talent into the public health workforce. That mentoring can be as simple as pointing out possible career opportunities in public health that a student had never heard of or introducing a research fellow to a leader in his or her field at the APHA Annual Meeting. Mentorship and networking can also help talented individuals from other industries to see how they might apply their skills in evaluation or education, for example, to a rewarding role in public health.
Mentors will find that millennials are largely eager recipients of their guidance, Tinger said. Tingler shared results from a survey of the APHA Student Assembly that demonstrated a broadly shared desire for more mentorship and stronger networks. As Tingler said, “We don’t want you [the older generations] to go – we want you to teach us.”
- Millennials seeking careers in public health face significant barriers to entry – and public health should strive to support millennials (and younger workers) through entry-level fellowships, debt forgiveness packages, and other incentives.
Lizzie Corcoran highlighted a seeming incongruity between two datasets: one, the explosion of interest in public health degrees by millennials; and two, the underrepresentation of millennials in the governmental public health workforce. Many audience members shared their experiences as a possible explanation for why, including:
- Outdated hiring requirements that require nursing or medical degrees to do public health work
- The concentration of job opportunities in major metropolitan areas
- The financial pressures of graduating with significant student debt
In her presentation, Brittany Marshall, DrPH, provided insights into one avenue for transitioning promising students into governmental public health: fellowships and professional associations. In her already-impressive career, Marshall has participated in the Public Health Associate Program (PHAP) at CDC, the CDC Evaluation Fellowship, and the APHA Student Assembly on national and state levels. Marshall has also pursued development opportunities outside of public health, such as the National Urban League Emerging Leaders program, the New Leaders Council, and LEAD Atlanta.
Fellowships are not only valuable, paid learning opportunities for the entry-level and early career workforce. They also allow fellows to create strong networks with their peers and current public health leaders that can open doors to the next career opportunity.
Marshall’s advice to millennials and the younger generation is to “make sure you’re always networking… you never know who you’ll meet. Ninety percent of my opportunities have been through a personal connection.”
Fellowships are only part of the puzzle. Corcoran identified several other strategies to help the public health workforce attract millennial talent, including:
- Streamlining hiring processes and making job descriptions clearer
- Collaborating with academic health departments
- Actively marketing career opportunities to students of public health
None of these fully address the ongoing student debt crisis in the United States, though. Ultimately, governmental public health will have to ensure that it’s financially viable for the average graduate to pursue a career in public health (by adjusting salaries or guaranteeing student loan forgiveness) or risk losing a generation of talent to the private sector.
- Millennials are ready and able to infuse the public health workforce with new energy – but the workplace has to be ready for them.
Millennials are graduating with public health degrees in record numbers and are passionate about making the world a better place. They’re digital natives, highly collaborative, and strong communicators, and they prize innovation and interdisciplinary action above tradition and siloed work. Not only that – they want to learn, from their peers as well as from their superiors.
As Corcoran shared from her own experience as well as her ongoing research on the millennial workforce, “Millennials have a lot of unique contributions to make to public health. We are passionate about public health, we are studying public health in order to practice it, and we’re passionate about our communities.”
The public health workforce should be welcoming millennials into their ranks with open arms, and yet clearly something is happening to discourage public health graduates from moving into the governmental workforce. With the millennials’ passion for public service, money is not the only barrier to entry, although it is a clearly a contributing factor.
The current public health workforce should see a clear path to engaging with millennials: reach out to talented individuals (even if they’re not currently working in public health!), communicate the mission of public health, and identify opportunities for them to bring their talents to bear.
Millennials are ready and able – now it’s time for the public health workforce to catch up to them!
To receive updates on our ongoing research into the public health workforce, including a forthcoming paper on millennials in the public health workforce, subscribe to our newsletter..