Mind the Gap

Prioritising mental health as we rebuild the public health workforce

As I move towards concluding the third season of The Public Health Workforce is Not OK, I am reviewing themes that have recurred throughout this series and seeking to consolidate lessons learnt. The entire archive of articles about working in public health is available here.

This week, in the penultimate episode of the season, I re-examine the importance of addressing mental health and wellbeing among the public health workforce.

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Systemic challenges within the public health workforce

Throughout this series, I have emphasised the need to develop healthy working practices and workplace relationships, in particular the need to go beyond the toxicity and dysfunction that have arisen as a direct result of the starvation and instability of funding for public health. Across jurisdictions, cuts in public health funding have consistently led to resource limitations, driving competition within and between programs and agencies, and generating heavy workloads, chronic understaffing, and reliance upon outdated technologies. Chronic organisational trauma from the consequences of rollercoaster funding and the difficult nature of our work continues to manifest through harmful interpersonal practices, such as bullying, silencing, and a culture of blame. I have personal experience of all of these phenomena, but I see them as structural consequences of the constrained environment: I don’t hold a grudge, but I am committed to rooting out these deeply entrenched practices.  Beyond a slap on the wrist and a mandatory training video, we must establish a public health workplace culture based upon values of basic civility and respect for differences, at minimum. We must aim to build workplaces that celebrate positive values including transparency, respect, gratitude, and above all kindness. 

The most prominent mental health challenges of our public health workforce, including burnout and marginalisation, predate COVID-19. Some brave individuals have started to go public (see E Lankau, p34) about their harrowing experiences working in public health and the havoc it has wreaked upon their wellbeing and their families. Many of us public health professionals also experienced extreme working conditions during the COVID-19 emergency and are left with lingering PTSD. Even if there were a supportive workplace intervention response, how would it reach us when so many of us are no longer in the same jobs, due to the expiration of funding?

My colleagues and I have worked together to start to develop recommendations for establishing psychological safety for the public health workforce through workplace policies informed by values of equity and recognition of trauma. However, even the best trauma-informed workplaces responding to the needs of a scarred workforce can only reach their current employees. Interventions are still needed to reach all those of us who continue to face the ongoing consequences of losing our jobs due to lack of funding or political forces. The most effectual wellbeing interventions will be those that centre robust pay, job security, respectful working relationships and career development opportunities, rather than a mandatory self-care training, a lapel pin, or an office pizza party. I don’t need a public Thank You or to see my name up in lights - I simply want the opportunity to develop a thriving career. In particular, concertedly devoting resources to growing healthy career development pathways is only going to become more urgently needed as our field shifts towards increasing remote work and outsourcing.

As we move forward to rebuild the public health workforce, we must be brave enough to acknowledge without blame the toxicity and dysfunction within our public health agencies that have resulted from the pressures of a chronic funding shortage. Let’s create spaces in which to listen to the voices of tired, traumatised, and recovering public health professionals, treating their individual experiences as the valuable data they are, in order to derive constructive lessons for our sector. Please contact me directly if you are a public health professional who would like to share your story on this platform, or if you represent an alternative platform suitable for sharing all our stories. 

Being undervalued: a perfect storm

The occupations to which I devote my personal and professional energies these days share a predilection for being undermined and discredited simultaneously and separately within multiple different value systems. I’m living at the intersection of a Venn diagram deliberately and repeatedly undervaluing me.

• As a sandwich generation caregiver, I am pulled daily in a million directions trying simultaneously to meet the needs of my children and my elders. My caring skills are repeatedly overlooked by an economy that doesn’t see the worth in what I do or offer my family any social safety net. 

• As a PhD level scientist, I was woefully unprepared for the challenges I have faced both inside and outside academia. Within academia, I still don’t understand why my world-class rigorous academic training and publications up the wazoo have been unable to secure even a toehold into the tenure track boys’ club. Outside academia, I was unprepared for employers to see my specialised skills as evidence of being overqualified* and irrelevant.

• As an epidemiologist working on the public health frontline throughout the emergency response to the COVID-19 pandemic, I have struggled with PTSD and fought for recognition when the public is weary of evidence-based precautions to prevent the transmission of infectious disease. 

• Furthermore, as a minority woman and immigrant, I have fought systematic discrimination throughout my career, and continue to battle ongoing barriers to entry that accompany each step. (Just ask me about trying to get my foreign qualifications accepted for candidacy for federal employment!)

These are my intersectionalities, my misogynoir, my perfect storm of being undervalued. What lessons should I take away from my countless repeated experiences of rejection? How should I pursue validation? Where should I seek support for overcoming the structural obstacles of my multiple identities?

Coping mechanisms

I started writing this column simply because I had nobody to talk to IRL about the experiences of building a career in public health who actually understood how soul-sucking it is. My first reader was my therapist, and once she didn’t sound any alarm bells or report me to the authorities, I gained the confidence to go public. JPHMP Direct saw that I was onto something long before I realised it and offered me a platform as a contributing columnist: we hit a nerve with an audience of readers who found my words resonant and who had previously thought that they too were alone in similar circumstances. The overwhelming response and discussions took off as soon as the first episode was published, and I've been writing this column regularly ever since. 

It’s hard to remember much about those early and traumatic days of the COVID-19 emergency response because the self-protective mechanisms of the brain prevent me from going back there. But writing this column has become one of my coping mechanisms, made more powerful every time my experiences are seen by an audience who has been there too, and every time that someone writes to thank me because they thought they too were isolated within the same experiences. Also early morning outdoor swimming, making fruit smoothies with my kids, and community service at vaccine clinics. But the greatest healer and motivator of all would be the opportunity to effect change. Let’s catalyze words into action; let’s find ways to build towards constructive change. 

* “Overqualified” = a BS excuse for “we couldn’t get away with how little we’d like to pay you”

In next week’s final episode of the season, I’ll conclude by turning my attention to the ways in which we have seen change throughout the time that I have been publishing this column The Public Health Workforce is Not OK.

Join me to continue the conversation in Notes or Chat or Comments or Threads.

• What are your coping mechanisms?

• How can institutions protect the mental health and well-being of the public health workforce in our inherently stressful roles?

• How can we channel our frustration and anger into positive, constructive action for change?