REBUILDING THE PUBLIC HEALTH WORKFORCE
A SUMMARY THAT WANTS TO BE A MANIFESTO
The public health workforce is not okay. In this series of articles, I will share what it has been like to work on the public health frontline during the COVID-19 pandemic and how these experiences have changed me forever. I will share the lessons I have learned and what I want the people around me to know, both inside and outside of the public health sector.
This post was originally published at JPHMP Direct.
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Frankly, I was ready to wind up this column after the last installment, and especially after my 2 recent posts on public health careers took off so widely (here and here). But I am encouraged by the positive feedback I have received on my suggestions for rebuilding the public health workforce, so I’d like to close on a constructive note by summarizing the recommendations I have made while writing this column.
Over the last 10 weeks, throughout this series of articles exploring the experiences of frontline public health professionals, I have shared my authenticity and vulnerability through personal and professional anecdotes. Woven throughout, I have also sought to derive constructive lessons for rebuilding the public health workforce based upon my lived experiences and those shared by my friends, colleagues, students, and contacts.
I have reviewed all the entries I have made in this column, seeking to extract and flesh out every constructive suggestion. I have distilled my suggestions and directed them towards 3 groups of constituents within our public health community, arranged according to perceived power in shaping the public health sector (acknowledging that these groups and their lessons surely overlap substantially):
Entrants: I’m addressing these suggestions explicitly to early-stage public health professionals, including students, and jobseekers at any stage of their career
Managers: These are suggestions directed towards more established public health professionals with supervisory responsibility as managers, implementers, communicators, and mentors, with limited capacities for decision-making and budgets
Leaders: These are recommendations addressed to public health policy makers, funders, advisors, and officials with substantive powers for decision-making, spending, and wider influence
Entrants
Don’t be discouraged by how difficult it is to find a public health job and/or to advance in your career. You are not alone. Seek strength in community: find ways to connect openly and authentically with like-minded colleagues. Communicate openly about the challenges: give and seek advice.
Stay flexible and consider taking a better offer in the short-term if it will help you gain skills and experience on the way towards something else in the long-term.
Network, network, network. Use LinkedIn strategically and discerningly. Build and join mechanisms for collective support and action.
We frequently work in silos that don’t communicate or prioritize each other’s skills. Recognize and adapt to working within the silos for now; let’s consider how to break them down in future.
Find your own coping strategies to adapt realistically to a harsh world that does you no favors. Establish your boundaries and stick to them.
Jobseekers, bring your authenticity. Be open, be patient, be flexible. It’s tough, I know. Find your people who understand and who live it with you.
Students, make strategic choices in your studies for how you specialize and define yourself.
Many of the barriers you are facing are structural obstacles, not to be taken as a personal reflection.
Managers
Toxic workplaces are not an acceptable norm. Eliminate toxicity and initiate steps towards repair and recovery from all of its manifestations, including bullying, silencing, and dysfunctional management practices.
Take complaints of management dysfunction seriously and eliminate it at its roots.
Promote open communications throughout teams, in ways that reflect the diverse skill sets and life experiences of team members rather than historic power hierarchies.
Promote genuine pathways towards equity that go beyond lip service to trendy catchphrases.
Adapt to remote work and flexible employment practices; create new and innovative opportunities to communicate and collaborate online. Consider lessons for building a workplace culture of belonging; seek to improve partnerships and negotiation within workplace relationships; develop internal communications strategies that flatten pre-existing hierarchies and power relationships. Focus less on technologies and more on interpersonal relationships: online working practices require innovative technologies, but the way they are deployed and adopted will be defined by human relationships and trust.
Acknowledge that there is no such thing as work-life balance and no prefabricated simple one-size fits-all solution. Recognize the need to establish trust and flexibility in crafting individualized approaches to work, meeting a diverse range of family and caregiving needs.
Address burnout by considering what obstacles can be removed from employees’ to-do lists to reduce workload and free up time: cancel meetings, streamline processes, eliminate regulations.
Recognize the lived trauma of many frontline public health workers and explore how to create a trauma-informed workplace.
Don’t give outdated career advice; think twice before blithely telling your more junior colleagues to simply do what worked for you. Listen to their lived experiences.
Work towards breaking down silos by valuing skills and experience outside your niche.
Hiring Managers and HR Departments: Entry level means no experience required, geddit? Advertiseaccordingly. Stop making applicants double-enter their application data. Include salaries in job advertisements. Review salaries for equity and create benchmarks. Treat job applicants with respect, including: streamline interview scheduling; speed up the recruitment process; clarify fair expectations during interview process (no unpaid on-spec work); eliminate one-way interviews; eliminate ghosting; put the humanity back into HR.
Leaders
Recognize and revisit the global body of scientific evidence and best practices for public health policy interventions and state of the art data systems.
Recognize and act on the incongruence between the increasing challenges of public health and yet the decreasing resources available. Work towards increasing the visibility of public health, with a view towards lobbying and advocacy for increased public funding at federal, state and local levels. Make sure that the dialogue about funding tangibles (vaccines, therapeutics) also addresses staffing needs and infrastructure.
Data Modernization Initiatives: let’s get cracking. Years after we first drew attention to the inefficient lab test result transfer process by fax, health departments are now receiving monkeypox test results the same way. Build a comprehensive data modernization process that addresses the human as well as the technology needs of our work. And meanwhile, let’s communicate our limitations externally, addressingoutdated technologies and a lack of standardization in order to manage expectations.
Harness innovation to sustainably build the skills of public health professionals already on staff and to absorb the influx of recent public health recruits and prepare them for secure opportunities to develop and advance their careers.
Work to make sure that HIPAA regulations actually protect patients by sharing data when appropriate rather than expose them to harm by always restricting data access.
Implement the best interventions for addressing mental health among burnt-out public health workers: respectful compensation and secure career development prospects. Recognize the effects of service of public health workers on parity with healthcare workers.
Reconsider entry routes into public health AND next steps: Are we generating new public health professionals at a greater rate than we can employ them? What are their next steps? Make sure there is a path for growth and development. Create and build career on-ramps but continue to develop actual careers afterwards with opportunities for genuine professional growth.
Forge pathways to continued professional development for experienced professionals to refresh skills and continue to advance. Create opportunities for staff to develop beyond a superficial understanding of many varied technologies, with opportunities to focus and grow.
Reconsider the use of contract and consulting hiring mechanisms. Earmark new funding to ensure that it goes to long-term sustainable internal job creation, decent salaries and professional development, not short-term contracts and hiring external consultants.
Use volunteers as a transitional measure and lobby for building a more stable and sustainable emergency system
Seek to eliminate toxic management and rise above. Respond to employee complaints of dysfunction with sensitivity and respect: recognize that these have become systemic practices reflected and amplified throughout an entire sector and should not be dealt with as isolated incidents. Seek out the root cause and downstream effects, and shine a light upon them. Actively promote and demonstrate the values of transparency, accountability, and open communications.
Consider our gating and definitional criteria, what brings us together, how we recognize and certify each other. Who speaks for us? Consider interactions between politics & communications and science & research (inc bench science and social/behavioral). Seek new non-traditional communications strategies and opportunities. Address toxic and dysfunctional leadership structures.
Job postings for public health should require public health credentials not medical credentials.
Work towards breaking down silos and valuing transferable skills.
Recognize that those of us who are left in the public health workforce are likely driven by ideological motivations, otherwise we would clearly have left long ago for the private sector. Give us ways to see the results of our work and to feel rewarded and encouraged to continue.
As I explained when starting this column, I was motivated to share my personal and vulnerable reflections in order to contribute to building a constructive dialogue for moving the field of public health forward.
Wouldn’t it be great to create a manifesto for the renaissance of the public health workforce, in order to rise to current and oncoming challenges? Can we reimagine and rebuild a public health workforce that is better prepared for future pandemics? DM me if you are interested in turning these ideas into a manifesto for action and exploring next steps together.