Public health practice is experiencing immense change driven by the COVID-19 pandemic, along with increasing recognition of how social, cultural, and political forces impact community health and resilience. For the governmental public health workforce, which has long been underfunded, the American Rescue Plan promises an increase of federal funds to address workforce challenges and improve the nation's governmental public health infrastructure.1
This influx of funds creates new flexibility and a rare opportunity for state and local governmental public health agencies to “dream big.” New data from the 2021 Public Health Workforce Interests and Needs Survey (PH WINS) capture the perceptions and experiences of the governmental public health workforce and provide a unique road map for strengthening and modernizing our public health agencies. These data can help ensure that those “dreams” target the most pressing workforce needs and can measure progress toward fortifying a system critical to maintaining and improving the public's health.
As the Workforce Has Changed, So Has PH WINS
Since its inception, PH WINS has evolved to reflect changing roles and perceptions of governmental public health employees. In 2013, the de Beaumont Foundation and the Association of State and Territorial Health Officials (ASTHO) first convened the National Consortium for Public Health Workforce Development, leading to the report Building Skills for a More Strategic Public Health Workforce: A Call to Action.2 One recommendation called for a mechanism to assess training needs and help the workforce plan for succession, boost recruitment and retention, and position the workforce for success.
At the time, individual state and local public health agencies and membership societies were fielding employee surveys that used different instruments with inconsistent sampling strategies, making valid comparisons impossible. The national surveys that existed primarily captured administrative data at the organizational level. PH WINS was created to provide data that previously had not been consistently collected nationally. With the partnership of ASTHO and the help of workforce champions in the participating agencies, there were 23 000 responses collected in the inaugural fielding of PH WINS in 2014, with more than half of states and a few local health departments (LHDs) participating.
In 2017, the number of responses more than doubled (47 000) and included 47 states and the first ever nationally representative sample of the workforce in local governmental public health agencies.3 What resulted was a national benchmark against which LHDs could measure their workforce, which did not exist previously. Furthermore, survey organizers expanded the training needs questions and highlighted responses by supervisory status, leading to more actionable findings.
PH WINS continued to expand in 2021 with a new pilot program, PH WINS for All, that included all governmental public health agencies in HRSA Regions 5 and 10, yielding useful insights into LHDs. New questions about health equity and racism sought to build on 2017 data, which showed that while the importance of addressing social determinants of health (SDOH) was widely recognized, there was not broad consensus about who should be involved in such efforts and low self-reported competence and confidence in these areas.4 Following Centers for Disease Control and Prevention's (CDC's) April 2021 declaration of racism as “a serious public health threat”5 and several jurisdictions naming racism as a public health crisis, survey questions about health equity and racism also demonstrated how well health departments were equipped to address racism and move from declaration to action.
The pandemic's toll on the governmental public health workforce was another area of focus in 2021. Previous survey questions about stress and burnout as components of mental health were updated to reflect observations from the field; new questions about bullying and harassment were also added.
As the world and the workforce continue to evolve, PH WINS data will provide an important through line, as the only survey that longitudinally captures the individual perspectives of the state and local governmental public health workforce. While uniting and aligning stakeholders can be difficult, PH WINS 2021 represents a partnership across numerous public health entities, which has been and will remain essential to its success.
In This Supplement, Analyses of Timely Public Health Topics Provide Tools for Improvement
The state and local governmental public health workforce stepped up to respond to COVID-19, and the fallout from that shift in focus is starting to emerge. In “The Opportunity Cost of COVID for Public Health Practice: COVID-19 Pandemic Response Work and Lost Foundational Areas of Public Health Work,” McCullough and Robins explore what was lost with so much of the workforce diverted to pandemic response. For example, with more than 90% of the communicable disease workforce focused on COVID-19, diseases such as HIV/AIDS, influenza, and hepatitis were deprioritized, and vaccination schedules were disrupted at a time when polio and measles are growing threats.
Yeager, Madsen, and Schaffer take a more personal look at the pandemic response in “Qualitative Insights From Governmental Public Health Employees About Experiences Serving During the COVID-19 Pandemic, PH WINS 2021.” They identified the relationship between leadership and employees as a particular challenge during the pandemic, with breakdowns in communication that resulted in employees feeling undervalued and unappreciated. Nevertheless, public health workers remain committed to their jobs, taking pride in their work and seeking to collaborate with colleagues.
In “Awareness of and Confidence to Address Equity-Related Concepts Across the Governmental Public Health Workforce: Findings From the 2021 Administration of PH WINS,” Porter et al examine the workforce's awareness and confidence in addressing health equity, SDOH, and social determinants of equity (SDOE). While generally aware of these concepts, employees lack the confidence to address them in their work. Gaining insight into which areas the workforce has or lacks confidence enables decision makers to develop a plan to address these shortcomings.
Taken together, the 2021 PH WINS data and the analyses in this supplement provide needed data to jump-start the workforce planning and changes necessary to prepare state and local public health agencies to safeguard the nation's safety, security, and economic prosperity. These data offer not only a snapshot of what the public health workforce has experienced and felt but also the critical information that can be used to advocate for state and local governmental public health agencies and their employees, including the need for programs and training addressing health equity, anti-racism, SDOH, and SDOE.
These findings bolster anecdotal observations with robust data about recruitment and retention, burnout, and other issues facing the public health workforce—including qualitative data that humanize their experience and help tell their story.
This supplement should serve as the road map for the workforce improvement efforts that we most need. The availability of these data is timely as CDC prepares to release the awards from its recent Strengthening U.S. Public Health Infrastructure, Workforce, and Data Systems grant.6 As you read through the supplement and explore the data, we encourage you to consider how you can use them in your own work. Funding to support PH WINS is secured for 2024 and 2027. In future iterations of PH WINS, we will be able to evaluate the nation's collective efforts to improve the public health workforce and, in doing so, the health of the nation.
1. Centers for Disease Control and Prevention. CDC Crisis Response Cooperative Agreement: COVID-19 Public Health Workforce Supplemental Funding Guidance. Atlanta, GA: Centers for Disease Control and Prevention; 2021. https://www.cdc.gov/cpr/readiness/funding-ph.htm
. Accessed September 19, 2022.
2. de Beaumont Foundation. Building Skills for a More Strategic Public Health Workforce: A Call to Action. Bethesda, MD: de Beaumont Foundation; 2017. https://debeaumont.org/wp-content/uploads/2019/04/Building-Skills-for-a-More-Strategic-Public-Health-Workforce.pdf
. Accessed September 19, 2022.
3. Leider JP, Pineau V, Bogaert K, Ma Q, Sellers K. The methods of PH WINS 2017: approaches to refreshing nationally representative state-level estimates and creating nationally representative local-level estimates of public health workforce interests and needs. J Public Health Manag Pract. 2019;25(2)(suppl):S49–S57.
4. Shah GH, Yin J, Young JL, Waterfield K. Employee perceptions about public health agencies' desired involvement in impacting health equity and other social determinants of health. J Public Health Manag Pract. 2017;(2)(suppl):S124–S133.
5. Centers for Disease Control and Prevention. Media Statement From CDC Director Rochelle P. Walensky, MD, MPH, on Racism and Health. Atlanta, GA: Centers for Disease Control and Prevention; 2021. https://www.cdc.gov/media/releases/2021/s0408-racism-health.html
. Accessed June 30, 2022.
6. Centers for Disease Control and Prevention. Strengthening U.S. public health infrastructure, workforce, and data systems. https://www.cdc.gov/workforce/resources/infrastructuregrant/index.html
. Published 2022. Accessed October 3, 2022.