The Public Health Workforce Is Not Okay: Lessons from the Public Health Frontline

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.

Last month, I concluded working as an epidemiologist on the public health frontline of the COVID-19 pandemic emergency response. It has been nearly 2½ years of working under extreme conditions, both personally and professionally. Throughout the pandemic, I have worked in multiple positions across four governmental health departments (State and local), responsible for tracking the progress of COVID-19. My family has faced challenges that we had neither expected nor prepared for. And yet, as I reflect upon what I have learned from this tumultuous period, I must begin by checking my privilege and offering thanks for the ways in which my family and I have been protected from exposures of a different kind: we have two income earners in the family, both of whom were able to work from home; we have access to stable, secure housing and schooling; we’re all in good physical health and we have health insurance.

This period of 2½ years of working on the public health frontline has affected me more profoundly and personally than I could ever have dreamed possible, especially after the prior 20 years conducting research among families affected by HIV in sub-Saharan Africa. I have learned many new technical lessons about infectious disease epidemiology and about the work of applied epidemiologists. COVID-19 has become my entrée into the US public health sector, and I remain shocked at how insulated it is from so-called “Global Health” dialogue and at the state of the health data systems in current use.

I have written elsewhere about opportunities to apply lessons learned from HIV1 to the new frontier of COVID-19; the importance of infection prevention precautions for children and vulnerable people in specific circumstances; and the need for a modern interoperable data system for tracking the progress of the COVID-19 pandemic, a need that is becoming increasingly urgent daily. I’d like to use this opportunity to focus on lessons learned from COVID-19 for the public health workforce, as a vital and overlooked component of the long-neglected public health infrastructure of the United States.

The public health workforce is not OK. In this series of articles, I will share what it has been like to work on the public health frontline during the COVID-19 emergency response 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.  

July 2022:

  • WHO has finally declared Monkeypox to be a Public Health Emergency of International Concern.
  • An individual in New York State has been diagnosed with polio, and traces of poliovirus have been detected in wastewater in London.
  • Two deaths due to Marburg virus have been confirmed in Ghana.
  • Debate continues regarding outbreaks of acute viral hepatitis among children and meningococcal disease among MSM.
  • Meanwhile, COVID-19 is still silently surging.
  • And don’t get me started on reproductive health and even infant feeding, all of which have been making headlines.

The challenges of public health are growing, in the US and globally. And yet, public health professionals are being laid off.

Make it make sense.

My most recent job has been cut due to lack of funding, which is not the first time that this has happened to me during this pandemic. COVID-19 continues to surge, but the money for responding to it is drying up, along with public attention. Reporting on a proposed COVID-19 aid package currently stalled in Congress, media coverage has focused on the pressure to supply the goods, like vaccines and therapeutics. But without the necessary funding, what’s going to happen to the public health professionals needed to deliver the goods? Who is going to fund those jobs?

At the start of the pandemic, Congress allocated funds to public health activities under the American Rescue Act. As a volunteer at a local health department at the time, my colleagues and I waited eagerly for the new funding to trickle down towards us in the form of job advertisements posted online. We are still waiting. If the career opportunities for experienced public health professionals have expanded over the last 2½ years, we are yet to see it.

During the pandemic, I have worked as a contractor, a consultant, and a volunteer. Contract employment has come to dominate public health hiring, in a flurry of temporary short-to-medium term assignments that are now coming to an end. The move towards contract hiring is akin to the “adjunctification” of the academic job market: get used to being treated as a commodity. When you are hired through a contract, you are seen as a means to an end. Contract work means get the job done and move on – there’s no option for long-term professional development of the workforce, where an employer invests in relationships and skills-building for the long-term benefit of the employee and the sector as whole. An entire cohort of public health professionals has been robbed of job security and training, not to mention benefits. We’re still waiting for the injection of federal funding to fix the previous decades of workforce neglect – where did it go?

To add insult to injury, try explaining this conundrum to anyone outside public health. Looking for a public health job during a global pandemic – isn’t that supposed to be easy? If COVID-19 hasn’t been enough to shake up our job market and create opportunities, what is it ever going to take?

So, in addition to getting the job done, we’re also continually job searching. Do not underestimate the toll of constantly working within a broken system to do good, yet always looking for the next job.

My experiences working on the public health frontline have shaped me, my family, and the way we are seen by others. These experiences will continue to impact my decisions about my next job and my ability to set boundaries in the workplace. By sharing my perspectives in this series, I hope to start a conversation around rebuilding the public health workplaces of the future. These personal and vulnerable reflections are shared in a constructive spirit, with the motivation to start the dialogue for moving ahead.

What changes do YOU want to see in the public health workforce? How can we build the public health workforce of the future?

JOIN THE CONVERSATION. LEAVE A COMMENT BELOW.

References:

  1. Schenk KD, Okal J. COVID-19 and HIV: Similarities and differences – what have we learnt? Chapter in Voices from Within: A Public Health Perspective on the Response to COVID-19 (Eds. Kingori C, Nicks S), Ohio University Press, forthcoming 2022

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Author Profile

Katie Schenk
Dr. Katie Schenk is an infectious disease epidemiologist and public health informatics specialist. She has been working on the public health frontline for governmental Health Departments throughout the COVID-19 pandemic. Currently, Dr. Schenk is serving as a member of the US Medical Reserve Corps at COVID-19 vaccination and testing sites. She teaches Public Health and Global Health at American University in Washington DC and George Mason University, VA. Previously, Dr. Schenk led a portfolio of social and behavioral research studies on children and families impacted by HIV and AIDS in sub-Saharan Africa at the Population Council. Visit her website: https://kdspublichealth.com/about-dr-katie-schenk/ Follow her on Twitter: @skibird613 and LinkedIn: dr-katie-schenk-4a884b84

3 comments

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  • Totally agree with you about these obstacles. We need to get over the siloing, especially to get better at valuing the skills and contributions of our colleagues in neighboring fields and recognizing transferable skills for employment.
    I get so frustrated every time I see epi and PH positions advertised as short-term contract or consulting assignments. Initially I thought this was a stop-gap pandemic emergency response strategy but it is still continuing now, even 2 years after the ARA funds started. I hope to be able to revisit this topic in a future instalment.

  • From the perspective of someone with a “permanent”, full time position, the idea of positions moving to contract is frightening. There is already the issue of siloing within LHDs, where environmental rarely talks to community, and mental health is so separate that we often don’t know what is going on in other divisions. If more positions become short term contract, the communities will suffer and responses will be less effective because contract workers may not know what services are available or what other employee has the knowledge/experience for an issue. LHD staff are working above paygrade, out of title, and with untenable workloads, being blamed by directors and supervisors for the position they are in because “they’re union” or “everyone is working above paygrade, with excessive workload.”

    Many of us are burning out but don’t want to give up on public health because we believe in it. But it gets harder to stay every day.