Examining data from the 2017 and 2021 PH WINS, Big Cities Health Coalition (BCHC) Director Chrissie Juliano describes changes in the BCHC governmental public health workforce, including workplace perceptions, training needs, COVID-19 efforts, and well-being.

The Big Cities Health Coalition (BCHC) is a forum for the leaders of America’s largest metropolitan health departments to exchange strategies and jointly address issues to promote and protect the health and safety of the more than 61 million people they serve. These BCHC health departments (HDs) participated in the 2021 Public Health Workforce Interests and Needs Survey (PH WINS), the results of which describe workplace perceptions, training needs, COVID-19 efforts, and their own well-being.

The Survey

The 2021 PH WINS was sent to more than 135,000 individuals in the governmental public health workforce, representing 47 state health agencies, 29 BCHC HDs, and 262 other local health departments. The BCHC HD results include responses from 44,732 staff, about 35% of eligible respondents. 

By drawing comparisons to the survey’s previous fielding in 2017, we hope our article in the Journal of Public Health Management and Practice will help leaders of BCHC HDs and key stakeholders better understand the workforce’s strengths and gaps and can guide future investments to improve the nation’s ability to respond to community health needs.

Key findings:

• The staff of big city health departments are incredibly diverse. In both 2017 and 2021, more than two-thirds of respondents identified as Black, Indigenous, and people of color (BIPOC). In comparison, two-thirds of the public health workforce at the state level self-identified as White.
• Respondents were mostly female, including at the most senior levels, and few were very young. The age and gender distribution of the BCHC workforce remained relatively stable between 2017 and 2021. In 2021, 76% self-identified as women. Further, nearly three-quarters of supervisors, managers, and executives self-identified as women. Nearly all respondents were age 31 or older.
• The percentage of tenured, permanent staff fell, likely due to the influx of pandemic response hires. Those employed directly by health departments fell to 85% in 2021 from 95% in 2017. In parallel, the percentage of contractors and temporary staff increased between 2017 and 2021. As such, the 2021 BCHC workforce was less tenured than their 2017 counterparts: staff reporting 0–5 years tenure in their current agency was 43% in 2017, versus 51% in 2021.
• The percentage of the BCHC workforce who worked on communicable disease more than doubled. The percentage of staff working in this area rose from 14% in 2017 to 29% in 2021. Those working in “other health care” also increased from 11% to 17%, while the proportion of staff in nearly every other program area decreased from 2017 to 2021.
• Most respondents reported high satisfaction, but more can be done to ensure retention. The majority of the BCHC workforce was satisfied with their job (76%) and organization (65%). However, the percentage who intend to leave their organization within the next five years (excluding retirements) increased slightly between 2017 and 2021. HDs have room to grow in regard to communications between leadership and staff and rewarding creativity and innovation.
• Some staff reported harassment and poorer mental health since the pandemic began. Despite the demands of the COVID-19 pandemic, three-quarters of the BCHC workforce said their mental or emotional health was “excellent,” “very good,” or “good.” A quarter rated their mental or emotional health as “poor” or “fair.” Thirteen percent felt “bullied, threatened, or harassed” and 27% still felt their “public health expertise was undermined or challenged.” Mental health and emotional well-being differed by age, gender, and race and ethnicity, with staff younger than 31 more likely to report poorer mental health. Twenty percent of staff who rated their mental health as fair/poor were White.
• Burnout and stress are real; almost 1 in 3 respondents experienced probable PTSD. Burnout was reported as an issue by 43% of respondents, up from 25% in 2017. Stress was reported by 39%, up from 25%. Overall, 29% of the BCHC workforce reported three out of four symptoms that indicate probable Post Traumatic Stress Disorder (PTSD). BCHC HD respondents were slightly more likely to report probable PTSD than those at state or other local HDs.

Additional considerations:

The field of public health shares the goal of having its workforce “reflect the community it serves.” As in years past, the BCHC HD workforce remains particularly diverse with large majorities of staff and leadership identifying as BIPOC. This is an important strength of the BCHC HD workforce, bringing different perspectives and life views in service to incredibly diverse populations in the nation’s largest cities.

Despite the demands of the pandemic and other public health challenges, the BCHC HD workforce remains committed to their work and mission. However, issues with retention and workplace environment require attention to sustain a strong and well-skilled workforce. In addition, it is notable that there was a huge influx of contract staff, which doubled between the 2017 and 2021 PH WINS.

The BCHC HD workforce is resilient but needs ongoing support. With nearly one-third reporting symptoms of probable PTSD from their pandemic response efforts, supporting the mental health and well-being of the workforce must be prioritized.

Read Our Paper in the Journal of Public Health Management and Practice to learn more:

• Recovery and Resiliency in 29 Big Cities: Results From the 2021 Public Health Workforce Interests and Needs Survey

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Chrissie Juliano, MPP, is the Executive Director of the Big Cities Health Coalition. BCHC is a forum for the leaders of America’s largest metropolitan health departments to exchange strategies and jointly address issues to promote and protect the health and safety of the more than 61 million people they serve. Ms. Juliano was the Deputy Director of BCHC from December 2014 to June 2015. [Full bio]