Disability and the Public Health Workforce

Posted on August 31, 2023 by Nikki Weiss

This entry is part 36 of 43 in the series Wide World of Public Health Systems

Nikki Weiss discusses three disability justice issues that are likely to significantly impact public health systems.

Public health has historically been a reactive field rather than a proactive one. Case in point: immediately before the COVID-19 pandemic, public health systems researchers estimated we were 80,000 workers short of being able to provide basic, fundamental public health services in the United States. Though the pandemic has been difficult on many sectors, its effect on the public health workforce has been particularly brutal – in 2021, 44% of public health employees surveyed said they were considering leaving their jobs in the next five years. Potentially exacerbating this crisis is the effect that disability currently has and will continue to have on the public health workforce.

This blog post discusses three disability justice issues that are likely to significantly impact public health systems: 1) disability from Long COVID, 2) PTSD and complex PTSD, and 3) disability related to pollution and other factors associated with climate change. These three concepts aren’t new. Disabled folks like myself have been warning about similar issues for years. However, all three issues have recently become more dire, so I also discuss how we can begin to mitigate these issues using principles of universal design.

Long COVID

In early 2023, approximately one in ten people who have had COVID-19 reported that they were still suffering from at least one symptom, which defines the condition called Long COVID. Data from the previous year (2022) indicated that about one in five people who have had COVID-19 still had Long COVID at the time the survey was completed. Numbers of those who have ever had Long COVID are (naturally) higher: one Lancet review showed that nearly half of those who have had COVID-19 had at least one unresolved symptom at some point. Considering how widespread those numbers are – and that symptoms include brain fog, fatigue, difficulty breathing, sleep problems, etc. – the logical question public health systems researchers must now ask is not if but how Long COVID will affect the public health workforce.

We’re beginning to see data emerge that may help us answer this question. Earlier this summer, the Centers for Disease Control and Prevention gave a presentation on how Long COVID has affected the workforce at large, noting that approximately 18% of those in one study with Long COVID hadn’t returned to work in more than a year. Furthermore, 2022 data suggested that as many as 4 million were out of work due to Long COVID. However, exact numbers on Long COVID’s impact on the public health workforce specifically are as of yet unknown, and more research should focus on this area so the field is best prepared to support its workers.

PTSD and complex PTSD

Intertwined with Long COVID for many people, especially frontline workers, is some form of post-traumatic stress disorder (PTSD). PTSD in particular tends to stem from one major traumatic event; complex PTSD, on the other hand, results from repeated exposure to trauma. So while PTSD and complex PTSD aren’t necessarily symptoms of COVID-19, more than half (56%) of public health workers reported experiencing at least one symptom of PTSD that they attribute to the pandemic. In comparison, in an average year about 5% of Americans suffer from PTSD, with about 6% ever suffering from it at some point in their lives.

Both PTSD and complex PTSD can cause issues with fatigue and concentration, as well as other symptoms that can affect one’s ability to work. Though conversations have begun about PTSD and the public health workforce, it is unknown exactly how much PTSD and complex PTSD attributable to the pandemic have affected public health employees’ ability to do their jobs. As with Long COVID, more research is needed in this area so we can better understand the most common trauma response symptoms reported by public health workers, allowing management and supervisors to create environments that mitigate those symptoms.

Air quality and pollution

While not directly related to COVID-19, the third disability justice issue considered in this blog post has the potential to amplify COVID-19 symptoms. Climate change is not a new challenge, but its effects are more acute than ever. For example, much of the United States has been confronted with unhealthy air quality this summer due to wildfire smoke, causing air quality indices (AQI) to skyrocket from more common values of 50 or less to over 100. Many areas have routinely experienced consecutive days of 150+ AQI, while one day in June 2023 New York City recorded an AQI of 484, which is considered hazardous. Exposure to elevated AQIs is linked with numerous physical health problems, including fatigue. Furthermore, the particulates in wildfire smoke may also worsen mental health conditions, including depression and anxiety, and these particulates have also been linked to an uptick in mental health crises. And though poor air quality affects everyone, people with heart and lung conditions (among other health conditions and disabilities) are most at risk for severe symptoms.

But despite the ubiquity of poor air this summer, alarm bells seemingly have gotten less, not more, frequent. Rather than accept poor air quality as a new normal, this should be another area upon which to focus research efforts. How does poor air quality affect public health workers? And what can we do to mitigate these effects – on each of us personally and on our communities?

Accessibility and universal design

As it turns out, there’s a fair amount we can do to address air quality, and many of these things can help reduce the impact of COVID-19 as well. Public health as a discipline should start by emphasizing proactive universal design instead of retroactive accommodations. This shifts the burden away from disabled folks who have to advocate for accommodations (which ends up being more work). Examples of universal design include allowing and encouraging remote work, providing N95 masks to employees (for inside and outside, especially during wildfire season), and ensuring that offices have HEPA filtration for those who want to work at work.

Just as importantly, we in public health need to understand that “self-care” is a band-aid for broken bones if the system itself is preventing our colleagues from healing – that is, if the system is breaking the bones. Part of this is acknowledging that we shouldn’t be advocating for universal design just to ensure people can contribute to the workforce/productivity machine.

We should be advocating for universal design because clean air and health shouldn’t be luxuries.

They should be human rights.

Author Profile

Nikki Weiss: Nikki Weiss is a biocultural anthropologist specializing in mixed methods research. She completed her undergraduate education in biology at the University of Wisconsin-Eau Claire, and she earned her master’s and doctorate in anthropology from Ohio State University. Before arriving at CPHS, Nikki worked for the Johns Hopkins Center for Indigenous Health – Great Lakes Hub, as well as for the CDC Foundation. Her research interests include health equity and making health care accessible and attainable for all.