With opportunities in public health increasingly advertised as consulting contracts rather than job opportunities, get ready for even lower expectations regarding employer accountability to the workforce.

Back in September 2022, I wrote in Season 1 of this column: “I’ve been applying for public health jobs on-and-off for the past 20+ years. Would you say that makes me an expert, or — by definition — not very good at it?”

Here’s how I answer that question: with another question. Would you seek advice on the current dating market from someone who has been happily married for decades?

Working in public health across the non-profit and academic sectors, I have learned that there’s no such thing as job security, so I’m always on the lookout for an opportunity. I feel as though I am constantly job searching. It’s exhausting. As I said last season, “Do not underestimate the toll of constantly working within a broken system to do good, yet always looking for the next job.”

Hopes and expectations: these are not the same.

Let’s get real about the numbers: in my 20+ years of employment in public health, I have never had an employment contract that lasted longer than 2 years. The one time that I actually had an indefinite contract for a “permanent” job, I was forced out after 3 months due to external reasons. (That’s a story for another time and a suitable beverage.) Even though there was one job in which I stayed happily for more than 12 years, throughout periods of personal and professional growth, it still required me to go through a contract renewal process in which I had to repeatedly justify my continued employment. On my resume it looks as though it was secure, but in practice I never felt as though I had any long-term job security. Lately, public health has gone through enormous change and instability: employment contracts these days are more likely to be measured in months or to be assigned as at-will employment with no guarantees. I’m still looking for a secure, stable, long-term opportunity – please remind me, do they even exist?

Last year, when I was approached by the media to talk about the challenges of working in public health, I advocated loudly for the creation of more stable job opportunities within public health, in order to work towards long-term capacity-building across the workforce for emergency preparedness and responding to current and future challenges. I sensed the interviewer pushing back a little at my outrageous demands for long-term employment opportunities within a field well-known to be long starved of funding. It was only later, in retrospect, that I realized that the interviewer had quite naturally interpreted my desperate plea as a demand for the creation of budget lines for permanent, indefinite, full-time jobs with full benefits, including vacation time, sick days, health insurance, professional development – whereas really, I should have specified that I had a much more modest goal in mind. 

Quite honestly, all I was asking for was a stable medium-term contract, where pay is beyond a pittance and not measured hourly, whose length is not measured by a couple of months or worse, determined by a handful of deliverables. Dare I even ask for the opportunity to accrue vacation time or sick leave? It was only then that I realized how low my expectations had sunk. Of course, I still hope for an offer of a long-term, maybe even permanent job. But realistically, I suppose I’d settle for expectations of much less. This is what it’s like in public health, even after 20 years.

Benefits

Public health is a great career for someone who has a spouse with a reliable job that offers health insurance. <#SARCASM and flagging my privilege, just in case it wasn’t already obvious.> Repeatedly engaging in all of these short-term contracts has thoroughly drained my ability to engage in completing health insurance forms and the distinctly American concern of establishing continuity of care with in-network healthcare providers. A couple of years ago, I finally transferred my kids and myself onto my spouse’s health insurance and have never looked back. I am sincerely grateful for this privilege, but I don’t take it for granted. I am hyper-aware that most of my would-be colleagues do not have access to this advantage. This is not an acceptable assumption upon which to base the functioning of our sector. I’m wondering whether we could track a drop-off in public health careers after the age of 26, when children are considered no longer eligible to be a dependent on their parent’s health insurance coverage?

With opportunities in public health increasingly advertised as consulting contracts rather than job opportunities, get ready for even lower expectations regarding employer accountability to the workforce. Employers offering contract jobs and consulting assignments in public health see no hypocrisy in transgressing all requirements for improving population-level health across the workforce: reset all expectations of health insurance, sick pay, and taking personal leave for caregiving.

Contracting was perhaps an understandable short-term trend created by the financial pressures on our sector to get the job done in the most efficient manner possible, but time’s up. Time is long overdue to invest in the long-term skills development and institutional memory of a public health workforce that knows whether it’s still going to have a job next week. We aren’t all LLCs, nor do we want that hassle. If I’d wanted to be an adjunct, I would have stayed in academia.

Why should public health jobs be stable?

Having spent most of my public health career working on global health research within NGOs and academia, I am relatively new to the domestic US governmental public health scene — but I am fast coming up to speed. I will restate what I have learnt about expectations for job security and benefits in public health jobs, but if you know better, please share more information to set me straight and help us all to learn together? I would particularly appreciate input on the legal, regulatory, and funding issues of recruitment in public health.

Here’s my view from 30,000 feet. Employment in Governmental public health (local, State, federal) typically consists of a fixed number of permanent, full-time jobs, with full benefits including health insurance, sick time, vacation time, etc. The number of these positions is tightly limited by budgets which must be politically approved, and recruitment may be subject to external regulations, such as the rules of employment unions. Research indicates that the number of these positions currently falls short of what is required to provide a minimum package of public health services by 80%. Employment in the non-profit scene working to support public health services through communities and agencies etc. is typically on the basis of fixed term contracts, where employees only have a job for the duration of their funding grant, until they have managed to fundraise for the next contract. Benefits may be good, bad, or nonexistent. In between these 2 options, there’s also a grey area of temp contract workers who are hired by the Governmental public health agencies: prevented from creating a budget line for a full-time hire, they typically turn to a third-party agency to recruit temp workers in order to get the work done. Pay is often hourly; benefits are somewhere between shitty and non-existent. Any presumed advantages of economic efficiency must surely be entirely imaginary, once agency fees and turnover are factored in, but hey, this get-around avoids the need to get political approval for job creation. I am deliberately avoiding addressing the role of private sector consulting employment in public health, which is a different conversation for another time.

Bottom line: the capacities for institutional learning and long-term strategic development within the public health sector are limited by caps on hiring, threatening the ability to respond not just to current and immediate challenges, but on developing a long-term strategic response plan to equip public health agencies for future emergencies and preparedness. Without the stability of long-term employment, public health agencies are prevented from developing long-term plans for how they will respond to future pandemics and natural disasters, along with meeting routine ongoing needs such as childhood immunization and responding to community needs such as addressing the opioid epidemic.

Sausage-making

Schools of public health appear to have done a great job of taking advantage of the newly raised profile of public health during the COVID-19 pandemic: there has been a sudden proliferation of public health degree programs at all levels, and these have succeeded in recruiting new candidates into qualifications including new undergraduate degrees, the more traditional MPH route, and even new doctoral-level public health programs. But I have witnessed no comparable expansion in the market for public health jobs. Where are all these newly minted graduates going to go next? There’s a bottleneck in the sausage machine.

Questions (join me for discussion in the comments or on LinkedIn)

• What has been your past experience of job security in public health? How long is the longest job commitment you have experienced?
• What are your hopes for job security moving forward? Realistically, what are your expectations for job security?

Read previous columns in this series:

• It’s Not You, It’s Public Health
• Rebuilding the Public Health Workforce: A Summary that Wants to Be a Manifesto
• Unity, Community, Immunity, Opportunity: Lessons Learned from Writing About Public Health
• What Actually Works? Careers Advice in Public Health, Part 2
• Using LinkedIn to Your Advantage: Careers Advice in Public Health, Part 1
• It’s a Jungle Out There: Power Balance and Job Applications in Public Health 
• Atrophy and Adjunctification: Changes in Public Health Employment Opportunities
• Advice for Building a Career in Public Health — Does Any of It Really Work Anymore?
• Mental Health and Wellbeing Among Public Health Professionals
• Public Health Workspaces
• The Public Health Workforce Is Not Okay: Lessons from the Public Health Frontline

About the Author

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

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