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.
I’ve been writing this weekly column for JPHMP Direct for a couple of months now, so I would like to take the opportunity to reflect upon what I have learned from this journey.
After years of being told to be silent, the words have come flooding out and I have found my voice. I am grateful to @JPHMPDirect for inviting me into this space and giving me the opportunity to publicly share my reflections on what it has been like to be a frontline public health professional working through the COVID-19 pandemic emergency response, and to present my ideas and constructive suggestions for rebuilding our profession.
Every week, as I shared another installment of this column, I invariably received private messages from readers reaching out to say “Me too!” and “Thank you for expressing exactly what I have been feeling.” I certainly did not expect to encounter zero disagreement. I confess I was really rather hoping to confront a critic who would point out exactly where I had been going wrong in my dismal assessment of public health opportunities and help to set me straight along a flourishing career path. And while visible public comments on these articles have been limited, private responses have been overwhelmingly positive. In fact, I have received so many private messages that I have found it difficult to keep up with providing adequate individual responses, so I began to invite all of these individuals finding resonance in my writing to join me in conversation within a private LinkedIn group instead. (DM me if you want to join us!)
So what does this show? That nobody dares speak out about our reality, for fear of harming our employment prospects? I was silent for years too, which left me feeling lonely and isolated, and quite evidently hasn’t helped me to land a decent job either. But as soon as I started to speak out, I found a community of like-minded public health professionals all laboring under the impression that they too are isolated in their uniquely dysfunctional journeys to try to build a career in public health. The discovery that I am not alone, that there are many of us out there who are all separately on this frustrating path, has provided me with immeasurable support and encouragement. This discovery has also started me thinking about everything else that we are not discussing as public health professionals and all the other lost opportunities to act in community.
Who exactly are we as public health professionals? Our career has no universally accepted entry criteria, no single qualification or identifier as a badge of recognition. We are epidemiologists, nutritionists, policy analysts, occupational health specialists, lab technicians, sanitarians, communicators, … the list of our disciplines goes on. While the tools of epidemiology represent the fundamental building blocks for measuring and analyzing public health, there’s no universally accepted certification to become an epidemiologist — I sometimes wonder whether perhaps the only unifying characteristic that we can agree on is imposter syndrome. Furthermore, there remains a mismatch with job postings for public health leadership positions, which – despite their rarity — appear to consistently prioritize a medical degree as a prerequisite, as if medical training automatically covers public health. (Spoiler alert: it does not.)
Public health professionals work in silos that do not share priorities or value each other’s skills: heaven forbid that an infectious disease epidemiologist such as myself would comment on an issue relating to chronic disease (no matter that we likely use the same tools for quantitative data analysis, so we have relevant technical skills in data interpretation); or that an neonatal specialist would dare interpret a question relating to sexual health (no matter that all our interests overlap when talking about vertical HIV transmission). We’re so focused on what keeps us specialized and apart that we’ve lost the voice that brings us together.
Where is the authoritative scientific and professional voice of public health leadership? Who gets to provide trustworthy evidence-based pushback when President Biden makes a premature declaration that the pandemic is over, or to reliably assert that NYC subway’s communication strategy of “You do you!” is definitely not a public health approach? Whose is the recognized and respected public health voice that can actively and decisively promote uptake of the new bivalent booster vaccine and authoritatively quash misinformation? Where is the lobbying and advocacy on behalf of rebuilding our beleaguered public health workforce, making sure that the hotly anticipated new grant funding will go towards long-term budget lines for job creation, respectable salaries, and professional development at State and local health departments, rather than to short-term agency contracts and management consultants? Or even roads and building projects? When discussing the possibility of schools reopening for the 2021-2 school year, we heard the united voices of pediatricians advocating in favor of reopening so that children could attend schools in person, and we heard the united voices of teachers’ unions arguing to slow down the reopening process for the protection of school faculty and staff. But where was the pragmatic voice of public health professionals objectively evaluating the pros and cons of reopening schools and providing practical guidance for exactly what protections ought to be in place and under what community conditions?
This lost messaging, lost voice, lost visibility, lost funding, lost jobs has inevitably led to loss of life.
As public health professionals, we have seen many changes since the start of the COVID-19 emergency response: remote work has opened up opportunities thankfully no longer tied down to geographic location; there are lots of new job seekers at entry level, including recent grads and career changers; many of us are now exhausted and traumatized from the experiences of the last 2.5+ years. Many aspects of our work have not changed however, no matter how much we want them to: we’re still siloed; we still lack opportunities for job security, decent pay, and career development; our systems for collecting and analyzing public health data remain laughably out of date; our workplaces remain plagued by toxic and dysfunctional leadership structures.
One welcome change in this new era is the advent of more jobs and trainings for entry-level and early-stage professionals (eg, contact tracers, community health workers), and I’m especially pleased to see the arrival of free training resources and certifications accessible to all (eg, ASTHO, CSTE, Johns Hopkins University, Boston University, WHO). However, I’m still watching and wondering what will be the next step in the career path for these new recruits after their initial fixed-term contracts end. I suppose I should be glad to see an increasing number of new entry routes into public health (eg, AmeriCorps, CDC Fellowships), but what about those already in public health facing career stagnation? I’m seeing training courses for mid-level management in public health (eg, CSTE LEAD, CSTE Data Science, ASTHO, WomenLiftHealth, de Beaumont/BEAM), but all of these opportunities require funding, and some may require employment in order to get sponsorship — what about those of us who can’t even get a job? What do you do when you already have advanced qualifications and 20+ years of experience but there are no jobs? When you’ve done all the things you were supposed to do, but there’s no opportunity to progress? Do I sound bitter? Because I am.
Public health colleagues: is it normal to be this angry and frustrated ALL the time? I am by nature patient and optimistic, and I am glad to see emerging media attention reflecting growing awareness of the needs for data modernization and rebuilding the public health workforce. I try to channel my energies into positive action, community-building, and productivity. However, after all that I have seen, I am finally reaching a limit and questioning the naïve and idealistic career motivations that got me here. I’m currently considering enrolling as an Uber driver, in search of a more promising route towards income and a flexible work environment. At least the entry criteria and work expectations are clear.
When the COVID-19 pandemic emerged, I initially felt a smug sense of anticipation as I waited for the moment that the wider community would recognize the value of all the research on community-based public health interventions from the social and behavioral sciences that public health implementation scientists had been steadily growing for years. Unfortunately, we’re still waiting. It turned out that the solid scientific evidence base on pharmaceutical and non-pharmaceutical interventions implemented globally (eg, lessons about the crucial role of community health workers; the importance of a health equity lens) was devalued and undermined in favor of partisan messaging promoted by politicians and chat show hosts. Having spent decades building a portfolio of public health research designed to inform policy development, I soon saw that the lonely arrogance of science had led us to overlook the missing piece of translating research findings relevant to the COVID-19 emergency response into media-friendly political communications and online soundbites, and developing strategies to defend challenges to research authenticity, none of which were ever covered in any of my public health studies.
So, as I question the next steps along my winding career path that has led me between the separate worlds of academic and applied public health, I find myself questioning what it would take for me to return to research. Why focus on research when experience shows that our pre-existing wealth of scientific evidence on behavioral strategies has been so thoroughly sidelined at the very moment it was most needed? When the opinions expressed by chat show hosts are held in higher regard than scientists presenting the results of specialized training, rigorous methodologies, and lifetimes of experience? I’m learning that there is a greater need for translating that expertise into the language of politics and popularity. Public health on TikTok? And unless there’s a new format for introverts reading together in comfortable silence, I don’t think I would make a very good chat show host.
These are dark days for those of us who care about public health and reproductive health in the United States of America. I don’t understand why the courts can’t require a person to wear a mask to protect those around them from disease, but they can require a person to carry a pregnancy to term. I draw strength and light from focusing on the work that I can do right here right now to make this country a safer place for all our families. I continue to volunteer at community clinics for vaccination and testing: first for COVID-19, and now for monkeypox, too. Each time the COVID-19 vaccine eligibility criteria expanded, I’ve been up there in clinic with the weeping parents and the squirming kids. I stand in awe of the recent groundswell of grassroots action within the LGBTQ+ community. I’ve developed a true understanding of what diversity actually looks like. I’ve expressed frustration at our inability to access medical records from neighboring jurisdictions to verify vaccine schedules, when HIPAA laws intended to provide protections to patients are actually exposing them to risk.
It’s undeniably rough out here in #publichealth right now, where “public health professional” has become synonymous with burnout. In addition to my volunteer work described above, my personal coping strategies include relentless outdoor swimming and inventing dreamy smoothies (AKA cocktails) with my kids. Giving voice to my professional and personal reflections in this space has become a creative and therapeutic outlet. I continue to build communities for conversation with like-minded public health folk, as we seek a path towards effective lobbying and advocacy that genuinely represents the voices within public health. I’m privileged to have been able to switch my family’s health insurance over to my husband’s stable job while I take a step back from the frontline to recover and consider my next move. But what with job applications, freelance writing, consulting, volunteering, professional webinars, family caregiving, and keeping up with the school run, I had no idea that unemployment was going to be so hectic and exhausting, and I’m still no closer to the art projects or home organization tasks that I had envisaged. Job-seeking alone is a full time job, let alone healing and recovering from frontline trauma.
It has recently become de rigeur among nonprofits to offer freebie swag as a visible demonstration of thanks to employees for working during the pandemic, perhaps in lieu of decent salaries. I don’t mean to sound ungrateful for these gifts, but instead of the logo-adorned t-shirts, fabric facemasks (fabric facemasks!) and even a lapel pin I have received without even a personalized note of thanks for my service, I would rather that these resources were invested into functional HR systems that demonstrate genuine care for employees and their professional development. (Even if I ever wore clothing with a lapel, isn’t a lapel pin more suitable to be worn to signify ongoing employment rather than by someone who has just been laid off?) So, as a gift of thanks to my fellow public health professionals seeking appreciation, and especially as the latest round of layoffs in public health takes effect, I offer the words below. I developed this mantra to help make my peace with my experiences on the public health frontline, especially the dysfunctional leadership, toxic work environments, and inability to develop professionally. I hope that it helps you too. See you in the comments and on LinkedIn.
Read all columns in this series:
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JPHMP is grateful for partnerships with ASTHO, NACCHO, and the de Beaumont Foundation.
JPHMP Direct is grateful for support from the de Beaumont Foundation.
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