Insights Into the Local Health Department Workforce: Putting PH WINS Data Into Action

New colleagues in public health and health care are often amazed that in the US, there is no centralized, national registry for local health departments (LHDs) or their staff. This makes the most straightforward tasks—including enumeration of the public health workforce—exceptionally difficult.1 Instead, we rely on a patchwork of ongoing surveys that create snapshots of various subgroups within governmental public health at different moments in time.2 The primary ongoing surveys that capture the broadest national view of governmental public health are the de Beaumont Foundation’s Public Health Workforce Interest and Needs Survey (PH WINS),3 the Council of State and Territorial Epidemiologists’ (CSTE) Epidemiology Capacity Assessment,4 the Association of State and Territorial Health Officials’ (ASTHO) Profile of State and Territorial Health,5 and the National Association of County and City Health Officials’ (NACCHO) Profile of Local Health Departments Study6 and its associated Forces of Change Survey.7 These are supplemented by a few ongoing topical surveys, such as NACCHO’s Preparedness Profile.8 Of these surveys, PH WINS is the only one that focuses on all individual staff members as the primary sample and the primary focus of the questions. PH WINS has a unique role and responsibility in both public health services research and applied practice because it speaks for individual public health workers, represents their unique and combined interests, and provides insight into the functions and status of the people in the public health workforce. For this reason, we are particularly excited that the 2024 PH WINS is now open to all LHD staff, regardless of the size of the health department. The voices and needs of small LHDs—with less than 25 staff members or serving less than 25 000 persons—are often overlooked because the data are difficult to capture. These small LHDs face further headwinds as their response rates tend to be lower due to the sheer number of them and compounded duties that make it difficult for them to find time and resources to respond. However, small health departments make up nearly two-thirds of the over 3300 LHDs in the US, making them a critical component of the country’s public health workforce. The importance of including small LHDs in surveys is demonstrated by NACCHO’s recent work on harassment in the public health field. We know from our ongoing work studying the harassment of LHDs that staff from small health departments face unique challenges precisely because their communities are so small. In small communities, the harasser is very likely to be someone you see regularly outside of your employment, such as the person who bags your groceries every week at the only grocery store in your community. With the recent expansion of the inclusion criteria to small LHDs, we are certain that the field will benefit from hearing all voices. The 2024 PH WINS data play another critical role. Combined with recent and upcoming NACCHO and ASTHO Profile studies, the data tell the full story of the COVID-19 pandemic. We are now gaining a clearer picture of what happened before, during, and after the pandemic. Entering the COVID-19 pandemic, data showed that LHDs were understaffed; however, after an influx of federal investments, LHDs were able to surge staff to meet unprecedented community needs. Throughout the pandemic, LHD staff answered the call to service, often placing themselves at risk for infection themselves. Local public health staff delivered lifesaving services while enduring intense political and public harassment.9 Now, their efforts to protect the country’s health security are at risk as the federal government continues to make significant staffing and budgetary changes, leading to reduced federal support for local public health.10 To demonstrate the impact of COVID-19, NACCHO utilized PH WINS data to explore how the described pressures, including harassment impacts, affected local health department staff. The National Association of County and City Health Officials examined the impacts on the mental well-being of local public health professionals, including their intent to leave their organization during the pandemic.9 In this special issue, we examine burnout and mental well-being as predictors of turnover intent among local public health department staff.11 These issues are critical to understanding the drivers of workforce turnover and the policies that support retention in a field that has been under intense scrutiny and stress for nearly half a decade. The National Association of County and City Health Officials is able to use these data to impact national policies that support the retention of LHD staff. In response to repeated analyses of PH WINS data showing a high proportion of LHD staff with an intent to leave the field, we learn from our members of ongoing indications of staffing difficulties. To this end, NACCHO led a national coalition of over 100 organizations to introduce and enact legislation establishing the Public Health Workforce Loan Repayment Program, which supports loan repayment for public health professionals working in governmental public health. The PH WINS data were both foundational to understanding the circumstances of LHD staff and a powerful tool for communicating to partners and legislators the need for the Loan Repayment Program. The National Association of County and City Health Officials continues to analyze the new data, incorporating the latest findings from the 2024 PH WINS into its work on behalf of LHDs. The present findings show a workforce that is younger with more formal public health training than in the past. This positive finding shows some reinvigoration of the workforce with an infusion of newly trained professionals who will bring much-needed and fresh ideas and perspectives to LHDs. However, at the same time, it is notable that there is a loss to the field of critical and irreplaceable institutional knowledge, and this must be contended with as the field moves forward. The age and tenure findings, added to the staying and leaving findings, do portend some positive upturns in terms of the return of morale to the field and commitment to the work. Overall, it speaks to the need for increased capacity building to support public health professionals new to the governmental public health workforce. Degrees alone do not provide the education necessary for success. The 2024 PH WINS data again show the need for training in budget and fiscal management, policy, systems thinking, and change management. In response to the PH WINS data, combined with NACCHO’s own data on training needs, NACCHO has launched key programs, including Management Essentials, focusing on enhancing key knowledge and skills, and RISE: A Roadmap for New Local Health Officials, helping new leaders succeed in their roles. These programs aim to ensure individuals are effective in their work, thereby increasing their retention within the governmental public health workforce. With its focus on individual staff members and new reach to all LHDs, the data from the 2024 PH WINS survey, as discussed, are critical to the field. Along with NACCHO’s and ASTHO’s Profiles and CSTE Assessment, these surveys tell the story of public health infrastructure, systems, and staffing in the US across points in time. It remains critical for the de Beaumont Foundation, ASTHO, CSTE, and NACCHO to continue working closely together, collaborating so that data from these surveys can be used to fully reflect the state of the public health workforce at the local, state, and ultimately national levels. Harmonizing the data enables researchers to utilize data from multiple surveys to inform public health practices and practitioners to identify and address critical challenges that impact the health of their communities. The result is better data that drive the work of creating a stronger public health infrastructure and workforce.