Dramatic Changes in Public Health Require a Stronger Focus on Engaging Workforce and Communities

Over the past 5 years, the nation’s public health sector has experienced a series of whiplash-inducing ups and downs. While typically subject to boom or bust funding cycles, public health departments enjoyed an unprecedented infusion of national-level funds during the COVID-19 pandemic,1 only to watch billions disappear2 in 2025 as a result of the rescission of the declared public health emergency, and the change in direction by a new presidential administration. While the vital importance of public health was celebrated during the start of the pandemic, public health is now being carelessly dismantled from the top down. In 2020, most public health workers were asked to shift priorities, take on new responsibilities, and sacrifice their personal lives, and many did so willingly, out of a sense of commitment to their communities. This experience took its toll on an already anemic and stretched governmental public health workforce. Now these dedicated workers face layoffs, threats, and ongoing uncertainty about their careers. The Public Health Workforce Interests and Needs Survey (PH WINS), administered nearly every three years since 2014, has helped draw attention to workforce trends impacting health departments across the United States. As the 2024 PH WINS shows, today’s public health workforce is often burned out, disillusioned, and dejected.3 This calls for a dramatic shift in how we acknowledge and support these workers and, in turn, the communities they serve. During this tumultuous time, it is critically important that our workforce maintains a clear vision of what public health could and should be. In Public Health 3.0, the National Association of County and City Health Officials (NACCHO) outlined priorities for local public health leaders to build upon.4 But, as PH WINS demonstrates, there is a pressing need to help our exhausted yet resilient workforce tackle the mounting challenges of the 21st century. Not only do workers need to recognize our unwavering commitment to advancing public health, they need to see a future in public health for themselves. At the City of San Antonio Metropolitan Health District (Metro Health), building employee resilience is a top priority. The department has a myriad of tools at its disposal to recruit, engage, and retain its staff. This commitment is codified in the Metro Health 2.0 strategic plan and the department’s workforce development plan.5 In 2023, PH WINS data guided our New Hire Orientation (NHO), and helped us develop a NHO curriculum that puts staff connection, engagement, and continuous learning at the center of the new employee experience. These transformational efforts have been accelerated by the Public Health Infrastructure Grant (PHIG), which the department received from the Centers for Disease Control and Prevention (CDC) in November 2022. Our emphasis is not just on the employee as an individual, but also as part of a team focused on quality improvement. The department has established a robust culture of quality improvement that includes a systematic method of gauging the pulse and needs of staff. Our Workforce Development Team is leading departmental efforts to support our employees and build a highly competent, confident, culturally sensitive, and trauma-informed workforce. Public health leaders must also support the workforce by actively engaging the communities we serve. In redefining the role of public health departments, we are also redefining the roles and expectations of our local governments, stakeholders, and beneficiaries. We need to build community awareness and acceptance of these changes, thus paving the way for our employees, particularly those who frequently interact with the public. Local partnerships and local funding are essential to creating a more stable and rewarding environment for public health workers, while also demonstrating the value of collaborations anchored to neighborhood-based assets. This will not happen unless we consistently underscore the important influence of public health on the quality of life in communities, regardless of one’s neighborhood, socio-economic status, or politics. We will not accomplish all of this overnight. Now more than ever, public health leaders have to be agile, adaptable, patient, and resilient. While Metro Health has seen incremental progress, as reported by our workforce in recent PH WINS, we are now experiencing a slight dip in morale, a trend that illustrates the plight of staff at the nation’s larger health departments. In this time of great upheaval, we must help our workforce see beyond the ups and downs of funding cycles. Instead, let’s clarify their purpose, internally and externally. Let’s invest in their development and give them opportunities for personal growth. Let’s make sure they feel part of something bigger than themselves. We have a tremendous opportunity to demonstrate the value of tapping into the “people power” within the department and the community at large to ensure a better quality of life for all those who coexist in our shared village.