PH WINS: Largest-ever survey of public health workers highlights gaps, challenges and opportunity

According to a new, first-of-its-kind survey of the nation’s public health workforce, 38 percent of workers are planning to leave their current positions before the next decade. On its face, that’s a deeply worrisome number. But Brian Castrucci is an optimist — “where there is change, there is opportunity,” he says.

Castrucci serves as chief program and strategy officer at the de Beaumont Foundation, which along with the Association of State and Territorial Health Officials, recently released the findings of the Public Health Workforce Interests and Needs Survey. The survey, referred to as PH WINS, is the largest-ever study of the public health workforce, surveying more than 10,000 workers from 37 state health agencies. While previous public health workforce studies have surveyed professional association members or workers in a specific state, for example, PH WINS is the first nationally representative survey of state health agency employees. As Castrucci told me, PH WINS represents the “national voice of the public health workforce.”

“Now we have the data,” he said. “So, the question is: what are we willing to do about it?”

To gather the PH WINS data, Castrucci and his colleagues worked with human resource directors and workforce champions at the state level, sending out an online survey invite to about 25,000 workers. The data collection began in winter of 2014 and eventually the survey yielded a 46 percent response rate. Today, the results of PH WINS as well as analyses of its implications have been published in a special supplement of the Journal of Public Health Management and Practice. (On a side note, Castrucci said he and his colleagues weren’t entirely sure how many workers would even respond to the survey invite. But as they watched the data roll in, they were elated. In fact, PH WINS researchers were able to move from data collection to a special journal supplement in less than a year. Castrucci joked: “I have no idea how we pulled it off.”) Thankfully, the survey was a success and its findings provide eye-opening insights into the workforce challenges facing the public health field.

When it comes to workforce turnover, PH WINS found that 38 percent of workers plan to leave their current positions before 2020 and of those, 25 percent plan to retire and 13 percent plan to leave for a job outside of public health. Besides those workers who plan to retire, those most likely to leave the field are people ages 25 to 40, racial and ethnic minorities, and workers with less than 10 years of experience in public health. PH WINS also asked about job satisfaction, finding that 79 percent said they were “somewhat satisfied” or “very satisfied” with their jobs. But only 48 percent reported being “somewhat” or “very satisfied” with their pay.

On the topic of training, 80 percent of respondents said their health agencies provide on-site training and 77 percent said their employers pay for travel and/or registration for trainings; however, just 30 percent said their employers require continuing education. Also, just 50 percent said they have sufficient training in using the technology they need to do their work. PH WINS also asked about the types of skills workers believe are important to public health. For instance, 72 percent said “influencing policy development” was “somewhat” or “very important,” however 35 percent also said they were unable or have only a beginner’s level of proficiency at it. Seventy-six percent said “understanding the relationship between a new policy and many types of health problems” was important, but again 30 percent said they were unable or have only a beginner’s level of proficiency at it.

A couple more interesting findings: While pay disparity tends to be narrower in public health than in other sectors, women and people of color still make less than their white male counterparts. This is despite the fact that women outnumber men within the public health workforce. In addition, while black and Asian members of the public health workforce are represented in proportion to overall population numbers, the Hispanic community is not. Seventeen percent of the general population identifies as Hispanic or Latino, but just 7 percent of the public health workforce does.

In an overview article about PH WINS that was published in the journal supplement, the authors write:

These findings support a number of concrete recommendations. First, governmental public health must make a high priority of succession planning. Preserving institutional knowledge, preparing mid-level managers to lead, and retaining high-performing individuals must be key objectives of the workforce and succession planning. (State health agencies) also need to devise a strategy to recruit young and mid-career professionals into the field, with a particular emphasis on Hispanic/Latino staff given their under-representation in the workforce and the needs of the population they serve. The demographic composition of the workforce will need to be continually monitored as the demographics of the population evolve in order to ensure that the workforce is well suited to serve the diverse population of the United States.

When discussing PH WINS, Castrucci is adamant that this data is actionable. Yes, public health capacity is often shaped by the ebb and flow of politics and policy. But when it comes to many of the workforce issues identified in PH WINS, state public health leaders can take action now, Castrucci told me. For example, he said, addressing job satisfaction doesn’t have to take one extra budgeted dollar. And yet it could make a big impact considering that PH WINS found that intention to leave the field decreases as job satisfaction increases. PH WINS data can also shape existing training opportunities and inform future ones. In addition, Castrucci noted that the data highlight a need to better engage millennials, saying: “We’re very fortunate that we have a generation coming that believes very firmly in service-driven lives…we have to play on that to engage that generation.” Today, the average age of a public health worker is 48.

Castrucci said that every state health agency could use the new data to address workforce challenges. In fact, each state was sent their own, individualized PH WINS report — “this is about the practice and the action,” he said.

“It was never our intent to do a research project,” Castrucci said of PH WINS. “It’s to improve the workforce and help it evolve and develop to meet future challenges. …At the end of the day, if PH WINS yields 1,000 peer-reviewed articles, but nothing changes, that’s not a success.”

Fortunately, public health leaders are taking notice. For example, in the Journal of Public Health Management and Practice supplement, John Wiesman, Washington state secretary of health, writes:

We were surprised to learn that a smaller proportion of (Washington Department of Health) staff plan to retire before 2020 than other agencies in the region and the nation. Unfortunately, PH WINS results still show that 23% are considering leaving the organization within a year! This lights a fire for succession-planning efforts and retention efforts, which we had already begun to prioritize.

Gail Vasterling, director of the Missouri Department of Health and Senior Services, writes:

Some of the most revealing data from the survey are those that indicate the difference between know-how and perceived importance. We will need to determine whether and how training that increases knowledge might increase perceived importance, which could, in turn, change employees' behavior and improve their performance.

At the end of our conversation, I asked Castrucci how worried we should be about the fate of often-fragile public health achievements in the face of so many planning to leave the field. (Keep in mind that 25 of the 30 years in additional life expectancy gained in the U.S. in the last century were attributable to public health advances.) Castrucci said that, yes, the workforce “exodus” makes a good headline and is “cause for great concern,” but this is hardly an intractable problem.

“I don’t know of any change that’s not simultaneously scary and exciting,” he said. “It’s in our hands.”

Learn more about PH WINS and browse through its data here and here.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.