Preserving Public Health Capacity

This issue brief is informed by the American Public Health Association’s Policy Statement No. 20228.¹

Summary
Public health officials are part of the front line in combating the spread of disease, safeguarding community well-being, and promoting preventive measures to ensure the overall health of populations. It is essential that the public health workforce has the authority to act upon threats to the public’s health, and that the workforce itself is protected.

IPHA supports the following actions, endorsed by the American Public Health Association,¹ to preserve public health roles and to protect the workforce:

• Defense of existing statutes allowing public health officials to act within their full capacity.
• Adoption of policies by state and local governments condemning the harassment and threats directed at public health officials.
• Implementation of legislation to safeguard public health officials.
• Increased state and local funding for public health infrastructure.

Health Impact
Public health officials play an essential role in community and population health. Through monitoring, interventional programs, and policies created, public health departments are able to respond to disease outbreaks. When officials are no longer able to effectively perform their tasks, this could lead to increases in rates of preventable disease in a community. Additionally, ineffective responses to disease outbreaks or ineffective programs may be implemented, wasting taxpayer dollars and having potentially no positive impact on the public’s health.

Even prior to the COVID-19 pandemic, there were increasing rates of turnover in the public health workforce. Many factors are cited for why officials are leaving public health, including a poor workplace environment.² When high turnover rates exist, public health agency performance may suffer; newer employees may not be as aware of the needs of their local communities as seasoned officials. When public health agencies are not able to perform to their maximum ability, the health of the public suffers.

Health Equity and Minority Impact
Public health plays an important role in mitigating disparities among racial and ethnic minorities. These disparities include an increased risk of lacking health insurance, limited access to care, and suboptimal health outcomes for preventable and treatable conditions.³ Addressing these disparities and tackling the social determinants of health are central themes in Healthy People 2030, data-driven national objectives for public health created by the U.S. Department of Health and Human Services.⁴ A diverse and skilled public health workforce is essential for effectively addressing the social determinants of health and persistent health disparities within the populace.³

Iowa Data
The public health workforce within Iowa has seen a 4.7% decrease in full-time employees between fiscal years 2021 and 2022. The most difficult positions to fill following this decrease in full-time workforce have been Registered Nurses and Nursing Aides/Home Health Aides. While there have been similar rates of overall employee turnover between fiscal years 2021 and 2022, there has been an increased rate of administrative turnover. In 2022, there were 22 new local public health administrators compared to 12 in 2021 and 16 in 2020. 56% of local public health administrators have only been in their role for less than 5 years.⁵

There have been multiple bills passed and signed into law by the Iowa government that have hindered public health officials from taking evidence-based approaches to public health, especially surrounding COVID-19. House File 902 allowed employees to seek exemptions from COVID-19 vaccinations by submitting a statement claiming that the vaccine posed a threat to their “health and well-being or that of individuals residing with them.”⁶ This law contradicts scientific research, which has consistently demonstrated the safety and efficacy of the COVID-19 vaccines.⁷ Policies such as this one have led to negative downstream impacts on the health of the community. Presently, only 60.3% of Iowa’s population is fully vaccinated,⁸ falling below the 70-85% threshold required for herd immunity.⁹ When public health experts are hampered in their ability to issue science-based public health directives and initiatives, the well-being of the community inevitably suffers.

Additional Information
Prior to the onset of the COVID-19 pandemic, there was a 15% decline in state and local public health positions nationwide.¹⁰ The pandemic has prompted numerous public health officials to voluntarily leave their roles, intensifying staffing shortages. Between 2019 and 2021, the number of public health officials who planned to leave their job within one year increased from 20% to 33%.²,¹¹ NACCHO reported in May 2021 that 250 public health officials had left their positions,¹² and the New York Times reported this number had increased to 500 by October 2021.¹³ These departures have been aggravated by targeted attacks against public health workers and their families, leading to heightened psychological stress at work.¹⁴ Malicious posts on social media, radio smear campaigns, vandalized vehicles, and demonstrations at clinic sites are just some documented examples of attacks in the Centers for Disease Control and Prevention’s summer 2021 survey of mental health among public health workers.¹⁵

• Preserving Public Health Capacity by Protecting the Workforce and Authority Infographic
• Social Media Image Set

References

1. Preserving Public Health Capacity by Protecting the Workforce and Authority. (2022, November 8). https://www.apha.org/Policies-and-Advocacy/Public-Health-Policy-Statements/Policy-Database/2023/01/18/Preserving-Public-Health-Capacity
2. Halverson, P. K. (2019). Ensuring a strong public health workforce for the 21st century: Reflections on PH WINS 2017. Journal of Public Health Management and Practice, 25(2), S1–S3. https://doi.org/10.1097/phh.0000000000000967
3. Jackson, C. S., & Gracia, J. N. (2014). Addressing health and health-care disparities: The role of a diverse workforce and the social determinants of health. Public Health Reports, 129(Suppl 2), 57–61. https://doi.org/10.1177/00333549141291S211
4. U.S Department of Health and Human Services. (n.d.). Healthy People 2030. https://health.gov/healthypeople
5. Iowa Department of Health and Human Services. (2023b). Iowa’s Local Public Health System: A Report on the Results of the Local Public Health Systems Survey. https://hhs.iowa.gov/sites/default/files/idphfiles/PHSS-Report-Final-4-26-23.pdf
6. Iowa Legislature. (2021, October 29). Bill Information for House File 902 in the 89th General Assembly.https://www.legis.iowa.gov/legislation/BillBook?ba=HF902&ga=89
7. Dhamanti, I., Suwantika, A. A., Adlia, A., Yamani, L. N., & Yakub, F. (2023). Adverse reactions of COVID-19 vaccines: A scoping review of observational studies. International Journal of General Medicine, 16, 609–618. https://doi.org/10.2147/ijgm.s400458
8. Iowa Department of Public Health. (2023). COVID-19 Vaccine Data. Iowa Public Health Tracking Portal. https://tracking.idph.iowa.gov/Health/Immunization/covid-19-vaccine/data
9. Suryawanshi, Y. N., & Biswas, D. A. (2023). Herd Immunity to Fight Against COVID-19: A Narrative Review. Cureus, 15(1), e33575. https://doi.org/10.7759/cureus.33575
10. Haskins, J. (2020). When We Need Them Most, the Number of Public Health Workers Continues to Decline. De Beaumont Foundation. https://debeaumont.org/news/2020/when-we-need-them-most-the-number-of-public-health-workers-continues-to-decline/
11. de Beaumont Foundation & ASTHO. (2022). The Impact of the COVID-19 Pandemic: Rising Stress and Burnout in Public Health. De Beaumont Foundation. https://debeaumont.org/wp-content/uploads/dlm_uploads/2022/03/Stress-and-Burnout-Brief_final.pdf
12. Kounang, N. (2021, May 23). The pandemic has pushed more than 250 public health officials out the door. CNN.https://www.cnn.com/2021/05/23/health/public-health-officials-quit/index.html
13. Baker, M., & Ivory, D. (2021, October 20). Why Public Health Is in Crisis: Threats, Departures, New Laws. The New York Times. https://www.nytimes.com/2021/10/18/us/coronavirus-public-health.html
14. Duchaine, C. S., Aubé, K., Gilbert-Oulmet, M., et al. (2020). Psychosocial stressors at work and the risk of sickness absence due to a diagnosed mental disorder: A systematic review and meta-analysis. JAMA Psychiatry, 77(8), 842–851.
15. Bryant-Genevier, J., Rao, C. Y., Lopez-Cardozo, B., et al. (2021). Symptoms of depression, anxiety, post-traumatic stress disorder, and suicidal ideation among state, tribal, local, and territorial public health workers during the COVID-19 pandemic—United States, March–April 2021. MMWR Morbidity and Mortality Weekly Report, 70(26), 947–952.