The Call to Join Public Health

ROBERT JOHNSON:
This is Public Health Review. I'm Robert Johnson.

On this episode, solutions to help stabilize and grow the public health workforce.

JP LEIDER:
The workforce is in an interesting and somewhat precarious position.

HEATHER KRASNA:
There's 80,000 missing positions, missing people.

JOHNSON:
Welcome to Public Health Review, a podcast brought to you by the Association of State and Territorial Health Officials. With each episode, we explore what health departments are doing to tackle the most pressing public health issues facing our states and territories.

Today, research and tools to help agencies rebuild the public health workforce, as explained by two educators who are leading the work on solutions.

Dr. JP Leider is an associate professor at the University of Minnesota School of Public Health. He also is director of the Center for Public Health Systems. He's along later to talk about approaches that can help connect graduates to work in the field.

But first, we visit with Dr. Heather Krasna, Associate Dean of Career Services and Professional Development at the Columbia University Mailman School of Public Health. She also collaborated with ASTHO to develop the new publichealthcareers.org website. The site, among other tools is intended to help agencies connect with candidates to fill openings, that number in the 10s of 1000s. nationwide. Not all of them are funded, but they certainly are needed.

The question then is, if we had the money, would there be enough people ready to answer the call?

KRASNA:
I think that there's a huge interest. What I'm seeing is here working at a university in a school of public health is that we had the largest graduating class of public health graduates in 100 years from our school. And it's not only Columbia, it's schools around the United States. Because what happened in fall of 2021, you know, two years before, is that we had a huge number of people who saw what happened in the pandemic and who wanted to make a difference. And they spent the last couple of years getting their public health degree here at Columbia. It's mostly their master's degree, but you know, in other places, there's a lot of bachelor's level graduates at that undergrad level who are really, really passionate about making their community healthier, keeping people safe, promoting really good, healthy opportunities, making public health the ideal option for people, making it available for people.

And, you know, now they've graduated into a world where the funding is not where we thought it would be. Where suddenly, you know, some of the emergency funding is not there. And it's, you know, we're having some challenges.

So, I think there's tremendous interest and now there's going to be a giant question of where are all these people going to get jobs, who really want to work in public health?

JOHNSON:
Tell us how it works. How does the website work?

KRASNA:
Sure. So, the first thing that it does I think that's groundbreaking, is that it actually has a map that you can click on. So if you are, you know, open to different locations, you can actually go to the site and find a map of all the state health departments and just click on them, and it brings you right to the job board for each state. And that might seem like really low hanging fruit, but it didn't exist before. So that's one really easy thing that it does to help people find opportunities.

It does have a job board, which you can also search by a whole bunch of different things—by geographic location, by the type of position, by keywords, buzzwords, things like that.

Then there's that educational piece, like what is public health? Why is public health something you should consider? There are fellowships and internships, I know we're going to be building that out a little bit more. And, you know, there's some sort of highlighted fellowships on there that you can explore. And, you know, again, that educational component, and we're building that out further also in terms of helping people understand, you know, what are the jobs that exist in public health? So, you'll see, just a quick overview, really, of, you know, what are the topic areas that health departments work on? And, you know, what are some of the actual job types? What kind of jobs could you get in a health department?

So all of that stuff and putting it all in one place, I don't think it has ever been done before. So that's some of the benefits for a job seeker, is that it gives you a taste of what kind of jobs could exist and then it actually brings you to real job opportunities that you can apply to right now.

JOHNSON:
Public health agencies are on the other side of the equation, obviously. What is the benefit to them? How does the website help them?

KRASNA:
Yeah no, a lot of health departments have been either manually posting positions or else, they have now managed to set things up to some extent for certain health departments that it'll just magically pull. I don't know how they do it. But there's some great tech people on the back end, who are creating a feed of job postings from the different health department job boards, which is really, makes it easier for those health departments that have that sort of applicant tracking system or some other way that they can just kind of hook it up to constantly send postings.

So you can actually see, there's 1,400 and something jobs currently posted on the site. And so you can search, you know, by cities and states, and by category. And so, we're hearing from health departments that this is bringing more candidates in, that people are clicking on the postings and then it brings them over to where they can apply for these different positions around the country.

So hopefully, it draws people maybe that hadn't even thought about public health, it's kind of enticing them to consider it and then making it easy for them to apply for positions.

JOHNSON:
Another exciting development coming soon is a career assessment tool. Can you tell us what that's about and why it's important to have that available to people as they look for a job?

KRASNA:
Sure. So, that's probably the piece that I'm most excited about and that's because it's the first really evidence-based career assessment that's specific for jobs in health departments.

So, to create that assessment, what we did—and this is based on research that I've been doing for a couple of years now—is that I was able to match the different job functions that exist in health departments with these standard occupational classification codes from the U.S. Department of Labor, which are sort of standard descriptions of different jobs. Those descriptions, in turn are matched to career interests that are part of a career assessment, which is free. Designed by the US Department of Labor, it's open to the public to use and it's only 60 questions that are very, very quick, you know. And you can answer these questions and it'll tell you, not, you know, definitively "okay, drop everything and go become an epidemiologist," but it will tell you, "hey, you really liked doing research things. You are somebody who's very investigative but you also really like creativity and you're an artistic person. So here's a list of jobs that include investigative and artistic and these are the ones that exist in health departments." And then from there, you can go and explore actual job postings on the site that would match your career interests.

And this is very, very helpful for people that are either brand new to careers in general, maybe they haven't had jobs before, they're trying to figure out what to major in in school, not sure what they really like.

But also for career changers. Maybe there's people who have worked in different kinds of settings. You know, maybe they have worked in a corporate job and now they want to find a job which is very mission-driven, in a different way. And now they're checking out what might exist in public health. And this can tell them, what kind of job function might work best for them.

So, we're working now on creating this quick assessment and then actually mapping it to the positions that are in that job board, so that people can do the assessment and then research further about these careers, you know, learn what kind of education or training you might need for each one. And then actually look at real jobs that are currently open at a health department that they could apply to.

So, I'm really excited for that to launch. It'll be a little bit longer, but when it launches, it'll be like a quick, easy way and very evidence-based to help people figure out what to do and where they could fit in public health.

JOHNSON:
You give a lot of career advice, so I'd like to know what your advice is to the listeners. Whether they have a degree or not, if they're interested in public health, what do they need to know?

KRASNA:
You know, exploring what you want to do is a first step. Some of that is self-assessment. Thinking about what skills you really enjoy using, what skills maybe you don't enjoy using that you would love to not have to use those skills, maybe there's certain things that you can do but you find it boring or something. So, what skills do you like to use? What are you motivated to do? What achievements are you really proud of? And was there a sort of a pattern in terms of each time you were working on something you really enjoyed? You were using certain skills each time and those are the skills you want to use in the future? That's one piece.

Second piece is, are you passionate about a particular mission? Like I was saying, some people are motivated to work with kids and families, and some people are motivated for you know, health equity and others are specifically focused on environmental health or whatever. So, is there certain issues and topics that you're passionate about?

A third piece is kind of what kind of career setting are you interested in? You know, government is not for everybody. It is, it has a lot of really special benefits that don't exist in other sectors. Sometimes health departments may have, you know, certain kinds of benefits that other sectors don't always have. So, it's worth kind of thinking about that. But just figuring out lifestyle wise, you know, what is it that you're going to prioritize. And that first step of assessing and figuring out what's important to you, that's the groundwork you have to do.

And then, you have to go out and explore. And I would say, exploring could mean even just reading what's on that website, reading the book about 101+ Careers in Public Health. We profile many different public health professions in there, we have interviews of people in there. But also talking to people, reaching out to people over social media like LinkedIn. Or if there is a State Chapter of like APHA or a local health department, one of the state associations for public health. Those type of programs or organizations are ways that you can meet people and talk to them, and ask what they actually do. What is the day in the life really like? And then, you know, putting yourself out there can be hard, but applying for opportunities is really crucial to finding these positions.

I would also say, you know, sometimes with public health, health departments, depending on the health department, the job application process can look kind of different from what you might see in the private sector.

JOHNSON:
Clearly, you have a passion for this kind of work. But I'm wondering what it is that drives you to do all of this, was it the pandemic or something else?

KRASNA:
For 25 years or more, really, I've been very lucky to have a career that I really enjoy, which is career counseling and coaching and helping students find employment. But I've also been a very mission-driven person, in addition to that.

Where I started out in nonprofit management and I was very lucky to eventually find a position as a Director of Career Services at a policy school, working with people, working in public administration, and nonprofit management. And then, ended up also moving into the Mailman School where I've been for the last 10 years, the Columbia Mailman School of Public Health.

And I just have to say that I'm passionate about this type of work of connecting people who want to make the world better, to job opportunities where they get to do that. It's just a privilege and an honor.

I would say the pandemic did sort of impact me pretty strongly, because it was at that time that I came to really realize living in New York City during the pandemic, that the backbone of public health is local and state, and tribal and territorial health departments. And when that backbone is not supported and funded properly, the rest of the public health infrastructure is not going to maintain itself very well.

We all in different ways contribute to public health. Public health is very diverse and very, very broad and it expands way beyond the core of that government public health. But if we don't have that core, then we're really in trouble.

JOHNSON:
Dr. JP Leider has worked 15 years to improve public health resources. In addition to his position at the University of Minnesota, he directs the Center for Public Health Systems, where agencies can access technical assistance and research about workforce, finance, infrastructure and policy. He's also a member of the consortium for workforce research in public health.

Safe to say Leider knows what's happening in the public health pipeline.

LEIDER:
In 2018, pre-pandemic, that was our high point for master's degrees. It started to go down nationally, until the pandemic hit. And then we had a pretty substantial spike at the master's level. And it's been kind of retreating since then. The question is really—except for a couple of the big schools—what is the new normal?

That's not necessarily the case for bachelor's degrees. A couple of years ago, bachelor's surpassed master's as the most awarded public health degree. Doctoral degrees are kind of their own thing. The question is really, how many high-quality applicants do we have that want to leave their job if they get in? Because we continue to have a lot of applicants for doctoral slots, but maybe not as many as you think that want to come if they get in.

So, the real question is by degree type, you know, what is that trend? I think bachelor's is actually continuing to grow a lot. It's really interesting and surprising. And hopefully, we can sustain interest, assuming that we can place our students in jobs that they want to be in. Master's degrees, somewhat of a different story, I think.

JOHNSON:
Are you surprised at the amount of interest in undergraduate degrees in public health?

LEIDER:
I was maybe more surprised 10 years ago, when I noticed the start of the trend. I'm a little bit less surprised now.

Back then, this spike was relatively newer, and the data were relatively less understood. Back 10 years ago, undergraduate public health was just on the initial upshot. And folks were trying to understand, you know, what is it about the bachelor's degree in public health that kind of made it this like new shiny object?

What we're seeing now is that it has a lot of play as an employability factor for folks who are pursuing further education, whether in medical school, in the health sciences, but it is a good replacement for those who had traditionally sought humanities type degrees, because you get concrete skills and statistics and other sciences. So, there's just a lot that public health skill sets can get you in this day and age.

And now there are just many, many, many, schools that offer this kind of degree. So, there's a little bit of supply induced demand as well, I would say. But really, students continue to flock to the program, we have well over 20,000 degrees awarded each year at the bachelor's level.

JOHNSON:
Public health was under attack during the pandemic. But what I hear you saying is, people are still interested in this field, they want to get a degree and they want to get involved.

LEIDER:
Well, there's a little bit of a disconnect there. Because whether at the bachelor's or master's level, people that get degrees in public health don't really go into governmental public health. It's maybe the fourth or fifth thing that folks go into, after health care, or health insurance, or research. You know, it's it's pretty far down that list. So, I think that's part of what's very different now versus 30 years ago.

JOHNSON:
Fair enough. How do we fix that?

LEIDER:
One of the really beneficial things about the time we live in now, is there's a lot more recognition about the need to build pathway programs, between schools and health departments—which I think there's always been this idea of, "Oh, yeah, you need to have internships." But, now we recognize you need to have paid internships that are systemic and structural, and are not just based on "Oh, yeah, I know, this person over here, I know that person over there."

You need to create something that exists between institutions, that's easy for students, that pays them for their time. But after, there's a summer internship, that makes it easy for them to later get a job. That after school, makes it so that they want to stay there. I think that's what's a little bit different now that kind of makes that barrier to entry, lower than it's ever been. I think that's what's really different now.

JOHNSON:
How does the work you're doing for the Consortium for Workforce Research in Public Health attempt to resolve some of these questions?

LEIDER:
What's really exciting about what the consortium is doing and this new public health workforce research center, is that it's the first time such a center has ever really existed for public health. There are nine of these health workforce research centers in the country. You know, there's one for behavioral health, one for the emerging health workforce, but public health hasn't had its day in the sun before. And I think there's recognition now by HRSA, and the CDC, that public health has long needed this.

And every year, we do at least eight research projects that are selected and pitched by the public health community. So, not just by us at a university or with our partners at universities, but by the entire community. We kind of come together and try and figure out what is most pressing.

And recruitment is almost always at the top of that list. How we figure out how many students are even available is kind of like a supply, a labor supply. That was one of the first projects we did in our first year, last year. We have these kinds of projects every year, and then it's not just a matter of, "hey, we're going to figure out this answer and go publish a paper, or go present somewhere." That's important. That pushes forward the science, but we're also creating products with our practice partners, getting results out to the health department's directly because they are our partners in all of this. So, trying to kind of translate the science in real time with the folks that helped us select the problem in the first place, so that it doesn't go sit on a shelf somewhere. It can go help in the real world as quickly as possible.

JOHNSON:
What can you tell us you're learning from all of this work?

LEIDER:
So, an example that I'll give you is the kind of labor supply one that I just talked about. It's like a little dry, I know. But if we're worried about the workforce question, it kind of matters, like how many students are even around? And what we're finding is that, yes, the case, as you might expect, that in those big cities there are a lot more folks, right, that are graduating, but there's far far, far more competition in those jurisdictions. And certain regions of the country like the Pacific Northwest, the East Coast, they have a lot more to choose from, because as it happens, there are a lot more schools with bachelor's programs, for instance. And that some of these rural jurisdictions have maybe 10 graduates within 150 miles total. Or some of these urban jurisdictions are competing so much, that on average, they have approximately 15 or 20, in a given year that they can even compete for at a master's level. So, like they're not that much off better. But at least it's not in total, right.

So, one of the interesting challenges that we're finding for some of these regions is that you would think with so many bachelor's and master's degrees being conferred, there'd be a pretty decent labor supply to choose from. But in certain parts of the country, there's actually quite a dearth. And so, we might consider really strong pathways or incentive programs in particular regions, like in Wyoming and Idaho, parts of New Mexico and so on, where it appears like there might not be that much to choose from. So, we've been able to kind of identify particular geographies where this is an issue.

JOHNSON:
We're talking a lot about workforce-related tools on this podcast, but one we haven't mentioned yet, is the Staffing Up calculator. What is it? And how does it play into the solution?

LEIDER:
The Staffing Up calculator is a project that was funded by the de Beaumont Foundation and CDC, in partnership with the Public Health Accreditation Board, and a whole mess of us worked on it. I'm pleased to say that it's this kind of multi-year project culminating in this workforce calculator.

Originally, Staffing Up was created to answer a kind of straightforward question, how many people do we need in public health to deliver the foundational public health services? The foundational public health services being this framework around, what do you need to deliver everywhere, for public health to work, anywhere? It's not just what you need in a community, for that whole community to work, right? There are these community-specific services you need, that are kind of particular to your community, but there's this core that everywhere needs. That's the foundational public health services.

And Staffing Up was conceived during the pandemic with the idea that one day the pandemic would be over, or we would be recovering from it. And we would need to know, you know, what do we need next? What did we need before it? And so Staffing Up kind of 1.0 came out a few years ago now, and it found that prior to the pandemic, we needed at least 80,000 FTEs more across kind of a whole array of state, local. And it wasn't evenly distributed between say, chronic disease and communicable and so on. Like the foundational capabilities, like administrative and organizational competencies, and so I needed a lot more folks. And so did environmental health and so on.

But, what came in Staffing Up kind of 2.0, was this idea that we could create a tool that individual agencies could kind of use as the beginning of a conversation, to figure out what might I need in my organization to do this work? And so that's what the calculator can help work toward. To look at this number and say, "does this seem right to deliver the foundational public health services?" Not to deliver every single activity that I might need in my organization, but to deliver that kind of core. And that's what the calculator, that's what we built it to do.

JOHNSON:
There are all kinds of jobs in public health, but you must have a sense for which positions need to be filled the most. What is the biggest need in public health right now?

LEIDER:
When we do research about kind of the most in need staff, the most in need occupation types, you know, you kind of hear pretty clearly that yes, you need a lot of organizational admin staff around the financial areas to support the running of your orgs. But, in terms of like public health and clinical care, you always hear that you need more public health nurses. But these days, I would say even more than that, it's data scientists types and EPI types, and then community health workers. That's very clearly the types that you're hearing, have a tough time keeping, getting, finding at all.

JOHNSON:
Are you hoping that all of this research will somehow accelerate the process, get more people interested, fill the pipeline faster, lead to more hiring sooner?

LEIDER:
Yeah, I think that there's very little that a given agency can do to raise all of its salaries. But, one thing that most agencies can do is target specific pay bands. So if they know they're not being competitive, even for, say, public health nurses, maybe what they can do is target the support staff, right? So, maybe they can split that occupation and think, "hey, maybe I don't need a public health nurse to do all of the things I have my public health nurse doing. Maybe I can reserve their expertise more to the clinical perspective, like the top tier of the clinical perspective and have other kinds of clinical support staff or other support staff do those roles." That kind of medical division of labor, clinical division of labor happened in the 90s. But you've you've also seen it start to happen with other kinds of functions and logistical and data support too, in the public sector more broadly. And I think public health could benefit from that as well.

JOHNSON:
The pay band idea is an interesting approach. But I assume there are others. Can you talk about some of those?

LEIDER:
I would say that when it comes to finances, people these days are competing a little bit on pay, and a little bit on benefit and feel like a lot of that's out of their control. And so where I see people being successful is a lot in the job environment space. So, they're doing more with flex work and full-time remote work, which I think is very smart. People don't want to come to the office four days a week anymore, or maybe even three.

But, they're also doing things that I think are very, very smart around making it clear about internal promotion and career tracks.

So we know that people who are millennials and younger, don't stay in their jobs for a career, right? They're there for a few years and maybe longer if you're lucky, but probably not.

How can you make it clear what their trajectory is? And how can you make the job environment beneficial and enticing, but not expect them to stay for 10 or 15 years? And settle for that? Like how can you as a manager find that acceptable? Being realistic, I think is a very smart idea.

JOHNSON:
You're an expert in this field, so we'd like to get some words of wisdom or advice from you. Anything that agencies looking to fill, a lot of positions ought to be focused on right now?

LEIDER:
So in my work with HR folks and administrative folks, around recruiting and retention, the biggest issue that I have run into these days, is that our recruitment systems are beyond antiquated. It's not just that we're behind the times, we're so behind the times that like the private sector isn't even competing with us anymore.

And so my advice would be, do all of the things that you can to speed up the time from your job post to onboarding. You know, get yourself updates to your HR systems and your HR models, by any means necessary.

Whatever you have to do, because it's the talent pipeline and the modernization of it, that will pay enormous dividends, almost more than anything else. And the ongoing vacancy rates that will hurt you more than anything else, those have multiplying effects in your organization. So, if you have a 25 to 35% vacancy rate, it's not just a statistic that looks bad. It hurts every part of the organization.

JOHNSON:
As we wrap up, can you give them something to look forward to?

LEIDER:
People that are applying that are younger, are more educated and interested in the work as a group, than they have ever been before. And so, to be able to capture that interest and excitement, even if it's only for three to five years, compared to you know, 12 to 15 years before, is something that is hugely beneficial. It's just a matter of how do you harness that potential for the time that you have them?

JOHNSON:
Thank you for listening to Public Health Review.

If you liked the podcast, please share this episode with your colleagues on social media. And if you have comments or questions we'd like to hear from you. Email us at pr@astho.org—that email again, P-R at A-S-T-H-O dot org. You can also follow us using the Follow button on your favorite podcast player.

And another thing. Stay informed on everything happening at ASTHO by tuning in every weekday morning for Public Health Review Morning Edition. We cover news like this every day. Look for the link in the show notes and be sure to let us know what you think.

This podcast is a production of the Association of State and Territorial Health Officials.

For Public Health Review, I'm Robert Johnson. Be well.