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BACKGROUND: The COVID-19 pandemic posed an enormous challenge on the public health workforce, leading to the hiring of much temporary staff. Temporary staff may experience poorer working conditions compared to permanent staff. From a public health perspective, we need to know how working conditions are experienced when there is an acute pressure on recruiting sufficient public health care staff. This study aimed to investigate differences in job demands and work functioning between temporary and permanent public health care staff, during the fourth wave of the COVID-19 pandemic in the Netherlands and compare it with available pre-pandemic data from the general working population. METHODS: This cross-sectional study included temporary (n = 193) and permanent (n = 98) public health care staff from a municipal health care service in the north of the Netherlands. The participants completed a questionnaire with items about quantitative, cognitive, emotional demands (Copenhagen PsychoSOcial Questionnaire, COPSOQ, range 1-100) and work functioning (Work Role Functioning Questionnaire, WRFQ, range 1-100). The participants' scores were compared to the general working population and differences between temporary and permanent staff were investigated using linear regression analysis. In addition, explorative analyses were conducted with temporary staff stratified by task and permanent staff by department. RESULTS: Permanent staff had relatively high scores on job demands compared to the general working population, whereas temporary staff had relatively low scores. On work functioning, permanent staff had similar scores as the general working population and temporary staff had better scores. Compared to permanent staff, temporary staff had lower, i.e. better, scores on quantitative (regression coefficient (B)=-26.7; 95% Confidence Interval (CI) -30.8 to -22.5), cognitive (B=-24.4; 95% CI -29.0 to -19.9), and emotional demands (B=-11.8; 95% CI -16.0 to -7.7), and better scores on work functioning (B = 7.8; 95% CI 4.5 to 11.3). CONCLUSIONS: Temporary staff experienced lower job demands and reported better work functioning than permanent staff. The acute expansion of the public health workforce did not seem to negatively impact the job demands and work functioning of temporary public health care staff.

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Background: The COVID-19 pandemic highlighted gaps in the public health workforce's capacity to deploy digital technologies while upholding ethical, social justice, and health equity principles. Existing public health competency frameworks have not been updated to reflect the prominent role digital technologies play in contemporary public health, and public health training institutions are seeking to integrate digital technologies in their curricula. Objective: As a first step in a multiphase study exploring recommendations for updates to public health competency frameworks within the Canadian public health context, we conducted a rapid review of literature aiming to identify recommendations for digital competencies, training approaches, and inter- or transdisciplinary partnerships that can enhance public health practitioners' capacity to support the digital transformation of public health. Methods: Following the World Health Organization's (2017) guidelines for rapid reviews, a systematic search was conducted on Ovid MEDLINE, Ovid Embase, ERIC (Education Resources Information Center), and Web of Science for peer-reviewed articles. We also searched Google Scholar and various public health agency and public health association websites for gray literature using search terms related to public health, digital health, practice competencies, and training approaches. We included articles with explicit practice competencies and training recommendations related to digital technologies among public health practitioners published between January 2010 and December 2022. We excluded articles describing these concepts in passing or from a solely clinical perspective. Results: Our search returned 2023 titles and abstracts, of which only 12 studies met the inclusion criteria. We found recommendations for new competencies to enable public health practitioners to appropriately use digital technologies that cut across all existing categories of the core competencies for public health framework of the Public Health Agency of Canada. We also identified a new competency category related to data, data systems management, and governance. Training approaches identified include adapted degree-awarding programs like combined public health and informatics or data science degree programs and ongoing professional certifications with integration of practice-based learning in multi- and interdisciplinary training. Disciplines suggested as important to facilitate practice competency and training recommendations included public health, public health informatics, data, information and computer sciences, biostatistics, health communication, and business. Conclusions: Despite the growth of digital technologies in public health, recommendations about practice competencies and training approaches necessary to effectively support the digital transformation of public health remain limited in the literature. Where available, evidence suggests the workforce requires new competencies that cut across and extend existing public health competencies, including new competencies related to the use and protection of new digital data sources, alongside facilitating health communication and promotion functions using digital media. Recommendations also emphasize the need for training approaches that focus on interdisciplinarity through adapted degree-awarding public health training programs and ongoing professional development.

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BACKGROUND: There is limited evidence about the mental health and intention to leave of the public health workforce in Canada during the COVID-19 pandemic. The objectives of this study were to determine the prevalence of burnout, symptoms of anxiety and depression, and intention to leave among the Canadian public health workforce, and associations with individual and workplace factors. METHODS: A cross-sectional study was conducted using data collected by a Canada-wide survey from November 2022 to January 2023, where participants reported sociodemographic and workplace factors. Mental health outcomes were measured using validated tools including the Oldenburg Burnout Inventory, the 7-item Generalized Anxiety Disorder scale, and the 2-item Patient Health Questionnaire to measure symptoms of depression. Participants were asked to report if they intended to leave their position in public health. Logistic regression was used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) for the associations between explanatory variables such as sociodemographic, workplace factors, and outcomes of mental health, and intention to leave public health. RESULTS: Among the 671 participants, the prevalence of burnout, and symptoms of depression and anxiety in the two weeks prior were 64%, 26%, and 22% respectively. 33% of participants reported they were intending to leave their public health position in the coming year. Across all outcomes, sociodemographic factors were largely not associated with mental health and intention to leave. However, an exception to this was that those with 16-20 years of work experience had higher odds of burnout (aOR = 2.16; 95% CI = 1.12-4.18) compared to those with ≤ 5 years of work experience. Many workplace factors were associated with mental health outcomes and intention to leave public health. Those who felt bullied, threatened, or harassed because of work had increased odds of depressive symptoms (aOR = 1.85; 95% CI = 1.28-2.68), burnout (aOR = 1.61; 95% CI = 1.16-2.23), and intention to leave (aOR = 1.64; 95% CI = 1.13-2.37). CONCLUSIONS: During the COVID-19 pandemic, some of the public health workforce experienced negative impacts on their mental health. 33% of the sample indicated an intention to leave their role, which has the potential to exacerbate pre-existing challenges in workforce retention. Study findings create an impetus for policy and practice changes to mitigate risks to mental health and attrition to create safe and healthy working environments for public health workers during public health crises.

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BACKGROUND: Addressing threats to the nursing and public health workforce, while also strengthening the skills of current and future workers, requires programmatic solutions. Training programs should be guided by frameworks, which leverage nursing expertise and leadership, partnerships, and integrate ongoing evaluation. PURPOSE STATEMENT: This article provides a replicable framework to grow, bolster, and diversify the nursing and public health workforces, known as the Nurse-led Equitable Learning (NEL) Framework for Training Programs. The framework has been applied by several multipronged, federally funded training programs led by investigators embedded in an academic nursing institution. METHODS: The NEL framework focuses on: (1) increasing equitable access to the knowledge, skills, and competencies needed to prepare a diverse workforce to deliver effective interventions; (2) fostering academic-practice linkages and community partnerships to facilitate the deployment of newly gained knowledge and skills to address ongoing and emerging challenges in care delivery; and (3) continuously evaluating and disseminating findings to inform expansion and replication of programs. RESULTS: Ten programs using this framework have successfully leveraged $18.3 million in extramural funding to support over 1000 public health professionals and trainees. Longitudinal evaluation efforts indicate that public health workers, including nurses, are benefiting from the programs' workplace trainings, future clinicians are being rigorously trained to identify and address determinants of health to improve patient and community well-being, and educators are engaging in novel pedagogical opportunities to enhance their ability to deliver high quality public health education. CONCLUSIONS: Training programs may apply the NEL framework to ensure that the nursing and public health workforces achieve equitable, sustainable growth and deliver high quality evidence-based care.

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The field of public health informatics has undergone significant evolution in recent years, and advancements in technology and its applications are imperative to address emerging public health challenges. Interdisciplinary approaches and training can assist with these challenges. In 2023, the inaugural Public Health Informatics and Technology (PHIAT) Conference was established as a hybrid 3-day conference at the University of California, San Diego, and online. The conference's goal was to establish a forum for academics and public health organizations to discuss and tackle new opportunities and challenges in public health informatics and technology. This paper provides an overview of the quest for interest, speakers and topics, evaluations from the attendees, and lessons learned to be implemented in future conferences.

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INTRODUCTION: Burnout is an occupational phenomenon resulting from chronic workplace stress. We conducted this review to estimate the pooled global prevalence of burnout among the public health workforce. METHODS: We conducted this review as per the PRISMA 2020 guidelines. We included only cross-sectional studies reporting outcome estimates among the study population. We included articles published before December 2023. We used a search strategy to systematically select the articles from PubMed, Embase, and Google Scholar. We assessed the quality of the studies using an adapted version of NIH's study tool assessment for cross-sectional and observational cohort studies. We estimated the pooled proportion using the random-effects model. RESULTS: We included eight studies in our review, covering a sample size of 215,787. The pooled proportion of burnout was 39% (95% CI: 25-53%; p-value: < 0.001). We also identified high heterogeneity among the included studies in our review (I2: 99.67%; p-value: < 0.001). Seven out of the eight studies were of good quality. The pooled proportion of the studies conducted during the COVID-19 pandemic was 42% (95% CI: 17-66%), whereas for the studies conducted during the non-pandemic period, it was 35% (95% CI: 10-60%). CONCLUSION: In our review, more than one-third of public health workers suffer from burnout, which adversely affects individuals' mental and physical health. Burnout among the public health workforce requires attention to improve the well-being of this group. Multisite studies using standardized definitions are needed for appropriate comparisons and a better understanding of variations in burnout in various subgroups based on sociodemographic characteristics and type of work responsibilities. We must design and implement workplace interventions to cope with burnout and increase well-being. LIMITATIONS: Due to the limited research on burnout among public health workers, we could not perform a subgroup analysis on various factors that could have contributed to burnout.

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The diversity of racial/ethnic representation in the health services and policy research (HSPR) workforce plays a crucial role in addressing the health needs of underserved populations. We assessed changes (between 2012 and 2022) in the racial/ethnic composition of students and faculty from departments of Health Policy & Management (HPM) and Health Education & Behavioral Sciences (HEBS) among the Association of Schools and Programs of Public Health member institutions. We analyzed annual data from over 40 institutions that reported student and faculty data in 2012 and 2022 within each department. Racial/ethnic populations included American Indian/Alaska Native (AI/AN), Asian, Hispanic, Native Hawaiian/Pacific Islander (NH/PI), Black, White, Unknown, and Multiracial. We conducted analyses by department and examined racial/ethnic composition by student status, degree level, faculty rank, and tenure status. We found statistically significant increases in Black assistant professors (HPM and HEBS) and tenured faculty (HPM), Hispanic graduates and tenure-track faculty (HPM), Asian professors (HPM: full and tenured, HEBS: associate and tenured), and Multiracial students and graduates (HPM and HEBS). Statistically significant decreases were observed in White professors (HPM: assistant and full, HEBS: all ranks) and tenure-track faculty (HPM and HEBS), AI/AN associate professors and tenured faculty (HEBS), Hispanic associate professors (HPM), Asian assistant professors (HEBS), and NH/PI students (HPM and HEBS). Our findings highlight the importance of increasing racial/ethnic representation. Strategies to achieve this include facilitating workshops to raise awareness about the structural barriers encountered by Hispanic faculty, providing research support, evaluating promotion processes, establishing more pathway programs, and fostering interdisciplinary academic environments studying AI/AN or NH/PI populations.

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OBJECTIVE: A severe staff shortage and a dearth of professionals from underrepresented backgrounds in the public health workforce are contributing to poor health outcomes in the United States. Schools and programs can mitigate these problems by admitting more graduate public health students overall and from underrepresented backgrounds. We identified predictors of foundational graduate public health course grades and graduate grade point average (GPA), sharing evidence to remove application factors that are admission barriers and do not predict student outcomes. METHODS: We conducted a linear regression analysis on demographic and academic factors from 564 graduate public health applications for students at the University at Buffalo who received their degree from January 1, 2016, to February 1, 2021, analyzing age, race and ethnicity, sex, income, undergraduate degree, verbal and quantitative Graduate Record Examination (GRE) percentiles, and undergraduate GPA. Outcomes were grades in foundational public health courses and cumulative graduate GPA. RESULTS: Undergraduate GPA was the best predictor of graduate public health student success, explaining nearly 7% of foundational public health course grades and 29% of graduate GPA. Higher undergraduate GPA contributed to higher course grades and graduate GPA. GRE scores explained <1% of student outcomes. CONCLUSIONS: Our findings add to the growing body of research showing that standardized test scores may not predict graduate student outcomes and provide further evidence for the field of public health to consider removing this admission barrier. By doing so, institutions could admit more students to graduate public health programs who can bring needed skills to the market, further diversifying the workforce and public health faculty, to better meet population health needs.

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The need for a robust public health system in the United States is critical for safeguarding population health. However, current data suggest an insufficient number of individuals entering or staying in the governmental public health workforce. Expanding the public health pipeline requires creative thinking about recruitment and training activities. To attract students to public health and other health-related fields, including medicine, one institution in the Southeast recently initiated the Public Health Influencers Summer Institute (PHISI), a program that addresses the beginning of the career development continuum: recruitment of high school students. For this investigation, we reviewed evaluation data of the PHISI and provided descriptive analyses and selected quotes to reflect student learning. Participants reported increased familiarity with all public health topics after participating in the program, with the greatest increases in public health policy and social determinants of health. In addition, all participants reported increased or significantly increased understanding of public health after participating in the program. While interest in the field of public health increased due to the COVID-19 pandemic, there are not enough individuals entering or staying in the public health workforce, leaving a critical shortfall. Introducing high school students to the field of public health may increase their interest in entering the public health workforce in the future, thereby strengthening the overall public health infrastructure. We propose that the PHISI may be an innovative strategy for increasing both the number and diversity of students interested in pursuing a career in public health.

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This Viewpoint reviews the debate about whether the professionalization of public health practice should be approached through a certification and licensure system. It introduces the recent attempt at professionalizing public health in Taiwan with the newly enacted Public Health Specialists Act of 2020, regulating the Public Health Specialist (PHS) through a state-mandated certificate. The Viewpoint discusses the implications of this new PHS Act on Taiwan's public health education and professionalization. The PHS model in Taiwan is one of the first of its kind around the globe. Advocates of public health professionalization and public health educators could benefit from Taiwan's experience.

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OBJECTIVES: A need persists for graduates with public health training in government public health roles; however, earnings for these positions tend to be lower when compared with earnings for people with undergraduate or graduate training who are working in other sectors, such as private health care or pharmaceuticals. This study assessed federal student loan debt associated with education for public health, with an aim to quantify the need that may be met through the federal Public Health Workforce Loan Repayment Program (PHWLRP), which is one tool that policy makers have proposed to incentivize people with public health training to pursue employment in government public health. METHODS: We analyzed federal student loan data provided by the National Center for Education Statistics College Scorecard for the 2018-2019 academic year. We merged these data with the Integrated Postsecondary Education Data System to estimate the number of degrees awarded. We used Spearman rank correlation to compare associations between debt and annual earnings by award level (bachelor's, master's, and doctoral degrees). RESULTS: Across all award levels, the median level of federal student loan debt associated with education for public health was $33 366. The median annual earnings 1 year after graduation were $80 687 for graduates with doctoral degrees and $33 279 for graduates with bachelor's degrees. CONCLUSIONS: As policy makers attempt to strengthen the public health workforce with a focus on funding and implementing the PHWLRP, the existing levels of student debt should be considered to ensure that programs such as the PHWLRP are funded and reflect the needs of graduates and government public health employers.

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BACKGROUND: This study presents the prevalence of burnout among the Canadian public health workforce after three years of the COVID-19 pandemic and its association with work-related factors. METHODS: Data were collected using an online survey distributed through Canadian public health associations and professional networks between November 2022 and January 2023. Burnout was measured using a modified version of the Oldenburg Burnout Inventory (OLBI). Logistic regressions were used to model the relationship between burnout and work-related factors including years of work experience, redeployment to pandemic response, workplace safety and supports, and harassment. Burnout and the intention to leave or retire as a result of the COVID-19 pandemic was explored using multinomial logistic regressions. RESULTS: In 2,079 participants who completed the OLBI, the prevalence of burnout was 78.7%. Additionally, 49.1% of participants reported being harassed because of their work during the pandemic. Burnout was positively associated with years of work experience, redeployment to the pandemic response, being harassed during the pandemic, feeling unsafe in the workplace and not being offered workplace supports. Furthermore, burnout was associated with greater odds of intending to leave public health or retire earlier than anticipated. CONCLUSION: The high levels of burnout among our large sample of Canadian public health workers and its association with work-related factors suggest that public health organizations should consider interventions that mitigate burnout and promote recovery.

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The COVID-19 pandemic has caused social and economic disruption worldwide and spurred numerous mitigation strategies, including state investments in training a large contact tracing and case investigation workforce. A team at the University of Alaska Anchorage evaluated implementation of the COVID-19 contact tracing and case investigation program of the State of Alaska Department of Health and Social Services, Division of Public Health, Section of Public Health Nursing. As part of that evaluation, the team used COVIDTracer, a spreadsheet modeling tool. COVIDTracer generated projections of COVID-19 case counts that informed estimates of workforce needs and case prioritization strategies. Case count projections approximated the reported epidemiologic curve with a median 7% difference in the first month. The accuracy of case count predictions declined after 1 month with a median difference of 80% in the second month. COVIDTracer inputs included previous case counts, the average length of time for telephone calls to cases and outreach to identified contacts, and the average number of contacts per case. As each variable increased, so too did estimated workforce needs. Decreasing the average time from exposure to outreach from 10 to 5 days reduced case counts estimated by COVIDTracer by approximately 93% during a 5-month period. COVIDTracer estimates informed Alaska's workforce planning and decisions about prioritizing case investigation during the pandemic. Lessons learned included the importance of being able to rapidly scale up and scale down workforce to adjust to a dynamic crisis and the limitations of prediction modeling (eg, that COVIDTracer was accurate for only about 1 month into the future). These findings may be useful for future pandemic preparedness planning and other public health emergency response activities.

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The persistent understaffing of the governmental public health workforce has led to program cutbacks, staff burnout at local health departments (LHDs), and an urgent need to replenish staffing. To build recruitment pathways into LHDs and build their workforce capacity, we introduced a paid internship initiative connecting Master's in Public Health students from a Midwestern university with LHDs in the state. This article presents the pilot program developed and the insights gained from it. Program participants included nine LHDs that hosted 10 students for 12-week internships. Internship projects were developed by LHDs with support from the state's association of county and city health officials. All students completed their internship projects satisfactorily. The experience highlighted that while students contributed to LHDs through short-term projects, with sustained backing and minor adjustments, this model can serve to reinforce the governmental public health sector's existing and future capacity in the long term.

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Introduction Job stress is recognized as a significant concern across various occupational settings which have profound implications for both individuals and organizations. During the COVID-19 pandemic, job stress among the public health workforce (PHW) has been a significant concern, as they face a significantly increased risk of infection and mortality due to excessive COVID-19 exposure. This study presents a descriptive exploration of key job stress-related factors among PHW in Terengganu, Malaysia. Methodology This is a cross-sectional study conducted from May 2022 to April 2023, encompassing all eight District Health Offices (DHO) and government health clinics in Terengganu. Data collection involved a Malay version of the Job Content Questionnaire (M-JCQ), which assesses job characteristics based on Karasek's demand-control-support model and consists of four main domains: decision latitude, psychological job demands, physical job demands, and social support. Data was collected from 1044 participants, and statistical analysis was performed using SPSS version 27 (IBM Corp., Armonk, NY, USA). Findings Of the 1044 participants, 18.9% experienced job stress. The highest percentage of job stress was observed among nurses (24.3%), followed by medical assistants (18.3%) and physicians (16.0%). In contrast, the public health assistant (PKA) group had the lowest rate of job stress. Job types based on Karasek's model also showed variations, with doctors having the highest percentage of active jobs (46.4%), while medical assistants had the highest percentage of low job strain (17.9%), and PKAs had the highest percentage of passive job types (44.7%). Conclusion This study offers significant insights into the work-related challenges faced by the public health workforce in Terengganu, Malaysia, especially during the COVID-19 pandemic. Job stress is a substantial concern, and understanding its underlying factors is essential for improving the well-being of PHWs. Decision latitude, job demands, and social support play critical roles in shaping job stress among PHWs. Strategies and interventions are needed to mitigate job stress, improve working conditions, and enhance the effectiveness of PHWs in public health initiatives. This study highlights the importance of addressing job stress in this sector, with potential benefits for both the mental and physical health of PHW.

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CONTEXT: The contributions from the field of public health to human society are numerous and are often taken for granted. The COVID-19 pandemic thrust the largely invisible public health workforce into the public eye. Like other career civil servants at the intersection of the citizen-state encounter, reports of uncooperative, hostile, and even violent confrontations between public health workers and those they serve are on the rise. This study explores the attitudes of public health professionals in two states in the American West. METHODS: The authors conducted an anonymous web-based survey of public health professionals in Montana and Oregon one year into the COVID-19 pandemic. FINDINGS: Public health workers who responded to the survey reported beliefs that the COVID-19 pandemic was politicized by actors in the government, both major political parties, the media, and the public broadly. This politicization affected workers' abilities to do their jobs, with respondents in Montana experiencing more negative impacts than those in Oregon. CONCLUSIONS: Public health workers face growing antagonism from the public and pressure from political leaders, which poses a significant concern for the public health workforce and for communities as they prepare to address and overcome future public health challenges.

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