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The Public
Health Workforce Is Not Okay |
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Interviewer: Madeline Roberts, PhD, MPH
Katie D Schenk MA MSc PhD
is an infectious disease epidemiologist and public health informatics
specialist based in Washington DC. She also writes the column: This interview has been edited and condensed for length. EpiMonitor: Can you tell us a little about how you first became interested in public health and epidemiology? KS: As a student in the UK, I became very motivated to travel and work in Africa. I was lucky to get a volunteer internship as a fieldworker for an NGO at a peri-urban informal settlement (AKA high-density area or slum) in Zimbabwe, which expanded my horizons and brought me face-to-face with the brutal realities of poverty and HIV. I became passionate about public health and spent the next 20 years conducting social science implementation research into health behaviors from within the nonprofit sector, focused on evaluating community-based HIV interventions in sub-Saharan Africa. Along the way, I gained a PhD, published a book, and developed a strong academic research and teaching portfolio. [When] COVID-19 hit, I felt a powerful call to offer my relevant practical skills to serve my local community. I started seeking work opportunities in epidemiologic surveillance at State and local public health departments. EpiMonitor: You've written extensively about how "The Public Health Work Force is Not Okay," which is even the name of your newsletter column. Can you talk about what led you to write that first series of articles and what you learned along the way? (Was the process of writing that series at least somewhat cathartic as I am imagining?) KS: I originally drafted an opinion piece about learning from my experiences working on the public health front line during the COVID-19 emergency and was looking around for a suitable outlet to publish. One of the crazy features of our field is that we are heavily siloed, and we lack any single universally recognized publication of central professional authority. A supportive contact in my LinkedIn network introduced me to JPHMP Direct, a companion site to the Journal for Public Health and Management Practice, which would enable me to reach their readership of public health professionals. It became apparent from the enthusiastic audience reaction [to my initial articles] that I had hit a nerve, and my editor suggested “The Public Health Workforce is Not OK” should become a recurring column. One year later, I’ve completed 2 seasons as a contributing columnist sharing my insights into the public health workforce, facilitating some very lively conversations about where it is headed, and responding to a range of questions about careers advice for public health professionals. It has indeed been somewhat cathartic, but more importantly, it has been meaningful to be able to share my hard-earned experiences and lessons learned with colleagues throughout our sector, and to engage in positive, constructive discussions for moving forward. Could you talk a bit about your current work and any projects you're interested in right now? Throughout this journey, I started writing my column “The Public Health Workforce is Not OK” in which I share advice for building a career in public health and offer insights and observations about the public health workforce. This originated from a feeling of frustration that I had been working in public health and epidemiology for more than 20 years, and yet, due to the choppy nature of our work, I still lacked any opportunity to showcase a solid body of valuable skills and expertise. For example, the lack of consistent funding in our field has meant that I have never experienced job security and am always searching for the next assignment, contract, or consulting gig. On the plus side, it has made me flexible and innovative and independent, and it has given me a diverse technical skillset and the ability to join a new team and immediately figure out how to make myself useful, which is a priceless skill. All of these angles turned out to be common threads that many of my readers related to, and they commented that nobody else was speaking out about them. One of the hallmarks of my column is that I employ an approach of radical transparency in sharing the intimate details of my job-hunting experiences - details that most people seek to keep quiet because they are upsetting or embarrassing. In particular, when I started speaking out about some of the harsher sides of job applications, including the unacceptable practice of ghosting, I found that readers resonated with these experiences and appreciated feeling less alone. I am honored to be able to use my experiences to offer advice and guidance to public health professionals at all career stages, and to offer an outlet for constructive discussion of the urgent need to nurture and reimagine what the public health workforce could still become. EpiMonitor: You previously worked in academia and have since transitioned away. Can you talk about why you made that transition, and what kind of opportunities might be available to epidemiologists outside of the world of academia? KS: That’s right, for most of my career I have pursued the nexus between academic and applied public health, and I have found that my interests on each side serve to enrich the other. I’ve grown a really interesting research portfolio about how to mitigate the impacts of HIV on families and children, including running an NIH-funded research study in Zimbabwe, which really felt like coming full circle from where my inspiration started. However, the trouble is that we are so heavily siloed within public health that academic and applied epi rarely speak to one another, and we struggle to recognize and value the skills and experiences from the other side of the boundary. I found the increasing move towards relying on adjunct professors made it very difficult to forge an academic career path, especially without a mentor or academic network of my own (since my education was outside the US system). I welcome any advice on how to navigate that challenge. Academic epidemiologists might be heartened to learn that their analytic skills could be applied within nonprofit organizations designing and analyzing the community fieldwork of health behavior interventions, or within governmental departments of health and social services gathering and responding to data on the social determinants of health or reportable communicable diseases. However, they would undoubtedly have to adjust to a different way of thinking and different standards for methodologies and the quality of evidence. EpiMonitor: The Report to the President on Supporting the US Public Work Force recently came out. Did anything, in particular, stand out to you from that report? KS: Yes, wasn’t that a fabulous report?! I’d like to draw attention to one of the opening sentences, which provides a helpful summary: “A well-defined, well-trained, well-resourced, and well-compensated workforce is the foundation of a truly robust U.S. public health system that can serve the needs of the American people.” Doesn’t that just say it all? I think that the authors of this report did a truly marvelous job of summarizing the challenges of the public health workforce today and deriving recommendations for much-needed action. The question I wonder about is Now What? This report has the status of a White House memo to inform the President, but I don’t know what happens to it next, and I worry that without any attached budget, it will become just another report sitting on a shelf. EpiMonitor: In view of the hurdles and struggles we're collectively facing in public health, is there anything that makes you hopeful? And what do we need to do to move forward? KS: You’re right, we have to acknowledge the many hurdles and struggles, and I do a lot of that in my column because that's what the readers ask me about. But I see a great deal of hope too. I think that the public health workforce is the most important asset of public health: we have many dedicated, motivated, passionate, and highly skilled public health professionals who are eager to get to work and implement the principles of public health (or preventive health or population health) just as soon as there is a budget allocation for them to get to work. Yet we still have a long way to go to learn to value the public health workforce, to nurture it back to health after a history of underfunding, and to reimagine what we could yet become. There are lots of exciting new voices drawing attention to the need to build healthy, trauma-informed workplaces, and promoting the important values of transparency and accountability within public health workplaces. However, the bottom line has to be funding: without any sustainable, long-term, stable funding for public health, we’re not going to see any sustainable, long-term, stable jobs in public health. As public health professionals, we’re going to need to get a lot better about advocacy and communicating our needs - especially funding. That means we’re also going to have to get savvy about how we navigate politics, which is a skill rarely taught to epidemiologists. And the other urgent need that I see is for workforce development initiatives in public health - both for recruitment and for retention. We want public health professionals at all stages of their career to feel cherished. We need to overhaul the processes of recruitment in public health, because right now it is brutal out there. We haven’t traditionally had much of a culture of mentorship, so we urgently need to build one. We need actual career development paths and job security. We epidemiologists must be at the heart of public health work and ensuring that it is data-driven. These are some of the topics that I talk more about in my column. The Public Health Workforce is Not OK just yet, but I believe that it’s going to be. ■
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