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The opioid epidemic has exacerbated the shortage of board-certified forensic pathologists, presenting a major workforce challenge for public health systems.

ASTHO engaged Oklahoma public health officials, members of the Oklahoma Harm Reduction Alliance, Health Minds Policy Initiative, and representatives of the Southern Plains Tribal Health Board, and others in a Boundary Spanning Leadership workshop.

Building a Culture of Care: Leadership in Public Health Agencies astho, association of state and territorial health officials, association of state and territorial health officials astho, state health official, public health official, territorial health official, island jurisdictions, state health, health department, public health, centers for disease control, creating a culture of care, public health workers, health equity, physical health, building a culture of care, health departments, public health professionals, training program, school of public health, mental health problems, public health leaders, public health workforce, mental well-being, culture of care, mental health, workforce development Chris Taylor ASHTO | A blog post highlighting three simple actions agencies can take to strengthen a culture of care. Throughout the COVID-19 pandemic response, many of us have witnessed or experienced increased feelings of exhaustion, mental distance from our work, negativism or cynicism related to our jobs, and reduced professional efficacy. The World Health Organization classifies these symptoms of burnout as an occupational phenomenon, rather than as a medical condition. For governmental public health agencies to successfully promote and protect the health of their communities, it is imperative that they support their staff to remain healthy and resilient. This blog provides information and considerations for state, territorial, tribal, and local health departments to identify and address work related causes of burnout, as well as build and maintain the health and mental wellbeing of their staff. Governmental public health continues to play a central role in the COVID-19 response, which for more than two years has created unprecedented and prolonged demands on staff. Beyond the COVID-19 response, there continue to be massive changes in how and where we do business, as well as how we interact with one another, contributing to additional organizational stress. In 2021, CDC surveyed state, territorial, tribal, and local public health staff to assess symptoms of anxiety, depression, post-traumatic stress disorder (PTSD), and suicidal ideation. Among 26,174 public health staff who participated: 53.0% reported symptoms of at least one mental health condition in the preceding two weeks, including anxiety (30.3%), depression (32.0%), PTSD (36.8%), or suicidal ideation (8.4%). The highest prevalence of symptoms was among respondents 29 years or younger, as well as transgender or nonbinary persons (i.e., those who identified as neither male nor female) of all ages. Public health staff who reported being unable to take time off work were more likely to report adverse mental health symptoms. Severity of symptoms increased with increasing weekly work hours and percentage of work time dedicated to COVID-19 response activities. In a 2022 follow up survey, 75.5% of respondents did not think their employer had increased mental health support. Additionally, other recent surveys have indicated a trend of rising stress and burnout in the public health workforce, leading many to resign and more to consider leaving their agencies. While some support to the workforce may be available in government agencies, staff may feel they don’t have time, or feel supported to utilize these programs. This blog series will explore strategies that health department leadership may consider to strengthen a culture of care in their organization. Three Simple Actions You Can Take Today to Strengthen a Culture of Care Health department leaders can have a major impact on the behaviors and health of their workforce. Consider taking these actions: Practice and offer a model of your own commitment to self-care Self-care, which includes a healthy diet, adequate sleep, and regular exercise, are critically important for leaders in maintaining productivity and effectiveness, particularly during stressful periods. Other ways to practice self-care can include meditation or mindfulness practices, journaling, expressing gratitude or acts of kindness, or connecting with friends and loved ones. Send a message to your entire department discussing the importance of self-care and sharing examples of how you practice self-care. This not only demonstrates that your organization values and supports self-care, but also gives practical examples for staff to consider implementing. This would also be an excellent opportunity to highlight the availability of an employee assistance program (EAP) or employee wellness programs and benefits. Acknowledge the mental health effects of the COVID-19 response Share an example of how you (or someone you care about) has been impacted emotionally or psychologically by the COVID-19 pandemic. Your example can normalize the burnout and moral injury that some of your staff may be experiencing, as well as build trust and connectedness. Talking about mental health at work is important to reduce the stigma and create an environment that is more open and understanding about anxiety, depression, and other mental health issues that might show up in the workplace. This is also an opportunity to discuss mental health coverage in your health insurance plan(s), as well as resources available in the community, some which may be funded by your department. Exercise at the office or on the office grounds One well-proven approach to addressing stress and improving mental health is exercise. As a leader, you can model the importance of exercise to your agency. This can be as simple as taking the stairs rather than the elevator, incorporating stretching throughout the day, or walking during phone calls. Invite staff of all abilities to join you in a stretch, movement, or walk break. Consider a standing desk, replacing your chair with a stability ball, or keeping exercise equipment in the office for use during breaks. By prioritizing and modeling physical activity, you are sending a message that self-care is important. What Does a Culture of Care Mean for You? Has your organization prioritized a culture of health and well-being? Are there lessons learned for your organization’s support of staff during the COVID-19 response? How is your organization ensuring a manageable workload, particularly during times of emergency response? Speak with your employee wellness, workforce development, human resources, and/or professional development teams to ensure the organization is best meeting the health and wellness needs of employees. Based on the alarming findings of the CDC surveys, special emphasis should be placed on ensuring employees have additional information about, and are aware of, services/referrals to treat anxiety, depression, PTSD, and suicidal ideation. What’s to Come? Many employers and leaders have been creative in strengthening a culture of care in their organization. Over the coming months, ASTHO will highlight specific strategies to increase a culture of care in your organization. We’ll also share examples employed by health officials and other senior leaders within health organizations. Finally, we plan to curate a list of resources for executives, supervisors, and employees for creating a culture of care, stress reduction, self-care, and burnout prevention. Conclusion For public health systems to serve their communities most effectively, it is imperative that their staff are healthy, both physically and mentally. State, territorial, tribal, and local health departments should consider policies and programs that support the health and mental well-being of their staff – particularly in high stress emergency responses. We look forward to additional opportunities to discuss these important issues, hear how health department leaders are strengthening a culture of care, and learning how ASTHO can support your efforts. website yes

Accurate and timely communication from health officials during a public health emergency is critical to ensure people can reduce their risk of illness or death. Karen Smith (alumni-CA) talks about her experiences communicating policy changes, as well as key strategies for maintaining public trust.

Board-certified forensic pathologists play a critical role in public health by investigating death so as to better serve the living. Despite forensic pathology’s contribution to public health surveillance, prevention, and response, the discipline remains largely under-resourced and over strained. These briefs spotlight the critical role that international medical graduates play in minimizing forensic pathology workforce shortages and spotlights a local effort to address financial disincentives for medical graduates entering the field and highlights federal funding opportunities and resources for state partners looking to minimize forensic pathology workforce shortages.

As part of ASTHO’s Public Health - Hope, Equity, Resilience, and Opportunity initiative, we are using this post to highlight some acts of thanks for organization leaders and supervisors to consider.

Vaccines are one of the greatest public health achievements of the last century, as well as some of the most powerful and cost-effective tools to prevent disease, disparities, disability, and death among children and adults. The COVID-19 pandemic and the unprecedented development and distribution of the vaccines against the novel coronavirus have generated much focus on state laws related to vaccinations. As state and territorial legislatures prepare to convene in the coming weeks, we can already identify several topics within vaccine law that policymakers across the country will consider.

Amid so much uncertainty, it might feel naïve to make any claims about what the future holds. But it is in these moments that it becomes more important than ever to have beacons to guide us and give us hope. As we look ahead to 2022, here are four priorities that must steer the public health course in the year to come.

States and territories have broad powers to protect public health and safety, including powers to prevent and control the spread of communicable disease typically exercised by state and territorial health departments. This authority is an essential tool in the fight to keep the public safe and healthy.

Every year on Nov. 22, ASTHO—and countless other agencies and organizations worldwide—take a moment to acknowledge the public health workforce on Public Health Thank You Day. Like so many other days of recognition, it has become a blip on our yearly calendar. And, simply put, that’s just not enough. This year, ASTHO leadership took pen to paper to share some of our feelings, fears, and—yes, our thanks—for everything the public health workforce has always done to protect us.

Continuing ASTHO’s Legislative Prospectus series—which highlights the top 10 public health policy issues for 2022—we are focusing this week on mental and behavioral health as well as supporting the public health workforce.

While governments have faced challenges in adopting a Health in All Policies (HiAP) approach to respond to COVID-19, the impact of the public health emergency across sectors such as housing, transportation, and employment has created a unique opportunity for stakeholders to build and strengthen collaborative systems to address the inequities exacerbated by COVID-19.

In addition to the countless hours worked during the COVID-19 pandemic, many public health workers are also grappling with how to repay outstanding federal loans. In response, the U.S. Department of Education (DOE) recently announced temporary relief to current and future Public Service Loan Forgiveness (PSLF) program participants as a result of the COVID-19 pandemic.

An ASTHO blog article about how to communicate with care to staff about telework policies with the shift of the pandemic.

After decades of underinvestment, health departments received increased funding for disease intervention services, strengthening the existing workforce, and providing opportunities to expand workforce capacity.

Here are some things health officials should consider when developing a strategy to improve trust between health departments and their audiences.

This post highlights three strategies health department leaders can explore to reduce staff stress and burnout in the office: quiet spaces, art on display, and allowing pets in the office.

San Diego Academic Health Partnership Strengthens Service During COVID-19 and Beyond San Diego Academic Health Partnership Strengthens Service Mayela Arana Learn how the Academic Health and Human Services Department in San Diego strengthens service, research, workforce development, and more in the region. In San Diego County, the connection between academia and public service continues to grow stronger, shaping the future of health and human services. With over 8,200 employees serving a diverse population of 3.3 million residents, the County of San Diego Health & Human Services Agency (HHSA) plays a crucial role in advancing health, housing, and social services across the region. Recognizing the immense value of bridging education with real-world public service, HHSA and San Diego State University (SDSU) formed an Academic Health and Human Services Department (AHHSD): the Live Well Center for Innovation & Leadership (LWCIL), a first-of-its-kind initiative in San Diego County. This partnership is more than just a collaboration; it’s a transformative effort to strengthen education, research, workforce development, and service in the region, inspired by collaborative successes during COVID-19. A Vision Years in the Making Even before the COVID-19 pandemic, leaders at HHSA, SDSU, and SDSU’s College of Health and Human Services (CHHS) recognized the opportunity to deepen their relationship through an Academic Health Department (AHD) partnership. Many of those contributing to HHSA’s success began their journey at SDSU, with over half of the agency’s leadership team and a significant portion of its workforce having graduated from SDSU, particularly from CHHS. With a long history of partnering to provide real-world experiences for students, collaborating on research, and developing practice-informed curriculum, formalizing the partnership to integrate academia and health and human services practice was a natural next step. An Academic-Public Health Partnership in Action HHSA and SDSU’s longstanding relationship initially focused on student field experiences, research collaboration, and workforce development across select schools and decentralized departments but went on to have a major impact on the ground — most notably, enhancing HHSA’s COVID-19 response. Mobilizing Promotoras for Outreach and Support SDSU and HHSA worked together on recruitment, training, and community outreach. They successfully recruited 40 community health workers for a Promotoras program, which initially helped with contact tracing within the highest-risk communities. The Promotoras also identified where people needed assistance (e.g., food, services). SDSU provided support by organizing food pantries in high-risk areas, while the Promotoras took food to those in need. As vaccines became available, HHSA trained the Promotoras on messaging and communications to dispel misinformation and to encourage vaccine uptake. The Promotoras also helped those in the highest-risk communities get appointments at the county vaccination sites. Expanding Public Health Capacity with Nursing Students In addition, SDSU and HHSA worked together to train and deploy nursing faculty, students, and recent graduates in county vaccination efforts. From January through March of 2021, the SDSU School of Nursing partnered with Champions for Health, the local nonprofit arm of the San Diego Medical Society, to train 200 vaccinators. Once trained on the proper storage and administration of the COVID-19 vaccine, faculty-led groups of undergraduate nursing students administered vaccines at community sites in primarily underserved areas of the county — many organized by the San Diego Black Nurses Association. In addition to providing surge capacity staffing to support community and public health efforts, the partnership allowed students to complete clinical hours required for graduation during the pandemic when students were restricted from other clinical sites. Many of the students and graduates who served as temporary contact tracers and case investigators transitioned into full-time positions within HHSA as the COVID-19 response scaled back. Formalizing Collaboration for Lasting Impact Given the tangible value of their collaboration demonstrated during the COVID-19 pandemic, HHSA and SDSU chose to use and adapt the national AHD model — gaining access to the growing, nationwide network of AHD partnerships that inform their goal of sustaining a high-impact academic-practice partnership. They formalized the partnership with a public signing of an overarching five-year memorandum of agreement (MOA) in October 2022 that launched the bold vision of creating San Diego County’s first and only AHHSD. They assigned an additional MOA specifically addressing joint research and data sharing in December 2024, and an addendum supporting agency-wide student field experiences is underway. With formal agreements across all key areas, the foundation will be in place for increased and accelerated collaboration by summer 2025. Building on the regional collective impact vision called Live Well San Diego, the AHD partnership adopted joint branding as LWCIL. An active Steering Committee, co-chaired by HHSA’s Deputy Chief Administrative Officer and CHHS’s Dean, meets quarterly and represents the highest-level leadership for each organization. Members include key leaders in HHSA operations, human resources, and strategy, and the directors from each of its eight service departments. On the academic side at SDSU, the Steering Committee includes representatives from the six schools and multiple institutes within CHHS. Setting Partnership Priorities LWCIL co-created and recently adopted a joint, multi-year Strategic Roadmap to guide the next three years of the partnership’s development and its contribution to a healthy, equitable, safe, and thriving San Diego region. It is organized around four high-impact priority areas: People Success: Build a diverse, competent, and engaged health and human services workforce​, including students and both partners’ workforces.​​ Research & Data Excellence: Inform and improve academia, policy, and practice with rigorous and relevant research. Service to Community: Integrate academia, practice, and community to advance equity and eliminate health disparities. Leadership & Sustainability: Create a nationally recognized academic-practice model with innovative leadership committed to improving academia, policy, and practice. Subcommittees for each priority area, co-chaired by leaders from both organizations, have launched and created action plans tied to advancing the Strategic Roadmap. In addition, emerging workgroups are aligning ​work plans​. Next steps include: Assessing what is already in place and integrating it into the partnership. Developing a standardized and streamlined process for students to complete internships at HHSA. Leveraging opportunities to bridge research and practice and, where appropriate, in collaboration with the community. Investing in capacity has been essential in moving the partnership forward and providing coordination. The director of LWCIL is a “boundary spanning” position, co-funded by SDSU and HHSA. Additional staff support has assisted the partnership, including two HHSA Management Fellows engaged in a year-long program. Advice for Others Seeking to Establish AHD Partnerships HHSA and SDSU offer the following tips to agencies looking to develop or expand AHD partnerships, based on their experiences: Secure leadership commitment: Ensure the highest-level leaders are committed to the partnership’s success and sustainability. LWCIL started with the support of the dean, deputy chief administrative officer, and directors within both organizations who continue to be actively involved as members of the Steering Committee and subcommittees. By doing so, they have helped set priorities, identified staff to participate, and continuously champion the partnership within their respective organizations. Start small: Build from what already exists between the partners, leverage willing internal resources, and celebrate early successes. LWCIL started with conversations focused on workforce development because of existing relationships and shared interests. Those conversations eventually evolved to include collaborating on rigorous equity-focused research and partnering to address needs identified by the community, such as housing stability for our older adult population and food insecurity. The subcommittee structure was created to support those shared priorities; however, it began with smaller, more narrowly focused conversations. Be strategic: Create a common agenda/plan that aligns with the goals of both organizations, making it easier for already-stretched organizations to commit to and benefit from the partnership. LWCIL's co-creation of a multi-year Strategic Roadmap allowed the partners to discuss the many opportunities for collaboration and integration, and to prioritize. It now guides where the partnership is going and helps keep everyone focused on what they collectively decided is important. Then, grow: By getting systems in place and understanding the benefits and challenges between two organizations (HHSA and SDSU), LWCIL is setting the stage for expansion to include other local universities. Take time to plan and set up structures: Creating the LWCIL ​Strategic ​Roadmap was a six-month process that engaged leadership from both organizations. This was critical for identifying priorities and direction, including what structures and systems needed to be organized so the work could move forward. Learn more about San Diego’s Live Well Center for Innovation & Leadership and AHD partnerships, or explore other workforce development resources from the Public Health Foundation. If your health agency wants more information about planning support, please submit a PHIG technical assistance request through PHIVE or contact

Accompanying an infusion of federal funding, states are considering several policy changes to strengthen the public health workforce and address challenges within the health care workforce.

Public health officials have a significant opportunity to provide leadership on the issue of Long COVID, through their own authorities, and by capitalizing on their influence in the public health and healthcare sectors.