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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.

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

Public health agencies have an opportunity to recruit for and retain a diverse and skilled workforce. As new funding opportunities emerge ASTHO recommends a focus on proof, people, and processes.

The COVID-19 pandemic highlighted the importance of having in-house skills to respond to worldwide public health emergencies. Because of this, the American College of Preventive Medicine recommends that health departments consider bringing a board-certified preventive medicine physician on staff or to have one available to assist with preparedness and population health interventions.

To learn more about how the DELPH program has influenced our scholars’ leadership journey so far, ASTHO spoke with three leaders in the current cohort: Andrea Lowe, director of legislative services at the Nebraska Department of Health and Human Services; Tiffany Wilson, data analytics branch manager at the Alabama Department of Public Health; and Harold Gil, data science support unit supervisor at the Washington State Department of Health.

An issue that public health wrestles with is how to combat racism as we would any other public health emergency. ASTHO’s board of directors has declared structural racism a public health emergency. And health equity is the number one priority in ASTHO’s strategic plan, which means our staff will prioritize equity work as we support all aspects of our members’ technical assistance and capacity building needs.

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.

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.

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.

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.

Six questions with Scott Becker, CEO of the Association of Public Health Laboratories. Becker is active in national and international public health initiatives. He chairs the Governance Working Group for the Global Laboratory Leadership Program, a collaboration with the World Health Organization, CDC, and others to develop a competency-based curriculum for laboratory leaders. Additionally, Becker is a member of the Affiliate Council of ASTHO, which he formerly chaired.

Pharmacies have long been instrumental partners in providing lifesaving vaccines nationwide. As state and territorial health officials evaluate their COVID-19 response, planners must include input from the pharmacy community when identifying areas for improvement, as well as best vaccination practices in advance of future public health emergencies.

Though now an illegal practice, government contracts, policies, and practices have generally excluded women, and Black, Indigenous, and people of color. Still, practices and existing structures continue the inequitable distribution of all contracts. Governmental and non-governmental grants and funding should benefit the communities they serve while being proportionate to the communities' demographics. This is where inclusive contracting comes in.

As we head into Memorial Day weekend and honor the members of our armed forces who have made the ultimate sacrifice for our country and its freedoms, it is also important for us to give thanks to public health workers for being a shining example of what it means to lead in the face of a crisis.

When rural hospitals close, it increases the distance people must travel for essential healthcare services. The COVID-19 pandemic has highlighted and magnified the factors leading to rural hospital closures across the country. Many healthcare facilities suspended elective procedures to conserve critically needed personal protective equipment and reduce the risk of exposure to COVID-19 by patients and hospital staff. For many rural hospitals, however, the suspension of elective procedures with the reduced the use of non-urgent services by apprehensive patients meant a loss of revenue and the furloughed healthcare staff. Since the onset of the COVID-19 pandemic, approximately half of all rural hospitals are experiencing negative operating margins due to reduced outpatient revenue. The rate increases in states that have not expanded Medicaid. Unfortunately, these kinds of challenges are not new to rural hospitals.

Over the years evidence has expanded on community health workers (CHWs) improving outcomes and even reducing disparities in heart disease and many other public health priority areas. However, their presence in state and local public health workforce is still modest. A number of efforts have sought to expand the role of CHWs in medical care settings by developing reimbursement through third party payers, along with including them in managed care contracts and incorporating them in state Medicaid plans. The experience and lessons of the COVID-19 pandemic could substantially change the way we practice public health in the future, and provides opportunities to expand the role and presence of CHWs in the state and local public health workforce.

Insight and Inspiration: Conversations for Public Health Leaders ASTHO is honored to present Insight and Inspiration, the premier webinar series designed to motivate public health leaders as they respond to new and ongoing public health challenges. The nation’s preeminent thought leaders, authors, and strategic thinkers offer attendees strategies to further develop their leadership skills as well as ground themselves and their teams even amid crisis. This series is open to governmental public health professionals at all stages of their careers. Check out upcoming opportunities and previous session recordings below to take your leadership to the next level. website

Get insight into the successes and challenges of integrating race/ethnicity data in public health and future directions in this field.

South Carolina Levels Up Public Health Leadership With New Program Avalon Warner-Gonzales Learn in this blog post how South Carolina’s Department of Public Health is fostering strong leaders with a new public health leadership development program. CDC’s Public Health Infrastructure Grant (PHIG) is a substantial investment in public health infrastructure, supporting initiatives in health departments across the nation to develop cutting-edge programs and bolster department operations. The South Carolina Department of Public Health (SCDPH) used this funding to pilot Leading the Way, a program that provides leadership development and network building for SCDPH staff. ASTHO spoke with Cynthia Naasira Taylor, coordinator for Leading the Way, about the program and its inaugural cohort. What inspired SCDPH to create the Leading the Way program? We created the program to address a gap in leadership development opportunities for the department. Staff developed a pilot that met the same requirements as the state Associate Program Manager program and included additional wrap-around leadership sessions. The staff who developed the pilot then presented it to the Executive Leadership Team, who approved using PHIG funding to formalize the program. Leading the Way is designed to develop, connect, and challenge SCDPH leaders to grow and improve key leadership skills while building strong, effective professional networks. Following the theme of “iron sharpens iron,” the program underscores self-improvement, education, and teamwork. The program envisions leaders coming together, rubbing blades (experiences, knowledge, strategies), forging alliances (networking, building relationships), and making their edges (competencies, skills) sharper and more efficient. How did PHIG support the development of the program? We used the PHIG funding to establish a dedicated staff position for formalizing and implementing the program, which has been critical to its success. We were able to bring in experts in team leadership, presentation mastery, and strength-based leadership to facilitate three primary leadership workshops. We were also able to provide one-on-one feedback sessions for cohort members, acquire supplies, and secure spaces for the workshops and graduation ceremony. Olivia Gomez - SC Leadership Program Tell us a little more about the inaugural cohort. The 2024 cohort is a well-rounded group of individuals who are directors, managers, nurse consultants, and program administrators. There is also a training instructor, microbiologist, intervention specialist, nutritionist, and nutrition educator. These individuals work across many fields throughout the department, including finance, IT, health equity and inclusivity, public health laboratories, and more. What were the goals of the program, and what activities supported those goals? Leading the Way is a seven-month program designed to challenge, stretch, and propel participants into their next level of leadership with four goals: Attain the Associate Public Manager Certification by completing classes offered by the SC Department of Administration. During the classes, participants receive in-depth training on coaching skills and techniques, supervisory skills, and goal setting and productivity training. Increase participants’ knowledge and competency of key leadership skills through workshops and activities. Activities include: a Team Players Style Survey to assess the participants’ natural team tendencies; the Teams Presentations Project in which the cohort—divided into four teams—researched, developed, designed, and facilitated presentations on current and relevant issues in public health; and a Networking with the Boss event during which participants networked with each other’s managers and directors. Advance strength-based leadership principles. Individuals complete the StrengthsFinder 2.0 online personality/behavioral assessment and receive personal feedback on their results from a licensed professional behavioral coach. The cohort received training on the CliftonStrengths domains and themes, how to implement strength-based leadership in their own professional growth, and how to promote strength leadership in their teams. Increase leadership competencies and strategies through networking opportunities. The Iron Sharpens Iron sessions provided a framework for cohort members to connect and identify competencies and strategies to integrate into the workplace. The cohort had the opportunity to bring awareness to challenges and best practices in their respective areas, and how they can solve problems in other areas across the state. What are your biggest takeaways and lessons learned from this first cohort? Without the PHIG funding for the program and for dedicated staff, we would not have been able to successfully launch the first official cohort. Even with the dedicated funding, it was a feat—while we were developing the program, we were also undergoing a significant agency restructure as the former SC Department of Health and Environmental Control split into SCDPH and the SC Department of Environmental Services. Our first cohort of participants and program staff demonstrated remarkable resilience and dedication throughout the program as they juggled it with the restructuring, their regular duties, and personal responsibilities. As program manager, I learned the importance of bridging new connections with agency leaders during the development phase. I also learned to allow the cohort space to dance to their own tune and let the rhythm of the group evolve naturally. The reward is seeing a cohesive band of leaders emerge and continue their relationships after graduation. Marcus Lara - SC Leadership Program Have you seen any early impact of the program? Since graduating, the cohort has continued to stay connected. They have established a dedicated Teams channel to continue collaborating and sharing experiences. Cohort members reached out to the facilitator for a workshop they attended on self-care and mental health to schedule a more robust session for later this fall, demonstrating their continued commitment to their mutual development. We’ve seen two cohort members receive promotions to director positions immediately following graduation. One of the recently promoted graduates manages a newly organized team. She wanted to charter her group and I offered to provide information. Since then, I’ve worked together with her team and facilitated several meetings to help them build their team charter. So, our connections have grown stronger since the inaugural program’s culmination. Adrienne Whitney - SC Leadership Program Looking ahead, how do you anticipate leveraging PHIG funding to support future efforts in South Carolina? The original pilot cohort identified the need for an agency mentoring program and created an outline for such a program. We are now in the process of developing an agency-wide mentoring program. The PHIG-funded position created for managing Leading the Way was also budgeted to develop the mentoring program. Additionally, PHIG funds have been allocated for tuition assistance. While this has been a necessary benefit to employees and the agency to fill critical positions, we have realized that this educational pathway is just one approach to ensuring a robust, qualified, and diverse public health workforce. SCDPH would like to use PHIG funds to support staff interested in pursuing shorter-term educational offerings such as certifications in public health, project management, human resources, and more. Kristen Smith - SC Leadership Program OE22-2203 PHIG article yes

This blog post highlights strategies to support the public health workforce, including improved compensation and other benefits.