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Friday, March 24, 2023

Public Health Workspaces – JPHMP Direct

The public health workforce is not okay. In this series of articles, I will share what it has been like to work on the public health frontline during the COVID-19 pandemic and how these experiences have changed me forever. I will share the lessons I have learned and what I want the people around me to know, both inside and outside of the public health sector.
In the first installment last week, I provided some introductory context on my background and my motivation for speaking out. In today’s second installment, I offer some assorted reflections on public health work and workplaces. I welcome conversation in the comments, especially with colleagues who are also familiar with these settings.
If we have seen any changes in the growth of public health careers over the last couple of years, it has been the rush of excitement to develop new entry-level jobs for all the recently inspired MPH grads and people entering into the public health field from other careers. But these short-term positions as contact tracers and community health workers are already running out. What will happen to the emerging public health professionals left behind? Are we creating new public health professionals at a greater rate than we can employ them? What are the changes we want to see to the work of public health professionals that will bring our workplaces up-to-date and positioned to rise to current and future challenges? I’ll suggest 3 areas of attention in need of immediate improvement: addressing outdated technologies and a lack of standardization, repairing and recovering from dysfunctional management practices, and adapting to remote work.
Standardizing and Modernizing Public Health Workplaces
What if people outside our field understood how outdated our technologies for gathering and analyzing data really are? In a world in which my local supermarket offers me special personalized bargains based on my tracked purchasing history (including discounts from the gas I purchase anywhere in the region), how is it possible that we are still receiving lab test results by fax and then double-entering data that we try to match manually with prior health records? How is it possible that hospital medical records do not automatically link to patient immunization history?  The missing link of unique identifiers seems too obvious to point out. It’s been 2½ years of urgency and we’re still making the case for interoperability one mystical day in the future? Forgive my impatience: for too long I have spent all day manually reconciling Excel spreadsheets many thousands of rows long with separate data sources that should have been automated at a systems level before I even woke up. 
Having now worked on different assignments throughout the pandemic at 4 different governmental Health Departments (State and local), I have seen firsthand the lack of standardization of processes and systems for tracking and aggregating COVID-19 data. You know what they say: you’ve seen one Health Department – you’ve seen… one Health Department. Each of the 4 Health Departments at which I have worked has taken a wildly divergent approach towards software, systems, and data automation overall, requiring different skills and roles from me. Technologies in everyday use have ranged from fax machine and Excel to cloud computing and SQL. So I have dabbled in multiple programming languages and got up to speed as a user of many different systems, but my expertise grows for as long as my contract lasts and is then rendered useless. I have not had the opportunity to become an expert in any of the programming languages I have had to use. However, the skill I have mastered to expert level is that of entering a new workplace and quickly assessing where I can best fit in and make an impact, and when to keep my mouth shut. (OK, so I’m still working on keeping my mouth shut.)
The time is long overdue for a comprehensive data modernization process that addresses the human as well as the technology needs of our work, harnessing innovation to sustainably build the skills of public health professionals already on staff and to absorb the influx of recent public health recruits and prepare them for secure opportunities to develop and advance their careers.
Improving Public Health Workplace Culture
It’s vital to prioritize values of equity in the ways that we gather, analyze, and respond to data, in order to ensure the representation and participation of people whose interests have historically been overlooked. Public health professionals in governmental health departments still have a lot to learn from our academic colleagues employing mixed methods for data collection. Harsh budgetary realities often prevent us from supplementing epidemiological methods that traditionally leverage strictly quantitative approaches with resource-intensive qualitative enquiry that actively seeks out minority voices in order to flesh out a fuller understanding of community realities. Simultaneously and internally within the public health workforce, a growing awareness of DEI (Diversity, Equity, and Inclusion) approaches in the ways that public health sector workplaces recruit, train, and manage roles serves as a step towards establishing fair and just work environments in which all employees can thrive. However, both external (data equity) and internal (DEI) practices are undermined by the reality of widespread toxic and dysfunctional management that can affect all staff members, especially those who have been historically marginalized. Paying lip service to the elimination of micro aggressions towards minorities (eg, mispronouncing an unfamiliar name) while simultaneously engaging shamelessly in macro aggressions across a team (eg, bullying, silencing) offers a fine example of hypocrisy. 
A toxic workplace is not an acceptable norm. An emergency is not an excuse. Especially when we are more than two years into said emergency. Responding to reports of toxic management within public health workplaces must recognize that these have become systemic practices reflected and amplified throughout an entire sector and not dealt with as isolated incidents. When an employee takes the brave step of trying to call attention to management dysfunction, an appropriate leadership response is not to minimize, to silence, or to normalize — rather to seek out the root cause and downstream effects, and to shine a light upon them. There are no substitutes for transparency and accountability in the workplace. Even a cog in a machine needs the lubricant of open communications from management. 
On the plus side, I have witnessed so much appalling management throughout the pandemic that I have become a much better manager myself. Honestly, I would have much preferred some role-modeling of positive management practices, but I’ll take what I can get and try to learn from it.
Friendships borne out of workplace alliances and forged under extreme work pressure have sustained and enriched my life outside the workplace throughout the pandemic. I wonder whether these friendships will endure through less trying times. 
Some tropes that have outlived their usefulness after more than 2 years of emergency response:
Transitioning to New Workplace Practices
I spent several months working in-person at Health Department offices, classified as an essential worker and brandishing my permit to drive on empty streets during stay-at-home orders alongside my immigration paperwork. By the time that my Health Department moved to remote online working too (finally prompted by a COVID-19 outbreak in our office), other businesses had figured out before us how to get it done. We just struggled longer with the technology, as we usually do, and we remain several decades behind the private sector.  During the COVID-19 pandemic, the combination of insecure short-term jobs and a reluctance to permit employees to work remotely required too many public health professionals to uproot their lives as they moved cross-country in search of employment that turned out to be temporary. Scaling up remote work has the potential to bring enormous benefits to jurisdictional health departments, by hiring new recruits on the basis of their relevant skills and experience, rather than where they happen to be living. 
Different people thrive in different work environments. For me, working from home simultaneously allowed me to eliminate my commute, to concentrate better, and to multitask with family goals, which suddenly came to include managing online schooling and feeding a bunch of ravenous children. Out of sheer force of necessity, I became a far more productive and efficient employee. For others who gain energy from the interactions of the office environment, the trade-offs may go in the opposite direction. Employers and employees should work together to figure out the best balance on an individual basis. But virtual workplaces benefit from authenticity and honesty, just as in-person office work. A bullying manager in person will still be a bullying manager online. 
Online, I find that I have developed a new personality. Suddenly my introverted self has become a community-builder seeking connections. Come talk to me online: to my surprise, I always welcome conversation and finding mutual support through establishing common ground. But if you meet me in real life, don’t hug me.
There’s no denying that the work has been rough. Managing COVID-19 data systems during the week and volunteering at vaccine clinics on weekends has been demanding. But it has given me a tremendous sense of fulfillment and purpose. Particularly when family life has been dominated by grief and anxiety, and as my formerly active community life crumbled, the ability to make a positive contribution within the wider community has given me a crucial framework for surviving some of the hardest times. 
If any of these observations resonate with you, please join me for conversation in the comments.
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The Journal of Public Health Management & Practice is published by Lippincott Williams & Wilkins, Inc.
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JPHMP is grateful for partnerships with ASTHO, NACCHO, and the de Beaumont Foundation.
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