In recent years, the public health workforce has faced unprecedented challenges—from responding to the COVID-19 pandemic to addressing the impact of social determinants of health on communities to stark changes in policy at the federal level. These pressures have led to poorer quality of care, reduced access to services, diminished preparedness, and a decline in public trust in the public health system. As political tensions deepen and workplace stress intensifies, public health employees are reporting increased mental health concerns, including burnout and moral injury.
To address this crisis, government and non-governmental agencies are implementing actionable strategies to support workforce wellness. These include trauma-informed leadership, peer support networks, flexible work policies, and regular wellness check-ins. By creating supportive environments and promoting resilience, organizations can strengthen the public health infrastructure and ensure the workforce is equipped to meet both current and future demands.
Mental health and stigma
The Public Health Workforce Interests and Needs Survey (PH WINS) reveals alarming levels of burnout among public health professionals. In 2021, nearly half of respondents reported frequent feelings of burnout—up from 32% in 2017. Similarly, nearly half expressed intentions to seek new employment, compared to 33% in 2017.
These findings underscore the need for proactive measures such as open dialogue around mental health, access to resources, and flexible work arrangements.
Read our previous article to explore PH WINS data and the evolving landscape of public health transformation.
Understanding burnout and moral injury
Burnout is closely linked to mental health conditions such as anxiety, depression, and trauma. It often manifests as exhaustion, reduced motivation, and cynicism. According to the National Center for PTSD, moral injury was initially identified in military veterans exposed to events that violated their deeply held moral beliefs. In the context of clinical health workers, moral injury is described as “knowing what your patients need and being unable to provide it due to external constraints.”
These issues are increasingly prevalent across the public health workforce—from community health workers to epidemiologists—and affect both governmental and non-governmental organizations. The de Beaumont Foundation defines burnout as an occupational syndrome caused by chronic workplace stress, leading to emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment. Key contributors include excessive workloads, moral injury, and insufficient support.
To mitigate these effects, agencies are encouraged to implement peer support programs, conduct interviews to understand retention drivers, and explore alternative support models such as the Critical Incident Peer Support Model used in emergency response sectors.
Real-world impact
The strain on public health workers is evident in crisis situations. For example, in January 2023, over 653,000 people—roughly 20 per 10,000—experienced homelessness in the U.S. As emergency shelters reached capacity, public health workers faced increased workloads with limited staffing and resources. The emotional toll of turning away individuals in need further deepens moral injury and burnout.
These scenarios highlight the importance of building a dynamic public health emergency response infrastructure and reinforcing core public health functions to better support both the workforce and the communities they serve.
Trauma-informed public health practice
To support recovery and resilience, agencies are increasingly adopting trauma-informed approaches. These frameworks recognize the impact of trauma on both the workforce and the communities served. Trauma-responsive leadership can empower public health professionals to perform effectively while fostering healing.
A trauma-informed organizational change model is built on four core assumptions—known as the “Four Rs”:
- Realization of the widespread impact of trauma
- Recognition of trauma symptoms
- Response through integrated policies and practices
- Resisting re-traumatization
These are supported by six guiding principles that promote safety, trust, collaboration, empowerment, and cultural sensitivity. Agencies can use these principles to create trauma-informed environments that support healing and resilience.
Key recommendations for agencies
To champion mental wellness and build a resilient public health workforce, agencies can:
- Create supportive environments: Encourage open dialogue around mental health, provide access to supportive resources, and implement flexible work policies.
- Promote work-life balance: Support boundary-setting and offer flexible schedules to reduce overload.
- Establish peer support networks: Create safe spaces for sharing experiences and mutual encouragement.
- Conduct regular wellness checks: Use surveys and check-ins to detect early signs of burnout.
- Build leadership pathways: Review promotion practices and policies to help assure accessible career ladders within the public health agency
- Strengthen emergency response infrastructure: Develop dynamic systems to handle public health crises.
- Reinforce core public health functions: Invest in foundational capabilities.
- Foster trauma-responsive environments: Ensure organizational practices support healing and resilience.
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