A culture of well-being in public health requires self- and community-oriented care, with a multi-level approach cognizant of environmental factors that shape individual behavior. The socioecological framework, used widely in health promotion, recognizes the influence of factors that shape health behavior and outcomes at four levels: individual, relationship (interpersonal), community, and societal . I offer this framework to guide for adjusting the culture of public health to prioritize well-being of the workforce.
Public health professionals need to be aware of risk factors that can worsen well-being and recognize and respond to early signs of secondary traumatic stress (STS) and burnout. Practices to cultivate mindfulness such as reflection, committing reflections to writing in journals, and meditation can help individuals recognize and address stress. Individuals can develop a wellness plan using tools such as the University of Buffalo self-care starter kit, which helps individuals evaluate their stress coping behaviors, both positive (e.g. breathing exercises) and negative (e.g. yelling, assess current wellness practices (e.g. exercise, writing in a journal), identify areas of focus based on their needs and preferences (e.g. physical, emotional), and troubleshoot potential barriers (e.g. lack of time) . Organizations can hold informal sessions to practice wellness techniques and reflect on the importance of one’s well-being in carrying out an organization’s mission.
A wide range of organizations have created content to support the well-being of public health professionals during the pandemic [26,27,28,29]. These include training programs to address important topics such as practicing first aid for mental health, responding to trauma at the individual and organizational level, understanding how racism is perpetuated by institutional policies and practices, and processing negative public reactions to public health professionals . It is critical to ensure, over time, that workforce development efforts are evidence-based and rigorously evaluated for effectiveness. During the 2008 economic downturn, a lack of objective evaluations and studies of effectiveness in the area of public health preparedness and emergency response left this area vulnerable to funding cuts .
Research shows that social support can mediate the relationship between stress and burnout among health care workers . How do social norms in important relationships (family, friends, peers, colleagues) and other elements of one’s sociocultural context (identity characteristics, lived experiences, cultural roots) shape perceptions of and willingness to engage in wellness practices? It is important to understand the impact of interlocking systems of oppression on those who belong to multiple marginalized subgroups (such as race, gender, class, citizenship status) shapes the unique stressors in one’s life and an individual’s response thereto. We should encourage professionals to nurture relationships where they can support each other in practicing wellness, in service of developing a professional norm that workforce well-being is requisite for serving the larger population.
We should take into consideration the role that environment (home, schools, workplaces, neighborhoods) can play in shaping norms and access to resources for engaging in wellness practices, including safe environments for exercise. At the community level, seek preventive strategies rather than wait until burnout manifests to optimize effectiveness and retain our workforce. In a resilient organization, such as a workplace, leaders act with emotional intelligence and practice transparent and open communication, and employees believe their leadership addresses their concerns and prioritizes their well-being. Such organizations embrace trauma-informed practices and equip individuals with skills to manage stress. Organizations can address primary, secondary, and tertiary prevention of secondary traumatic stress and burnout .
Societal factors include policy and laws at the local, state, and national level, as well as policies issued to govern a profession (e.g. medicine). To date, no profession’s accrediting body requires the integration of professional wellness into their educational curriculum. Public health has an opportunity to lead in this area by integrating wellness into the Council for Education in Public Health (CEPH) competencies for undergraduate and graduate programs, and core competencies for public health professionals. Furthermore, while we continue to advocate as a collective for policies that can ensure availability of and access to resources that allow individuals to properly care for themselves (e.g. health insurance), we must also advocate for our own well-being. By proactively addressing each of these layers, we can reduce stressors at the organizational level as well as enhance individuals’ ability to effectively cope with existing stressors.
Primary prevention activities include interventions enacted by workplaces to address those at particularly high risk for burnout, and create policies to ensure reasonable workloads and breaks for personal care, or physical or mental stress reduction practices such as meditation. Given that public health challenges often arise outside of working hours, it is essential for leadership of organizations to enforce professional boundaries to combat growing pressure to be available for work and responsive to communication around the clock.
Secondary prevention activities include early and regular screening for indicators of stress and burnout, using tools such as the professional quality of life scale (PRO-QOL 5)  and Maslach Burnout Inventory . Organizations should implement appropriate interventions for those exhibiting chronic stress or high levels of compassion fatigue or burnout. The secondary traumatic stress organizational assessment (STS-OA) may help organizations assess the extent to which they are prepared to acknowledge and address trauma incurred by staff, and be responsive to trauma in the populations they serve . The San Francisco Department of Public Health developed a Trauma-Informed Systems (TIS) initiative to move organizations along a three-step continuum, from (1) “trauma organized” organizations which perpetuate and inflict trauma, to (2) “trauma informed” organizations that understand trauma and its effects, to reach (3) “healing” organizations which acknowledge their own trauma and take meaningful steps to reduce trauma in the populations they serve . In healing organizations, the culture shifts through engagement among leaders who are committed to change and enact these efforts through training of leaders and staff, changes in policy and practice, and evaluation.
Tertiary prevention efforts include interventions to treat individuals experiencing mental or physical health effects of chronic stress or burnout reduce the likelihood of negative sequalae such as anxiety, depression, or chronic disease. Organizations looking to help those dealing with the effects of STS should ensure access for individuals to medical care and mental health care, with time to attend appointments and to counseling resources, amplifying and expanding existing benefits. They should decrease exposure by reducing caseloads and increase autonomy, flexibility, and choice in workers’ roles, and time to recover . To maximize use of these resources organizations should assure policies support preventive care and affordable health care.