Over the next month, The Medical Care Blog will feature a new series of posts on public health leadership. The goal is to help better prepare public health students and early career professionals for the many leadership challenges that await.
Public health has a problem
Whether it is COVID-19, drug overdoses or gun deaths, the United States has struggled to stem major public health crises. In raw numbers, the U.S. has the highest total number of deaths so far from COVID-19 (1.1 million) among developed nations. It had near record drug overdose deaths in 2022 (105,452, second only to the 107,573 in 2021). And it recorded the highest number of gun deaths (both suicides and homicides) ever in 2021 (48,830). 
There are also some key public health issues that continued unabated while the focus shifted to COVID-19 and other crises. The adult obesity rate, for example, continued to creep up, reaching a new national high in 2021 of 33%. Similarly, sexually transmitted infections (STIs) like chlamydia, gonorrhea, and syphilis continued an upward trend, reaching more than 2.5 million infections in 2021. And climate changing emissions that have dramatic health implications continue to grow.
There are recent public health successes, including stemming the tide of mpox (though a CDC study raises warning flags about the potential for summer outbreaks). Teen births reached a new record low in 2021 (13.9 births per 100,000 teens), down 7% from 2020 and down 79% since it peaked in 1991. And new HIV infections in the U.S. have been declining slowly, but steadily for the past five years, also reaching a record low of 32,100 in 2021. Still, all of these are far higher than in economically comparable nations.
Public health needs reinforcements
These public health problems require a stronger public health workforce. In fact, awareness of, and interest in, public health has grown in recent years. In 2022, over one-quarter of the public said that keeping healthier (including following public health advice) became more important to them during the pandemic. This health focus preceded a record number of applications to graduate programs in public health, an increase of 40%.
Still, nearly half the population has been skeptical and critical of U.S. preparedness for the pandemic. And with the COVID-19 emergency declarations now behind us, there are big questions about future public health preparedness. Moreover, 15 states have passed or are considering laws that severely limit the authority of public health agencies to protect public health going forward.
Given this, the looming departure of the CDC Director is not a surprise. Public health leaders have left their positions in droves. And in 2021, about one in three public health workers anticipated leaving their position in the next year. And almost half were considering retiring or leaving in the next five years. The main reason: stress and workload (i.e. burnout). Other public health workers have lost their positions as COVID-19 funding ends, suggesting a return to a cycle of boom and bust that does little to proactively protect public health.
A new series on public health leadership
A new blog series helps to meet these challenges. The series emerges from three events held at the California State University Los Angeles, where public health leaders spoke to public health students, recent graduates and early career professionals. The events were part of a department-wide book club reading of Lifelines by Dr. Leana Wen, which is an autobiography of one of the nation’s most prominent voices on public health.
The first of the forthcoming posts focuses on an event with Dr. Chris Chanyasulkit, the president of the American Public Health Association. She spoke about ways to embrace public health leadership early in a career. The second post highlights advice from Jackie Valenzuela, chief advisor to the County Health Officer of the Los Angeles County Department of Public Health. She discussed how to find your niche in public health leadership.
The final post features reflections on our interview with Dr. Wen. Having served as health commissioner for the city of Baltimore and as the president of Planned Parenthood, Dr. Wen shares her practical approach to public health leadership. She offers advice about how public health can be at the decision-making table (and when it should set its own). And she describes the value of finding political commonality in bringing about changes in public health.
Look for these posts next month.
Gregory Stevens