Building a Sustainable Governmental Public Health Workforce: A Look at the Millennial Generation.

CONTEXT: Millennials have had a profound impact on society, the economy, and the US workforce. This study used generational definitions published by the Pew Research Center. Millennials includes respondents who reported an age between 21 and 36 years (born in 1981-1996) at the time the 2017 Public Health Workforce Interests and Needs Survey (PH WINS) was administered. Generation X includes respondents who reported an age between 37 and 52 years (born in 1965-1980), and the baby boom generation (baby boomers) includes respondents between 53 and 71 years of age (born in 1946-1964). Public sector agencies, including governmental public health, are increasingly interested in figuring out how to attract and retain millennials. As the governmental public health workforce anticipates upcoming retirements, knowledge about the motivations and organizational characteristics that appeal to millennials is crucial to understanding the millennial workforce and workplace dynamics for decades to come. In 2017, millennials made up 22% of the governmental public health workforce, Generation X 40%, and baby boomers 37%. OBJECTIVE: This study examined opinions, expectations, and important workplace environment factors of millennials working in governmental public health compared with other generations. DESIGN: We performed bivariate analyses and fit a logistic regression model to evaluate the association of generation with responses to a set of satisfaction and engagement PH WINS survey questions. SETTING AND PARTICIPANTS: Data were drawn from the 2017 PH WINS of governmental health department employees, including state health agency and local health department staff. PH WINS excludes local health departments with fewer than 25 staff members or serving fewer than 25 000 people. PH WINS included responses from 47 604 staff members, which reflected a 48% overall response rate. RESULTS: The generations that were examined (millennials, Generation X, and baby boomers) were similarly satisfied with their jobs, organizations, and pay security, and millennials intended to leave their jobs for similar reasons as other generations. Millennials reported more strongly than other generations that their supervisors treated them with respect, that they had sufficient training to utilize technology, that their training needs are assessed, and that creativity and innovation were rewarded. They, however, reported less strongly that they were completely involved in their work and determined to give their best every day. CONCLUSIONS: Millennials in governmental public health agencies (excluding local health departments with <25 staff members or serving <25 000 people) may not be as different from other generations as previously thought. Governmental public health agencies should focus on highlighting workplace environment factors rated highly by millennials and on showcasing how careers in governmental public health could be attractive career options for millennials.

Attracting New Talent to the Governmental Public Health Workforce: Strategies for Improved Recruitment of Public Health Graduates.

CONTEXT: Governmental public health (GPH) agencies need a diverse, skilled, and motivated workforce to advance health and well-being, but they face a number of recruitment challenges. While there has been massive growth in public health degree programs and graduates, those with a degree in public health are underrepresented in the GPH workforce. OBJECTIVES: This study evaluates potential reasons undergraduate and graduate public health degree holders are underrepresented in the GPH workforce, assesses student awareness of and interest in GPH jobs, and identifies strategies for improved recruitment. DESIGN: We conducted pilot focus groups to explore public health students' interest in working for GPH agencies, obstacles to employment, and how this career path could be better promoted. SETTING AND PARTICIPANTS: Eight focus groups were conducted with a total of 33 participants at 3 universities and at the Annual Meeting of the American Public Health Association. Participants were enrolled full-time in or graduated within the last year from a public health bachelor's degree program or a public health master's degree program. Undergraduates had declared a public health major and were in their senior year; graduate students were in their second year and actively job seeking; or participants graduated within the past 12 months. MAIN OUTCOME MEASURES: The focus groups sought to capture students' perspectives of GPH agencies and how they believe recruitment can be improved. RESULTS: Participants described attractive job attributes including fulfilling, meaningful work; a position at a mission-driven organization; and the opportunity to make an impact on their community. Governmental public health agencies were viewed as bureaucratic, lacking innovation, and underresourced. Participants reported difficulties accessing and finding relevant job postings. CONCLUSIONS: Key to effectively recruiting and retaining new graduates is understanding their perceptions about/experiences with GPH agencies. While GPH jobs have desired attributes, participants reported that health departments are not effectively recruiting them.

Training Needs and Awareness of Emerging Areas of Public Health Practice Among Epidemiologists Working in State Health Agency Central Offices in the United States, 2017.

CONTEXT: Epidemiologists working in state health agency central offices (SHA-CO) are key professionals working to monitor population health indicators. Assessing training needs to identify gaps is critical to ensuring a competent public health workforce. OBJECTIVE: The objective of this research was to identify training needs of SHA-CO epidemiologists and their awareness of emerging areas of public health practice (EAoP) using data from the 2017 Public Health Workforce Interests and Needs Survey (PH WINS). DESIGN: SHA-CO epidemiologists were surveyed in fall 2017 using a Web-based tool. Balanced repeated replication weights were used to account for complex sample design. Differences in responses by tenure, education level, and supervisory status were assessed using multinomial logistic regression. SETTING: Forty-seven state health agencies. PARTICIPANTS: Permanently employed SHA-CO epidemiologists. MAIN OUTCOME MEASURES: Training needs were identified by classifying skill gaps as those skills that participants self-reported as high relevance to day-to-day work but self-rated as having low proficiency. Awareness of EAoP was self-reported. RESULTS: Systems and strategic thinking and budget and financial management were the areas with the greatest training needs. For most skill domains, fewer participants reported skill gaps with increasing years of public health work experience. Participants with 16 or more years of work experience were less likely to be motivated by most training motivators listed by epidemiologists with 5 or fewer years of experience. The EAoP participants reported greatest awareness of evidence-based public health practice (67%), and the EAoP they reported hearing least about was Health in All Policies (14%). CONCLUSIONS: Stratified analyses by tenure identified important differences in training needs and motivators that employers can use to customize workforce development strategies. SHA-CO epidemiologists reported varying amounts of awareness of EAoP. Specialized training approaches may contribute to improved employee engagement and reduce skill gaps among SHA-CO epidemiologists.

Determinants of workplace perceptions among federal, state, and local public health staff in the US, 2014 to 2017.

BACKGROUND: The governmental public health workforce in the United States comprises almost 300,000 staff at federal, state, and local levels. The workforce is poised for generational change, experiencing significant levels of retirement. However, intent to leave for other reasons is also substantial, and diversity is lacking in the workforce. METHODS: Workforce perception data from 76,000 staff from Health and Human Services (HHS) including 14,000 from the Centers for Disease Control and Prevention were analyzed across 2014 and 2017. Additionally, data from 32,000 state and local health department staff in 46 agencies reporting in both years. Estimates were constructed accounting for survey design and non-response. RESULTS: In 2017, women made up 43% of the total US government workforce and 33% of supervisors or higher, compared to 73 and 68% generally in State Health Agencies (p < .0001); and 62% vs 52% in HHS (p < .0001). Among state staff, intent to leave increased from 22 to 31% (p < .0001), but fell in 2017 from 33 to 28% for HHS (p < .0001). Correlates of intent to leave included low job satisfaction, pay satisfaction, and agency type. Federal entities saw the highest proportion respondents that indicated they would recommend their organization as a good place to work. CONCLUSIONS: While intent to leave fell at federal agencies from 2014 to 2017, it increased among staff in state and local health departments. Additionally, while public health is more diverse than the US government overall, significant underrepresentation is observed in supervisory positions for staff of color, especially women.

MAT2A Inhibition Blocks the Growth of MTAP-Deleted Cancer Cells by Reducing PRMT5-Dependent mRNA Splicing and Inducing DNA Damage.

The methylthioadenosine phosphorylase (MTAP) gene is located adjacent to the cyclin-dependent kinase inhibitor 2A (CDKN2A) tumor-suppressor gene and is co-deleted with CDKN2A in approximately 15% of all cancers. This co-deletion leads to aggressive tumors with poor prognosis that lack effective, molecularly targeted therapies. The metabolic enzyme methionine adenosyltransferase 2α (MAT2A) was identified as a synthetic lethal target in MTAP-deleted cancers. We report the characterization of potent MAT2A inhibitors that substantially reduce levels of S-adenosylmethionine (SAM) and demonstrate antiproliferative activity in MTAP-deleted cancer cells and tumors. Using RNA sequencing and proteomics, we demonstrate that MAT2A inhibition is mechanistically linked to reduced protein arginine methyltransferase 5 (PRMT5) activity and splicing perturbations. We further show that DNA damage and mitotic defects ensue upon MAT2A inhibition in HCT116 MTAP-/- cells, providing a rationale for combining the MAT2A clinical candidate AG-270 with antimitotic taxanes.

Voluntary Separations and Workforce Planning: How Intent to Leave Public Health Agencies Manifests in Actual Departure in the United States.

OBJECTIVES: To ascertain levels of turnover in public health staff between 2014 and 2017 due to retirement or quitting and to project levels of turnover for the whole of the state and local governmental public health in the United States nationally. DESIGN: Turnover outcomes were analyzed for 15 128 staff from public health agencies between 2014 and 2017. Determinants of turnover were assessed using a logit model, associated with actually leaving one's organization. A microsimulation model was used to project expected turnover onto the broader workforce. RESULTS: Between 2014 and 2017, 33% of staff left their agency. Half of the staff who indicated they were considering leaving in 2014 had done so by 2017, as did a quarter of the staff who had said they were not considering leaving. Staff younger than 30 years constituted 6% of the workforce but 13% of those who left (P < .001). CONCLUSIONS: Public health agencies are expected to experience turnover in 60 000 of 200 000 staff positions between 2017 and 2020. IMPLICATIONS: As much as one-third of the US public health workforce is expected to leave in the coming years. Retention efforts, especially around younger staff, must be a priority. Succession planning for those retiring is also a significant concern.

A Multilevel Workforce Study on Drivers of Turnover and Training Needs in State Health Departments: Do Leadership and Staff Agree?

OBJECTIVES: To characterize agreement between senior governmental public health staff and their subordinates concerning drivers for staff turnover, and skill importance and ability. DESIGN: Data were combined from 2 national surveys conducted in 2017; one was a nationally representative, individual-level survey of public health workers, and one was an individual-level survey of their leadership. SETTING: State health agencies. PARTICIPANTS: Respondents who held scientific, nonsupervisory positions at state health agency central offices (n = 3606) were matched with leadership (n = 193) who provided programmatic area oversight. MAIN OUTCOME MEASURES: Drivers of turnover and training needs are the primary outcomes examined in this article. RESULTS: Leaders and their staff agreed on the main 2 drivers of turnover (low salary and lack of opportunities for advancement), but discordance was observed for other major drivers of turnover. Substantial discordance was observed between leaders and their staff in terms of perceived staff proficiency with selected skills. CONCLUSIONS: This multilevel assessment of workplace perceptions offers evidence around training needs and drivers of turnover in state health agencies. Although staff and leaders agree on some major drivers of turnover, other potential reasons for leaving cited by staff, and the difference in perceptions of skills, can help target job satisfaction, training, and retention efforts in state health agencies.

Public Health Across Partisan Lines: What Has Changed Since the Onset of COVID-19.

Two polls were conducted by an independent polling firm in September 2018 and July 2020 to assess public perceptions of public health departments and services among voters in the United States. The poll also sought to uncover changes in perception before and after the onset of COVID-19. A random sample was drawn from state voter files proportional to the national registered voter population by state, with quotas set by specific demographics to ensure representativeness. Overall, 1800 individuals participated between the 2 polls and weights were used in the analysis to adjust for nonresponse. From 2018 to 2020, respondents' familiarity with local public health departments rose 11% and their perception of the importance of the public health department to community health increased by 16%. In addition, support for public health departments and services differed significantly by political affiliation. In 2020, 85% of Democrats perceived the public health department to be very important while only 62% of their Republican counterparts felt similarly. Public health advocates have a unique opportunity to demand sustained funding for public health as American voters are more familiar and supportive of public health departments now than they were before the pandemic. In addition, policy makers, elected officials, and political candidates have the opportunity to leverage these data to fight for the health of their communities.

Business Leaders' Attitudes About Value of Employee and Community Health.

OBJECTIVE: This study uses qualitative methodology to describe a range of business leaders' attitudes about health. METHODS: Five Chambers of Commerce executives and 10 business leaders shared their opinions on the value they place on health in their business and the larger community. RESULTS: Employee health was highlighted as a top priority among business leaders. The importance of business investment in community health more broadly was not discussed as frequently among business leaders. While attitudes may vary across industries and company sizes, many business executives recognized the direct role health plays in their business productivity and revenue. Compared with employee health, community health was not as salient to these business leaders; however, they do recognize the link between community health and economic development. CONCLUSIONS: Increasing business leaders' engagement in improving community health may require additional education and resources. Further research is needed to gather representative data on business leaders' attitudes about health.

Master's-Level Education in the Governmental Public Health Workforce.

OBJECTIVES: More than 16 000 graduate degrees in public health are awarded annually. Yet only 14% of the governmental public health workforce has formal public health training of any kind, and 8% has a master of public health (MPH) degree. We characterized the differences among governmental staff members with master's degrees across US health departments. METHODS: We used data from the 2017 Public Health Workforce Interests and Needs Survey, a national survey of state and local public health departments (43 669 responses; response rate, 48%). We examined the characteristics of the workforce by educational attainment and compared respondents who had obtained a "terminal" (ie, highest degree obtained) MPH degree with respondents who had obtained a terminal non-public health (non-PH) master's degree. RESULTS: Respondents who had a non-PH master's degree were as likely as respondents who had an MPH degree to hold a supervisory role (43% vs 41%; P = .67). We found only 1 significant difference between the 2 groups: respondents aged ≤40 with a terminal MPH degree were significantly less likely than respondents aged ≤40 with a non-PH master's degree to earn more than the national average salary (adjusted odds ratio = 0.67; 95% CI, 0.47-0.97; P = .03). CONCLUSIONS: We found only marginal differences in career outcomes for people working in governmental public health who had a terminal MPH degree vs a terminal non-PH master's degree. This finding does not necessitate a full reconsideration of the MPH as it relates to governmental public health practice but a greater recognition that there are multiple paths into practice.

Using Public Health Workforce Surveillance Data to Prioritize Retention Efforts for Younger Staff.

INTRODUCTION: The public health enterprise has a people problem. An aging workforce coupled with a sustained, strong economy and healthcare sector has made the recruitment and retention of young, educated staff challenging. Approximately one third of public health staff aged 33 years and younger are considering leaving their organization in the next year. Their reasons for leaving, and considerations for staying, are not well characterized within public health. METHODS: Data were drawn from the Public Health Workforce Interests and Needs Survey, a nationally representative survey of state and local governmental public health employees across the U.S. In 2017, a total of 43,701 staff responded. Descriptive statistics across age groups were examined, and reasons for leaving were characterized. A latent class model and an intent-to-leave logit model were fit in 2019. RESULTS: Pay and lack of opportunities for advancement were most frequently selected as reasons for considering leaving. Results of a logit model showed that being somewhat or very dissatisfied (versus somewhat or very satisfied) was associated with higher odds of intending to leave (AOR=4.4, p<0.0001), as was pay dissatisfaction (AOR=2.0, p<0.0001). Scoring higher than the agency median on a construct measuring perceived lack of organizational support (AOR=1.8, p<0.0001) and on a scale measuring burnout (AOR=2.6, p<0.0001) was also associated with higher odds of intending to leave. CONCLUSIONS: Many factors associated with an increased intent to leave are present among all age groups. However, support is needed for managers as they attempt to develop and implement solutions that seek to retain the younger workforce in particular. Creating paths for promotion, competitive pay practices, organizational support, and engagement are all critical for retention in this group.

Tenure and Turnover Among State Health Officials From the SHO-CASE Survey: Correlates and Consequences of Changing Leadership.

OBJECTIVE: To examine characteristics associated with tenure length of State Health Officials (SHOs) and examine reasons and consequences for SHO turnover. DESIGN: Surveys of current and former SHOs linked with secondary data from the United Health Foundation. SETTING: Original survey responses from SHOs in the United States. PARTICIPANTS: Respondents included SHOs who served between 1973 and 2017. MAIN OUTCOME MEASURES: Tenure length and consequences of SHO turnover. RESULTS: Average completed tenure among SHOs was 5.3 years (median = 4) and was shorter in recent time periods compared with decades prior. Older age at appointment (ß = -0.109, P = .005) and those holding a management degree (ß = -1.835, P = .017) and/or a law degree (ß = -3.553, P < .001) were each associated with shorter SHO tenures. State Health Officials from states in the top quartile for health rankings had significantly longer average tenures (ß = 1.717, P = .036). Many former SHOs believed that their tenure was too short and reported that their departure had either a significant or very large effect on their agency's ability to fulfill its mission. CONCLUSIONS: State Health Official tenures have become shorter over time and continue to be shorter than industry chief executive officers and best practice recommendations from organizational researchers. States have an opportunity to consider and address how factors within their control influence the stability of the SHO position.

The State of the US Governmental Public Health Workforce, 2014-2017.

Public health workforce development efforts during the past 50 years have evolved from a focus on enumerating workers to comprehensive strategies that address workforce size and composition, training, recruitment and retention, effectiveness, and expected competencies in public health practice. We provide new perspectives on the public health workforce, using data from the Public Health Workforce Interests and Needs Survey, the largest nationally representative survey of the governmental public health workforce in the United States. Five major thematic areas are explored: workforce diversity in a changing demographic environment; challenges of an aging workforce, including impending retirements and the need for succession planning; workers' salaries and challenges of recruiting new staff; the growth of undergraduate public health education and what this means for the future public health workforce; and workers' awareness and perceptions of national trends in the field. We discussed implications for policy and practice.

The Methods of PH WINS 2017: Approaches to Refreshing Nationally Representative State-Level Estimates and Creating Nationally Representative Local-Level Estimates of Public Health Workforce Interests and Needs.

CONTEXT: The Public Health Workforce Interests and Needs Survey (PH WINS) was first fielded in 2014 and is the largest public health workforce survey in the nation. This article elucidates the methods used for the 2017 PH WINS fielding. PROGRAM OR POLICY: PH WINS was fielded to a nationally representative sample of State Health Agency Central Office (SHA-CO) staff, as well as local health department (LHD) staff. The instrument largely mirrored 2014, though the training needs section was revised, and a validated item measuring burnout in staff was added. IMPLEMENTATION: Staff lists were collected directly from all participating state and local agencies. Forty-seven state health agencies (SHAs), 26 large LHDs, and 71 midsize LHDs participated. All SHAs were surveyed using a census approach. The nationally representative SHA-CO frame is representative of all central office staff members. The nationally representative local frame was a complex survey design, wherein staff from LHDs were randomly sampled across 20 strata, based on agency size and geographic region. Staff were also contributed with certainty from large LHDs in nondecentralized states. The frame is representative of staff at LHDs serving more than 25 000 people and with 25 or more staff members. Other LHDs are excluded, and so PH WINS is not representative of smaller LHDs. Balanced repeated replication weights were used to adjust variance estimates for the complex design. EVALUATION: Overall, 47 604 people responded to PH WINS in 2017 across all frames. PH WINS 2017 achieved a response rate of 48%. The design effect for the SHA-CO frame was 1.46 and was 16.42 for the local frame. DISCUSSION: PH WINS now offers a nationally representative sample of both SHA-CO and LHD staff across 4 major domains: workplace environment, training needs, emerging concepts in public health, and demographics. Both practice and academia can use PH WINS to better understand the perceptions and needs of staff, address training gaps, and work to recruit and retain quality staff.

Changes in the State Governmental Public Health Workforce: Demographics and Perceptions, 2014-2017.

CONTEXT: Workforce is a critical cog in the governmental public health enterprise in the United States. Until 2014, workforce research was largely conducted at the organizational level. However, the fieldings of the Public Health Workforce Interests and Needs Survey allow for nationally representative comparisons with individual respondents. OBJECTIVE: Using data from agencies that participated in 2014 and 2017, we conducted multi-cross-sectional comparisons of the Public Health Workforce Interests and Needs Survey data. DESIGN: The Public Health Workforce Interests and Needs Survey participants at the State Health Agency Central Offices were surveyed using a Web-based platform. Balanced repeated replication weights were used to account for differential designs between 2014 and 2017. SETTING: Thirty-three state health agency central offices that participated in both 2014 and 2017. PARTICIPANTS: Permanently employed governmental public health staff. MAIN OUTCOME MEASURES: We examined changes in perceptions of the workplace environment, job and pay satisfaction, intent to leave, awareness of emerging concepts in public health, and demographic/worker characteristics. Pearson and Rao-Scott-adjusted χ analyses were used to compare changes between 2014 and 2017. RESULTS: The percentage of staff who are people of color increased from 29% (95% confidence interval, 28%-30%) to 37% (95% confidence interval, 36%-38%) from 2014 to 2017 across 33 states. Approximately 26% of staff were younger than 40 years in 2014 compared with 29% in 2017 (P < .001). Job satisfaction increased in 17 states overall (P < .05, n = 5) and decreased in 16 states (P < .05, n = 5) but did not change in aggregate. Overall, the percentage of staff considering leaving the organization in the next year or retiring within 5 years is up from 44% to 48% (P < .001). CONCLUSIONS: Global measures of satisfaction are relatively high and consistent between 2014 and 2017. Demographics are shifting toward a marginally younger workforce as many retire, and a significant portion of staff indicates that they are considering leaving their organization or planning to retire.

The Public Health Workforce Interests and Needs Survey (PH WINS 2017): An Expanded Perspective on the State Health Agency Workforce.

CONTEXT: Workforce surveillance efforts have long been called for in public health: the Public Health Workforce Interests and Needs Survey (PH WINS) answers that call. OBJECTIVE: To characterize the state of the governmental public health workforce among State Health Agency-Central Office (SHA-CO) staff across the United States. DESIGN: The SHA leadership were contacted and invited to have their agency participate in PH WINS 2017 as a census-based fielding. Participating agencies provided staff lists, and staff were then directly invited by e-mail to participate in a Web-based survey. Pearson and Rao-Scott χ analyses are employed in descriptive analyses. Balanced repeated replication weights account for design and nonresponse. SETTING AND PARTICIPANTS: SHA-CO staff. MAIN OUTCOME MEASURES: The PH WINS focuses on 4 primary domains: perceptions of workplace environment and job satisfaction, training needs, national trends, and demographics. In addition, measures of intent to leave and employee burnout are analyzed. RESULTS: The state governmental public health workforce is primarily female (72%), non-Hispanic white (64%), and 46 years of age or older (59%). Nearly one-third (31%) of the workforce is older than 55 years, with 9% aged 30 years or younger. Overall, 74% of respondents indicated that they had at least a bachelor's degree, and 19% indicated having a public health degree of some kind. Seventy-nine percent of the respondents indicated that they were somewhat/very satisfied with their jobs. Approximately 47% of SHA-CO staff say that they are considering leaving or are planning to retire. With respect to training needs, the largest overall gaps for the state health agency workforce were observed in budget and financial management, systems and strategic thinking, and developing a vision for a healthy community. CONCLUSIONS: PH WINS represents the first nationally representative survey of governmental public health staff in the United States. It holds potential for wide usage from novel workforce research to identifying and helping address practice-based needs.

Considering Leaving, But Deciding to Stay: A Longitudinal Analysis of Intent to Leave in Public Health.

CONTEXT: Public health has been hit by the first wave of the "silver tsunami"-baby boomers retiring en masse. However, thousands of staff members say they are considering voluntarily leaving for other reasons as well. OBJECTIVE: To identify characteristics of staff who said they were planning on leaving in 2014 but stayed at their organizations through 2017. DESIGN: Data from the 2014 and 2017 Public Health Workforce Interests and Needs Survey (PH WINS) were linked by respondent, and characteristics associated with intent to leave were analyzed. Longitudinal logistic models were fit to examine correlates of intent to leave, with job and pay satisfaction, demographic variables, and workplace engagement perceptions as independent variables. SETTING AND PARTICIPANTS: Respondents from state health agency-central offices and local health departments that participated in the PH WINS in 2014 and 2017. MAIN OUTCOME MEASURES: Intent to leave (excluding retirement), demographic measures, and changes in the perceptions of workplace engagement. RESULTS: Among all staff members responding in 2014 and 2017, 15% said they were considering leaving in 2014, excluding retirement, compared with 26% in 2017 (P < .001). Overall, 21% of those who were not considering leaving in 2014 indicated they were doing so in 2017. Comparatively, 57% of those considering leaving in 2014 said they were still considering it in 2017. The regressions showed those who were somewhat or very satisfied were significantly more likely to indicate they were not (or were no longer) considering leaving. CONCLUSIONS: Among staff members who have been considering leaving but have not yet left their organization, improvements to workplace engagement perceptions and job satisfaction were highly associated with not considering leaving their job.

Making a Living in Governmental Public Health: Variation in Earnings by Employee Characteristics and Work Setting.

CONTEXT: This article examines factors related to earnings in the context of the governmental public health system's urgent need to recruit and retain trained public health workers as many in the existing workforce move toward retirement. METHODS: This article characterizes annualized earnings from state and local public health practitioners in 2017, using data from the 2017 Public Health Workforce Interests and Needs Survey (PH WINS), which was fielded in fall/winter 2017 to more than 100 000 state and local public health practitioners in the United States. The response consisted of 47 604 public health workers for a response rate of 48%.We performed descriptive statistics, bivariate analyses, and interval-based regression techniques to explore relationships between annualized earnings, supervisory status, gender, years of experience, highest degree (and whether it was a public health degree), job classification, race/ethnicity, union/bargaining unit, paid as salary or hourly wage, setting, and region. RESULTS: Higher supervisory status, higher educational attainment, white non-Hispanic race/ethnicity, male gender, salaried employment, bargaining unit (labor union) position, certain geographic regions, having a clinical/laboratory/other scientific position, and working in either a state health agency (SHA) or a large local health department (LHD) setting are all associated with higher salary. Having a public health degree versus a degree in another area did not appear to increase earnings. Being a person of color was associated with earning $4000 less annually than white peers (P < .001), all else being equal. The overall regression model showed a gender wage gap of about $3000 for women (P = .018). Supervisors, clinical and laboratory staff, public health sciences staff, and union staff also earned more than their counterparts. DISCUSSION: As multiple factors continue to shape the public health workforce, including increasing racial/ethnic diversity, continued retirements of baby boomers, and the growth of bachelor's-level public health education, researchers should continue to monitor the gender and racial/ethnic pay gaps. This information should help the field of governmental public health as it endeavors to rebuild its capacity while current workers, many at the highest level of leadership, move on to retirement or other jobs. Public health leaders must prioritize equitable pay across gender and race/ethnicity within their own departments as they build their organizations' capacity to achieve health equity.