Depression and assets during the COVID-19 pandemic: A longitudinal study of mental health across income and savings groups.

The prevalence of depression in U.S. adults during the COVID-19 pandemic has been high overall and particularly high among persons with fewer assets. Building on previous work on assets and mental health, we document the burden of depression in groups based on income and savings during the first two years of the COVID-19 pandemic. Using a nationally representative, longitudinal panel study of U.S. adults (N = 1,271) collected in April-May 2020 (T1), April-May 2021 (T2), and April-May 2022 (T3), we estimated the adjusted odds of reporting probable depression at any time during the COVID-19 pandemic with generalized estimating equations (GEE). We explored probable depression-defined as a score of ≥10 on the Patient Health Questionnaire-9 (PHQ-9)-by four asset groups, defined by median income (≥$65,000) and savings (≥$20,000) categories. The prevalence of probable depression was consistently high in Spring 2020, Spring 2021, and Spring 2022 with 27.9% of U.S. adults reporting probable depression in Spring 2022. We found that there were four distinct asset groups that experienced different depression trajectories over the COVID-19 pandemic. Low income-low savings asset groups had the highest level of probable depression across time, reporting 3.7 times the odds (95% CI: 2.6, 5.3) of probable depression at any time relative to high income-high savings asset groups. While probable depression stayed relatively stable across time for most groups, the low income-low savings group reported significantly higher levels of probable depression at T2, compared to T1, and the high income-low savings group reported significantly higher levels of probable depression at T3 than T1. The weighted average of probable depression across time was 42.9% for low income-low savings groups, 24.3% for high income-low savings groups, 19.4% for low income-high savings groups, and 14.0% for high income-high savings groups. Efforts to ameliorate both savings and income may be necessary to mitigate the mental health consequences of pandemics.

Symptoms of Posttraumatic Stress During the COVID-19 Pandemic in the Governmental Public Health Workforce and General Population.

We aimed to estimate the prevalence of COVID-19-related posttraumatic stress symptoms (PTSS) in the governmental public health workforce and in US adults, assess differences in reporting PTSS within subgroups, and evaluate whether frontline workers reported higher levels of PTSS than persons in other jobs. We used data from 2 nationally representative studies: the 2021 Public Health Workforce Interests and Needs Survey (PH WINS) and the COVID-19 and Life Stressors Impact on Mental Health and Well-being (CLIMB) study. Our study found that the state and local governmental public health workforce was more likely to report PTSS than the general adult population. Almost a quarter of public health agency employees (24.7%) and 21.1% of adults reported at least 3 symptoms of posttraumatic stress. Differences in levels of PTSS appeared within demographic groups for both samples. Personal care and service frontline workers had 4.3 times the odds of reporting symptoms of posttraumatic stress than non-frontline workers.

What's Missing from Data Modernization? A Focus on Structural Racism.

Public health data modernization efforts frequently overlook the far-reaching effects of structural racism across the data life cycle. Modernizing data requires creating data ecosystems grounded in six principles: dismantling structural racism and building community power explicitly; centering justice in all stages of data collection and analysis; ensuring communities can govern their data; driving positive population-level change; engaging nonprofit organizations; and obtaining commitments from governments to make changes in policy and practice. As government agencies spearhead and finance data modernization initiatives, it is imperative that they address structural racism head-on and integrate these principles into all aspects of their work.

Staffing Up and Sustaining the Public Health Workforce.

OBJECTIVES: Estimate the number of full-time equivalents (FTEs) needed to fully implement Foundational Public Health Services (FPHS) at the state and local levels in the United States. METHODS: Current and full implementation cost estimation data from 168 local health departments (LHDs), as well as data from the Association of State and Territorial Health Officials and the National Association of County and City Health Officials, were utilized to estimate current and "full implementation" staffing modes to estimate the workforce gap. RESULTS: The US state and local governmental public health workforce needs at least 80 000 additional FTEs to deliver core FPHS in a post-COVID-19 landscape. LHDs require approximately 54 000 more FTEs, and states health agency central offices require approximately 26 000 more. CONCLUSIONS: Governmental public health needs tens of thousands of more FTEs, on top of replacements for those leaving or retiring, to fully implement core FPHS. IMPLICATIONS FOR POLICY AND PRACTICE: Transitioning a COVID-related surge in staffing to a permanent workforce requires substantial and sustained investment from federal and state governments to deliver even the bare minimum of public health services.

Awareness of and Confidence to Address Equity-Related Concepts Across the US Governmental Public Health Workforce.

OBJECTIVE: To assess the governmental public health (GPH) workforce's awareness of and confidence to address health equity , social determinants of health ( SDoH ), and social determinants of equity ( SDoE ) in their work. DESIGN, SETTING, AND PARTICIPANTS: A nationally representative population of US local and state GPH employees (n = 41 890) were surveyed through the 2021 Public Health Workforce Interests and Needs Survey (PH WINS 2021). MAIN OUTCOME MEASURES: Self-reported awareness and confidence were explored by self-identified racial and ethnic group identity, public health degree attainment, and supervisory status. RESULTS: GPH employees reported higher levels of awareness across concepts ( health equity -71%, 95% confidence interval [CI]: 70.5-71.6; SDoH -62%, 95% CI: 62.3-63.5; SDoE -48%, 95% CI: 47.2-48.4) than confidence ( health equity -48%, 95% CI: 47.8-49.0; SDoH -46%, 95% CI: 45.4-46.7; SDoE -34%, 95% CI: 33.4-34.6). Self-identified Black or African American employees reported higher confidence across all concepts ( health equity -56%, 95% CI: 54.3-57.6; SDoH -52%, 95% CI: 50.8-54.1; SDoE -43%, 95% CI: 41.3-44.6) compared to other self-identified racial groups. Employees with a PH degree reported higher confidence across all concepts ( health equity -65%, 95% CI: 63.8-68.8; SDoH -73%, 95% CI: 71.3-74.1; SDoE -39%, 95% CI: 36.9-40.1) compared with employees without a PH degree ( health equity -45%, 95% CI: 44.8-46.1; SDoH -41%, 95% CI: 40.6-41.9; SDoE -33%, 95% CI: 32.6-33.8). We found an inverse relationship between supervisory status and confidence to address SDoE : Nonsupervisors reported higher confidence (35%, 95% CI: 29.2-31.9) than supervisors (31%, 95% CI: 29.2-31.9), managers (31%, 95% CI: 28.8-32.6), and executives (32%, 95% CI: 27.5-34.4). CONCLUSION: PH WINS 2021 reveals that GPH employees are aware of equity-related concepts but lack confidence to address them. Public health agencies should build employees' confidence by prioritizing and operationalizing equity internally and externally in collaboration with communities and partners.

Workplace Perceptions and Experiences Related to COVID-19 Response Efforts Among Public Health Workers - Public Health Workforce Interests and Needs Survey, United States, September 2021-January 2022.

The COVID-19 pandemic has strained many essential frontline professionals, including public health workers*; however, few studies have evaluated the specific challenges facing public health workers during this period. Data from the 2021 Public Health Workforce Interests and Needs Survey (PH WINS), a nationally representative survey of individual state and local governmental public health agency workers, provide insight into public health workers' demographic characteristics and experiences during the COVID-19 pandemic, tenure, and intention to leave their organization† (1). Surveyed governmental public health workers identified predominantly as non-Hispanic White (White), women, and aged >40 years; however, workforce characteristics differed by agency type. Overall, 72% of respondents reported working fully or partially in a COVID-19 response role at any point during March 2020-January 2022. An estimated 44% of workers reported that they were considering leaving their jobs within the next 5 years for retirement or other reasons. Of those considering leaving, 76% began thinking about leaving since the start of the COVID-19 pandemic. When asked what was needed, besides funding, to respond to the COVID-19 pandemic, 51% selected additional staff capacity. Survey findings highlight the importance of focused attention on recruitment and retention that promotes diversity (2) and workers with public health experience, which will be critical as the workforce rebuilds as the COVID-19 pandemic evolves.

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.

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.

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.

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.

Engaging With Communities - Lessons (Re)Learned From COVID-19.

Coronavirus disease 2019 (COVID-19) has underscored longstanding societal differences in the drivers of health and demonstrated the value of applying a health equity lens to engage at-risk communities, communicate with them effectively, share data, and partner with them for program implementation, dissemination, and evaluation. Examples of engagement - across diverse communities and with community organizations; tribes; state and local health departments; hospitals; and universities - highlight the opportunity to apply lessons from COVID-19 for sustained changes in how public health and its partners work collectively to prevent disease and promote health, especially with our most vulnerable communities.

Leadership Disparities in State Governmental Public Health Workforce: Examining the Influence of Gender.

OBJECTIVE: To determine the extent to which gender disparities exist in either obtaining a leadership position or pay equity among those with leadership positions in state governmental public health agencies. DESIGN: Utilizing the 2014 Public Health Workforce Interests and Needs Survey, a nationally representative cross-sectional study of state governmental public health agency employees, the characteristics of the state governmental public health agency leadership were described. We estimated the odds of being a manager or an executive leader and the odds of leaders earning greater than $95 000 annually for women compared with men using polytomous multinomial regression and logistic regression models, respectively. SETTING AND PARTICIPANTS: The Public Health Workforce Interests and Needs Survey was conducted via electronic survey at 37 state health departments. This study utilized only those respondents who listed their current position as a supervisory position (n = 3237). MAIN OUTCOME MEASURES: Leadership position and high-earning leadership were the 2 main outcome measures explored. Leadership position was defined as a 3-level ordinal variable: supervisor, manager, or executive leader. High-earning leadership was defined as a member of leadership earning $95 000 or greater. RESULTS: Women accounted for 72.0% of the overall state governmental public health agency workforce and 67.1% of leadership positions. Women experienced lower odds (odds ratio = 0.55, 95% confidence interval: 0.39-0.78) of holding executive leadership positions than men and lower odds (odds ratio = 0.64, 95% confidence interval: 0.50-0.81) of earning an annual salary greater than $95 000. CONCLUSION: While women were represented in similar proportions in the general workforce as in leadership positions, gender disparities still existed within leadership positions. Increased effort is needed to ensure that opportunities exist for women in executive leadership positions and in pay equity. With public health's commitment to social justice and the benefits of diversity to an agency's policies and programs, it is important to ensure that women's voices are equally represented at all levels of leadership.

The First Nationally Representative Benchmark of the Local Governmental Public Health Workforce: Findings From the 2017 Public Health Workforce Interests and Needs Survey.

CONTEXT: A changing public health landscape requires local governmental health departments (LHDs) to have a workforce prepared to meet complex challenges. While previous assessments looked at organizational data on the LHD workforce, the Public Health Workforce Interests and Needs Survey (PH WINS) is the first nationally representative survey to examine individual perceptions of training needs, workplace environment, job satisfaction, and awareness of emerging concepts in public health. OBJECTIVES: Characterize key interests and needs of the local governmental public health workforce. DESIGN: Survey invitations were sent to individual LHD employees on the basis of a stratified sampling approach. The LHDs had to employ a minimum of 25 staff and serve a population of 25 000 or greater to be eligible for inclusion. SETTING: 399 LHDs across the United States. PARTICIPANTS: A total of 26 533 LHD employees completed the survey (59% response rate). RESULTS: The majority of local public health workers are female (81%, 95% confidence interval [CI]: 78%-84%) and white non-Hispanic (68%, 95% CI: 64%-72%). Of the nearly quarter of workers who declared an intent to leave within the next year excluding retirement (22%, 95% CI: 19%-25%), the most common reasons included pay (46%, 95% CI: 42%-50%), lack of opportunities for advancement (40%, 95% CI: 38%-50%), and workplace environment (30%, 95% CI: 27%-32%). Across jurisdiction size and supervisory level, skills gaps were noted in budget and financial management, systems and strategic thinking, developing a vision for a healthy community, and change management. CONCLUSIONS: As the first nationally representative sample of the local governmental public health workforce, these data create a national benchmark against which LHDs can measure their workforce. Given the similarities found across LHDs serving different jurisdiction sizes, a unified approach to workforce development should be employed across all LHDs. The LHD leadership should address retention, reward creativity and innovation, improve communication between leadership and employees, and provide opportunities for advancement.

The Governmental Public Health Workforce in 26 Cities: PH WINS Results From Big Cities Health Coalition Members.

CONTEXT: More than 80% of Americans live in urban areas. Over the past 20 years, an increasing number of local governmental public health departments, particularly those in big cities, have taken pioneering action to improve population health. This article focuses on members of the Big Cities Health Coalition (BCHC) who participated in the 2017 Public Health Workforce Interest and Needs Survey (PH WINS). If the impact of these health departments is to be sustained, they will require a workforce prepared for the challenges of 21st-century public health practice. OBJECTIVE: To characterize workforce interests and needs among staff in 26 large, urban health departments who are BCHC members. DESIGN: Administered PH WINS survey to staff in BCHC member health departments to assess perceptions about the workplace environment and job satisfaction; training needs; awareness of national trends; and demographics. SETTING: In total, 26 of 30 BCHC member health departments, United States. PARTICIPANTS: In total, 7453 of 17 613 staff members (response rate 43.4%) from participating departments. RESULTS: The workforce consists predominantly of women (75%) and people of color (68%). Staff is satisfied with their job (81%), the organization (71%), and pay (59%), but more than a quarter are considering leaving within the year. The agency's mission drives staff, but it lacks an environment fostering creativity and innovation. Training needs include budgeting/financial management, change management, and strategic thinking. CONCLUSIONS: BCHC departments must improve retention, provide opportunities for advancement, enhance communication between leadership and staff, foster creativity and innovation, and align labor allocation with disease burden in local communities. Findings from the second iteration of PH WINS allow a comprehensive, comparable analysis of the workforce across the 26 BCHC member health departments that participated. These data expand upon the ability to assess and monitor improvement in the workforce environment, job satisfaction, awareness of national trends, and training needs.

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.