Protecting the Well-being of the Nation’s Health Workforce

The American Journal of Public Health recently published a special supplement with 15 articles focusing on health worker mental health. As part of this special issue, our article Protecting the Mental Health and Well-being of the Nation’s Health Workforce summarizes the scope of the issue and prevention efforts underway at the Centers for Disease Control and Prevention (CDC) and the National Institute for Occupational Safety and Health (NIOSH). A summary consisting of excerpts from the article follows.

While working in health occupations has always been challenging, our entire system of providing health care has been under extreme duress for the past three years, and in some cases, it has been pushed near the breaking point. Difficult working conditions associated with health occupations, including long work hours and shiftwork, intense physical and emotional labor, exposure to human suffering and death, and risk of exposure to disease and violence, have all been magnified by the COVID-19 pandemic (National Academy of Medicine). Health workers including not only frontline health care workers such as nurses and physicians but also public health workers, emergency medical service (EMS) first responders, mental health workers, long-term care workers, and others in many supporting roles, have been especially impacted by increased poor mental health outcomes.

CDC Efforts

It has become increasingly evident that mental health and well-being is an important aspect of public health, and the CDC has prioritized the implementation of approaches to support positive mental health outcomes across multiple domains, including in working populations. CDC also recognizes work as a social determinant of health, as it affects a wide range of health, functioning, and quality-of-life outcomes and risks. CDC has developed a behavioral health coordination unit to coordinate agency strategy and priorities in mental health around ongoing programs focused on youth mental health, coping with stress, cultural and social connectedness, and pandemic-related mental health impacts. For example, the CDC developed the How Right Now campaign to promote and strengthen emotional well-being and resilience, largely in response to the mental health impacts of the COVID-19 pandemic across the US population, including elevated rates of stress, depression, anxiety, PTSD, suicidal behavior, and substance use disorders.

NIOSH Efforts

For more than a decade, the NIOSH Total Worker Health^® Program has focused on the overall health and well-being of workers by specifically looking at the connection between their work, safety, and overall health and well-being. ​The Total Worker Health approach is defined as policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness–prevention efforts to advance worker well-being. In Fall 2021, NIOSH launched a Total Worker Health Center of Excellence dedicated to workplace mental health. This new center joins nine other funded academic centers researching the most effective ways to improve the overall well-being of workers.

CDC and NIOSH were funded by Congress in 2021 to develop and conduct a national evidence-based education and awareness campaign to safeguard and improve the mental health of health workers. The main charge for this effort was to promote primary prevention of mental health conditions, encourage secondary and tertiary prevention by encouraging health care professionals to seek support and treatment of their own mental health, and help such professionals identify risk factors in themselves and others and respond to those risks. In 2021, NIOSH established a five-part plan to raise awareness of mental health concerns and suicide risk among health workers and to urge employers to build a sustainable infrastructure for future generations of health care workers. The following elements make up the five-part plan:

1. Understand and spotlight the personal, social, and economic burdens of difficult working conditions and their toll on health workers when it comes to poor mental health outcomes.
2. Assimilate the best evidence, develop a repository of best practices, resources, and interventions.
3. Leverage partners to reach and inspire specific audiences and amplify our message.
4. Identify and adapt tools; improve data, surveillance, and screenings; grade the evidence around current interventions; develop trainings and resources; and, ideally, motivate game-changing policies.
5. Generate awareness by conducting a national multidimensional social marketing campaign to stimulate interest in good mental health, lower stigma, normalize the conversation around mental health, lower barriers for care-seeking, and bring a positive message that people can get better, lead more fulfilling lives, and remain in the profession they love.

Several efforts from the five objectives are reflected in this special issue. Additional NIOSH efforts include:

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  The Impact Wellbeing social marketing campaign designed to reach decision-makers within hospitals and hospital systems (C-suite executives) as these leaders have the unique ability to leverage their high-ranking positions to impact mental health policies and practices at the organizational level

• A NIOSH fact sheet and a joint statement with the Dr. Lorna Breen Heroes’ Foundation about removing overly invasive mental health questions from hospital credentialing applications
• A burnout prevention training specifically designed for supervisors of public health workers which aims to assist public health workers who also saw consistent challenges and working conditions worsen because of the COVID-19 pandemic
• Partnerships with others also working on the mental health crisis, including CDC’s National Center for Injury Prevention and Control; the US Surgeon General; the Health Resources and Services Administration; the Dr. Lorna Breen Heroes’ Foundation; the National Action Alliance for Suicide Prevention; the National Academies of Sciences, Engineering, and Medicine; the Service Employees International Union; the American Hospital Association; and many others

The journey to safeguarding and improving the mental health of those who safeguard the health of us all is vital. CDC and NIOSH are committed to providing the most accurate, timely, and compelling science to drive this change. The nation is well aware of the problems at hand, and it is clear the time for action is overdue. With dedicated partners and organizational-level commitments, we aim to improve the health of these workers and, in turn, all Americans for generations to come. Our ultimate success will depend upon those who lead health care-providing organizations. We urge you to join us on this critically important journey.

Learn how to get involved on the Impact Wellbeing website.

John Howard, MD, is the Director of the National Institute for Occupational Safety and Health. 

Debra Houry MD, MPH, is the Chief Medical Officer and Deputy Director for Program and Science at CDC.