Overall, our findings show that EH pro- fessionals in Montana are slightly older than their national counterparts. In Montana, EH professionals have a similar but dierent age distribution than those reported nationally by Gerding et al. (2019). Our findings indicate that 64% of EH professionals are between 30 and 59 years and only 7% are <30 years. Con- versely, Gerding et al. (2019) reported that 23% of national EH professionals are <26 years. We also had 13% of respondents report being >65 years, compared with 3% for the same nationally reported age group (Gerding et al., 2019). These proportions are signifi- cantly dierent ( p -value < .05). Challenges Faced by the Profession The COVID-19 pandemic has significantly aected public health overall. EH profession- als, like all of public health, have been tested by this crisis over the past few years. The U.S. pub- lic health system has suered for some time with chronic underfunding, workforce short- ages, and outdated infrastructure (DeSalvo et al., 2021). The pandemic exacerbated long- standing challenges and brought attention to racial and socioeconomic inequities such as lack of access to healthcare, lack of quality care, and adverse health outcomes for disadvantaged groups (DeSalvo et al., 2021). Between 2008 and 2016, it is estimated that more than 2,000 EH positions were lost due to the Great Reces- sion and associated budget cutbacks (Gerding et al., 2019) and 56,000 positions overall were lost in public health (Gadarian et al., 2021). The EH profession has never recovered despite the ever-increasing need. The pandemic pre- cipitated gaps in quality information; distrust in public health leaders; and politicization of resources, guidance, operations, and leader- ship (DeSalvo et al., 2021). Nearly one fifth of EH professionals in Montana reported that their routine duties were subordinated to COVID-19 priorities, and 84% reported performing nonroutine job duties. Most respondents (77%) reported their organization being understaed to meet current needs. Similarly, the needs assessment conducted by NEHA (2020b) found that EH professionals were fully engaged in the pan- demic response and reported being emotion- ally exhausted by feeling understaed. In Montana, EH professionals reported that they conducted contact tracing, enforced mask mandates, operated vaccine clinics,
reviewed social distancing and viral reduc- tion plans, carried out public education, participated in conflict resolution, and per- formed their usual work duties. Nearly 40% reported that their stress level was so high that they could not complete all the duties of their job and they were feeling symptoms of burnout. Key factors that created increased stress included hostility from the public, being short-staed, unmet personal and eco- nomic needs, working remotely, having lim- ited time in the field, and the politicization of the public health response. Furthermore, EH professionals felt that there was a significant backlash from the state legislature against public health during the pandemic, which resulted in less authority and support for local health department operations. Political Challenges The Montana legislature passed a law in April 2021 that prohibits health departments from closing establishments or creating mandates that are perceived to hurt business (Hough- ton, 2022). Mask mandates could no longer be enforced, and businesses could not be closed due to public health threats (Montana Public Radio, 2021). House Bill 121 eec- tively removed 100 years of basic, preven- tive public health measures that were aimed at stopping the spread of disease in public places during times of crisis (An Act Revising Laws Related to Local Boards of Health, 2021; Montana Public Radio, 2021). House Bill 121 created increased control over local health departments. Now, local health departments are governed by commu- nity boards that can block or amend informed recommendations from health departments for managing public health emergencies. Montana was 1 of 26 states that moved to roll back powers of local health departments (Houghton, 2022). Furthermore, House Bill 702 blocks business owners from restrict- ing service to those without proof of vac- cination and does not allow discrimination against those who chose not to get vaccinated (An Act Prohibiting Discrimination, 2021; Houghton, 2022). Social and political forces have strained public health to new limits in recent years and were acutely exacerbated by the COVID- 19 pandemic. DeSalvo et al. (2021) reported that 50 states and 9 territories delivered pub- lic health services through a variety of struc-
tural models with highly variable funding levels. For example, New Mexico provided funding at $140 per capita, compared with Missouri at $7 per capita. Alaska spends the most for public health, at $449 per person (United Health Foundation, 2023). Gadarian et al. (2021) found that parti- sanship played a central role in individual and community responses to the pandemic. Nearly one third of all health departments had opted out of accreditation because of a lack of adequate funding and personnel (DeSalvo et al., 2021). The lack of funding at the state and local level, aging infrastruc- ture, partisanship, and conflicting messages amounted to an uneven response to the pan- demic across communities (DeSalvo et al., 2021; Gadarian et al., 2021). Two of the greatest challenges in public health during the pandemic were the misinfor- mation and partisanship that led to community distrust of science and public health, which resulted in loss of authority through revised public health policy. More than one half of U.S. states, including Montana, have passed legisla- tion that diminished powers of public health departments (Montana Public Radio, 2021). We found that EH professionals in Montana wanted more support from the public, com- munity leadership, and the state legislature. Job Conditions and Satisfaction Improving the work conditions and experi- ences for EH professionals in Montana would have a positive impact on the workforce and the delivery of services. Recommendations for improvement include greater funding for public health, higher salaries, increased sta, reasonable workloads, narrower job descrip- tions, more flexibility, technical and non- technical training, professional development, career advancement opportunities, improved management and leadership, and greater sup- port from elected o¦cials. These recommen- dations could have a positive eect on public health in Montana. Despite the stresses and strains on EH pro- fessionals in Montana, we found that 97% reported they loved their jobs and felt their work was meaningful. Furthermore, 92% reported that they were satisfied or somewhat satisfied in their current position, even though 60% were thinking about leaving public health for a variety of reasons. Nationally, Sellers et al. (2015) reported that 79% of public health
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