For the first time, all eight U.S. territories and freely associated states have been included in PH WINS, or the Public Health Workforce Interests and Needs Survey. Rachel Hare Bork joins the show to discuss how this landmark pilot effort came together, why it took extensive travel and collaboration to make it happen, and what the results reveal about the public health workforce across the islands. She explores key findings, like the islands’ notably younger workforce, gaps in public health education, and the powerful new data leaders can use to advocate for resources. She also digs into why counting these communities matters for both territorial planning and the national public health conversation, and what it will take to continue this work in future PHWINS cycles.Webinar Registration - ZoomSubscribe | ASTHO
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This is Public Health Review
MORNING Edition for Thursday,
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December 18th, 2025.
I'm John Sheehan with news from
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the Association of State and
Territorial Health Officials.
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Today we hear about newly
collected data concerning the
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needs, challenges and
demographics of public health
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workers from all eight US
territories and freely
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associated states.
The information was collected as
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a pilot program of the pH WINS,
the Public Health Workers
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Interests and Needs Survey,
which is run jointly every three
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years by the de Beaumont
Foundation and ASTO.
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The survey hadn't included US
public health workforces in
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island territories until now.
Puerto Rico and the US Virgin
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Islands in the Atlantic.
In the Pacific we have American
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Samoa, the Commonwealth of the
Northern Mariana Islands and
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Guam, and then we have 3 freely
associated States, the Federated
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States of Micronesia, the
Republic of the Marshall
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Islands, and the Republic of
Palau.
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This is Rachel Herr Bork,
director of pH Wins for the De
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Beaumont Foundation.
I am so excited that all of the
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eight US territories and freely
associated states participated
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in some shape or form on our pH
WINS Islands pilot.
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We sent the survey to almost
9000 individuals working in
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government public health and it
had a response rate of 28% among
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eligible employees, which is
something that we are really
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excited about.
And how?
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Did you get such a high?
Participation rate.
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We worked really hard in
conjunction with ASTO and the
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Pacific Island Health Officers
Association, PIHOA, to really
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explain the survey.
We did a lot of travel,
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attending national meetings,
going out to these specific
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islands to meet with leaders,
explaining to them what the
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survey is, what the survey is
not.
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We also worked with them to
adjust some of the questions so
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that the survey did match the
unique context of the island.
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And it's some pretty far-flung
places.
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Yeah, I have a lot of air Miles.
No doubt this is the first time
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this survey has taken data from
these territories.
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Yes.
It was something that we always
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had wanted to do, but we're
never able to.
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And we're really fortunate that
we got financial support from
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CDC to make this happen.
And we're thrilled that now
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these islands have a voice.
And it's really great that since
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the islands participated, we now
have data that expresses how
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they are similar to the rest of
the country and also their
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unique characteristics.
That's great.
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So what were some results?
Yeah.
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So we found some really
interesting things when we ran
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the survey, places in which
these islands are really similar
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to the mainland United States
and places where they are a bit
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different.
So one area that we really
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focused on in the survey is
understanding the workforce that
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is 35 years old or younger.
And what we see is that the
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islands have a much younger
workforce than the mainland of
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the United States.
So here in the mainland, 25% of
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our workforce, about one in four
folks are going to say that they
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are 35 years old and under.
In the islands as a whole, that
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number goes up to 32%.
And when you just look at the
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Pacific Islands, it's 36%.
So that cuts both ways.
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On the one hand, it's really
great to have young people with
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fresh ideas entering the
workforce.
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At the same time, they may lack
institutional knowledge and they
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may in some places lack
training.
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And this is another interesting
finding.
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So within the mainland, it's
actually 36% of those who are 35
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and under have a degree in
public health.
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That's compared to 17% of older
folks in the mainland United
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States.
In the islands, it is reversed.
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So on the islands as a whole,
only 30% of that younger
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population has a degree in
public health.
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And in the Pacific, it's really
low.
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It's only 12% of people who are
35 and under have a degree in
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public health, which shows that
there needs to be more
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opportunities for education and
training for the younger islands
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workforce because they don't
have it at the same levels as
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their peers in the mainland.
And did you find that this these
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survey results were surprising
to to the territorial
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leadership?
Yes and no.
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I think in a lot of times pH
Wins gives you the numbers of
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things that you kind of already
know, but that and that is
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powerful, right, to be able to
go to leaders with those
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numbers.
I think in the Pacific, they
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know it is an issue.
They have training programs that
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they're really proud of that
they're working to expand.
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I think the number itself maybe
was a little jarring exactly how
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low it is.
And I also think it's really
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powerful and this is about pH
wins in general, is that the
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survey allows you to compare to
so that they can now go to
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leadership and say, hey, we have
a real training problem.
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Only 12% of our USAPI under 35
workforce have a degree in
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public health.
We are behind the rest of the
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islands and we are way behind
the mainland.
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And that is, I think, a really
powerful narrative that leaders
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can use that they couldn't say
before they participated in pH
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ones.
Yeah.
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Is that an example of one of the
directions, maybe one of the the
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takeaways that leadership can
can bring from the data results?
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Yeah, I think a lot of the
leaders have talked about using
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this data to go to territorial
leadership or freely associated
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state leadership to say, hey, we
need more money for public
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health in our island.
And here are findings that show
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kind of the, the extent of our
need, what our workforce is
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saying they need, how the skill
level or lack thereof of our
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workforce.
Because at the end of the day,
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they're fighting with lots of
other issue areas to get a piece
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of the pie as as happening in
states across our country,
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right?
So I think the fact that they
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have this pH wins data is a
really powerful advocacy tool
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that public health leaders now
have to try and get more
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resources for public health in
their islands.
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Yeah, Is the hope that it will
influence the national
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conversation as well, now that
you can sort of compare data
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from the Pacific islands to the
continental US?
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Yeah, exactly.
I think it'll be really powerful
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that they are now part of the
narrative.
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And this was a criticism that we
got in previous cycles of pH
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wins.
That was fair that islands
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weren't counted, and if you're
not counted then you can't be
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part of the story.
And finally, so this was a pilot
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program, is the intention for it
to continue?
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That is our hope.
CDC funded this pilot and we
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were really grateful for their
support and we are having
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conversations with them about
continuing this work because one
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of the most powerful things
about pH wins is that it is a
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survey that is taken over time.
So in, you know, for ASTO
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members, right, those that have
participated can look at how
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their data has changed over
time.
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This PH1's islands pilot gives
us a baseline for the islands,
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but of course we'd love to run
it on the same cadence of about
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every three years so that these
islands can track their progress
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across these metrics.
Rachel Herr Bork is the director
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of research and impact at the de
Beaumont Foundation and holds a
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pH.
D in Politics and Education from
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Teachers College, Columbia
University.
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Oh, and one more thing.
For those folks who are
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interested in learning more, we
really encourage you to go to
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our website, phwins.org.
There's a drop down menu there
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and under 2024 findings you'll
see another tab that says pH
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Wins Islands Pilot.
There you'll find tons of data,
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infographic reports, and of
course, all of the data is
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publicly available on our
dashboards.
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We hope interested individuals
will take a look at the data and
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explore on their own.
Join Manisha Juthani, MD,
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Commissioner, Connecticut
Department of Public Health and
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ASTO President, and John
Auerbach, MBA, Senior Vice
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President for Public Health,
ICF, for a webinar that examines
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how clear, purposeful leadership
strengthens both internal and
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external trust.
Through insights and reflection,
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we will examine how leaders
embody steadiness amid
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uncertainty, set a sustainable
pace, and provide calm direction
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that builds trust and drives
performance.
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This conversation aims to
inspire participants to
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recognize their composure and
capacity not as a personal
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indulgence, but as a fundamental
leadership function that shapes
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the overall tone, focus, and
confidence of their
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organizations.
Stay current on all ASTO news by
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subscribing to Public Health
Weekly and Legislative Alerts
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for updates, analysis, resources
and events on pressing issues in
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state and territorial public.
Health.
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You can find it all at asto.org
or the link in the show notes.
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This has been Public Health
Review MORNING Edition.
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I'm John Sheehan for the
Association of State and
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Territorial Health Officials.