Working conditions and health status of 6,317 front line public health workers across five provinces in China during the COVID-19 epidemic: a cross-sectional study.
Li J, Xu J, Zhou H, You H, Wang X, Li Y, Liang Y, Li S, Ma L, Zeng J, Cai H, Xie J, Pan C, Hao C, Gilmour S, Lau JT, Hao Y, Xu DR, Gu J.
BMC public health. 2021; 21(1): 106

Abstract

BACKGROUND: Public health workers at the Chinese Centre for Disease Control and Prevention (China CDC) and primary health care institutes (PHIs) were among the main workers who implemented prevention, control, and containment measures. However, their efforts and health status have not been well documented. We aimed to investigate the working conditions and health status of front line public health workers in China during the COVID-19 epidemic. METHODS: Between 18 February and 1 March 2020, we conducted an online cross-sectional survey of 2,313 CDC workers and 4,004 PHI workers in five provinces across China experiencing different scales of COVID-19 epidemic. We surveyed all participants about their work conditions, roles, burdens, perceptions, mental health, and self-rated health using a self-constructed questionnaire and standardised measurements (i.e., Patient Health Questionnaire and General Anxiety Disorder scale). To examine the independent associations between working conditions and health outcomes, we used multivariate regression models controlling for potential confounders. RESULTS: The prevalence of depression, anxiety, and poor self-rated health was 21.3, 19.0, and 9.8%, respectively, among public health workers (27.1, 20.6, and 15.0% among CDC workers and 17.5, 17.9, and 6.8% among PHI workers). The majority (71.6%) made immense efforts in both field and non-field work. Nearly 20.0% have worked all night for more than 3 days, and 45.3% had worked throughout the Chinese New Year holiday. Three risk factors and two protective factors were found to be independently associated with all three health outcomes in our final multivariate models: working all night for >3 days (multivariate odds ratio [ORm]=1.67~1.75, p<0.001), concerns about infection at work (ORm=1.46~1.89, p<0.001), perceived troubles at work (ORm=1.10~1.28, p<0.001), initiating COVID-19 prevention work after January 23 (ORm=0.78~0.82, p=0.002~0.008), and ability to persist for > 1 month at the current work intensity (ORm=0.44~0.55, p<0.001). CONCLUSIONS: Chinese public health workers made immense efforts and personal sacrifices to control the COVID-19 epidemic and faced the risk of mental health problems. Efforts are needed to improve the working conditions and health status of public health workers and thus maintain their morale and effectiveness during the fight against COVID-19. FAU - Li, Jinghua AU - Li J AD - School of Public Health, Sun Yat-sen University, No. 74, Zhongshan Second Road, Guangzhou, 510080, China. AD - Sun Yat-sen University Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-sen University, Guangzhou, 510080, China. FAU - Xu, Jingdong AU - Xu J AD - Hubei Province Center for Disease Control and Prevention, Wuhan, 430097, China. FAU - Zhou, Huan AU - Zhou H AD - West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610000, China. FAU - You, Hua AU - You H AD - School of Public Health, Nanjing Medical University, Nanjing, 210000, China. FAU - Wang, Xiaohui AU - Wang X AD - School of Public Health, Lanzhou University, Lanzhou, 730000, China. FAU - Li, Yan AU - Li Y AD - Guangzhou Center for Disease Control and Prevention, Guangzhou, 510440, China. FAU - Liang, Yuan AU - Liang Y AD - School of Public Health, Huazhong University of Science and Technology, Wuhan, 430074, China. FAU - Li, Shan AU - Li S AD - Zigong Center for Disease Control and Prevention, Zigong, 643000, China. FAU - Ma, Lina AU - Ma L AD - Hubei Province Center for Disease Control and Prevention, Wuhan, 430097, China. FAU - Zeng, Jing AU - Zeng J AD - School of Public Health, Sun Yat-sen University, No. 74, Zhongshan Second Road, Guangzhou, 510080, China. FAU - Cai, Huanle AU - Cai H AD - School of Public Health, Sun Yat-sen University, No. 74, Zhongshan Second Road, Guangzhou, 510080, China. FAU - Xie, Jinzhao AU - Xie J AD - School of Public Health, Sun Yat-sen University, No. 74, Zhongshan Second Road, Guangzhou, 510080, China. FAU - Pan, Chenghao AU - Pan C AD - School of Public Health, Sun Yat-sen University, No. 74, Zhongshan Second Road, Guangzhou, 510080, China. FAU - Hao, Chun AU - Hao C AD - School of Public Health, Sun Yat-sen University, No. 74, Zhongshan Second Road, Guangzhou, 510080, China. AD - Sun Yat-sen University Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-sen University, Guangzhou, 510080, China. FAU - Gilmour, Stuart AU - Gilmour S AD - Graduate School of Public Health, St. Luke's International University, Tokyo, 104-0045, Japan. FAU - Lau, Joseph Tak-Fai AU - Lau JT AD - Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China. FAU - Hao, Yuantao AU - Hao Y AD - School of Public Health, Sun Yat-sen University, No. 74, Zhongshan Second Road, Guangzhou, 510080, China. AD - Sun Yat-sen University Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-sen University, Guangzhou, 510080, China. FAU - Xu, Dong Roman AU - Xu DR AD - Acacia Lab for Health Systems Strengthening and Department of Health Management, School of Health Management, School of Health Management, Southern Medical University, 1023 South Shatai Road, Guangzhou, 510515, China. romanxu@i.smu.edu.cn.



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