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1. Home
2. American Journal of Public Health (ajph)
3. May 2022
THE POLITICIZATION OF PUBLIC HEALTH AND THE IMPACT ON HEALTH OFFICIALS AND THE
WORKFORCE: CHARTING A PATH FORWARD
Affiliation
Valerie A. YeagerDrPH, MPhil Author affiliations, information, and
correspondence detailsValerie A. Yeager with the Indiana University Richard M.
Fairbanks School of Public Health, Indianapolis.
COPYRIGHT
Correspondence should be sent to Valerie A. Yeager, Indiana University Richard
M. Fairbanks School of Public Health, 1050 Wishard Blvd, RG 6144, Indianapolis,
IN 46202 (e-mail: vyeager@iu.edu). Reprints can be ordered at http://www.ajph.
org by clicking the “Reprints” link.
https://doi.org/10.2105/AJPH.2022.306744
Accepted: January 16, 2022
Published Online: April 13, 2022
* Full Text
* References
* PDF/EPUB
*
Before the COVID-19 pandemic, few Americans had a clear understanding of what
public health is or what it does for society because many of its activities and
protections take place behind the scenes. In the absence of a crisis, public
health does not receive much attention. As it turns out, this creates ongoing
challenges for public health. Over a 100-year period, public health measures
have improved life expectancy by 25 years1; however, as recent public dialogue
has indicated, these benefits and public health’s credibility can easily be
forgotten.2
THE NEW VISIBILITY OF PUBLIC HEALTH
Section:
ChooseTop of pageTHE NEW VISIBILITY OF PUB... <<THE REALITY OF WORKPLACE
...CHARTING A PATH FORWARDREFERENCES
Two years into the pandemic, nearly every American seemingly has a strong
opinion about public health. Public health is now regularly discussed at dinner
tables, and previously unknown agency acronyms and their public health leaders
are household names. In fact, in many instances, state or local health officials
have become the scapegoats for many of the COVID-19 restrictions society has
experienced.3 The distaste for mask requirements and stay-at-home orders as well
as other limits on individual liberty have been used as reasons to threaten
health officials with violence, attack them on social media, and stage protests
at their homes and workplaces. In some cases, they have also been the targets of
“doxing,” where their personal information is distributed so that others can
join in on the harassment.
THE REALITY OF WORKPLACE VIOLENCE
Section:
ChooseTop of pageTHE NEW VISIBILITY OF PUB...THE REALITY OF WORKPLACE ...
<<CHARTING A PATH FORWARDREFERENCES
Harassment of health officials has made national headlines, particularly because
it was often coupled with news of their firing or resignation. It was also
newsworthy because it occurred during the longest public health emergency
response the United States has seen since the 1918 influenza pandemic. Not only
is this a time when public health leaders are essential to leading their
agencies and their staff, but it also occurred at a point when public health is
dually challenged by ongoing staff shortages and the impending retirement of a
large portion of the existing workforce.4,5 One might say that losing valued
experts from the field could not come at a worse time.
In their article in this issue, Ward et al. (p. 736) explore the role of
harassment in health official turnover during the first 10 months of the
pandemic. The authors reviewed and cataloged media reports of the harassment of
US public health officials and linked these data with health official turnover
records. The authors also used data collected by the National Association of
County and City Health Officials in late 2020 and early 2021. Completed by local
health department officials or their designee, the survey collected information
about harassment targeting either the health official or the agency as well as
health official turnover. These various data were merged and analyzed
collectively by the authors.
Ward et al. found that approximately half of the local health departments
reported at least one type of harassment of their health official, which was
similar to the findings of their media analysis. They also found that one in
three health officials who left their positions during those first 10 months of
the pandemic (222 health officials in total) had experienced harassment.
However, perhaps more important, they found that a substantial portion of health
officials who experienced harassment, including personal threats, did not
voluntarily leave their positions. These public health officials stayed on and
endured.
News reports about the harassment and turnover of health officials bring
attention to societal changes and happenings. The study by Ward et al. helps put
these news reports into context and provides qualitative insights that are
incredibly telling. The researchers grouped the challenges that health officials
experienced into five categories: underrecognized expertise, an underresourced
infrastructure, villainization, politicization, or disillusionment with their
roles. Along with explanations of each of these categories, the authors discuss
the overarching implications of these issues for the field and offer suggestions
for ways to address these issues.
CHARTING A PATH FORWARD
Section:
ChooseTop of pageTHE NEW VISIBILITY OF PUB...THE REALITY OF WORKPLACE
...CHARTING A PATH FORWARD <<REFERENCES
Perhaps one of the biggest take-aways from this work is that the backlash
against public health and ongoing politicization of public health mean that the
path forward for both public health leaders and the workforce is complex. It
will require navigating widespread burnout, posttraumatic stress and other
mental health issues, and disillusionment with their contributions to the
greater good. Thankfully, the authors’ thoughtful discussion and recommendations
provide a starting place for action.
One of the authors’ recommendations is to train health officials to respond to
political conflict and improve colleague support networks. This suggestion
aligns with recent findings from studies of current and former state health
officials who reported that the skills they needed the most included navigating
political processes and working with governmental leaders.6 The Association of
State and Territorial Health Officials has a leadership institute that offers
training for state public health leaders on how to navigate politics and work
with lawmakers. A similar program could be valuable for local health officials.
Recent Health Resources and Services Administration guidance for the Regional
Public Health Training Center Program requires that each training region have a
leadership institute, which may eventually provide similar trainings and
networking among local health officials. In addition, leadership institutes
should also provide trainings in health policy and advocacy, public health
science, and media management. Ward et al. note that these skills may be
particularly useful for countering the public health backlash to mitigation
efforts of protracted emergencies.7
In the context of the public health worker disillusionment that Ward et al.
identified, they recommend providing trauma-informed worker support and
establishing workplace violence reporting systems and legal protections for
public health. The authors poignantly remind us that “no public health employee
should be made to feel unsafe or devalued in their effort to protect the health
and safety of the public.” Another essential component to prioritizing worker
well-being and addressing burnout is ensuring long-term public health staffing
and infrastructure investments. Requests for public health infrastructure funds
are not new,8 and, yet, a declining infrastructure and staffing losses directly
limited public health’s ability to respond to the current pandemic and will do
so in the future if it is not addressed.2
One upside to the pandemic is that it put a spotlight on the nation’s public
health needs. Unfortunately, the pandemic also more firmly placed public health
leaders and public health science into political discourse. The pandemic will
eventually subside, and traditional public health activities will continue to be
needed. Foodborne outbreaks, multidrug-resistant tuberculosis, lead
contamination, and other such “routine” public health challenges will still
require the types of actions by public health officials that are today placing
them in harm’s way. For the sake of society at large, I hope we can find a path
to ensuring the safety and stability of the public health workforce, despite the
recent politicization of public health protections.
See also Kapadia, p. 706, and Ward et al., p. 736.
CONFLICTS OF INTEREST
The author has no conflicts of interest.
REFERENCES
Section:
ChooseTop of pageTHE NEW VISIBILITY OF PUB...THE REALITY OF WORKPLACE
...CHARTING A PATH FORWARDREFERENCES <<
REFERENCES
1. Bunker JP, Frazier HS, Mosteller F. Improving health: measuring effects of
medical care. Milbank Q. 1994;72(2):225–258. https://doi.org/10.2307/3350295
Crossref, Medline, Google Scholar
2. Baker M, Ivory D. Why public health faces a crisis across the US. New York
Times. October 18, 2021. Available at:
https://www.nytimes.com/2021/10/18/us/coronavirus-public-health.html. Accessed
January 8, 2022. Google Scholar
3. Mello MM, Greene JA, Sharfstein JM. Attacks on public health officials during
COVID-19. JAMA. 2020;324(8):741‒742. https://doi.org/10.1001/jama.2020.14423
Crossref, Medline, Google Scholar
4. Sellers K, Leider JP, Gould E, et al. The state of the US governmental public
health workforce, 2014‒2017. Am J Public Health. 2019;109(5): 674–680.
https://doi.org/10.2105/AJPH.2019.305011 Link, Google Scholar
5. Staffing up. Workforce levels needed to provide basic public health services
for all Americans. De Beaumont Foundation, Public Health National Center for
Innovations. 2021. Available at:
https://phnci.org/uploads/resource-files/Staffing-Up-Research-Brief.pdf.
Accessed January 8, 2022. Google Scholar
6. Halverson P, Castrucci BC, Moffatt S, Hancock SE, Boedigheimer SF, Baker EL.
State health officials—defining success and identifying critical success
factors. J Public Health Manag Pract. 2017;23(2):192–194.
https://doi.org/10.1097/PHH.0000000000000535 Crossref, Medline, Google Scholar
7. Yeager VA, Menachemi N, Jacinto CM, Chapple-McGruder T, Danielson EC,
Halverson PK. State health officials: backgrounds and qualifications. J Public
Health Manag Pract. 2020;26(1):9–15.
https://doi.org/10.1097/PHH.0000000000000937 Crossref, Medline, Google Scholar
8. DeSalvo K, Parekh A, Hoagland GW, et al. Developing a financing system to
support public health infrastructure. Am J Public Health.
2019;109(10):1358–1361. https://doi.org/10.2105/AJPH.2019.305214 Link, Google
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ARTICLE CITATION
Valerie A. Yeager, DrPH, MPhil Valerie A. Yeager with the Indiana University
Richard M. Fairbanks School of Public Health, Indianapolis. “The Politicization
of Public Health and the Impact on Health Officials and the Workforce: Charting
a Path Forward”, American Journal of Public Health 112, no. 5 (May 1, 2022): pp.
734-735.
https://doi.org/10.2105/AJPH.2022.306744
PMID: 35417216
Recommend this Journal to your library.
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WE RECOMMEND
1. Pandemic-Related Workplace Violence and Its Impact on Public Health
Officials, March 2020‒January 2021
Julie A. Ward et al., Am J Public Health, 2022
2. Violence and the COVID-19 Pandemic: A Public Health of Consequence, May 2022
Farzana Kapadia, Am J Public Health, 2022
3. Unanticipated Pandemic Outcomes: The Assault on Public Health
Lori Tremmel Freeman, Am J Public Health, 2022
4. Mass Exodus of State Health Department Deputies and Senior Management
Threatens Institutional Stability
Leslie M. Beitsch et al., Am J Public Health, 2019
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Rosley Anholon et al., International Journal of Public Leadership, 2020
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