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Restoring Trust in
Restoring Trust in Public Health
STATE HEALTH OFFICIALS HOPE TO REESTABLISH CONFIDENCE IN THE PUBLIC HEALTH SYSTEM FOR FUTURE GENERATIONS
by Michael Fraser, Chief Executive Officer, Association of State and Territorial Health Officials (ASTHO)
The COVID-19 pandemic brought much devastation and loss to our nation. Far too many people perished and far too many lives were altered — damages that have forever changed the landscape of our nation and our world. The pandemic has been unprecedented in terms of its scope, magnitude and impact on our way of life and — perhaps most revealing — the vulnerability of our public health system. COVID-19 has tested our nation’s public health and health care capacity, and many early challenges were a result of a fragile public health infrastructure that has been crippled by years of neglect and underfunding. While Congress has appropriated historic investments in our public health system to help governmental public health “build back better,” they have limited capacity to address even more alarming trends that have been the result of COVID-19: the politicization of public health decision-making and the public harassment many public health leaders experienced after recommending mitigation measures such as mandatory mask wearing and other public health protections. These new investments in public health capacity building will need to be complemented by new initiatives to restore trust in public health leaders who have been stifled, disrespected, disregarded and left out of critical discussions and decision-making.
Harassment of Public Health Officials
Unfortunately, many public health practitioners became scapegoats for people who were angry at having their daily lives curtailed to slow COVID-19 transmission, and they experienced pushback for recommending that people wear masks and practice social distance or for suggesting that we follow the science. Protestors, including some who were armed, gathered at the private residence of Dr. Amy Acton, Ohio’s former health director. Another state health official had to have police protection when she left her house, even just to walk her dog. Public health leaders received death threats, were harassed at public meetings and have been recipients of hate speech about their gender, religion, and other identities. As a result, there have been significant turnovers in public health leadership nationwide. For example, since the start of the pandemic, 18 of the collective 59 state and territorial health officials have left office, with at least 33% of this turnover attributable to conflicts with elected officials and/or threats of physical harm/harassment from the public. Similarly, at the local level, 30% of the 37 county/city health officials who have left office during the pandemic did so because of COVID-19 response conflicts with local politicians or the public. This means that many public health agencies responsible for protecting the public's health are experiencing disruptions in leadership during the most challenging public health event of our lifetime.
Building Back Better
As we reflect on the scope of these transitions and the open harassment of public health leaders, we must ask: How do we restore respect for public health decision-making and how can we rebuild public trust in public health for the next generation of Americans? Millions of people depend on our governmental public health system, an invisible web of protections that keep us all healthy every day. COVID-19 made that invisible web much more visible: few people even knew who their state health officers were prior to the pandemic, and now they are featured prominently in local, state and national news. Fewer knew the critical state of our public health infrastructure until now. Unfortunately, over the last year, we have all witnessed a public health system that was overwhelmed by the global pandemic. Despite the challenge, public health and health care workers all served essential roles in the battle against COVID-19, often sacrificing their own health in order to protect the health of others.
To honor the sacrifices of these professionals, we must rebuild our public health system with a renewed commitment to innovation and collaboration. We must work as partners to provide effective vaccines, drugs and diagnostics and invest in the systems to distribute them while simultaneously protecting and promoting the health of all Americans. We must intentionally remove the pervasive and systemic health inequities that keep many from enjoying optimal health and wellness. And we must prioritize key functions and resources that every local and state public health system must have to be effective and create resiliency. There is much more work to be done, and we must all actively engage in addressing these challenges to end the pandemic and begin the process of restoring confidence in our public health system. Together, we can use the pandemic as a catalyst for transformation of our public health system and work to change public policies, attitudes and behaviors. By doing so, we can build a more trusted and robust public health system that is prepared to handle the next public health crises.
At least 33% of this turnover results from conflicts between the health official and elected officials or threats of physical harm and/or harassment from the public.
At the local level, 37 county/ city health officials have left office during the pandemic.
30% of those did so as a result of COVID-19 response conflicts with local politicians or the public.
