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More than a third of local and state public health officials who resigned or were fired in the first 10 months of the COVID-19 pandemic reported incidents of workplace violence such as threats, harassment, and intimidation, according to a mixed-methods US study yesterday in the American Journal of Managed Care.
The Johns Hopkins University researchers analyzed 583 responses to a survey sent to 2,430 public health department members of the National Association of County and City Health Officials, media and social media content, news releases, local board of health meeting minutes, personal correspondence with journalists and health departments, and publicly reported position departures from March 2020 to January 2021.
Public health officials found themselves thrust into the limelight as often-unpopular public health measures were instituted to quell the pandemic, the researchers said.
By June 2020, media reports of social media insults, public distribution of personal information (doxing), protests, and threats of violence against public health officials began to emerge. In August, conflict-related resignations and firings also started to surface.
Social media backlash, angry messages
The survey revealed at least 1,499 harassment incidents from 335 departments (57%). The most common type of harassment occurred on social media, with 296 departments (51%) reporting incidents, 194 of them targeting local department leaders. The second most-cited threat targeting individuals was messages containing indirect threats (30%).
Nationally, 222 public health officials (36%) left their positions due to resignation (120), retirement (58), firing (20), or another action (24). Another 34 threatened to leave but didn’t.
The departures occurred in 42 states and involved 51 state and 205 local health officials. Thirty-two agency leaders from 25 local jurisdictions quit or were reassigned or fired because of political pressure or conflict. A sustained spike in retirements began in May, and resignations peaked in July and December.
Overall, 253 of 583 local respondents (43%) reported at least one form of harassment targeting leaders. Likewise, media content showed that 112 of 256 state and local officials (44%) described experiencing one or more forms of harassment. Eighty of 222 officials (36%) who left their positions reported harassment.
Threats to individual or family safety affected 9% to 12% of officials and 15% of departments. Role departure was tied to a third of the 30 state and local cases involving direct threats, and protests at private homes were reported in 2% of media cases, targeting 2% of survey respondents’ leaders and affecting 2% of local departments.
Media reports showed that doxing affected about 3% of all officials, while the survey showed that it affected 7% of local officials. One state official departure was linked to a residential protest and doxing.
Social media backlash (eg, Facebook demands for firings, criticism, personal insults) and individually targeted messages (eg, emails or phone calls saying the official was evil or using racial or gender-based slurs) were reported by a larger proportion of survey respondents than was reported by the media.
The officials described disillusionment due to disrupted work-life balance, structural and political undermining of their professional duties, marginalization of their expertise, social villainization, politicization, a “matchsticks and Scotch tape” infrastructure, outdated technology that complicated contact tracing, and a lack of appreciation and support. At least 90% of respondents said they had personally experienced or observed one of these issues. Many affected respondents remain in their positions.
“They identified multiple public health issues as co-occurring with the pandemic, including extreme weather events, an influx of vaping-related injuries, and calls to action on longstanding social inequities,” the researchers wrote. “All these emergent issues demanded public health expertise, yet public health officials believed their responses to these needs were underappreciated, criticized in personal attacks, and further constrained by forces beyond their control.”
From trusted public servant to villain
Overall, most leaders were White and women. Black and Asian leaders were disproportionately affected (26 of 256 [10%]), and local cases were overrepresented in the Midwest (75/205 [37%]) and West (83/205 [40%]), while state cases were overrepresented in the South (18/51 [35%]).
Roughly half of local cases occurred in rural jurisdictions (110/205 [54%]). Policy precipitators of leadership turnover weren’t identified in most cases, but when they were, mask mandates and multiple COVID-19 prevention policies were the most mentioned. Policy-associated departures tended to be from local departments (76/205 [37%]) rather than states (11/51 [21%]).
“Particularly in rural communities, health officials described challenges in being the public representative of a policy that was not always within their authority to decide,” the authors wrote. “The role of the villain…was often juxtaposed with the official’s previous persona as a public servant and a trusted community member.”
In a Johns Hopkins press release, senior author Beth Resnick, DrPH, called the findings “a wakeup call for the field about the need to prioritize the long-term protection of our public health workforce.”
“Taking care of the workforce needs to be a fundamental component of the public health infrastructure that doesn’t end when the pandemic does,” Resnick added.
The study authors said that health officials are public servants with the responsibility to protect and promote health in their jurisdiction, including the creation and implementation of laws that affect health.
“Thus, for public health officials, residents of their jurisdiction are analogous to patients in a health care setting,” they wrote. “In health care settings, such as emergency departments, nonphysical workplace violence perpetuated by patients has been associated with reduced job satisfaction and burnout.”
The researchers called for interventions in order to have a sustainable public health system. “We recommend training leaders to respond to political conflict, improving colleague support networks, providing trauma-informed worker support, investing in long-term public health staffing and infrastructure, and establishing workplace violence reporting systems and legal protections,” they wrote.
Resnick said that no public health professional should feel undervalued or unsafe or be left to question the fundamental mission and purpose of their work. “We need to do better and prioritize worker well-being and safety by implementing policies that reduce undermining, ostracizing, and intimidating behaviors to support these key workers and leaders,” she said.
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