For more than a year, the nation's public health professionals have logged long hours and worked weekends to protect the public during the COVID-19 pandemic. But the recent high-profile termination of a Tennessee physician has put a spotlight on how often this dedication is met with ingratitude — or worse.
Dr. Michelle Fiscus served as that state's medical director for vaccine-preventable diseases and immunizations. On Monday, the Tennessee Department of Health fired her. In response, Fiscus released a fiery letter, saying she was let go for political reasons after doing vaccine outreach to teens. She wrote that she "became the 25th of 64 state and territorial immunization program directors to leave their position during this pandemic."
While an editorial writer was unable to confirm those exact statistics, there is strong evidence that scores of experienced public health staff have left during the pandemic. "At least 181 state and local public health leaders in 38 states have resigned, retired or been fired since April 1," concluded a joint investigation by the Associated Press and Kaiser Health News (KHN) that was published in December. "According to experts, this is the largest exodus of public health leaders in American history."
The numbers are alarming and require remedy. Even when there's not a pandemic, public health staff at the state and local levels do vital work. They track outbreaks, prevent chronic diseases, combat injuries and violence, ensure safe drinking water, do food safety inspections, monitor health facilities and run newborn screening programs, just to name a few responsibilities.
The public is best served when talented, experienced people lead these efforts. Shrinking funding made this a challenge well before COVID. "Since 2010, spending for state public health departments has dropped by 16% per capita and spending for localhealth departmentshas fallen by 18%," according to the Associated Press and KHN. "At least 38,000 state and local public health jobs have disappeared."
The pandemic has unfortunately added to the difficulty. Public health officials have been threatened to the point where they've needed security details. Or they've been subjected to criticism that crosses over to abuse. Officials' advice, such as masking or social distancing, also is too often disregarded by those who deride COVID as a hoax.
It's little wonder that when public health officials decided earlier this year to survey how this workforce is doing, the resounding answer was "not good." The results appeared in a July 2 article in Morbidity and Mortality Weekly Report. Minnesota State Epidemiologist Dr. Ruth Lynfield is among the article's authors.
More than 26,000 state, tribal, local and territorial public health workers responded. One troubling finding: "53.0% reported symptoms of at least one mental health condition in the past 2 weeks." That's significantly higher than a previously reported 40.9% prevalence in the general population.
Lynfield, in an interview, was struck by other data points. About 72% reported feeling overwhelmed by workload or struggled with work/family balance. Almost a quarter of respondents said they had felt "bullied, threatened or harassed because of work." Nearly 12% said they had received threats because of their job.
Minnesota's public health corps hasn't escaped. "Components of the public have not been enthusiastic about mitigation measures,'' Lynfield said. "We have experienced a lot of bullying and that is new. Every once in a while we might have had a nasty e-mail or phone call. It has become more routine."
Minnesotans need to do better at expressing their differences more constructively. Policymakers also need to consider remedies to retain the state's world-class staff.
State lawmakers authorized $250 million in bonus pay for the pandemic's front-line workers. It appears the definition of that workforce could include public health as well. A high-profile public "thank you" would also help combat burnout and keep talent from leaving.