Respect must be earned, even during a pandemic.
The Kaiser Health News article “Public Health Officials Are Our COVID Commanders. Treat Them With Respect.” was the lead story in the Sept 2, 2020 AcademyHealth email blast. It jumped out at me immediately, particularly the word “Commanders.” Even though I’m a PhD candidate in Health Policy and Management, I tend to come at areas other than my specific field as a consumer, patient and citizen rather than an expert or researcher. As my background is actuarial work and the economics of insurance, public health is not my specific field. However, as a citizen, I find the article quite troubling if it accurately represents how public health officials view their role and the public.
The author seems to focus narrowly on the virus and ignore the enormous consequences to health and mortality of shut downs and other restrictions. Suicides, drug and alcohol abuse, and domestic violence are up considerably compared to prior years (see here and here). Social isolation, unemployment and loss of income have well-documented effects on morbidity and mortality (1,2 and here). Care has been delayed or foregone due to government allowing only the most urgent problems to be treated during shut downs, and due to patient fears of contracting the virus in a health care setting (3,4). Shouldn't health consequences of shut downs receive attention from public health officials? People who die from consequences of shut downs are just as important and just as dead as people who die from the virus.
The author uses fear to manipulate the reader. She writes, “People are dying every day as a result of government decisions — and indecision — and the death toll is climbing with no end in sight.” In truth, current hospitalizations and deaths had declined significantly by the time of her writing (see here and here). Why is she trying to scare us?
She uses the analogy of being at war, yet members of the public are not cogs in some war machine. We are not all the same. We are individuals with unique health concerns, risk preferences and personal situations; we are thinking people who should be allowed to make our own decisions, particularly when so much is not known about the virus and the consequences of prolonged shut downs are so dire.
Rather than viewing the public as children to be commanded and viewing yourselves as experts who have all the answers and know what’s best for everyone, I’d like to suggest that public health officials view the public as competent and themselves as public servants. Ever hear of servant leadership? To earn the respect of the public, I recommend the following actions for public health officials:
Approach the role of public health as educating the public and providing evidence about the virus and possible actions we could take to protect ourselves
Acknowledge that much is not yet known about the virus, and acknowledge that actions to slow the spread or reduce mortality due to the virus have health and mortality consequences that should not be ignored
Acknowledge that public health and other government officials have made many mistakes and missteps, such as numerous testing and reporting problems (for examples click here, here and here), even conflating the effects of the pandemic with the effects of government response to it as was done by both esteemed health care leaders in this webcast.
This has been a very difficult situation for everyone, and guidance and education from public health officials could be valuable. But when you use fear mongering to secure our compliance, when your guidance flip flops for no reason (masks being the most egregious example) or lacks evidence, yet you insist on mandating the same onerous restrictions on everyone everywhere subject to jail time and stiff fines, regardless of one’s health or business situation or even how prevalent the virus is in an area, please don’t act surprised when the public does not respect you.
(Of course, threatening public health officials is not ok and should not be tolerated.)
1. Hollingsworth A, Ruhm CJ, Simon K. Macroeconomic conditions and opioid abuse. J Health Econ. 2017 Dec;56:222-233. doi: 10.1016/j.jhealeco.2017.07.009. Epub 2017 Aug 23. PMID: 29128677.
2. Stern J. The relationship between unemployment, morbidity and mortality in Britain. Popul Stud (Camb). 1983 Mar;37(1):61-74. PMID: 11630873.
3. Masroor S. Collateral damage of COVID-19 pandemic: Delayed medical care. J Card Surg. 2020 Jun;35(6):1345-1347. doi: 10.1111/jocs.14638. Epub 2020 May 17. PMID: 32419177; PMCID: PMC7276840.
4. Ciacchini B, Tonioli F, Marciano C, Faticato MG, Borali E, Pini Prato A, Felici E. Reluctance to seek pediatric care during the COVID-19 pandemic and the risks of delayed diagnosis. Ital J Pediatr. 2020 Jun 29;46(1):87. doi: 10.1186/s13052-020-00849-w. PMID: 32600464; PMCID: PMC7322712.