LINDSAY SMITH ROGERS: Harassment online. Harassment in person. Threats of violence andeven brutality itself. In the last yearamid the pandemic, public health workers haveexperienced most direct attempts than at any time inthe previous century. I’m Lindsay Smith Rogers, creator of Public Health On Call. This week, as part ofNational Public Health Week, we’re bringing you aspecial four-part series with bouts excerpted froma webcast from last-place month. The webcast was producedin collaboration with the Association ofState and Territorial Health Officials known as ASTHO, theNational Association of County and City Health Officialsknown as NACCHO, and the Big CitiesHealth Coalition. In this serial, we will explorethe singular challenges facing the field of publichealth in the COVID era. We’ll hear from healthofficers on the front lines about their experiences, from investigates about the scale of the problem, and from the leaders of ASTHO, NACCHO, and the Big CitiesHealth Coalition about what is to be done.In part two, we hear fromDr. Beth Resnick and Paulani Mui, result researchers on theissue of the challenges facing public health officersduring the pandemic. They too kept thesecurrent challenges in the context oflong-standing underfunding of critical publichealth infrastructure. Please note that thepresentation they reference is linked in theepisode description. BETH RESNICK: Hello, I’m Beth Resnick. PAULANI MUI: AndI’m Paulani Mui. BETH RESNICK: We’re delightedto be here with you today. Paulani and I are theleads on the research team at Johns Hopkins on thisimportant public health issue, and we are looking forward tosharing our obtains with you today.So we’re now going toexamine the problem to give us somecontext and background around the leavings, harassment, and menaces of public health officials, andhow these challenges have been accelerated by recent effortsto reduce public health authority and achronic underfunding and neglect of the publichealth infrastructure. Let’s start by looking athealth official deviations, hassle, and threats. Since the start ofthe pandemic, we’ve seen a large exodus ofstate and local leaders from public health departmentsacross the country. Building on the media reports, we related 190 deviations from March 2020 through January 2021, which reflects the departures, retirements, and firings of public health masters fromboth urban areas and urban health departments of all sizesacross the country. It’s important to notethat the data here are limited to departuresof leader castes that were reported in themedia, so the actual exodus, including staff-leveldepartures, is likely much greater thanwhat we are seeing here.In addition to the uptakein lead departures, the pandemic hasalso identified an increase in menaces and violenceagainst public health officials across the country, so most probably doesn’t wonder the fullscope of what public health officials are experiencing. Of document, many of theharassment and menaces have targeted women andminority public health workers. This hassle is continuingand is not acceptable. We conducted a thematic analysisof the reported departures and persecution to examinethe common themes. The length of the words orphrases that are depicted here correspond to how frequentlythey were mentioned by public health officials. The most common themeswere direct threats against, or harassmentof, the health officials and their familiesor their personnel, affirms at the homesof the health officials, reaction against publichealth protections, and likewise a lack of supportfrom state or regional elected officials. To better understandthe experience of being a publichealth official in the midst ofthis pandemic, here are some thinkings in thehealth officer’s own messages about what they are facing.”I am sad. I am tired. There was anugliness and ruthlessnes in our national rhetoricthat should worry us all. I was junked onFacebook, like every day. My babies were accosted at academy. My wife was accostedat the food market. I felt myself crying thatthings wouldn’t get any worse. Threats around weapons andabout stringing beings up. Statements about thefact, precisely based on what we looklike, we patently weren’t state professionals andshouldn’t be listened to. Our staff, and particularlyour female faculty, are met withhostility at a stage that we have never seen before. They are doing their profession. They are doing whatwe’ve asked them to do. Imagine if objectors indicated upat the home of the barrage premier to protest the way theywere organizing a fire.But that’s exactlywhat’s been happening to regional public healthofficers as they strive to do their job based on science.” So as noticeable fromwhat I have just presented to you, thisharassment and threats are a thriving issuethat’s stymieing the ability of ourpublic health chairwomen to protect the healthof our community at this time when theirexpertise and leadership is needed most. Now you’re going tohear from Paulani Mui about some otherunderlying factors that are acceleratingthis problem. PAULANI MUI: Thanks, Beth. I’m now going to discuss howthis issue has been further affected both by a neglectedpublic health infrastructure, as well as attempts tolimit public health supremacies. I’ll start with efforts toreduce public health authority. As was mentioned by a formerlocal state detective, political disagreementsand gamesmanship have contributed to increaseddisrespect and dislike for public healthleaders, as well as calls for retraction ofevidence-based public health guidance. As of December, at least 24 countries have filed billsthat would limit governmental public healthpowers at both the mood and local levels, includinglimits on quarantine, contact drawing, inoculation requirements, and disaster executive powers.And while others are ofthe monies disappointed, others are currentlyunder consideration. And now that numerous statelegislatures are back in period, additional effortsto roll back public health protections may be underway. Should these effortssucceed, health bureaux could lose legalauthority that is essential for theprotection of communities from disease and illness. Another contributingfactor to the challenges health bureaux arefacing is neglect of our public healthinfrastructure at all levels of government. Underinvestment inpublic health is not new. At the federal height, thePrevention and Public Health Fund established as partof the Affordable Care Act to help improve and sustain ournational public health system, has viewed a 50% cut in fundingsince its creation in 2010, with fund shiftedto other platforms, as well as the payroll tax chipped, instead of its intended use for public health. Disinvestment in publichealth likewise extends to state and localgovernments, specially since the Great Recession whenpublic health plans were cut and was ever replenished. This infographic depictshow public health spending in most states has stagnatedor declined since 2010. As to be noted by aformer health policeman, public health has beenchronically underfunded compared to fire departmentsor other agencies tasked with emergency response. In addition, thenation is facing growing public health challengeswith a expended public health workforce. State and localpublic health authorities have lost more than4 0,000 importances since the GreatRecession, amounting to more than one fifthof the total workforce. In comparison to the 2009 H1N1 pandemic response, we’re now fighting COVID-1 9with a smaller public health workforce hitherto having to meetthe needs of a larger and more diverse population. A year into this pandemic, our public health bureaux continue to be elongated thinwithout suitable reinforcements or tide faculty tosupport the response. Our public health workersare overworked, overwhelmed, and physically andmentally spent. We need timely and efficientdetection and response, yet our publichealth enterprises are saddled with fragmented andoutdated data systems, as well as technology, along withinsufficient capacity to collect and report data. Countless healthdepartments are still forced to rely on paper-basedrecords, faxes, and manual data entry.And as you can seehere, more investment is needed in order to modernizeour nation’s public health system. I’d like to leave you all withthis quote from health policeman Dr. Matt Willis on the currentstate of public health. “We’re all left scramblingat the local and state level to extract resourcesand improvise mixtures in a fracturedhealth care system, in an under-resourced publichealth system. ” Thank you. LINDSAY SMITH ROGERS: Thesedata are incredibly valuable. One of the most importantaspects of addressing a problem is really understanding it. Tomorrow, we’ll hearfrom three public health patrolmen about some potentialsolutions to turn the corner. JOSH SHARFSTEIN 😛 ublic Health On Call is produced by JoshSharfstein, Lindsay Smith Rogers, and Stephanie Desmon. Audio production by SpencerGreer, Niall Owen McCusker, Cian Oatts, and Matthew Martin, with supporter from Chip Hickey. Distribution by Nick Moran. Production supportfrom Catherine Ricardo and Neiman Outlen. Social media corroborate from BrendaHageter, Grace Holz-Fernandez, and Caroline Wang. Thank you for listening.