Initial survey findings of PH WINS 2021 released in March 2022 revealed high levels of stress, burnout, and intent to leave among the governmental public health workforce during the COVID-19 pandemic. 

COVID is not over. Will it ever be? We are clearly still coming to grips with it – as a field and as a society – what it meant and what it means. Studies are still coming out periodically that leave us feeling both enlightened and frustrated, and it is interesting to see how the public responds. Before COVID, I don’t think I ever would have seen this discourse in a space where I work with such frequency. Public health and public health systems were just never in the limelight in this way. But recently, I saw Topazian et al’s article on public perception around bullying harassment of public health professionals, which was published in JAMA Network Open at the end of July (with an excellent accompanying editorial by UMN’s own Sarah Gollust), and Minnesota’s largest newspaper devoted an editorial to the topic. So, naturally, I read the comments.

Was it an unmitigated disaster? Yes. Was it instructive? Also yes. This was another place where frustrations with the public health response to COVID boiled over, where ‘changes’ to science were re-litigated, and where people said it was not fair or right, how much was asked of them. And, I will say, plenty of defense of public health. Which was a bright spot in the general ugliness of internet comments. My fault for going swimming in a swamp.

COVID response has been a singular challenge in my career, and I’m not on the frontlines. I have happily, or begrudgingly, spent nights and weekends over the past 2.5 years working on Minnesota’s response and national issues, but I don’t work at a health department doing what public health practitioners do, day in and out, protecting and promoting the public health. I have received only the tiniest bit of mean-spirited criticism for my COVID work so far (it doesn’t even amount to harassment), and no threats. And it is still unpleasant, and I still wish people were more understanding. I have friends at health departments dealing with this stuff every day, who are burnt out and thinking of leaving. The stories I hear are ludicrous, and I know I haven’t heard near the worst of them.

Public health doesn’t have it the WORST, but has it pretty bad.

There was a news story in my state a couple months back about how one-fifth of rural health care providers were thinking about leaving or retiring in the next few years. That’s bad. We should do something about that. But it’s almost twice that for public health workers (Figure). It’s not as bad as nursing homes, or food service, but I’m not sure anything is, and I’m not sure if it’s fair or reasonable to compare public health to those occupations. COVID is weighing on us as a field. It’s not tenable. How could it be? As the Minnesota Commissioner of Health points out in that editorial, there is something traumatic in seeing just what fellow residents and citizens think is acceptable in public discourse after public health has committed so much to COVID response. And I have to say reading these comments, they are hard to read, but they are instructive in that they are a microcosm for challenges that we face as a field.

The frustrations I sometimes hear in my neighbors’ voices are real, and that’s what I saw again in the comments in my local paper’s editorial on bullying. Some feel too much was asked of them during COVID response, that they didn’t get enough in return. That public health professionals were not equipped to communicate (or, in their view, did a bad job at it). That the threats of the vaccines are greater than COVID itself. I may not think those are necessarily valid, sound, scientifically supported, or reasonable criticisms, but I do think some feel that way, and so should be taken seriously – and some sentiment should be taken more seriously than others.

Could we work on crisis communications? Resource public health better? Be more consistent and harden our public health science against political whims? Absolutely. Can we guarantee that the science doesn’t “change” during a pandemic? No, but we can probably be more considered, and consistent. But more consideration and kindness in return is both appreciated and necessary. Appreciated in that it is the decent thing to do from a reciprocity perspective. Necessary because, if society doesn’t treat public health practitioners better – even though practitioners have high rates of job satisfaction and feelings that their job is important – they will continue to burnout and leave the job, leaving us all less the safe for it.