What Goes into Decision Making by State Health Officials in a Public Health Emergency

This entry is part 2 of 11 in the series Nov 2023

Decision making by state health officials in a public health emergency is a complex and critical process involving many variables.

In our article titled, “Understanding Factors Influencing Decision Making by State Health Officials in a Public Health Emergency” my colleague, Michael Fraser and I set out to explore how State Health Officials (SHOs) make critical decisions in a public health emergency.

To examine this question further, we developed an 11-question interview guide to gain insight into the various public health emergencies that the SHOs have responded to in the past, the leadership determinations they used in these responses, the organizational responses that they have led and issues that have impacted their responses.


The findings from the interviews with State Health Officials (SHOs) highlight several important points regarding their experiences during public health emergencies, particularly the COVID-19 pandemic:

  • Significance of the COVID-19 Pandemic: The unanimous mention of the COVID-19 pandemic as the most complicated public health emergency underscores the unprecedented nature and global impact of this crisis. It likely placed tremendous pressure on SHOs and their respective state health agencies.
  • Lack of Decision-Making Tools: The fact that SHOs did not have a specific decision-making tool to rely on during the COVID-19 pandemic indicates a potential gap in preparedness. Public health emergencies require quick and well-informed decisions, and having a structured tool or framework can be invaluable.
  • Consensus-Driven Decision Making: The use of a consensus-driven decision-making process suggests that SHOs relied on collective input and collaboration with their teams and possibly other stakeholders. While consensus is valuable, it may also lead to delays in decision making, especially in fast-evolving crises.
  • Need for a Decision-Making Tool: The identification of a need for a step-by-step decision-making tool is a critical finding. Such a tool could provide SHOs with a systematic and efficient approach to decision making during public health emergencies. It can help ensure that important considerations are not overlooked, and decisions are made in a timely and well-informed manner.
  • Methodical Approach: The potential for a decision-making tool to lead to a more methodical approach is significant. Methodical decision making can enhance consistency and effectiveness in response efforts, reducing the risk of ad hoc or inconsistent decisions during crises.

Click to Read the Article

Overall, these findings emphasize the importance of preparedness and support for State Health Officials in their roles during public health emergencies. Developing and implementing a decision-making tool tailored to the unique challenges of such emergencies could be a valuable step in improving the response and management of future crises at the state level. It can help SHOs make more informed and timely decisions, ultimately benefiting the health and well-being of the population they serve.

To learn more, read our research article, “Understanding Factors Influencing Decision Making by State Health Officials in a Public Health Emergency” in the November issue of the JPHMP.

Author Profile

Raphael M. Barishansky
Raphael M. Barishansky, DrPH, is a public health and EMS leader with more than 30 years of experience in a variety of systems and agencies in positions of increasing responsibility. Currently a consultant providing his unique perspective and multi-faceted public health and EMS expertise to various organizations, his most recent position prior to this was as the Deputy Secretary for Health Preparedness and Community Protection at the Pennsylvania Department of Health, a role he recently left after several years.
Mr. Barishansky recently completed a Doctorate in Public Health (DrPH) at the Fairbanks School of Public Health at Indiana University. He holds a Bachelor of Arts degree from Touro College, a Master of Public Health degree from New York Medical College and a Master of Science in Homeland Security Studies from Long Island University. Barishansky is also currently adjunct faculty at the Temple University Master of Public Health (MPH) program as well as University of Maryland Baltimore County (UMBC) Emergency Health Services (EHS) master’s program. His publications have appeared in various trade and academic journals, and he is a frequent presenter at various state, national and international conferences.
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