Victimizing Health Professionals: How Lifesaving Heroes Became Lifesaving Villains During the Pandemic
What We Can Learn About Health Policy Landscapes: Workplace Violence, Public Health Officials, and Public Policy Theory
By Daniel Hermansen and Shatarupa Dey
December 16, 2022
Lifesaving Villains | The Landscape
Without frontline workers’ unceasing assistance and support, the world would have collapsed during the COVID-19 pandemic. Interventions were required to reduce the risk of intimidation, ostracization, and undermining in times such as ours. Effective political and public sector leadership in health policy, lobbying, and media management helped dispel messages of undervaluation of important health professionals and can help increase effective health policy.
Public health officials and medical professionals faced and still face quite an arduous task of successfully managing public health during times of crisis, such as the recent COVID-19 outbreak. Nothing is worth doing or has been easy, and there lies the challenge. They experienced increased levels of negative behavior towards them during the pandemic. These contributing members of society were treated by some as “lifesaving villains.” We believe that they also became “lifesaving victims.”
Perception and overall public opinion of government officials are widely studied. The COVID-19 pandemic changed many people’s views on healthcare professionals and has resulted in many new studies on the subject. Backlash towards health professionals for suggesting and taking steps to safeguard communities from COVID-19 was unprecedented in its breadth and intensity; it took many forms; however, social media was a particular channel used in the ongoing public response to the pandemic.
Reflecting on our experience, the information influx and divisiveness during the pandemic augmented misunderstandings, infused competing perception biases about risks, and led to a broader deterioration in public civility. Some of these factors jeopardized easy fixes to the broader problem of the pandemic. For example, the basic mistreatment of health professionals brought public health policy to the forefront of day-to-day life for Americans, just to add to the difficult challenges faced by all.
Public health interventions during the pandemic were critical. Health departments, under the aegis of the federal government, performed critical functions (e.g., data reporting, testing clinics, contact tracing). There were many challenges that they faced: barriers to exchanging information, operational silos, a lack of disaggregated data, insufficient training, and limited capacity. These are indicative of larger design flaws. The pandemic also illustrated a potential lack of investment in America’s public health system. On top of all of these challenges, perhaps the most difficult to overcome was public outrage. This ranged from workplace violence, threats, intimidation, harassment, and physical assaults directed at people within the healthcare industry. Beginning in June 2020, journalists began documenting incidents against those in public health.
Reports of verbal abuse on social media, various public information campaigns (private information becoming public, aka “doxxing”), demonstrations, and armed threats against public health officials rose. The backdrop for new interest in the “public health official” was obvious to everyone.
Punctuated Equilibrium | The Rising Role of Health Policy
Punctuated interest in quarantine, social distancing, shutdown, stay-at-home, and reopening was a key component to why health professionals were at the forefront of our lives as health policy rose in the general political landscape.
This graph demonstrates one core element from Punctuated Equilibrium Theory (PET). While PET is typically applied to budgetary changes, it generally seeks to explain how policy areas undergo incremental versus rapid, or punctuated, changes. As most policies are often created and implemented incrementally, dramatic shifts may occur. Sometimes the causes of these events are known as “external events” because they are outside of institutional control.
The COVID-19 pandemic is one of these external events that impacted the policy equilibrium. The purpose of this model is to demonstrate the impact that health policy is having on the lives of everyday Americans. Perhaps increased focus on health policy will lead to more focus on their actions, inactions, and treatment- for better or worse. This is the landscape in which the “lifesaving villains” and victims were essentially born.
While PET embodies many comprehensive components, it helps contextualize the “interest over time” model above. Before COVID-19, there was stasis. If one were to expand the years in view, one would also find equilibrium before COVID-19. After the main punctuation in the middle of 2020, there is a return to relative normalcy, though the punctuation still exists, and we have yet to return to our pre-COVID-19 trends. This narrow application of PET is best illustrated with other public policy theories such as Social Construction Theory (SCT) in considering the impact on health officials and the landscape in which they faced.
What Types of Social Constructions Were Created?
Social Construction Theory (SCT) is a core theory in public policy and can help further illustrate our pandemic landscape. COVID policies were influenced a lot by the public’s perception of the pandemic. SCT explains how social group dynamics impact policy choices and value judgments about those social groups, which are at the foundation of public policies.
This includes policymakers, the public, and the media. It aims to explain how “deserving” different social groups are of receiving help from the government. The power and perception of these groups are vital components of framing. For example, in framing a policy, attacking a highly advantaged group, such as medical professionals, is more challenging than attacking deviant groups, such as drug addicts. This is a fairly simple illustration, although distinctions can become more or less challenging depending on the political environment, as we will see next.
The table below accurately depicts how major social constructions can work from the public’s point of view. Health officials typically experience High Power and Positive Construction. Nevertheless, the pandemic landscape may have altered this; they may have remained in the High Power assignment (because they were the ones still making health policy decisions), but they received a more Negative power construct, in the perceptive components of the theory. They were negatively constructed by the treatment they received from patients and the backlash from the public, as will be demonstrated later. It is important to note that health officials still remain broadly respected in the larger sense of the theory.
During the pandemic, the public often disregarded expertise, staffing, information demands, and infrastructure capacity as the public created stressors. An uptick in health professional resignations also rose as soon as August 2020. Many of these factors were not on the radar before the pandemic. As healthcare officials saved lives, they were also painted as villains. This led to healthcare personnel becoming more emotionally spent, exhausted from the lack of staff in hospitals, and frustrated by the patients’ increasing cynicism and anger.
Amy Arlund, a nurse in a Fresno, California, intensive care unit, claimed that “our patients don’t trust us anymore.” She further states, “A year and a half ago, the emotion that came with the influx of these patients was sympathy, empathy, remorse, guilt — and that well of emotion has dried up. What is left is anger and hostility and mistrust.” Hence, the name “lifesaving villain” was coined in a study by the American Journal of Public Health (AJPH).
Protecting and promoting the health of all populations is easier said than done. Drafting, supporting, and implementing policy is a core component of the work of legislators and public health officials at all levels of government. Public health officials have a lot to consider in this process. Workplace violence, for example, comes in many forms, one of which is non-physical workplace violence. Nonphysical violence generally occurs through harassment or threats, in this case from the public, ranging from patients to demonstrators in public spheres.
This type of violence was, and continues to be committed by patients and has been linked to decreased job satisfaction and burnout, especially in emergency rooms. Notably, the experiences and effects of this violence often remain unknown. The unknown makes addressing this policy area even more difficult. For example, it is often unclear how these interactions might influence existing job satisfaction, morale, and turnover. This landscape is at the forefront of many studies.
Many would agree that health officials and medical professionals are often considered a strong and privileged social group. Saving lives, promoting public health, and earning respect are typically associated with those in these professions. However, the public and the media seemed to paint many as lacking expertise and unable to solve the problems they were trained to do, as mentioned earlier. Health policy was thus at the forefront of the public mind, for better or worse.
In this way, health professionals and officials were not only directly affected by the actions of the patients on an individual level. Perhaps they have lost some power and positive construction as an advantaged social group, albeit temporarily. Time will tell. It seems as though things have tapered off as we have learned more about the pandemic and vaccines; this has seemingly taken some of the heat off of health officials. Similarly, the narratives surrounding health officials have played a key role in further shaping the landscape.
Narratives: Impacts on Health Officials
Leaders play a critical role in every organization. Public perception often shapes how those leaders are viewed and subsequently treated. Related to SCT, the Narrative Policy Framework focuses on how stories are told. They usually contain a setting, characters, plot, and morals.
The narrative surrounding health officials developed from “heroism” pre-COVID-19 to one of “villainy.” It caused many health officials to reconsider their longevity in the field. The narrative of being life savers in their typical setting often did not seem as “helpful” as it once did, as indicated by the harassment and threats they received. Of course, there is more to this as lives were in jeopardy; in any case, the pressure was unsurmountable.
The pandemic significantly impacted leadership turnover. According to national reports, research finds a lot of leadership turnover in the public health sector between March 2020 and January 2021.
During this time, harassment reports against public health officials rose. One study surveyed 583 local health departments (LHD). Reports of specific targets and types of harassment were found in 57% of the participating departments. While this is a post-hoc view of these experiences, they were nonetheless at the forefront of these organizations as it seemed like we could not get enough help from health officials mid-pandemic.
LHD officials were impacted, whether specifically targeted or in charge of the operations of an affected department. Officials who were surveyed reported being targeted in 43% of cases. This same study identified 222 public health officials who left their positions between March 2020 and January 2021.
It was also found that allegations of harassment accompanied 36% of departures. Of course, you must still consider how the connection between leadership departures, harassment, and personal threats might not be as clearly defined as the survey data might suggest. Whether or not the health officials knew the data “behind” their landscape, it affected them very heavily.
In any case, the same study found many public health officials who received personal threats did not resign. Specifically, only ten safety threats led to leadership changes (4%). This is interesting because 15% of departments and 9% of surveyed officials reported direct threats to personal or family safety.
As pointed out earlier, harassment and turnover are strongly linked. A national survey of 583 LHDs found roughly 1499 reports of harassment in 57% of the participating departments and 43% of individuals reported being targeted between 2021–2022. Health officials were affected so drastically by the landscape of the pandemic.
Whether directly targeted or responsible for an affected department’s operations, LHD officials were impacted. Between March 2020 and January 2021, roughly 2500 state health departments (SHD) and LHDs experienced 222 public health officials who left their positions. However, many public health officials who experienced personal threats did not resign.
A Center for Disease Control and Prevention survey of more than 26,000 public health workers in April 2021 identified symptoms of mental health conditions among half of the respondents, including 37% with symptoms of post-traumatic stress disorder.
While post-traumatic stress disorder may not lead to turnover, it is likely to be a predictor of burnout, which may also lead to turnover. The narrative surrounding the health officials has been painted very differently by the public and the officials themselves, as they have reconsidered many areas of their day-to-day profession. The undesirability of being a victim of becoming a burnt-out lifesaving villain has been a consequence of the policy punctuations, the social constructs, and narratives on national and sub-national levels.
The Future
There are many challenges and successes that health officials face. There are areas that they handle well and should continue to pursue in the future. Many leaders and staff stayed in their positions despite the direct threats or violence. Health officials have believed that their expertise was under-recognized and underappreciated. Ongoing surveys may eventually return to the equilibrium of satisfaction in their important role in shaping health policy. While health officials shape policy, their future actions will also impact the scope and impact of medical practitioners.
As health officials felt limited by poor infrastructure, politics, and the public’s backlash, they struggled with personal and professional disappointments. They were torn between what they thought they should do and their ability to pursue it. For some, the conflict was a challenge. As we advance, health officials have mentioned the need for a renewed commitment in light of the workplace violence that they have faced.
The challenges and successes made health officials highly visible and accessible to the public as they were ready to react to policy changes, sometimes to the point of villainization. There will be an expanded role for increased safety without undermining public safety and developing more robust public health networks despite the challenges.
Without frontline workers’ unceasing assistance and support, the world would have collapsed during the COVID-19 pandemic. As such, interventions were required to reduce the risk of intimidation, ostracization, and undermining in times such as ours. Effective political and public sector leadership in health policy, lobbying, and media management helped dispel messages of undervaluation of important health professionals and can help increase effective health policy. Although it is quite an arduous task, nothing worth doing is or has been easy, and therein lies the challenge. The use of public policy theory will continue to contextualize discussions around the policy landscape during the pandemic, and future applications of Punctuated Equilibrium, Social Construction Theory, and the Narrative Policy Framework lie ahead.
