Pandemic-Related Workplace Violence and Its Impact on Public Health Officials, March 2020–January 2021

Julie A. Ward, MN, RN; Elizabeth M. Stone, MS; Paulani Mui, MPH; Beth Resnick, DrPH, MPH

Disclosures

Am J Public Health. 2022;112(5):736-746. 

In This Article

Abstract and Introduction

Abstract

Objectives: To characterize the experience and impact of pandemic-related workplace violence in the form of harassment and threats against public health officials.

Methods: We used a mixed methods approach, combining media content and a national survey of local health departments (LHDs) in the United States, to identify harassment against public health officials from March 2020 to January 2021. We compared media-portrayed experiences, survey-reported experiences, and publicly reported position departures.

Results: At least 1499 harassment experiences were identified by LHD survey respondents, representing 57% of responding departments. We also identified 222 position departures by public health officials nationally, 36% alongside reports of harassment. Public health officials described experiencing structural and political undermining of their professional duties, marginalization of their expertise, social villainization, and disillusionment. Many affected leaders remain in their positions.

Conclusions: Interventions to reduce undermining, ostracizing, and intimidating acts against health officials are needed for a sustainable public health system. We recommend training leaders to respond to political conflict, improving colleague support networks, providing trauma-informed worker support, investing in long-term public health staffing and infrastructure, and establishing workplace violence reporting systems and legal protections. (Am J Public Health. 2022;112(5):736–746. https://doi.org/10.2105/AJPH.2021.306649)

Introduction

The COVID-19 pandemic imposed social, economic, and health burdens on individuals and communities; strained health systems; and thrust public health into the spotlight. An immediate rise in attention on public health interventions nationally[1] was shadowed by reports of public backlash.[2,3] By June 2020, journalists were reporting cases of social media insults, doxing campaigns (i.e., public distribution of personal information), protests, and armed threats against public health officials.[4] By August 2020, conflict-related resignations and firings were also reported.[5] According to the National Institute for Occupational Safety and Health, such nonphysical violence (e.g., threats, harassment) and physical violence (e.g., assaults) directed at people while at work, like the acts targeting public health officials, constitute workplace violence.[6]

Public health officials are hired or appointed to a state health department (SHD) or local health department (LHD) as public servants. They work to protect and promote the health of all populations within their jurisdiction, including the responsibility to create, champion, and implement laws that affect health.[7] Thus, for public health officials, residents of their jurisdiction are analogous to patients in a health care setting. In health care settings, such as emergency departments, nonphysical workplace violence perpetrated by patients has been associated with reduced job satisfaction and burnout.[8] The experiences and consequences of nonphysical workplace violence in the form of harassment or threats from the public directed at public health officials remain unexplored. In addition, how such interactions may affect pre-existing public health workforce concerns related to job satisfaction, morale, and turnover is unknown.[9–11]

A team of public health policy researchers and practitioners, including an occupational health nurse and a former employee of the National Association of County and City Health Officials (NACCHO), collaborated with NACCHO to understand the extent of public health officials' pandemic-related experiences of violence in the form of harassment and threats. Our aim was to characterize the experience and impact of such acts on public health officials during the first 10 months of the COVID-19 pandemic. We selected a mixed methods approach to enrich and contextualize media reports. We discuss our findings in terms of nonphysical workplace violence implications on the public health workforce.

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