Politics and the Public Health Workforce: Lessons Suggested from a Five-State Study.

Policy Points The United States public health system relies on an inadequate and inefficient mix of federal, state, and local funding. Various state-based initiatives suggest that a promising path to bipartisan support for increased public health funding is to gain the support of local elected officials by providing state (and federal) funding directly to local health departments, albeit with performance strings attached. Even with more funding, we will not solve the nation's public health workforce crisis until we make public health a more attractive career path with fewer bureaucratic barriers to entry. CONTEXT: The COVID-19 pandemic exposed the shortcomings of the United States public health system. High on the list is a public health workforce that is understaffed, underpaid, and undervalued. To rebuild that workforce, the American Rescue Plan (ARP) appropriated $7.66 billion to help create 100,000 new public health jobs. As part of this initiative, the Centers for Disease Control and Prevention (CDC) distributed roughly $2 billion to state, local, tribal, and territorial health agencies for use between July 1, 2021, and June 30, 2023. At the same time, several states have enacted (or are considering enacting) initiatives to increase state funding for their local health departments with the goal of ensuring that these departments can deliver a core set of services to all residents. The differences in approach between this first round of ARP funding and theseparate state initiatives offer an opportunity to compare, contrast, and suggest lessons learned. METHODS: After interviewing leaders at the CDC and other experts on the nation's public health workforce, we visited five states (Kentucky, Indiana, Mississippi, New York, and Washington) to examine, by means of interviews and documents, the implementation and impact of both the ARP workforce funds as well as the state-based initiatives. FINDINGS: Three themes emerged. First, states are not spending the CDC workforce funding in a timely fashion; although the specifics vary, there are several organizational, political, and bureaucratic obstacles. Second, the state-based initiatives follow different political paths but rely on the same overarching strategy: gain the support of local elected officials by providing funding directly to local health departments, albeit with performance strings attached. These state initiatives offer their federal counterparts a political roadmap toward a more robust model of public health funding. Third, even with increased funding, we will not meet the nation's public health workforce challenges until we make public health a more attractive career path (with higher pay, improved working conditions, and more training and promotion opportunities) with fewer bureaucratic barriers to entry (most importantly, with less reliance on outdated civil service rules). CONCLUSION: The politics of public health requires a closer look at the role played by county commissioners, mayors, and other local elected officials. We need a political strategy to persuade these officials that their constituents will benefit from a better public health system.

The Effects of Partisan Media in the Face of Global Pandemic: How News Shaped COVID-19 Vaccine Hesitancy

Some might expect the promise of ending a global pandemic via vaccination to interrupt conventional partisan media effect processes. We test that possibility by bringing together sentiment-scored COVID vaccine stories (N > 17,000) from cable and mainstream news outlets, N > 180,000 Vaccine Adverse Event Reporting System (VAERS) reports, and six original surveys (N = 6,499), in order to investigate (1) whether partisan news outlets covered COVID vaccination in different ways, and (2) if differences in coverage increased vaccine hesitancy. We find that Fox News' (FXNWS) coverage was significantly more negative than that of other cable and mainstream sources, and is associated with increased negative public vaccine sentiment. In the aggregate, adverse event reports tended to increase following periods of heightened negativity on FXNWS. At the micro-level, self-reported FXNWS exposure is associated with increased vaccine refusal. Collectively, the results provide new insights into the public health consequences of vaccine politicization. © 2023 Taylor & Francis Group, LLC.

Depressive and anxious symptomatology in a Lebanese sample during the COVID-19 outbreak

This study explores the correlates of depressive and anxious symptomatology in a Lebanese sample during the COVID-19 outbreak. A convenience sample of 191 respondents participated in a cross-sectional survey and completed measures of fear of COVID-19, rumination about COVID-19, job insecurity, political trust, depression, and generalized anxiety. Results indicated that political trust was associated with greater wellbeing (manifested as decreased job insecurity, fear of COVID-19, depression, and anxiety). Respondents who reported no compliance with self-isolation measures reported less rumination about COVID-19 and less fear of COVID-19 than those who did. Multiple regression analyses showed that fear of, and rumination about, COVID-19 predicted depressive and anxious symptomatology while political trust was protective against depressive symptomatology only. This study provides a novel perspective on mental health in Lebanon, by focusing on its social and psychological predictors during the COVID-19 pandemic. Due to political and economic instability in Lebanon, the COVID-19 crisis may have deleterious effects on mental health in the Lebanese population. Internet-based cognitive behavioral therapy is an evidence-based and cost-effective approach to enhancing mental health during the pandemic and may be beneficial in the Lebanese context.Copyright © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

A comparative analysis of non-invasive prenatal testing in Ontario and Quebec: the role of governing style in health technology innovation & adoption.

BACKGROUND: While processes of adoption and the impacts of various health technologies have been extensively studied by health services and policy researchers, the influence of policy makers' governing styles on these processes have been largely neglected. Through a comparative analysis of non-invasive prenatal testing (NIPT) in the Canadian provinces of Ontario and Quebec, this article examines how decisions about this technology were shaped by contrasting political ideologies, resulting in vastly different innovation and adoption strategies and outcomes. METHODS: A comparative qualitative investigation comprising of a document analysis followed by semi-structured interviews with key informants. Interview participants were researchers, clinicians, and private sector medical laboratory employees based in Ontario and Quebec, Canada. Interviews were conducted both in person and virtually- owing partly to the COVID-19 pandemic - to garner perspectives regarding the adoption and innovation processes surrounding non-invasive prenatal testing in both provinces. All interviews were recorded and transcribed verbatim and data were analyzed using thematic analysis. RESULTS: Through an analysis of 21 in-depth interview transcripts and key documents, the research team identified three central themes: 1) health officials in each province demonstrated a unique approach to using the existing scholarly literature on NIPT; 2) each provincial government demonstrated its own preference for service delivery, with Ontario preferring private and Quebec preferring public; and finally, 3) both Ontario and Quebec's strategies to NIPT adoption and innovation was contextualized within each province's unique financial positioning and concerns. These findings illustrate how both Quebec's nationalist focus and use of industrial policy and Ontario's 'New Public Management' style had implications for how this emerging healthcare technology was made available within each province's publicly-financed health system. CONCLUSIONS: Our study reveals how these governments' differing approaches to using data and research, public versus private service delivery, and financial goals and concerns resulted in distinct testing technologies, access, and timelines for NIPT adoption. Our analysis demonstrates the need for health policy researchers, policy makers, and others to move beyond analyses solely considering clinical and health economic evidence to understand the impact of political ideologies and governing styles.

Along party Lines: Examining the gubernatorial party difference in COVID-19 mortality rates in U.S. Counties.

Drawing upon the literatures on risk factors for COVID-19 and the roles of political party and political partisanship in COVID-19 policies and outcomes, this study quantifies the extent to which differences in Republican- and Democrat-governed counties' observable characteristics explain the Republican - Democrat gap in COVID-19 mortality rate in the United States. We analyze the county COVID-19 mortality rate between February 1 and December 31, 2020 and employ the Blinder-Oaxaca decomposition method. We estimate the extent to which differences in county characteristics - demographic, socioeconomic, employment, health status, healthcare access, area geography, and Republican vote share, explain the difference in COVID-19 mortality rates in counties governed by Republican vs Democrat governors. Among 3,114 counties, Republican-governed counties had significantly higher COVID-19 mortality than did Democrat-governed counties (127 ± 86 vs 97 ± 80 per 100,000 population, p < 0.001). Results are sensitive to which weights are used: of the total gap of 30.3 deaths per 100,000 population, 12.8 to 20.5 deaths, or 42.2-67.7 %, are explained by differences in observable characteristics of Republican- and Democratic-governed counties. Difference in support for President Trump between Republican- and Democrat-governed counties explains 25 % of the additional deaths in Republican counties. Policies aimed at improving population health and lowering racial disparity in COVID-19 outcomes may also be correlated with reducing the partisan gap in COVID-19 mortality.

Symptoms and Stereotypes: Perceptions and Responses to Covid-19 in Malawi and Zambia

A large literature documents Covid-19's health and economic effects. We focus instead on its political impact and its potential to exacerbate identity divisions, in particular. Psychologists argue that contagious disease increases threat perceptions and provokes policing of group boundaries. We explore how insider-outsider status and symptoms of illness shape perceptions of infection, reported willingness to help, and desire to restrict free movement of an ailing neighbor using a phone-based survey experiment administered three times in two neighboring African countries during different stages of the pandemic: Malawi, from May 5 to June 2, 2020 (n = 4,641);Zambia, from July 2 to August 13, 2020 (n = 2,198);and Malawi again, from March 9 to May 1, 2021 (n = 4,356). We study identities that are salient in Malawi and Zambia but have not induced significant prior violence, making our study a relatively hard test of disease threat theories. We find that symptoms more strongly shape perceptions and projected behavior than insider-outsider status in both countries and across time, suggesting that there are limits to the ability of pandemics to independently provoke identity politics de novo. [ FROM AUTHOR]

Attention to the COVID-19 Pandemic on Twitter: Partisan Differences Among U.S. State Legislators

Subnational governments in the United States have taken the lead on many aspects of the response to the COVID-19 pandemic. Variation in government activity across states offers the opportunity to analyze responses in comparable settings. We study a common and informative activity among state officials?state legislators? attention to the pandemic on Twitter. We find that legislators? attention to the pandemic strongly correlates with the number of cases in the legislator?s state, the national count of new deaths, and the number of pandemic-related public policies passed within the legislator?s state. Furthermore, we find that the degree of responsiveness to pandemic indicators differs significantly across political parties, with Republicans exhibiting weaker responses, on average. Lastly, we find significant differences in the content of tweets about the pandemic by Democratic and Republican legislators, with Democrats focused on health indicators and impacts, and Republicans focused on business impacts and opening the economy.

Politicized disease surveillance: A theoretical lens for understanding sociopolitical influence on the monitoring of disease epidemics.

Sociopolitical forces commonly influence the collection, analysis, dissemination, and general perceptions of epidemiological information. Yet few theoretical lenses provide insight into the mechanisms through which such influence occurs. In this article, I draw and expand upon empirical findings to propose a novel theoretical lens, politicized disease surveillance, which I define as extreme or undue sociopolitical influence on public health surveillance systems or processes in ways that impact disease incidences and prevalences, or estimates or perceptions thereof. This lens foregrounds disease incidence and prevalence as objects of contestation and policy influence and articulates how certain facets of sociopolitical forces shape disease incidences and prevalences-especially amid an epidemic-through one or more channels: (1) the diagnostic construct; (2) screening tools, procedures, or systems; or (3) the behaviors of individuals who are living with or at risk for a certain disease. I provide several contemporary illustrations of politicized disease surveillance and discuss its theoretical and practical implications.

How do you solve a problem like Maria? The politics of disaster response in Puerto Rico, Florida and Texas.

COVID-19 is not the first, nor the last, public health challenge the US political system has faced. Understanding drivers of governmental responses to public health emergencies is important for policy decision-making, planning, health and social outcomes, and advocacy. We use federal political disaster-aid debates to examine political factors related to variations in outcomes for Puerto Rico, Texas, and Florida after the 2017 hurricane season. Despite the comparable need and unprecedented mortality, Puerto Rico received delayed and substantially less aid. We find bipartisan participation in floor debates over aid to Texas and Florida, but primarily Democrat participation for Puerto Rican aid. Yet, deliberation and participation in the debates were strongly influenced by whether a state or district was at risk of natural disasters. Nearly one-third of all states did not participate in any aid debate. States' local disaster risk levels and political parties' attachments to different racial and ethnic groups may help explain Congressional public health disaster response failures. These lessons are of increasing importance in the face of growing collective action problems around the climate crisis and subsequent emergent threats from natural disasters.

How information about race-based health disparities affects policy preferences: Evidence from a survey experiment about the COVID-19 pandemic in the United States.

In this article, we report on the results of an experimental study to estimate the effects of delivering information about racial disparities in COVID-19-related death rates. On the one hand, we find that such information led to increased perception of risk among those Black respondents who lacked prior knowledge; and to increased support for a more concerted public health response among those White respondents who expressed favorable views towards Blacks at baseline. On the other hand, for Whites with colder views towards Blacks, the informational treatment had the opposite effect: it led to decreased risk perception and to lower levels of support for an aggressive response. Our findings highlight that well-intentioned public health campaigns spotlighting disparities might have adverse side effects and those ought to be considered as part of a broader strategy. The study contributes to a larger scholarly literature on the challenges of making and implementing social policy in racially-divided societies.

A spectrum of (Dis)Belief: Coronavirus frames in a rural midwestern town in the United States.

Community responses to the SARS-CoV-2, or "coronavirus" outbreaks of 2020 reveal a great deal about society. In the absence of government mandates, debates over issues such as mask mandates and social distancing activated conflicting moral beliefs, dividing communities. Policy scholars argue that such controversies represent fundamental frame conflicts, which arise from incommensurable worldviews, such as contested notions of "liberty" versus "equity". This article investigates frames people constructed to make sense of coronavirus and how this affected social behavior in 2020. We conducted an interpretive framing analysis using ethnographic data from a predominately white, conservative, and rural midwestern tourist town in the United States from June to August 2020. We collected semi-structured interviews with 87 community members, observed meetings, events, and daily life. We identified four frames that individuals constructed to make sense of coronavirus: Concern, Crisis, Constraint, and Conspiracy. Concern frames illustrated how some individuals are uniquely affected and thus protect themselves. Crisis frames recognized coronavirus as a pervasive and profound threat requiring unprecedented action. Constraint frames emphasized the coronavirus response as a threat to financial stability and personal growth that should be resisted. Conspiracy frames denied its biological basis and did not compel action. These four conflicting frames demonstrate how social fragmentation, based on conflicting values, led to an incomplete pandemic response in the absence of government mandates at the national, state, and local levels in rural America. These findings provide a social rationale for public health mandates, such as masking, school/business closures, and social distancing, when contested beliefs impede collective action.

Normalising abortion: what role can health professionals play?

BACKGROUND: Despite being a common gynaecological procedure, abortion continues to be widely stigmatised. The research and medical communities are increasingly considering ways of reducing stigma, and health professionals have a role to play in normalising abortion as part of routine sexual and reproductive healthcare (SRH). We sought to investigate how health professionals may normalise abortion and challenge prevailing negative sociocultural narratives. METHODS: As part of the Sexuality and Abortion Stigma Study (SASS), qualitative secondary analysis was conducted on two datasets containing health professionals' accounts of providing abortion in Scotland and England. A subsample of 20 interviews were subjected to in-depth, thematic analysis. RESULTS: Four key themes were identified in heath professionals' accounts: (1) encountering resistance to abortion from others working in SRH; (2) contending with prevailing negative sociocultural narratives of abortion; (3) enacting overt positivity towards abortion provision; and (4) presenting abortion as part of normal, routine healthcare. CONCLUSIONS: It is clear that negative attitudes toward abortion persist both inside and outside of healthcare systems, and need to be challenged in order to destigmatise those accessing and providing services. Health professionals can play a key role in normalising abortion, through the ways in which they frame their work and present abortion to women they treat, and others more widely. Our analysis suggests a key way to achieve this is by presenting abortion as part of normal, routine SRH, but that appropriate support and structural change are essential for normalisation to become embedded.

The comparative politics of COVID-19: The need to understand government responses.

COVID-19 has created a ramifying public health, economic, and political crisis throughout many countries in the world. While globally the pandemic is at different stages and far from under control in some countries, now is the time for public health researchers and political scientists to start understanding how and why governments responded the way they have, explore how effective these responses appear to be, and what lessons we can draw about effective public health policymaking in preparation of the next wave of COVID-19 or the next infectious disease pandemic. We argue that there will be no way to understand the different responses to COVID-19 and their effects without understanding policy and politics. We propose four key focuses to understand the reasons for COVID-19 responses: social policies to crisis management as well as recovery, regime type (democracy or autocracy), formal political institutions (federalism, presidentialism), and state capacity (control over health care systems and public administration). A research agenda to address the COVID-19 pandemic that takes politics as a serious focus can enable the development of more realistic, sustainable interventions in policies and shape our broader understanding of the politics of public health.