Hair on Fire

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Burden S. Lundgren
August 19, 2024

Anyone who has read my columns knows that I often approach an issue coming from its historical background. The world we have today was created from the world of yesterday. If we don’t study the latter, we can’t understand the former. That is why I have been particularly critical of the historians who failed to bring their expertise to the general public during the recent pandemic.

Like most in the humanities, historians are troubled by the fact that their field seems to be in decline.  Departments are being downsized. I have been in contact with officials of the American Historical Association recommending they see themselves as a service profession rather than simply an academic specialty, that they could have elevated their profession in the public mind by sharing their knowledge of past epidemics. For the public, every social event in the pandemic came as a shock. Historians could have warned them that suppression of first cases is the rule rather than the exception, that the first victims tend to be blamed, that social fissures will be exposed, that marginalized populations will suffer the most, that there would be public resistance to public health measures, that confidence in the government would erode and that the world coming out of the pandemic will not be the same as it was going in.

But we are a service profession. Recently, there have been trenchant columns on this site warning of the consequences of recent Supreme Court decisions and Project 2025. My purpose here is to urge that we avoid the experience of the historians who talked about the epidemic almost only among themselves and reach out to a population that doesn’t appreciate the benefits of an honest, educated government workforce.

We have a way to go. Historians, though they may be regarded as “absent minded professors”, enjoy a relatively benign public reputation—bureaucrats not so much. As a nurse, I enjoyed the respect that comes with belonging to the profession that is rated the “most ethical” in poll after poll. When I began to work for the federal government, I found that the fastest way to gain credibility were the four words “I am a nurse.”

Project 2025 recommends replacing the current non-political government workforce with workers whose loyalty is not to fulfilling the laws, but to the president personally. It is not clear how far down in grade this direction would apply, but it appears that thousands would be affected. The federal workforce would be a political arm of the presidency.

What would that mean? For one thing, it would mean frequent workforce turnover—older workers taking their experience with them to the private sector and workers coming in completely new at their jobs and bringing new loyalties with them. Essentially, you could buy your job, and you would keep it so long as you promoted the politics of the moment.

Then there is “Chevron” which basically eliminates the role of expertise in determining complex regulations that affect us all including health care protections. Seventeen health professional organizations immediately issued a joint statement condemning Chevron. The Kaiser Family Foundation (KFF) forcefully warned that shifting the patient protections in the ACA and other insurance programs from federal agencies to the courts would be leaving those decisions to persons with no expertise to make them.   

The success of public health can be defined by what doesn’t happen. This was well documented in a New York Times article by Belle Boggs aptly titled A Bat Flew into My Bedroom and Reminded Me of All We Take for Granted (8/1/24). Bats, of course, can carry rabies as well as other viruses making exposure an immediate health risk. Ms Boggs described the assistance she received from the CDC, from the county’s animal control center, from the county public health nurse, and finally from her local emergency room. What didn’t happen here was a case of rabies—prevented by public health organizations unknown to most people until a threat appears, but lifesaving when that happens. What if all that expertise were unavailable?

Ms. Boggs is one person—but we can expand her experience to the millions affected by the COVID pandemic where we have the experience of expertise unheeded. A recent article in JAMA Health Forum (7/26/24) cited a study looking at state restrictions and concluding that up to 470,000 deaths could have been avoided by universal application of the strictest state restrictions. Would this failure have happened if the public had more respect for the public health workforce? 

A less noticed Supreme Court decision is the one essentially decriminalizing bribery of elected officials. If elected officials can be paid off, why not civil servants? I think of my international students who had to remember to take cash when they went home to bribe officials there—and my American students who simply couldn’t imagine such a situation.

We need to reach out by any medium necessary to convince the public how lucky we are to have an expert, honest government workforce to protect us from bats in the bedroom and all the other hazards of life. No one is going to do it for us.

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 Author: Burden S. Lundgren, MPH, PhD, RN practiced as a registered nurse specializing in acute and critical care.  After leaving clinical practice, she worked as an analyst at the Centers for Medicare and Medicaid Services and later taught at Old Dominion University in Norfolk VA.  She has served as a consultant to a number of non-profit groups.  Presently, she divides her time between Virginia and Maryland. She can be reached at [email protected].       

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