Violence Against Public Health Workers Will Not Make Us Healthier

Why we need evidence-based discourse, not explosive rhetoric, to address America's health challenges

Improving the health of people is the goal of those who work in public health. The core frustrations of many groups, such as the Make America Health Again (MAHA) movement, are shared issues of many people in public health. There are many ultra-processed foods that are cheaply and readily available, compared to the price and availability of foods with easy-to-pronounce ingredients. Disease treatment is the engine of the US healthcare system, rather than disease prevention. To make America healthier, the core concerns of the American people need to be addressed. Scientists, especially public health scientists, want to see solutions for health issues that do not just involve individual behavior change, but changes that focus many people. We want America to be healthier just as much as anyone. Violent acts targeted at officials who want to help our public are unacceptable. I feel that disrespectful rhetoric that targets people who are at the front lines of our public health infrastructure is also unacceptable and feeds into an environment that encourages violence. Dissent and disagreement are not the same as attacks on character and motivation.

On Friday afternoon, August 8th, a 30-year-old gunman from the suburbs of Atlanta opened fire at the CDC headquarters. He shot hundreds of rounds, and killed the security guard. There are reports that he did this because of his fixation on the coronavirus vaccine, something that he directly attributed to his own physical ailments. His actions are not reflective of everyone (and I believe the majority) in the anti-vaccine movement. I can empathize with the frustrations of this group. Public health interventions are straightforward on paper, you make choices to bolster disease prevention and set the floor for the health of the public. In practice, we sometimes must make sacrifices that are not communicated clearly, or the ideas we have might not get the full public support and buy-in we would need to be successful. Success is also broadly defined from person to person. Much like how figuring out one unknown variable in a math equation is a simple algebra task, figuring out a bunch of unknown variables is complex. People right now are angry, but anger should never lead to violence, it should lead to solutions. If you really care about disease prevention, you do not open fire on government buildings; you find solutions for these issues.

I am big fan of the "Why Should I Trust You" podcast

(

Why Should I Trust You?

on Substack). Their mission is:

We hear from people who are wary about public statements, recommendations and studies coming from what they view as an elitist and conflict-riddled scientific establishment. And we hear from those in this establishment who fear the consequences of what they see as a dangerous trend towards anti-expertise. And then somehow, we will seek a path through all this!

The episode they released right after the shooting at the CDC had representatives from the MAHA movement (whom I disagree with on the merits of their proposed solutions but I understand their frustrations). I was incredibly pleased to hear them at the start of the podcast acknowledging that violence is never the answer. Unfortunately, many of the most prominent proponent’s of the movement like RJK Jr. have a leadership style that is not built on either accountability or scientific evidence. I was not in the head of the shooter and cannot draw a causal link between just one thing that was said and his inevitable choice to attempt to kill many federal workers (and success in killing one). What I can say is that explosive rhetoric not supported by scientific evidence is easier to access than ever, and accountability for spreading anecdotal evidence opposed to causal evidence is a common theme for anti-scientific movements.

Dissent is important for the scientific process, but dissent without evidence is a bad faith argument. Unfortunately, instead of desiring to have a stronger standard of evidence, we have an unequal platform that is leaning more into rhetoric-based arguments instead of evidence-based ones. If the new leaders of HHS, CMS, NIH, EPA, etc. all made research practices more transparent and required everyone to have stronger evidence standards, I would welcome it. I have not seen any solutions thus far that have systemically increased standards for transparency and evidence generation.

Sarah Gollust, a professor in the Division of Health Policy and Management at the University of Minnesota School of Public Health, has an excellent invited commentary essay where she outlines the importance of protecting the public health workforce from threats and harassment. This piece was published on July 29th, 2022. She states:

“Social science research affirms that no one silver bullet will reduce the hostility of political discourse at the moment, whether about politics in general nor public health in particular. However, the price of inaction and hopelessness is too high.”

We are in an environment where there are on-going threats to scientific infrastructure from the top down (through massive funding cuts, wide-scale layoffs, and banning the investigation of certain topics). Jerome Adams, the Surgeon General from 2017-2021 (appointed during the first Trump Administration), also had a great piece arguing that the CDC shooting is a wake-up call that leaders of federal health organizations need to work harder to protect the missions of their organizations and the very people who are employed to execute said mission. One of the most chilling parts of that opinion piece:

"One particularly telling — and troubling — comment came from Vinay Prasad, a high-level FDA official handpicked by Kennedy. (He recently left his position only to return weeks later.) After being asked whether Americans should forgive public health figures for their missteps, Prasad responded: 'I don't believe in forgiveness because in my opinion these pieces of shit are still lying.' This raw, venomous language from a senior public official doesn't just reflect deep frustration — it helps fuel a culture of dehumanization that may instigate real-world violence."

These isolated statements cannot be drawn as a causal link for the violent actions, but collectively allowing this rhetoric will cause more problems than solutions. I mourn for the CDC workers who have to go back to work with a heightened sense of fear. Many feel their leaders do not have their backs. Public service involves sacrifice, but their job description never included evading bullets because of rhetoric amplified by your bosses.

Disclaimer: My first internship in public health was at the CDC from January to March 2020. I am clearly biased, but they are some of the most hard-working and well-intentioned people in our country. The exact opposite of pieces of shit.