Stakeholder’s Analysis on the Greene County Health Department

The John Glenn College of Public Affairs, The Ohio State University

PUBAFRS 6051: Introduction to Public Administration, Leadership, and MPAL

The year 2020 has caused great pain and concurrently been a catalyst for innovation. Some of this innovation has been in business. Many have learned how to employ technologies to scale tasks or jobs that had once been regarded as unnecessary or even unachievable. Other innovations have taken place in governance, where states and localities have come together during this global pandemic to lead when those needed abdicated. Today people, the true stakeholders of this nation, are looking not to the federal government for truth, but to their state and local leadership. This is the year that health officials and departments have gone from being a quiet, unassuming department to one where their expertise and solutions have never been needed more than today.

The Greene County Health Department (GCHD) was founded in response to the 1918 Spanish Flu Pandemic. Nearly one hundred years after this pandemic, it is again fighting a similar struggle. This time it was predicted, seen coming, but not prepared for at almost any level of governance. Due to this unpreparedness, thirty-nine people have died, one hundred sixty-two people remain hospitalized, and over one thousand eight hundred and twenty-four people have contracted the novel coronavirus in Green County alone (Greene County Public Health, 2020). Considering that Greene County, like others have failed in fulfilling their mission statement “to prevent disease, to promote health and wellness in Greene County,” it would be the right time to understand what brought this about and what can be done to improve this situation so it does not happen again.

This year has clearly shown the necessity for preparedness, expertise, and selflessness — these traits are what is to define a health department, or any governmental agency for that matter. The GCHP states that their purpose is “to provide an organized approach to public health activities in communities… [such as] education, environmental health, screening and immunizations, communicable disease control, epidemiology, vital statistics, emergency preparedness” (Greene County Public Health, 2020). The proper fulfillment of the duties of a health department are integral to a well and proper functioning developed society. Without an empowered and effectual health department, a society will soon devolve into a wasteland of communicable diseases.

Seven months prior to COVID-19 in the United States, the health departments were unfunded and often not seen with the import they deserved or needed (Weber et al., 2020). What has faced health departments at a nationwide level, in addition to a lack of funding is a system of planned, purposeful, unconstrained, and autocratic leadership that

[Appropriated] a public enterprise and [made] it into an agent of propaganda for a political regime. It’s mind-boggling in the totality of ambition to so deeply undermine what’s so vitally important to the public (Bandler et al., 2020).

Figure 1 (Hamel et al, 2020)

Due to the undercutting by word, deed, and funding of the nation’s health departments and medical experts, the trust that the average citizen places in local health departments and the medical community has followed a downward trajectory, among a segment of the American society (Funk et al., 2020). This places health departments in a position where they will find it necessary, to accomplish their mission of preventing the spread of diseases and promoting optimal health, to bring onboard the recalcitrant and sardonic. To accomplish this exacting task, health departments across the nation will be required, more or less, to delve into who are their true stakeholders, who are the subjects and players, and when the Rubicon appears, understand what powers they have in order to successfully inoculate the necessary ninety percent of the population from the novel coronavirus (D’Souza & Dowdy, 2020).

At the local level, the response to this crisis is correctly articulated by the GCHD in that it has the potential to “face a market in which there is no demand for the service or product, negative demand for the product, or an unwholesome demand for an alternative product that runs counter to the desires of the public health practitioner” (Greene County Public Health, 2015). In this extremely partisan environment, GCPH is facing is a situation where nearly everyone involved has become a player in some sense. According to Bryson, GCPH and other agencies who are combating COVID-19 need to find ways to tailor or sell the necessary policies, programs, and projects to the stakeholders in a way that causes them to believe that their personnel self-interests are being advanced (Bryson, 2011, p. 344). This attempt, however, is being stymied. As in any normal situation, some stakeholders are more important than others. For instance, some do not even have to reside in Greene County, in the State of Ohio, or have ties to government or medicine — such as the president, QAnon or those who deny the science of the ongoing global pandemic (Bryson, 2011, p. 135). These very public and prominent stakeholders actively drive many of the practices that the county is attempting to encourage to only partially work since the aforementioned stakeholders are working against science and the medical community (Issacs, 2020; Greene County Public Health, 2020).

Figure 2 — (@GreeneCoPH, 2020)

When evaluating the stakeholders, who they are, and their influence and reach, Greene County Public Health is facing a two-prong assault. One from the virus itself, and two from those who ought to be encouraging proper behavior and decency from the citizenry. Thus, GCPH is fighting a losing battle with the virus seeing rising cases and deaths. The other stakeholders who left to deal with the consequences of these, at times, far flung actors are institutions like the local government, nonprofits, and the private sector — such as mayors, health departments, EMTs, hospitals, religious institutions, long-term/age care facilities, and social service organizations. This is not even including the impact that these far flung stakeholders have on relationships amongst family and friends (Ellison, 2020).

The institutions and citizens who are left to deal with the effects of the virus and the deniers of its seriousness, face the decision of whom to trust. The choice is between the position of authority where people have looked historically and naturally towards for leadership in times of crisis, or if they are fortuitous, their local and state medical institutions. Since this is the world of social media, where governing institutions and politicians use these tools there is a situation where the citizens themselves have brand loyalty to their political person rather than listening to experts. For instance, the president, unlike the integral health departments during this national crisis, has, as of 2017, one-hundred and thirteen million social media followers where he freely admits he uses it “to keep people interested” and to claim that the institutions meant to inform the general public are “fake” and “treat [him] very unfairly” (Antoniades and Mohr, 2020, p. 446). This outsized influence that he and his perspective have makes it immensely difficult for the scientific community to stem the flow, to prevent transmission, and to save lives. His popular influence also radicalizes the common person to believe that they are holders of ‘secret’ knowledge that gives the right and ability to disregard the edicts or guidance health departments issue — which in turn is causal with cases and death (Bursztyn et al., 2020).

With the radicalization of the political and medical environment, the remaining stakeholders are not able to put forward policy with great success, but rather must be watchful and responsive to the actions of out of state and oversized stakeholders. Mr. Trump and those who deny the science of COVID-19 and basic medicine, such as the efficacy of masks, are players. They “have both interest and significant power” provided via the tools of social media, talk radio, and the bellicose current administration (Bryson, 2011, p. 338; Anoruo, 2020). Though the current administration and the COVID-19 deniers are not the only players during this pandemic — there remains the Ohio Department of Public Health, the GCHD, and the scientists and medical professionals who insist on honestly keeping the general public informed. Some organizations — whether they are state, local, non-profit, or some in the private sector are also players.

The GCHD has attempted to have everyone, including businesses and individuals to adhere to “social distancing and face covering requirements set forth by the Ohio Department of Health Director’s Order” and the Centers Disease Control (Green County Public Health, 2020). During this pandemic, no one is truly a member of the subject class, context setters,or crowd when it comes to the spread of this virus. This is since all persons, regardless of position, authority, or importance have the chance to contract and potentially be negatively affected from the virus. Moreover, no one is an island in this fight against COVID-19, since nearly everyone has an opinion and shares it with their friends and neighbors via the tools they have at their disposal — such as social media, email, and or telephonic communication. Though when it comes to the lawmaking and regulation portion of handling this virus, some segments are more important than others. For instance, GCHD has played a role in requiring local business to engage in more comprehensive and thorough cleaning procedures (Green County Public Health, 2020). Though, some businesses that are in the county area took it upon themselves to engage in responsible behavior prior to governmental orders came down (Jelinek, 2020).

In order to accomplish GCPH’s mission, it must have the resources necessary — i.e. financial, medical, and testing supplies. In 2019, the GCPH received $1,910,755 from the state and federal government (Greene County Public Health, 2019). A little over $1 million of that came from the federal government — which matters this year since the current administration cannot come to any form of agreement with the legislative branch (Zurcher, 2020). This conflict between Congress and the executive branch is causing

bare-bones staffs of medical and administrative workers [who] are trying to answer a sudden rush of demands — taking phone calls from frightened residents, quarantining people who may be infected, and tracing the known contacts and whereabouts of the ill — that accompany a public health crisis few have seen before (Bosman & Fausset, 2020).

Throughout this crisis, the governor of Ohio has been a point of leadership, ordering a shutdown of the state early in the crisis with one other state following suit. However, he faced the issue of governing in a Neo-Republican state, with a Republican legislature, and a populist chief executive at the federal level. Due to this, Governor DeWine tried to placate both sides by backing down on a mask order and instead strongly recommended that the citizens of Ohio wear masks. When this failed and cases and death continued to climb, he ordered that specific counties that were ‘hot’ would be required to wear mask. However, this was unsuccessful in slowing the rate of transmission, prompting the Ohio Director of Health to orders Ohioans to wear masks in non-residential indoor locations. Repeatable statistics validate that properly wearing a mask is a successful tool to slow the rate of transmission. The month after the mask mandate Ohio’s rate of COVID-19 spread was decreased by over thirty-one percent (Zuckerman, 2020).

Adherence to public health directives has not been helped by “President Donald Trump and Vice President Mike Pence [making] public showings of their refusal to wear masks” even when “touring a mask factory and military hospital” (Zuckerman, 2020). Moreover, his statements that the nation needs to learn to deal with, often times two-thousand people dying daily from COVID-19, and that we need not to be afraid of this pandemic, but rather merely believe that the nation will beat COVID-19 is doing nothing to aid public health or save lives. (Zurcher, 2020). However, this language is not just coming from the federal level but, with encouragement from the federal level, state officials are also advocating and inciting public disobedience and irresponsibility (Shear & Mervosh, 2020).

Figure 3 — (Powell, 2020)

For instance, state representative (SR) Rick Perales (OH-73) has chosen to align himself with SR Nino Vitale (OH-85) and SR Jena Powell (OH-80) in endorsing or voting for bills such as Ohio Senate Bill 1 and Ohio House Bill 62. These bills would strip life saving measures away from the experts in this crisis — such as county and state health departments and give it the Ohio legislature to debate and let ‘die’ in committee (Staff Writer, 2020). This is all being attempted in the name of ending the “stifling” regulation of wearing a facemask and being required to engage in socially responsible­­­­ behavior.

The actions by these political overseers and stakeholders has and continues to do nothing to help the health departments in the state of Ohio and the nation in accomplishing their life saving mission. Their actions have actively harmed GCHD’s mission, dissuaded businesses from fully enforcing mask orders, empowered law enforcement to choose not to enforce lifesaving measures and given the average citizen the tacit authority they can and will disregard mandates that they personally disagree with (Demillo, 2020). To appropriately judge the response and actions taken by the GCHD, an understanding that this an ongoing crisis, a good amount of magnanimity due to the stressors of the outside environment, and that with proper leadership in power this crisis could have and would have been handled much more adeptly and appropriately by all involved.

Figure 4 — (FT Visual & Data Journalism Team, 2020)

Taking those three understandings into account — ongoing crisis, magnanimity, and needing better leadership, judging the performance of the GCHD still a difficult task. However, they did the best they could in the current environment given their present resources. Their statements, websites, and social media all share information that is accordance with Center for Disease Control and the World Health Organization. The mask orders they put forward, if followed would decrease the spread in Greene County, Ohio by sixty-seven to eighty-three percent (Liu et al., 2020, p. 897).

Additionally, the performance of GCHD can be measured in not only their attempts in controlling this virus but also in how they have continued to aid the disenfranchised and needy. Throughout this crisis, they still have come alongside local and non-profit women’s shelters, food shelters, and other communicable disease programs — such as HIV.

To work in the health and medical field this year is a thankless and unappreciated career. Throughout the pandemic, the Green County Health Department has done the best that is possible with the financial backing and legal empowerment that they received. They do not deserve to be criticized for the COVID-19 response that is taking place across the globe and in Greene County, but it instead needs to be a learning lesson for all involved, every stakeholder. It is evident that health departments and the medical community require more funding and greater tools at their disposal to impel the common man to do what is good not for him or herself but what is good for the community. Moreover, state and local health departments must be more aware and responsive to diseases, whether at a domestic or international level, that are going on. This would aid in not having a situation where the federal chief executive is allowed put his or her reelection chances or popularity before the health and welfare of the people.

The American people ought to be paramountcy, grateful and adherent to the lifesaving guidance that they have received from the scientists and researchers, that have put in such long hours and dedication, during this pandemic. However, some Americans, who “are otherwise adapt and successful in their daily lives” are actively campaigning “against established knowledge” and it is “unfounded arrogance, the outrage of an increasingly narcissistic culture that cannot endure even a slightest hint of inequality of any kind” (Nichols, 2017). This arrogance and narcissism at both the federal and common person level have actively harmed the ability for the experts, such as the Green County Health Department, amongst others, to respond effectively. From this narcissism and conceit has come an unmatched amount of societal pain that could have been avoided if the United States had just listened to Dr. Anthony Fauci, the epidemiologist and immunologist instead of Dr. Scott Atlas, the radiologist. Every single stakeholder has played an active part in where society is today — some for the better and others for the worse. While society has innovated and advanced during this crisis, it has also endured unnecessary suffering. The hope, that many have, is that each of us learn from this so it does not occur again.

[1] Numbers as accurate as of the date of writing — 15 October 2020

Works Cited:

Anoruo, N. A. (2020, May 14). How Social Media Undermined the COVID-19 Response. ABC News. https://abcnews.go.com/Health/social-media-undermined-covid-19-response/story?id=70511613.

Antoniades, N., & Mohr, I. (2019). Presidential Candidates’ Popularity and Voter Loyalty in the Age of Social Media. Society, 56(5), 445–452. https://doi.org/10.1007/s12115-019-00397-y

Bandler, J., Callahan, P., Rotella, S., & Berg, K. (2020, October 15). Inside the Fall of the CDC. ProPublica. https://www.propublica.org/article/inside-the-fall-of-the-cdc.

Bosman, J., & Fausset, R. (2020, March 14). The Coronavirus Swamps Local Health Departments, Already Crippled by Cuts. The New York Times. https://www.nytimes.com/2020/03/14/us/coronavirus-health-departments.html.

Bryson, J. M. (2011). Strategic Planning for Public and Nonprofit Organizations: A Guide to Strengthening and Sustaining Organizational Achievement (4th ed.). San Francisco, CA: Jossey-Bass.

Bursztyn, L., Rao, A., Roth, C., & Yanagizawa-Drott, D. (2020, September 3). Misinformation During a Pandemic. Becker Friedman Institute for Research in Economics. https://bfi.uchicago.edu/working-paper/2020-44/.

Demillo, A. (2020, July 26). Some US police Resist Enforcing Coronavirus Mask Mandates. The Washington Post. https://www.washingtonpost.com/health/some-us-police-resist-enforcing-coronavirus-mask-mandates/2020/07/26/cc273002-cf5f-11ea-826b-cc394d824e35_story.html.

FT Visual & Data Journalism Team. (2020, October 18). Coronavirus Tracked: Has the Epidemic Peaked Near You?Coronavirus chart. https://ig.ft.com/coronavirus-chart/?areas=usa.

Ellison, K. (2020, August 8). Perspective | Stress from the Pandemic can Destroy Relationships with Friends — Even Families. The Washington Post. https://www.washingtonpost.com/health/stress-from-the-pandemic-can-destroy-relationships-with-friends--even-families/2020/08/07/d95216f4-d665-11ea-aff6-220dd3a14741_story.html.

D’Souza, G., & Dowdy, D. (2020, October 14). What is Herd Immunity and How Can We Achieve It With COVID-19? Johns Hopkins Bloomberg School of Public Health. https://www.jhsph.edu/covid-19/articles/achieving-herd-immunity-with-covid19.html.

Funk, C., Kennedy, B., & Johnson, C. (2020, August 27). Trust in Medical Scientists Has Grown in U.S., but Mainly Among Democrats. Pew Research Center Science & Society. https://www.pewresearch.org/science/2020/05/21/trust-in-medical-scientists-has-grown-in-u-s-but-mainly-among-democrats/.

Greene County Public Health. “2019 Annual Report.” Greene County Public Health, 2020. http://www.gcph.info/files/announcements/attachments/885_Annual_Report_2019.pdf.

Greene County Public Health. (2020, October 15). COVID-19 Update. Public Health. http://www.gcph.info.

@GreeneCoPH. (2020, October 15). Level Three Status [web log]. https://twitter.com/GreeneCoPH/status/1316823663614857222?s=20.

Greene County Public Health. (2015, September 10). Marketing Plan. Greene County Health Department. http://www.gcph.info/files/resources/Marketing_Plan.pdf.

Greene County Public Health. (2019). 2019 Annual Report. Greene County Public Health. http://www.gcph.info/files/announcements/attachments/885_Annual_Report_2019.pdf.

Greene County Public Health. (2020, October 15). COVID-19 Risk Level 3 Guidance. Public Health. http://www.gcph.info/files/announcements/attachments/1040_GCPH_COVID-19_Risk_Level_3_Guidance.pdf.

Greene County Public Health. (2020). What is Public Health? gcph.info. http://www.gcph.info/about-us/what_is_public_health.

Hamel, L., Kearney, A., Kirzinger, A., Lopes, L., Muñana, C., & Brodie, M. (2020, September 10). KFF Health Tracking Poll — September 2020: Top Issues in 2020 Election, The Role of Misinformation, and Views on A Potential Coronavirus Vaccine. KFF. https://www.kff.org/coronavirus-covid-19/report/kff-health-tracking-poll-september-2020/.

Isaac, M. (2020, October 5). How Facebook and Twitter Handled Trump’s ‘Don’t Be Afraid of Covid’ Post. The New York Times. https://www.nytimes.com/2020/10/05/technology/Trump-Afraid-Covid-Facebook-Twitter.html.

Jelinek, C. (2020, May 4). Mask Required at Costco Wholesale. Coronavirus. https://www.costco.com/coronavirus.html.

Liu, C., Diab, R., Naveed, H., & Leung, V. (2020). Universal Public Mask Wear During COVID‐19 pandemic: Rationale, Design and Acceptability. Respirology, 25(8), 895–897. https://doi.org/10.1111/resp.13892

Nichols, T. M. (2017). The Death of Expertise. Oxford University Press Inc.

Shear, M. D., & Mervosh, S. (2020, April 17). Trump Encourages Protest Against Governors Who Have Imposed Virus Restrictions. The New York Times. https://www.nytimes.com/2020/04/17/us/politics/trump-coronavirus-governors.html.

Powell, J. (2020, August 11). Anti-Mask Statement. Twitter. https://twitter.com/VoteJenaPowell/status/1293231739758936070?s=20.

Staff Writer. (2020, July 28). Editorial: Lawmakers Put Ohioans’ health at Risk With Senate Bill 1. The Columbus Dispatch. https://www.dispatch.com/story/opinion/editorials/2020/07/28/editorial-lawmakers-put-ohioansrsquo-health-at-risk-with-senate-bill-1/42101501/.

Weber, L., Ungar, L., Smith, M. R., The Associated Press, Recht, H., & Barry-Jester, A. M. (2020, August 24). Hollowed-Out Public Health System Faces More Cuts Amid Virus. Kaiser Health News. https://khn.org/news/us-public-health-system-underfunded-under-threat-faces-more-cuts-amid-covid-pandemic/.

Zuckerman, J. (2020, August 25). Coronavirus Cases Down 31% in First Month Since Mask Mandate. Ohio Capital Journal. https://ohiocapitaljournal.com/2020/08/26/coronavirus-cases-down-31-in-first-month-since-mask-mandate/.

Zurcher, A. (2020, October 6). Trump Covid: President Downplays Virus on Leaving Hospital. BBC News. https://www.bbc.com/news/election-us-2020-54427390.

Zurcher, A. (2020, October 7). Trump Ends Covid budget Stimulus Relief Talks. BBC News. https://www.bbc.com/news/world-us-canada-54443057.

--

--

Get the Medium app

A button that says 'Download on the App Store', and if clicked it will lead you to the iOS App store
A button that says 'Get it on, Google Play', and if clicked it will lead you to the Google Play store