North Carolina State Epidemiologist Resigns In Defense Of Public
Health
Political Pressures Not Uncommon In Public Health Practice
North Carolina State Epidemiologist Megan Davies
surprised many when she resigned from office earlier this month ending
a seven year tenure.
Davies had been at the center of a discussion regarding
contaminant levels, specifically hexavalent chromium, in well water
surrounding the coal ash dumps of Duke Energy. Her sudden resignation
was in response to an open editorial1 published by the top
leadership of the North Carolina Department of Health
and Human Services (DHHS) that, according to Davies,
“deliberately misleads the public.”
Misrepresentation of The Public Health Process
The
controversy began in early 2014 when nearly 40,000 tons of coal ash
landed in the Dan River following a pipe break. Six months later the
Coal Ash Management Act (CAMA) was passed. At that time, no state or
federal standards existed that defined unacceptable levels of
potential coal ash contaminants such as hexavalent chromium, so new
ones were developed. The process of defining those thresholds is at
the heart of Davies’ resignation. The open editorial signed by Tom
Reeder, Assistant Secretary for the Environment, Department of
Environmental Quality (DEQ), and Randall Williams, MD, Deputy
Secretary for Health Services (DHHS), asserts that state toxicologist,
Ken Rudo (DHHS), acted independently to set the threshold for
hexavalent chromium. In her resignation letter2, Davies
describes a very different process that involved the input from four
different toxicologists (including Rudo) and was presented and vetted
up the chain all the way to the Secretary of Health and Human
Services.
Can We Separate
Public Health and Politics?
As North Carolina
Health News reported3, the now very public disagreement
between state officials leaves the “impression of a department where
decisions reflect political expedience, rather than public
protection.” This undermines the public health process and engenders
distrust. Reduced confidence in public
health can ultimately lead to unnecessary disease and illness in the
future. According to Davies, “They accused public health of
being unprofessional and irresponsible, and I couldn’t leave that out
there.”
All
this begs the question, is it possible to isolate public health
officials from political pressure? While asserting that “public health
is politics” may be going too far, state epidemiologists as well as
other public health professionals in decision-making or advising roles
often face situations where they must balance the demands made by
political realities and those dictated by scientific evidence. It is a
“constant balancing act”, according to Jeff Engel, Executive
Director of the Conference of State and Territorial Epidemiologists.
In
state health departments, the final decision making role is often that
of the state health director and the role of the state epidemiologist
is to weigh in on the side of the evidence. The values of the
political leadership will vary depending on their views about the role
of government in society, and the same evidence may be interpreted
differently or lead to very different policy decisions in different
states---think red states versus blue states. Another important factor
is the level of risk tolerance on the part of the population. This
presents a communication challenge for any scientists trying to
explain risks and their attendant uncertainties.
Many other epidemiologists have been in situations similar to those
confronted by Megan Davies, and according to Engel, “epidemiologists
are all incredibly proud of her for taking the ultimate step.” Many in
her position might choose to stay in either because they fear the
long-term career consequences of resignation or because they believe
the only way to remain effective is to stay within the organization.
The
Nature of Accountability
Just nine days before Megan Davies’ resignation, Michigan State
Epidemiologist, Corinne Miller, also found herself embroiled in
a water quality controversy*, but the similarities end there. Miller
was arraigned on charges for alleged misconduct during the Flint water
crisis. Some interesting questions do arise from the coincidence of
these two cases. Can epidemiologists in possession of data or
actionable information be held liable for public health inaction? What
responsibility do epidemiologists have to advocate for evidence-based
public health policies when the evidence appears to dictate a course
of action?
According to Jeff Engel, such inaction is unlikely in the case of a
disease outbreak because the media serves as the court of public
opinion and inaction vis a vis controlling an outbreak is difficult to
imagine. On the other hand, when very few persons or households are
affected as is the case in the North Carolina water controversy, or
when a long latency period exists between exposures and disease, such
inaction may be more likely.
1.
https://tinyurl.com/gt5t8jy
2.
https://tinyurl.com/jdnb72x
3.
https://tinyurl.com/glxlgna
*For more on Corinne Miller, see this month’s Epi News
Briefs.
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