Bismarck, North Dakota Correspondent — I’d start with what actually happened rather than with the principle, because the principle sounds fine in either direction.
Health officers across the country have resigned, retired, or been removed since April — the count is somewhere near fifty by the reporting I’ve seen. Some of them left after threats at their homes. Ohio’s director resigned in June after protests outside her house and legislative attempts to strip her authority.
Whatever your view of the orders, that’s a workforce problem. These are jobs that were hard to fill in a good year, in counties that pay poorly for them, and we have just demonstrated that the position carries personal risk.
So my answer is that the accountability question is downstream of a staffing question nobody is asking. In a lot of rural counties the health officer is a local physician doing it part-time as a service, and if that stops being a thing people are willing to do, the debate about who they report to is moot.
Knoxville, Tennessee Correspondent — I work in county government, so let me describe the mechanics rather than the theory.
The health officer holds a delegated statutory authority. The county mayor holds a political one. In an ordinary year those never conflict, because the health officer is dealing with restaurant inspections and a tuberculosis case and nobody is watching.
This year they conflicted constantly, and what we discovered is that nobody had thought about it. The statutes are old, they were written for quarantining an individual, and they don’t contemplate a health officer setting economic policy for a county for a year.
I’d insulate the technical judgment and make the elected official own the order. The officer says what the evidence supports. The mayor signs it or declines and answers for either. That splits accountability from expertise, which is what we do with the county engineer, and it works because nobody expects me to also be the person who takes the political consequence of my recommendation.
Prescott Valley, AZ Correspondent — This is a familiar problem in institutional design and it doesn’t have a clean answer, which is why it keeps recurring.
Full insulation produces an official who can act on evidence and cannot be removed for being wrong. Full accountability produces an official who can be overruled by a board that dislikes the finding.
The version that works elsewhere is neither: technical independence in what the officer is permitted to say, political responsibility for what gets done about it. A public health officer whose assessment can be edited by an elected board is worthless, because you can no longer tell whether the assessment is the assessment.
What I’d add is that the loss of trust runs both directions and both are real. Some officials were overruled for political reasons. Some officials issued orders well beyond anything the evidence supported and then declined to explain themselves. Neither problem is solved by moving the reporting line.
Cheyenne, Wyoming Correspondent — Small counties don’t have this structure to argue about.
Our health officer is frequently the local doctor doing it on the side. He isn’t insulated from anybody. He sees the commissioners at church and the people affected by his order at the grocery store, and that arrangement has advantages that a bigger place doesn’t get.
The advantage is that he can’t issue something absurd, because he’ll have to defend it in person on Saturday. The disadvantage is the same fact.
I’d keep it. What I wouldn’t do is take the model that works in a county of nine thousand and pretend it scales, or take a model built for a city and drop it on us.
Long Island, New York Correspondent — The legal answer to this question has already been given in one state and nobody outside it noticed.
In May the Wisconsin Supreme Court struck down that state’s stay-at-home order on the ground that the health secretary had exceeded her delegated authority — that an order of that scope was effectively a rule, and a rule required the process the legislature had established for rules.
Whatever you think of the result, the reasoning is the live question. These orders rest on statutory grants written decades ago in extremely general terms, and courts have not previously been asked whether a general grant supports closing an economy.
So my answer is that the insulation question is going to be settled by legislatures rewriting those grants, not by an argument about reporting lines. And they should rewrite them, because the current statutes give a health officer either far too much authority or far too little depending on which judge you draw, and neither the officer nor the public should find that out during an emergency.
Wheeling, West Virginia Correspondent — In a place like mine the health officer is somebody’s neighbor and that’s the whole answer.
Trust here doesn’t attach to a position. It attaches to a person, and the person either has a history in the county or doesn’t. Nobody in Wheeling has an opinion about the concept of public health authority. They have an opinion about whether Dr. So-and-so is straight with them.
That means the insulation question is mostly irrelevant locally and mostly the wrong frame. What matters is whether the officer is from here, has been here a while, and will still be here afterward.
What damaged trust this year wasn’t a reporting line. It was orders arriving from a state capital with a local signature attached, so the neighbor got blamed for something he hadn’t decided.
Gastonia, NC Correspondent — I’ve been reading and editing coverage of these conflicts all year and there’s a pattern worth naming.
The stories that ran were almost entirely about the confrontations — the resignation, the threat, the board overruling the officer. Almost nothing ran about the ordinary functioning, which is most of it.
That’s not bias exactly. It’s what coverage is. But the aggregate effect is that the public’s picture of the relationship between health officers and elected officials is composed entirely of the cases where it broke, and that picture then feeds back into the politics.
On the substance I’d take independence in the assessment and accountability in the decision. On the coverage I’d say my trade has made this harder and mostly hasn’t noticed.
Sydney, Australia Correspondent — Our arrangement is close to the one being proposed here as a compromise, so I can tell you how it functions under strain.
Each state has a chief health officer with statutory independence, who advises but generally does not decide. The premier decides and answers for it. During the crisis those officers became household names — appearing at daily press conferences beside the premier, taking questions directly, and occasionally disagreeing with the politician standing next to them in public.
The strength is that it’s legible. Everyone can see which part is advice and which part is a political choice, and when a decision goes beyond the advice, the premier has to say so.
The weakness is that the officer becomes a public figure and therefore a target, which we also experienced. Victoria’s chief health officer received a great deal of abuse and a security detail.
I’d still recommend it. Making the two roles visible separately is worth the cost, because the alternative is a politician hiding behind an expert or an expert carrying a political decision, and we’ve watched both this year.
