EAGER: Risk Objects in Public Health Crisis: An Exploratory Investigation of Stigma, Role-Triage, and Cautionary measures

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The recent Ebola crisis in the United States showed a need for improvements in the management of complex public health emergencies, especially those that are new or surprising. Public anxiety about this disease intersected with lingering ambiguities about modes of transmission to create substantial leadership challenges for health administrators, clinicians, other healthcare workers, and public officials. This research will study the response of the New York City public health system to the Ebola crisis in order to develop decision support tools that can be utilized by health officials, physicians and other practitioners during future communicable disease outbreaks. Although based upon a case study of one event, the results will be relevant to other large, public health emergencies and epidemics in other settings. Agencies disseminated contradictory information that, rather than reassure the public, created further anxieties. Meanwhile the infection of two nurses from Dallas suggested that the public health system was faltering. In this environment of uncertainty and doubt, people and places were stigmatized by the public as well as by as officials asserting they were acting "out of an abundance of caution." Teachers were put on leave; a nurse was quarantined in New Jersey; schoolchildren were not allowed to register for classes; and some hospital workers reported difficulties at work or at second jobs. The need for institutions to function during ambiguous crises suggests the need to better understand how people and places become defined as risk objects. In other words, how people treat people and how people defend themselves against perceived unfair treatment - including stigma-driven policies - may lead them to take steps that undercut or challenge public health needs or other important public services. This project plans to engage in new research on ideas about stigma and how people defend against stigma. Focus groups, interviews, and review of documents will show how people were stigmatized and resisted stigma. Although focused on a particular health crisis in a particular city, the findings from this research will be important elsewhere. In particular, it was noted that stigmatization created substantial individual and social disruption and had potential, with a slightly different set of events, to affect the delivery of health care or other services. This project will explore who is involved in creating stigma, the consequences, and how people promote, resist, or manage those labels. This research will be important in learning, in an environment of scientific uncertainty and multijurisdictional conflict and contradiction, about countering stigmatization and mitigating the creation of risk objects.