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

美国最近爆发的埃博拉危机表明，需要改进对复杂的突发公共卫生事件的管理，尤其是那些新的或令人惊讶的突发公共卫生事件。公众对这种疾病的焦虑与对传播方式的挥之不去的模棱两可交织在一起，给卫生行政人员、临床医生、其他医护人员和公职人员带来了巨大的领导力挑战。这项研究将研究纽约市公共卫生系统对埃博拉危机的反应，以开发决策支持工具，供卫生官员、医生和其他从业者在未来爆发传染病时使用。虽然基于一个事件的案例研究，但结果将与其他大型公共卫生突发事件和其他环境中的流行病相关。这些机构传播了相互矛盾的信息，这些信息非但没有让公众放心，反而引发了进一步的焦虑。与此同时，两名来自达拉斯的护士的感染表明，公共卫生系统正在步履蹒跚。在这个充满不确定性和怀疑的环境中，人们和地方被公众和官员们污蔑，声称他们的行为是“出于高度的谨慎”。教师被要求休假；一名护士在新泽西州被隔离；学童不被允许注册上课；一些医院工作人员报告说，他们在工作或兼职方面遇到了困难。机构需要在模糊的危机期间发挥作用，这表明有必要更好地理解人和地方是如何被定义为风险对象的。换句话说，人们如何对待人，以及人们如何针对被认为不公平的待遇--包括耻辱驱动的政策--为自己辩护，可能会导致他们采取措施，削弱或挑战公共卫生需求或其他重要的公共服务。该项目计划对污名的概念以及人们如何抵御污名进行新的研究。焦点小组、访谈和文件审查将展示人们是如何被污名化和抵制污名的。尽管这项研究的重点是特定城市的特定健康危机，但这项研究的结果将在其他地方发挥重要作用。特别是，有与会者指出，污名化造成了严重的个人和社会破坏，并有可能对保健或其他服务的提供产生影响，因为事件的范围略有不同。这个项目将探索谁参与了制造污名，后果，以及人们如何宣传、抵制或管理这些标签。在科学不确定和多管辖冲突和矛盾的环境中，这项研究对于学习如何应对污名化和减少风险对象的产生具有重要意义。

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.