When the System Fails Its Protectors: An Anonymous Account of Neglect in Public Health - Voices #25
A former public health professional reveals how systemic neglect, toxic workplace culture, and disregard for regulations can drive skilled professionals out of the field and endanger the public.
We continue our series Voices from the Field: Meeting This Moment in Public Health in which we lift the voices of public health professionals reflecting on the realities we’re facing today - and the lessons learned across the arc of their careers.
Public health relies on skilled, committed professionals to protect communities from harm, yet the people doing this critical work are often undervalued, overlooked, and exposed to unsafe conditions themselves. This account from former public health professional Elsbeth Picard highlights how toxic workplaces can push public health workers out of the field, with consequences that extend far beyond the office walls.
If you’d like to follow Elsbeth’s lead and share your own perspective on public health in these times, I’d love to hear from you. Please get in touch!
When the System Fails Its Protectors: An Anonymous Account of Neglect in Public Health
By Elsbeth Picard, MS Ed., MPH
I left public health nearly two years ago. The hurt and anger have not faded.
For many people who share their stories through this newsletter, there is still hope. A belief that reform is possible. A feeling that the system, while strained, can still be repaired from within. This is not one of those stories.
When Prevention Works, Nothing Happens
For more than 8 years, I worked as a health inspector for a governmental public health agency. My responsibilities included inspecting facilities for safe food storage and handling; verifying water systems for proper chlorination and bromination; identifying structural, electrical, and fire hazards; and ensuring that waste systems functioned as required. On paper, the job was straightforward. In reality, it carried weighty consequences. I was responsible for identifying risk, documenting violations, and enforcing regulations meant to prevent harm.
Much of this work happens out of sight. When public health works, nothing happens. No outbreak. No injury. No headline.
I believed in that work. I still do.
Health inspection relies on understanding that harm is rarely caused by a single catastrophic failure. It emerges when small problems accumulate, when warning signs are ignored, when protective layers erode. We often describe this using the “Swiss cheese” model of accident causation. Each layer of regulation, oversight, and prevention reduces risk. When the holes align, people get hurt.
Critical Violations and “Bad Day” Violations
Violations fell into two broad categories. Critical violations posed immediate and serious risk: temperature-controlled food held in unsafe ranges that permitted bacterial growth; swimming conditions that increased the risk of unobserved drownings or disease outbreaks due to inadequate chlorination; surfacing sewage exposing the public to pathogens (e.g. septic systems leaking human waste in mobile home parks); exposed electrical wiring or overloaded adapters in hotels.
Non-critical violations were smaller failures that weakened protective systems over time. I called them “bad day” violations. Alone, they might not cause injury, but left unaddressed, they slowly create the conditions for serious harm. One emergency light being out would not prevent safe egress, but left unfixed, it could become several dark exits during a fire.
Within the office, we were discouraged from documenting too many non-critical violations. The rationale was efficiency and education. Facilities, we were told, should not feel overwhelmed. Focus on the most serious issues. Address a few things at a time.
But in practice, this approach erased risk from the record.
Uncited violations did not exist for enforcement purposes. Patterns disappeared. Repeated failures went undocumented. When facilities failed to correct problems, there was often no paper trail showing how long conditions had persisted.
In the field, operators wanted context. Hotel and restaurant managers, water system and pool operators, cooling tower managers, and children’s camp directors all valued inspectors who could explain chains of risk rather than rely on “because I said so.” They wanted to see how small failures connected to larger hazards so they could prevent harm.
I saw how early documentation could prevent major harm and expense. I also saw the opposite: facilities where problems were repeatedly minimized eventually faced far more extensive and expensive repairs because early warnings had been ignored.
When Compliance Becomes Optional
This disconnect extended far beyond inspection practices. Over time, I observed a wider institutional disregard for the history and intent of public health regulations. Rules were characterized as unnecessary or burdensome, losing sight of their purpose: to protect the public.
Early in my tenure, I discovered that critical data had been entered incorrectly into a state system, preventing safety alerts from triggering as designed. Correcting the error required substantial effort, but the deeper issue was cultural. The system existed because people had been harmed before. The mistake did not cause immediate injury, but it increased underlying risk. That increase was treated as acceptable.
This is the same culture that fuels resistance to new programs designed to prevent or reduce harm by addressing aging systems or pandemic response preparedness. I wish I could say it was one program or one person. It was not.
Public health in the United States is reactive by design. Many regulations exist because someone was injured or killed. Treating compliance as optional is not a neutral act. It transfers risk back onto the public, often onto children, workers, and vulnerable people with the least power to protect themselves.
When I raised concerns, I was told that regulations did not mean what they plainly said. Interpretations shifted depending on convenience. Scientific evidence was dismissed when it complicated enforcement. Efforts to clarify standards were met with resistance or hostility. Over time, it became clear that this was not a problem of training. It was an entrenched organizational culture.
Workplace Harm is Public Health Harm
Early in my tenure, I was promoted quickly into a role vacated under troubling circumstances. Stepping into that position came with an unspoken understanding that serious issues had been tolerated until they became impossible to ignore. That pattern repeated itself elsewhere.
Within the same organization, serious workplace misconduct was handled much like regulatory risk. Known problems were minimized. Complaints were reframed as misunderstandings. Patterns were broken into isolated incidents so they could be dismissed. Accountability only appeared when those in power felt personally threatened.
Women made up the majority of the workforce. Men disproportionately held authority.
Harassment was normalized. Boundaries were blurred. Reporting carried consequences for the person who spoke up, not the person whose behavior caused harm. Over time, silence became safer than integrity.
These workplace dynamics are not separate from public health practice. An organization that tolerates misconduct internally is also an organization willing to ignore inconvenient regulations, dismiss evidence, and cut corners when enforcement becomes uncomfortable. The same culture that undermines worker safety undermines public safety.
Eventually, the personal cost became too high. I left public health entirely.
After I left, false narratives about my work were allowed to stand. Professional relationships were severed. Without credible references, reentry became impossible. My years of experience were effectively erased.
My story is not about one agency or one individual. It is about what happens when systems designed to protect the public fail to protect the people doing the work. When harm is tolerated internally, it does not stay contained and eventually reaches outward.
I work in a different field now. I took a pay cut. My long-term financial stability has been permanently altered. My new field of employment is known to carry significant mental health risks. Still, my well-being has improved dramatically.
That fact alone should be alarming.
Toxic management practices tolerated within public health signal systemic dysfunction. When the people responsible for protecting the public are forced to work under such conditions, it reflects deep structural problems that threaten both the workforce and the communities we serve. Addressing these issues requires a fundamental reckoning with how public health institutions value and support their own staff.
When people ask whether I would ever return to public health, or what would need to change, my answer is simple: No and nothing. There is no reform package that restores trust once it has been systematically broken.
Public health cannot afford to keep losing people this way. And it cannot fix what it refuses to see.
🆕 Action steps
✨Starting last week in honour of MLK Day, all newsletter authors are invited to share action steps. We compile all suggestions into the Resistance Action page that we have been building since we started. ✨
Are you experiencing toxicity at work?
🚩Check the systemic red flags listed here for some signs to look out for.
The views expressed here are those of the author and do not represent the views of any organization, employer, or institution with which they are affiliated.
Elsbeth Picard, MS Ed. MPH is the pseudonym for a former public health professional with 8 years of public health experience and more than 10 years of experience in related fields. She shares her story anonymously to give strength to anyone else experiencing the same, and to help them to know that they are not alone.
If you would like to share your perspective on public health right now in this Newsletter written TO and FOR and BY and ABOUT the public health workforce, we are currently running two series:
Write an opinion article grounded in lived experience for Voices from the Field: Meeting This Moment in Public Health; or
Compose a Love Letter to Public Health in poetry, prose, visual art, or another creative medium.
🆕 I’m also considering a new series: Resignation Letters. We have already shared two letters from public health professionals who felt compelled to leave, and their words make clear how much is being lost in this moment. If you have left the public health workforce during this period, for any reason, and want to share your reasons or your message publicly, I invite you to get in touch. This platform exists to document what is happening to our people and our institutions while the record is still being written.✨
Please get in touch if you would like to submit a draft to any of these series. I will work closely with you to prepare it for publication. Review previous instalments for examples. I will offer you my personal promise of confidentiality if requested.
🆕Resistance action steps - Editor’s note from Katie✨
Thank you for reading this newsletter for and about the public health workforce. At this tumultuous time, I’m still really not sure where we go from here. But each time that I publish this newsletter and receive positive feedback from readers, my list of ideas for action steps continues to grow. I will start to compile these suggestions here. As we learn more, let’s keep adding to this list.
I close by emphasising what I said in a previous newsletter:
“At this time of uncertainty for the public health workforce, let’s remember our commitment to science and evidence and data. We know that validating emotions and baggage has a place too, but we need to be able to identify them and distinguish opinion from fact.
Let’s recommit to kindness and mutual support for the public health workforce and beyond. If leaders are trying to sow divisions among us, the best we can do is to respond with empathy, and by strengthening, connecting, and lifting up one another.
Right now, the best I can offer my fellow public health professionals is a place* to gather and reflect and share and vent and organize and ask questions and offer support to one another. We’re going to need that now more than ever.”
*This is a plug for the Public Health Connections Lounge on LinkedIn, where we seek to build community and conversation among public health professionals. Join us.
If you are new around here, Welcome to The Public Health Workforce is Not OK! In this newsletter, I share frank insights and start conversations about the experiences of building a public health career. You can get to know me here and here. Please subscribe, review the action steps and the archive, and join the conversations in the Lounge. I am committed to keeping this newsletter free for job seekers (at least, for as long as I still have a job).
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