The Mental Health Costs for Frontline Health Workers

The COVID-19 pandemic showed the world what many in the global health community already knew – the stressors of being a frontline health worker can significantly impact mental health. Recently, Global Health Council had the opportunity to speak to Juan Carlos Negrette, Director of Global Health at the University of Utah. Mr. Negrette believes that this challenge requires additional research to understand its scope and impact. Ultimately, a holistic framework must be developed to address what is a growing crisis. Read our interview below to hear what he has to say:

Can you tell us about University of Utah’s work in global health?

The University of Utah has a large global footprint, with over 100 programs in more than 55 countries. The vast major of these activities are associated with research. We also have student exchange programs and work in development.

We inhabit the same space as many other GHC members. We often work for USAID and CDC; in fact, we’re one of the largest recipients of federal funding in the nation. Our menu of interventions is quite wide, including everything from NCD research in Tonga to maternal and child programs in Ghana and wastewater studies and diagnostics in Pakistan.

Why has mental health become an area of interest?

It is estimated that at least one physician commits suicide every day in the U.S. In a way, it’s nonsensical to attempt to try and quantify this kind of tragedy. You can assess the opportunity costs associated and DALYs (disability-adjusted life years) and the like, but that does not speak to the magnitude. And this is only for one segment of health workers. We have found that the numbers are even larger for other providers.

As usual, the impact is even greater on women. We know, for example, that women are paid less than men. In the U.S., the average salary for a male physician is over $360 thousand per year, whereas women make $300 thousand per year.

Providers, in general are well compensated in the U.S. The physicians and nurses in this country are almost the top paid in the world. But no matter how well paid you are, it does not address your overall level of happiness. We can’t simply address the issue of compensation in the vacuum. I’m not saying that we shouldn’t be advocating for adequate salaries. What I’m saying is the salary is not the only factor.

Certainly money plays a role, but it’s not entirely sufficient to look at it from that perspective. If the issue is systemic, as we think it is, it has to be addressed in broader terms. I would argue that we need to look at it in terms of values.

In the U.S., students entering medical school have the same level of satisfaction and expectations as their peers in other post graduate programs. But over time, medical professionals become less satisfied, comparatively.

When people enter into their profession, they are doing so for a variety of reasons. And, if they feel that the system within which they work is forcing them to do things they don’t want to, it creates a cognitive dissonance. In the extreme, this may cause them to abandon their profession entirely. Or worse.

Is this a new or growing phenomenon, resulting from the COVID pandemic?

It’s been lurking beneath the surface for a long time, but was exacerbated by the pandemic. It was a crisis that had some level of acknowledgement and led to things like the creation of a Chief Wellness Officer role in some organizations. But the pandemic amplified the problem exponentially. It’s like, when you’re ready for rain, you put on your raincoat. But then you realize that there’s a hurricane raging.

You recently partnered with EngenderHealth and the University Hospitals of Geneva to address this challenge. How has this collaboration evolved?

At last year’s World Health Assembly, I moderated a panel discussion that served as a sort of prelude to these efforts. Dr. Lia Tadesse (the then Minister of Health of Ethiopia), Dr. Idris Guessous (Head of the Division of Primary Medicine at the University Hospitals of Geneva), Dr. Roopa Dhatt, (Executive Director and Co-Founder of Women in Global Health), Traci L. Baird, (President and CEO of EngenderHealth) discussed the increasing global concern regarding healthcare worker well-being. We talked about tackling burnout and promoting resilience among healthcare professionals to uphold high-quality patient care, ensure safety, and prioritize the well-being of healthcare providers.

It became clear that this is not only a problem within high income countries. It’s happening all over. And we wanted to continue the conversation. Now, we are working to engage different audiences including hospitals and hospital systems, administrators, the public and private sectors, academia, and, of course, governments.

How do you envision this work taking shape in the next year or so?

It is an approach I have discussed with others. Through these conversations, we hope to put together ideas from the different groups and develop a framework of interventions. This would offer a more comprehensive view of the issue, a holistic approach to addressing it, and a way to advance it.

The first step will be bringing stakeholders together to actually put our hands in the mud and give shape to things. We are hoping to have another conversation, in Geneva this spring, to introduce the concept. We will then conduct a series of workshops over the next six months. The hope is that, in about nine months, we will be able to share a proposed approach.

It is Frontline Healthcare Workers Week; the theme this year is “Safe and Supported: Invest in Health Workers.” What does that mean in the context of your work?

The patient-centered mantra has been incredibly useful for elevating quality across the globe. But how do we bring the provider into that? How do we avoid providers becoming patients as a result of their profession? If your healthcare providers are not healthy, how can you expect your healthcare system to be?

The relationship between the provider and the patient happens within a systems context. We have to protect both sides of the equation because they are both equally important.

Are there any last thoughts that you would like people to know about the mental health of frontline health workers?

At the end of the day, this is a fixable problem. We have tackled enormous global health challenges before; think of the eradication of small pox, or how close we are to eradicating polio. Think of the reduction of maternal and child mortality across the globe, and mortality associated with HIV. We know things can be done. And this one can be done, too.