Many people in the public health field—including members of the Harvard Chan School community—have been facing waves of uncertainty due to changes in federal policy. Grant reviews have been frozen in many fields. Contracts have been terminated. Data sets have disappeared from website—and in some cases, have reappeared with warning labels. And the Trump administration has cut hundreds or thousands of jobs in federal agencies focused on public health. Karestan Koenen, professor of psychiatric epidemiology and an expert in stress and trauma, discusses the impact on public health professionals—and offers tips on coping.
Q: What are you hearing from people during this time of transition?
A: I’m hearing a lot of uncertainty about the future.
Even though priorities change over time, people in public health have worked in areas usually acknowledged as being important, so we always thought that federal funding, particularly from the National Institutes of Health (NIH), would continue. Now, we don’t know if it will.
I’ve been hearing from students who are concerned about finding jobs in research or in public health departments or agencies. People are also concerned about areas they study. For example, if they study transgender health, should they continue? Will it put them at risk somehow? Will there be funding? Junior faculty are in a particularly tough spot, wondering what the changes mean for their careers.
People go into public health because they want to make a difference and improve lives. It’s really mission-driven. And we feel like we’re being attacked at the core of our mission, making it, in some cases, practically impossible to do our work.
Q: Among people affected by the current changes, what are some of the toughest things they are dealing with?
A: Every day there seems to be something new. People are trying to make sense of it, but … there’s a lot we don’t know.
For example, those of us who have worked with the NIH for a long time usually had [frequent] conversations with our program officers. And that’s been really limited lately. So our normal ways of doing business have been disrupted.
Another problem is the removal of websites and publicly available data. It hit me the other day as I was working on some research and wanted to look for something in the Youth Risk Behavior Survey, data that is usually on the website [of the Centers for Disease Control and Prevention]. I did find it, but it had a big warning label on it saying any information on the page promoting “gender ideology” was “inaccurate” and “does not reflect biological reality.” It’s not clear whether these surveys, which are very important to public health research, might be conducted in the future. Or if they are conducted whether they will include information important to identify the populations most at risk.
This disruption of data has really shaken the foundation of everything we do. It feels devastating.
Q: What can people do to cope in the face of this uncertainty?
A: When people are dealing with threat, uncertainty, unpredictability, or something they can’t control, it can lead to psychological distress. But I know both from my own experience and from the research that if you can find meaning or purpose even within a difficult experience, it can help.
One of the books I have gone back to over and over again at difficult times in my life has been Victor Frankl’s “Man’s Search for Meaning.” He reminds me of the importance of finding purpose in even the most difficult times, even if that purpose is simply navigating those times with honor and dignity. I experienced a sexual assault in my early 20s and a critical aspect of my recovery was finding ways to use my experience to support other rape survivors. I volunteered at a rape crisis center, became a clinical psychologist, and eventually testified in Congress—all driven by a desire to find purpose in a terrible experience.
One of my close colleagues, Laura Kubzansky, has done research on this topic. For example, her work has shown that having a sense of purpose is associated with better health behaviors in older adults, including reduced risk of cardiovascular disease and lower mortality risk. Purpose in life has also been associated with better mental health.
Q: What are some other ways people can manage the sorts of challenges they’re experiencing now?
A: Continuing to do our important work in the field of public health—trying to improve people’s lives, which many of us feel a calling to do—is one way. I find the work being done by my colleagues and students on the Data Rescue Project particularly inspiring right now. Dropping off food at a food bank can be meaningful. For some it might involve smaller, more personal things. For example, I’ve been trying to have people come to my place more, because I feel like people want to hang out together.
Sometimes when we’re under stress and there’s a lot going on, we find ourselves not doing things that we normally do that can help us feel better. Whether it’s meditation or exercise or watching what you eat, it’s important to be more disciplined during times like this, rather than less. It’s the plane-safety analogy: You need to put on your oxygen mask before helping someone else with theirs. I am finding this difficult to remember myself!
It can help a lot to schedule things with other people. For example, I might not feel like going to a yoga class but if I plan to meet a friend there I will go whether I feel like it or not.
All of us have been through difficult times before. We are all still here because we survived. After all, the pandemic wasn’t that long ago. You can think, “What helped me get through that?” And you can reflect on that and think, “How can I use some of that now?”
