Putting Out Fires: The Experiences of Wisconsin Rural Health Officers During the COVID-19 Pandemic

Samantha Crowley, MD, MPH; Sarah D. Hohl, MPH, PhD; Hazel Behling; John Eich; Gary D. Gilmore, MPH, PhD, MCHES; Jonathan Temte, MD, PhD

WMJ. 2025;124(5):445-451.

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ABSTRACT

Introduction: The COVID-19 pandemic created significant challenges for public health systems, which were exacerbated in rural settings due to chronic issues of resource allocation, underfunding, and politicization. Differences in attitudes about governmental roles have resulted in differences in acceptance of public health interventions, such as masking mandates and COVID-19 vaccinations. This study explored contemporaneously the pandemic’s impact through the lens of Wisconsin rural health officers (RHOs).

Methods: We conducted semistructured key informant interviews with RHOs in 13 rural Wisconsin counties to explore the breadth and depth of their lived experiences during the COVID-19 pandemic. We applied directed content analysis to interview transcripts.

Results: RHOs identified numerous challenges faced during the pandemic, including lack of adequate resources and workforce capacity, inconsistent communication from state health officials, lack of support from their communities and local political leaders, misinformation and disinformation, strained personal relationships, and threats of physical violence. These challenges caused mental anguish and burnout among health officers and their colleagues. RHOs also identified successes, including strengthened partnerships with local health care organizations, school administrators, and businesses.

Conclusions: Health officers in rural Wisconsin faced significant challenges throughout the COVID-19 pandemic that impeded their ability to address COVID-19 and other health needs in their communities. Allocating resources such as increased funding for public health infrastructure, ensuring protections for public health employees, and supporting improved communication channels between state and local health departments could help RHOs mitigate effects of COVID-19 and successfully address the health of rural communities.

Author affiliations: Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (Crowley, Hohl, Behling, Temte); Wisconsin Office of Rural Health, UW School of Medicine and Public Health, Madison, Wisconsin (Eich); Department of Public Health and Community Health Education, University of Wisconsin-La Crosse, La Crosse, Wisconsin (Gilmore).
Corresponding author: Samantha Crowley, MD, MPH, email scrowley@uwhealth.org; ORCID ID 0000-0001-5174-9466
Financial disclosures: None declared.
Funding/support: This work received support from the University of Wisconsin (UW) School of Medicine and Public Health Department of Family Medicine and Community Health Summer Research and Clinical Assistantship.
Acknowledgements: The authors would like to thank the rural health officers who participated in this study, as well as the UW School of Medicine and Public Health Department of Family Medicine and Community Health, UW-La Crosse Department of Public Health and Community Health Education, and the Wisconsin Office of Rural Health.

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