On November 28, 2022, Norwegian Cruise Line (NCL), one of the world’s largest cruise companies, made a pivotal change in its approach to health and safety on board by concluding that public health officers were not the answer. After amassing a collection of “sanitation superheroes” to rival any Marvel Cinematic Universe or DC Multiverse film franchise, this was the day when NCL’s public health officers (PHOs) found out their services would no longer be needed.
This marked a significant departure from the company’s previous strategy, established during the cruise industry’s initial recovery from the hiatus imposed by the COVID-19 pandemic. Media reports had emphasized NCL’s commitment to having a designated Public Health Officer on board each vessel in its fleet as cruise operations restarted; a need NCL fulfilled by offering one of the most competitive contracts on the market. Yet, less than two years later, this policy would be reversed in a move that garnered considerably less attention in the media.
The intent in highlighting NCL’s decision to operate their ships without PHOs is not intended as a criticism of their corporate strategy. Rather, the objective is to pose the question of whether public health officers are necessary to ensure adequate hygiene and sanitation standards are maintained on board.
For one major cruise line at least, the answer is they are not.
The History of a Public Health Officer
Prior to the emergence of the SARS-CoV-2 virus, the position of a cruise ship public health officer was established, albeit not as prevalent as it is today. Numerous companies had a dedicated PHO aboard each ship, while other cruise operators appointed travelling fleet sanitation officers tasked with overseeing public health standards across multiple vessels during the course of a single contract. The onset of the COVID-19 pandemic, however, significantly altered the status quo.
As the cruise industry faced a multitude of regulatory demands to resume operations, it became apparent to cruise line executives that a dedicated individual responsible for on board sanitation and COVID-19 outbreak prevention initiatives was essential. Consequently, this created a plethora of employment opportunities for public health professionals, as cruise lines eagerly recruited PHOs or infection control officers—many of whom had no prior experience working on ships—to fulfil this critical need.
While the SARS-CoV-2 virus continues to evolve, infecting hundreds of thousands of people worldwide each month, more than a year has elapsed since the World Health Organization (WHO) declared that COVID-19 no longer represents a “global health emergency”. Fortunately, for public health officers who were newly employed during the pandemic, most cruise lines have maintained the role within their fleets. Maritime public health does, after all, encompass a broader scope than merely managing a novel respiratory disease.
What are the Responsibilities of a Public Health Officer?
The day in the life of a Public Health Officer varies depending on the cruise line they work for. Nonetheless, responsibilities typically include components of the following key maritime public health topics:
- Disease Surveillance: Monitoring the spread of communicable diseases on board in conjunction with medical staff.
- Disease Prevention & Control: Implementing measures to prevent and control communicable disease outbreaks.
- Food Safety: Upholding the critical principles of food safety—cleaning, cross-contamination, cooking, and chilling—in all food areas.
- Water Safety: Overseeing the provision of potable water to ensure the vessel’s supply meets drinking-water quality standards, as well as supervising the management of recreational water facilities to enable a safe and hygienic environment for bathers.
- Integrated Pest Management: Controlling and preventing pest infestations.
- Public Health Training & Inspections: Conducting routine inspections and training to support company compliance initiatives.
The illustrations presented provide a mere glimpse into the vast array of duties a PHO performs; a closer look at their key responsibilities reveals the true breadth of their role. The principal regulatory framework for public health within the cruise industry, notably the CDC’s Vessel Sanitation Program (VSP), prescribes over a thousand hygiene standards that vessels are expected to comply with. Fundamentally, the role of a Public Health Officer on board—as perceived by the companies who employ them—is to ensure adherence to these standards via inspections, training, and effective communication.
Such responsibility is a considerable burden to bear for any one individual, although it’s important to recognize that PHOs are the guardians of public health on board, rather than the managers. It falls upon the leaders of each department to ensure that their respective operational domains uphold the required standards. Public health is everyone’s responsibility, not just the sanitation superheroes.
The Challenges Public Health Officers Face
The placement of a Public Health Officer within the organizational structure of a cruise ship can influence the success of their role. In some companies, PHOs report directly to the Captain or Staff Captain, consistent with the hierarchy of other officers responsible for safety, environmental compliance, and security. Alternatively, in other cruise lines, PHOs are part of either the medical team or the food & beverage department.
Regardless of rank or position within a ship’s hierarchy, public health officers must collaborate closely with all department heads, as disease prevention impacts every aspect of a vessel’s operation. Nonetheless, there are reasons why compliance departments ashore are usually separate from those handling day-to-day operations. It’s a strategic approach that benefits a company’s long-term success and reputation by maintaining integrity, avoiding conflicts of interest, and ensuring regulatory compliance.
The point being made is not to question the leadership skills of positions such as a Food & Beverage Director or Hotel Manager; rather, it acknowledges that they are tasked with balancing other significant priorities such as on board revenue, guest satisfaction, and managing food costs. For example, PHOs reporting to a supervisor within the food & beverage department may face challenges in advocating for particular food safety concerns, especially when new on board and operational reasons are cited for decisions where public health standards could be compromised.
A further obstacle frequently encountered by PHOs is a lack of adequate support. Many PHOs are deployed on vessels without any prior training, based on the assumption that possessing an environmental health degree and a capacity to comprehend a company’s protocols is sufficient preparation for their duties. When confronted with challenges on board, they are expected to navigate and resolve issues independently.
Earning a degree in environmental health is a commendable educational achievement, however, it doesn’t equate to one being an expert, particularly in the niche field of cruise ship public health. This is due to several reasons including:
- Depth of Knowledge: Courses in environmental health provide a comprehensive overview of disease prevention, but often lack the depth required for aspects specific to managing public health on cruise ships, such as potable water safety and recreational water facility management. True expertise is rooted in an in-depth understanding acquired through specialized experiences and ongoing learning.
- Practical Experience: There is a distinct difference between academic knowledge and what is gained through practical, hands-on experience. Knowing the theoretical aspects of disease transmission is different from the actual responsibility of managing and containing outbreaks on a cruise ship through effective interventions.
- Critical Thinking: Being an expert involves the ability to critically evaluate information, adapt it to different situations, and solve complex problems. These are skills refined over time through practical experience.
In essence, while a degree lays the foundation, the edifice of expertise is constructed through a combination of advanced learning, real-world application, and a dedication to continual professional growth. It’s a journey of lifelong learning and professional development. The expectation that a PHO can single-handedly elevate public health standards on board, akin to a lone superhero, without requiring additional support, training, or mentoring is a fallacy that needs to be urgently addressed within our industry.
The Value of a Public Health Officer
Quantifying the value of a Public Health Officer can be complicated for cruise line executives as their contributions are largely preventative. A PHO’s work is dedicated to protecting the health of the crew, guests, and communities visited by averting illness, preventing outbreaks, ensuring compliance, and avoiding potential legal issues. Consequently, any measurement of success is often reflected in the absence of adverse events; in other words, in what doesn’t happen. This aspect of their role is less visible, and unfortunately, often underappreciated.
There is a general lack of understanding about what public health officers can achieve on a day-to-day basis, making it difficult to appreciate their contribution to both the vessels they serve on and the broader organization. The benefits a PHO can provide, such as increased risk mitigation and upholding a company’s reputation, are intangible and not easily translated into the metrics of quarterly financial reports.
The COVID-19 pandemic has had an unprecedented economic impact on the entire cruise sector. As the industry continues its efforts to recover, it’s understandable that cruise lines are focused on cost management, however, it’s a misconception to consider public health merely as an expense. This view overlooks the potential for public health to enhance operational efficiency, improve internal processes, and contribute to an organization’s profitability in the long term.
How many cruise ships operate without the presence of a Safety Officer, Environmental Officer, or a Security Officer on board? Given that these positions are considered integral to compliance, it’s reasonable to question why the role of a PHO isn’t regarded with the same level of necessity. This observation further accentuates the sentiment raised in our previous article, “Making Maritime Public Health Compliance Cool”—public health frequently doesn’t receive the same level of recognition afforded to other areas of maritime compliance.
While it’s well-known that adherence to regulations is essential in any business, the cruise industry often adopts a reactive approach to public health, fulfilling only the minimum requirements needed to comply with industry standards and accepting a traditional view of compliance as a cost of doing business. However, repositioning public health as a key strategic priority by embedding it within the very fabric of a company’s culture, has the potential to be a significant game changer.
In a conducive environment, a Public Health Officer can be instrumental in driving forward this transformation. Nevertheless, just as Batman—the iconic superhero from DC Comics—needs Alfred, his loyal butler and constant companion, so too does a PHO need help. Devoid of Alfred’s essential aid, Batman’s crusade against Gotham’s criminal underworld would prove significantly more challenging: the same applies to a sanitation superhero’s quest to improve the standards of public health on board.
When a Public Health Officer works within an environment where public health is a prerequisite for success—where a company’s commitment to disease prevention is evident at every level of the organization—and they have the support and assistance necessary from senior management, then they are well-positioned to contribute to exceptional organizational results. Conversely, if a PHO is embarked on a ship and expected to transform a company’s public health culture all on their own, it’s unlikely that their efforts will yield the desired results.
In such a scenario, perhaps relying on public health officers to maintain hygiene standards might not be the answer.