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HomeMy WebLinkAbout021621_ra03JEFFERSON COUNTY BOARD OF COUNTY COMMISSIONERS AGENDA REQUEST TO: Board of County Commissioners Philip Morley, County Administrator FROM: Julie Shannon, Executive Secretary II DATE: February 16, 2021 SUBJECT: DISCUSSION AND POTENTIAL ACTION re: Public Health Regionalization Letter STATEMENT OF ISSUE: Commissioner Dean is drafting a letter for potential adoption by Board of County Commissioners to be co- signed by sister jurisdictions/Boards of Health in Jefferson and Clallam Counties regarding Public Health Regionalization. ANALYSIS: n/a FISCAL IMPACT: n/a RECOMMENDATION: Discuss and possible approval of a Letter regarding Public Health Regionalization by the Board of County Commissioners to be co -signed by sister jurisdictions/Boards of Health in Jefferson and Clallam Counties Administrator Date Esteemed Legislators, The signatories of this letter, representing multiple tribes, local governments, Boards of Health and hospital districts of the North Olympic Peninsula (24111 Legislative District), are united in our desire and efforts to see our Public Health systems made more robust, responsive, equitable and accessible to all. This commitment has been evident throughout the Covid-19 pandemic, during which our region in general, and the signatories here, have exemplified regional collaboration, coordination, efficiency and care for our most vulnerable. We commend the State of Washington for managing this unprecedented pandemic better than a majority of states, and we recognize the vast complexity of challenges that the Legislature, like many of us, is attempting to steer our shared constituency through safely. Lastly, we appreciate the willingness of legislators, to date, to consider proposed amendments to legislation affecting public health. We hope you will continue to consider the input of those of us implementing services on the ground, in our communities. Specifically, we write to you with the following recommendations and concerns regarding House Bill 1152 and Senate Bill 5149 . (Without express reference, these recommendations include associated, amended, and substitute legislation). 1. Adequate funding for Foundational Public Health Services is critical to communities. The Covid-19 pandemic has exposed the fragility and inequities of our public health system. For many years, Counties and Public Health officials have been seeking a dedicated source of funding to ensure that all Washington residents have access to core services. We are thrilled to see Senate Bill 5149 address the chronic need for funding and urge your support. It will provide a stable and increase of resources over the long-term to bolster public health for all. 2. 2021 is a terrible time to be restructuring Public Health. The past year has been, arguably, one of the most challenging for public health in a century. The challenges have many causes, but the causes notably include economic uncertainty, loss of loved ones, the effects of isolation and stress to families, businesses and communities. But the sector hit hardest by the demands of the unexpected and unprecedented pandemic is healthcare, including public health. Whether because of fatigue from conducting testing and contact tracing, or the exhaustion from continuously pivoting to provide services in new and unexpected ways, or the discouraging effects of political debate from response to the pandemic, we know that public health professionals are retiring, quitting and burning out in record numbers.. And yet now, while desperately trying to vaccinate our entire population, we are asking these same public health folks to strategize on inventing and building a new public health system. And this reinvention is supposed to occur before we have even begun the process of evaluating the short -and long-term effects of the most wide -spread pandemic in modern history. There are plainly lots of lessons to be learned from responses, good and bad, to the pandemic, but learning lessons needs sufficient time to occur. This year, 2021, is the year get Washingtonians vaccinated and back to work; it is NOT the year to be restructuring public health. We therefore urge you to support House Bill 1340 to create a robust after -action plan to assess strengths and weaknesses of our current structures. At the very least, the Work Group created in HB 1152 should spend 2021 doing analysis to inform regionalization bills in 2022. 3. We fully support expansion of Board of Health membership. Both Clallam and Jefferson County Boards of Health were early adopters of an expanded membership to ensure more expertise, less politicization, better collaboration and increased representation for stakeholders and residents alike. Our Boards of Health have worked in good faith and in lock -step with our highly - regarded Health Officers, Dr. Berry and Dr. Locke respectively, throughout the pandemic. We urge your support of adopting the language from HB 1110, independently or by adding it to HB 1152, to require Boards of Health to expand membership while allowing for flexibility in identification of membership based on the unique circumstances of each jurisdiction. 4. Keep policy -and priority -setting local in order to best serve our communities. While some services are best delivered at a federal or state level, public health relies heavily on local partnerships, an intimate understanding of the communities being served, and connections and relationships that foster trust, communication and understanding. This has been evident throughout the pandemic, where communities who share a "We're in this together" attitude have markedly lower rates of infection, better adherence to masking/ distancing, and were able to "flatten the curve" more quickly. The regionalization of public health is problematic if it strips away local relationships and authority and replaces them with a regional framework, which may not reflect the communities therein. As an example, Clallam County has one of the highest rates of overdose deaths from opiates. In response, they expanded their naloxone program, used their local authority to make overdose events a notifiable condition, and intensified efforts to expand treatment access.. Similarly, Jefferson County had a high teen pregnancy and suicide ideation rate in the past. Their Public Health Department sought funding to secure family planning and mental health clinics in high schools leading to the launch of three school -based clinics. These are just two examples of our region responding to local needs and building on local expertise to solve priority issues. In a regional health district, our smaller counties would have less say in policy and funding decisions, therefor less ability to act swiftly to respond to local crises. 5. We support, and operate, regional public health collaborations. As a rural region, we well understand the concept of interdependence and sharing resources, Clallam and Jefferson Counties have a history and practice of identifying common needs. We shared a Health Officer for many years, we synched our early Covid re -opening efforts in summer 2020, and now the Jamestown S'Klallam Tribe is instrumental in vaccinating not only tribal members, but thousands of Olympic Peninsula residents. These collaborations enhance our local capacity; we resist regionalization efforts that hamstring our efforts to respond nimbly to local needs. Similarly, we take part in myriad, successful regional efforts such as behavioral health administration, workforce development and educational service districts. We recognize the added value of regional planning and shared resources, but in all of these cases we maintain local authority. Our entities are willing participants in discussions of sharing diverse assets such as epidemiologists, laboratory services and emergency supplies. Additionally, we understand the need to connect state funding to performance- and evidence -based public health programming- so long as local Boards of Health and local health jurisdictions are kept whole and autonomous. 6. Keep our Health Officers local. Dr. Berry and Dr. Locke have been sources of credible information, sound science, comfort and stability during Covid-19. This is no small thing; attracting, recruiting and retaining public health professionals in our rural communities is extremely difficult. Having our health officers live in, be invested in and accountable to our residents and jurisdictions has great value. The success of much of their efforts to control SARS-CoV-2 spread depends on ongoing engagement with local public hospitals and medical community. The longevity of many Health Officers speaks to the long-standing relationships, trust and commitment fostered by having a local health officer. We oppose the concept, introduced in HB 1152, of reassigning them as employees of the state. We have shared in the dismay of seeing the firing of health officers in 2020. We strongly believe this political problem is best solved by diversifying Boards of Health, NOT by making health officers employees of the State. We support efforts to allow local public health jurisdictions and diversified Boards of Health to maintain authority and flexibility with their health officer. To the extent health officers have been subject to politically motivated attacks and wrongful dismissal, we support changes in statute that assure due process rights are respected and allow for appeal of contested job actions to an oversight body such as the State Board of Health. We see this as the best path forward to forging strong, collaborative ties to our communities and our public health infrastructure. Please consider these recommendations of our diverse region's tribes, hospital districts, local governments and Boards of Health as a desire to reach solutions to improve the public health outcomes of Washington - whether rural or urban, east or west, Democrat or Republican. Divesting in local public health at this time will only serve to further undermine trust in government and public health interventions. Maintaining an accessible, known, credible and effective local public health department is the best way to invite rural communities into important conversations about population health, social determinants of health and health equity and access. We share in your interest, and appreciate your efforts, to strike the right balance of local authority, consistency and fairness for all. This balance plays out every day at the local level in our very jurisdictions and we hope you will continue to engage with diverse entities to inform future legislative action. Thank you for your ongoing commitment and efforts. Lynatones of the North O 0