Rhododendron County Health

STRATEGIC PLANNING AND THE RHODODENDRON COUNTY HEALTH DEPARTMENT

The Rhododendron County Health Department

In 1990, the department of Health and Human Services published Public Health Service: Healthy People 2000: National Health Promotion and Disease Prevention Objectives. Objective 8:14 of that document calls for ninety percent of the population to be served by local health departments that would effectively carry out the three core functions of public health: assessment, policy development, and quality assurance. (Sultz and Young, 2001).

It is through the fulfillment of these public health responsibilities that public health departments protect the public against preventable communicable diseases and exposure to toxic environmental pollutants, harmful products, and poor quality health care. (Sultz and Young, 2001).

The Administrative Staff

The Rhododendron County Health Department is located in Washington State, and like other public health facilities in the state, they are going through a challenging time trying to balance the need for change and a focus on population-based services with the financial and political realities of public health on the local level.

The director of the health department is Barbara Simmons. She and her staff have a history of providing clinical services and have gained respect in the community for these services.

Robert Cooper is the part-time health officer and practices in the community as a primary care physician. He understands public health issues and is an articulate spokesperson for the importance of public health. Although there has been little contact between Rhododendron County Physicians and the Health Department, Dr. Cooper is trying to organize and educate physicians about public health issues but has not been very successful.

Although Ms. Simmons supports Dr. Cooper's role as a health officer and has encouraged more involvement with the provider community, she has not encouraged a leadership role on policy issues. Dr. Cooper's involvement with the Board of Health has been limited to providing expertise on clinical issues. He wants to be involved in educating the BOH about their role and, at the same time, advocate for the importance of public health. He has held back his desires because he doesn't feel that Ms. Simmons is very supportive regarding his involvement in policy issues.

Travis Johnson is the Director of Environmental Health Services. He is a superb field sanitarian, but his management style is autocratic as indicated by his refusal to encourage the ideas and efforts of his staff. This has resulted in low morale in that department. Ms. Simmons has tried to work with him on his management skills, but due to higher priorities she has chosen to ignore him.

Maria Espinoza is the Director of Personal Health (PHS). She is an excellent manager and very supportive of her staff. She believes that the role of public health is to either directly provide services or make sure that people in need have access to services from another high quality source. Maria is becoming concerned about the quality of clinical services reaching high-risk populations. In June, well-child services were terminated because of declining revenues. Of children receiving the services, eighty percent that were eligible for Medicaid were no longer coming because they were receiving care form their Healthy Options providers.

The Board of Health

According to the Washington Department of Health's website (www.doh.wa.gov), the Board is assigned by statute to serve as the focal point for professional and citizen health concerns and to gather these concerns into a coherent policy. The BOH works to develop and establish policies in several ways. The board solicits diversified information about health concerns by holding its monthly meetings, sponsoring public forums, and conducting citizen surveys in a variety of locations throughout the State; Advises the Secretary of the Department of Health on health policy issues pertinent to both the agency and the State and assists health research by adopting rules related to the assessment of health databases and explores ways to improve the health of the citizenry of the State.

The Rhododendron Board of Health is comprised of the three county commissioners. They want the health department to be credible with the community and not be the cause of constituent complaints, especially constituents such as builders. They have decreased county funding of the health department from thirty percent of the health department budget in 1988 to twenty two percent in 1994. Barbara feels that they do not adequately fund public health and the BOH does not think they have a duty to increase funding. They expect the health department to continue to provide the same level of services, without using county funds for those services.

Barbara has used various tactics to educate the commissioners on public health issues. The efforts have met with some success: Commissioner Michael Wright did not know much about public health but is now a strong supporter and understands the importance of disease prevention and health promotion. He reads all materials presented by the staff. Commissioner David Sloan is becoming even more of a fiscal conservative. His emphasis is on increasing the county reserves and funding as little of county government as possible. He does not understand the regulatory requirements of BOH to fund the health department. He also does not understand prevention; his philosophy is more focused on downstream approaches. Commissioner Susan VanDoren is also a fiscal conservative; she sometimes supports public health but vacillates. She does not read materials distributed but she balances the budget to the penny and is very detail oriented.

In 1994, Washington State created the Public Health Improvement Plan (PHIP). The PHIP is the blueprint for improving health status in Washington though prevention and improved capacity for public health services delivery. (www.doh.wa.gov). The plan calls for strengthening the ability of the public health system to prevent health problems and defines eighty-eighty capacity