How important is a strong local health department?

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The El Paso County Department of Health and Environment is considered a large health department — only 4 percent of health departments across the country serve populations of more than 500,000 people.

Large health departments are expected to provide services that might not be required of smaller health departments, such as sophisticated information and communication systems and professionals trained in epidemiology, biostatistics and health education.

Just as El Paso County residents expect local hospital facilities and medical providers to offer full-service localized care, the same expectations hold true for public health services.

Specific services that a large and “healthy” community expects from its local public health agency include:

  • Monitoring for possible infectious disease outbreaks and other communicable diseases that pose public health risks. This monitoring must be robust enough that residents trust that they will have adequate warning to be able to protect themselves and their families.
  • Expertise to identify cases of infectious disease and the ability to implement control measures quickly to halt the spread of the disease throughout the community.
  • The infrastructure and skills to communicate potential public health risks to the public in a manner that does not cause panic but provides information about how residents can protect themselves from becoming ill.

As an example of how EPCDHE delivers the above services, consider the actions taken during a recent school-based exposure involving an active tuberculosis case. This one active case required TB testing and skin test follow-up for more than 200 students and staff from School District 49.

About half of the Health Department’s staff took part in the investigation, which called for rapid response and initiation of various communications.

During this TB investigation, it was clear that our community members expected specific services to be delivered by EPCDHE:

  • School officials and parents expected EPCDHE to have the expertise to quickly identify where TB exposure occurred and stop a potential outbreak.
  • School staff and parents of children who were exposed expected to be evaluated and treated appropriately.
  • School staff and parents of children who were not exposed expected accurate information about why they were not at risk.
  • Physicians expected to receive prompt information from the Health Department informing them about the situation and what to expect from parents and patients.
  • Local news media expected accurate information so that they could inform the public.
  • Residents expected up-to-date information to reassure them that their families were not at risk.

It is evident that a strong public health response to a potential outbreak is an expectation of any community. Just as we expect to receive comprehensive medical services in Colorado Springs, we also expect public health expertise to be close at hand. We do not want to wait for help to arrive from Denver or a surrounding county.

However, if funding for public health in El Paso County continues to decline, that is what we might be facing.

Fighting infectious disease outbreaks depends on local funding. Public health departments across the country receive an average of 44 percent of their funding from local government appropriations. EPCDHE receives less than 25 percent of its funding from local appropriations. Health departments serving populations of more than 500,000 have a median number of 340 employees. EPCDHE has 215.

A study published in the American Journal of Public Health by Glen P. Mays Ph.D., MPH, of the University of Arkansas’ College of Public Health, found that adequate governmental funding is necessary for a strong and effective public health system. This is especially true for local government funding.

Local public health agencies must have the capacity to protect their own residents. Relying on state or federal agencies to respond quickly to diagnose and stop the spread of disease throughout a local community is unrealistic.

In addition, effective daily monitoring of data to warn about possible cases can only be accomplished at the local level. When an infectious disease case is reported, there is a critical time period for identifying exposed individuals and stopping the spread of disease that can only be met by locally placed public health experts. These local experts know their community and are able to quickly disseminate information to residents to assist them in protecting themselves.

We have a choice to make. Are we committed to supporting a strong local public health system in El Paso County to protect ourselves, our families and our friends or are we willing to trust those outside our county boundaries to protect us?

Rosemary Bakes-Martin M.S., M.P.H., Public health administrator of El Paso County.