Over the past three years, we’ve grown accustomed to Public Health wearing a mask and sticking needles in people’s arms.
Speaking for myself, I didn’t mind wearing a mask during the COVID crisis, even though I had little faith that an inexpensive cloth or paper mask would physically prevent the transmission of microscopic virus particles. But I did feel that mask-wearing was a simple way to visually remind my neighbors that a potentially deadly disease was present in the community, and that we could probably minimize the spread by keeping our distance.
That is to say, the masks weren’t a protective device, so much as they were a public warning signal.
On the vaccine side of the campaign, I was one of the approximately 30% of Archuleta County residents who may have questioned the distribution of a poorly-tested vaccine of a type that had never before been administered on a mass scale — an ‘mRNA’ vaccine — and who thus declined to be vaccinated. I ended up getting COVID (according to an inexpensive testing kit purchased at Walmart) and spent three days in bed with flu-like symptoms.
This morning, Tuesday April 11, at 10am, the Archuleta Board of County Commissioners will be meeting with their Public Health Department Transitional Advisory Committee to discuss a number of interesting topics, including (I assume) the eventual composition of the ‘Board of Health’, the type of board specified by Colorado law as the governing body for a public health department. The Advisory Committee had submitted a recommendation to the BOCC on that topic, and then had seen a different composition placed on last week’s BOCC agenda as a proposed resolution.
The proposed resolution was tabled, and the BOCC scheduled a meeting for this morning. Maybe, an attempt to get everyone on the same page?
Yesterday morning, April 10, the Advisory Committee held a regular weekly meeting and discussed a number of topics, including the topic: What does the BOCC want the Advisory Committee to do, and not do?
Another topic: Can we have better communication between the various staff and volunteers working on this planning project?
Yet another topic: The Advisory Committee can make estimates of a future budget, but we first need to know what services the Archuleta County Public Health Department will be providing. What will those services be?
This last question is of interest to me, and possibly to other people in the community.
In connection with that question, we can assume there are certain services that a county public health department is required to provide, according to Colorado law.
At the conclusion of yesterday’s Advisory Committee meeting, I approached a couple of the committee members and asked if the committee had put together a list of required services. I was told they have not yet put together such a list.
We know (or can find out?) what services the San Juan Basin Public Health district has been providing.
We can, for example, peruse their 9-page fee schedule, which you can download here.
But as a member of the taxpaying public in Archuleta County, I don’t yet know exactly which services are ‘optional’ and which are ‘required’. I also don’t yet know which services are provided by SJBPH staff and which services are provided by independent contractors. I don’t yet know how many people in Archuleta County benefit from each service.
In other words, I still have a lot to learn, if I want to understand ‘Public Health; in Colorado. I’m not sure if the Public Health Department Transitional Advisory Committee or the BOCC have all the necessary information yet.
One of the things a county public health department must have: a plan. From Colorado Revised Statutes, 25-1-501:
Thus, the state of Colorado and each local public health agency should have a comprehensive public health plan outlining how quality public health services will be provided.
This appears to be one of the more important functions of a public health department, considering that it’s the very first requirement mentioned in CRS 25-1-501 et seq.
Other requirements appear in the Colorado Code of Regulations, in 6 CCR 1014-7 (5 pages, which you can download here) and 6 CCR 1014-9 (also 5 pages, which you can download here).
6 CCR 1014-7 appears to have a list of ‘required services’ which, as we will discover, may or may not actually be ‘required’:
Foundational public health services in Colorado shall include, but need not be limited to the following:
Communicable Disease Prevention, Investigation and Control
Colorado’s governmental public health system will carry out state and locally coordinated surveillance, disease investigation, laboratory testing, and prevention and control strategies to monitor and reduce the incidence and transmission of communicable diseases. Programs will target illnesses that are vaccine-preventable, zoonotic, vector-borne, respiratory, food- or water-borne, blood-borne, healthcare associated, and sexually transmitted as well as emerging threats. Communicable Disease Control will collaborate with national, state, and local partners to ensure mandates and guidelines are met and timely, actionable information is provided to the public and to health professionals.
As we note here, a public health department is expected to ‘reduce the incidence’ of communicable diseases. The rule does not, however, specify the amount of ‘reduction’ required.
Environmental Health
Colorado’s governmental public health system will use evidence-informed practices to understand the cause and effect relationships between environmental changes and ecological and human health impacts, to protect, promote, and enhance the health of the community and environment. Agencies will participate in the protection and improvement of air quality, water, land, and food safety by identifying, investigating, and responding to community environmental health concerns, reducing current and emerging environmental health risks, preventing communicable diseases, and sustaining the environment in a coordinated manner with agencies at the federal, state, and local levels as well as industry stakeholders and the public.
As we note here, again, that a public health department needs to ‘participate in the protection and improvement’ of the environment. How much ‘participation’ and ‘improvement’ are not specified.
Maternal, Child, Adolescent and Family Health
Colorado’s governmental public health system will develop, implement and evaluate state-wide, regional and local strategies related to maternal, child, adolescent and family health to increase health and wellbeing, reduce adverse health outcomes and advance health equity across the life course. Strategies may include but are not limited to identifying and providing information, promoting evidence-informed and multi- generational approaches, identifying community assets, advocating for needed initiatives, and convening partners.
Once again, we have a list of things a public health department ‘may’ do, but no exact ‘requirements’.
‘6 CCR 1014-7’ lists two more ‘foundational public health services’ — ‘Chronic Disease and Injury Prevention and Behavioral Health Promotion’ and ‘Access to/Linkage with Clinical Health Care’ — in language that is similarly vague.
Maybe ‘6 CCR 1014-9’ can give us better guidance, as to what is — and is not — required?
Bill Hudson began sharing his opinions in the Pagosa Daily Post in 2004 and can’t seem to break the habit. He claims that, in Pagosa Springs, opinions are like pickup trucks: everybody has one.