Yesterday we touched lightly on the idea that the not-yet-appointed Archuleta County Board of Health — the governing body for the Archuleta County Public Health Department — will have the responsibility for overseeing the ‘public health’ of the citizens in our community.
When the Archuleta County Public Health Transitional Advisory Committee met earlier this week, they invited public comment, and I had a chance to share a couple of thoughts with them. (I do not serve on the Committee; I’m just an interested citizen.)
It seems to me that ‘Public Health’ is not necessarily the same thing as ‘Health’.
‘Public Health’ has the word ‘Public’ attached.
I suggested to the Advisory Committee that some health issues are ‘public’ issues, and some health issues are ‘personal’.
The difference became especially apparent — or maybe, especially confusing — during the COVID crisis. During that crisis, the federal and state governments became surprisingly generous with public health funding, in an effort to prevent the spread of the COVID virus.
As we now know, the virus was particularly dangerous for people over the age of 70, and relatively harmless for children.
According to the CDC website, a total of 1,582 American children aged 0-17 were provisionally counted as COVID deaths, out of about 114,086 children who died during the three-year period from January 2020 through April 2023.
So, about 1.3 percent of the deaths in that age range. (Provisionally.)
Among Americans age 75 and older, about 597,200 deaths were provisionally counted as COVID-caused, out of 5.8 million total deaths. So about 10.3 percent of the total in that age range. (Provisionally.)
Contagious diseases are obviously a societal concern. That is to say, these are ‘public’ health issues.
Some health issues, however, are not so clearly ‘public’ issues. How I, personally, choose to eat, drink, sleep, exercise, work, and medicate myself seems, to me, a ‘private health issue.’
Should the pending Archuleta County Public Health Department get involved in my ‘private health’? Or ought my local government focus its limited resources on ‘public health’ issues?
From what I can tell, the public health industry has experienced ‘mission creep’ over the past few decades, and has become more and more involved in ‘personal health’. This makes a certain kind of sense in a country where we are striving to make sure that all segments of society have access to sufficient health care. Many Americans, however, believe that government should have only limited involvement in social issues like health care, housing, and maybe in education.
One health issue that’s obviously ‘public’ is water quality. We all share the same water, according to the Colorado Constitution, and we’re all responsible for keeping that water clean.
No one believes we should allow pollution to be added to our rivers and groundwater. (No one except maybe certain manufacturing concerns, agricultural industries, oil and gas corporations, and mining operations.)
Colorado assigns the oversight of water quality — on the wastewater side of the equation — to local public health departments and sanitation districts. But we have limited manufacturing, oil and gas, and mining in Archuleta County, and I’ve never heard of anyone monitoring agricultural pollution here. So as the BOCC stands up its new Public Health Department, one of the required jobs will be the permitting and monitoring of small wastewater systems. On-site Wastewater Treatment Systems (OWTS).
Septic systems.
The BOCC and County Manager Derek Woodman have asked County Development Director Pamela Flowers to begin designing a budget, and hiring staff for a Water Quality Department. Legally, however, (as far as I can tell) environmental health is the responsibility of the Archuleta County Board of Health, once that Board is appointed. Nevertheless, Ms. Flowers gave the BOCC a Power Point presentation on Tuesday, which you can download here.
The budget estimate from Ms. Flowers was based on the percentage of OWTS permits and inspections that San Juan Basin Public Health (SJBPH) budgeted to be performed in Archuleta County — about 36% of the jobs. Ms. Flowers seems to have taken the revenue figures and expenditures and multiplied them by 0.36 to get an estimate for the 2024 fiscal year, when Archuleta County will officially be in charge of our septic system approvals.
Septic system approvals, and especially, fees and requirements, were one of the key points of controversy and disagreement between SJBPH and Archuleta County, over the past several years. The Archuleta BOCC looked at how much SJBPH was charging for its OWTS services, and noted that the fees were some of the highest in Colorado. SJBPH responded by claiming they were only charging the amounts permitted by Colorado law, to cover staff, equipment and other costs.
The regulations governing septic systems are not, however, set by the local public health department. The regulations come from the Colorado Department of Public Health and Environment… and those regulations largely determine the cost of a OWTS installation.
It appears that the preliminary budget numbers from Ms. Flowers were based on 36% of the SJBPH revenues and expenditures — which, as we mentioned, are based on some of the highest permit and inspection fees in Colorado.
As we might notice, these fees were adopted by the SJBPH Board of Health. It’s possible that Colorado law requires fee schedules to be adopted by a Board of Health, but I can’t say. I’ve not heard that question addressed at the meetings I’ve attended.
There are Colorado county public health departments that charge about half the amount of the SJBPH fee for a OWTS permit. So, around $500 instead of $1,023.
But even a OWTS permit fee of $1,023 is practically negligible, compared to the cost of engineering and installing a new septic system, which can easily run $30,000 or more, depending on the soils on the property, and the topography.
There is one way that Archuleta County could greatly reduce the cost of home construction outside the municipal sanitation districts.
Allow composting, incinerating, or waterless toilets.
Will our new Board of Health want to tackle that challenge?
Who knows?