During the COVID crisis in Archuleta County, the community developed a split personality. A three-way split, you might say.
On one side, we had community members who fully supported the rather draconian policies put in place by Governor Polis and his administration — business shutdowns, the prohibition of public gatherings, mandated mask-wearing, the encouragement of vaccinations — which were in turn reinforced by the San Juan Basin Public Health district in La Plata and Archuleta counties. Some of the more extreme members of this group publicly blamed the spread of COVID on non-conforming, non-vaccinated citizens, in letters to the newspaper and at public meetings.
During the conversations about Archuleta County forming its own independent public health department, some of these folks urged the commissioners to remain part of the San Juan Basin Public Health district.
At the other end of the spectrum, we had community members who believed that the COVID crisis had been artificially manufactured for political purposes, with the goals of reducing personal freedom and increasing government control over the citizenry. Many of these community members opposed the state’s temporary public health policies — given that there was no clear indication just how ‘temporary’ the prohibitions and requirements might be. Some of the more extreme members of this group protested angrily at school board meetings, at Town Council meetings, and at Board of County Commissioners meetings.
Some of these folks urged the commissioners to abandon the San Juan Basin Public Health district, and form an independent, locally-controlled public health department.
In the middle, we had a large segment of the population who were willing to abide by the unpleasant public health orders, and get vaccinated, without having strong opinions one way or another.
Witnessing the confrontations as a news reporter, I could understand the perspectives of all three groups. I also gave some thought to a question I hadn’t considered previously. What, exactly, is meant by the term, “Public Health”?
Generally speaking, Americans embrace a philosophy that each person’s bodily health is their own responsibility, to care for or to neglect as each person chooses. One individual might make weekly visits to the doctor and spend thousands of dollars each month on prescription drugs; another might avoid doctors completely, and address their health issues using traditional herbs, dietary adjustments, and, perhaps, prayers or meditation.
We seem to believe that these important health decisions are each individual’s responsibility. (Or maybe not?)
At the same time, Americans generally believe that certain health issues — that is, contagious diseases and illnesses caused by environmental or social factors — involve the entire community. These are presumably the issues on which a “Public Health” agency would focus its efforts and resources.
Which health issues are “public” and which are “private”?
Current medical theory defines heart disease — for example — as a personal health issue, caused by an individual’s lifestyle choices and by their individual physiology. I’ve not come across the argument that heart disease is contagious, or that it’s caused mainly by environmental or social factors.
Cancer — to take another example — was once thought to be an individual situation, but over the past 50 years, science has identified numerous environmental agents that appear to encourage cancer in certain individuals. Asbestos. UV rays from the sun. Diesel exhaust. Certain viruses. Wood smoke.
Other set of potential exposures can result from individual lifestyle choices. Tobacco smoke. Deep-fried foods. Processed meats. Artificial sweeteners. Hydrogenated oils.
Let’s consider tobacco smoke. “Public heath issue”? Or “personal health issue”?
The line is not clear, because our society has chosen to view a older person’s health — once they reach the age of 65 — as a public concern, to be funded partly through the collection and expenditure of Medicare taxes. We’ve also chosen to view the health of disabled individuals, military veterans, mothers, children, and people living in poverty as “public health” issues, to be addressed, partly at public expense, through diet, advice, and (often very expensive) medical procedures and prescription drugs.
An individual who chooses to smoke two packs a day might live to be 100 years old and experience no ill effects from their habit. Another individual might develop lung cancer, and require hundreds of thousands of dollars in medical procedures. Those procedures will be paid for, by someone. It could be the taxpayers. It could be the members of the same insurance pool.
Is tobacco use, then, a “public health” issue? Should our new Archuleta County Public Health Department spend local tax money, educating people about tobacco, and helping them quit?
Let’s consider sanitation. Here in Pagosa Springs, most homes are served by a municipal wastewater treatment facility, for which they pay a monthly fee. But increasingly — as long-term housing becomes less and less affordable and available — working households are improvising their wastewater disposal, especially in outlying rural areas.
The regulation of wastewater treatment is a well established “public health” concern. But should our community actually help fund proper sanitation — say, for certain segments of the population? The disabled, the elderly, veterans, mothers, children, people living in poverty?
Last week, the Archuleta County Board of Health held its second official meeting, as discussed in Part One and Two. The five-member board — Jon Bruss, Warren Brown, Veronica Medina, Stacy Foss, and Jessica Cox — discussed a number of issues with Department staff.
Very few members of the public attended.
I guess I have to ask. Where were the citizens who had such strong opinions during the COVID crisis, and during the discussions about abandoning SJBPH?
Perhaps the community feels that our public health concerns are now in competent hands? And we no longer need to pay attention, or express our opinions?