Board recommits to bold action as Local Public Health Authority

November 9, 2018

The Board of Commissioners on Thursday reaffirmed its authority as the Board of Health, setting the stage to more directly address the region’s leading causes of harm. As the Board of Health, commissioners govern the Local Public Health Administrator and the County’s public health activities.

Public Health Director Rachael Banks, left, testifies alongside county attorney Bernadette Nunley

“This gives us a chance to flex our muscles,” on some of the toughest public health issues facing the region, said Chair Deborah Kafoury. “We have the ability to do something about it strategically, thoughtfully, proactively.”

Multnomah County operates as the Local Public Health Authority in accordance with Oregon law. Thursday’s resolution reaffirms Multnomah County’s authority to pass regulations, set fees and collect fines as the Local Public Health Authority. It’s an authority the Board has exercised a few times in recent years and one that has influenced other agencies in tackling big problems.

In 2009, the Board passed innovative legislation requiring national restaurant and coffee chains to include calorie counts on their menus so consumers could make more informed decisions about the foods they eat.

In 2014, due to overwhelming data on the harms of tobacco and targeting of youth, the board asked for a youth tobacco and nicotine prevention strategy. They held a series of public hearings on youth access to nicotine, then moved in 2016 to raise the legal age of e-cigarettes. And in 2017, the Board passed a comprehensive tobacco retail licensing program. The state followed in 2018 by passing a law raising the legal smoking age to 21.

The best medicine public health can prescribe is sweeping public policy, said Public Health Director Rachael Banks, who is also the local public health administrator. Governments pass laws that require people to buckle up in cars, require kids to wear helmets on their bikes, prohibit smoking in government buildings, and ban lead from paint and gasoline. The lead-related policies, for example, have had the biggest impacts in protecting people from injuries and exposure to lead.

“We have built a really fine public health system,” Banks said during the Nov. 8 board meeting. “But the challenges we’re seeing now will require us to use and enhance our tools; things like assessment and epidemiology, savvy equity analysis, partnerships and policy.”

Banks was born and raised in the Black community of Northeast Portland. “I got to see and experience the brilliance and resilience and thriving nature of communities, and also the systemic neglect and the way systems were constructed that didn’t allow our full opportunity to thrive,” she said.

Banks went on to study psychology and work at the Oregon State Hospital, where she took a training in HIV prevention that “blew my mind,” she said. The training blamed the unnecessary spread of HIV on  racism, stigma, and homophobia. That social justice perspective enticed Banks into public health at Multnomah County, where she would have the opportunity to tackle big problems by coupling data with community wisdom and the leadership of people with lived experience.  

Public Health Advisory Board Co-Chair Tyra Black said she's excited to work with the board on policy.

“That’s what drives me today,” she said. “The Board of Health has the opportunity to make decisions, to set a broad health vision. This is about creating the conditions for folks to be healthy. And those conditions are based on where you live and the opportunities you have.”

Banks said she wants to brief the board more regularly on systemic and enduring problems in public health, so the board can be proactive in its preventative and upstream health policy. Programs within public health have scheduled a series of briefings for the Board. Research has shown that jurisdictions with the best health outcomes are those where public health administrators and agencies regularly report to elected officials, Briefings will be held:

Banks said she will return to the Board next spring with members from the Public Health Advisory Board to propose strategies and policy to narrow health disparities and support the health of all residents.

“I just want to reiterate the excitement we feel about the potential for activating the Board of Health,” said Advisory Board Co-Chair Tyra Black, “And how we can use that to move forward with policy priorities and continue to protect the health of Multnomah County residents.”