The role of public health has traditionally been clear.
“We make sure the water is safe, the air is clean, make sure people have good housing, access to food, make sure communicable diseases are monitored and controlled,” said Joanne Fuller, director of the Multnomah County Health Department.
But that’s changing, Fuller and a panel of public health experts told the Multnomah County Board of Commissioners this week during a roundtable discussion on the future of public health.
“Health develops over time; It often happen before an individual is born,” said Tricia Tillman, public health director. “This helps us think about early childhood, family, aging. We’ve got to look earlier.”
The health of a mother - and even a grandmother - can greatly affect the health of a child. And physical health is affected by so many social and environmental factors that it’s impossible to separate physical health from poverty, isolation, stress or segregation, she said.
Tillman said her department is seeking accreditation by the
Public Health Accreditation Board as a way to organize their goals. The Public Health Accreditation Board, or PHAB, is a nonprofit committed to approving the quality public health departments across the United States.
“The value of accreditation lies in the culture of quality,” she said. “The investment of time and resources helps us align our work, which has been a struggle given the vast scope we have.”
Leaders within public health will evaluate whether it has the right staff in the right positions, whether the staff is diverse enough, whether the office has invested adequately in community health workers or policy analysts. And it will include communities in those discussions
“In order to achieve equity, we have to look at how we engage with community partners,” Tillman said. “Bringing in community members as co-creators early long before we move into implementation.”
Community might be the country's biggest asset when envisioning the future of public health.
“Where we’ve seen the most promise is when you invest and partner with the community to develop their own solutions,” said Nicole Maher, president of the Northwest Health Foundation, which funds grants to counties and nonprofits for public health. Multnomah County is the foundation’s top grantee.
“Where we see counties try to be the one-stop shop and voice of health, we’ve seen that be less effective,” she said. “Typically Multnomah County comes to us and says, ‘there’s this health disparity. Help us build our capacity to provide services. That community doesn’t have the capacity.’”
That puts the county in the position of savior, sweeping in to fix the problem. But it must consider whether a community really lacks capacity, and if so, how can the county help it build more.
“You’re at an exciting time to consider what the future holds, what you do best, what you can do differently,” she said.
Liz Baxter, executive director of the Oregon Public Health Institute, said their work has focused on just that.
“We see ourselves as a way to help communities build capacity,” she said. When she goes out into the community, people aren’t talking about medicaid or primary care doctors.
“When I talk to folks, they're talking about affordable housing, living wage jobs, where that next rail line is going, affordable child care,” she said., “all the other pieces that we call the ‘social determinants of health’.”
Dr. Jennifer Vines, the county’s deputy public health officer who has led such work as the recent regulations on e-cigarettes, said she started her career as a family doctor, treating chronic disease, addiction and mental health issues at the county’s Westside Health Center.
“As a society we’ve invested heavily in medical health,” she said. “Health insurance and medical home incredibly important. But the goal is to be well, not to get poked and prodded. When I worked in primary care, there was this belief that somehow I’m going to have the answer to your problems.”
But she often felt like she didn’t have the answers, or the answers she offered came too late, and that her intervention could have been prevented by investing in wellness.
“I feel much better sending the message that you have the answer to your problems and I think what you’ve heard today is that doctors don’t always have the answers, public health doesn’t necessarily have the answers, but that perhaps the community has the answers,” she said. “Supporting community partners is where we can create wellness and health.”
Commissioner Judy Shiprack thanked the speakers for pushing the county to continue improving its service. “Your comments on the deployment of our resources are so important,” she said.
Commissioner Diane McKeel agreed. “I just see that so much of this in East County, the strength of the people who live in East County,” she said. “I’ve seen a number of community collaboratives that have really made a difference.”
Chair Deborah Kafoury said she’s excited at the opportunity to plan for the future and conscious of the monumental task at hand.
“Now we have a the chance to move forward. It is a big ship that we’re trying to turn,” she said. “So continuing to have these conversations is crucial because it’s so easy to fall back to the status quote and so hard to make real change that may be uncomfortable to people talking about things we don’t want to talk about. But that’s the only way we’re going to make real change.”