“Nothing can be more important to a state than its public health; the state’s paramount concern should be the health of its people.” — Franklin Delano Roosevelt
“The health of the people is really the foundation upon which all their happiness and all their powers as a state depend.” — Benjamin Disraeli
Public health isn’t rocket science. It isn’t brain surgery, either. But both fields instruct us.
We must examine the governance of public health in Douglas County. Now.
In rocket science, one can simply launch in the general direction of a target, knowing that most rockets will fall on untended geography. The Germans did this with V-2s in World War II: Hamas does this against Israel today. It can cause a lot of damage and fear, but it’s mostly ineffective. A guided missile, though, continuously evaluates its position, velocity, and trajectory, and modifies those with respect to a programmed target, to deadly effect. In brain surgery, a surgeon may remove a tumor while the patient is awake and talking. As long as it’s tumor that’s being removed, all is well and good, but by monitoring the patient, the neurosurgeon can know whether she is getting close to speech centers, high school chemistry, or wedding memories, and not remove what ought not be removed.
On their website, Douglas Public Health Network indicates:
“In 2014, Douglas County was struggling to adequately provide public health services to the community and a report was conducted in order to analyze the county’s best options.
“The result of this report, and the hard work of public health leaders in the community, was the decentralization of public health from the county and the establishment of a 501©3 non-profit known as Douglas Public Health Network in the fall of 2015.”
How’s that working out, six years later?
“We envision a healthy and prepared Douglas County as shown by:
Healthy behaviors such as regular exercise and healthy eating a rates above those of similar counties
Unhealthy behaviors such as smoking and binge drinking at rates below those of similar counties
All children adequately nourished
Immunization rates among the best in Oregon
Exemplary preparedness and response to man-made and natural disasters
Meeting the goals of both the community and state health improvement plans
Addressing all public health issues identified by the public”
I think it fair to say that these goals are not met, nor have they been expanded to include pandemic responses.
Turns out, neutering a public health department does not improve the health of the public.
The people at the Douglas Public Health Network are well trained, well-intentioned, hard-working people who are beset by immense challenges. I also know that it’s most important to fix the problem, not to fix the blame on anyone. Almost always, when organizations fail, it’s not because of individual people, but because of structural impediments to success.
Dr. Bob Dannenhoffer has done heroic work in a county that is structurally and temperamentally inamicable to public health. We need to intelligently restructure our system and assign Dr. Dannenhoffer far greater authority.
Consider the case of the notorious Dr. Allen Thomashefsky, who “treated” the rich, famous, and gullible in California — and in Oregon, too. His sloppiness (and other failings) resulted in Hepatitis C infections and other problems in his patients. He was shut down by an aggressive — and empowered! — public health officer, Dr. Charity Dean. (It’s nicely chronicled in Michael Lewis’ book, The Premonition.) Dean shut down Thomashefsky, who ultimately surrendered his licenses in California and Oregon.
It’s always the responsibility of leaders to assess what’s gone right, what’s gone wrong, and what structural changes need to be made in order to meet the mission.
The time is now. One does not course-correct a rocket after impact. Competent neurosurgeons don’t wait to see if language, high school chemistry, and wedding memories were removed, only after the patient has awakened, aphasic and amnesic.
Our County Commissioners have this responsibility. There are numerous public health organizations available for consultation, numerous models of successful public health departments exist, and a wealth of knowledge, skill, and passion dwells in the Douglas Public Health Network, right now.
Fifteen counties in Oregon have accredited public health departments. Douglas County is not among them. Oregon has a decentralized public health system: Douglas County chose, tragically, to further decentralize back in 2014-2015. Fix it.
The time is now: the rocket is in flight, brain tissue is at risk, metaphors are exhausted, and so are we. The commissioners must act, now, to rebuild a robust public health department, with a broad mandate and powers of enforcement, that will allow Dr. Dannenhoffer and the team of professionals to protect and improve the health of the public.