“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.

Joseph Yetter, M.D., MPH, is a retired Colonel in the United States Army. He practiced pathology and family medicine in the military and in civilian life on three continents, and has been involved in public health policy during that same career. He’s now retired and is servant to cattle, sheep, chickens, and one old dog. That Benjamin Disraeli quote was chiseled into stone at his medical school long before he attended 1968-1972. It is now chiseled into his mind and heart.

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(6) comments

Huge bbfan

The state is only responsible for preserving our rights, something they aren't doing, preserving my health is my responsibility.

The desire to "save humanity " is nothing more than the urge to have complete control over everything and everybody.

mworden

You certainly take clean water, sewage disposal and garbage dumps for granted. Without government rules and regulations and heavy government funding, we'd all be facing cholera on a regular basis.

I'm always shocked when someone reveals they have no idea at all how we ended up able to flush away our daily sewage and drink clean water from our taps right in the comfort of our homes. And the two don't mix. Amazing!

Hint: It's because the government is responsible for our health.

CitizenJoe

mworden: exactly. and: As our Declaration of Independence declares, governments are established to preserve unalienable rights, among which are

"Life, Liberty and the pursuit of Happiness."

Says it right there.

The Covid vaccines--and many others--save lives.

It's tough to pursue happiness when you are comatose and on a ventilator.

And being in an iron lung with polio definitely reduces one's liberty.

It's hard to believe anyone has such a blinkered view of rights or the role of government as does "fan" up above. I think it's just trolling.

mworden

I don't know what bbfan's story is, but I have no doubt that many worthy citizens have never given a single moment's thought to the modern miracles of clean water and sanitation. They're taken completely for granted.

mworden

[thumbup] I wholeheartedly agree with Dr. Yetter.

SkeensWA

[thumbup]

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