Critics of a bill to replace local boards of health with regional jurisdictions questioned whether the middle of a pandemic is the right time to restructure the state’s public health system.
But at a public hearing last week, supporters — who say House Bill 1152 will adequately fund and depoliticize public health — argued that now is the perfect time, with health inequities highlighted by the public health emergency.
Currently, local boards of health are largely divided by county and governed by local elected officials.
“What happens when politics infects public health? We need to ensure there’s a structure in place that puts science, people, and public health over politics,” said the bill’s prime sponsor, Rep. Marcus Riccelli, D-Spokane. “The stakes have never been higher.”
But others pushed back. Keith Grellner, an administrator for Kitsap Public Health District, said while he supports some ideas in the bill, it should wait until after the pandemic.
“Forcing our local public health system to react to this bill at this moment in time is taking us away from life-saving work which we remain understaffed and underfunded,” Grellner said.
Christina Ortega, on the other hand, said the shift should happen sooner than the bill lays out. Ortega, Latino Community Fund’s manager for civic engagement and advocacy, raised concerns that the new districts wouldn’t be implemented until 2023 after a broad workgroup hears public comment and makes recommendations.
“Our people are dying because of decisions that are being made by politicians instead of people that have healthcare certifications or know exactly what they're doing,” Ortega said. According to data from the state Department of Health, Hispanic residents are being hospitalized due to COVID-19 at a rate disproportionate to their overall population. Hispanic Washington residents makes up 13% of the population but 33% of COVID-19 cases in which ethnicity is known, according to a recent report by The Seattle Times.
James Sledge, a retired Spokane dentist and former state Board of Health member, said it “seems crazy” that local boards of health don’t “have a significant presence of people with experience in health, and more broadly public health.”
The state’s new secretary of health, Dr. Umair Shah, told lawmakers that larger structures can allow for consistency and efficacy.
“Everyone in our state deserves to have equitable access to governmental public health services,” Shah said. “And that’s not happening in Washington right now. And that’s become apparent during this pandemic.”
Lewis County has firmly objected to the idea of regional health districts, which was included in Gov. Jay Inslee’s budget proposal prior to the legislative session. Public Health Director J.P. Anderson fears it would undermine local relationships and trust critical to effective public health work. But he also noted that the increased funding for foundational public health services — another intent of the proposed legislation — would have a profound impact.
Other public health officials echoed Anderson’s concerns, including Benton Franklin Health District’s health officer Amy Person and Jefferson County’s c health officer Tom Locke.
“I know from long experience that a local health officer’s effectiveness is crucially linked with his or her work with the local board and the ability to be flexible and respond to specific community needs,” Locke said.
Others pointed to inequities they see as a result of local politicized decisions. Amber Lenhart, a former health policy specialist for Spokane Regional Health District, said she quit her job over the issue.
“I had my dream job. But over time it became apparent that our supposed commitment to health equity wasn’t driving the decisions at all,” she said. “When our board of health terminated our health officer during a pandemic and cut programs like African American initiatives and the walking school bus, as a national and local expert in keeping public health objective and apolitical, I knew I couldn’t work for an agency that made decisions based on politics instead of lives.”
One Wenatchee resident pointed to an incident last year in which Douglas County Commissioners who also served on the Chelan-Douglas Board of Health sued Inslee over COVID-19 restrictions. Health district administrator Barry Kling, who critiqued the move as wasting public health personnel’s time, later resigned.
Under the bill, regional health districts would be composed of representatives from counties, cities and tribes in the district, and would have one district health officer. The number of seats filled by county and city officials would be matched by hospital representatives, licensed physicians, licensed nurses and consumer representatives.