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County Officials Fear Inslee's Public Health Plan Could Strip Away Local Control

The Chronicle
Dec 19, 2020

Dec. 18—Gov. Jay Inslee's plan to "regionalize" public health districts in 2021 has raised "major concerns" among Lewis County public health officials and electeds, who fear the plan will shift control away from local communities.

Rumors of the plan circulated last week, and Inslee's 2021-2023 budget proposal, released Thursday, confirms that he will put forward legislation "that creates a regional, coordinated approach to local public health through comprehensive public health districts," combining county public health districts.

Although the bill has not been dropped yet, Lewis County Public Health Director J.P. Anderson expects it will "functionally dismantle local health jurisdictions," especially in counties with small populations. Although local public health officials are outside the political ranks, many counties' boards of health (BOH) are composed of elected officials, who have some control over the direction of public health — incoming County Commissioner Lindsey Pollock was tapped this week to chair the county's BOH in 2021, with Commissioner Gary Stamper serving as vice chair. County Manager Erik Martin said the new regional districts, with staffers reporting to the state, would likely insulate public health from local politics, which in 2021 has been polarized by the COVID-19 and public health measures.

"I can understand after this year, feeling like it would be easier to get this work done if everyone came from the same background and had the same perspectives at the start," Anderson said. This year, county commissioners, serving on the BOH, openly flouted health guidelines at large, unmasked events.

"But I think the divide we see on some of these issues would actually increase, because you would be reducing the local capacity to work on, understand, communicate ... it would become more centralized, and I think that would actually backfire."

According to a policy brief from the governor's office, the idea is to address disparities across local health jurisdictions, and create "standardized systems and infrastructure, with local tailoring, to improve how we use disease reporting data to address concerns and compare data across the state."

On Monday, County Commissioner Edna Fund said the rumored legislation was "a huge shock" to the Washington State Association of Counties (WSAC), which was "not made aware this was going to be introduced."

Anderson also suggested that Lewis County residents may be less receptive to state officials enforcing and informing public health, and raised concerns that "rural communities could be lumped in with metropolitan areas, and have a diminished seat at the table, to say the least."

While county officials are opposed to the idea, Inslee's budget proposal also includes an influx in funding for public health — $397 million for the biennium to cover PPE, testing supplies, lab costs, contact tracing, and more. Anderson also noted that Inslee's plan for regionalized public health districts could lock in more reliable funding for "foundational public health services," which would have a "profound" effect on Lewis County, benefiting local work on behavioral health, substance abuse prevention, environmental health, and code enforcement.

"I do think the foundational public health funding is critical. Just as an example, receiving no funding for communicable disease work, and that being a statewide policy, I think in the event of COVID-19 we've seen that's pretty short-sighted," Anderson said.

But shifting control away from communities, he added, "goes against some basic principles of wellness, health, and self-actualized control of your community," and could undermine the community relationships and trust that is foundational to public health.

In voicing their concerns, county officials highlighted the example of reopening schools. As much of Washington kept students home, per the state's guidelines, Lewis County aggressively brought students back to classrooms this fall, despite surging COVID-19 cases — an effort enabled by the state's largely hands-off approach to schools. The move was spurred by vocal parents, and spearheaded by a workgroup of superintendents, pediatricians, and public health officials, which has been celebrated by the county as a major success.

"I'll tell you right now, if it was regional health coalitions, I don't think we'd have as many schools open as we do in Lewis County," Stamper said. "Because I think the opening of schools was directly related to the negotiations or the working agreement between Lewis County health and the superintendents. I just think that's a horrible horrible idea to take that away from individual counties."

Martin agreed, arguing that "you just can't recreate that at a regional level."

After Lewis County began reopening schools, more evidence emerged suggesting in-person learning could be safely operated. This week, the state Department of Health revised its metrics to allow for more in-person learning, although the recommendations are still stricter than the county's approach.

Fund reported that she has discussed Inslee's plan with district 19 and 20 state legislators, who are aware of local officials' opposition to it.

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