By Rose Hoban
With the passage of a new law this past year, county public health agencies could look very different – and some public health professionals are making their unhappiness about it known.
At a meeting of the N.C. Public Health Association last week at the New Bern Convention Center, state Sen. Fletcher Hartsell (R-Cabarrus) was forced to defend a bill he shepherded through during this year’s legislative session that allows county boards of commissioners to disband local boards of health and assume their powers.
The new law also allows for county commissioners to consolidate public health and social services agencies, and creates incentives for smaller counties to join together to provide services across county lines.
“We have multiple reports that say … integration of health and social services is necessary and inevitable,” Hartsell said, holding up a number of printed reports during his 30-minute remarks.
“We’ve simply got to integrate these services,” Hartsell said. “It’s a fiscal matter.”
But during the question-and-answer period, former Public Health Association President Michael Clements got up to tell Hartsell that the legislation “to have boards of county commissioners dictating to public health is one of the worst decisions I’ve ever heard in my career.”
The room broke into loud applause.
“I expected that,” Hartsell said afterwards. “I think it’s an honest exchange of ideas.”
Health officials fear loss of autonomy, authority
People on both sides of the aisle opposed the bill as it made its way through the General Assembly this spring; many former public health officials were the most vocal opponents.
Retired Brunswick County Health Director Don Yousey said he was concerned that often county commissioners make decisions based on politics, “but the board of health decisions are based on science.”
Yousey is a Republican who lost a primary bid to become a Brunswick County commissioner this past year.
“I had county managers and county commissioners ask me to do things that don’t follow the law … and I said no,” Yousey said.
He explained that under the former system, boards of health – not boards of commissioners – have hired and fired county health directors. That’s given health directors the ability to push unpopular initiatives like smoking bans or stricter sanitation rules in restaurants.
“I understand why commissioners want some changes,” Yousey said. “They want total control. I wouldn’t mind giving them that control if they understood the public health system better.”
“You have people who have been on the board of health and have worked in pubic health for 15, 20 years of their careers,” said Clements after Hartsell’s speech. “Yet you have a commissioner who’s on the board for a two-year term, a four-year term. How are they in a better position to really discuss public health?”
Clements said that when he was at Baptist Hospital in Winston-Salem, county commissioners opposed having the hospital go tobacco-free.
“When our health director tried to push public health issues, he was fought tooth and nail and told [by commissioners] they would get rid of him,” Clements said.
But Hartsell said public health officials shouldn’t worry so much about the changes the new law might bring. Instead, they should attempt to educate county commissioners about what they do – from vaccines to sanitation to prevention.
“You have to sell your service,” Hartsell said. “You’ve got to market public health, you’ve got to sell public health, not just to the constituency that you deal with, but to the public as a whole, because they don’t understand it.”
Hartsell said he didn’t believe that every county would make the changes, but wanted to give counties that wanted change the opportunity.
“Sometimes you have to stir things up to make something happen,” he said.