Later this month Dr. Mark Wallace, the director of the Weld County Department of Public Health and Environment will retire. He first joined the office in 1995 and became its director in 2000. Wallace joined Colorado Edition to discuss his career and what lies ahead.
These interview highlights have been lightly edited for length and clarity.
Erin O'Toole: I understand you were initially trained as a doctor. Why did you decide to go into public health?
Dr. Mark Wallace: I wanted to be a physician since I was about seven years old. And I stuck with that as I went through school and trained primarily as a family physician. I really wanted to be engaged with families, children, all the way up through their senior years.
And then what I recognized as I was going through my training in my early days of practice, is that the ability to impact our health as a community, as a country, was much slower taking it one patient at a time. I could go in and attempt to treat diabetes the best way we could, but I was treating one person with diabetes at a time. I wasn't really working on the prevention side as much as I would have liked to. It wasn't a population health approach: what are those things in our communities that help us to lead healthy lives that can prevent us from having diabetes?
So very early on, I dipped my foot over onto the public health side, and got really enticed into the possibilities over there. So, I ended up walking on both sides — on the health care side and on the public health side — throughout most of my career.
Is there an easy way to describe the job of a public health director?
It’s an interesting world because when you look at public health, especially the way we do public health in Colorado, it spans across a lot of different domains.
For example, we’re trying to do background things to ensure that our communities are as healthy as they can be — those traditional things that have really impacted us. It's clean air, clean water. There's that side that's very environmental. It's looking at what is the community around us like?
And then, what are we doing to have people understand what healthy behaviors look like? And then how do I access that healthy behavior? So if I understand nutrition better, and I have access to healthy foods, and I know how to prepare those healthy foods, I can afford them.
There's a part of it that is very designed at teaching people. It's saying this is how you can contribute to making good choices.
And then, there's that early detection. If I'm at risk for diabetes, are there programs available that will advertise and that will actually do early detection of diabetes? There could be programming that we do there.
There are things we do purely for prevention. For example, a big part of public health work is preventing the spread of communicable diseases. One of the ways to do this is with vaccines. We’re looking at administering vaccines, educating on vaccines, helping providers have access to vaccine, knowing how to administer them, store them, all that kind of stuff.
What's been your biggest challenge?
I will tell you that the pandemic has been the biggest challenge. As public health officials, we’ve trained for a long time and we build strong teams. You could look at a pandemic like this as our World Cup. It's not played every year, but we train for it all the time, and then it comes along.
This has been a huge World Cup. This is running a marathon at a sprint pace. This is no breaks in the game. You’re in. You're in it all the time — injured, tired, whatever. And, you're playing hard and you're doing it in a way that — unlike a soccer game in which all the rules are known and you've been able to practice all these different plays — we don't know the rulebook.
In a pandemic like this, we know some foundations of it, but we don't know it and we are making adjustments every day, based upon the best information.
There’s been kind of a clash between politics, for lack of a better term, and the science. How do you feel when you look at that either in Weld County or elsewhere?
A pandemic is a health-driven emergency. I mean, it is a virus that is relentless. We don't know much about it, other than that it spreads very easily and makes some people very, very ill.
There were a lot of people on the health side being impacted by this. But, in many ways, it was still at a level where I don't think most average people on the street today have felt the impact directly. They think, "Well, I might not even know anybody who's tested positive for this. And I may not have had one of my relatives in the hospital on a ventilator for three weeks, let alone die." Our personal experience is a bit removed.
So here, you may not understand because you haven't been directly impacted by the virus. And now you're told you can't go to work. Your business is shuttered, and we're going to do that for a long period of time. Economically, you're affected.
I think what happens is that we've got folks on one side, who are very aware and very affected by the health impact. On the other hand, you have people who are really impacted by the economic side of this. And what I've watched is the tension between those two.
We have lots of people on ventilators that we normally don't have. They're on those ventilators for long periods of time, and they're leaving after weeks in the hospital. And it is our mission — physicians and public health practitioners — to prevent that. My days are filled with a focus on that.
At the same time, I have to be sensitive to concerns about what we are doing on the economic side. You have some communities that decided to focus the economic impact and accept some of the health consequences. That certainly has been a big part of the challenge with COVID-19.
From your perspective, what is the biggest risk you see to the community from COVID-19?
What we have to do right now in order to control the spread of COVID is an uncomfortable thing. It's not natural for who we are as people. This whole issue of physically distancing from one another — keeping group sizes down, turning everything into a Zoom or other kind of meeting where we're not face-to-face — that's not actually who we are. We're naturally very social creatures, and we want to be together. But you've got public health and health professionals saying, “Oh, but don't do that. Please don't do that,” for we don't know how long. And that's really difficult.
We're waiting for a drug or a vaccine to come along, and we can't tell you how soon that's going to be. That's the part that I'm worried about. If we have a resurgence of the spread, it impacts everything downstream. It affects schools. It affects our businesses, our families, our workplaces. And people's ability to be patient with that begins to get more and more difficult.
So, I'm worried and my colleagues are worried about it having a resurgence and can we keep it tamped down so that it's controllable. How do we get our community cohesive and contributing in every way that we can to not have this spread?
I imagine this was a very difficult time to make the decision to retire. How do you feel about that?
I have worked for a long time. I'm 25 years just in this public health world. I've been working since I was 12 years old. I feel like I’ve built a strong foundation.
I will say that there got to be times in which my 90 to 100 hours a week of work were just fatiguing. I thought, you know, I can step back and I can hand it over to good, qualified people to take over the reins. Is there ever a good time? No. Is that a really difficult time during a pandemic? Yes, certainly is.
But I came to it after a lot of reflection and a lot of conversation with family and friends. I had to make the decision for personal reasons to go ahead and say now is the time.
There's been some public conjecture about friction between your department and the Weld County commissioners. Did that play any role in your decision to retire?
Those of us who lead public health departments, we are generally appointed officials who are appointed by either a Board of County Commissioners or Board of Health. We are always in a position of making recommendations.
Inside a pandemic, I'm going to focus on the health and public health components of this crisis. When I bring in those recommendations, there are going to be times — and it's not only with this, it happens in any place in which I'm advising a governing body — where they will add other factors in their analysis of what's going on. I recognize that. I've done that for 25 years.
There are lots of components brought in that are not my area of expertise. I can make the health contribution. But they have to balance the economic impact with the health impact.
There were times those debates were vigorous. But inside our meetings, we’re all on the team. We’re going back and forth on what is the best approach, and for how long, until what point and then what do we do next?
During the pandemic, those conversations are happening almost hourly. It adds to the fatigue for somebody who's been in it for as long as I have. I started to think that I might not be as vigorous as I once was and that there are other people who can do it with a renewed sense of energy.
I have felt very supported over the years. We would not have been able to build this department were it not for the support that we got from our county government and all of the commissioners over the years. I want to be certain that a snapshot in time doesn't reflect on what we built here in Weld County, which is a premier health department.
The Weld commissioners have said that their authority supersedes that of the health department, and that they're the de facto health department. What kind of challenges does that create, and is that unique to Weld, or is that the case with other counties in Colorado?
Weld County is structured as a home rule county. The board is the ultimate authority in all of government activities for Weld County. Our health department here in Weld County is structured as a department of county government that reports directly to the Board of County Commissioners and they serve as our Board of Health. That would be typical.
What might not be as typical for our structure compared to some others is that there are communities around Colorado in which there is a Board of Health that is between the Board of County Commissioners and the health department. And that Board of Health fills a bit of a different role. There, the health department is somewhat more removed from being directly reportable to the Board of County Commissioners.
There are pros and cons to those different models. But it is correct that the Board of County Commissioners is the ultimate authority for operating Weld County government as a whole.
Weld County is one of the hotspots in our state for cases and deaths with COVID-19, in part due to outbreaks at meatpacking plant JBS and long-term care facilities. Looking back on the county's response to the coronavirus, do you wish the county had been able to do anything differently in its response?
I think that what we did in our response was appropriate.
Other communities weren't confronted with a large portion of their workforce being in essential business. We had to ask ourselves more questions. How do you run the business? How do you remain responsive to a national cry that says we can't impact the food supply chain? You're also working with the company to balance worker safety. Those are different challenges and opportunities that we faced here in Weld County.
We began moving as quickly as we could. We tried to think about what might be best for an essential industry like meatpacking, and the number of employees there are, and how they come to work. But there aren’t any studies. In our business, starting a shift is maybe 80 people. In that industry, it's 1,700 people showing up at one time to start a shift.
I don't think that we were delayed in our responses. What we were trying to do is balance state, local and business interests across the spectrum of public health response. And that takes time to make it work. It's iterative. You get to one stage and you don't see enough impact. Then you go to the next stage, and you look for more impact. And then you get to this very difficult place. Obviously JBS closed for a period of time.
And what's next for you in retirement? What are you looking forward to?
I'm looking forward to stepping back from that constant drinking from the fire hose every day. I’ll have time to do a little more reflection and then offer some advice over time to folks. I’d like to continue to mentor people.
I am very connected to the community. I love health and healthcare, so I'm not going to be too far from it. But it'll be a nice time to reflect and get a breather and then say what's next. I think there's a lot out there to do.
This conversation is part of KUNC’s Colorado Edition for May 28. You can find the full episode here.