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On The ‘Front Lines’ Of An Outbreak: The Role Of Local Public Health Officials During A Pandemic

Leigh Paterson / KUNC

As the COVID-19 pandemic continues, the work of local public health officials around our state is taking center stage.  But, as that work is increasingly in the spotlight, some of these professionals are also facing pushback from local officials and constituents.  

Theresa Anselmo, The Executive Director of the Colorado Association of Local Public Health Officials, joined KUNC's Colorado Edition to discuss the role of local public health officials during a pandemic.  


Interview Highlights: 

These interview highlights have been lightly edited for length and clarity. 


Henry Zimmerman: Tell us about the role that local public health officials play in this pandemic. 


Theresa Anselmo: Particularly in Colorado, local public health officials are really the very front lines of any type of infectious disease outbreak, and even more so, in this particular outbreak. We haven't had a pandemic in this country since 1918.  


Colorado is a “local control” state. What does that mean for local public health officials? 


[It] means that governance of local public health agencies actually falls to the county or counties that those local public health agencies represent.  


In Colorado, there are two forms of governance. One is an independent board of health, meaning that medical, health care, public health and other experts serve in advisory roles. The other way that governance occurs is that county commissioners can actually serve as the Board of Health.  


There are other states that have local control or a decentralized public health system, as we like to call it. But Colorado is rather unique in the fact that elected officials can serve as the Board of Health. The other thing about that is that Board of Health has the statutory authority to appoint the public health director. In that case, the public health director actually becomes a quasi-political appointment, if you can imagine. 


I’d like to talk about the role of local authority. How common is it for county commissioners to supersede public health officials around the state? 


The Colorado statute that governs Public Health Authority is very clear, particularly for local public health. The local public health agency includes the Board of Health -- and in some counties, the Board of Health, as I said, are the commissioners. So, often county commissioners have the final say on what policies this public health agency passes.  


The fact of the matter is local public health directors are advisors. Their role is to relate and educate on the evidence and the science behind things. And they do have authority in the state statute to execute public health orders. But that also has to go along with the public health department, Board of Health and the whole agency as it is a unit within that government structure. 


Right now, it seems like public health officials are really put between a rock and a hard place. They always have this health side of their job, but they're also responsible for communicating and talking with commissioners. The role of being a health director seems really politicized now. 


That's very true, unfortunately. Folks get into public health because they are passionate and are compassionate about people being healthy. A number of them have backgrounds in clinical health care. Fundamentally, they are scientists and healthcare professionals who really want to make sure that people are as healthy as they possibly can be.  


Unfortunately, we can see from the federal level down, this has become a very politicized issue. And I think we're seeing those same things play out here in the state of Colorado. I'll refer back to my previous comments about how local public health directors are appointed to their positions, often by county commissioners. I think that creates a significant tension between those elected officials and these scientific, nonpartisan advisors to public health policy. 


The politicizing of this - is that a relatively new phenomenon with COVID-19, or has that always been the case with public health officials? 


I think unfortunately, we can see it play out in other issues.  


Most recently, issues have come up when we talk about reducing the simplicity of opting out of vaccinations. Public health sees vaccination as a significant public health achievement for preventing the spread of contagious diseases. And in the last year, we had before the legislature a bill proposed to make opting out of immunizations take a little bit more effort, not just a letter from a physician. As you may recall, hours and hours and hours of testimony at the Capitol. The sponsor of that bill was getting threats.  


So this is not something that's necessarily new. But it is rather startling, the degree to which this has escalated in the state at this point in time - threats and threats of jobs, threats to persons, vandalism of local public health agency satellite offices, etc. 


Let me ask about folks who are leaving during the pandemic. Dr. Mark Wallace (Director of Weld County Public Health and Environment) has announced his retirement - that'll be happening soon. Are you concerned that other health officials are leaving because of the pandemic? 


Dr. Wallace is the first of three local public health directors that I know have left, or been asked to leave, their positions as a direct result of this pandemic and the politicization of the work that they're doing. 


I also have been informed from my directors that some of their staff are leaving because of the pressure that they're feeling. In the small rural communities, they often see their neighbors in the grocery store, their kids may play sports together, they may have gone to school with individuals that are very, very unhappy about the actions that public health officials are required to take to make sure that this disease doesn't overtake our communities. That lack of anonymity can create an additional layer of pressure and discomfort and fear in those public health agency workers. 


Very early on, I said to the Lieutenant Governor that I felt we would see a significant hemorrhaging of public health workforce after this pandemic was over - not only because of the demand on the workload that they're having to do, the under-resourced capacity that they've been working with for decades - but then you add this additional layer of stress and trauma. That really is not something that they signed up for, but become the target of when you're dealing with a situation that has become as political as this has become. 


How do you think the role or stature of local public health officials might change after this pandemic? 


Unfortunately, I think local public health has taken a beating during this response. And the way that this pandemic has been politicized has called into question the science and the credibility of public health professionals across the country. And I don't know how the public view of that is improved.  


We've already been a hidden profession to begin with. People take for granted that you can turn on the water and that it comes out of your faucet and that is safe to drink. So much of what public health does is already invisible. And while this has brought it to the forefront, I don't know that it's brought it to the forefront in the best light, because what we see are people questioning the credibility of these professionals that have dedicated their life to trying to make sure that people have the conditions that they need to be and stay healthy and that the environment is healthy. I do worry that there will be a significant amount of regaining of trust of the public related to public health professionals and what our jobs are.  


This conversation is part of KUNC’s Colorado Edition for May 28th. You can find the full episode here.  


KUNC's Colorado Edition is a daily look at the stories, news, people and issues important to you. It's a window to the communities along the Colorado Rocky Mountains.