For some counties and cities that share a public health agency with other local governments, differences over mask mandates, trade restrictions, and other covid preventative measures have strained those partnerships. At least two were pushed past the breaking point.
A Colorado county and a small town in Southern California are splitting off from their longtime public health agencies to create their own local departments. Douglas County, Colorado and West Covina, California plan to contract out some of their health services to private entities.
In Douglas County, Colorado, which sits just south of Denver and has one of the highest median household incomes in the nation, many residents had opposed the Tri- County Health Department, a partnership between Adams, Arapahoe and Douglas counties. Tri-County issued a mask order for county school districts in September 2021, and within days conservative Douglas County announced that its commissioners had voted unanimously to form its own health department.
Douglas County, which joined what was then called the Tri-County District Health Department in 1966, is phasing out of the partnership and plans to exit it altogether by the end of this year. He has already taken over many of his own covid relief efforts from Tri-County.
It outsources things like covid case investigation, contact tracing and isolation and quarantine advice to a private consultant, Jogan Health Solutions, founded in early 2021. The contract is said to be worth $1.5 million.
“We believe the greatest challenges are behind us … those associated with being one of three counties with different and competing public health demands, on a limited budget,” the county spokeswoman said. Douglas, Wendy Manitta Holmes, in a statement.
Daniel Dietrich, president of Jogan Health, declined a request for an interview. “All data Jogan Health collects goes directly to Douglas County for public policy to align with real-time data to keep Douglas County residents safe,” the Jogan Health spokesperson said. , Sam Shaheen, in a prepared statement.
A similar situation is playing out east of Los Angeles, in West Covina, California. Its city council voted to end its relationship with the Los Angeles County Public Health Department over disagreements over covid shutdowns.
West Covina officials have criticized the county health department’s covid restrictions as a one-size-fits-all approach that might work for the second-largest city in the United States, but not for their suburb of about 109,500 people. West Covina plans to join Long Beach, Pasadena and Berkeley as one of the few California cities with its own health agency. The date of separation has not been set.
As in Douglas County, West Covina plans to contract out some services to a private consultant, Transtech Engineers, which works primarily on municipal engineering projects and federal contracts, according to its website. Transtech officials did not respond to requests for comment.
West Covina Councilman Tony Wu and area family physician Dr. Basil Vassantachart are leading efforts to form the city’s own department. They hope that Los Angeles County’s oversight of about 10 million people — “larger than some states,” as Vassantachart noted — can be broken down into regional departments.
Amitabh Chandra, who directs health policy research at the Harvard Kennedy School of Government, said the private sector won’t necessarily have better answers to a public health problem. “They may be good at delivering some parts of what needs to be done, but other parts still need to be done in-house,” Chandra said.
Jeffrey Levi, professor of health policy and management at George Washington University, suggests that there are too many local health departments in the United States and that there should be more regionalization, rather than divide into smaller departments.
“It’s very difficult to spend money effectively and build the core capabilities associated with meaningful public health service,” Levi said. “Doing this just out of anger over something like a mask ordinance is really unfortunate.”
Levi noted that public health departments are responsible for everything from restaurant and septic tank inspections to administering the Special Supplemental Nutrition Program for Women, Infants and Children, or WIC, a federal program of food aid. If a department lacks adequate resources or preparation, residents could see lapses in food or water security efforts in their community, Levi said.
“The LA County Public Health Department is one of the most sophisticated and robust health departments in the country,” Levi said. “You lose access to a very wide range of expertise and services that can never be replicated locally. Never.”
“The public will be hurt in a way that will not be immediately measurable,” he added.
The most recent major private sector takeover of public health was a flop. A private nonprofit, the Institute for Population Health, took over Detroit’s public health functions in 2012 as the city neared bankruptcy.
The experiment failed, leaving a private entity unable to properly oversee public funding and public health issues put on the back burner amid the city’s economic woes. Residents also had no say in where the money went, and city staff were stripped and could not properly monitor the nonprofit’s use of funds. In 2015, most services were transferred to the city when Detroit emerged from bankruptcy in 2014.
“This private institute thought it was going to issue government orders until it was told it had no authority,” said Denise Chrysler, who leads the network’s mid-states region for the right to public health at the University of Michigan School of Public Health.
In Colorado, Tri-County Deputy Director Jennifer Ludwig expressed concern about Douglas County’s creation of non-covid programs essential to the operation of a public health service.
“We have programs and services that many single county health departments are unable to do just because of the resources we can draw on,” Ludwig said. “Building this from scratch is a huge feat and will take many, many years.”
There are also practical advantages. According to Ludwig, a larger health department is more competitive for grants, can attract and retain high-quality expertise like a data team, and can purchase supplies in bulk.
But West Covina’s Wu accepts that the city cannot build its department overnight. “You have to start small,” he said.
Douglas County and West Covina face another major problem: hiring amid a national shortage of public health care workers. Douglas County officials say they are conducting a nationwide search for an executive director who will determine staffing needs for the new health department.