“I’ve been doing this job for 25 years and it’s the first time I’ve been to something like this,” said Deborah Pentland, a Santa Barbara School Districts nurse, during a break in this week’s forum on public health hosted by Supervisor Janet Wolf and Dr. Takashi Wada, Director of the Public Health Department (PHD).
Wada, who came to Santa Barbara from a similar job in Pasadena, is only in the eighth month of his tenure, but his willingness to listen is already earning him a measure of good will. He will need it because his audience members did not have the rosiest view of the current state of Santa Barbara’s public health.
Neither do objective observers. In a study of public health measures in 56 California counties completed by the Robert Wood Johnson Foundation, Santa Barbara came in a respectable 13th in mortality (life span) but 35th in morbidity (health status). The county also came in 35th for physical environment despite Santa Barbara’s eco-conscious bona fides. It is safe to say that Santa Barbara County is not a paragon of public health policy.
Wada shared these rankings during a presentation in which he also defined public health and explained the role of the PHD. Public health addresses medical care but also social, environmental, and economic variables which can affect a person’s wellness. Wada offered the example of two young boys with asthma whose lungs may look the same on an x-ray but whose levels of health might be completely different. One of these hypothetical asthmatic boys lived in a mansion in Beverly Hills, had regular access to a doctor, and therefore rarely missed school. The other lived in a trailer in Riverside County where the air is heavily polluted, cannot afford to see a doctor enough, and therefore misses significant amounts of school. Public health policy seeks to address all of the medical and non-medical factors that lead to the inequity of wellness between these two boys.
Some of the field’s major accomplishments in the last century have been exponential increases in food safety and decreases in infant deaths as well as heart attacks and strokes, the recognition of tobacco as a health hazard, the control of infectious diseases, vehicle safety, and widespread vaccination.
Santa Barbara County PHD provides a host of services ranging from animal control to the Sexual Assault Response Team.
The forum was open to the public and while most of the attendees represented health professions or the health care industry, some came on their own volition — including Nicole Carillo and Elizabeth Figueroa, nursing students at SBCC. They participated in a breakout session that included Lyle Luman, CEO of CenCal Health which administers publicly-funded health care in Santa Barbara and San Luis Obispo Counties. All three agreed that the public needed better health education. Lyman’s biggest public concerns were obesity, diabetes and asthma. “If we don’t address those, they will lead to higher costs,” he said.
Margarita Cisneros of the Carpinteria Children’s Project agreed that cases of type 2 diabetes and childhood obesity are ballooning. School nurse Kim Whipple said that the “kids are falling apart,” referring to what she perceives as a large number of students with mental health disorders including depression, anxiety, and schizophrenia.
On top of these public health concerns shared by community members, PHD faces two immediate challenges. The first affects all public agencies right now: a shrinking budget. On top of that, however, PHD must prepare for the changes which will be wrought by the Patient Protection and Affordable Care Act, better known as health care reform. Wada said that commenting on the wisdom of the federal legislation is beyond his job description, although he also said that “something had to be done” about the more than 50 million uninsured Americans.
He expects that Santa Barbara County’s clinics will soon get an influx of patients who had been previously uninsured. To deal with that, PHD is already working on an application for a Medicare Section 1115 waiver which would provide matching federal funds for the treatment of indigents. Currently the cost of such treatment is swallowed by both hospitals and the county.
Wada said that currently PHD spends between $5 and $6 million on indigent care, but that figure discounts public health spending by other county agencies such as those which provide mental health and social services. (Although they are dispersed by PHD, funds for indigent care are allocated by the state. They do not come from county coffers.)
Twenty percent of Santa Barbara County residents under the age of 65 are uninsured. County clinics treat 30 to 40,000 patients in over 120,000 visits per year.
Yesterday’s breakout sessions allowed community stakeholders to help define what the department’s priorities should be heading forward, and they seemed to appreciate the opportunity.
“Denial is worse than the disease,” said Pentland, the school nurse. She was not referring to matters of health.