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OPINION

Pandemic stretches ability of county commissions to make public health decisions

By Ximena M. Garcia
Special to Gannett Kansas
Ximena M. Garcia, M.D.

When I cast my vote for county commissioner, I had no idea I was voting for one-third of the Shawnee County Health Board. I wonder if even they knew how important their role would be in helping lead our county’s response to this deadly pandemic.

Kansas state law dictates local officials control public health policies. This is the decentralized model of public health governance used in at least half the states. The Kansas state statute assigns public health decisions to each of our 105 counties individually.

Each county commission — acting as the local board of health — is charged with hiring the public health officer and overseeing decisions. Given the small size of each county, this is an inefficient and archaic practice.

Nevertheless, it is the system we have. The vexing thing about this arrangement is that the three elected county commissioners who oversee public health policies are not required to have any medical or public health knowledge. The only voices around the table are often those of business owners. That is an important perspective — but it cannot be the only consideration in public health decisions.

The downfall of the current system in Shawnee County has been laid bare during the coronavirus pandemic. Decisions by the Health Board/County Commission have brought us to this: Hospitals are at capacity, health care staff are depleted both emotionally and physically and instead of having fewer cases and fewer deaths after nine months battling the pandemic, we are in a much more dire situation than we were a few months ago.

We had the great fortune of having an exceptionally well-trained and knowledgeable health officer, Dr. Gianfranco Pezzino. However, because of the structure of the county commission, decisions were made against the public health’s best interest by two of the three commissioners. Businesses and families have been impacted for much longer than necessary because the proper precautions were not consistently adopted. 

This may not be the only pandemic we will experience in our lifetime and other public health emergencies occur regularly. We need a fully functioning and capable model to ensure swift and efficient responses to crises that prioritize the health of the public.

The simplest solution (adopted successfully in several states) would be for the county commissioners to appoint representatives to act as a board of health. This appointed board could act initially as an advisory board, until state laws are amended to allow a full delegation of authority from the current board of county commissioners.

The board of health would then be made up of a diverse mix of people with differing perspectives; all stakeholders would have a voice. As a starting place, the board of health could be a group of seven community members.

For example, two public health professionals, one mental health professional, two physicians and two community members. This would allow the county commissioners to feel confident in their appointed board, and at the same time give the health officer a knowledgeable group to make county health decisions.

The recent appointment of a small Technical Advisory Board is a step in the right direction, but the board needs to be expanded. And of course, the county commissioners need to show willingness to listen to the recommendation of their advisory board — which only one of the three commissioners has done.

We need a public health system in Shawnee County and in Kansas that the public can fully support and trust. One that represents their public health interests.

We would be remiss not to learn from this year’s mistakes and proactively have a system in place that will keep us safe far into the future.

Ximena M. Garcia, M.D., is a retired physician who lives in Topeka.