February 15, 2013 – Dr. Justin Denny was born in the United Kingdom and has lived and practiced medicine all over the world – most recently in Laos, where he worked for the United Nations and the U.S. Centers for Disease Control as a physician and epidemiologist, treating and trying to contain the spread of infectious diseases, as well as training other epidemiologists.
But coming back to the Portland area last summer, he said, felt like coming home. On February 1, Denny stepped into the role of Tri-County Health Officer, overseeing health departments in Multnomah, Washington and Clackamas Counties, following the retirement of Dr. Gary Oxman on January 31.
Denny first came to Oregon to enroll in the master of public health program at Oregon Health & Science University, which he completed in 2002. Already a board-certified physician, Denny said he'd become interested in public health because he wanted to address health problems before they began.
“It was always frustrating to do clinical work because it felt like you were fighting the tide,” Denny said.
After finishing his M.P.H., Denny served as the public health officer of five counties in Oregon and Washington: Clark County in Washington, and Wasco, Columbia, Washington and Clackamas.
After a stint in Sweden with the European Center for Disease Prevention and Control, in 2008 Denny and his wife decided to move to Southeast Asia – partly because their adopted 12-year-old daughter was born in Thailand.
Denny held positions there and in Laos before deciding to return to the United States. The humidity and homesickness were getting to be too much to bear, and Denny said he was frequently ill with viral infections, but he hopes to keep certain aspects of Lao culture – and an international perspective -- in mind as he steps into his new position.
“When I came back, I worked in the ER at [Legacy] Good Samaritan, and I was just shocked,” he said. “In Laos, they do a better job of taking care of their poor, and they live on five dollars a day.” While poverty is rampant, people with disabilities do not live in isolation, and families in villages tend to take in children who have lost parents or other family members.
So often the patients he saw in the emergency room in Portland had problems that couldn't be effectively handled by an emergency room physician – such as chronic pain, mental health and substance abuse issues, or housing and financial stressors, or some combination thereof.
He would often tell hospital social workers, “Most patients need to see you, not me.” Referring patients to services that can help them deal with major underlying problems – including counseling, but also housing services, relationship classes, and other issues – does more to keep people healthy. For those living with chronic pain, he said acupuncture, yoga, and even counseling patients about their posture and gait (which are often factors in back pain) can do more good, on a longer-term, less invasive, less expensive basis than what many physicians can do once a patient comes into the emergency room.
“I've seen it be taken care of so much better with so much less money,” Denny said.
From that perspective, Denny is optimistic about the state's healthcare transformation process, because of its emphasis on primary care and involving social workers and community health workers to help patients navigate the system.
Still, switching from paying for services to paying for outcomes will be difficult, both because services are more concrete and easier to track, and because change is always difficult for people to accept.
“I think it'll work easier in some systems,” Denny said. “It will not work as well in others.”
“This is where Gary's legacy will be missed. I think he's very good at process. He had a good sense of the community,” Denny said, adding that Oxman will continue to serve the county in an advisory role in the next few months to wrap some projects.
Denny's also encouraged by the fact that there are so many strong leaders at work on transformation, including Lillian Shirley, the director of the Multnomah County Health Department and a member of the board of Health Share of Oregon, and Dr. Bruce Goldberg, as well as Dr. Mel Kohn and Governor John Kitzhaber.
“There's just such a good team of leadership right now,” Denny said.
In addition, while the social safety net may be patchy, American culture has a strong spirit of wanting to step in and help others, and Denny sees that as particularly strong in Portland.
“I'm in listening mode and will be for some time,” Denny said.
