Public Health Modernization Coming to Oregon

The Public Health Advisory Board dives into details to amendments to HB 3100, intended to modernize Oregon’s public health system – and ultimately seeks to bring Oregon, which currently ranks 46th out of 50 states in per capita funding of public health, closer to the national median.

It’s not just that Oregon funds public health – everything from restaurant inspections to epidemics – at a per capita rate of $13.37 versus the national median of $27.40. Wide variations in levels of county funding result in big disparities.  The focus on individual service delivery comes at a cost of providing communitywide interventions.  Reliance on federal funding – such as Centers for Disease Control dollars – means programs have federal, not community need, at the forefront.

The fix? HB 3100 seeks to establish agreement on the foundational capabilities of public health -- emergency preparedness, communications, policy planning, community partnerships, health equity and cultural responsiveness. So far, the bill’s outline of programs such as communicable disease control, environmental health, prevention and health promotion and access to clinical prevention services have run into no opposition.

But the devil resides in the details. 

On Monday, the Public Health Advisory Board heard more about recommendations that expand its role as “the governing authority that provides oversight for Oregon’s public health system.” They had questions and concerns about the enhanced and re-envisioned advisory board.

For starters, Josie Henderson suggested a restoration of term limits, preferably of eight years, for PHAB members to prevent those appointed from viewing their status as permanent.

Several members worried about geographic representation and representation from communities of color, although no immediate mechanism arose to address the issues.

For example, amendments added to the bill would leave 90 percent of the state’s population – the inhabitants of Benton, Clackamas, Deschutes, Jackson, Lane, Marion, Multnomah and Washington counties -- with a single representative.

Alejandro Queral said he plans to contact Rep. Mitch Greenlick, D-Portland, with his concerns.

“I know Rep. Greenlick is anticipating more amendments,” said Rosa Klein, the Oregon Health Authority’s legislative coordinator, but the bill needs to move out of the health care committee by April 21 to passes the House, then go on to the Senate, where  Sen. Laurie Monnes Anderson, D-Gresham, said “it’s still a turf war, it seems,” with counties over the idea of regionalization.

“I wish the counties didn’t think we were being punitive,” said Sen. Monnes Anderson, who herself saw disparities and need for collaboration as a public health nurse for two counties -- Multnomah and Clackamas. “My vision was that we could have more robust public health.”

As the House bill stands now, local public health can meet its foundational requirements through a single-county structure, with shared services or a multi-county jurisdiction and implementation would occur in waves.

Jan Johnson can be reached at janjohnson6@earthlink.net

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