By Mary C. Selecky
Washington’s public health network is an investment that pays off every day. State and local public health agencies are always working to make sure water is safe to drink, food is safe to eat, and our communities are protected from infectious diseases. This strong partnership begins locally, where public health experts work with private and public partners to help people stay safe and healthy.
Everyone deserves consistent health protections, regardless of where they live or how much money they make. That’s the premise behind the public health network. Funding for public health relies on partnership — local, state and federal tax-supported funds and local fees for things like septic systems and restaurant permits.
Although local health agencies get funding through local taxes and fees for such work, the full cost of services is paid for in large part through funding from state and federal sources. Unfortunately, tax-supported funding remains extremely tight and public support for government services is declining.
In the past five years, state funding for public health has been cut by more than $50 million a year. This has increased our reliance on federal funding, taking decision-making further from home and leaving us at greater risk of cuts that can jeopardize our public health services. And it’s just as challenging on the local level. Hundreds of local public health jobs have been cut in recent years, forcing local health agencies to drop services and turn some folks away.
For 14 years, I’ve been honored to serve our state’s public health system as the secretary of health. I’m proud of our accomplishments in the face of some very challenging circumstances. Each day brings new opportunities to protect and improve health. Over the years I’ve seen many times when Washington’s public health system came together quickly, assessed an urgent need, agreed on a response, and took decisive action.
In fact, we’re currently going through that. In April I announced that whooping cough had reached epidemic levels across the state. We’ve seen more than 2,000 cases already this year, affecting 31 of Washington’s 39 counties. Combating this outbreak is a top priority across the state. The epidemic began as early as last May, when the Snohomish Health District sounded the alarm about a worrying increase in whooping cough cases being reported.
Snohomish County usually has about 30 total cases a year; already this year they’ve reported more than 300. Outbreaks like this use a lot of resources, and local and state public health agencies are already operating on reduced staff and budgets.
At times like this we need the support of our community partners, and people and organizations are indeed coming together to help. Pharmacies and health care providers are offering free or low-cost vaccine supplied through a partnership between the state and vaccine manufacturers; schools and daycares are sending out alerts developed by public health; private contributions paid for a notice to be sent to every residence in Snohomish County; disease investigators are identifying and contacting people who were exposed; and doctors continue testing and treating people who are ill.
And my agency, the state Department of Health, is coordinating a statewide investigation, immunization outreach, and communication. Gov. Chris Gregoire supports these efforts, and has provided money from her emergency fund to help us get the word out about how serious this illness is, and what people can do to fight it. Combined, this work can and does save lives. And although the epidemic continues, we’re making headway; more people are getting vaccinated and cases are being more quickly identified and treated, which means they’ll expose fewer people to the illness.
Another example of effective partnership took place recently in Penn Cove on Whidbey Island. On May 15 our state health shellfish program quickly closed the area to harvest after a big fishing boat burned and sank, spreading a fuel sheen over the water. The closure made sure that our food supply was protected. Federal, state and local health and environmental protection groups established a joint response, working together to minimize the harmful impact on environmental and human health.
Pollution in water can end up in our shellfish; so, we routinely test water quality and the shellfish that are headed for our dinner tables, restaurants, and to other states and countries where our shellfish are shipped. Washington’s shores contain some of the most productive shellfish-growing areas in the world, and our joint effort to protect and restore these sensitive areas contributes to a healthy food supply and economy.
Our state public health work goes well beyond responding to events or outbreaks. We protect health and safety in many ways, including making sure that our state’s licensed health care providers maintain the highest quality care and behavior. We license and provide oversight for thousands of health professionals providing services from brain surgeons to podiatrists, nurses to massage therapists and counselors.
Most of these professionals display skill and dedication to patient care and safety; however, when something goes wrong, we take action. Just this year, we’ve identified people who were duping and endangering the public by masquerading as doctors, nutritionists and massage therapists. We take away the licenses of those who don’t provide high-quality health care and those who breach the trust of their relationship with patients. Protecting patient health and safety is a fundamental responsibility of the public health system.
Health care providers are a vital ally in protecting and improving community health, often serving as our eyes, ears and voice for health. They influence the health of individual people, which influences the health of the community. Health care providers often take a leadership role in community partnerships working to solve difficult health problems like obesity, tobacco and substance abuse, and access to care. Partnering among health professionals brings many benefits, including more efficient service delivery, advances in disease prevention, and a stronger public health network.
We don’t have to look too far to see the results of inadequate public health systems. In many developing countries, tuberculosis, polio, cholera and malaria continue to cause illness, disability and death — one in every three people in the world has now been infected with tuberculosis. Many popular European travel destinations have low immunization rates, and measles outbreaks are common. Travelers often bring these public health problems to our communities. Our public health network identifies incoming threats and takes action; hopefully, before these conditions spread to others in our communities.
Fast-spreading illnesses also originate close to home. We saw that in February when thousands of cheerleaders, coaches and spectators from teams across the state gathered in Everett for the state cheerleading championship. When these folks headed home, many developed severe diarrhea and vomiting. Sick people began calling their schools and local health agencies, who notified state health investigators.
We worked with the Snohomish Health District, event organizers and the facility. We contacted event attendees to tell them how to stop the illness from spreading, and to find things they had in common that could lead us to the source of the outbreak. The health district worked with the arena on sanitization procedures, and assessed the food and water supplies. More than 800 people filled out questionnaires and our state public health lab tested specimens from the ill.
Ultimately, norovirus — an organism commonly linked to intestinal diseases — was identified as the culprit. Within a few days the outbreak sickened at least 262 people from 15 counties in the state. Thanks to a quick, coordinated response the illness did not spread further into communities. Norovirus illness is not often serious, but other illnesses like E. coli and salmonella can be, and we’ve come to expect our public health system to be ready to respond to whatever the threat emerges.
Washington has a strong public health system, with innovative partnerships and approaches to advancing public health in our state. Our future effectiveness depends largely on organizations and professionals working in strong collaborative relationships, both public and private. It also depends on adequate funding for local and state public health agencies. It’s my hope and belief that our system and partnerships will strengthen and flourish in the coming years.
About the author
Mary C. Selecky has been secretary of the Washington State Department of Health since March 1999, serving under Gov. Chris Gregoire and former Gov. Gary Locke. Prior to working for the state, Selecky served for 20 years as administrator of the Northeast Tri-County Health District in Colville.