Editorial: Keep health district independent by reforming its oversight

By The Herald Editorial Board

That the Snohomish Health District has been able to deliver a range of public services and fulfill its duties — as it faces dwindling and uncertain financial support in recent years — is credit to its staff and the officials and professionals who work with it.

But that lack of reliable financial support, the changes in health care, a growing population and difficulties in governance of the district could threaten its ability to deliver those services.

The health district is the independent countywide agency responsible for promoting the delivery of public health services. That includes responding to outbreaks of disease, addressing chronic health concerns and administering nutrition assistance to single parents, as well as issuing food-handler permits and reviewing and permitting septic systems, among many other responsibilities. But the district receives no direct tax support of its own and relies on support from the county, some revenue from license and permit fees and state and federal grants.

Jefferson Ketchel, the district’s environmental health director, told the district’s board of directors last week that what was once an “excellent” public health system was “crumbling away before your eyes,” The Herald’s Sharon Salyer reported Monday.

In the short-term the health district has taken its funding concerns to the councils in its cities and towns, requesting that each provide a grant of $2 per resident to support the programs that benefit all residents. Assuming all participate, the district could see a revenue boost of $2.4 million next year.

But there are no assurances that cities are ready to make that a regular funding source.

One long-term solution, proposed by Snohomish County Council member Ken Klein, would be to dissolve the district and make it part of county government, which could reduce costs in delivering services through better efficiencies.

The district also has sought assistance this year from the William D. Ruckelshaus Center to conduct a study and make recommendations regarding its sources of funding, its management and the role of the district in delivering public health services. The Ruckelshaus Center, a joint effort of Washington State University and the University of Washington, facilitates public policy efforts, such as the Joint SR 530 Landslide Commission that made recommendations for disaster response following the March 2014 landslide near Oso.

Following interviews with more than 70 people involved with the district, the Ruckelshaus report makes recommendations that go beyond funding concerns and included how the district is directed, managed and advised, some of which has had an impact on its funding.

Making the district part of county government, while offering some advantages, would come at a challenging time, the report says.

It’s hard to argue otherwise. With the county facing budget cuts and general financial uncertainty, taking on what would be an additional department, without an identified source of funding, wouldn’t seem to make delivery of services any more certain.

Instead, the report recommends the district and its board make use of a scheduled update of its 2014 Strategic Plan and the Board of Health’s 1997 charter to improve its governance, using a collaborative process that involves district staff, the board, the Public Health Advisory Council and other community members to clarify purposes, roles and responsibilities.

For example, the district’s board of directors, seeking to include representation of the county and its cities, includes each of the five county council members and 10 representatives from various city councils. But that makeup hasn’t guaranteed support from the cities; the board’s size has made it difficult to convene a quorum at times, and turnover has made it difficult to retain board members who are up to speed on district programs and needs, the report found.

The report recommends evaluating ways to streamline and rebalance the board’s membership to address the split between cities and county, support more collaborative decision making and generate greater support and participation from the cities.

No single source of funding is going to support the district, the report said, another argument against a county-run department. Funding solutions will require commitment from all involved: county, city, state and federal. Among potential sources noted were county and city retail sales taxes or property taxes, a tax on cannabis products or even making the district a junior taxing district with its own authority to levy taxes.

There’s overall agreement regarding the importance of the health district’s work and the services it provides. By keeping those goals for public health in mind, all involved can reform its governance and its support so it continues to protect the health of all residents.