Oregon seeks to modernize public health even as they monitor pandemic fluctuations

The plan focused on creating a task force to consider regional structures, to look at enhancing efficiency and effectiveness, and allowing partnerships with regional care providers and community organizations. Changes were to reflect considerations of cultural and historical appropriateness and be supported by best practices.

Prior to the COVID pandemic North Central Public Health District (NCPHD) was part of a 13-county Eastern Oregon Collaborative working on modernization goals, with NCPHD taking the lead and having fiscal oversight. The focus of that grant was around Sexually Transmitted Diseases (STD’s), especially gonorrhea, and do so with a health equity lens, according to NCPHD Director Shellie Campbell. That emphasis was based on an increase in STD’s throughout the 13-county region.

“And then COVID hit,” Campbell noted.

In 2020, all health department work — and its entire budget — shifted to address the COVID response, and that remained true for about 2 1/2 years; only recently has the shift back to modernization occurred, Campbell said.

In the last two months, state, regional and local health agencies are again shifting their focus to modernizing the public health workforce and infrastructure. Issues to be addressed include Communicable Diseases (CD); the Public Health Emergency Preparedness Program (PHEP); and general workforce and infrastructure issues and access to critical care.

“People have been saying for years public health is chronically underfunded. Some program elements were not addressed pre-COVID, and all those things came together and had an impact when COVID hit and we really had to ramp up,” Campbell said.

That big picture of public health needs to be considered with an “equity lens,” she added, to make sure that under-served and vulnerable populations get the critical care they need.

Current modernization efforts, unlike those undertaken in 2013, will have some significant funding available.

NCPHD is now the fiscal agency for only Wasco, Sherman, Klickitat and Gilliam counties, and Campbell said the agency anticipates seeing regional funding of $265,576 related to Communicable Disease in all four counties; local modernization funding of $230,226 will support work in Wasco and Sherman counties. Additional local funding includes workforce development funding of $72,564; and Community Based Organizational (CBO) grants of an undetermined amount.

During COVID, CBOs were invited to seek public health grants to provide a range of services. That focus has changed, and CBOs were invited to seek new grants. Those grants are still being reviewed.

Four local CBO agencies that have applied and received modernization funds are The Next Door; CRITFC (Columbia River Inter-tribal Fishing Enforcement); Age Plus; and Eastern Oregon Center for Independent Living (EOCIL).

“I don’t know if more are going to be funded locally, there are conversations going on,” Campbell said. She noted local public health officials were not involved in early planning and funding regarding the CBOs. “We shared our concerns with OHA, and continue to have those conversations,” she said. Their were also CBOs from Portland and other metro areas applying to work on grants locally that had never been known to work in the area, she said. “We have been asking questions like, ‘How are they going to work in Wasco or Sherman counties, what presence do they have there? Will they be visiting, will they be setting up offices there?’

“I think because of those conversations, many of those were pulled back or not awarded,” Campbell said. “We made it clear we needed to be in the same room with these people, we needed to make sure we had a relationship with them, so that we were all working together,” Campbell said. “There are concerns with how CBOs from Portland or Eugene are going to be doing work in Wasco or Sherman counties, and there is still work being done with that. We have not been notified on that.”

It was a challenge, she admitted, and the process is not complete, she said.

“We love our CBOs. We had strong relationships with our CBOs before the pandemic, during the pandemic, and we will be continuing to have those strong relationships," Campbell predicted. She noted the NCPHD was already working on strategic planning, looking to the future.

“That’s a lot of work done, and a lot of worked needed,” said Commissioner Steve Kramer. “Thank you for staying on top of it.”

“It’s good to see we are getting some funding for this,” Commissioner Cathy Schwartz noted. “Public health has been neglected for so long. And I’m glad to hear the CBOs that are going to funded will in fact be serving needs in our area.”

Ongoing pivots

Campbell said the future was not likely to be a straight path forward in public health. “We have learned to be very flexible, knowing that even as we move modernization forward, at any moment we may need to pull back and address COVID. We are seeing that today, as cases and hospitalizations surge in the county,” she said. “Every time that hapens, our communicable disease staff needs to pivot back to COVID work, and that takes them away from some of the modernization work.”