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HomeMy WebLinkAboutItem 8.1 - 3501 Public Health Departments (2) Page 1 of 5 STAFF REPORT CITY COUNCIL DATE: December 1, 2020 TO: Honorable Mayor and City Councilmembers FROM: Linda Smith, City Manager SUBJECT: Informational Report: Local Public Health Departments Prepared by: John Stefanski, Assistant to the City Manager EXECUTIVE SUMMARY: The City Council will receive an informational report on city-run Public Health Departments and the process to form a local Public Health Department. STAFF RECOMMENDATION: Receive the report. FINANCIAL IMPACT: None. DESCRIPTION: Under Item 9 of its October 6, 2020 meeting, the City Council made a request for information on public health departments and the process to form such a department locally or regionally with other Tri-Valley cities. Legal Background County Health Officers, whether at the city or county level, are responsible enforcing and observing: 1. Orders and ordinances of the governing body of the city pertaining to the public health; 2. Orders, quarantines, and other regulations concerning the public health as prescribed by the department; and 3. Statutes relating to public health. Cities have a duty to appoint a health officer unless they consent to the county for certain enforcement responsibilities. The City of Dublin, as part of its articles of incorporation in 1982, consented for its health services function to remain with Alameda County (Dublin Ordinance No. 13). Page 2 of 5 The process of establishing a local Public Health Department in California requires a city, by resolution and ordinance, to terminate service by the County Health Officer by March 1 of each year. The city would have then until July 1 to establish and staff its newly assumed public health duties. While these legal processes are straightforward, the practical realities of establishing a new public health bureaucracy present several challenges, presented throughout this report. Overview of City Public Health Departments Of the 482 cities in California, only four maintain their own public health departments. The overwhelming majority of cities consent to enforcement by their county health officer. This section details those four agencies – Berkeley (population 121,643), Long Beach (population 467,354), Pasadena (population 141,246), and Vernon (population 112) – and their individual public health departments. In the late 1800s it was more common for incorporated cities to maintain some form of their own public health department, largely to address the more common infectious diseases and public health issues of that era. Berkeley, Long Beach, and Pasadena, all incorporated during this time, were no different in this respect. However, as the science around infectious diseases evolved, so did the structure of local public health administration, reflecting the understanding that jurisdictional boundaries do not contain infectious diseases. Thus, the functions of individual public health departments eventually consolidated to the county level to provide greater coordination, efficiency, and effectiveness at addressing cross-jurisdictional public health problems. However, Berkeley, Long Beach, and Pasadena wished to maintain their local control over public health to better ensure the department was responsive to the individual needs of their community. Information regarding the establishment of Vernon’s public health department was not readily available. The scope of public health functions at the local level is varied amongst the four cities. They can be narrowly tailored for the specific needs of a community such as in Vernon, an almost entirely industrial city in which its Public Health Department is largely responsible for environmental and occupational health programs which support the variety of industrial activities taking place. Public health functions can also be broad, from the operation of public health clinics and community health programs to vector control and food facility inspections, like in Long Beach, which maintains the largest municipal public health department in the State of California. Below is a brief overview of the public health functions administered by each of the four cities mentioned above. Berkeley Berkeley’s Public Health Division is a part of the City’s Health, Housing, and Community Services Department. The Division has a total budget of $10.5 million and approximately 58 employees. The Public Health Division has three sections: 1. Family Health a. This section is responsible for Childhood Health, Nursing Field Services, and Communicable Disease Control (HIV/STD/TB). 2. Clinical Services Page 3 of 5 a. This section oversees the City’s various clinical and school-based sites which provide clinical services and health education programming. The section also is responsible for the administration of the Women, Infants, and Children (WIC) and Vital Statistics and Epidemiology programs. 3. Health Promotion a. This section is responsible for health education and promotion programs including nutrition, lead prevention, hypertension, and heart health programs. This section also oversees public health emergency preparedness, pandemic flu, immunizations, and tobacco prevention programs. The broader Health, Housing, and Community Development Department also contains the Environmental Health and Mental Health divisions which work closely with the Public Health division. Long Beach The Long Beach Health and Human Services Department has a total budget of $157M and 439 employees, with $27.5M specifically budgeted for public health purposes. The department has five department bureaus: 1. Community Health a. This bureau oversees Nutrition Services (WIC program), Homeless Services, Health Promotions (tobacco education and fitness programs), and family planning and wellness programs. 2. Environmental Health a. This bureau is responsible for the testing and inspection of food facilities, hazardous materials (HAZMAT), tobacco retailers, and pool and beach water. The bureau also oversees vector control, noise control, and air quality resource education. 3. Housing Authority a. This bureau supports economically disadvantaged populations, including targeted groups such as the homeless, those living with disabilities, HIV+/AIDS, and Veterans, with rental housing assistance and other support services. 4. Physician Services a. This bureau oversees five public health clinics as well as a public health laboratory. 5. Policy, Planning and Prevention a. This bureau is responsible for Nursing Services, Public Health Emergency Management, Epidemiology and Communicable Disease Control, and Strategic Planning. Pasadena The Pasadena Public Health Department has a total budget of $15.5 million and approximately 99 employees. There are five divisions in the department: 1. Community Health Services a. This division oversees health programs targeted towards infants, children, and families. Examples of programs in this division include Immunization Clinics, Communicable Disease Prevention, Child Health and Disability Page 4 of 5 Prevention, and Tuberculosis Clinics. 2. Environmental Health a. This division oversees Food Protection, Vector Control, Tobacco Retail Enforcement, Animal Care and Control, and several general environmental health programs. 3. Health Administration a. This division oversees Medi-Cal administrative activities as well as general budget and administrative functions. 4. Prevention and Policy Programs a. This division administers the WIC, Obesity Reduction, and Tobacco Control programs. 5. Social and Mental Health Services a. This division is responsible for mental health services, substance abuse treatment and prevention, HIV and STD services, and other special community initiatives which address homelessness and violence prevention. Vernon The City of Vernon’s Public Health Department is substantially different from the other three departments discussed in this report. This is due in part to the City being composed of almost entirely industrial uses with a very small population for an incorporated city. Given this dynamic, the City’s Health and Environmental Control Department focuses on HAZMAT, food safety inspections, storm water, solid waste management, garment manufacturing, animal and vector control, and general environmental health. The City has not posted its Fiscal Year 2020-21 budget, but according to the Fiscal Year 2019-20 Budget, the Health and Environmental Control Department had a total budget of $1.4M and four employees. Conclusion While the process for establishing a public health department is routine in concept, in practice the formation of such an agency is rife with complications and significant upfront and ongoing investments in capital assets and personnel. There are several considerations worth noting, which are not answerable within the research done for this report. In the case of Dublin, there would be considerable work identifying how and which public health functions would be transferred to a newly formed department from Alameda County. As this report details, there is no standardized approach to public health at the City level. It is unclear whether the County would allow the City to assume certain parts of public health responsibilities while allowing the City to contract for others; or, whether the County would obligate the City to assume other public health related functions beyond the scope of what may be desired locally. The funding of the public health department is another unknown. Using the four city-run public health departments as a baseline, it is reasonable to expect the annual operational costs of a local public health department would be in the millions to tens of millions of dollars. However, California has a decentralized structure for funding and implementation of public health. Each local public health department is independent and Page 5 of 5 must secure its own funding from state and federal grants, supplemented with local revenue. In most cases, this funding is contingent upon the programs and services the department provides or is tied to specific services/programs (e.g. WIC). It is unclear, however, if those funding sources would negate the need for a General Fund subsidy. Public health departments require teams of individuals with degrees of expertise and advanced skills as well as specialized facilities, equipment, and materials, which present additional human resource, procurement, and real estate complications in establishing a new department. For reference, the City of Dublin’s contract for Police Services includes an 18-month period of transition if the City decided to establish its own police department; in that instance, the City already owns much of the asset inventory needed for a police department. For establishing a new public health department, the timeline would potentially be longer, as the City would be starting the process with much less. In the end, these complications impact the overall value proposition of forming a municipal public health department in the City of Dublin or with regional partners. While the City would gain more local control over public health affairs, the costs of doing so and the efficiencies at which such services are provided may not ultimately produce the value desired or needed by residents. Staff believes that the current arrangement with the County providing public health services is the best option for the City given the County’s existing infrastructure, operational economies of scale, and access to expertise and technology. STRATEGIC PLAN INITIATIVE: None. NOTICING REQUIREMENTS/PUBLIC OUTREACH: None. ATTACHMENTS: None. Item 8.1 Informational Report: Local Public Health Departments December 1, 2020 Legal Background •Cities have a duty to appoint a Public Health Officer. –Can consent to the county for certain activities. •Public Health Officers are responsible for enforcing and observing: 1.Orders and Ordinances of governing body relating to public health, 2.Orders, quarantines, and other regulations concerning the public health as prescribed by the department, 3.Statutes relating to public health. Legal Process •Establishing a Local Public Health Department is a straightforward process. –Requires the City Council to adopt a Resolution and Ordinance terminating service by March 1. •City would have until July 1 of the same year to establish and staff public health duties. City Public Health Departments •City Public Health Departments are a relic of the late 1800s. –Consolidation to County reflected science around infectious diseases. •Of the 482 cities in California, four maintain their own public health departments –Berkeley (population 121,643) –Long Beach (population 467,354) –Pasadena (population 141,246) –Vernon (population 112) Local Public Health Departments •The scope of public health functions at the local level is varied amongst the four cities. –Vernon: narrow focus on occupational and environmental health programs. –Long Beach: broad focus encompassing public health clinics and public health programs to vector control and food facility inspections. •Costs range from millions to tens of millions. Closing Considerations •Scope of Services –How and which public health functions? County dynamics? •Upfront Costs and Ongoing Funding –Reliance on State and Federal grants. General Fund subsidy? •Bureaucratic Logistics –Human resource, procurement, real estate needs. •Overall Value Proposition –City would gain more local control over public health affairs. –Cost of and efficiencies at which such services are provided may not ultimately produce the value desired or needed by residents. Questions? Item 8.1 Informational Report: Local Public Health Departments December 1, 2020