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Following the passage of a bill that checked the powers of county boards of health this past session, the West Virginia Legislature is studying other ways the state’s public health system should operate.

Health officers from across West Virginia presented to the Joint Committee on Health Monday evening, explaining how the system works and what improvements they believe need to be made. The biggest complaints were about communication between county health departments and the state, and, of course, funding.

There are 48 health departments in the state tasked with promoting public health, enforcing state health laws and responding to public health emergencies, like the COVID-19 pandemic.

Of the 48 boards of health, 24 have four or fewer employees. They are tiny but mighty, officials said Monday.

Mineral County, along the border of Maryland, is one of these small health departments. A.Jay Root, administrator and preparedness/IT director of the Mineral County Health Department, said health officers in Allegheny County, Pennsylvania, and in Maryland — both with much larger staffs and budgets — called him for advice when the pandemic began, and then when the vaccine rollout began.

“They’d ask me how we did it, and we just did,” Root said. “It’s what all these people do.”

Dr. Lee Smith, executive director and health officer at the Monongalia County Health Department, said West Virginia’s system helped the state dive head-first into vaccinating the public. That’s why the smaller departments were doing better than departments in other states with budgets the size of West Virginia’s entire public health budget, he said. But the pandemic also revealed the flaws in the system.

The bill passed this year, Senate Bill 12, was initially spurred by concerns, mainly from businesses, about the control health departments had over business.

A small number of business owners have complained about the power of the health departments when the state passed the Clean Indoor Air Act, which permits county boards of health to enact non-smoking ordinances for public spaces. But during the pandemic, especially in the early stages and in the initial shutdown, many businesses felt unfairly targeted and confused by disjointed messages coming from departments around the state.

Senate Bill 12 requires any rule set by county boards of health to be approved by the county commission and any other appointing authority after a public comment period. For example, rules set by the Cabell County Board of Health will need approval by the Cabell County Commission and Huntington City Council, as they both have authority to appoint members to the board of health. The appointing authorities can approve, disapprove and amend rules.

While the new law may put some power back in the hands of elected officials, it doesn’t do much to help the heart of the issue when it comes to public health: a lack of infrastructure and funding.

All West Virginia health officers meet weekly now on Zoom, a pandemic necessity turned permanent after the value was seen, said Terri Harlan, administrator at the Fayette County Health Department. But they still don’t have a way to easily share data and analysis, and they all operate on different systems.

Communication also can lag from the state. The pandemic also highlighted that, particularly when Gov. Jim Justice would make an announcement during his video briefings and the health departments would find out something they needed to do at the same time as the public. Harlan said there were sometimes curse words heard from the back of her office when an announcement she wasn’t ready for came from the lips of the governor.

Funding also remains an issue, prohibiting systems from being updated and other infrastructure improvements. Smith, for example, runs one of the largest health departments in the state, yet operates out of three buildings because the department can’t find the funds to build a new space.

“You can’t get grants for brick and mortar,” he said.

Delegate Matt Rohrbach, R-Cabell, asked if Smith believed regionalizing the health departments would be the way to go to get the most bang for the state’s bucks, but Smith said it would depend on what that looked like. He said he strongly supports having a public health presence in each county. It may work for hospital systems, but due to the preventative role of effective public health, it may not work best for health departments.

The Joint Committee on Health has a sub-committee working with the public health officials to find a path forward.

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