“Public health is critical for society’s well-being and needs protection from the vagaries of partisan politics ... . What model of funding streams and governance structure can help to insulate public health institutions from near-term political concerns and position them to generate and disseminate data and science to best serve the public, including anticipating and responding to public health emergencies?” — Drs. Venkat Narayan, James W. Curran and William H. Foege, JAMA, Feb. 9.
House Bill 2015 and its close companion, Senate Bill 12, under consideration in the West Virginia Legislature, directly violate these words from some of our nation’s most experienced health policy experts.
The bills require that local board of health rules be approved by their appointing entities — county commissions and city councils. In addition, they place local boards of health under the authority of the state health officer in times of emergency. The few words these bills add to code belie their potential effect on the health of all.
Except for the emergency provision, the bills are not new. Past versions have failed, yet these new ones are moving. Advocates have typically been those interested in reversing clean indoor air or other specific health regulations.
The thinking behind the concept is that county commissions and elected officials more easily can be influenced on controversial issues and “held accountable.”
Accountability is incredibly important in government and society. I have great respect for city council members and county commissioners. I value their leadership. I want their input, ideas and partnership in creating sound public health policy.
I don’t want them being the final authority on it any more than I want my insurance company or legislator directly providing my family’s medical care.
In the 1880s, West Virginia founders structuring our public health system thought through this. They made county commissions and city councils responsible for appointing board of health members. So health policy could be grounded in scientific principle, expert guidance and public input, they gave those boards, not county commissions or city councils, the authority to establish health ordinances for the common good.
To avoid specific political overreach, appointing authorities may not simply remove and replace health board members at will. They may, however, shape board of health composition over time. The design not only provides better, more stable health policy, but it also protects elected officials and the public from situations where political expediency and special interests could override public good. And it helps protect high-risk populations with little political voice (low-income workers, children, etc.)
SB 12 and HB 2015 undermine these purposes. They increase the risk of policy based on identity politics, election cycles and special interests. They decrease accountability of local health boards to the public.
Boards of health should not only develop well-informed policy but also adapt it over time based on experience, changing science and input from the public, elected officials and community partners.
COVID-19 reminds us that individual health is shaped by the health of our community and that health and economy integrally intertwine. The U.S. response to the pandemic has, sadly, been one of the world’s worst. Globally, we have 4% of the world’s population but 25% of all COVID-19 cases and 20% of deaths. Lives and businesses have been lost unnecessarily because of identity and partisan politics, misinformation and poor coordination. Science was shunned and suppressed, and health policy, at times, was shaped by the style and personality of political leadership, especially in an election year.
While not at the same level, such issues in West Virginia have influenced what, how and when data is shared; the ability of public health and leadership to rapidly strategize with partners or proactively engage legislative leadership; and the flexibility of communities to apply guidance in locally relevant ways.
I am excited, although not surprised, to see that, with vaccination efforts, planning systems seem to be improving and communities are hitting their stride. That is critical, given new virus variants likely to be with us at some level for years.
Finally, SB 12 and HB 2015 would create confusion and distraction for health departments and businesses at a time when focus and clarity going forward is critical. For those desiring more consistency in rules across jurisdictions, these bills would make things worse (what happens when a city council votes one way and a county commission votes another?). What about health departments working to coordinate and support services across borders while still maintaining a local presence (something many are encouraging)?
Must they go to every appointing council or commission? And what if each votes differently?
The bills also undermine a workforce currently stretched thin as they diligently work to inform and vaccinate all West Virginians who desire the same.
Yes, there are real challenges with West Virginia’s public health system and much need to strengthen it, including potential structural change. Doing so deserves the input of many and a sincere political commitment to work with stakeholders in shaping it longer term. We should start this process soon.
I applaud the desire of many to do something about public health in the short term. A good place to start would be restoring funding, protecting it from near-term budget cuts and making the training, interning and hiring of public health workers easier.
They could consider the issue above at the state level, where executive powers and public health policy development have even less separation.
West Virginia’s public health system needs to be stronger, more robust and well-linked into economic development and public policy. There, we will most fully affect true drivers of change, turn around community health and help attract business. Bills generating avenues for overriding public- and science-informed health policies or creating disjointed approaches that affect our businesses will not get us there. Most county commissions know this and are against these two bills, as well.
Let’s keep our eye and our energies on the systems, policies and environments that create thriving and healthy families and communities. That’s how our economy and our health can shine.