Before the COVID-19 pandemic, the Grand County Board of Health mostly focused on funding maternal-child programs, the wellbeing of the elderly population, vaccinations, disaster preparedness and disease prevention projects.
Dr. Darcy Selenke, who spent much of the pandemic as the medical director for Grand County Public Health, explained these duties in a letter to the county’s board of health, which is made up of the Grand County commissioners. Selenke pointed out that prior to COVID, public health orders were never necessary or even discussed.
“The board of health simply supported the initiatives of the community and their public health department, without having the pressure of making decisions that affected the day-to-day existence of every community member and business,” said Selenke, who currently serves as assistant medical director to the health department among other duties.
In March 2020, all that changed. In reaction to the pandemic and other public health issues facing Grand County, a group of citizens has put forth a proposal to form an independent board of health.
Grand is one of 24 counties of Colorado’s 64 that do not have an independent board of health. Colorado counties with a population under 100,000 are not required to have a board of health separate from the county commissioners. As is the case in Grand, commissioners of smaller counties fill that role instead.
The citizen’s group known as Engaged Citizens for a Healthier Grand County explained that the county does have the option to create an independent board of health if the commissioners choose to do so.
Typically, counties don’t have the resources to support a separate board of health. Joined Tuesday by roughly a dozen people from a variety of backgrounds in healthcare, John Riedel explained that his group believes that Grand County does.
“One thing we wanted to show here is that we’ve got (the resources) I think in spades in our county,” he said to commissioners. “Our group is a small group of a much larger group of people with strong backgrounds in healthcare.”
An independent board of health would have no more and no less power than the board of county commissioners has when acting as the board of health. By statute, the board of health selects a public health director, acts in an advisory capacity to the public health director, develops and promotes public health policies, and provides financial oversight to the health department.
The group spoke with the health directors of other small counties that did have independent boards of health including Otero, Rio Grande, Rio Blanco and the Silver Thread Health District, representing Hinsdale and Mineral counties. They also cited a study by the Colorado School of Public Health, which found that independent boards of health helped significantly lower premature mortality from preventable health conditions among other benefits.
Riedel proposed the independent board of health could be composed of five to seven Grand County residents serving five-year staggered terms on a voluntary basis. The members would be required to attend annual training and certification from the Colorado Department of Public Health and Environment, as per a new state law.
“Ideally we can get a broad group of citizens that represent their field and help the county with relevant issues,” Dr. Jessica Klabak said during the presentation.
The group emphasized that the benefits of an independent board of health could go far beyond the pandemic, highlighting a number of issues the proposed board could work toward. Topics like mental wellness, social support, substance abuse prevention and housing are also public health issues the board could pursue.
A number of community members supported of the proposal, including the Grand County Rural Health Network, who cited the short staffing of health resources in the county.
“Especially in the rural community we’re in, our local health resources and staff are stretched incredibly thin,” said Amanda Uehlein, interim director of the Rural Health Network. “An independent board of health may be better equipped to support those staff.”
The Rural Health Network did think that the independent board of health should be made up of a blend of both public health professionals and county commissioners.
Other commenters raised questions about who would be on this proposed board, something that would be determined by commissioners if they were to move forward with the proposal.
Selenke pointed out in her letter that Grand County Public Health and the board of health have been adopting policy and public health orders on a much more routine basis since the pandemic.
“When it comes to the idea of changing the setup of the board of health, I think this could be an opportunity to truly examine what made things difficult over the past year and a half and how we could make it better in the future,” Selenke said. “As I said before, the perception of politicization of the decisions that were made was very unfortunate and not good for our community. Bringing on more medical expertise could help further inform decisions as we go forward.”
But others had a number of concerns about conferring public health powers to an appointed group. Several citizens spoke up wondering whom the independent board of health would be accountable to.
“I’m actually concerned overall that this is just a way to circumnavigate the powers that the state constitution has provided each and every county and particularly the board of county commissioners,” Grand County resident Christian Hornbaker said. “This would be a group that’s not elected, but selected. I don’t think that’s the right way to go about this … We should not be using fear based reactions to current events to make permanent changes in our governing structure.”
The county commissioners expressed a similar worry about accountability for an independent board of health. They also highlighted the strides the county has made in healthcare affordability without an independent board of health.
Commissioner Rich Cimino applauded the group’s efforts, but argued that the county did not need more decision makers. He encouraged the group to continue this momentum and direct their energy toward existing efforts to improve public health in Grand.
“Let’s step out slowly. Let’s see how this shapes up,” he said, proposing the group possibly form an advisory committee. “I oppose going straight to a full on independent board of health and all the responsibilities it entails.”
Commissioners Kris Manguso and Merrit Linke also pointed out that, though the commissioners are not public health experts, the county does employ public health experts who counsel the board.
“They do advise us and we do listen,” Manguso said.
She went on to emphasize that the decisions that the county commissioners make are rarely clear cut and, as elected officials, they do their best to balance the wants and needs of viewpoints across the county.
“I think we provide a balance to the medical side versus the business side,” Manguso said. “I think that is kind of our statutory responsibility as well. There is a balance. There’s schools, businesses, the medical side and individual choices and individual freedoms.”
The commissioners left the door open to additional dialogue but made it clear that an independent board of health was not something they were in favor of at this time.
“I’m not opposed to getting advice,” Linke said. “I’m never opposed to getting information. But responsibility without authority is no responsibility at all. I don’t think I’m really ready to go down that path.”
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