- Associated Press - Sunday, March 13, 2016

ASTORIA, Ore. (AP) - Clatsop County only has a few public-health nurses to serve more than 37,000 people, a thin front line of defense against critical health concerns like communicable disease and unwanted pregnancy.

Three full-time positions are filled on a rotating basis by six nurses working one to five days a week. If a nurse calls in sick, Public Health Director Brian Mahoney said the department has to play musical chairs.

“When there are absences, there is a domino effect on the services, or there are no services at all,” Mahoney said.

An increase in required services, but less funding, has caused a strain on public health departments across Oregon. As an example, the state made HIV case management mandatory, but reduced funding for such management by $20,000 in 2013.

Over the past five years, Clatsop County Public Health received nearly $600,000 less than what was budgeted. The department’s annual budget has remained about $2 million, yet expenses and salaries continue to increase.

The department has lost programs, funding and full-time positions since 2007.

The three nursing positions are split among five programs: communicable disease, general clinic, home visiting, family planning and a program for women, infants and children.

Overcoming challenges

“We try to rise to the occasion,” Mahoney said. “We are always being challenged.”

A challenge came recently when one man with tuberculosis exposed more than 100 people in the county.

Staff had to find where the person with TB had been, how long he spent in those places and who was exposed. Every one of those people had to be tested and some had to be treated with a four-month regimen of daily medicine.

Since last summer, seven communicable disease outbreaks occurred in Clatsop County. The outbreaks - defined as more than two nonrelated people with the same disease - happened in schools, nursing homes and other congregated areas.

“There is a lot of work that goes into trying to keep people from communicable diseases,” Mahoney said.

Public health modernization

Overall, Mahoney said, public health departments have successfully treated acute diseases such as influenza or tuberculosis. However, the public health system is not set up to properly treat the recent rise in chronic diseases.

“We are at a point where we have a lot of chronic diseases,” Mahoney said. “The killers now are heart disease, hypertension and diabetes.”

Each health department in Oregon is undergoing a statewide assessment, called public health modernization. The effort was born out of the state Legislature.

The departments are reviewing their own capacity, capability, spending and costs. The self-assessments will be compiled into a plan for a public health modernization bill in the 2017 session.

“We are rating ourselves on all of these various areas,” Mahoney said.

The result of modernization will help departments understand the resources they have and need while looking toward the future. The idea is that every health department should have the same basic capabilities.

One need Mahoney sees for the county is an epidemiologist, a professional who studies patterns, causes, and effects of health and disease in a population.

Community support

Moving forward, Mahoney said, a key to success for public health is working with the community. Public health plans to continue partnering with nonprofits, hospitals and other organizations.

Mahoney is also working with the county through the budget process. He is emphasizing that funding prevention programs is the most efficient use of funds. For every dollar spent on prevention, Mahoney said, it saves $5.60 in health care costs.

Clatsop County Commissioner Sarah Nebeker, who serves on the county’s Human Services Advisory Council, said education and an open dialogue about health should be a priority for the community.

“I would like to see far more funding for these programs,” Nebeker said. “Our staff works very hard to do the best they can and meet as many needs as possible.”

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Information from: The Daily Astorian, https://www.dailyastorian.com

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