On July 1, Gilliam County began operating its own public health department. The move ends, after 13 years, its membership in a regional health district that includes neighboring Wasco and Sherman Counties. Gilliam won approval from the Oregon Health Authority to create its own local health authority after officials conducted a feasibility study last year to examine the cost and level of service the county could directly provide its roughly 2,000 residents. Elizabeth Farrar is the Gilliam County Judge. She joins us to explain how the county’s experience during the pandemic prompted this transition, and the top public health priorities for the new agency she now oversees.
Note: The following transcript was computer generated and edited by a volunteer.
Dave Miller: This is Think Out Loud on OPB, I’m Dave Miller. For the last thirteen years, including more than two years of a global pandemic, Gilliam County in North Central Oregon was part of a three county health district with neighboring Wasco and Sherman Counties. But now this county of roughly two thousand residents is splitting away. With help from the state, they’re offering their own public health services. Elizabeth Farrar is the Gilliam County Judge, meaning she is the county’s chief executive. She joins us now to talk about the county’s decision to go its own way. Welcome to Think Out Loud.
Elizabeth Farrar: Thank you. Thank you for having me.
Miller: It’s good to have you on. My understanding is that this switch over was being talked about before the pandemic. What were the initial reasons, back in 2019?
Farrar: It was just looking at the difference between providing what is really community health on a regional level versus on a local level. And so some of our local medical providers here in Gilliam County just felt that having services available within the county provided some benefits to our residents. We were very pleased with North Central Public Health there, our public health district, but they are based in the Dalles, which for many of our residents means a significant drive, sometimes as much as ninety minutes each way, to access services. So that has been something we, living in rural Oregon, regularly that’s a challenge for us to access services, but particularly with public health, we wanted to see if there was a way to bring those services closer to the populations we were serving.
Miller: Ninety minutes each way. So three hours of driving to access certain services, total. Can you give us a sense for the kinds of services that you had been getting from North Central Public Health District?
Farrar: Absolutely. The big ones that people are probably most familiar with are things like immunizations, our kids are going back to school. North Central Public Health was able to send staff out occasionally for things like that, but say you were a parent, you happened to miss that immunization day, then you need to make arrangements really to transport your child to the public health office in The Dalles. Some of the other programs that people may be familiar with are WIC, the government’s Women, Infant and Child Program, which provides nutrition assistance to pregnant women and young children. Again, that is something that North Central Public Health would provide staffing that would come out remotely maybe one day a month, but if you have scheduling conflicts on that particular day, that would mean needing to drive to The Dalles to access those services. So those are probably the most direct in terms of things that consumers were accessing. In addition they provided environmental health services. So inspecting restaurants and hotels and pool facilities, those types of services along with a lot of prevention work. As you may know, public health, a lot of what we do on that side is actually prevention. So having those services in the county made some sense as well, just because every community is unique and so by having it based here in Gilliam County, I think we’re able to really focus on the specific communities here and the populations here and crafting a prevention strategy that makes sense for these communities, which is just a tougher role when you’re looking at three counties as opposed to one.
Miller: So all of that was the case, pre-COVID, and then the biggest public health emergency of our lives happened. How did your experience, the county’s experience maybe, even just in the early days or early months of the pandemic, influence your decision to leave the North Central Public Health District?
Farrar: What we found in the beginning months, especially, I’m sure you remember things were very chaotic, there was a lot of changing information constantly, and it was a challenge for everybody to manage. What we found was that challenge increased, because we were trying to respond regionally. So for our little county just as context, we are one of the smallest counties in the state of Oregon. And so for most of our county government, there is one person per Department. And what we were finding with the ergional approach is, there were a lot of meetings that were having to happen in order to allow communication and coordination between the three counties that made up that North Central Public Health District. For us, what that meant was a lot of my staff were spending time communicating with our partners rather than responding on the ground. So sort of being the small county in that partnership meant that we were finding a lot of the resources that we needed to actually respond to, say our first responders here, and make sure they were fit tested and for their masks, and all of the things we were trying to do with our school districts, all of those things. We were finding the resources we needed to do those things, locally, were being diverted in order to try to be a good partner on the regional level.
Miller: Just to put that in perspective, correct me if I’m wrong, but roughly, Wasco County, which is home to The Dalles, has a population that’s ten times larger than your county, so a lot more is going on there?
Farrar: Correct. And we also found there’s some differences between the counties as well. Gilliam County, all three counties are agriculturally-based counties, but Gilliam County and Sherman County are more wheat farming. Wasco County has a lot more orchards and things like that, and so one of the big issues at that particular time was migrant workers that were coming in and how to prepare for them. Obviously very crucial for Wasco County to address, not something that Gilliam County really needed to be concerned with, but because we were part of that planning apparatus, we were devoting our resources to trying to help solve the problem regionally, where that particular issue wasn’t really something that impacted how Gilliam County needed to respond. It’s just one example, because each of the counties are very different, when you try to approach something like this regionally, it really complicates what was already a very sort of chaotic response, just because of the nature of the way that the pandemic unfolded.
Miller: I’m curious about finances because what you’re talking about here are the bureaucratic challenges of being a small partner in a bigger consortium and having some of your specific needs maybe being swallowed up by the needs of a larger number of people. But the hope from the beginning, the plan was, was in some ways a little bit different than that – It was that you could take advantage of economies of scale and efficiencies, and if you partnered with these other counties, including a much bigger one, you could benefit perhaps in financial ways or residents could have access to services, they might not otherwise have access to. Are you giving up anything when you’re taking yourselves out of this partnership?
Farrar: That was the question that the county court, which I’m the chair of here in Gilliam County, so the governing body really wanted to know, we first started, with really looking at the feasibility of this back in March, we commissioned a feasibility study to answer that very question. The court’s directive was, we’re going to make this transition, we want to make sure that the service level remains at least the same or better than what we were receiving through North Central Public Health, and would not cost county taxpayers significantly more than what we were already contributing. So the way we fund public health is, the state is a huge funder through Oregon Health Authority, but each of the counties within North Central Public Health, were also contributing through their general fund. And so we wanted to make sure that based on what we knew the state would be able to send through OHA, that that combined with what we were spending in general fund dollars would be sufficient to provide services. And what we found is that by and large, we thought that service would be as good or better. Honestly, I think that the geography of accessing service, now, one of our clinics here in town is providing much of the service itself, that’s kind of how we developed an economy of scale internally, is that rather than Gilliam County itself hiring nurses and practitioners, we’re partnering with our local health clinics to deliver those services. But what that means for, say, a family with young children that’s trying to access WIC is that they have maybe a five minute walk to the office as opposed to a ninety minute or three hour round trip drive. And so based on that, we were able to come up with a transition plan and a strategy that allows us to provide virtually the same services that North Central Public Health was providing but provide them at a local level where they’re accessible five days a week for people to walk in instead of needing to drive. So that makes a huge difference in terms of the level of service, I think.
Miller: What have you identified as the key public health priorities for the county? You now are in the position where at the county level and as one of the county leaders, it’s up to you and other leaders in the county to take care of public health for residents in a way that you were less responsible before. What have you seen as the most urgent needs in terms of public health?
Farrar: A lot of our focus, and partly this is driven as well by where the state, where OHA is putting its resources because obviously that impacts the areas that we’re really able to focus on. If OHA has more money in certain pools, it makes sense for us to try to take advantage of those programs and make sure that we’re providing services.
Miller: With the hope that there is some kind of overlap between what money is available and what needs you have?
Farrar: Correct. Yes, obviously one of the big things for us, and a place where OHA Is still investing very heavily, I think in response to the pandemic, really is in alcohol and drug prevention. You know, I think folks went through a very difficult period and they coped in different ways and so that is one area that OHA is investing heavily, and that happens to have a good overlap with what we see in the community and know our needs for our community to address. So we are leveraging those dollars to do prevention work in our schools with our behavioral health partners, to be able to provide treatment options for folks who are struggling with addiction. And so that’s one of those things that has a nice overlap between where the state is making more investments anyway and where we see a need in the community.
Miller: Right now, we’re experiencing a wave of COVID-19 infections in Oregon and around the country. The expectation is that it could be actually, in terms of case numbers, the biggest wave yet. This is because of the BA four and five Variants. What does it look like in Gilliam County, right now?
Farrar: Gilliam County is small enough that I could probably tell you who all has COVID [laughing], well, has been at the moment, because that’s the size of our county. But we’re like anybody else we’re not immune obviously to when there are spikes in cases. We see spikes in our cases as well. We are smaller and we are more remote by nature. I mean a lot of folks choose Gilliam County because of the space that they wanted. So I think that has helped over time for our infection rates to stay reasonable, I don’t know what’s reasonable, but moderate, we’re like anybody else, when there’s a variant that comes through, we will see an uptick and just like other communities, we have segments of our population that are resistant to vaccination and things that we know are effective in slowing infection rates and so that will continue to be something that our public health folks work on is making sure that folks have access to vaccination and boosters and know the risks if they go unvaccinated. I think hopefully one of the advantages is, this is ‘neighbors to neighbors’ talking about these issues. And I think the closer that you get to the community, maybe the more likely that you are to affect change. And so that’s my hope, at least.
Miller: If I understand you correctly, you’re saying a hope, now, is that with local people in charge of public health at the county level, they may be slightly more able to convince vaccine hesitant people to finally get a covid vaccine?
Farrar: In general, we’ll see how the numbers look, but I think in general, people are more likely to listen to their neighbors and people that they know and trust within a community than they are to say, you know, a state agency telling them how to respond. And I think especially watching how the pandemic has unfolded over the last two years, over time it seems that the public really has grown a little weary of the different advice and you know, things that we’ve changed over time to try to control the spread. So my hope is that yes, that when public health officials are your neighbors, that maybe folks who have been hesitant in the past will be a little bit more open to listening than they were when it was strangers trying to make the case to them.
Miller: Just briefly, in terms of population, Sherman County is about the same size as Gilliam, maybe a little bit smaller. Since you made this switch, have officials in Sherman County come to you to ask for your advice on whether or not they should follow suit and also break away?
Farrar: No, as Sherman County I think is intending to stay at North Central Public Health, but really, I think the difference is in geography, you know, a lot of Sherman County’s residents are within a 15 to 30 minute drive of The Dalles, and so the geographical barriers to service are not the same in Sherman County, and so given that that was a big driver for our decision, I’m not sure that there would be the same push in Sherman County because their residents are so much closer to where the service would be provided.
Miller: Elizabeth Farrar, thanks very much for joining us today.
Farrar: Thank you.
Miller: Elizabeth Farrar is the Gilliam County Judge overseeing the new Gilliam County Public Health Department. Tomorrow on the show, we’re going to hear about a new production at the Oregon Shakespeare Festival. It’s called Dr. G’s Bingo Extravaganza. It is an immersive experience that puts the audience at the center of the show. It celebrates Doctor Geneva Craig, Civil Rights Leader, Nurse, Community Leader in Southern Oregon. If you don’t want to miss any of our shows, you can listen on the NPR One App, on Apple Podcasts, or wherever you like to get your podcasts. Our nightly rebroadcast is at eight pm. Thanks very much for tuning in to Think Out Loud on OPB and KLCC. I’m Dave Miller, we’ll be back tomorrow.
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