Partnerships drive better community health, leaders say

Key Takeaways

Success stories of county-public health partnerships took center stage at NACo’s Public Health Leadership Academy on June 4, demonstrating their impact on community well-being.

Thurston County, Wash. worked with its public health department to create its Street Vendor Program, which allows operators to sell food without a traditional food truck, while still prioritizing health and safety standards, according to Thurston County Commissioner Carolina Mejia. 

“What really gives me optimism about Thurston County is we have a very collaborative community,” Mejia said. “We’re always talking about partnerships, and everyone’s always willing to roll up their sleeves and get to work.”

Washington counties can develop their own county-wide code. That, in addition to the state’s “broad and vague” administrative code, gave Thurston County the necessary latitude to create the Street Vendor Program, said Dr. Jen Freiheit, director of Thurston County Public Health and Social Services Department. 

“It was a unique concept — Washington didn’t have this anywhere else,” Freiheit said. “… This was a very grassroots effort led by some entrepreneurs in our community who were interested in promoting this lower cost option and starting up businesses, so it was a really innovative approach, really championed by community.”

Because street vending doesn’t follow the code of traditional physical facility requirements and entails unknown food sources, the county needed to identify regulatory concerns. 

To better understand logistics around how the street vendors would operate, such as the processes around preparation, developing food and storage capacity, the county brought together five entrepreneurs who helped inform the creation of the Street Vendor Program. 

“This really was a big partnership where we had the vendors come in and sit around the table with public health and the commissioners and just talk through all the pieces of it,” Freiheit said.  “Of like ‘What does a refrigeration unit mean?’ … or ‘If I’m operating from a brewery, if I’m operating on the street, it’s going to be hard for me to find a connection.’ 

“So, I really appreciated how we all came around the table and talked through the different pieces to get to the solution.”

The street vendors still operate under strict requirements, but not to the extent of a food truck, Freiheit noted. Participating vendors must apply for a Mobile Food Unit Permit and a variance, have access to a commissary kitchen, maintain an insulated mechanical refrigeration system and have a commercial-grade handwashing station with hot water.

Following the two-year pilot program, one of the five entrepreneurs continued as a street vendor, and two moved their businesses into brick-and-mortar locations. 

“We are very proud of the people who have used this as a stepping-stone to actually open up brick-and-mortar places, because it’s a driver for economic development and small businesses,” Mejia said. “So, that’s one of the areas where we’ve shown that public health can be an economic driver.”

There are now eight active street vendors operating across Thurston County, and the county is currently reviewing an additional seven applications. 

“This was a really great program to promote economic development, public health and safe outdoor food access without people just popping up and doing it on their own,” Freiheit said. 

In Delta County, Colo., a preschool located in an area where bats regularly migrate, combined with low confidence in vaccines among some residents, created conditions that could have led to a rabies outbreak.

County officials and public health leaders worked together to mitigate the situation in a way that worked for their community.

“Delta County doesn’t have a formalized animal control, so a lot of those things end up on public health,” said Jacqueline Davis, Delta County Public Health Director. “Many times, we refer to ourselves as the bat wranglers.”

A nurse was conducting vision and hearing tests at a preschool in the county when a bat fell from the ceiling. She took the bat into Delta County Public Health, which had it tested for rabies; roughly 15% of bats in Colorado that are tested for rabies have the viral zoonotic disease which are infections caused by viruses that naturally jump from animals to humans.

The bat tested negative, but state guidance maintained that the 120 preschoolers who were potentially exposed should receive rabies post-exposure prophylaxis (PEP), a four-dose vaccine series along with one dose of rabies immune globulin. 

“We have very low vaccination rates for MMR [Measles, Mumps and Rubella, a routine childhood immunization],” Davis said. “So, it wasn’t something that was going to be accepted well in our community.”

The state’s recommendations of administering PEP, which is a 14-day process, and closing down the school, a Head Start program, didn’t feel realistic for the county, Davis said. 

“You could feel the tension in the room when they said, ‘You have to vaccinate all these children with this long, drawn-out process, you’re going to have to close this building, you’re going to have to do this, this, and this,’” Davis said. “They had a lot of really good information that we were able to share and to glean from it, but you could tell from everybody else in the room that it wasn’t a good situation, it wasn’t going to end pleasantly if we continued.”

The school district, county commission and board of health came together to determine a path forward that would work for their community, Davis said. 

“I said, ‘OK, what are we going to talk about? How are we going to do this?’” Davis said. “‘And how are we going to coordinate and make this really a livable situation for everybody?’”

Instead of closing the school, the public health department’s environmental health director and County Commissioner Wendell Koontz went to the preschool to ensure that there were no more bats and professionals were brought in to disrupt the migratory pattern. 

Education was also provided to the parents about the risk of rabies, as was the opportunity to have their kids vaccinated as protection against the potential exposure. The county worked with a regional hospital to ensure that its small community hospital would have the resources to provide the PEP that would be needed, if the demand was there. Only one preschooler ended up receiving PEP and there were no infections reported, Davis noted. 

“We worked through different perspectives and reached something that was very practical for everybody,” Davis said. “Because everybody could join together, understand the risks and benefits of everything and come to a conclusion.”

Public health, the school district and county government all having established relationships was key to coordination in crisis, Davis said. Local governments represent their communities and should keep that in mind while still ensuring that public health is accounted for, she said. 

“Lessons learned is that trust matters,” Davis said. “… And having those conversations early, and not about how you’re going to respond [once it’s already happened]. Community context matters. Decisions must consider both scientific evidence and local reality. 

“We’re in local Colorado, there are things that’re not going to happen, so how are we going to, in the best and healthiest and safest way, be able to execute that? Problem solving and communication matter.”