SNOHOMISH COUNTY—On May 2022, after years of financially struggling, the Snohomish County Health District announced that its local public health services would be integrating to the county government structure as the newly formed Snohomish County Health Department.
Despite financial constraints, the District had an eventful final year before the integration commenced on January 1, 2023: responding to the COVID outbreak, monkeypox, RSV, and sexually transmitted disease outbreaks, carrying out over 4,000 safe food inspections, over 1,100 pool inspections, holding approximately 260 pollution prevention visits, responding to about 190 septic complaints and over 400 solid waste complaints, issuing nearly 16,000 birth and nearly 30,000 death certificates.
Although the Health Department recently celebrated one year of operation on January 1, 2024, the dissolution of the former Health District only fully concluded that same month with much of the Department’s first year focused on handling budget transfers, handing over the building title to the county, and even a long, bureaucratic, process of working with the Federal Government to change the recipient information of awarded funding.
The Snohomish County Health Department’s first year was primarily focused on handling these processes of finalizing the District’s dissolution, working to integrate into a county government structure, all while juggling its core responsibilities.
Stepping into the role of Department Health Director, Dennis Worsham, a former employee of the recently dissolved Health District, who returns to Snohomish County after nearly 30 years working for the Washington Department of Health and various public health roles for the City of Seattle and King County – including Interim Director.
Worsham’s love for the mission of public health blossomed while working for the Snohomish County Health District in the 90’s and early 2000’s. When he joined the team in 1993 his focus centered on AIDS and HIV prevention.
“I came in with the intent of just doing HIV work and step away, but I totally fell in love with the mission of what public health was trying to do; work with community, and really try and change the overall health outcome,” said Worsham.
Worsham followed former Health Officer Dr. Chris Spitters down to King County to manage its tuberculosis program. He worked his way through various leadership roles until climbing his way to Interim Director during the peak of the coronavirus pandemic.
“It burnt me out, quite honestly, and I was in a reflective mode of what I want to do next, after a year and a half in that role,” Worsham shared. “The position opened up here [in Snohomish County] with the announcement that they were moving from a District to a Department, and I was familiar with the model, I think it’s a good model that really supports and sustains a public health presence in the community. [Snohomish County] being my first love I was really excited to throw my name in the hat.”
When Worsham initially left Snohomish County in 2005 to pursue a position in King County, the Snohomish County Health District had over 300 employees but just prior to the pandemic that number fell to 106—one-third of its workforce!
Snohomish County is one of the largest counties in Washington State with nearly 900,000 residents, according to Census data, but ranked last in the Washington State Department of Health’s Budgeting, Accounting, and Reporting System (BARS) for investments made in public health per capita.
Perhaps the biggest benefit of integrating the Health District to a government system is the added financial support that comes with it. Snohomish County Executive Dave Somers, who served on the Board of Health for several years prior to becoming County Executive, has monitored this erosion of health care service in the county for a number of years and has pledged to bring the care levels back to numbers which better serve the community.
Just recently, the Department received a portion of the state’s opioid settlement dollars, the county’s chemical dependency mental health funds (paid for by a 1/10 sales tax in the county), one-time American Rescue Plan Act (ARPA) funds, as well as a series of grants. These funds will go toward strengthening the Department’s level of care by adding services and staff to fill in some of the gaps and deficiencies found through running assessments while bolstering its focus on substance abuse in particular.
Some of these projects include funding the County’s Savvy Septic Program, a one-stop-shop for financing options, incentives, and education to help maintain a healthy septic system, and purchasing a mobile care unit, a van which can remove barriers in access to care by meeting the community where they are for immunizations and other needs.
The Department also plans to work closely with the Community Health Center to expand services for behavioral and mental health access for youths in the county, especially with the increasing need coming out of the pandemic.
Funding will also go towards remodeling its current Everett building, which withstood detrimental flooding damage eight years ago but due to a lack of funding could never be repaired. That flooding damage completely wiped out the existing STI and immunization clinic, both of which were never reopened.
There are differences when integrating from an independent district to a government department, however. For example, prior to integrating into a government system the Health District had a Board of Health which encompassed every member of the County Council in addition to City Council liaisons adding their individual jurisdictional lenses to the decision-making process. Furthermore, the district had its own Human Resources team, its own administrators, as far as operations go is was fully internalized before seeking Board approval on certain decisions.
What comes with integrating into a county department comes aligning with county policies, reporting to a county executive, and being more cognizant of taxpayer spending, to name a few.
“It’s moving from being nimble and small, through a Board of Health, to now going to the county process where you go through an executive branch, then the county council, then getting an approval over those processes all while integrating to their system,” said Worsham. “It’s a different mechanism but the payoff is we have more staff working and more financing to really wrap around and help us where we might get stuck.”
In its first year of operation, the Health Department added new services including the opening of a brand new Sexually Transmitted Infections Clinic at 3020 Rucker Avenue in Everett, offering testing, treatment, and other supports to reduce the spread of sexually transmitted infections in the county. The county’s STI/STD rate has quadrupled since its last STI clinic closed in 2009 making this a welcome, and needed, service for residents.
Now, going into 2024, the Department’s priorities will be cracking down on the opioid epidemic, and assessments of where it is as well as assessing its new identity as a new department. It plans to do this by gaining input from the community, looking at public health accreditation standards, and meeting with key stakeholders including government and community partners. Through this work, the Health Department plans to develop a Strategic Plan which will then be implemented in 2025.
