Ask people what societal responsibilities fall under the purview of public health and you’ll likely get a range of responses.

A task force charged by the Legislature to draw up a new, regionalized system of doling out public health services in Oregon discussed just that at its meeting Monday at St. Charles Bend.

“As a state, we haven’t taken the time to say, ‘What is government public health?’ So here we are trying to answer what that looks like,” said Tammy Baney, Deschutes County commissioner and chairwoman of the Future of Public Health Task Force.

The Legislature last year passed a bill creating the 15-member task force that in October will report back with recommendations on what public health services communities must provide, how to restructure the state’s public health system — in which services currently are doled out at the county level — and how to fund public health in a sustainable way. It will then be up to the Legislature whether to move forward with a new regional framework.

Sectors that the group agreed should be included under the public health umbrella include prevention and health promotion (things like cancer prevention, tobacco control, suicide prevention and oral health), access to clinical services, environmental health (lab testing, restaurant and drinking water inspections) and communicable disease control.

Although it’s not yet known what form the regional model will take, task force members emphasized the need for coordination among Oregon’s Coordinated Care Organizations.

The CCOs are the 16 entities across the state responsible for administering the Oregon Health Plan, the state’s Medicaid program, and county public health programs.

The public health responsibility of pool inspections, for example, would not be a good thing to have CCOs involved in because of their lack of expertise in that area, Baney said. Maternal and child health, by contrast, is an area they’re intimately familiar with.

The CCOs and public health sector should team up in areas where there is overlap between their roles, said John Sattenspiel, a task force member and chief medical officer for Trillium Community Health Plan, which operates a CCO in Lane County.

“What the county builds, what public health builds for maternal child health programs really needs to be coordinated with our program,” he said. “We can’t operate efficiently alone.”

The ultimate regional model could end up looking like an “enhanced CCO system” that would look differently across the state, Baney said.

Some of Monday’s discussion highlighted the belief that the current system of public health funding is broken.

“I get the sense that tough questions aren’t being asked,” said Gary Oxman, an at-large task force member and former Multnomah County public health officer. “I’m seeing signs of all kinds of compromises being made. When are we really going to look at doing things differently?”

Following a presentation on public health nurses who go into peoples’ homes to assess needs, Sattenspiel commented that it’s important to look at some of the “sacred cows” in public health and determine where cuts can be made. As a CCO leader, he said, he’s experienced an unwillingness to change longstanding ways of doing things from public health leaders.

“We are not trying to diminish the scope of services,” he said. “What we are looking to do is figure out how the heck we can come together, recognize resources and responsibilities we have and figure out how we can get more bang for the buck that we are spending.”

Teri Thalhofer, director of the North Central Public Health District, which oversees services for Wasco, Sherman and Gilliam counties, responded by reaffirming the importance of having medical professionals perform assessments in homes. She said CCOs are only accountable to the Medicaid population, not the public as a whole, whereas public health spans a population, including immigrants in the country illegally, for example.

At its next meeting, the group will look at how to provide sustainable funding for these services. Finally, it will try to identify the best structure for providing them in communities.

Some public health leaders in Oregon have expressed concern about the potential for regionalization of public health services to diminish the scope or quality of those services.

Jane Smilie, the new director for Deschutes County’s Health Services Department, said Crook, Jefferson and Deschutes counties already work well as a region, although it’s unclear whether that will be the final structure.

“Public health is a fundamentally community-based enterprise,” she said, “and I think the concern is more about making sure we meet the needs of the community in terms of providing health programs and services. I think that the concern comes more for assuring the health of the community than necessarily holding only dollars.”

— Reporter: 541-383-0304, tbannow@bendbulletin.com