Heightened focus on health departments has some LA County cities wanting to create their own
As the coronavirus transformed from nascent oddity to deadly pandemic early last year, a previously obscure government agency rose to newfound prominence:
Local health departments.
Thousands of frightened people tuned in regularly to hear public health officials discuss the latest developments of the virus and its spread. Those officials offered safety guidelines and blunt warnings.
In turn, they became household names.
In Los Angeles County, that household name was Public Health Director Barbara Ferrer, who provided televised updates daily during the pandemic’s onset.
Yet, as frequent viewers likely noticed, there were two cities — Long Beach and Pasadena — that received special mention. That’s because they’re the only two cities in the county with their own health departments.
As the pandemic wore on, many residents and business owners became frustrated with government mandates intended to stem the further spread of the coronavirus, particularly county rules that were at times stricter than statewide guidelines. As the months passed, and shutdown orders remained, some cities began to wonder: If Long Beach and Pasadena have their own health departments, why can’t we?
In recent months, nearly a dozen cities, from Beverly Hills to West Covina, have contemplated breaking from the county’s health department. Their reasons largely center around greater autonomy and flexibility in dealing with health crises.
But making a clean break isn’t so simple. Health departments deal with more than just society-altering pandemics, after all. They manage mosquito abatement, anti-smoking campaigns and restaurant inspections, to name a few.
Still, some city officials remain undaunted.
“Everything has to be local, based on local data and local policy to take care of the local issue,” said West Covina Councilman Tony Wu. “That is the only way.”
It’s also an untraveled way: Los Angeles County hasn’t seen a new health department created in more than a century.
Besides Beverly Hills and West Covina, the cities of Azusa, Claremont, Diamond Bar, Lancaster, Palmdale, San Dimas, Santa Clarita, Walnut and Whittier have all expressed interest in breaking from the LA County Department of Public Health in recent months.
Most of those, however, have opted not to rush in. It would take, they acknowledge, at least another year — and likely even longer — before they could get their own health departments up and running.
The Whittier City Council, for example, voted in December to research possible options for leaving the county Public Health Department, including setting up a joint-powers authority with other towns.
City staff and attorneys told the council they probably couldn’t create a health department until July 1, 2022, at the earliest — and, more realistically, a year from then.
And even that could be optimistic, with Councilman Fernando Dutra saying he thinks there is only a 10% chance of success.
Still, he said, it would be unfair “not to close the loop on this and have some resolution.”
Santa Clarita got an even earlier start – but a local health department there is still a ways off.
The City Council voted in September to spend $25,000 on a consultant to look into creating a health department, a report on which, city spokeswoman Carrie Lujan said, is expected to be released at the end of the month.
West Covina, though, has moved quickly.
The City Council, with Wu as one of its most outspoken advocates for a local health department, voted late last month to end its agreement with LA County, effective July 1.
Wu, in a recent phone interview, said that while the city’s approach may seem aggressive, government officials must do everything they can to protect their residents.
Relying on LA County for health services, he said, would not be in the best interest of West Covina residents. There’s too much bureaucracy within the agency, he said, to adequately respond to the needs of all 86 cities and more than 100 unincorporated communities under the health department’s jurisdiction.
“The county health department is just too huge,” Wu said. “You have a big health department with 4,000 employees — that sounds like a lot, but you’re taking care of a 10-million-or-more population, with a vast geographic area.”
The LA County Public Health Department did not directly respond to criticisms from Wu or others. But it did say, in a statement, that it will support West Covina as the city creates its own agency.
One major step, the county said, is to have the state recognize West Covina’s new department, once it exists, as a “local public health jurisdiction.”
Then, the county said in its statement, it “will work with the City to transfer all of the work required by a local public health department.
“Until West Covina has a state recognized city public health department,” the statement added, “LA County Public Health will continue to serve the residents of West Covina in its current capacity.”
It’s unclear, however, what West Covina’s alternative will look like, how much it will cost – or how long it will take to set up.
But it’s taken the first step.
Frustration with the county
Each town has individual reasons for considering its own health department, but some refrains resonate across city borders.
Many cities have been frustrated that they’ve had to go along with LA County’s coronavirus health restrictions. And some have also said they want more control over health measures, such as contact tracing and vaccine administration.
In Whittier, for example, the council voted to explore separation soon after LA County banned outdoor dining in November. Long Beach followed suit in that prohibition — but Pasadena did not.
“When we found out on a Sunday night that they’re going to shut down all these businesses the day before Thanksgiving at 10 p.m., with no discussion,” Whittier Mayor Joe Vinatieri said during the council’s December meeting, “that gave me a very good lesson.
“We don’t have the ability to deal with our destiny.”
Wu, in West Covina, said that one of his primary criticisms of LA County was the lack of adequate contact tracing early on, which he said could have helped contain the virus’s spread.
And if West Covina were in charge of its own coronavirus response, Wu said, its officials would also be more accountable.
“Otherwise, the city manager won’t be the city manager for long,” he said, “and the City Council won’t be the City Council and the mayor won’t be the mayor.”
Limits of independence
The last year in Long Beach and Pasadena, though, has shown the limits of independence from LA County.
Dr. Ying-Ying Goh, Pasadena’s health director and medical officer, said she’s fielded calls from officials in other cities wanting insight on starting their own departments. They have thought, she said, that if a city with its own health department disagreed with the county’s rules, it could forgo those restrictions.
“Our understanding,” Goh said, “is that’s not the case.”
Rather, a local health agency’s own restrictions can’t be looser than the state’s requirements. And even under California’s “Blueprint for a Safer Economy,” which introduced the colored tiers for coronavirus management, cities like Long Beach and Pasadena don’t control when they can reopen further. That’s because the state judges reopening criteria by county — not city.
So they must move through the tiers with Los Angeles County.
And while wanting more control of epidemiology programs is understandable, Goh also pointed out that health departments handle far more than disease control.
They inspect residential homes. They run the city’s tobacco prevention program. They examine how economic and social conditions impact health outcomes. They record birth and death certificates, promote maternal and child health, and work to reduce chronic diseases.
“All local public health jurisdictions must be able to provide” those services, the county health department said in a statement. “The LA County Public Health provides these services to all of its contracted city partners at no cost.”
The perception that an independent health department can disregard state rules, though, isn’t limited to cities looking to create their own agencies.
In Long Beach, for example, residents have criticized shutdowns there, the city’s Health and Human Services director, Kelly Colopy, said in a recent phone interview.
“People want us to move more quickly than the state,” she said, but “with the state, we can choose to be more restrictive, but we can’t be less.”
Independent departments do have some advantages, however.
Pasadena’s Goh and Long Beach’s Colopy, for example, said their teams could be more nimble, in many cases, than LA County in changing testing or vaccine distribution strategies.
And building community trust, in some ways, is easier.
“Because we are smaller — because we’re a city, because we work where we live — we have a lot of relationships that are just one step away from us,” Goh said. “I think in a large jurisdiction, those same folks might be many steps away.”
Those tight relationships have helped with vaccination efforts and combating misinformation.
Pasadena, for example, worked with nearly three dozen community organizations, from churches to political advocacy groups, during the recent push to make vaccine distribution more equitable.
And Long Beach has vaccinated nearly every employee in its entire public education system, thanks, in part, to relationships with the local school board, community college and university.
Close connections to other city agencies, like the Convention & Visitors Bureau, allowed Long Beach to quickly launch sites for mass testing and vaccinations.
“Because we’re a local health department, we actually have the authority and access to get resources from the federal and state level to put things into place quickly,” Colopy said. “And Long Beach has the opportunity to really be more flexible at a local level based on the relationships we have.”
For cities considering independence from the county Public Health Department, one question looms above all else:
Is the massive undertaking worth it?
Such an effort won’t be quick. Or cheap. Pasadena’s 2021 public health budget, after all, was about $16 million, and Long Beach’s was $157 million.
But for Wu, in West Covina, the answer is simple — even if the process is not.
“Money comes and goes; you fall in love, you break up,” he said. “The only thing that’s irreplaceable is people’s lives. How do you get that back?”
A local health department is necessary, he said, because “you’re sworn in to protect your residents, so you have to do that.”
Health department strategies can make the difference between life and death. And the heightened focus on local health departments, officials said, could be a much-needed correction to the ambivalence most people felt pre-pandemic.
Goh, for her part, said she hopes that focus doesn’t fade.
“I don’t want us to come out of this pandemic and be in the situation we were before,” she said, citing annual decreases in funding. “That would just be shameful for us to continue that mistake, that error.”
If officials like Wu have their way, that mistake won’t happen.
If they have their way, local health departments — after perpetual pre-pandemic obscurity — will remain in the public spotlight for years to come.