Editorial from The Aegis
2:20 PM EDT, June 18, 2013
The Harford County Council's vote last week to establish a "healthy community planning board" makes a lot of practical sense, political prejudices about government involvement in health care notwithstanding.
Under the Harford County Charter, the county council also is the county's board of health. There's a good reason for this because the county government bears a measure of oversight responsibility for the Harford County Health Department, even though that agency is primarily an arm of the state's Department of Health and Mental Hygiene insofar as county health department employees are state government employees, not county government employees.
Still, health department reports are made periodically to the county council, usually during regular Tuesday night council meetings, but with the council sitting not as the county's legislature but as the county board of health.
These reports tend to be rather pro forma, as members of the council generally are not particularly well-versed in the particulars of the health department's services. Such services include, but are not limited to, planning to respond to public emergencies, providing a range of health and vaccination clinics, coordinating programs that deal with diseases ranging from tuberculosis to HIV/AIDS, ensuring students attending public schools are vaccinated against certain diseases – the list goes on and on.
Receiving a report twice a year on the health issues of the moment and reviewing a budget each April hardly constitutes the kind of detailed management and coordination of the spectrum of public health services that affect just about everyone who lives in Harford County.
By contrast, the Harford County Council has another governmental role under the charter analogous to that of board of health. The council also serves as the Harford County Board of Zoning Appeals, and in that capacity it retains expert assistance for reviewing disputed zoning matters. As the zoning appeals board, the county council hires zoning hearing examiners, who are lawyers well-versed in the field of land use law, to hear the particulars of each case in carefully organized hearings that closely resemble the proceedings in a courtroom. When a hearing examiner makes a decision, the county council then has the option of affirming or overturing that decision. The losing side then has the option of appealing to the court system.
As a practical matter, the zoning hearing examiner system saves the council, which isn't comprised of land use law experts, from making costly legal blunders. As a philosophical matter, however, the model has a lot of applications with regard to the county's management of health resources.
To a degree, the Harford County Council's move to establish a county health commission is the result of reports that, on average, Harford County residents are more obese and more likely to smoke and abuse drugs and alcohol than people in other parts of Maryland.
If a committee charged with more effectively allocating existing health department resources can make changes that help the citizenry lose weight, quit smoking and overcome drug and alcohol dependence, that would be good. Moreover, an advisory group consisting of doctors and experts in the fields of public health has a lot more potential to effect a change than the existing board of health, which consists of elected officials, none of whom have backgrounds in medicine or health.
Curiously, the council member with the strongest claim on a health background expressed the most vehement opposition to establishing a healthy community planning board – retired coach and physical education teacher Dick Slutzky.
Slutzky raised the politically charged issue of New York City attempting to regulate the sizes of sweetened sodas offered for sale in the five boroughs, and questioned the need for a board whose job it is to make recommendations about health issues saying: "What part of this can't we do without this board?"
He raises two valid points. Governments cannot legislate healthy behavior because it doesn't work. The abuse of illegal drugs serves as one example as people have no trouble acquiring and becoming dependent on such substances, even though their actions are illegal. Try to outlaw triple-extra-large sodas or double bacon double cheeseburgers and people will find a way to get those as well.
As for the matter that the county council, at least in theory, could pay closer attention to how it manages and allocates health resources, he is absolutely right – but only in theory. In practice, the track record is one of hearing reports twice a year, nodding in somber agreement that cancer rates are unfortunately a bit high in Harford County, then moving on to the next matter of public business.
There's no harm in appointing a volunteer board of people passionate about public health issues and having them come up with ideas for improving public health. Indeed, there's good reason to believe that the county council's action, or inaction, as a board of health is comparable in its level of competence to a council as zoning appeals board acting without the expert advice of a hearing examiner.
While the legal costs of botching zoning appeals decisions would show up on the bottom line in the form of public money paid for legal services, the cost of botching health policy coordination is a bit harder to quantify.
Unfortunately, the price of failing to prevent disease isn't paid in something as easily replaced as taxpayer money, though that would be bad enough.
Instead it is paid for in years subtracted from lives.