Safeguards certified

In the 40 years Cathy Raevsky has worked in public health, she’s seen many advances. An oral vaccine for polio, released to the World Health Organization in 1970, contributed to the eradication of the crippling disease in the United States and near-eradication worldwide. Tobacco use and death from heart disease have decreased; early detection of cancer has increased. Treatments for cancer and HIV/AIDS have improved.

The list goes on.

One thing hasn’t changed, a thing that remains a source of frustration for her and others in her field: The general public doesn’t understand public health.

As director of the Butte County Public Health Department, Raevsky oversees clinics and labs, with their clinicians and techs. She also oversees animal control, water quality, restaurant inspection, birth and death certificates—a lattice of programs.

The connection is public health’s mandate to safeguard the entire community. Raevsky contrasts this definition with that of “health care,” which she characterizes as focused on an individual patient. Butte County Public Health does see patients, but only for specific reasons—such as screenings, immunizations, sexually transmitted diseases—that fit in the broader context.

“[What public health does] is a hard message to get across,” Raevsky told the CN&R at her Oroville office. “People understand health care because it’s their personal experience … but a lot of the stuff that we’re doing, they don’t necessarily see—and also because it has so many faces.”

Butte County Public Health has approximately 125 employees. Inconspicuousness is one measure of their success—no outbreaks, no attention. Another measure is national accreditation by an independent organization, which the agency received this fall from the Public Health Accreditation Board.

Raevsky said two common misconceptions persist about public health: “Either that it’s limited to health care for the poor or they think we’re everything to everybody.”

By the first, she means residents assume public health clinics care for Medi-Cal and Medicare patients who otherwise go untreated. Butte County Public Health does not provide primary care, urgent care or emergency room services.

By the second, she referred to individuals and groups approaching the department seeking support for an issue: gun control, domestic violence, human trafficking.

“They all want to define that as a public health problem,” she continued. “Therefore, it should be our No. 1 priority. And while there are parts of those problems that are public health, and will work with people, it’s not central to what we’re trying to do.”

The main focus is disease control. That, Raevsky explained, was the original purpose of public health. In the early 1900s, poor water quality and sanitation spread infections, as it still does in many impoverished countries. Life expectancy for Americans has jumped by 30 years in a century—from living 45 years to 75 years—with the U.S. Centers for Disease Control and Prevention attributing 25 of those gained years to public health advances.

That delineation between public health and health care isn’t a hard line, however. Increasingly, medical offices and hospitals—“health care”—have responsibilities to public health such as reporting certain diagnoses such as tuberculosis and measles.

“Over the years we have seen how public health and health care really need to work together to best protect the health of the community,” Raevsky said. “The medical care community is a vital part of what we do.”

As such, Butte County Public Health considers its recent certification an achievement transcending the department.

The national accreditation, at its essence, “demonstrates [to residents] that their health department is meeting the highest of standards and has been confirmed by an outside entity [to be] a high-functioning health department,” said Gene Azparren, Butte County Public Health’s accreditation manager. “It’s a really great accomplishment, and it ties to the community because that’s where our services are and we detailed our collaboration with the community—stakeholders and community members.

“So it’s not really a health department achievement but a community achievement as well.”

It’s also rare. Of 3,410 eligible health departments nationwide (local, state and tribal), just 198 have national accreditation. Butte County is among 10 of 61 in California so certified by the Public Health Accreditation Board; the only other north of San Francisco is Humboldt County.

Butte County Public Health was accredited in September, culminating a process that began formally in May 2014. Preparations began a few years earlier, in 2012-13, after then-state health officer Ron Chapman added to what Azparren described as encouragement “at the national level” to pursue accreditation.

The accrediting agency formed in 2011. Its criteria stem from research and practice standards. Turns out, Raevsky played a part in that development: The public health department where she worked in Michigan, for the 12 years prior to coming to Butte County in March 2013, had state-level accreditation and participated in a multistate learning collaborative “that was like the laboratory before national public health accreditation.” (Her previous department got nationally accredited in 2014.)

“I was hired here, in part, to get this department nationally accredited,” she said.

Currently 161 departments are mid-process and 360 more have applied, according to the organization’s website. Azparren said “hundreds if not thousands” are preparing to apply.

The process begins with the department performing a self-assessment based on the established requirements. The accreditation agency requires documentation; Azparren said Butte County Public Health “must have reviewed more than 1,000 documents and ended up submitting 488.” (That happened in July 2016, more than two years after starting.) Finally, the accreditation body sends a trio of professionals for a site visit to validate the department’s report by inspecting facilities and interviewing staff and community partners; a team visited Butte County in May.

Accreditation runs for five years, at which time a department can seek to get reaccredited.

Why go to this effort?

Azparren said Butte County Public Health has gotten better and will continue to get better thanks to accreditation.

“It’s a continuous quality improvement process,” he explained. “For us, it was a great opportunity to assess programs and services, and compare them [to] those standards, and then always seek to improve…. That’s why we’ve really appreciated the program and the process.”