Decision Making

Colorado law notes several requirements of any public health department. Within each requirement, the health department has opportunities to determine how to best meet the public health needs in the community. Furthermore, the County must consider service capacity and other program-specific standards and requirements in its decision making.

Specific feedback mechanisms are currently in development and will help the County better understand our community’s public health expectations and needs. More information will be available on our website as those opportunities are scheduled.

The County is pursuing an aggressive timeline to evaluate and design new public health services, including considering the following categories:

Governance

By state law, a public health department must be governed by a board of health. The board of health must include at least five members who are seated by appointment. The board of health must hold meetings at least once every three months.

Decision opportunity: Arapahoe County Commissioners can determine it is appropriate to have more members of the board of health and if those additional members are appointed or elected. They can also outline more requirements for any additional members. 

Decision: At a meeting on March 29, Commissioners approved the establishment of a foundational board of health. The board would have five members, including two commissioners. It will be empaneled in summer 2022 to complete operational items associated with establishing the health department prior to Jan. 1, 2023. Once the health department is operational, the County intends to transition to a board of health with a wider variety of expertise.  

The public health department must also have a public health director.

Decision opportunity: Anyone can be hired as the health director. However, if the public health director is not a doctor, the health department must also hire or contract with a medical officer.

Decision: At a meeting on March 29, Commissioners approved contracting with a qualified medical officer with public health expertise.

Services

A public health department must include the following services: vital records, communicable disease surveillance and control, immunizations, onsite wastewater, land use cases and nuisance abatement. 

Decision opportunity: Beyond services that are required by law, a public health department can provide services based on community needs.

Decision: At a meeting on March 29, Commissioners voted to provide the services that are critical based on community need. All services fall into two broad categories: consumer protection and community health:  

Consumer protection

  • Environmental health, which includes inspections for restaurants, childcare facilities, body art facilities, and water/wastewater
  • Communicable disease surveillance and control
  • Emergency preparedness and response
  • Community health and prevention, which includes tobacco education/prevention, behavioral health, and primary prevention programs
  • Vital records

Community health

  • Public health nursing
  • Harm reduction, which includes HIV and Hepatitis C testing, and syringe access services
  • Immunizations
  • Child fatality case review
  • Maternal child health
  • Nutrition program for women, infants, children (WIC)
  • Family planning

Consideration of additional services is ongoing. The County will engage with members of the public and partner organizations to ensure that the needs of the community continue to be met, and to fine-tune services offered. 

Assessments and plans

A health department must deliver or assure that core public health services are provided to the community. These methodologies are required:

Community Health Assessment

A Community Health Assessment provides an overview of the current health status of the community. It gives organizations comprehensive information about the community’s current health status, needs, and issues.  

Decision opportunity: Arapahoe County will need to determine how to use the new Community Health Assessment to guide its decision-making on how to address public health needs and develop a public health improvement plan.

Public Health Improvement Plan

Using insight gleaned from the Community Health Assessment, a five-year local Public Health Improvement Plan directs efforts to engage partners in improving the health of their communities. Tri-County Health has a current public health improvement plan that guides planning through 2024.

Decision opportunity: Arapahoe County can determine if it makes sense to use the plan created by Tri-County health through 2024 or create its own plan.

Other considerations

Funding

A percentage of a public health department’s funding will come from the Arapahoe County General Fund (money that was previously sent to fund Tri-County Health). However, traditionally public health is funded by a wide range of sources including: state and federal funding, Medicaid and Medicare, fees and foundations. Some funding is tied to specific programs or services.

Decision opportunity: Funding previously given to Tri-County Health may not automatically transfer to a single-county health department. The County is in the process of matching funding sources with programs and costs and recognize that there are one-time costs that will need to be covered. We are continuing discussions with funding partners.