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Marion County looks at public health with new lens

Of the Keizertimes

Disclosure: The author of this article was one of the participants in the workgroup at the center of the story.

When thinking about substance abuse in Marion County, what is the first substance that comes to mind? Heroin, opiates, alcohol, marijuana, tobacco, methamphetamine… the choices feel endless.

For a group of about 50 local community leaders asked to participate in a workgroup at the Keizer Civic Center Thursday, May 31, the answer was either alcohol or opioids. However, the responses were based only on perceptions.

Answering that question with certainty, and then developing an approach to solving it, is the task ahead for the Marion County Public Health Division (MCPHD) of the Marion County Health & Human Services. And the work is just getting underway.

With funding either flat or shrinking to tackle public health problems, program administrators, led by Program Manager Kerryann Bouska, are rethinking how to address substance abuse issues with wide-ranging effects on society.

In the past, public health officials were reliant on donors with specific agendas and tasked with developing programs that catered to the needs of specific populations or mitigated risks. Despite good intentions, new information and shifting goalposts often left the same programs in the lurch when the money dried up or a new donor was secured with a different set of priorities.

Agencies like MCPHD are combatting those forces with new emphases, different tactics, and a bigger goal.

In contrast to past efforts, which focused on getting a program in place to care for specific subgroups, evaluating its effectiveness and then looking at how the approaches to such problems might be altered for greater benefits. MCPHD is using a Strategic Prevention Framework that puts the emphasis on assessing needs, system capacities and planning before execution.

This is why such a large group was put together to begin investigating substance abuse problems in Marion County. With representatives from K-12 schools, colleges and universities, health professionals, media, law enforcement and numerous other agencies, MCPHD tapped into a large array of perceptions within the local community. Even though opioids and alcohol rose to the top as the leading problems, participants were also asked where they would look for data to back up their assertions. Suggestions ran the gamut from student wellness surveys to police reports and hospital intake data.

Once the actual leading problem is identified, the next step will be to look at what environmental influences might contribute to the problem. That step will take into consideration retail availability, social availability, community and cultural norms, promotional aspects, law enforcement, prices and factors affecting individual factors.

The goal of the second phase is to identify environmental factors that could be addressed through public policy. For example, one of the most effective public health initiatives in U.S. history was raising the age of alcohol consumption from 18 to 21. Doing so lead to lesser rates of alcoholism and fewer alcohol-related deaths among youth.

Such steps fall under the umbrella of harm reduction. Rather than seeking to prohibit or put in place outright bans, public policy was enacted to reduce harm to some of the most vulnerable segments of the population. In an example closer to home, the community in Hood River, Ore., recently set out to combat the public perception of the city as a party town – an image bolstered by data revealing it had the highest per capita sales and consumption of alcohol in the state.

Rather than looking to close down bars, breweries, cideries and other outlets, public officials engaged owners who increased training for bartenders, servers, security and event coordinators; asked for commitments from local law enforcement agencies to enforce liquor laws; and reworked event licenses based on the behavior of the licensee and community expectations. As a result, public perception is changing.

The end goal of all this investigation and planning is to arrive at policy solutions with the potential to change an entire population – by raising the standards of the community – rather than risk and prevention needs of individuals.

It is a different lens to look through than what’s come before, but the results have the potential to be more surprising and, potentially, beneficial.