Should a plan to improve health in Sedgwick County talk about Medicaid expansion, food deserts and bicycling? Or it should it limit itself to health statistics?
That’s part of the debate that culminated in commissioners cutting the budget for the Sedgwick County Health Department this past week.
They voted to eliminate a position that managed the county’s role in a report on community health, which tracks progress on key health goals and how to best meet them.
A majority of commissioners said the plan unnecessarily delved into social topics and pushed for policies they disagreed with, like Medicaid expansion and reducing requirements for welfare recipients.
“It’s more focused on what a bunch of liberals in the room think need to happen with respect to health care,” said Commissioner Richard Ranzau. “It’s a vehicle to push a progressive agenda to increase government involvement (in public health).”
It’s more focused on what a bunch of liberals in the room think need to happen with respect to health care. It’s a vehicle to push a progressive agenda to increase government involvement.
Sedgwick County Commissioner Richard Ranzau
But public health advocates and some commissioners said the county was backing away from its role as a local board of health. They say community health improvement plans should be able to explore policies that could alleviate health problems.
“It’s something that our community needs…so that we can be organized and coordinated as we address problems,” said Becky Tuttle, who chairs the Health Alliance coalition of organizations.
‘Promoting a political agenda’
Public health groups, nonprofits, universities and others participate in crafting the community health assessment and improvement plan, which surveys community members on health problems like access to care, disease rates and obesity. It’s funded by the county and grants from the Kansas Department of Health and Environment.
Ranzau has long criticized elements of the community health assessment, which he said ignored feedback from interviews and promoted personal opinions of its authors.
He pointed to policy recommendations to expand Medicaid, add more bike lanes, make more places smoke free, expand earned income tax credits for low-income families, improve kindergarten readiness, prevent food deserts and others.
“It’s not really about health. It’s about promoting a political agenda,” Ranzau said. “‘Just spend, spend, spend and everything will be okay.’”
Ranzau voiced his concerns about the assessment to Commissioner Michael O’Donnell, who joined the commission at the beginning of the year after leaving the Kansas Senate.
O’Donnell took exception to the report describing a 36-month lifetime limit to Temporary Assistance for Needy Families eligibility as an example of “punitive policies limiting receipt of public benefits.” O’Donnell said he was “the driving force” behind that policy change while in the Kansas Legislature.
“I wasn’t upset because I was involved in it. It upset me because it was unfounded and incorrect,” he said of the report’s description. “I’d argued countless times about the benefits of that policy (welfare eligibility changes) to get more Kansans off of welfare and into the workforce.”
‘A worthwhile effort’
Tuttle said she and O’Donnell had a positive discussion about the wording of the welfare recommendation. So the current version of the improvement plan talked about improving welfare policies, which it no longer called “punitive.”
“It is a living document and documents such as this are made to be modified if it can be improved,” she said.
Sonja Armbruster, director of Wichita State University’s Center for Public Health Initiatives, said eliminating the position undercuts an essential function of a local health department. She also said economic and social factors are important to a community’s health.
“Nationwide, leading public health planning is just fundamental work that health departments do,” she said. “Public health is supposed to do assessment and policy development…It’s inherently what the role of public health is.”
Nationwide, leading public health planning is just fundamental work that health departments do…It’s inherently what the role of public health is.
Sonja Armbruster, director of Wichita State University’s Center for Public Health Initiatives
“It’s sad to see that our agency is not supported to do this,” she added.
Chairman Dave Unruh and Commissioner David Dennis took issue with some of the report’s stances, but voted against O’Donnell’s motion.
“For the most part, these are recommendations and good citizens sitting together trying to make our community more healthy,” Unruh said. “That’s a worthwhile effort and we should have our health department represented at the table.”
Unruh said eliminating the position over sections of the report was an overreaction.
“Some of my colleagues see this report as part of sustainability and part of Obamacare,” Unruh said. “I think our community partners scratch their heads wondering what are our values and what are our goals.”
Role of report
Unruh said the health improvement plan means people “are going to come up with new ideas” that commissioners may not agree with.
“That doesn’t mean we’ll have to implement them or fund them,” Unruh said.
Tuttle said her group’s push for Medicaid expansion and other policies was not politically motivated, but based on needs.
“We developed strategies to address the health issues in our community,” Tuttle said. “It (Medicaid expansion) is something that will lead to better health outcomes. It’s not something that was politically motivated. It was just based on what the community to address.”
But Ranzau said assessment makers should focus solely on producing health data.
“It shouldn’t be used as a political thing,” Ranzau said. “I think it’s incredibly flawed.”
O’Donnell said the report should have avoided charged topics like education and taxes.
“They’re all trying to tie it back to public health,” O’Donnell said. “This group really got into areas that don’t have anything to do with public health.”