Fellow board members and I were quite surprised to learn that the Commissioners want to dissolve the independent Boards of Health & Social Services and assume full authority over each department. Especially with how well things have been going.

During my time as member and Chair of the Board of Health, I have seen nothing but continuous improvement. Life expectancy is on the rise, child mortality is falling, and the prevalence of HIV and Hepatitis A has significantly decreased. Along with maintaining our required state accreditation, the department successfully completed national accreditation, joining only one other county in the state with this distinction. Environmental Health is able to complete just as many inspections as other similarly sized counties, despite operating with about half of the staff. Ongoing efforts are being made to include the perspective of our counties’ diverse minority communities, so that the department can address health challenges faced by all citizens.

We are a national leader in local government efforts in tackling substance abuse disorder, and other local governments in NC and nationwide often seek our help. We have been recognized through various awards and distinctions, nominated for NC Health Department of the year, and Director Danny Scalise and his team have individually received awards. This expertise is recognized by the public health community - they are often invited to serve on important committees, participate in distinguished certification programs, provide advice to other health departments, speak at conferences, and submit papers on their work to medical journals.

County Manager Brian Epley, who will have supervisory authority over the directors, says that concerns over the potential risks of this change are overblown and it simply means all county departments can “row in the same boat”. Similarly, Commissioner Chair Jeff Brittain says that this change allows everyone to “work together as one cohesive team”.

However very little information has been shared about specific challenges or limitations that prevent these departments from doing that now. The best path forward is for everyone to work together within the current structure to solve those problems. Their goals could be achieved while maintaining the independence of each board to continue public health and social services programs with a layer of protection from political interference -  a win-win for everyone.

It’s disappointing that in over four years of my service, the Commissioners have not once asked us to work with them towards their stated goals of increased efficiency, collaboration, and coordination. They have left us out of attempts at solving these problems and discussions about shifting power, which Brittain says have been taking place for over a decade.

Many important concerns about their plan have not been adequately addressed:

1. Now more than ever our lives and our health are cynically used as fodder for the aspirations of political parties and pundits. If passed, this gives politicians control over what is best left to doctors, nurses and qualified public health professionals. Politicians are frequently influenced by political, financial, or other pressures, rather than purely by public health considerations. Interference could undermine public health efforts, where hesitation or wrong decisions can lead to sickness and death.
   
2. Other counties that have done this have had bad results. A recent statewide study led by Karl Johnson at UNC Gillings School of Public Health concluded that they become “less concerned with and less empowered to respond to public health needs in the community” and “rarely maintain or improve the performance of public health service delivery”. The study also confirmed fears that “politics would control the department’s agenda” and that Commissioners “would not be capable of fulfilling the Board of Health’s responsibilities.“
   
3. Cleveland County, where Brian served as County Manager before coming here, is one of the few counties that have Commissioner-controlled health and social services departments. Yet, we haven’t heard much about the outcomes there. I found that in 2022, Cleveland County’s Department of Social Services received a letter from the NC Department of Health and Human Services requiring them to correct issues that endangered the safety of children. These problems included understaffing, incompetency, and procedural errors, which led to children being wrongly removed from their homes.
   
4. At this year’s primary election, voters decided that they did not trust two outgoing commissioners with the future of our county. Making a long-term decision during a lame-duck session does not respect the will of the people, and bypasses the input of the new commissioners who will inherit increased responsibilities and workload.

In what might be our last official act, the Board of Health unanimously passed a resolution requesting a delay in the vote and a public report on the potential effects of the new governance structure. We believe at the very least that it would be wise to take our time and carefully consider the potential consequences.

Slowing down is clearly in the best interest of the citizens of Burke County.