Public-health issues are everywhere. Some examples include: ensuring the food in restaurants is safe; preventing disease, injury and substance abuse; promoting healthy behaviors; immunizing kids; inspecting public pools; providing access to nutritional food for new moms; preserving a healthy environment; monitoring disease-carrying insects and rodents; issuing septic permits; and providing birth-control options.

Historically, San Juan Basin Health Department has responded to health needs of vulnerable populations that were not being met in the community. This strongly held value resulted in the provision of dental services for children, adult chronic-disease prevention, senior home health and outreach, and prenatal services. Unfortunately, public funds or fees do not cover the true costs of many of our programs. We therefore have frequently sought private grants to provide funding to address community needs. While generous, these funding sources are often not sufficient or sustainable.

Over the last four years across Colorado and the nation, many agencies and businesses have been forced to look at reducing costs. This unfortunately results at times in cutting unsustainable services. Public-health departments across the country have cut about one-fifth of their workforce since 2008, with more than half cutting services in the first six months of 2011. Over the last two years, our reserves have been substantially tapped in order to continue programs valued by our community. However, the ongoing economic downturn, funding decreases and a commitment to balance our 2012 budget necessitated examining programs and services. In doing so, we also evaluated whether the program was available elsewhere in the community and if it was a core public health service.

As of December 2011, San Juan Basin Health discontinued two programs that are already offered in our community in order to build a solid, viable foundation on which we can continue offering our core services. Prenatal care and the personal care provider agency now officially are closed. Clients were transitioned to other providers in La Plata and Archuleta counties. While difficult for clients and employees, I am proud of the way our staff and community providers worked together during a challenging time for the benefit of affected individuals.

Three other equally valuable programs either recently ended or will soon as their private grant funding runs out. These include the Senior Outreach, Integrated Child Health and Promoviendo La Salud programs. Some components of these services are being incorporated into an innovative program that is just beginning. Because this initiative is funded through a local private-public collaboration, the intention is that it will be more sustainable.

As we start 2012, this balanced foundation allows us to focus on continuing to deliver essential public-health services while embarking on a journey to meet future needs in Southwest Colorado. One of our goals this year involves the core function of assessing and planning. San Juan Basin Health has begun a community health assessment in partnership with Mercy Regional Medical Center and Pagosa Springs Medical Center. We are seeking community input on area health needs and our capacity to address these needs. Stakeholders meetings were just held in Pagosa Springs and Durango. Feedback from these meetings and public input will be combined with information from more than 200 health indicators to further discussion about our community’s health priorities. This will lead to creating our public-health improvement plan, which will help guide what activities we undertake over the next five years and how we partner with other organizations.

While evaluating needs is a necessary step in addressing health issues, it often takes strong partnerships, creative solutions and a collective will to make a difference.

One example is the current launching of our community care team. This team will help people with chronic health conditions navigate the fragmented health-care system. Mercy and Pagosa medical centers again join us in this collaborative endeavor along with Axis Health Systems, La Plata County Human Services, Pediatric Partners of the Southwest and Rocky Mountain Health Plans.

The community care team is the fruition of several years of meetings between these private and public partners.

While the new year brings changes, rest assured that the vast majority of our wide spectrum of programs and services remain. Remember: Public-health issues are everywhere. Help us in continuing to protect, preserve and promote health in our community by providing your input about how we might address future health needs in Archuleta and La Plata counties.

Joe Theine is public health director at San Juan Basin Health Department. Reach him at jtheine@sjbhd.org.