San Juan Basin Public Health ceased to operate much like it began – with a meeting.

“The San Juan basin public health department set out Wednesday toward its goal – reducing disease hazards in the five southwestern Colorado counties – by organizing its program, choosing Durango as headquarters and naming Mrs. James Russell president,” Durango’s newspaper read on Sept. 25, 1947.

Although Archuleta and La Plata county commissioners had set a dissolution in motion over a year before, that very board upon which Russell sat, her seat now occupied by Fort Lewis College Biology Professor Shere Byrd, spoke the last word on the department’s demise on Dec. 14.

With Byrd’s call for a motion, the Board of Health adopted a final proclamation recognizing its own dissolution and the department’s achievements.

The similar, understated nature of these two moments speaks to a key characteristic of public health work: the public, by and large, doesn’t know what it is or how it operates.

But the three quarters of a century in which SJBPH served Southwest Colorado was punctuated by grand achievements in the field of public health, the emergence of society-altering medical interventions and a remarkable evolution in the understanding of what public health is.

The department was built on a foundation of unity. Five counties came together to pool resources. The enterprise was inherently political in a sense, given that public money was being used for a public service.

Perhaps it is no surprise, then, that political disputes arose throughout the department’s history, and ultimately spelled its end.

San Juan Basin Public Health, then called the San Juan Basin Health Unit, formed in response to an overhaul of state policy.

After a two-year tour of the state, Dr. Florence Sabin, the head of the governor’s Committee on Health, pushed for the passage of several pieces of legislation, known as the “Sabin Bills.” One bill allowed counties to join forces and form health districts so that they were better equipped to respond to public health concerns.

“It was (like pushing) a boulder uphill at the time, to dedicate resources in a sparsely populated state with a backlog of environmental and infectious disease concerns,” said Liane Jollon, SJBPH’s former executive director of nearly 10 years.

Jollon left the department in May 2023.

She called the region a “tremendous force” in the adoption of Sabin’s work.

With tuberculosis running rampant and heightened concerns about food safety, La Plata, Archuleta, Montezuma, Dolores and San Juan counties joined forces to create the San Juan Basin Public Health Unit.

“This part of the state has had a long interest and a long commitment to working together across counties to improve and protect individual and community health,” Jollon said.

The department was small at its inception. Although its services stretched from the Utah border to Pagosa Springs, the unit had just 13 people on staff. Its first budget was $50,120 (about $670,000 today; by comparison, SJBPH’s 2022 annual budget was $6.9 million).

Many of the department’s undertakings were similar to the responsibilities left to public health agencies today.

Testing of school children in 1948 revealed that a third of local high school students were positive for tuberculosis. Jollon said the department was an effective tool in reversing tuberculosis rates, and that, over time, those services provided a foundation for increased public health services targeted at young people.

“The relationships that were built early on in protecting the health of youth and young people morphed, over time, into some really progressive programming in schools,” she said.

Water quality monitoring, food safety and vaccinations all became key components of the department. According to SJBPH’s 75-year retrospective report, the agency established restaurant safety codes in its first few months of operations. In 1948, 92 restaurants, 30 dairy barns and eight milk-processing plants were inspected.

In 1955, Dr. George Moore took over leadership of the department. He moved its headquarters into Mercy Hospital and commenced touring the district and meeting with physicians.

“Several of the physicians, however, were suspicious of the new 33-year-old health officer from the federal government and wondered if ‘socialized medicine’ might be just around the corner,” Moore wrote in a 2008 report on the department’s early years. He died in 2010.

Socialized medicine – a term used to monger fear especially among doctors during President Harry Truman’s push for national health care reform in the 1940s – was not around the corner, although the passage of Medicare and Medicaid in 1965 was a direct evolution of Truman’s multiple failed proposals.

But the fear of which Moore wrote spoke to a broader sense of identity insecurity in public health. The department’s work at the time was piecemeal in nature and unbound by any specific definition of the field.

The health unit provided maternal and child health clinics, services for disabled residents, issued licenses to food handlers, added fluoride to drinking water, engineer pipelines to a cleaner water source for Mesa Verde, regulated swimming pools, kept an eye on Animas River water quality and did crime scene lab analysis for sheriffs’ departments.

The department’s responsibilities were somewhat shored up by the mid-1970s. The federal Clean Air Act of 1963, Medicare and Medicaid signed in 1965 and the Clean Water Act of 1972 all focused attention on environmental health factors and primary care.

The department caught or responded to several water contamination incidents throughout the 1970s in Vallecito Reservoir, Ignacio and the San Juan River.

Over time, that attention faded, for better or worse.

“Do we walk outside and breathe in clean air and say, ‘Boy, I’m sure glad for the public health system today?’ We probably don’t,” said Brian Devine, SJBPH’s environmental health director and the last person to occupy the director’s office. “And that’s, I think, actually a marker both of the system’s success, as well as the risks. When we’re very good at our jobs, we’re a little bit invisible.”

Lynn Westberg joined the department in 1972, commencing a 38-year career at the department, including 24 years as its director.

Around the time she took over as director in 1986, the department began picking up slack left in primary care services by a dysfunctional American health care system. But a revolution in public health nationally was also underway.

“The Future of Public Health,” published in 1988, described the “disarray” of the public health system nationwide. Its publication is now recognized as a watershed moment in the field.

Westberg recalled a national push to distill local departments’ responsibilities into three core tasks: assessment, policy development and assurance.

“You figured out what your problems were in the community using data, primarily, and statistics. You made a plan for what needed to be done and prioritized the plan – that was the policy development part,” she said. “And then the assurance part was to try to make sure somebody in the community was providing it. The problem was that a lot of communities couldn’t provide everything that was needed, including this one.”

Given that struggle, the department continued to provide services including women’s health, sexual health care, infant and child immunizations and broader primary care services in its clinic.

“If nobody else was providing the service, we should jump in and try – that was a position I took,” Westberg said.

Even in the early 2000s, she said the community struggled to retain sufficient primary care providers.

“There was a huge issue in the community … that you couldn’t get primary care,” she said.

The Colorado Public Health Act of 2008 changed the department’s trajectory. It modernized the public health system in the state and introduced mandates for certain services.

Conversations at the time turned toward discussions of fracture. With infrastructure and resources more formally available, La Plata County began to explore dissolving the district so that local leaders could retain more control.

“I fought to keep the health department together,” Westberg said.

A tense battle between La Plata County commissioners and Westberg ensued. It was ultimately this disagreement between herself and the county that led to her resignation in 2010.

After a series of short-tenured directors, Jollon landed the job in 2013. The Affordable Care Act, signed in 2010, had brought health insurance to uninsured or underinsured residents and the need for primary care began to shrink.

“She was willing to examine things that worked well and seemed like they were within the capabilities of public health, and was willing to let go of things that didn’t seem like they belonged in the purview of public health anymore,” Byrd, a board member of 12 years and its last president, said of Jollon.

The clinic services shrank under her leadership.

“We took on a different role, which was helping people find that care or helping them navigate the health care system,” Byrd said.

An increasing emphasis on public health’s role in public emergencies came into play in 2015, when the Gold King Mine spill put water quality in Southwest Colorado at the forefront of the nation’s consciousness.

Jollon hired Devine, a water quality expert, for a six-week term to help the agency navigate the disaster. But 8½ years later, he was interim executive director – this spoke to a characteristic of the agency that Westberg, Jollon and Devine all say was integral to its culture.

“It’s always been a place where people were willing to take on the job that was needed, always willing to learn something new,” he said.

Although she left under some scrutiny for accounting practices, Westberg was publicly lauded at the time of her retirement for the low turnover rate in the agency. Jollon’s departure 13 years later was also followed by questions of financial record keeping.

“Public health has always been in the background,” Byrd said. “It’s always been an expectation, an unknown expectation that people have in the United States, that we have a safety net.”

The agency responded to fear of bioterrorism, influenza outbreaks and hazardous materials spilled into waterways. Sixty years before Gold King, the department conducted testing after a truck snapped an axle crossing Lightner Creek, releasing 3,000 gallons of “poisonous sulfuric acid” into the Animas River.

Jollon, throughout her 10 years as director, was fond of saying that communication was the most effective tool public health had.

“You kind of had to do some PR in your community, you kind of had to be visible,” Westberg said.

That never became more important in the department’s history than when COVID-19 broke out in spring 2020.

Byrd describes the pandemonium of the pandemic as a microcosm of the rest of society. Disinformation, evolving information and partisanship clouded perception of public health’s role and actions – a challenge for an organization that is predicated on education.

“Like everything else that we have in our society, (people) either agreed or vehemently disagreed with the role that public health played during COVID,” Byrd said.

In spring 2021, protesters showed up outside Jollon’s home to decry the state’s lockdown restrictions, which the department enforced; business owners sued the department.

And amid the chaos, the two counties now remaining in the district, Archuleta and La Plata, began exploring the possibility of a politically tinted dissolution.

“Those questions had been asked before,” Devine said, referencing the unrest that followed the 2008 overhaul.

The questions were not new. The musings of COVID-19 vaccine skeptics is hauntingly similar to those who questioned the efficacy of the polio vaccine upon its introduction in 1955.

“Childhood immunizations are one of the single most effective public health interventions in our nation’s history, and they were quite controversial when they were first introduced,” Devine said.

But this time, SJBPH was unable to weather the storm.

Citing “different visions of public health,” the Archuleta and La Plata county commissioners both voted Nov. 15, 2022, to dissolve the district.

On Dec. 28, SJBPH closed its doors for the last time.

“Although we’re (forming) our separate public health departments, I think that we are closer now and have a better relationship today than we did in January (2022), even, and much of that has to do with the staff here at San Juan Basin health,” Archuleta County Commissioner Warren Brown said at the health board’s final meeting on Dec. 14.

He concluded with a concise word of gratitude: “Thank you for partnering with us for 75 years, thank you for leading us for 75 years and thank you for making our communities better for 75 years.”

rschafir@durangoherald.com