After criticizing County of Orange public health leaders for neglecting central county’s working-class Latinos during the COVID-19 pandemic, Santa Ana City Council members are studying how their own municipal public health department might work.

The idea could bridge some of the longstanding disparities currently holding Santa Ana back from enjoying the concept of health equity – with officials able to more directly address things like healthcare access, nutrition, and disease control.

But keeping up with the responsibility might be a tall order, warned researchers the city hired to look into the idea’s feasibility, during a public presentation to the council last month.

“We’d like to suggest for your consideration other options that may not involve the creation of a public health department,” said one of the city-contracted researchers, Christina Altmayer of Healthcare Management Associates, at council members’ Feb. 15 meeting. 

Alternatives might include hiring “a chief health strategist” or committing “supplemental public health investments” that achieve some of the city’s community health goals without binding the city to the state’s demanding regulations around local health departments, Altmayer said. 

But in that case, Santa Ana would more-or-less stay reliant on the county Health Care Agency – the reason officials looked into a municipal health department, to begin with. 

Thus a majority of council members last month acknowledged the idea could test City Hall greatly, but also said they would like to see a deeper look at how much a municipal health department might cost and the staffing levels which would be required. 

Researchers said they could come back with more information in June. 

After all, one thing was clear to council members like Thai Viet Phan that night: 

“It always feels like Santa Ana is treated as the black sheep of Orange County.”

Indeed, Phan said Santa Ana’s issues are “different.” 

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“Our concerns are different,” she added, listing off health issues that residents in town tend to face more often than those in coastal or south county areas, according to county data. “I am someone who experienced obesity and still struggles with it. I am someone who grew up here in the city with asthma and continues to experience it.”

There are also cultural nuances to the health issues facing residents in town; even the health safety education of the city’s mom-and-pop Latino and Asian restaurants need a deft approach, Phan said, adding there’s a “cultural aspect to it.”

“All of those things are issues I don’t see the county prioritizing and they will never prioritize in my opinion because we don’t make up enough of the county for them,” Phan said.

But the vision for a Santa Ana health department also comes with questions. 

How feasible is the idea? 

At what cost would it come to other city budget priorities? 

Is City Hall up to the task? 

Only four other cities in California operate their own public health departments: Pasadena, Long Beach, Berkeley, and Vernon.

In joining them, Santa Ana would incur additional responsibilities of health inspections, disease investigation, monitoring and reporting, and operating a public health lab, said Altmayer and fellow HMA researcher John Friedman, on Feb. 15.

On top of that, state officials in Sacramento set the responsibilities of local health departments, so cities and counties “are not independent actors,” Friedman said. “They have to align, and it’s the state health officer who can countermand the local health officer.”

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Santa Ana Mayor Vicente Sarmiento first proposed the idea of a municipal health arm. 

Still, he said at that night’s meeting, “I know there are many cities which got way ahead of themselves without taking this step.”

“West Covina, Whittier — they went out and said, ‘We’re gonna start our own public health agency,’ and didn’t ask these difficult questions,” Sarmiento said. 

“And they’re profound.”

Here’s a way of looking at it, through a hypothetical scenario which researchers gave council members on Feb. 15: A daycare center reports multiple children have exhibited similar symptoms and suspect it may be connected to a foodborne illness.

In that scenario, according to Altmayer and Friedman, the city would have to do the following under overhead regulations for public health departments: 

The city would also have to assess food handling procedures and conditions at the daycare center. 

The public health lab would have to conduct and confirm diseases through testing to identify the disease’s strain. 

Public health nurses would have to interview and index all disease contacts and provide guidance to parents and daycare employees.  

It would also be incumbent on officials to alert the public as appropriate, informing people on proactive measures they can take to protect their health.

Yet some on the council like Sarmiento indicated this may be a duty the city must shoulder to improve its service to residents.

“This is an unfortunate exercise we find ourselves in,” Sarmiento said. 

Though he welcomed the caution from the HMA researchers, saying it’s in the interest of “giving us as much as we can to also understand the challenge.”

Brandon Pho is a Voice of OC reporter and corps member with Report for America, a GroundTruth initiative. Contact him at bpho@voiceofoc.org or on Twitter @photherecord

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