Some local leaders in Arapahoe County worry that a decision of whether to break away from Tri-County Health Department on the heels of neighboring Douglas County's moves to exit the agency would be influenced by the “politicization of public health.”

“There was this question about what is the message to our residents about the politicization of public health and the trust and responsibility in government if there's a perception that this decision is being made because of politics around COVID? What are we saying to our residents?” said Lisa VanRaemdonck, a consultant who is gathering opinions to guide Arapahoe County's decision of whether to form its own health department after Douglas County exits Tri-County Health.

Douglas County had long been contemplating leaving Tri-County Health amid a rift over the health agency's coronavirus safety orders. Douglas County commissioners formalized the decision to leave Tri-County in a meeting Sept. 7, opting to form its own health department.

In early September, Arapahoe County confirmed that Arapahoe and Adams counties had also been contemplating splitting away from Tri-County Health, among other options, driven by Douglas County's intention to leave. A county spokesman at the time said a separation wouldn't be driven by any policy disagreement with the agency, but rather by potential financial or budgetary problems for the other two counties cauased by Dougco's exit.

Tri-County is the local public health agency that serves Adams, Arapahoe and Douglas counties. Arapahoe has been a part of the agency since its founding in 1948.

VanRaemdonck spoke to Arapahoe County's elected commissioners during a Sept. 14 meeting, relaying what she heard in interviews with various local leaders about their concerns and preferences about public health services as Arapahoe weighs the decision of whether to preserve a partnership with Adams County or to form its own health department like Douglas.

The Arapahoe County leaders who provided opinions included:

• The five county commissioners

• Three members who represent Arapahoe County on the Tri-County Board of Health

• 12 department directors

• Nine city councilmembers and town trustees from five cities and towns

• Four mayors

• Four city managers

• 12 “business community partners”

• Two superintendent representatives from two school districts

The names of those who provided opinions — and the jurisdictions they serve — were not listed during the Sept. 14 presentation, which occurred during an Arapahoe commissioners' study-session meeting. The meeting provided a portion of information that consultants had gathered, and more was set to be included in a full report.

The commissioners were scheduled to hear more details around mid-October, according to VanRaemdonck.

Considering impacts

A majority of the local elected officials, city managers and town administrators, and superintendents' representatives in Arapahoe who were interviewed were in favor of “staying together and making improvements” through Tri-County Health Department, according to the presentation.

The members of superintendents' teams “were very specific about it's helpful to have an independent health authority when we have to close a school building or when we need to say we can't drink out of the drinking fountains today because there was a water main break,” VanRaemdonck said. “They felt like it was useful to have this external voice that felt like a less-embedded-in-county-government voice in their work.”

Another concern heard, she said, was about what could be seen as more bureaucracy: moving from having one health department to one in Adams and one in Arapahoe, along with the impending one in Douglas.

“So especially folks that appreciate less government in their lives sort of had this (thought) like, 'Isn't this just more government?'” VanRaemdonck said.

Meanwhile, the “jurisdiction size and complexity” was a concern that came up in discussions about keeping the district — or combined — structure of Tri-County, according to the presentation.

Some people who interact with Tri-County on a business basis and “sort of feel like it's a one-stop shop” because they do business both in Adams and Arapahoe would have to adjust if there were two health agencies, she added.

An owner who has a restaurant in both counties would need to interact with both health departments for restaurant inspections, for example, VanRaemdonck said.

Some were curious about the impact on existing staff at Tri-County.

“You heard respect and a belief that they're a high-quality group of folks, so what does this mean for them, and for ourselves? (Some interviewees also asked) does this mean we lose access to staff expertise and potentially lose economies of scale?” VanRaemdonck said, using a term for financial efficiency.

The consultant team also talked with Tri-County's department directors, the kind of staff who have conversations with their funders, including grant sources and other government funders.

“There's a sense there that Tri-County Health Department is more competitive because you can say we're the largest health department in state of Colorado — we serve (a large portion) of the population,” VanRaemdonck said. “Those kinds of things, they were feeling like, make them more influential and more competitive for grants and federal funds.”

The team also heard “deep concern” about the clients they serve and any potential impacts on the residents of Arapahoe County, VanRaemdonck said.

That topic included thoughts such as, “We just got that WIC mom to start coming in and seeing us again, and what will happen with that relationship and that person?” VanRaemdonck said, appearing to use an acronym for the Special Supplemental Nutrition Program for Women, Infants, and Children, a federal grant program.

'Unelected people'

Arapahoe County Commissioner Nancy Sharpe expressed surprise that there wasn't more discussion from the community and community leaders about Tri-County's governance.

“That's a lot of what we've heard over more than a year is … about the governance and who's making decisions and, quote-unquote, unelected people,” said Sharpe, who appeared to favor “more diversity” on the Tri-County Board of Health. That could mean a larger board with input from the business community or an elected official, she said.

The Board of Health is the policy-making body for Tri-County Health, composed of nine members — three each from Adams, Arapahoe and Douglas.

Amid some of the public health orders during the pandemic, many of the “good things” that Tri-County does on a regular basis haven't gotten as much attention in the public eye, Sharpe said. Tri-County does “great work,” she added.

Aside from issuing public health orders amid the pandemic, Tri-County responds to outbreaks of all kinds, keeps track of infectious diseases, provides parenting and child health services, and gives training and services regarding drug use and abuse, according to an Arapahoe County spokesperson.