Who is responsible for the health of our community?

Representatives of Jefferson Healthcare, Jefferson County and a number of other public agencies have spent a significant amount of time in the last three years to consider what they call a Community Health Improvement Plan, better know as CHIP.

It's been a huge undertaking to look at community health trends, analyze mountains of data and arrive at four priorities where, based on the data, it's apparent improvements are needed.

The four priorities the group identified to focus on are: access to mental health and chemical dependency care, chronic disease prevention, access to health care in general, including dental care, and immunizations.

All four of these priorities are important and the strategies and objectives outlined in a report released last week offer excellent talking points.

The Jefferson Healthcare Board of Commissioners and the Jefferson County Board of Health are to officially adopt the CHIP at their respective meetings later this month.

One missing piece: not one agency is responsible for community health. Some of the elected officials involved immediately suggested the need to hire a "professional person" to manage the plan going forward. Who would pay that person's salary is still up for discussion.

Progress is apparently being made now, without such a project manager. The area where the must "wins" have already occurred is in regard to immunizations, according to the CHIP presentation.

Of 39 counties in Washington, according to the CHIP report, Jefferson County ranks 30th in having kindergartners immunized and less than half of the kindergarten students start school with the full set of required immunizations.

By August 2017, the CHIP report says, it wants to achieve 100 percent compliance for immunization documentation for kindergarten students with Jefferson County Public Health and schools taking a lead.

Now here's where it gets tricky.

That's not going to happen unless parents agree to it and that's not going to happen unless there's a conversation in Jefferson County about why people aren't immunizing their children.

Then there's access to dental care.

Of 39 counties, Jefferson County has the lowest utilization rates of dental services in the state for those people who have Medicaid.

Why? Because only a handful of dentists in Jefferson County accept Medicaid, in part because Medicaid doesn't pay for the true cost of providing dental care. Until the Legislature changes this, or until a nonprofit organization like Sea Mar Community Health Centers venture in to Jefferson County, as has been suggested, that's unlikely to change.

Then there's the issue of access to mental health care.

“Long-term poor mental health and substance use are linked to poor physical health and premature death,” the CHIP report says.

Dozens of people with a loved one who exhibits signs of mental illness were disappointed this past spring when Jefferson Healthcare turned back a $1.5 million grant to build a seven-bed inpatient psychiatric facility in Port Townsend. Again, the problem is rules set forth by the state and federal government and reimbursements for Medicaid patients. It was a reasonable thing to decline that grant because of the associated operational costs, and a limited budget.

Since that grant was turned down, there's been little discussion of alternatives for obtaining help, although, again, a nonprofit like Sea Mar could be an answer to the problem.

There's also this reality: Jefferson County has been designated as a health care professional shortage area for both primary providers and psychiatrists.

What does that mean?

While it is true that the Affordable Care Act – more commonly known as Obamacare – has opened the door to access to health insurance for more people than ever before, it is also true that there has been a shortage of providers to deliver services.

That's not an easy problem to solve because it's not just Jefferson County that is having provider problems; it's a problem for rural areas all over the county.

So back to who is responsible.

We live in a rural county. Not long ago, within the memory of old-timers, no doubt, there were no first responders, no emergency medical technicians or paramedics to answer our 911 calls. Clearly, we've come a long way from those days, thanks in part to people like our current public officials talking and realizing the problems.

While they consider a plan of action, let's be realistic.

We are all responsible for taking care of ourselves first as best we can, for getting immunizations, for seeking help for our loved ones in need, for eating right and for exercising as much as we can. It almost goes without saying.

The conversations that all those public officials have been having about access to care are an excellent start, but it's not just public officials looking at statistics who are responsible for us, it's up to us, the public, as well to do our part.

And that means keeping the conversation going about the health of the community and what we can do for ourselves and for the community as a whole.

– Allison Arthur