Wellness: Core concerns

Amid tight budgets and tough economic times, the Buncombe County Health Department continues to implement major changes.

"We're in the process of redesigning and refocusing the work we do to really focus on the core public-health issues in our community," Health Director Alma "Gibbie" Harris reports.

The reconfiguration involves shuffling departments, services and staff. By January 2012, the department expects to leave its longtime home at 35 Woodfin St. in downtown Asheville, relocating to the renovated Human Services Building (40 Coxe Ave.). Meanwhile, the department is operating out of several interim sites (see sidebar, “At Your Service”), increasingly relying on outside partnerships to deliver primary care.

In January 2010, many of the department's physicians and prenatal services were transferred to the nonprofit Western North Carolina Community Health Services, which qualifies for a higher federal-reimbursement rate. And Cynthia Yancey, a staff physician for 23 years before taking over as the county’s medical director last year, says she’s preparing to follow many of her former co-workers "back into the trenches" at WNCCHS; she's retiring from her Health Department job and will start work as a prenatal physician at the nonprofit in July.

The change, she explains, "is not only logical for all of us but will help to assure safety-net care over there, because I've done it here for so long, and I'll just be doing it under a different roof. It's another logical transition for me, toward the end of my career, to help others take that over. … WNCCHS is a good clinic."

Jennifer Mullendore will replace Yancey as medical director; come July, she'll be the only physician left at the Health Department. The county will also lose three nursing positions: One is retiring; the others have accepted jobs elsewhere, notes Harris, adding, "We're not quote-unquote ‘laying folks off.’ … When it's all said and done, they'll all still be employed if they choose to be. … The reduction of those three nurses should not hurt us."

Ten of the department’s 49 remaining nurses will see their duties change as part of the redesign, she says. The plan is to focus their efforts on "really core public-health issues that we need to deal with," such as sexually transmitted and communicable diseases, family planning and student health.

"Our teen-pregnancy rate is a little more than double what the national benchmark is for that. And our STD rate is three to four times higher," notes Harris.

At the end of this school year, the department plans to close its student health centers at Asheville and Erwin middle schools and Asheville High. To help with the transition, three county nurses will be placed in those schools full time. Still, Harris acknowledges that the change will cut the county's ability to deal with "episodic care — the sore throats, the ear infections, the sports physicals, those kind of things."

Instead, the focus will shift to prevention: “Working specifically with those high-risk and special-needs children to make sure they're getting the care they need," she explains. "Working with families to make sure their children are vaccinated so they can be in school."

Buncombe County, notes Yancey, has the highest immunization-exemption rate in North Carolina: As of last year, 4.02 percent of the county’s children weren't vaccinated. Statewide, the average is 0.82 percent. Many of those cases, she explains, involve parents who claim religious or medical exemptions, fearing that immunizations do more harm than good. Yancey believes this has contributed to the continuing local pertussis outbreak: 66 cases have been reported over the last six months. In response, the county has launched a marketing campaign to educate the public on the importance of immunizations, and has formed an immunization-exemption committee to study the issue further.

Despite all the challenges, both Yancey and Harris say they’re hopeful about the future.

"I think this recession is one of the hardest times that I've lived through in public health," Yancey acknowledges. "But with all of this integration and innovation, I think there's real possibilities for focusing and doing more good for the public's health than ever before. We have studied so hard the core services that public health has to ensure in this county."

Harris echoes those sentiments.

"The intent behind all of this is to focus our work and do what we do really well," she maintains. "Our focus has to be on prevention and education, and working with specific populations to make sure they're as healthy as they can be."

— Jake Frankel can be reached at 251-1333, ext. 115, or at jfrankel@mountainx.com.