"The budget is a huge policy issue," Thorburn says, because if the health officer has no control over the budget then policy recommendations have no teeth. She points out that most metro areas in the state -- including Snohomish County, Bremerton, Tacoma-Pierce County, and the Tri-Cities -- are led by health officer directors. Spokane city councilman Brad Stark says the split would move responsibility for the budget, along with staffing decisions and communications, to the administrator position. The medical director would be responsible for enforcing the health laws as well as promoting goals such as injury prevention and healthy lifestyles and running health district clinics. But, says Stark, "We're nowhere close to having an informed dialogue or making a decision." He says the board will be conducting discussions throughout the state and the country, a process likely to take several months. Board member Dick Denenny adds they will be consulting with Secretary of Health Mary Selecky to find out how duties can be separated
Whatever may happen to the responsibilities of the health officer, Thorburn says she is deeply fearful that the health district as it now stands would be dismantled and reduced to a health department entirely under the control of county government. She says the county commissioners have the power to decide the form of the local public health agency. All it would take is two of the three commissioners to vote in favor of an ordinance to do so. "In 1996," she says, they came really close." All that stopped commissioners Phil Harris' and Steve Hassan's proposed breakup then was the citizens' advisory panel that recommended against it.
Spokane city councilman Brad Stark says no way: "If that were going to happen, it would have happened by now." Citing objections of representation and accountability, he says health board members representing cities "would be pounding our shoes on the table."
While it is important to preserve the local government function of the health board, Thorburn says, the tension between science and politics could be eased by appointing constituent members. That's the way it works on the Washington state Board of Health; Thorburn was appointed to the state board by Gov. Gregoire after recommendations from health officers in the state.
Spokane Valley city councilman Dick Denenny likes the local board the way it is because the board offers broad regional representation. "When it comes to policies that impact the general public and require public funding, accountability has to rest on elected officials," he says.
But Thorburn argues members wouldn't need public health or medical backgrounds, just a commitment to the mission of public health. Whether the issue is espresso huts or fluoridation, she thinks politicians will be susceptible to pressure from their constituents. The big problem with Spokane's regional health board, whose members serve by virtue of their positions in city or county governments, says Thorburn: "There is no guarantee that they are interested in the [public health] mission."