The Role of Public Health

In March 1603, William Shakespeare was at the pinnacle of his career as a playwright. His theater troupe was in high demand, his writing was prolific, and he was becoming a very wealthy man.

Then, in April, the plague hit. Again.

Bubonic plague, also known as the Black Death, had ravaged Europe for hundreds of years at this point. It was a truly horrifying disease, causing gangrene in the extremities (thus the black in the Black Death, referring to literally rotting tissue), as well as painful buboes on the lymph nodes that would swell until they burst, causing excruciating pain.

Needless to say, when the plague reemerged in April 1603, officials tried hard to reduce its spread by isolating patients into plague hospitals, restricting ships to port, and – sadly for Shakespeare – shutting down theaters.

No one knew at the time that the plague was caused by diseased fleas, who would bite humans and infect them. In the absence of scientific data, local leaders did their best to protect their citizens, becoming the first (albeit not particularly effective) public health officials.

Fast forward several centuries to today’s public health departments. Medical knowledge, epidemiology, multidisciplinary teams, and technology have advanced the field of public health by leaps and bounds, ensuring that public health decisions are data-driven and focused on equity (see Why Racial and Health Equity Matters on page 15) For the County of Santa Clara Public Health Department (SCCPHD), that means a dedication to its mission and vision of protecting and improving the health of the local community, ensuring that everyone thrives in healthy and safe communities.

“Our goal is just like the goal of a physician taking care of an individual patient—we work to keep people as healthy and safe as possible. It’s just that our patient is the whole population,” says Dr. Sara Cody, SCCPHD Health Officer. “Our tools are a bit different, and our focus is on changing systems and policies to prevent illness, but our goals are really the same.”

What does Public Health do?

To be sure, disease identification, control and prevention remain a primary function of modern public health, which was made clear during the recent COVID-19 (see COVID response on page 18) and Mpox (see Mpox Response on page 21) outbreaks. But the public health mandate has also expanded beyond that critical goal. Since its founding, for example, the PHD has created programs that: • Support healthy choices related to nutrition, exercise, and tobacco • Prevent and reduce the effects of chronic diseases like diabetes and cancer • Advocate for Black maternal health equity

The range of programs reflects a modern understanding of how health is achieved – it cannot simply be placed upon the individual to make good choices. Instead, health is a function of many different yet overlapping systems, like our environment (clean air and water), city planning (ensuring neighborhoods have grocery stores, parks, and walkable neighborhoods), and healthcare (providing accessible and affordable services in hospitals and neighborhood clinics).

With this understanding in mind, the County of Santa Clara Public Health Department (SCCPHD) organized itself into five branches that work together to ensure optimal community health: 1. Maternal, Child, and Family Health. This branch is focused on improving the health and well-being of women, infants, children, and adolescents residing in the County, especially those most at risk of poor health outcomes. Programs include the Women, Infants and Children (WIC) program to support nutrition, California Children’s Services (CCS) to care for children with special healthcare needs, and many public health home visiting programs. 2. Infectious Disease and Response. Although the public mostly associates public health with new outbreaks like COVID, the core of most Public Health departments’ activity is dealing with often mundane, endemic diseases like TB, flu, foodborne illnesses and sexually transmitted infections. It is this branch of SCCPHD that doctors in SCCMA will interact with the most.

3. Healthy Communities. The goal of the Healthy

Communities Branch is to prevent chronic conditions; build healthy, safe, and peaceful communities; and address social and economic factors leading to poor health outcomes. Programs include violence prevention, active and safe transportation, climate change, healthy food and beverage initiatives, diabetes collaborative initiative, healthy aging, oral health, tobacco-free communities, and the COVID-19 community engagement and resiliency hubs. 4. Department of Environmental Health. Although the

Department of Environmental Health had been operated separately from the Public Health Department for almost 30 years, it has recently been folded back under the umbrella of Public Health. The change recognizes that community health is intertwined with environmental health, particularly with the ongoing climate crisis. 5. Science, Epidemiology, Informatics, and Improvement. If you see a dashboard full of data on the Public

Health website, it’s the work of this newly formed branch.

The data scientists in this branch ensure that all the other branches have the information they need to make informed decisions about policies and programs.

How can physicians work with Public Health?

Many of the physicians in SCCMA already do interact with SCCPHD on a regular basis because they are part of the County of Santa Clara Health System. The health system includes not only the Public Health Department but also: • Behavioral Health Services • Hospitals and clinics (Santa Clara County Valley Medical Center, O’Connor Hospital, St. Louise Regional Hospital, Valley Health Center Morgan Hill, and Valley Health Center San Jose) • Emergency Medical Services Agency • Custody Health Services Department

Together, these entities serve as a safety net of mental and physical health services for all residents in Santa Clara County. However, physicians outside of the County, as well as others, also provide critical information for Public Health, which is why the SCCPHD works so closely with key partners to achieve its mission and goals.

Partnerships with professional organizations like the SCCMA, the California Department of Public Health, and community-based organizations provide the opportunity for information sharing, collaboration, understanding, and actions to improve the local community’s health.

How Public Health Supports Hospitals, Providers, and the Community

SCCPHD offers direct support to clinicians and health care entities in a range of ways from capacity building and training to case management of certain patients and conditions. Below are just some of the programs and services that SCCPHD manages. Communicable Disease Control

SCCPHD receives disease reports from providers on all diseases required to be reported under Title 17, SS 2500 of the California Health and Safety Code (see Communicable Disease Reporting on page 25). Depending on the urgency, CD Prevention & Control will connect with providers to obtain additional information, support them in clinical decision-making, and collaborate with them on preventing further spread of diseases like measles, meningococcal disease, shigella or any other communicable disease. SCCPHD also collaborates with hospital epidemiologists to support investigation of healthcare acquired infections and hospital outbreaks, to better protect patients and healthcare staff. Sexual Health and STIs

Public Health’s Sexual Health and Harm Reduction Program (SHHRP) can locate syphilis and HIV records reported to any County in California to assist in diagnosis and treatment recommendations. They’re also able to help locate patients through databases and field visits, and facilitate disclosure of sensitive results to patients and their partners using allowances in privacy regulations not available to health care providers.

The Positive Connections Program provides short-term case management for people living with HIV who need help accessing insurance coverage, health care, and additional supportive services . Finally, health educators are available to bring in-service trainings directly to clinics and providers by submitting a request on any of the above-linked pages. Tuberculosis Prevention & Control1

In addition to investigating exposures in the home and in congregate settings, the TB Prevention and Control Program provides case management and directly observed therapy to patients with active tuberculosis, assisting the healthcare

“SCCMA has been a wonderful partner to public health over the years,” says Health Officer and Director of Public Health Dr. Sara Cody. “It’s really important that physicians know and understand the work that we do and can collaborate with us whenever it makes sense.”

Source: County of Santa Clara Public Health Department (November 2022),

provider with medication compliance and successful completion of treatment. Emergency Preparedness

SCCPHD works with hospital and clinical leadership to ensure readiness for public health and other emergencies that may impact clinical care settings by helping to review plans, share best practices, support exercises to detect gaps in preparedness, and link to funding and other resources. Public Health Laboratory2

The Santa Clara County Public Health Laboratory is a member of the Laboratory Response Network and is a Biosafety Level 3 facility, allowing it to perform diagnostic and research assays not available to clinical labs, such as testing ticks for Lyme disease, bats for rabies, or clinical specimens for measles or viruses causing Ebola, to name but a few. California Children’s Services3

California Children’s Services (CCS) is a case management program for certain pediatric conditions or diseases that are chronic, disabling, or life threatening. CCS provides authorizations for diagnostic and treatment services, medical case management, equipment, and physical and occupational therapy services to children 21 years of age or under, diagnosed with certain medical conditions. Nurse-Family Partnership

The Nurse-Family Partnership Program (NFP) is an intensive home visitation program for low-income first-time mothers. A Public Health Nurse is paired with a pregnant first-time mother, who is followed from pregnancy, through the infant’s delivery, and until the child is age two years old. Black Infant Health Program4

The Black Infant Health (BIH) Program strives to improve poor birth outcomes and health disparities in maternal and infant health. Research shows that black women are at higher risk for various pregnancy-related complications such as preterm birth, low birth weight babies, and infant mortality. The BIH Program addresses contributing factors such as chronic stress, social isolation, and racial inequities. The program helps reduce stress, build resilience, promote healthy behaviors, and increases social supports. Clinic to Community Program

Strategies that connect community-based prevention programs with clinical services help ensure that people with or at high risk of chronic diseases have access to the resources they need. SCCPHD has several Clinic to Community programs that provide seamless links to community resources, such as walking programs, park engagement activities, smoking cessation, intimate partner violence, diabetes prevention, and nutritional support programs.

Program Links 1. https://publichealth.sccgov.org/disease-information/tuberculosis-tb-information-residents 2. https://publichealth.sccgov.org/services/public-health-laboratory 3. https://publichealth.sccgov.org/services/california-childrens-services-ccs 4. https://publichealthproviders.sccgov.org/programs/blackinfant-health 5. https://covid19.sccgov.org/dashboard-wastewater Health Officer on Call

The team of Public Health physicians rotate on call to provide 24-7 coverage to respond to clinicians with public health emergencies such as suspected cases of botulism or needs for rabies prophylaxis. During business hours, the team can be reached at (408)-885-4214, option 3, and on nights, weekends, and holidays, the Health Officer on call can be reached through the County Communications dispatcher at (408)-998-3438. Wastewater Partnership5

In addition to clinical partnerships and support for providers, SCCPHD has also had key academic and research collaboration with academic hospitals and clinical entities. One example is the collaboration with researchers from Stanford University to evaluate wastewater from the four major sewersheds serving Santa Clara County residents for SARS-CoV-2. These data have provided invaluable insight into the level of disease transmission in our County in a way that is more robust, and not subject to changes in testing and reporting practices.

Wastewater data have complemented other sources of surveillance data, and ultimately proved to be more reliable, enabling SCCPHD to make more emphatic recommendations about COVID safety. The research collaborators are now testing wastewater for additional pathogens such as Monkeypox (mpox), Influenza A and Respiratory Syncytial Viruses.

Shaping Policy

Finally, SCCPHD advises on public health policy with input from community partners and stakeholders, including physicians and other medical providers. Public health policy aims to establish laws, regulations, guidance, and social actions that improve the health of populations. SCCPHD also works diligently to pass policies that improve the built environment and reduce access to factors that serve as risks for healthy populations. Examples of such policies include the prohibition of the sale of tobacco products, smoke-free facilities, car seat laws, development of parks, authorization of mixed-use space that promotes walking and community cohesion, restrictions on concentrations of fast-food restaurants in specific geographic areas, and access to products to reduce harm due to substance abuse and sexual practices. Providers have an opportunity to have a profound impact on the health of their patients by serving as advocates and collaborators in public health policy.

Source: County of Santa Clara Public Health Department