Latest / Healthier Together: Larimer County's Public Health Podcast / A Board of Health Exit Interview with Dr. Bernard Birnbaum

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A Board of Health Exit Interview with Dr. Bernard Birnbaum · Healthier Together: Larimer County's Public Health Podcast

0:01
Welcome to Healthier Together, Larimer County's
0:03
public health podcast, where we come together
0:05
for healthier lives, connected communities, and
0:07
real conversations. From your local public health
0:09
team, I'm your host, Tom. And I'm Joanna. The
0:12
health department is governed by the Larimer
0:14
County Board of Health. Today, we're joined by
0:17
the Health Department's Executive Director, Tom
0:19
Gonzalez, here to help us understand how the
0:22
Board of Health functions and interacts with
0:24
the Health Department. We'll also be talking
0:25
to Dr. Bernard Birnbaum, who recently completed
0:28
his term as a member of the Board of Health,
0:30
and joins us to share a bit about that experience.
0:33
Tom and Dr. Birnbaum, thank you both so much
0:35
for joining us. Thank you for having us. Yeah,
0:38
it's great. Tom, to start, can you explain what
0:41
the Board of Health is and its relation to the
0:43
health department? Yeah, the Board of Health
0:45
in Larimer County is our governance and policy
0:49
board. And ultimately, I, as the director, report
0:53
directly to the Board of Health. And the Board
0:55
of Health is a five -member Board of Health.
0:58
And how does the Board of Health and then the
1:00
Health Department fit into the larger governance
1:02
structure of the county? What I like to look
1:04
at is high policy. That's the Board of Health.
1:07
So the strategic plan, the approval of our mission,
1:11
those kind of things, that's ultimately approved
1:14
by the Board of Health. The operations, the day
1:16
-to -day, how we carry out our services, that's
1:20
through the public health director and the team,
1:22
the staff. How are these members elected or appointed?
1:26
Yeah, good question. I'm going to back up a little
1:28
bit because in Colorado, there's actually two
1:30
sets of boards of health based on population
1:33
of the jurisdiction. Counties or communities
1:35
under 100 ,000, the boards of county commissioners
1:39
serves a board of health. We're over 100 ,000,
1:42
so we do have a separate Board of Health that's
1:44
appointed by the Board of County Commissioners.
1:46
They're five -year terms. We'd like to see no
1:48
more than two terms, so 10 years total. And that's
1:50
what Dr. Bernie Birnbaum served was 10 years
1:53
on the Board of Health, so he's seen quite a
1:55
bit. I can even vote now. Are there criteria
1:59
for board membership or for, you know, to kind
2:02
of throw your hat into the ring there? There's
2:03
some guidance from the Colorado Department of
2:05
Public Health and Environment for boards of health.
2:08
They always recommend to have a medical physician
2:11
connected to the community. So that's been an
2:13
important piece that Bernie's had. They recommend
2:16
having maybe somebody with a nursing background,
2:19
a business background or environmental health,
2:21
maybe somebody that's got more policy, public
2:24
health policy or initiatives. But there's some
2:27
recommendations trying to get a diverse group
2:30
of five on your board. And there are some boards
2:33
of health that are even bigger. How often does
2:35
the Board of Health meet? We meet once a month,
2:38
every third Thursday from 6 to 8 p .m. And are
2:42
those meetings open to the public? They are.
2:44
We post the agenda. at least 24 hours in advance
2:47
so folks can see the agenda. And then they're
2:49
open to in -person as well as the meetings available
2:52
on Zoom. Is there a way that Larimer County residents
2:55
can submit public comment or come attend a Board
2:59
of Health meeting? Absolutely. In fact, the board
3:01
enjoys that. There's a way you can get on a list.
3:05
Monday before the meeting, we've got it available
3:07
on our website at larimer .org backslash health,
3:10
or you can just show up at the meeting. But there
3:12
is a public comment. It's usually right after
3:15
a of the agenda, we allow up to two to three
3:18
minutes for a community member to voice a concern
3:21
or a question to the Board of Health. That's
3:23
really great. Dr. Birnbaum, you recently completed
3:25
your second five -year term as a member of the
3:28
Board of Health, and we wanted to hear what your
3:30
experience was like. But to start, can you give
3:33
us a little bit of background on what your professional
3:36
life has been like? Yeah, sure. I'm a family
3:39
physician, so my main job is I see patients and
3:43
teach. medical learners, both medical students
3:45
and residents. I ended up out west. I grew up
3:48
on the East Coast. I'm from Chapel Hill, North
3:49
Carolina. I was looking for Chapel Hill, North
3:51
Carolina, which is how I ended up in Fort Collins,
3:53
Colorado. They're actually incredibly similar
3:56
towns. I've always been committed to working
4:00
with an underserved population. And so that was
4:03
important. And one of the things I found in my
4:05
role as a personal physician was that I was missing
4:08
the influence in public health. And so I was
4:11
really interested in serving organizations or
4:16
working with organizations that were interested
4:17
in the health of communities rather than the
4:20
health of individuals. So before being on the
4:22
Board of Health, I was elected to the Health
4:23
District Board for eight years. And that was
4:26
two four -year terms from 2008 to 2016. And I
4:31
loved that. I felt like that was a little mini
4:33
public health fellowship or degree or something
4:37
along those lines. The idea of going to a graduate
4:39
degree seemed like much. So that's how I ended
4:42
up there. And then after being on the board of
4:45
the health district, which is a governmental
4:48
special district, I wanted to serve for a large
4:51
organization or for a group that was countywide.
4:54
And thankfully, I was able to be appointed to
4:56
the board of health. Was there any one particular
4:58
facet of the underserved communities that you
5:00
saw that you really wanted to try and make an
5:02
impact on? I mean, the one that's coming to mind
5:04
right now is the unhoused community. Those communities
5:08
have a tremendous impact on our communities.
5:12
This is a very expensive place to live. Frankly,
5:15
everywhere in the United States right now is
5:17
expensive to live in. And the challenges that
5:19
that community faces are really unfair. And I
5:22
think that there's things that we could do as
5:25
a society. So that was one area. Another one
5:28
that I've been really interested in is food security.
5:29
And a third would be substance use disorders.
5:32
I do a lot of work with addiction and with...
5:37
treating folks with a history of substance use
5:38
disorders. And I think one of the things that
5:40
unifies those things is that a lot of people
5:44
that use services like food pantries or the food
5:47
bank, like substance use treatment, like homeless
5:51
shelters, often feel judged by those around them.
5:55
And they have both social and medical factors
5:59
that make their lives more difficult. And if
6:00
we can treat people like humans, then we can.
6:04
help them with their problems, at least. At least
6:06
it's a start to have a conversation as opposed
6:08
to othering people. So, I mean, it sounds like
6:10
you do have this call to public service, you
6:13
know, especially for underserved communities.
6:14
I am curious, what was the process like of actually
6:17
getting on the board here at Larimer County?
6:20
I knew Dr. LaBailey, who was the director at
6:23
that time, and she encouraged me to apply when
6:25
there was an open board position. They had had
6:27
a previous physician on the board from Estes
6:29
Park. who, when he was term limited, they wanted
6:32
to find another medical provider to be on that
6:35
board. And so I applied at the time, interviewed
6:38
with Steve Johnson and Dr. LaBailey, and they
6:41
didn't think I was crazy, which is good. So what
6:43
was that interview process like? It was questions
6:46
about what do I see as the major issues involved
6:48
in county health, right? So, you know, the big
6:51
things when I look at county health, we live
6:53
in a very blessed community. You really do. Like
6:56
the rates of chronic disease and obesity are
6:59
less than the general population. The rates of
7:01
smoking are less than the population. The rates
7:03
of alcoholism are higher. I talked about mental
7:07
health issues at the time when I started on the
7:09
board. The rate of adolescent suicidality in
7:12
the county was higher than just about anywhere
7:13
else other than Native American reservations.
7:16
And I thought that that was worth talking about
7:18
and highlighting. The community has done tremendous
7:20
work around that in that time. So those were
7:23
things that I... I talked about, I think, in
7:26
that interview. Once you joined the Board of
7:27
Health, was there anything that surprised you
7:29
about how it functions or the work that they
7:32
do? I'll say yes. I mean, I think, you know,
7:34
when you join a board, you think that you have
7:36
lots of influence or maybe power. But I think
7:39
what you have is a little bit of influence. And
7:41
I think in reality, a governance board's job
7:44
is to make sure that the fiduciary responsibilities
7:47
of the department are done. And in some sense,
7:50
that's a little boring. You know, it's not always
7:51
that exciting. It's making sure that there's
7:54
good septic regulations. It's making sure that
7:57
the budget is being adhered to carefully. It's
8:00
making sure that the director is working well
8:03
with their staff. You know, it's making sure
8:05
that those things are happening. I think really
8:08
it's listening to the staff, listening to the
8:10
director, guiding based on the needs of the community,
8:13
and then making sure that we're doing our things
8:16
financially responsibly. Tom, I guess I kind
8:18
of wanted to offer the same question to you.
8:20
I know you have a very long history of public
8:23
health experience, but having stepped into the
8:26
director role in the middle of the time that
8:28
Bernie was on the Board of Health, was there
8:30
just anything that surprised you about that relationship?
8:34
Bernie was one of the members of the board that
8:36
hired me. So that bittersweet having a board
8:39
member that was part of that process and then
8:42
seeing them graduate from the process per se.
8:46
Quickly, we went right into COVID and just understanding.
8:51
what the public health director's mandates and
8:54
obligations are, as well as how does that work
8:57
with the Board of Health. That was something
8:59
that... Bernie was the president for much of
9:01
COVID. Him and I working together hand in hand,
9:04
working with the attorney and trying to do the
9:07
best for this community, which I think the community
9:09
did a fantastic job. But that was a surprise.
9:12
It's hard to get a board of five together, post
9:15
it 24 hours and have a meeting. We did that during
9:18
COVID. We had numerous special meetings where
9:21
we would email and say, we need to have a meeting
9:23
within a day or two because we got to talk about
9:25
some things. So that right there, this step process
9:27
of being a public health director, In a pandemic,
9:30
I learned a lot. Speaking of COVID, Bernie, your
9:33
time on the Board of Health covered a lot of
9:36
pretty significant public health events and challenges.
9:39
What events or decisions have stuck with you
9:41
or impacted you the most? I think that a lot
9:44
of the decisions around COVID, which, by the
9:47
way, frankly, were not necessarily even our decisions
9:49
to make. They were made at the state or the federal
9:51
level. I think those decisions and supporting
9:54
those decisions were really momentous. at least
9:59
the way that I approached the question, was how
10:02
do we protect the community? Public health often
10:05
or sometimes conflicts with individual rights.
10:09
You know, we have to wear seatbelts in cars,
10:11
right? We have to have regulations in our homes
10:14
about fireproofing, right? You know, we pay taxes
10:18
to fund firefighters in our community. Public
10:21
health is another example of that, where during
10:23
COVID we needed to wear masks. You know, we needed
10:26
to do social distancing. And the work that we
10:29
did and the decisions that we made around that,
10:31
I firmly believe, saved many, many lives. I was
10:33
a doctor working in the intensive care unit during
10:36
COVID. I watched many people die. It would have
10:39
been a lot worse. And the decisions that were
10:43
made around that time or re -emphasized in our
10:45
community that were not emphasized in some other
10:47
communities in Colorado made a difference in
10:50
the way that we experienced the pandemic. And
10:53
it didn't mean that those things didn't suck
10:54
for people. They were... onerous for their individual
10:57
liberties. But my belief as a public health practitioner
11:01
and as a public health physician is that there
11:03
are times that the health of the many is more
11:06
important than the difficulty put on the one.
11:08
And I think that that's a key principle. And
11:10
that was hard. You know, we had people come to
11:13
meetings and call us names. And I think we were
11:16
following what we believed was the best science
11:17
at the time. I'm curious if your time with the
11:20
Board of Health has changed how you see public
11:23
health just in your day -to -day life at all.
11:26
That's an interesting question. I mean, remember,
11:28
I had eight years in public health before coming
11:30
here. I think what it made me understand was
11:35
that when a governmental organization takes an
11:39
action, that there will be people on any side
11:43
of the political spectrum that will have a problem
11:45
with that action. And that because we are a tax
11:50
-funded organization, we really have to listen
11:51
to everybody. And that's hard. The other comment
11:55
that I would make is that the history of American
11:59
individualism argues that individual liberty
12:02
or autonomy comes first. And fundamentally, that's
12:06
problematic in emergency situations. And how
12:08
do we balance that and communicate around that
12:11
becomes very, very important. So part of my understanding
12:14
of public health is not just the. Let's look
12:18
at epidemiologic data to make the community healthy.
12:20
How do we communicate about the policy decisions
12:23
that infringe on autonomy? And I think we didn't
12:27
do that so good. And when I say we, I mean the
12:30
national. I don't think I have any particular
12:33
criticism of this department's communication.
12:35
I have lots of feelings about statewide communication
12:38
and lots of feelings about national communication.
12:41
But I think as a public health infrastructure
12:44
nationally, we didn't communicate. in a way that
12:47
a lot of people could understand. And we also
12:50
had to climb over the wall of the belief that
12:53
individual liberty is paramount. Yeah. Bernie,
12:55
you hit on something that's just so important.
12:57
It's really a system. And it's a public health
13:01
system. That's how it's built in the USA. Federal,
13:04
state, down to locals, and then our tribal and
13:08
our territories. And if any part of that system
13:11
is not functioning or not communicating well
13:14
or doesn't have the resources, it suffers. You
13:16
can't meet people and start the communication
13:18
and relationship building right in the event.
13:20
We need to be doing it now. Make sure we all
13:22
know who each other is, what's our role, how
13:24
do we work together, what's our interest. Colorado,
13:27
we are a local control state. We like that. But
13:29
that doesn't mean we throw out the system. It's
13:32
a system that works based upon cultural values
13:35
and local values. But that was really shown.
13:39
during the pandemic at times where it's not a
13:42
cohesive system. And I'll comment on that. We
13:44
were actually incredibly lucky to be here in
13:46
Fort Collins or to be in Larimer County, where
13:48
we had a large major university that had laboratory
13:53
capacity. And we were able to, while the state
13:56
wasn't able to keep up with testing capacity,
13:58
we were able to develop that capacity locally,
14:00
which other people in other areas couldn't do.
14:03
We had a great partnership. And that... was a
14:06
little bit of a circumstance of luck. I mean,
14:08
I also said like, hey, we're really lucky here
14:09
in Larimer County. We are really lucky here at
14:11
Larimer County. And that's one of the reasons
14:13
that we're lucky is that we were able to do that.
14:18
I agree. The other comment I want to make on
14:20
the system side, I think the public believes
14:23
that public health has a lot of power. And I
14:25
think the reality of it is that that's just not
14:27
true. And it's not true in two ways. Number one
14:31
is that our decisions can be subverted politically.
14:34
And they clearly were during the pandemic. And
14:36
they clearly are being subverted politically
14:38
right now. I mean, let's just talk about clean
14:40
air, right? Let's talk about the environment,
14:43
environmental health. But the other way that
14:46
they're subverted is that our budget is minuscule,
14:49
right? The budget of health care, which is individual
14:55
and technologically based, right, is very, very
15:00
large. The budget of our healthcare providers,
15:03
and I am one, is very large. So our countywide
15:07
public health budget is a drop in the bucket
15:11
of the healthcare expenditures. Yet what keeps
15:15
us alive is clean water, right? Availability
15:19
of basic services, clean food. Knowing that if
15:24
I go to a restaurant that I'm not going to get
15:26
sick. Like that's what actually helps us live
15:29
a long time. I really began to see, and I wouldn't
15:33
say that I didn't know this before, but I think
15:35
I drew a much deeper understanding of this, that
15:37
the maldistribution of resources into just medical
15:41
services rather than into communal public health
15:44
services makes us less well. And to me, that's
15:48
really important. And it comes up at every board
15:51
meeting because we look at the budget and we're
15:53
like, oh, we got X amount of money. We in the
15:57
health care system can spend that in a day in
15:59
the hospital. We get that much money takes care
16:03
of this whole county for a year. I just think
16:07
that's that was impressive. And that was very
16:09
evident during covid when we were trying to up
16:12
ramp our services and hire people to do contact
16:15
tracing or hire people to do investigations.
16:18
And we had tiny little pots of money. I just
16:21
think that that's an interesting dichotomy. that
16:25
the public needs to understand is that they have
16:27
this sense that we have this power to do things,
16:29
but in reality, our budget is exceptionally small.
16:32
And our ability to affect change may lie in the
16:35
policy realm, but that can be subverted by politics.
16:38
And that's interesting to me. You both sort of
16:43
touched on how partnerships show up in public
16:46
health, how the health department works with
16:48
healthcare providers and education, the universities
16:53
in town. I wonder if you could just comment on
16:56
the importance of those relationships from the
16:58
Board of Health's perspective and then day -to
17:00
-day health department operations. One of my
17:04
interests when I came on the Board of Health
17:06
was in the concept of the health strategist.
17:10
I think where public health is often incredibly
17:13
effective is in the development of strategic
17:16
partnerships based around health data. And if
17:19
you look at how people trained in public health
17:21
is people trained in public health are trained
17:23
in epidemiology and the understanding of disease
17:25
or the understanding of health risk factors over
17:28
time and in population. And so it was really
17:30
important to me in our first strategic planning
17:32
initiative was to really highlight the idea of
17:37
developing the health department as a strategic
17:40
partner to other organizations in the community.
17:43
Again, if we have a really small budget, how
17:44
do we extend that? And the way that we extend
17:47
that reach is by being the bearer slash understander
17:52
of good data, informing the county commissioners,
17:56
informing CSU, informing the health systems and
17:59
bringing those people together. And I think we
18:01
did that actually remarkably well. That was like
18:03
one of the real successes of the COVID pandemic
18:05
was in bringing, for example, our health systems
18:07
together and doing that very successfully. And
18:10
I think Tom put a tremendous amount of work into.
18:13
making the right people be in the same room and
18:15
actually talking to each other and those people
18:17
they rose to the occasion and that again made
18:21
the health of our community drastically better
18:23
but what we did is we convened and gave data
18:25
which to me seems like a good that was a big
18:29
part of my interest in our initials for various
18:31
reasons a great place to raise your family is
18:34
the board wanted to go in the direction of public
18:36
health 3 .0 and becoming the health strategist
18:38
being the convener bringing partners together
18:42
to solve problems. It was kind of a national
18:44
movement, and I definitely want to come and let's
18:47
do this. And I'll give you two examples where
18:49
it just brilliantly works. First is during COVID,
18:53
relationships with UCHealth, Banner Health, and
18:57
Public Health. You know, I was meeting with the
18:59
CEO of Banner and UCHealth weekly. We were getting
19:03
data from our team. We were transforming more
19:06
into this health strategist, getting more population
19:08
epidemiologists. Those that have the data, we
19:11
were getting data from the hospitals. Then that
19:13
would get data that I could get to the team and
19:15
ultimately the Board of Health. But I knew daily
19:18
what was going on in the hospitals. That relationship
19:20
and partnership, and then having two competing
19:23
health systems together, working together, saying,
19:26
well, I can take some space if you need help.
19:28
We worked as a team in Northern Colorado. Matter
19:30
of fact, Around the state, folks were like, how
19:32
are you doing that? You guys are setting all
19:35
of your ego aside and working for the community,
19:38
and that's those relationships. Another one was
19:41
right in 2021, data was coming from the hospitals,
19:44
and we were seeing a large amount of youth, specifically
19:49
girls, ages 13 to 17, visiting the hospital for
19:53
anxiety, suicide thoughts, just emotionally stressed.
19:59
And it was significant that we've got our three
20:02
superintendents for our school districts here
20:04
in Larimer County. We got the community, we got
20:07
nonprofits, and we sat down and we put together
20:10
a plan. And what came out of that was the Youth
20:12
Mental Health Task Force. And I'm proud to say
20:15
our most recent Healthy Kids Colorado survey
20:18
is showing that that has dropped by 50%. Wow.
20:21
It takes a community to do that. It can't be
20:24
just one health department. It can't just be
20:26
one organization. But that's where we took data.
20:29
We brought in the partners. Bernie was at some
20:32
of these meetings at night at Thompson School
20:34
District. And we all strategized, broke up in
20:37
groups, and had action items to go and work on.
20:41
And that continues because we want to see that
20:43
number even smaller. But that's an example of
20:46
where those partnerships and being health strategists
20:47
actually play out. Dr. Birnbaum, what would you
20:50
say you're most proud of from your time on the
20:52
Board of Health? I made it. I mean, I think I'm
20:58
really proud of the work that we did during COVID.
21:01
What I would say of this community, Larimer County,
21:04
is that we were able to come together. We were
21:07
able to socially distance. We were able to mask.
21:09
And we had lower fatality rates than the surrounding
21:12
communities. The fact that we still have the
21:15
inequities that we have, that we still had plenty
21:18
of disease, we were successful. And despite the
21:22
fact that there were protesters and people even
21:25
in political power that opposed us locally, actually
21:28
as a whole, the community really came together
21:30
and was exceptionally effective. I'm proud of
21:33
our board's behavior during that time. We didn't
21:36
all agree, but we really listened to each other.
21:38
I am proud of the staff. I'm proud of Tom who
21:42
got like really attacked during that time in
21:45
ways that like. As a board, we had to figure
21:48
out both how to listen to those attacks and also
21:50
support Tom. So that's probably what I'm most
21:52
proud of. I will say that this kind of public
21:56
service is inherently selfish. And anybody who
21:59
tells you otherwise isn't really understanding.
22:01
The Board of Health commitment is not the most
22:04
huge commitment. It's not paid, but it's not
22:06
massive. And I learned more than I gave. And
22:09
I really do feel that way. I feel like I learned
22:11
a tremendous amount. I feel very thankful. for
22:14
the experience that I got during both of my different
22:17
board services, I feel like I was able to get
22:20
a real understanding as a physician of what is
22:23
communal health rather than what is individual
22:26
health. And the reality of it is, is it's brought
22:29
me in my medical practice to a place where I
22:32
can really understand that the factors and choices
22:34
that people made are not just about their own
22:36
decisions and behavior, but about the community
22:38
they live. And if we can understand that and
22:41
then connect them back into the community, they'll
22:43
often do much better. So I think that connected
22:46
it up for me there and hopefully helps me be
22:49
a better medical educator and a better doctor.
22:52
So those are some of the examples of the things
22:54
that you're proud that you did. What is something
22:56
that you enjoy doing on the board that you're
22:59
going to miss? I think that we're all too serious
23:01
most of the time and that we need to have a good
23:03
time. So I think I will miss that kind of like
23:07
having a little bit of fun at the board meetings
23:09
because the reality of it is in public health
23:11
is we're dealing with. usually fairly important
23:14
issues. And they're issues that don't have simple
23:17
solutions. Like when you're talking about equity,
23:19
for example, or you're talking about populations
23:21
that struggle with different things. Yeah, I
23:23
think like that, I'll miss that. I think just
23:25
I'll miss the knowledge dump. I don't read public
23:28
health journals, for example, and I don't have
23:31
a great way to keep up with the world of public
23:34
health. And I felt like being on the board and
23:36
being on the health district before that gave
23:37
me the opportunity to have some window into public
23:40
health. That's how I learned about Public Health
23:43
3 .0. That's how I learned a lot about the epidemiology
23:46
that I understand. And Tom, what are you going
23:50
to miss about working with Dr. Birnbaum? Well,
23:52
right there, the humor. He was, gosh, he could
23:55
put a smile on you in the most trickiest times.
23:59
I'm going to miss just his knowledge. You just
24:02
listen to him. He comes with a wealth of knowledge.
24:05
I can give you tons of stories. One I'll give.
24:07
Just last year, we were doing Radon Action Month
24:10
and talking about our plans to get the free test
24:13
kits out and educate homeowners and renters regarding
24:17
indoor radon. And Bernie's right there said,
24:20
hey, have we thought about educating health care
24:22
providers, doctors? And we hadn't. And we put
24:26
together a whole program. It was so successful
24:28
this year because now they're aware and they
24:31
can now educate to their. communities and to
24:35
their clients. And so that's what we're going
24:38
to miss because he's very good at connecting
24:40
dots. Bernie's well involved in the community.
24:44
I've always looked to him. I'm going to miss
24:47
him. He challenged me and that's important. I
24:50
can get complacent too. You need a board that's
24:53
going to ask questions. They're going to challenge
24:55
you. They're going to say, we thought about this.
24:57
Going to get us out of our comfort zone because
24:59
that only makes us better. And our outcomes ultimately
25:02
for the community are 377 ,000 people. That's
25:06
the goal. We got a great board of health. They
25:08
work very well. They disagree at times, but they
25:11
do it in a manner that produces a good outcome
25:14
for staff. So, Dr. Birnbaum, as you reflect on
25:18
your time with the board, do you think you had
25:21
the impact that you were hoping for when you
25:23
first joined? I mean it when I see public service.
25:27
I believe that public service is at least somewhat
25:29
selfish. Right. You know, people like to say
25:33
a great public servant is someone who is selfless.
25:35
And that is somewhat true in the political realm.
25:38
Like a great politician reads all the stuff they're
25:41
given and knows the details. Right. I feel like
25:45
I learned an unbelievable amount. So I'm incredibly
25:47
thankful for that. I hope that I did a couple
25:50
of things. One, I hope that I challenged Tom
25:53
in the way that you're talking about. but also
25:55
made you feel supported. I hope that the staff
25:58
felt like we as the board had their back, right?
26:01
I hope that the staff understood that they are
26:06
the experts in public health and that the board
26:09
is filtering that expertise to understand how
26:12
that works in our community, right? Which is
26:14
like, fundamentally, that's what the role is.
26:16
And so I hope that that was successful. Very
26:22
proud of how we dealt with the pandemic. You
26:25
know, I'm wondering, you know, for the person
26:27
who fills your shoes, what kind of advice would
26:29
you give them? You got to come prepared to meetings.
26:32
Meaning that, you know, they send out the information
26:35
that we're going to talk about. And I think it's
26:37
actually pretty important to read that. And I
26:39
think it's pretty important to think about what
26:42
are the implications of the things that we're
26:43
going to talk about for this community. I think
26:46
particularly for a physician coming into that
26:48
role. I think understanding the difference between
26:52
individual and public health is really important
26:53
and it's really hard. And I found myself struggling
26:57
with that sometimes during COVID because I would,
27:00
as a doctor, go down that path of what's best
27:03
for an individual, right? When in reality, you
27:06
have to be able to pull back from that and say,
27:08
how do I think about community -wide solutions?
27:11
And then I think the final thing is really like,
27:13
listen to the staff, like listen to the presentations
27:16
because There are little nuggets in there that
27:19
are really important. And then the final thing
27:21
that I would say is our job is not to micromanage
27:24
stuff. Like we're not, we are, like I said, we're
27:27
not the experts in public health, but we're also
27:29
not the people doing the work. So I think sometimes
27:33
as a board member, we want to ask really nitty
27:37
gritty questions that parse out things. That's
27:40
really not our job. What we're looking for is
27:42
big picture things that we need to push in a
27:44
different way and then trust the staff and the
27:46
director to be able to manage that appropriately
27:48
unless we have data that shows otherwise. What
27:51
is the secret to a good board? How do you guys,
27:54
when you disagree, actually come to a consensus?
27:58
I mean, you have to start from a place of mutual
27:59
respect. I think the reality of it is, is that
28:02
anybody that's choosing to serve in this capacity
28:04
is trying to do so for good reason. You know,
28:08
anybody coming onto the board is looking to serve
28:11
in some way, and that doesn't mean that they
28:13
all do it perfectly. But I think if you start
28:15
from that understanding of respect and treat
28:17
each other that way, you can have pretty big
28:21
differences in opinion or in approach, yet come
28:25
to consensus. The other thing that has been really
28:28
fun on this board for the full 10 years that
28:31
I've been on it is that there really has been
28:33
an attempt to find consensus. That doesn't mean
28:35
that we always have to be right in step. Early
28:38
in the board, I remember doing a retreat. It
28:42
was before Tom was here and talking to one of
28:44
the board members and realizing that we really
28:46
had some fundamental disagreements around how
28:48
we would approach something politically, but
28:51
that the underpinning values were the same. And
28:54
we were able to take a step back and say, well,
28:56
we really respect each other's values. So how
28:59
do we find a place where we can have a conversation
29:00
about this topic? And that was really cool. I
29:03
mean, I learned a tremendous amount from that
29:05
because I tend to be very. strong political left
29:08
you know but i was really able to in that context
29:12
both with the county commissioners at the time
29:14
who i did not agree with and with this board
29:16
member actually find a tremendous a tremendous
29:19
overlap of core values that allowed us then to
29:22
like work together very amicably that's that's
29:26
where a board needs to start isn't with that
29:27
like place of mutual respect i do wish that there
29:31
was more time to get to know each other and i
29:34
think it's always hard like You come here after
29:36
work at 5 .30, you shove some food in your face.
29:39
You know, by about 8 .30, you're like... And
29:42
so there's not a lot of time for that bonding,
29:44
but I do think that some of that's really important,
29:47
hence why I think retreats are so important.
29:49
I would also add, too, and this was when Bernie
29:52
was president, while we were working on a new
29:55
tool to evaluate the public health director,
29:58
it was also, well, let's do a self -evaluation
30:00
for the Board of Health, the Board of Health
30:02
every year. Now does, and it's the third time,
30:04
done a self -evaluation. And there, during a
30:08
retreat, a work session, the board has those
30:11
kind of conversations about where are we not
30:13
aligning? What are we doing that maybe isn't
30:16
working? And those are very healthy conversations.
30:20
And I think that just fosters this board to work
30:24
even stronger together and get to know each other
30:26
a little better. So that's something that...
30:28
Under Bernie's leadership implemented about three
30:31
years ago, wasn't it? More as it was, it was
30:33
2021 or 22. We worked with, we worked with a
30:37
consulting group to help come up with an evaluation
30:40
for Tom that helped Tom grow as opposed to just,
30:44
I don't know, just give feedback that maybe is
30:46
hard to act upon and then help the board to ask
30:49
the questions of how do we work together better?
30:51
I think it's been helpful. I think. It allows
30:53
us to see each other for who we are and where
30:56
we come from. And I do think it's interesting.
30:59
We each represent different constituencies. And
31:01
I think it's important to remember that and to
31:03
remember that each of those constituencies is
31:06
very valid and part of the community. So I think
31:09
that's also an important piece of that. Is there
31:11
anything on the horizon that you're excited or
31:14
interested to see the health department tackle
31:16
now as a Larimer County resident? Yeah, I would
31:20
love to see us. continue to delve into policy
31:24
because ultimately policy that happens around
31:27
health is what leads to change. Things that I
31:31
think are important are regulation of tobacco
31:33
products, but particularly vapes, you know, I
31:36
think is an important one. I think looking at
31:39
our food security system is really important.
31:43
I think we have to maintain the fiduciary responsibilities.
31:46
Like we have to be really good at restaurant
31:48
inspections. We have to be really good at septic
31:51
system. You know, those are elements that we
31:56
need to maintain. But I think as we get really
31:59
good at doing that and keep that tight, let's
32:02
also make sure that we're looking at policy both
32:05
on the regional and state level. I love that
32:07
Tom's involved in regional and national public
32:10
health leadership. I would love to see other
32:12
staff engaged in that. We had a presentation
32:15
at one of the last board meetings from one of
32:18
the environmental health people who had done
32:19
and done work in Puerto Rico. And I think those
32:23
sort of involvements beyond the county, while
32:27
you could argue that they detract from the work
32:30
that they're doing here, actually make us much
32:32
stronger and lead to partnerships that make the
32:35
department stronger and hence the health of the
32:36
community stronger. Do you have any plans for
32:39
what comes next, either in terms of public service
32:41
or just with your free Thursday evenings? Not
32:46
yet. I like to joke, I have a 1 .2 FTE job. So
32:50
I got plenty of work to do. I still actively
32:53
have a patient panel that I manage. I teach medical
32:56
students in residence. I help administrate our
33:00
residency program. I think in the short term,
33:03
I'm going to do that. I'd like to look at ways
33:06
that I could get involved either locally or regionally
33:08
to stay involved in public health issues, but
33:11
they don't have to be named public health, right?
33:13
So I mean, like one of the biggest public health
33:15
features of any community is its transportation
33:18
system. Right? Another example of that is environmental
33:22
health. How do we think about our healthy environment
33:26
and the structures that we put into that community
33:29
to keep us healthy, keep us moving? I think about
33:33
housing. I think housing is just an absolutely
33:35
huge issue in Fort Collins specifically, but
33:38
in Larimer County as a whole. And how do we think
33:41
about good, stable housing that people can afford
33:43
to have a reasonable job and live in? I, as a
33:48
physician who makes good money, could not move
33:51
here and live where I live now. Like, there's
33:53
no way. I live right in the center of town. My
33:56
house would be way overpriced for what I make.
33:59
So, I mean, I think thinking about how do we
34:02
think about that stuff all feels like public
34:04
health to me. Because ultimately, if you don't
34:06
have stable housing or stable food or stable
34:09
transportation, you cannot make healthy decisions.
34:12
And we put all of our money into the healthy
34:15
decision side. and not into those structural
34:18
things that make us healthier. So I'm interested
34:20
in that. Another thing that Bernie brought was
34:24
with his residents. They spend a week or two
34:27
with us and learn what we do in public health.
34:31
I think that has been a wonderful synergy right
34:34
there with that. Yeah, I want to maintain that.
34:37
I started a rotation for medical students at
34:40
the CU at CSU Branch Campus looking at community
34:43
perinatal health. So for... moms and babes and
34:47
that's been really cool it's been a great partnership
34:49
i'm doing something similar with the residency
34:51
i want to make sure that that future health care
34:54
providers that provide individual health really
34:57
fully understand that health is about the community
34:59
not about individual decisions and and i think
35:03
that's important i call it polluting young minds
35:06
but you know and at the time we can give them
35:09
a radon test kit too right look i actually got
35:12
a radon dex kit And radon mitigated my owls.
35:15
And I'm incredibly healthy now. You just mentioned,
35:19
you know, there's these staff development opportunities
35:23
that can really change somebody's life. Was there
35:27
anything similar to that that happened to you
35:29
that had, you know, that lightning strike moment
35:31
where you're like, hey, I want to get into healthcare
35:33
in some fashion? It sounds like you were passionate
35:36
about serving underserved communities. I'm just
35:37
also kind of curious how that came. There's a
35:40
couple of ones that I'll throw out there. I mean,
35:42
the first one, I knew I wanted to be a doctor
35:43
when I was like eight. So this was a long career
35:47
path for me. But I think part of what pushed
35:50
me towards education was a group called Generalist
35:53
Physicians in Training that was run by the American
35:55
Medical Student Association. I was in medical
35:57
school and seeing the reality that what our country
36:02
needs is good primary care doctors. And having
36:05
great mentorship in that process pushed me towards
36:09
wanting to be a primary care doctor that mentors
36:11
learners. So that's one thing. And then mentorship
36:14
during medical school from great people who were
36:16
like, you can do this. In the more recent past,
36:21
probably serving on the health district board,
36:23
which the way that I actually got there was Avi
36:27
Strand, who was the nursing director here for
36:31
51 years. who had also been on the health district
36:37
board. I met her early in my time here on Fort
36:40
Collins and she said, you know, you'd be really
36:42
good at this. You should do this. You have something
36:45
to offer and you'll learn a lot, which was the
36:47
thing that came for me. And so, and you can run
36:51
for this and we can see if we can make it happen.
36:53
And so I ran for that position and that was a
36:57
great, I'm an energetic guy. I need a lot of
37:01
input. It helps me to have things that I'm working
37:04
on, and it gave me that thing that gave me something
37:07
to learn about. Awesome. Well, Tom and Dr. Birnbaum,
37:10
thank you both so much for joining us. My pleasure.
37:12
Thanks, Bernie, for 10 years on the Larimer County
37:15
Board of Health. Appreciate you. Thank you. I'm
37:17
going to miss it a lot. Like I said, it was an
37:19
incredible learning experience, so maybe I'll
37:21
have to read a book now. Do you have a question
37:27
about public health in Larimer County or a topic
37:30
you'd like us to discuss? Let us know. Email
37:33
us at HealthierTogether at Larimer .org. Thanks
37:36
for listening, Larimer County. Until next week,
37:39
stay well, stay connected, and remember, we really
37:41
are healthier together.