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History of Public Health in Larimer County · Healthier Together: Larimer County's Public Health Podcast

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Welcome to Healthier Together, Larimer County's
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public health podcast, where we come together
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for healthier lives, connected communities, and
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real conversations. From your local public health
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team, I'm your host, Tom. And I'm Joanna. This
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week, we are thrilled to bring you a feature
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episode with Dr. Adrienne LaBailey. Dr. LaBailey
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served as the previous director of the Larimer
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County Department of Health and Environment.
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before retiring in 2019 after 31 years at the
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health department. Today, she's here to share
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some of the history of public health in Larimer
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County and reflect on how the work of public
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health has changed over time. Dr. Bailey, thank
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you so much for joining us. Thank you for inviting
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me. To start, can you tell us a little bit about
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yourself and your career? Well, I grew up in
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the suburbs of Chicago, so I'm originally an
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Illinois resident. I went to the University of
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Illinois for my undergraduate, and my major was
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English, and I thought I was going to be a high
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school English teacher. And instead, just before
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I was going to graduate in three years instead
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of four, just before I was supposed to do my
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student teaching, I helped a teacher friend of
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mine who had been sick and was running behind
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grade some papers, and I really enjoyed the first
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five. By the time I got to the last five, I realized
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I could not do this the rest of my life. Decided
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to do a fourth year of college and picked up
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the science I needed to apply to medical school.
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Got in to my surprise because I was only 10 weeks
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into my first college biology class when I had
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to take my entrance exams for medical school.
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And I went to Rush Medical College in Chicago.
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I interned at Cook County Hospital. And while
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I was there, got interested in public health
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and decided to do a specialty in preventive medicine
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and public health. A lot of people don't even
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know that that's a medical specialty like pediatrics.
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But went to Johns Hopkins to do that, to do both
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the residency program and to get a master's in
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public health. What initially drew you to public
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health when you were at Cook County Hospital?
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Well, at Cook County. It's a large urban hospital,
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mostly very low -income patients, frequently
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patients who had delayed many years to have a
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problem seen, evaluated, treated. And I kept
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seeing a lot of people whose health problems
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could have been resolved much more quickly if
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there had been earlier interventions. And I thought,
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you know, you're spending hundreds of thousands
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of dollars to keep this person alive for a few
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more weeks. And what if you had put that money
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into preventing the problem? I also read a book
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at that time on international health. And that
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got me really interested in public health and
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international health. And that's what I started
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to specialize in when I went to Johns Hopkins.
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But I quickly realized that a lot of different
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factors were going to keep me in the United States.
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And I switched to health policy and management,
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which... And lead in a lot of different directions.
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One of my residency rotations was with a local
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county health department in Maryland. And I just
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loved that and that this is what I want to do.
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And so I did. And then what brought you here
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to Larimer County? Well, my first job after finishing
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the training program at Johns Hopkins was to
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be a city health public health director in a
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town in Connecticut, Waterbury, Connecticut,
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which was. Very different from here. Waterbury
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was the brass capital of the United States before
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the brass industry went to Asia. And so it was
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an industrial town and very blue -collar, very
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different than this community, but it was a great
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place to learn how to be a public health director.
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I happened to see the ad in the American Journal
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of Public Health for a position in Larimer County.
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I had to look it up. on a map to find out where
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it was. I had backpacked in Rocky Mountain National
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Park when I was in medical school. And I thought,
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oh, the eastern half of Rocky Mountain National
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Park is in Larimer County. That would be a cool
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place to live. So I almost didn't come for the
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interview because we were in the middle of a
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big cholesterol screening project with the whole
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community. I said, I can't leave in the middle
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of that. You really do have to, you know, we'll
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pay for you to come out. an interview. And so
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I did and got the job. I was very fortunate.
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Fort Collins, I think, is wonderful. So you started
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working here at the health department in 1987
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as the medical director. What did the department
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look like at that time? Well, I'm going to start
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with the physical department because I was a
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little shocked when I came for my interview and
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they brought me to the building. We ended up
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going up this alley in Old Town and We parked
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at what was obviously the back entrance of a
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building. And the building that we were in at
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the time was the former, the original Woodward
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Governor Industrial Manufacturing Plant. It had
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no windows, if you can imagine. We shared the
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building with the Human Services Department and
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the Health Department because it wasn't big enough
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for all of us. We had a couple of storefronts
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on Linden Avenue, which later became tobacco
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and martini shops. And it was just, everything
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was orange. We'd been moved there in 1976 when
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they hired the first physician, public health
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director, Dr. Robert Sherwood. So we'd been put
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there temporarily. And it was 1987 now. We were
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still temporarily there. You have to realize
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that at that time, all of our communication devices
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pretty much consisted of mail and telephone.
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There were no cell phones in the department.
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There were no computers in the department. There
6:15
was no email. There was no web. So it was just
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a very, very different experience. But I think
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it was actually the fact that they had no windows.
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I walked in. The first thing I had to do was...
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be part of a staff interview, so any employees
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who are available. So the first question was,
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what would you change about the department? And
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I said, the only thing I can tell you in the
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first five minutes of being here is that you
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need more windows. And they all started cheering.
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And we got to design the building that we're
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in now and lay it out and do things. And I don't
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think anybody doesn't have access to a window.
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I'll take credit for that. So what were some
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of the most pressing public health needs when
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you first started working here in Larimer County?
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Well, I don't know if this is surprising or not,
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but the first thing that I really had to focus
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on was helping get access to care for low -income
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people here. And we were not going to be the
7:12
providers of care, but my very first day on the
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job. The community health director, Abby Strand,
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said, you have to come to a meeting tonight.
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I'm not even unpacked. And she said, no, you
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have to come to a meeting tonight because there's
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a meeting about how there are no OBGYNs in Fort
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Collins who will accept Medicaid and we have
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nobody to take care of babies. Of course, I went
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and it ended up being a partnership among many
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different entities. Out of that effort, Poudre
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Valley Prenatal was created, where the physician
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who was the OB -GYN consultant to our family
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planning program and his partner became the attending
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physicians. They work with the residency program
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at the hospital to create a way for people who
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are on Medicaid to be able to get prenatal services,
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which we were very concerned about, obviously
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really important. And then a local pediatrician,
8:16
Tom Wera, came and said, OK, now we've got the
8:19
babies born, but we don't have any pediatricians
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to take care of these babies. So we worked together
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on something that became the children's clinic
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at that time. I wrote a federal grant to try
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to get them money to get them off the ground.
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And that got them started. They had transitioned
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then into a piece of a hospital. and ultimately
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they are saluted now, your neighbors. But there
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were no what are called federally qualified community
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health centers anywhere in Larimer County in
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1987. So we had no infrastructure for taking
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care of people's medical care needs. And so among
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the other things we did over the years is try
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to help Loveland get the designation as a medically
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underserved area only for low -income people.
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Obviously, you had to get a lot of data and show
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need to get the federal funding. The Loveland
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became Sunrise Clinic, affiliated with the Well
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County Clinic. And eventually, there was also
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Clinic Services in Estes Park. So those were
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some of the earliest things we did from the health
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point of view. From the office point of view,
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trying to modernize our equipment. get people
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using computers. During our big measles outbreak,
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we didn't even have a fax machine. I mean, if
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we wanted to fax something, we had to go to the
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commissioner's office or the sheriff's department
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because they had fax machines. We couldn't send
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out press releases urgently, and that became
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really important. Fortunately, on my way home,
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a Coloradoan on Riverside was still being written
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and printed there. So people were there like
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a ton o 'clock at night. So I would just frequently
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stop by with press releases on what was going
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on with the measles outbreak in 1990. There's
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obviously no web, no social media. I don't know
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if you're aware from outbreaks that are going
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on now in the United States, but if you know
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you've been someplace where measles has been,
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and it can stay in the air for hours, if you're
10:29
unvaccinated, you have a 72 -hour window to try
10:32
to get a vaccine. And so it was like really,
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really, really important to get that out quickly
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so that we could stop as many potential cases
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as we could. So that was really important. But
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it was a challenge to get information out to
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the community. And we had such short timelines
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to try to prevent cases. So you've had quite
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the career here over at the Larimer County Department
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of Health and Environment. And you already mentioned
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one of those significant events and crises that
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have come up, which was the measles outbreak.
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Can you talk a little bit more about what that
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was like? Sure. That was an interesting situation.
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I was related to Colorado State University. In
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March, they had had their spring break. And a
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lot of CSU students went to South Padre Island,
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Texas for spring break. where apparently a measles
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outbreak was going on, but we didn't know that.
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And even at that time, very few physicians had
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ever seen a case of measles, which is still true
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today, unless you're in an outbreak community.
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But a lot of them had, like as myself, I had
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measles as a kid, but I had never seen it after
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going to medical school or anything like that.
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In the end, what we found out is that there were
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three separate people who imported measles back
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to Fort Collins. Two of them were students on
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spring break, and one of them was the travel
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agent who had arranged for all of these CSU students
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to go on spring break. We also had a state epidemiologist
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locally based in this area that served all of
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northern Aramore County, and we'd gotten this
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report of somebody who might be an adult with
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measles, but... We weren't sure, and we didn't
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know of any other existing cases. So we went
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to his apartment and interviewed him. And he
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said, you know, this could be measles. Really
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can't tell. It could be a lot of other things.
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But just to be on the safe side, we're going
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to isolate you and your wife for right now. Because
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at that time, the test for measles was not a
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PCR, which is much faster now. long -term antibodies,
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which suggested that they were vaccinated, or
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only the short -term antibodies, the IgM, which
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suggested you had an active case. Well, we could
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have been wrong, but it turned out we were right.
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So that was helpful. But he wasn't, he had gotten
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it from somebody else. So we knew it was tracing
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back to figure out where had it come from. Anyway,
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so we did a lot of vaccination encouragement
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at CSU. Actual clinic staff did the vaccinations.
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There was no requirement for college vaccinations
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at the time. There were no requirements for anybody
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past elementary, high school in Colorado at the
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time. Although that changed after our outbreak.
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We also made ourselves very unpopular by saying
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no indoor graduation ceremonies because by that
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time it was May. We knew we had people from all
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over the country coming into Fort Collins for
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graduation and then to have them go back and
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potentially spread measles. all over the country
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was what we were trying to stop. That was also
13:42
not super popular, but they moved it. They broke
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it up into two groups based on student protests
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so that they didn't have all the graduates in
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one session. It was, you know, one was one hour
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and one was like two hours later on a Saturday.
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And nobody prayed harder than me for the rain
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to not start until after the graduation ceremonies
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were over. And we just made it. But it was a
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challenge. It was a challenge for our department.
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Again, we didn't have a lot of good ways to communicate.
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We created a hotline for people to call into,
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which was staffed for the very beginning, like
14:18
24 -7, because I was there one night at 2 o 'clock
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in the morning answering phones. But when we
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first put out the information about the hotline,
14:29
The Coloradoan ended up putting the wrong phone
14:31
number in, and it went to a lady who was on oxygen
14:34
in her 70s. Oh, man. And so our brilliant staff
14:40
went to her house, brought an answering machine
14:43
that said, if you're trying to call the measles
14:45
hotline, call this number instead, and turned
14:48
off her phone, basically, so she wouldn't be.
14:51
Because they were just calling her, like, at
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6 o 'clock in the morning when it first came
14:54
out. You always have to be prepared for little
14:57
glitches like that. It was quite the outbreak.
15:04
In 1990, the health department started operating
15:07
under the name it has now, which is the Larimer
15:09
County Department of Health and Environment.
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Can you tell us about that change? The health
15:15
department was created in 1968. We were one of
15:19
the last. We were the last large front -range
15:22
county to have an organized health department.
15:24
They'd been working on it since the 1940s with
15:28
Florence Sabin, who you may know as a famous
15:31
public health worker who has her statue in the
15:33
Hall of Statuary in Congress. The city of Fort
15:37
Collins and the city of Loveland did their own
15:39
public health services. And they weren't really
15:43
interested in combining with the county and paying
15:47
the county money. And the county didn't went,
15:50
look, we're not going to pick up the cost of
15:52
all this. So it took until 1968 to actually make
15:57
it happen. Before that, there had been four county
16:00
nurses that only served the non -incorporated
16:03
areas. And then there were, I think, about four
16:06
environmental health people who did restaurant
16:08
inspections and septic systems and stuff like
16:10
that. What happened in 1990 is, for whatever
16:14
reason, and it might have actually started with...
16:17
Colorado Department of Public Health, that they
16:20
changed their name. It used to be the Colorado
16:22
State Health Department, and then they changed
16:24
theirs to the Colorado Department of Public Health
16:28
and Environment, which I didn't really care for
16:31
because it's really all public health. I would
16:34
have loved being called Larimer County Public
16:36
Health Department because environmental health,
16:38
community health are all part of public health.
16:39
Whether it was they wanted to emphasize environmental
16:42
health, what changed here is that people in environmental
16:44
health didn't feel like they were being recognized.
16:47
And so they said, well, when the state changed
16:50
their name, you know, and we just changed ours
16:52
to health and environment. Towards the end of
16:55
my term, I did sort of pull the whole staff and
16:58
say, do you want to be Larimer County Health
17:00
Department? Do you want to be Larimer County
17:02
Public Health Department? Do you want to be Larimer
17:04
County Public Health and Environment? And it
17:06
was about one third, one third, one third. So
17:09
we're not changing. There's no strong feeling
17:12
about what the department. There's no unanimous
17:16
feeling about what the department should be called.
17:19
Another one of the crises that came up during
17:21
your tenure was the 1997 Spring Creek flood.
17:25
Yes, that was really sad. We lost five people
17:27
at a mobile home park just on the other side
17:32
of railroad tracks. Well, that was an interesting
17:35
evening because what happened to be happening
17:37
at the health department that night was that
17:40
we meet with septic installers and septic engineers
17:44
to get their feedback on proposed regulation
17:47
changes. And we were meeting in the conference
17:49
room that night. And we could hear the rain hitting
17:53
the roof. And it was like really, really boring.
17:56
And so we were like trying to get out of this
17:57
meeting. And we went home. And I had to cross
18:02
Spring Creek on LeMay to get to my house. And
18:05
I made it before it flooded over. And apparently
18:09
during the night, we had people doing some response
18:13
during the night. But they were all trying to
18:14
call me, and I had bought a new phone for my
18:17
bedroom, and somehow it came with the ringer
18:20
turned off. So I slept through the whole thing,
18:22
got up the next morning watching the news. I
18:25
found messages on my phone downstairs because
18:27
I didn't have an answering machine upstairs.
18:29
I was trying to figure out, well, how do I even
18:31
get to work today? The health, the clinical side
18:35
of the department was important in getting...
18:40
People who were involved in the response vaccinated
18:42
for tetanus because you're wandering in, you
18:46
know, muddy waters and you can cut yourself and
18:49
making sure people were up to date on their tetanus
18:52
vaccinations. Environmental health had a lot
18:55
of different problems in that, you know, there
18:57
were restaurants in areas that had been flooded.
19:00
There was a fire, a train derailed, and there
19:04
was a flood all happening at the same time. You
19:06
know, moving up in time here, in 2003, there
19:09
was the first cases of West Nile virus. Curious
19:12
to see how that was for you and dealing with
19:15
that. Well, we knew it was coming. I mean, we
19:19
had the advantage by that time that we knew what
19:21
the disease was and what the virus was because
19:24
it had moved into New York City in 1999. We knew
19:29
in 2002. in Larimer County that we had had some
19:34
horse cases, that we had had some bird cases.
19:37
We are not aware that we had human cases, but
19:39
most likely we did. We didn't have good surveillance
19:42
systems. I mean, now we have this incredible
19:44
surveillance system where we have mosquito traps
19:47
every square mile of the city of Fort Collins
19:49
and quite a few in Loveland as well that keep
19:53
track in live time. We noticed, we had doctors
19:57
calling us and saying, we're seeing a lot of
19:58
febrile illness. with a rash. And based on what
20:04
we read about West Nile from the eastern half
20:07
of the United States, the rash was only in about
20:10
maybe 20 % of people. And we were getting this
20:14
rash in about 80 % of people. At that time, we
20:18
had a fax machine. We had a fax network that
20:20
we could send to other health departments. I
20:23
guess we got email in 1997, finally. We didn't
20:27
even have email before that. We sent out a message
20:30
to other local health departments along the Front
20:32
Range saying, are you seeing febrile illness?
20:34
And they said, no, we're not seeing that. We
20:37
didn't even have our first recognized confirmed
20:39
human case until late July, but then it just
20:43
exploded. So in the end, we ended up having,
20:46
I believe, nine human deaths in Aramur County,
20:49
about 56 neuroinvasive cases of West Nile. And
20:55
officially, we had like 556 confirmed total cases.
21:00
But the doctors stopped testing after a while
21:03
because they said, this is West Nile. There's
21:05
nothing we can do for you. Why even bother to
21:08
test? Our best estimate is we probably had about
21:11
1 ,500 actual cases in Larimer County that year.
21:14
I think finally did do some truck spraying. I'm
21:17
not sure if they did truck spraying that year,
21:19
but we ended up getting... Aerial spraying in
21:23
some areas of the county. The city of Fort Collins
21:26
didn't like the aerial spraying, so as the planes
21:29
went over from Loveland to Fort Collins, they
21:31
had to turn off their sprayers as they went over
21:34
Fort Collins and turned around. But it was a
21:38
very difficult year. I mean, I just got used
21:42
to being criticized and getting nasty calls about
21:47
rain. I was really glad I wasn't here for the
21:50
pandemic. So moving forward just a little bit
21:53
more, in 2008, there was an initiative to basically
21:57
introduce long -acting reversible contraception
22:00
in our clinic down here. What was that initiative
22:02
like? How did that get off the ground? Finances
22:04
are always an issue for public health everywhere,
22:07
always, probably more so now. And an anonymous
22:12
donor picked Colorado and I think another state
22:15
to... infused with money for long -acting reversible
22:19
contraceptives. I mean, we had had, obviously,
22:22
IUDs had existed a long time. But because of
22:26
this money that came in to help us support long
22:29
-acting reversible contraceptions, we were able
22:31
to offer that to young women for the first time.
22:34
And we're obviously able to achieve a lot more.
22:38
I mean, we had relatively decent teen pregnancy
22:42
rates here. But they dropped significantly more
22:45
after we were able to do that. There was some
22:48
money to pay for it. And unfortunately, a lot
22:50
of what you do in public health is what you can
22:53
find the money to pay for. And there's really
22:56
important things that you wish you could do that
22:58
you can't. But that was really successful. We've
23:03
had really good family planning staff. Another
23:07
item that came up during your tenure was the
23:09
first community health improvement plan. Can
23:11
you tell us a little bit about the background
23:13
on that and what the goals were? Well, it was
23:16
to involve the community more formally in developing
23:19
priorities, not only for the health department,
23:23
but for partners in the health department. So
23:25
it was an opportunity to get people together
23:27
to discuss a lot of different potential issues
23:31
that one could be working on. And to see, you
23:35
know, how can we reinforce each other? How can
23:37
we help? You know, what are the people's priorities?
23:41
And involve a broader group than just the Board
23:44
of Health and the staff of the health department
23:47
and staff of the state health department. The
23:51
state health department, I think, also was mandating
23:53
it at some point. I can't remember if it was
23:55
a mandate at that time or not. They had been
23:58
working on developing. improvement plans for
24:01
the state health department as well. We really
24:04
needed to improve data systems to help give us
24:07
the evidence for where are the gaps. You might
24:12
have a really good teen pregnancy rate overall
24:14
in Larimer County, but then if you look at Hispanic
24:17
teens, it's not nearly that good. It gave us
24:21
the ability to look at the problem from different
24:23
points of view and then to also involve a greater
24:26
number of folks in the community too. be involved
24:29
in the prioritization process. I'm trying to
24:32
remember. We know raising healthy children was
24:34
one of our two priorities. Raising healthy children
24:37
also had to do with child care, although we couldn't
24:39
focus on child care. Obviously, another huge
24:42
need. I'm thrilled that the tax initiative got
24:46
passed early in November to make some resources
24:51
available for that. Our department has always
24:54
been really good at working with lots of partners,
24:57
but I think it's strengthened it even more. We've
25:00
had great relationships with the health district
25:03
of Northern Larimer County. Now, 90 % of people
25:05
in Larimer County don't know the difference between
25:07
the health district and the health department.
25:09
But we worked together very closely during all
25:12
those years, during the H1N1 pandemic, which
25:17
people don't even remember was a pandemic. anymore
25:20
because it was so different than COVID. But we
25:23
had done a lot of pandemic planning in this department
25:25
starting back in 1995 when they first discovered
25:32
H5N1 influenza in China. We'd been working on
25:36
it and we had a big pandemic planning initiative
25:39
around 2006 working with schools. businesses,
25:46
just religious organizations, everybody in the
25:49
community, because we were very concerned that
25:51
there was going to be an influenza pandemic and
25:54
we wanted to be prepared for it. And then we
25:57
had this little, it was more of a children's
26:00
pandemic, the H1N1. It was mostly children who
26:02
were affected. And people sort of, I think, lost
26:05
interest after that. But we had great partnerships
26:09
in the community. or a lot of different kinds
26:13
of public health initiatives to respond to disasters,
26:16
to respond to floods, to respond to fires, because
26:19
we've had to deal with all of those. Most public
26:22
health disasters happen on Fridays, usually after
26:25
4 o 'clock, preferably on a three -day weekend.
26:29
It's just really great to work with a team of
26:31
people who are resourceful, who are very experienced
26:35
and can put things together. There was a, in
26:39
2004 in the fall, There was a national shortage
26:42
of flu vaccine because there were two companies
26:45
that made it. And one of the companies' manufacturing
26:48
plant had been inspected and found to be deficient.
26:51
And so FDA pulled their ability to manufacture
26:54
that vaccine. So half of the people, including
26:57
the health department, because we had ordered,
26:59
they were a little bit cheaper than the other
27:01
company. So we had ordered our flu vaccine from
27:03
them. And it was a fairly bad year. And, you
27:07
know, senior citizens, at least in those days,
27:09
were really excited about getting their flu vaccines.
27:11
And we had finally gotten some in in October.
27:15
And we weren't going to deliver it ourselves.
27:18
The visiting nurses were going to deliver it.
27:20
But we were organizing an immunization clinic
27:24
at the senior center. And I guess, you know,
27:29
you say it opens at 10. Well, people started
27:31
lining up hours before that. Some in wheelchairs,
27:35
you know, I mean, very infirm people. Some of
27:40
your 72 -year -old people waiting for COVID shots.
27:43
You sound familiar. And we realized, you know,
27:46
we've got enough vaccine for these people, but
27:48
we can't have them all standing out here. So
27:51
we said, this is like a traffic jam. What we
27:53
need to do is give them times to come back. So
27:57
we went down the line, you know, with the people
28:00
in the front getting the first time to come back.
28:02
And if that didn't work, you know, we'd arrange
28:06
a different time later in the day. And so we
28:09
fixed it so that we didn't have these vulnerable
28:13
people outstanding. Because it was cold. It was,
28:17
I think, cold and rainy that day. And so, you
28:21
know, we just have to figure out this traffic
28:23
jam situation. So we don't have traffic jams.
28:27
In 2009, when we had the swine flu. pandemic,
28:33
mini pandemic. And the criteria for who could
28:38
get vaccinated kept changing because first it
28:40
was only kids and really super high risk adults,
28:43
you know, immune problems, things like that.
28:46
Recommendations would change every couple of
28:48
weeks. So as we were putting clinics together,
28:51
we said, we've got to use our tools. At that
28:54
time, we knew that about 90 % of Fort Collins
28:57
residents. Larimer County residents had access
29:00
to the internet. And that was when we created
29:03
an online sign -up service to pick a time for
29:07
our big vaccination clinics, which we did at
29:09
the ranch and in a few other places in some high
29:12
schools. But by doing that, by telling only come
29:16
at this time, you know, we were spreading the
29:19
people out and we were able to get people in
29:24
and out of the vaccine. whole vaccine process,
29:28
usually in 15 minutes. Whereas if you looked
29:32
at the other health departments around us, people
29:35
were buying lawn chairs to sit in the lines outside
29:39
waiting to go in to be vaccinated. So it was
29:42
a real success. Now, we realized that not everybody
29:45
had internet access. So we also had call -ins
29:48
to make appointments in English and in Spanish.
29:52
A lot of the screening process was actually automated,
29:56
you know, so you could place one, yes, are you
29:58
meet these criteria? And the criteria kept changing.
30:01
So we kept having to change the software for
30:03
that. But it was a really wonderful experience.
30:09
We had our own IT people helping us at the time.
30:12
And that laid the groundwork for not only those
30:16
clinics. We did about 1 ,000, 2 ,000 in each
30:20
clinic at those. But when we did the CSU, meningococcal
30:24
outbreak vaccination clinics when we did over
30:27
7 ,000 in one day. We knew exactly how to do
30:32
what needed to be done, except we didn't realize
30:34
that CSU students don't have printers. They couldn't
30:36
print out their form. So we had the IT people
30:40
here at the county brought 12 HP printers, and
30:44
so we printed it out for them before they went
30:46
in. So we already had all of their medical information,
30:48
all of their background. The only thing they
30:50
couldn't answer is like, how are you feeling
30:52
this day? that kind of thing. But it gave us
30:55
a lot of experience in doing mass vaccination
30:58
clinics. And we got really good. Looking back,
31:04
what was the most challenging part of your career?
31:08
Finances are always really challenging and not
31:10
being able to do what you'd really like to or
31:12
seeing programs that you know are super valuable
31:15
going away. We lost a lot of our child wellness
31:20
clinics. Along the way, when Medicaid changed,
31:24
we used to get money to do both developmental
31:29
screening, so how are kids hitting their developmental
31:32
milestones from infancy to about kindergarten
31:35
age. And we also had well -child clinics for
31:38
low -income folks. And when they moved that from
31:43
being grants from the federal government to,
31:45
oh, we're just going to fold that into Medicaid.
31:49
Those were some of the things that we had to
31:51
give up. We used to have a program called Healthy
31:56
Communities, formerly EPSDT, where we helped
32:00
people who didn't have access to care find some
32:04
way to get access to care. We knew the resources
32:07
to get them to. We had to give that up as we
32:11
lost funding for it. So it's always really hard
32:14
when you've got really good programs and really
32:17
good people in them. see them go away, but that's
32:20
kind of life. So finances are one thing. Politics
32:24
are also always another thing. You know, in the
32:27
30 years I've been here, Larimer County's gone
32:30
from a very red conservative county to now more
32:35
of a more purplish and now probably blue county.
32:39
And public health is, you know, lower on the
32:44
priority for some groups than others. But, you
32:48
know, you always have to deal with elected officials
32:50
and you always have to deal with voters to, you
32:53
know, hope you can get things done, to hope you
32:56
think that what you do for the community is valuable.
33:00
You know, and you're going to make enemies sometimes
33:03
doing that. I mean, one of the things that we
33:05
did in, well, going back, this is going back
33:09
in time. The county, I think, created their first
33:12
website around 1996. Well, I decided. to learn
33:17
HTML so we could create our own health department
33:19
website. And one of the things I really wanted
33:22
on the website were the restaurant inspection
33:24
results. At the time, we would rank the inspection
33:29
results as, you know, medium, good, excellent
33:33
kind of thing. And a lot of restaurant owners
33:36
didn't like that. I got interested in the history
33:38
of public health in Larimer County and who was
33:42
the very first environmental inspector. In this
33:46
area, in 1906, a book called The Jungle was written.
33:52
Upton Sinclair's The Jungle, which talked about
33:54
the meatpacking industry in Chicago. And it was
33:58
like really gross to the people who read it.
33:59
He was trying to show the poor working conditions
34:02
and how workers are being abused. And people,
34:04
instead of getting hit in their conscience, were
34:07
hit in their stomachs when they read about what
34:09
the food was like. So Federal Pure Food Act passed
34:12
in 1907. And then... A veterinarian at CSU, George
34:18
Glover, became very active in trying to get a
34:21
Fort Collins food, safe food ordinance passed.
34:25
He was successful at doing that. City of Fort
34:27
Collins, him to be our first food inspector.
34:30
Well, in those days, it was inspecting the animal
34:33
that was being slaughtered to make sure it wasn't
34:35
full of disease. It's not going into restaurants.
34:38
And to test the milk. And he actually... put
34:42
in the newspaper the results of the monthly testing
34:46
of the milk, including the Colorado Agricultural
34:49
College's own university's dairy scores and how
34:52
many bacteria were growing in the milk. And I
34:56
thought, you know, this is the perfect, to put
34:58
it on the web is the perfect way to honor Dr.
35:02
Glover. Unfortunately, they're going to tear
35:05
down the building at CSU that is named after
35:07
him, but he was really the father of the veterinary
35:09
school over there, and he was our first. environmental
35:13
public health person. What are you most proud
35:16
of from during your career? Well, I've always
35:21
really loved public health as a profession. I
35:25
decided that you can sometimes help more people,
35:29
not by being a medical care provider yourself,
35:32
but by looking at the whole community. So I've
35:35
been very proud to have done that. I'm glad we've
35:39
been. so successful at working with many partners
35:42
in accomplishing. I mean, you can't do public
35:45
health by yourself. And I'm sure that continues
35:48
to be true today that you are also currently
35:51
working with a lot of partners, even though I'm
35:54
not up to date on your day -to -day activities.
35:57
And seeing rates go down, smoking rates, seeing
36:02
teen pregnancy rate go down, seeing life expectancy
36:07
go up, maybe not during COVID. But it's not exciting.
36:13
It's not like saving someone's life by compressing
36:16
their chest. But those are some of the things
36:19
that I'm really glad that I went into public
36:23
health. I'm glad I'm not doing it right now,
36:25
unfortunately. I don't know. I'm concerned about
36:30
our country today. I'm concerned about what seems
36:32
to be a war on science, a war on public health,
36:35
a war on some of our... constitutional values,
36:40
but I'm hoping that will change. It's just a
36:45
tough time to be in public health right now.
36:47
And I'm not sure I would have survived the COVID
36:51
pandemic just because politicization of public
36:55
health during COVID. And I know people got death
36:59
threats here. I know people got lots of hate
37:02
mail. And I would have probably taken it more
37:06
personally. If I were working at that time during
37:09
the COVID pandemic, that would have killed me,
37:11
not COVID. It was just a really hard time. I
37:15
was glad to not, I was really glad to be retired
37:17
by then. Speaking of, how, from your perspective,
37:22
has the approach to public health changed over
37:24
the last 30 years? be a key piece, not the only
37:40
piece in prioritizing things. You obviously can't
37:44
decide your programs just on data. You need to
37:48
involve the public. You need to involve the people
37:50
who are going to be affected by the program.
37:52
But that's changed, I think, somewhat. The technology
37:56
changes have been tremendous. We have a lot more
37:59
ways to communicate with. I am personally not
38:02
a huge social media fan. I'm glad it's a way
38:07
to communicate to a lot of people. I think as
38:10
we have diversified our sources of information
38:12
and we've also narrowed what we listen to, I
38:16
think it remains to be seen whether social media
38:20
is more of a harm than a help. I've sort of been
38:24
leaning on the harm side. And then there's AI
38:27
coming, which there are days I love AI and there
38:30
are days that I am afraid it could destroy humanity.
38:35
see what happens with AI too. But I do love asking
38:39
questions. So you kind of already answered my
38:42
next question here, which was, you know, one
38:44
of the biggest changes during the time period
38:47
since you started until now has been the changes
38:50
in technology and the availability of information.
38:53
In what ways have that really changed public
38:55
health? You just talked about, hey, there's misinformation,
38:58
disinformation. As a whole, though, do you think
39:00
it's more of a benefit or do you think that there
39:02
are some significant drawbacks that are big threats
39:06
to public health. Well, I think when you only
39:10
get information from one point of view, that's
39:12
a bad thing. One of the advantages of working
39:15
in the 70s and 80s is that people pretty much
39:20
heard the same thing. I guess you could agree
39:23
or disagree with it. The networks tended to be
39:26
pretty much trusted. Now there's such a wide
39:28
diversity of people giving information and misinformation
39:32
that It's very difficult to work against it at
39:39
times. There's just a lot of yelling, unfortunately,
39:45
online. I don't like trolls online. I don't like
39:50
the nastiness of a lot of online messages. For
39:55
me, it's actually really hard to understand.
39:59
I'm hoping that... The good will outweigh the
40:02
bad. I'm hoping the good of AI will outweigh
40:05
the bad. I like being able to get good health
40:08
information and get good health data, but I think
40:13
we are giving up a lot of our privacy, and I'm
40:16
pretty much of a privacy advocate. Public health
40:20
has always had a very good reputation for keeping
40:25
their health information private. There was a
40:28
big fight in Colorado. In fact, it was one of
40:31
the reasons I ended up in Colorado as a public
40:33
health worker. Colorado was one of the first
40:36
states to make HIV reportable, to make AIDS reportable.
40:40
Tom Vernon was the state public health director.
40:43
We need to treat this like any other disease.
40:46
And I can understand small counties where everybody
40:49
knows everybody else that that could be pretty
40:52
scary to a person. But we need to treat this
40:57
as a disease and we need to, you know, try to
41:00
prevent spread. And because Colorado was the
41:04
very first state to make HIV reportable, I was
41:07
very impressed by Tom Vernon. He was at an AIDS
41:11
convention in New York in, I think it was 1985,
41:15
86, and I'm going, that's really cool. And that
41:18
was why I got really interested in this job in
41:20
Colorado, because I really loved working with
41:23
Tom Vernon. And I think public health has done
41:27
a really good job of that. You know, we know
41:31
things that have to be kept confidential. We
41:35
need to keep our systems safe. With public health,
41:38
you're always balancing public benefit and private
41:42
rights. That's always been a tension, whether
41:45
it's vaccinations, disease reporting, or a lot
41:49
of other issues. So right now, what do you consider
41:52
the most significant challenge for public health?
41:55
I would say the attacks on public health and
41:58
science are the things I'm most concerned about
42:00
right now. You're always going to have financial
42:02
things, financial issues. I have not followed
42:08
the news closely enough. I think the state per
42:11
capita grants to local health departments did
42:13
get hit with the big shortfall that the state's
42:17
experiencing with losses in Medicaid and stuff
42:19
like that. Those are always going to be problems.
42:25
The whole anti -science atmosphere that we're
42:30
seeing, particularly in Washington, I think is
42:32
extremely concerning to me. We're having a brain
42:36
drain, I think, in science and in public health
42:38
with people either deciding not to work in public
42:41
health or for the scientists moving to other
42:43
countries to do their work. And I hope this is
42:46
reparable. I think it's going to take years to
42:50
get back to where we were. Unfortunately, I think
42:54
you're correct. On that note, though, what areas
42:57
of opportunities, what do you think that the
42:59
health department maybe should be doing or could
43:01
be doing better? I think there are incredible
43:03
scientific things happening in the world. And
43:07
I think we're going to be able to do a lot more
43:10
for health. I think we're going to be able to
43:12
do a lot more for longevity, intervening early.
43:16
I think it's probably true that heart disease
43:18
could be eliminated, ischemic heart disease could
43:22
be eliminated if we... started early. And this
43:26
isn't the health department's job necessarily,
43:28
but, you know, if we could get people to understand
43:32
how important exercise is, how important control
43:35
of cholesterol is, all of the things that you
43:38
can do to protect your heart and your brain and
43:41
your psyche. I think there's a, I get really
43:45
excited sometimes. Now there's treatments for
43:47
genetics diseases that clearly are going to be
43:50
coming. You know, I'm hoping I'll be able to
43:54
stay healthy as long as I can, both physically
43:57
and mentally. I don't know if things will be
44:01
resolved in my lifetime, but I think there are
44:04
some very exciting things scientifically going
44:06
on. What advice would you give to someone who
44:10
is considering a career in public health? You're
44:13
very brave. Actually, at the beginning of the
44:15
pandemic, it got a lot of people interested in
44:18
going into public health. I think... Some years
44:22
on, as they've seen how things have transpired,
44:24
how money has gone away, that has probably reduced
44:27
their enthusiasm for it, which I think is a shame.
44:30
Public health is a field that, I mean, you either
44:34
really love it or, you know, you're not going
44:41
to go into it. It's not high paying. I don't
44:45
know what the situation is now. We've got a lot
44:47
of nurses who got tired of it. hospital nursing
44:50
who went into public health and they absolutely
44:52
fell in love with it when they started doing
44:54
it. We have always been really successful at
44:57
getting public health staff because there's a
45:00
wonderful environmental health program out of
45:02
CSU and there's a wonderful nutrition program
45:04
out of CSU. So we never had problems hiring environmental
45:08
health specialists or hiring nutritionists because
45:11
people who went to school in Fort Collins wanted
45:13
to stay in Fort Collins. We've always had good
45:17
professional staff here. And the thing that I
45:21
really like that has been added is we didn't
45:23
have data scientists. I was trying to do that
45:26
on top of being both the public health director
45:28
and the medical director in one person and staying
45:32
here until 10 o 'clock at night. We've had great
45:36
opportunities. We have a school of public health
45:38
now where there was obviously no school of public
45:40
health. I like working at the local level. I
45:43
think there are lots of good opportunities to
45:46
do things. Lastly, what are you doing during
45:49
retirement? What am I doing during? I am having
45:51
so much fun. You may or may not know this about
45:54
CSU, but CSU allows anyone in the community who
45:59
is 55 years or older to take any class that they
46:03
offer for no credit or no tuition if the class
46:08
is in full and if the professor gives the permission.
46:11
So since the fall semester of 2019, I have taken
46:16
at least one class at CSU every single semester,
46:20
including summers. I have been loving it. So
46:23
I went to undergraduate back in the 70s. And
46:27
when you're working, you're not really staying
46:30
up with basic science, you know, like chemistry
46:34
and biochemistry and genetics and all that stuff.
46:37
And what I learned then, even if you... try to
46:41
stay up with literature and public health and
46:43
medical stuff. And for a long time, I was trying
46:46
to stay up with all the information technology
46:48
changes. And I was sort of a DOS guide for my
46:53
department at the beginning, but it's really
46:56
hard to keep up with everything. So now I'm taking
46:57
a lot of basic science classes at CSU, and I'm
47:02
really loving it. So at the beginning of the
47:04
pandemic, I was taking epidemiology of infectious
47:07
disease. Then I took... and then I took virology,
47:11
and it's mostly been science classes. I do need
47:14
to diversify into some non -science things, but
47:17
right now I'm taking a molecular genetics class,
47:21
actually. I'm loving that, and so that's what
47:24
keeps my mind active. I get my dopamine hit in
47:28
my brain by learning new things, which is, you
47:31
know, I think maybe safer than some other ways
47:34
people get their dopamine. I get way more exercise
47:38
now than I did when I was working, you know,
47:41
when you stay late at night. You know, it took
47:46
me a long time to get things done, so I worked
47:48
very late into the night, and I just spent ridiculous
47:51
hours. I was the director. So it's very nice
47:55
not to do that. I play a lot of tennis, which
47:58
is my favorite sporting activity. For those of
48:02
you who don't know, tennis, racquet sports are
48:05
the... Physical activity that's tied to the highest
48:08
longevity of all sports. Really? So, yeah. Probably
48:13
because of the repetitiveness. Supposedly we
48:16
live longer than cyclists and runners and swimmers.
48:18
And I think part of it is because the diversity
48:21
of, you know, when you run and you're kind of
48:25
like doing the same thing repetitively. And things
48:29
are always changing in tennis. You know, where
48:31
you're moving, how the ball, where you're going
48:32
to hit it, you know, what's your target. And
48:35
it's also a very social sport where, you know,
48:39
at least if you play USTA, you know, right after
48:42
the match, you know, you end up having drinks
48:44
with your opponent and stuff like that. So I
48:47
think that's good for your brain. So I walk,
48:50
I hike. I haven't traveled as much as I would
48:53
have liked to. You have animals, and having animals
48:56
makes it hard to travel. I love learning. More
49:01
recent years, I didn't realize how incredibly
49:03
important exercise is for your brain. I knew
49:06
it was good for your heart, but it's like super
49:08
important for your brain too. I think that's
49:11
another good exercise and sleep. Which I was
49:15
not doing very well when I was the public health
49:18
director. I'm doing exercise and sleep much better
49:20
now. I am enjoying that part. I feel like I'm
49:25
probably healthier now. Well, Dr. Littlebailey,
49:29
this has been a pleasure. Thank you so much for
49:31
joining us, Tenny. Thank you for inviting me.
49:35
I hope you can find some usable pieces in this
49:37
whole interview. Do you have a question about
49:41
public health in Larimer County or a topic you'd
49:43
like us to discuss? Let us know. Email us at
49:47
healthiertogetheratlarimer .org. Thanks for listening,
49:50
Larimer County. Until next week, stay well, stay
49:53
connected, and remember, we really are healthier
49:55
together.