With issues like opioid addiction, low vaccination rates and unequal access, being a public health officer has never been more important.
IN NOVEMBER OF 2010, a 44-year-old Matt Willis was sent from his job at the Centers for Disease Control in Atlanta to Marin County to study the outbreak of pertussis (whooping cough). A graduate of Harvard’s School of Public Health, with a medical degree from Temple University, Willis grew up in Marin. He’d previously returned to the county as a pro cyclist on the racing circuit, but it was during this visit that he started to think about moving back with his wife and three kids.
His next assignment for the CDC that year was a trip to Haiti, after the earthquake that displaced millions, where he reported on outbreaks of vaccine-preventable disease — a situation clearly brought on by lack of access. He thought back to Marin County, where, ironically, residents were facing the same outbreaks by choice. Fast-forward three years to his relocation in Marin, where one of the first items on his agenda as the county’s Public Health Officer was to find out why so many Marin parents were choosing to not vaccinate their children — at a rate four times greater than in any other county in the state. He decided to do something about it.
Willis and the rest of the team in the Public Health Department, trying to devise forward-thinking approaches to Marin residents’ health issues, have already created a handful of protocols that have been shared with agencies across the country. The latest project, a partnership with other County of Marin departments called Hack4Health, wrapped up this month.
How is the health of our county residents?
Marin has been ranked the healthiest county in California seven years in a row by the Robert Wood Johnson Foundation, has the longest life expectancy of any county in the nation, and was named the country’s healthiest county for children by U.S. News & World Report. When I took this job, I wasn’t interested in being the Maytag repairman of public health, and when we dig deeper we see that we have plenty of work to do to. We’re at risk of outbreaks because of low vaccination rates. We have huge disparities in health status between communities across the county, with much higher rates of preventable illnesses like heart disease in some low-income neighborhoods. And we stand out year after year as having high rates of substance use and have been deeply impacted by the national epidemic of opioid painkiller abuse. These problems are the focus of Hack4Health.
What are you hoping for with Hack4Health? The County of Marin is committed to using technology in innovative ways and this program was created by the Information Services and Technology Department here. They have important data, such as on the 15,000 calls that came through 911 last year, as well as community information on vaccinations, childhood obesity and opioids. To make sense of this information they have asked us here at Health and Human Services to analyze it. Think of it like CSI Marin. We brought in high school and college students to come up with innovative solutions to some of our biggest [health] challenges here in the county. Ideally, we will end up with important information such as where bike crashes might occur most often, or is there a city where seniors are having more issues. Our goal is to come out with a few ideas such as an app for a patient with pain. For instance, because of the opioid epidemic, doctors are prescribing fewer narcotics for pain; we’d make even more progress if we had an easy way to access healthy alternatives like physical therapy, acupuncture or chiropractic. An app could help with that.
Can you describe your work with the vaccination issue and tell us what the current status is here in the county? When I came on board we had the lowest vaccination rate in the Bay Area and were about four times lower than the state average. The message that vaccines were safe and effective just wasn’t penetrating, and our first step was to understand why. We did a survey of parents to ask what their beliefs were when they decided to not vaccinate. This was something that hadn’t really been done at a community level before, and it added nuance to the conversation. One of the big factors, we learned, is that parents really didn’t understand that vaccination is not just a personal decision. When we vaccinate our kids it protects their friends, neighbors and classmates. When they see it as part of community well-being, I think more people opt in. A local measles outbreak, the understanding of the risks of non-vaccination and changes in vaccine policy have all played a role in improving our rates. Since 2012 our rates have improved every year.
Can you talk about the crisis surrounding opioid abuse? The leading cause of accidental death in Marin is prescription drug overdose. Opioid painkillers are driving most of this. They’re highly addictive and even one too many pills can end a life. In the years 2012 and 2013 one person overdosed accidentally every two weeks in Marin, one in five high school juniors reported they’d taken painkillers recreationally, and the problem was getting worse. To me, this data was a real call to action, and we convened a town hall–style meeting in early 2014. One hundred or so people including doctors, police officers, elected officials, educators and parents came, and we spent five hours designing a game plan. Out of that grew RxSafe Marin, our countywide prescription drug abuse coalition. This has been one of the most rewarding projects, since I’ve gotten to work with great people who share responsibility for protecting our community inside and outside of government. Now we’re sharing our coalition model with other communities as people are looking for solutions to the opioid epidemic nationally.
Our positive health scores are off the charts, but we seem to be on the opposite side of the scale when it comes to substance abuse. High rates of substance use are really inconsistent with the other health norms in Marin and it’s a concern. In California, the Healthy Kids Survey says 80 percent of high school juniors report that alcohol and marijuana are easy to access, and half that number report using these in the past month. With changing laws and the likely increased availability of marijuana, we approach this a lot like alcohol. Whatever our beliefs about adult marijuana use, we should all agree that it’s not safe for young people. In considering dispensary locations and practices, we’re working with the county to help ensure that kids are protected. We’re also learning more and more about adolescent brains, and it’s clear that use at that age impairs development and increases risk of lifelong addiction. I also see how hard Marin parents and kids work to set themselves up for success. While substance use threatens that goal of high performance, we’re also hearing from kids that stress is one reason they’re looking to alcohol and other drugs. The county health rankings are a stark reminder of our substance abuse problem. While we rank far above most counties in almost all established indicators of community health, we rate near the bottom in three: adult binge drinking, DUI rates and accidental drug overdoses.
How can parents who like to have that drink or two at the end of the day model good behavior? It’s important to me to show our kids that we can be together and celebrate with friends without alcohol. There’s a big difference between a beer or wine with dinner, versus sneaking a flask into a high school soccer game. I don’t think it helps our kids to pretend they don’t have choices — but we can help them navigate the real choices they have by modeling good judgment.
Are you concerned about losing Affordable Care Act benefits? Totally. We have made such positive gains with this program. Under the ACA, 14,000 uninsured Marin residents gained health insurance. We saw a reduction in emergency room visits for that population since people had access to a regular doctor. When people don’t have access to preventative primary care, too often they end up going to the emergency room, either for small things that are best dealt with in a clinic or they’ve waited so long and are so sick they need to be hospitalized. Not only is this expensive for the county, but it’s dangerous as well. In the case of communicable diseases, people will wait longer to get help, thereby infecting many more people.
What is the current state of health equity within the county? While our health scorecard is very high for the most part, there are communities within Marin that do not share these healthy statistics. For instance, the life expectancy of someone in Marin City is 15 years shorter than for someone in Ross. We don’t think that your ZIP code should determine how long you can expect to live. Again, looking at the data we gain some clues in how to address this injustice. Turns out that the leading driver of preventable death in our low-income communities is heart disease. We can do something about that by making sure everyone has the same chance to have good nutrition, recreation for an active life and access to health care. For the kids, we’re focusing on schools with higher obesity rates. For the adults, we partner with clinicians, who identify individuals who would benefit from our Parks Rx program, which offers boot camp–like workouts at parks around the county.
What was it about Marin that lured you back? Last weekend I was at the top of Tam with a group of high school students. My daughter is on the Drake mountain bike team and I help lead team rides. When I see those kids digging deep and making it under their own power all the way up Tam, I’m so grateful to be part of that picture. It’s a really unique place. The promise of that kind of day was part of what brought us here. Most of my best memories of growing up here revolved around being outside with friends. I wanted a place where my kids could roam safely and have little adventures and feel capable and have healthy relationships. Professionally, I thought this would be a wonderful place to do a deep dive into what sustains health in a community, to define those factors that correlate to health and longevity and spread them to every community.
How do you like your job? I love my job. This is a well-resourced county with a real dedication to well-being — quality of life is important to people in Marin County. So I think I have the best job in the county, for sure. I get to step back and say what can optimize this community, what are we doing well and what could we improve. I’m really interested in how we organize to support the basics of health for everyone across the age spectrum, while protecting ourselves from harmful things like substance abuse. We have solid ways of measuring the vital signs of our community through data. It’s no coincidence that the county with the longest life expectancy also has measurably high rates of regular exercise, healthy eating and access to health care. Our number-one status is exciting, but we have an even more important goal: when those health benefits extend to every community, we’ll really have something to celebrate.