Mission statement debate exposes fissures on county health board

Gathering together for an inaugural work meeting, Lincoln County Health Board members navigated fault lines exposed by the pandemic while brainstorming a new mission statement.

The March 9 work meeting, meant for discussion rather than action, came out of efforts by the board’s membership to bone up on Robert’s Rules of Order and parliamentary procedure. After a winter — and fall, and summer — of the public’s discontent, members underwent the training at the behest of county commissioners, who likewise voiced displeasure at how meetings were handled.

“We haven’t done this before,” said Chair Jan Ivers. “This is new. And I’m kind of excited about that.”

For several members, it was the first chance to meet in person. The board, which includes representatives from Eureka, Libby and Troy as well as one commissioner and three at-large members appointed by commissioners, has gathered largely via Zoom during the pandemic. Newcomer Scott Bernhard of Eureka traveled from north Lincoln County along with County Commissioner Josh Letcher (D-3) and Eureka representative Debra Armstrong to attend the session, held in Libby’s Ponderosa Room.

Missing at the meeting was Dr. Sara Mertes, vice chair and at-large member, and a Libby representative. City councilors in the county seat are still looking for a successor to former member Laura Crismore.

But warm welcomes quickly made way for longstanding fissures over what constitutes public health, although the verbal sparring was less tense face-to-face than over Zoom.

Examining the existing mission statement — “[The board] works to prevent disease and illness, ensures a healthy environment and promotes healthy choices by setting county-wide policies and regulations to protect the health of Lincoln County residents — members found it wanting. Ivers called it “vague.”

“I would like to see something in the mission statement about following evidence-based information. I would like to also see … a differentiation between personal health and public health,” Ivers said. “To me personal health means I take responsibility for me. … Public health is what I do that affects other people.”

Where to draw that line, between the personal and the public, proved a thorny topic.

“So when you say public [health] are you just talking communicable disease-only?” asked Armstrong, who has regularly pushed back on county Health Officer Dr. Brad Black’s assessment of the pandemic and urged caution about promoting COVID-19 vaccination efforts.

“Many times during our conversations about this pandemic, we’ve heard ‘I’m not going to wear a mask because its my constitutional right not to,’ and I agree with that except where it’s infringing on other people,” replied Ivers.

Letcher argued that people would differ over prevention. He took sex as an example. Where one person might believe in contraception, another might not. Letcher argued the board should not forget the vulnerable, among which he included the unborn.

That led Armstrong to ask who the most vulnerable were to COVID-19. Jim Seifert, the Troy representative to the board, said it was overwhelmingly the elderly and those with underlying health issues. That’s why they were at the top of the list for vaccinations, he said.

“That’s the way it is with any disease,” Armstrong said, later arguing that the board’s purview should be education rather than rulemaking. When Seifert asked about enforcing quarantines, Armstrong rejected the measure.

“I would not like to be dictating anything, necessarily,” she said. “I think our position is mainly educating.”

Armstrong used smoking as an example. It’s a personal choice to smoke, but health officials discourage it and offer help to those quitting. Still, it’s up to the individual whether to buy a pack of cigarettes.

Ivers agreed, though she noted that second-hand smoke affects other people.

But if health officials could aid in smoking cessation, then they were intervening in personal health, Armstrong said.

“I think that is one example of a personal health issue that is a choice,” said Armstrong, who admitted that nicotine addiction could be seen as removing free will. “That’s a personal health problem that is entirely appropriate for us to be addressing and I think there are others, too.”

The debate represented a proxy war of words. As concerns about the pandemic increased in the fall, several residents clamored for officials to promote vitamins, supplements and nutrition as much as — or more than — vaccinations. Where a few members have been leery of making recommendations about supplements, others have asked that the board approach vaccinations with the same level of concern.

Vitamin D has emerged as a high profile player in that debate. A correlation between vitamin D deficiency and COVID-19 mortality rates was found in 2020. New studies, including one from Canada’s McGill University, questioned those early findings and failed to show a link between vitamin D supplements and the severity of coronavirus.

In the meantime, residents opposed to vaccination have presented vitamin D as a near cure-all during public comment periods of board meetings and on local social media websites.

Ivers said that she uses vitamin D at the recommendation of her primary care physician. Still, recommending its use for residents seemed risky, she said. And it might alienate residents if it seemed like the board was pushing supplements, Ivers warned.

“Well, we’re not giving out vitamin D3 and setting up vitamin D3 stations,” Armstrong said, referring to the vaccine clinics hosted by the county health department.

Ultimately, board members leaned toward emphasizing education in their mission statement. Underscoring good personal health, like nutrition and sleep, seemed appropriate as long as the board kept up with scientific advancements and offered information with the caveat of checking with a health provider first.

“As the science improves we need to improve, too,” said Letcher. “I think we can be overloaded with information. The more we can help people get the proper information they need for themselves [the better].”