Director's Message

Aug. 3, 2007

To: All DHS employees

From: Susan Allan, M.D., J.D., M.P.H., Public Health director

"It is a lot harder to keep people well than it is to just get them over a sickness."
~Dr. DeForest Clinton Jarvis (a Southern "country doctor")

"Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity."
~Preamble to the Constitution of the World Health Organization, 1948

For this last week that Bruce Goldberg is out of town, I have the opportunity to write the Director's Message. I am the Assistant DHS Director for the Public Health Division.

There are an incredible number and diversity of programs in the Public Health Division, but in general the purpose of public health is to prevent illness and injury, and to protect and promote health. We do this work under the umbrella of the DHS mission statement: "Helping people become independent, healthy and safe." With so much recent attention to health care reform, this is a great opportunity to take a step back and think about what "health" really means and how the many different programs of DHS can create or support health for the people and communities of Oregon.

On average, people of our generation live much longer than our great-grandparents did. Is that because our individual behaviors are superior to those of past generations? Of course not! The water they drank was contaminated with sewage. The food they ate was monotonous and often rotten or contaminated. Deaths from injuries or toxic exposures at work were commonplace. Everyone accepted that children died of diarrhea and that women died in childbirth. The major advances in health resulted primarily from changing the environment in which people worked and lived to make it easier for them to do what promoted health rather than what created illness.

This approach applies just as much today. The Oregon tobacco control program has reduced smoking by making it easier not to be exposed to smoke and harder to smoke (by restricting smoking areas and removing cigarette vending machines, for example). Educating people about the risks of smoking accomplishes very little, unless education efforts are supported by changes in the community that encourage healthier behavior. The medical system can prolong or improve the life of someone with heart disease, but the only "cure" is to prevent it. In fact, the medical system has only limited benefits to offer for the major diseases that affect us today. Our health is shaped more by the things we do every day throughout our lives than by what happens to us in a doctor's office.

What does this have to do with ASD, AMH, CAF, DMAP, FPA, SPD -- and the diverse programs of PHD? If DHS is about promoting health, then we must try not only to address clients' problems, but also to create a wrap-around environment for clients and communities that makes it easier for them to choose the things that strengthen their health -- their physical, mental and social health.

For the moment, the focus of many DHS programs is fixing problems rather than preventing them. And certainly it's right to offer services to people with serious needs. But as the community and our department enter into the discussion of health care reform, let's use this as an opportunity to get beyond the relatively narrow concern about "medical" care and consider how we can link across programs and join with community partners to become active agents for promoting health for all people and communities.

To provide feedback email: DHS.Directorsoffice@state.or.us

This message is intended for all department employees. Please read it electronically, if possible. Managers and supervisors are asked to share the message each week with employees who do not have email access.