On Tuesday, June 1, 2021, the Davis City Council created a budgetary “placeholder” to fund a new position to oversee social services. This article argues that the position should focus on public health and safety and be a director-level position.
Summary
While police departments have taken on many public health-type functions in cities across the US, they are not designed to address public health challenges effectively. Davis already has various public health programs related to homelessness, youth diversion, and mental health crisis interventions. A public-health-trained Director of Public Health and Safety can lead a small department to focus on greater coordination of current efforts, help the City Council set clearer programmatic priorities, leverage County resources, and create synergies with UC Davis, DJUSD, and non-profit organizations in the City. To advance public health efforts, the City Council should create and fund a new director position that reports to the City Manager.
Background
Cities across the US are (re)examining their police departments’ purpose, function, and role. Beyond the rhetoric of “defunding,” the police are essential questions about the militarization of local police forces, protections afforded to police officers—so-called “qualified immunity,” systemic racial bias in policing, the appropriate role of police in mental health crisis response, and the role of armed officers in routine code enforcement.
There is little argument that the police in many cities have become the de facto public health response unit for diverse challenges like domestic violence, substance abuse, school violence, general welfare checks, homelessness, and mental health crises. Some of these responses may even be built into laws and policies.
And yet, police forces are not public health agencies. They are not structured or trained to analyze the root causes of public health challenges. Moreover, they do not evaluate outcomes based on an understanding of the social determinants of health. As a result, when they respond to a crisis, it is long past the time to consider primary or secondary prevention strategies.
By the time police departments are called to “deal” with these issues, they are already at a very late stage in which only drastic “health interventions” or “palliative” care can provide a reasonable response. And yet, we continue to call upon the police to “solve” these complex public health challenges because we have created too few alternatives.
Our public health approaches are fragmented—held hostage to short-term funding cycles, changing priorities, and too little focus on creating durable local partnerships to engage in primary and secondary prevention programs. They do not adequately leverage local resources, expertise, or community support to develop relational approaches to confront our significant public health challenges proactively. Instead, we too often use the only tool at hand—the police—to staunch the bleeding.
It is legitimate to ask: “What are the things that police are uniquely qualified to do?” What follows will not attempt to answer that broader question, but it takes as a given that the police are not well-positioned to lead the response to local public health challenges, nor are they the keystone of public safety.
Without clarity about what is required to improve health and safety in our community, we will continue to revert to the police as the “answer” to public health challenges. Without envisioning a system—including staffing and funding priorities—that achieves our ends, without a clear set of ideas of how change happens—we are left with the police as the “essential” organization in the City government to respond to adverse public health outcomes.
Our Current Public Health Challenges
While city-specific data on public health challenges are rare, we can look at County-level data and the limited studies we have to outline the critical public health challenges in our City. In addition, COVID-19 has revealed that sub-populations within Davis are more likely to suffer from broader systems failures common in communities across the US. Finally, we can also look at the programs Davis already provides via County contracts and its funds to enumerate the challenges.
They include the complex syndrome that we refer to (too simplistically) as homelessness. It hides various challenges, including untreated mental illness and substance use disorders and the still poorly addressed challenge of untreated childhood and lifetime trauma.
They also include substance use disorders and, again, untreated mental health conditions among young people. Among the same group, there is also the challenge of obesity linked to poor nutrition (which in turn is related to too-high levels of food insecurity and poverty[1]), which are precursors for lifelong health problems, including Type II diabetes and cardiovascular disease.
Finally, the COVID-19 pandemic and the changing demographics of Davis have revealed how vulnerable low-income seniors are, given poor nutrition and isolation.
This is not an exhaustive list, but data from various sources—provider and County- and School District-sponsored studies suggest that they are priorities. Indeed, programs that the City and the School District have developed indicate they are priorities.
A Director and Department of Public Health and Safety for Davis—Function and Structure
A Director and Department of Public Health and Safety will
- focus on greater coordination of current public health efforts,
- help the City Council set clearer programmatic priorities,
- leverage County resources, and
- create synergies with UC Davis, DJUSD, and non-profit organizations in the City.
The key to the Department is to have a qualified Director who can coordinate local efforts and provide critical data analysis for decision making. The Departmental staffing is limited by design and buttresses County efforts, in no way replacing or duplicating them, but rather leveraging them for more significant impact.
Launching it would allow all current public health and safety activities to come together into one department with limited additional staff needed. The Department would also produce an annual report on public health and safety for the Council and be a clearinghouse for data from all City activities connected to health, safety, and wellbeing.
There are several historical and practical challenges to developing a separate Department of Public Health and Safety to address these priorities. Still, the cost of not managing them proactively and comprehensively indicates the need for a City Department to coordinate efforts related to them.
In fact, in recent years, the City has created new positions and used consultant services to formulate successful programming to address homelessness (as one example). The consultant has helped build accountability structures around these programs and brought in resources for the Bridge to Housing and Employment and emergency shelter programs and significant funding for Paul’s place. Imagine what a full-time staff person tasked with developing community health and safety programming could do to increase funding and build programming accountability.
The two figures show a Public Health and Safety Department’s place within the current City structure and how it could be structured internally to coordinate programming and launch new initiatives.
First, note that the new department would combine with Fire and Police to form a public health and safety coordinating body. The purpose of this body is to analyze public safety across departments, share and discuss data, develop the template for an annual “public health and safety report,” and look for ways to streamline public safety services in the City to avoid duplication and assure efficient use of resources. The Department of Public Health and Safety is headed by a Director who reports to the City Manager. The position overseas current programs and develops new ones in priority areas.
The second figure[2] illustrates the key divisions within the Department and demonstrates that solid data analysis, program evaluation, and interagency collaboration are central to its mandate. It also calls out this department’s potential to coordinate reporting on public safety-related code enforcement in the City. Not all code enforcement is safety-related (think parking enforcement), but much of it is. The Fire Department, the Planning Department, and the Police Department carry out most code enforcement actions. Creating a new Department will enable the City to “step back” and ask about the best ways to carry out, coordinate, and, most importantly, report to the City Council and community about code enforcement actions and results. Having a coordinating body will enable the community to understand better the role of code and code enforcement in keeping citizens safe. It will also permit a re-evaluation of the best ways to carry out enforcement.
The ideal candidate for the Director role is public-health-trained with a solid epidemiological background and community-based programming experience. The department’s staff can be lean with the Director heading all current initiatives until funding for new initiatives supports division heads.
It is essential to point out that City staff do not implement programs for the most part. Instead, high-quality local non-profits, like Communicare, HEART of Davis, and YCRC, receive contracts to implement programs. This is consistent with current practice in programs such as the Davis Emergency Shelter Program, the Respite Center Program, the Youth Restorative Justice Program, and Project Roomkey (all existing projects). These programs receive funding from County and State grants and general fund dollars designated for community priorities.
A key in this model is Community Health Workers—called “Navigators” here—to extend services and build truly relational programming.[3] Navigators are a critical part of the Department’s service delivery and are a feature for which Davis has unique opportunities. Given the University and many healthy and knowledgeable retirees, recruitment of high-quality navigators who speak a variety of languages will enable a deepening of services in any of the programmatic divisions.
Perhaps most importantly, the Department will be a hub of activity that links the City with the University and School District on programming and draws from University research and expertise to test new programs and provide students with learning opportunities. Healthy Davis Together (HDT) has forever changed how the City, School District, and University view collaboration to solve real-world problems. HDT has shown that the three agencies can face a significant challenge and coordinate activities with County health officials to achieve impactful outcomes.
Having a Department that builds upon and enhances these new and still evolving partnerships will extend health and harm reduction programming developed for UC Davis students and staff into the community. It will create a city/university learning environment in which new programs can be tested, evaluated, and improved. It will create synergies that will extend dollars from each entity’s budget to improve the wellbeing of the Davis community.
Having a Director of Public Health and Safety will strengthen the City’s voice at the Yolo County Homeless and Poverty Action Coalition (HPAC). It will help the City to place and coordinate resources flowing from the County more effectively. And it will enable greater accountability towards the Citizens of Davis.
Paying for it
An obvious question is how the City pays for this new full-time senior position to staff. The first answer is that budget decisions are about the relative City priorities, and my experience on the City Council indicates what we value we will fund.
Citizens in Davis pay additional annual taxes to fund the purchase and maintenance of open space and pay for parks and our library. In addition, we tax ourselves to provide maximum programmatic choice for students in our schools. These are our choices, and we staff programs based on these choices.
We, that is, our City Council, can decide to move general funds to hire a Director of Public Health and Safety. This is a choice.
It appears from Tuesday’s decision that the City Council is prepared to find the funding from a combination of sources—including American Rescue Plan funds and by moving funds from other City programs. This demonstrates that there is the political will to make this change. This is the first and most crucial step.
The decision is about priorities. We have already decided that we must more actively address homelessness, mental health crises, and youth challenges in Davis. Funding a new position takes the next step to assure that the benefits and reach of such programs are maximized by having staff devoted to overseeing their implementation and impact.
Power Dynamics and Institutional Change
To close, I return to a consideration of the role of the police in this and any city. Police and Fire are the two premier public safety institutions in any city (while programs like wastewater, solid waste disposal, and water are essential broad-based public health services).
Whenever public health and safety are a topic of City concern, the Davis Police and Fire Departments are “at the table,” both figuratively and literally. The City Manager and the City Council thus hear, consider, and give weight to their perspectives. They “frame” issues according to their view of how the City should solve its public health and safety problems.
This framing gives these departments significant power to determine the public health and safety programs the City will carry out and recommend budgets to carry them out. And yet, while both departments play a role in public health and safety programming, neither views problem solving from a public health perspective. With limited exceptions (inspections and pro-active code enforcement), both departments are “responders.” They respond when situations get out of control—when public health and safety are under threat. They are not primarily concerned with primary or secondary prevention.
A Director of Public Health and Safety position creates a new voice—a new framing of solutions—within the City. It is a “power center” with a unique perspective about the role of prevention. Given the nature of public health practice, it is also a center that seeks cross-sectoral collaboration and multi-disciplinary problem-solving. This is the unique contribution that a Department of Public Health and Safety brings to the City of Davis, and I believe it is past time to create it by hiring a Director of Public Health and Safety as a first step.
[1] Space does not permit a full development of the social determinants of these health challenges but poverty, poor access to care, and racial and linguistic exclusion from information and resources are critical to many of them.
[2] Items highlighted in green are existing programs and activities. The red dotted line illustrates staffing that is not City employed but is privately contracted via non-profits or other organizations or is volunteer. One exception is the extensive senior-focused programming that the City already has. Those programs would be moved under the Director of Public Health and Safety in this model.
[3] For more on Community Health Workers (CHW) see here, here, and here.
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