What is public health?
It's a question the Monroe County Health Department is asking itself and the community, as the department transitions many of its primary care clients to health care partners in the community.
According to Florida statute, county health departments are legislated to provide services for environmental health, communicable disease control and primary care.
"We've always provided these services in one way or another, either through referrals to community health care partners or taking on the provider role ourself whenever there's a shortage of a particular service," Health Department spokesman Chris Tittel said.
Over the years, the primary care role the department has played, especially for low- and no-income residents, has grown.
"Shortly after the new administration took office in Tallahassee in 2010," Tittel said, "inventories of various state agencies -- including the Florida Department of Health, which is the parent agency of the Monroe County Health Department -- were taken to determine where departments might be merged or even cut.
"We were watching the events in Tallahassee from afar and considering how this might impact us at the local level."
At the same time, health care agencies across the state were applying for Federally Qualified Health Center (FQHC) status and funding that would allow them to serve a community's primary care needs from cradle to grave.
Nationally, FQHCs, brought about by federal legislation in 1991, are growing in number.
Within the past three years, two FQHCs have sprung up in Monroe County: The Rural Health Network, based in Key West, and Community Health of South Florida Inc. of Homestead.
"It's a question of shifting focus from providing the clinical needs of the individual to serving the needs of communities at large," Tittel said.
"As we begin to refer more and more primary care clients to FQHCs and other health care partners in the community who can provide those services, we can get to the bigger questions that public health can pose for our populations."
Population-based services the department provides target, among other things, HIV/AIDS awareness, healthy nutrition and smoking cessation and prevention.
One of the most effective population-based programs involves vaccinations, including childhood, adult and travel. The department is currently promoting a vaccination among adolescents against the human papillomavirus, or HPV, which is increasingly linked to cancers later on in life.
Health Department employees are also trained as emergency first-responders for both natural and man-made disasters, including hurricanes.
And for good measure, Tittel is also one of three "certified helmet fitters" in the department, which also distributes bicycle helmets to low-income kids as part of its injury prevention program.
Tittel sees FQHCs as a force for good that will free the department to focus on broader issues, while much of the public is unaware of their existence.
"The example I like to use is Dr. (Jerome) Covington," said Tittel. "He was performing primary care functions for us at the Health Care Center and the Roosevelt Sands Center. Now, his same patients are seeing him at dePoo, under the auspices of the Rural Health Network.
"For his patients, nothing has changed. For him, nothing has changed.
"For us, it offers the chance to focus on the population-based programs ... such as vaccinations, and sexually transmitted disease awareness programs, and even find out from our partners and the public other areas on which we might focus. The FQHCs are a good way to make sure people are taken care of on the clinical side, while we tackle much broader issues."
Tittel wants to hear from the community about what the Health Department's focus should encompass.
"I invite interested parties in the community to contact me with their questions or concerns," Tittel said.
"Help us adapt to the changing needs of county residents. The Monroe County Health Department is your health department."
Contact Tittel at 305-809-5653 or Christopher_Tittel@doh.state.fl.us.