COUNTY OF MONTEREY HEALTH DEPARTMENT Celebrating 100 Years of Public Health

2 The County Health Department originated with a Rockefeller Foundation grant for $5,000 and a match of $5,000 approved by the Board of Supervisors in February 1923. Much has changed since that time, but the Health Department’s commitment to the wellbeing and health of Monterey County residents and its environment has not. In 1923, the life expectancy in the United States was 56 years of age for men and 58 for women. Top causes of death at that time included measles, typhoid, diphtheria, diabetes, influenza, and cancer. Today, the life expectancy for men is 77 years and 81 years for women with heart disease, cancer, and stroke being the leading causes of death. The increase in life expectancy and changes in causes of death is a result of implementation of evolving public health practices over the last 100 years. In the early days of the Health Department, the small staff focused on maternal and child health and the prevention of diseases, plus inspections of dairies. Today, your Health Department has over 1,200 employees and annual operating budget of $370 million and provides services across many programs, from chronic disease and injury prevention, communicable disease surveillance and response, public health and chemistry laboratory, primary care and behavioral health clinics, emergency medical services, environmental health and animal services, public administrator/conservator/ guardianship, and health equity. It is safe to say that every day your life is touched by the Health Department in some way. In the last hundred years, major advancements have been made in public health science and practice. The development of vaccinations resulted in the prevention of illness and death from diseases that used to be fatal. Advancements in the field of epidemiology resulted in better surveillance and investigations which prevent further spread of communicable diseases. Other major accomplishments in public health include improved maternal and child health services and passage of policies that reduce injuries and premature death due to seat belt laws and tobacco sale restrictions. These innovations in public health practice and policy have reduced and prevented the spread of disease and injury, keeping residents of Monterey County healthier and living longer. Education has long been at the core of the services your Health Department provides. Today, we implement programs that educate residents and policymakers in Monterey County on healthy living, nutrition, diabetes prevention, food safety, infant care, mental health awareness, vaccinations, tobacco policy, and community engagement. We believe it is critical to advocate for environments and policies that make it easier for our residents to make healthier choices and achieve their unique potential. A LETTER FROM OUR DIRECTOR Copyright © 2024 by The County of Monterey Health Department. Produced by Milestone Communications. All rights reserved. Any unauthorized reproduction of this publication or its materials is prohibited.

3 County of Monterey Health Department strives to make our county a healthier place to live, work, play, learn, and pray and as such has adopted a Health in All Policies approach, focused on advancing health and racial equity driven by community voice. Research shows that life expectancy is affected by where one lives and that communities of color experience disparate impacts in health, housing, economics, and mental wellbeing. Through engagement practices and culturally and linguistically relevant programs, policies can be developed to better serve communities that have historically been disinvested. No look back is complete without mentioning the recent pandemic. The COVID-19 pandemic was not easy for any of us and required all of us to make sacrifices for the health of our communities. Even as of this writing, it remains a major cause of death in the United States. The pandemic also shined a bright light on how much inequity exists in our communities and how vulnerable some of our residents are. The pandemic response spearheaded by the Department’s Public Health bureau was also a collaboration of many other agencies, organizations, businesses, and the residents of Monterey County. Looking towards the future, our mission will not change. The current topics and issues may change, our population will change, and we will learn more about how to make our communities healthier. I invite you to become involved in making Monterey County healthier. Learn more about opportunities to engage in local health policy considerations and programs. I encourage young people and individuals looking to make a career change, to consider public health. Together we can make Monterey County a healthier and happier place to live, work, play, study, and pray. Elsa Jimenez, Director of Health Services – County of Monterey

4 The County of Monterey Health Department celebrates 100 years this year, commemorating a vibrant history responding to the ever-changing needs of county residents. Dr. Robert Melton served as Director of Health Services and Health Officer for the County of Monterey Health Department from 19822001 and his perspective on the department’s history is insightful. “(First) the health department primarily did things for people. Then we did things to people,” Melton said. “Now we do things with people.” Through these distinctive eras and still today, the County of Monterey Health Department’s deep connections across its sprawling 3,700 square miles of service area continue to promote a healthy and thriving community for everyone. The County of Monterey Health Department’s official beginnings trace back to 1923, when $5,000, one part-time doctor and one parttime nurse embraced the task of elevating the overall health of the entire county, says Karen Smith, the MCHD’s Public Information Officer for the last 17 years. A lot of people don’t understand that public health is focused on the community while regular health care relates to the individual,” Smith said. “While we may do individual things, the purpose of public health is to create a healthier community so that people flourish.” Well before the official foundations of the MCHD 100 years ago, Melton discovered evidence of a concern for community health way back in records from the 1700s. “They cared about mental health in 1780. They were writing about it,” said Melton. He describes a journal entry where a Surgeon General in Monterey’s early Spanish colonial era attributed the “high frequency of insanity” to Monterey County’s “overstimulating climate.” “People weren’t that different in what they thought about and worried about,” Melton said. As Monterey County entered the 19th century, public health prioritized projects like establishing sanitary sewer systems, building landfills, and standardizing drinking water. As germ theory, or the 1920 Public Health 1920s Science-backed clinics run by city health departments begin to take shape across the country, providing medical care and health education. Immunizations begin to reduce death rates from typhoid and diphtheria but others, like tuberculosis, are not yet understood

5 belief that microorganisms cause disease, gained traction in the mid19th century, Melton found evidence of community-level efforts to fight life-threatening infectious diseases. In the 1840s, an image of a “pest house” illustrates early quarantine efforts. “Monterey attracted people with education, information, training, and sophistication,” said Melton. From this innovative environment, the work of the MCHD would evolve to handle waves of threats to community wellbeing. The 20th century brought an explosion in diversity to Monterey County, with the first significant recruitment of immigrant labor emerging in the 1920s. By 1924, Salinas became the wealthiest city per capita in the United States, per the Monterey County Historical Society. Advances like “ice-bunkered railroad cars” sparked a switch to nationwide shipments of lettuce and artichokes instead of the valley’s previously-prized sugar beet crop; the region was becoming The Salad Bowl of the World. By 1930, the population of Salinas ballooned to 10,263 and Dust Bowl migrants joined the expanding and increasingly diverse immigrant farmworker labor force. According to the Salinas Public Library, this concern about an influx of migrant workers grouped into labor camps motivated community-level efforts to control infectious disease. Melton described nurses as the primary influencers of public health in the MCHD’s earliest work. Their efforts reached into the forgotten 1923 One part-time doctor, one part-time nurse, and $5,000 establishes the County of Monterey Health Department (First) the health department primarily did things for people. Then we did things to people. Now we do things with people. – Dr. Robert Melton

6 corners, which Melton describes as “a big county of small communities.” “The 1920s really was a great era in public health nursing because they were doing things no one else was doing,” he said. “They were out in the field all the time.” Containing communicable disease remained the top priority for the MCHD from its earliest days through the 1950s. Before vaccines and antibiotics, threats from infectious disease made a short life expectancy an accepted fact of life. “Communicable diseases were the threat from the Spanish period all the way through the 1950s. They were everywhere and on everybody’s mind,” said Melton, who ranked the eradication of communicable diseases like polio, smallpox, and tuberculosis during this era as one of the best achievements of public health. Monterey County operated a robust public health lab throughout this communicable disease era, even investing big to retrofit the lab for safe testing of tuberculosis cultures. The lab has evolved considerably since, now completing water safety testing and risky evaluations of animals for traces of rabies. Monterey remains one of the few counties in California dedicated to maintaining a budget for their lab. Half of the state’s public health laboratory facilities have closed since 1980, according to Melton. “Public health labs have been rare since the 1950s,” said Smith. “Most are closed down because (counties) can’t afford to keep them open unless it’s a big city.” As infectious disease risk lowered with the introduction of coordinated vaccination campaigns and widespread antibiotics, the MCHD transitioned to a new purpose: educating Monterey County residents about the risks of long-term health concerns. Dr. Melton entered the MCHD in the early 1980s, but the department he inherited represented an organization largely operating like it was still the 1950s. It became clear the county’s needs had shifted from communicable disease to chronic disease, he said. In 1982 MCHD expanded the Health Promotion division and received significant grant funding and national recognition for its work on anti-tobacco campaigns and awareness around seatbelts and car seats. Even local celebrity Clint Eastwood got involved with the MCHD, starring in a commercial about Public Health Public Health provides an array of services that are as diverse as the communities we serve. – Dr. Edward Moreno 1930 1930 The National Institute of Health (NIH) begins 1930s Monterey County labor camps filled with a diverse immigrant farmworker labor force prompt community-level efforts to control infectious disease. Public health nurses provided on-the-ground care in the forgotten corners of Monterey County.

7 the importance of buckling up. Simultaneously another chronic condition was demanding the attention of the MCHD: mental illness. As the trend to deinstitutionalize psychiatric patients in the 1950s and ‘60s accelerated nationwide, Monterey County worked to support this in-need population who now had nowhere to go, said Melton. The solution came from an enduring partnership between MCHD and Interim, Inc., a community nonprofit focused on supporting people with chronic, severe mental illness. Interim has now built and operates permanent, affordable, supportive housing units for more than 150 people throughout Monterey County. As recently as 40 years ago, the MCHD oversaw the organization of the county’s first coordinated ambulance service. Before these efforts, not only did ambulance service not cover the entire county, there was no standard of medical training for those responding to emergencies, said Melton. Dr. Melton remembers the impact of this public health initiative clearly. “The first week we had a paramedic ambulance in Big Sur an 8-year-old child was stung by a wasp,” Melton said. “The ambulance was there, had an EpiPen and could respond to the scene of the kid who was allergic to the sting and treat him. It was the first example of the difference (EMS service) makes in a place 45 minutes from a hospital.” The closure of Fort Ord and Silas B. Hayes Army Hospital in 1994 brought new challenges to MCHD, Melton said. The Health Department responded by quickly mobilizing primary care clinics in Seaside and Marina. These humble beginnings included a former dental office lent to MCHD for Marina’s clinic. Seaside’s new location provided care from a rented trailer in a parking lot, remembered Melton. “Now there’s a county-wide clinic system. Now there are obstetricians, internists, and others,” Melton said. “Building the clinic system was a big step for the health department.” As the 20th century drew to a close, the MCHD responded to the HIV epidemic and helped residents grapple with their increasing concerns about environmental health and climate change. These layered concerns for residents prompted a new focus on innovative collaboration for the health department, Melton said. “Before 1990 local health departments were not viewed as engaged in community activities,” he said. “But since the 1990s, health departments all 1937 National Cancer Institute begins 1940s County of Monterey Health Department evolves to include other public health concerns, like vermin control, air pollution, and water quality 1940

8 over California and around the country have really learned and become aware of the importance of collaborating.” The new millennium brought a continued focus on chronic disease, including an emphasis on childhood obesity and social isolation as a more sedentary, plugged-in population developed. The legalization of marijuana and annual threat of wildfires were two topics the MCHD grew to embrace. The department now registers medical marijuana cards for patients and helps hospitals respond to environmental disasters. Of course, the recent COVID-19 pandemic kept public health front and center for years – an unexpected position for this under-the-radar department, said Melton. “Public health has worked almost entirely behind the scenes. People are unaware of it and take it for granted,” said Melton, describing such wide- ranging services as animal control, conservatorships and restaurant inspections as responsibilities of the MCHD. Dr. Edward Moreno serves as the current Health Officer and Director of Public Health for Monterey County. The department has grown to a budget size of nearly $46 million – quite a leap from the start-up investment of $5,000 one century ago. Moreno oversees programs implemented by 213 employees fanning out across the county to help families afford groceries with the WIC (Women, Infants, and Children) program. Others deliver anti-bullying programs in schools. Public health workers test for potential water contamination and safely dispose of syringes. “Public Health offers services at our main offices in Salinas. However, we don’t stop there. We also bring services to schools, homes, businesses, and other locations across the county. Public Health provides an array of services that are as diverse as the communities we serve,” said Dr. Moreno. “Public Health is credited with adding 25 years to the life expectancy of people in the United States.” As the MCHD embarks on its next 100 years, Melton explained a continued need for community-level education not only about health issues but also about cooperation. “The challenges for the future are public understanding of how science saves lives,” said Melton. “It always surprises me how people are unaware of the activity going on and unaware of what a difference (MCHD) has made in life expectancy. What is needed now is public cooperation for the public good.” Public Health 1947 California begins sending consistent state funding to local health departments for the first time 1944 The Public Health Service Act modernizes public health in America, including raising standards for sanitary and professional healthcare environments

9 The Environmental Health Bureau (EHB) of the County of Monterey Health Department works behind the scenes to protect everything from the food we eat in restaurants to the homes we make for our families. “Environmental Health Bureau’s influence can be seen everywhere; in clean air, clean water, sanitation, green spaces and safe workplaces, all that enhance quality of life,” said Ric Encarnacion, Bureau Chief and Director of Environmental Health for MCHD. “This ultimately results in healthier lifestyles, improved productivity, empowerment of women, safer children, and security for the elderly,” says Encarnacion. “We have about 10,000 environmental health-permitted activities that we oversee per year,” Encarnacion continued, “The EHB ensures that those who can affect the health of others, through their business or own personal actions, do what results in positive outcomes for their customers and the general public.” In addition to these permitted activities, the 52-member EHB team also monitors “a few hundred more” non-permitted issues that may need a quick response, like complaints of illegal housing or food-borne illness outbreaks. The Environmental Health Bureau operates offices in Monterey, Salinas, and King City with a $13 million budget. While these efforts may feel cumbersome to citizens, Encarnacion asserts the EHB is “directly linked” to sustaining a more nurturing community and boosting a population’s overall mental wellbeing. The EHB evolved to meet the needs and challenges of California’s First City, ever since the first investigations to identify and control communicable diseases among early settlers in 1870. Then called the State Board of Health, these closely-tied functions of environmental and public health formed the foundations of the County of Monterey Health Department. Public Health remains in collaboration with Environmental Health, although the bureau’s name can be a misnomer to the public, said Encarnacion. “Another common misperception is that environmental health is only about preserving the (natural) environment,” he said. “Our primary duty is to protect the health of the public, especially by Environmental Health 1950 1950s Communicable diseases like polio, smallpox, and tuberculosis, once the number one priority of public health, are eradicated through vaccination campaigns

10 ensuring people use the environment responsibly.” As the bureau and the region changed, EHB grew to specialize in the pressing issues of the time. Monterey County’s “sanitarians” helped tackle complicated needs like monitoring water quality and air pollution and controlling vermin throughout the mid-20th century. By the 1970s and 80s, as concerns with our shared natural environment occupied more of citizens’ thoughts and behaviors, a push to use recycled water for agricultural purposes took shape. Former Monterey County EHB representative Walter Wong earned recognition across the state for his forward-thinking conservation efforts that still resonate today. “In any county, the dominant industry must partner with environmental health regulators to assure safety and security for all,” Encarnacion notes. “Decisions regarding water quality, water sustainability, food safety, employee housing, organic waste and many other programs must and will consider the impact that agricultural and tourism practices have on health, the economy, and resources.” As the 21st century began, Monterey County’s EHB rolled out several unique programs to serve the region’s two major industries: agriculture and tourism. Former EHB Director Allen Stroh developed the voluntary Gold Seal food recognition program in the early 2000s. These gold seals still adorn local restaurants and other food service facilities demonstrating “substantial compliance” to the California Retail Food Code, like avoiding contamination and promoting proper employee hygiene. A few years later, the EHB responded to a multi-state E. coli outbreak by creating an inspection program for toilets used by agricultural workers in local fields. This 2005 program, developed by former EHB director John Ramirez, is now considered the industry standard for maintaining health standards among leafy green vegetable growers and shippers. Because Monterey County must juggle significant environmental health demands from the agricultural and tourism economies, the EHB developed its own training and education protocols in 2012. The Monterey County Environmental Health Environmental Health 1960 1956 The Federal-Aid Highway Act of 1956 created the interstate system, inviting peak car culture in the United States. Increased traffic prompts action to address smog, pollution, and other air quality issues 1960s A trend to deinstitutionalize psychiatric patients accelerates nationwide. Monterey County establishes an enduring partnership between MCHD and Interim, Inc to support these people

11 Leadership Institute (MEHPLI), modeled after the Center for Disease Control’s similar programs, is now regularly recognized around the state and nation for its excellence. The sanitary toilet program for agricultural workers and MEHPLI represent programming developed to address the needs of Monterey County. The Local Small Water Program is another example of a customized program, developed to meet the needs of locals. This program regulates water systems with as few as two to four connections, compared to other counties who may only regulate water systems with more than 15 connections. “Although regulating very small communities or businesses that have limited resources can have challenges, our Local Small Water Program has been considered a pro-active public health program by the State and community advocates, as information and standards for drinking water are made known to residents where otherwise they would not,” said Encarnacion. Most recently, Monterey County’s EHB tackled the shifting challenges of the COVID-19 pandemic. Educating the public about social distancing and enforcing health orders became the daily need, while also assisting with wildfire recovery services that were simultaneously needed. Today the wide scope of the EHB, includes permitting and inspecting swimming pools and spas and ensuring vegetable packing plants have a plan for any accidental release of ammonia. The bureau oversees any health-regulated business, whether that is before its construction, during operation, or even after its closure, said Encarnacion. After 100 years, this bureau continues to meet the needs of its community, like building intentional health equity standards into its programs. Encarnacion described projects like translating services into multiple languages and adopting a “consultative approach” for low-income clients, instead of more common, fee-based enforcement, as examples. “Health equity for environmental health regulators is a fundamental shift for some of our programs where equal treatment of the law and fair business practice dictated much of our field practice,” said Encarnacion. “With health equity in mind, EHB intends to update our practices to ensure we provide investments to gain not only environmental health compliance but improved positive health outcomes for all.” From assisting in wildfire recovery to inspecting tattoo parlors, collecting and safely disposing of chemicals, batteries, and food, to protecting our water, air, and soil, Encarnacion describes the EHB as the “crucial” link to promoting sustainable and well communities. “Environmental health is an essential service of any comprehensive public health system. There is always something in the environment that, if not controlled or addressed by some type of authority, will continue to have a significant impact on people’s lives.” said Encarnacion. “We do this to protect the guests and residents of our county and promote healthier environments for all.” Our primary duty is to protect the health of the public, especially by ensuring people use the environment responsibly. – Ric Encarnacion, Bureau Chief and Director of Environmental Health 1970 1967 The Federal Air Quality Act gives California the ability to set stringent air quality rules 1970s Public health labs from the MCHD process everything from tuberculosis cultures to rabies samples. Most labs in California begin to close by the end of the decade, but Monterey County’s continues today 1970 April 22 – the first Earth Day

12 The County of Monterey Health Department is turning 100 and even its youngest bureau is delivering impressive results. The Clinic Services Bureau, established in 1995, has become a, “dominant primary care provider in the county of Monterey,” said Bureau chief Prashant Shinde. After the Fort Ord military base and its hospital closed in 1994, the County of Monterey Health Department (MCHD) filled this urgent need with its own clinic system. Of course, this began with just one clinic: a humble rented trailer in a Seaside parking lot. Soon after Seaside’s clinic began, a location in Marina opened. The clinics next expanded to Salinas, first with a center in East Alisal. In 2015 six MCHD clinics began operating from Natividad Medical Center. In 2019, the clinic system reached another milestone: achieving official federally qualified health center status and federal funding. Shinde explained this distinction further expands the clinic in its mission to be a medical resource for everyone. Part of the bureau’s mission statement includes goals “to focus on supporting and caring for the most vulnerable within the community” and “provide high quality healthcare to all those unable to find it elsewhere, regardless of ability to pay.” The county’s clinic system operates on a sliding-fee scale, depending on the size and income of the patient’s family unit. Patients do not need to be residents of Monterey County, or to hold health insurance, said Shinde. About seven percent of patients at the county’s clinics are uninsured. Medi-Cal patients comprise the majority at 80 percent of patients. Medicare patients make up eight percent, and those with employer- insurance comprise five percent. “(Clinic Services is) a medical home for the entire family,” Shinde said. Today the ten MCHD clinics that form the Clinic Services bureau employ 342 people with a budget of $55 million. Alisal Health Center, Clinic Services 1980 1980s An investment in the Health Promotion department creates a buzz, receiving significant grant funding and national recognition for work on anti-tobacco campaigns and awareness around seatbelts and car seats featuring commercials with Clint Eastwood

13 Laurel Internal Medicine, Laurel Pediatric Clinic, Laurel Family Practice, Laurel Vista and NIDO operate in Salinas. One Bienestar clinic serves Salinas too, with another Bienestar location in Marina, alongside the Monterey County Clinic at Marina. The flagship Seaside Family Health Center still serves patients, as it approaches its 30th birthday. Clinics provide outpatient services for patients of any age, meeting needs as diverse as OB GYN visits to youth hearing and vision screenings, and adult primary and preventative care. Another aspect of the Clinic Services Bureau’s mission includes supportive services to help remove barriers for patients, providing transportation assistance and widespread health advocacy services. Clinic Services also employs California Rural Legal Assistance attorneys to help patients with their legal challenges around complex issues like immigration and housing. “It’s unique and expresses the mission that we have,” said Shinde. Clinic Services continues to add outpatient services to its clinics, including plans for mobile clinics and oral health and dentistry services. The bureau is “exploring the possibility” of opening its 11th clinic in North Salinas with additional capacity and expedited care services to help meet increasing demand, Shinde said. “Value-based healthcare” may be another new frontier for Clinic Services. This alternative payment model incentivizes providers to deliver results for patients to receive payment, instead of billing per visit. This long-term effort began with Medi-Cal patients in the 2010s. All of these initiatives together reinforce the significance of Clinic Services in Monterey County, said Shinde. “Quality, affordable, and equitable access to primary care provides the biggest impact to achieving overall county health.” Quality, affordable, and equitable access to primary care provides the biggest impact to achieving overall county health. – Prashant Shinde, Clinic Services Bureau Chief Late 1980s Debbie Weschler, RN, MPH is hired as the first epidemiologist for the MCHD 1986 On September 2, the first paramedic ambulance based in Monterey County was placed on the Monterey Peninsula

14 Since 1984, the Monterey County Emergency Medical Services (EMS) bureau has focused on developing a high standard for its public safety net services, including most notably, ambulance services. But ambulances are just part of this essential bureau of the Monterey County Health Department (MCHD). Before the mid-1980s, emergency services throughout Monterey County consisted of a patchwork of various private and public ambulance providers, said Teresa Rios, Emergency Medical Services Director at MCHD. “Many areas had no medical first response to help start care until the ambulance arrived. Coordination of response and patient care was limited at best,” Rios said. With the passage of the Emergency Medical Service and Emergency Medical Care Personnel Act in 1980, states across the nation were newly tasked with overseeing emergency medical services. In September 1986 the first paramedic ambulance based in Monterey County began operating on the Monterey Peninsula. In addition to standardized ambulance services, the nascent EMS department also began to tackle related tasks. “State laws require an EMS agency to have paramedics functioning in the prehospital environment,” said Rios. “All aspects of the EMS system from answering the phone at the EMS communications center, to response, patient care, and transport by first responders and transport providers, and specialty care within the hospitals are provided in a timely manner by (EMS) personnel who are qualified and trained to provide the service.” EMS operates with nine staff within a $1.8 million budget. In addition to the vast and diverse geographic area of Monterey County, Rios pointed out the fluctuation of visitors and residents to the area during tourist seasons or busy local events adds additional challenges to the department. “Most people assume the ambulance will just show up if they call 911,” said Rios. “There is a significant amount of planning and coordination that takes place.” In the last decade, EMS focused on improving outcomes on specific illnesses that improve with rapid, specialized interventions. This department developed precise services at designated hospitals to help patients suffering from STEMI (a specific type of heart attack requiring rapid care), stroke, and trauma. In 2015, EMS designated Natividad Medical Center as a Level II trauma center, further supporting better outcomes for illnesses like STEMI and installing much needed, local trauma care without leaving the county. Today, EMS also responds to opioid addiction and overdoses with medical assisted treatment. “Naloxone and buprenorphine distribution are two of the most recent evolutions keeping EMS relevant for today,” says Rios. “As EMS evolves, EMS systems become more involved in the health of the community.” Emergency Medical Services 1990 1990s The MCHD responds to the AIDS epidemic and other contemporary challenges like climate change, bullying, and obesity

15 As the County of Monterey Department of Health celebrates 100 years, the Behavioral Health Bureau is experiencing a time of exciting growth and development. Post-pandemic, the need for the bureau’s mental health and substance use disorder treatment services has increased as anxiety grows and resilience wanes. “Every individual living in Monterey County is directly affected by mental health and substance use conditions. I believe our communities are starting to accept the fact that sometimes someone needs medication for behavioral health, just as someone might need insulin for diabetes treatment,” Behavioral Health Bureau Chief Katy Eckert said. Eckert remembered hearing a memorable remark at a recent meeting of the California Department of Health Care Services, where someone stated statewide behavioral health initiatives “are now making up for decades worth of neglect.” “That is very true. There are uncountable numbers of complex policy changes being enacted right now and even more on the horizon,” Over the bureau’s history, the method of delivering behavioral health services has fundamentally changed. Instead of an office-based model using long-term hospitalizations, Behavioral Health shifted to community-based services and treatment. “We bring an understanding of the best ways to reach and serve individuals where they are at, in order to help individuals and the community be well,” Eckert said. The bureau performs their work through direct services or by contracting through partners, providing prevention and early intervention services and working closely with schools, law enforcement, social services, probation, the courts and other service providers. “Our community has a strong history of collaboration and Behavioral Health has been one of the leaders delivering services to the community,” Eckert said. “Behavioral Health also has a strong focus on equity, on serving the different populations within the county according to their needs, including their preferred languages.” The Behavioral Health bureau operates a $161 million department, employing 376 people in 22 locations throughout Monterey County. However, one common misconception of the Behavioral Health Department is its scope of services, explained Eckert. “The community at-large believes that County Behavioral Health serves everyone. The reality is County Behavioral Health primarily serves the Medi-Cal and indigent populations who have serious mental illness or serious emotional disturbance or substance use disorder,” said Eckert. “County Behavioral Health does not have the funding or staffing to take on the treatment needs of the entire low income population. It is the responsibility of health care insurers to provide mental health treatment for other individuals. Treatment is available!” 2000 Behavioral Health 1995 Ambulance services consolidate into one ambulance provider 1995 Seaside opens the county’s first clinic, with locations in Marina quickly following 2000s The Gold Seal program begins, a food safety recognition program for restaurants still used today We bring an understanding of the best ways to reach and serve individuals where they are at... – Katy Eckert, Behavioral Health Bureau Chief

16 The old-fashioned images of the town dogcatcher, armed with a net and chasing down neighborhood strays, do not reflect the extensive scope of services performed each day by the animal services bureau of the County of Monterey Health Department to keep animals and the public healthy and safe. In the United States, 66 percent of homes include a pet, says Cindy Burnham, Animal Services Administrator at Hitchcock Road Animal Services. This means animal services address a huge and sprawling need throughout Monterey County – a service area 1.5 times the state of Delaware, said Burnham. Calls for animal bites, aggressive animals, stray dogs, or sick and injured animals are handled by Hitchcock Road, alongside daily care for the stray and homeless animals residing in the shelter itself. This bureau remains the lead rabies control agency in Monterey County, the role it has historically played in the community for many decades. “I think the biggest misconception really is that we don’t care or don’t want to do anything for our community. Our community can be proud and trust that we will do what we can for the animals as we can,” said Burnham. “The staff here care so much and work so hard every day to go above and beyond to help the animals in the community and in the shelter.” Located at 160 Hitchcock Road in Salinas, Hitchcock Road Animal Services is a recent merger between Monterey County and City of Salinas animal service departments, forming an entity that can now be more proactive to face the needs of local companion animals and their owners. Hitchcock Road employs 28 staff and operates a budget of nearly $5.2 million. “(The merger) has taken many years, including during a pandemic, to work through but we’re excited to be a place to start to build an Animal Services agency that can really work for our community,” Burnham said. The gradual evolution of animal services shows an effort to offer proactive resources for scores of animal owners, as well as reactive support for animal aggression or to save and adopt an abandoned animal. “Now we’re working to be proactive with our community and support them to help keep their pets. Then our resources can be best used for the animals that don’t have a home to stay in,” Burnham said. “We want to support pet owners in the home as well as be there for the ones that really need us.” Animal Services 2010 2005 After E. coli outbreaks, former Environmental Health Director John Ramirez created an inspection program for agricultural field toilets, which became the industry standard for leafy green vegetable growers and shippers

17 The County of Monterey Department of Health operates a unique bureau offering protection and advocacy for the most vulnerable adults in our communities. The County of Monterey, Public Administrator, Public Guardian, Public Conservator Department (Monterey PA/ PG/PC) reaches across its network to meet the everyday needs of adult clients who cannot provide their own food, shelter, or clothing. Unlike similar bureaus in other counties, the Monterey PA/PG/PC serves its clients across all three roles: public administrator, for residents who died without a will or someone to complete administrative tasks after death; public guardian, where a conservator helps manage personal and financial needs; and public conservator, which provides additional mental health care services for its clients. “By serving in all three roles as the PA/PG/ PC with legal authority it allows our department to cross-over between each authority. For example, we may have an individual under a mental health conservatorship, but also needing estate protection,” said Sarah Solano, Chief Deputy of Monterey PA/PG/PC. A team of 17 employees and one assigned county legal counsel provide a wide span of services to meet the evolving needs of disabled, frail, or other adults who need care but have nowhere to turn. In Monterey County there is a due process ensured for every client at every appointment and clients are assigned a court-appointed attorney. Clients have a right to a hearing or trial at any time and the client may challenge any decisions made by Monterey PA/PG/PC. Layers of legal and ethical standards safeguard the rights of every client, Solano said. This diverse set of responsibilities means Monterey PA/PG/PC achieves daily milestones, said Solano. In the recent past, the bureau assisted at-risk adults by retrieving thousands of dollars in benefits owed, saved client homes from foreclosure, prevented homelessness for individuals with a mental health diagnosis, and located unknown or missing family members. “Our continued work has assisted clients to reintegrate back into the community with family and friends,” said Solano. Monterey Public PA/PG/PC (Public Guardian) Our continued work has assisted clients to reintegrate back into the community with family and friends. –Sarah Solano, Chief Deputy of Monterey PA/PG/PC 2012 Victims of STEMI, a type of heart attack, receive specialized care through a collaboration between paramedic service providers, CHOMP, and Salinas Valley Healthcare 2015 Natividad Medical Center in Salinas is designated as a Level II trauma center 2017 MCHD is awarded the Arnold X. Perkins Award for Outstanding Equity Practices

18 2020 2020 MCHD leads Monterey County through the global COVID-19 pandemic, helping educate residents, schools and businesses about evolving health measures and promoting vaccines 2020 County animal services and City of Salinas Animal Services merge into Hitchcock Road Animal Services 2023 MCHD celebrates 100 years of better health 2018 MCHD becomes one of the first health departments in California to become accredited by the Public Health Accreditation Board The Health Department has exciting new ventures and initiatives planned in the future. See this peek at what is ahead Administration: In the very near future, the Health Department will adopt an updated Strategic Plan to guide us in furthering our Health in All Policies work. This inclusive definition of the Health Department’s purpose and goals is led by community voices to improve opportunities for all through systems and policy changes. Animal Services: Hitchcock Animal Services is exploring opportunities to expand services to residents and their furry companions throughout the County by increasing availability of spay and neuter services, incorporating radiology services in its clinic to address animals’ immediate medical needs, and increasing public education. Behavioral Health: This spring, the new Alisal Integrated Health Center will open for business on Sanborn Road to better serve the residents of Salinas and surrounding areas. Greater access to quality mental health and primary health care fulfills the Health Department’s main goal of equitable services for all. Further into the future will be the opening of our new 100-bed Mental Health Rehabilitation Center. Clinic Services: Planning is underway to construct a new health center in Marina, replacing our existing small and mighty clinic. In addition to primary healthcare services, our new clinic will provide dental services for children and adults. Emergency Medical Services: An important effort in pre-hospital emergency care will soon be launched with a request for proposals for a new Ambulance Services contract. Environmental Health: Planning is underway to establish new Healthy Housing Services, to establish a pro-active housing inspection program, incorporating not only healthy housing principles but also health equity to ensure more positive health outcomes for all. Public Guardian: The office will continue its dedication to support the health and wellbeing of our residents who are not able to care for themselves due a mental illness, substance use, or dementia. Public Health: The Bureau will expand its program efforts by providing additional supports to help seniors age gracefully in their own homes, as long as safely possible. Improvements in our quality life depend on our use of science and best practices, and just as importantly, on involving residents in the planning, design, and delivery of services and programs. What will remain constant is the Health Department’s mission to protect and improve the health and wellness of all residents and safeguard the environment. As seen through COVID, wildfires, and floods, the Health Department will pivot as needed to address emerging public health issues. Together, we can make Monterey County a stronger, healthier, and happier place to live. Looking to THE FUTURE