Taking a Chance on health

Lucky 13th for Greg Chance

by Mike Kroll

It is now hard to believe that establishing a county health department was so controversial at one time. A group of citizens worked hard to convince Knox County voters to approve the November 1992 referendum that created the Knox County Health Department. Five months later, the newly established Board of Health hired its first employee, Greg Chance. Virtually no one expected that the Health Department would be involved in so many local activities or that Chance would remain at its helm 13 years later.

Chance himself credits his parents and upbringing. “I think the fact that I’m not really an outsider has a lot to do with my success and longevity here. My family lived near Macomb as I grew up and this familiarity with the area I think helped me establish relationships early on that were critical to my successes. I understand that there still remain people in the community that don’t understand or appreciate the role of a health department but those numbers have declined significantly since the referendum was passed. My staff and I are still striving to convince the remaining doubters through education and results.”

That original referendum permits the Board of Health to levy a property tax in Knox County to fund the department and the tax has been in place since the beginning. It has never come close to the maximum rate allowed. Since its inception, the Health Department has always maintained a property tax rate below half of the limit. “We have obviously been lucky there,” acknowledges Chance. “We clearly benefited from the better economy at our onset in the early 1990s and the higher assessed property values, but now we are obviously in a different era. Grants and other outside funding have always been our biggest revenue source, but today public health officials like myself are becoming very concerned about the prospects of greatly reduced state money for public health programs.”

“Unfortunately the state of Illinois has lost sight of what our public priorities should be in terms of public health. While we hear a lot of rhetoric from Springfield, what concerns me is that for a governor that touts health care as a cornerstone of his political agenda he fails to appreciate the appropriate investment of public dollars in prevention. Governor Blagojevich has failed to deliver any kind of increase in funding of public health departments since his tenure. As the current president of the Illinois Local Health Department Association, I can say that our members are all very disappointed in the Governor’s apparent low priority of public health department funding.”

Chance acknowledges that one political reality is that many of the important prevention areas are political hot potatoes. “Obviously some areas of prevention are controversial, such as when we talk about HIV/AIDS or teen pregnancy or especially sexually transmitted diseases, which remain huge issues in our community, some members of the community get excited about our involvement in a less than supportive way. Some people don’t like to discuss those things but that is a mistake. I would say, for example, that sexually transmitted diseases are approaching an epidemic, a problem that is nationwide in scope and that thrives on lack of understanding. Most people don’t appreciate the full impact of sexually transmitted disease financially in terms of what it costs to treat or the long-term health impacts. The public and politicians fail to recognize that prevention dollars are the most cost effective way to address this problem.”

“My Board of Health has been willing to take on these controversial issues but we have been careful to do so in a way that doesn’t create roadblocks. We have recognized the potential pitfalls of being too aggressive and we have identified means of achieving our goals at a slower pace. Let me use teen pregnancy as an example. When we did our first Healthy Communities Assessment back in 1994, the statistics said that teen pregnancy was a huge local problem. We recognized then that the community was not ready to have an appropriate level of public dialog to address this problem head-on. So we put it on the back burner and over the next several years we began to create a public awareness of the issue indirectly through key stakeholders in the community. By the time we did our second assessment in 1997-98, the community was ready to begin serious discussion of teen pregnancy and we began energetic prevention efforts in that regard.”

“But sometimes we tend to focus in on these controversial issues and miss the bigger picture. One of the things we haven’t done as well at is marketing our successes. Here I am thinking about testing drinking water, permitting on-site wastewater disposal, food safety or lead poisoning. Those are all areas where our department has made significant public health gains and created little controversy. You can also look at our immunization program or efforts to encourage smoke-free restaurants across Knox County. In fact, I credit the food safety inspection program as one of the key reasons the voters approved creation of the Health Department in 1992. I can’t tell you how many food-borne illnesses we have prevented; I can’t measure that. But I can give you national data on the number of food-borne illnesses one should expect and Knox County’s rates are far below that. Now some of that is due to under-reporting but I believe most of the difference can be credited to our inspection program.”

“One of the things I am most proud of is my department’s success working in collaboration with elected officials, schools, businesses, social service agencies, the two hospitals and others to address a range of health-related issues. I think we have had a positive working relationship the majority of times and we have always put issues out in front of the public and not made decisions in a vacuum.”

The Knox County Health Department is now an integrated component in our community. It is almost hard to recall when it didn’t exist. And Chance has been at its helm from the beginning. He acknowledged that he has turned down offers to leave Knox County and even that other opportunities have passed on him, but he convincingly asserts an appreciation for this community and the people who work for him. The job has never failed to challenge Chance who continues to see new challenges foisted upon his department with little or no new funding accompanying the task. Whether it be Avian Flu, West Nile Virus, bioterrorism or just plain indigent health care, all of these problems fall in Chance’s lap.