The high-profile turmoil in Ferguson, Missouri, following the death of Michael Brown last August not only made international headlines; it impacted the health of the entire city. The St. Louis County Department of Public Health sprung into action to protect the health of its citizens, but according to its director and APHA Health Administration Section member Faisal Khan, MBBS, MPH, the incident and aftermath illuminated a clear need for the department to “get plugged in at the ground level” more than ever before.

Public Health Newswire spoke with Khan about the events in Ferguson, how the public health department responded to the city’s unique health needs in time of crisis and how the incidents have sparked a sea change in the way public health is conducted in St. Louis County. Note: Check out part one of this series, which focuses on the public health department’s name change, the unique challenges facing St. Louis and the value that APHA brings to Khan’s work.

Faisal Khan, Faisal Khan, MBBS, MPH, is the health director for the St. Louis County Public Health Department. Photo by St. Louis County Public Health Department

Faisal Khan, Faisal Khan, MBBS, MPH, is the health director for the St. Louis County Public Health Department. Photo by St. Louis County Public Health Department

St. Louis County recently experienced high-profile protests and civil unrest stemming from a range of inequities. Health is certainly one of them. How did your department respond to this unrest?

If you’ve been familiar with the St. Louis area for the last year or so we’ve been in the news for a lot of the wrong reasons. And my challenge to all our staff after I was appointed to this position was, “OK, so you’ve observed what’s been happening in Ferguson. You’ve observed all the public unrest. What public health engagements do you think we ought to have been involved with in past years that we’ve missed and where do you think we should be plugged in now, as of yesterday?” And everybody sort of looked at me and said, you know, “What do you mean? We’ve got all these great health centers, three of them. We provide primary and specialty care services. We do disease investigations and restaurant inspections and building permits and milk inspections and water inspections.”

And I said, “No, no, no. Set that aside.” What you see in Ferguson and neighboring areas are communities under a toxic amount of stress that has built up over decades as a result of gentrification, urban renewal — and all of those are sort of code words for socio-demographic changes. But [we’ve got] issues such as concentrations of poverty, unemployment, youth disenfranchisement, perceived or real injustices by municipal police department to the point that it leads to high incarceration rates, failing school systems, the lack of safe and walkable communities and recreational facilities.

All of those add up to create a toxic level of stress and when it exploded in this expression of anger, people were shocked and I, as a public health professional, was shocked that they were shocked. Because if we had our fingers on the pulse of the community for the last decade or so, or even earlier, this would not have been a shock to us. It would not have been surprising. Ferguson was just a symptom of what is happening in the northern part of St. Louis County. We see it happening in Baltimore, we see it happening in Cleveland and other metropolitan areas. So I’m not in a club of one. Unless we get plugged in at the ground level in addressing a lot of these concerns we’re not going to be able to make a difference. We can sit in our offices and keep talking about public health interventions and excellent programs until the cows come home. It won’t actually make a difference in terms of improving the measurable health outcomes that we desire to see.

So my challenge with our public health department is to think outside the clinic setting. Yes, to some extent, provision of primary and specialty care services is a critical part of what we do because we serve the underinsured, the working poor and the completely uninsured and indigent. But what happens to them when they’re actually living in their houses and communities is just as important.

“Unless we get plugged in at the ground level in addressing a lot of these concerns we’re not going to be able to make a difference. We can sit in our offices and keep talking about public health interventions and excellent programs until the cows come home.” — Faisal Khan

So obviously I can’t address issues such as housing and unemployment on my own. But I can take the approach that I can be a catalyst and force the conversation about housing being treated as a public health issue. Is it safe, is it healthy? Does it provide the level of comfort and recreation needed to make a community grow rather than create festering sores all over the community? I know that sounds grandiose but this is an idea whose time has come and frankly arrived a decade ago.

Baltimore City Health Commissioner Leana Wen recently spoke to us about the department’s response to unrest in its city. How did your response, especially in terms of going into the community in real-time, compare to the Baltimore experience?

We did exactly the same thing. Our health department and mobile health unit were deployed to the area, along with United Way colleagues, and of course we coordinated our services with the police department and made sure staff were protected. We went door-to-door last year to check on people, to get them their medications, to do blood tests and draw blood, to get them to the lab, transport people to hospitals — like people that needed dialysis and couldn’t get transportation. Get them out of the house, get them to the dialysis unit and back. It taught us a valuable lesson in terms of coordinating on-site issues before they happen with the community itself.

We ended up creating rapport with popular opinion leaders on-site who could help us navigate some of those neighborhoods and needs so that one person would have a better sense of who needs what, instead of us having to find out. Animal control was fully involved with taking care of people’s pets. In some situations people needed to be evacuated from their houses because it was unsafe, maybe if there were riots taking place outside. And so those people were moved to hotels and motels and shelters in the area. Their pets needed to be cared for so animal control jumped in and took control of their companion animals until they got back. It becomes a huge logistical challenge and planning exercise.

We are gearing up for the first anniversary of the Ferguson incident [on Aug. 9] which led to all the unrest. We fully anticipate that it’s going to be a summer that we will have to re-engage members of the community. Some of this planning is now beginning to take shape. We’re setting our plans in motion for that.

But the health department cannot step back. The fact is the community looks up to us to coordinate their services and point of care.

With a new name and a new logo, the St. Louis County Department of Public Health will shift toward "emerging public health issues above and beyond the clinical issues," according to its health director, Faisal Khan. Photo by St. Louis County Department of Public Health

With a new name and a new logo, the St. Louis County Department of Public Health will shift toward “emerging public health issues above and beyond the clinical issues,” according to its health director, Faisal Khan. Photo by St. Louis County Department of Public Health

And have you looked into building these long-term relationships and dialogues with community members?

I don’t think health departments have traditionally taken the lead in that. But a department of public health certainly must, for its own survival and effectiveness, remain plugged in to the community, particularly in areas of greatest need. In Ferguson, for example, I don’t think we would be able to address the needs of the community if we were not checking in on a daily, weekly, monthly, quarterly basis with the popular opinion leaders and the list of people we established a rapport with. These are mostly people who lived there — some of them have concerns about issues, others have a great feel for what the community actually wants — and different portions of our staff have been in contact with all of them to check in.

It’s almost incumbent upon us to tally that information. So that’s what we’ve been doing since January of this year. The major issue that is absolutely public health-related is the almost desperate need for trauma-informed mental health services and acute crisis management for mental health care. That has both a clinical and public health space associated with it. Clearly that’s not something we can do on our own but we can facilitate conversation between different agencies that want to help, hospital systems that want to contribute.

So what we’re telling people is before you think about donating money or developing a grant, talk to us so we can develop a joint [request for proposal]. We can figure out where the areas of greatest need are. We can put you in touch with people who can help you have a conversation directly with the community so that you don’t do your own little bit without contributing to the whole effort. So I think that’s a great role that we’ve played and we look forward to expanding that in the next several months.