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Gary Zaborac

Director of Public Health, Clay County Public Health Center

What are some of the barriers or challenges in which people live, work, or play in your community that affects the health of people there?

 

We have an eclectic mix of communities in our jurisdiction, from urban to metropolitan to rural areas, and the health challenges and barriers facing each of these places are different. For example, we have one rural community that has lower education status, lower-income status, lower health status, and actually, the lowest life expectancy in the county. Then, about 10 miles away, we have a metropolitan community with the highest life expectancy, almost eight to nine years higher than that other community. The people in that metropolitan community have higher educational attainment, and housing, transportation, education, and food security aren’t issues. But all of those things are challenges in the rural community.

 

Just down the road from that metropolitan community is an urban community, in which there’s a neighborhood grade school where 40 different languages are spoken. The neighborhood there also struggles with housing, transportation, and food security issues. So the challenges and barriers in our jurisdiction are varied, which makes us a little unique than a more homogenous environment. Still, across the entire county, there are commonalities in the issues people are facing. The top three issues affecting the health of our people are behavioral health, chronic disease, and access to care. It’s particularly challenging, yet also very rewarding and interesting because we have to tailor services and programs to match each community’s needs.

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Biggest misconception about the Clay County Health Center

 

The biggest misconception people have about the Clay County Health Department is that we just provide immunizations and have a WIC program and that’s all. Part of that’s on us for historically not getting the message out more effectively, but we’ve been doing a much better job of that over the last few years. We also provide important population-based programs like environmental health for restaurant inspections, septic system inspections, pool inspections, epidemiology and communicable

disease control to prevent the spread of diseases, and community development and health education services. COVID caused a whole bunch of problems — not only the obvious ones about health but also with the image and public perception of our department. So we’re trying to fix that through community health education.

 

Overall, the biggest misconception stems from the fact that we’ve had such incredible growth and development in this community. We have one of the highest growth rates in the state. Because so many communities are doing well, some people mistakenly believe we don’t have any poverty issues, housing issues, education issues, etc. Life is good, except if you’re in any of those categories - and there are a lot of people in those categories. Unfortunately, there is still a lack of awareness by many about these issues in Clay County. That neighborhood with the grade school where 40 languages are spoken - I guarantee a whole bunch of folks would be dumbfounded if they knew that even existed. That’s how insulated some have become through all this positive growth that’s occurred.

Community pride in Clay County is huge, as demonstrated by Operation Safe

 

Community pride in Clay County is huge. There’s a competitive spirit in all of the continuous growth and development here, but the other side of that is that Clay County is steeped in collaboration and helping each other out. Even though each community is fiercely independent, when somebody needs help, everybody comes together. It’s amazing! And the quintessential example of that has been COVID.

 

An effort called Operation Safe was put together by Liberty HospitalNorth Kansas City HospitalClay County Health Department, and Cerner. And the next thing you know, we were putting up a mass vaccination site. In three months, we ended up putting almost 100,000 shots in arms. About 250,000 people live in Clay County, and every community here contributed resources. Each ponied up money, people, whatever it took. We got to the point where we were vaccinating 5,000 people a day in clinics.

 

No matter what, the spirit of collaboration and of communities working together for the greater good is very strong, and I learned this on day one, about 17 years ago.

Establishing the Northland Health Alliance

Something we’re very excited and proud about is the Northland Health Alliance.

 

In the late ’90s, there was an organization called Vision North, put together by three entities to do an assessment to identify areas where individuals could invest money back into the community to help out. We have some pretty big family names in the Kansas City area, and they wanted to be philanthropic towards their communities in more targeted ways, but it was not a comprehensive community health assessment. I got here in 2004, and I’m originally

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from Illinois, a state where it’s a requirement for the health department to conduct a community health assessment, otherwise the state won’t fund you. That process didn’t exist in Missouri at the time. I also wasn’t able to engage with this first effort because I was still new to the county. But with the next Vision North project I was able to participate in, the challenge was that there was no actionable plan or strategy to take what was learned from the assessment to the next level and create programs and services to solve those issues or monitor any progress made.

As the health department, we tried to bring people together to address them. We have five hospitals in our jurisdiction and they are historically competitive with each other. They all declined to participate in the first efforts, which left a huge hole in the process. Then in 2009, the Supreme Court finally said the Affordable Care Act was here to stay. And there was a clause, an IRS 990 requirement that not-for-profit hospitals had to participate in community health assessments and they had to engage with their local health departments. Before that point, Vision North had been doing a community health assessment and hospitals had been doing their own. So we called a time-out and said, "It doesn’t make sense to be duplicating all of this work. Why don’t we work together and just do one?" Once we started working together, we made some real traction.

 

I’m happy to tell you that now, that collaboration has become a 501(c)(3) organization in Missouri. All of the hospitals are members and so are the Clay County Health Department, Platte County Health DepartmentTri-County Mental Health Services, a couple of psychiatric hospitals, Northland Health Care Access, and Synergy Services. They elected me as chairman, a title I still hold today. As a non-profit, we all contribute our own money to the group. And we started doing our new community health assessments. The big difference is that now we create one community health improvement plan as well. It has evidence-based strategies for health equity and social determinants of health built into it.

We’re doing a CHA and a CHIP every three years now. Just last year, we received a $50,000 grant from a charitable foundation to help facilitate some of those evidence-based strategies from the CHIP that we’re implementing. One of the things we’re addressing is teen suicide. One of our intervention strategies has been to partner with schools to provide coping strategies and education, utilizing law enforcement and behavioral health counselors and all kinds of resources to help reduce stress and lower teen suicide.

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How did you first get involved in public health?

When I graduated with my undergraduate degree in microbiology in the ’80s, I was ready to take on the world but there was a recession. There weren’t a lot of jobs available, so I was sending out resumes by the hundreds, responding to anything and everything. I saw an ad in the paper for an environmental health sanitarian. There was a brief description of what that was and I thought, ‘I meet those qualifications. Let’s see if I can get an interview.’

Lo and behold, I did. Much to my great pleasure, I was hired. To be honest, I didn’t know anything about public health at the time. I started out doing restaurant inspections, private sewage disposal systems, private water wells, lead abatement program, and rodent control which was… awful. But I got into the work and it was almost like a bug that bit me. I was like, "I could see myself doing this for a career. This is pretty fun."

 

Since I was working at a larger health department in Illinois, I would meet other people there and hear about what they were doing too. It was quite by accident that I got into public health, but it’s all I’ve ever done since my undergraduate degree. Then I got a graduate degree in health services administration. I went to school at night and on the weekends while working in public health during the day. I wanted to have more of an opportunity to make a difference and felt like the way to do that was at the macro level with policy, like what I’m doing now.

 

I started out in small rural agencies and eventually moved to the metropolitan level I’m at today. This is my 37th year in public health, and I’ve been a health director for 32 of those. When I started out, having a master’s degree in public health was not very common. Nowadays, we rarely hire people unless they have it. It’s a completely different world from when I started. But that’s how it happened, and I wouldn’t change it one bit.

Who has been a mentor to you? Are you a mentor to anyone else?

 

My supervisors when I first started out were incredibly knowledgeable. I was like a sponge, trying to absorb everything they said. They were also so supportive. Matter of fact, it was one supervisor who said, "You ought to explore this master’s program. I’m thinking about doing it. Why don’t we do it together?" That’s pretty cool for a boss to do that. So I was truly inspired by those two guys. If I hadn’t had them, who knows where I’d be today.

 

My deputy director started out here in the environmental health program as an inspector, and I like to feel like I’ve been a mentor to him too. He’s worked his way all the way up to being second in command. I’ve always told him, "You’re going to learn some things to do from me and you’re going to learn some things not to do from me. I’m going to be different from you and maybe do some things you don’t agree with, but that’s okay. You’ll learn just as much from those experiences as you do from the ones in which you agree with me." He just went back to school a few years ago and graduated with his MPH. Now, he’s set. When I retire, which is not that far away, I’m hopeful that he’ll step into my role. I know he’ll do a great job. I don’t make the hiring decisions, but I’ll definitely be recommending him to the board as their next CCPHC director.

Why did you choose to commit to work in public health?

 

The most impactful experience that inspired me to do the work I do today happened at my first director’s job when I was at a small, rural health department. There was a phone call from a staff member who described the deplorable circumstances an elderly couple was living in. They said, "We want you to go down there." Any rural health department employee will tell you this — you are a jack of all trades. You wear multiple hats; you have multiple roles. You might be the director of environmental health and still do inspections. You might be a nurse supervisor and still do clinics. I happened to be the former and I said, "Okay, I’ll go down there."

 

I went to an old aluminum trailer on a piece of ground and the problem was they had no running water. Unfortunately, the day I arrived, it was like 95 degrees. I knocked on the door, an elderly lady answered, and she invited me in. I walked in and it pains me to describe the conditions. There was no running water. The bathtub was where they went to the restroom. The odor, the flies — it was horrific. They didn’t have any air conditioning. That just totally got me. I went back to the office and reported to the person who called me and I said, "Oh my gosh, it is terrible. We can’t let this continue now that we know about it."

 

I called up the cooperative extension service and talked to the person in charge. They had a program where they could put in a water well, since these people lived out in the country, and all the people had to do was pay $5 a month. With this rural water program, they could put in a well and suddenly they’d have indoor plumbing inside their trailer. So I went back to talk to the couple and asked, "Can you guys afford $5 a month?" They said, "Yes." And I said, "Okay. We’re going to get you water." And she just started crying. It was then and there that I realized, "Yeah, I made the right choice working in this field."

 

We went out and put that well in, got everything cleaned out, did a follow-up inspection, and now they have fresh running water. When you turn on the spigot to get a drink or go to the bathroom or take a bath, you don’t even really think about it, do you? But these people were in a spot where those things weren’t even an option. I just couldn’t imagine getting up every day like that. That was powerful to see and that’s when I said, "You know what? I’m now in this work for sure."

Gary Zaborac

Director of Public Health

Clay County Public Health Center

Storytelling and photos by:

Humans of St. Louis / Ava Mandoli