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Kathryn Metzger

Program Manager, Environmental & Community Outreach, Taney County Health Department

What are some of the barriers or challenges in your community that affect health and wellbeing?


In the Branson area we are a tourism-based economy and that work is seasonal work. So what we have is a lot of low skill positions. Some of them pay fair, but aren’t necessarily 40-hour a week positions. A lot of our health inequities here have to do with unstable employment, where they will be employed most of the year, but as the tourists leave, the business that cater to those tourists greatly shrink or close down for a season, and that puts a lot of people out of work.

Even during the regular tourism season, people aren’t necessarily working a 40-hour week. They may work 8 hours this day, 12 hours that day, and so it’s not a consistent paycheck from week to week, nor month to month.

A lot of times people will come to our community seeking employment and they’ll find that maybe it’s not really what they thought it was going to be, or they’ll come towards the end of the tourism season, where they’ll have a great job for a very short amount of time, and then be unprepared for that season where they’ll be out of work.

What are some of the ramifications of unstable employement and housing?


It’s similar to what you’d see with any population that lives with poverty. When people have jobs that are in the service industry, they have barriers to being able to take time off either for sick leave, to go to the doctor, get themselves taken care of if they’re having a problem, or for preventative care. There’s an inability to pay for that care. They are less likely to have insurance or any benefits to support that.

Additionally, what we see in our community is unstable housing. These individuals will be staying in some of our extended stay hotels. Those are usually a week-to-week or a month-to-month lease, and they don’t necessarily have like a contract, like they’d have if they were renting an apartment.

As far as health equities go, we’re definitely seeing barriers to care. We have transportation issues. Their work life doesn’t necessarily support taking time out in order to seek preventative services, take time off if they need it, and then, of course the financial barriers to being able to live a healthy life.


How is the Health Department addressing health inequities?


We definitely try to serve individuals who are living in poverty or maybe have some barriers to care. In our community that just tends to be more of these individuals with a specific situation, and so we look for ways to bring services to the facilities that they’re already going to, whether it be our partners at Elevate Branson or the CAM food bankSo we definitely work with our community partners in order to extend services. Additionally, we work with a lot of community organizations, including the

Chamber of Commerce and some of the associations that support the tourism industry, in order to serve not only their needs as a business, but the needs for their employees as well.

When we’re talking about new programs, or we’re talking about service delivery, we’re always trying to keep the people in our community in mind. Health equity is a huge part of that. So we’re constantly keeping that in mind in order to not just reach those people that are easy to reach – those people that may not necessarily need our services – but ways to reach individuals who have barriers that health inequity will throw up.

How does your organization use Missouri's Foundational Public Health Services model as a framework for public health service delivery?


Missouri’s Foundational Public Health Services model is definitely something that is applicable to all of our programs, whether that be WIC, clinical, our environmental health services, or our community outreach. Most recently it really came into play during COVID where we were seeing there were some clinical needs, some linkage to care needs that needed to happen, especially very early on. We were having calls all the time trying to help people navigate that.

When we started looking at the implications of COVID on environmental programs, and our work in that field, we saw shortages of employment - difficulty being able to fill positions, even though in our community we do have a lot of people who come here to work in that industry. Coming out of COVID shutdowns, it’s just been very interesting to see how they come back to work. What we see is that when they come back, they’re not necessarily trained, including management. They’ve left a job. They’ve taken a different job, and so we have an environmental health training gap.

The FPHS capabilities are important, no matter what population you’re serving. We need to make sure that we are providing the appropriate education materials, and we’re communicating in the right way, using language and media that is accessible by the people we are trying to reach.

In our community in particular, there are some barriers when it comes to internet access, and so we’ve got to make sure that we’re looking for ways to communicate outside of just typical social media in order to get messages out. For that, we depend a lot on our community partners to help us reach specific populations.

How important are community partnerships?

Community partnerships are absolutely essential in our community. I mean, we’re only one department, and we can only do so much, and so there’s no reason to re-create the wheel.

We’re always looking for a way to support other people’s work in the community in order to extend those services and do a synergistic approach to reaching specific populations. So all communities' partnerships are important, but they’re extremely important in our community. We’re constantly looking for new partners –


really anybody interested in working with us, or anyone that we can benefit.

How did COVID affect the job market and housing situation and exacerbate health inequities?


Especially early on in the pandemic, everything was shutting down, there was scarcity - the inability to find basic resources, and people were losing their employment – it just kind of all came crashing in. We had young mothers who had been laid off from their job and couldn’t find infant formula. It really brought all of our simmering problems absolutely to the top almost immediately and in almost an overwhelming way for us and for our community.


We had these highly vulnerable people in the first place, then everything they had built had fallen out beneath them, in an environment where it’s already hard to build any kind of security, any kind of financial security, any kind of savings. It just immediately eliminated that for so many people. So those individuals that were just keeping their head above water, when the pandemic came and shut down their place of employment and took away their ability to get to the grocery store and their ability to get groceries at a price they could budget for, it really negatively impacted a lot of people in our community in ways that they’re going to take a long time to recover from. A lot of their long term health issues will become exacerbated because of that - an inability to obtain or pay for medication, inability to get those services that normally would have been a low cost and easier to access before they closed down. 

Some of the stimulus checks have definitely helped people get their feet back underneath them. As that money runs out, we’re seeing some people start to show the financial strains that the pandemic caused - food insecurity. We’re starting to see higher utilization of our food banks and our facilities, in particular, or the ones we regulate in our environmental health division. When we look at the restaurants, hotels, facilities that support our tourism industry - they were closed down. As people return they’re having a difficult time reaching full staffing, and the people coming in are brand new or they’re really rusty on some of their practices.


So we’re seeing in our community a lot of lack of knowledge in order to meet the regulations and maintain food safety and lodging practices, whether it be a continued inability to find the resources that they need, such as some of the chemicals they need to clean or sanitize – that’s still a struggle. Whether it be staff - being able to find staff - or being able to find staff that comes in and knows what they need to do. We have brand new management in a lot of these places because the former management had moved on to something else.


In our community in particular, these frontline workers are our most vulnerable people when it comes to COVID, so we’re concerned as the community opens back up and people come from outside of our community, they’ll bring COVID with them. While we don’t expect the economy to shut down again, we’re very concerned about the personal health of these individuals that are supporting our economy here.


How do partnerships benefit public health work?


Most people see the health department as government, and there’s a natural distrust for government. For many people, the only awareness they have of us is as regulators, when, in truth, we’d much rather be educators over regulators and are continuously trying to reach out to our business community and say, “Let us help you before our inspectors show up. Let us help you meet the requirements before your inspection.”

We’re definitely partnering with our Chamber of Commerce and with a lot of our associations that represent that organization. When we look at individuals with unstable housing, we very much need to rely on our partners that have already serviced them and have that long standing trust and relationship. We struggle in order to be able to serve those people, because they have to have a need for us, for one, and often times the perception is when the health department shows up it’s a negative, rather than realizing that we actually bring a lot of services, a lot of programs, and a lot of support, and we’re really just looking for a way to do that. So we rely on our partners to help us help our community.


The most important thing is that we’re able to offer those services, and we’re able to help our community and the individuals living here, and the businesses here. If that requires a partner being the face of that, we just want to get the help to the people and make sure that we have a healthy, safe community.

How has perception of the Health Department changed recently?


The perception of the health department and public health has changed quite a bit over the last year. You know the old saying that "public health works best when no one knows it’s there," is true, but they know we’re here now.


These are good people who work here. These are people that live in the community and want to help our community, and we really just need the opportunity to do that. We’re really looking for that opportunity, because we want to lift everybody up.

Kathryn Metzger

Program Manager

Environmental and Community Outreach

Taney County Health Department

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