In a sense, Dr. Bob Lutz is the physician he is today because of a dirty swimming hole in a small central Pennsylvanian coal-mining town, where decades ago five young kids contracted polio.
One of the kids was his mom.
After multiple surgeries at a Philadelphia hospital, Lutz’s mother worked for years to overcome the challenges of her disease, and eventually became a successful nurse.
“For me, that was really motivating to see,” he said.
After eight years as a Board of Health member, Lutz was appointed in June as the new health district officer for the Spokane Regional Health District (SRHD), which covers the entire county. In addition to keeping swimming pools and restaurants safe for consumers, the agency monitors the community’s health and provides educational outreach to residents and local policymakers.
Early on, Lutz said he learned that the foundation of an individual’s physical well being was the health of their community.
Always a “bio-geek,” Lutz initially wanted to become a surgeon. However, after completing a surgical internship, he said he found that there was more to patients than the problem that brought them to the operating room.
Instead, there are often underlying issues and stories – life in a neighborhood where it is too dangerous to walk, or budgets too strained to buy the healthiest foods – that one needs to know in order to really understand why an individual is there, Lutz said.
Lutz went into practice in family medicine, which focuses holistically on the health and well-being of individuals across a family’s generations. He said family medicine allowed him to see how daily life and the interactions within a family could seriously impact a person’s health – for better or for worse.
“Then you realize families are necessarily nested within neighborhoods and within communities, and you see that there’s a much bigger picture,” he said. “Here I am focusing on medicine, but I’m only focused on the individual, and the outcome of [an issue] that may be [several steps removed].”
Known as the upstream theory, it states that public health should focus on addressing what are known as social determinants of health – things like the quality of housing, the availability of nutritious food, safety from violence, and education – to prevent health issues from ever developing to the point of needing recurring, and often expensive, hospital care.
While for many years public health districts provided clinical services, and were often considered an option of last resort to provide care for the sickly and impoverished, the reality is that it doesn’t make sense for public health to work in the clinical arena anymore, Lutz said. Public health agencies lack the resources to provide the one-on-one care that is available at hospitals, and instead should focus on spending the time that doctors lack to educate the community on healthier living, he said.
Lutz, who has a master’s in public health, views his role as health officer as a spokesman for the agency who can inform elected officials, physicians, and policymakers on how their work can impact the community’s health.
This includes vital public health issues like birth control, needle exchanges (like one the agency runs), and even gun control, which are increasingly politicized and divisive policies despite their support by scientific evidence.
Though the agency might not always commit resources to these sorts of issues, Lutz said that nothing would stop him from speaking out and educating on what the best medical science shows would make the community a healthier place.
“Public health oftentimes likes to be invisible, and it oftentimes is invisible,” he said. “We aren’t going to be the leader [in the conversation] all the time, but we’re certainly going to be and should be somebody at the table because we know the health of our community the best.”
The role Lutz currently occupies is different than it was less than a year ago, when the health officer was the top job at the SRHD. In October, the board voted to amend its governance and place an administrator, not a medical doctor, in charge of the agency. The change comes a decade after former health officer Dr. Kim Thorburn was fired from her post following a series of clashes with boardmembers.
Having served on the board, Lutz said that he believes his existing relationships with the board will allow him to effectively bridge the divide between policy and public health.
Lutz, a board member at the time of the vote, abstained because he knew he was interested in pursuing the health officer job, he said. The role, which is only 30 hours a week, pays Lutz $130,232 annually. He continues to work several hours a week in urgent care for Rockwood.
From a local syphilis crisis and the nationwide opioid epidemic to the serious cuts to Medicaid proposed in the latest Republican health care reform bill, Spokane faces a number of critical public health dilemmas, Lutz said. However, poverty and economic inequality in the city – such as the divide between neighborhoods like Rockwood and West Central – are by far the most pervasive health problem, he said.
“[It’s] where we were, and I would argue where we still are at a significant level because we really haven’t addressed that to the degree that we could, or should,” he said.
Lutz said the community needs to realize that they aren’t alone in dealing with their health, and said that citizens need to become “socially responsible” to one another before the community can be healthy.
Asked how he would define success in his role, he said: “It would be for me to assist our community – our elected [officials], our citizens – to understand that we as a society … need to be fundamentally acknowledging and recognizing that many of the ills of our society are caused by pre-existing institutions, pre-existing infrastructure that prevents people from being healthy.”
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