November 20, 2012 - After 12-plus years at the helm of the Long Beach Health and Human Services Department, one of only three city jurisdictions in the state, Ron Arias announced he is retiring at the end of this year.
Before he retires from a career in public health, Arias agreed to sit down with the Long Beach Business Journal to discuss how, as director, he has helped develop and maintain the local department's public health programs and supported the overall wellbeing of the community.
Arias has lived in Long Beach for more than 40 years. "I would say that one of the reasons I was hired is due to the fact that I have been in Long Beach since '69," he told the Business Journal. "I graduated in '71 from Long Beach State, and then I worked at the East Long Beach Neighborhood Center in '71 and '72. So I started at the local level."
His work at the neighborhood center led Arias to pursue a graduate degree in public administration at USC. He continued his career in public health working for the Community Health Foundation of Los Angeles and the Health Systems Agency for Los Angeles County before getting a job with the American Lung Association in 1983 as the director of communications and government affairs. In 1990, Arias decided to go back to his roots and was hired as the manager of the public health bureau in Long Beach.
"The psychology of complex organizations, whether you're in the nonprofit sector or the private sector or the government sector, is relatively similar," Arias said, reflecting on his work on the local, county and national levels. "You have identified leaders. There are policies and procedures that you have to learn. There are people who have more influence than others. And you learn what is required to get things done."
Arias worked in that capacity for a decade before he began his tenure as director of the department in February 2000. Since then, he has spearheaded the development of the Miller Family Health Education Center, an educational hub for collaboration with the city's diverse community on public health; established Community Health Research Studies (part one and two); helped roll out the city's first 100 percent ban on smoking; developed chronic disease prevention programs and more.
LBBJ: What initially attracted you to the healthcare field?
Arias: I think that the attraction for me was a desire to help the community. My very first job was at the East Long Beach Neighborhood Center right on the corner of Anaheim Street and Junipero Avenue, which later became the United Cambodian Community building. In the late '60s and early '70s it was an all-inclusive community center. I was a housing coordinator. Renters would point out problems with their landlords and ask for help, and we would try to negotiate repairs. At one point, somebody said I should contact the health department for help, and to my surprise they had a health housing program that required apartment complexes of four units or more to meet certain standards.
That was my first introduction to public health. I had originally thought I was going to be a teacher. I had an interest in coaching, and my undergraduate degree is in physical education, kinesiology. But after that experience I decided to go after my master's degree in public health administration with an emphasis in health services administration. I followed primarily a public health track since then.
LBBJ: I noticed that you have experience working in Los Angeles in the nonprofit sector and for a federally funded, temporary health program in Los Angeles County, and also for the American Lung Association. What was it like working for a national health organization compared to a local health agency?
Arias: The key part of a local health jurisdiction is and still remains being connected to the community and adapting to the needs of Long Beach residents, providing services that they believe are important. The skill set I learned from the American Lung Association (ALA) was still applicable, but I did need to make changes that allowed me to learn the formal and informal structures of city government.
One of the benefits that I brought with me was having worked two or three years in anti-smoking policy in different communities. When I came to Long Beach, the city's policy was 25 percent no smoking in restaurants. I brought knowledge of stronger policies, and one of my very first assignments as a new bureau manager was to work with the city council in developing a strong no-smoking ordinance. Having that background with the ALA was invaluable. As a result, by 1993 the City of Long Beach, working with Judy Ross and with Councilmembers Evan Braude and Ray Grabinski at the time, had a policy of 100 percent no smoking [inside restaurants]. It was almost three years before the State of California adopted similar policy. Some of that benefit and credit goes back to the experience I had at the ALA.
LBBJ: Long Beach is one of only three cities in the state with its own health department. How significant is it for the city to continue to have its own health department to address local public health issues?
Arias: It's an extraordinary benefit to have a local health jurisdiction. The status, which is designated by the state, immediately allows Long Beach not only to receive funding from the state but also opens up the door for us to receive direct funding from the federal government, increased funding from the state and additional funding from county government. We have been here since 1906, and we're not the same that we were in the early days when our focus was food and water. But as we evolved, we began to see a pattern. Our pattern has always been [to address] the public health issue of the day or the decade. In the 1920s we administered over 50,000 smallpox vaccinations. In the '40s it was all about controlling and knocking down tuberculosis. In the '50s it was polio vaccinations. We vaccinated the entire community. There were clinics we set up at schools and here at the health department. It's a vehicle that we've had and one that is a proud legacy and tradition of public health. In the '80s we launched an all-out war against HIV/AIDS. And, of course, the '90s was the beginning of the tobacco wars.
LBBJ: What would you say were the top three public health concerns when you became director in February 2000?
Arias: The issues in 2000 were primarily funding, but also addressing the issues of health disparities. We were recognizing that Long Beach had significant pockets of poverty and we were seeing higher incidences of [health] conditions that were preventable. I would say the third issue is cultural and linguistic isolation. It was one that we were recognizing as a problem, and of course it is also connected to health disparity. But it is one that we believed we could correct by being smart, developing our materials in multiple languages and the ultimate development of the Miller Family Health Education Center.
LBBJ: Are those three health concerns still at the top of your list today?
Arias: Funding remains a major challenge. Keep in mind that we are a $119 million department. We receive approximately 1 percent of our funding from the city's general fund. We are very proud of the fact that we are not in any way dependent on the city for support. At the same time, it does put a lot of pressure on the health department to ensure that we maintain funding through a large patchwork of grants both from government and private foundations, which is hard work. We write our own grants.
I would say that the more topical issue, which has emerged over the past several years and I see going on into the next decade at least, is obesity. We focus on childhood obesity because that's where we believe the line needs to be drawn, where we can begin to develop policies and programs that will stem this problem. It's working with young people and helping them understand that they need to eat a little better. They need to be conscious of what they are putting into their systems, that it can hurt them over a long period of time. And, reminding them that physical activity is still a very good thing and it's fun. We're getting away from calling it exercise. Let's just go play and have fun. We're trying to work with parents and community service programs in getting kids back onto the field and into physical activity.
LBBJ: What impacts have the childhood obesity prevention programs had on the Long Beach community since you helped establish and implement them?
Arias: What we are seeing is a better understanding of what the causes of childhood obesity are. It's not necessarily rocket science. We are targeting certain things. "Rethink Your Drink" is a campaign that we have been involved with for two years. It shows a young person that a 16-ounce regular soda has up to 20 packets of sugar in it. There are not too many people that are going to take 20 sugar packets, pour them into a 16-ounce container and then drink it. But that's what a child or an adult gets when they drink a regular soda. We are informing people that, of course, corn syrup and other types of sweeteners can have a negative affect on your health.
The policies have been fewer. We were able this year to get a healthy snack policy passed within the City of Long Beach. Any event or activity that occurs in the City of Long Beach where city resources or city funds are being used, there is a healthy snack standard. The beverages are primarily water, some artificially sweetened beverages and juice; on the snack side we are looking at more raw nuts, popcorn, carrot packs, celery with a peanut butter spread. These are things kids will like. We are battling some very strong cultural taste expectations. Cheetos, Fritos and Doritos are tasty; I'm not going to deny that. We're not arguing for the elimination of those products; we're just supporting moderation.
LBBJ: In light of the impacts of post-Hurricane Sandy on the East Coast, what is the health department prepared to do in the event of a natural disaster or pandemic?
Arias: Our plan of attack is primarily an all-hazards public health emergency management plan. When I say all hazards, we are looking at things such as natural disasters, a natural biological disaster such as an outbreak of an infections agent or a weaponized biological agent used by terrorists. In the event of an emergency – a disease outbreak, biological threat or natural disaster – the City of Long Beach Department of Health and Human Services can respond in a variety of ways. We have a public laboratory that is registered with the Centers for Disease Control and the FBI as a sentinel laboratory under the national laboratory response network. Our lab is equipped to respond to acts of bioterrorism, infections disease, natural disasters and other public health threats. Our epidemiologists have gone through various levels of training for the surveillance, detection, investigation, monitoring and reporting of public health threats. They are also connected to our national surveillance team. They are online and working 24/7, 365 days a year.
A better example is our emergency medical dispensing capability. The Long Beach Health Department can respond to a public health emergency by activating points of distribution (PODs). On Thursday, November 1, the health department's emergency management team, spearheaded by Dr. Mitchell Kushner, MD and city health officer, held a regional POD exercise that involved L.A. County, Orange County, the Pasadena Health Department and the Long Beach Health Department. The Long Beach Health Department was the lead agency. The POD is the vehicle that the health department would deploy in the event we needed to vaccinate or administer medicines to a large segment of the population that had some type of exposure or a pandemic outbreak. At that particular exercise, we administered 751 vaccinations. It is considerable, [since] it was only open for four hours. That's a lot of shots. That was part of a drill, but it was also part of our winter flu vaccination program. We coupled these items together, so not only were we able to exercise, we were also able to administer actual vaccinations.
LBBJ: In your role as director, you oversee six departmental bureaus including the housing authority. According to the city's website, the housing authority assists more than 6,300 households in Long Beach.
Arias: It's actually 6,700 in 2012.
LBBJ: Very good. How much has housing assistance, in terms of vouchers and placement, increased in Long Beach the past decade, and do you feel more assistance is needed?
Arias: Housing [assistance] is critical to a community, particularly low-income and poverty level communities. It's one of the things that we battle with in terms of the people that are on the cusp, just about to become homeless. Since we have homeless programs, we are well aware of what happens to individuals and families when they lose their home. We believe that the HUD (housing and urban development) housing choice voucher program (Section 8 housing government subsidy) is a valuable tool for a major metropolitan area the size of Long Beach. The 6,700 families that we provide housing assistance are able to live in very good housing. In the City of Long Beach, this is scattered throughout the city and not concentrated.
LBBJ: But would you say that it has increased in the past decade?
Arias: The housing authority has only been in our department for a little over two years. It's a newer program [to the health department]. I believe that it has increased. I don't believe it has increased dramatically. This is a federal program that had been in the city for a very long time. [Secondly], are there more needs than we have resources? The answer to that question is yes. There are 3,000 or 4,000 people on a waiting list for obtaining a housing choice voucher, which, again, reflects the great need in the city.
LBBJ: Is there anything you would like to see the health department do differently in terms of addressing public health needs?
Arias: Probably one of the most important parts of a local health department is its ability to adapt and to change to meet the current needs of the community. I've shared with you many of the historical changes that we have made. I think that is the future. The future of the health department is staying focused, looking at data, identifying problems and marshaling resources to address these problems.
As I've mentioned, childhood obesity is a current target. I believe that will remain for several years. We struggle with that. There is no national title that actually funds chronic disease in the way that we receive monies for maternal and child health or for communicable disease or for HIV/AIDS or tuberculosis. All of those have federal policies that have defined funding in those areas. This has been one of the frustrations for most local jurisdictions; we are still battling this particular problem with less than optimum resources or even defined resources. I think that's going to be a problem.
The thing that I want to end with is that the health department does so many things that the community does not see. That's not always a bad thing. Because when your health department is doing its best work, you're not going to hear much about it. We are providing 18,940 environmental health inspections of restaurants, cafes and food distributors including supermarkets. We provided 14,780 vaccines to local residents in 2011. Of course, this includes our flu vaccines and all of the vaccines that we receive and then distribute to partners like The Children's Clinic and the Westside Neighborhood Clinic and the various community based organizations where we are making sure that children and adults, particularly seniors, receive these vaccines. We distribute 6,700 housing vouchers as I've just mentioned. We do vital records. We gave out 18,778 certified vital records [birth and death certificates] to Long Beach residents. If they didn't have the health department, they would have to go to Norwalk or downtown L.A. to obtain these documents. These are important functions that we provide. I think that we do a very good job of it and I hope [the department] is around for another 100 years.
LBBJ: So what is next for you in post-public sector retirement?
Arias: First of all, I'm only retiring from city work. I remain on three boards in the city. I'm a trustee on the Miller Foundation. I am on the board of directors for the Ronald McDonald House. I am a boardmember of the Rancho Los Cerritos Foundation. And I will remain active. I have been involved in community affairs since I graduated from college, and I guarantee you that I will continue to be involved in issues that will help Long Beach to be the world-class city that it is.