Collaborating across sectors to work through jurisdictional challenges
Guest blogger: Jamie Moore, CPHI(C)
Environmental Health Officer
Government of Manitoba (Winnipeg)
In over 20 years of working in public health, I have seen how Environmental Health Officers (EHOs) can be effective advocates for individual clients, but knowing when to intervene in an individual case in the name of public health can be a challenge. As EHOs, we encounter situations that are affected by the social determinants of health, such as income and mental health, and often solutions involve more than just the EHO to take action.
I was once involved in the case of someone who was living at home with their mother when she died. The house was left to them to live in, but he had mental health issues in addition to having no source of income. He didn’t know that social assistance was available to help him, and he was socially isolated, afraid to answer the door when anyone knocked. He had a problem with hoarding, and the house became packed full of things, posing a safety hazard for him. Neighbors contacted our Environmental Health Services Branch because they were concerned that the house was a fire hazard and a risk to the community. The house had no running water or heat other than a small electric heater in one room on the second floor.
As an EHO, I had to decide what I was going to do to resolve this situation. When a home is owner-occupied, an EHO, in my jurisdiction, does not have authority to force the owner to vacate the property without an order written by the Medical Health Officer (MHO), who will not usually write this order unless the owner-occupant has other living arrangements secured. So I wrote this individual a letter and put it in his mailbox, expressing concern for his safety and offering to link him to services, including alternate housing at no cost to him. I gave the option for him to contact me, and eventually he did - and I believe it was because he felt in control of the decision to initiate contact instead of having someone come in and try to take over his home. We had several meetings over time, which allowed trust to build. I connected him with emergency social services and community mental health. He qualified for income assistance and public housing, and agreed to move out of the house and into a public housing unit. Once that happened, the MHO agreed to write an order to “placard” the house and maintain it vacant (meaning it was not permitted for anyone to live there).
Unfortunately, he continued to hoard which got him evicted from public housing and with nowhere to live, he had to move back into the placarded house. The MHO and I told the client that he could no longer live there because the house was placarded. I remembered the client saying he eventually wanted to sell the house but first wanted to clean it up and he had $20,000 in unpaid bills and couldn’t afford another place to live. Knowing that there must be a solution, I had to think outside the box. I looked for the real estate agent who had most of the listings in the area; the realtor did a drive-by assessment of the house and came up with a price. I talked to the client, and he was pleased with it. Because the client had built up trust with me as an EHO, he consented to me communicating with the community mental health worker; together, along with a social services worker, real estate agent, and a family member, the client was supported to negotiate terms of a house sale. It was arranged that upon selling the house, the client’s debts would be paid, and the rest of the money could be kept “in trust” with a family member. A clause was built into the conditions of sale that when the purchaser of the house was clearing it out, my client could keep what he wanted that would fit into a small storage container. The house sold, accommodation at a rooming house was secured, the client reconnected with family who helped support his ongoing needs, and he felt some control over the situation.
There were a lot of lessons in this case for me. Actions need to be done in a dignified manner when dealing with individual clients, nudging them in the right direction while recognizing that the barriers they face may be beyond their control. As EHOs, we need to be open to working with other departments and professionals within the Regional Health Authorities. Working intersectorally and inviting “atypical” partners to the table (in this case, a realtor) to help find a solution can have a big impact. Collaboration between public health and other community services could help identify and resolve health concerns in communities. We need to build relationships with community members so we can better understand a client’s situation and help them navigate the system. As EHOs, we have the skill set to do that. We just need to be willing to take that first step.
We would like to hear from you! What experiences have you had in addressing the SDH and health equity in your environmental health practice? Please send your stories to Dianne Oickle, Knowledge Translation Specialist and help us share your practice stories. Our colleague Karen Rideout at the National Collaborating Centre for Environmental Health (NCCEH) will be continuing to collect stories from health protection or PHIs/EHOs who have taken action on SDH or health equity through their work. She would love to hear from you too!
Please visit the NCCDH Resource Library for related materials, including:
- Let’s Talk: Advocacy and health equity
- Key public health resources for advocacy and health equity: A curated list
- Leadership for health equity: Working intersectorally and engaging the community in Western Health
- Curated reading list: Intersectoral collaboration to address health equity