On Friday, May 10, Montgomery County Commissioner Valerie Arkoosh will deliver the keynote speech at the College of Public Health graduation ceremony. First appointed to fill a vacancy on the Commission in January 2015, Arkoosh won election to a full four-year term in November 2015 and served as Commission Vice Chair until her election as Chair in 2016. Since then, she has managed human services, the county court and criminal justice system, voter services, roads and other infrastructure in Montgomery County, the third most populous county in Pennsylvania.
Arkoosh is a graduate of the University of Nebraska College of Medicine and received a Master of Public Health from the Johns Hopkins Bloomberg School of Public Health. She performed her residency at Jefferson Medical College in anesthesiology with a special focus on obstetrics. She has an undergraduate degree in economics from Northwestern University.
How does your background in both medicine and public health inform how you approach your role as Commissioner?
What’s been so interesting about this position is that I can help connect odds for people that they might not normally connect. For instance, I could be talking to people in transportation, and I always remind them that their work is integral to a senior citizen being able to age in place in the home that they love. If they can help make sure that there’s public transportation for that person, and that public transportation stops near grocery stores, stops near doctors office or hospitals, but also gets to neighborhoods, then that could be the difference between a person having to go to a nursing home or being able to stay in the home that they love. And people are not always used to hearing that perspective.
I think that one of the things that is hardest to reconcile is the acceptance that these issues of housing and food are actually, with the exception of maybe vaccines, sometimes more important to people’s health than a lot of the things we do as doctors...If we could do a better job at gun violence and do a better job with preventive health care measures, our doctors and hospitals would have fewer patients.
Our college includes a range of disciplines not often found in traditional public health schools, such as physical therapy, nursing, social work, and speech-language pathology. What do you see as the relationship between more traditional areas of public health and the more clinical disciplines?
I think that it's a huge opportunity to inform each other; the clinical people should be informing the more traditional public health people and vice versa about the challenges their patients are facing. It’s a great opportunity to spread messages. Take an elderly person that’s had a stroke and now has difficulty walking or can’t drive anymore. That occupational and physical therapist could really help inform policy around supports and services for seniors that include things that are really more, in my view, in that public health side that asks, “how do we create safe communities for aging adults that allows them to stay in their home?” I think that it’s a really great opportunity for those two worlds to talk to one another in a way that is sorely lacking.
I spend so much of my time building bridges between people and explaining to people why they should talk to one another. And once they actually talk to each other, they get it. The hard part is often getting them to even see that there would be value in the conversation. It’s really an interesting thing.
What do you see as the biggest health challenges facing Montgomery County today and in the coming years?
We have some really interesting challenges here. We don’t have nearly enough affordable housing, just as Philly doesn’t. And we don’t have enough public transportation, which is something that the city does pretty well. Of all the counties in the United States, Montgomery county rates in the top percentile in the number of people who are food insecure but making too much money to qualify for SNAP. So we have problems that aren’t always as visible or obvious and are a little more subtle and nuanced.
Another challenge is helping the rest of the world understand that Montgomery County isn’t represented by just one area, and that we need lots of targeted resources here, too. It’s an interesting kind of conundrum, how you message that and how people see that. We have food pantries all over this county, for instance—Busy ones.
How do you ensure that efforts to address health crises take into account the entirety of the county and not just certain areas?
We have to approach our work in a different way; we have to be very collaborative; we have to be very good listeners. You really have to listen and you have to really meet people where they are. Because they're all in very different places in this county. We try to work on messaging that’s as inclusive and respectful of the diversity of this county as we can. We have a lot growing immigrant populations, for instance, and very different work experience from the eastern part of the county to the western part, where we have 30,000 acres of farmland. We’re working really hard to preserve that and connect those farmers and their food to some of the more urban parts of the county. It’s really like running a small state.
Our planning commission offers grants to municipalities for certain projects, and all of those projects fit into the county’s comprehensive plan focused on three areas: sustainability, vibrant communities, and connected communities. We try to make sure everything we are doing as a county fits into one of those buckets. So we just keep moving forward, hopefully together, in a coordinated fashion.
As Montgomery County includes a range of settings and demographics, what do you think are some of the differences when we think about public health in urban vs. suburban settings? The similarities?
It’s interesting. I think the actual issues are pretty similar, as we’ve talked about; it’s just that the acuity of one issue versus another might be a little bit different. And we are blessed to have more resources than Philly, in aggregate. Although we don’t have enough affordable housing, I feel like we’re constantly working to get more built.
I also think that there are issues that Philadelphia and its suburbs could be working on and should be working on more closely together. The opioid issue is one. And that is already starting to happen: There has been a little bit more of a regional approach to this, which has been great.
Another issue that I’m still learning about, but one that has really come to seem critically important, is that the criminal justice system has been sort-of walled off. As I have now been in this job for four years and have inserted myself by asking a million questions into all sorts of things, I now see there is this chasm between the criminal justice community and the public health community. And we’ve been starting to bridge that here in the county, slowly. I’m really hopeful that, collectively, we can do more work around re-entry and making sure that some of the social determinant of health pieces are in place as people leave the prisons, which will ultimately help recidivism. If we could get the public health community wrapped around these folks as they re-enter, we’ll do a lot better in keeping them here.
— Chris Sarachilli