Riverside County Public Health Celebrates 100 Years Of Service

With a budget of roughly $155 million this fiscal year, Riverside University Health System—Public Health, is tasked with preserving and protecting the health of the county’s 2.5 million residents and visitors.

“When we are doing our jobs, everything is going great, people aren’t getting sick, we’re having better health outcomes, people are all around happy,” Riverside County Public Health Director Kim Saruwatari said in an interview with The Riverside Record. “And then something happens, and then suddenly people are more aware of what’s happening.”

That’s exactly what happened in the spring of 2020 when Riverside County reported its first locally-acquired case of Covid-19.

“People went from not even knowing what public health was to public health being front and center, and on the forefront of the response and on everybody’s minds,” Saruwatari said.

In the years since the height of the pandemic, Saruwatari said the department has largely gone back to its mostly quiet work of collecting and monitoring data at its lab and from the community.

“There are actually more than 85 reportable diseases in California that healthcare providers, laboratorians have to report to us, so we actually sometimes are able to detect increases in diseases even before other agencies are, and certainly sometimes before the medical community is,” Saruwatari said. “We also monitor other data sources like wastewater and death records.”

At the on-site laboratory, infectious disease and environmental testing supports disease surveillance and community health through a number of efforts including its Rabies Surveillance Program, Wastewater Surveillance Program, Antimicrobial Resistance Surveillance Program and Respiratory Surveillance Program as well as specimen testing for infectious diseases and other pathogens.

“In the past we did cultures, viral cultures, things of that nature,” Public Health Microbiologist III Anthony Walker said in an interview with The Record. “You fast forward now, everything’s gone molecular.”

Because of technological advances, testing that used to take days can now be done in hours, allowing for a quicker response if the data starts showing something unusual. When that happens, the department reaches out to its community partners in an effort to get a more complete picture of the situation to inform its next steps, whether that’s continued monitoring or the implementation of control measures.

“That is both the science and the art of public health: Creating that full picture,” Saruwatari said.

But the county’s approach to public health has not always been so comprehensive.

“In 1893, the Board of Supervisors appointed its first public health officer, a part-time health officer,” Saruwatari said. “His name was Dr. Barber, and the office was discontinued four years later, in 1897.”

The county hired its second part-time public health officer in 1902, but the position would once again be vacant by the end of the decade, despite a February 1908 letter from Dr. N.K. Foster, then-Secretary of the California State Board of Health, urging the county to hire a full-time public health officer.

“Although you may seem to get along very well without a health officer, I can assure you you would get along better with one,” he wrote. “I have had numerous complaints from inside the county and out of neglected cases of communicable disease, and have again to request that you appoint a county health officer.”

It wasn’t until June 14, 1926, that the county took action to hire its first full-time public health officer. According to county archives, the supervisors accepted $2,500 from the State Board of Health and $2,500 from the International Health Board of the Rockefeller Foundation and agreed to allocate $5,000 in county funds for the department’s first year. 

Not long after, the county named Dr. William B. Wells to the role, a job he held until his retirement due to ill health in 1935, according to an archived issue of the Journal of the American Medical Association.

“That’s what we consider the 100 year start, when we had the first full-time health officer,” Saruwatari said. “And it was really a combination of public health and environmental health, and as time went on, mental health, as it was called back then.”

At the time of the department’s start, there were fewer than 100,000 residents in the county. According to a report archived by the Centers for Disease Control and Prevention (CDC), health officers across the country were tracking seven common illnesses — diphtheria, measles, polio, scarlet fever, smallpox, typhoid fever and influenza/pneumonia. 

Additionally, California health officers were tracking leprosy, cerebrospinal meningitis, lethargic encephalitis, chicken pox, mumps, tuberculosis and whooping cough. And, in Riverside County, a large portion of the early public health reports were about unsanitary agricultural practices.

“You didn’t necessarily have clean water, and we didn’t know how to store food, necessarily,” Saruwatari said. “We didn’t know causation for a lot of the diseases that were happening, so we were learning as we were going, which we have seen in public health in the later years as well.”

From its humble beginnings, the department continued to grow, tackling the polio epidemic, outbreaks of measles and tuberculosis and the HIV/AIDS epidemic while continuing to support the overall health and wellbeing of the county’s increasing population.

“Starting early on, we were very much focused on what I would call core public health, so disease control activities, environmental health, really kind of health and safety,” Saruwatari said. “And then, as we have matured as a department over the years, it’s become more about the health of the community and figuring out where there are poor health outcomes, and then building programs around those things, so that we can really lift them up and try to help our communities thrive.”

Throughout the 1990s and early-2000s, the department continued to increase its capacity with the adoption of electronic disease reporting systems, the implementation of Vaccines for Children, the monitoring of West Nile Virus and the expansion of emergency preparedness following 9/11. It was during this time that Saruwatari first started working with the county.

An epidemiologist by training, having previously worked in HIV, AIDS and sexually transmitted disease control and also in general epidemiology and disease control, she came to Riverside County to work in bioterrorism preparedness and response following the 9/11 terrorist attack and the subsequent anthrax attacks on the East Coast.

“There was a recognition that public health played a role in those responses and in helping support communities going through something like that,” Saruwatari said. “So the federal government authorized funding for health departments to build up some of their bioterrorism preparedness, and I was fortunate enough to get to come to Riverside County and start that program.”

After more than a decade heading that department, she left in 2015 to launch the county’s Emergency Management Department where she became the inaugural director. But in 2017, she had the opportunity to return to Public Health as its director, a role she’s held ever since.

“Public health is my passion,” Saruwatari said, adding that she was initially drawn to epidemiology because of the detective-like work of trying to figure out how and why people were getting sick.

“That’s really the role that public health has played throughout history,” Saruwatari said. “Identifying the source of disease, how it’s being spread, who’s getting it and how we stop it.”

As part of this work, she said the department has put a heavy emphasis on equity when it comes to its more than 40 program offerings.

“We’re talking about equity from a health outcomes perspective, so we can look across our entire county and we have people who live much longer than other communities that are only a few miles away, and why is that,” Saruwatari said. “That’s really the science of public health, is digging into the why, and so we look at our different communities, we look at rates of disease, we look at other health outcomes.”

That includes programs for HIV/AIDS prevention that specifically target communities in the county experiencing the highest rates of the disease to ensure they have access to the information and treatment options they need and programs that focus on Black maternal and infant health to ensure they have the services and support they need to thrive.

And while the work of public health is focused on community health and improving health outcomes across the county, Saruwatari acknowledged the challenge of communicating those efforts to the community in a way that’s transparent, accessible and builds trust.

“We’re here to support the community and make the community healthier, and we can only do that if we’re listening to the community,” she said. “That’s where trust is built, in the community, not sitting in an office and thinking that we know what’s best, but actually going out, being with the community, being at community events and working with community partners.”

For the past 100 years, the department has continued to learn from the lessons of the past, adapt to meet the changing needs of the county’s population and plan for whatever the future brings.

“Change is constant, and here in Public Health we understand that the future will require that we identify, adapt and meet emerging health challenges as they come,” Riverside County Health Officer Dr. Jennifer Chevinsky said in a release celebrating the department’s centennial. “For that reason, the lessons of the past make us stronger so that we will be ready.”

The history of public health, Saruwatari said, has been marked by periods of neglect followed by periods of panic during a public health emergency before cycling back to neglect. Her hope is that, this time, that cycle stops.

“I think it’s really an exciting time in public health,” she said. “We’re starting to see advances in the types of analysis that we can do in public health and, this may sound silly, but I also think that this concept of rebuilding trust with the community is exciting, because I think it’s an opportunity for us to demonstrate to the community that we’re in it for them.”