.Santa Cruz County Health Services Agency Director Mimi Hall Reflects on Her Career

There has been no shortage of work for Mimi Hall over the past 19 months.

Since last March, the County Health Services Agency (HSA) director and her peers have had the enormous responsibility of trying to slow the spread of Covid-19 in Santa Cruz County—while weighing the effects their health orders will have on the lives of those they’re trying to protect. That has meant poring over thousands of data points, following and communicating mandates handed down from the state and guiding some 300 county health employees toward the ultimate goal: saving as many lives as possible.

Hall was, for most locals, just another county worker before the novel strain of coronavirus arrived. But after businesses were forced to close, schools sent children home and masks and vaccinations were required for everyday life to return, she, like many public health officials, became a target.

Through it all, Hall never wavered—and she spoke up about the treatment she was receiving, in hopes it would inspire other health officials to do the same. For those efforts, Hall and County Health Officer Dr. Gail Newel earlier this month were awarded the PEN/Benenson Courage Award by PEN America—a national nonprofit that advocates for literary freedom and human rights—during a ritzy awards gala at the American Museum of Natural History in New York.

While rubbing elbows with Henry Louis Gates, Jr., Jodie Foster, Lin-Manuel Miranda and Awkwafina at the gala might have made the past two years a bit more palatable, they have undoubtedly taken their toll on the lifelong public servant. 

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Hall will step down from her position at the end of the month, a move she tells GT is bittersweet after an exhausting but rewarding career in public health that has spanned multiple California health agencies and began during the AIDS epidemic.

Hall is not only stepping away at a time of mass exodus for those in public health leadership, but also at a key period of transition for the public health realm. Still, Hall, a staunch advocate of public health equity, believes the county will be just fine without her so long as it follows the golden rule: “every life matters.”

Reunion Tour

When Hall abruptly stepped in as director in 2018, roughly a month after joining HSA as second in command, she knew her first job was to get to know the community. What she didn’t know was that she would have to rehabilitate several relationships. The county had for years served as somewhat of a competitor to nonprofits and health care providers that were trying to help some of the same populations. Her goal to improve those relationships was simple: stop being an adversary and become a partner.

That groundwork paid off when Covid-19 began to ravage Watsonville and its densely populated community full of essential workers. When federal and state funds started flowing into the county, Hall immediately turned to service providers in the county’s southernmost city and told them it was time to get to work. 

“It was time to save lives,” Pajaro Valley Prevention and Student Assistance CEO Erica Padilla-Chavez remembers. “She could’ve very easily said, ‘No, the county health department’s got it,’ but she didn’t do that. She created space for conversation. She really brought in her team to listen to us, to listen to what we were hearing from our community members. I think that speaks to Mimi’s true understanding of equity.”

Salud Para La Gente CEO Dori Rose Inda says that those efforts were borne out in data that shows the 95076 zip code, which covers much of Watsonville, has the highest vaccination rates in the county. Inda says that Hall’s most impressive attribute during the pandemic was her understanding of the Watsonville community and the challenges those residents—many of them immigrants living below the poverty line—faced.

“She not only understood the people who live here, but she identified with their experience,” Inda says. “She understood what it meant to work hard and earn less, to worry about having enough food and a safe environment to live and work in. She made those inequities the focus of the public health response during the pandemic.”

Equating Equity

Hall spent the first four years of her life in Myanmar, a Southeast Asian nation formerly known as Burma that is home to the world’s longest running civil war. Her father and mother were once civil service physicians there working in a hospital that was “six cots and a dirt floor,” Hall says, before a hospital in New Jersey sponsored her father to help the family escape the decades-long conflict. They eventually moved to Chicago, where her father gained residency at a hospital. She grew up in a public housing building that was a “broken-down, decrepit high-rise” that has since been gentrified.

After his residency, her father struggled to find a hospital that would hire him. Looking back, she believes it was because of strong anti-Asian American sentiment in the U.S. during the Vietnam War. Her father eventually did find a job in a hospital on the north side of Chicago, where she says he worked for half the pay and took on twice as many on-call shifts as his white counterparts.

“He would curse when he had to do the extra on-call [shifts]. He knew it wasn’t right,” she says. “He told me when I was young, ‘When you grow up, you’re going to feel racism and sexism. But you won’t be able to name it and you won’t be able to prove it because it’s going to be so subtle.’ And he was absolutely right.”

Hall didn’t find her calling until she went to college in Hawaii during her late 20s, at the height of the AIDS epidemic. It was then that she saw the beautiful, albeit chaotic, dance between health agencies that public health directors help coordinate. It was also when she learned that to really make a difference in people’s lives through public health, the emphasis must be on prevention.

When she arrived in California in 2005, she wasted no time making her mark in public health, first serving as assistant health and human services director in Sierra County before moving to Plumas County and becoming the lead health official there. Although she oversaw a county that was only 18,000 people strong, Hall made sure their voice was heard at the state level. While serving on the County Health Executives Association of California (CHEAC), she advocated for the state to reform its funding strategies to bring needed services to small rural counties where treatment was lacking.

Hall remembers applying for a federal grant and telling the agency that it can’t say that “because it’s too hard and it costs more, these people don’t deserve the same kind of treatment and care if they were somewhere else.”

“Bringing that care to those communities, that’s equity,” Hall says. “I’m so grateful for my time in those small counties. It doesn’t matter how small you are … as long as you can be a voice for the whole public health community, you can make a change so that wherever you work you can elevate public health overall.”

The Future Of Public Health

In a slideshow presentation that Hall uses to teach county supervisors throughout the state how public health works, she has a quote from famed American engineer W. Edwards Deming: “Every system is perfectly designed to achieve exactly the results it gets,’” Hall says with a trailing chuckle. “If you don’t change and grow, you’re going to only do what you’ve always been doing.”

Hall, a steadfast rule follower, says that public health is all about structure, responsibilities and laws. But for the first time in her career, she will get to work outside of those lines a bit. Next month she’s joining Manifest MedEx, a nonprofit health data network, as its director of public health innovation. In that role, she’ll work with county and state agencies to improve public health and prevention by using Manifest’s data network that spans more than 28 million Californians, 125 hospitals, 1,500 ambulatory care sites and nine health plans—the largest such web in the state.

“With the expansion of Medi-Cal and bold legislation that will require providers, hospitals and health plans to share health data, California stands at a pivotal moment when we can truly transform public health for generations,” said CEO Manifest MedEx Claudia Williams.

Part of that evolution, Hall says, is a campaign coined by the Centers for Disease Control and Prevention as Public Health 3.0. That initiative, in a nutshell, says that although the U.S. has made progress in increasing the health and longevity of its residents through public health interventions and high-quality health care, it must now work to address the widening gap in life expectancy between the highest and lowest income communities.

Public Health 1.0 brought forth, among other things, basic sanitation, improved water and food safety and the introduction of vaccinations, and Public Health 2.0 focused on “siloed” funding streams such as alcohol or tobacco prevention campaigns. Public Health 3.0 emphasizes that a person’s zip code is the strongest determinant of their life expectancy, and that public health agencies must be the catalyst for change in their community by bringing various sectors—education, transportation, local government, health care providers—together in order to improve a region’s health outcomes.

“It takes a whole community, because there’s no one thing that influences health,” Hall says.

In many ways, Hall’s leadership style from the past four years mirrors Public Health 3.0. County health department heads in the future will likely be the strategists of long range plans who will then be tasked with getting multiple organizations to buy in and execute it.

Of course, these plans will need funding to be completed, but Hall says she’s confident those dollars are on their way. As CHEAC Board President, she helped get the state legislature to fund a $300 million yearly allocation for public health infrastructure in next year’s legislative cycle. “And that’s just the start,” she says.

Locally, the county’s Freedom Boulevard location is set for a large expansion that will add some 10 to 15 dental chairs in a partnership with Dientes, and a 16-bed children’s residential crisis center. Hall says those upgrades were set for two years down the road, but the money is expected to be there now and the need in Watsonville after the pandemic is very high.

“The time is now, the money is coming now, let’s serve our community,” she says.

The Hall family isn’t leaving the area—she will be working remotely for Manifest—but she will have to watch the department move forward from the sidelines. Looking back at the last four years, she says she’s proud of what HSA accomplished.

“But I’m also not full of myself enough to think it’s me—this is an amazing team,” she says. “The only thing I did was allow them to work the way their training said it should work. I know they’re going to be more than fine when I leave.”

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