Layton Long submitted his two month’s notice for retirement back in February, not knowing what was about to happen.
He was all set to leave his job as the director of the Chatham County Public Health Director — ending a six-and-a-half-year tenure there and more than 30 years in public health — at the end of April.
Then COVID-19 hit.
“My timing’s not real good,” he said. “If I had retired in January, it would have been a totally different story.”
Long is officially stepping down at the end of this month after extending his stay for an additional few weeks. On the eve of his retirement, he spoke with the News + Record about his career in public health, operating in the center of Chatham’s COVID-19 response and what advice he’d give Chatham residents related to their health.
How did you end up as the Health Director in Chatham County?
I had been Health Director in Davidson County for eight years and was asked to take a position at the state health department as the state environmental health director because that had been my background early in my career. So after much thought, I took the position. That was under the (Gov. Beverly) Perdue administration and worked briefly under the (Gov. Pat) McCrory administration. I really missed the local involvement. It’s a totally different thing at the state level; I felt disconnected. And I had been in public health for about 22-23 years, something like that at that point. And going to the state was just a totally different environment. I like interacting with local agencies and local partners, those kind of things at a local level that I didn’t have at the state. And so I just realized that it wasn’t something that I wanted to stay with and began looking for health director positions that were coming open and that I could apply for. And I knew the previous Health Director here, Holly Coleman, as a colleague for several years and I knew she was retiring and so I applied and subsequently was hired to come to Chatham County, and that was in December of ’13.
In non-pandemic circumstances, what are the responsibilities of the Public Health Director?
The health directors across the state are charged with a lot of legislatively-mandated responsibilities. You are the chief public health officer for the community. With that comes the responsibility of assuring public health services are provided for, ensuring other types of medical services are maintained. In other words, if you recognize a service isn’t available in your community, then it’s your responsibility to find a way to bring that service into the community, either doing it through the health department or doing it through a community partner or advocating for somebody to come into the community to provide that service.
It’s monitoring and assessment of the community in terms of service availability for the residents, that’s one aspect. The other aspect is enforcement. The health directors are ultimately responsible for enforcement of communicable disease laws. Environmental Health is an enforcement branch of the health department. You are the chief administrator of the hiring and firing authority for the health department. In our situation, I work directly for the Board of Health, which is a policy-setting board for the health department. You have the fiscal responsibility for the health department. I sign all the contracts for the health department under the law.
I have responsibility as an advocate through local elected officials and state officials, advocate for the county for involvement with conversations with the state health department. It kind of goes on and on. I’ve served on many boards and committees — I don’t even recall so many of them now — throughout my career. And just generally, administrative, oversight, advocacy, enforcement, rabies law. Even though Animal Services is no longer with the department, ultimately, those responsibilities for enforcement of those rabies laws still fall under the health director. All the health directors across the state do these same things.
I think the biggest thing that a health director can do is be a voice for public health in the community, and try to build partnerships to advocate and make linkages that improve the health of the citizens, whoever they are. Educating the public, educating officials around the public health and the things that we do and why it matters — that’s a big part of it.
What do you see as some of the highlights of your career?
Throughout my career, I’ve worked on a lot of legislative agendas. One of the highlights of my career — and it wasn’t here in Chatham County — was working very closely on the bill that outlawed smoking in restaurants and bars. At that time, the representative that was pushing that legislation was in my county and he and I worked very closely together on that. So that was a one of those things you kind of look back and say, “Yeah, I was a part of that.”
But in Chatham County, I think some of the biggest things that I think we’ve achieved here is the Community Health Assessment, the way it’s being done; the partnership that we forged with Piedmont Health and the hospital; the current construction plan that we have for co-location with Piedmont Health; to forge those and strengthen those relationships and that better serves the community; and we’re working so collaboratively together with the Chatham Health Alliance. And I don’t take credit for any of these things. I think it’s been a collective effort of all the people in the health department that have been involved with it. So it’s just things that you’re proud that you were part of during your tenure that felt like it moved the needle forward, while you’re there.
The anti-smoking, anti-tobacco work that the department has done even in the last year-and-a-half seems to fall right in line with your earlier work and seems to be a passion of yours.
You can ask any of my staff and they will tell you: if you start talking tobacco around me, I pull up my soapbox and stand on it. I will say this: tobacco is still the biggest public health threat as far as early death and disease in the country and in the state, in the community. It’s unfortunate that it disproportionately affects disadvantaged populations. The marketing that the tobacco companies do toward youth, and historically have done, I find appalling.
It is a product that people get addicted to and they struggle with for years. It’s just one of those things as a public health director that has always been forefront of my mind. I cite this statistic all the time, but when you have 90 percent of tobacco users that begin before age 18, that tells me that it is necessary for us to get addicted to this product for the industry to survive. I just don’t like the idea of children getting addicted to a product that is going to cause him early death and disease and their long term.
What makes COVID-19 different than other health disasters you’ve experienced?
I’ve been at this 32 years now in public health and I’ve been through a lot of disasters. I’ve been through when rabies first came back into North Carolina, started making a presence again, I’ve been through H1N1, I’ve had through hurricanes, been through floods, Hepatitis A outbreak, Shigella outbreaks — all of these things that get you at a really heightened state and all-hands-on-deck, and you go through this intense period of dealing with these things. But they usually resolve after, you know, two, three, four weeks, you can see some resolution.
This is a different circumstance to those events. Those events were just as high but they weren’t as sustained. And this is the difference here with what we’re dealing with at the tail end of my career for the past three months that I’ve been working. So the intensity hasn’t waned, and that’s the difference in this.
These last few months, how crazy it’s been. You were at a press conference with the governor, had to talk to media probably more than you’ve ever talked to the media before.
I have done a lot of media over the years, a lot of it, particularly when I was in Buncombe County. It was a small market, and I was constantly in front of the camera. There’s been a real compaction of media attention in this past few months and I haven’t seen in my career so yeah, it’s been quite intense. I’ve been involved with massive hepatitis A outbreaks at a very busy restaurant, and the media attention is just incredible. And it runs for about two to three weeks, and then it’s gone. This has been three months and it’s not showing any signs of waning, so it’s different that way.
The media is incredibly important. And I’ve always tried to be responsive to the media. We’ve had these discussions when you’re in one of these events and you’re getting hammered again and again and again and again and again, by media, then you’re having to pull away from things. I don’t remember specifically what the intensity was around the issue, but we tried to corral those things in a manageable way so that we could do our primary job but still managed to speak to the media in a responsive way. The media is incredibly important to public health. It really is. I can’t say that enough, because the messaging that (the media) can convey is incredibly important.
I have to say, all in all, the media has been good. I have bad experiences with the media, but not here.
What was the biggest challenge you’ve faced in your public health career aside from COVID-19?
Getting the public to understand the importance of public health. I’ve always said that, if public health is successful, nothing happens. And it’s hard for people to understand the importance of public health if nothing happens. I think what we’ve seen here with COVID is a recognition that public health matters and people get it now.
We all understand the necessity of having a firehouse, fully staffed and equipped. And I think what the struggle has been is to get people to understand public health is that same model. We have literally tried to build and staff the firehouse while the building is on fire. And that’s the unfortunate part of being in a situation where, if things are going along and nothing is happening, then people don’t see the need and the funding gets cut, and the resources all of a sudden aren’t there and when the building catches on fire, who do you call?
That’s what I’ve seen over the several years is funding cuts, and that leads to personnel cuts, and that leads to capacity cuts, and that leads to expertise cuts. And these things, I think, have been a challenge for public health over recent years. It’s not a visible thing. People see houses catch on fire, they see buildings catch on fire. They don’t see public health staff going out in the community every day, day in and day out doing what they do, and because they do those things, nothing happens.
You think about something as simple as environmental health going out and permitting wells and doing well installation inspections. Nobody really thinks about it. But if they weren’t there doing those things, then the probability of having poorly installed well and contaminated water supplies greatly increases, but nobody really pays any attention that they’re doing these things. Our CD [communicable disease] staff, which have been so integral to this COVID response, they had jobs prior to this day in and day out. They are tracking communicable diseases, whether it be TB or STIs [sexually-transmitted infections] or pertussis or whatever it might be. They’ve been doing all of that. That’s just what they do, day in and day out. And so people don’t recognize these things that are happening.
If you’re doing your job and you’re doing it OK, nothing happens. Even something as simple as restaurant inspections — nobody gets sick because environmental health is out there every day, going out there doing those things to make sure people understand, say, food handling, so therefore, nothing happens. But when you do have a foodborne outbreak, then people do say, “Where’s the health department?” I’ve always said I don’t want to be the first health director in decades that has a human rabies case in North Carolina, and we work diligently every day to make sure that doesn’t happen. So it doesn’t happen.
What’s one piece of advice you would give Chatham County residents related to their health as you step out of this position?
When I become just “public citizen,” I feel like it’s my responsibility as a resident, as a citizen of the community, to do those things that not only protect myself, but protect my neighbors. These minor annoyances with wearing a face covering — the thing of it is, if we all contribute to it and quit looking at it like it’s an imposition on me or that it’s something you’re trying to take away from me, and we look at it as a social responsibility, we can all get back to work sooner.
It’s counterintuitive to say that you want to get back to work, but yet you don’t help everybody doing these things that to get us back to work. If you’re wearing a face covering, if you’re socially distancing and you’re doing other things that you’ve been asked to do, then we all benefit, all of us can get back to some level of normalcy. But if you don’t, if there’s a large swath of people in the state or the country that don’t do that, then it makes it much more difficult to get to wherever we all want to be. That would be my messages: let’s work together as a community to try to get back to some level of normalcy. We all want that. And I think if we just do those things it will be it’ll help get us there.
I want to protect my family, I want to protect my friends and my neighbors. And if by doing these simple things I can do that, then I feel like it’s my responsibility to do that.
Same question, but non-COVID...
It’s hard for people to understand what public health does. Recognize that the public health department is staffed by community servants that are trying to do the right thing by the community, and sometimes that work requires them to do things that don’t necessarily seem to make sense, or it may be things that require certain things of certain people, but it makes all of our lives better by them doing that whether it’s Chatham County or the 99 other counties out there in the state.
Collectively, the public health work that’s going on benefits all of us. Through safer places to eat — I don’t have to think about a worry about, “Am I going to be infected by some disease because somebody’s not being monitored and provided health care that they need?” Access points for folks that struggle getting access to health care hopefully have been improved, because public health is there helping to work on those issues. It goes back to the point of because they’re out there working and doing those things, everybody’s life is better, and to try to recognize that public health is important in the community, even though it goes under the radar most of the time.
And you’re not quite done with public service: you’re the chairman of the Goldston planning board.
And right now I’m still on the Cardinal (Health Innovations) board of directors, the MCO [Managed Care Organization] agency for the 20-county region. To whatever extent we can do anything with the Goldston planing, I’m still chairing that, though that’s been put on hold because of the inability to have meetings. I don’t know what else I’ll be doing. Right now, I just want to spend a lot of time in woodworking shop and if I can ever get back to where I can go fishing back at the coast, I’m going to try to do more of that.
I do want to say, what a tremendous staff we have at the health department. We have some of really what I consider some of the highest caliber of people I’ve worked with, and Chatham County is very fortunate to have the people that got in these positions, and again, express my appreciation to the county administration for all the support they have given us over the years. And to the elected officials that have been very supportive of the health department. This county has been supportive in so many ways of the efforts of the health department and that makes a tremendous difference on what you can accomplish.
Reporter Zachary Horner can be reached at zhorner@chathamnr.com or on Twitter at @ZachHornerCNR.