Dr. Francisco Garcia

Submitted Photo

The county's new health director began his job in the midst of a brutal winter of illness and is looking to even an even busier upcoming year as provisions of the new federal health law kick in.

Dr. Francisco Garcia is still trying to figure out the role that the Pima County Health Department will play as the Patient Protection and Affordable Care Act rolls out, but he does know that local access to health care is a big problem and the law won't entirely solve that.

U.S. census data for 2011 ranked Tucson the sixth poorest large city in the U.S., and that means a large number of people who may not be getting the medical care they need, Garcia said this week.

"Our big challenge is trying to make sure that we figure out what our role is under the Affordable Care Act. It's the kind of thing that may redefine what public-health entities do on a day-to-day basis," he said.

Two-thirds of people without health insurance in the U.S. live in 12 states including Arizona, according to Enroll America, a national non-profit group that's dedicated to ensuring Americans are enrolled in and retain health coverage. The group says 78 percent of people who are uninsured don't know about the state exchanges that are being set up through the new law as a marketplace for purchasing health insurance.

And Garcia stressed that while the health law is expected to decrease the number of people who are uninsured, it will not eliminate them.

"We have some folks who have educational challenges. We have folks who have linguistic and/or cultural challenges. We know that some folks are not going to come into the care system because of immigration issues, so it really is a huge issue," he said. "Nationally we will be among the states with highest level of folks who are not going to have coverage. It's the kind of thing we really need to be thoughtful about."

Later this month, Garcia will be meeting with U.S. Centers for Disease Control and Prevention Director Dr. Thomas Frieden to talk about the new law and improving Pima County residents' access to health care. It's not clear how public health departments will figure into implementing the law, he said.

Garcia is a recent appointee to the U.S. Preventive Services Task Force, a group that does evidence-based health recommendations for the federal government.

"One of the reasons I accepted that appointment was to sort of be up-close in D.C. as some of these discussions are happening and to try to understand the implications for us locally - both for our provider community, for the people who are out there providing clinical care, as well as for us as a public health entity," he said.

The new law may force Americans to reconsider who their providers are and look to people like nurse midwives and nurse practitioners for primary care, he said.

"We need more doctors but we need a lot of other folks in the workplace. The landscape of public health and clinical health-care delivery in the next few years is going to be changing, I think, fairly dramatically," he said. "Thinking about population-based approaches to health is what county health departments should be doing - how we move communities toward better health."

Garcia's job used to be held by two people. But after the county health department's director and chief medical officer left within months of one another last year, county officials decided to merge their positions into one job. Garcia came to the county from the University of Arizona, where he held several appointments, including director of the University of Arizona Center of Excellence in Women's Health as well as director of the Cancer Disparities Institute at the Arizona Cancer Center.

While his role as the face of public health in Pima County continues to evolve, Garcia said his most important goal is ensuring a healthy community. He'd like to improve health literacy, make sure people all over the county have access to healthy food, and understand the county's opportunities to improve mental health.

"The big thing is giving people the tools to make their own health judgments and health decisions. I'm not in the business of telling anyone what to do," he said. "I just want people to have the information they need to make the decision that is best for them."

The county health department oversees disease control, immunizations, birth and death records, a tobacco and chronic-disease prevention program, and the county animal-care center.

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Local illness roundup

On the job since Jan. 3, Dr. Francisco Garcia took the helm of the county health department during a winter that's been busy for disease - flu, norovirus, whooping cough and respiratory synctial virus.

"We have a little peak of pertussis (whooping cough) right now," Garcia said. "My perception is that we may be having a few more cases than typical. It's really important because it is happening in schools and in day care settings."

Garcia said the department is studying the current whooping-cough numbers and comparing to other years.

"The first thing we investigate is whether those people are vaccinated, and are the people taking care of them vaccinated," Garcia said.

Flu season appears to have peaked and is now on the decline, though Garcia still advises anyone who hasn't had a flu shot to get inoculated. As anyone who has had the flu this season can attest, there's a particularly unpleasant strain in circulation.

"It's been really knocking people down," Garcia said.

Contact reporter Stephanie Innes at 5730-4134 or sinnes@azstarnet.com