Established In 1872, El Paso County Public Health (EPCPH) serves the residents of El Paso County. Located in the central part of the state, it is the second most populous county and includes the City of Colorado Springs, the second largest city in the state. Encompassing 2,158 square miles, EPCPH serves 735,175 residents in both urban and rural areas. Within the state, EPCPH is one of two local health departments serving a population base of this size. While many statewide health departments are staffed with a significantly smaller staff-to-resident ratio, EPCPH serves the growing population of El Paso County with 158 full-time equivalent employees.

The U.S., Colorado, and El Paso County are becoming more culturally diverse. At least two-thirds, 68.6% of El Paso County residents identify as either White or Non-Hispanic White, 17.7% identify as Hispanic or Latino and 6.9% identify as Black or African American. According to 2019 Census data for El Paso County the median income is $68,779 with 8.8% of residents living in poverty. (Quick Facts El Paso County, Colorado; Coorado, 2019) The U.S. Bureau of Labor Statistics documents an average rate of unemployment for 2019 at 3.3%, however this figure rose dramatically in 2020 with a current average of 7.1% for the year. (Economy at a Glance, Colorado Springs, CO , 2020) There are higher rates of poverty in the older, urbanized areas and some rural communities. Additionally, there are stark differences between health status by income. (Department, 2017)

The issue of unemployment and associated disparities related to poverty is further exacerbated by the current pandemic. Once the first cases were detected In March 2020, EPCPH realized cross-sector collaboration would be critical in order to develop an orchestrated and actionable plan designed to meet the health needs of community residents. At this time, it also became apparent to the business sector that a collaborative approach would be critical to response, relief, and recovery.

Launched in April of 2020, the Regional Recovery Council (RRC) was formed as a collaborative effort between the El Paso County Health Department and the Chamber of Economic Development team. The Council represents multiple disciplines including economic development, municipal government, destination marketing, public health, workforce, education, non-profit and philanthropy, community development, and economics. This joint effort is an innovative collaboration between public health and commerce and represents the collective understanding about the co-dependent relationship between public health and the economic health.

EPCPH is focused on balancing the needs of public health with what is required to sustain the local economy during this crisis and beyond.  In collaboration with the local Chamber of Commerce, Economic Development, and multiple businesses EPCPH has maintained a focus on supporting this collaboration through dedicating the time and staff resources needed to mitigate COVID-19 disease spread in the community. These efforts include robust risk communication, education, testing and containment measures, and now, most recently, the orchestration of the COVID-19 vaccination campaign for the region. 

As infections of COVID-19 increased across the region, it became evident that the pandemic would have a significant and substantial impact on the community. Shortly after the first positive cases surfaced in March in El Paso County, El Paso County Public Health and the Colorado Springs Chamber and the Economic Development Council organized a convening of multiple community partners to assess the immediate issues. Assessing the need through the perspectives of the community was the first strategic initiative, and a survey of regional businesses was created.  The group took into consideration the proliferation of multiple surveys resulting in survey fatigue and decided to develop one comprehensive survey which would assess the needs of the community and could serve to guide early intervention programs. The original groups represented multiple perspectives and disciplines and included public health practitioners, epidemiologists, an economist and policy experts, the business community, municipal partners, workforce partners, higher education, and the non-profit community.

The survey was first launched in March, and the initial findings were communicated to the public in April of 2020. These results established and refined the initial response and relief programs, including a philanthropically funded low-interest loan program for small businesses, resources and trainings for small businesses and entrepreneurs, and services and relief for newly unemployed individuals and their families. 

The COVID-19 Regional Recovery Council (RRC) is a collaborative initiative among community leaders to collect data and respond to the business community. Championing the recovery and resiliency efforts for the business community became the next high priority area to address. A multi-disciplinary team was formed and officially recognized as the COVID-19 Regional Recovery Council.

Leadership at El Paso County Public Health has historically emphasized initiatives and strategies targeting the development of a full, robust 3.0 Public Health program in the region. This provided another opportunity to further strengthen the infrastructure required to actualize the model through this collaboration. EPCPH soon became integrated into the committees work and relished the opportunity to interact and partner closely with El Paso County businesses. While intensely focused on mitigating disease spread in the local community caused by the worst global pandemic in history, EPCPH balanced the economic impacts of public health orders with exceptionally strong partnerships with the RRC including Pikes Peak United Way, Colorado Restaurant Association, Pikes Peak Area Attractions, Downtown Partnership, Colorado Springs Chamber and Economic Development Council. EPCPH was involved in the beginning stages of initiating the RRC and due to this were able to immediately bring the public health perspective to the table. Critical, timely, and factual information was shared with the business community and also the general public through intentional, and coordinated messaging across partners.

The Regional Recovery Council became the middle ground and trusted space where public health and the business community engaged in bringing together public health and economic interests. The integral aspect of this work is intentional representation from multiple perspectives. One result of this collaborative effort was the drafting of a multi-pronged variance designed to help businesses across several sectors reopen as safely and quickly as possible in accordance with statewide (stay at home) health orders.

Many cross-discipline solutions resulted from the formation of the Regional Recovery Council. There are several initiatives exemplifying the intersection between the interests of the business community and the need of public health to protect the residents of El Paso County. For example, customized support and access to resources for businesses were developed by EPCPH and addressed how these sectors could assure the safety of their employees as well as their customers. A safety pledge promotion was designed to boost tourism as well as multiple public service announcements which provided key tips and tools for everyone to employ to reduce the risk of getting or spreading COVID-19. 

The establishment of the Regional Recovery Council demonstrates how quickly the creation of a coalition can provide opportunities in the midst of a crisis. While many sources cite the importance of multi-sector partnerships in attaining the goals of the Public Health 3.0 model, it is clear how this need is heightened during a disaster relief effort. The Public Health 3.0 model emphasizes the imperative for local health departments to actively engage both the public and private sectors in order to support healthy, equitable, and resilient communities. During times of stability, strategic partnerships expand the capacity of the health agency through shared funding opportunities which allows for integrating multiple revenue sources. A shared vision also supports collective action through minimizing redundant initiatives and sharing access to sector specific resources. (Karen DeSalvo, 2017) Economic development is one factor impacting a person’s overall health and well-being and is considered to be a major social determinant of health. Within various regions across the nation, leaders within the communities have established coalitions to improve the outcomes for residents including promoting economic opportunity, ensuring community safety and promoting mental health. (Karen DeSalvo, 2017)

The Regional Recovery Council has continued to meet consistently since its inception. The operating goals of the group are to anticipate needs, develop multiple-disciplinary solutions, and cross-promote important information, programs, and results. To address sustainability, it is forecasted the group will continue to serve the community post-COVID. The focus in the future will remain on ensuring public and economic health through continuing to connect and refine disaster preparedness plans to enhance resiliency and recovery for the next natural or man-made disaster that affects the Pikes Peak Community.

EPCPH has a history of collaboration within the El Paso County community. In 2017, EPCPH facilitated the development of the El Paso County Community Health Improvement Plan (CHIP) as part of the Healthy Communities Collaborative (HCC), a stakeholder group of more than 60 community partners. The community members are representatives from schools, hospitals, health systems, non-profit organizations, city and county government agencies, public health, medical providers, businesses, and interested citizens.

During this process the HCC developed a five-year Community Health Improvement Plan (CHIP) that was implemented in 2017. A community health assessment conducted over an 18-month period informed the goals, objectives, and primary community health focal areas outlined in the plan. The product of this work is a report framing El Paso County health information through a lens of equity with disaggregated demographic and socioeconomic data highlighting health disparities within the region.

The initial work of establishing the Healthy Communities Collaborative laid the groundwork for future coalition building. Over the course of the response to the pandemic, EPCPH forged strong partnerships across El Paso County including all cities and towns as a coordinated response to mitigate disease spread. The formation of the partnership with the El Paso County Economic Development and Small Business Development Center affirms the continued priority EPCPH places on increasing capacity through cross-sector endeavors.

The Regional Recovery Council represents a vital partnership between Public Health and Economic Development, a relationship pivotal in addressing the potential effect of the pandemic in exacerbating existing health disparities. The mission of the RRC according to Dick Draper, the President and CEO of the Colorado Springs Chamber and Economic Development Corporation (EDC), is to achieve economic prosperity for the region and act as a catalyst for business innovation and growth. It is the overarching goal of the partnership to balance the health needs of the community with what is required to address the impact of COVID-19 on the economy. Leadership at EPCPH focused on what was possible, and what could be accomplished through brainstorming on creative solutions co-constructed to address restrictive measures driven by the increasing prevalence of COVID-19 in the region. A proactive stance taken by the RCC provided lead time to strategize on how to lessen the impact to the local economy.

EPCPH leadership equipped businesses with resources empowering them to continue operations while promoting the safety of employees and customers. Because of these steady efforts, sales tax revenues for both the City of Colorado Springs and El Paso County are beginning to recover sooner than expected. This emphasizes the positive impact attributed to the collaborative work of El Paso County, including all municipalities, with the business and medical communities that ultimately supported the economy in opening faster, while still protecting the health of the community.

Clear guidance is required and necessary for businesses and economic recovery. Consumer confidence was built during the constantly changing landscape driven by COVID-19 through providing guidance and interpretation to businesses for the swiftly changing public health orders from the state.  Collaboration between the agency and the business community resulted in multiple campaigns created to provide a credible, consistent, relevant and timely message about how to safely sustain the consumer relationship.

Opportunities were identified to provide clear and consistent information in innovative ways. Early in the response phase, a webinar series was organized on contact tracing, outbreak investigations and communicable disease to help businesses understand the value in partnering with Public Health and best practices that, when implemented, can strengthen the community. A “Peak to Safety” campaign was launched in August through a collaboration between Visit COS, the Colorado Springs Chamber and EDC, Downtown Partnership and the City of Colorado Springs. The campaign was developed with the objective of uniting businesses, visitors and residents in a unified effort to stay safe, follow public health guidelines, and slow the spread of COVID-19.  By taking the pledge, visitors and residents become eligible for an array of discounts and deals throughout the region, further supporting local businesses.

An additional initiative highlighting the impact of the partnership in addressing the impact of COVID-19 on the public health of El Paso County was the development of resources focused on addressing the pronounced changes in the workplace. As part of efforts to advocate for increased teleworking, a package for resources was launched titled “Clocking in from the kitchen table: tools to help your company effectively telecommunicate.” The telecommuting toolkit includes information and resources for both employers and employees, from tips on managing teams remotely to ideas for staying focused at home.

In preparation for the fall and winter months, EPCPH worked with the business community to develop two “bundle up” winter toolkits. One was aimed at business owners and focused on providing tangible tips and recommendations. The toolkit provided a multitude of examples like increasing handwashing signage in offices, maximizing opportunities to telecommute, providing flu shots, and putting in place sick policies that make it feasible for employees to stay home when sick. An additional toolkit, focused on community members, highlighted ways to maintain civic and social engagement in the winter months while still practicing COVID-19 prevention measures. EPCPH also worked closely with the retail food community, in addition to participating in a statewide workgroup, on developing innovative ways to expand winter dining options during the winter months.

The business community was also provided with guidance on how to safely reopen their business after quarantine. General strategies and practical guidelines outlined the steps necessary for businesses to help prevent the spread of COVID-19 in staff and the general population. A final example of an initiative resulting from this unique collaboration is the #SmallActs Campaign emphasizing the community effort required to keep the economy open, hospitals operating at optimal levels, and the community safe during the COVID-19 pandemic. The campaign outlines several, proactive actions the public can take to mitigate the disease spread.

Colorado utilizes a framework to manage the COVID-19 response that assigns each county in the state a level using the following three metrics: incidence, positivity, and hospital status. Each level defines how each sector operates through providing guidelines determining capacity restrictions. Public information about the framework states it “is a tool that allows Colorado to balance the urgent need to contain the virus with the need for localized guidance during the pandemic.”  (Colorado Public Health and Environment, 2020)

During the pandemic, El Paso County experienced surges in rates of case incidence, positivity, and the capacity of local hospitals. Many businesses, especially restaurants, are negatively impacted when the metrics move the county to a more restrictive level. Often the result is the restrictions for indoor dining require restaurants to pivot between operating at full capacity to completely closing all access to indoor dining.

An example of how the partnership between EPCPH and Regional Recovery Council addressed this issue is the collaborative work undertaken to draft a variance to these guidelines. EPCPH worked with the Regional Recovery Council to draft a proposal allowing local restaurants to operate at expanded capacity through meeting specific requirements outlined in the document. The proposed program would provide individual restaurants the option to attain certification through meeting specified standards and if met, would be granted the ability to operate at higher capacity levels than what the state’s Dial framework would allow.

Recently, the state of Colorado created its own certification system, designed to recognize the tenuous circumstances restaurants and businesses are experiencing as a result of State level COVID-19 restrictions. While similar to the local proposal, the statewide system outlines additional standardized certification requirements. The challenge is that the original proposal, drafted specifically to meet local concerns and a product of much deliberation, will now not be considered given the statewide adoption of what is now known as the 5-Star Certification program.

However, the new statewide program does provide the opportunity for local restaurants to apply for certification and potentially expand operations. The newly drafted El Paso County 5 Star Program, is an active and collaborative effort between the County, the City of Colorado Springs and other municipalities, El Paso County Public Health, the Colorado Springs Chamber and EDC, and various community partners to safely and efficiently implement the State’s 5 Star State Certification Program locally.

The Program is led by a cross-sector Administrative Committee, which consists of one representative from the program partners and is responsible for the overall administration of the Program. Each Program partner has committed to dedicate staff and/or resources to managing the application and business inspections in their jurisdiction and/or to support other jurisdictions. The El Paso County Public Health Department will coordinate with each partner and subcommittee on technical matters and otherwise assist with Program implementation consistency. 

The 5-Star program is a current example of the ongoing work required to ensure the region emerges from the pandemic healthy, strong, and resilient. As vaccinations are becoming available in the county, the need for the partnership between public health and the business sector will continue to exist and evolve as we progress through the relief phase of the pandemic. Looking forward to recovery, the goal is to adapt the work of the Regional Recovery Council to the evolving needs of the community.

The Public Health 3.0 framework envisions a “strong local public health infrastructure in all communities and its leaders serving as Chief Health Strategists that partner with stakeholders across a multitude of sectors on the ground to address the social determinants of health.”  (Karen DeSalvo, 2017) Over the past year it has become increasingly evident of how important it is to create a space where public health and economic interests come together to work on inclusive and impactful solutions for the community. This impact is also recognized by city officials. In 2020, the Colorado Springs Mayor John Suthers recognized he agency with a 2020 Spirit of the Springs Celebration Award stating, “This city is grateful to the leaders of El Paso County Public Health for their swift response to the pandemic, their emphasis on collaboration these past few months and their contribution to our overall resiliency during this difficult time. This is a small of shoring our appreciation for their critical work.”

The ongoing commitment of EPCPH is to utilize the latest data and evidence, and it is acknowledged that many factors will change over the course of the pandemic. For example, as EPCPH embarks on vaccinating more and more of our population, the organization is contemplating revisions to current policies, metrics, and thresholds. This is an urgent and important question, and over the next two weeks, EPCPH will closely engage stakeholders for input on how the frameworks should evolve in 2021. The health department will also carefully monitor the epidemiology trends to ensure a rapid response to any increase spurred by the holidays that might delay reopening.  

At the start of the response effort, EPCPH grappled with numerous, external challenges. In addition to contending with the novel virus, there were a multitude of external challenges impeding the response effort including a lack of resources, the absence of a statewide and federal unified plan, insufficient public health infrastructure, and a proliferation of misinformation shared through social media. Yet, despite these issues, EPCPH continued to thread the needle successfully due to the unified efforts and work conducted prior to and throughout the pandemic. Considering lives lost to COVID-19 nationally and in Colorado, it is apparent this proactive approach most likely mitigated and decreased the potential impact of COVID-19, saving both lives and livelihoods. In the months ahead there will be additional metrics EPCPH will be able to leverage to demonstrate the success of the unified crisis and recovery response and at that point, reflect upon lessons learned to improve future planning and response efforts.