Meet Mr. Marin Public Health. Larry Meredith, director of the county Department of Health and Human Services, believes that everything he does should send the message of healthy living. So, as he likes to say, he walks the talk. Aside from setting a good example, his job is to come up with ways to help all Marinites lead healthier lives. He’s part creative thinker, part policy wonk, part bureaucrat, part cheerleader for public health. And you couldn’t find a more enthusiastic guy to lead the pep rally.
Meredith oversees a budget of $117 million and 700 employees working to protect the physical and mental health of all Marin residents. It’s a broad mandate. He’s ultimately responsible for programs such as researching the causes of breast cancer in Marin; maintaining a corps of medical volunteers to mobilize in case of a natural disaster or terrorist attack; finding jobs for the unemployed; treating the mentally ill; helping your elderly mother live independently; keeping your teenager off drugs and alcohol—just to name a few.
Public education is a biggie for Meredith. He’s working on a Web site that will give people the information they need to get started on new activities like jogging, bicycling or rock climbing. Another site in the works will post local statistics on issues like breast cancer, infant mortality and childhood obesity. He likes tracking the trends—”We should know where we are and we should let everyone else know, too,” he says.
Meredith grew up in the countryside outside Toronto, the only child of an attorney and a stay-at-home mom. After earning an undergraduate degree in business administration at University of Western Ontario, he bummed around Europe in the early ’60s. He wound up in London in 1964, hanging out with a bunch of crazy Aussies and living down the street from the Rolling Stones. Eventually, he went back to school for a master’s and a doctorate in clinical psychology at Pennsylvania State University. He came to California to do epidemiological research in alcohol and drug abuse, then worked for the next 30 years at the San Francisco Public Health Department. He has headed Marin Health and Human Services since September 10, 2001. He and his wife have lived in Marin for 34 years. Their two children are grown. Their son is a techie in San Diego, their daughter an epidemiologist with Doctors Without Borders, now working in Darfur.
Meredith’s public health message is evident throughout his offices, housed across the road from the Civic Center. He keeps healthy snacks and drinks in the vending machines, posts good nutrition reminders on the bulletin boards. A woven basket on his desk is filled with fresh, tempting-looking bananas, apples and oranges. At 64, Meredith looks trim and fit. When he has the time, he likes to play hockey, go biking or hiking. When he can’t, he works out daily at the gym. His hair is gray. His beard is closely trimmed, his cheeks shaved to the jawline. As we talk, his impulse is to illustrate and document his words: grabbing a chart here, opening a report there, calling me over to his computer to show me photos and slides.
I was surprised to read on your Web site that one-third of Marin children are obese.
In some areas; in Novato, it’s up to 40 percent. People think that because we are as active as we are, and as educated, that it may not be as prominent here as it is in the rest of the country, but it is an issue of poor nutrition, lack of activity and a preponderance of junk food. We’re working with a number of organizations to bring to people’s attention the fresh fruits and vegetables that Marin is famous for. There are over 36 certified organic farms in the county.
And here you have these beautiful fruits right on your table!
We graze, like a lot of field animals. So we’ll eat whatever is around our environment. We’re not all that discriminating. If it’s Krispy Kreme doughnuts or it’s fresh fruits and vegetables, we’ll graze on what’s there.
So the idea is to keep the good stuff handy.
Make it easy for people to do the right thing. We’ve been changing our food policy here in all Health and Human Services buildings to reflect the importance of good nutrition and physical activity. We have many catered public events here and we make sure that we provide healthy choices. There’s a strong emphasis on walking the talk here. Fifty percent of what’s in our vending machines is nutritious. And we’ve labeled all the food, using the coding system from the Monterey Aquarium, with green for healthy, yellow for caution and red for under no circumstances. And we’re planning on getting rid of all the red. We’re modeling what other organizations and other employers can do, and should be doing.
What about providing healthy foods in the public schools?
Great question! [grabs a report, flips it open to a page showing a line of children in a school cafeteria] This is at San Geronimo, where we got the funding to put in a nutritionist a couple of years ago. It’s a state grant for developing healthy choices. So this is a collaboration of the school district with the Novato Food Service, Good Earth Natural Foods, our department with the grant and the parents. They’re offering all organic foods for lunch, in competition with the regular foods. On the day I was there last week, something like 140 kids selected the organic food and two chose the regular stuff.
What were the choices? Was this a fair test?
Well, the quick answer is it probably wasn’t. You’re introducing a new variable here, fairness. All of the junk food folks have spent lots of money researching what sells, and they have replaced community health values with corporate values to the point where we have this obesity epidemic. So fairness? I think the regular food was a turkey sandwich with chips. And the organic food was a burrito with guacamole, sour cream, rice, tomatoes, onions and beans. There’s no soda there. The U.S. only started measuring obesity in 1985 and since then a greater and greater percentage of people have become obese, all across the country. Obesity is related to such a wide range of medical issues—everything from breast cancer to heart disease, stroke, diabetes, arthritis. If we’re overweight, we’re more likely to be injured. It has a ton of consequences. Your quality of life is severely compromised. If we continue going the way we’re going now, the kids born today will not live as long as their parents.
Really? Each new generation has always lived longer than the previous one!
Yes, it’s a reversal.
And that’s because of obesity?
Yes. It’s estimated that 30 percent of the children born today will have Type II adult-onset diabetes by the time they’re 40. We are saddling our children with both a decreased life expectancy and a decreased quality of life. And as a community I don’t think we fully appreciate this. I want to create an environment that makes it easy for people to get their five to nine servings of fresh fruits and vegetables every day and get their 10,000 steps a day—10,000 steps, that’s 30 minutes! Don’t take elevators! Rather than parking close to the building, park far away! Give yourself a break! Get your steps in while you’re going to a meeting, doing your shopping. It just takes a consciousness. Here in Marin, we not only have all this organic agriculture, we have the glorious hills and parks and physical space where we can be active.
It seems another hidden problem in Marin is alcoholism. I understand we have one of the highest rates in the state for alcohol-related deaths and hospital discharges.
People drink more here than in the rest of the state. We’ve been looking at alcohol as it’s related to breast cancer. Clearly, the women in Marin drink more than their counterparts in the rest of California and the rest of the country. In the schools, binge drinking is much more prominent than in other parts of the country. We’re awash in a sea of alcohol. And it’s taking a toll on our health. We’re working with the schools, the justice system, the youth groups and the parents to look at the sale and promotion and ready availability of alcohol to young people. We also want to change the culture of the Marin County Fair—which is the largest annual event bringing together residents of Marin, usually a family event. For the last 20 years the fair was sponsored by Miller Brewing. What’s that all about? So last year, we put together a coalition of six agencies and we bought out Miller Brewing. Why would a county fair want to fly the colors of a brewery? Come on! That’s crazy!
When something like that goes on for 20 years, you tend not to notice it anymore. What brought it to your attention?
It’s a no-brainer. We’re looking for the big symbols of community values. And we all grew up with county fairs. It’s one of the few events that brings kids with parents. We’re systematically going to move in and decrease the promotion that alcohol vendors can have at the fair that associates having a good time with alcohol. Another thing we have there is the Prevention Pavilion. We brought together 30 agencies involved with prevention—everything from seat belts to breast-feeding. It’s got to be one of the largest booths at the fair now. We give out pedometers, and if a person comes back showing that they’ve walked 5,000 steps, they get a prize. We have rated all the foods at the fair using this green, yellow and red coding, and we give people a menu of how to eat healthily at the fair. To our knowledge, this is the first time a county fair has been taken over by health interests.
It’s a revolution!
Exactly! You know, I spent a ton of years at the Public Health Department in the city before coming here, and working for this county and this board of supervisors and the community organizations and the [Marin Community] Foundation—this is a community that really does want to do the right thing, that works well together, that is very supportive of the problem-solving that needs to go on. It’s really been delightful. I think that Marin can be a sort of laboratory for the country on what is possible. I think we’re doing it on breast cancer, I think we’ll do it on obesity, we’re going to do it on booze. The compassion is here, the commitment is here, and while our resources are not as much as we need, we don’t have the violence or the major public health problems of other areas—so we can focus on prevention, on health, on safety, on well-being in ways that other counties can’t because they’re so overburdened by the problems of everyday living. The fact that there wasn’t a homicide in Marin County last year is a proxy measure for the level of violence here. Not that bad things didn’t happen—domestic violence is one of the silent, hidden areas that we need to expose. But the sum total of all the support and desire to do the right thing is really quite wonderful.
I hear a Canadian accent. Where are you from originally?
Toronto. And I grew up in the country, in farm country. So living in Marin is like coming home. My wife and I lived in the city for about a year and a half and one August morning when I put my down jacket on to go out and get the paper in the lee of Twin Peaks where the fog comes in and you really don’t get any summer, we came to Marin to find a house. In the city there’s so much asphalt, so much cement that everything is vibrating. I needed to come out where there was green and earth.
There must be some things you miss about Canada, though—like the universal health coverage.
It’s a national obscenity in the U.S. that not everyone has health insurance. Because when one individual is ill, the whole community is suffering. It’s just crazy.
Do you think a single payer system is doable here?
I think it is. Clearly, [state Senator Sheila] Kuehl’s bill—the Lewin Groups has studied it, it shows that it would not only not cost money, it would save money! The system we have is inefficient and it’s wrong. I think there need to be some pockets or regions that do pilots with single payer. There’s got to be some phase-in period. But I love that the discussion is getting more real.
Do you ever think of moving back to Canada when you retire, so you can have access to a more sensible healthcare system?
I do think about it, although the Canadian system, to be fair, is having its own difficulties. There are pluses and minuses. But my mother, who lives in Vancouver, has had excellent care. I’ve been monitoring her care, and it’s really been quite spectacular.
How old is she?
Ninety-five and still going strong.
Good genes! What about your dad?
He died when he was 90.
Not too shabby! Tell me about your early years. As a kid, what did you want to grow up to be?
Well, my father was an attorney and both my folks had a business focus, so I went to business school as an undergraduate and later went to law school. So I was just going down this mindless track, falling forward. After I graduated from university I went to Europe. I intended to go for the summer and stayed for a year and a half.
Where in Europe did you go?
I traveled for half of the time, hanging out, going to Spain. I wanted to break away from the conservative Canadian trajectory. I got a motorcycle and just traveled around. I’d meet up with friends from college in Pamplona for the running of the bulls—I did that a couple of years in a row. I went to Morocco. Then I was in London for six months, in 1964. And that’s where I found some resonance with psychology. I was working for Nestle’s doing market research. I fell in with a crowd of Aussies. And during that time, the Rolling Stones lived just down the street, and that was really quite a scene. It was a very heady time. Nestle’s sent me to Oxford for trainings, which was good, because I could get my mind stretched and still have a very alive post-work environment.
How did you go from market research to epidemiology?
Well, it’s numbers, it’s research, it’s looking at trends, it’s studying people. But what I wanted to do was go into clinical psychology, so I came back home and went to Penn State for my master’s and doctorate. Then I went to Boston for my postdoctoral internship at a VA hospital. Then in 1969 I was recruited to UC Berkeley to do social research in alcoholism. But I found that I was not a researcher—there was too much isolation from people. So I moved to the Department of Public Health in the city. First I was a clinical psychologist with the Bureau of Alcoholism. I was developing a continuum of care for people who had alcohol-related problems. I also had a private practice for about 15 years while I worked for the city. For a while I was interim executive director of Laguna Honda Hospital. Then I was chief operating officer for the health department, overseeing budgeting and finance and contracts. Later I headed up a unit focused on prevention of AIDS and STDs, alcohol and drugs, traffic and pedestrian fatalities, tobacco. And even though I had done a wide range of things, I was ready for a change. And my predecessor here, Nancy Rubin, encouraged me to apply here—we were old friends and colleagues. I started here at the county on September 10, 2001. I had eight hours of how it used to be.
How did the department change after 9/11?
We got a major initiative on public health preparedness and bioterrorism. There were fears of weaponized anthrax and we were a target! It was very crazy times. But it led to close working relationships between us, the police, fire, environmental health, the hazardous materials unit. The public was on edge, so we had to have communications that were clear but not anxiety-provoking. Now we have a volunteer medical disaster corps. We’ve trained about 300 physicians, nurses, pharmacists and gotten an expression of interest from over 1,000 people. Should there be a natural disaster or a man-made one, we want to make sure that the medical people who reside here can quickly move into a coordinated response.
You’re 64, you worked for San Francisco for 30 years and for Marin for three and a half. Ever think about retiring?
I’m having too much fun! This is exciting. This is changing. This is helping to make a healthier, safer, more satisfying quality of life.
PHOTO OF LARRY MEREDITH BY ROBERT VENTE
