ROX Interview: Leslie Horton

Director of Public Health for Yavapai County

Interview by Ray Newton

‘Helping people make healthy choices, for a better quality of life – that’s what my role in life is’ — Leslie Horton

When her parents flew the family from Fairbanks, Alaska, to sunny Phoenix for a vacation in 1993, that’s all it took to convince the 13-year-old Leslie Horton that someday she was going to live in Arizona.

Leslie laughs about it now. But then, after having grown up in the frigid winters only polar bears appreciate, and then having experienced that much sunshine and warmth, Horton says no one can imagine how glad she was to move permanently to the Valley of the Sun from Fairbanks in 1998.

“When I was born, it was 60 degrees below zero. I don’t think I ever got warm,” she chuckles. “I just love Arizona and Prescott.” 

Her family lived in Alaska because her father was an engineer who had moved there to help build the Alyeska Pipeline, and then worked for oil companies on the North Slope at Prudhoe Bay. Her mom was a home engineer (or homemaker). Her brother Steve is now a mechanical engineer in Montana, and her sister, Laura, passed away many years ago. 

Once in Arizona, she completed a bachelor of science degree in health education in 2003 and then a master’s degree in public health in 2006, both from Northern Arizona University.

The trim and suntanned Horton, 40, has been in Prescott since 2002, when she married Kevin Horton, and accepted a job with Yavapai County Community Health Services as a health educator. She had that position for four years and then was promoted. Her promotions continued until 2017, when she was named Director of Public Health for Yavapai County.

In her role as director, Horton directs and administers a public health department with an annual budget of approximately $6.7 million. It has 85 employees, including physicians, nurses, environmental health specialists, health educators, dietitians, and office and operational staff. She also directs and supervises the Medical Examiner’s Office. 

The department covers the entirety of Yavapai County, with a growing population estimated at 240,000. 

“We have well over 30 major public health operations and programs, and we try to serve everyone countywide with the best possible health support we can,” she emphasizes.

She says the Health Services agency position has its challenges. Among those are recruitment and retention of employees, finding external grant support to supplement internal funds, and of course, helping educate the public about critical health issues. 

“One of our big challenges — combatting the ever-increasing drug addiction scourge attacking society,” she emphasizes. “We all are impacted negatively by it.”

Horton also serves on several community, county and state organizations and agencies that service the public. She is on the board of directors for MATFORCE, Northland Cares, the Yavapai Justice and Mental Health Coalition, and other advisory councils. She is a board member for the Gardner Family Teacher Scholarship. She frequently is invited as a speaker or health resource person to meetings throughout Arizona and the Southwest.

She loves spending free time — when she has it — with her two children, son Jackson, 11, and daughter Lyla, 9. “I love introducing them to all the things I enjoy, like hiking, boating, and all kinds of sports. Prescott and the Quad Cities — the perfect place to do it. I can’t imagine being elsewhere,” she smiles.

Prescott Living: What prompted you to select health services as a career?

Leslie Horton: I’ve always been interested in health services and originally wanted to be a nurse. Nursing is such a great transitional career where you can really work anywhere and have a lot of options. However, I did two years of nursing school and got all of my prerequisites out of the way, and realized that I was more interested and passionate for prevention-type work.

That is, working kind of upstream of health issues, trying to prevent those from happening. I took a brief hiatus from college; was at Grand Canyon University at the time. I switched to Northern Arizona University and pursued a degree in Community Health Education and Health Promotion, which is more of a balance of physical activity, nutrition and disease prevention. It’s exciting to be able to work with younger individuals, you can educate them and frame their healthy behaviors or health choices, with education and knowledge that can, hopefully, help them live a healthier life and avoid major health problems and chronic disease.

Prescott Living: You’re more into the policy than the procedure then, right?

Leslie Horton: Yes, I like to give people the knowledge base, as well as encourage adjustments to their environment to be more conducive to health. I think that healthcare is obviously a huge need in our country, yet we know that through prevention, we can help avoid chronic disease and illness. People can live a long and healthy life and place far less burden on our healthcare system. By providing environmental changes within the community, as well as teaching youngsters and adults to make healthy choices, we truly can enable them to experience better quality of life as they grow older.

Prescott Living: Prior to your job as director here, what were you doing?

Leslie Horton: When I graduated from NAU, or actually even prior to graduation, I moved to Prescott and I got an internship as a tobacco health educator for the County Community Health Services; it was in 2002. I was an intern with the same department I’m in now and spent those four months there, finished my degree, and was immediately hired as an entry-level health educator at the county. I spent several years teaching children in the schools about healthy behaviors, like substance abuse prevention, tobacco prevention, physical activity and nutrition education and a variety of health-promoting behaviors.

And back then, we had grants for tobacco education, physical activity education, a little bit in other areas, but they were mainly focused in those two areas. I spent a couple of years as a health educator before I went back to school at NAU online, when they first developed the Master of Administration program and they had an area where you could do an emphasis in Public Health or Health Administration. So, I went back, got my master’s degree while I was working and was able to, almost immediately, move into a managerial position as the community health education section manager. I spent eight years in that position. During that time, I also served as our public information officer, and I really got to know our department as a whole.

We grew the community health education portion of the department significantly through new grants, different funding streams that allowed us to really branch out our work in the schools and in the community. We did more around policy and systems change in the community to help people have a healthier environment and opportunities to recreate and be healthier in Yavapai County. After that position, I became the assistant director through the county, and so I was very excited for that opportunity.

I felt like I was still too young for it, but I was excited for a new challenge, and that job was a great fit for me. It was a huge challenge, and I had to really learn our department and all of the sections involved. I was in the position for two years and then promoted again into the position of director. And I’ve been there since 2017, so almost 3 years now.

Prescott Living: I keep hearing about working with children, with youngsters. Is that your passion? Or, what about adult education?

Leslie Horton: I do love children, and they are impressionable in a way that we can truly teach them new, healthy ways of living. There’s a family dynamic now where a lot of times parents are doing their best but both parents are working, and kids are eating meals sometimes that are quick and easy to produce, or eating out a lot. We’re trying to teach kids to understand the benefits of eating healthfully, of getting out and exercising, of being mindful and smart about the choices that they make and how those will lend to a better future for them.

As for adults, we have great programs available, and I have a passion for teaching adults as well. We have programs like chronic disease self-management and Matter of Balance, and other programs that help people not only manage chronic diseases or diabetes, but we also help to teach them ways of becoming stronger and more balanced so we prevent falls. There’s a high rate of falls in our county among our senior populations. 

 Other programs that we offer for adults are immunizations, travel shots, and we are working on priority areas such as social isolation, suicide prevention, and substance abuse prevention. There’s so many things that we do also to broaden the scope of health across the county. We lead hiking groups and try to make sure that we’re working with the municipalities to make bikeable and walking-friendly communities. Cottonwood’s gotten many awards for their bikeability and walkability, and I’ve recently heard Prescott is doing great things to increase their walkability and bikeability, because we live in this beautiful place where you can spend time outdoors and you can really, truly make healthy choices. You can walk, you can bike and you can do these things that are beneficial to health overall.

Prescott Living: Tell us about the Yavapai County Community Health Services program. How big is it, in land mass? 

Leslie Horton: In land mass, we’re the size of New Jersey.

Prescott Living: Now, you’re responsible for the entirety?

Leslie Horton: Yes. (Laughs) So, geographically we are a gigantic county. Our main locations are in Prescott Valley, Cottonwood and Prescott, but our programs reach every corner of our county and we try to serve every area, no matter how rural, especially getting out into the schools and reaching as many people with as many of our services as possible. 

We have a department of approximately 85 employees, most of which are full-time. The department encompasses public health services and the medical examiner’s office. We have a team in the medical examiner’s office of about eight people, and 77 people in in the public health department. We have a budget of just under $7 million. Ninety-three percent of that is grants or fee-generated. Also, 7% of our budget comes from the county general fund, and those funds go to programs that are not fully grant-funded, or programs that we see as opportunities for the community that will be a good fit for Yavapai County but that don’t have grant funding yet.

Ray Newton: You have five divisions within your program?

Leslie Horton: Yes, so we have WIC, which is the Women, Infants, and Children program. We have community health education, which is comprised of about 13 different health education grants in the schools or for adults. We have communicable disease and immunizations, which is disease tracking, as well as travel shots, child immunizations and adult immunizations. We have public health preparedness and disease prevention, which is actually under communicable disease now. We have environmental health, which is our health inspectors that inspect restaurants and pools throughout the county. And our finance and operations section. 

Our offices are in Prescott, off Commerce Drive. There’s one in Prescott Valley off Windsong Drive, at the Del Webb Center at the hospital, and then in Cottonwood on South Sixth Street and that’s right in the county complex. And we have a satellite location in Chino Valley that is for WIC and immunizations only.

Prescott Living: What are the major challenges your unit has?

Leslie Horton: Internally, as a department, our biggest challenge is employee retention. We have a lot of longtime employees, people who love the work. They appreciate the services that we provide and the impact that they make in the community. We struggle to keep our newer or younger employees for very long anymore, because there’s more job opportunities right now than there has been in the past. People can find better-paying jobs, even if they have to move in order to get those jobs.

More recently, it has been a challenge to keep our new good employees. We try to make sure we provide a great internal environment that allows people to have a lot of flexibility and the ability to do the things that they love and are passionate about; however, that’s not enough for some people, and we realize that. 

External to our department, the challenges really revolve around mental and behavioral health issues, like high rates of suicide, and high rates of substance use disorder. These have been ongoing challenges, without easy solutions. It seems like as soon as we get a handle on one type of drug or another, the whole environment or type of drug that people are seeking changes. Suicide is a saddening and complex issue, for which we are still seeking intervention strategies 

We work with law enforcement, medical providers, and substance use treatment, along with any other partners that we can draw in to help address the issue of substance use disorder. These are difficult issues to solve, but I feel that with strong community support and awareness, families understanding warning signs in their children at a young age, and wrapping care and services around those at highest risk, we will all lead to a better future for these kids.

Prescott Living: Is substance abuse more prevalent among younger people or older people? 

Leslie Horton: Across the board, we have people of all ages who are addicted to opioids and other drugs. We have too many youngsters who begin at young age with alcohol or marijuana, and move onto harder drugs in their teenage years. We try to prevent that in children, but also teach parents what to look for in those youth who might be struggling.

Prescott Living: What about vaping?

Leslie Horton: Vaping has become a serious concern. Now it’s seen as an emergency, but I think even a decade ago when vaping started becoming popular we really didn’t know much about it. It’s always been my standpoint that if it’s not clean air and you’re breathing it into your lungs, it cannot be good. For many years, we did not know the health detriments of vaping.

Now, all of a sudden, we’re seeing respiratory illnesses in young people, as well as adults, who have not vaped very long. Some people have vaped for a decade now, and may have started using it as a tobacco cessation tool, as it was initially marketed. Now it’s become a widespread addiction for most people who utilize it. We are seeing severe scarring of the lungs on autopsies of vape users in our medical examiner’s office. I think we are going to see far, far more extreme lung damage as a result of vaping. Like tobacco, I hope that it can be regulated and controlled in some way. Yet, you take away the vape delivery system for nicotine, and you still have a population of people addicted and dependent on nicotine, who may turn to other tobacco products if they cannot quit.

Prescott Living: You’ve already kind of talked about relationships, partnerships with other county agencies. 

Leslie Horton: We have excellent working relationships with our state health department and with other state agencies. I work quite a bit with ADEQ (Arizona Department of Environmental Quality) and environmental issues as well. And we have national partnerships in some of these programs that we’ve been getting national attention through. And on a local level, which is where our focus truly is. 

As a local health department, we try to make sure that we are collaborating effectively with as many community agencies and partners as possible. And so it’s exciting to be able to work so effectively with these other agencies that have an investment in the health and well-being of the residents here.

I do serve on other boards throughout the community that help to complement some of the work that we do through the health department, but it’s areas of work that we’re not the lead agency on. I’m on the executive board of MATFORCE (Yavapai County’s substance abuse coalition). I’m also on the executive board at Northland Cares, our HIV and AIDS care provider in town. I’m on the GiFTS (Gardner Family Teacher’s Scholarships) board, where we can give out educational scholarships to youth who are interested in pursuing education as their degree. I am on the Western Homeland Security Council and a number of other partnerships through the hospital, advisory councils, and others that I participate in in order to make sure that they are understanding what we do as a health department, so I can help them provide services in the community that are ones we are not the lead agency for.

Prescott Living: If you could click your heels, put on your ruby slippers, what would you do?

Leslie Horton: You know, one thing would be health equity in Yavapai County and across our nation. Health equity is equal access to good health, to healthcare services, healthy environments, and all aspects of health. I think that if I had a magic wand, that would be my dream is to have people all having that same opportunity to be healthy, which plays into every aspect of their life.

Especially when we look at health equity, it would be wonderful if our children could all have access to healthy nutrition, physical activity, safe environments to play in, and safe environments in the home. You know, all of those things lend to a child’s development, their health and happiness in the long run, and that would be amazing if children could all have those equal opportunities to develop in a healthful way.

Prescott Living: When do you get your cape that has an S on it?

Leslie Horton: (Laughs) I’d prefer a sash. 

Prescott Living: What are your personal passions, things that you like to do?

Leslie Horton: I love to travel. Especially as it gets cooler here in Prescott, I like to get out of town and go to a beach somewhere. I also enjoy boating. It’s one of my favorite things. Paddle boarding, wakeboarding, snowboarding. I love playing with my kids outdoors, whether that’s biking or hiking or any variety of it — rolling down a sand dune at Lake Powell. And, I love relaxing, as well. I think that is one thing that as a working mom that I’ve learned to really appreciate, a little bit of relaxation once in a while in between all those other passions. It’s amazing to live in a place where year-round we can enjoy being outside. We are an hour from large lakes for boating, or locally, I can go paddle boarding, hiking, biking, and running easily!

Prescott Living: You’re into sports, right?

Leslie Horton: I grew up in sports. I was especially into volleyball and basketball. As an adult, I love college basketball. I also love college football and I will watch the NBA and the NFL and pretty much, you know, any of those if given the opportunity and the time. 

Prescott Living: What kind of books do you read?

Leslie Horton: You know, I actually mostly make short commitments, such as magazines. I love increasing my knowledge of health and other things that might be good for me. But I find that with two small children, and a very busy job, and all of these other passions that I have, committing to a novel is, um, something I would like to do some day. (Laughs)

Prescott Living: What’s your favorite holiday?

Leslie Horton: I love Easter in the spring. I also love Fourth of July weekend here in Prescott because there’s so many festivities happening. But I love any holiday, really, where it brings family together and you can enjoy seeing the fun and amazement of the children.

Prescott Living: What’s your favorite meal?

Leslie Horton: Dinner. (Laughs) Would you like to know what type of food?

Prescott Living: Yes.

Leslie Horton: I love seafood so if I were to pick a type of food, seafood.

Prescott Living: Well yeah, in Alaska …

Leslie Horton: In Alaska. I didn’t know as a child that growing up on things like salmon and moose meat were going to be exceptional for health in the long run. I even complained that my parents never bought chicken or beef. But I am so appreciative now to have had those opportunities to eat so well up in Alaska. Now I actually have to work to find those kind of foods. But I still go up to Washington, where my dad lives now, and we bring back salmon every year. 

Prescott Living: What’s your future career? What ambitions do you see 10 years from now? 

Leslie Horton: I have to say I am in my dream job. I love what I am doing. I never expected to be a director of a health department where I’m at now. I thought of it as a “last five years of the career” kind of job. And so I just feel so fortunate to have had the opportunity to do this job at a point in my career where I am still growing and developing my skills and learning leadership skills. I have a great capacity to make change in our community and influence healthy choices and behaviors. And so if I could think of where I would want to be in 10 years, I hope that I’m either doing this or something very similar to it.