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As the top public-health leader of Seattle and King County, Dr. David Fleming helped expand his agency’s attention far beyond disease outbreaks and restaurant cleanliness to address income disparity, racial barriers, gun violence and other issues.

Facing the possibility that even some core functions may be cut back as a continuing budget squeeze worsens, Fleming suddenly announced his resignation as director of Public Health — Seattle & King County.

“As we look at all the changes that are going on out there in the health-care system, increasingly I’ve been recognizing that we need leadership here in the health department that is prepared to be here for another five years,” Fleming said Tuesday. “And that’s not a match with my personal needs at this point.”

Fleming, whose last day as director will be Aug. 11, will continue in his role as county health officer on an interim basis during the transition.

Seattle Mayor Ed Murray and King County Executive Dow Constantine said they will begin the search for a new director. Constantine has appointed Patty Hayes, director of the agency’s community health-services division, to serve as interim director.

Dr. Howard Frumkin, dean of the University of Washington’s School of Public Health, called Fleming one of the best local public-health officials in the country. “His departure is a real loss to the people of the city and county,” Frumkin said.

Fleming has been a leader in focusing attention on the dramatic health disparities that exist within King County and on “the root causes of sickness and health,” Frumkin said.

“Wherever he ends up, I’ll be delighted if his gifts and talents and passions continue to serve the people of this county. He’s really a gem,” he said.

Constantine, in a statement, thanked Fleming for his efforts to “transform public health and establish a strong foundation upon which we will continue to build.”

He noted that during Fleming’s tenure, the agency helped more than 165,000 King County residents sign up for health insurance under the Affordable Care Act, reduced youth obesity by 17 percent in participating King County schools, and established King County as the region with the world’s best survival rate for cardiac arrests.

At 60, Fleming said he did “a lot of soul searching” before deciding to leave his position. “I think I have at least one more job in public health in me,” he said, but he doesn’t have any definite plans.

In his “all-consuming job,” he’s been too busy to think about what’s next, he said.

One thing he’s sure about: He will continue to focus on what he calls his passion — “this new cutting edge of public health.”

“Historically, public health has had one set of things it has needed to do to keep people healthy,” Fleming said. “But increasingly, we’re needing to turn to these underlying drivers of what’s really making people sick.”

Those include income disparities, racial barriers, unsafe neighborhoods and lack of access to transportation — subjects outside public health’s traditional boundaries.

As he continues as county health officer during the transition, he hopes to keep working with a project called “Communities of Opportunity” funded jointly by King County and The Seattle Foundation to improve health, social, racial and economic equity in King County.

Fleming says he “got the equity bug” in his former position as director of the Bill & Melinda Gates Foundation’s Global Health Strategies Program.

“That’s the idea that everybody should have an equal chance to do well, which is the guiding philosophy at Gates,” he said. “That is just so right, that I have to think that wherever I go, whatever I wind up doing next, that’s going to have to be a part of it.”

Fleming has also served as the deputy director of the Centers for Disease Control and Prevention, and as Oregon’s state epidemiologist.

When he was nominated for the public health job in Seattle in 2006, Fleming said it had been great working at the Gates Foundation, giving resources to others to get the job done, “but I find that I miss actually doing the work of getting the job done.”

He was unanimously confirmed by the Metropolitan King County Council.

In June, Fleming announced that an expected $15 million budget shortfall for Public Health — Seattle & King County in 2015 could force the department to divest itself of up to six clinics and more than 200 staff members.

Despite the budget problems, which have built up over the past decade, Fleming said his department has accomplished great work.

“I’m really proud of this department and the work we’ve done,” particularly in attacking “those things that cause people to be sick or die before they should,” he said.

“This is the future of public health that we’re talking about, particularly as you look at the profound disparities that we have in health across place and race. And that’s where we should be focusing our attention. At the same time, we do have this budget issue.”

Carol M. Ostrom: or 206-464-2249. On Twitter @costrom