HomeMy WebLinkAboutBoard of Health February 5 20131
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WHATCOM COUNTY COUNCIL
Board of Health
February 5, 2013
CALL TO ORDER
Council Chair Kathy Kershner called the meeting to order at 10:35 a.m. in the
Council Chambers, 311 Grand Avenue, Bellingham, Washington.
ROLL CALL
Present: Barbara Brenner, Ken Mann, Sam Crawford, Bill Knutzen, Kathy
Kershner, Carl Weimer and Pete Kremen.
Absent: None.
1. PUBLIC SESSION
No one spoke.
2. HEALTH BOARD RESOLUTION
Regina Delahunt, Health Department Director, referenced the resolution in the
packet related to State funding for public health services. The Washington State Association
of Local Public Health Officials encourages all local Boards of Health to pass such a
resolution, which encourages the State legislature to maintain funding local public health.
Currently, the County receives about $1.2 million annually in local public health support
from the State.
Brenner stated the wording bothers her to say they will ensure that all children are
healthy and ready to learn. She moved to approve the resolution and moved to amend
the third whereas statement, 'Whereas, an effective public health infrastructure is essential
to decreasing the burden of chronic disease and
to learn increasing the number of healthy children who are ready to learn; and" They can't
ensure that all children are healthy and ready to learn. Kids are born with different things
that aren't curable, but may be maintainable.
Kershner asked what is at stake, what is at risk, and why they are approving this
resolution this year. They haven't approved this resolution before.
Crawford stated they are sharing a lobbyist with the City of Bellingham. He asked if
this is on the lobbyist's agenda. He believes she was trying to say that if they are going to
ask for something, they must say what they want to give up in favor of this. He asked
where this fits in with their legislative efforts overall and also whether they indicate which
priorities are lesser. Delahunt stated this is on the legislative agenda of the Washington
Association of Counties (WSAC). The resolution is on the legislative agenda to maintain
current public support. This is money they're already getting. They're saying that they
know times are tight once again, and they want to maintain the $1.2 million and keep the
funding from getting cut.
Board of Health, 2/5/2013, Page 1
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Crawford asked if the Executive supports the resolution. Delahunt stated he does.
She's not in a position to identify which items are a lesser priority.
Kershner asked what kind of services the $1.2 million pays for. Delahunt stated the
funding is for communicable disease, immunizations, and chronic disease prevention. There
is no revenue associated with those. Most of the dollars are foundational, and can be used
any way the department sees fit. The funds backfill the programs that have no associated
revenue available.
Brenner stated she doesn't want the funding cut. She is just concerned about some
of the wording, especially about the third whereas statement. Work toward the goal rather
than claim they can do something they can't do.
Kremen stated they don't need to spend an inordinate amount of time arguing about
the suggested language. It's boilerplate language. The intent is the same. He will support
the motion to amend. It's likely the Mayor would support the resolution. The federal
government is going to reduce the funding and assistance it will provide for public health.
More than ever, they need to maintain whatever level of funding they can get from the
State and not have any more reductions. Over the decades, there has been a significant
decrease in public health support. This should be a high priority.
Kershner asked how the Affordable Care Act relates to some of the foundational
public health services. She asked if there is a transition of funding or if the old funding
sources will remain. Delahunt stated she's not sure that the County will receive funds from
the Affordable Care Act for these services. The Act includes a prevention fund. However,
some of the programs that had been funded in other ways have been cut. Some of the
dollars from the Affordable Care Act will backfill other programs that have been cut. It's not
likely they will see a big increase in funding for public health and prevention services
through the Affordable Care Act. Some dollars are allocated, but she's not sure how much.
The motion to amend carried by the following vote:
Ayes: Weimer, Kremen, Crawford, Brenner, Knutzen, Mann and Kershner (7)
Nays: None (0)
Brenner moved to amend the second whereas statement, "Whereas, prevention
and public health is services are recognized to play an important role in improving the
health of Washingtonians; and"
The motion to amend carried by the following vote:
Ayes: Weimer, Kremen, Crawford, Brenner, Knutzen, Mann and Kershner (7)
Nays: None (0)
Mann stated the Council approves many letters and resolutions that are messages to
the legislators. It's hard to know when the Council should weigh in as a group. He asked if
another resolution is significant, and whether other departments are lined up with other
resolutions that send messages telling the State legislators what to do. His default
preference is to not approve these messages to the State or federal government. He asked
the context of this resolution in terms of other requests from other department heads.
Delahunt stated this is on the WASC legislative agenda. When WSAC goes to the
legislators, they would like to have a resolution from each county they represent saying that
this is important. That's the strategy.
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Brenner stated this is different from what the lobbyist will do. The County Health
Department represents everyone in the county. This is what the Board does that is outside
of what the lobbyist does.
Kremen stated it is important for the State legislators to know, just as it's important
for the councilmembers to know how their constituents in Whatcom county feel about the
issues that are before the Council. The legislators are inundated with thousands of bills. It
is necessary that the legislators have input from Whatcom County constituents. Public
health is an important issue. Passing this resolution shows the legislature what the people
back home want. This is a very critical and important issue. The Council needs to let the
legislature know what the community wants.
Kershner stated she understands Councilmember Mann's concern. She will support
the resolution. It is important to talk about these things. By submitting this resolution, the
legislature may need to take a different decision on something else that is equally or more
important to the County, that they are not currently discussing, such as cutting the
Department of Corrections, resulting in the level three sex offenders moving onto the 5100
block of Meridian, causing much more damage to this community than the decrease in
funding that this issue may cause. Without seeing how the legislature will act, she will
support this item, but continue to have a cautious eye on this so they don't regret spending
the dollars elsewhere. She would like to resolve to ask them to maintain the current level of
funding for these programs in lieu of increasing compensation or retirement packages to
State employees, for example. It would make the resolution stronger if the County provides
options and solutions to the legislature.
Brenner stated that when the Council had its budget retreat, they talked about
putting public healthy and safety at the top. These are the foundational issues that are
critical.
The motion to amend carried by the following vote:
Ayes: Weimer, Kremen, Crawford, Brenner, Knutzen and Kershner (6)
Nays: Mann (1)
Delahunt stated she suggests that the resolution be sent to all of the State
legislators. She will also forward a copy to WSAC.
3. COMMUNITY HEALTH IMPROVEMENT PLAN
Regina Delahunt, Health Department Director, stated several people will speak to the
Board about the Community Health Improvement Plan and the community's priorities.
Astrid Newell, Health Department, stated a number of community health partners
helped on this. She submitted a substitute copy of the update that corrected scriveners
errors (on file). In 2010, a partnership developed between Peace Health St. Joseph Medical
Center and the County Health Department to conduct a comprehensive community health
assessment and improvement plan. A number of agencies and individuals have also
participated. The main purpose of the plan is to seek nation accreditation for the Health
Department. Also, the Affordable Care Act requires nonprofit hospitals to have a community
health assessment plan in place. Today's speakers will talk about the perspective of their
agencies and why this is important to them and the community as a whole.
Chris Phillips, Peace Health St. Joseph Medical Center Director of Community Affairs,
stated the Affordable Care Act requires that nonprofit hospitals engage in a community
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health assessment. It also requires that the assessment be done in cooperation with the
Health Department. The plan is consistent with the Peace Health mission to ensure
personal and community health in collaboration with government agencies and the
community.
Peter Theisen, United Way of Whatcom County President, stated his organization
adopted a set of goals around education, income, and health. They have targeted resources
to meet those goals. His board is committed to the Community Health Improvement Plan
(CHIP) effort. Benefits include a consolidated needs assessment and a shared community
agenda that identifies goals and objectives and assigns accountability. More efficient use of
scarce public and private resources, coordinated action, and accountability are beneficial
results.
Sue Sharpe, St. Luke's Foundation Executive Director, stated they committed over
$16 million dollars in the past three years to the health and medical services in the
community. Her Board has recognized that health is a constantly changing dynamic.
Community health is the future for dealing with the growing cost of health care. They
restructured their vision for the future. The revised mission and vision statement align with
the language in the community health assessment in which they share a vibrant community
where every child gets a healthy start and everyone gets the care they need during their
lifetime. They will achieve that by investing in strengthening and advancing individual and
community health. Her Board has committed to setting aside a significant portion of their
grant dollars to help focus on a particular issue identified in this process. They embrace this
plan and intend to align with other entities for implementation.
Mauri Ingram, Whatcom Community Foundation Chief Executive Officer, stated her
agency is only sixteen years old. They work closely with many partners. They have the
broadest mission of all the funding organizations. They want to align their discretionary
funding with the goals and objectives of the community at- large. They attract other
resources by working with donors in Whatcom County. The information in the plan is
invaluable in talking with those donors about where they can make an impact in the
community. They also work with other funders in the region. They have been successful in
attracting sizeable grants.
David Stalheim, City of Bellingham Block Grant Manager, stated the City is involved
in the process, which has been an eye opener for him. Look at the document regarding the
subjects of mental health and substance abuse, which affects the community in profound
ways. They started to pull the data together and put the information into the City's plan, so
it can start identifying priorities of the community and begin to look at funding. The plan
helps focus resources and tell the groups the City funds where the City wants to see
outcomes. For example, the City wants to see low- income housing projects close to bus
lines and close to healthy food sources. The City is now a major funding source. It has
over $4 million per year that it funds. The City plans to use the CHIP to help frame those
decisions.
Doug Benjamin, Public Health Advisory Board Chair, stated he wants to reassure the
Health Board that the Advisory Board has been very involved in this plan. The number one
mission of the Public Health Advisory Board is to act in an advisory capacity to the Health
Board and to recommend programs and policies. The Advisory Board is made up of a
variety of professionals representing business, environmental health, health care, and
higher education. The group is capable of evaluating policy and mission and to properly
advise the Health Board. The Advisory Board has been deeply involved in this process from
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the beginning and supports the plan. The Advisory Board will continue to use the plan as a
mechanism to set its agenda.
Newell stated she thanks all the community partners for speaking today. They will
talk in -depth about the priorities within the plan.
Mann stated the community health assessment was completed about a year ago. He
asked if this is the plan. Newel stated today's presentation is on the priorities on which the
community has selected to focus in the plan.
Mann asked if today they are still talking about strategy and goal- setting as opposed
to implementation and programs.
Kershner stated the staff asked the Council's priorities as they presented the
assessment. She asked if all of that input was incorporated and is now coming forward.
Newell stated that is correct. There are overarching themes of the plan and three main
priority areas. Ms. Delahunt will then talk about the next steps.
Ingram stated she will talk about the CHIP overview. The primary goal is to improve
health for all Whatcom county residents, especially vulnerable groups and populations with
poor health outcomes. Individuals, businesses, and the community as a whole all suffer
from the cost of poor health outcomes. To turn this plan into action requires community
engagement and community -based leadership that includes the County Council, local
funders, service provider organizations, and individuals who take personal responsibility for
improving their own health. They need to look at metrics to track where they go. Make
sure the data is meaningful. A striking component of the plan is the inter - relationship of all
the issues. All the issues are complex, and none can be addressed in isolation. Knowledge
is not enough to be healthy.
Sharpe stated she hopes the policy makers share responsibility. The most successful
and sustainable efforts have been driven by public and private partnerships. The Health
Department and Peace Health could have done this project independently to meet their
mandates. However, they chose to involve the community to build ownership in the plan.
There is a broad commitment to make sure the work comes to fruition. Her role as a
community funder is to help facilitate the dynamics between the public and private sectors.
This is a unique opportunity. The community has the capacity to achieve goals if they agree
on the shared goals and align resources.
Theisen stated he will talk about specific priorities of the plan, including helping
children, youth, and family development. Throughout the CHIP and assessment processes,
it became clear that children who started behind in life remained behind in life. The costs
for remediation later in life are higher than early intervention. Goals include reducing
percentage of children in poverty, reducing the impact of adverse childhood experiences,
and increasing academic success. An action being considered in the plan includes a
coordinated system for new families with home nursing, mental health case management,
housing, and financial literacy. Another action being considered is increasing access to high
quality early learning and alignment of the pre- Kindergarten with the K -12 educational
system. Another action is implementing evidence -based approaches in schools to respond
to children with adverse childhood experiences and other challenges. Partnerships are
between local governments, public schools, health care, and community providers.
Stalheim stated public and private funders and community groups are getting
together to talk about shared goals and outcomes, which include promoting healthy and
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active living in communities. Think about how these funds are being used in the most
effective way. Shared outcomes result in the most effective use of limited resources. For
example, he's worked on housing issues with the Health Department and Veterans Affairs.
Look at things to improve healthy living in neighborhoods. As a funding source, the City
wants to fund projects that meet the shared goals.
Phillips stated a question was how much they have incorporated the input from the
Board of Health. Other jurisdictions are impressed that the County Council is involved. The
Council emphasized children and families. It is the top priority. The Council responded to
the language at the beginning of the process. The language in the report is a direct result
of that input. The first goal of strategic priority three is to ensure that everyone have
access to healthcare. In the next 18 months, they can help people get insurance. The
second goal is to ensure access for specific populations to medical homes. A small portion
of patients use a large percentage of the healthcare dollar. Medical homes reduce that
percentage and are a way to have a more equitable distribution of resources. The third goal
ensures that everyone feels welcome in the healthcare system. Not everyone feels
welcome. The focus of the healthcare plan is on vulnerable populations. Everyone is
touched by some issues outlined in the plan, including substance abuse. The plan identifies
strategies and tactics to deal with substance abuse.
Delahunt stated all of these are public health issues. The Health Department cannot
work on the issues alone. It's important that the community work together. The Health
Department will look at these three strategic priorities and make sure they connect with
actions in the department. Programs may change and refocus as a result of the community
priorities. There is not yet a plan written and ready to give to the Council. They do have
the strategic priorities set by the community. The next step is to get commitment from all
the organization leaderships. They will come back to the Health Board for its commitment
to these three priorities. To begin the plan, there will be work groups to refine the strategic
priorities, measures, and goals. Another work group will talk about how to communicate
this plan to the community. They will work with a consultant to write a clear document that
connects the plan to the community health assessment data. They must work on a
community structure to help this plan actually happen. They must work together to
measure progress and make sure they move forward.
Kershner referenced the proposed initiatives and actions and asked if these are just
examples. Delahunt stated they are. When the work groups get together, they will be
more specific. The executive level of the organizations will be asked to commit to the
priorities, rather than the specifics of the plan.
Crawford referenced the third item on strategic priority two regarding land use.
Generally, the Council has agreed that it not be included, but it continues to be. Stay away
from the land use stuff. The County Council generally regulates the rural areas of the
county. There is a rural versus urban dichotomy. If the information remains, specify in the
heading of strategic priority two that they promote healthy and active living in urbanized or
non -rural neighborhoods and urbanized or non -rural communities. He doesn't want the
added pressure of another layer of land use regulations on the rural areas of the county. If
the cities want to add transit routes, access to recreational or medical facilities, those are
good and worthy decisions. He is cautious and concerned about incorporating this in a
countywide document, particularly when the venue for the Board of Health is rural areas.
Delahunt stated this is a community -wide plan that includes cities and the County.
Last week's Public Works, Health, and Safety Committee talked about potential ways that
health can be viewed or incorporated into land use planning, such as the berm and trail
Board of Health, 2/5/2013, Page 6
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along Birch Bay. Those are the things they're talking about when talking about how health
can be considered in land use in rural areas.
Crawford stated they've talked in the past about dictating that the bulk of the
windows in a house must face a certain way because sunlight is good for people. Stay out
of those types of regulations. The County does have jurisdiction over the urbanized area of
Birch Bay, which is an exception. Be abundantly cautious about incorporating any of that
into countywide rules. Delahunt stated consider the plan in the context of the overall
community.
Crawford stated make sure groups that use this as a guiding document are aware of
the issue. He will continue to speak out on his concern.
Kremen stated Councilmember Crawford's points are valid. Today, all the presenters
were well - prepared, concise, and comprehensive. He's impressed by the collaboration
among all the agencies that deal with public health. He commends the Health Department
for being a leader in this project. The product impresses him. He looks forward to the next
steps. The product will be very effective. He encourages everyone to return to the Council
so the Council can review the product to see if it's consistent with the direction the
policymakers want to go.
Brenner stated she would like to know how medical homes are going to reduce costs
and more about compassionate care for kids. Phillips stated medical homes are when a
doctor works together with a team that includes a social worker or nurse to provide more
comprehensive care. People with a chronic condition will wait to see a doctor until their
symptoms become out of control. Sometimes they end up in the emergency department,
which is very expensive. A medical home is a registry that has information from a team
about a patient.
Brenner stated she would like detailed information about how much money it would
save. She asked about compassionate care for kids. Newell stated it is a model called
compassionate schools. It is an approach for the whole school culture to identify and
address children who have had trauma in their lives.
Brenner asked to see the model.
Kershner stated the number one health care issue in the country is obesity. She
asked why is there not something about obesity and specifically access to whole foods to
work on our community health. Missing from the proposed initiative is that communities
are healthy when people are working. She asked if they can regulate that people need to
have jobs so they can sign up for health care and have money to buy the local food.
Everyone did a great job, but there are a couple of things she is not comfortable with and
would like to think about. For instance, she is not comfortable with putting more money
into early childhood education. Children belong with their families during those young ages.
Boost families so they provide nurturing, care, love, and support for children so they are
ready to learn when they enter Kindergarten. Kids should not be in an institutional group
setting at two years old. She asked if there is data showing different. She also has
concerns about the land use piece of this plan. If included, it should be specific. She
agrees it should identify the urban neighborhoods. Countywide land use regulations could
ensure growth of locally sourced food.
Mann stated the information from the Health Department has been top notch. He's
grateful to the community partners for their collaboration. This is general information, so
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he doesn't share the same concerns as Councilmembers Crawford and Kershner. Place and
location in terms of community design are important. Certain specific things, such as
mandating sidewalks on both sides of rural roads, won't be done. However, stating that
place matters and land use matters in general is important. He will wait to see the specific
recommendations.
Kershner stated make sure land use includes rural grocery stores in neighborhoods.
Newell stated this plan doesn't and can't include everything. The issues around nutrition
and obesity have been part of the conversation. They're thinking about it differently, to
support children and families. Food is part of that. They look at neighborhoods and
communities in terms of access to healthy foods. Ensuring healthcare for vulnerable
populations includes populations that have health needs related to obesity and chronic
diseases.
Mann stated he would like feedback from everyone about an email they received
from Abe Jacobson, who raised a legitimate point about local consolidation of medical
providers within Peace Health St. Joseph. Mr. Jacobson was concerned because he is not
Catholic, and all health care would be filtered through some sort of religious algorithm that
would deny needed care to folks. Phillips stated he would like to provide a response to Mr.
Jacobson if Councilmember Mann could forward the email. Peace Health has more than 120
years of service to this community. It is strongly committed to the community, and access
to health care is not going to stop. Things are changing in the healthcare industry. Their
mission and commitment to the community has remained consistent.
ADJOURN
The meeting adjourned at 12:07 p.m.
The Council approved these minutes on March 12, 2013.
ATTEST:
WHATCOM COUNTY COUNCIL
WHATCOM COUNTY, WASHINGTON
Please contact the Council Office to obtain an
official, signed copy:
360- 676 -6690 or council(g-,o.w hatcom .wa.us
Board of Health, 2/5/2013, Page 8