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WHATCOM COUNTY COUNCIL
Board of Health
June 12, 2012
CALL TO ORDER
Board of Health Chair Kathy Kershner called the meeting to order at 10:30 a.m. in
the Council Chambers, 311 Grand Avenue, Bellingham, Washington.
ROLL CALL (10:32:08 AM)
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. PERTUSSIS UPDATE
German Gonzales, Health Department, stated this is a dynamic situation. They've
had to adjust the data. From January to June, there have been 54 confirmed cases. There
is more activity with young children. His investigation team is very good. It's hard to
investigate one case. He described the investigation process. They secured extra TDAP
vaccines last year. They have since dispensed all that extra vaccine. They are working with
local pharmacies and clinics to immunize citizens.
Brenner asked what they do since the 1,500 doses are gone. Gonzales stated they
have asked for another 1,500 doses of the vaccine. The State also provided vaccines it
purchased. They will continue to have the clinics put as much vaccine as possible out there
to help control pertussis.
Brenner asked if the pharmacies also stock the vaccine. Gonzales stated the County
provides vaccines to the pharmacies, which gives the vaccine at no charge to the low -
income or uninsured public with vouchers.
Regina Delahunt, Health Department Director, stated pharmacies stock the vaccine
for the general insured population with insurance.
Brenner asked if seniors should be a targeted population because they have lower
immunity. Gonzalez stated they target the population most at -risk, which is the infants and
children. The County gives the vaccine to seniors as well, especially if they are around kids.
Brenner stated she heard that the pertussis vaccine is no longer good after a certain
amount of years. Gonzalez stated that is correct. There are studies being done about how
long the vaccine will provide protection. Delahunt stated the most at -risk population is the
babies.
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Brenner asked how increasing resources by 1.5 full -time equivalent (FTE) employees
will affect the budget. Gonzalez stated there is one nurse dedicated to this full time. He
has to draw staff from other nurses to investigate cases. They are trying to cross -train all
the nurses to work on any front needed.
Delahunt stated they haven't increased staff. They've pulled staff from other areas.
The staffing levels have been reduced during the past four or five years. They are having to
cross -train people more and more. If staffing levels were any lower, they wouldn't be able
to do that. Things aren't getting done right now because they're putting so much resource
into this effort. They are at critical mass. The team is doing a great job.
Kremen asked the number of FTE's that have been reduced in the Health
Department. Delahunt stated the Health Department had a high staffing level three years
ago of 92 FTEs. The department is now down to about 77 FTEs. Most of the positions were
reduced due to attrition, retirement, and a few lay offs.
Mann asked how often an investigation leads to another case of pertussis. He asked
the typical result of the investigation. Gonzalez stated an investigation usually leads to
another case. When they talk to people, they ask if they've been to the doctor or in contact
with anyone else.
Mann stated he gives the team credit for the public education, which penetrated his
field of awareness. As a parent of small children, he got his vaccine.
Kershner asked about the ten to 13 year olds who didn't get the vaccination when
they were infants, and if they are more susceptible to getting pertussis. Gonzalez stated
they've added that question to the studies. He can't give specific information about this
population if the cause is due to waning immunity or lack of an immunization. There may
be a direct relationship with lack of immunization.
Delahunt stated the State requested assistance from the Centers for Disease Control
and Prevention (CDC) to help figure out the age groups and where most of the cases were
occurring.
Brenner asked if the DTP vaccination was one shot or a series that possibly wasn't
finished. Gonzalez stated the vaccine is a series of vaccinations. They have a good
immunization rate. The CDC is trying to figure out the rate of immunity for these vaccines.
3. COMMUNITY HEALTH IMPROVEMENT PLAN
Regina Delahunt, Health Department Director, stated they've been working on the
assessment for about one and a half years. The packet information includes the complete
data sets, which they're still working through. The executive summary tells the story of
what they found in the data. Page four of the summary lists the core group of community
members who worked on the data and with the community partners to make sure the two
sources of information meshed. They're trying to figure out what areas in which to focus to
really make a difference in the health of the community.
Astrid Newell, Health Department, gave a staff report and described the work done
on this project so far. The data collected was condensed into the summary document in the
Board packet (on file). She referenced and read the strategic questions on page 21 of the
executive summary.
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The two key goals are how to optimize the health and well -being of childhood and
how to impact the population that is disproportionately impacted by health and social
disparities.
(10: 58:36 AM)
Strategies they've identified support both goals. To improve the health status of
populations that experience disparity and to optimize the health and wellbeing of the
children, they want to focus on five strategies that impact both areas. One strategy is
population- based, to support the population of at -risk children and young families. She is
talking about social supports that make sure people are connected to the resources. A
second strategy is place- based, to focus on particular neighborhoods or community
environments in targeted areas that have fewer resources. The third and fourth strategies
are problem -based regarding substance abuse and housing. Both situations contribute to
family stress and have significant impacts on children. The community needs to figure out
how to coordinate a response to the substance abuse crisis. Promoting affordable and
stable housing is something they've done in this community. It's important especially for
at -risk families. The last strategy is to integrate elements around children's health and
include health efforts in the existing planning initiatives in the county.
Knutzen asked what Whatcom Futures is. Newell stated there is an initiative by the
Northwest Economic Council to envision the future of Whatcom County. The idea is to tie
into existing efforts rather than creating lots of new initiatives, and make sure these
concepts are brought to the table.
Crawford stated he's leery of imposing health design and engineering into housing
issues. Whatcom County is over - regulating housing. It's nice to talk about affordable
housing, but land use policies have as much or more impact on housing affordability than
anything else. Remove that from the packet. They don't need another layer of planning
and regulatory review from a health perspective when fundamental things not related to
health can hugely impact housing affordability. He's brought up this concern before, but
item E on page five says to promote CHIP goals and objectives into these County planning
activities. It keeps popping up. Bellevue, for example, probably doesn't have a community
health problem because there isn't any housing affordability. It's not a good parameter to
use.
Kremen stated a lot of thought, work, and collaboration obviously went into this.
However, he agrees with Councilmembers Crawford and Knutzen. There seems to be a
theme or agenda here shown on the first page of the summary, or page five of the packet.
One bullet point says, 'Dynamic tension exists between environmental protection and
development interests." That has a negative connotation. Instead, change the language,
"development OnteFests- needs for growth." There is a need for growth in the community.
The language indicates a certain bias. Make it more objective. Delahunt stated that's a
good comment. That negative connotation wasn't intended.
Crawford stated another example is the mention of the Gateway Pacific Terminal, but
there isn't even an environmental impact statement (EIS) yet. Take all that stuff out. He
asked who owns the report. Delahunt stated this is a community assessment and plan. It's
not from the Health Department or Whatcom County. The Health Department will evaluate
its current programs and plans to align with this community plan. As the department does
that, it will bring forward issues to the Board of Health. The Board may be required to make
some sort of policy decision based on alignment with this plan. Other community members
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are looking to this plan and assessment to also align their efforts. The plan is to bring
everyone together and focus on certain areas.
Kershner asked if the leadership group that put this plan together understands the
concerns from Councilmembers Crawford and Kremen. It sounds like they don't have
access to food in the rural areas because the zoning doesn't allow grocery stores in the rural
areas, because the Growth Management Hearing Board has been lobbied by the most anti-
growth people in the county. It's an endless circle. She would like to submit this plan with
the rural element as evidence they need grocery stores in the rural area. Delahunt stated
this isn't a plan at this point. It's an outline of issues. They certainly don't want to have a
plan that the policy- makers don't support.
Brenner stated anyone with a clinical depression symptom could apply to anyone.
Also, there are too many categories of people who are minorities. Concentrate instead on
people who are in trouble, regardless of minority categories. Everyone would at one time or
another fall into one of the minority categories. Don't portray people as victims. She likes
the part that gets to the abused and neglected children. It's not realistic to not talk about
resources. Focus on people who are in trouble rather than a particular group. The
categories imply that being a minority makes someone at -risk. Delahunt stated the
leadership group had a similar discussion. The data shows that people who are a racial
minority or very low income have much worse health outcomes.
Brenner stated she hates the Caucasian racial group being called "White." It's broad,
weird, and inaccurate. There are many ethnic groups, such as the Russian population, that
are white. Delahunt stated that's the way the national and state data are sorted.
Kremen stated his comments weren't meant to be disparaging, but to point out the
need to look at this in an unbiased way. There needs to be credibility and buy -in. If people
accept the document and this approach toward dealing with health in Whatcom County,
there will be more cooperation, participation, and success. This summary should include
prioritization. For example, childhood obesity is something that is the most pressing issue
facing the community. It's something they can successfully improve. Newell stated the
summary is the broad list of everything the community looked at and synthesizes that
information. The community health improvement plan (CHIP) will focus on prioritized
issues. Many strategies are broad and more comprehensive that will address many things.
This particular document doesn't include childhood obesity, but it would be a long -term
outcome.
Kremen stated the most recent studies show that the amount of food eaten is more
of a factor than activity. Portion sizes, processed food, and sugars appears to be the
biggest cause of obesity in the United States. The next factor is a sedentary lifestyle.
Newell stated other factors are the social environment around food, stress, lack of sleep,
and other factors. Obesity is much more than just the portion sizes.
Kremen stated it causes diabetes, hypertension, heart disease, and stroke. The
ramifications of obesity are far - reaching and the overall problem with the nation's health.
Prioritization and implementation are critical. Delahunt stated they must develop a way to
measure how they are successful. They have to work down to the specifics that will be in
the plan.
Mann stated he appreciates the work gone into this effort. He likes the document
overall. The vision statements incorporated their feedback given last time. He supports the
vision statements and goal one. He agrees with certain feedback regarding goal two. He
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has some discomfort with targeting specific populations instead of providing opportunities
for everyone, as the vision statement says. It would be difficult to implement. Land use is
a contentious issue. Avoid it when talking about health. Don't contaminate the discussion
with other emotional reactions to land use decisions. They shouldn't focus on it. If they
knew how to affect affordable housing or how to impact employment in Whatcom County,
they would do it. The macro - economic conditions are more powerful than the community or
County can implement. They risk more discord and conflict amongst the decision - makers if
they try to address those issues. It's not worth it. He asked how much more they can do to
tell people that smoking is bad for them. Don't keep sending money to that population
group if they're that uninformed. Delahunt stated just telling people that smoking is bad
will no longer make a difference. Smoking, especially in certain populations, is a symptom
of other issues that need to be addressed. They need to address underlying issues. The
community is filled with people who know how to address the issues and who are dedicated
to getting the work done.
Mann stated the rate of smoking is double in lower incomes. People have to take
some personal responsibility. There may be some populations they just can't reach. Be
more targeted and strategic with the funding. Target mental health, but not low income.
Newell stated individuals who start smoking as teenagers tend to be the ones who continue
to smoke long -term. They have a really hard time giving up smoking. Focus on youth. Try
to reduce the exposure to tobacco in terms of advertising, so it's not right in their faces.
Change the norms in the community. Smoking is really addictive and hard to give up.
Some are successful. Many are not. Get kids to not start smoking, especially if they are
younger than 18.
Mann stated he supports targeting the youth and mentally ill. Don't single out ethnic
minorities or those who are economically challenged.
Brenner stated one of the biggest reasons for obesity is that kids have much less
exercise at school. That may not be the place to cut back. Focus on people who are in big
trouble. Some people have very good insurance, but still get knocked around. Change the
way the system works for everyone, so it's much more inclusive of the patient. Also,
seniors with Medicare are vulnerable because doctors don't take those patients. Focus on
the system for everyone, not just groups of people.
Kershner stated items of major concern include the high school graduation rates;
high rates of child abuse; low breastfeeding rates in the Women, Infant, and Children (WIC)
program; high rates of tooth decay in third graders; low immunization rates, and;
continuing and increasing drug abuse rates. Focus on those areas.
Weimer stated he appreciates the plan. He likes the way the data is presented.
Categorizing people presents red flags and problems. Don't remove any of it, even the land
use stuff. Just be careful about how it's portrayed. The land use concerns can go both
ways. Either provide health clinics and grocery stores in places where people can afford to
live, or make it affordable to live in places where those services are located.
Newell stated leadership group members will meet to further define the strategies
and measures. They are presenting to other groups in the community, such as hospital
leaders, to get more feedback and input. They hope to refine the plan at the end of the
summer. The idea is to have this document as a guide as the Health Department puts
together the budget and thinks about policy direction.
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The Health Department and County are one participant in developing this plan, but
it's really about the community. Other healthcare organizations have a role. This will guide
the agency and also be a mechanism to engage the public.
Knutzen stated he would like accountability built into a plan. Teach people to sustain
a house and save 30 percent of their income. Many programs give people things, but don't
have any accountability. If people earn something, they will take better care of it than if it
was given to them.
OTHER BUSINESS
Crawford asked about the health and safety of mobile food trucks in Whatcom
County. He would like a presentation on how the County makes sure they are safe.
Regina Delahunt, Health Department Director, stated they must be permitted. The
staff watches out for trucks that aren't permitted. They are inspected, and they have to
have food handler cards. There have been challenges with mobile food units. She will
schedule a presentation.
ADJOURN
The meeting adjourned at 11:49 a.m.
The Council approved these minutes on August 7, 2012.
ATTEST:
WHATCOM COUNTY COUNCIL
WHATCOM COUNTY, WASHINGTON
Please contact the Council Office to obtain an
official, signed copy:
360- 676 -6690 or council@�omhatcomma.us
Board of Health, 6/12/2012, Page 6