HomeMy WebLinkAboutBoard of Health June 1 20101
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WHATCOM COUNTY COUNCIL
Board of Health
June 1, 2010
CALL TO ORDER
Council Chair Sam Crawford called the meeting to order at 10:30 a.m. in the Council
Chambers, 311 Grand Avenue, Bellingham, Washington.
ROLL CALL
Present: Barbara Brenner, Sam Crawford, Kathy Kershner, Bill Knutzen, Ken Mann,
L. Ward Nelson and Carl Weimer
Absent: None
1. PUBLIC SESSION
No one spoke.
2. PUBLIC HEALTH SERVICES PRIORITIZATION
Regina Delahunt, Health Department Director, stated she wants to focus today on
how the Board envisions the Health Department operating over the next period of time.
She hopes to do business differently.
Brenner stated there is a lot of subjective political terminology instead of public
health terms in the packet. She's very upset about it. She asked who wrote the
documents.
Crawford stated they will discuss that after Ms. Delahunt's introduction.
Delahunt asked for direction on how they do their work in the future. They would
like to work differently.
Crawford referenced packet page 18, and asked if the Board should take votes on
the items on page 18. Delahunt stated the Advisory Board made recommendations on the
items on page 18 and how they feel the department should consider providing those
services in the future. She submitted the information (on file). She would first like to talk
about the systems -level approach to things.
The strategic plan talks about how they do what they do in the community, not what
they do. They would like to incorporate the three strategies on packet page three into
everything they do. She described the three strategies.
The main item to focus on it the second strategy of creating a system -level change.
There are examples of how to apply this strategy in the Human Services Division of the
Health Department.
Board of Health, 6/1/2010, Page 1
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Ann Deacon, Health Department, stated they try to leverage as many resources as
possible, due to budget cuts. They are reconsidering the role in the community, which is to
build capacity in the community. Three examples of working with community partners to
build a comprehensive system in the community include the triage center, housing program,
and sales tax funding programs. She described the three examples. They want to leverage
more than just County resources and partner with other jurisdictions and agencies to build
capacity within the community. Through partnership building and relationships, they can
build a capacity that wouldn't exist if the Health Department tried to do everything.
Delahunt stated there are many areas in the Community Health Division to apply
these principles. There are examples of where they have tried to do some of these things
in this division. Programs would look different if they moved in that direction.
Astrid Newell, Health Department, state the Community Health Division is trying to
do systems -level health care in areas including tobacco prevention (10 :49:39 AM),
breastfeeding promotion, and the program for children with special healthcare needs. They
must coordinate with community partners to provide direct services, so the Health
Department can focus on making sure those services exist for the community, rather than
providing direct services. They struggle with staff capacity.
Delahunt stated they have minimal or almost no staffing for some of these programs
because they've lost so many public health nurses. The nurses still remaining with the
County have been moved to other programs that provide required direct services. Now,
they're not doing a good job with direct services in those areas, and they are doing a poor
job with the community coordination and policy level and systems level change that they
need to focus on. (10 :53 :53 AM)
Brenner stated she cares about public health and helping those who are having a
harder time. The entire packet includes subjective political terminology, not public health
terminology. For example, the packet includes a term "social justice." The definition looks
like the definition of socialism. There is too much subjective terminology. Use the term
"mental illness" instead of "mental health." Deal with the problem, not with the health.
Certain groups use the term "social justice," which sounds exclusive and causes others to be
concerned.
Delahunt stated they are going to see these terms in much of what they've been
discussing in public health. Over the last three to five years, this has been the direction
where people in public health are looking. They are looking at the basic causes of issues,
such as poverty and lack of education. Public health is going in the direction of addressing
those basic causes rather than chasing diseases.
Brenner stated "social justice" is a partisan comment by certain groups. She doesn't
understand what it means, but she understands what "public health" means. Therefore, she
feels left out. It's another instance of using politically correct terms rather than talking
about what is really wrong.
Delahunt stated they intended for the term to mean they are all- inclusive.
Crawford stated they all understand what they intend. However, folks in the
community could read a lot into this. This phrase is creeping into the public health
discussion, and it's a fact they have to deal with.
Board of Health, 6/1/2010, Page 2
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Brenner stated government must acknowledge and respect mental illness, not hide it
under other terms.
Mann stated he agrees that the definition of social justice hasn't anything to do with
health in the draft plan, but he understands the intent.
Knutzen stated he also understands the intent of the term. He asked if there is any
problem with religious affiliations when choosing community partners to work with.
Delahunt stated they work with different faith organizations.
Knutzen asked if those partners would have access to the County database.
Delahunt stated they would. They're making it easier for those partners to obtain Health
Department information, and want to spend more time analyzing the data to pinpoint
necessary improvements. They can make a better public health system in the community
than what currently exists by doing their work in a different way. They're not trying to
eliminate programs.
Nelson asked how many homeless are in Whatcom County. Deacon stated the
annual point -of -time count in January was 1,300. The chronically homeless population has
been cut by one -third in the last two years.
Nelson asked if the homeless population has not changed. Deacon stated it has
changed. They have become better and finding people to count. The count the previous
year was also about 1,300.
Nelson stated they have an increased tax to eliminate the homeless problem. No
matter how much they spend, homeless is an issue that will always be with them. Deacon
stated Clallam County has almost gotten to almost zero homeless with their programs.
Whatcom County is paralleling some of those programs. The economy slowed their
progress and challenged numbers. However, programs are in place.
Nelson asked to evaluate dollar effectiveness in programmatic results. He'd like to
see the details of how they are spending the dollars and the result of those expenditures.
Deacon stated she can make a presentation on a future agenda.
Nelson asked for more information about how they determine the needs of the
stakeholders, based on a larger and broader infrastructure, without becoming chaotic.
Deacon stated one example is their partnership with the school districts. She described
partnerships with school districts for mental health services.
Nelson stated he has no problem using a broader infrastructure, as long as there is
monitoring of efforts. Put this in the Health Committee to discuss this more in- depth.
Delahunt stated quality assurance is part of the systems approach of public health.
Their job is to make sure services delivered are quality, make a difference, and are what
people in the community really need.
Nelson stated don't get so expansive that they don't have enough personnel to make
sure they get results. Delahunt stated that is factored into the systems approach.
Deacon stated program and outcome monitoring is part of any contract with a
partner.
Board of Health, 6/1/2010, Page 3
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Nelson stated he would like more information on how that's done. He asked about
how they determine and implement the policies to control behavior. Newell stated they are
working also with the hospital, City, and other policy makers in addition to the Board of
Health. The Advisory Committee will vet policy plans for the Board of Health.
Delahunt stated they aren't talking just about public policy. They are also talking
about educating school districts, for example, on creating policies for the school districts.
Nelson stated they are talking about comprehensive health planning so they all agree
on what's happening in the community. Some of this is beginning to get disjointed. They
have to be done comprehensively. This needs to go to the Health Committee to review
what the Health Department is doing. The Board members will get concerned about the
Department developing policies to control behaviors. He is interested in determining issues
of public health, not social justice. (11:23:27 AM)
Knutzen asked about partnering with school districts to provide lockers to the
homeless community.
Brenner asked if the school districts pay the true cost of programs with the Health
Department. Delahunt stated there are no contracts where the districts pay the County.
Brenner stated do what they're doing with the school districts already, but the
County should only agree to pay the costs of district programs if the districts agree to
ensure that their school meals are healthy.
Some of the values listed in the packet should be changed. Regarding the integrity
value, they should say they strive to do their best, not the right thing. Regarding the
positive work environment, change the word "enjoyment" to "satisfaction." Also, they can
strive for mental health and chemical non - dependency. She made other suggestions
(11 :28 :38 AM) When addressing problems, those problems should be clearly stated.
Mann asked how many homeless are repeat customers. He asked if there is
turnover. Deacon described the homeless services. Once housed, it's rare for someone to
come back into the system.
Mann asked if the border situation is one of the reasons for the homeless population.
Deacon stated the homeless population has changed. The count is misleading because
they've become more adept at counting.
Mann asked if there is a circumstances in Whatcom County that give them a fresh
supply of homeless people. Deacon stated folks the Health Department serves can't be
transient who arrived in Whatcom County recently. They have guidelines about who the
County services, which include people who have been homeless here for a very long time or
who were residents here and lost housing.
Delahunt stated a big part of the program is preventing homelessness.
Knutzen asked if they work with Washington State University (WSU) Cooperative
Extension on school nutrition, and how effective that program is. Newell stated they work
with WSU Extension, but she can't say how effective their program is.
Brenner stated many people are turned away at the border, and Whatcom County is
the end of the line for them. Border counties tend to have that problem. That population
Board of Health, 6/1/2010, Page 4
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needs to be acknowledged. The State and federal government must acknowledge that
Whatcom County has problems different from other counties.
Nelson stated have a discussion on maintaining the protection for all in addition to
vulnerable populations. Don't lose the focus of what public health is. Delahunt stated she
agrees to look at the population as a whole, including the most vulnerable.
Nelson stated discuss what they do and don't want to do at this time, but schedule it
before the Health Committee.
Crawford stated schedule a discussion with the Health Committee on the future role
of the Health Department in the community, based upon strategic goals.
Chris Phillips, Public Health Advisory Board Chair, stated the Public Health Advisory
Board is committed. The Advisory Board affirms this strategic direction toward a systems
approach. Given the budget crisis, there is opportunity to affirm the system direction. He
referenced and read from the handout of the Public Health Advisory Board recommendations
(on file).
Crawford asked if this is driven by money. Delahunt stated it is partially about
money, and partially about transitioning to a systems approach.
Crawford asked why they feel that someone else can provide a service more cost -
effectively than the Health Department. Phillips stated there is some duplication of existing
services. If a service is provided well in the community, the Health Department doesn't
need to duplicate the service.
Mann stated all the community agencies are suffering budget crises. He asked how
the community can pick up the services that the County drops. This puts a lot on the belief
that someone else will pick up the slack. Phillips stated if the County doesn't provide the
service, the clients will shift to the private providers, and their financial situation will
improve. They are Medicaid services.
Delahunt stated they aren't planning to do anything that will have a negative impact
on the community. They are meeting with these providers. Also, they are exploring the
ways to make the system better. The State will meet with community providers about
improving the system. They don't want to make things worse.
Brenner stated the Health Committee should discuss these issues. She asked how
they can do something different about Group A and B drinking water sanitation.
Delahunt stated the State Department of Health is responsible for those systems,
and they can provide that service.
Crawford asked if this discussion is in the context of work done in 2011. Delahunt
stated it is. They're just looking for agreement on the broad direction the Health
Department is going.
Nelson stated be careful about targeting public health programs. The Board's
responsibility is not administrative. It's about policy. Develop policies so the administration
can make a recommendation on programs. Don't try to go through an incorrect process.
He asked how the essential projects are deemed essential. Phillips stated they had
Board of Health, 6/1/2010, Page 5
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conversations with staff, made a recommendation, and considered the possibility for
community engagement.
Nelson asked if system leverage means there will be evaluation of the results or just
that they will control the contracts. Phillips stated the Advisory Board assumes there will be
measures tied to goals.
(12:01:23 PM)
Nelson stated have more dialog on this. He is interested in the policies they can
make regarding better - managing finances overall. They need to have a clearer
understanding of the relationship of the Board of Health to provide guidance to
administration.
Kershner stated she fully supports allowing community providers to do the programs
just as well, with more capacity. She likes this direction. She supports moving forward
with finding that capacity in the community. It costs about twice as much for government
to provide the service as it does for the community to provide it.
Crawford asked if they've done a financial analysis on moving certain programs to
the community providers. Delahunt stated they haven't. They wouldn't eliminate all
staffing associated with a program, because they would still do system -level work.
Crawford asked that the Health Committee look at the Maternal Child Health,
Children with Special Needs, and Women, Infant, and Children (WIC) programs when it
meets in two weeks.
Brenner asked for a list of potential community partners in these areas that are
recommended for modification or elimination.
Crawford stated the Board members seem to agree to give the Health Department
direction to continue to work on these programs and this systems approach, and discuss it
further in the Health Committee.
Nelson stated they must first keep in mind that they're developing policies to help
the administration make determinations for recommendations. Second, the goal for the
Health Department is to decide how they work on public health for the entire community.
Third, define the relationship of the Health Board, administration, Public Health Advisory
Board, and County Council. This process today is very important. Don't attack specific
programs.
Brenner stated this is overwhelming. Councilmembers should attend the Health
Committee meeting.
Weimer stated he is comfortable with the direction. Develop measures to ensure
that people don't fall through the cracks.
Mann stated it's fine to move toward a systems approach. He has concerns with WIC
and maternity support services.
Knutzen stated he agrees with moving forward with the systems strategy.
Board of Health, 6/1/2010, Page 6
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3. ONSITE SEPTIC ENFORCEMENT (12:15:30 PM)
John Wolpers, Health Department, stated they have strengthened education efforts
and reviewed the reasons behind the time limits. The homeowner classes have been very
successful. Most people seem to enjoy and understand the class. The County has been
awarded $1.5 million for the homeowner low interest loan program.
Brenner stated she is very pleased with the tone of the draft letters provided in the
packet.
Nelson stated neither letter he received indicated which class he should attend. Also,
the class schedule was not included in the letter. Have a regular class schedule that they
can include in the letter. He asked what is in the class that will benefit him as a
homeowner. Wolpers described the topics discussed in the class.
Nelson stated provide more specifics about and justification for the purpose of the
class.
Knutzen stated explain the necessity for the Glendon system and why it's so
proprietary that most contractors in the county can't service or install it. Delahunt stated
staff will put together a fact sheet about Glendon systems.
Crawford asked for a presentation on the systems in the Council Public Works and
Safety Committee or the Health Committee.
Delahunt stated they also must come up with a process for people who really can't
afford to take the class or do an inspection.
ADJOURN
The meeting adjourned at 12:26 p.m.
Please contact the Council Office to obtain an
official, signed copy:
360- 676 -6690 or council@7.o.whatcorn.wa.us
Dana Brown- Davis, Council Clerk
Sam Crawford, Council Chair
Board of Health, 6/1/2010, Page 7