HomeMy WebLinkAboutBoard of Health April 1 20081
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WHATCOM COUNTY COUNCIL
Board of Health
April 1, 2008
Council Chair Carl Weimer called the meeting to order at 10:35 a.m. in the Council
Chambers, 311 Grand Avenue, Bellingham, Washington.
Present:
Barbara Brenner
Bob Kelly
Sam Crawford
Seth Fleetwood
Laurie Caskey- Schreiber
L. Ward Nelson
1. PUBLIC SESSION
No one spoke.
2. PHAB 2008 WORK PLAN
Absent:
None
Regina Delahunt, Health Department Director, stated Doug Benjamin, Public Health
Advisory Board (PHAB) member, will present the PHAB work plan for the next several
months. The PHAB is looking at its role, mission, and the needs of the community.
Doug Benjamin, Public Health Advisory Board Member, referenced the discussion
form for this item in the Board packet.
Nelson thanked Mr. Benjamin for his work on the Advisory Board. He asked about
strategies for increasing immunization rates. He asked if this item reflects the State
numbers presented. Delahunt stated they do. They will talk about that during the next
agenda item.
Nelson stated that if immunization and access is an issue to address, they must have
a full discussion about it. Delahunt stated they'll talk about the new State dollars, the 5930
funding. Improving immunization rates is one of the priorities for that funding. They will
ask the Advisory Board to work out specific strategies appropriate for this community.
Benjamin asked if the Board sees anything that the PHAB should include on the work
plan list that the Advisory Board has missed.
Weimer asked about obesity and chronic disease, and whether the County plays a
role in that issue. Delahunt stated that item is one of the State priorities for 5930 funding.
Chronic disease prevention is at the forefront of public health. Public health has not had
significant funding to get into that area and do significant work that can make a difference.
There isn't much of a program right now. They will lay the groundwork for the future. The
staff will talk to the Advisory Board about public health's role in the community.
Nelson stated people brought forward the issue of childhood obesity as a concern.
He asked if the Advisory Board should see how this issue comes out in the community
Board of Health, 4/1/2008, Page 1
1 rather than develop a list of pre- determined goals and objectives. The State survey showed
2 they do a better job with physical activity in the community. They have a better idea of
3 proper nutrition. Develop a mechanism to work with schools' lunch programs and about
4 nutritional education. Delahunt stated the chronic disease and obesity issue will come out
5 as a community issue they most work on. They will figure out the Health Department's role
6 versus the role of the community.
7
8 Benjamin stated the Advisory Board would like to have a joint meeting with the
9 Board of Health during the year.
10
11 Delahunt stated have a joint board meeting in September, after they draft the work
12 plan for 2009/2010.
13
14 Nelson asked if the Advisory Board will help the department with significant issues
15 through the budget process. He asked if the Board of Health should get involved before the
16 budget process. He asked if work on the issues will be status quo. Delahunt stated there
17 are no dramatic cuts in State revenue. Nothing too dramatic is expected. They will
18 consider shifting dollars around the programs to be more effective during the management
19 retreat in May. They must prioritize.
20
21 Caskey- Schreiber stated the Health Department offered to teach septic system
22 classes. She asked the cost of such a program. She asked the department's plan for that
23 program. Delahunt stated they are working on a plan. They will present updates on that
24 program to the PHAB and the Board.
25
26 Caskey- Schreiber stated it's important to evaluate the cost of that education system.
27 If the Council wants that cost to be reduced to the homeowner, it needs to be in the
28 upcoming County budget. Delahunt stated she will add that to the list for the PHAB.
29
30 Brenner stated that program should be free for homeowners.
31
32 Kelly asked about the loan program. Treasurer Steve Oliver was doing some
33 research on that program. Delahunt stated the County had a program at one time. There
34 were issues about loan defaults, so the County didn't renew it. However, they plan to apply
35 for the program again. They've added a grant component to the program. The Treasurer's
36 Office may administer the loan program. The Health Department is not in the business of
37 administering loans.
38
39 Kelly stated a concern is that the loan program is too focused on Hood Canal. Make
40 sure the local folks get the attention needed.
41
42 Brenner stated she would like very specific information on what went wrong with the
43 first system and what is right in other places. Compare what Whatcom County did wrong
44 with what other systems are doing right.
45
46 Weimer moved to approve the list, with the inclusion of septic system issue, and to
47 schedule a joint meeting.
48
49 Motion carried unanimously.
50
51 3. 5930 FUNDING PRIORITIES
52
Board of Health, 4/1/2008, Page 2
Regina Delahunt, Health Department Director, stated there are new dollars from the
State. Public health educated the legislature for two years to get additional funding. They
identified a need of $300 million to fill all the gaps. The legislature provided $20 million of
that $300 million. Of that, Whatcom County will get $277,000 per year for two years. To
get that money, the legislature really wants to see improvements in public health. Public
health was asked to prioritize where they would spend the dollars and to come up with
performance measures to prove they've made significant progress. It is not a great amount
of money in the context of the serious issues.
The three priority areas are:
1. improving immunization rates,
2. improve reporting and follow -up of communicable diseases, and
3. interventions to address obesity and chronic disease
Crawford stated Whatcom County has three percent of the State population. Three
percent of the $20 million is over $600,000. Apparently the funding given isn't based on
population. Delahunt stated it is partly based on population. A base amount is assigned to
each county. The $20 million is for two years. The smaller jurisdictions got a higher base
amount because their populations are so low that the amount assigned to them wouldn't
have made any difference
Fleetwood asked the difference between a communicable disease and a chronic
disease. Delahunt explained the difference.
Whatcom County looked at its needs regarding the three priority areas. By the time
it gets to communicable disease, it would have already spent its money. The County
doesn't have the capacity to do really good investigation of communicable disease or getting
immunization rates up. It will focus on the first two priority areas. The County will still
work on the third issue, but not with these dollars. The department will work with the PHAB
to come up with specific strategies that will make a difference.
Weimer stated he supports the plan. They must prove to the legislature that there
will be a benefit to the dollars spent. It will be more difficult to prove that they make a
difference with chronic disease.
Brenner stated it's harder to show improvements with obesity and chronic disease.
However, they've come a long way with immunization and reporting of communicable
disease. It's easiest to show improvements with those two items. That doesn't make them
the most important. However, addressing obesity and chronic disease issues is
preventative. Delahunt stated the majority of the dollars would go for staff to work on
communicable disease. Now, they don't have the capacity to investigate sexually
transmitted diseases (STD's) and other communicable diseases in this community. The
number of cases of Hepatitis C is increasing dramatically. They do a good job on the rest of
the reportable diseases they investigate. The existing staff workload doesn't have capacity
to do basic work, such as community education, and establish procedures. They will still
work on obesity and chronic disease issues, but not with these dollars.
Nelson stated access is critical to increase immunizations. It's cost - prohibitive in
many cases. Insurance companies need to do better reimbursements. Allow immunizations
at pharmacies. Many parents don't have the time for an appointment at a physician's office,
but insurances don't provide reimbursements to pharmacies. Put dollars and effort into
getting those access issues resolved. Delahunt stated the Advisory Board will provide
advice on how they can reduce barriers and be more effective. This performance measure
Board of Health, 4/1/2008, Page 3
1 is specific to children's vaccines supplied by the State. The pharmacies can't take
2 advantage of that vaccine, which is a barrier.
3
4 Brenner asked if the Health Department will do vaccinations. Delahunt stated it
5 depends on the barriers that exist.
6
7 Brenner stated the fact that pharmacies can't do immunizations is a glaring issue
8 that needs to be addressed, not discussed more. It's definitely a big barrier. Delahunt
9 stated that may be something that comes out of the discussion.
10
11 There are performance measures to support 5930 funding. She referenced the
12 matrix in the Board packet. It is for the Board's information. She will work on a State
13 committee to increase local and stable public health funding.
14
15 Brenner asked if children are required to have immunizations or a note regarding
16 religious objections. Delahunt stated they are.
17
18 Brenner asked if the issue is simply making the schools comply. Delahunt stated it
19 depends on the school district policy.
20
21 Astrid Newell, Health Department, stated it depends on the school district policies.
22 Bellingham has a high immunization exemption rate. If kids aren't up -to -date, the school
23 staff has them just sign an exemption. That's an issue. Problems includes reporting, school
24 policies, and timing of immunizations.
25
26 Brenner asked if this is an unfunded mandate to the school districts. Newell stated
27 the issue is not so much about the schools not getting the information. It's more about
28 parents who haven't immunized their kids in the past. It's easier for families to just sign an
29 exemption than get the kids immunized.
30
31 Brenner stated it seems like it will require more staff of the school districts. Any
32 system change costs money. A question is whether the County is passing an unfunded
33 mandate to the districts.
34
35 Nelson asked if they are concerned about specific vaccinations. Delahunt stated that
36 regarding the performance measures, they will focus on Varicella, Rota Virus, human
37 papillomavirus (HPV), and pediatric influenza. Those are the four vaccines they are trying
38 to improve.
39
40 Nelson asked if they must focus on these four immunizations because there is a
41 higher incidence in the community. Delahunt stated it's not about higher incidences. It's
42 about low vaccination rates for these particular vaccines.
43
44 Brenner asked if they are not going to look at the more classic immunizations.
45 Newell stated the work plan includes a task to work with providers on increasing their
46 immunization rates. Staff looks at whether immunizations for children 19 -35 months old
47 are up -to -date. In doing that work, they will have an opportunity to work on the other,
48 under -used vaccines.
49
50 Nelson asked about the HPV vaccine in young children. Newell stated it is not for
51 children. It is recommended for young girls aged 11 -12 and girls aged 13 -26 who have not
52 yet been vaccinated. The goal is to educate health providers about that vaccine and
Board of Health, 4/1/2008, Page 4
1 encourage families to have their girls vaccinated. The task is educating providers, parents,
2 and young women.
3
4 Delahunt stated the State created the performance measures matrix. She asked
5 that the Board approve the Health Department's priorities, so they can work with the
6 Advisory Board.
7
8 Nelson moved to have the Advisory Board address the immunization and
9 communicable disease issues, specifically look at barriers that reduce effectiveness of
10 programs, and provide suggested remedies to the Board of Health.
11
12 Brenner asked if the staff are comfortable putting the chronic disease issues on the
13 back burner. Delahunt stated they are still planning to work on chronic disease issues. The
14 department is planning to see how it can move forward in a strong way to address chronic
15 disease in the community. It is such a big issue that community partners must be included.
16 The Health Department can't do it alone.
17
18 (Clerk's Note: End of tape one, side A.)
19
20 Brenner stated she would like to see a statewide survey of people over a certain age
21 to find out which chronic diseases are most prevalent. Delahunt stated the most prevalent
22 chronic diseases are heart disease, diabetes, and lung disease.
23
24 Newell stated the behavioral risk factor surveillance survey is a statewide survey
25 done annually. This year, they will have Whatcom County data on those chronic diseases,
26 including disease and death rates.
27
28 Brenner stated she thought heart disease rates in Washington State were going
29 down.
30
31 Caskey- Schreiber stated this money is from the State. All areas of the State are
32 focusing on these three issues. They hope to compare all the results to see if this money
33 makes a difference, which would be grounds for the State to provide more money.
34
35 Newell stated the items are in priority rank order from the State. They must do item
36 one first, then two, then three.
37
38 Motion carried unanimously.
39
40 4. LOCAL PUBLIC HEALTH INDICATORS OVERVIEW
41
42 Astrid Newell, Health Department, gave a Power Point presentation (on file) on local
43 public health indicators. She referenced the list in the Board packet of 32 key health
44 indicators. She read the presentation.
45
46 Fleetwood asked the definition of being overweight. Newell stated overweight is
47 defined as a body mass index (BMI) over 25. There are calculators that figure it out. It's a
48 measure of weight over height. It's a standard way to look at obesity. There are issues
49 with it because some people tend to have more muscle and are not overweight.
50
51 She continued to read the presentation on the all- county bar graph for obesity.
52 Whatcom County is doing well in terms of the State rates.
53
Board of Health, 4/1/2008, Page 5
1 Nelson asked about jurisdictions that have done away with transfats in the
2 community. The City of New York did that. Delahunt stated transfat won't do a lot for
3 obesity. That has to do with cancer issues. Seattle and King County have recently passed
4 an ordinance requiring menu labeling with calories, fat percentages, and other nutrition
5 levels on menus.
6
7 Brenner stated different fats promote weight gain or weight loss. The BMI is a
8 range, not a number. Newell stated she agrees. A BMI standard of 25 is considered
9 overweight.
10
11 She continued to read the presentation on early prenatal care.
12
13 Fleetwood asked what is standard prenatal care. Newell stated the standard is met
14 when a pregnant woman sees a doctor during the first trimester. The appointments during
15 the first trimester are about early identification of issues and the mother's health behaviors.
16
17 Crawford asked if there are resources in the community for any women who thinks
18 she's pregnant, such as community clinics. Newell stated it depends on the health care
19 providers. Interfaith doesn't do too much with prenatal care. Family physicians and private
20 obstetricians are mostly seeing these mothers. St. Joseph Hospital used to have a prenatal
21 care clinic. The problem is getting these women referred to the resources that exist. There
22 is a recent effort to change the system.
23
24 Delahunt stated the Whatcom Alliance for Healthcare Access (WAHA) has been
25 working on the situation with obstetricians. They've been meeting with providers, who
26 didn't know there was an issue with women getting into prenatal care. Now, providers are
27 setting up a system for those who need prenatal care.
28
29 Crawford stated he thought he was very aware of how available care is, and it's not a
30 financial situation. He's surprised to hear of this problem. There are resources out there.
31 He asked how they figured the county's rate is lower than the State's. Newell stated the
32 State comes up with that number.
33
34 Delahunt stated that information is asked on birth certificates.
35
36 Newell stated there may be other barriers, particularly for lower- income or Medicaid
37 mothers to seek care.
38
39 Crawford stated it's interesting that Whatcom County is lower than the State
40 average, when this community has tremendous resources for folks like that.
41
42 Brenner stated people with more resources tend to be more aware of their bodies
43 and more concerned about things. The fewer resources they have, the more people there
44 are who feel they don't have access. The question about insurance should have been about
45 people with adequate insurance. Many people have huge deductibles and aren't getting
46 services during the first trimester. Delahunt stated many people are under - insured.
47
48 Caskey- Schreiber asked if they broke down the data to identify the age groups in
49 that 24 percent. Newell stated she may be able to get that data.
50
51 Nelson stated the indicator is four percentage points from the State. The State
52 percentage indicates that it is missing data. Delahunt stated it's curious that this is the only
53 indicator in which Whatcom County is less.
Board of Health, 4/1/2008, Page 6
1
2 Brenner asked if there is much difference from the lowest to the highest. Newell
3 stated the highest was 89 percent and the lowest was 72 percent.
4
5 Newell completed the presentation on teen alcohol use, childhood unintentional
6 injuries, and website resource.
7
8 Brenner asked about the data on tenth graders. Newell stated that data is collected
9 from the Healthy Youth survey, given in the schools.
10
11 Brenner asked why tuberculosis (TB) and other mandatory reportable communicable
12 diseases aren't included. Newell stated the diseases selected are meant to provide a
13 snapshot of their health, and not meant to represent everything.
14
15 Brenner stated the rate of teens who are overweight as shown in the handout is low.
16 It is higher than the 23 percent reported. Newell stated that statistic is self- reported from
17 the Healthy Youth survey.
18
19 Nelson referenced the indicators of adults with unmet medical needs and adults with
20 a healthcare provider. Delahunt stated the adults may have a provider, but don't go
21 because of costs.
22
23 Nelson asked for a better understanding of what those unmet needs are.
24
25 Brenner stated that statistic is lower than the reality. A lot of adults would have
26 trouble admitting that happens. Delahunt stated they are asking an individual. The same
27 questions are asked randomly the same way across the state. All they can really do is
28 compare Whatcom County with other counties.
29
30 Brenner stated get facts and information from emergency rooms when a disease has
31 progressed.
32
33
34 ADJOURN
35
36 The meeting adjourned at 11:59 a.m.
37
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39
40 Jill Nixon, Minutes Transcription
41 �������iuuir,,�
42 `"oly ee QD >4 roved these minutes on July 8 , 2008.
44 �fiT �PTCp�.•% '��� WHATCOM COUNTY COUNCIL
45 J: !,.�`I� .: WHATCOM COUNTY, WASHINGTON
46
48 =L?� •
49 •
50 [Y ,a B - vie, '.Coecil Clerk Carl Weimer, Council Chair
Board of Health, 4/1/2008, Page 7