HomeMy WebLinkAboutBoard of Health September 30 20081
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WHATCOM COUNTY COUNCIL
Board of Health
September 30, 2008
Council Chair Carl Weimer called the meeting to order at 5:35 p.m. in the Council
Chambers, 311 Grand Avenue, Bellingham, Washington.
Present:
Barbara Brenner
Bob Kelly
Seth Fleetwood
Laurie Caskey- Schreiber
L. Ward Nelson
Public Health Advisory Board Present:
Lavern Lane
Doug Benjamin
Jayne Jurado
Jenny Shuler
Chris Phillips
L. Ward Nelson
Mary Ellen Shields
1. PUBLIC SESSION
No one spoke.
2. HEALTH DEPARTMENT 2009/2010 WORK PLAN
Absent:
Sam Crawford
Absent:
John Worlund
Regina Delahunt, Health Department Director, stated the two boards are to provide
input into the 2009/2010 work plan. The work plan format is different. In the past, they
haven't done a good job at tying community health data to the department's health
priorities.
The State Department of Health recently did a performance review. The Health
Department did well in all areas except tying community data to the department's health
priorities. They recently went through a review of public health standards with the State
Department of Health. Whatcom County did really well in meeting the performance
standards. One shortfall was tying the community data to the priority setting, and then
using the data to show they've made improvements in the community. That's why they
changed the format.
Staff spent time looking at the community data and came up with priority areas for
the focus. Also, they want to be able to measure changes in the community. The plan
includes performance measures to monitor change over time.
She asked the Boards to consider if they have effectively framed these community
issues with the data and whether they will be able to effectively show a change over time.
Board of Health, 9/30/2008, Page 1
1 This document is a draft. There are holes in some data spots, which is okay for now.
2 They included placeholders and types of measures they will look for in the next couple of
3 years.
4
5 She asked for input on selective goals from the Boards. Staff thought a lot about the
6 data and prioritizing, but they would like input from the Boards. She asked if there are
7 other areas in which the Boards would like to see data, have an opportunity to evaluate that
8 data with the department, and make recommendations for prioritization.
9
10 Not everything they do is in the plan. The plan reflects the areas on which they
11 intend to focus, but they will still do all the other daily programmatic work. They will have
12 to rework some programs and do more partnering with the community to accomplish goals.
13
14 Each manager will go through their priority area goal sheets. They selected five
15 priority areas for this work plan. She described the new format. The packet includes a
16 budget summary for each area.
17
18 Caskey- Schreiber stated she likes the new format. She asked if there is more
19 detailed information on the activities. Delahunt stated they will discuss the details.
20
21 Astrid Newell, Health Department, stated she would talk about communicable
22 disease prevention and early childhood health promotion.
23
24 Chronic disease is the major source of death and disability, so they must increase
25 activities and public health's role. Public health has a critical role in promoting healthy
26 behaviors that can prevent or delay chronic disease development and insure access to
27 preventative services. Whatcom County- specific concerns are physical activity, increasing
28 rates of obesity, lack of physical activity, ongoing tobacco - related illnesses, and oral health
29 issues. Dental care and dental cavities are the most common chronic diseases in children.
30 She read the three goals.
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32 Key activities for physical activity include mobilizing communities partners to
33 complete a community assessment and planning process in one of the rural communities
34 and looking at physical activities of kids through the schools.
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36 Caskey- Schreiber asked if this is enough, because 60 percent of adults in the county
37 are overweight. Newell stated this isn't all the activities the Health Department is doing.
38 It's one key thing. Other agencies are involved in doing activities as well.
39
40 Delahunt stated this isn't enough. Public health needs to deal with chronic health
41 prevention. That's what is killing society. Public health had money to address tobacco use
42 and did a good job reducing smoking rates. They get little funding for other chronic disease
43 prevention programs like nutrition and physical activity. They get very little State funding.
44 Over the next few years, that is the direction public health has to go. Most communities
45 allot a small portion of the budget to chronic disease prevention. If they are going to make
46 a real difference in health status in the communities, they need to start moving that
47 direction, and figuring out how to do that.
48
49 Fleetwood asked how the community need assessment was implemented. Newell
50 stated there is a toolkit to engage the community. They are trying to get community
51 leaders on board to begin the assessment process.
52
Board of Health, 9/30/2008, Page 2
1 Delahunt stated it's a program of community empowerment. They need to engage
2 the community members and other groups that are working on this to shift the paradigm
3 and shift people's views of what it means to be healthy.
4
5 Newell stated other communities in Washington State have used this Healthy
6 Communities toolkit as a best practice.
7
8 Brenner asked how they calculated that the population is 60 percent overweight.
9 Newell stated it's from a recent behavioral risk factor surveillance system survey. They
10 surveyed Whatcom County residents in 2007.
11
12 Brenner stated it seems like 60 percent is high. She asked the standard for
13 determining weight and obesity. The work plan references reducing adults who are
14 overweight and obese, but the work plan only references reducing obesity for children. Fat
15 cells are formed when young. If they are working on prevention, it's more important to deal
16 with children who are overweight. Delahunt stated reducing those overweight can be a goal
17 for pediatric as well as adults.
18
19 Nelson stated social engineering is difficult. That's the direction this country is going.
20 He asked how they establish a mechanism to get a return from the investment. That's key.
21 Define the results realized from lowering obesity, such as reduced diabetes. Demonstrate
22 the value added. In the future, find mechanisms for employers to get reduced insurance
23 rates for their employees because the community does the right thing. That would be a
24 good goal. He needs a better sense of the benefits.
25
26 Delahunt stated they can research returns on investments.
27
28 Shields stated there are clear weight standards, with deviations for ages. The
29 Centers for Disease Control and Prevention (CDC) calibrates the rates regularly. Sixty
30 percent isn't high for a community. That's standard.
31
32 Brenner stated this was done through a survey of individuals, not doctors. There are
33 many ways to calculate weight, including muscle mass.
34
35 Kelly stated other counties have taken a controversial approach to eliminate trans
36 fats. He asked if that is an option. Newell stated they would like to hear ideas today for
37 other activities they can work on.
38
39 Delahunt stated King County eliminated trans fats.
40
41 Phillips stated that if the Board of Health is interested in prohibiting trans fats, staff
42 can bring back recommendations. He would approve of that effort. Resources fund
43 activities that create outcomes. If the Board of Health is interested, the Public Health
44 Advisory Board can look into it.
45
46 Delahunt stated other jurisdictions have also dealt with menu labeling.
47
48 Caskey- Schreiber asked if they've ever considered doing outreach to larger
49 employers about offering subsidized or free health fitness programs for employees. Push
50 that more. Create incentive -based fitness programs for larger employers.
51
52 Fleetwood asked how much effort to increase youth fitness is done through the
53 schools. Newell stated one half of a staff position is working with the schools.
Board of Health, 9/30/2008, Page 3
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Brenner stated the reason there isn't as much physical activity is because the schools
don't have as much funding. This is a nice idea, but they must focus on life and death
issues at this point. Setting up benefits for employees is great, but many people don't work
for government. That money has to come from somewhere.
Newell stated two other areas of chronic disease are tobacco and oral health.
Tobacco activities are ongoing activities to work with low- income clients. They will continue
to reduce access to youth through compliance checks with retailers. They will work with
folks with chemical dependency on tobacco issues. They are also looking at smoke -free
housing policies for low- income rentals.
Oral health has to do with access to dental services and care. They work with the
oral health coalition. The State has asked that they do more assessment activities, so they
will do another smile survey in 2010. The purpose is to get a sense of what is happening
with dental health in the community.
Weimer stated many of these programs are statistically a waste of money because
there is no way to evaluate what they're doing has any effect. He asked if evaluation is
built into the plan to show results.
Phillips stated some have evaluation and some don't.
Dr. Greg Stern, Health Department, stated a lot of the interventions are based on
resource - intense research where program outcomes are proven. They can reduce the
number of chronic disease incidents by lowering weight, cholesterol, and blood pressure, for
example. Once they have that kind of research, they don't have to reproduce those results
locally. They've made the connection. It's hard to determine if the programs are
responsible for things like weight loss. Also, not just one program will be responsible for
reduced rates. It's a community effort. They may not be able to determine the impact of
one particular activity, but can use a menu of interventions that can, in total, have an
impact as evidenced by rates going down. The goal is to really reduce disease burden
within a budget.
Weimer stated that's the answer of every government agency around the country.
The bottom line is that the statistics find that doesn't work. It's better to pay for an
evaluation to see if a program works, rather than doing a lot of things and finding out that
none of them have really contributed. Measure the community toolkit results. Make sure
evaluation is built into the process somewhere. Ask for evaluation funding if they need it.
Delahunt stated that when possible, they can use best practices that have already
been evaluated for effectiveness.
Newell stated early childhood development is critical for creating long -term health.
Focus on best practices. The Nurse Family Partnership Program, a national program that
has been replicated across the country, will come to Whatcom County. A key to optimal
child health is a nurturing caregiver. The program is a nurse and family partnership with
home visitation, where nurses go into homes and serve first -time low- income moms from
early pregnancy through the child's second year of life. An enormous amount of data shows
impacts for both mothers and children that are significant, to reduce juvenile crime and
parent and child substance abuse. There is a lot of data and support for this program.
They will have to shift away from existing programs that may not be as effective.
Board of Health, 9/30/2008, Page 4
1 Jurado asked if that would take the place of First Steps. Newell stated they can use
2 First Steps dollars for enrollment and some of the services. It would enhance the First
3 Steps program for a targeted population of first -time mothers.
4
5 Jurado asked if it has the same guidelines for maternity case management. Newell
6 stated it's a different program.
7
8 Delahunt stated that if implemented, they would serve a different population than
9 they serve now. They would have to work with the community to make sure some of the
10 clients they are serving now will retain services, and also serve the new population.
11
12 Jurado asked if clients who now go to the Mother Baby Center or SeaMar would also
13 be eligible for this program. Newell stated they would.
14
15 Delahunt stated they'd trade clients. The Health Department would take more
16 difficult, at -risk clients.
17
18 Newell stated they will discuss the program at the October 15 Public Health Advisory
19 Board meeting.
20
21 Two other goals for early childhood are nutrition and early identification of children
22 with special needs. For nutrition, they are focusing on breastfeeding. Also, they will work
23 with community partners to improve systems to serve kids with developmental disorders.
24
25 (Clerk's Note: End of tape one, side A.)
26
27 Beth Melius, Health Department, stated she will talk about the communicable disease
28 health prevention priority area. The County is mandated by the State to report certain
29 diseases in the community, which can have a serious public health impact in the
30 community. They can limit the impact of communicable disease through immunizations,
31 reporting and early intervention, and public and community education. She read the three
32 goals. Private provider offices have low immunization rates, but school exemption rates are
33 high. She read the packet on the goals and activities.
34
35 Brenner asked what happens when a child has a bad reaction to a particular
36 vaccination. She asked if they can get individual immunizations. Stern stated they can.
37 One problem is boutique immunization schedules because of people's misperceptions. Get
38 people on a schedule and get kids vaccinated on time. They balance the benefit of the
39 vaccine against the known side - effects.
40
41 Shields asked if implementation with healthcare providers includes use of the vaccine
42 registry. Stern stated it does.
43
44 Delahunt stated public health's role for immunization has changed. Public health
45 departments used to give the shots. Now, they make sure the vaccines are available in the
46 community and physicians are getting kids immunized. The department gives very few
47 shots now.
48
49 Stern stated they are looking at the system to identify obstacles to full immunization,
50 to meet immunization targets, and to work with schools, pediatricians, and family practice
51 doctors to identify and get rid of obstacles.
52
Board of Health, 9/30/2008, Page 5
1 Weimer asked why the immunization rates in school exemptions are higher than in
2 other places. People in the community seem more scared of the immunization than the
3 disease. Stern stated it may be related to the failure of the fluoridation vote locally. People
4 have fears of interventions and don't trust science.
5
6 Delahunt stated they really don't know, which is why they want to implement pilot
7 projects. Go into schools and find out the real factor. Many different things could influence
8 the higher rate.
9
10 Phillips asked if the percentage of 70 percent is of incomplete immunizations or non -
11 immunized. Stern stated it is incomplete immunizations.
12
13 Melius read the second goal to encourage providers to report suspect cases so they
14 can intervene early. A measles case was reported earlier this month, but it turned out to
15 not be measles.
16
17 Stern stated it was a false positive. The false - positive report was not a mistake. It's
18 an illustration of what it takes to prevent outbreaks. He explained the specific case. The
19 cost to the County of this one false -alarm case was $6,770, not including his hours. Had it
20 turned out to be measles, the disease could have spread and the cost would have been
21 much higher. The decision is to wait before they have the absolute diagnosis before they
22 act or respond to an alarm, even though it turns out to be a false alarm. They are making
23 these judgments all the time. This is like the fire department responding to an alarm before
24 they know if it turns out to be a fire.
25
26 Nelson asked about information on recent influenza in seniors. He asked if they can
27 separate seniors who need to be immunized and find out the impact of pneumonia and
28 influenza. Put more emphasize on pneumonia than influenza for seniors. Stern stated a
29 recent study shows that shots to seniors are less effective. It's still protective to some
30 extent. Influenza sometimes reduce resistance to pneumococcal infections. Seniors who
31 get the flu, may die from the flue or may recover from the flu and end up dying from
32 pneumococcal infection. They want seniors to be vaccinated against pneumonia as well as
33 influenza. They recommend flu shots for all children now. Kids may be a reservoir for
34 spreading it around.
35
36 Nelson stated separate the information on influenza and pneumonia vaccinations to
37 better understand the relationship. Stern stated that is the indicator they look at for the
38 severity of influenza. They don't give case reports on individual cases. An indirect indicator
39 of influenza activity is the mortality from flu and pneumonia.
40
41 Melius stated they don't separate it on the death certificate.
42
43 Stern stated that's how they've. followed it for decades.
44
45 Nelson stated he recommends both vaccines for seniors, but many will get just the
46 influenza vaccine.
47
48 Melius read the third goal for communicable disease. She described the expedited
49 partner therapy, which is treating partners without seeing a doctor. Medications are given
50 to both the person diagnosed and the partner.
51
52 John Wolpers, Health Department, stated he would talk about environmental health.
53 He read the three goals. They've been working on goal one for the last couple of years,
Board of Health, 9/30/2008, Page 6
1 which is why he chose it. They will develop homeowner classes to ensure there is funding
2 through the Centennial Clean Water Fund. They have sent out 300 onsite septic system
3 (OSS) evaluations, and have so far gotten 60 percent back. The next letter will go out in a
4 week to all Drayton Harbor watershed residents. The goal by 2012 is to know where all
5 systems are and to get them fixed. Based on 2006 -2007 numbers of onsite sewage
6 failures, there were 26 failures in 2006 and 38 failures in 2007. In 2008, they are moving
7 toward their goal. They did 66 OSS evaluations in 2006. They changed how they do
8 evaluations. In 2007, they did 28 evaluations through April, and 1,300 from April 2007 to
9 today.
10
11 Brenner asked if the failures required repair or replacement. She asked if staff have
12 permitted any gravity systems and if she can get a list of them. Wolpers stated repair and
13 replacement are interchangeable. They have permitted gravity systems. He will provide
14 that information.
15
16 He read the second goal and activities. He described the inspection program. They
17 are making sure everyone is doing appropriate inspections the same way to get the same
18 results.
19
20 Caskey- Schreiber stated Health Department staff did an excellent job when she
21 recently contracted the Norwalk virus from a restaurant.
22
23 Nelson stated they use the Federal Drug Administration (FDA) food safety inspection
24 mechanism. There has been recent product recall information. He asked if there is a
25 system in Whatcom County to help small businesses who receive recall information have
26 access to information and an ability to know what products are recalled and how to get
27 them off the shelves. Wolpers stated they do have a system. There is staff follow -up to get
28 the information out to people. In the recent case, they found recalled product locally and
29 they were pulled immediately.
30
31 Delahunt stated there is a good recall system in place when there is a major recall.
32 They notify everyone and inspect.
33
34 Wolpers read the third goal and activities. Begin a safety inspection of school
35 facilities. The legislature is considering funding this effort. There is a new school rule that
36 the State will adopt in October. Implementation will be delayed, but he will do a pilot
37 project with one school district to do inspections. The ultimate goal is decreasing injury and
38 illness rates.
39
40 Phillips asked if the inspection is comprehensive. He asked if there is data showing
41 that this time and energy is worth the effort. It seems like a huge undertaking. He asked
42 who decided to do this and if that would include independent schools. Wolpers stated
43 inspection is comprehensive. The regulation applies to both public and private schools.
44
45 Delahunt stated the push for the updates is because there is a lot of evidence that
46 the school environments aren't the safest.
47
48 Phillips stated the fire department and other agencies are do school inspections.
49 Wolpers stated the agencies will coordinate. The Health Department will look for things
50 different from what other jurisdictions look for.
51
52 Delahunt stated they're making sure there is no duplication of effort.
53
Board of Health, 9/30/2008, Page 7
1 Terry Hinz, Health Department, stated he would talk about community services. He
2 read the goals and activities.
3
4 Brenner stated it's offensive to use the term behavioral health when they mean
5 mental health. Substance abuse is a subset of mental health. They keep treating it as
6 something separate. The more terms they use, the more confusing it is for people. Hinz
7 stated they now have a one -tenth of one percent tax board in addition to the other two
8 advisory boards to work on overlapping issues. There is overlap and competition among the
9 different disciplines. They need to work to bring that together. He tried to do that with the
10 term "behavioral health."
11
12 Brenner stated it's not an overlap. People are scared of using certain words. They
13 are creating separate kingdoms.
14
15 Benjamin stated the term "behavioral health" is used to encompass both mental
16 health and substance abuse. The reason the term has come into favor is to arrive at some
17 integration. There is a realization that separating mental health and substance abuse is a
18 mistake. They've done that historically.
19
20 (Clerk's Note: End of tape one, side 8.)
21
22 Benjamin continued to state it's not an effort to be politically correct. The purpose of
23 the term is to bring those two services together, because a lot of people have both.
24
25 Brenner stated substance abuse is a subset of mental health. There is no case of
26 substance abuse that isn't also a mental health issue.
27
28 Caskey- Schreiber asked for perspective on the sales tax board and how that will
29 interface with their goals and implementation. Hinz stated they are considering it. They
30 have met with the executive committees of the Mental Health Advisory Board and
31 Substance Abuse Advisory Board to talk about how they can work better together. They
32 need to figure out how to also include this new Board. They will consider if having three
33 boards is the best structure for the situation. They may need to consider more
34 consolidation.
35
36 Nelson asked if the enabling act requires this committee. Delahunt stated they set
37 up the board to provide advice on how to use those tax dollars. The Substance Abuse
38 Advisory Board provides advice about Division of Alcohol and Substance Abuse (DASA)
39 dollars. The Mental Health Advisory Board provides advice about other things. They could
40 have one board to fulfill all these obligations.
41
42 Nelson asked if 2010 projections for mental health outpatient treatment is for 300
43 consumers to benefit from increased revenue, and if it will come from jails and the criminal
44 justice system predominantly.
45
46 Hinz stated goal three addresses that item and performance measures.
47
48 Nelson asked if they don't have a performance measurement for diverting people
49 with behavioral health problems to jail treatment.
50
51 Jackie Mitchell, Health Department, stated that's correct. The portion of people who
52 come from jail diversion will be smaller. It's a chronic population.
53
Board of Health, 9/30/2008, Page 8
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Nelson stated when they're talking about diversion, they're talking about public
protection. He is also concerned about the appropriate type of treatment people go to.
Come up with specific information for that. Mitchell stated they are working on it with
criminal justice system providers to develop specific outcomes.
Delahunt stated they need to stress measurable outcomes. The programs they plan
to implement are proven to make a difference in other places.
Caskey- Schreiber stated there is a lot of proven information about what is effective.
Other counties have been doing this. King County has been doing it, and may have
information.
Delahunt stated a lot of thoughtful work has to go into this to determine what will
work for this community.
3. COMPREHENSIVE HEALTH PLAN UDPATE
Susan Sloan, Health Department, submitted and read from information (on file) on
the Future Search Conference. They have developed a theme. The conference will occur
March 2009. The action plans will serve as the basis for the written Comprehensive Health
Plan. This will create a lot of interest. They are inviting only 81 people from the
stakeholder groups.
Delahunt stated the Future Search Conference will culminate in a plan. they will
have the written plan by June.
Nelson stated he thanks all the work the Health Department staff have done. This
will get skeptics on board.
ADJOURN
The meeting adjourned at 7:21 p.m.
�:� 0--t--
Jill Nixon, Minutes Transcription
The ncil approved these minutes on November 12 , 2008.
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1Jana. wn= L1aV<i • Coun,�'II Clerk Carl Weimer, Council Chair
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Board of Health, 9/30/2008, Page 9