HomeMy WebLinkAboutBoard of Health June 26 2007WHATCOM COUNTY COUNCIL
Board of Health
June 26, 2007
Council Chair Carl Weimer called the meeting to order at 5:40 p.m. in the Council
Chambers, 311 Grand Avenue, Bellingham, Washington.
Present: Absent:
Barbara Brenner None
Dan McShane
Sam Crawford
Seth Fleetwood
Laurie Caskey- Schreiber
L. Ward Nelson
1. PUBLIC SESSION
No one spoke.
3. FOCUS REPORTS ON COMMUNICABLE DISEASES AND SEXUALLY
TRANSMITTED DISEASES (STD's)
Regina Delahunt, Health Department Director, stated this information is to make
sure the Board of Health is informed of the status of the various communicable diseases in
the county. Susan Sloan, the Health Department's health information specialist, did a
general report on communicable diseases. From the information gleaned, she did a more
detailed report on sexually transmitted diseases (STD's).
Susan Sloan, Health Department, stated the reports are available on the website.
She. handed out information (on file) about the location of the link on the website.
Now they are working on. the chronic disease report. Compared with chronic disease,
the mortality rates of communicable diseases and STD's are very low. Therefore, the
statistics in the report are on diseases and illnesses as opposed to deaths. Influenza and
pneumonia will be reported in the chronic disease report because they are one of the ten
leading causes of death for citizens in Whatcom County. They are not reportable diseases.
Greg Stern, Health Officer, stated specific case reports can be done on diseases that
occur in low numbers and are easy to diagnose. Influenza may affect 15 to 20 percent of
the population, so they don't do individual case reports. They have indirect measurements
of the impact, instead. Influenza and pneumonia deaths is one indirect impact of the flu.
Sloan stated public health does a good job of addressing communicable diseases.
Whatcom County can do additional information and work on enteric diseases, pertussis,
chlamydia, genital herpes, gonorrhea, and human papillomavirus (HPV). The rates of these
diseases are generally higher in Whatcom County than the state statistics or in other
counties in the state.
Brenner stated the pertussis vaccine is for the adolescents and adults up to age 64.
She asked what they do with people who are over 64 years old. Stern stated that age
Board of Health, 6/26/2007, Page 1
1 group was studied for safety. The people at the highest risk are infants. Children are
2 vaccinated. The immunity of the pertussis vaccine wanes after five years or so.
3 Adolescents and young adults may be the big reservoir for infecting infants. If they can
4 vaccinate adolescents and young adults, they would stop the transmission. Adults have
5 milder complications. Pertussis doesn't have a huge impact for older folks.
6
7 Brenner stated this information is very confusing for lay people to look at. They
8 should dwell on the fact that some STD's in Whatcom County are higher than the state
9 average, not on the STD's with lower rates. Stern stated this report is about the raw
10 statistics. One reason for higher rates is because of increased reporting. If people are
11 looking more for the disease, they will find it more.
12
13 Genital herpes is very common. The initial infection is reportable. They aren't
14 getting consistent reports on genital herpes. When the State revised its list of notifiable
15 conditions, there was general consensus to remove genital herpes from the list. However, it
16 was kept on the list because of ongoing research at the University of Washington. Don't put
17 a lot of weight on whether the statistics are up or down for genital herpes. In general, they
18 don't get a lot of reporting, and reporting bias is probably the issue.
19
20 Brenner stated it's an indicator. She's nervous about talking about levels being
21 down on some things and up on others. They don't give an accurate idea of potential
22 exposure. For a final report, talk about the problem.
23
24 Sloan stated the prevalence of chlamydia is more than the prevalence of herpes.
25
26 Brenner stated they shouldn't focus as much on numbers. Comparing the different
27 STD's with each other seems odd. If they have one, they are just lucky they don't have
28 others.
29
30 Nelson stated the comparisons are of the same disease. They are using numbers to
31 track trends. That's what public health does. They have to use numbers. It's a mechanism
32 to determine whether or not they are providing adequate health care facilities and access,
33 track the disease rates to make sure other outside influences take effect, and ensure that
34 they are doing a proper education process to decrease concerns about activities that lead to
35 STD's.
36
37 Delahunt stated there may be different interventions depending on age groups, for
38 instance.
39
40 Stern stated they get case reports and send them to the State Department of Health.
41 The State Department of Health sends the County a report of the numbers and comparisons
42 with other counties. What's left is deciding how to interpret the numbers. One of the
43 weakest aspects of the County Health Department is the data analysis. They are good at
44 collecting data and passing it on to the State. They are not doing a lot of analysis of the
45 data. They can still see trends. They can separate the data and the analysis, and then
46 derive the messages. Make sure the data reports are focusing on data, and that the
47 messages aren't mixed up with the data.
48
49 Brenner asked what's going on with the schools. Sloan stated legislation has been
50 passed that schools can't teach abstinence only if they are going to teach STD education.
51 That question will be up to the school districts.
52
Board of Health, 6/26/2007, Page 2
1 Brenner stated the County should fund an education service for all the school
2 districts that want it. Some school districts said they don't have the funding. One school
3 district doesn't teach anything. The more adults respect the intelligence of young people,
4 the less likely the young people are to rebel against everything. Allow them access to
5 information from a nurse who can come to the schools.
6
7 Crawford stated the potential may exist that there are more sexually active people in
8 the community due to the university. He asked if the university population statistics are
9 mixed with the County statistics. Stern stated they analyze all in the county. It would be
10 interesting to analyze by age group or region to see a more detailed analysis. That's part of
11 the enhanced surveillance and analysis that would need to be done. From that kind of
12 approach, they can do some strategic planning to the community.
13
14 Crawford stated they don't know statistically if there is a pocket of more cases at the
15 university, thus making the County's statistics higher. Stern stated that is correct. The
16 university students could also have a lower rate because of access to the university health
17 system.
18
19 Caskey - Schreiber stated she agrees with doing more outreach and making resources
20 available to the schools. Do outreach to the school districts and the university. Delahunt
21 stated she agrees. There are many ways they can address this problem. The problem is
22 not having enough resources to do everything they want to do. They also need
23 investigation to decide where to target the messages. The legislature has given local public
24 health additional dollars to use in this coming biennium. The highest priority of the local
25 public health agencies across the state is communicable disease. They are going to focus in
26 particular on STD's. Statewide, they will focus efforts in that one area to show they can
27 make a difference, Whatcom County didn't get a lot of money, under $300,000 per year for
28 the next two years. That will buy them some capacity, but not much. She is confident that
29 the focus area will be STD's. Staff talked about doing some of this analysis with the extra
30 money. At the end of the report, there are questions for which they don't have answers.
31 They want to do this analysis and then, based on their findings, start some intervention
32 programs. In 2008 and 2009, they should be able to come up with a prevention plan,
33 education outreach plan, and other things that will make a difference.
34
35 Caskey- Schreiber stated Planned Parenthood is very involved at the university. They
36 may be able to provide information on their clientele. Delahunt stated health care providers
37 can also sort data.
38
39 Brenner stated some of the school district respondents don't feel they have the staff
40 to do education. A good educator is the key to getting the message across. Get someone
41 who is trained to do that type of education for the school districts.
42
43 Crawford asked why influenza isn't in the report. Sloan stated it's not a reportable
44 disease. It will be covered in the chronic disease report.
45
46 Delahunt stated there are so many cases of influenza that they don't track them all.
47
48 Stern stated the Health Department is learning from each new report it does. They
49 started off with providing feedback to the community on the disease rates. Now, they will
50 have more analysis in the reports.
51
52 Crawford asked the status of West Nile virus. Stern stated there were two or three
53 human cases in the state. There have also been a few animal cases. They have reason to
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1 suspect that this will be the year it hits Washington State. As the population develops
2 immunity, the rate will go down. Washington State is one of the few states that hasn't had
3 a big outbreak yet.
4
5 Delahunt stated they are still doing mosquito and bird surveillance.
6
7 Stern stated another way to organize the report would be to focus on infectious
8 diseases that aren't passed person -to- person, but they would be useful reports. They can
9 do the data analysis, but make the reports more direct.
10
11 Nelson asked if the Health Department got good information when the County had an
12 epidemiologist. Stern stated it was a regional position. Whatcom County didn't use the
13 person that much. The quality of the work will depend on how experienced people are in
14 that position. The regional public health response group has an epidemiologist that focuses
15 on emergency responses. It's a potential resource they can use.
16
17 Nelson stated there is a reduction in bloodborne pathogens due to the needle
18 exchange program and education. It's an example of an instance when they identified a
19 problem and found the resources and mechanism to reduce the disease. For some
20 diseases, they can dump a lot of money on the problem, but it won't change much.
21
22 Sloan stated there are questions in the report for the County to further explore.
23
24 Brenner stated the County took a lot of heat for the needle exchange program. The
25 County won't take as much heat for a voluntary school district STD education program. The
26 needle exchange program results made it worth taking the heat.
27
28 Crawford asked about HIV /AIDS in Whatcom County. Delahunt stated the County
29 staff participates in a regional program. They are trying to identify the priority populations
30 and reach out to those folks.
31
32 Janet Davis, Health Department, stated this is an example of how the needle
33 exchange is probably making a difference.
34
35 Delahunt stated HIV funding is declining. They are working to make every dollar
36 count, find the cases, and do prevention.
37
38 Crawford asked if HIV /AIDS is reportable. Delahunt stated it is.
39
40 McShane stated some of the recommendations are to evaluate where they put the
41 resources to be most effective. Another question is how problems like homelessness affects
42 diseases. Homelessness is a high risk condition. Think about money spent on other social
43 programs that provide a fiscal benefit in other areas. They may get a double or triple bang
44 for their buck on some of these programs. Three areas fall into that category. One area
45 was the needle exchange. Include a. stronger education component. They are heading
46 down the right path. Think about where they have savings in other programs.
47
48 Stern stated many of these problems have multiple factors. It's hard to attribute
49 either cause or effect to one factor. They sometimes don't have the local resources to do
50 the research that would prove those extended benefits, but they can infer results from other
51 studies and apply the results locally. often, they are tempted to prove things locally.
52 However, they aren't a university. They can spend all of their resources doing research,
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and not get anything done. However, they want to make sure what they get done is based
on evidence.
McShane stated they can cite those studies. They don't have to reinvent studies that
have already been done.
2. WASHINGTON STATE DEPARTMENT OF HEALTH UPDATE ON SWIFT CREEK
Regina Delahunt, Health Department Director, introduced the State Department of
Health (DOH) Office of Environmental Health Assessments staff. The Agency for Toxic
Substances and Disease Registry (ATSDR) did a health assessment on the Swift Creek
dilemma. The State Department of Health did a health consultation and epidemiological
assessment. There aren't any cancer clusters associated with the asbestos at the site.
(Clerk's Note: End of tape one, side A.)
Crawford asked what the State Department of Health is doing to get the message
out to the community.
Gary Palcisko, Department of Health Office of Environmental Health Assessments,
gave a presentation. He read from the presentation and gave a history of the problem. The
State Department of Health asked the EPA and County Health Department to do more
characterization of the site. They continue to work on the problem to formalize necessary
health actions for the future. The Environmental Protection Agency (EPA) focused on a
narrow reach of the river to do it's studies. They are concerned about inhalation exposure
to asbestos. If activities went on over a long period of time, there would be an
unacceptable level of lifetime risk. The health consultation is looking for evidence of disease
In the community. They will also look at the important public health data that the EPA
didn't collect.
He described how they determined if anyone has been getting sick due to this
problem. There were no cases of mesothelioma, and lung and bronchus cancer rates were
no different from other areas in the county and state. Because of the small population
number, their confidence in the statistic isn't high. Therefore, even though there is no
evidence of disease, they are still concerned. There are other health issues besides cancer.
There are questions about the amount of asbestos exposure that is acceptable.
There are other areas where people may be exposed and where the State
Department of Health should continue to collect data. They should look at indoor dust and
areas where the sediment has been used as fill in the past. Downstream deposition is also
a concern. There is potential occupational exposure, but they won't delve into that issue.
They will get the occupational health agencies involved if necessary.
The State Department of Health recommends an action plan in its health
consultation, including free voluntary indoor testing. One of the most important things they
can do is provide messages to the local community. There has been discussion of putting
up signage and information at the site. The local health department is working on that idea.
The State Department of Health is working on an outreach plan to the community.
Agencies will collaborate to develop the best strategy to work on this issue. The first thing
that will happen is that he will write a letter to all the agencies who requested follow up
information on the health statistics in the area. The State Department of Health will also
develop fact sheets and brochures as they get more information. Next steps also include
future sampling and implementing the plans.
Board of Health, 6/26/2007, Page 5
1
2 Weimer asked if they pinpointed exactly where the 30 cancer cases were located.
3 Palcisko stated they didn't see any particular cancer cluster within the study area.
4
5 Nelson asked the time span for mesotheiioma to show up. Palcisko stated it takes a
6 long time to show up, such as 30 years.
7
8 McShane stated the slide reactivated in the 1940's. The amount of sediment
9 increased substantially in the last ten years. He's heard they dredged the creek as far back
10 as the 1960's, but the dredging frequency has gone up.
11
12 Nelson asked if it would start showing up now, if it was a factor. Palcisko stated
13 many mesothelioma cases were occupational, and the asbestos levels were much higher.
14 The only other location that was non - occupational is a location in Turkey where they've used
15 the natural asbestos in a whitewash on the homes. That was a different type of asbestos.
16
17 Brenner stated they could do a survey on an abnormal increase in lung- related
18 problems.
19
20 Greg Stern, Health Officer, stated asbestosis isn't reportable. A related condition is
21 pleural plaques. He would expect radiologists to point out any increased cases of that. That
22 would be another indirect measure to consider. Because he has not seen those conditions
23 or heard about those conditions occurring, he's reassured. If they do surveys, they need
24 control conditions, which would be very difficult to achieve. The sediment from Swift Creek
25 is sediment they've tested. There may be other sources of gravel and sand that hasn't been
26 tested for asbestos. If they don't know the source of the materials, they may attribute
27 asbestos to the creek. If they do selective testing, they must have comparisons to areas
28 that aren't related.
29
30 Brenner stated work back from what information they have. Identify the cases, and
31 then where the cases are located.
32
33 McShane asked if they are going to sample 13 homes in the area. Palcisko stated
34 that is correct.
35
36 McShane stated one area of concern is in places where fill had been used. He asked
37 the plan on that. Palcisko stated that is a more nebulous piece of the plan. They don't
38 know where the material has been used. If used off -site, they would be most concerned
39 about public, community sites. The agencies haven't agreed on how to approach situations
40 where the fill has been used in private driveways.
41
42 Crawford stated there are other potential sources of asbestos in home construction.
43 Palcisko stated asbestos in home construction is mostly bound to something, so it's not
44 crumbled and doesn't go into the air. This sediment is loose, and it may blow into the
45 house.
46
47 McShane stated they will struggle with how to dredge the stream. He was
48 disappointed that the EPA didn't evaluate the action of driving on this material. He asked if
49 there is a way to model the exposure to those who drive on the roads, if that dredging
50 continues and the material is used as fill in the roads. Palcisko stated he doesn't have that
51 answer.
52
Board of Health, 6/26/2007, Page 6
1 McShane stated people are concerned about downstream deposition. He asked if
2 people can evaluate the breakdown rate of finely- ground asbestos particles in a wet
3 environment. They do turn into clay. That's why the slide is there. Palcisko stated there
4 may be restoration work along the Sumas River, which has been halted due to the asbestos
5 concerns. The Department of Labor and Industries (L &I) may consult to provide information
6 about the levels of asbestos downstream and other information. The State Department of
7 Health is pursuing that consultation.
8
9 McShane stated County staff Paul Pittman is very experienced with the sources of
10 that area. The County has good mapping data. Mr. Pittman could provide more
11 information.
12
13 Weimer asked if the County staff is still meeting with the EPA.
14
15 Jeff Hegedus, Health Department, stated all the agencies continue to collaborate on
16 all the different issues. There is no real progress on the disposal of the sediment. The focus
17 now is on the offsite locations where the material may have been used and restoration
18 downstream.
19
20
21 ADJOURN
22
23 The meeting adjourned at 7:05 p.m.
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26
27 Jill Nixon, Minutes Transcription
28
29 The Council approved these minutes on July 24 , 2007.
30
31 ATTE��4��I��i, WHATCOM COUNTY COUNCIL
32 ���` ���V�''. WHATCOM COUNTY, WASHINGTON
33 .� .r D'� C
34
35 _
36
37 D a E& - i , ncil. lerk Carl Weimer, Council Chair
Board of Health, 6/26/2007, Page 7