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HomeMy WebLinkAboutBoard of Health October 4 20051 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 DISCLAIMER: This document contains the Whatcom County Council or Committee minutes, as approved. However, unless an attested signature page is attached, they are not the final approved minutes. WHATCOM COUNTY COUNCIL Joint Meeting of the Board of Health and Public Health Advisory Board October 4, 2005 Council Chair Laurie Caskey- Schreiber called the joint meeting to order at 5:30 p.m. in the Council Chambers, 311 Grand Avenue, Bellingham, Washington. WHATCOM COUNTY COUNCIL MEMBERS Present: Absent: Barbara Brenner None Dan McShane Sam Crawford Seth Fleetwood Sharon Roy L. Ward Nelson PUBLIC HEALTH ADVISORY BOARD MEMBERS Present: Andy Byrne Laurie Caskey- Schreiber David Davidson Lavern Lane - Oreiro Chris Phillips Mary Ellen Shields John Worlund 1. PUBLIC SESSION No one spoke. 2. 2006 HEALTH DEPARTMENT WORK PLAN Absent: Jenny Shuler Regina Delahunt, Health Department Director, stated she would discuss priorities for the Board of Health and Public Health Advisory Board for 2006. The work plan is structured in the format of the public health standards for Washington State. There are five key areas. She read the five key areas. In the past, public health work plans and work have been divided into health programs. Dividing the work into the five key areas makes the work more understandable. It's easier to see the big picture of what public health is all about. Recently, a State Department of Health audit was completed. It looked at a baseline of how local health departments can fulfill all the standards developed for Board of Health, 10/4/2005, Page 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 DISCLAIMER: This document contains the Whatcom County Council or Committee minutes, as approved. However, unless an attested signature page is attached, they are not the final approved minutes. Washington State. The State and the auditors were impressed with Whatcom County's work plan for meeting all the public health standards. It was designated as an exemplary practice in Washington State, and can be used as a model for other jurisdictions. The financial information in the Council's packet includes the department budget, expenses, revenues, and the current expense fund contribution. There is also information on non - personnel expenses and the percentages of the budget spent on each of the public health standards. The first standard is Understanding Health Issues. It is about doing assessments. Local health departments must understand the health issues in the community. The department must evaluate the issues by looking at data and making sure the policy decisions are based on the assessment the department has done. In the past, they've been lacking in this area, as most other public health jurisdictions have lacked in this area. This year, they were able to hire a health information specialist, which is the position to help do community assessment work. Also, in 2005 they updated four sections of the Health Status Report, which was last updated in 1996 or 1997. It should be updated at least every three years. The Centers for Disease Control and Prevention (CDC) fellow who worked with them enabled the department to do that work. In conjunction with the Coalition for Healthy Communities, they assisted with a project for tracking community health indicators. It's a large pilot project. Whatcom County is one of four communities in the nation that was selected for this project. She hopes to have it up and running next year. A lot of staff resources helped with data collection for that project. Last, they completed the 2002 behavioral risk factor survey. The last survey was done in 1997 or 1998. There are quite a few priority actions for 2006. In the past, they have not been strong in evaluating the programs to make sure they make a difference in the community. There are many good programs, but they don't have much evidence showing the programs are effective or the best programs the department can have. This year, with the new health information specialist, they will pick a few programs to set up indicators and evaluation measures. They also want to continue with the update of the Health Status Report, including the communicable disease section. Brenner asked who is included in the coalition. Delahunt stated there are many members. Board of Health, 10/4/2005, Page 2 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 DISCLAIMER: This document contains the Whatcom County Council or Committee minutes, as approved. However, unless an attested signature page is attached, they are not the final approved minutes. Phillips stated the primary sponsors include the hospital, Health Department, United Way, and the Whatcom Community Foundation. They have provided the financial support. Many other organizations are at the table. Delahunt stated the coalition includes school districts, physicians, and others. Caskey- Schreiber asked if there is a Council representative. Delahunt stated they don't. They would welcome one. Davidson stated physical activity program planning will be undertaken in 2006. In the same vein, they are looking to understand health issues. He asked if an evaluation of the status in the community can be done at the beginning of the program planning. Delahunt stated that is a good suggestion. Brenner asked if the County is involving people in the on -site sewage (OSS) operations and maintenance (O &M) business in the 2006 goal to plan and conduct evaluations of programs for OSS O &M. Delahunt stated they are. The Public Health Advisory Board has a subcommittee that meets and involves a variety of stakeholders in the planning process. Davidson stated the subcommittee has been challenging, especially with staying focused on what they are really trying to do. They are making progress. Staff will put together a suggested framework for an O &M program. The subcommittee has some ideas. Caskey- Schreiber stated Island County has a program that the subcommittee might want to look at. Delahunt stated that putting a program together is an enormous undertaking. There are many different interests at the table. Everyone wants to do everything. It's difficult for the committee to prioritize. Roy asked if there is representation on the subcommittee from the Shellfish Districts. Delahunt stated there is. Roy stated they should look at what they need to protect the resources they have, particularly water resources, and see what they need to do. After that, see how they will fund what they need. Don't adjust what they need to do based on what they think they can pay for. Figure out first what they need to accomplish. Don't let funding limit their thinking on what they need to do. Brenner stated there should be a yearly fee for operations and maintenance for anyone who has an on -site sewage. She asked if that fee could be attached to their taxes. Delahunt stated those are ideas that the subcommittee is discussing. They aren't limiting their perspective based on what they can pay for. Nelson stated the subcommittee is trying to think inside of a box, yet it must determine the proper response to septic systems. On -site septic systems don't contribute to all the degradation. Board of Health, 10/4/2005, Page 3 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 DISCLAIMER: This document contains the Whatcom County Council or Committee minutes, as approved. However, unless an attested signature page is attached, they are not the final approved minutes. McShane stated the idea is to get a good understanding of these issues. Delahunt stated the purpose is to take a look at developing measures to see if they're making a difference with the existing programs. Take a look at the outcome measures to see if the programs are making an impact. McShane asked if the program for children with special healthcare needs is an individual program. Delahunt stated it is one program that looks at many different needs the children have. McShane stated they will figure out a way to measure that. He suggests they have that information as a baseline before they embark on a new physical activity program. Delahunt stated they will have baseline outcome measures to see if the programs make a difference. Brenner stated it seems they have the data that shows who has OSS systems. They know the different types of soils and drainage in the county. People are in the business of O &M. It doesn't seem like a big jump to set up a fee schedule and an O &M schedule for everyone with an OSS system. Make it so that, by law, people must do O &M. The County can keep a copy of the contract to know that O &M is happening regularly. They need to make the determinations of what's working, but there are people who do that. Worland stated the issue is that they need a hammer. They really need a voluntary compliance program unless they are going to have a huge bureaucracy to check 30,000 tanks that have to be checked every year to three years. The issue is how to structure a program to get people to cooperate voluntarily and what to do with people who don't cooperate. Delahunt stated a lot of discussion by the subcommittee is enforcement. It's a huge prospect. Caskey- Schreiber stated Island County has very steep fines for people who do not keep up a septic tank system. People take it seriously. Crawford stated the goals for this program are sweeping. If they are going to emphasis things, include education, which is huge. People who have septic systems have lifestyle issues ingrained, but others don't. Some people wait until they have septic problems before doing any maintenance. There are a lot of educational things that would help a lot. The issue is discerning the problem users from those who do a good job of maintaining their systems. Delahunt stated the evaluation would be in relation to the educational programs they have in place. Caskey- Schreiber stated this is a high priority among councilmembers. Board of Health, 10/4/2005, Page 4 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 DISCLAIMER: This document contains the Whatcom County Council or Committee minutes, as approved. However, unless an attested signature page is attached, they are not the final approved minutes. Roy stated this is a really important topic to her. She's pleased to see the emphasis on it. Delahunt stated the subcommittee summary would get to the Board of Health in November. Delahunt stated the next standard is Protecting People from Disease. It encompasses the communicable disease programs and emergency response programs. They need to focus on disease surveillance. They do a good job at disease response. Upfront surveillance has suffered in the past, just because they don't have the capacity to focus on it. They would like to focus on it more. It's not listed as a priority action in the coming year, but it is something they want to focus on in the future. Now, they are focusing on emergency response plans. The major accomplishments include controlling the pertussis outbreak in 2004. Davidson stated there is a great opportunity now to look at the pertussis response that occurred last year. That could be a priority now. Delahunt stated that is another standard where they are not as strong as they should be. It's still a capacity issue. The communicable disease nurses are busy constantly trying to do control rather than surveillance. Shields stated a pertussis immunization is coming soon for adolescents. It's supposed to be available in this state sometime this year. Medicaid currently funds it. Dr. Greg Stern, Public Health Officer, stated there were multiple episodes of pertussis last year. The idea is to prevent infants from getting sick. They've done well at preventing that. The instances of pertussis is cyclical around the nation. Previously, pertussis vaccinations were available for kids under the age of seven. Now, there is a vaccination for adults and adolescents. Adolescents are the primary reservoir. There are vaccines available for different age groups. It is in the process of being approved by the federal government and Washington State. The State pays for all vaccines for kids under the age of 19, so it's a budget issue. There is a time delay between when the federal government approves the vaccine for use and the State approves it for funding. People can order the vaccine now. Roy asked if the upswing in pertussis has to do with the parents who do not vaccinate their children. Stern stated it does not. Vaccinations protect the individuals. It's only 80 to 85 percent effective and may reduce the severity of the disease. There is a huge reservoir of adults and adolescents who haven't been vaccinated. It won't impact its spread through society. Roy asked if they are seeing effects of parents who choose not to vaccinate their children. Stern stated it is an issue they're looking at. The State Board of Health is looking at the exemption policies from schools. Crawford asked if the nurse giving out fake flu shots was a Health Department issue and if there was any discussion about how they can keep that from happening. Delahunt stated it was not. It was a State Department of Health Board of Health, 10/4/2005, Page 5 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 DISCLAIMER: This document contains the Whatcom County Council or Committee minutes, as approved. However, unless an attested signature page is attached, they are not the final approved minutes. licensing issue. Internally, they have discussed what the Health Department can do, which is education to people who host flu shot clinics. They make sure the providers have checked the people they invite to clinics. Stern stated the department sent out information this week to clinic hosts. Delahunt stated there are two things to do in 2006 for the second standard. One is to test the plan for mass vaccination in case of an outbreak. Public health nurses will try to vaccinate 1,000 per day. Caskey- Schreiber asked if there is any word about the avian flu. Delahunt stated this topic is the second thing to do for the second standard. This year, they plan to finalize the plans for pandemic flu and SARS. There are draft plans for responding to those outbreaks. They have been involved in many meetings about the pandemic flu. Unfortunately, not a lot that can be done once the influenza hits. A vaccine can't be developed until they know the strain of influenza circulating in the community. It takes a vaccine six to nine months to be readily available. There are preparations they can do. Should avian influenza strike, a challenge will be maintaining community infrastructure. It's something the Department of Emergency Management must plan for. Education will be important. Nelson stated asked if there is enough money in budget for planning. Delahunt stated there is, but only recently because of new federal funding. Nelson asked where funds would come from if there was a pandemic response. Many pharmacies are stocking up. The private sector has already incurred an expense. He asked where the money from the public sector comes from. Delahunt stated if a pandemic flu hit, a state of emergency would be declared. Dollars would be accessible from the federal government CDC homeland security resources. (Clerk's Note: End of tape one, side A.) Nelson stated the County has reserve funds, which was originally set up for emergencies. He asked if they would be available. Dewey Desler, Deputy Administrator, stated they would be available. Nelson stated it's important to maintain a good reserve fund. Desler stated the Council recently adopted certain procedures that allow the administration to immediately respond financially, if needed. Brenner stated she's frustrated. The Health Boards nationwide should reprioritize so vaccines are developed more quickly. Make a strong statement to the federal government about this. Delahunt stated the country relies on private companies to supply vaccines. That is problematic. The companies are not going Board of Health, 10/4/2005, Page 6 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 DISCLAIMER: This document contains the Whatcom County Council or Committee minutes, as approved. However, unless an attested signature page is attached, they are not the final approved minutes. to stockpile and make a vaccine if they have to throw it away at the end of the year. If there is a national program, there could be a stockpile. Shields stated vaccine shortages aren't isolated to flu. There are also shortages of normal pediatric vaccines. That has never happened until the last few years. It's a serious federal problem that doesn't happen in other countries. One reason is only certain companies create certain vaccines. Sending a statement to the federal government is a good idea, but may not help. Nelson asked for more information on the mental health emergency preparedness plan. Delahunt stated that during a crisis or emergency, mental health is an issue for the survivors and first responders. They need to include that as a part of the emergency response plan. Make sure there are providers for mental health during an emergency. Delahunt stated Assuring a Healthy Environment is a third standard. OSS is a big part of it. Accomplishments includes a computer -based system for food worker training, which results in improved training and efficiency in customer service. Next year, the department can offer food worker training whenever anyone wants to walk in and take the food handler test. That will be a big improvement. Another accomplishment is that the Council amended Title 24 to include illegal drug manufacturing and storage regulations. The Kendall Clean Project is a notable project. They have worked with community partners, courts, and the Sheriff to curb illegal dumping. It is making a difference. Caskey- Schreiber stated she's noticed a difference in the Kendall community. Delahunt stated they will pick the top dozen offenders and work hard to get them taken care of. They will work through the court system now that they know how that works. There's a lot of cooperation, and the community appreciates it. In 2006, they will establish the OSS O &M system and coordinate with the Planning and Development Services Department on one -stop permitting system. Health Department staff is now stationed at the Planning Department offices a couple of days per week. It works well to improve communication and customer service. Crawford asked if the public can still get that service in town. Delahunt stated they can. The Planning Department and the Health Department are learning each others' processes. Davidson stated the environmentally related disease statistics on page six talk about disease instances. Some diseases such as giardiasis run a higher rate here. He asked if there is an action to change that trend. Delahunt stated there is. Board of Health, 10/4/2005, Page 7 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 DISCLAIMER: This document contains the Whatcom County Council or Committee minutes, as approved. However, unless an attested signature page is attached, they are not the final approved minutes. For the past couple of years, they have participated in a study with the University of Washington to get at the reason for the high rates of these enteric diseases. They're just finishing up that study. One or two other counties in the state also have these high rates. They're looking to see if there are common themes among these counties. McShane asked the status of the program for computer -based training for food workers. Delahunt stated they have the system, but the program is not implemented it yet due to space limitations. McShane asked about funding for the Kendall Clean Project enforcement for next year. Delahunt stated enforcement is funded with State dollars. They get some dollars that are meant to allow local health jurisdictions to expand capacity to do certain things. Caskey- Schreiber stated the Council approved the program. Delahunt stated another goal for this next year is to add an environmental health component to their childcare facility program. There are a lot of environmental health issues associated with childcare facilities. They will also do another study with the University of Washington related to childcare, in -home care, and how home nurses can intervene on some of those issues. More information will come forward later. Delahunt stated the next standard is Prevention and Health Promotion. They need to prevent chronic disease and promote healthy living. Existing programs include tobacco prevention and the Women, Infants, and Children (WIC) program. Now there is a new physical activity component. Brenner asked if there was supposed to be a mental health component in teenagers in schools. Delahunt stated that program is listed under a different standard of Helping People Get the Services They Need. Brenner stated substance abuse is in this standard, but not mental health. People can't have a substance abuse problem without a mental health issue. Mental health should be included. Delahunt stated accomplishments for this standard include the methamphetamine (meth) awareness campaign, oral health program, and physical activity program. Next year, priority actions include review of youth risk data related to substance abuse and secondhand smoke education for a smoke -free workplace. Initiative 901 is related to smoke -free workplaces. It adds to the existing statute. The current legislation talks about who is responsible for enforcing smoke -free workplaces. Initiative 901 will move responsibility from the fire marshal to local health departments. That could be significant. They will have to start thinking about implementing such an ordinance if the initiative passes. No money is available for enforcement. Board of Health, 10/4/2005, Page 8 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 DISCLAIMER: This document contains the Whatcom County Council or Committee minutes, as approved. However, unless an attested signature page is attached, they are not the final approved minutes. Brenner asked why the expenditures for this standard take a dip next year. Delahunt stated one reason could be that some of the physical activity dollars were available for only one year. They've applied for additional grant funding. Crawford asked if the Health Department is not directly engaged in meth prevention. Delahunt stated the Environmental Health Division is engaged in cleanup. Crawford asked if community presentations on the effect of meth continue in 2006. Delahunt stated it might, but not as much. Crawford stated a power point presentation he saw is striking. Get it to high school kids. Caskey- Schreiber stated they should also get to middle school kids. Roy stated scare tactics don't work with adolescents. Delahunt stated the last standard is Helping People Get the Services They Need. This is not to provide services to the community, but to make sure services are available to people who need them. This past year, they worked with Whatcom Alliance for Healthcare Access on several projects, including physician recruiting and retention, helping people who qualify for Medicaid, primary care access survey, and to get a new designation for a health professional service area, which brings more care to the rural areas. They will continue that in this funding year. Caskey- Schreiber asked if they have ever thought about doing methadone treatment in Whatcom County. There is an age group in the community that uses that drug. Get them treatment options. Getting treatment now is not viable. Delahunt stated there is an upcoming conference on opiate substitution that will happen in Whatcom County. That discussion is happening. Caskey- Schreiber stated she supports treatment here, especially because it's a university town. The use is very prevalent. Davidson stated the Health Department has done very well with the access issue. Keep at it. It makes a difference. He asked about coordinating a county housing effort. He asked how that comes home to the Health Department as opposed to other departments. Desler stated the Planning Department is regulatory. In this case, they want to integrate housing with low- income issues, organized through the Health Department. It ties together those substance abuse and mental health issues with housing. Board of Health, 10/4/2005, Page 9 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 DISCLAIMER: This document contains the Whatcom County Council or Committee minutes, as approved. However, unless an attested signature page is attached, they are not the final approved minutes. Delahunt stated homelessness and affordable housing is a key issue for a lot of the population served by the Health Department. The mental health, substance abuse, and low- income mother populations have housing issues. It's about affordable housing for the homeless. The program isn't about housing in terms of building houses. It is about the homeless and affordable housing. Desler stated Whatcom County doesn't currently have a community development operation like some cities have. In the future, there might be a more active effort by the administration on this issue. McShane stated that link to health is critical. He sees the situation getting more intense. Delahunt stated community stakeholders are working on a homeless housing plan. McShane stated people in that area do have mental health problems and physical problems. They must be served so others do not prey upon them. That is a separate issue regarding policing. Nelson stated this issue will be more prevalent because the State has withdrawn its resources to the local communities. He asked if the County chose not to engage in a lawsuit against the State for reducing its funding. Byrne stated the Regional Support Network (RSN) pursued a lawsuit for the loss of $10 million. Thurston County Superior Court ruled against the others. Nelson stated this is the direction of the future, which is unfortunate. Homelessness will become a critical issue in urban areas. The Health Department will be impacted. He's pleased they're doing additional work with housing. It's difficult to get some of these people into housing. The outreach program to get people into services is critical. Get people to services that are available and get people into treatment. Any type of program should be tied to treatment. 3. 2006 PUBLIC HEALTH ADVISORY BOARD WORK PLAN Regina Delahunt, Health Department Director, stated there is a list of topics that the Health Department would bring to the Public Health Advisory Board next year. She would like to get feedback from the advisory board and Board of Health about topics to look at next year. Davidson asked for Ms. Delahunt's top four topics from the list. Delahunt stated two would be on -site sewage operations and maintenance and an in -depth analysis of sexually transmitted disease (STD) rates and program capacity in Whatcom County. Board of Health, 10/4/2005, Page 10 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 DISCLAIMER: This document contains the Whatcom County Council or Committee minutes, as approved. However, unless an attested signature page is attached, they are not the final approved minutes. Davidson stated the STD rate locally is lower than the State rate. He asked why that is a priority. Delahunt stated the rate of incidences of some STD's have been increasing. Shields asked about the absence on the list of planning for pandemic. It needs to be on the top of the list. Include regular influenza, not just avian flu. The community is due for a pandemic. Include how they coordinate with other jurisdictions and outlying areas. Phillips stated there is a difference between having it as a priority for the department versus having it before the advisory board for discussion. He asked if the department has a work plan for it already. Delahunt stated the department is putting together the pandemic plan. Advisory board input would be valuable in terms of finding resources to implement the plan. Roy asked if physical activity program planning is something they are encouraged to do because there is a grant. Delahunt stated there is some grant funding. However, obesity and lack of physical exercise is a huge public health issue. Roy stated it's been an issue for the community her entire life. She's not hopeful that putting County resources toward it will change that reality. That is not a high priority for her because they won't get much benefit for the money spent. Dr. Greg Stern, Public Health Officer, stated physical activity and diet are seen as individual choices. One thing that impacts activity and nutrition is how they design society, such as there not being any safe places so kids can play and walk to school or if people are selling things that aren't nutritious. It's not that the Health Department will turn the problem around. The Health Department wants to be at the table with the coalition that will be part of the solution. Brenner stated she agrees with Councilmember Roy. The school buses get money for every kid they pick up. None of the kids are walking, even in areas that are safe. Stern stated type II diabetes is starting to show up in kids. It's a health impact that is a big problem. McShane stated they got here because society was ignorant of what it was doing to itself back in the 1950's and 1960's. He's frustrated that society is set up this way. It's because no one was at the table to discuss it. Think about the fact that the high schools in Bellingham have gigantic parking lots. Schools are set up so kids are bused because of other issues besides distance to the school. Development planning must include parks. Caskey- Schreiber stated the point is how much time they can put into this and come up with solutions they can implement. They definitely have to work on it. Board of Health, 10/4/2005, Page 11 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 DISCLAIMER: This document contains the Whatcom County Council or Committee minutes, as approved. However, unless an attested signature page is attached, they are not the final approved minutes. Delahunt stated they want to be a partner to this huge issue, but they aren't going to change Whatcom County overnight. Shields asked if school food is part of the discussion. It's disgusting. Delahunt stated it is not for the physical activity coalition, but it is an issue. McShane stated they don't have the solutions. The advisory board can identify the roles the Health Department can play to facilitate solutions. Delahunt stated she agreed. That's the discussion the department needs from the advisory board. Phillips stated that when the issues come to the advisory board, staff has prepared questions and issues to talk about. It sounds like this should be part of that discussion. (Clerk's Note: End of tape one, side B.) Delahunt stated part of that discussion could be the Environmental Health Division's role in the planning process for communities. The physical built environment has a huge impact on public health. That would be a topic for discussion. Shields stated it is a financial issue. Schools depend on Coke machines to fund the athletic departments, for instance. Be at the table to discuss things like how athletic programs are funded. Look at community planning more globally. ADJOURN The meeting adjourned at 7:05 p.m. Jill Nixon, Minutes Transcription The Council approved these minutes on October 25 , 2005. ATTEST: Dana Brown - Davis, Council Clerk WHATCOM COUNTY COUNCIL WHATCOM COUNTY, WASHINGTON Laurie Caskey- Schreiber, Council Chair Board of Health, 10/4/2005, Page 12