HomeMy WebLinkAboutBoard of Health September 19 20001
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WHATCOM COUNTY COUNCIL
Board of Health
September 19, 2000
The meeting was called to order at 12:30 p.m. by Council Chair Marlene
Dawson in the Council Committee Room, 311 Grand Avenue, Bellingham,
Washington.
Also Present: Absent:
Sam Crawford Robert Imhof
Barbara Brenner
L. Ward Nelson
Dan McShane
Connie Hoag
1. INTRODUCTIONS
Chuck Benjamin, Health and Human Services Director, stated Kay Guirl,
the Community Health and Wellness Manager, has retired. They are still
recruiting for that position. Representing the Community Health and Wellness
division would be Carol Allen, Kelly Molaski, and Sylvia Fragner. Regina
Delahunt from the Environmental Health division is also present.
Today he would bring forward the three -year plan. It is not a budget.
They are looking at the three -year plan, the multi -year goals, the three -year
objectives, and the annual activities. They also had the indicators, and changed
the format of the Community Health and Wellness portion of the plan. In
reviewing the new format at the Public Health Advisory Board level, the board
members felt uncomfortable with the new format not answering certain
questions. At the advisory board level, they tie the approval of the three -year
plan to the budget recommendation for approval. The board members had
trouble justifying the budget allocation based on the format. Also at that time,
they didn't have indicators. The revised packet added the new indicators. They
will also review the new format with the Board of Health.
2. PUBLIC SESSION
No one spoke.
3. THREE -YEAR PLAN REVIEW
Nelson stated the state has a plan they produced seven years ago. It
requires communities to plan their health care. This plan looks at all areas of
public health to determine the things the County wants in the community. Some
Board of Health, 9/19/2000, Page 1
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of the indicators will be for just the community and not the state or national
level.
Benjamin stated it also outlines the staffing resources for each program
area and the costs associated with each.
Administration
Benjamin stated that this entire section is brand new. It is a living
document they continually try to improve. In the year 2001, they need to look
at the development of policies, assess and ensure adequate staffing resources,
provide support for staff, and look at a strategic planning process to coincide
with the County strategic planning process. There are eleven full -time
equivalent (FTE) employees in administration. The fiscal office is responsible for
contract monitoring, claims, billing, and client tracking, and front reception.
The total cost for administration is about $1.3 million. There is $409,000
in revenue. The $409,000 is the money Olympia created to offset the impacts of
I -695. It would have been higher in 2001, but they made advance payments to
the counties in the year 2000.
Brenner asked if there are documents showing why I -695 cut the Health
Department's funding. Benjamin stated it did away with the motor vehicle
excise tax, a portion of which went to public health.
Brenner asked if that tax was to be for road related issues. It is up to the
legislature to replace it, not the county. Benjamin stated the public health
budget has been restored at 90 percent.
Benjamin continued to state that related to administration are the
administrative programs. This includes the community health assessment
coordinator, public health educator, the birth and death records, the Commission
Against Domestic Violence and the community health partnership. There are 3.5
FTE's for this area. The plan shows the cost of administration. They also
distribute the administrative cost proportionally across the programs, which
shows a truer estimate of the costs of the programs.
Brenner questioned whether this plan is what they have now. Benjamin
stated this is the proposal for 2001. The main purpose of the meeting is to look
at the goals, objectives, and activities. The budget amounts are included to give
the Council a full picture.
Environmental Health
Board of Health, 9/19/2000, Page 2
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Benjamin stated that this is the drinking water program. There are 2.95
FTE's. The total cost of the program is $202,022. There have been some
activities that were removed and others that were added.
Food Program
Benjamin stated they have 4.49 FTE's. The total cost of the program is
$322,000. They require permit fees for everything. They also charge for food
testing and a food handler's card. The revenue is $259,000.
Crawford questioned why the County's numbers are bad compared to the
state's actual and the U.S. goals regarding salmonella, a -coli, and
campylobacter.
Regina Delahunt, Environmental Health Services Manager, stated the
County's numbers have historically been high. It is related to the fact they are
an agricultural community. There are many animals and dairies. There are
similar rates in other agricultural communities.
Crawford questioned whether the state averages reflect a more urban
population. Delahunt stated that was correct. Numbers for e -coli in the
agricultural areas of Canada are similar.
Crawford asked about the rates for other rural Washington counties.
Delahunt stated she didn't recall the rates. In general, agricultural counties
have similarly high rates. Education is very important.
Brenner stated she understood that part of this is because they are in an
agricultural county. She questioned whether Whatcom County also had a higher
than normal rate of other problems compared to other counties.
Nelson stated other counties have major problems.
Delahunt stated there are outbreaks in other areas. In general, Whatcom
County rates are higher.
Crawford questioned health inspections for restaurants. Delahunt stated
they issue certificates annually. They do at least an annual inspection. An
inspection sheet covers certain items, such as sanitary conditions. Based upon
the score, the restaurant either passes the inspection or is required to take
remedial action.
Nelson stated major change in this food program was regarding the
training of food workers. He questioned whether that has an impact on the
budget or program needs. Delahunt stated they would try to accomplish the
state's directives with the resources that they have. Washington Administrative
Code (WAC) 246 -217 was revised. They are required to issue food handler
Board of Health, 9/19/2000, Page 3
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cards to all people working in establishments. In the past, the applicants study
a manual and take an exam. The state now requires interactive training. They
will use videos and group training sessions. It would be less convenient for the
people. They will also work with the community to transition that responsibility
out to the colleges, for example. The one issue is that the state sets in law the
amount of money that can be charged for the food worker card, which means
that it would be difficult to find someone in the community who may be
interested.
Benjamin stated that if they can find a community partner, there will be
the additional cost to food handlers who try to get the card.
Crawford stated some places don't look very clean. He questioned
whether it matters that the certificates are from another county. Delahunt
stated it doesn't matter. The standards are the same. Looks don't matter in a
restaurant.
Brenner stated the permit doesn't mean that everyone is doing it right all
the time. She questioned whether they are getting new rules for food handlers.
Delahunt stated the new rules require training.
Brenner asked if that has to be retroactive. Delahunt stated it takes place
when the handler renews the permit.
Brenner asked if the Vocational - Technical school would be the best place.
Delahunt stated they've approached the Vo -Tech.
Hoag asked about campylobacter. Delahunt explained that it is an enteric
bacterium specific to agricultural animals.
Hoag questioned where it typically shows up. Delahunt stated that in
many instances, they've associated it with handling animals and livestock.
Nelson stated it also shows up in milk products.
Benjamin stated it is reportable.
Crawford questioned whether they are saying that the amount of
problems from restaurants is comparable to other areas, and Whatcom County's
increase is from people around livestock that have also reported cases.
Delahunt stated that is correct. They are not saying the rates are higher
because of restaurants. Within the food program, they also investigate all
enteric diseases, whether or not it is associated with a food service. They try to
determine the source of the problems.
Hoag asked how serious Campylobacter is. Delahunt stated not as bad as
e -coli, but requires physician care. It is a reportable disease that is not
generally life- threatening.
Board of Health, 9/19/2000, Page 4
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Brenner stated they are not just from restaurants and agricultural
practices. There are many things in Whatcom County that can cause in increase
in infectious diseases.
Delahunt stated the County does a good job of reporting diseases. Some
other counties don't have a very good reporting system. Another reason the
rates may seem higher is because they actually receive the reports.
Brenner stated she wanted a list of all reportable diseases. Benjamin
stated they are called notifiable conditions. He would provide that information.
They were talking about the state's efforts to amend the notifiable condition list.
The Living Environment Program
Benjamin stated there are .85 FTE's. There is a total cost of $64,000.
Dawson questioned the risk factors for drowning. Delahunt stated there is
risk if there are no lifeguards, there is drinking, and if people are boating without
life jackets. They look at causes of drowning incidents.
McShane stated there is a drowning season, which is generally in May
when there is hot weather, but cold water, which causes muscle spasms and
other problems. Delahunt stated they do education on the risk factors.
Brenner stated she wasn't sure of the additions to the programs for next
year and what they are doing currently. There isn't anything to compare this
plan with last year's plan.
Nelson stated the total overall budget is less than last year.
Benjamin stated the three year plan requests no additional staff. In the
budget process is the additional services requests. This plan is the current
staffing levels with 2001 costs. They may have the same level of staffing, but
different costs. The budget process is going to seek additional service requests
for things not in this plan.
Crawford referenced page 12, objective four. He questioned whether they
are doing any monitoring of dog bites. Susan Donato and Greg Rustand would
like to propose changes to strengthen the animal control ordinance. Dog and
animal bites are in the hundreds per year. He questioned whether the Health
Department had looked at the problem. Delahunt stated they have an interlocal
agreement with animal control. The animal control agency responds to dog bite
calls and do the quarantine on the animals. They fill out the Health Department
report. The Health Department works in conjunction with them.
Benjamin stated the Health Department's involvement is human exposure
for the potential of rabies. They don't get involved in all bites.
Board of Health, 9/19/2000, Page 5
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Delahunt stated that if a dog has bitten, it needs to go into quarantine.
That is the arrangement.
Brenner questioned whether a dog has to go into quarantine if it's
updated shots are documented. Delahunt stated it does. The dog has to be
quarantined for ten days, but it can be done in the owner's yard.
Crawford stated he wanted to get the Health Department's opinion on
what is happening. Delahunt stated it is also related to injury prevention.
Onsite Sewage Program.
Benjamin stated the total FTE's are 5.35. The total cost is $468,000.
Hoag referenced the activity of objective one. She questioned if it applies
to new construction only, or also to existing construction. Delahunt stated they
don't do it in existing construction unless they suspect the system is failing. All
construction is intended for newly constructed systems. They do permit repairs.
They can clarify that language.
Hoag referenced activity two of objective one. She questioned whether
they can do that with existing staff. It seems pricey. Delahunt stated it
depends on the size of the survey area. They choose one area per year that
they feel has a higher than normal failure rate.
Nelson asked if the City of Bellingham pays the Health Department for
inspections. Delahunt stated they do in the Lake Whatcom watershed. They still
have an interlocal agreement with the City of Bellingham.
Hoag referenced objective two. The three activities regarding tracking
maintenance are unclear. She questioned how involved are they getting.
Delahunt stated they are only tracking the pumpers who send pumping records
to the Health Department. The record is entered into a database. Reminders
can be sent out if a system hasn't been pumped.
Hoag referenced activity two, objective two. She asked for clarification
and if they are getting too involved. Delahunt stated it is the operation and
maintenance that the Board of Health already approved.
Brenner asked if the Board of Health approved something that requires
people to do more frequent inspections. Delahunt stated they did. They haven't
implemented the privatized system of inspections, which is certifying operation
and maintenance specialists.
Brenner referenced objective one, activity two. She was concerned with
the wording. They need to be careful because of the Growth Management Act.
They can extend sewer systems when there is a health need only. They need to
Board of Health, 9/19/2000, Page 6
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add language specifying that, such as "...extensions where health issues are
discovered." They generally are supposed to stick to only doing extensions for
discovered health reasons. When the plan references the survey, she asked if
they are talking about new permits or already- existing systems. Delahunt
stated they are talking about already existing systems. It is a lot of work. In
certain areas, they know from experience that the soils are not good and the
failure rate is higher than it should be.
Hoag suggested language change, "...per year in aR one area..."
Nelson stated he didn't want that change. When they looked at the on-
site sewage ordinance, they looked at encouraging the pumpers to do the
notification. He hasn't seen that occurring. He asked if that was being
encouraged. Delahunt stated the Health Department sends out notices.
Nelson stated they talked about the pumpers sending out notices to
remind people to pump their systems. Delahunt stated that is a good idea. She
would look into it.
Brenner stated it would be cheaper for the County to send out the notices.
Solid waste program.
Benjamin stated there are 2.76 FTE's. The total program cost is
$226,000.
Brenner stated they received a report about the Y Road landfill. The
report stated it was benign, which surprised her. People felt that the scope of
work and methods were not done correctly to find what they needed to find.
Nelson stated the samples were taken from wells.
Brenner stated a concern was about where the wells were that were
tested compared to wells that should have been tested. Delahunt stated the
Public Works Department has asked the Health Department to take a look at
Susan Cook's comments. Senior Civil Deputy Prosecutor Dan Gibson, state
Department of Health, and state Department of Ecology also provided
comments. Also, there was a scope of work for phase two. A quick look at the
wells was initially done. The County is planning to do more in -depth study in
phase two.
Brenner stated she was left with the idea that things were okay from
phase one.
Nelson stated Delahunt made it clear that it was only an initial
assessment.
Board of Health, 9/19/2000, Page 7
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Brenner stated a person living in the area would be left with the
impression that the County didn't see a problem right away. She was concerned
that people are feeling okay about the water in that area.
Dawson stated they are going to do more studies.
Brenner asked McShane about what he thought about the scope of work.
Delahunt stated the first look at the area showed that it was okay.
McShane stated the scope of the first look was fine. It provided assurance
that there wasn't an absolute disaster. The results didn't surprise him. Focusing
in to make sure there isn't something there is warranted. He didn't see any
problem with the initial report. It was good news. It was the first question that
needed to be answered. There will be more work.
Nelson stated one could always challenge a study.
Delahunt stated the first phase was to answer the question of whether
there was a disaster for the wells and the creek. The initial look was good, but
they need to do more work.
Hoag encouraged another look. There have been fish kills in the area.
(Clerk's Note: End of tape one, side A.)
Brenner asked about the bio- medical and solid waste programs. She
wanted an activity to have an interactive program with solid waste facility works
and transporter workers. Many workers don't even know the Health Department
inspectors. The County should have a personal communication with the
workers. The workers could fill out anonymous surveys and communicate with
the Health Department to give them an understanding of their rights.
Dawson stated she was not sure that is the County's role.
Brenner stated it is the County's role, under its inspections. The County
could make contact with those workers. Benjamin stated the inspections are
unannounced. Qualified staff goes in to do the inspections. During the process
of the inspection, the inspectors do talk to the workers and ask them if they
receive bloodborne pathogen training.
Brenner stated she asked someone at the Health Department if the
inspectors talk to the workers, and she was told the inspectors don't talk to the
workers. Benjamin stated the inspectors do talk to the workers.
McShane stated there had been a contract to reduce the amount of
groundwater infiltration in the Cedarville landfill. He questioned whether there
was any room in participating with the Solid Waste Division in dealing with that.
Board of Health, 9/19/2000, Page 8
I Delahunt stated she didn't know the end of the story. She knew that the Pulbic
2 Works Department looked at reducing the leachate, but she didn't know of the
3 decision made by the Public Works Department. It was probably based on
4 economics. It is a question more for the Public Works Department.
5
6 Site Hazard Assessment.
7
8 Benjamin stated that there are 1.3 FTE's. The total program cost is
9 $98,000.
10
11 Nelson questioned whether the County Health Department would respond
12 to proposed pipeline in the watershed. The County has limited funding for
13 hazardous response in the watershed. This would create an increased potential
14 for a problem. Delahunt stated they could submit comments.
15
16 Hoag stated this talks about handling toxics and pesticides. She asked
17 about air problems. There is no mention of airborne toxins. Delahunt stated
18 that historically they have not been involved in air quality.
19
20 Hoag stated there are areas people are being subjected to toxins.
21 Looking at air quality is something the Board of Health wanted to address.
22 Benjamin stated they did discuss that. He recalled that they would have a
23 community physician discuss the incidents of cardio - pulmonary disease in
24 Whatcom County.
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26 Hoag stated they talked about asthma rates. There is more to it than
27 asthma. At industrial sites, there are pollutants that get into the food chain.
28 There is a total absence of that problem in the plan. It would be appropriate to
29 add that objective here. They need to look at the level of exposure of toxins in
30 the air. Delahunt stated it is a big project. They don't have the resources to do
31 that.
32
33 Hoag stated it is not that big to do. The Northwest Air Pollution Authority
34 ( NWAPA) has the output of all the major sources. It should be the County
35 Health Department's role to look at the impact of air pollution on the population.
36 They could take a look at some of the statistics about what the rates are in the
37 county and what they expect to see. Otherwise, the County is burying its head
38 in the sand.
39
40 Brenner stated that NWAPA does certain things, but the County can do
41 more. She would like to see the Health Department involved. She received a
42 call from a Canadian company to do seismic testing in Birch Bay to test for
43 natural gas. She asked if the County or NWAPA would respond natural gas
44 releases during testing. Delahunt stated that if there was an emergency related
45 to exposure, the Health Department would work with the Emergency
46 Management Division and the state Department of Health (DOH) to provide
47 information to the community about that particular release. What
48 Councilmember Hoag was describing more would be more of an epidemiology
Board of Health, 9/19/2000, Page 9
I study that the County doesn't have the resources for. The state DOH has limited
2 resources for issues such as that. Even though the data is available, there are
3 many confounding factors when relating the small amount of toxics that are
4 released to particular health outcomes.
5
6 Brenner asked if the county has nothing to do with these guys doing
7 seismic testing. Delahunt stated she couldn't imagine that there would be
s anything they need regulatory involvement with regarding seismic testing.
9
10 Nelson stated there was drilling going on in the County several years ago.
11 The Health Department wasn't involved. Delahunt stated it is possible they
12 would need a permit from NWAPA.
13
14 Nelson stated that property owners retain mineral rights. He questioned
15 whether that is considered a mineral right.
16
17 McShane stated many property owners have not retained their mineral
18 rights.
19
20 Nelson stated that is where the problem is.
21
22 Dawson stated the air quality is a valid concern. She wanted to see if any
23 other counties in the state address air quality. Delahunt stated that at the local
24 health level, no other counties have air toxics programs.
25
26 Nelson questioned whether they do epidemiological studies. Delahunt
27 stated they don't in general. King County may have an epidemiologist on staff.
28 She didn't know that they do a study in relation to air toxics. An epidemiologist
29 works more with diseases.
30
31 Nelson stated he was worried about the rise of bronchial asthmas. Some
32 of it is related to the homes they are building now.
33
34 McShane stated that if they want to take this seriously, they would need
35 to raise taxes or get a huge grant. He asked if the $72,000 grant is new.
36 Delahunt stated it is in the second year.
37
38 McShane asked if they had a list of sites for ranking. Delahunt stated
39 they do. The Department of Ecology provides funding for the Health
40 Department.
41
42 McShane stated the Department of Ecology's idea is to have a little more
43 local input than they've had in the past, which had been no local input.
44 Delahunt stated that is right.
45
46 McShane stated there have been discussions regarding ranking that the
47 County would do on follow up work on any sites that get the top ranking. He
48 questioned whether the Department of Ecology is going to focus on the top
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ranked site, or if the County would push DOE to look at that site. Delahunt
stated that if anything ranked number one it would require the Health
Department to pursue the Department of Ecology.
McShane gave credit to the Health Department for getting the grant. It
will be beneficial. In some areas, sites are ranked higher than they should be.
Delahunt stated there are also sites on the list that shouldn't be on the list. This
would help them to get off the list. A few of the sites the County has require no
further action.
Hoag stated her constituents told her to watch out for the fine print
regarding the drilling, and the companies coming forward had main goals to
obtain rights -of ways for pipelines and high power lines. It sounds like a
moneymaking opportunity when all they obtain is an easement. She suggested
that people take a close look at the contracts.
Regarding NWAPA, she is on their board. NWAPA only regulates. They
don't look at the health impacts of what is occurring. They just check to see if
something meets the standards. Regarding toxins, the standards are not health
based. The standards are technology based. In terms of protecting the local
population, it falls on the Health Department. A good first step would be to add
an objective to look at the major air sources and compare hospital rates with
other areas that don't have those sources. That was done in Canada. B.C. Lung
looked at whether hospitalization rates and air pollution rates coincide. It is not
a difficult thing to do. They could also use the Washington Toxics Coalition,
which is nonprofit. They could get information from NWAPA about the regulated
toxins in the county. The public has the impression that someone is looking at
this. No one is. It falls on the County because it is supposed to look after the
health and safety of the community. If the County knows something is a
problem, it needs to check it out.
Dawson questioned the cumulative effect of industries. Delahunt stated
health is a factor in many of the standards, but there are some standards that
are based on technology.
Hoag stated there is a difference between criteria pollutants and toxic
pollutants. Criteria pollutants such as carbon monoxide and sulfer dioxide are
supposed to be health based. The toxins, such as ammonia, mercury, and lead,
are strictly technology based. The standard is the best as currently accepted in
the industry right now.
it.
Dawson suggested that the Public Health Advisory Board (PHAB) address
Nelson questioned what they would base the study on.
Board of Health, 9/19/2000, Page 11
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Brenner suggested they look at available data, beyond hospital
admissions. They did it on a national level. They can do it on a local level. The
Health Department should just gather the information that is there.
Hoag stated they need to compare the data with other areas to know if
the county has a higher rate of incidents.
Benjamin stated that to do a thorough job, this is not a small project.
Brenner questioned whether they could do a cursory look, like they did at
the Y Road landfill. Benjamin stated they could not.
Nelson stated it wouldn't be good data.
Delahunt stated that to be meaningful, it is very difficult to do. They can
consult with the state Department of Health and get a little information from
them.
Benjamin stated they would discuss it with the PHAB and come back with
a proposal, which would have a price tag.
McShane stated he would be interested, but they need to recognize it is a
big project. They would have to add staff.
Nelson stated that, regarding air quality, he would be interested in talking
with pulmonary doctors in town to hear about what they see. Set up a survey.
Brenner stated they talked about having a presentation on that with PHAB
member Mary Ellen Shields. Benjamin stated it was scheduled for the October
meeting, which they may not have. They would try to get it in this year.
Hoag stated that is just the asthma thing. Her doctor told her there has
been a run of thyroid cases that is unusually high, and he contacted the County
Health Officer.
Nelson stated they don't want to scare the public when it comes to health
concerns.
Benjamin stated Dr. Stern might have done some analysis on thyroid
cases with the state.
Hoag stated Dr. Stern said it is not a reportable disease and they weren't
able to track it.
Nelson stated they have more cancer cases because they know more
about cancer.
Board of Health, 9/19/2000, Page 12
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Brenner stated that is probably part of it, but they have more cancer from
environmental pollution.
Nelson stated all of this is expensive and time - consuming.
Community Health and Wellness
Benjamin stated the Community, Health, and Wellness administration has
1.2 FTE's. The total cost is $126,000.
Hoag referenced page 22 regarding item four, staff training on health
lifestyles. The workshop with the advisory board was focused on a decrease in
youth smoking. She asked if that is part of the health promotion and behavior
change training. Benjamin stated it might be a small component. The primary
area for youth smoking is in human services. They are not going to see a
human services section for the 2001 three -year plan because of the change in
staff. They just received official notification from state DOH that they are
receiving tobacco funds based on the plan submitted. He credited staff and Dr.
Chris Covert - Bowlds. The community plan was submitted. The Boys and Girls
Clubs would also receive settlement dollars.
Dawson stated she was concerned about mental and emotional health
combined with healthy lifestyle. She asked about mentioning parent regulation
of movies and videos.
Hoag stated the American Medical Association (AMA) and Pediatric
Association said movies and videos have a negative effect on the psychology of
youth. It is appropriate.
Dawson stated former sheriff deputy Dave Waring said that the videos the
kids see have an effect. If they are so realistic that they are doing this, then he
expressed a real concern.
Brenner stated the emphasis needs to be on mental health programs
rather than this type of Band -Aid measure. It relates to family dynamics. It
should be handled through the mental health community. She asked about
number three and suggested "Develop a community response to prevent
smoking, alcohol, and dangerous drug abuse during pregnancy." There is no
safe level of alcohol use during pregnancy.
Benjamin stated they are still working with the new format. In this
report, if they listed every activity the document would be huge. They do
address more than smoking.
Carol Allen, Community Health and Wellness Supervisor, stated the plan is
a broad overview of their activity. As they get to the more specific program
areas, that will be addressed.
Board of Health, 9/19/2000, Page 13
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Brenner stated she wanted to see it be a Fiscal Year 2001 outcome.
Hoag stated they need to do more than screening. They need to do
education.
Brenner stated the three, smoking, drinking, and drug -use, should go
together everywhere in the document.
Nelson stated the Health Department has many programs and hand out
many brochures.
Allen stated they could add those words. There is already a community
response.
Maternal and Infant Program.
Benjamin stated there are 5.25 FTE's and a total program cost of
$382,000.
Hoag referenced page 26 regarding the number of low birth weight
infants. Allen stated that number is the actual number, not the percentage.
Hoag asked how the County compares them.
Sylvia Fragner, Community Health and Wellness Supervisor, stated the
County doesn't have a problem with low -birth weight infants. It is not a
particular area of concern. Other peer counties have more instances. The
implementation of the First Steps program dropped the rate significantly.
Brenner asked the number of total births in the county. Fragner stated
there were around 1,900 births in 1998. They've gone up to a little over 2,000.
It is less than five percent.
Crawford asked about the First Steps interview. Fragner explained that a
person is interviewed by a state Department of Social and Health Services
(DSHS) worker to determine if he or she is available for the low- income First
Steps medical program.
Crawford asked about the teen birth rate. Fragner stated the County
doesn't have a significant problem compared to the state and other counties.
Hoag stated a lot of people she knows have premature births in high -
nitrate water areas. There is no study. Fragner stated she had access to all
birth certificates four years ago, before they became electronic. She looked at
two years' worth of birth certificate data. She didn't find a correlation to a
particular area in the county.
Board of Health, 9/19/2000, Page 14
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Brenner referenced the amount of unplanned pregnancies in the First
Steps program. It should be 100 percent. People should not be planning
pregnancies that require public assistance.
Dawson stated they should discourage people who cannot support
children from planning pregnancies.
Crawford asked for clarification on what that number implies. A successful
outreach program for education would help people understand that if they are
going to need a significant amount of assistance, it may not be the best time to
have children. Fragner stated they put effort into helping women make good
decisions in the future. The women come to the Health Department already
pregnant.
Crawford stated that percentage going up wouldn't be a terrible thing.
Hoag asked what the County is telling people in terms of their pregnancy
options. Fragner stated she asks the woman if she is intending to parent. If the
person isn't sure, the County can talk to them about adoption.
Hoag asked if they offer life choices, not just abortion as a choice.
Fragner stated they do.
Child Health
Benjamin stated there are 7.6 FTE's. The total program cost is $517,000.
Hoag stated that on page 31, the item to promote healthy lifestyles is
very important. There is nothing on the effect of adult behavior on children,
particularly smoking. They should have a third bullet point.
(Clerk's Note: End of tape one, side B.)
Hoag stated the third bullet point should talk about what parents do and
the effect they have on their children's' health.
Dawson questioned whether that is something they do already. Fragner
said they do that continually. Smoking and alcohol are always addressed.
Nelson stated he didn't disagree. Health care is about many issues.
However, if they start down that path, they are legislating the legal things adults
can do. That is the practicality.
Hoag stated they are not legislating. This is promoting healthy lifestyles.
Brenner stated she didn't want to see the item added. She assumed that
was covered. Part of promoting healthy behavior in a child includes the adult's
behavior.
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Benjamin stated they could change the language in Essential Services 3,
Promote Healthy Lifestyle Item 2, to something like, "Help parents to promote
healthy behaviors in their children and themselves."
Dawson stated they need to include the connection between their
behavior and their children's behavior. Benjamin stated that statement includes
that connection.
Crawford suggested adding "by example."
Hoag stated that doesn't address her concern. It fits on preventing
smoking, but it doesn't connect smoking to the cause of a child's asthma.
Benjamin stated the Health Department would go there.
Sexually Transmitted Disease.
Benjamin stated that there are 3.7 FTE's. The total program cost is
$289,000.
Brenner asked about the results of changing the duties from public health
care to private health care. Benjamin stated it hasn't happened yet. They are
scheduling some upcoming meetings with the other providers to make sure they
have built their capacities up to take up the first of the year. At this point next
year, they will only have preliminary data. It takes longer than a year to see
how it is going. The three -year plan reflects the transition of the adult sexually
transmitted disease (STD) clinical services. They are still doing the teen clinic.
Hoag referenced the top of page 36. She hoped a right includes
abstinence. Benjamin stated that is correct.
Crawford asked if there are resources if a church wanted to have a sexual
abstinence course for teens. Benjamin stated there is not now.
Hoag stated Bethany Christian Services has a program.
Crawford asked how they are funded.
Hoag stated they are funded by donation. Teen pregnancy and STD rates
go down in schools where there has been abstinence training.
Brenner stated she wanted to see data on that claim.
Nelson stated abstinence training begins in the home.
Bloodborne Infections
Board of Health, 9/19/2000, Page 16
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Benjamin stated there are 3.8 FTE's. The total program cost is $306,000.
They have the needle exchange program in this area. In 2001, they will have a
progress report on that program.
Brenner asked for comments on an article she sent to Mr. Benjamin.
Benjamin stated the article was very factual. The Whatcom County Health
Department took all of those precautions listed in the article in the development
of their plan. The program includes a referral to drug treatment.
Nelson stated three people have gone into treatment due to the exchange
program.
Benjamin stated the article said that all exchange programs are not
comprehensive. The County's is comprehensive.
Dawson stated it is not just for drug users. She asked if the Health
Department asks what the needle is used for. Benjamin stated they exchange
needle for needle. They don't ask what the needle is for.
Hoag asked how they are doing on the numbers for Hepatitis C. Allen
stated Hepatitis C is a disease that has not been a reportable disease in the past
in Washington. It is now. It is problematic for identifying new cases compared
to old infections. They would get a partial picture once reporting starts. It will
take a while to figure out incidents and prevalence. Hepatitis C is a big problem
in Whatcom County. It became reportable September 1.
McShane thanked the Health Department for the document. It took a lot
of work, and it was very educational. He wouldn't mind having feedback on
whether the County is doing enough and if it needs to expand some of the
programs.
(McShane left the meeting at 2:17 p.m.)
Public Health Nutrition.
Benjamin stated that there are 9.2 FTE's. The total program cost is
$553,000.
Nelson asked about the revenue. Benjamin stated there is a $228,000
from grants and $45,600 for nutritional childcare.
Brenner stated this is related to what they just authorized at the last
meeting about the dental program. Benjamin stated that was a different
program. It is not nutrition. It is a part of the Child Health program.
Dawson asked about Women, Infant, and Children (WIC) services.
Benjamin stated a caseload of 2,100 is the number of clients they can serve.
Board of Health, 9/19/2000, Page 17
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Dawson stated people shouldn't be having children that need these
services.
Brenner stated there are problems in the economy. This is one of the
best programs she's ever seen. These are not welfare moms. These are people
who are below a certain level in income. Some of these people work full -time.
Nelson stated WIC provides proper nutrition for babies. This program
educates mothers on proper health care nutritional needs. If a child has proper
nutrition in the first two years, the future health care needs are greatly reduced.
The program prevents community health care costs in the future. They looked
at contracting this service out in the past.
Crawford asked how many women and children are served per year.
Kelly Molaski, Community Health and Wellness Supervisor, stated they
serve 2,100 per year.
Special Projects
Benjamin stated there are .2 FTE's. The total program cost is $16,000, all
offset with grant dollars.
Molaski stated it is a grant to provide nutritional education to food stamp
recipients. They chose to do the program at the food bank.
Nelson asked if those at the food bank use food stamps. Molaski stated
not all people at the food bank use food stamps. Less than 50 percent of the
people at the food bank and who attend the classes use food stamps.
Nelson asked if they are getting to the intended recipients. Molaski stated
they are eligible for them. They have not followed through and made application
for the food stamps.
Immunization Programs.
Benjamin stated there are 3.55 FTE's. The total program cost is
$262,000.
Brenner stated they are pushing people too hard. They should give
immunizations to people if they want it. Don't force people to have
immunizations. Her son had a terrible reaction, and she felt that she was forced
through the system.
Nelson stated that concern was raised at a seminar he attended. It is a
legitimate concern. The alternative is the number of children that would have
Board of Health, 9/19/2000, Page 18
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had an adverse effect if they hadn't had an immunization. The disease's adverse
effects are far greater than the adverse effects of an immunization.
Brenner stated that after her son's incident happened, years later, her
former pediatrician attacked her. No one warned her ahead of time. She was
also concerned about immunizing kids against everything. That develops
immunity- resistant strains of diseases. Allen stated there is always a balance
between the effects of the population versus the effects on an individual child.
The way to protect the large population is to immunize the large population. If
there are a large number of people who chose not to be immunized, then the
entire population will suffer. History has shown that with pertussis and measles.
They discuss the side effects with the people before they give the vaccination.
Nelson stated there was an article that said a certain vaccination was only
effective in women. They are researching vaccinations for cancer as a
mechanism for prevention of the disease. They are going to see more and more
of this being studied.
Tuberculosis Program
Benjamin stated there are 3.35 FTE's. The total program cost is
$253,000. This is a program that the County is required to assume, by state
statute.
Brenner asked if there is an emphasis on working with people in the
population who are more likely to be at risk, such as solid waste workers. Allen
stated there are high -risk groups. Those populations are those who are in
contact with tuberculosis (TB), those who are born in countries with TB, the
homeless, and people who have other diseases.
Brenner stated the state just decided that solid waste workers are high -
risk. Allen stated they would be in the group of people such as healthcare
workers and people who are in occupational settings where they would be
exposed. In general, not all solid workers are an at -risk population. It depends
on what one does in solid waste.
Brenner asked about the elderly and children. Allen stated the general
population of children and older adults is not a high -risk. They don't routinely
test everyone for tuberculosis. They target the people for screening who are
most at risk, and then offer preventive therapy for those people who are at risk.
If individuals who have been infected with tuberculosis, they are more likely to
get the disease. People with compromised immune systems are more likely to
develop the disease.
Brenner asked if exposure would weaken resistance. Allen stated only 10
percent who are exposed to tuberculosis get the tuberculosis disease. Those
people are the ones that have certain risk factors.
Board of Health, 9/19/2000, Page 19
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Brenner asked if the County follows those people with positive, active
tests. Allen stated people with positive tests are evaluated and consulted about
preventive therapy. If they elect to get the preventive therapy, the public health
nurse would provide follow up for that person. They do not follow those
individuals throughout his or her lifetime. That is the individual's responsibility.
The preventive therapy reverts to the primary care physician who manages the
person's healthcare.
Communicable Disease Program
Benjamin stated there are 1.65 FTE's. The total program cost is
$153,000.
Brenner asked if this is the same as reportable disease. Allen stated the
communicable disease program investigates reportable diseases. Certain
conditions are reportable. Some diseases are on the reportable condition list but
are not communicable diseases from person to person.
Benjamin asked for approval of the three -year plan. They are also looking
for feedback.
Nelson moved to approve the three -year plan with the suggested changes
and with the indices as revised. The changes include:
• Page 14, objective one, activity one, "system new construction."
• Page 22, item three of Promote Healthy Lifestyles, "...to prevent
smoking, alcohol, and drug use during pregnancy."
• Page 26, change the indicators for low birth weight and throughout to
a percentage.
Hoag moved to amend page 31, Essential Services three under Promote
Healthy Lifestyles, to reword item two to specify educating parents on the effects
of their behavior on children. She didn't care if it was a separate item three or a
part of number two. It is very important that it be in there.
Nelson stated he was comfortable with what the Health Department was
doing. He asked how they are going to force parents to examine their behavior.
Hoag stated it just says the Health Department will help them and give
them education.
Nelson stated they are already doing that.
Hoag stated this is supposed to be the plan the Health Department uses
to determine whether what they are doing matches the plan.
Nelson stated what they are doing does match the plan.
Board of Health, 9/19/2000, Page 20
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Hoag stated that if it isn't in the plan, they won't know that.
Brenner suggested a friendly amendment, "Help parents to promote
healthy behaviors in their children, including education about how their behavior
affects their children."
Hoag accepted the friendly amendment.
Nelson questioned what behavior they need to educate themselves about
it.
Hoag questioned whether Councilmember Crawford would support the
motion.
Crawford stated he would not because it doesn't matter. The County
won't be able to educate or legislate in this matter. He questioned where they
would stop. Philosophically, it is great. The churches need to take a proactive
role. It's already covered in the language that is there.
Nelson stated the Health Department deals with smoking, its effects in the
home and on children, in its literature. Alcohol abuse is covered with
information to adults by the Health Department and other agencies. They are
opening a can of worms with the word 'behaviors.' He wanted to know
specifically what behaviors they are targeting.
Hoag stated it is the Health Department's job to do everything it can to
help children who are exposed to smoking in the home. She is not talking about
legislation. She is talking about educating the parents. It should be an
important part of their focus because they are talking about children's health.
They are not talking about how that health is affected by what adults are doing
around them. She suggested the language, "...the effect of adult smoking, drug
abuse, and alcohol use on children's health." That is more specific. They need
to address it and make it a focus.
(Clerk's Note: End of tape two, side A.)
Benjamin stated that they have to look at the program. The program is
child health. When they are dealing with the child, they are dealing with the
parent at all times. If they are talking about healthy lifestyles, they are giving
messages to the parents about those healthy lifestyles.
Nelson stated that if the science shows that secondary smoke causes
problems in children, they are talking about it. If the problem shows that
alcoholic parents are more abusive, they are talking about it.
Benjamin stated they are not only dealing with the children during the
home visit. They are dealing with the parents at the same time.
Board of Health, 9/19/2000, Page 21
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Dawson stated this motion isn't going to make a bit of difference.
Hoag amended her motion to amend item two to, "...behaviors in their
children and encourage them to examine the effect of adult smoking, drug
abuse, and alcohol on their children."
Crawford called for the question.
Motion failed 3 -2 for a lack of a majority, with Nelson and Crawford
opposed.
Nelson restated his motion to approve the amended document including
the following changes by acclamation.
• Page 14, objective one, activity one, "system new construction."
• Page 22, item three of Promote Healthy Lifestyles, "...to prevent
smoking, alcohol, and drug use during pregnancy."
• Page 26, change the indicators for low birth weight and throughout to
a percentage.
Motion carried unanimously.
Nelson moved to approve the new format of the three -year plan. He
commended the staff for its effort. It is a concise, thorough look at the public
health needs in the community.
(Clerk's Note: the motion was not voted on.)
Brenner asked for a specific date on the presentation regarding increases
in respiratory problems. Benjamin stated it would be presented by the end of
the year.
Brenner stated there was mention at a previous meeting that every house
within a six -mile radius had cancer. Benjamin stated he talked about this with
Councilmember Hoag. They are gathering information. Until the Health
Department has that information, they can't do anything. They have already
looked at cancer rates in the county.
Brenner stated the Health Department should gather the information, not
the neighbors.
Dawson asked how Whatcom County compares with other counties.
Benjamin stated it varies. It takes thorough research.
ADJOURN
The meeting adjourned at 3:00 p.m.
Board of Health, 9/19/2000, Page 22
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Jill Nixon, Minutes Transcription
These minutes were approved by Council on November 28 , 2000.
ATTEST:
Dana Brown- Davis, Council Clerk
WHATCOM COUNTY COUNCIL
WHATCOM COUNTY, WASHINGTON
Marlene Dawson, Council Chair
Board of Health, 9/19/2000, Page 23