HomeMy WebLinkAbout2004-July File Copy
• Jefferson County
Board of Health
Agenda
Minutes
July 15, 2004
• JEFFERSON COUNTY BOARD OF HEALTH
Thursday,July 15,2004
2:30—4:30 PM
Main Conference Room
Jefferson Health and Human Services
AGENDA
I. Approval of Agenda
II. Approval of Minutes of Meetings of June 17,2004
III. Public Comments
IV. Old Business and Informational Items
1. Kid Bits Newsletter
2. Jefferson County Comprehensive Prevention Plan
3. 2004 West Nile Virus Activity
4. Informational Item
V. New Business
1. Public Hearing and Possible Adoption—Jefferson County Solid Waste
Ordinance
2. Breast Feeding and Public Health: Staff Presentation
3. Public Health Fee Policy Discussion: Current System and Options for
Change
4. On-site Sewage System Operation and Maintenance for Marine Counties:
Report on July 14,2004 State Board of Health Workshop
5. Environmental Health Director Recruitment Update
VI. Activity Update
VII. Agenda Planning
VIII. Proposed Next Meeting: August 19,2004
Main Conference Room
Jefferson Health and Human Services
•
JEFFERSON COUNTY BOARD OF HEALTH
MINUTES
• Thursday,June 17, 2004
Board Members: Staff Members:
Dan Titterness,Chairman—County Commissioner District#1 Jean Baldwin,Health&Human Services Director
Glen Huntingford—County Commissioner District#2 David Christensen,Interim Environmental Health Director
Patrick M.Rodgers-County Commissioner District#3 Julia Danskin,Nursing Services Director
Geoffrey Masci—Port Townsend City Council Thomas Locke,MD,Health Officer
Jill Buhler—Hospital Commissioner District#2
Sheila Westerman—Citien at Large(City) Ex-officio:
Roberta Frissell, Vice Chairman—Citizen at Large(County) David Sullivan,PUD#1
Chair Titterness called the meeting to order at 2:30 p.m. in the Health Department Conference
Room. All Board and Staff members were present with the exception of Commissioner Rodgers
and Member Westerman.
APPROVAL OF AGENDA
Member Masci moved to approve the Agenda as written. Vice Chair Frissell seconded the
motion which carried by a unanimous vote.
•
APPROVAL OF MINUTES
Member Masci moved to approve the minutes of May 20, 2004. Vice Chair Frissell
seconded the motion which carried by a unanimous vote.
PUBLIC COMMENT -None
OLD BUSINESS AND INFORMATIONAL ITEMS
Child Profile Landmark: Dr. Tom Locke presented an update on CHILD Profile Health
Promotion. Washington families of children birth to six years receive 17 different age-specific
mailings,which provide information and resources on growth,health, development, safety,
nutrition, school readiness and other parenting issues. In addition,reminders of well-child
checkups and immunizations are sent to parents of children turning six years old. The latest
survey has indicated that 30 percent of parents felt the information has helped change thoughts
and behaviors.
HEALTH BOARD MINUTES—June 17, 2004
Page: 2
Washington State Board of Health 2003 Report: Dr. Locke presented the Washington State
Board of Health 2003 Annual Report.
111
NEW BUSINESS
Draft Solid Waste Ordinance- Public Hearing Notice July 15,2004: David Christensen
reported that as directed by the Board during their meeting last month, he returned the draft solid
waste regulations to Deputy Prosecutor David Alvarez for review of the changes. Mr.
Christensen requested the Board set a hearing next month for public comment.
Member Masci moved to set a public hearing for July 15,2004 for review of solid waste
regulations. Member Buhler seconded the motion which carried by a unanimous vote.
Adverse Childhood Events Study: Julia Danskin, Nursing Services Director,presented the
Board with a condensed version of research on adverse childhood events and how it relates to
our local data and the services at the local Health Department. A major research project,the
Adverse Childhood Experiences (ACE) Study revealed a powerful relationship between
emotional experiences in childhood and physical and mental health in adulthood. From a survey
of 17-thousand middle-aged, middle-income participants, the study numerically scored adverse
childhood experiences, such as physical, sexual, emotional abuse, witness to domestic violence,
substance abuse,mental illness,parental loss and having a family member in prison. The results
showed that more adverse childhood experiences increased the risk for health problems
throughout the life cycle. Fewer adverse experiences appeared to promote effective coping
mechanisms. •
With regard to residents of Jefferson County,based on data from the Behavioral Risk Factor
Surveillance System(BRFSS) sampling of 2000-2001, it was determined that 25 percent
experienced abuse prior to age 18 (compared with the State average of 20 percent). Additionally,
adults with adverse childhood experiences appeared to experience more days (in the past 30) of
poor physical and mental health and impaired function,particularly those having the experience
of sexual abuse and domestic violence.
In response to the high infant mortality rate in our country, the Federal Government in 1989
enacted the "Maternity Care Access Act,"which provided health insurance and support programs
to pregnant women. Washington State began the First Steps Program(prenatal care) and the
Maternity Support Services Program, in which Jefferson County began participating in 1989,
paying for monthly visits from Public Health nurses, social workers and nutritionists. After
learning of 1990's research on violent crime that pointed to a higher incidence of adverse
childhood events in those imprisoned for violent crimes, Jefferson County Health Department
investigated research-based prevention programs and founded Nurse-Family Partnership (NFP)
in 1999, a best-practice program, using Public Health nurses to provide intensive home visiting
services during the first two years of a child's life. Ms. Danskin provided the Board with
impressive statistics on and examples of success. In 2002, the Health Department received a
three-year Federal grant expanding the NFP. Changes at the Federal level discontinued the grant
a year early, leaving our program out of Federal funding next month. The State and Federal
HEALTH BOARD MINUTES—June 17, 2004 Page: 3
Maternity Support Services program is experiencing loss of funds,while County costs have
risen.
The Health Department will re-prioritize clients,trying to serve the highest risk and those with
whom the Department may be most effective. Services will be lost; however, WIC program and
monthly maternity support services will remain funded. It is likely that the intensive best-practice
NFP program will be cut in half.
Mr. Sullivan posed a question regarding the feasibility of group, rather than individual focus.
Member Masci asked about the "Olds" and the "Y" models and suggested that it might be time
for Jefferson County and the City of Port Townsend to address these issues in a joint meeting.
Commissioner Huntingford recommended forming a long-term vision in addition to any
immediate solution.
Member Masci agreed and insisted that this Board begin looking at prioritization of programs.
Jean Baldwin, Health&Human Services Director,has addressed staff about prioritizing
community health funding. Staff's general response about the agency's most important task:
prevention,primary prevention and preparation for the next generation.
Commissioner Huntingford noted that priorities established here have to also fit the County
• budget.
Member Buhler stressed that the Hospital District wants to stay in contact with the Health
Department regarding programs and funding.
Mr. Sullivan reminded of the need to get the public involved in this community-wide issue.
2004 Washington State Health Report: Dr. Locke advised the Board that the bi-annual
Washington State Health Report is mandated to collect information from the public and state
agencies and components of health-related programs within the state, and then arrive at a series
of priorities for the Legislature, state agencies and others. The current report was generated by
the Governor's Subcabinet on Health in collaboration with the State Board of Health, coming up
with the following series of values to guide policy:
• Maintain and improve the public health system
• Insure fair access to critical health services
• Improve health outcomes and increase value
• Explore ways to reduce health disparities
• Improve nutrition and increase physical activity
• Reduce tobacco use
• Safeguard healthy air and healthy water
•
HEALTH BOARD MINUTES—June 17, 2004 Page: 4
Although many of the recommendations focus on state policy, a significant number have local
ramifications in areas that we want to examine, especially areas of nutrition and increased •
physical activity. It acknowledges the effectiveness of several programs. Its very solid data
appears to have influenced both the governor's budget and that of the legislature. Various
agencies and legislative leaders also agree with the priorities.
2003 WIC (Special Supplemental Nutrition Program for Women,Infants and Children)
Annual Report: Ms. Danskin reviewed the 2003 WIC Annual Report and cited Jefferson
County's uniqueness in administering WIC and other programs from one facility,particularly
identifying each Public Health nurse's ability to work with several programs. She pointed out that
WIC brings over$300,000 of Federal food dollars to Jefferson County.
The Board members were given flyers announcing the free women's mammogram and health
exam (sponsored in part by the Jefferson County Health and Human Services), to be held at
Hadlock Days on July 10, and reminded of the success of this program at the Quilcene Fair.
Public Hearing Priority Setting-Mandated Local Health Services: Dr. Locke referenced his
June 10, 2004 memorandum to the Board concerning mandated local public health services.
Essentially, local public health services are categorized as either mandated by statute,required
by contract, or identified discretionary local programs. Despite the worsening budgetary
conditions,programs provided by public health service that are considered "hard"mandates, (i.e.
communicable disease control, conduct endangering public health, food, on-site sewage systems
and public water systems)have specific standards, are primarily funded by county dollars, and
failure to enforce is easily identifiable and carries strict penalties. "Soft" mandates, other broad •
duties provided by local health boards and officers, are less specific and are regarded as a level
of service to which the public is entitled and may initiate legal action if harm befalls as the result
of absence of a service. Contractual obligations are legal mandates for the duration of a contract.
Elective, discretionary local programs, even those with huge impact on the health of the
community,have no law requiring them. In the priority setting, we initially determine statutory
mandate.
In response to Chair Titterness'query about listing and categorizing programs and procedures of
Board recommendations, Ms. Baldwin requested there be, at the July meeting, discussion about
how to frame the process of prioritizing the programs and assessing the damage to current level
of service. Regarding the matching of funding in the County General Fund, Ms. Baldwin
explained that funding might be matched with other sources, but not with federal funding.
Discussion ensued between Staff and Chair Titterness,Member Masci, and Mr. Sullivan
regarding additional funding sources,particularly private. Dr. Locke also identified the Public
Health Pool, authorizing the use of funds from sources such as foundations and charitable
organizations. Member Masci and Chair Titterness volunteered to work with Ms. Baldwin to
review alternatives prior to the July meeting.
ACTIVITY UPDATE/OTHER ANNOUNCEMENTS -None
•
HEALTH BOARD MINUTES—June 17,2004 Page: 5
AGENDA PLANNING/ADJOURN
The meeting was adjourned at 4:10 p.m. The next meeting will be on July 15, 2004 at 2:30 p.m.
in the Conference Room of the Jefferson County Health Department with an agenda including
the public hearing,programmatic update and priority setting, fee setting, ordinance, as well as a
brief presentation on breast-feeding work in the community and coordination with Jefferson
General Hospital.
JEFFERSON COUNTY BOARD OF HEALTH
Dan Titterness, Chairman Jill Buhler, Member
(Absent)
Roberta Frissell, Vice Chairman Sheila Westerman,Member
Geoffrey Masci, Member Glen Huntingford, Member
(Absent)
Patrick M. Rodgers,Member
•
Board of Health
Old Business
Agenda Item # IV., 1
• Kid Bits Newsletter
July 15, 2004
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Child Care H-eaLth Cowsultati,ow Prosrawt.
K.arew Shultz RN, PH-N 385-415
Dawa Fish ,el.sew RN, &wv%rowwLewtPL H-eaLth
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Summer Safety:
Hot weather is making a welcome return to the Olympic Peninsula area.When the temperature soars,you might plan on
making some changes in your usual routine. Babies,young children,the elderly,and those with chronic illnesses are •
most at risk for experiencing HEAT STRESS. Pets can be at risk too. Some suggestions to Prevent Heat Stress are:
• Reduce strenuous physical activity as much as possible.Take frequent rest breaks(Stay in the shade during the
hottest part of the day, between 10 AM-4 PM.
• Drink plenty of water and offer water to the children frequently.Children can be dehydrated even before they
ask for water. Pets need plenty of water too.
• Wear loose-fitting, lightweight clothing. Use sunscreen.Wear a wide brimmed hat and sunglasses to help block the
sun.
• Pull the drapes or shades to keep the"cool"air in. If you are using fans to move the air around be sure they are out
of reach of children.
• BE PREPARED TO CALL FOR IMMEDIATE MEDICAL ADVICE OR ASSISTANCE IF NECESSARY.
Review the signs and symptoms of heat exhaustion and heat stroke. Your first-aid manual will help in determining what
action to take.
Sun exposure can be hazardous to your health.
People of all skin colors from dark to light,can bum,
And therefore need protection from the sun's harmful rays.
Keep yourself and the children you care for safe by following these steps:
• Apply sunscreens beginning at six months of age • Beware of reflective surfaces; sand,snow,
liberally and frequently with a SPF of at least 15. concrete and water can reflect up to 85%of the
Reapply every two hours while outdoors. DO sun's damaging rays. 111
NOT APPLY SUNSCREEN TO CHILDREN
UNDER SIX MONTHS OF AGE. Make sure • Apply sunscreens even on cloudy days,when 80
children under six months of age wear a hat and percent of the sun's rays can penetrate the
are well protected from the sun's rays. clouds.
• Minimize sun exposure,especially during the • Wear a wide-brimmed hat,long-sleeved shirt
peak sun hours of 10 AM to 4 PM when the and pants during prolonged periods in the sun.
sun's rays are the most intense.
• Teach children about the need for sun
• Use sunscreen with a thicker consistency to protection, since skin damage from sun
minimize the chance of sunscreen rubbed in the exposure accumulates over a lifetime. One
eyes. Try an SPF 15 chapstick for the lips and severe childhood sunburn can double the
face. risk of developing skin cancer.
Washington State Law REQUIRES that parents give permission for the use of any medication, including sunscreen.A medical
provider's authorization is not required for use of sunscreen,as long as the package directions describe use,dosage, and
method of administration for the age of the child. If the parent's instructions are different from the package instructions, a medical
provider's authorization is required. Parents may provide sunscreen for their child,in the original container, labeled with the
child's name.Childcare providers may also provide sunscreen after obtaining appropriate written consents. All medication,
including sunscreen must be inaccessible to children. SUNSCREEN IS POISONOUS IF INGESTED. CALL WA STATE
POISON CONTROL AT 1-800-222-1222 IF A CHILD INGESTS SUNSCREEN.
ottimA'Z QE Time saving Tip: With parent's consent •1r '' it is much easier to use one large bottle of children's sunscreen
'� Jl�{�t1`t' for all (or most) children than it is for parent's to bring separate bottles for each child.
Nal
''YF ir"
IPlannins f®r a Safe and Fun Field Trip
Children,staff and everyone likes the excitement and the adventure of a field trip 4.3h especially when the
• weather turns warm.A little advanced planning can help make your trip a successful occasion that the children will remember
with pleasure. Here are some suggestions for developing your safety plan:
✓ Call ahead or visit the park or facility if you are unfamiliar V Apply sunscreen(follow container directions)to each
with the area or the services available(water, bathrooms,food, child as necessary. REMEMBER: Use of sunscreen
fees,etc.). requires parental permission
✓ Establish a safe and direct route to and from your V When you arrive at your destination,point out key landmarks
destination. and identify a"lost child"area.
✓ Maintain adult to child ratios needed to insure the safety V If you are using private cars, make sure there is a
and well being of the children.Add extra staff if safety is a booster seat or seat belt available for each child and that
special concern(crowded area, limited visibility,etc.). the car is insured for transporting children. Each adult
V Post trip information by the telephone in the office area or must have passed the Washington State background
check.
other pre-established location. Include route,destination,
departure and return times,a list of the children and adults V If you are walking, review safety rules(safe street
involved,field trip permission slips,and a cell phone number if crossing,staying together,etc.).
available.
V If you are going by van or bus review those safety
✓ Carry a first aid kit, health consent forms&emergency rules.
information for each child with you.Also include"as needed"
medications&directions for its use for that child. At least one staff V Teach children the steps to take if they get separated
member must have a current first aid and CPR certificate. from the group:
• • Remain in the area where they last saw the
Plan to keep food/lunches cold and safe. Make group or go to the"lost child"area.
arrangements for handwashing if running water is not • If possible,ask for help in an open visible
available. place from someone in charge(ticket taker,
clerk,etc.)
V Plan for frequent rest and water breaks between activities. • NEVER leave the area with an unknown
✓ Provide tags for each child with the name and phone • person.
number of your child care facility. If you do use individual Reassure the children that if they do become
separated from the group,you will be looking
names on the tag, use first name only. for them.
V Make sure the adults are all familiar to each child. • Count the group out loud so the children know
you will know if someone is missing.
✓ Establish a buddy system. Children with special needs may
need to have an adult buddy.
A reminder for parents and providers:
*Open windows can be hazardous for toddlers and young children.
They often climb up on the furniture to feel for a cool breeze!
*Screens may not hold securely if children push or fall against them!
* Window stops that allow windows to open only 4 to 6 inches let the breezes in
but prevent children from"falling out"!
* Children can also squeeze through the bars and railings on balconies and decks!
*Take time to check for potential hazards and correct, them
While taking precautions can prevent injury
NOTHING TAKES THE PLACE OF ADULT SUPERVISION!!
The POWER Of Physical Activity
What is physical activity? Physical activity is any movement that uses energy. Physical activity includes a •
wide range of activities from running,jumping, biking, and swimming to jumping rope, dancing, skating and
walking. What's so great about physical activity? The evidence is building and is more convincing than ever!
Physical activity can improve health and well-being. Regular physical activity in childhood has many benefits: it
improves strength and endurance, builds healthy bones and muscles, develops motor skills and coordination,
reduces depression and stress and promotes well-being. Most children naturally love physical activity because
it's fun, they can do it with friends, and it helps them learn, stay in shape, and feel better. Why are healthy
lifestyles important for young children? Early childhood is a key time for promoting the development of
lifelong healthy habits such as physical activity. Families and caregivers can be positive role models for young
children by participating in physical activity themselves and by participating in physical activity with children.
How can I encourage physical activity in my childcare program? A recent study designed
` to identify factors associated with physical activity in young children found that the activity level
t 1 z... in the childcare center had a profound effect on the child's overall physical activity. These
444.4
findings support a role for childcare providers in promoting quality activity programs and
providing space and time for young children to be active. Outdoor and indoor play can provide
lots of opportunity for physical activity. Both unstructured and structured playtimes are
important. Try some of the following ideas:
• Obstacle Course
Create an obstacle course that children can
climb over, under, around and through. Use p "'•
chairs, pillows, cardboard, etc. ' `
41S0 ,- ri
o Turn up the Music and Dance
Try freeze dancing where turn off the :>
music and have children hold their '
positions in place.
III
■ Creative Movement—How would you move to describe a sizzle, a splash or a
hammer? How would you walk on ice, hot sand, or in a strong wind? Can you move
like a duck, a horse or a dragon?
• Walk—and remember to limit time spent watching television or movies and
playing video games.
HAVE FUN and BE ACTIVEmiI
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DID YOU KNOW...
® NEED TO UPDATE A POLICY, PROCEDURE OR Children with Special Health Care Needs(CSHCN)s a
FORM? program for children between birth& 18 years old who are
We have the following model policies/forms available: at increased risk for serious chronic physical,developmental,
behavorial or emotional conditions who need health and
• Pet Policy related services of a type and amount beyond that which is
• Medication Authorization form generally required. This program is made possible through
• Incident Log federal and state funds granted to Jefferson County Health
• Communicable Disease Policy and Human Services. A CSHCN Public Health Nurse is
• Disaster Plan
available to assist with coordination of limited medical
services,equipment or supplies. Please call Marty Johnson
These can be made available to you in hard copy, floppy at 385-9422 for more information
disc or download through electronic mail. Give us a call.
411
•
. Are We Suoer-Sizing Our Children?
essi A look at childhood obesity
•
• Informarents of the
It only takes a P need to
stroll around a local mall limit television viewing,
to notice that people are getting bigger. Not Nutrition Facts computer use and other
t Serving size: 1/4 Recipe (1 sag)
only are 60% of American adults overweight, sedentary behaviors among
g r Servings Per Recipe 4 children.
toddlers are now counted among the groups Amount Per Serving
with increased rates of obesity leading to Calories 199 Cal from Fat 45
potentially damaging health complications. z Daily vale= Recommended Reading
Since the 1960s the prevalence of childhood Total Fat 5g sX
Saturated Fat 1g 4Z Vitamins, Minerals,and
obesity has more than doubled. Ten percent
Cholesterol of preschoolers are now considered Sodium 245 omg Supplements by
245mg l 0Z OX
Dietary pp ements
overweight, compared with less than 5% in Total Carbohydrate 31g -rox Marsha Hudnall, R.D. and The
1971. Obesity is now considered the nation's Dietary Fiber sg 35% American Dietetic Association.
number one public health problem. Sugars Og Wiley, 1998.
Protein 10g
Why are we so concerned about the growing ViaminA 75% Vitamin C 40%
numbers of overweight Americans? Health Calcium 10% Iron 20% The American Dietetic
complications linked to obesityinclude Type2 •Percent Daily Values is based on a Association's Complete
2000 calorie diet. Your daily values Food and Nutrition Guide by
diabetes, hypertension (high blood pressure), may be higher or lower depending on
high blood cholesterol and triglyceride levels, your calorie needs. Roberta Larson Duyff, R.D.,
sleep apnea, orthopedic problems, asthma Wiley, 1998.
complications and lower self esteem. The • Teach preschoolers to know
costs to society to treat these complications the difference between Dieting for Dummies by Jane
are overwhelming and will have an enormous physiological hunger and the Kirby, R.D., IDG Books
impact on an already stressed health care desire to eat because food is Worldwide Publisher, 1998.
sy available(and tastes good!);
W • Offer nutritious foods that
re some of the factors contributing to Diet foraSma//P/anet;
this problem?They include an increasing taste good in child care 20th Anniversary Edition by
number of working families eating out on a programs and encourage Frances Moore Lappe,
family style meal service that
regular basis, the tremendous growth in Ballantine Books, 1991.
portion sizes of food available, soaring rates trains children to take a
of soft drink consumption in the U.S., the vast portion appropriate for their The Diabetes Carbohydrate
amount of money spent by corporations to appetite and honors a child's and Fat Gram Guide by Lea
advertise high calorie/low nutrient foods to ability to stop eating when Ann Holzmeister, R.D.,The
young children, the ready availability of snack full; American Diabetes Association,
and convenience foods high in fat andInc., and The American Dietetic
g • Plan menus that follow the Association,
calories, and the decreasing rates of physical Dietary Guidelines for NTC/Contemporary, 2000.
activity among people of all ages. Americans and include a
How do we turn the tide of social forces variety of fruits and The New Laurel's Kitchen by
contributing to increased weight gain, vegetables instead of french Laurel Robertson, Carol Flinders
especially for our children? One way is to fries and tater tots; and Brian Ruppethal,Ten Speed
focus on the prevention of obesity among • Stop using food as a reward Press, Berkeley CA, 1986
young children. We need to: or comfort item and coercing
• Learn more about infant cues that children into cleaning their The ABC's for health:
indicate hunger and fullness and how plates;
to appropriately respond to these • Find ways to build physical Aim for fitness
cues; activity into the curriculum for Build a healthy base
• Provide better support to mothers very young children and to Choose sensibly
who breastfeed their infants and encourage staff working with
0 find ways to keep babies children to model physically
breastfeeding while in childcare; active behaviors;
•
HEALTHY EATING for A
WHAT's In A LABEL??? = '
LIFETIME
What we choose to eat can have a direct Serving Size:Standardized size based
effect on our ability to enjoy life to its on amounts people actually eat.Similar APPLE BERRY
0
fullest. This is true for everyone despite food products have similar serving sizes
his or her age and current health. Our making it easier to compare foods in the FRUIT LEATHER
same category. For example,the
food choices play a major role in:
nutritional content of two similar types of 3cups Apples cored and chopped
tomato sauce can be compared. 1 cup raspberries
- Promoting and maintaining good 2 TBSP frozen orange juice
health; Nutrition Facts concentrate
- Promoting growth in infants, Serving size: 1/4 Recipe (188g) 2 TBSP Honey
children and adolescents; Servings Per Recipe 4 1 tsp cinnamon
- Preventing some chronic diseases 1 tsp fresh lemon juice
(like heart disease &diabetes) and Amount Per Serving
Calories 199 Cal.horn Fat 45 Preheat oven to 140° F
treating others; 2 Daily Value'
- Speeding recovery from injury and Total Fat 5g 0% Using a blender, blend 1 cup apples,
surgery. Saturated Fat 1g 4% raspberries and the orange juice until
� � Cholesterol 0mg 0% smooth.Add remaining apples and
Sodium 245mg 102 blend until smooth. Pour apple
WV Total Carbohydrate 31g 10% mixture in a medium bowl then stir in
Dietary Fiber 8g 352 the honey,cinnamon and lemon
FRUIT PARFAIT ~-- Sugars Og juice.
Protein 109 Line a baking sheet with plastic wrap
1 cup apples chopped Vitamin A 75% Vitamin C 40% and tape to edges. Do NOT use wax
1 cup strawberries sliced Calcium 10% Iron 20% paper or
1 banana sliced aluminum Nutrition Facts
1 cup vanilla low fat yogurt 'Percent Daily Values is based on a
1 cuploa granolay2.000 calorie diet. Your daily values foil since it's Serving size: 1/8ofrecipe (72g)
may be higher or lower depending on difficult to Sere Per Recie 8
1/2 cup raisins your calorie needs. remove the p
fruit from Amount Per Serving
Using a clear %Daily Value: Indicates how food fits these items. Calories 59 Cal.from Fat iik
Nutrition Facts glass, within a 2,000 calorie diet. Based on Z Daily Value'
Servingsize: 1 Parfaitlayer the dietaryrecommendations for most Total Fat 0%
(209g) ingredients healthyPour apple 09
ServingsPerRecipe 4 startingngrwith a people.This helps you to mixture on Saturated Fat Og 0%
understand if the food has"a lot"or"a the plastic Cholesterol 0mg 0%
Amount Per Serving layer of one little"of the most important nutrients. lined baking .
Calories 271 Cat from Fat 26 fruit,then a Sodium
layer of sheet and Total Carbohydrate4%159 4%
X Daily Value' another fruit, Middle Section:The nutrients listed in spread with Dietary Fber 2g 8%
Total Fat 3g 4% then the the middle section are the ones most a rubber
urt, then important to good health.This helps you spatula until Sugars 4g
Saturated Fat 1g 4X yo gsome to calculate your daily limits for fat,fiber, it's 1/8 inch Protein Og
Cholesterol 3mg 0%granola, then sodium and other nutrients. thick. Leave VitaminA 0% Vitamin C 2Ca.
Sodium 111mg 4% another fruit, about 1/2 Calcium 0% Iron 0%
Total Carbohydrate 202 and top with Vitamins&Minerals:The Percent Daily inch of
y on a
raisins. Value is the same as the U.S. space open Percent
00calorie ydel.Values
based
values
Dietary Fiber 5g 20% Recommended Daily Allowance for from edge of may be higher or lower depending on
Sugars 7g vitamins and minerals(same levels). pan to allow your calorie needs.
Protein 7g Or be Note: Only these vitamins and minerals fruit to
creative and are required on labels although the expand while drying.
Vitamin 10% Vitamin C 50% layer it manufacturer has the option to include
Calcium 15% Iron 10% any way you others
like. Fruit leather is done when it is no
too. Bake in oven for 4-6 hrs.
"Percent Daily Values is based on a
2,000 calorie diet Your daily values ,.. longer sticky to the touch.
may be higher or lower depending on `-Melons are notorious for making
your calorie needs. people sick from foodborne illness When done, roll the fruit with the
germs. Scrub the skin with a brush}�; plastic wrap the long way. Cut into
under running water before slicing. 2-inch pieces.
Clean the cutting area and knife,
refrigerate the slices. ;
•, ; Store; Store pieces in an airtight container.
Ask The Child Care Team. . .
Dear Team,
r the past two months our toddler room has felt Dear Team,
ike a disaster. Things seemed to fall apart when "Paul" is a three (3)year old who has been coming to
one of the toddlers,new to the room, began biting our daycare since he was 4 months old. He has never
her peers. Several more children have started had a hard time saying good-bye to his mother until
biting and now parents are threatening to withdraw recently. He has become reluctant to stay at daycare
their children. What do we do? We've tried and cries and clings to her at drop off time. He is fine
everything. - Flummoxed after mom leaves then doesn't want to go home when
she comes to pick him up. His parents report nothing
Dear Flummoxed, has changed at home. How should I advise his mother?
What can we do to make the transition easier?
Biting can be a serious and upsetting problem when -Perplexed
it happens frequently and over long periods of time.
Parents get especially upset when they see those Dear Perplexed,
teeth marks on their child's body! It is important P
to provide first aid immediately after a bite occurs
(follow your policy for dealing with bites) or contact It's often puzzling when children who appear happily adjusted
our public health nurse, and identify ways to to a familiar childcare suddenly resist going.You were wise to
prevent the behavior from happening.
talk with his parents about any possible changes at home. It
You say you've tried everything. This means that sounds to me like he is trying to work out some ideas about
you have checked the classroom environment to see separation.Learning to say goodbye isn't always easy.It is
that the curriculum is developmentally appropriate, something that is learned in different ways throughout a
varied and interesting to the children. The noise
level is not overwhelming; there is quiet space, room child's development.
to move and a minimal number of transitions. The
teachers also must understand the special needs of Paul is makingthe developmental transition into his pre-school
the toddler. p
years.He is learning to be more independent and to mastering a
.ddlers who are frequent biters need special wide range of social and problem solving skills.His important
ention that begins with close observation. Are relationships are changing as he starts to do more for himself
e "bitrs" less talkative, less able to use4
and leave"babyhood." Paul's reluctance to leave at the end of
language? Do they walk around with little focus,
the day,and his crying at the start of the day,suggest that he
have trouble concentrating even for brief time
periods? Do they play best with sensory material is trying to work out control over the comings and goings of the
and still put non-food items in their mouth? most important people in his life.
Noticing little things can help teachers make the
best plan for biting prevention.
Given this understanding,spend extra time talking with Paul
Children who have little language can practice about how he misses his parent and how hard it can be to say
alternative ways of communicating. Help them to
goodbye.Advise his mom to develop ndrop-off ritual that is
take another child's hand or pull on a shirtsleeve to
consistent and includes"saying goodbye"on the way to
replace the biting behavior. Practice with situations
that might cause biting. For instance, when there is childcare rather than at drop-off time. Let Paul know you are
a toy he/she wants, or others move ito her space. delighted to see him and help him make the transition to child
care. At the end of the day advise mom to give him some time
Providers often end up "shadowing" a biter in the
to finish his activities and share his day at pick up.If time
hopes of preventing bites. As you shadow, talk to
the child about their friend's activities and how issues are critical help mom make the home-school transitions
they might participate. When they make a move to easier. Before mom arrives, help Paul identify some things he
bite, rather than calling attention to the biting would like to show her and let him get ready for her arrival.
behavior,show them alternative behavior for
reaching their goal. Praise them for following
through. Though Paul will likely regain his ability to have happy goodbyes,
ans the issue of separation is very important and will likely come up
Help children with especially short attention s
spend more time in play by joining the play andp again throughout his development.
adding new ideas and observations. Add more
sensory activity to the class including material that (references: Greenspan,Stanley I.,M.D.and Serena Wieder,Ph.D.
can be "bitten" like infant teethers. (1977).The Child with Special Needs.Boulder CO:Perseus Books.;
Lenore Rubin PhD,Seattle-King County Health Department)
this behavior does not stop after trying all these
methods, then it is time to call for help.
Kitchen sponges are germ breeding grounds. In a Think kids today just don't listen? You're right - at least
recent study it was found that bachelors who 49% of the time, according to a study from the University
neglected their kitchen counters have fewer germs of Guelph in Ontario.
on their counters than their"clean friends"who When researchers monitored 40 families with children
wiped their counters with sponges. Use scrubbies & between ages 4 and 6 for responses to simple request
dishcloths & keep the dishcloth clean. such as putting toys away or setting the table, the
discovered that moms got what they asked for- with
®®®®0 0® '= 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 challenge - only about a third of the time. Researchers
have not yet analyzed kids' responses to dads. Seventeen
Tri-Area Head Start Open House percent of the time, children who did comply did so on
JCHHS Childcare Team was invited to participate with their own terms (for instance, a child might agree to put
a booth at the Early Head Start Open House/Health away toys but only after she finished playing a game).
Fair that was held on March 8. We shared
information about hand washing, tobacco prevention, The good news: Noncompliance isn't necessarily a bad
child passenger safety and presented "The Sneeze" thing. "A child who negotiates with her parents or
video. It was a delight to be part of the day and complies but on her own terms is building important life
meet parents and community visitors. Thank you skills, such as assertiveness, says Susan Lollis, PhD, the
Head Start of Port Hadlock. study's lead author. Of course, there are limits. "Parents
®®®® ®®®®®®®®®®®®® �� ®®®®® need to decide what issues are not up for negotiation and
make this clear to their children, " she says.
JCHHS will be welcoming a new Child Care Health While researchers aren't sure why some kids listen more
Consultant after July 23rd. Karen is leaving to return and others less, one theory is that it may have to do with
to school and will be replaced by Yuko Umeda. Yuko
how their own requests are usually treated. "A parent-
has been a public health nurse for 15 years and is
very qualified to provide continuing services to you. child relationship is a two-way street,"says Dr. Lollis.
Please help us welcome her as she takes on this task. Note how often you say, Not now, I m busy.
Yuko can be reached at 385-9416. And remember: Children tend to model their parents'
behavior.
�q. '4 �h S- 4i �h 4i '�U / oil.♦ lhi
.; 7
910
4 4 4.9' h , 47 h / 4V ii - h / 4 4 �
Jefferson County Health and Human Services
615 Sheridan
Port Townsend,WA 98368
•
Board of Health
Old Business
Agenda Item # IV., 2
Jefferson County Comprehensive
A Prevention Plan
July 15, 2004
•
Jefferson County Comprehensive Prevention Plan
Fact Sheet—July, 2004
• Purpose: The purpose of the Jefferson County Comprehensive Prevention Plan is to provide public
and private sector policy makers with a framework to guide decisions related to prevention priorities,
funding, and evaluation.
What is Prevention—Prevention is "action"that keeps harmful things from
happening.
V2_1)4.
Thriving Communities: Thriving individuals, families, and communities are the
cornerstone of Jefferson County's prevention philosophy.
Comprehensive Prevention Plan Components (DRAFT)
,;l; * • Core Concepts/Philosophy
4, . • Core Competencies Checklist
• Definitions
• Resources
Timeline (tentative) What Who
June-July 2004 Develop Draft Comprehensive Internal Workgroup*
Plan
Early August 2004 Review 1 of Draft Plan Review Team**
Mid-August 2004 Revision 1 of Draft Plan Internal Workgroup
• Late August 2004 Review 2 of Draft Plan Review Team
Late August Revision 2 of Draft Plan Internal Workgroup
Mid/Late September Endorsement of Comprehensive Network
Prevention Plan BOH
October&on-going Public Presentations BOCC, City of Port Townsend, Law &
Justice, Substance Abuse Advisory
Board, VIPST, Mental Health Board,
Healthy Youth Coalition
*Internal Workgroup: Kellie Ragan—JCHHS, Beth Wilmart—Community Network, Anne Burns—
Olympic ESD, Heidi Dodd —JCHHS, Quen Zorrah—JCHHS
**Review Team: will consist of representatives from Community Network Board, BOH, Law& Justice,
Substance Abuse Advisory Board, VIPST, Mental Health, Youth Serving Organizations (County Rec,
Y, 4-H, Churches, Scouts, other)
We need volunteers to assist in the review process in August e'
For more info contact: Kellie Ragan—kragan@co.jefferson.wa.us
or Beth Wilmart—bwilmart@co.jefferson.wa.us
•
Prevention plan thunibrail 07-08-04kr
•
Board of Health
Old Business
Agenda Item # IV., 3
• 2004 West Nile
Virus Activity
July 15, 2004
•
2004 West Nile Virus Activity
in the United States
(reported as of June 29, 2004)*
For 2003 case information click here.
IIIOther Total Human
State Neuroinvasive Fever Clinical/ Cases Reported Deaths
disease Unspecified to CDC
Arizona 29 6 3 38 1
California 3 7 0 10 0
Florida 1 1 0 2 0
Michigan 1 0 0 1 0
Nebraska 0 1 0 1 0
New Mexico 0 3 0 3 0
South Dakota 1 0 0 1 0
Wyoming 0 1 0 1 0
Total 35 19 3 57 1
Neuroinvasive Disease refers to severe disease cases, particularly West Nile meningitis and West Nile
encephalitis. Click here for further explanations of
neuroinvasive West Nile virus disease and West Nile fever. .
est Nile fever refers to typically less severe cases that show no evidence of neuroinvasion. West Nile
WI. is not currently on the list of nationally notifiable diseases, and therefore it is optional whether or not
state health departments report these cases to CDC.
Click here for further explanations of neuroinvasive West (Vile virus disease and West Nile fever.
Other Clinical includes persons with clinical manifestations other than WN fever, WN encephalitis or WN
meningitis, such as acute flaccid paralysis. Unspecified cases are those for which sufficient clinical
information was not provided.
Total Human Cases Reported to CDC- These numbers reflect both mild and severe human disease
cases occurring between Jan.1 -June 29, 2004 that have been reported to ArboNet by state and local
health departments. ArboNet is the national, electronic surveillance system established by CDC to assist
states in tracking West Nile virus and other mosquito-borne viruses. Information regarding 2004
virus/disease activity is posted when such cases are reported to CDC.
Of the 57 cases 19 (33%) were reported as West Nile fever (milder disease), 35 (61%) were reported as
West Nile meningitis or encephalitis (neuroinvasive disease) and 3 (5%) were clinically unspecified at this
time. Please refer to state health department web sites for further details regarding state case totals.
•
Board of Health
Old Business
Agenda Item # IV., 4
• Informational Item
July 15, 2004
•
r
Washington State
Institute for
Public Policy
010 Fifth Avenue Southeast,Suite 214 • PO Box 40999 • Olympia,WA 98504-0999 • (360)586-2677 • www.wsipp.wa.gov
July 6, 2004
BENEFITS AND COSTS OF PREVENTION AND
EARLY INTERVENTION PROGRAMS FOR YOUTH
Does prevention pay? Can an ounce of prevention been completed only in the last two decades, and
avoid (at least)an ounce of cure? many new rigorous studies will become available in
the years ahead. As the evaluation evidence
More specifically for public policy purposes, is there accumulates, and as the market matures, our relative
credible scientific evidence that for each dollar a ranking of programs can be expected to change.
legislature spends on "research-based" prevention or
early intervention programs for youth, more than a Third,while Washington has taken significant steps
dollar's worth of benefits will be generated? If so, in recent years, many currently funded prevention
what are the policy options that offer taxpayers the and early intervention programs in the state have
best return on their dollar? not been rigorously evaluated. Thus,for many
programs in Washington, there is insufficient
These are among the ambitious questions the 2003 evidence at this time to determine whether they
Washington State Legislature assigned the produce positive or negative returns for taxpayers.
Washington State Institute for Public Policy
(Institute).' This report describes our findings and The main policy implications of these findings are
provides an overview of how we conducted the straightforward and analogous to any sound
analysis.2 An Appendix, published separately, investment strategy. To ensure the best possible
contains a full description of our results and methods.3 return for Washington taxpayers, the Legislature
• and Governor should:
Summary of Findings. Our principal conclusion is • Invest in research proven "blue chip"prevention
that, as of July 2004, some prevention and early and early intervention programs. Most of
intervention programs for youth can give taxpayers
a good return on their dollar. That is, there is Washington's prevention portfolio dollars should
credible evidence that certain well-implemented be spent on these proven programs.
programs can achieve significantly more benefits • Avoid spending money on programs where
than costs. Taxpayers will be better off if there is little evidence of program effectiveness.
investments are made in these successful research- Shift these funds into successful programs.
based programs.
• Like any business, keep abreast of the latest
This good news, however, must be tempered in research-based findings from around the United
three important ways. First, we found evidence that States to determine where there are
some prevention and early intervention programs opportunities to use taxpayer dollars wisely.
fail to generate more benefits than costs. Our The ability to distinguish a successful from an
research indicates that money spent on these unsuccessful research based program requires
unsuccessful research-based programs is an specialized knowledge.
inefficient use of taxpayer money. • Embark on a strategy to evaluate Washington's
currently funded programs to determine if benefits
Our second caveat concerns the"marketplace"for exceed costs.
rigorously researched prevention and early
intervention programs: it is a young market, but it is • Achieving "real-world"success with prevention
evolving quickly. Most high-quality evaluations have and early intervention programs is difficult; close
attention must be paid to quality control and
adherence to original program designs.
1 ESSB 5404 Sec.608(2),Chapter 25,Laws of 2003. Successful prevention strategies require more
2 Suggested study citation:Steve Aos,Roxanne Lieb,Jim effort than just picking the right program.
Mayfield,Mama Miller,Annie Pennucci.(2004)Benefits and
• costs of prevention and early intervention programs for youth. • Consider developing a strategy to encourage
Olympia:Washington State Institute for Public Policy. local government investment in research-proven
The Appendix is available from the Institute's website: programs.
<http://www.wsipp.wa.govirptfiles/04-07-3901a.pdf>.
•
Table I
• Summa of Benefits and Costs (2003 Dollars)
Total Benefits and Costs Per Youth
Benefits Costs Benefits Benefits
per Dollar Minus
of Cost Costs
(1) (2) (3) (4),
.o. zea
1 I $
Early Childhood Education for Low Income 3-and 4-Year-Olds' $17,202 $7,301 $2.36 $9,901
HIPPY(Home Instruction Program for Preschool Youngsters) $3,313 $1,837 $1.80 $1,476
Parents as Teachers $4,300 $3,500 $1.23 $800
Parent-Child Home Program $0 $3,890 $0.00 -$3,890
Even Start $0 $4,863 $0.00 -$4,863
Early Head Start $4,768 $20,972 $0.23 -$16,203
Nurse Home Partnership for Low Income Women $26,298 $9,118 $2.88 $17,180
Home Visiting Programs for At-risk Mothers and Children* $11,089 $4,892 $2.27 $6,197
Parent-Child Interaction Therapy $4,724 $1,296 $3.64 $3,427
System of Care/Wraparound Programs* $0 $1,914 $0.00 -$1,914
Family Preservation Services Programs* $0 $2,531 $0.00 -$2,531
Healthy Families America $2,318 $6,888 $0.34 $4,569
Comprehensive Child Development Program -$9 $37,388 $0.00 -$37,397
The Infant Health and Development Program $0 $49,021 $0.00 -$49,021
a a ws e@� >. w
40 Seattle Social Development Project $14,426 $4,590 $3.14 $9,837
Guiding Good Choices(formerly PDFY) $7,605 $687 $11.07 $6,918
Strengthening Families Program for Parents and Youth 10-14 $6,656 $851 $7.82 $5,805
Child Development Project $448 $16 $28.42 $432
Good Behavior Game $204 $8 $25.92 $196
CASASTART(Striving Together to Achieve Rewarding Tomorrows) $4,949 $5,559 $0.89 -$610
Big Brothers/Big Sisters $4,058 $4,010 $1.01 $48
QuantumyyppOpportunities Project $10,900 $25,921 $0.42 -$15,022
* ,'. Y 1:f i
Adolescent Transitions Program $2,420 $482 $5.02 $1,938
Project Northland $1,575 $152 $10.39 $1,423
Family Matters $1,247 $156 $8.02 $1,092
Life Skills Training(LST) $746 $29 $25.61 $717
Project STAR(Students Taught Awareness and Resistance) $856 $162 $5.29 $694
Minnesota Smoking Prevention Program $511 $5 $102.29 $506
Other Social Influence/Skills Building Subtance Prevention Programs* $492 $7 $70.34 $485
Project Towards No Tobacco Use(TNT) $279 $5 $55.84 $274
All Stars $169 $49 $3.43 $120
Project ALERT(Adolescent Learning Exp. in Resistance Training) $58 $3 $18.02 $54
STARS for Families(Start Taking Alcohol Risks Seriously) $0 $18 $0.00 -$18
D.A.R.E. Drug Abuse Resistance Education) $0 $99 $0.00 -$99
Source:S.Aos,R.Lieb,J.Mayfield,M.Miller,A.Pennucci.(2004)Benefits and Costs of Prevention and Early Intervention Programs for Youth.
Olympia:Washington State Institute for Public Policy,available at<http://www.wsipp.wa.gov/rptfiles/04-07-3901.pdf>.
Meta-analytic results,references,and detailed benefit-cost calculations are presented in the Appendix to this report,available at
<http://www.wsipp.wa.gov/rptfiles/04-07-3901a.pdf>. The economic values on this table are estimates of present-valued benefits and costs of
. each program from the societal perspective. The benefits are estimated for six types of outcomes:crime,education,substance abuse,child
abuse and neglect,teen pregnancy,and public assistance,for each program with statistically significant results for any of these outcomes. Many
of these programs have achieved outcomes in addition to those for which we are currently able to estimate monetary benefits.
*Programs marked with an asterisk are the average effects for a group of programs;programs without an asterisk refer to individual programs.
6
Table 1 (Continued)
• Summary of Benefits and Costs (2003 Dollars)
Total Benefits and Costs Per Youth
Benefits Costs Benefits Benefits
per Dollar Minus
of Cost Costs
(1)
Teen Outreach Program $801 $620 $1.29 $181
Programs for Teen Parents* $1,772 $1,763 $1.00 $8
Reducing the Risk Program $0 $13 $0.00 -$13
Postponing Sexual Involvement Program -$45 $9 -$5.07 -$54
Teen Talk $0 $81 $0.00 -$81
School-Based Clinics for Pregnancy Prevention* $0 $805 $0.00 -$805
Adolescent Sibling Pregnancy Prevention Project $709 $3,350 $0.21 -$2,641
Children's Aid Society-Carrera Project $2,409 $11,501 $0.21 -$9,093
Dialectical Behavior Therapy(in Washington) $32,087 $843 $38.05 $31,243
Multidimensional Treatment Foster Care(v. regular group care) $26,748 $2,459 $10.88 $24,290
Adolescent Diversion Project $19,713 $1,777 $11.09 $17,936
Mentoring(in the juvenile justice system)* $23,143 $6,471 $3.58 $16,672
Functional Family Therapy(in Washington) $16,455 $2,140 $7.69 $14,315
Other Family-Based Therapy Programs for Juvenile Offenders* $14,061 $1,620 $8.68 $12,441
Multi-Systemic Therapy(MST) $14,996 $5,681 $2.64 $9,316
• Aggression Replacement Training(in Washington) $9,564 $759 $12.60 $8,805
Juvenile Boot Camps* $0 -$8,474 $0.00 $8,474
Juvenile Offender Interagency Coordination Programs* $8,659 $559 $15.48 $8,100
Diversion Progs.with Services(v. regular juvenile court processing)* $2,272 $408 $5.58 $1,865
Coordination of Services $0 $408 $0.00 -$408
Juvenile Intensive Probation Supervision Programs* $0 $1,482 $0.00 -$1,482
Juvenile Intensive Parole(in Washington) $0 $5,992 $0.00 -$5,992
Scared Straight -$11,002 $54 -$203.51 -$11,056
Regular Parole(v. not having parole) -$10,379 $2,098 -$4.95 -$12,478
Other National Programs
Functional Family Therapy(excluding Washington) $28,356 $2,140 $13.25 $26,216
Aggression Replacement Training(excluding Washington) $15,606 $759 $20.56 $14,846
Juvenile Intensive Parole Supervision(excluding Washington)* $0 $5,992 $0.00 -$5,992
Source:S.Aos,R.Lieb,J.Mayfield,M.Miller,A.Pennucci.(2004)Benefits and Costs of Prevention and Early Intervention Programs for Youth.
Olympia:Washington State Institute for Public Policy,available at<http://www.wsipp.wa.gov/rptfiles/04-07-3901.pdf>.
Meta-analytic results,references,and detailed benefit-cost calculations are presented in the Appendix to this report,available at
<http://www.wsipp.wa.gov/rptfiles/04-07-3901a.pdf>. The economic values on this table are estimates of present-valued benefits and costs of
each program from the societal perspective. The benefits are estimated for six types o outcomes:crime,education,substance abuse,child
abuse and neglect,teen pregnancy,and public assistance,for each program with statistically significant results for any of these outcomes. Many
of these programs have achieved outcomes in addition to those for which we are currently able to estimate monetary benefits.
*Programs marked with an asterisk are the average effects for a group of programs;programs without an asterisk refer to individual programs.
•
7
•
Board of Health
New Business
Agenda Item # V., 1
• Public Hearing & Possible Adoption
Jefferson County Solid Waste
Ordinance
July 15, 2004
•
LEGAL NOTICE
• Please publish one(1)time: Wednesday,June 30,2004
Bill: Jefferson County Health &Human Services
C/o Dave Christensen
615 Sheridan
Port Townsend, WA 98368
NOTICE OF PUBLIC HEARING
NOTICE IS HEREBY GIVEN that a public hearing is scheduled by the Jefferson County
Board of Health for THURSDAY, July 15, 2004 beginning at 2:30 p.m. in the main conference
room at Jefferson County Health & Human Services, 615 Sheridan Street, Port Townsend,
WA, to take comments for and against a proposed ordinance entitled "Solid Waste Regulations".
The Ordinance, as proposed, can be summarized by its section titles, which are as follows:
1. Authority
2. Purpose
3. Applicability and Exemptions
4. Definitions
5. Authority and Responsibility of Health Officer
6. Owner,Operator,and Occupant Responsibility for Solid Waste
7. Unlawful Dumping,Depositing or Burning
8. Permits
•
8.1 Permit Required
8.2 Permit Applications
8.3 Permit Issuance
8.4 Permit Renewal
8.5 Department of Ecology Review
8.6 Permit Fees
8.7 Permit Conditions
8.8 Permit Suspension
9. Placement of Solid Waste During Emergencies
10. Inspections and Searches
11. Fee Schedule
12. Civil and Criminal Penalties
13. Performance of Work,Abatement and Liens
14. Hearings and Appeals
15. Waivers to this Chapter
16. Variances to Chapter 173-350 WAC
17. Conflict
18. Severability
The full text of the regulation will be mailed upon request by contacting the Jefferson County
Environmental Health Office at 615 Sheridan Street, Port Townsend, WA 98368 or(360) 385-
9444.
• JEFFERSON COUNTY BOARD OF HEALTH
\\Dan Titterness, Chairman
Draft
JEFFERSON COUNTY BOARD OF HEALTH
ORDINANCE NUMBER 2004-
SOLID WASTE REGULATIONS
•
•
Draft Solid Waste May 2004
Effective Date mm/dd/04
1
Draft
June 2004
0,1, e
Pertaining to the Management of Solid Waste
TABLE OF CONTENTS
Section Section Title Page
1. Authority 3
2. Purpose 3
3. Applicability and Exemptions 3
4. Definitions 4
5. Authority and Responsibility of Health Officer 6
6. Owner, Operator, and Occupant Responsibility for Solid 7
Waste
7. Unlawful Dumping, Depositing or Burning 7
8. Permits 9
8.1 Permit Required 9
8.2 Permit Applications 9
8.3 Permit Issuance 10
8.4 Permit Renewal 10 •
8.5 Department of Ecology Review 11
8.6 Permit Fees 11
8.7 Permit Conditions 11
8.8 Permit Suspension 12
9. Placement of Solid Waste During Emergencies 12
10. Inspections and Searches 12
11. Fee Schedule 13
12. Civil and Criminal Penalties 13
13. Performance of Work, Abatement and Liens 14
14. Hearings and Appeals 14
15. Waivers to this Chapter 14
16. Variances to Chapter 173-350 WAC 15
17. Conflict 15
18. Severability 15
•
Draft Solid Waste May 2004
Effective Date mm/dd/04
2
--)raft
• OiO!4 •. .,, * £t '..!:-:.:70116 Code
Pertaining to the Management of Solid Waste
1. Authority
1.1 These regulations have been adopted by the Jefferson County Board of Health
under the authority of Article XI,Section 11 of the Washington State Constitution,
Chapter 70.05 Revised Code of Washington (RCW),Chapter 70.95 RCW and,
Chapter 70.93 RCW.
1.2 The Jefferson County Board of Health retains the authority to hold hearings,
adopt findings and decide cases as authorized under the laws of the State of
Washington.
1.3 The Board may appoint a Hearing Officer to hold hearings and decide cases or
make recommendations for decisions,as determined by the Board and stated in the
letter of appointment by the Board.
2. Purpose
The purpose of these regulations is to prevent, control, mitigate, and correct the
• health hazards; nuisances, and the air,water, and land pollution associated with the
disposal of solid wastes, and to achieve compliance with Chapter 173-350-700 (2)
WAC.
3. Applicability and Exemptions
3.1 These regulations shall apply to all persons and in all territory within the
boundaries of Jefferson County, except actions by persons on lands under the
jurisdiction of the Federal Government or recognized Native American Nations and
Tribes.
3.2 Chapter 173-304 WAC, Chapter 173-350 WAC, Chapter 173-351 WAC, shall be
enforced by the Health Officer as applicable.
3.3 These regulations are intended to allow the Health Officer all of the authority
needed to implement and enforce the regulation of solid waste in Jefferson County.
All valid statutes and regulations that apply to the regulation and management of
solid waste in Washington State may be employed by the Health Officer when he or
she has cause to do so.
• 4. Definitions
Draft Solid Waste May 2004
Effective Date mm/dd/04
3
Draft
Agricultural Wastes: Non-dangerous wastes on farms resulting from the •
production of agricultural products including, but not limited to: crop residues,
manures, animal bedding, and carcasses of dead animals weighing each or
collectively in excess of fifteen (15) pounds.
Board of Health: or"the Board", the Jefferson County Board of Health.
Commercial Dumping: The dumping or depositing of commercially generated
solid waste.
Construction Waste: Non-dangerous solid waste, largely inert waste, generated as
the result of construction of buildings, roads, and other man-made structures.
Construction waste consists of,but is not limited to: concrete, asphalt,brick, rock,
wood and masonry,composition roofing and roofing paper, shakes, shingles,plastic
and paper wrappings, plastic pipe, fiberglass insulation, carpeting,floor tile, glass,
steel, and minor amounts of other metals.
Container: A portable device used for the collection, storage, and/or transportation
of solid waste including,but not limited to: re-useable containers, disposable
containers, and detachable containers.
County: Jefferson County,Washington •
Demolition Waste: Non-dangerous solid waste,largely inert waste,resulting from
the demolition or razing of buildings,roads and other man-made structures.
Demolition waste consists of, but is not limited to: concrete, asphalt,brick,rock,
wood and masonry, composition roofing and roofing paper, shakes, shingles, plastic
pipe,fiberglass insulation,carpeting,floor tile, glass, steel, minor amounts of other
metals, and incidental amounts of clean soil associated with these wastes. Plaster
(i.e., sheet rock or plaster board), yard wastes, stumpage, or any other materials that
are likely to produce gases or leachate during the decomposition process are not
considered to be demolition waste for the purposes of this definition. Additionally,
an item of waste having exterior dimensions (height+ length+ depth) in excess of 72
inches, waste items such as appliances, and asbestos-containing materials are not
considered to be demolition waste for the purposes of this regulation.
Department, or Jurisdictional Health Department: the Jefferson County Health and
Human Services Department.
Drop Box Facility: A facility used for the placement of a detachable container,
including the area adjacent for necessary entrance and exit roads, unloading and
turnaround areas. Drop box facilities normally serve the general public with loose •
Draft Solid Waste May 2004
Effective Date mm/dd/04
4
Draft
loads and receive waste from off-site. Drop box facilities may also include
• containers for separate or mixed recyclables, which need to be clearly labeled.
Ecology: the Washington State Department of Ecology.
Health Officer: the Jefferson County Health Officer as defined in RCW 70.05.010
and RCW 70.05.050, and/or his or her authorized representative.
Hearing Officer: the person authorized by the Health Officer to conduct appeal
hearings, or permit hearings, and to make findings and decisions from those
hearings.
Illegal Dumping: Any dumping or depositing of any type of solid waste in
violation of this Chapter or in violation of any applicable state law, state regulation
or County Ordinance.
Litter: All waste material including,but not limited to: disposable packages or
containers thrown or deposited as herein prohibited, and solid waste that is
illegally dumped,but not including the wastes of the primary processes of mining,
logging, saw-milling,farming, or manufacturing. This definition of"Litter"
includes the material described in subsection 13 as Potentially Dangerous Litter.
• Moderate Risk Waste (MRW): Solid waste that is limited to Conditionally Exempt
Small Quantity Generator (CESQG)Waste and Household Hazardous Waste
(HHW) as later defined in this regulation.
MRW Facility means a solid waste handling unit that is used to collect, treat,
recycle, exchange, store, consolidate, and/or transfer Moderate Risk Waste. This
does not include mobile systems and collection events or limited MRW facilities that
meet the applicable terms and conditions of Chapter 173-350 WAC-360 (2) or (3).
Notice and Order to Correct Violation: NOCV: This is an official notice sent by
the Department to the alleged violator, notifying him or her of the violation, and
laying out a timeframe for correction.
Nuisance: A condition created by unlawfully performing an act, or failing to
perform a legal requirement,which act or omission either annoys, injures or
endangers the repose,health or safety of others; or unlawfully interferes with,
obstructs or tends to obstruct, any lake or navigable river, bay, stream, canal or
basin, or any public park, square, street or highway; or in any way renders other
persons insecure in life, or in the use of any property. and any other act or
omission by a person or business entity that constitutes a nuisance according to
• state law.
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Person: Any individual, corporation, company, association, society,firm, •
partnership,joint stock company, other form of business entity, any branch of
federal, state, or local government or any other entity.
Potentially Dangerous Litter: Material that is likely to injure a person or cause
damage to a vehicle or any other real property. This includes, but is not limited to:
1. Cigarettes,cigars or other tobacco products that are capable of starting a fire;
2. Glass;
3. A container or other product made primarily of glass;
4. A hypodermic needle or other instrument designed to cut or pierce;
5. Raw human waste, including soiled diapers, regardless of whether the waste
is in a container of any sort; and,
6. Nails or tacks.
Problem Wastes:
1. Any solid material removed during a remedial action, a dangerous waste site
closure, other cleanup efforts, or other actions,which contain hazardous
substances, but are not designated "dangerous wastes";
2. Dredge spoils resulting from the dredging of surface waters of the state •
where contaminants are present in the dredge spoils at concentrations not
suitable for open water disposal and the dredge spoils are not dangerous
wastes and are not regulated by Section 404 of the Federal Clean Water Act
(PL 95-217); or
3. Waste abrasive blasting grit or other material used in abrasive blasting.
Common aggregates include, but are not limited to: silica sand,utility slag or
copper slag. "Waste abrasive blasting grit" does not include blasting grit that
will be reused for its intended purpose.
Solid Waste: All putrescible and non-putrescible solid and semi-solid wastes
including, but not limited to: garbage,rubbish, ashes, industrial wastes, swill,
construction and demolition wastes, land clearing wastes, abandoned vehicles or
parts thereof(including waste tires), and discarded commodities. This includes all
solid and semi-solid materials that are not the primary products of public, private,
industrial, commercial, mining and agricultural operations. Municipal sewage
sludge or septage is a solid waste when placed in a municipal solid waste landfill
subject to the requirements in Chapter 173-351 WAC, (Criteria for Municipal Solid
Waste Landfills),Chapter 173-308 WAC, (Biosolids Management), and a solid waste
handling permit issued by the Health Officer.
•
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Solid Waste Handling: The management, storage,collection, transportation,
• treatment,utilization, processing,and final disposal of solid waste, including the
recovery and recycling of materials from solid wastes, the recovery of energy
resources from solid wastes or the conversion of the energy in solid wastes to more
useful forms, or combinations thereof.
Vector: A living animal, including,but not limited to, insects, rodents, and birds,
which is capable of transmitting an infectious disease from one organism to another.
5. Authority and Responsibility of the Health Officer
5.1 The Health Officer of Jefferson County shall have the authority and
responsibility to implement and enforce these regulations as stated in Chapter 70.05
RCW, Chapter 70.95 RCW,Chapter 173-351 WAC, and Chapter 173-304 unless
repealed or superseded by Chapter 173-350 WAC.
5.2. The Health Officer shall have the authority to take action or bring any legal
proceeding as stated in RCW 43.70.190, including,but not limited to the special
proceedings authorized in Title 7,RCW(Special Proceedings and Actions).
5.3 The Health Officer,with the approval of the Board of Health, and/or the Board
of County Commissioners, may contract with Ecology to assume responsibility and
. authority for all or part of Chapter 70.93 RCW, as stated in RCW 70.93.050. The
Health Officer, subject to approval of the Board,shall also have the authority to
negotiate a contract with Ecology dividing or sharing responsibilities with other
entities as allowed by RCW 70.93.050.
5.4 The Health Officer and any Jefferson County department named in a contract, or
inter-local agreement as in section 5.3 above, shall have authority to enforce the
requirements and levy the penalties cited in RCW 70.93.060, according to the terms
of the contract. Citations shall be adjudicated as required by Title 7, RCW ("Special
Proceedings and Actions").
6. Owner,Operator and Occupant Responsibility for Solid Waste
6.1 The owners of any property, premises,business establishment, or industry shall
be responsible for the legal and satisfactory arrangement for the proper handling
and disposal of all solid waste generated or accumulated by them on the property.
Putrescible solid waste and any waste that attracts vectors shall be stored in
watertight containers with lids securely fastened.
6.2 The operators, occupants, or tenants of any property, premises,business
establishment, or industry shall be responsible for the legal and satisfactory
arrangement for the solid waste handling of all solid waste generated or
•
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accumulated by them on the property. Putrescible solid waste and waste that
attracts vectors shall be stored in watertight containers with lids securely fastened. •
6.3 It shall be unlawful for persons to allow or permit solid waste to be deposited on
or to remain on property or premises under their control without a permit as
required by this Chapter. The Health Officer is authorized to require the owners,
operators, occupants, tenants or other persons responsible for solid waste handling
to abate illegal dumping or disposal maintained on property under their control, as
part of a "Notice and Order to Correct Violation(NOCV)" issued because of these
regulations or other actions permitted by law.
7. Unlawful Dumping, Depositing or Burning
7.1 Violations and Exemptions. It shall be a violation of these regulations for any
person to dump or deposit or permit the dumping or depositing of any solid waste
onto or under the surface of the ground or into the waters of the state except at a
facility that is permitted to accept the solid waste:
(a) PROVIDED, that this Chapter does not apply to the facilities, activities and
wastes cited in WAC 173-350-020, "Solid Waste Handling Standards", when those
facilities, activities and wastes are in compliance with applicable standards and legal
requirements, and there has not been a violation of the performance standards as
discussed in WAC 173-350-040, or a health hazard or nuisance has not been created.
(b) The exemptions in section(a) above that may be applied to single family
residences or family farms is limited to twelve (12) cubic feet for any single family
residence lot or twelve (12) cubic yards per five (5) acres on acreage tracts to
accumulate no more than twenty-five (25) cubic yards per single family residence or
family farm.
(c) If any owner or operator of any solid waste facility, or exempt facility or
activity as cited in WAC 173-350-020 fails to comply with the performance standards
in WAC 173-350-040, the Health Officer may initiate any action authorized by or
cited in this Chapter.
7.2 Presumption. Whenever solid waste dumped in violation of Section 7.1 of this
regulation contains three (3) or more items bearing the name of one individual, there
shall be a rebuttable presumption that the individual whose name appears on such
items committed the unlawful act of solid waste dumping.
7.3 Burning of Solid Waste Prohibited. It shall be a violation of these regulations
for any person to burn solid waste in violation of Chapter 173-425 WAC and the
regulations of the Olympic Region Clean Air Agency. It shall be a violation of this
regulation for any person to cause or allow any open fire containing prohibited
materials which include, but are not limited to: garbage, dead animals, petroleum
products, paints,rubber products, plastics, paper(other than what is necessary to .
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• start a fire), cardboard, treated wood, processed wood, construction debris, metal or
any substance which,when burned, releases toxic emissions, dense smoke or
obnoxious odors.
7.4 Disposal Service Required. When a person does not dispose of solid wastes in a
manner consistent with these regulations, the Health Officer may order said person
to obtain ongoing and regularly scheduled solid waste collection service if said
person does not already have this service and if a solid waste collection service
exists or is offered in the geographic area where the person resides. If said person
does not have this service and resides in a geographic area where a single solid
waste collection service operates exclusively under covenant or ordinance as
required by local government, and said service is mandatory for persons residing
within the jurisdiction of the local government, the Health Officer may schedule
ongoing regularly scheduled service for said person with this solid waste collection
service. If service is cancelled through nonpayment, it will be deemed a violation of
this paragraph.
7.5 Disposal Receipts Required. Any person in violation to whom a "Notice and
Order to Correct Violation(NOCV)" has been issued is required to produce receipts
from a permitted solid waste disposal, recycling and/or reclamation facility or solid
waste transporter to demonstrate compliance with the NOCV issued by the
• Department.
8. Permits
8.1 Permit Required. No solid waste disposal site or facility in Jefferson County
shall be maintained, established, substantially altered, expanded, or improved until
the county, city or other person operating or owning such site or facility has
obtained a permit from the Department.
8.1.1 Only persons complying with these regulations, Chapter 173-350 WAC,
Chapter 173-351 WAC,the Jefferson County Comprehensive Solid Waste
Management Plan (JCCSWMP), applicable county/city ordinances, and the
conditions of the issued solid waste permit shall be entitled to receive or maintain
such a permit.
8.1.2 The Health Officer may require a permit, or take other enforcement action,for
any site or facility handling fifty (50) cubic yards or more of any solid waste as
stated in Chapter 173-350-020 WAC, if the handling of the solid waste at the site or
facility poses risk of environmental degradation(including, but not limited to:
surface or ground water pollution, air pollution or methane generation) or has
potential impacts on public health.
• 8.2 Permit Applications
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8.2.1 Applications for new or expanded solid waste disposal sites or facilities shall •
be submitted on a form approved by the Health Officer in accordance with Chapter
173-350 WAC and/or Chapter 173-351 WAC. Filing shall not be complete until the
Department has received:
(a) two copies of the completed application and attachments signed by the
property owner and applicant,
(b) the Department has evaluated application materials to ensure all required
information has been included,
(c) the applicant has filed an environmental checklist required under the State
Environmental Policy Act(SEPA) rules,Chapter 197-11 WAC,completed all
hearing requirements of County SEPA and land-use regulations, and
(d) the applicant has paid all applicable review fees.
8.2.2 Permit applications for solid waste facilities shall be prepared by a licensed
civil or sanitary engineer with experience in the areas necessary for submitting
acceptable solid waste designs and specifications. Applications shall comply with
the requirements of Chapter 173-350-710 WAC and Chapter 173-350-715 WAC. The
Health Officer may exempt certain solid waste facilities from the engineering design
requirements depending upon the nature and type of solid waste material handled.
8.2.3 The Health Officer may request additional information if it is deemed
necessary for consideration of an application. The permit application shall not be •
considered complete, and the ninety (90) day review period started until all required
and requested information as required by WAC 173-350-700(1)(a) and WAC 173-
350-715 has been received by the Department.
8.2.4 When the application is complete, the Department shall forward one copy of
the complete application to Ecology for a forty-five (45) day review,as discussed in
WAC 173-350-710(1)(c)(i).
8.2.5 Every completed solid waste permit application shall be approved or
disapproved within ninety (90) days after its receipt by the Department or the
applicant shall be informed as to the status of the application.
8.3 Permit Issuance
8.3.1 The Health Officer may issue a permit for a period of up to five years when it
has been determined that the facility meets the requirements of these regulations
and all other applicable laws and regulations, conforms with the approved
JCCSWMP, and complies with applicable county/city ordinances. The initial period
of validity shall be determined by the Health Officer, and may be based on the
Health Officer's need to determine adequacy of compliance with permit conditions
or may be based on the stages of development of the solid waste facility, or other •
aspects of the permitted facility.
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. 8.3.2 Permit issuance shall comply with Chapter 173-350 WAC-710 (2) and,Chapter
173-351 WAC, or Chapter 173-304 WAC, as applicable. Permits will be valid from
February 1 through January 31st of each calendar year.
8.3.3 Post-closure permits shall comply with Chapter 173-350 WAC,WAC 173-351,
and all conditions contained in the post-closure plan.
8.3.4 The permit shall be displayed at the solid waste facility at all times of
operation.
8.4 Permit Renewal
8.4.1 The owner or operator of a facility shall apply for renewal of the facility's
permit thirty (30) days prior to permit expiration, in accordance with Chapter 173-
350-710 WAC, Chapter 173-351 WAC, or Chapter 173-304 as applicable, and these
regulations. Previous information submitted to the Department may be referred to
on the application forms. Changes in operating methods or other changes must be
noted on the application in order to be authorized by permit, unless the changes in
operating methods are at the direction of the Health Officer.
8.4.2 The renewal application will be reviewed for compliance with these regulations
• and all other applicable regulations. Other information from inspections,
complaints, or known changes in the operations will also be reviewed.
8.4.3 Every completed solid waste permit renewal application shall be approved or
disapproved within forty five (45) days after its receipt by the Department, or the
applicant shall be informed as to the status of the application.
8.4.4 Any facility not in complete conformance with these regulations or arty other
applicable regulations may be made subject to a Performance Contract.
8.4.5 All facilities subject to post-closure permits and conditions are also subject to
modification if site conditions or monitoring results indicate the need for changed
permit conditions.
8.5 Department of Ecology Reviews. All solid waste facility permits issued or
renewed will be forwarded within seven days of issuance to the Department of
Ecology for a thirty (30) day review. Upon review, Ecology may appeal the
Department issuance or renewal of a solid waste facility-operating permit to the
State Pollution Control Hearings Board, as stated in RCW 70.95.185 and RCW
70.95.190.
• 8.6 Permit Fees.
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8.6.1 An annual permit fee shall be charged as specified in the fee schedule adopted
by the Jefferson County Board of Health. .
8.6.2 Facilities that continue operation past January 31st of the permit year without
having paid all required fees shall be considered a) not to have a valid permit,b)
may be considered in violation of this regulation and/or c) may be ordered closed
by the Health Officer.
8.6.3 Facilities monitored under a post-closure permit shall pay annual fees as
required by the adopted fee schedule.
8.7 Permit Conditions
8.7.1 Each permit issued by the Department may include conditions set by the
Health Officer. The conditions of the permit shall assure that the permitted facility
conforms with the purpose and objectives of this regulation.
8.7.2 The conditions that may be set by the Health Officer include, but are not
limited to:
(a) compliance schedules
(b) types and quantities of wastes accepted;
(c) operating procedures;
(d) scheduling and hours of operation;
•
(e) types and frequency of any environmental monitoring;
(f) addition of pollution control and reduction systems;
(g) other relevant conditions that have been identified by the SEPA compliance
review process;
(h) conditions based on the inspection of the facility or the review of the facility at
the time of permit renewal; and
(i) conditions based on the results of required facility environmental monitoring
data.
8.7.3 The conditions under which the permit is granted shall be specified in writing
and shall be in addition to applicable regulations and approved operating plans and
specifications included in the solid waste application. In the absence of any
additional conditions set forth by the Health Officer, the approved operating plans
and specifications shall constitute the conditions of the solid waste facility operating
permit.
8.8 Permit Suspension
The Health Officer may suspend all or part the activity permitted by a solid waste
permit upon discovery of actions or physical conditions that are a violation of these
regulations, state solid waste laws, or the conditions of the issued permit.
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9. Placement of Solid Wastes During Emergencies
•
9.1 Upon request, the Health Officer may allow the transportation and storage of
solid wastes to a location approved by the Health Officer during or after an
emergency. The materials that may be so placed include building materials and
foundations,utility pipes,wires, materials from roads and bridges,materials from
floods or landslides or other geologic events,materials from fires or explosions, or
other materials as determined by the Health Officer.
9.2 The purpose of allowing this emergency transportation and storage is to allow
the clean up or restoration of critical community facilities in a timely fashion while
reserving the right to make further changes at a later time.
9.3 The Health Officer may limit the nature and quantity of materials so placed in
order to prevent health hazards, nuisances or other issues cited in these regulations.
9.4 The Health Officer may require the subsequent removal or relocation of any
materials found to be unsuitable for long-term storage or disposal on the originally
approved location.
10. Inspections and Searches
10.1 Inspections and Searches of Permitted Facilities. All facilities that have
• applied for a solid waste permit or have received a solid waste permit have by
accepting the permit consented to and are subject to inspection by the Health
Officer without notification. These inspections are necessary to determine
compliance with permit conditions, and to prevent the hiding or burying, or
improper destruction of materials subject to those conditions. The Health Officer
may enter and inspect and take samples at any such facility or location, private or
public, at any reasonable time or during the facility's regular business hours to
determine compliance with legal, permit, or environmental conditions. For this
purpose,facilities include all real property, buildings, equipment,vehicles, storage
containers, and structures related to waste handling, and all records, both print and
electronic,that are related to the reception, storage, handling or disposition of solid
waste materials.
10.1.1 The Health Officer may require that solid waste permit applicants or permit
holders produce records for inspection.
10.1.2 The Health Officer shall notify all applicants for solid waste permits and all
holders of solid waste permits that they are subject to inspection as in section(1)
above. A similar notice shall be included in all issued solid waste permits.
10.1.3 The Health Officer may only release records to the public when such release
•
is in compliance with Chapter 42.17 RCW.
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10.2 Obtaining a Search Warrant. If the Health Officer is refused entry to any •
facility as in 10.1 above,he or she may seek and obtain a search warrant from a
court of competent jurisdiction. A non-specific search warrant may be issued by
the court because of the extremely variable nature of solid waste and because solid
waste disposal is a pervasively regulated industry.
10.3 Inspections and Searches Not Associated with Permitted Facilities. The
Health Officer may view and inspect the areas outside the buildings of private or
public property at any reasonable time when he or she has cause to believe that a
violation of these regulations has occurred or is occurring. Said viewing and
inspecting must occur from a public right-of-way or from an adjacent property if
the owner or occupier of that adjacent property has given his, her or its consent.
10.3.1 The Health Officer may inspect any location on property or premises,
including,but not limited to,the interiors of buildings or structures,when granted
permission by the property owner or person in control of the property or having
obtained and presented a valid search warrant issued by the court. The Health
Officer may seek and the court may issue a search warrant based on probable cause
that a violation exists without first seeking voluntary permission for access or entry.
11. Fee Schedule
0
The Board of Health shall adopt a fee schedule and revise as needed, covering the
permit and service categories relevant to the solid waste program. Categories shall
include,but not be limited to: permits, penalties,waivers, services, and appeals.
12. Civil and Criminal Penalties
12.1 Civil infractions shall be imposed pursuant to Chapter 7.80 RCW, Chapter
70.93 RCW, Chapter 70.95 RCW,Chapter 173-350 WAC, and Chapter 173-351 WAC,
and these regulations. Appeals to such citations shall be in the appropriate court,
i.e., either the Jefferson County District Court or the Jefferson County Superior
Court, according to which court has jurisdiction. All lawful enforcement options,
including judicial solutions, may be used to enforce state law or regulation or any
local ordinance as stated in the Jefferson County Policy on Complaint Review and
Enforcement, Resolution No 42-03.
12.2 The Health Officer shall work cooperatively with the Washington State
Department of Ecology, the Jefferson County Sheriff and the Jefferson County Code
Enforcement Officers to implement the enforcement in section(1) above.
13. Performance of Work,Abatements and Liens
•
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Failure to comply as directed by an order of the Health Officer may result in efforts
4111 by the Health Officer to mitigate actual or potential health risks, environmental
risks or public nuisances by:
13.1 performing necessary corrective work and billing the cost of that work to the
violator (or the violator's heirs or assigns) at established rates; or,
13.2 contracting with qualified firms or persons to perform said work or any
combination of 13.1 and 13.2. Billings for work performed under this Section shall
be sent to the violator and payment is required within thirty (30) days. If a bill is
not paid within the given time period,the County Assessor may be directed to
attach this bill to the property as a special assessment with the same priority as real
estate taxes and with the same ability on the part of the County to foreclose. Final
settlement of this lien may include interest of 8% per annum on the lien amount.
14. Additional Health Hazards and Solid Waste Deposits--Abatement, Control or
Reduction-- Summary Action--Recovery of Costs.
(1) The owner of land where a health hazard or an illegal solid waste
accumulation exists and the person responsible for the existence of a health hazard
or illegal solid waste accumulation shall take reasonable measures to reduce the
dangers associated with the health hazard or solid waste accumulation from the area
• and may abate the hazard by actions approved by the Health Officer.
(2) The Department shall use these regulations and existing solid waste and
litter control laws when directing a person responsible to abate an accumulation of
solid waste.
(3) The owners or persons responsible for the existence of the health hazard or
solid waste accumulation are required to abate, control or reduce the hazard. The
duty to abate, control, or reduce, and liability under this, arises upon creation of the
health hazard or illegal solid waste accumulation. Liability shall include, but not be
limited to, all enforcement and administrative expenses incurred by the Department,
regardless of cause.
(4) If the owner or person responsible for the existence of the health hazard or
illegal solid waste accumulation subject to these regulations refuses, neglects, or
unsuccessfully attempts to abate,control, or reduce the same, the Department may
summarily abate,control, or reduce the health hazard or remove the solid waste
accumulation as required by these regulations and recover two times the actual cost
thereof from the owner or person responsible. The Department's reserve account
monies may be used for this purpose,when available. Monies recovered by the
Department pursuant to these regulations shall be returned to the Health
Department reserve account.
(5) Such costs shall include all salaries and expenses of people and equipment
incurred therein, including those of the Department. All such costs may also be a
•
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lien upon the land enforceable in the same manner with the same effect as a
mechanic's lien. •
(6) The summary action may be taken only after twenty-one (21) days' notice in
writing has been given to the owner or reputed owner of the land on which the
health hazard or illegal solid waste accumulation exists. The notice shall include a
suggested method of abatement and estimated cost thereof. The notice shall be by
personal service or by registered or certified mail addressed to the owner or reputed
owner at the owner's last known place of residence.
(7) Billings for work performed under these regulations shall be sent to the
violator and payment is required within thirty (30) days. If a bill is not paid within
the given time period, the County Assessor may be directed to attach this bill to the
property as a lien. Final settlement of this lien shall include interest of eight percent
(8%) per annum on the lien amount.
15. Hearings and Appeals
The Health Officer will act as the Hearings Officer or will appoint a delegate to the
position.
(a) (1) Appeal of Solid Waste Permit Decisions. Any solid waste
permit applicant or owner of property on or for which a solid waste permit
has been submitted or issued, or a person whose property is adjacent to
property subject to the solid waste permit, or other person who is aggrieved
by a permit issuance, permit denial, permit suspension, or action by the •
Health Officer, shall have the right to appeal the matter and have a hearing
before a Hearings Officer authorized by the Board to conduct such hearings.
Any such appeal must be made within ten (10) days of service of the NOCV,
Abatement Order or other lawful notice to the owner, occupier or operator.
The appeal will conform to the requirements of WAC 173-350 and these
regulations. The decision of the Hearing Officer regarding solid waste permits
or notice or order may be appealed to the Board of Health. Any action to
review the Hearing Officer's decision must be filed within thirty (30) days of
the date of the decision. Except for conditions causing risks to human health
or safety, appeals shall act as a stay of the Health Officer's decision or order.
Hearing Officer Administrative Hearing. Any person aggrieved by a permit
decision or notice or order of the Health Officer may request, in writing, a
hearing before the Hearing Officer. The appellant shall submit specific
statements in writing of the reason why error is assigned to the decision of the
Health Officer. Such request shall be presented to the Hearing Officer within
ten (10) days of the action appealed. Upon receipt of such request, together
with any applicable hearing fees, the Hearing Officer shall notify the
appellant, and permit holder or applicant, if different from the appellant,in
writing of the time, date, and place of such hearing, which shall be set at a
mutually convenient time not less than twenty (20) days nor more than fifty
(50) days from the date the request was received. The Hearing Officer will •
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issue a decision affirming, reversing, or modifying the Health Officer's
• decision, which has been appealed. The Hearing Officer may require
additional actions as part of the decision.
(b) Hearing Procedures. Hearings shall be open to the public and presided
over by the Hearing Officer. Such hearings shall be recorded. Hearings shall
be opened with a recording of the time, date and place of the hearing and a
statement of the cause for the hearing. The Hearing Officer shall then swear
in all potential witnesses. The case shall be presented in the order directed by
the Hearing Officer. The appellant may present rebuttal. The Hearing Officer
may question either party. The Hearing Officer may allow for a closing
statement or summation. General rights include:
(i) To be represented by an attorney;
(ii) To present witnesses;
(iii) To cross-examine witnesses;
(iv) To object to evidence for specific grounds. In the conduct of the
proceeding, the Hearing Officer may consider any evidence,
including hearsay evidence that a reasonably prudent person
would rely upon in the conduct of his or her own affairs.
Evidence is not admissible if it is excludable on constitutional or
statutory grounds or on the basis of evidentiary privilege
recognized in the courts of this state. The Hearing Officer shall
• decide rulings on the admissibility of evidence, and the
Washington State "Rules of Evidence" shall serve as guidelines for
those rulings but need not be strictly followed.
(c) Record. Inasmuch as any appeal to the Board of Health from a Hearing
Officer's decision is a review on the record,the Hearing Officer shall ensure
that the record generated contains all testimonial and documentary evidence
supporting the Hearing Officer's issuance of the hearing decision.
The Hearing Officer may continue the hearing to another date to allow for
additional submission of information or to allow for additional consideration.
The Hearing Officer shall issue his/her oral ruling on/or before the tenth
business day after the hearing closes. The appellant shall bear the burden of
proof and may challenge the permit decision based on the preponderance of
the evidence.
(d) Appeals. Any decision of the Hearing Officer shall be final and may be
reviewable by an appeal filed with the Board of Health. Any action to review
the Hearing Officer's decision must be filed within thirty (30) days of the date
of the decision.
(2) Appeal of Decision of the Hearing Officer Regarding Solid Waste
Permits.
(a) Any solid waste permit applicant or owner of property on or for which a
solid waste permit has been submitted or issued, or a person whose property
• is adjacent to property subject to the solid waste permit, or other person who
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is aggrieved by a permit issuance, permit denial, permit suspension, or action
by the Health Officer,or aggrieved by the findings, conclusions or orders of •
the Hearing Officer shall have the right to appeal the matter by requesting a
hearing before the Board of Health. Such notice of appeal shall be in writing
and presented to the clerk of the Board of Health within thirty (30) days of the
Hearing Officer's decision. The appellant shall submit specific statements in
writing of the reason why error is assigned to the decision of the Hearing
Officer.
(b) The decisions of the Hearing Officer shall remain in effect during the
appeal. Any person affected by the solid waste permit decision may make a
written request for a stay of the decision to the Hearing Officer within five (5)
business days of the Hearing Officer's decision. The Hearing Officer will then
grant or deny the request within five (5) business days.
(c) Upon receipt of a timely written notice of appeal, the clerk of the Board of
Health shall set a time, date, and place for the requested hearing before the
Board of Health and shall give the appellant written notice thereof. Such
hearing shall be set at a mutually convenient time not less than twenty (20)
days or more than fifty (50) days from the date the appeal was received by the
clerk of the Board of Health unless mutually agreed to by the appellant and
clerk of the Board of Health.
(d) Board of Health hearings shall be open to the public and presided over
by the Chair of the Board of Health. Such hearings shall be recorded. Board •
of Health hearings shall be opened with a recording of the time, date and
place of the hearing and a statement of the cause for the hearing. The hearing
shall be limited to argument of the parties and no additional evidence shall be
taken unless, in the judgment of the Chair, such evidence could not have
reasonably been obtained through the exercise of due diligence in time for the
hearing before the Hearing Officer. Arguments shall be limited to the record
generated before the Hearing Officer unless the Chair admits additional
evidence hereunder.
(e) Any decision of the Board of Health regarding the appeal of a decision by
the Hearing Officer or the Health Officer relative to a solid waste permit shall
be final and may be appealed to the Pollution Control Hearings Board
pursuant to RCW 70.95.210.
(3) Appeal to Hearing Officer of a Solid Waste Violation Not Associated with
a Permitted Facility.
(a) Stay of Corrective Action. The filing of a request for a hearing pursuant
to this section shall operate as a stay from the requirement to perform
corrective action ordered by the Health Officer while the hearing is pending,
except there shall be no stay from the requirement for immediate compliance
with an emergency order issued by the Health Officer or from the
requirements regarding human health and safety.
4111
Draft Solid Waste May 2004
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18
Draft
(b) Hearing Officer Administrative Hearing. The owner or occupant of
IDproperty on or for which a solid waste violation has been submitted or
issued, or a person whose property is adjacent to property subject to the solid
waste violation, or other person aggrieved by a notice and order to correct a
violation may request, in writing, a hearing before the Hearing Officer. The
appellant shall submit specific statements in writing of the reason why error
is assigned to the decision of the Health Officer. Such request shall be
presented to the Hearing Officer within ten (10) days of the action appealed.
Upon receipt of such request, together with any applicable hearing fees, the
Hearing Officer shall notify the person in writing of the time, date, and place
of such hearing,which shall be set at a mutually convenient time not less than
twenty (20) days nor more than fifty (50) days from the date the request was
received. The Hearing Officer will issue a decision affirming,reversing, or
modifying the "Notice and Order to Correct Violation". The Hearing Officer
may require additional actions as part of the decision.
(c) Hearing Procedures. Hearings shall be open to the public and
presided over by the Hearing Officer. Such hearings shall be recorded.
Hearings shall be opened with a recording of the time, date and place of the
hearing and a statement of the cause for the hearing. The Hearing Officer
shall then swear in all potential witnesses. The case shall be presented in the
order directed by the Hearing Officer. The appellant may present rebuttal.
. The Hearing Officer may ask questions. The Hearing Officer may allow the
opportunity for a closing statement or summation.
General rights include:
(i) To be represented by an attorney,
(ii) To present witnesses,
(iii) To cross-examine witnesses,
(iv) To object to evidence for specific grounds. In the conduct
of the proceeding, the Hearing Officer may consider any evidence, including
hearsay evidence that a reasonably prudent person would rely upon in the
conduct of his or her affairs. Evidence is not admissible if it is excludable on
constitutional or statutory grounds or on the basis of evidentiary privilege
recognized in the courts of this state. The Health Officer shall decide rulings
on the admissibility of evidence, and the Washington"Rules of Evidence"
shall serve as guidelines for those rulings,but need not be strictly followed.
Inasmuch as any appeal to the Board of Health from a Hearing Officer's
decision is a review on the record,the Hearing Officer shall ensure that the
record generated contains testimonial and documentary evidence supporting
the hearing officer's issuance of the "Notice and Order to Correct Violation".
The Hearing Officer may continue the hearing to another date to allow for
additional submission of information or to allow for additional consideration.
Written findings of fact,conclusions of law and orders shall be served on the
• appellant within ten (10) business days of the oral ruling. The appellant shall
Draft Solid Waste May 2004
Effective Date mm/dd/04
19
Draft
bear the burden of proof and may overcome the "Notice and Order to Correct
Violation" by a preponderance of the evidence.
(d) Appeals. Any decision of the Hearing Officer shall be final and may be
reviewable by an appeal filed with the Board of Health. Any action to review
the Hearing Officer's decision must be filed within thirty (30) days of the date
of the decision.
(4) Appeal of Decision of Hearing Officer Regarding Solid Waste Violation Not
Associated with a Permitted Facility.
(a) The owner or occupant of property on or for which a solid waste
violation has been submitted or issued, or a person whose property is
adjacent to property subject to the solid waste violation, or other person
aggrieved by a NOCV may appeal the decision of the Hearing Officer by
requesting a hearing before the Board of Health. Such notice of appeal shall
be in writing and presented to the clerk of the Board of Health within thirty
(30) days of the Hearing Officer's decision. The appellant shall submit
specific statements in writing of the reason why error is assigned to the
decision of the hearing officer.
(b) The decisions of the Hearing Officer shall remain in effect during
the appeal. Any person affected by the NOCV may make a written request
for a stay of the decision to the Hearing Officer within five (5) business days
of the Hearing Officer's decision. The Hearing Officer will grant or deny
the request within five (5) business days. .
(c) Upon receipt of a timely written notice of appeal, the clerk of the
Board of Health shall set a time, date, and place for the requested hearing
before the Board of Health and shall give the appellant written notice
thereof. Such hearing shall be set at a mutually convenient time not less
than twenty (20) days or more than fifty (50) days from the date the appeal
was received by the clerk of the Board of Health unless mutually agreed to
by the appellant and the Board of Health.
(d) Board of Health hearings shall be open to the public and presided
over by the Chair of the Board of Health. Such hearings shall be recorded.
Board of Health hearings shall be opened with a recording of the time, date
and place of the hearing, and a statement of the cause for the hearing. The
hearing shall be limited to argument of the parties and no additional
evidence shall be taken unless, in the judgment of the Chair, such evidence
could not have reasonably been obtained through the exercise of due
diligence in time for the hearing before the Hearing Officer. Argument shall
be limited to the record generated before the Hearing Officer unless the
Chair admits additional evidence hereunder.
(e) Any decision of the Board of Health regarding the Health Officer's
actions not related to permitted facilities shall be final and may be
reviewable by an action filed in Superior Court. Any action to review the
•
Draft Solid Waste May 2004
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20
„
Draft
Board's decision must be filed within thirty (30) days of the date of the
decision.
16.Waivers to Provisions of this Regulation
Whenever a strict interpretation of provisions of this regulation,which are not
required by Chapter 173-350 WAC,would result in extreme hardship,the Health
Officer or an appointed Hearing Officer may waive the provision(s) causing
extreme hardship in accordance with the provisions of this regulation. Provisions
required under state laws or regulations may not be waived without written
concurrence from the Department of Ecology or other applicable state agencies.
17. Variances to Chapter 173-350 WAC
Any person who owns or operates a solid waste handling facility subject to a solid
waste permit may apply to the Department for a variance as stated in Chapter 173-
350 WAC-710 (7).
18. Conflict
Whenever a conflict between statutes, or regulations is discovered or is alleged, the
Health Officer shall interpret the laws and conditions and shall take an action that
protects public health and is the most compatible with this regulation.
19. Severability
If any section of this regulation or its application to any particular person and/or
circumstance is held to be invalid,the remainder of this regulation and its
application to other persons and/or circumstances shall not be affected.
Effective Date.
The effective date of this regulation shall be July 15, 2004.
ADOPTED this day of 2004
JEFFERSON COUNTY BOARD OF HEALTH JEFFERSON COUNTY HEALTH
OFFICER
Dan Titterness, Chair Thomas H. Locke, M.D.
• Date Date
Draft Solid Waste May 2004
Effective Date mm/dd/04
21
•
Board of Health
New Business
Agenda Item # V., 2
•
Breast Feeding and Public Health
July 15, 2004
•
.
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and Public
Health in the United States
The medical community has I Jacqueline H.Wolf,PhD
orchestrated breastfeeding cam-
paigns in response to low breast- IN THE EARLY 20TH CENTURY, _ ing rates continued to generate With breastfeeding campaigns
0 feeding rates twice in US history. as part of the national campaign public health problems,the link on the horizon after a century-
The first campaigns occurred in to lower infant mortality,public between human milk and human long hiatus,the original crusades
the early 20th century after re- health officials around the country health was less obvious.Only re- are worth examining.The old
formers linked diarrhea,which hung posters in
tub neighbor- cently has this relationship be- campaigns can teach the archi-
caused the majority of infant hoods urging mothers to breast- come evident again as contempo- tects of breastfeeding promotions
deaths,to the use of cows'milk feed or to avoid feeding their ba-, rary research demonstrates that today that,as important as breast-
as an infant food. bies the spoiled,adulterated cowsexclusive breastfeeding for 6 feeding is to health,cultural
Today,given studies showing milk that pervaded US cities.The months and prolonged breast- norms often override healthy ac-
language on the posters was un- feeding thereafter is key to main- tivities.If breastfeeding initiation,
that numerous diseases and con-
ambiguous.One commanded,"To taining children's and women's exclusivity,and duration rates are
ditions can be prevented or lim lessen baby deaths let us have health.Extended breastfeeding to increase in the United States,
ited in severity by prolonged more mother-fed babies.You can't not only reduces the incidence in breastfeeding mothers need un-
breastfeeding,a practice shunned improve on God's plan.For your children of acute illnesses such as ambiguous medical,social,and
by most American mothers,the baby's sake—nurse it!"'Another, diarrhea,ear infections,pneumo- cultural support.
medical community is again in- which explained the importance nia,and meningitis,it lessens the
augurating efforts to endorse of home pasteurization and keep- occurrence of chronic diseases CHANGE IN INFANT
breastfeeding as a preventive ing cows'milk on ice if a mother and conditions such as sudden FEEDING PRACTICE
health measure. did not breastfeed,pleaded,"Give infant death syndrome(SIDS),
This article describes infant the Bottle-Fed Baby a Chance For obesity,childhood leukemia, In the 1880s,women began in
feeding practices and resulting Its Life!"' asthma,and lowered IQ.And large numbers to supplement
public health campaigns in the By the late 1920s,with laws women who practice prolonged their own milk with cows'milk
early 20th and 21st centuries in most municipalities mandating breastfeeding enjoy significantly shortly after giving birth and to
the pasteurization and hygienic reduced rates of breast cancer. wean their babies from the
and finds lessons in the original handling of cows'milk,the urban These studies have spurred re- breast before they were 3
campaigns for the promoters of breastfeeding campaign disap- newed interest in publicizing the months old.This represented a
breastfeeding today. peared.Although low breastfeed- importance of breastfeeding. stark change from the colonial
•
2000 I Public Health Then and Now I Peer Reviewed I Wolf American Journal of Public Health I December 2003,Vol 93,No.12
t- _,
era,when mothers normally about feeding them."'New ex- for this difference in mortality is
breastfed at least through infants' pectations for marriage,based that stay-at-home working moth-
second summer.'The move to less on economics and procre- ers breastfed.12 The disparity cor-
early weaning was so relentless ation and more on love and corn- roborates other studies con-
that doctors complained bitterly panionship,influenced middle- ducted at the time that indicated .
in a 1912 issue of the Journal of class women's infant feeding that babies fed cows'milk died at
the American Medical Association practices as their connection with much higher rates than breastfed
that breastfeeding duration rates their husbands began to eclipse babies."
had been declining steadily since their relationship with their in-
the mid-19th century"and now it fants.As one woman wrote to a INFANT FEEDING AND
is largely a question as to magazine on behalf of her preg- INFANT HEALTH
whether the mother will nurse nant daughter in 1886,"She
her baby at all."' wants to be more of a compan- Although the reasons for cows'
Middle-class mothers corrobo- ion for her husband than she milk feeding differed significantly
rated this observation.They often could be if she should nurse according to class,the move to
referred in letters and diaries to Baby;and...we wonder if it cows'milk negatively affected
"feeding"their babies,a short- would not be best for all that the the health of all infants.Cone-
s
ened version of the term"hand- little one be fed."t0 quently,physicians unanimously
feeding,"meaning offering some- Economic factors were the pri- decried the"trouble and dangers
thing other than the breast, mary force behind the infant of artificial feeding.""The Ladies'
usually cows'milk,to an infant.
One mother demonstrated just
how commonplace hand-feeding Today's medical community recognizes what their
was becoming when she wrote
nonchalantly of her 3-month-old predecessors knew a century ago—that the
in 1884,"I feed her a little now."'
Another mother explained to the American propensity to shun human milk is
readers of Babyhood magazine in
} 1887,"We have just welcomed a public health problem and should
our sixth baby,and,as our babies •
need to be fed after the third be exposed as such.
month,we are feeding this baby
after the second week from its
birth."'Josephine Laflin,a wealthy feeding habits of working-class Home Journal admonished moth-
Chicago mother,reported in her mothers.Women who worked ers in 1900,"Cow's milk is the
diary in 1903 that she"decided outside the home had no choice food of the calf....It is the viola-
to feed"her 10-week-old.' but to leave their infants with tion of these laws of Nature
This custom of"feeding"cows' grade-school daughters and artifi- which produces the so-called
milk to tiny infants was not lim- cial food."Samuel Preston and 'cholera infantum'[infant diar-
iced to women of means,how- Michael Haines offer as evidence rhea]and the other diseases of
ever.Upper-,middle-,and work- of this phenomenon statistics the second summer."16 Mothers
ing-class women alike—albeit from late-19th-century Baltimore, of means customarily alleviated
prompted by different social,eco- where the mortality rate was the ramifications of artificial
nomic,and cultural factors—all 590/0 higher than average among feeding by hiring a wet nurse to =
participated in this practice' infants whose mothers worked rescue their sick babies.Work-
Upper-class women customarily outside the home and 5%lower ing-class mothers,however,could
turned their babies over to ser- than average among babies not afford that luxury,and the
vants,precluding breastfeeding. whose mothers worked at results were obvious.16 In
As one typical wealthy father ex- home—taking in laundry and Chicago in the summer of 1909,
plained in 1893,nurses had cooking meals for unmarried public health workers identified Far left:A Chicago Infant Welfare
of
cared for all 4 of his children, men,for example.Preston and the location of everyinfant deathSociety nurse talks with urtesys f
p infants in 1911.Photo courtesy of
hence his wife"knew nothing Haines contend the likely reason from diarrhea,and the resulting Chicago Historical Society.
December 2003,Vol 93,No.12 l American Journal of Public Health Wolf Peer Reviewed Public Health Then and Now l 2001•
s
map indicated that infants living miserable condition."In all his ties but the kitchen is so nasty
in congested immigrant neigh- experiments,Coit discovered that that even the water in the tea
borhoods died at much higher newborn animals fed the milk of kettle is greasy."The baby's diar-
rates from the disease than ba- another species"were inferior to rhea did abate for a time under
bies living in wealthier neighbor- the breast-fed animals,both at his mother's care,and Mayme
hoods." the time of the experiment and wrote happily one day,"Baby is
Chicago's in- afterwards."22 real well.He has a quart of milk
• ,° fant mortality Some doctors experienced the a day and sometimes we have to
' t e statistics typified difficulties of artificial feeding on water it to make it hold out till
a r _' the nationwide a personal as well as professional the milk man comes at seven....
_ crisis In 1897, level.When pediatrician Dorothy He is the happiest and best today
�N18%of Chicago's Reed Mendenhall's son,John, that he has been yet since he
aux
'. babies died be- was 2 weeks old in 1912,she began to ail."However,James
fore their first and a nurse drove from Chicago, Glover did not survive his first
../ -"-l-
e f - birthday and where John was born,to Madi year.'-4
,, t. _ ' _ , ,� Wis,than 53% son, s,where Mendenhall
4''..??1',."..:.,1/41.., ' "` ; of the dead died lived.It was a very hot day and CAMPAIGNS FOR "MORE
t, ,. r ,I' of diarrhea.18 during the long car ride the baby MOTHER-FED BABIES"
t ),, ..''?,1,:*.-- - ! The Chicago De- suffered convulsions.As AND PURE COWS' MILK
1 partment of Mendenhall recalled years later,
Healthesti "The excitement of the trip and The poor health of artificially
i - € =. mated that 15 my apprehension for John,dried fed infants spawned widespread
- ., w a hand-fed babies up my milk and I never could recognition by the 1910s.Two
„ ;e' .'' %' ,;: ° .4.! were dying for furnish another drop."Forced to sets of public health campaigns
-*---'.."4 a '-* "`ry every 1 breast- resort to cows'milk,she corn- resulted.One,designed almost
```"l .. = ---.6.-
, t e_'' fed baby.'9 One plained,"I literally took his milk solely by local public health offi-
exasperated apart and put it together again.I cials,urged mothers to breast-
Typical dairy barn with filthy floor, physician,after railing against had him on fat free,sugar free, feed for as long as possible.The
0 walls,and ceiling,circa 1900."This the use of cows'milk as an in- mineral free,and whey mixtures. other—involving public health de-
s the kitchen where baby's breakfast fant food at a 1909 conference Nothing seemed to help."John partments and a much wider
is Prepared,"comPlamed one doctor in Connecticut on the preven- did not return to his birth weight arrayof supporters,including
Source:Milk and Its Relation to the g PP
Public Health.Washington,OC, tion of infant mortality,re- of over 8 pounds until he was 6 concerned citizens,municipal
Government Printing Office;1908. minded colleagues,"Nature's months old.Mendenhall main- government,medical charities,
normal nutriment does not pre- tained that if she had not been settlement houses,private physi-
dispose to death."'" trained in pediatrics,he would cians,and newspapers—crusaded
Late-19th-century physicians have died.23 for clean cows'milk.
were not only cognizant of the Mendenhall's Herculean at- Calling pure cows'milk"one
dangers cows'milk posed to in- tempt to keep her artificially fed of the essentials of daily living,"
fants,they were equally con- son alive was hardly unique. urban newspapers decried"the
scions of the immunologic prop- Women who did not breastfeed diluted,adulterated,and harmful
erties of human milk,and so they often experimented with assorted quality of milk"common to US
constantly decried the"children cows'milk concoctions,usually cities.As the country's infant
with weak and diseased constitu- futilely.Mayme Glover,despon- death rate garnered unprece-
tions belonging to that generally dent after moving from Min- dented concern,journalists
wretched class called bottle- nesota to Champaign,Ill,in the charged that cows'milk`plays no
fed."21 In a series of experiments summer of 1901,found that her small part in this colossal crime
in 1912,pediatrician Henry L. artificially fed son's chronic diar- of infanticide.""Reformers
Coit demonstrated how detri- rhea exacerbated her misery.She fought for pasteurized milk gath-
mental the milk of one species wrote to family back in Min- ered from healthy cows,
could be to the offspring of an- nesota,"We don't dare to give processed under sanitary condi-
other.After feeding human milk the baby the water here it is too tions,sealed in individual bottles,
to puppies,he found they"re- nasty for us even....I have and shipped in refrigerated rail-
mained alive,but...in a very been trying to wash baby's bot- road cars.26
•
2002 1 Public Health Then and Now I Peer Reviewed i Wolf American Journal of Public Health I December 2003,Vol 93,No.12
ja 3LiCt AE°H l 1 to 1011-1
E
a I
f
While urban reformers fo- Sedgwick's philosophy inspired
cused on cleaning up cows'milk, formation of the Breast FeedingMOTHER'S MILK FOR MOTHER'S'S BABE
' •
I
COW'S DIILI;; FOR CALVESLVEFS
human milk advocates concen- Investigation Bureau of the De- l 117
4.
4
.'p''"'
trated on keeping babies at the partment of Pediatrics of the Uni-
§ breast.One tool used in many versity of Minnesota in 1919. ,rh' �
it cities was a home visit by public Under the bureau's auspices, _; fit"* . , f E „
health nurses.In Chicago,begin- Minneapolis public health work- 't"�� /4i `_ 1`- 1-,-ale
'; ning in the summer of 1908, ers met with virtually every new ���
Health Department officials sent mother immediately after the 4�VI>►� Liill P
nurses into neighborhoods with birth of her baby and as many Fra- `4 'nie Long a:r
; . . y3 tv _
the highest death rates to discuss times as necessary thereafter for ��, The Short Haul ;
I.V
infant feeding with mothers.'' the next 9 months,"even daily," — t 6 -.. ,`
These officials,however,deemed to help with lactation-related 4i b�—ke d e 36 t ._-
� .,- the mn".dd the tube the
the nonacculturation of immi problems.This intense focus on
"V, b.b eed d elie tube �"
...ra� e:.ore o.rey d.a. ^��ias
y-.tend r be"& i p.l !fo l`..'r.
grants to be at the root of infant the needs and concerns of new _`jthee.,�,►. m
mortality and so sent these mothers and their babies paid •eerkseted pieces.
y be•
t nurses,always multilingual,only off.During the bureau's first ^�' "'° M4•4 MIAs ,"'"'"'� �' .� ."
into immigrant neighborhoods, year,96%of babies born in Min- r heed the ,pee 8 -,I 1
baby a mu bed, get
ignoring the plight of Black and neapolis breastfed through their 'I• w.aend " ""°"`
Ti
il
ki, Te Lass 4N Deaths Lel D.14w _� L
native-born White infants.="To second month and 72%breast- "Me'"°'"`"''"`
Yee net beer«•m Cod.plea °,z�F%��'
i- Adel E.r•v Ob'•3.4.--A.w tet IV�'L¢t't'
Late-19th-century physicians . . . constantly 1 - . .
3- decried the `children with weak and diseased , a ��� "
constitutions belonging to that generally -1”-j .,../it'
wretched class called bottle-fed.' " ti" r . ;
V.— A.a i z.ens •
augment these visits,the Chicago fed through their ninth month.'' om ` j -
Department of Health also Infant deaths declined 20%that ....' ,,,,14.k,
,t^. '=ii. - .a• ITA
posted notices on the sides of year.''In contrast,Chicago,with
buildings in 10 different lan- its more haphazard approach to GIVE THE BOTTLE-FED BABY ��e
to es to alert immigrantbreastfeeding "' ' int NM. T
g moth- education,found in A CHANCE FOR 1T3 LIFE'I gag z7
ers to the importance of breast- 1912 that even after 4 years of A few tedtrla In milk as M leaves
feeding! home visits by public health ''-'"V the farm can became millions by the a.
...R..., time it reaches the consumer intim ci t9
While big cities like Chicago nurses—visits conducted immedi- Ona-third of Me city's milk sappty : -
usually used the home visit for ately after a birth—supplementa-
contains
n each h fifteen
dddnin�o0o bacteria
mass education—by unleashing tion with cows'milk remained MOTHER5,PR07ECT YOUR BABIES
SagoMy fresh milk In bottles
nurses on neighborhoods to ran- rampant.Only 39%of mothers Pasteurt3e It at home to kill ;,-.4:-,,
the lama it contains.
domly catch mothers who might exclusively breastfed their new- .' '..14 Always keep on Ice in clean. ».n ...-
be home—Minneapolis used it,far borns." tight�Iqq stoppered bottles
Keep it away from fres, !
more effectively,to address spe- The Minneapolis medical com If flies Leat the beby+v �'��'
In-,•1 It,let the files haw n:, `r '.
cific mother's difficulties with munity attributed their singular �4 NVE {ILK_ �}.,
breastfeeding.This tactic was the achievement almost solelyto the :���' n_1 SAVES SICKNESS. j
brainchild of Julius Parker Sedg- multiple,timely home health vis- ion. Arit,
wick,chief of the Department of its.As one physician explained, � � �•.•ya. a...d.
Pediatrics at the University of "The importance of the personal Top:This Chicago Department of Health poster urged moth-
Minnesota Sedgwick deemed visit of the nurse...cannot be ers to breastfeed and traced the penlousupath of cows'milk
human milk absolutely vital to in- overestimated.Mailinginforma- from rural Schooldaof Sanitarya o urban cuc (June.Source:3,1111.14
Chicago Instruction 3,1911)14
fret health and urged in 1912 lion does not get across.Pre-
that breastfeeding be made"the natal education as to breast feed Bottom:A Chicago Department of Health poster explains
to mothers how to make cows'milk safer for bottle-fed
keystone"of the national cam- ing is often forgotten.The time •
babies.Source:Bulletin:Chicago School of Sanitary
paign to prevent infant mortality.'° to bring forward our facts is at Instruction(August 31,1912).15
December 2003,Vol 93,No.12 I American Journal of Public Health Wolf I Peer Reviewed I Public Health Then and Now 12003
r
the critical moment when the weeks and months of life,but and Children(WIC).Indeed.
IIImother begins to doubt the ad- more and more mothers did not breastfeeding habits in the last
visability or the possibility of breastfeed at all.By 1971,breast- 30 years have differed according
nursing her baby."14 A Minneapo- feeding had reached an all-time to class and race in a much
•
lis Infant Welfare Society nurse low in the United States.Only starker way than they did a cen-
agreed.Just when a mother was 24%of mothers initiated breast- tury ago.Only one group of
"most liable to discouragement feeding—that is,only 24% women have embraced breast-
[and]anxiety...convinced that breastfed at least once before feeding in large numbers since
her milk was not the right food," hospital discharge."Not until the early 1970s—White,college-
the nurse arrived to alleviate ma- later in the 1970s did the femi- educated women.47 Not only have
ternal apprehension.''In 1924, nist-inspired women's health re- Black women initiated breastfeed-
one doctor urged the nation's form movement rekindle interest ing at roughly half the rate of
medical community to follow the in breastfeeding.One young White women,but the majority
example of Minneapolis and mother,caught up in the social of Black women who do breast-
view public health from a"busi- activism of the 1970s,recalled feed introduce formula to their
ness-like standpoint"and"rank how the politics and communal- infants while still in the hospital."
the promulgation of breast feed- ism of the time heralded new in- The race gap in breastfeeding ini-
ing education as one of our best fant care practices.Her daughter nation,exclusivity,and duration
investments."" "never drank out of a bottle..., rates is,in fact,so cavernous that
When we needed a baby sitter, one group of researchers argues
THE FALL AND RISE OF therewerealways other nursing that convincing more Black
BREASTFEEDING moms in the neighborhood will- women to breastfeed and to
INITIATION RATES ing to take her.We all nursed
breastfeed longer would narrow
each other's babies.In fact,it the race gap in infant mortality—
Yet breastfeeding never became seemed that every woman I currently 1.3 times higher for
the cornerstone of preventive knew was nursing."4° Blacks than Whites—as signifi-
• medicine that so many early-20th- Yet the breastfeeding initiation candy as preventing low birth-
century physicians recommended. rate has not seen the steady in- weight,once thought to be the
Instead,the lay and medical crease that this woman and her co- primary,
communities came to believe horts might have predicted in the the high Black infant death rate."
that pasteurization nullified the 1970s.Rather,the rate has inexpli- The news of the recent in-
differences between human and cably receded and surged.Be- crease in breastfeeding gratified
cows'milk.With readily avail- tween 1984 and 1989,initiation many in the medical community.
able clean cows'milk,breastfeed- rates declined 13%,from almost Ruth Lawrence,a neonatologist
ing crusades and breastfeeding it- 60%to 52%.Not until 1995 did and pediatrician at the University
self seemed antiquated and these rates return to their high of of Rochester Medical School,told
unnecessary.By the early 1930s, 600/a"And in December 2002, USA Today that it was"the best
a new generation of doctors be- the Ross Products Division of Ab- news I've heard for children in a
littled human milk as"nothing.. bott Laboratories reported the long time."She warned,however, ,
.sacred.""Unlike their breast- highest rates since the company "We still have a long way to
feeding-activist predecessors, began collecting data in 1955.In go."46 While the rise is significant
these pediatricians never wit- 2001,69.5%of US mothers initi- because it occurred among r
nessed the"slaughter.'"of infants ated breastfeeding.'z women who have not recently
by spoiled and adulterated cows' The medical community
milk and so came to place more deemed this increase particularly able and be breastfeeeficial infant feeding
a
faith in the efficacy of cows'milk significant because the bulk of method,the habit of introducing 1
than human milk. the increase was among those formula well before 6 months
From 1930 to the early least likely to breastfeed in recent persists among all women who ;
1970s,now with the collusion of history—Black women,women initiate breastfeeding.Despite the a
physicians,not only did mothers educated only through high advice of both the American
continue to supplement their school,and women enrolled in Academy of Pediatrics(AAP)and
• breast milk with cows'milk and the Special Supplemental Nutri- the World Health Organization
wean infants in the first few tion Program for Women,Infants, :
(WHO)that infants should exclu-
2004 l Public Health Then and Now l Peer Reviewed I Wolf
American Journal of Public Health I December 2003,Vol 93,No.12
:)TSLC liEALTH THEN AND NOW
sively breastfeed for 6 months— •
: that is,consume no other food, More recently, researchers have connected not
not even water,during this just acute illness but a host of serious, chronic
time—only 17%of American
women adhere to the recommen- and conditions—SIDS, obesity,
dation."Fifty-three percent of leukemia, breast cancer, asthma, and lowered
lactating mothers introduce for-
mala before their babies area IQ—to infants' consumption of formula.
t- week old,68%do so by 2
months,and 81%by 4 months.48 dearth of human milk in an in- weeks are 5 times more likely to
Breastfeeding duration rates fant's diet can herald ill health die of SIDS than infants breastfed
are lower still.Although the AAP for years. for more than 16 weeks.52 The
counsels mothers to breastfeed The shift from breast to bottle early introduction of formula also
babies for at least a year(and the essentially redefined"normal" increases the incidence of child-
WHO recommends at least 2 infant health.As early as the hood obesity.Babies breastfed 2
years),fewer than 50/o of Ameri- 1930s,pediatricians deemed months or less are almost 4 times
can mothers are still breastfeed- strings of respiratory,ear,and more likely than babies breastfed
ing when they celebrate their ba- gastrointestinal infections in- for more than a year to be obese
bies'first birthday.49 Since dozens evitable childhood events.Only when they enter elementary
of recent studies show that how with the upswing in breastfeed- school."Childhood cancer rates
long a mother feeds her baby ing initiation rates in the 1970s are affected by how infants are
human milk exclusively,and how did the medical community once fed as well.Infants breastfed for
long a mother continues to again link formula feeding with 6 months or less are almost 3
breastfeed thereafter,are more sick children."One cannot help times more likely to contract a
meaningful predictors of health but recall Henry Coit's 1912 ex- lymphoid malignancy than babies
than the simple fact that a child periment in which he fed human breastfed longer than 6 months.'4
was ever breastfed,persistently milk to puppies.Would Coit have Recently,the media alerted •
low exclusivity and duration described today's artificially fed the public to an epidemic of
rates continue to spark concern children—with their significantly asthma among children.Medical
in the medical and public health higher rates of ear infections, journals have linked that epi-
communities despite the recent stomachaches,and runny noses— demic,in part,to formula feed-
rise in initiation rates. as he did those unfortunate pups: ing.In September 1999,the
as being,in a strictly dispassion- British Medical Journal reported
HUMAN MILK AND ate clinical sense,"in a miserable that 3 factors are associated with
HUMAN HEALTH: condition"or"inferior"to breast- the development of asthma:ges-
A DOSE—RESPONSE fed infants?S1 tational age less than 37 weeks,
RELATIONSHIP More recently,researchers household smoking,and the in-
have connected not just acute ill- troduction of formula before 4
The current customs of sup- ness but a host of serious,chronic months of age.In another
plementing breast milk with for- diseases and conditions—SIDS, asthma study,researchers
mula early in an infant's life and obesity,leukemia,breast cancer, grouped breastfed infants accord-
then discontinuing breastfeeding asthma,and lowered IQ—to in- ing to how long they had been
altogether after a few weeks or fants'consumption of formula. breastfed:less than 2 months,2
months are identical to the prac- These studies are especially sig- to 6 months,7 to 9 months,and
tices a century ago that prompted nificant because they demon- longer than 9 months.After con-
municipalities to alert mothers strate that not only initiation of trolling for household smoking,
to the connection between in- breastfeeding,but exclusivity and low birth weight,and low mater-
fant mortality and babies'con- duration of breastfeeding,matter. nal education,investigators
sumption of cows'milk.Today There is a dose—response rela- found that breastfeeding for only
We are in a similar situation as tionship between human milk 9 months or less was a risk fac-
studies alert physicians to what and human health.Researchers tor for asthma.55 Scientists have
their forebears well knew:for- have found,for example,that ba- linked the early introduction of •
mula and the concomitant bies breastfed for less than 4 formula to lowered intelligence
December 2003,Vol 93,No.12 I American Journal of Public Health Wolf I Peer Reviewed I Public Health Then and Now 12005
as well.In the most recent of sev- rates is a logical avenue to both HHS also called for a social ma
• eral articles on the subject,re improved child health and dinun- keting effort to explain to the
searchers in the May 2002 issue fished costs.'"Recognizing this, public the importance of human
of the Journal of the American several organizations in recent milk and the dangers of formul<
Medical Association studied 3253 years initiated breastfeeding pro- feeding to the nation's babies."'
Danish men and women and motions heralding breastfeeding In June 2002,the Ad Counci
found that the more human milk as preventive medicine at its
responded to that call.The Ad
they had consumed through 9 best.The first organization to do Council—renowned for its ability
months of age,the higher they so was the AAP in 1997 with to alter human behavior and att
scored on intelligence tests in their widely publicized policy tudes via such memorable publi
their late teens and 20s." statement,"Breastfeeding and service announcements as"You
Mothers even influence their the Use of Human Milk."The Can Learn a Lot From a Dummt
own health when they breast- statement enumerated the nu- and"Friends Don't Let Friends
feed,and here,too,breastfeeding merous acute and chronic dis- Drive Drunk"—announced that
duration is important.A study in eases thwarted or limited in its next task would be to formu-
the American Journal of Epidemi- severity by breastfeeding.It also late a campaign to convince
ology in 2000 found that women encouraged mothers to consider Americans of the importance of
who breastfed each of their chil- breastfeeding exclusivity and du- breastfeeding.fz Those ads,whicl
had not yet appeared at press
Today, more than half of women in the United States with children time,might influence breastfeed-
ing rates as profoundly as e
less than a year old work outside the home. Yet there is almost no Council has affected seat belt Ac
evidence of employers accommodating lactating employees. use,particularly if they speak to
the women least likely to breast-
feed today,most notably Black
dren for only 1 to 6 months ration rates,rather than focusing and low-income women.
• were twice as likely to suffer
from either premenopausal or solely on initiating breastfeeding, Although today's breastfeed
by advising exclusive breastfeed- ing campaigns are not as visible
postmenopausal breast cancer ing for 6 months,continued
as ch will
than women who breastfed each breastfeeding until an infant was doubt tchange saft lrlthe Ad']o
of their children for more than 2 at least a year old,and breast- Council weighs in),the AAP
years.Authors of a subsequent feeding thereafter for as long as statement and the HHS booklet
study likewise discovered that mother and baby desired." suggest that today's medical
the longer women breastfed,the Headlines announcing the new community recognizes what
less likely they were to get breast guidelines appeared in everytheir ors knew a _
cancer.After examining data major American newspaper and tury ago—that the American n
from women in 30 countries, prompted discussion on televi- propensity to shun human milk
these researchers estimated that sion news shows for several
if every mother in the United days.'" is a public health problem and
should be exposed and managed
States breastfed her babies only Three years later,with consid- as such.The first sentence of
6 months longer than originally erably less fanfare albeit using the HHS piece—"Breastfeeding
planned,there would be 250 000 more forceful prose,the Depart- is one of the most important
fewer cases of breast cancer in ment of Health and Human Ser- contributors to infant health"—is
the country each year." vices(HSS)published a booklet reminiscent of the early-20th-
titled HHS Blueprint for Action on century public health cam-
INCREASING Breastfeeding.HHS called the paigns'insistence that having
BREASTFEEDING lack of exclusive and prolonged been breastfed was the single
RATES TODAY breastfeedingthe United
inmost powerful predictor of an
States"a public health challenge" infant's ability to survive child-
With contemporary asthma and urged health care providers, hood.The HHS booklet was a 3
and obesity epidemics among employers,and child care facili- clarion call to Americans.How s
0 children and health care costs formulate poliies support that challenge will be met is still
soaring,increasing breastfeeding fiveties ofto extended breastfeeding, to be seen.
I
2006 1 Public Health Then and Now I Peer Reviewed I Wolf
American Journal of Public Health i December 2003,Vol 93,No.12
s
t
'CAN HISTORY INFORM breastfeeding,they did it neither particular women's attention •
(BREASTFEEDING exclusively nor for very long. have been employed successfully.
.:.'CAMPAIGNS TODAY? The AAP attempted to clarify the Changes in WIC policy to pro-
more than century-old misinter- mote breastfeeding,rather than
Perhaps history can help steer pretation of what constitutes simply to supply free formula to
today's nascent campaigns clear breastfeeding when the organiza- low-income mothers,were instru-
of the mistakes made by earlier tion issued its breastfeeding mental in effecting the recent in-
crusades,which looked largely to guidelines 5 years ago.The rec- crease in breastfeeding
cows'milk as the solution for too ommendation that mothers initiation."Some hospitals have
little breastfeeding.Those cru- breastfeed their infants exclu- likewise focused on intense
II sades,in fact,led to our current sively for 6 months served to dif- breastfeeding education with
ambivalence about breastfeeding. ferentiate between breastfeeding similar success.The hospital of
The efforts at the turn of the and the more common practice the Medical University of South
20th century to simultaneously of supplementing breast milk Carolina,whose largely Black
l
t
ss promote breastfeeding and pro- with formula.The admonition population of birthing mothers
vide palatable cows'milk to ba- that mothers should continue to breastfed at rates well below the
a bies sent a mixed message to breastfeed for at least a year,and national average,successfully in-
mothers.Society has perpetuated "thereafter for as long as mutu- creased rates between 1993 and
that ambiguity ever since.Even ally desired,"stressed that dura- 1999.Via training for hospital
as more women in the 1970s tion is a vital component of personnel and pre-and postnatal
nursed their infants,the medical breastfeeding." patients,the university raised
4 community never deemed The statement also implied breastfeeding initiation rates
',breastfeeding the standard of that the child has agency,which from 18.9%to 47.1%among all
care.Rather,formula feeding re- represents a real change in the mothers and from 19.2%to
mained the norm and nursing medical/maternal view of the 60.80/0 among mothers of
became the"best"thing to do, breastfeeding relationship.Yet preterm infants."" •
akin to putting cotton clothing on newspaper headlines invariably The lesson to be learned from
your baby rather than polyester— misrepresented the suggested the WIC and the Medical Univer-
a nice touch,but unnecessary timetables and their implication. sity of South Carolina(and the
As lactation specialist Diane The most common distortion of intensive postnatal home visits in
Wiessinger explains,"Our own the guideline was to state that Minneapolis more than 80 years
experience tells us that optimal is the AAP advised breastfeeding ago)is clear.The success of any
not necessary.Normal is fine,and babies for one year,intimating breastfeeding educational cam-
implied in this language is the ab- that(1)the AAP opposes breast- paign relies on readily available
solute normalcy—and thus safety feeding for more than a year, personnel able to support breast-
and adequacy—of artificial feed- (2)supplementation with formula feeding mothers with accurate in-
ing."Wiessinger suggests that the is a normal adjunct to breastfeed- formation and kind,enthusiastic,
medical community can help the ing,and(3)weaning should be persistent assistance.Yet it is so
public think of breastfeeding as done by the clock and not ac- rare for medical schools to spend
standard with more accurate lan- cording to either a mother's or a any time teaching medical stu-
guage."Because breastfeeding is child's desires.' dents about lactation and human
the biological norm,breastfed ba- When early-20th-century pub- milk that whether a physician or
bies are not healthier;'artificially- lic health officials sent visiting a physician's wife has breastfed is
fed babies are ill more often and nurses into neighborhoods with the best predictor of a doctor's
more seriously."' the highest infant death rates to ability and willingness to give ac-
In recognizing the power of discuss infant feeding with moth- curate advice and appropriate
language,the medical commu- ers,they recognized the public support to lactating mothers.G9
nity can also do something their health advantages of targeting Unless medical schools incorpo-
forebears did not do a century the women least likely to breast- rate the teaching of lactation
ago:define breastfeeding.In feed.As the latest Ross survey in- physiology,breastfeeding man-
1900,while the vast majority of dicates,this remains a vital les- agement,and the relationship be-
•
mothers unquestionably initiated son.66 Recent tactics to get these tween human milk and human
December 2003,Vol 93,No.12 I American Journal of Public Health Wolf I Peer Reviewed 1 Public Health Then and Now I 2007
health into their curriculums,the all ethnic,education,and age been ubiquitous medical knowl- 5. Letter from Martha Luey Parish tc
III dearth of knowledge about groups.'The current Family and edge-that the adequate con Lestern,Annie and Father.November
breastfeeding among medical Medical Leave Act,mandating sumption of human milk as an 2, 1884.Parish Family Letters.New-
berry Library.Chicago.
professionals will continue to only 12 weeks of maternity infant and toddler is a powerful 6. "The Mother's Parliament."Baby-
match the dearth of human milk, leave,unpaid no less,is only one guarantor of health and long life. hood 3(April 1887): 170.
and the abundance of formula, example of the failure of contem- Forgetting the history of the 7. Josephine K.Laflin Diary.
available to babies. porary American society to rec- struggle to lower infant mortality 1903-1907,March 31. 1903 entry.
While the advice meted out ognize the reality of mothers' and morbidity can be equally Laflin Family Papers,Chicago Historica
by physicians is formed by the lives and their need for social dangerous.The maintenance of Society.
in order to meet the nu infant health has longbeen rec- 8. For a more detailed explanation of
cultural milieu of medicine, support
the complex reasons behind women's
health choices made by con- tritional,immunologic,psycho- ognized as one of society's best changing infant feeding habits than
sumers are similarly shaped logical,developmental,and cog- investments.In that tradition,the what is contained in this paragraph•see
Kill Your
more by economic and social nitive needs of their babies.'' medical and public health corn- JBaby:Ptblacquelinei Health a.Wolf.Dnd the Decline of
forces than health warnings.In Increasing breastfeeding initia- munities should acknowledge Breastfeeding in the 19th and 20th Cen-
the case of infant feeding deer tion and,especially,exclusivity what the first generation of tunes(Columbus:Ohio State University
y
Bions,American women are and duration rates will take Press.2001),9-41.
American pediatricians and in-
9.thwarted in their ability to planned effort.As in the 19th fant welfare reformers promul- M h,"M Vinton, ry GuFirst
choose the healthy option by the century,the societal definition of gated:infants'and toddlers'fail- ntary�1893)`tB9 NurserGuis de 9(Feb
demands of work outside the appropriate infant care is a more ure to consume sufficient human 10. "Nursery Problems,"Babyhood 2
home and lack of societal sup- powerful shaper of human be- milk has vital implications for (luny 1886):291.For more on the
port for new mothers.Today, havior than health warnings. public health.■ growing intimacy between husbands
more than half of women in the Supplementing breast milk with and wives,sde Johnreedman,InttDaelio and Es-
telle Q.Fimmatte Mutters::I
United States with children less formula early in an infant's life About the Author History of Sexuality in America(Chicago:
than a year old work outside the and discontinuing breastfeeding The author is with the Department of So- University of Chicago Press. 1997).
after a few weeks or months nal Medicine,Ohio University,Athens. 11. Many cities housed Little Mothers
home.Yet there is almost no evi-
Requests for reprints should be sent to Clubs.organizations customarily aflili-
dence of employers accommo- have been culturally acceptable Jacqueline H.Wolf,PhD,Department of ated with public schools or settlement
• dating lactating employees.The practice for more than a century.
vast majority of working women To make breastfeeding the stun Social Medicine,Ohio University,Athens, houses.These clubs trained young girls
OH 45701(e-mail:wolfjl @ohio.edu),
This article was accepted May 2. to better care for the infant siblings so
often left in their charge.See Rima D.
who are breastfeeding their ba- dard of care,health care 2003.
Apple.Mothers&Medicine:A Social
bies have no access at work to a providers can play an important History of b font Feeding 1890-1950
private place to pump milk,a re- role but rarely take the opportu- Acknowledgments (Madison:University of Wisconsin Press.
frigerator to store milk,or breast- nity.Currently,only 80/a to 24/overy grateful
1987),. 102-103:2. Wolf;Don't Kill Your
° o I am to Benita Blessing. Bey,21_22. 120-121.
feeding breaks to nurse a nearby of women report receiving gttid- Lawrence nt.Gunner,Norman Gevjtz.
Katherine Jellison.Sam When,Robert\'. 12. Samuel I I.Preston and Michael R.
infant.'"Absent prolonged,paid ance about infant feeding from Wolf,and 2 anonymous reviewers for Haines,Fatal]ears:Child Mortality in
maternity leave,on-site day care, their physician."Yet 80 years their critiques of previous versions of Late Nineteenth-Century America(Prince
accommodations at work,and ago in Minneapolis,prompt in- this article. ton,NJ:Princeton University Press,
1991)•27.
flexible work hours,working formed assistance from visiting 13. Infant deaths from diarrhea soared
women will continue to find nurses dramatically increased in big cities each summer.One study
breastfeeding difficult breastfeeding rates and lowered Endnotes conducted in Berlin in 1901,however.
While the initiation of breast- infant mortality in a single year. 1. Bulletin:Chicago School of Sanitary showed that these summer deaths were
Instruction 14(June 3, 1911):back page. virtually nonexistent among breastfed
feeding appears to be unaffected Similar efforts focusing on sup- children.See Preston and Haines,Fatal
n breast- 2. Bulletin:Chicago School of Sanitary years,27-28 In another study of al-
by a mother's employment status, porting and encouraging gInstruction 15(August 31, 1912): 140. most 2000 infants who died of"degen-
breastfeeding duration is decid- feeding among women trans- 3. In this era before access to ice and erative disturbances,"physicians noted
edly influenced by full-time ma- formed mothers'practice at the refrigeration,breastfeeding was espe- that only 3%had been breastfed.In an
dally important during hot weather. additional study of 718 babies who died
ternal employment,not unlike a Medical University of South Car
oliva and in WIC offices around Therefore,mothers never weaned dur- of diarrhea,only 4%were breastfed.
Century ago." Only 10%of full-
ing the summer and customarily breast- Frank Spooner Churchill,"Infant Feed-
time working mothers breastfeed the country!'All 3 endeavors fed their babies through at least 2 sum- ing,"Chicago Medical Recorder 10(Feb-
their 6-month-olds compared made breastfeeding not just the mers.Marylynn Salmon,"The Cultural ruary 1896): 102-114.
•
Significance of Breastfeeding and Infant 14. Nathan Allen,"The Decline of
with almost 3 times that number healthy thing to do but the so-
Care in Early Modem England and Suckling Power Among American
of stay-at-home mothers.This as- dally acceptable,"normal"thing America,"Journal of Social History 28 Women,"Babyhood 5(March 1889):
sociation between maternal em- to do. (Winter 1994):247-269. 111-115.
110 ployment and decreased breast- With the pasteurization of
4. "The Care of Infants Historical 15. S.T.Rorer,"The Proper Food for a
feeding duration is evident across cows'milk,society lost what had Data"Journal of the American Medical Child in Summer,"Ladies'Home Journal
Association 59(1912):542-543. 17(July 1900):26.
2008 1 Public Health Then and Now I Peer Reviewed I Wolf American Journal of Public Health I December 2003,Vol 93,No.12
i
i
s,
k
w' 16. For a history of wet nursing and its 27. "Infant Welfare Service 1909— Breast-Feeding in the United States, Nutrition Examination Survey(Phase"
ramifications for both the wet nursed 1910,"in Report of the Department of 1984 Through 1989,"Pediatrics 88 1991-1994),"American Journal of
• infants and the infants of wet nurses, Health of the City of Chicago for the Years (1991):719-727. lic Health 92(2002): 1107-1110.
• see Janet Golden,A Social History of 1907,1908, 1909, 1910(Chicago, 40. North Country Co-op(Minneapolis, 49. Ryan,"Resurgence of Breastfeeding."
Wet Nursing in America:From Breast to 1911), 170-180. Minn)Records, 1972-2000,Minnesota
Bottle(New York:Cambridge University 50. For information on the relationship
28. Letter to Mrs.Ba.A.Eckhart from Historical Society,St.Paul,Minn. between formula feedingand otitis
% Press.1996);Wolf,Don't Kill Your Baby, Edna L.Foley,January 16, 1923,Visit-
132-157 41. Alan S.Ryan,"The Resurgence of media,see Nancy F.Sheard,"Breast-
ing Nurse Association of Chicago Pa-
Breastfeeding in the United States,"Pe- Feeding Protects Against Otitis Media."
r 17. Report of the Department of Health pers,Chicago Historical Society.For diatrics 99(1997):E12,available at: Nutrition Reviews 51 (1993):275-277;
of the City of Chicago for the Years 1907, more on the attention paid by public www.pediatrics.org/cgi/content/full/99/ B.Duncan,J.Ey,C.J.Holberg,A.L.
1908,1909,1910(Chicago,1911),174. health departments to the infants of im- 4/e12,accessed October 10,2002. Wright,F.D.Martinez,and L.M.Taus-
18. For a complete explanation of migrants at the expense of their Black
and native-born White counterparts,see 42. Alan S.Ryan,Zhou Wenjun,and sig,"Exclusive Breast-Feeding for at
I. these statistics,see Wolf,Don't Kill Your pm H �� Contin- Least 4 Months Protects Against Otitis
Lynne Curry,Modern Mothers in the "Breastfeeding
Contin-
-:, Baby,xiv,208-211. nes to Increase Into the New Millen-
867-872;
Pediatrics 91 (1993):
Heartland:Gender,Health,and Progress
867-872;G.Aniansson,"A Prospective
19. Effa V.Davis,"Breast Feeding," (Columbus:in Illinois,1900-1930 mum,"Pediatrics 110(2002):
tCohort Study on Breast-Feeding and
Bulletin:Chicago School of Sanitary In- Ohio State University Press, 1999), 1103-1109.
so-action 13(June 8, 1910):2. 10-11,35-36. Otitis Media in Swedish Infants."Pedi-
43. Ryan et al.,"Resurgence of Breast- atric Infectious Disease Journal 13
: 20. Ira S.Wile,"Educational Responsi- 29. Posters appeared in English,Bo- feeding";Ryan et al.,"Breastfeeding (1994): 183-187.For information on
bilities of a Milk Depot,"in Prevention of hemian,Croatian,German,Italian, Continues to increase";Alain Joffe and the relationship between formula feed-
Infant Mortality,Being the Papers and Lithuanian,Polish,Serbian,Swedish, Susan M.Radius,"Breast Versus Bottle: ing and gastrointestinal disease,see
• Discussion of a Conference Held at New and Yiddish. Correlates of Adolescent Mothers'In- A.S.Goldman,"Modulation of the Gas-
k.
Haven,Connecticut,November 11, 12, fant-Feeding Practices,"Pediatrics 79 trointestinal Tract of Infants by Human
', 1909(N.p.,n.d.), 139-153. 30. Julius Parker Sedgwick."Maternal (1987):689-695;Ryan et al.,"Recent Milk,Interfaces and interactions:An
Feeding,"The American Journal of Ob- Declines in Breast-Feeding";Christine E.
21. W Thornton Parker,"The Refusal stetrics and Diseases of Women and Chil- Evolutionary Perspective,"Journal of
to Nurse and its Consequences,"Baby- dren 66(1912):857-865. Peterson and Julie DaVanzo,"Why Are Nutrition 130(2000):426S-431S;
hood 3(August 1887):313. Teenagers in the United States Less L.K.Pickering and A.L.Morrow,"Fac-
31. Julius Parker Sedgwick."A Prelimi- Likely to Breast-Feed Than Older tors in Human Milk That Protect Against
22. Henry L.Coit,"The Effects of nary Report of the Study of Breast Women?"Demography 29(1992): Diarrheal Disease,"Infection 2(1993):
Heated and Superheated Milk on the Feeding in Minneapolis."Transactions of 431-450:Ayala Gabriel,K.Ruben 355-357;Amal K.Mitra and Fauziah
i infant's Nutrition(Recent investiga- the American Pediatric Society 32 Gabriel,and Ruth A.Lawrence,"Cul- Rabbani,"The importance of Breast-
lions),"Transactions of the American Pe- (1920):279-291. tural Values and Biomedical Knowl- feeding in Minimizing Mortality and
diatric Society 24(1912): 128-138. edge:Choices in Infant Feeding,"Social MorbidityFrom Diarrhoeal Diseases:
32. J.P.Sedgwick and E.C.Fleischner,
23. "DorothyReed Mendenhall's Auto- Science and Medicine 23(1986): The Bangladesh Pers ective,"Journ
"Breast Feeding in the Reduction of In- g P
biography," 1939,typed manuscript, fent Mortality,"American Journal of Pub- 501-509;Natalie Kurinij,Patricia H. Diarrhoea!Diseases Research 13(19
Dorothy Reed Nlendenhall Papers. lic Health 11 (1921): 153-157.This was Shiono,and George G.Rhoads,"Breast- 1-7.For information on the relationship
Sophia Smith Collection,Neilson Li- Feeding Incidence and Duration in between lower respiratorytract infec-
P especially significant because as late as
brary,Smith College,Northampton, 1948 the law did not require that milk Black and White Women,"Pediatrics 81 tions and formula feeding,see A.L.
Mass. sold in Minneapolis be pasteurized. (1988):365-371. Wright,C.J.Holberg,F.D.Martinez,W.
24. Familytree and letters dated July44. Kurinij et al.,"Breastfeeding inti- J.Morgan.and L.M.Taussig,"Breast
33. "Infant Welfare Field Work,"Report
10. 13,and 16. 1901,Mary Scofield and Handbook of the Department of Health dence":Ryan et al.,"Recent Declines in Feeding and Lower Respiratory Tract
and Family Papers,Minnesota Historical of the City of Chicago for the Years 1911 to Breastfeeding";Renata Forste,Jessica illness in the First Year of Life."British
Society,St.Paul,Minn. 1918 Inclusive(Chicago,1919).567. Weiss,and Emily Lippincott,"The Deci- Medical Journal 299(1989):946-949;
sion to Breastfeed in the United States: Y.Chen,"Synergistic Effect of Passive
25. "Scarcely Any Pure Milk."Chicago 34. E.J.Huenekens,"Breast Feeding," Does Race atter?"Pediatrics 108 Smoking and Artificial Feeding on Iios-
Daily News(September 1,1892),2; American Journal of Nursing 24(1924): (2001):291-296. pitalization for Respiratory Illness in
"Stop the Bogus Milk Traffic,"Chicago 751-757. Early Childhood,"Chest 95(1989):
Tribune(September 23, 1892).4. 45. Forste et al.,"Decision to Breastfeed." 1004-1007:A.L.Wright,C.J.f Iolberg,
35. N.C.Rudd,"Breast Feeding in
26. In Chicago,the milk crusades Mlinneapolis,"Mother and Child 2 46. Marilyn Elias,"US Breast-Feeding L.M.Taussig,and F.D.Martinez,"Bela-
began in 1892 and continued for (1921): 171-173. Rate Soars." USA Today,December 1, tionship of Infant Feeding to Recurrent
more than 30 years.There was no 2002.available at:http://www.usato- Wheezing at Age 6 Years,"Archives of
legal requirement to seal milk vats 36. E.J.Huenekens,"Breast Feeding day.com/news/health/2002-12-01- Pediatric and Adolescent Medicine 149
until 1904.to bottle milk in individ- From a Public Health Standpoint," feeding-usat_x.htm,accessed December (1995):758-763.See also Paula D.
ual bottles until 1912.to pasteurize American Journal of Public Health 14 2,2002. Scariati.Laurence M.Grummer-Strawn,
milk until 1916,to keepmilk cold (1924):391-394.For a more detailed and Sara Beck Fein,"A Longitudinal
47. American Academy of Pediatrics,
duringshipping until 1920,or to test analysis of the work in Minneapolis,see Analysis of Infant Morbidity and the Ex-
Jacqueline PP g Jacqueline H.Wolf,"`Let Us Have Mlore "Breastfeeding and the Use of Human
cows for bovine tuberculosis until tent of Breastfeeding in the United States,"
Mother-Fed Babies':Early Twentieth- Milk,"Pediatrics 100(1997):
1926.For more on the milk crusades 1035-1039;World Health O za- Pediatrics 99(1997):E5,available at
Century in Chicago,see Wolf,Don't Kill Your
Breastfeeding
inB�
Campaigns
tion,"The Optimal Duration of Exclu- www•pediatrics.org/cgi/content/fu11/99/
Baby,42-73.For the story of pure Chicago and Minneapolis,"Journal of6/e5,accessed October 11,2002.
Human Lactation 15(1999): 101-105. sive Breastfeeding,".Note for the Press
milk campaigns in other cities,see Ju- No.7,April 2,2001,available at:www. 51. Coit,"Effects of Heated and Super-
dith Walzer Leavitt, The Healthiest 37. "Are Infant Feeding Methods whoint/inf-pr-2001/en/note2001-07html, heated Milk."
City:Milwaukee and the Politics of Changing?"Public Health Nursing 23 accessed October 10,2002;Ryan et al., Wennergren,52. B.AlmG. enne
Health Reform(Madison:University of (1931):581-585. rgre
n S.C.Nor-
Wisconsin Press, 1982), 156-189; "Breastfeeding Continues to Increase." venins,et aL,"Breast Feeding and the
Richard A.Meckel.Save the Babies: 38. "Slaughter of the Innocents" 48. Li Ruowei,Cynthia Ogden,Carol Sudden infant Death Syndrome in Scan-
Chicago Tribune August 23. 1892,6.
Imerican Public Health Reform and the Bellew,Cathleen Gillespie,and Lau- dinavia, 1992-95,"Archives of Diseas
Prevention of Infant Mortality, 39. Allan S.Ryan,David Rush,Fritz rence Grummer-Strawn,"Prevalence of in Childhood 86(2002):400-402.
1850-1929(Baltimore:Johns Hop- W.Krieger,and Gregory E. Exclusive Breastfeeding Among US In- One recent article in Pediatrics argues
tins University Press, 1990),62-91. Lewandowski,"Recent Declines.in_ fants:The Third National.Health and - that the race gap in infant mortality in
December 2003,Vol 93,No.12 I American Journal of Public Health Wolf I Peer Reviewed I Public Health Then and Now 12009
•
Board of Health
New Business
Agenda Item # V., 3
� Public Health Fee Policy
Discussion
July 15, 2004
f
STATE of WASHINGTON
COUNTY of JEFFERSON
T e Matter of an Ordinance Amending }
IlIrtain Fees Contained in Section 2 of }
Ordinance No. 11-1115-99 for the } ORDINANCE NO. 05-0419-04
Health and Human Services Department }
SECTION 1 -PURPOSE AND SCOPE:
The purpose of this ordinance is to amend specific fees for the Jefferson County Health and Human Services
Department.
SECTION 2 -FEE SCHEDULES: The portion of the fee schedules are as follows:
PUBLIC HEALTH CLINIC SERVICES
All of the fees listed in Ordinance No. 11-1115-99 under Public Health Clinic Services are hereby being
replaced with the following:
The Health Department Community Health Nursing Fee Schedule will be set at the same amount,to the nearest
higher dollar, as the current rate schedule—Reimbursable by the Washington State Department of Social and
Health Services for Medicaid clients.
Community Health offers fees based on the sliding scale schedule to clients who are not on Medicaid. Clients
are not turned away due to the inability to pay. A copy of the current Federal Poverty Guidelines,which
•blishes the sliding scale fees,is available at the Health Department.
All fees for immunizations not subsidized by the Washington State Department of Health will be the cost of
vaccine,handling, shipping and visit fee. The visit fee is set by Medicaid standards. There is no sliding fee
scale for privately purchased vaccines.
Laboratory Services are based on the actual fees of laboratory contractors. Price lists are available. Cost is not
subject to sliding scale. In cases of communicable disease prevention,the lab costs may be waived.
Fees for medications, family planning methods, and antibiotics are based on cost of acquisition and are updated
quarterly.
Vital Records services are not subject to a sliding scale and fees are set by the RCW 70.58.107. The cost sheet
is available by request.
ENVIRONMENTAL HEALTH SERVICES
Specific fees listed in Ordinance No. 11-1115-99 under Environmental Health Services are hereby being
amended to add the following:
Add to the end of the list under Evaluation of Existing System:
.A$30.00 filing fee for Evaluation of Existing System (EES)reports submitted by third party inspectors.
.Onsite classes for public and certified professionals will be supported by attendees.
Add to the end of the list under Food Service Establishment Permits (Annual Permit):
Food Services late fee is defined as fees paid past the expiration(January 31) of permit. Late fee paid less
than or equal to 30 days is 25% of base fee and late fee paid after 30 days is 50% of base fee.
ANIMAL SERVICES
Specific fees listed in Ordinance No. 11-1115-99 under Animal Services are hereby being amended with the
following:
Add to the end of the list under Adoption Fees:
Adoption Fee—Dogs and Cats—Includes spay or neuter,vaccination, and veterinary exam. DOES NOT
include cost of license.
•
SECTION 7-REPEALER
This Ordinance repeals and replaces only those portions of Section 2 of Ordinance No. 11-1115-99 that deal
with the specific Health and Human Services fees identified in this ordinance.
SECTION 8-SEVERABILITY
If any section, subsection, or sentence, clause,phrase, or figure of this Ordinance or its application to any person
or circumstance is held invalid,the remainder of the ordinance or the application to other persons or
circumstances shall not be affected.
SECTION 9-EFFECTIVE DATE
This Ordinance shall become effective upon adoption. 110
Approved this /9 day of /4-70A,:j, ,2004
SEAL: , � JEFFERSON COUNTY
' BOARD OF COMMISSIONERS
(C'xe&seY
Glen ..unt'•gford, Chairman
.iii/—
, : :, 'I -mess, Member
•
) I , %-
Attest: Patrick M. Rodgers, Member
ulie Matthes,Deputy Clerk oft Board
Approved as to fo only:
DU 4 '/ 2O
411
David Alvarez De u may'
p ty Prosec ing Attorney
•
Board of Health
Media Report
•
July 15, 2004
•
• Jefferson County Health and Human Services
JUNE — JULY 2004
NEWS ARTICLES
1. "Free Women's Mammograms",Ad in Walker Mtn.News, June 2004
2. "Fluoridation support reaffirmed",Peninsula Daily News,June 16, 2004
3. "Baby care aid funds face cuts", (2 pages),Peninsula Daily News, June 16, 2004
4. "Sign up for free mammograms",P.T. Leader, June 16, 2004
5. "Homelessness",P.T. Leader, June 16, 2004
6. "Input sought on health programs",Peninsula Daily News, June 18, 2004
7. "Best Beginnings resuscitated",P.T. Leader,June 23, 2004
• 8. "County tackles junk,noise",P.T. Leader,June 23,2004
9. "City OKs funding for nurse program",Peninsula Daily News, June 23, 2004
10. "Advice sought from local youth", P.T. Leader, June 23, 2004
11. "Retailers are recognized for outstanding efforts,News Release, June 30,2004
•
. .
FREE WOMEN ' S•
MAMMOGRAMS 8z,
•
HEALTH. EXAMS
In Port Hadlock at Hadlock Days
SATURDAY , JULY lOT
Call now for an Appointment !
360 .. 385 -9423
,, g a ^:art '-"'. t _ rr>::
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' :)ystif Et, . I ,f . ' 1 t ' : 2 .-•
4.
,- ,,., .. , , ... .,L‘.,=.-::$" .-', .44.;-?:, -,.--4- : . .-' ''.- r
: _ . ,..... ._ .,:.,...,},:z., , ,,. :.,„.„.„,::..i.,,,,,, :„., , -,'4,:,:f>:',!-;t,nt-t4-L-V-jr,:zz' A.k-,'',-- '.-4,.."' ',. ,,"' '''ffiiiiipk
s s'ys
` e^.. v. yea��a,a °-
i
Between the ages of 40 and 64?
Limited income?
Have no insurance or limited insurance?
WE CAN HELP!
Sponsored by Port Townsend/East Jefferson County Soroptimists and
Jefferson County Health & Human Services
iWith generous funding from the Susan G. Komen Foundation and
Washington State Breast & Cervical Health Program
G ig.-C_ t
..
•
•
Fluoridationsupport reaffirmed
Clallam health board follows The city Department of Health Board members that
Community Development the group was "very con-
ruled in October that fluorida- cerned" about the specific
doctor recommendation for PA
tion of the city's water supply chemical the city has chosen to
-
BY JEFF CHEW Forks. did not pose a significant envi- fluoridate its water — fluo-
Pt NTNSULA DAILY NEWS Locke board's risk and did not rosilicic acid.
said the boards require an environmental- "By no means is it a natural
PORT ANGELES — action was timed..with a July impact statement. substance," said Meyer.
Encouraged by Clallam and 28 appeal hearing of the city's Lockeand
decision.28 that the
Jefferson counties'health offs – Appeal filed chemical is used in most
cer, the Clallam Board of He urged the board to tell municipal fluoridation s s
Health vested Tuesday to reef City Council members that appeal of that decision tems y
firm its support of Port Ange- their decision is a good one." to the City Council was filed "It comes from marine sed-
les' plans to fluoridate the Nov 14 by the groups Clallam iments rich in calcium fluo-
municipal water system. Decision in 2003 County Citizens for Safe ride,"Locke said.
"This is a natural phenom- The City Council voted 6-1 Drinking Water and Protect Apologizing to Meyer,
enon that was p en . in The City 003 taccept a The Peninsula's Future; Port County Commissioner Mike
have health bas discovered
i sco Dr.Tom in February
eb gtonua y Dental Services ptea MungAngeles resident Barney Doherty, D-Port Angeles, said
Locke told Health Board mem- Foundation grant of as much Eloise eKailin nd Sequim resident hef supported supporte city's from "a
bers. as $260,000 for installation of MaryMeyer, representing after hearing "e
The board followed Locke's a fluoridation system and pub- Clallm County Citizens for medical society great great majority
dental
recommendation, five of its lic education efforts. Safe Drinking Water, told society."
seven members in attendance,
to approve of the City Coun-
cil's plans to fluoridate. '
III
Two members of the newly
expanded board were absent
Tuesday — John Beitzel of
Sequim and Camille Scott of
.4
_ ,
2--16-0 -
_.
..
•
•
,.
•
lYN'ewspa_:per June 16,-2'004
• r
aid f
face c
County wants
PT council „,
to chip in �=
i V
Vp ..
BY LUKE BOGUES
PENINSULA DAILY NEWS Kolff Titterness
A Jefferson County program to "It's not only morally right, it's
provide nurse visits for low-income financially right," he said.
mothers and their babies is sched For each dollar spent on Best
uled to be cut in half next month Beginnings, eight tax dollars are
• when federal funding dries up. saved down the road when the people
Commissioners for the cash-
strapped county are asking the Port involved don't end up on welfare or
in the court system,Baldwin said.
Townsend City Council to bail out The program monitors partici-
the program. pants for 15 years.
But the city budget is in an About 40-50 families are in the
equally precarious situation, leaving program at any given time, Baldwin
members of the council angered that said.
the city is forced to find at least County Commissioner Dan Titter-
$25,000 to keep the Best Beginnings ness, R-Port Townsend, doesn't dis-
program, for moms and babies pute the success of the program, but
through age 2,from being halved. added that asking the city for funds
County Health and Human Ser- is a last resort for the commissioners.
vices Director Jean Baldwin said
Tuesday that the federal money lost Other services jeopardized
as of July 1 could be as much as
$40,000. Financial hemorrhaging in the
The council will discuss the fund- county Health Department doesn't
ing issue at its next meeting,Monday step at Best Beginnings.A number of
night at 6:30 p.m. in City Hall, 540 services that are not mandated by
Water St. law but are used by numerous resi-
dents are in jeopardy of being
'Trickle-down' trimmed or cut entirely over the next
"This was trickle-down responsi- year.In. a May 24 letter to the City
bility," Councilman Kees Kolff said Council, county commissioners
Tuesday. "Ultimately it's the respon- asked the city to front $110,000 a
sibility of the federal government." year for health and human services.
"When the federal government The money would make up for
shirked its responsibility, it went to what the county feels is the city's
the state, from there the county — proportional share of the Depart-
and they sent it to us." ment of Health Services.
Kolff, a retired pediatrician,
vowed to do whatever it takes to find
• the funding. TURN TO HEALTH/A9
Health: Funds scheduled to be cut
•
CONTINUED FROM Al ing the city pay a proportional last week, many members of "Taxpayers, in the efforts
The abortion not rrautr cl toshare of Health Department the City Council were in tears and attemptsto pay less, have
the loss of federal funds comes services. while discussing ttru effects nut reduced heir expectations
from the state,Titterness said. that losing Best Beginnings of service level," she said.
When the state Legislature City uses more could have on children. "It's not rocket science. It's
affirmed the $30 vehicle Although city residents are Through tears, Robinson fourth-grade math that says
license renewal fee proposed outnumbered by unincorpo- and Councilwomen Laurie you can not provide the
by Initiative 695 in 2000, it rated residents two to one,city edlicott and Michelle San- desired level of service when
took away the motor vehicle residents use Health Depart- doval said they
ey wouldn t be you have less funding."
excise tax that in part funded ment services 20 percent more swayed by the county to pro- Despite their own corn-
many health programs, the than those outside the city vide funding when the city's plaints about being forced to
commissioner said. limit in some cases, Masci budget can't support it. act, Kolff and Masci intend to
For the past few years, the said. make sure funding is found.
$25,000 possible
state has continued to fund A lot of that has to do prox- "I'm not willing to stand by
health -programs despite the imity, surmised Masci,.who Kolff, Masci, Councilman and not see anything happen .
revenue loss. sits on the county-Board of Frank Benskin and Council- . . and not see these children
Now that funding will.stop, Health as well as the city woman Fre' Fenn said they get the help they need," Kolff
despite a"previous-promise"" council.-The"health office" is - would "wo ' to appropriate said.
froth the state to continue the located inside the city. $25,000 ---9 though they
cash flow, Titterness said. Mayor Robinson feels the resented the county leaving
county is asking city residents the funding up to the city.
Funding gap to pay twice for Health A decision could be made at
In the midst of cutting back Department services. the council meeting Monday
county services to stop an Already city residents pay night.
impending budget crisis, the same county taxes for the City Manager David Tim-
money hasn't been found to programs that unincorporated mons is slated to present the
replace" the state funds, he area residents do, she said council with a number of
saiTuesday.
ted' "You're asking city resi- options on how to round up
Historically, cities paid into dentss to pay more than county the money.
county health departments At the meeting last week, •
residents for the same ser-
before the establishment of Timmons advised the council
vices,„ Robinson said.
motor vehicle excise tax not to provide the funding
money,Titterness said. The amount being asked for because it's not the city's
He views this as a return to takes the county taxes into responsibility.
the way funding worked account, Titterness Robinson, a therapist, cried
responded.
before the state came in. last week as she stated her
While other programs are
Port Townsend Mayor at risk,Best Beginnings is first reasons against givingthe
Catharine Robinson, however, county Health Department
on the chopping block when
points out that there is Doth money.
ing in current state law the federal money runs out The county had the option
requiring the cityto payin to July 1. to find the money,
q g The net effect will be the • sjust as the
the county service. city does,but chose not to, she
loss of one full-time job in the
There is also nothing pre- said.
venting it, either, Titterness program' "We all have the ability to
replies. Substance abuse choose and prioritize,” she
Meanwhile, Titterness and said.
other commissioners are Financial changes in sub- "The county commissioners
searching for more health stance abuse services will also are spending on land use
funding, he said. cause the loss of a job in that issues instead of children's
Commissioners may ask program, Baldwin said. lives. I quibble with that
county voters this fall to alter Cuts in other areas may be spending priority."
a road maintenance levy to delayed until next year's Taxpayers might have to
direct some of the property tax county budget is put together. become accustomed to such
money to the county's general At an emotional Port cuts because of tax-cutting ini-
fund. Townsend budget workshop tiatives, suggests Medlicott.
The measure wouldn't be a
tax increase,but a reallocation
of where the money goes.
If the measure wins voter
approval, it could provide
some relief for Health and ..
other county departments.
But it isn't a complete fix, III
and still the county is request-
•
• A 2•Wednesday,June 16,2004
Signup for free mammograms
Special quick-result lab coming to Hadlock Days Jul
10
By Beth Cahape Quilcene Fair," said public
woman can have to detect breast ing a mastectomy [complete
Leader Contributing Writer health nurse Marji Boyd. "We cancer early, when treatment is breast removal) or a situation
actually ran out of appointment most effective. And considering where you can't do anything
For the second time in just times pretty quick. the statistics that breast cancer is about it because it's spread
nine months, free onsite mam- "No one is ever turned away the second leading cause of can- throughout your body."
mograms will be available to from these services at the Health cer death among women in the Stelow, a local Realtor and
Jefferson County women who Department," she emphasized; United States,it's also an essen- Soroptimist, is a fierce advocate
are low income and uninsured or "but this event is extra handy tial practice. of breast cancer awareness.
underinsured. because it's right there in Port Accordingexperts to at the Together with Boyd, she has
However, women have to
Hadlock, rather than us sending Comprehensive Breast Center, a mobilized area Soroptimists to
sign up now to get one of the you down to Silverdale." part of Seattle's Swedish Medical make a long-term commitment
limited appointment slots, And the process of getting a Center, a woman's chances of to bring free, easily accessed
according to Jefferson County manunogram from the mobile surviving breast cancer are more mammograms to women in the
Soroptimists and Public Health unit will be a whole lot faster and than 90 percent if it's detected county, funded primarily from a
Department staff,who are work- efficient as well."New this year," early. The sad fact is that many grant from the Susan G. Komen
ing in tandem to bring a state-of- added Boyd, "is that the techni- women in our state find out too Foundation and the state-spon-
the-an mobile mammogram unit cians will actually beam the late,when the cancer has become sored Breast and Cervical Health
to the July 10-11 Hadlock Days mammogram film directly to too advanced. Swedish experts Program(BCHP)program.
illocelebration. Swedish Hospital[owner of the 'estimate that in 2004, about 750 In addition to free manuno-
"There are only 24 slots mobile unit] and they'll have a Washington state women will die grams at the Hadlock Days cele-
available, and last year a phe- radiologist check it immediately." from the disease. bration, area Soroptirnists will
nomenal number of people Getting an annual mammo- Early detection also means be on hand to offer information
called-us when we did this at the gram'is one of the best tools a that the treatment is much easier and guidance about breast
to go through. • health. And because they have
"One of the best things about all gone through breast cancer
early detection is that you can training with Cancer
have a modest lumpectomy that Information Service,they're also
might be just an inch long,"said prepared to offer support for
breast cancer survivor Nancy those who might face further
Stelow. "Otherwise you're talk- exams and/or treatment.
These free mammograms are
available to women ages 40 to
64. To arrange one, call Health
Department BCHP screening
coordinator Jennifer Doyle at
385-9423. To learn more about
this group's efforts or to volun-
teer your time, call Stelow at
379-9236.
•
Wednesday,June 16,2004•B 5 •
Homelessness
join planning meeting Friday
The Continuum of Care support housing for the City of
planning' process for the Seattle Mayor's Office of
homeless invites the public to Housing. He was responsible
a meeting from 10_a.rd. to for administering the Sound
noon Friday, June 18 at the Families Initiative program
Jefferson County Health and funded by the Bill & Melinda
Human Services conference Gates Foundation,which funds
room,615 Sheridan St. regional housing with support-
Attendees will focus on ive services for families in tan-
creating a 10-year plan for sition out of homelessness.And
ending chronic homelessness he has worked for Harborview
in the county. Medical Center, developing
Facilitating the meeting is housing resources for those
Papl Carlson,federal regional with severe mental illness.
representative, who is tasked "We are excited about col-
with providing coordination laborating with Jefferson
and liaison with state and County Community Network
local governments, regional on its long-term prevention
offices of federal agencies, plan," said Sylvia Arthur,
local providers and the public Continuum of Care plan
in their collective efforts to •coordinator."It will make our
combat homelessness. results more comprehensive
Carlson served as strategic and will help streamline our
adviser on homelessness and planning process."
June 18 19,, 200;4 x*
LT
� cm1 iI1il !
° c tInput sou ht �• o , Lr _o „'c c) ...,.„1 .acvr uog.., >,
8.,,_,
az, 0
° 0 I01rn3 �v c L s.G a , �� N °M � �aon health N .cb v ..a
v �90 ' acvP.3 „
b'a ‘ ,..6, „ E 8 . qr.:au, cmprograms n va � �v4= � ~ �3h . 3� � gh$ u- 8E2oo-848.0- a; 1
„ 1..,
aio Board wants comment w °' `� ❑ a
O Cb 3 �w C o two . a u ko
as funds crisis develops 4.� - 4-+ a g g .� .r) a N 3 a a. .5 A o
BY LUKE BOGUES a�3 h o ca a,
PENINSULA DAILY NEWS C ° '>"'m a' `n 0 °'•4 2 ; le t5. j.:
+' 6Ao S >moo• .�•°t�' ow.�
A crisis in public health tom" U ° (1_4
_ . "• ; o U^g�+j p� !.8 a m y o.Q 1
C .-, ~ 2 s C a e 1 5 U'0^C'5,e o=
funding may be too severe for �y o 0
•fie"� Jefferson County health ofli- O a i>'-o 5°c o •, o � o 8 0 0^',rte-a w t
cials to solve on their own,the �, ax ao as •' Eo E Z 8 8
; Board of Health conceded ` o ur 'B y H "F o f7 d E o
:Y;.z ` ', Thursday. Cl) ,..,,„4„, pC v° o o as $ 8 S o
s...",),-,: It's time for the public to �/J « yp 0 o 0 0
i prioritize what services it aa,;� 0 3 c. '�3 �� ° ,G as co) Cdo
-� •
rr fi wants,or else risk losing those •(� C q e'en ami x o fob `2 0 a .B c a>>'n '
ori, programs as early as next �� •° o o tn. 8 ❑ o �, o Q
Masci month, said Julia Danskin,ttho N o o oil a m ' ° a
director of nursing at the .c t4•� .522.i
; -° d a E.5,..,•° o
county Health Department. •r-•1 a a:b aoi• T m F 0 go 0 8 4, ooa•.
Funding is drying up from federal and state �_ U a t g$ g E -a c 8 b w o ° .c 3 t U e
sources, leaving health officials scrambling to v N eo 8 „r ' >p•, a, t-0 o . [ E.E o
adjust to declining revenue streams. _ � rl .--0.,w-'4'4,n, [ y §',.:4). E ,-9. ,26,1,-' o -E
• Talk about money problems was a central a, ea o'A a ', m a' a N ° •,g 0 8; q,s a,
topic at the county Board of Health meeting 4' a o a, �a c Zr.. m a.
Thursday at the Health Department offices in O E F" o 2' '� c" 0 4,' -o a ,� 0 c w w E.. M w
Port Townsend. a 0.3 0.>, Ax 'az U E C3<°,, 8�.'.E .2 ca
Health and Human Services Director Jean
Baldwin is in the midst of preparing a depart- (� a -c g N ani�i o.c
ment budget for next year. iii u A o `y� o
It's not a matter of if there should be cuts, O o S 0 a a; .a y 080 8 a,N �i EC o.ar y E
it's deciding on what services the ax should fall, E v a o, rg- •c, a 2 v>' : q z 8 w� a. o 8 0
she said Thursday. (/) E 8 •5.g to>, E o >, �o - .E a, ce v a k> E
County Commission Chairman Dan Titter- 8 m -.- g— 0 0 0 o a .a x °.ti 8 ,,
q o r 3 co 8 0 3 0,� 0 0
ness,ft-Port Townsend,said Thursday that he o N o f:',',2 a, 0) p'^ o„ ° Kn 0 0 °a o•O' ..Ths,,,,,
intends to take another look at the county bud- _ m " a; -45 q -., on a 0 w, , N c o0
get to see if there isn't a way to commit more ( e c ani �''" `� •� [ ° a`i'mo i > 8
money to the Health Department. r 1 v ti >..,9a 3.5,o vii -o a,w a 0 q v' 0 oa
-Longterm health funding is desperately `�� o a' o w o c ° v o °o G� e
_ U o.
needed,Danskin said. IC ) .o l., 8 ° a) ca co 8-o E.., a E. a b Es., o w 0 8
City Councilman Geoff Masci, who also sits `+�/ s.•°.-, x,o z _ •; iz ..0.� .� >, a m•4
on the Board of Health, proposed to the corn-
missioners that the city and county jointly dis- m g ctl 0.....0Q a, 04 o..0...= >S a o v
cuss paying for the programs. ■ ■ o a a oo ,.. 46 E 3 a 'a m o.l a c >. s,x
d a, a ,o ° ' � o E ,° a) a
TURN TO HEnL'rH/A11 t=. •„m,g 0_g.2 a,+'�-'.0 .4. 3 m 3 U u u u u o cd' O
co
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Best Beginnings•
r. esu citated
City, county agree to help Health Department
By Sarah J.Bell
Leader Staff Writer "I •think it's great that we can
The Port Townsend City Council approved by 4-2 vote work together to solve eommu-
a one-time donation of $17,500 to help save Jefferson p
County's Best Beginnings program from the budget buzz- ”
saw. Earlier Monday, the county commissioners had nay problems,
pledeed$12,500.
The preventative program, run by the county Health Dan Tittemess
Department, aids newborns and mothers.But a $25,000 county commissioner
grant expires July 1,and without that money,the success •
-
ful program faced a huge cut. can retain current staff for the next six months and allow
"We can serve up to 40 families,but I would have had staff to continue serving all of the women who are
to cut that number in half if the funding did not come approved for Best Beginnings. Jean Baldwin, Health
through;" said Julia Danskin, the county's public'health Department director, has not otherwise been able to
nursing director. replace the grant money.
County Commissioner Dan Titterness of Port • • After heated debate, the City Council approved the
Townsend attended Monday evening's City Council meet- appropriation of $17,500 from its contingency fund.
ing to ask for the city's help. Tittemess said the county Catharine Robinson and Michelle Sandoval were opposed,
committed $12,500 of the required $25,000 to keep the Freida Fenn absent.
program running from July 1 until year's end. The amount of $17,500 was decided upon after
Since the program's start in 1999,Best Beginnings has Councilmember Geoff Masci made a failed motion to
served 82 families. Danskin said the current active case approve$23,000.
load is about 35 families.The program serves.each family The $17,500 is being given to the county Health
for two years; therefore, numbers vary from month to Department on one-time basis, with the caveat that the
month,she noted. City Council and Board of County Commissioners would
Danskin said that with$25,000 the Health Department See BEST,Page A 11
Best411
Continued from Page A 1
continue to react to the pro-
gram's loss of funding.
"1 think it's great that we can
work together to solve commu-
nity problems," Commissioner
Titterness said of City Council.
"I appreciate the council's sup-
port on this issue,as I'm sure the
other commissioners do."
Sales tax support
Titterness said that in discus-
sion among county commission-
ers earlier in the day,they mulled
the idea of offering the opportu-
nity for Jefferson County resi-
dents to levy-a'txx with the°rev- _.l
enue supporting the program.
The tax has not been
approved for placement on any
ballot.
The idea of a 3/I Oths of 1 per-
cent sales tax to support the pro-
gram
(10—a3"--6
was discussed by
Titterness at the council meeting.
He said a third of the revenue
from the tax would go to law and
thirds seruland the hr twand •
thirds would go to health and
human services.