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HomeMy WebLinkAbout2009- February File Copy • Jefferson County Board of 3-Cealth Agenda _Minutes • February 19, 2009 • • JEFFERSON COUNTY BOARD OF HEALTH February 19, 2009 Jefferson County Public Health 615 Sheridan Street Port Townsend,WA 2:30—4:30 PM DRAFT AGENDA I. Approval of Agenda II. Approval of Minutes of January 15, 2009 Board of Health Meeting III. Public Comments IV. Old Business and Informational Items 1. Draft National Public Health Week Press Release 2. More Retailers Selling Tobacco to Minors 3. 2008 State Board of Health Annual Report • 4. National FluView V. New Business 1 Legislative Advocacy: Public Health Funding Letter 2. Syringe Exchange Program Report 3. Jefferson County Demographic Data Update 4. Substance Abuse Board Report 5. Public Health Mutual Assistance Agreements Updates VI. Activity Update VII. Agenda Planning VIII. Next Scheduled Meeting: March 19,2009 2:30—4:30 PM Jefferson County Public Health • DRAFT JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, January 15, 200 2:30 PM—4:30 PM Health Department Conference Room, 615 Sheridan Street, Port Townsend Board Members Staff Members Phil Johnson, County Commissioner District#1 Thomas Locke,MD,Health Officer David Sullivan, County Commissioner,District#2 Jean Baldwin,Public Health Director John Austin, Chair, County Commissioner,District#3 Julia Danskin,Nursing Services Director Chuck Russell, Vice Chair Hospital Commissioner,District#2 Michelle Sandoval,Port Townsend City Council Sheila Westerman, Chair, Citizen at large(City) Roberta Frissell, Citizen at large(County) Chair Westerman called the meeting of the Jefferson County Board of Health to order at 2:30 PM. Members Present: John Austin, Roberta Frissell, Phil Johnson, Chuck Russell, David Sullivan, Michelle Sandoval, Sheila Westerman Guests Present: Frances Joswick, Substance Abuse Advisory Board • Staff Present: Jean Baldwin, Dr. Thomas Locke, Julia Danskin A quorum was present. APPROVAL OF AGENDA Chair Westerman announced a change to the order of agenda items under section V; item 4 was placed ahead of item 3. Member Sullivan moved to approve the agenda, as changed; the motion was seconded by Member Johnson. The agenda was approved unanimously, as changed. APPROVAL OF MINUTES Corrections: page 2, second paragraph: "... school age children are ... factor in... ", not is. Page 3, last paragraph: Member Westerman, not Chair Westerman Member Johnson moved for approval of the minutes, as amended; Member Russell seconded. The minutes of December 18, 2008 were approved, as amended, by unanimous vote. PUBLIC COMMENTS There were no public comments. Chair Westerman noted that, during her tenure as Chair, if • members of the public are not present at the beginning and arrive during the meeting, she would add a Public Comment period at the end of the meeting, as possible. Page 1 of 12 4 DRAFT OLD BUSINESS December Provider Advisories: MRSA and Antiviral Medications Dr. Locke discussed the two provider advisories in the packet. He noted that he and fellow health officer Dr. Lindquist are attempting to increase regional outreach to hospitals and medical providers. Whenever such issues arise at the County level, they consider the regional implications and tailor their message for regional applicability. The Methicillin Resistant Staph Aureus (MRSA) advisory was prompted by a series of articles in the Seattle Times in mid November, entitled "Culture of Resistance". Dr. Locke pointed out several contentions in the article were not accurate. The article stated that hospital associated MRSA have gotten substantially worse when, in actuality, it is community acquired MRSA that has worsened. Rates of hospital transmission have been relatively stable for the last twenty years. Secondly, the article strongly suggested that, for this very complex problem, there is a simple solution: nasal cultures for patients before entering the hospital, with isolation of all MRSA carriers. This type of article presents a challenge for medical providers in communicating with their patients about MRSA. Dr. Locke noted that Dr. Scott Lindquist, Deputy Health Officer for Jefferson County, is an infectious disease specialist. The advisory he has written provides facts and advice for health • care providers. Dr. Locke also discussed the Expert Panel recommendations referenced in the advisory,which reflect the complexity of hospital infection control. Dr. Locke noted that there is a bill before the legislature that would require nasal screening cultures for hospital patients. There is conflicting scientific evidence over whether this would be effective or not. Considerable international research efforts have been undertaken to resolve these issues. As the evidence emerges, hospitals are adopting these recommended practices. However, Dr. Locke noted that the problem will not be simply resolved. It is persistent problem created by the promiscuous use of antibiotics, not only in the treatment of humans, but also for livestock. Chair Westerman asked how the science-based viewpoints will be presented to the legislature, especially input/plans from the Washington State Department of Health. She noted that the newspaper series had generated a great deal of attention, and had appeared to be well researched. Dr. Locke said that infectious disease experts are taking the lead. Dr. Jeffery Duchin, Chief, Communicable Disease Control, for Seattle/King County had written a very good rebuttal editorial for the Seattle Times. Jean Baldwin added that. Dr. Duchin had also appeared on KUOW and on local talk shows. Dr. Locke said that Dr. Lindquist and other infectious disease specialists would likely be asked to testify before the legislature. Dr. Locke also discussed the Health Advisory regarding influenza treatment guidance. This communication, which is a condensation of a ten page CDC document, provides specific advice for antiviral treatment. The main circulating strain of influenza, H 1 N 1, appears to be resistant to . the main antiviral medication in use—Oseltamivir("Tamiflu"). Over the course of one year Page 2 of 12 0 DRAFT resistance rose from 11%to 98%. Dr. Locke explained that the more an anti-virus drug is used, the more resistant strains are selected out. Vaccination is the best way to control influenza, along with respiratory hygiene to reduce transmission. There was a brief discussion about the disposition of stock-piled oseltamivir for use in the event of an influenza pandemic. Dr. Locke said the shelf-life is about seven years. He said it will probably be useful in the first big wave of an influenza epidemic before resistant strains emerge. Tamiflu is not recommended for most flu patients; on average, it reduces the duration of illness by only one day. It is most useful in the very young (under 6 months of age), the very old, and those whose health is compromised. Public Health Impacts of Heavy Rain and Flooding Jean Baldwin pointed out the press release regarding drinking water safety was based on the Kitsap County release. There was little local damage in Jefferson County. She noted that in addition to the advantage of location within the rain shadow, Jefferson County has been planning ahead and has been moving people out of flood plain areas through Conservation Futures purchases and other means. Ms. Baldwin discussed a related problem, food distribution during prolonged closures of • highways, particularly I-5. Local markets are normally restocked continually; closures of I-5 do cause some disruptions in the flow of market supplies. She also discussed the impact on the Jefferson County transfer station. When solid waste and recyclables cannot be transported away, it accumulates rapidly. Recovery to normal levels requires considerable time, especially when other areas of the State are similarly affected. She said that system agreements between FEMA and local EOCs (Emergency Operations Centers) are not always fully worked out in advance to handle FEMA vouchers during periods of flooding. This could be a problem in the future if Jefferson County should experience serious flooding. She explained that normally the State Public Health system works with a local EOC group to identify issues that arise, such as animal disposal. Although not seriously affected by the recent floods, representatives of the Jefferson Health Department have been monitoring impacts in the other areas. Member Sandoval inquired about a recent problem at the EOC during a general power failure; apparently the emergency generator did not come online. She said that she had received an early morning phone call, informing her of an anticipated two to three day outage, but that a solution involving the Clallam PUD had been arranged, thereby shortening the outage. Julia Danskin noted that the City EOC/Fire Department had been able to mobilize as part of their back up function for the EOC. Jean Baldwin noted that the Health Department had used their emergency power generator to ensure refrigeration for stored vaccines, based on information that the outage would be of short . duration. The contingency plan for a longer outage would be to move vaccines to the hospital for storage. Page 3 of 12 4 DRAFT • Chair Westerman asked how the information about water safety is disseminated. Jean Baldwin indicated that in addition to press releases, the information is posted on the web and in certain locations such as grocery stores. Copies are also sent to Bob Hamlin for dissemination to the emergency preparedness neighborhood groups via their e-mail distribution list. School-based Clinic Opening—January 2009 Jean Baldwin distributed copies of survey results, entitled "Jefferson County School Based Health Center Data, January 2009". This is a summary of the parent/student survey of Chimacum and Port Townsend Schools attendees to determine their opinions, needs and concerns related to the school-based clinic plans. She noted that of the 604 students responding, many recognized behavioral risk issues including nutrition, stress, tobacco use, lack of physical activity and depression, and their long term health impacts. Ms. Baldwin said she thought it important to share the perceptions of these families. Jean Baldwin also mentioned a Letter to the Editor, included in the Media Packet, from a Port Townsend High School ASB (American Student Body) member, expressing concerns about confidentiality and cost; this student had not been involved in planning/advisory efforts for this initiative. She recalled that both Chimacum and Port Townsend ASB members had been attending advisory meetings along with teachers, counselors, Health Department representatives, school administration from the spring of 2008 through the fall of 2009. They had explored ideas • and options for the school based clinic including outreach, confidentiality and other important design/implementation issues. Ms. Baldwin then consulted with The Leader about the most appropriate way to publicize information about the program. A Leader journalist then spent several hours at Port Townsend High School interviewing students, Principal, Superintendent, and various staff to gather relevant information for a feature article. Ms. Baldwin said this approach is intended to convey how comprehensive this service will be and to convey as much information as possible. Copies of a one hour call-in program on school based clinics, aired on KUOW on January 12, are available and the program can be downloaded. She said local Seattle/King County people called in with questions/comments for a nurse practitioner, mental health counselor and clinic coordinator. The overall tenor of the program was very positive and provided an overview of the complexity of services available. Ms. Baldwin said that many callers were parents whose children had benefitted from the program over the long term. At this point, the school based clinic program, which took 8 months of planning, is ready to begin. There has been extraordinary outpouring of community and school support, including volunteer hours and business donations. Two local businesses, Carpet One and Peninsula Floors, are providing thousands of dollars of product, use of equipment and installation. The Boeing Blue Bells remodeled Chimacum High School at no cost; both Chimacum and Port Townsend High School ASBs contributed $500. She said both spaces are up and running. • Page 4 of 12 EE 4 • DRAFT An adolescent specialist from Kitsap Mental Health, paid from the Jefferson one tenth of one percent funding, has been seeing students since October. Jefferson Health Care and the Health Department are working together on funding. The goal is to open on February 2 at PTHS two days per week for medical primary care and family planning. Tobacco prevention will be added as soon as feasible. Parental information and consents are in place. She said it is not possible to anticipate exactly how the program will be accepted and utilized, but that signs are positive. One remaining challenge is to put billing capability into place for those services that can be billed. She added that staff members are touring selected sites in Seattle to observe their school clinic operations. Thank You Letters Julia Danskin reviewed the letters of appreciation to the owners of Chimacum Chevron for their $500 donation, which will be used for family support programs, and to the Port Ludlow Yacht Club Women's Group for their donation to the Breast and Cervical Health Program. Both donors have also supported Jefferson County Public Health in prior years. NEW BUSINESS Pharmaceuticals, Personal Care Products, and Water Quality • Jean Baldwin introduced Tami Pokorny of Jefferson County Water Quality and Environmental Health, and called attention to the Rivers for Life, WRIA 16 Newsletter, in the packet. Ms. Pokorny explained that WRIA 16 stands for the Water Resource Inventory Area that spans southern Jefferson County including the Dosewallips and Duckabush Watersheds, as well as portions of Mason County along the west and south shores of Hood Canal. She noted that the newsletter has been published for about 5 years. The most recent issue contains an article about PPCPS (Pharmaceuticals and Personal Care Products) and their impact on water quality. As mentioned in the article, the Puget Sound Partnership, the EPA and the Washington State Department of Ecology are collaborating on a study of the effectiveness of municipal water treatment in removing PPCPs. She reviewed the extensive and nearly universal use of these substances, which include over the counter as well as prescription medicines, by-products of soaps, shampoos, cosmetics, aerosols, growth hormones used in livestock, veterinary medications, etc. The amount of these substances released into the environment is estimated to be about the same as the amount of pesticides used each year. The US accounts for about half of all pharmaceutical use in the world. In recent years, there has been increasing awareness of the presence of PPCPs in drinking water. She cited information from studies conducted in 2002 and 2004 that had identified chemicals in water downstream from urban areas and elevated antibiotic levels in rural areas. One serious issue is that water treatment facilities are not targeting many of these compounds for removal, and even very low levels can affect the growth and behavior of wildlife such as fish and oysters. • PPCPs enter the environment in gray water and in human and animal waste. It has also been common practice to dispose of unused medications by flushing them down the toilet. Ms. Page 5 of 12 DRAFT Pokorny said the newsletter is intended to raise awareness and to provide guidance as to the best means of in home disposal, i.e. via the trash. Ms. Pokorny noted that federal guidelines for disposal of prescription drugs are also posted on the Jefferson County Public Health website. Recommendations include obscuring the identification label/container and mixing contents with contaminating materials such as coffee grounds or kitty litter before sealing and concealing. Ms. Pokorny also briefly discussed a second newsletter article, The Hood Canal Clean Water Project. This is a 4-year project initiated by Jefferson County Environmental Health to evaluate water quality and collect data on pollution and nitrogen sources entering the Hood Canal. She noted the multiple perspectives and contributors who assisted with this informational article, versions of which will also be submitted as press releases. Ms. Pokorny pointed out the notice regarding the "Who Speaks for Hood Canal" Video Newsletter on the last page of Rivers for Life. She described the video and its availability at http://hoodcanalwrial6vide.blip.tv. Jean Baldwin requested suggestions from the BOH on distribution of this newsletter issue concerning PPCPs. Suggestions included: hospitals, health care provider waiting rooms and pharmacies. Frances Joswick noted that many people are not aware of proper disposal procedures for unused/expired pharmaceuticals. She suggested posters with disposal guidelines be hung in pharmacies and physician offices, and articles in the Leader and PDN. Dr. Locke explained that laws prohibiting pharmacies from accepting unused drugs for disposal were intended to prevent re-sale of expired drugs. He also noted that the Health Department • recommendation is not in agreement with federal guidelines that continue to recommend flushing controlled substances down the toilet. In response to a question about incineration, Dr. Locke said that the efficacy of that disposal method would depend on the particular compounds involved and incineration temperature. School Immunization Trends—Jefferson County and Washington State Dr. Locke provided background information on the State program which has been supplying free vaccine for children. He said this would be the first in a series of reports this year regarding immunization for children, a program that is very much in flux. The focus of this report is to provide new local data regarding a worrisome statewide trend of increasing exemption levels in school age children. Washington State has a requirement in statute that children entering pre-schools or public schools have immunization stipulated by the State Board of Health. Not all childhood vaccines are mandated. Those vaccines that deal with diseases that potentially cause outbreaks in school settings have been placed on the mandatory list. Washington State also has a very broad immunization exemption policy in the same state statute. It says that a parent can exempt their child from this school entry requirement for one of three reasons: a religious exemption, a medical exemption, or a personal exemption. Over time, that exemption rate has been increasing year across the State. The most recent data on K-12 exemption rates by county (2007-2008 School Year) was included in the Board's packet. About 10 to 15 years ago, the average • exemption rate in Washington State was about 3 percent. Currently, there are significantly Page 6 of 12 DRAFT . higher exemption levels. Jefferson County, at 11.9%, is among the highest; the rate has been rising from about 8 % within recent years. (Ferry and Stevens County in the northeast part of the State have the highest exemption rates, but very low populations.) The infectious diseases that we are most concerned about are measles, mumps, rubella, pertussis and diphtheria. In order to prevent outbreak of these diseases, between 90 -95% of children must be immunized. Dr. Locke explained that the levels of unimmunized children are reaching the point that will support localized outbreaks. Dr. Locke pointed out the data for the current school year for the Jefferson County Schools. He noted the ranges among the different schools and the exemption levels, and the fact that virtually all the exemptions are personal ones. Religious exemptions are very unusual, and medical exemptions are rare. Member Sullivan asked if there is a threshold percentage or number that would be considered alarming and indicative of possible outbreak. Dr. Locke said the threshold differs for each disease. Measles, which can be a deadly infection, is of greatest concern. Measles cases are now reported in Washington State on a routine basis; there was an outbreak in Grant County last year. The required immunization rate for measles is 95%; any exemption rate that exceeds 5% presents a risk for outbreak. For some diseases, the rate is lower. For example, with influenza, at least 90% of children should be immunized, although influenza is actually not mandated. The rates for mumps and rubella are around 90%. • Member Russell inquired as to the meaning of personal exemptions. Dr. Locke stated that the current form is extremely simple and does not collect parental reasons for exempting the child. The exemption form has been redesigned for next year and will ask for reasons. He said that focus groups and surveys indicate that exemptions break down into two categories: One has been called philosophical objections, i.e. people believe that vaccines are harmful or unnecessary, or that some are vaccines are beneficial and some are not. People are making a conscious decision based on information they have received or values they hold. The other category has been called convenience exemptions. For these, it appears that people are not opposed to vaccinations but sign the exemption form to avoid the requirement to produce vaccine records. Their children may not be up to date on immunizations or they cannot immediately produce the vaccine records. Dr. Locke said that some of those children may subsequently get vaccinated, but there is not clear data. It is believed to be about a 50/50 mix, half being philosophical opposition to vaccination and half being convenience issues. Public health officials are focusing on the latter group in order to identify barriers that may prevent or delay vaccinations or to obtaining records. The goal is to assure that all children whose parents consent to vaccination are fully immunized. Jean Baldwin said that, every other year, staff has investigated the issue of convenience exemptions. In doing so, they check to identify any changes in school personnel or procedures, or to identify areas that can be improved internally. She mentioned that the Chimacum Schools . now use an effective referral system. She also described the counseling work that is done in the weekly mothers' breast feeding group. The topic of immunizations has been discussed on Page 7 of 12 DRAFT . several occasions, and every attempt is made to work with mothers by listening to concerns, providing guidance and assisting in stretching out immunizations, etc. Dr. Locke also discussed the related issue of the overall record on childhood vaccinations within the State. He said that the first three years of age are the most dangerous time for vaccine preventable diseases. The national standard for a fully vaccinated child is measures children between ages two and three. He referred to the National Immunization Coverage Rates (blue toned map) in the packet, which shows coverage for children in the 2-3 year old age group; numbers at the top refer what a fully vaccinated child at age 2 should have: 4 DPT shots; 3 Polio shots, 1 Mumps/Measles/rubella shot, 3 Haemophilus Influenzae Type B shots, 3 Hepatitis B shots, 1 Varicella(Chickenpox) shot. Washington State has one of the lowest rates of achieving that target in the USA. That is a particular challenge for Washington, despite the fact that it is one of only 6 or 7 states that pays for 100% of childhood vaccinations through a combination of state and federal funds. One of the problems with childhood vaccinations, as shown by the Environmental Change sheet in the packet, is the growing number of vaccines and the associated complexity. In 1985 there were only 7 antigens administered and several were combined: two or three shots with multiple boosters. By 1996 there were 10 antigens and by 2008, thirteen years later, there are 16. In the pipeline are still more; there are almost two dozen vaccines in development, not all of which are childhood vaccines. Dr. Locke said it may be possible to prevent multiple types of cancer through vaccine, and/or to prevent diabetes and certain types of autoimmune disease. • Vaccination has become a very powerful medical tool. Chair Westerman added that some of these vaccines are not targeted to children; HPV for example is not administered until adolescence. She also said, in her opinion, that because vaccines have been so successful in preventing outbreaks, people are not worried. There is a sense of security in the general population. She said that, apparently, the issues are not being communicated clearly. She suggested that perhaps there should be more emphasis on the fact that these issues concern not just one's own children, but everybody's children. Jean Baldwin mentioned that there have been two outbreaks of pertussis in this county in the last three years in the same population of ten home schooled children, which consumed many hours of staff time. Members briefly discussed whether there should have been more public information disseminated in that case, and whether additional measures are needed related to at risk schools. Dr. Locke explained that if a child is not vaccinated and an outbreak occurs,the child is not allowed in school for the duration of the outbreak, unless they can be vaccinated. That is the reason these records are kept and there is a consequence. He mentioned a recent case where the Health Department was prepared to pull unvaccinated children out of school, but that tests had turned out to be negative. Chair Westerman asked about the process for home schooled children, and was told that there is no tracking of immunizations for those children. • Page 8 of 12 DRAFT • Concept Mapping and Strategic Planning-- Overview Jean Baldwin said that before moving into concept mapping, she felt it important to discuss the larger context and the general economic uncertainty of the times. She discussed the larger picture of budget cuts that are currently under consideration at the State level, including how the shortfalls in the Governor's annual and long range budgets will be addressed. She discussed the types of information that is available with regard to proposed cuts, and cited the lack of a comprehensive picture as to how pending legislative decisions will actually impact State and local budgets and programs. She noted that layoffs and rollbacks are partially invisible and have a diffuse impact on the community. She said she was very concerned about what is going on in the community and how families are and will be affected Ms. Baldwin said that she believes it prudent to pull all the unfolding information together and examine it. She said she had brought the topic to this body because she believes the BOH has a broad community, non-partisan vision. The BOH is charged with, not just the Health Department, but also regulatory issues and other broader ones. She said she was seeking the BOH's guidance as to whether this scope of effort was appropriate. She offered several examples as to the difficulty of translating budget decreases for particular agencies, such as Mental Health, into real community impacts. She said that she was deeply concerned about the probable impacts over the next few years, but did not know if the collection and analysis of all the relevant information was necessary, or even possible, and appropriate at the Health Department level. 110 BOH members sought clarification on the types of information that would be collected. Ms. Joswick stated that it is extremely important to know the numbers of people affected in order to assess the potential impact on the community. Jean Baldwin explained that the information would be essential in prioritizing how staff and other resources would be assigned and shifted according to changing needs. She noted that Medicaid and Medicare are very expensive systems and are at the brunt of recent cuts. She said the affected clients would not likely come forward directly, but would be evident in ER, police and jail statistics. She said that although there is clearly not enough public funding from City and County to meet these needs, there should at least be information to support decision making and prioritizing. There was a brief discussion about GAU (General Assistance for the Unemployable), a State DSHS assistance program for those temporarily unable to work, which has been cut completely from the Governor's 09-11 budget. It was noted that although the numbers of people in this program are relatively few, these individuals also use mental health, hospitalization and other treatment programs that will no longer be reimbursed. The idea of a shared web site for various agencies to post quantitative impact information was suggested and briefly explored. Some members questioned the feasibility of reducing the complexity of data to meaningful planning information. There was a suggestion that the State • should be tracking this type of information. Ms. Baldwin noted that DSHS could/would not do this, since the money was already cut from their budget. Page 9 of 12 DRAFT BOH members discussed the purpose and use of such a database and how it would inform policy • discussion. One use would be assessment of needs and associated prioritization of resources at the City and County level. Another suggestion would be to support education/advocacy efforts at the State level and to provide justification for funding requests. In response to a question as to the extent of impact on health care for children, Julia Danskin summarized the provisions in the Governor's budget. She said the Healthy Kids Now program would continue to cover children(under age 19)up to 200% of the poverty level for free and up to 250% for families that pay a premium. The expansion to 300%of the federal poverty level that was planned to begin on January 1 was cut. She said that Washington State continues to have one of the best programs for children 18 and under. The federal government is also working on standardizing S-CHIP, which is promising. Ms. Danskin also provided an update on the previously announced cuts to the Department of Alcohol and Substance Abuse. After initial information that Ford Kessler from Safe Harbor Recovery Center would see a$60,000 cut between now and June, it was learned that smaller counties such as Jefferson would continue to receive their base allocations, while larger counties will see large cuts. She said Janet Polley, Jefferson Mental Health, and Ford Kessler had both confirmed that their budgets are stable through June, and they see no service reductions for the time being. There is no specific information about 09-11 budget as yet. With regard to funding for the developmentally disabled population, Ms. Danskin said there are • some major cuts that do not affect this County due to our small size. She said she was not aware of any cuts in our current budget between the present and June 2009. Jean Baldwin stated that there is expectation of further cuts. Ms. Joswick suggested that the period between the present and June 30 be used to collect information and project the impacts to services and numbers of people. Chair Westerman asked if Ms. Baldwin would be able to pursue this data collection idea by deferring some other tasks and activities. Ms. Baldwin said she would attempt to develop some form of grid. Chair Westerman said that the BOH realized the pressures and did not wish to impose more work without adequate resources, but thought that the information would be valuable to the BOH as it faced prioritizing decisions in the future. Member Johnson agreed that the information would be valuable. Julia Danskin added that the Washington Association of County Commissioners is in the process of collecting this type of data. She said there is preparation and monitoring of the legislative process to determine if the DSHS and other cuts will be sustained. She said she expected that the BOCC would be lobbied by the Association. Member Sandoval expressed concern about retroactive provisions mentioned earlier. She questioned whether or not this included the electrical rates for the paper mill, and whether or not they would owe considerable money, having already laid off 28 people. Other members had no • information on this issue. There were additional comments about the apparently limited nature Page 10 of 12 DRAFT • of impacts at the present time. Member Sullivan suggested that one way to pick up the slack as a community would be through volunteerism, donations and non-profit organizations. He acknowledged the symptoms of system failure, as well as the need to find crucial solutions. Member Russell added that volunteers had served 28,000 hours in the hospital last year. Ms. Joswick pointed out that some skilled needs cannot be met by volunteers alone. She restated that impact data or reasonable estimates are important for planning and responding. In summarizing, Jean Baldwin said that she would explore data collection further. She invited others who were interested to participate. Ms. Joswick volunteered to assist, as possible Flow Sheet—Boards and Committees related to Substance Abuse Treatment and Prevention Julia Danskin referred to the flow sheet in the packet, which had been developed as part of an orientation for the Substance Abuse Advisory Board; it is a representation of how various government and non-profit entities overlap/interact with one another with regard to substance abuse and treatment. She indicated that the Department of Social and Health Services is a huge department and has many programs. She said this is a way to explain the roles of various committees and why representation on them is important. • Member Russell noted that the 1/10th of 1%Advisory Board seems central to many things. He asked what it is and who serves on it. Chair Westerman listed herself, John Austin, Conner Daily, Catherine Robinson, Ann Winegar, and Barbara Carr. She said they meet monthly and their role is to make recommendations on how the 1/10th of 1% tax revenues will be spent. She said they were developing a means to determine how effective those allocations to various organizations are. She confirmed that the members are appointed by the BOCC. Member Sullivan explained that the tax is authorized by the legislature for mental health and substance abuse. The 1/10th of 1% funds fall directly under the BOCC, not the BOH. Member Westerman pointed out that the importance of this fund lies in the fact that it is ongoing and can be depended on, and that its use is determined by local control. Ms. Danskin pointed out that the City receives significant funds from the Liquor Excise Tax revenue and $35,000 goes to the County drug and alcohol prevention programs. Member Sandoval asked if the Health Department receives any grants from the USDA. Ms. Danskin said that only the WIC program is funded by the USDA through the Washington State Department of Health. Health Care Community Discussion Forums—Jefferson County Input Julia Danskin reported that three health care meetings associated with the Obama-Biden • Transition Project were held in the community, two in December and one in January. She noted that the perspective published in the packet summarizes well the issues and discussions at the Page 11 of 12 DRAFT meetings. The majority of people want a universal health care program and evidence-based • practice. Jean Baldwin said that all of these meetings were very well done. She commented on the quality of participation and the level of discussion at the meeting she attended. She said they are very well organized by the local Health Care Access committee, of which Julia Danskin is a member. Dr. Locke called attention to page 2 of the "Participant Guide" in the packet, which presents the three main priorities of the Obama Health Care Plan. He said that in his experience there has been a great tradition in health reform to pay lip service to prevention but not actually fund it. He said the real test will be the funding that is actually applied. He believes that Tom Daschle, who will head the new administration's initiatives on health care reform, does understand the economic argument for prevention. In response to a question, Jean Baldwin added that Mr. Daschle has been an advocate of health insurance reform, and is now working closely with many associates who hold broad perspectives. Agenda Planning The next BOH meeting is scheduled for February 19, 2009 at the Health Department. Vice Chair Russell will conduct the meeting since Chair Westerman will be unable to attend. The State Board of Health will be visiting on July 8 in Port Hadlock. Member Austin has conveyed that all are welcome to attend. Ms. Danskin noted that the 2008 Annual Report of the State Board of Health, of which John Austin is a member, was recently published. Adjournment • Member Russell moved for adjournment and Member Frissell seconded. Chair Westerman adjourned the meeting at 4:31 PM. JEFFERSON COUNTY BOARD OF HEALTH Sheila Westerman, Chair Phil Johnson, Member Chuck Russell, Vice-Chair Michelle Sandoval, Member Roberta Frissell, Member David Sullivan, Member John Austin, Member • Page 12 of 12 • JEFFERSON COUNTY BOARD OF HEALTH MINUTE S Thursday, January 15, 2009 2:30 PM—4:30 PM Health Department Conference Room, 615 Sheridan Street, Port Townsend Board Members Staff Members Phil Johnson, County Commissioner District#1 Thomas Locke,MD,Health Officer David Sullivan, County Commissioner,District#2 Jean Baldwin,Public Health Director John Austin, County Commissioner,District#3 Julia Danskin,Nursing Services Director Michelle Sandoval,Port Townsend City Council Chuck Russell, Vice Chair, Hospital Commissioner, District#2 Sheila Westerman, Chair, Citizen at large(City) Roberta Frissell, Citizen at large(County) Chair Westerman called the meeting of the Jefferson County Board of Health to order at 2:30 PM. Members Present: Roberta Frissell, Phil Johnson, Chuck Russell, David Sullivan, Michelle Sandoval, Sheila Westerman Members Absent: John Austin • Guests Present: Frances Joswick, Substance Abuse Advisory Board Staff Present: Jean Baldwin, Dr. Thomas Locke, Julia Danskin A quorum was present. APPROVAL OF AGENDA Chair Westerman announced a change to the order of agenda items under section V; item 4 was placed ahead of item 3. Member Sullivan moved to approve the agenda, as changed; the motion was seconded by Member Johnson. The agenda was approved unanimously, as changed. APPROVAL OF MINUTES Corrections: page 2, second paragraph: "... school age children are ... factor in... ", not is. Page 3, last paragraph: Member Westerman, not Chair Westerman Member Johnson moved for approval of the minutes, as amended; Member Russell seconded. The minutes of December 18, 2008 were approved, as amended, by unanimous vote. Page 1 of 12 PUBLIC COMMENTS • There were no public comments. Chair Westerman noted that, during her tenure as Chair, if members of the public are not present at the beginning and arrive during the meeting, she would add a Public Comment period at the end of the meeting, as possible. OLD BUSINESS December Provider Advisories: MRSA and Antiviral Medications Dr. Locke discussed the two provider advisories in the packet. He noted that he and fellow health officer Dr. Lindquist are attempting to increase regional outreach to hospitals and medical providers. Whenever such issues arise at the County level, they consider the regional implications and tailor their message for regional applicability. The Methicillin Resistant Staph Aureus (MRSA) advisory was prompted by a series of articles in the Seattle Times in mid November, entitled "Culture of Resistance". Dr. Locke pointed out several contentions in the article were not accurate. The article stated that hospital associated MRSA have gotten substantially worse when, in actuality, it is community acquired MRSA that has worsened. Rates of hospital transmission have been relatively stable for the last twenty years. Secondly, the article strongly suggested that, for this very complex problem, there is a simple solution: nasal cultures for patients before entering the hospital, with isolation of all MRSA carriers. This type of article presents a challenge for medical providers in • communicating with their patients about MRSA. Dr. Locke noted that Dr. Scott Lindquist, Deputy Health Officer for Jefferson County, is an infectious disease specialist. The advisory he has written provides facts and advice for health care providers. Dr. Locke also discussed the Expert Panel recommendations referenced in the advisory, which reflect the complexity of hospital infection control. Dr. Locke noted that there is a bill before the legislature that would require nasal screening cultures for hospital patients. There is conflicting scientific evidence over whether this would be effective or not. Considerable international research efforts have been undertaken to resolve these issues. As the evidence emerges, hospitals are adopting these recommended practices. However, Dr. Locke noted that the problem will not be simply resolved. It is persistent problem created by the promiscuous use of antibiotics, not only in the treatment of humans, but also for livestock. Chair Westerman asked how the science-based viewpoints will be presented to the legislature, especially input/plans from the Washington State Department of Health. She noted that the newspaper series had generated a great deal of attention, and had appeared to be well researched. Dr. Locke said that infectious disease experts are taking the lead. Dr. Jeffery Duchin, Chief, Communicable Disease Control, for Seattle/King County had written a very good rebuttal editorial for the Seattle Times. Jean Baldwin added that. Dr. Duchin had also appeared on KUOW and on local talk shows. Dr. Locke said that Dr. Lindquist and other infectious disease • specialists would likely be asked to testify before the legislature. Page 2 of 12 Dr. Locke also discussed the Health Advisory regarding influenza treatment guidance. This communication, which is a condensation of a ten page CDC document, provides specific advice for antiviral treatment. The main circulating strain of influenza, H1N1, appears to be resistant to the main antiviral medication in use—Oseltamivir("Tamiflu"). Over the course of one year resistance rose from 11% to 98%. Dr. Locke explained that the more an anti-virus drug is used, the more resistant strains are selected out. Vaccination is the best way to control influenza, along with respiratory hygiene to reduce transmission. There was a brief discussion about the disposition of stock-piled oseltamivir for use in the event of an influenza pandemic. Dr. Locke said the shelf-life is about seven years. He said it will probably be useful in the first big wave of an influenza epidemic before resistant strains emerge. Tamiflu is not recommended for most flu patients; on average, it reduces the duration of illness by only one day. It is most useful in the very young (under 6 months of age), the very old, and those whose health is compromised. Public Health Impacts of Heavy Rain and Flooding Jean Baldwin pointed out the press release regarding drinking water safety was based on the Kitsap County release. There was little local damage in Jefferson County. She noted that in addition to the advantage of location within the rain shadow, Jefferson County has been planning ahead and has been moving people out of flood plain areas through Conservation Futures . purchases and other means. Ms. Baldwin discussed a related problem, food distribution during prolonged closures of highways, particularly I-5. Local markets are normally restocked continually; closures of I-5 do cause some disruptions in the flow of market supplies. She also discussed the impact on the Jefferson County transfer station. When solid waste and recyclables cannot be transported away, it accumulates rapidly. Recovery to normal levels requires considerable time, especially when other areas of the State are similarly affected. She said that system agreements between FEMA and local EOCs (Emergency Operations Centers) are not always fully worked out in advance to handle FEMA vouchers during periods of flooding. This could be a problem in the future if Jefferson County should experience serious flooding. She explained that normally the State Public Health system works with a local EOC group to identify issues that arise, such as animal disposal. Although not seriously affected by the recent floods, representatives of the Jefferson Health Department have been monitoring impacts in the other areas. Member Sandoval inquired about a recent problem at the EOC during a general power failure; apparently the emergency generator did not come online. She said that she had received an early morning phone call, informing her of an anticipated two to three day outage, but that a solution involving the Clallam PUD had been arranged, thereby shortening the outage. Julia Danskin noted that the City EOC/Fire Department had been able to mobilize as part of their back up function for the EOC. Page 3 of 12 Jean Baldwin noted that the Health Department had used their emergency power generator to • ensure refrigeration for stored vaccines, based on information that the outage would be of short duration. The contingency plan for a longer outage would be to move vaccines to the hospital for storage. Chair Westerman asked how the information about water safety is disseminated. Jean Baldwin indicated that in addition to press releases,the information is posted on the web and in certain locations such as grocery stores. Copies are also sent to Bob Hamlin for dissemination to the emergency preparedness neighborhood groups via their e-mail distribution list. School-based Clinic Opening—January 2009 Jean Baldwin distributed copies of survey results, entitled"Jefferson County School Based Health Center Data, January 2009". This is a summary of the parent/student survey of Chimacum and Port Townsend Schools attendees to determine their opinions, needs and concerns related to the school-based clinic plans. She noted that of the 604 students responding, many recognized behavioral risk issues including nutrition, stress, tobacco use, lack of physical activity and depression, and their long term health impacts. Ms. Baldwin said she thought it important to share the perceptions of these families. Jean Baldwin also mentioned a Letter to the Editor, included in the Media Packet, from a Port Townsend High School ASB (American Student Body)member, expressing concerns about • confidentiality and cost;this student had not been involved in planning/advisory efforts for this initiative. She recalled that both Chimacum and Port Townsend ASB members had been attending advisory meetings along with teachers, counselors, Health Department representatives, school administration from the spring of 2008 through the fall of 2009. They had explored ideas and options for the school based clinic including outreach, confidentiality and other important design/implementation issues. Ms. Baldwin then consulted with The Leader about the most appropriate way to publicize information about the program. A Leader journalist then spent several hours at Port Townsend High School interviewing students, Principal, Superintendent, and various staff to gather relevant information for a feature article. Ms. Baldwin said this approach is intended to convey how comprehensive this service will be and to convey as much information as possible. Copies of a one hour call-in program on school based clinics, aired on KUOW on January 12, are available and the program can be downloaded. She said local Seattle/King County people called in with questions/comments for a nurse practitioner, mental health counselor and clinic coordinator. The overall tenor of the program was very positive and provided an overview of the complexity of services available. Ms. Baldwin said that many callers were parents whose children had benefitted from the program over the long term. At this point, the school based clinic program, which took 8 months of planning, is ready to begin. There has been extraordinary outpouring of community and school support, including volunteer hours and business donations. Two local businesses, Carpet One and Peninsula Floors, . are providing thousands of dollars of product, use of equipment and installation. The Boeing Page 4 of 12 • Blue Bells remodeled Chimacum High School at no cost; both Chimacum and Port Townsend High School ASBs contributed $500. She said both spaces are up and running. An adolescent specialist from Kitsap Mental Health, paid from the Jefferson one tenth of one percent funding, has been seeing students since October. Jefferson Health Care and the Health Department are working together on funding. The goal is to open on February 2 at PTHS two days per week for medical primary care and family planning. Tobacco prevention will be added as soon as feasible. Parental information and consents are in place. She said it is not possible to anticipate exactly how the program will be accepted and utilized, but that signs are positive. One remaining challenge is to put billing capability into place for those services that can be billed. She added that staff members are touring selected sites in Seattle to observe their school clinic operations. Thank You Letters Julia Danskin reviewed the letters of appreciation to the owners of Chimacum Chevron for their $500 donation, which will be used for family support programs, and to the Port Ludlow Yacht Club Women's Group for their donation to the Breast and Cervical Health Program. Both donors have also supported Jefferson County Public Health in prior years. NEW BUSINESS Pharmaceuticals, Personal Care Products, and Water Quality Jean Baldwin introduced Tami Pokomy of Jefferson County Water Quality and Environmental Health,and called attention to the Rivers for Life, WRIA 16 Newsletter, in the packet. Ms. Pokorny explained that WRIA 16 stands for the Water Resource Inventory Area that spans southern Jefferson County including the Dosewallips and Duckabush Watersheds, as well as portions of Mason County along the west and south shores of Hood Canal. She noted that the newsletter has been published for about 5 years. The most recent issue contains an article about PPCPS (Pharmaceuticals and Personal Care Products) and their impact on water quality. As mentioned in the article, the Puget Sound Partnership, the EPA and the Washington State Department of Ecology are collaborating on a study of the effectiveness of municipal water treatment in removing PPCPs. She reviewed the extensive and nearly universal use of these substances, which include over the counter as well as prescription medicines, by-products of soaps, shampoos, cosmetics, aerosols, growth hormones used in livestock, veterinary medications, etc. The amount of these substances released into the environment is estimated to be about the same as the amount of pesticides used each year. The US accounts for about half of all pharmaceutical use in the world. In recent years, there has been increasing awareness of the presence of PPCPs in drinking water. She cited information from studies conducted in 2002 and 2004 that had identified chemicals in water downstream from urban areas and elevated antibiotic levels in rural areas. One serious issue is that water • treatment facilities are not targeting many of these compounds for removal, and even very low levels can affect the growth and behavior of wildlife such as fish and oysters. Page 5of12 PPCPs enter the environment in gray water and in human and animal waste. It has also been • common practice to dispose of unused medications by flushing them down the toilet. Ms. Pokorny said the newsletter is intended to raise awareness and to provide guidance as to the best means of in home disposal, i.e. via the trash. Ms. Pokorny noted that federal guidelines for disposal of prescription drugs are also posted on the Jefferson County Public Health website. Recommendations include obscuring the identification label/container and mixing contents with contaminating materials such as coffee grounds or kitty litter before sealing and concealing. Ms. Pokorny also briefly discussed a second newsletter article, The Hood Canal Clean Water Project. This is a 4-year project initiated by Jefferson County Environmental Health to evaluate water quality and collect data on pollution and nitrogen sources entering the Hood Canal. She noted the multiple perspectives and contributors who assisted with this informational article, versions of which will also be submitted as press releases. Ms. Pokorny pointed out the notice regarding the "Who Speaks for Hood Canal" Video Newsletter on the last page of Rivers for Life. She described the video and its availability at http://hoodcanalwrial 6vide.blip.tv. Jean Baldwin requested suggestions from the BOH on distribution of this newsletter issue concerning PPCPs. Suggestions included: hospitals, health care provider waiting rooms and pharmacies. Frances Joswick noted that many people are not aware of proper disposal procedures for unused/expired pharmaceuticals. She suggested posters with disposal guidelines be hung in pharmacies and physician offices, and articles in the Leader and PDN. Dr. Locke explained that laws prohibiting pharmacies from accepting unused drugs for disposal were intended to prevent re-sale of expired drugs. He also noted that the Health Department recommendation is not in agreement with federal guidelines that continue to recommend flushing controlled substances down the toilet. In response to a question about incineration, Dr. Locke said that the efficacy of that disposal method would depend on the particular compounds involved and incineration temperature. School Immunization Trends—Jefferson County and Washington State Dr. Locke provided background information on the State program which has been supplying free vaccine for children. He said this would be the first in a series of reports this year regarding immunization for children, a program that is very much in flux. The focus of this report is to provide new local data regarding a worrisome statewide trend of increasing exemption levels in school age children. Washington State has a requirement in statute that children entering pre-schools or public schools have immunization stipulated by the State Board of Health. Not all childhood vaccines are mandated. Those vaccines that deal with diseases that potentially cause outbreaks in school settings have been placed on the mandatory list. Washington State also has a very broad immunization exemption policy in the same state statute. It says that a parent can exempt their child from this school entry requirement for one of three reasons: a religious exemption, a • medical exemption, or a personal exemption. Over time, that exemption rate has been increasing Page 6 of 12 • year across the State. The most recent data on K-12 exemption rates by county(2007-2008 School Year) was included in the Board's packet. About 10 to 15 years ago, the average exemption rate in Washington State was about 3 percent. Currently, there are significantly higher exemption levels. Jefferson County, at 11.9%, is among the highest; the rate has been rising from about 8 % within recent years. (Ferry and Stevens County in the northeast part of the State have the highest exemption rates, but very low populations.) The infectious diseases that we are most concerned about are measles, mumps, rubella, pertussis and diphtheria. In order to prevent outbreak of these diseases, between 90 -95%of children must be immunized. Dr. Locke explained that the levels of unimmunized children are reaching the point that will support localized outbreaks. Dr. Locke pointed out the data for the current school year for the Jefferson County Schools. He noted the ranges among the different schools and the exemption levels, and the fact that virtually all the exemptions are personal ones. Religious exemptions are very unusual, and medical exemptions are rare. Member Sullivan asked if there is a threshold percentage or number that would be considered alarming and indicative of possible outbreak. Dr. Locke said the threshold differs for each disease. Measles, which can be a deadly infection, is of greatest concern. Measles cases are now reported in Washington State on a routine basis; there was an outbreak in Grant County last year. The required immunization rate for measles is 95%; any exemption rate that exceeds 5%presents • a risk for outbreak. For some diseases, the rate is lower. For example, with influenza, at least 90% of children should be immunized, although influenza is actually not mandated. The rates for mumps and rubella are around 90%. Member Russell inquired as to the meaning of personal exemptions. Dr. Locke stated that the current form is extremely simple and does not collect parental reasons for exempting the child. The exemption form has been redesigned for next year and will ask for reasons. He said that focus groups and surveys indicate that exemptions break down into two categories: One has been called philosophical objections, i.e. people believe that vaccines are harmful or unnecessary, or that some are vaccines are beneficial and some are not. People are making a conscious decision based on information they have received or values they hold. The other category has been called convenience exemptions. For these, it appears that people are not opposed to vaccinations but sign the exemption form to avoid the requirement to produce vaccine records. Their children may not be up to date on immunizations or they cannot immediately produce the vaccine records. Dr. Locke said that some of those children may subsequently get vaccinated, but there is not clear data. It is believed to be about a 50/50 mix, half being philosophical opposition to vaccination and half being convenience issues. Public health officials are focusing on the latter group in order to identify barriers that may prevent or delay vaccinations or to obtaining records. The goal is to assure that all children whose parents consent to vaccination are fully immunized. Jean Baldwin said that, every other year, staff has investigated the issue of convenience • exemptions. In doing so, they check to identify any changes in school personnel or procedures, or to identify areas that can be improved internally. She mentioned that the Chimacum Schools Page 7 of 12 now use an effective referral system. She also described the counseling work that is done in the • weekly mothers' breast feeding group. The topic of immunizations has been discussed on several occasions, and every attempt is made to work with mothers by listening to concerns, providing guidance and assisting in stretching out immunizations, etc. Dr. Locke also discussed the related issue of the overall record on childhood vaccinations within the State. He said that the first three years of age are the most dangerous time for vaccine preventable diseases. The national standard for a fully vaccinated child is measures children between ages two and three. He referred to the National Immunization Coverage Rates (blue toned map) in the packet, which shows coverage for children in the 2-3 year old age group; numbers at the top refer what a fully vaccinated child at age 2 should have: 4 DPT shots; 3 Polio shots, 1 Mumps/Measles/rubella shot, 3 Haemophilus Influenzae Type B shots, 3 Hepatitis B shots, 1 Varicella(Chickenpox) shot. Washington State has one of the lowest rates of achieving that target in the USA. That is a particular challenge for Washington, despite the fact that it is one of only 6 or 7 states that pays for 100% of childhood vaccinations through a combination of state and federal funds. One of the problems with childhood vaccinations, as shown by the Environmental Change sheet in the packet, is the growing number of vaccines and the associated complexity. In 1985 there were only 7 antigens administered and several were combined: two or three shots with multiple boosters. By 1996 there were 10 antigens and by 2008, thirteen years later, there are 16. In the pipeline are still more; there are almost two dozen vaccines in development, not all of which are childhood vaccines. Dr. Locke said it may be possible to prevent multiple types of cancer • through vaccine, and/or to prevent diabetes and certain types of autoimmune disease. Vaccination has become a very powerful medical tool. Chair Westerman added that some of these vaccines are not targeted to children; HPV for example is not administered until adolescence. She also said, in her opinion, that because vaccines have been so successful in preventing outbreaks, people are not worried. There is a sense of security in the general population. She said that, apparently, the issues are not being communicated clearly. She suggested that perhaps there should be more emphasis on the fact that these issues concern not just one's own children, but everybody's children. Jean Baldwin mentioned that there have been two outbreaks of pertussis in this county in the last three years in the same population of ten home schooled children, which consumed many hours of staff time. Members briefly discussed whether there should have been more public information disseminated in that case, and whether additional measures are needed related to at risk schools. Dr. Locke explained that if a child is not vaccinated and an outbreak occurs, the child is not allowed in school for the duration of the outbreak, unless they can be vaccinated. That is the reason these records are kept and there is a consequence. He mentioned a recent case where the Health Department was prepared to pull unvaccinated children out of school, but that tests had turned out to be negative. Chair Westerman asked about the process for home schooled children, and was told that there is no tracking of immunizations for those children. • Page 8 of 12 • Concept Mapping and Strategic Planning-- Overview Jean Baldwin said that before moving into concept mapping, she felt it important to discuss the larger context and the general economic uncertainty of the times. She discussed the larger picture of budget cuts that are currently under consideration at the State level, including how the shortfalls in the Governor's annual and long range budgets will be addressed. She discussed the types of information that is available with regard to proposed cuts, and cited the lack of a comprehensive picture as to how pending legislative decisions will actually impact State and local budgets and programs. She noted that layoffs and rollbacks are partially invisible and have a diffuse impact on the community. She said she was very concerned about what is going on in the community and how families are and will be affected Ms. Baldwin said that she believes it prudent to pull all the unfolding information together and examine it. She said she had brought the topic to this body because she believes the BOH has a broad community, non-partisan vision. The BOH is charged with, not just the Health Department, but also regulatory issues and other broader ones. She said she was seeking the BOH's guidance as to whether this scope of effort was appropriate. She offered several examples as to the difficulty of translating budget decreases for particular agencies, such as Mental Health, into real community impacts. She said that she was deeply concerned about the probable impacts over the next few years, but did not know if the collection and analysis of all the relevant information was necessary, or even possible, and appropriate at the Health Department level. • BOH members sought clarification on the types of information that would be collected. Ms. Joswick stated that it is extremely important to know the numbers of people affected in order to assess the potential impact on the community. Jean Baldwin explained that the information would be essential in prioritizing how staff and other resources would be assigned and shifted according to changing needs. She noted that Medicaid and Medicare are very expensive systems and are at the brunt of recent cuts. She said the affected clients would not likely come forward directly, but would be evident in ER, police and jail statistics. She said that although there is clearly not enough public funding from City and County to meet these needs, there should at least be information to support decision making and prioritizing. There was a brief discussion about GAU (General Assistance for the Unemployable), a State DSHS assistance program for those temporarily unable to work, which has been cut completely from the Governor's 09-11 budget. It was noted that although the numbers of people in this program are relatively few, these individuals also use mental health, hospitalization and other treatment programs that will no longer be reimbursed. The idea of a shared web site for various agencies to post quantitative impact information was suggested and briefly explored. Some members questioned the feasibility of reducing the complexity of data to meaningful planning information. There was a suggestion that the State • should be tracking this type of information. Ms. Baldwin noted that DSHS could/would not do this, since the money was already cut from their budget. Page 9 of 12 BOH members discussed the purpose and use of such a database and how it would inform policy • discussion. One use would be assessment of needs and associated prioritization of resources at the City and County level. Another suggestion would be to support education/advocacy efforts at the State level and to provide justification for funding requests. In response to a question as to the extent of impact on health care for children, Julia Danskin summarized the provisions in the Governor's budget. She said the Healthy Kids Now program would continue to cover children(under age 19)up to 200% of the poverty level for free and up to 250% for families that pay a premium. The expansion to 300%of the federal poverty level that was planned to begin on January 1 was cut. She said that Washington State continues to have one of the best programs for children 18 and under. The federal government is also working on standardizing S-CHIP, which is promising. Ms. Danskin also provided an update on the previously announced cuts to the Department of Alcohol and Substance Abuse. After initial information that Ford Kessler from Safe Harbor Recovery Center would see a$60,000 cut between now and June, it was learned that smaller counties such as Jefferson would continue to receive their base allocations, while larger counties will see large cuts. She said Janet Polley, Jefferson Mental Health, and Ford Kessler had both confirmed that their budgets are stable through June, and they see no service reductions for the time being. There is no specific information about 09-11 budget as yet. With regard to funding for the developmentally disabled population, Ms. Danskin said there are some major cuts that do not affect this County due to our small size. She said she was not aware • of any cuts in our current budget between the present and June 2009. Jean Baldwin stated that there is expectation of further cuts. Ms. Joswick suggested that the period between the present and June 30 be used to collect information and project the impacts to services and numbers of people. Chair Westerman asked if Ms. Baldwin would be able to pursue this data collection idea by deferring some other tasks and activities. Ms. Baldwin said she would attempt to develop some form of grid. Chair Westerman said that the BOH realized the pressures and did not wish to impose more work without adequate resources, but thought that the information would be valuable to the BOH as it faced prioritizing decisions in the future. Member Johnson agreed that the information would be valuable. Julia Danskin added that the Washington Association of County Commissioners is in the process of collecting this type of data. She said there is preparation and monitoring of the legislative process to determine if the DSHS and other cuts will be sustained. She said she expected that the BOCC would be lobbied by the Association. Member Sandoval expressed concern about retroactive provisions mentioned earlier. She questioned whether or not this included the electrical rates for the paper mill, and whether or not they would owe considerable money, having already laid off 28 people. Other members had no information on this issue. There were additional comments about the apparently limited nature • of impacts at the present time. Member Sullivan suggested that one way to pick up the slack as a Page 10 of 12 • community would be through volunteerism, donations and non-profit organizations. He acknowledged the symptoms of system failure, as well as the need to find crucial solutions. Member Russell added that volunteers had served 28,000 hours in the hospital last year. Ms. Joswick pointed out that some skilled needs cannot be met by volunteers alone. She restated that impact data or reasonable estimates are important for planning and responding. In summarizing, Jean Baldwin said that she would explore data collection further. She invited others who were interested to participate. Ms. Joswick volunteered to assist, as possible Flow Sheet—Boards and Committees related to Substance Abuse Treatment and Prevention • Julia Danskin referred to the flow sheet in the packet, which had been developed as part of an orientation for the Substance Abuse Advisory Board; it is a representation of how various government and non-profit entities overlap/interact with one another with regard to substance abuse and treatment. She indicated that the Department of Social and Health Services is a huge department and has many programs. She said this is a way to explain the roles of various committees and why representation on them is important. Member Russell noted that the 1/10th of 1% Advisory Board seems central to many things. He • asked what it is and who serves on it. Chair Westerman listed herself, John Austin, Conner Daily, Catherine Robinson, Ann Winegar, and Barbara Carr. She said they meet monthly and their role is to make recommendations on how the 1/10th of 1% tax revenues will be spent. She said they were developing a means to determine how effective those allocations to various organizations are. She confirmed that the members are appointed by the BOCC. Member Sullivan explained that the tax is authorized by the legislature for mental health and substance abuse. The 1/10th of 1% funds fall directly under the BOCC, not the BOH. Member Westerman pointed out that the importance of this fund lies in the fact that it is ongoing and can be depended on, and that its use is determined by local control. Ms. Danskin pointed out that the City receives significant funds from the Liquor Excise Tax revenue and $35,000 goes to the County drug and alcohol prevention programs. Member Sandoval asked if the Health Department receives any grants from the USDA. Ms. Danskin said that only the WIC program is funded by the USDA through the Washington State Department of Health. Health Care Community Discussion Forums—Jefferson County Input Julia Danskin reported that three health care meetings associated with the Obama-Biden Transition Project were held in the community, two in December and one in January. She noted • that the perspective published in the packet summarizes well the issues and discussions at the meetings. The majority of people want a universal health care program and evidence-based Page 11 of 12 practice. Jean Baldwin said that all of these meetings were very well done. She commented on 4111- the the quality of participation and the level of discussion at the meeting she attended. She said they are very well organized by the local Health Care Access committee, of which Julia Danskin is a member. Dr. Locke called attention to page 2 of the "Participant Guide" in the packet, which presents the three main priorities of the Obama Health Care Plan. He said that in his experience there has been a great tradition in health reform to pay lip service to prevention but not actually fund it. He said the real test will be the funding that is actually applied. He believes that Tom Daschle, who will head the new administration's initiatives on health care reform, does understand the economic argument for prevention. In response to a question, Jean Baldwin added that Mr. Daschle has been an advocate of health insurance reform, and is now working closely with many associates who hold broad perspectives. Agenda Planning The next BOH meeting is scheduled for February 19, 2009 at the Health Department. Vice Chair Russell will conduct the meeting since Chair Westerman will be unable to attend. The State Board of Health will be visiting on July 8 in Port Hadlock. Member Austin has conveyed that all are welcome to attend. Ms. Danskin noted that the 2008 Annual Report of the State Board of Health, of which John Austin is a member, was recently published. Adjournment Member Russell moved for adjournment and Member Frissell seconded. Chair • Westerman adjourned the meeting at 4:31 PM. JEFFERSON COUNTY BOARD OF HEALTH 144/1-6-4 ke. "At Sheila = terman, Cha' Phil Jenson, Member )77aCte,,GC huck Russell, Vice-Chair Michelle Sandoval, Member 44144i Cz- Roberta Frissell, Member David Sullivan, Member Excused John Austin, Member • Page 12 of 12 • Board of 3fealt( Oki-Business .Agenda Items # 1'V., 1 • Draft National-Public 3feaCth "Week Press Release February 19, 2009 • • z= JEFFERSON COUNTY PUBLIC HEALTH 615 Sheridan Street • Port Townsend •Washington • 98368 www.jeffersoncountypublichealth.org w Draft PRESS RELEASE for Board of Health to review February 19, 2009 Contact: Julia Danskin Jefferson County Public Health is Celebrating National Public Health Week beginning April 6, 2009 Jefferson County Public Health (JCPH) is celebrating National Public Health Week. This year the National Public Health Week theme is "Building the Foundation for a Healthy America" and will be April 6th-12th. JCPH asks you to join us in nominating local Public Health Heroes by telling us their story. JCPH began honoring Public Health Heroes as a way to locally celebrate National Public Health Week. The annual public health awards honor people who live or work in Jefferson County and promote Public Health in their daily lives. Nominations are open to the public through Thursday, March 17th. Please submit a nomination for an individual, agency or group you feel is making a difference in the health of Jefferson County. What is Public Health?: Public Health helps communities to be healthy places to • live, work and play. Public Health provides reliable information you can use to make healthy choices and protects our communities from hazards in the environment. Public health works to prevent health problems before they occur. The focus is on improving an entire community's health through achieving healthier lifestyles. What is a Public Health Hero? A Public Health Hero is a person or organization that promotes public health in their daily lives. Public Health Hero awards could represent the following categories but are open to others: • The Community Health Promotion award honors individuals or groups whose efforts increase the quality of life in the county. • The Public Health Leadership award honors those in our community who have provided leadership in creating policy solutions that assure, promote, and protect the community health. • The Business Merit award recognizes a companies for environmentally sound practices but many make healthy choices in what they sell, how they support employees, and how they promote community health. • The Community Based Organization award recognizes those who provide infrastructure and services that promote public health in a variety of ways. • The Special Recognition for the Public Health Hero honors individuals or organizations who help identify a problem and then help the community work towards its resolution, e.g. planting trees, building trails, promoting physical exercise or health diets, or fitting children's car seats. • COMMUNITY HEALTH DEVELOPMENTAL DISABILITIES PUBLIC HEALTH ENVIRONMENTAL HEALTH ALWAYS SAFER WATER QUALITY MAIN: 360385-9400 MAIN: 360385-9444 FAX: 360-385-9401 HEALTHIER COMMUNITY FAX: 360379-4487 , I know someone in my community who is a Public Health Hero. How do I nominate them? • Nomination forms may be picked up at the JCPH office, 615 Sheridan St., Port Townsend, or • Download form online at www jeffersoncountypublichealth.orq, or • Request that an application be mailed to you by calling (360) 385-9400 How do I return the completed nomination form? • Drop off or mail completed forms to: JCPH c/o Public Health Heroes, 615 Sheridan Street, Port Townsend, WA 98368, or • Email completed form to publichealthhero( jeffersoncountypublichealth.orq, or • Fax completed form to (360) 385-9401 Can I nominate more than one person or group? You can nominate as many deserving people or groups as you like. The deadline for submitting nominations is Thursday, March 17th. Winners will be announced at the April 16th Jefferson County Board of Health meeting. Learn more about National Public Health week and "Building the foundation for a health America" at www.nphw.org. Jefferson County Public Health is always working for a safer and healthier Jefferson County. • * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * COMMUNITY HEALTH PUBLIC HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIES ALWAYS WORKING FORSAFER AND NATURAL RESOURCES • MAIN:360-385-9400 MAIN: 360-385-9444 FAX:360-385-9401 HEALTHIER COMMUNITY FAX: 360-385-9401 NPHW 09 Page 1 of 1 rts/Tcois P rtn raS onsor Share Y`iur'tor events � �ocK � Press • Oi.EN ^^ -'4'ciri,F,.,1 ' 4...4".-d- .' ' ''',` „,',..,..5,,, ' ?: ' t..,..,,,.-- ,s,,,,,,„:„ . ,t,,,,„01 ., ,-,,..„'4, , 4, ,,,,,,, ,otilt, , , ,o,,,,i. ;�`"'� * �ye« ^t, y Nation ria! Public Health We k Apr:t 6-1z.:00: Building the Foundation ftor a Healthy America What's New Despite our best efforts,Americans ae ot as healthy as they should be. Although we spend more on ealth care than any other Spar your bti Health country, the health system is failing and our nation is falling behind in many important measures of what it means to be Story ' +t.4 healthy. We have reached a point where we must examine our I health system and the foundation upon which it stands. We have the potential to greatly improve our population's health in the future. , • By recommitting ourselves to support our nation's public health system, we can build on the successes of the past and establish the solid foundations needed for a healthy nation. f Join us in celebrating National Public Health Week 2009 and supporting public health efforts aimed at"Building the Foundation for a Hea/thy America." ,‘:,,,:, :e..t„:::::t.,, t i..,,, ,i r. g.� :', .� �? t F � i s'` {q'''',�° +"�,�`q,`•ter"ar x'. �+: , e A g , .y..$„ t. ' �d a , .FY l'i'd Citt`S 2 .qe ry t x tiCJrtc t' #3 L2€ i4�� �: x." �`-,�.''y a k`' tl x }y •�`•z 's y, v yaza. t 3 qn.,U �$P , �� tr[ ,.s.`d � �' -J 9 X M � a ..^r,e xt' ...2, :has + r .�� t"` .. �r 40, ,;s 9 44 ,-� Downlo.F.;+p NPr'�A Brnc3Is„ar St S� public M l Health i2 Y - d Associationa • 2/12/2009 http://www.nphw.org/nphw09/default.htm • Board of Health Old Business .agenda Item # IV., 2 Nlore Retailers Selling • Thbacco to .Minors lebruary 19, 2009 • }= Washington State Department of IP 1*Health ew s e ea se For immediate release: February 5, 2009 (09-021) Contacts: Tim Church, Communications Office360-236-4077, pgr, 360-534-0068 More retailers selling tobacco to minors;;. State increases outreach to educate retailers abou atlie'law alis OLYMPIA—The number of Washington retailers illegally se lm t > acco to minors has �s , tripled since 2006, according to a new report. The annual rate a illegal-§#10,,s was about 15 percent in 2008. That's up from nine percent in 2007 aand`five'percent in 20(1= ,�i[he state :,E Department of Health(www.doh.wa.gov) is working:with otheistate and local agencies to expand the effort to make sure retailers know what's expected,4Fthem—along with the penalties they face for violating the law. ::, "This is unacceptable. Our state laws are mtef�dedito keep this deadlydproduct out of the hands of our youngpeople,"" said Secretaryof Health ' '' ' P p � �ary Se��c � We ve got to reverse this trend now. • We know when tobacco is 44iderIo get, kids ar albs likely to pick up this deadly habit." H 1. The state health departn}eptt local I.i alth agencies, and the state Liquor Control Board are is i. increasing outreach to retaif s t bug t iniperson education and training for all stores in the state that sell tobacco"pti du.Cts. ThelOepartmern of iiealth and the state Department of Social and Health=S'ervices have upd it d retaildi ed cation materials and created new, practical tools to address con non barriers to c�npliandd. The materials include pamphlets and posters in multiple languages, listnig acceptable Maims of identification and where to find age information. Online training for clerks is'also being developed. It will show the correct way to read identification and how to refuse sales to Underage customers. Local health agencies and the Liquor Control Board will continue to conduct random checks of tobacco retailers to find stores that violate the law. Working with law enforcement, under-age customers try to buy cigarettes and other tobacco products. The state recently began using older teens, primarily 16 and 17-year-olds, for these compliance checks. That may account for some of 411 the increase in illegal sales. —More— Clerks who sell tobacco to minors can be fined up to $100; retail owners can be fined up to $1,500 and have their license permanently revoked after multiple violations. A study conducted by Public Health— Seattle & King County found that stores with attached gas stations are most • likely to sell tobacco to minors. Extra education will be directed at these retailers. "Most retailers are taking the time to properly check identification and refuse sales to minors," said John Taylor, acting director of the DSHS Division of Alcohol and Substance Abuse. "However, our community partners will be going store to store to make sure all retailers are aware of the law, the resources available to support compliance, and the consequences of violations." The national "Synar Report" shows the percentage of stores selling tobacco to minors. Until recently, the rate in our state had steadily declined. If it exceeds 20 percent, Washington could lose about $13 million in federal funding for drug, alcohol, and tobacco prevention and treatment. Official youth checks determine the rate of illegal sales, yet anyone can report a violation on the Liquor Control Board's Web site (www.liq.wa.gov/enforcement/report_violation.aspx). Along with outreach to tobacco retailers,the Department of Health and its partners work to 411 prevent youth tobacco use through support for youth anti-tobacco groups, educational programs in schools, grassroots efforts, and a multimedia advertising campaign and Web site, NoStankYou.com. Since the comprehensive state Tobacco Prevention and Control Program began in 2000, smoking rates have decreased among youth by about 50 percent overall and there are 65,000 fewer youth who smoke in the state. ### Visit the Washington Department of Health Web site at http://www.doh.wa.gov for a healthy dose of information. Jefferson County SYNAR compliance check rate 2008 15%based on 20 qualifying attempts and 3 sales. Jefferson County YOUTH Current Cigarette Smoking •Our most recent survey data (HYS 2006) showed 6th grade: 0.6% in Jefferson County, and 1.9% statewide, reported they currently smoke cigarettes. 8th grade: 10.1% in Jefferson County, and 6.4% statewide, reported they currently smoke cigarettes. 10th grade: 24.3% in Jefferson County, and 14.9% statewide, reported they currently smoke cigarettes. 12th grade: ** in Jefferson County, and 20.0%statewide, reported they currently smoke cigarettes. data not reported because less than 40%grade-level participation of eligible schools. • Board of 3-CeaCth our Business .agenda Item # 1V., 3 • ZooB State Board of Health AnnuaCRey ort February 19, 2009 • . ON COUNTY it IN JEFFERSON COUNTY 1,132 Clients served by Title X and State Funds in 20076 3,936 Female residents 15-44 years old' 1,100 Women ages 13-44 in need of publicly supported contraceptive supplies and services2 18.5% County population receiving Medicaid' 2006 COUNTY PREGNANCIES 43.8% Estimated unintended pregnancies compared to 50.8% in Washington State" 13.5 Teen pregnancy rate per 1,000 females ages 15-17,compared to the State rate of 27.64 62.9% County births paid for by Medicaid compared to the State rate of 47.1%3 139 Medicaid paid births' $664,000 Estimated cost of publicly funded births from unintended pregnancies' 2007 COUNTY SEXUALLY TRANSMITTED DISEASES Chlamydia rate= 129.4 per 1,000 residents' State Chlamydia rate= 294.7 per 1,000 residents' Gonorrhea rate= 17.5 per 1,000 residents' ,te Gonorrhea rate= 56.2 per 1,000 residents' 1 f Washington State Department of Health FAMILY PLANNING AND REPRODUCTIVE HEALTH FUNDED CLINICS IN JEFFERSON COUNTY 1 ,1 32 CLIENTS SERVED IN 2,OA County Clients(' Percent Sex Female 89% Male 11% Age 17 and under 15% 18-29 50% 30 or older 35% Race/Ethnicity White 94% Black 1% American Indian/Alaskan Native 2% Asian/Pacific Islander 2% Hispanic 1% Federal Poverty Level 100%or less Tryinik 101%-250% 27e Over 250% 2% County Client Services6 Number Females receiving physical exams 527 Females receiving pregnancy testing 356 or counseling Clients receiving sexually transmitted 889 disease testing or counseling REFERENCES '2007 Washington State Office of Financial Management 22002 Guttmacher Institute • 32006 Washington State Department of Social and Health Services ^2006 Washington State Center for Health Statistics 52007 Washington State Department of Health Infectious Disease and Reproductive Health Assessment Unit 62007 Title X and State Data CONTACT US Visit http://www.doh.wa.gov/cfh/FPRH/Pub Reports.htm for additional copies of this report. For more information about the Washington State Family Planning Program,visit htto://www.doh.wa.gov/cfh/FPRH/or cal 360-236-3471. For persons with disabilities,this document is available on request in other formats.To make a request,call 1-800-525-0127(TDD/TTY 1-800- 833-6388). Funded in part by Washington State and the U.S.Department of Health and Human Services grant#6 FPHPA100029-18 2008 Publication#930-116 • Board of Health Netiv Business .agenda Item #17., 5 Public 3-fealth Mutual .Assistance .agreements Updates • February 19, 2009 • d • Lummi Nation Mutual Aid Agreement between the Lummi Nation and the Whatcom County Health Department Relating to Disease and Contamination Control Measures WHEAREAS, the Whatcom County Health Department (WCHD) and the Lummi Nation (collectively, "the Parties" or individually, the "Party") each desire to enter into this Mutual Aid Agreement ("Agreement") to protect the health and safety of members of the Nation and Indian and Non-Indian employees, residents, visitors, guests and other people on Tribal Lands (collectively, "People on Tribal Lands"), and people within Whatcom County, Washington; and WHEREAS, for the purpose of this Agreement, "Tribal Lands" shall mean land within the Lummi Reservation boundary, Lummi Tribal Trust Lands, Lummi Tribal Member Trust Lands and lands governed by the Lummi Nation of Indians Settlement Agreement, and collectively, as those lands may be added to or subtracted from, from time to time; and WHEREAS, an outbreak of a communicable disease, disease or contamination emanating from a natural disaster, or a biological, chemical or radiological event ("Disease or Contamination Event") occurs across jurisdictional boundaries, can . affect the health and safety of People on Tribal Lands and People in Whatcom County alike, and creates health threats to the region; and WHEREAS, a Disease.or Contamination Event requires epidemiological research to determine the cause of health hazards and may require containment, preventive and treatment measures; and WHEREAS, WCHD is responsible to undertake such Disease and Contamination Event epidemiological research and containment, preventive and treatment measures for Whatcom County; and WHEREAS, the parties agree that in certain circumstances, Disease and Contamination Event control measures, including isolation and quarantine of individuals or groups, are vital to prevent the spread of disease, to maintain healthful sanitation, or to contain biologic, radiological or chemical hazards to human health; and WHEREAS, the Nation has non-exclusive authority over public health measures that affect certain people on Tribal Lands, whether Indian or Non-Indian; and WHEREAS, pursuant to RCW 70.05.070 and WAC 246-100 et seq., WCHD's Health Officer has responsibility to control and prevent the spread of any . dangerous, contagious or infectious diseases that may occur within his or her jurisdiction, and to order isolation or quarantine, if necessary; and 1 WHEREAS, WAC 246-100 et seq., creates standards and legal processes regarding the isolation and quarantine of individuals and groups of individuals in • Washington State in response to public health threats, and WHEREAS, under the Laws of the United States, The Lummi Tribal Court has either exclusive or concurrent jurisdiction (with federal or state courts) over certain civil matters; and WHEREAS, WAC246-100-036(4) provides that a local health department may make agreements with tribal governments that empower the local health officer to conduct investigations and institute control measures in accordance with WAC 246-100-040 on tribal lands; and WHEREAS, the Nation has determined that a beneficial and efficient means of preventing, containing and treating the health impacts from a Disease or Contamination Event is to enter into an agreement with WCHD granting the WCHD authority to conduct epidemiological research and institute necessary containment, preventive and treatment measures affecting people who, absent this Agreement, would fall under the Nation's jurisdiction; and WHEREAS, WCHD believes it is in the interest of public health and common good to accept this grant of authority from the WCHD and the Nation in order to simultaneously help protect all of the people in the Whatcom region in case of a Disease or Contamination Event. • THEREFORE, the Parties agree as follows: 1. Subject to the conditions set forth in the Agreement, the Nation agrees to grant and the WCHD agrees to accept the authority in conjunction with LIHC director over Tribal Lands, People on Tribal Lands and the Nation members off Tribal Lands but within Whatcom County, for the purposes of epidemiological research, investigation, prevention, containment and treatment related to a Disease or Contamination Event affecting human health ("Public Health Authority"). 2. The Parties agree that WCHD will exercise, in conjunction with 1_IHC director, such Public Health Authority in accordance with the laws of Washington State, including but not limited to WAC 246-100 et seq., and laws of Whatcom County and the United States. 3. The Nation agrees to give full faith in conjunction with LIHC director to Emergency Detention Orders and court orders of the courts of the State of Washington related to isolation or quarantine, and to cooperate fully in carrying out the terms and conditions of such orders, including providing enforcement through the Tribal Police. The Nation agrees to grant the WCHD in conjunction with LIHC director access to Tribal Lands and to People on Tribal Lands to • 2 conduct epidemiological research, to investigate a Disease or Contamination . Event, and to perform preventive, containment or treatment measures. 4. Notwithstanding anything to the contrary in this Agreement, People on Tribal Lands and Nation members placed in isolation of quarantine shall reserve the right to seek redress from an Emergency Detention Order of Washington State Court Order, and may do so in any court of competent jurisdiction, including but not limited to Whatcom County Superior Court or the Lummi Nation Court. 5. As required by law WCHD in conjunction with LIHC director will first seek and individual's voluntary compliance to isolate or quarantine prior to issuance of an Emergency Detention Order ("EDO") or filling a Petition with the Whatcom County Superior Court. 6. WCHD will in conjunction with LIHC director comply with the conditions and principles for isolation and quarantine set forth in WAC 246-100-045 and will provide an isolated or quarantined individual or group with food, clothing, shelter, medication, communication and a safe place to recover. WCHD will afford individuals or groups affected by this Agreement the same treatment as received by an individual or group under Whatcom County WCHD jurisdiction. ID7. The Nation agrees to cooperate with WCHD in conjunction with LIHC director to help provide for People on Tribal Lands and The Nation members and to make available Tribal agency personnel, facilities, materials and other support as necessary and feasible to assist in carrying out and complying with isolation or quarantine orders. 8. If People on Tribal Lands or Nation members seek redress in Superior Court and request the assistance of court appointed counsel, and if legal and financial eligibility requirements are otherwise met, an attorney from the Whatcom County Office of Assigned Counsel will be assigned to represent that individual or group. 9. Should a provision in a health order issued by the Washington State Department of Health, a state or federal emergency declaration, or order of any court of competent jurisdiction contradict a provision of this Agreement, then the provision in the health order, emergency declaration, or court order shall control. 10. The Nation and WCHD shall each separately maintain errors and omissions insurance coverage applicable to personnel assigned to perform or support services under this Agreement. In addition, the Nation and WCHD shall each separately maintain commercial general liability and • comprehensive automobile liability insurance. The Nations commercial 3 Ntt general liability insurance policy and comprehensive automobile liability insurance policy shall name WCHD as an Additional Insured. • 11. The Nation and WCHD shall each appoint a designated representative to serve as liaison for all purposes under this Agreement. The designated liaisons are: For the Nation Name: Address: Phone: For the WCHD Name: Greg Stern MD., MPH Local Health Officer and Medical Director Whatcom County Health Department Address: Phone: 12. The Parties to this Agreement agree to provide the support and services specified in this Agreement on a gratuitous basis, with no expectation of direct reimbursement by the other Party. To the extent that any third-party payer, such as the United States Government, has funds or processes • available for reimbursement of a Party's activities under this Agreement, the Parties agree to cooperate fully with one another in submitting any appropriate claim(s) for.reimbursement and providing copies of records necessary to submit claims. 13. The Parties agree that all medical records and reports related to this Agreement shall be maintained in accordance with HIPPA and RCW 70.02 et seq.. The Parties agree to share disease or contaminant information necessary to avert serious harm to the health of personnel performing support or services under this Agreement. The Parties shall maintain their own records and reports concerning the provision of any support or services under this Agreement. 14. Each party to this Agreement shall be legally responsible for its own acts and omissions arising under this Agreement, and of its respective appointed and elected officials, employees, officers, agents, agencies, assigns and representatives. Each party agrees to defend, indemnify and hold harmless the other party and it's respective appointed and elected officials, employees, officers, agents, agencies, assigns and representatives from and against any and all liability, loss, cost, damage and expense arising or alleged to have arisen directly or indirectly out of or in consequence of the performance of this Agreement by the indemnitor. 4 • 15. Either Party may terminate this Agreement with thirty (30) days written notice to the other Party. This Agreement shall be interpreted under the laws of the State of Washington. 16. Nothing contained herein shall abrogate powers granted to the Centers for Disease Control, the Indian Health Services, the Washington State Department of Health or other county, state or federal governmental authority by the laws of Whatcom County, the State of Washington or the United States. • • • 5 RESOLUTION #2006 OF THE LUMMIN INDIAN BUSINESS COUNCIL TITLE: Adopting the Lummi Nation Isolation and Quarantine Mutual Aid Agreement Between The Lummi Nation and the Whatcom County Health Department Relating to Disease and Contamination Control Measures WEAREAS, the Lummi Indian Business Council is the duly constituted governing body of the Lummi Indian Reservation by the authority of the constitution and By-laws of the Lummi Tribe of the Lummi Reservation; and WHEREAS, The Lummi Indian Business Council continues to make a commitment to public safety on the Lummi Reservation; and WHEREAS, the Lummi Indian Business Council is charged with the responsibility for the protection of the health and safety and welfare of the members of the Lummi Nation. NOW THEREFORE BE IT RESOLVED, The Lummi Nation Mutual Aid Agreement between The Lummi Nation and Whatcom County Health Department Relating to Disease and Contamination Control Measures is approved in its entirety, effective this date; and BE IT FURTHER RESOLVED, that any future amendments to the Mutual Aid • Agreement between The Lummi Nation and Whatcom County Health Department Relating to Disease and Contamination Control Measures shall be submitted to the Lummi Indian Busiriess Council for their review and approval, and BE IT FINALLY RESOLVED, that the chairwoman (or the Vice-Chairman in his absence) is hereby authorized and directed to execute this resolution and any documents connected therewith, and the Secretary (or Recording Secretary in his absence) is authorized and directed to execute the following certification. LUMMI NATION Evelyn Jefferson, Chairwoman Lummi Indian Business Council 411. 6 • CERTIFICATION As Secretary of the Lummi Indian Business Council, I hereby certify that the above Resolution #2006 was adopted at a special meeting of the Council held on the day of , 2006, at which time a quorum of was present by a vote of for, against, and abstention(s) Donna Mae Cultee, Secretary Lummi Indian Business Council • • • 7 Board of Health Media Report • february 19, 2009 • • Jefferson County Public Health January/February 2009 NEWS ARTICLES 1. "County, city eye post office," Port Townsend Leader, January 14th, 2009. 2. "County permit fees might rise," Port Townsend Leader, January 14th, 2009. 3. "New place to dump dim bulbs," Peninsula Daily News, January 21st, 2009. 4. "School clinics: about more than sex," Peninsula Daily News, January 21st, 2009. 5. "Marine toxins close beaches," Port Townsend Leader, January 21st, 2009. 6. "County mulls uses for$55.8 million," Peninsula Daily News, January 27th, 2009. 7. "The Port Townsend &Jefferson County 2009 Building Codes," Port Townsend Leader 2009 Home Improvement Supplement," January 28th, 2009. 8. "Jefferson fretting about watercourses," Peninsula Daily News, February 31d, 2009. 9. "Border Patrol opposed," Peninsula Daily News, February 4th, 2009. 10. "Toxins have a grip on lake," Peninsula Daily News, February 5th, 2009. 11. "Fluorescent lamp recycling now available," Port Townsend Leader, February 11th, 2009. • • 2.''' _dreft,q, ` i,t.i'.,, it 44 ,fir` f`` � � � � .�� �- � .; �w � � --a • _ a "p� s °.- AC „i �' cash a3� f3a ® ..: rim I - • rww».c i : 1,:=,:.:,,.,kr mak.= a --A E� 1.4-7=4,--..4,-.7:::.,-7.-i-,-4,;,,:z e , ':} '-7,114,16.=:', gA A.� f t-14 " ir—- , _ ES_ 14 ..`e-'- .." '',.it :,.4,—.''r•-,..ot 1-, Itifir l'2177,g ,�� -.4.- •�..._ ..�.r .,.-, M"•.-4t4...1 1 e .4 , . 4.,.I iv":A :.�...m ( f.� Ss;r}ri .4; i ..._ :ice" i E ,lam i !4L i,a 1i !mop.., .,,,,,. is ,1� -- - -.^...... ,..�. • -rye' The city of Port Townsend and Jefferson County are discussing ways they can work together to keep Port Townsend's historic post office operational while meeting the evolving operational concerns of the postal service.Adequate security for the post office and good access for people with disabilities are two areas of concern.Photo by Barney Burke County, c� e e osoffice Possible partnership could save historic building By Allison Arthur of The Leader could be built on two acres of c by stairs,and because of security county-owned property behind `There,s.no rules,the,postal service wants to • Jefferson County and the City the Goodwill store in the Port change the habit of meeting some of Port Townsend are talking Townsend Business Park. timeline or customers at the building's rear about how creating a public devel- A musical chairs in govern- loading dock. opment authority (PDA) could ment offices,then could occur if a 'commitments Mayor Michelle Sandoval has save the"Customs House"build- new distribution center is built. said thatthe postal service has ing and keep it as a working post Ownership of the historic post no funds available to renovate old office while moving postal distri- office could be transferred to the being made. bution operations elsewhere. PDA,which then would contract --- buildings, roely"theyid new ones, � and therefore don't want the A new distribution''center with the county'to:move some Its all building." For example, late last of its offices to the historic build- - year the postal service announced ing,potentially allowing QFC food exploratory closure of the old post office build- store to expand into.offices the ing in downtown Bremerton in county now uses,county Sand cityfavor of a new facility. authorities said Monday. and its all County Commissioner Phil •City Manager David Timmons Johnson, D-Port Townsend, said said the post office has done a being funded Monday that the conversation has historical structures survey of the been started with Timmons,with Customs House building and dis- by the postal the city looking at creating a PDA, covered that vaults are stacked which is an independent authority inside the building on top of each f� that could also be used to help other on all floors and that"they service. build affordable-housing projects. measure out to make an elevator," • 'This is all very vague at this a discovery that could help the Dave Timmons point,"Johnson said. PDA eventually make the post City manager,Port Townsend Timmons elaborated Monday office accessible to people with he would be talking to the City disabilities. —xavot�fes for people with dis- In .September 2008, it was abilities had petitioned the postal Council about the PDA idea at an announced that'the U.S. Postal service to make the 1893 building upcoming retreat and he would Service had signed a nonbind- at the corner of.Harrison and recommend that it be created not ing letter of intent'with the City Washington streets accessible only to help with historic a mecha- va- of. Port Townsend that could to patrons with disabilities after tion but also to serve as a using. preserve the historic Customs Swain's Outdoor ended its con- nism to build affordable housing. 'House,where the local post office tract post office in 2007.The his Timmons noted that Pike Place has;• opecatedsincel1893. ' toric building is accessible only Market in Seattle is operated by a PDA,as is Historic Seattle. // /d/ A PDA has no taxing authority While the county wants to but can issue tax-exempt bonds work with the city on the project, and can receive state and federal Morley said the county also needs grants, Timmons said, adding to be sure to get full compensa- 1111that it likely would be eligible for ton for the property it would be infrastructure funding,as is being using as part of the deal, touted by President-elect Barack Morley said PDAs do a better Obama. job of serving as a bridge for pub- Created by ordinance, the lic-private partnerships,a concept PDA would have a board of direc- echoed by Timmons. tors and would have to find fund- 'This is a real opportunity for a ing,Timmons said. city-county partnership," Morley Hypothetically,the PDA would said. acquire the county property and The letter of intent signed work with the post office to build a last Aug. 18 by City Manager new distribution center,Timmons Timmons says the postal ser- said.When that was complete,the vice will convey its property "in Customs House ownership would exchange for Agency [city] Con- be.transferred to the PDA and veying a new distribution facility the post office would enter into on a site located at Port Townsend a long-term agreement with the Business Park. PDA to retain the post office retail "The project will be at no portion in its current location. cost to USPS, with the Agency The PDA then would take steps [city] responsible for all associ- to make the historic Customs ated USPS-incurred costs for this House building accessible for exchange, including but not lim- people with disabilities. ited to: closing, USPS-required Timmons said the Customs due diligence, design documen- House was a federal courthouse tation preparation, construction in one incarnation, and so it's management/observations, etc.," possible law-and-justice offices the letter states. that are currently at the Jefferson As requested by the city, the • County Courthouse could be postal service is paying for a fea- moved to the Customs House. sibility study looking at seismic- But all that is three to five ity, access for patrons with dis- years away from reality, he abilities,and other issues with the acknowledged. 115-year-old landmark building. 'There's no timeline or comm Sandoval said that the study is . mitments being made. It's all key to deciding whether and how exploratory, and it's all being to proceed with the concept. funded by the postal service," (Information from previous sto- Timmons said. ries by Barney Burke was used to • Johnson told fellow commis- compile this report.) sioners that there is talk of mov- ing the county Department of Community Development(DCD), the Public Health division of Environmental Health, and the Public Works Department into the top two floors of the current post office, which would free the Castle Hill Center space now used for DCD and the Environmental Health department for commer- cial purposes and allow the adjoin- ing QFC grocery store to expand. The Public Health offices could be moved into the space where Public Works is now,which would keep it near Jefferson Healthcare Hospital. "It's very intriguing,"Johnson said of the talk,later adding that he expects the idea to take some time. County Administrator Philip Morley said the postal service is interested in getting out of the landlord business, and at the same time it seems it is in the community's best interest to"save this remarkable property." County ppermit fees might rise • By Allison Arthur of The Leader County Administrator Philip The proposed new hourly rate about lowering fees for affordable Morley suggested that details of a would also be factored into the housing projects,and Scalf noted Land-use permit fees in Fast Friday idea would need to be cost of boundary line adjustment that Frank Gifford,public works Jefferson County may jump by 27 worked out to ensure fairness and reviews, conditional use permits manager, had suggested moving percent as early as March. to manage"expectations"so that and short'plat applications, so affordable housing and commer- JeffersonCounty'sDepartment people aren't disappointed and those costs also would go up cia]buildings to the top of DCD's of Community Development are turned away at the counter. roughly 27 percent. list as priorities, but that never Director Al Scalf outlined a cost- Building official Fred Slota There was a brief discussion happened. recovery plan Monday after- noted that other county depart- noon epartnoon to county commissioners ments, including public health and received their permission to and public works,would need to press forward with a proposal to be on the same page in order to increase an hourly fee of$55 to an move building permits forward. hourly fee of $70.67. "If the economy starts to recov- Scalf said after the meeting er and we're backed up, we're he hoped to have information to going to hear about it,"Scalf said present more formally to corn- in promoting the Fast Friday idea, missioners in two weeks and go details of which he acknowledged to public hearing in February, have not been ironed out. • potentially implementing the fee Commissioner John Austin, hikes in March. D-Port Ludlow,noted that unlike • Asked why the fee-hike pro- other businesses in which people posal was needed when the econ- can go elsewhere if they are not omy is in a crisis,Scalf said:"My satisfied with service,the county first answer would be that DCD is has a monopoly on issuing build- an enterprise function and oper- ing permits. ates like a business and needs Commissioner Phil Johnson, to remain competitive. I have to D-Port Townsend, said that time recover the costs of my depart- is money to contractors.Johnson mens." also has been a contractor. Sralf told commissioners that Commissioner David Sullivan, labor and benefit costs as well as D-Cape George, said he agreed • other costs have risen in recent with Johnson's assessment, that years and DCD fees have not time is money, so a decrease in kept up. service is "probably less desir- In conjunction with the pro- able"than what he called a"slight posed hike,Scalf suggested add- increase in fees." ing what he called a"Fast Friday" Scalf showed commissioners option for building permits only, hourly rates of planning depart- in aneffort to return some DCD ments in nearby counties,includ- staff members to a 40-hour work- ing Kitsap, Mason and Clallam. week and help push forward Kitsap's hourly rate is $85. building permits that are ready Mason's hourly rate is $68, and to go in order to keep contractors Clallam's hourly rate is$50. working. DCD took the brunt of county budget cuts in November, laying off six full-time employees effec- tive Dec. 1 while moving to a four- day workweek for other employees and closing DCD on Fridays. • P x x, .w% '�:rx-':r • s xs '�,E K +"� naq s „,,,,,,,,...,,,e;04.,,..::::. ,,zra a� s a s s t `� � .a� s. ',r s '� ,,,,,,,,„ , ,,, ......,,. ,,,.. ..,::,..;...!''....:*,:2L.,: :......',.... A fi} ,,a � ` rg. T4s 3 .;,,,,o,� ms 1, ' • . h� ; � � a �` t `r.,.✓ ; 3.: . . "� ¢a,T aEj • %,,,,..,41,a1,-- '''''':>:,..41.,7":','',t=>.4tti,:t''''“ . Ts,',-1'. ,",:4',' .4..V"•P'.-4 ' ' '?-,'I ' '‘''',e „",,,'..,,, . K- f ? , qt eat . ., r. • .wsa' �' �, ' . ,-•.t.!'''''';'',' : !!: _��; s , q,y - ' 'fa>`Y rY �sFiRtxy 'n ix� x a� 7 a�Ww� d' S b5. 1 * A� Vark 4h ` "$ ::„,:,i,'4.,,,,,,,...'.,•,......,,-,,.1../i>.41, E ...,r ,ufi 4 0 • ' c ..: :. ;,.;:,,..1,,,,,, '11.1 .w' �a� KAZ8 FO(T I(GHTS z r �h �z F ki '7rs , S r 1 s n "sy % a .•' £ 't y�5.. sem'i.. h +aa� 4� .•;'''i'.''' ?xs � - tz �Y yi , cit.:: Z 3 i - Xat'; A $ Ilt aI $1 s .a x '1.,,,,,,c &f00tL£Gh"f� f %�1. AF 3 3.Q'.w�+A, .� ,..4%...,. •i:.Cr..... rS� w" , t %s y / r S 3 a..Y A r x„ �' �.: JEFF CriFw (2)/Pt��aA :_. D.-,.:;., \F-,�' Bob Crawford, an equipment operator for Skookum Contract Services at the Jefferson County transfer station recycling center, shows some of the burned out fluorescent bulbs that can be recycled. II New p la ee to dump dim bulbs PT center now accepting fluorescent lights to recycle The Home Depot in Freilich did not know on BY JEFF CHEW Sequim accepts compact Tuesday when the Port AND LEAH LEACH vl u 1G' ay Angeles center would the Moderate Risk Waste fluorescent bulbs at no g begin PENINSULA DAILY NEWS Facility at the Port charge,Freilich said, taking fluorescent bulbs. PORT TOWNSEND — Townsend Boat Haven For more information When it does,it will offer marina,282 10th St. from the store at 1145 W. the service free of charge to The Recycle Center at PortWashington St.,phone 360 residents. Townsend Transfer Station She added that she hopes recently has become another Clallam County 582 1620. P In the future, the city's that more and more busi place on the North Olympic Fluorescent bulbs also nesses will take them back, Peninsula that will Acte t y Moderate Risk Waste Facil P can be recycled at Port it at 3501 W. 18th St. in as well as having the ser- fluorescent bulbs and tubes Angeles and Sequim busi y for recycling. nesses, said Helen Freilich, Port Angeles also will take vice at the city facility. The Recycle Center pro- city of Port Angeles waste the bulbs,Freilich said. for customers"It be convenient to take them gram is program is free to reduction specialist. The city is negotiating a back to where the residents,operated through ASM Signs in Port Ange- change in its contract with y bought county contracted Skookum Waste Connections of Wash- them,"she said. Contract Services at the les,1327 E.First St.,accepts ington, which operates the For more information center at 301 County Land- both long tubes and corn- city-owned Regional Trans about disposal and recycling fill Road, off Jacob Miller Pact fluorescent bulbs fora fer Station that will make at the Port Angeles facility. Road. small fee,Freilich said. several changes, including Phone 360-417-4874 . The cost ranges from 80 The Recycle Center is allowing the site to begin open from 9 a.m, to cents to $1.50 depending taking both businesses' 4:30 p.m. Monday through upon size. For more infor- waste and fluorescent tubes Friday and from 10 a.m. to oration, phone the business and bulbs,she said. 2 pan,Saturday at 360-452-7785. 1' �/�/ ,} Yea aas�� sr f .;.•,*,,,... it'.s • 4 gLp ff��'U F •k ,� $ cd. 3M Guidelinesvit# > �,L t � , vs In Port Townsends _� y $tSf :nC gela Pieratt, Jefferson �� � � ounty environmental 't, N � 4 2 , ealth specialist, said ,' .: ,, ,. ouseholds using the selfIVA; f \� a r ` _ rve drop off site t, either .: X1 „,,,,-;e::;.??., h + #, location should follow theselit � ` 'x; guidelines to ensure safe � �` z�� ° <� ,�` � 1 . �f�� disposal: Q, < j n- ti ■ All size florescent g -� .� tubes and bulb styles are R :s � * ° accepted including, circular �� � tS) U-tUb R al bulb ���� �g s� s �'� �, x�f�i �qr .� � , VW 10 RC1 UUlUJ. �+ y �'f k'�FT 5 { k k� kYe :::.''..-,;,•,'. ...',.....!...''.f . &s ■ Tubes accepted for r disposal need to have tape V t:i'i' „ 4c 1 , $x r f r ` p --grog k6g t,f L ri'. F .f f 3 3'sk �Y3 .k. and ac removed. � 1� 3 s 3 � , 0 ■ Broken tubes are not •k ' t accepted or recyclable. al=h 'qf F ,„.4.,--i.,,-., �; - • Fluorescent tubes con _. • ;•pr fain mercury and must not •y',.,:'•,','`.,,,,;,,..:,..-•.� y • x §__ be broken. 3 , If a tube breaks,the cus- tomer must evacuate the A sign promotes the new effort to recycle area and alert Recycle Cen- fluorescent bulbs at the Jefferson County ter staff for proper han transfer station recycling centers dling. The federal Environ degraded water quality and Keep using them mental Protection Agency can cause health risks for says that if every American humans,fish and wildlife "Encouraged by the home replaced just one light Each CFL contains a growing popularity of co bulb with an Energy Star- very.small amount of mer pica:: lamps, or qualified fluorescent light, cury — usually around 5 CFCs, Jefferson County it would save enough energy milligrams, or about the' Public Health and Public to light more than three amount that would cover Works are urging residents million homes for a year the tip of a ballpoint pen. to continue replacing incan xnd prevent greenhouse gas, For more information on descent lights with this emissions equivalent to Jefferson County's Solid energy efficient technology more than 800,000 cars. Waste Program,visit www. that now comes in a variety "Many reasons make SolidWaste.wordpress.com. of sizes and lighting quali- CFL's a great choice; how ties, Pieratt said in a writ ever, the fact they contain port Townsend-Jefferson ten statement. mercury magnifies the County Editor Jeff Chew can be "CFCs save money importance of recycling reached at 360-385-2335 or at Jeff because they use about 75 CFCs as a household haz chew�peninsuladailynews.com. percent less energy than ardous waste item,"Pieratt 0 standard incandescent said. bulbs and last up to 10 "When mercury is times longer. improperly discarded, it "These small fluorescent leaches from common con- light bulbs can be screwed sumer products into the into a regular light socket." environment, resulting in bii y ,, y v'.•S o $ •n 6 7, E'tl .G X .. ti ° cov, W vw79 > W .c N Giycmc N ^NL ° m to °R ;.5Y 3\ - _ 2 ^E x . o . bo3Lj W yA'aLLL V O to ° y L C to, .E ui 1_!flhiIIijU ' p °iv22cE ° v = ° wF. cNSr° •5O .52. ° 0.8w,, 75a, >v 3cc cnT, v • v� - uE Nc , '° EJa ° ° oE `�v >- ao �0 N �v ,...t= E... ° • c•53c a)• ^ •2 L ov 'u ° m , E N z - c"0 .2.5a ;o = o vscri•°'N colo t' N•EE ci.2 5u "NOE ' 4. v :r -� — V aCLC•-• d ° 6"- N u; 0O .Ac °= oL > .LCC07,32 NF3vNNL•.ar cv• m °v� nL . 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E o 4 ( 1 " z 0Toa88k o.. rsl V/ I� Q O•o a N_ 0 F , 0 c2C:5 bta C .4" 1 E "E ir, M ,jQi o . o4o� 7 . d VE_9 ..1. o ih ^- 0.vaO Sy r � CI) O o alb 0 ^ as f P-....0 Z4 V • 4 --,V:: ' /moi 47)e ..:11/. ./1 s Water and sewer plans Prior to approval, the Jefferson quired for septic systems.One comes at the time for new construction projects County Environmental Health Depart- of application and includes a visit to the site.The Plans ment evaluates the soil on the site from second comes at time of installation. should a for include co strct and sewer service plans.A minimum of three sets a minimum of four test holes. Often, • of engineering plans are required for soil evaluation must be conducted dur- A Septic System Primer ng the wet season. Both primary and Waste water and (effluent) must be street development permits.ln unincor- reserve drain fields are required and sewage porated areas, a water service agree- soil must be approved for each.The treated to prevent disease.Effluent flows from the • men( from the water supplier shouldhouse to a septic tank,from where it flows into also be presented.Unless the property system should be designed for greater drain lines that carry it to absorbing soils.As it is served by city sewer service,an on- than typical capacity. filters down through the soil,it is purified by soil site sewage disposal permit from the If approved, permits are issued for bacteria.Two to four feet of good soil must exist Jefferson County Environmental Health the specific site,not the family or busi- below the drain field pipes to treat the effluent The Department is also required. ness.Permits are valid for three years. amount varies due to soil types. If the nature of the work is such that Applications are made at the Jefferson Soil types range from gravel to sand,sandy loam, Communit County Department ofy loam,to clays.If the effluent flows or percolates some of the required plans,calculations Development or Environmental Health (peres) too quickly, it may reach ground water or construction inspection require- Department. without adequate purification,polluting neighbor- ments are not necessary, the building New on-site septic systems are only official may waive those requirements. allowed in the City of Port Townsend ing wells or springs. for new single family residential Bevel- If it percs too slowly,the effluent backs up into • foropentnew which is greater than 260 feet the house or resurfaces.Sandy soil requires less CHAPTER 10: from the nearest city sewer main and area than finer,loamy soils.Conventional septic sys- • Onsite septic systems which is not subject CO any of-the fol- tems cannot be used in clay or other impervious lowing:a) review and threshold deter- some si proved alternative systems can overcome • Why Septic Is Needed mination under the State-Environmen- some site limitations. tal Policy Act Implementing Ordinance On-Site-Septic systems (OSS) are effective if Because soil varies,the ability of each the following conditions exist (Chapter 19.04 PTMC)or b)permit re- soil to absorb sewage effluent also var- uiremencs of the Environmentally Sen- I.Properly designed and installed system. ies. Serious health problems can arise q 2.Adequate soil conditions. sitive Areas Ordinance (Chapter 19.05 from an overloaded or poorly designed 3.System is not overloaded,neglected or im- septic system. PTMC). On-site septic systems must peded by excessive wastes from the house or be approved by the Jefferson County While most of us are acquainted business. Health Department. 4.Solid wastes are ke t at a minimum.Septic • with the top soil on our property,syr- P If an on-site septic system within Gems must rely on the lower soils.Gla- systems can handle only human excrement,toilet ciers left deposits of till and silt over the City of Port Townsend fails (at any paper and wash water.Garbage disposals may be much of the area.These and clay soils time),connection to the City's system too much. is required unless the nearest portion can create hardpan soils which restrict liquidthrough Clear is visible throu h annual visual • of the parcel is greater than 260 feet • water absorption. Impermeable soils - inspections.from the nearest sewer main,in which keep sewage near or at the surface,or case the septic system may be repaired 6.Pumped out every three to five years. may cause back-up into the house. 7.The drain field is protected from vehicles. to serve the property. When Is a Permit Required? Septic Inspections Any place where people live,work, re- or congregate,which is not served by a Two inspection approvals are sanitary sewer needs to have a permit- ted on-site sewage system. New con- struction to replace or remodel an ex- isting structure requires a new permit. Temporary uses (more than 30 days) such as camps or recreational vehicles • also require a permit. • Applications must include plans de- signed by a licensed engineer or licensed septic designer.Plans are drawn to scale and show the required distances be- tween a well,septic tank,surface water, and buildings. • • 0 aroi %•&, a)TiA.�� q, Bea ° 2' 6 1.5 .Atv °220g 0 & W ° ¢ .i slit!= ° `oma.s . . cf) 0 „ Or �� al) „. Oa2 ii :hi1JIiId °op4 a W,.., +a C N N 'oeF 7 Ei� 0 hON ° ' ro ' X2• qoae o 'i q > a V bA m • glg 1:1 a ° ,n�i• b05 � � WNdOtiyOpp Ywa0ro (98ooz L y® 3'oW '7 'rmU '5E 15-1 Q cF '� ' 3 y3,r;o °1q2 Zo rnEI'oo g-L- ac ° 0.°' _ 3w A i:, U) GV N. f.GO M 8 C. c0'v~,5 O q3 aw o N .o d go ro row q 71.5-D 5 p' ] a 3 d fi c 1 00 Ero g i -]— aid0 .p &isdjrng ~,G U 5 ,n 0 8 • ° c$ ot3 ofliqua . t aoH � ° y� �o N 1 v. ° o aro N y 'ti N 3 gg g;o▪ :• .5 `1514,1"5,10p y 443 g +gyp c> .5.c ainia ai : °o v .0 3 ° 3b'�r. 'o'• T G2 Ebg qb 0• d 7 o g E 4 d • CU K)3 ' lUl 5U9V 6.°°.. 3" o to •;) c•ocg a v a� c bob �, 3 •r bo a° c 3j a'i �+?'� F^° yF rox to C u ,>,� G'CC/) ��; W �� p� 3 N !-•.; _,>' pi8ro 300 au �' aoi apiac w cli) 4 ,9e 2.. giel yi F r�q5 1'� r+ o N 0-7. 06. °c3 s, " a o4 .s tia1d © 1 •�gP'aSL p w . ° p ° Trovg � xt o aHhIfl ,42 Ci/ . ociwg R1.0 so" • Z vO 4k tg I z t 8 Border Patrol Democrats: Statement releases opposedCONTINUED FROM Al lators and federal Depart- between the ports of entry, As part of a build-up of ment of Homeland Security the Border Patrol's mission immigration law enforce- "I have talked to the Secretary Janet Napoli- is to prevent the entry of menton the country's north- . chair in Jefferson County, moo• terrorists and their weap- em border, Border Patrol and we haven't had a meet- "We're sending it every- ons of terrorism:to enforce agents based in Port Ange- Jefferson Democrats ing since they adopted this, where,from elected officials the laws that protect Amer- les have increased from four but we will look at the next to neighboring parties," ice's homeland by the detec- to 24 during the last two resolve to restrict ict opportunity,"Marrs said. Sircely said. tion,interdiction and appre- years,and the Department "I'm inclined to agree in "I have spoken with our hension of those who of Homeland Security has Border Patrol activity principle with their concern, colleagues in Clallam attempt to illegally enter or announced plans to build a but until the meeting, Pm County,and I know there is smuggle any person or con- facility with a short-term not ready to go any further." concern over there, and I traband across our nation's detention area in Port Ange- BY East HIDLE The Clallam' County know they will take a look sovereign borders," the les in 2009. PENINSULA DAILY NEWS Democratic Central Corn- at this. statement said. The Jefferson County PORT TOWNSEND — Jefferson Countymittee meeting will be in Patrol statement "In addition to this, Democrats' resolution and the Raymond Carver Room checkpoint operations other documents are avail- Democrats have passed a,resolution opposing of the Port Angeles Library, The Border Patrol greatly enhance the Border able for viewing at www. increased presence ot-B ,'der,Patrol.agents,on 2210 S.Peabody St. released a statement on Patrol's ability to carry out Jeffcodemocratacom. the North Olympic Peninsula—and the Clal- The Jefferson County Tuesday reiterating its corn- the mission of securing the lam County Democratic Central Committee resolution is addressed to mitment to its work on the nation's borders against ter- will consider a similar move in March. ' Reporter Erik Hidle can be The Jefferson President Barack Obama, Peninsula. rorists,smugglers of weap- reached at 360-385-2335 or at County resolution "I believe this congressional leaders, Gov. "As the primary federal ons of terrorism,other con- erik.hidleepeninsuladailynews. calls for a "suspen- Chris Gregoire,state legis- law enforcement agency traband and illegal aliens." corn. sion of' expanded resolution carries Border Patrol activ- weight all by itself ity away from the because we're the border until the util- ity,legality and con- first county t0 stitutionality of this speak out," expansion has been Marr SIRCELY determined by the chairman, Congress and the Jefferson County courts." Democratic Party The resolution passed unanimously • late last week at a membership meeting of about 50 of the county's some-400 party mem- bers,said Matt Sircely,Jefferson County party chairman. The federal Border Patrol conducted road- blocks—called checkpoints—on U.S.Highway 101 northeast of Forks and on state Highway 104 near the Hood Canal Bridge last summer and have boarded Olympic Bus Lines buses to look for illegal immigrants. Border Patrol detentions have prompted protests in Port Townsend as well as Forks, Port Angeles and Sequim. Fiscally Irresponsible The resolution also says that the Jefferson County Democrats are concerned that the Bor- der Patrol expansion is fiscally irresponsible, infringes on the jurisdictions of local law enforcement agencies and that"the location of checkpoints and frequency of stops raises con- , cern about racial profiling." While it is non-binding on anyone,Sircely feels the statement is important. "Very often these types of resolutions don't carry a lot of weight and are part of a formal process to try and get something passed on the state level,"Sircely said. "At the same time,I believe this resolution carries weight all by itself because we're the first county to speak out." The Clallam County Democratic Central Committee will consider either adopting the same resolution as the Jefferson County group or writing one of its own when it meets at 10 a.m.March 21,John Marrs,chairman,said • on Tuesday. TURN To DEMOCRATSIA4 Vii;<r%' So far,samples from Anderson Toxins have told the same story.Toxicity levels rise dangerously high in late spring before slowly dissipating by the time winter rolls around. 110 have "It's been like clockwork the last three years,"Harrington said."At least it's being predictable." With that in mind,a club mem- ber at the Olympic Peninsula Fly a gFip Fishers'December meeting posed a question to state Department of Fish and Wildlife biologist Thom Johnson.Why not open Anderson, on Iwhich is stocked with trout fry every year,to fishing in the winter when toxins aren't at elevated levels? Harrington,for his part,said that would appear to be a possibility. ANDERSON LAKE TEASES "It seems that there's algae [at anglers so. Anderson] all year round at some The wildly level;however,when we've gotten popular Jeffer- Matt very concerned is usually when we son County lake Schubert see a scum form and a lot of toxin has fallen into a produced,"he said."That usually sick cycle in st doesn't happen until spring. recent years. f'b . a i "Generally what we were really Open to fish- :,,..,,.,4';',','0,71‘, concerned about at Anderson was ing in April, 3t. 'a 3 the lake was really toxic,and if close down only , someone were to capsize their boat a few weeks =" [ l 41 01 or some kids playing next to the later after ele- ,L lake [might swallow some water], vated levels of 4 li s the risk was very high that they'd toxic blue-green3 have health problems." algae becomes l uY The final decision would go to dangerously state parks,which ultimately makes present. the call whether to open or close a 41110 Jefferson park. County Environmental Health's Neil Fish and Wildlife would also have Harrington doesn't see an end to the to change its fishing regulations as twisted tango as things are right well,something Johnson said the now. department was open to. And tests have revealed elevated "Our bottom line is that's a good levels of toxic algae showing up at idea and we'll consider it,"Johnson other lakes(Leland,Gibbs and Tar- said."But it's too soon to take any boo to name a few)in the county as action because we're not sure what's well the last few years. causing the toxic algae. . .and we The Greywolf Fly Fishing Club don't know if the fish themselves are will host a forum discussing the safe to eat." algae problems next Wednesday at Those are the questions that Har- the Gardiner Community Center's rington is trying to answer,not just main hall at 7 p.m. for Anderson but Leland,Gibbs and Dr.Tom Locke,health officer for several other Jefferson lakes. Jefferson and Clallam counties,and "When you talk to folks they say Harrington will be among the Anderson has always been green," speakers at the forum. Harrington said."But we don't know State fisheries and parks officials have also been invited. if that was some other algae [that doesn't produce toxins].I want to see Lake monitoring what happens this spring. "Why are these [toxic] species Harrington,the water quality predominant?That,I don't know." programs manager for Jefferson County,said he plans on talking • about the lake monitoring program . Matt Schubert is the outdoors during the forum, and sports columnist for the Penin- Ever since a dog died in 2006 sula Daily News.His column appears after drinking Anderson's water, forcingon Thursdays and Frida • park officials.to close it,the y Fridays.He can be county has vigorously tested lakes reached at matt.schubert@ throughout the area. peninsuladailynews.com. is/)4' W4cy Fluorescent • lamprecycling now available Fluorescent bulbs and tubes a fee at the Moderate Risk Waste are now accepted for recycling Facility. at the Recycling Center at the Compact fluorescent lamps Jefferson County Transfer Station, save money because they use 325 Landfill Road,off Jacob Miller about 75 percent less energy Road in Port Townsend, open than standard incandescent Monday through Saturday. bulbs and last up to 10 times This is in addition to the ser- longer,but they contain mercury vice presently provided at the and should be treated as house- Moderate Risk Waste Facility at hold hazardous waste, empha- 282,10th St., in the Port of Port size department spokespersons. 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I n by tD 17,1 fp co rn NilotalP lirVitar ' = COt� G CO lII1 Ii II -. = T. cna � in vi atD c ° ° - cri 0 o '0 = a I lz E -I a; —' < C 2 [D .... -• -1 07 0 Ct. •!.' -i:-- 1 e \ A • Board of 3-feaCth New Business .Agenda Item #T., 1 Legislative .Advocacy: • Public Health Funding Letter February 19, 2009 • JEFFERSON COUNTY BOARD OF HEALTH • February 19, 2009 Representative Lynn Kessler Representative Kevin Van De Wedge Senator Jim Hargrove Washington State Legislature Olympia, WA Dear We, the members of the Jefferson County Board of Health, are writing to express our priorities for upcoming 2009-2011 Biennial budget. As you are all too aware, Washington State is faced with an unprecedented economic crisis and the need to drastically reduce state expenditures in the upcoming Biennium. Many difficult choices will have to be made about the priorities of government, the needs of vulnerable populations, and the likely adverse consequences of budget cutbacks. As you face these hard choices, we would like to share our priorities for legislative action this year. Local health departments across Washington State have already made substantial staff and service reductions in line with local budget realities. It is crucial that the three state funding streams that support local public health— Motor Vehicle Excise Tax (MVET) backfill funding ($48 million per biennium), funding through the 2007 SB d ($20 million per biennium), and Local Capacity Development Funding ($16 million per nnium)-be preserved as recommended in Governor Gregoire's budget. We also ask that you support the public health funding goals of HB 1985. While this bill does not offer the increased local revenue options we will need for the future, it does consolidate and equitably distribute existing funding and updates accountability standards for public health programs. There is a growing national consensus that expanded investments in preventive health services and public health infrastructure are among the highest priorities for successful health reform. Until these resources become available, however, it is crucial that we preserve as much of our essential public health infrastructure as possible. Here in Jefferson County, local government has risen to this challenge and is maintaining core public health services. It is our urgent request that you do likewise and support existing state public health funding streams for the duration of our current economic crisis. Sincerely, Chair, Jefferson County Board of Health • 615 Sheridan • Castle Hill Center• Port Townsend • WA (360)385-9400 • Board of Health New Business .agenda Item #`V., 2 Syringe Exchange Program Report • February 19, 2009 • r 0, ,r JEFFERSON COUNTY PUBLIC HEALTH -,4„,,,(00 615 Sheridan Street • Port Townsend •Washington • 98368 www.jeffersoncountypublichealth.org • Jefferson County Syringe Exchange Program (SEP) Annual Report 2008 Jefferson County has provided a Syringe Exchange Program (SEP) since 2000, as part of a state and regional effort to reduce the risk of HIV infection in our communities. This program also reduces the risk of Hepatitis A, B and C infections. Syringe Exchange Program clinic hours are Mondays and Wednesdays, 1:30pm-2:30pm, with drop-in exchange based on staff availability, Monday through Friday, 9:OOam-4:30pm. SEP is staffed by multiple nurses trained in the program and it would be rare that a nurse would not be available. Clinic hours are posted; however, most clients drop in at other times. This has been consistent over past years despite offering clinics on various days and times. Risk reduction education and referrals are routinely offered at each visit. Education includes verbal and printed information on hepatitis, HIV, STDs, health alerts (for example, wound botulism), care of abscesses, street drugs, intravenous drug use safety (including one time use of needles), and immunizations. Internal referrals include STD, HIV, Hepatitis B & C screening and counseling, tuberculosis screening, family planning and immunizations. External referrals include drug treatment, medical care, mental health care, domestic violence, food, clothing and shelter. Clients are informed of two free programs which began in mid-2008 and are continuing in 2009: Hepatitis C testing and counseling and Hepatitis A and B immunization in a combination product, • Twinrix. These programs are being provided for at risk clients through the Washington State Department of Health and the Center for Disease Control. These are excellent services which many clients would unlikely be able to obtain due to limited income. Free HIV testing and counseling continues to be offered, as in past years. SEP utilization is up slightly from 2007, as evidenced by an increase in numbers of visits. There were more visits the first six months of 2008, with decreasing numbers in the second six months. However, the majority of new clients were seen in the second half of the year. See Syringe Exchange Utilization graph. Data from intake interviews with clients indicates that SEP has been very successful in its goal of reducing reuse of syringes/needles through education and availability of free syringes/needles in a safe, anonymous environment. This, in turn, achieves the ultimate goal of reducing the transmission of the blood borne communicable diseases HIV and Hepatitis B & C. This is newly reported this year in the SEP Visits by Reported Syringe Use graph. Also, new in this report this year is the number of individuals indirectly utilizing SEP through secondary exchange. Of the 70 client visits to SEP in 2008, all but 3 (and 1 unknown) reported exchanging syringes for others. These clients reported exchanging for 2-5 other people at each visit. This significantly expands the reach and success of SEP in the community. • COMMUNITY HEALTH HEALTH DEVELOPMENTAL DISABILITIES PUBLIC HEALTH ENVIRONWA ERLQUALITY MAIN: (360)385-9400 ALWAYS WORKING FOR A SAFER AND MAIN: (360) 385-9444 FAX: (360)385-9401 HEALTHIER COMMUNITY FAX: (360) 379-4487 Syringe Exchange Utilization, 2000-2008 Jefferson County Washington 80 — - 30000 (=Number of SEP 1.1 70 — attendees 65 . 63 64 - 25000 -p —+—Number of syringes — — 58 rn N 60 — exchanged — 03 m 18060 24585 - 20000 o c 50 — 21130 w ;; 41 13716 ai a 40 — — 36 17905 - 15000 a rn >, w u)630 — "6 d 9222 - 10000 2 320 — 16 E Z 14 I— 1 4206 - :000 Z 10 — —1 2076 506 0 i i - i i i i -I I i 2000 2001 2002 2003 2004 2005 2006 2007 2008 SEP Visits by Reported Syringe Use SEP Visits by 6 1 1 3 Zip Code Each sryinge 3 98368 used once r,„ � • ■Other within �_ � ■Each sryinge Jefferson Cty , !,;!-,,ice,kr;',45),t14 • : used 2-5 times ''� ❑Outside of - , Jefferson Cty , ❑Each sryinge ounknown used 5+ 63 times 63 Table 1 Materials Distributed by Jefferson County SEP Syringes IDU Prevention Condoms/ HIV Educational Referral Outreach Exchanged Prevention Kits2 Latex Tests Materials3 Information” Educations Materials' Barriers Offered 2008 21,330 7941 0 140 27 32 35 32 2007 24,585 9,988 0 20 22 18 23 N/R' 2006 17,905 9,000 0 0 2 3 2 N/R 2005 13,716 7,611 0 20 0 6 11 N/R 2004 18,060 7,265 6 228 N/06 48 11 N/R 2003 9,222 1424 38 800 N/O 42 18 N/R 2002 4,206 1,026 35 427 N/O 50 NA N/R 2001 2,076 3 9 14 N/O 9 5 N/R 2000 506 11 15 33 N/O 10 2 N/R COMMUNITY HEALTH DEEVELOPMENTALLTH D DISABILITIES PUBLIC HEALTH ENVIRONMENTAL QUALITY (! MAIN: 3603855-9400 �'rrr4 ,aY �',,'1t,3 w •`""�AV MAIN: 360385-9444 FAX: 3603859401 HEALTHIER COMMUNITY FAX: 360379-4487 Notes IDU Prevention Materials include:same as prevention kit with individual items given on an as needed basis 2 Prevention Kits include:tourniquets,cookers,cottons,sterile water,sharps containers,alcohol preps,antibiotic ointment, bandaids and sterile pads for wounds,tape,antiseptic towelettes, hand sanitizer,hygiene items(toothbrush,soap,comb, razor) 3 Educational Materials include information on hepatitis, HIV,STDs,health alerts(ex.wound botulism),care of abscesses, • street drugs,tattoo safety, needle reuse, IDU safety,domestic violence,immunizations 'Referrals: Internal referrals include STD, HIV and Hepatitis B&C screening and counseling,tuberculosis screening, family planning and immunizations. External referrals include drug treatment,medical care,mental health care,domestic violence,food,clothing and shelter. SOutreach education is defined as face-to-face education on safe injecting practices,vein care,blood borne pathogens, risk reduction methods,and other as needed 6N/0:Not offered 7N/R: Not reported Table 2 Jefferson County SEP Clinics/Demographics Clients Clinics Clinic and New Returning Reporting Offered Drop-In Clients Client Secondary Visits' Visits' Exchange' 2008 99 70 6 64 67 2007 97 65 9 56 58 2006 126 58 8 50 49 2005 119 36 6 30 29 2004 136 64 12 48 45 2003 119 63 9 55 53 2002 108 41 11 29 25 2001 98 16 6 9 5 2000 33 14 3 7 3 Note: Represents duplicate clients • 2009 Goals • Continue anonymous, safe services to promote revisits by clients and to encourage clients to tell their friends and contacts about SEP • Continue to inform and refer clients for substance abuse assessment and treatment • Inform clients, on an as needed basis, about the Jefferson Aids Services (JAS) incentive program • Offer free HIV testing and counseling at each visit • Offer free Hepatitis C testing and counseling and Hepatitis A& B vaccine at each visit • Provide each new client with a prevention kit, hygiene materials and condoms, educational materials and referral information • Increase distribution of condoms and hygiene materials • Review intake data forms and update/revise as needed • Revise quarterly reports to reflect all data collected on the intake data forms Data Source:Jefferson County Public Health SEP Intake Records Prepared by Carol Burwell, PHN,Jefferson County Public Health 02/02/2009 COMMUNITY HEALTH PUBLIC HEALTH ENVIRONMENTAL HEALTH • DEVELOPMENTAL DISABILITIES MAIN: ALWAYS WORKING FORASAFERAND WATER QUALITY FAX: 360-385-9401 HEALTHIER COMMUNITY MAIN: 360379-4487 FAX: 360.379-4487 • Board of Health Netiv Business Agenda Item #T., 3 Jefferson County • Demographic Data Update yebruary 19, 2009 • Publications & Data ... keep what's here ... The following are links to the current publications. • Publications & Data Health of Jefferson County <opens to other page> Jefferson County Youth <opens to other page> Health Consultation - WA... <opens to document> Methamphetamine "Meth" in Jefferson County <opens to document> Resources Prevention in Jefferson County Youth Yellow Pages Community Presentations Health Care Access Forum.... Health of Jefferson County Health of Jefferson County Updates • 2008: Demographic Profile Update 2007: Part 1: Demographic Profile Part 2: Mental Health, Alcohol & Drug Use Summary Sheet: Mental Health, Alcohol & Drug Use Health of Jefferson County, 2003: a compilation of data from a... The report is presented here in HTML... Click here to view Health of Jefferson County, 2003 Click here to download Health of Jefferson County, 2003 in Adobe Acrobat (pdf) format. Jefferson County Youth Jefferson County Youth, 2007 2004 Jefferson County Healthy Youth Survey: Jefferson County Public School Students Respond A report provided as a courtesy... Keep all other text but remove link to evaluation survey Jefferson County Demographic Profile Update T How people live-the sociodemographic context of their lives-influences their health. People who have lower incomes may not have the resources to meet basic needs including food,clothing, shelter, and healthcare. Insufficient resources can lead to negative health outcomes.Those with higher incomes may have adequate resources to meet basic needs, which in turn leads to improved heath outcomes. Communities with concentrations of low-income populations often have higher levels of health-related problems than more affluent communities. Identifying these patterns is important because differences between a community's demographic characteristics can help explain differences in health indicators for these communities. Therefore, understanding variations in community characteristics is an important part of community assessment. The Jefferson County Demographic Profile Update includes data on population growth,the County population's gender, age, race/ethnicity, education, income, disability, and housing. Total population and annual population growth • The 2008 estimated population of Jefferson County is 28,800 persons. • Population growth has been around one to two percent since the mid-1990's. Components of population growth • Population growth in Jefferson County has resulted from in-migration since the mid-1990's. Population by gender and age groups • • Among both men and women, the population age 35+ has grown considerably while the population age 20-34 has decreased. Population change from 1990 to 2008 by age groups • Compared to 1990, the Jefferson County population has increased most in the 85+age group (169%), 50-64 age group (146%) and 75-84 age group (61%). Median Age • The 2008 median age in Jefferson County is 49.8 years, an increase of almost 3 years since 2000. Race and Ethnicity • Jefferson County is predominately white (90%), the population of non-whites increased 1.2% from 2000 to 2008. Disability status • Fewer Jefferson County adults age 65+ report being disabled (34%) than Washington State adults age 65+ (42%), however more Jefferson County adults age 16-64 report being disabled (18%) than Washington State adults age 16-64 (14%). Highest education attained • About a third of Jefferson County adults report having high school or less (32%), some post high school (34%), or at least a bachelor's degree education (35%). • Compared to 1990, more adults report at least a bachelor's degree. High School graduation rates • The graduation rate for Jefferson County high schools is about 80%. Household composition • From 2000 to 2005-2007, nonfamily households (individuals living alone) increased 4.5%while single parent households decreased 3%. Median household income • • The Jefferson County median household income in 2008 is $48,069, nearly$12,000 below Washington State. Jefferson County Public Health February 2009 Jefferson County Demographic Profile Update Per capita personal income • • The per capita personal income in 2007 was $38,004, only$208 below Washington State. Working poor • About 30%of Jefferson County residents live at 185%of poverty-a family of four earning less than $39,225 per year-compared to 25%of Washington State residents. Poverty of all residents • About 11%of Jefferson County and Washington State residents live at 100%of poverty-a family of four earning less than$21,203 per year. Children age 5-17 living in families in poverty • Nearly 16%of children age 5-17 live at 100%of poverty compared to 13%of Washington State children. Public School student applications to the free and reduced lunch program • Fourty-three percent of Jefferson County children enrolled in public schools are eligible for the free and reduced meals program compared to 38%in Washington State.The rates range from 40% to 93%in different Jefferson County school districts. Medicaid-paid births • Two-thirds of Jefferson County resident women giving birth in 2006 had births covered by Medicaid compared to 47%in Washington State. Median house prices • The median house price in Jefferson County and Washington State peaked in 2007 and has dropped during 2008. Housing affordability gap • Jefferson County residents earning an average income wanting to purchase an average priced home would be face an affordability gap-amount of addional income needed to purchase-of about $35,000. • Housing affordability • About 23%of Jefferson County households earn incomes that would allow them to purchase an average priced house, compared to 34%of Washington State households. Owner-occupied housing • More than three-quarters of Jefferson County houses are owner-occupied. Housing costs • Twenty-five percent of Jefferson County residents spend 35%or more of their monthly income on owned housing; 31%spend 35%or more of their monthly income on rented housing. Jefferson County Public Health • February 2009 Total Population and Annual Population Growth • Jefferson County, 1960-2008 Intercensal Estimates of the Total Resident Population with 2001 -2008 Postcensal Estimates Source: Washington State Office of Financial Management The population of Jefferson County was around 10,000 persons from 1960 through the early 1970's. Thereafter, growth has been steady. From the mid-1990s to the present, the growth rate has been about one to two percent. The 2008 estimated population of Jeferson County is 28,800 persons. , 4. .t r =` sem' t ' r� �� f Age w� I III • ' 4 � ti , F, ' _ ° i s A �, � •z _ m : • ,, '; »®. ��- z ' 44 . �, '"ye,,.n , . .t1. ,+3.r , --o,,,t. - » 'W 4 s '* :. 4'4 C' a 4 -iei.,..Pot �f d'r ; � . f..F.r'�?�.»; ^, � �'arw. .,-----").m», iµ II Jefferson County Public Health December 2008 Jefferson County Year Popluation %Growth 1960 9,639 • 1961 9,800 0.2% 1962 9,700 -1.0% 1963 9,800 1.0% 1964 9,900 1.0% 1965 9,800 -1.0% 1966 10,000 2.0% 1967 10,300 3.0% 1968 10,700 3.9% 1969 10,200 -4.7% 1970 10,661 4.5% 1971 10,600 -0.6% 1972 10,600 0.0% 1973 10,700 0.9% 1974 11,300 5.6% 1975 11,800 4.4% 1976 12,300 4.2% 1977 12,800 4.1% 1978 13,900 8.6% 1979 14,800 6.5% 1980 15,965 7.9% 1981 16,736 4.8% 1982 17,017 1.7% 1983 16,925 -0.5% 1984 17,480 3.3% • 1985 17,873 2.3% 1986 18,317 2.5% 1987 18,533 1.2% 1988 19,131 3.2% 1989 19,673 2.8% 1990 20,406 3.7% 1991 21,408 4.9% 1992 22,238 3.9% 1993 22,732 2.2% 1994 23,298 2.5% 1995 24,112 3.5% 1996 24,437 1.3% 1997 25,116 2.8% 1998 25,451 1.3% 1999 25,664 0.8% 2000 26,299 2.5% 2001 26,446 0.6% 2002 26,600 0.6% 2003 26,700 0.4% 2004 27,000 1.1% 2005 27,600 2.2% 2006 28,200 2.2% 2007 28,600 1.4% 2008 28,800 0.7% 4111 Jefferson County Public Health December 2008 Components of Population Growth Jefferson County 1980-2007 IllSource: Center for Health Statistics, Washington State Department of Health and Washington State Office of Financial Management The components of population growth are births, deaths, and migration. Population increase results from births; population decrease results from deaths. Natural increase is the number of births in excess of the number of deaths. All population increase above natural increase is estimated migration. * r �.v (,..1h000:1---:::4:‘, _.. S r" �f Iii 4 A0- F11 Is Y' 4 - - f f�f d $ i J �. v ;fidL ti o ��sy gel z ai!'' � �-�� 't � l �l .:� _ '"sof '�� � �a '� �� .'i, b e = f,- 'P "f,:� �- ra z M gin. a � .# 4 ��, as ' ts z4. �z7 ,*».r (F4 ,� wc , ., -. _ 11`,1C) - '50t."' t u3 ` ='G ,:i::'g�" Natural Estimated Births ..,i)74..10,0,•,-,, increase migration Population 1980 225 "' ' ;,ti 1 71 700 15,965 1981 235 93 188 16,736 40 1982 237 69 -161 17,017 1983 204 , .. 36 519 16,925 1984 224 �� $ : 60 333 17,480 1985 223 '4 75 369 17,873 1986 197 , :« 11 205 18,317 1987 218 43 555 18,533 1988 232 �' 35 507 19,131 1989 200 � , -22 755 19,673 1990 216 7 995 20,406 1991 248 �?'�� 53 777 21,408 1992 233 ' 29 465 22,238 1993 236 ..:.'':::: 4 562 22,732 1994 214 ° \ -40 854 23,298 1995 216 ' -25 350 24,112 1996 199 n -68 747 24,437 1997 214 -41 376 25,116 1998 207 z -75 288 25,451 1999 220 -63 698 25,664 2000 211 -50 197 26,299 2001 200 7�, -63 217 26,446 2002 188Wi -80 180 26,600 i 2003 226 ��� -88 388 26,700 2004 195 � �r.V -97 697 27,000 2005 204 `,I ,v -91 691 27,600 fill) 2006 221 -83 483 28,200 2007 210 -88 288 28,600 2008 28,800 Jefferson County Public Health December 2008 N o-0 0 0.0 0 0 0 o a o 0 0 0 0 0 ca B- E\° N NCO W r O V V'-.- N M .- 0 CO N V W r O O co y M V [r'V N M co V CO N W O) CO N Q M N N O _C V LL • N •o I d� II _ �o O � O -^--- — --� "' d 0 0 0 0 0 i!..; 0 0 0 0 0 0 0°0 0 0°o .0 � C 0) — -"-' _ 6\ 0C- � NO V VNCO'9.6:t m(n r� N r` r`r.'13.: Nw S c D — '� 64 Y u r r ri y v n o0 0o a r N O U .p ----- — ot O Na w C Q i� C a) _ 6e W t`O) or`M co 0c T(o CO rn CDNN` .7 Lc, COO 7 9e N N CO CO r C V 0Mi n co,_,__,rn r N M V.4' 0 OO '' ,.� % • r r y o lL •- c no iC ' k mSNCO 0, � O aOri OON co CD n N V COOM N > "'O • r a S 'CO NOV(V W O C CO VN co M O N-N N N- -1174.0 % V * C) C iO(O � NN �O) v) 0CO C� 3 -n, L ..,2 j - - -1nW n) O .(2 N� K« ' - Ux N U 0 �_ - 0 •- V C C O Q Cn _a) a) ..- _ B� y) O ro Be 0 0 0 0 o v o 0 0 0 0 0 0 0 0.0 0 O N. - V V O CD V N.r O O)CO N. 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C € Cl) l0 r.- C0 Cn N CD O V 00 0) CO V 0 CO N(P N 0 O , a_ we U N t` (D N V• N• n• OD CO CO Q V O (D M p ,1� q " "- O Ca • Q CO `- O in_ C° C W D N p - C c C a) 0 O• �O H O - ^' 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 CA 0 M N t` r-�- .-O r V'f" CO V O ',--N). N W r L ^ C 0 C M - CC C)M C')M th V V• M CV N N C') C'') f•') N.'- O O 4) '- CD II e LL '� C r^ a i' Cl) C co 0 0 - c < Q ,4 d0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 a ,C• 3 O C ��. n ^-^• .--- - C V M M(D O O d'N(O N N N 7 M N N N M W r .5 O 0 M 5 M M Ch Co Ch V .C`�N N N lh Ch C7 N r-O O C9 .. 2 0) c �' 6 - � Q. ›... .4„. 0 - 0 0 - o- a� ,Q = c (� N ""i'`�'4t''6t-,-7-4t-A-,.,-6, °aa r w '� , t6rM)o° vomu°)) rco7LLDcomcom .- o h p, N -N-4,-,. „eyy�y g' p -(n )n v))n v)cD cD v M COM v )n )n v M 0 /N a & . °° ^ a�' I 04` .c a -0- C V • CO O U O O cO Il C mow,„.... G„y „,. -- C (V co V Cn O) O N O N-co_ V N- N O N N�V N�co d' • OO O. Q V U N co cO N N a CD r CO V CO M Lo N N M co O) ra e Q7 n L Q) - O 7 d 0 D a - n vmvmvmvmvm vrnvo, v 0 , C- E a _ b ' O '"CP N M M V N CO (O (O h''—z, N ^, 0 0 O Q 0 O N O N N N M M V 'Ct N co co O N W co v) LL a of Population Change from 1990 to 2008 by Age Groups Jefferson County and Washington State • Source: US Census and Washington State Office of Financial Management Between 1990 and 2008, the Jefferson County and Washington State population groups age 85+ and 50 64 have experienced the highest percent population increase compared to other age groups. The Jefferson County populations age 25-34 and 0-4 have experienced a population percent decrease. From 1990 to 2008, the Jefferson County population has increased 41.1%,just over the 35.4% increase in Washington State. Cal ead ae 4$0464,vels; r5tlu ti -%, z r'x�1 t .. ;a r t } .� t .. _ ...�i^? ,', Pia `-_-'��'z �Yo int t 8- 4�~ �� �� p !s a � 40 :::".,:e..-=.;,,,,i4;:, ���tib'"- `' x � :r;� ���� ' r x ;:.:,� .q k "� � '`� �. �� �� h �:'ro( h t, 4 a *,,. ' z� l , 911 a"' r qq iiki g i .`�', ,_i, �ti ' r § i ' i a to 'sa,w �`�+ ?% . i � ''''''...4t Q Q. / ®. .,:.:, _ re - -. x,� yr Percent change 1990 2008 Jefferson Washington Age group county State Preschoolers(024)4) 23.0% -5.9% 15.8% Schooltansitiage (5 18 17) 16.2% 28.1% ron ( 36.8% 35,4% Young in adults (25 34) 4.1% YoungerOlder middle le age (35-49) 31.9% Youth d 146.1% 109.9% Youngermidseniorsage (65(50 64)74) 28.2% 21.6% Older seniors(75-84) 60.6% 35.6% Oldest seniors(85+) 168.6% 113.7% TOTAL 41.1% 35.4% • Jefferson County Public Health December 2008 Median Age Jefferson County and Washington State, 1980-2008 Source: Washington State Office of Financial Management III Median age divides a population into two equal halves s.o that 50%of the residents in agiven place are older, and 50% are younger. Jefferson County's median age is the second highest in Washington State. The median age in Jefferson County has been steadily increasing. 60.0 T � �' 50.0 49.8 40.0 ' 36.7 30.0 20.0 Jefferson County 10 0 Washington State �, as ,m 'ct' h W A . N ch V' �U d(*j.. fA+ 4 x.'#' - Year Jefferson County Washington State Difference 1980 35.0 29.8 5.2 1981 35.5 30.0 5.5 • 1982 36.3 30.4 5.9 1983 37.3 30.9 6.4 1984 37.9 31.2 6.7 1985 38.5 31.6 6.9 1986 39.0 32.0 7.0 1987 39.6 32.3 7.3 1988 40.2 32.6 7.6 1989 40.6 32.8 7.8 1990 41.0 32.5 8.5 1991 41.4 33.1 8.3 1992 41.9 33.3 8.6 1993 42.4 33.5 8.9 1994 43.0 33.7 9.3 1995 43.6 34.0 9.6 1996 44.2 34.3 9.9 1997 44.9 34.5 10.4 1998 45.6 34.8 10.8 1999 46.3 35.1 11.2 2000 47.1 35.3 11.8 2001 47.0 35.5 11.5 2002 47.4 35.7 11.7 2003 47.8 36.0 11.8 2004 48.2 36.2 12.0 2005 48.6 36.5 12.1 2006 49.0 36.6 12.3 • 2007 49.3 36.7 12.7 2008 49.8 36.7 13.0 Jefferson County Public Health December 2008 iii ,.x a � a C3 s N z4 " N • C3 a N y r ;.gQ L ?`a a) •C U t/? b° �° L U N ,t..,...16):,:- c co c0 } O '',7)::,..:.-?'*”-':'-',... '` £ i q o v �° e e tiff � r ,: c O c.-4,. N O O m co N m H ogee s �a ���� b� *� o C C> O O r-- O r- f i•a : y �a ;.:. fib £ v�C '.ky 11'''-,V''''';',.;.,::,,.". N t i = Y as r's,�'�' a 3 n 3 _ l,, sk 4 cv c• h N x U O a{�v % `"` - C H r, Cr) '0 N O' C U ;- E N- g� o N q. �' t� � rf c ,w t ,zk . rs ,Cyr fir~ (_) •O* • " i O O O N N N flfl • a) v. Q and ` s {j c W o 0 0 0 0 0 0 U ££wrM ,a i ,:. .0 O SJ o U O D E Q o . � Y bra r " s N th U U p row C m Q - Q C i - c4-3-'.4.1'-'7` a 4¢ a wd .� + - W q,m} U " V N � m L, F .� N U .. .+".aa.:. .3,„ .. " G U! ! W O '..:`-'42,f,"4.".•" Q0.., : 3 O U) A : , — (� U •-- Op � c Q N `ia - �. - �'' 0 �?0 C Q " a,' C� v) 1— N .co 0 o N Aik CON ' n' - " ai ;.: db - .I n N Oco'°u +it• ^s i^• Virn Cs O > . 0v o U p ap _ 0 N0 csj — .o m L 5 o CON 0) in O Ch t. o b O CO o 0 0_0 b,- 0 —� � N60 0 av,!o ' CaC V c° �0 c':'°' oO 00 ONNco O C oO OO O U o OO o CO 0.t •CcD N ,— 0.-)N N N UN ON 0, p,..,--,-.'kg,.0 h Nv N c`1 O 'd" 6 iA C - o Q ;n Q F,O N sn , a o(NI O � csq Lo I NOo N , . s. I tO ys o.O O oaNv> o•�i Ut! CgyZr)a) p- O ,p + ccU cc NQ 0 -o ,C �, u Up:�o UN pO Q.i v QQII N Q 8°fi'<^ °p & E y N 5€U 4.C • cn (-)- .N . C o = NG ' V Cu1 tNh U ' 0iii , m2O 0_ _0 0 0 Q) 0 O O Q 34" .. ,f ) p H o ,44 45 O13 c U 8 O o. O O o Q) ..Q , 4 C � Lo E O " cg. r u} N o 0 O f L + — co O 7:5 p 0 o Oo v o p 0 0 M M o d1 O cti 13 o 13 LO c H O v, N N i o M N O : U c U 0 N N N N (N o W Q p C : 3� -- • o • x off' a o eo (o;JJ �� g lc O " m O o p U r , , ' O 00 &o co O M co O N CNI p �= 01 O 6o b� O C1 '_ .c O O o (.1 o N oco i Q 0 i14,1 i oN O M O p O M p- 0LpN p C 0U "O O -( H 11011 o c a NO C o NU C '' a Oc 0dU U rg .' O- �U C W 0 h� NwIV N HON C 0 • W High School Graduation Rates Jefferson County School Districts, Jefferson County and Washington State: 1993-94 through 2005-06 • Source: Washington State Office of the Superintendent of Public Instruction Graduation Rate:%of students enrolled in grade 12 in the fall who earn a diploma in the spring. Cohort Ontime Graduation Rate: %of students enrolled in grade 9 (including transfers assigned to the cohort) who earn a diploma in 4 years. High schools must have a graduation rate of at least 68% to meet federal and state goals. If the rate is below 68%, "adequate yearly progress"can be made if the rate is at least 2% above the previous year's rate. This goal will increase gradually to 85% in 2014. The average cohort ontime graduation rates for Port Townsend, Chimacum, Quilcene, Jefferson County and Washington State in the period 2002-03 through 2005 06 have been above the federal and state goal of 68%. All of the average Jefferson rates were higher than Washington State. Progress is needed to reach the 85% goal by 2014. =� art` ` 0 Graduation Rate - � ',� Cohort Ontime Graduation Rate "te ,�" I'�✓� '�' —. � " t$ :4',44444:74"11-FfAk :' ,..':!,;C?:::1:t;:1,1;''';'.i'. .,,;.,,,.,,'..8rol:*1. 1f7;t:.art...;:;r'..` ;'.4',„:!:‘y:'4.'"*.:3, ?;;.,$':". "1?,-.;;;it''1.:'':"":"1::.ta, fib h J t1$ = rant .r t! ° a.,. A �; ,. .,°pax_' : .. `«` rx Jefferson County School Districts School Port Jefferson Washington / Year Townsend Chimacum Quilcene County State FedStateGoal 1993 94 84% 74% 100% 83% 84% 68% 1994-95 92% 76% 72% 84% 83% 68% 0 13 1995 96 97% 74% 69% 86% 83% 68% 1996 97 100% 90% 90% 95% 83% 68% •° 1997-98 85% 83% 95% 85% 85% 68% p 1998 99 89% 83% 85% 87% 84% 68% 1999 00 82% 67% 87% 77% 77% 68% 2000-01 85% 88% 85% 82% 68% 2001-02 88% 78% 100% 85% 82% 68% 02002 03 79% 60% 96% 71% 66% 68% 2003 04 70% 81% 69% 74% 70% 68% .0 2004 05 84% 91% 71% 85% 74% 68% o • 2005 06 78% 89% 73% 81% 70% 68% o 8 2006-07 U 02007-08 Av. rate 2002-06 78% 80% 77% 78% 70% Jefferson County Public Health December 2008 N p _� +"1 n�" 21 : Va a Ate��+x ' N • c — p $WAh, U • ` C Ti. ps , ° c� tr c7 0 , si C N O � Q fil , � ,� b° "���a�' �4 � o Q • o 0 Q 0 �q v r ry $ � y SPC r G o r 4 0 0 r8r I h— (I) c y o 0 '• �i RagigA (15 in • N U d„� o —� ,,,angtaits„,10. 11.2,-.91,41,10,2y, �r i odl Q C d o 0 0 6..„. 0 pL Q o> in N N Co oNc•x t Q Q T `^ „..„„:.::::...„,:.:.::::„,::::„.„.„„0.7„:„.„.0.„2......::.,......:,..::,„:::,.:.......::.::.... tnr. Q O 3 (" 3 Q p p i , p c 0 0 0 0 0 � � � cw: x . ,�--- o r) � m � •� � -C, � ter.; �-� ; r.. .,_ ., d v • • i C Q p Q v co v o v O LOI Q U sa cin N O w— S / A\ .:z ,,,, fit^ N O • 2 j � _ov � . i 1 Q � �; + � " Z S S S (7, "r CN Y S •� C 0 .E co '4314:4110100ntri 14 ...E f• ) Q •C r 'a t us - '--V n N E U 6 vw" i .._<�� k:.-.4.%:;:::4441444.000 aV �_ • i t N rpt „�+ a n t , .h�4 d _ a3 (� C Q ti .?- ..4-. 9 Clatifitik.'11%4',.4fiblitiltirliiWZ;4*.til,moolliiiitilittiltil,..45,71111111.111 Q � :itt•.::'01:.,:!: :.'::1:-': (1) :0_ 0 -0 ,-- alownettigtitkoiliiiigalliMt-40:10iwAvw-,-.--r--- O o U Q N N E,� 5° N U• .� • b O Z Q O O O .�. z' -� v> F- L cn N U Median Household Income Jefferson County and Washington State, 1989-2008 Source: Washington State Office of Financial Management • Median household income is the income at which half of resident households have higher incomes and half have lower incomes. The median household income in Jefferson County in 2008 was . about $1 2,000 below the median for Washington State households. '.1�' .„' a t 4 t% .('d" l 4 U czar .r< r�. :, '::,. - " ��yy 0{�y '� - roe-- a xar v s ��,�mit$S3k,7 V� -�, � i a :`� _ � � y 1 � r 6 ;0�0 ° 5 YO mmyignijtgoj°p' Y , k 'Y .2 S w„ S o -i-` ^} 'C'�Lk$` ' '�S u"M �: �i��"-� �, � 3 ���' �''-ia" �a ,„i �` ; zea � .�<.� �r'��, � �l�Gt� Ex'° i 2 vof�-zi r` r.'4 .r1 „_ ,' ''s'", wf ¢ ,:5 "'"{9'o4* c si�P sr' ,40,; O re ria s� Mkt n fV, (f ®E� o rS i ,o e ..KtnlNASIRgtiggtf,, - - r iigiogliiNg$ ti--4'0,-----,,,-0,---,,,------'_ ... ;'� u�: �a.�+ - - ,. s 'z"" a'` < <e s .; -r m ate: 0 4a • t4- a� =i "`. { iA ,4..4 �0.� i 1 Year Jefferson County Washington State differen 1989 $25,197 $31,183 -$5,986 •ce 1990 $27,294 $33,417 -$6,123 1991 $28,465 $34,379 -$5,914 1992 $29,171 $35,882 -$6,711 1993 $29,885 $36,679 -$6,794 1994 $30,606 $37,895 -$7,289 1995 $31,058 $38,997 -$7,939 1996 $32,530 $40,568 -$8,038 1997 $34,282 $42,399 -$8,117 1998 $36,404 $44,514 -$8,110 1999 $37,869 $45,776 -$7,907 2000 $39,185 $48,301 -$9,116 2001 $41,110 $49,364 -$8,254 2002 $41,548 $50,003 -$8,455 2003 $42,018 $50,846 -$8,828 2004 $44,047 $53,890 -$9,843 2005 $45,722 $54,085 -$8,363 2006 $47,303 $56,184 -$8,881 2007* $48,112 $59,119 -$11,007 2008** $48,069 $60,010 -$11,941 *Preliminary estimates for 2007 are based on the payroll data compiled by the state Employment Security Department and the state person( income data published by BEA. **Projection for the year 2008 is based on the Revenue Forecast Council's September 2008 forecast of the state personal income. • Jefferson County Public Health December 2008 Per Capita Personal Income Jefferson County and Washington State, 1980-2007 40 Source: Bureau of Economic Analysis, US Department of Commerce Personal income is income received by all persons living in a specific place from all sources. It includes net earnings; dividends, interest and rent; and personal current transfer receipts. 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'i•e9 ei,..9.,A•,,i2iier, 00,9,...,eSP 4,'S,A'er;k1,111,'.4F4,i;,e,1;50','ai;$4.:..Pv.' 101,41901111990,e .s.-' ''',• ':10'''''..,',X*AY*1144)","5-`,,N90 ,, 'i./'-4.''T*,tri',''' 7,`-'211`,,g7;,,, ''.., -'*.**74? `",?i,;`,..;';1.4,1,e.-0.7'0 40 t,';0","..Jt-,V;,.•it4 ,,,,".,'-'5, ,--' Difference Jefferson% Jefferson Rank between WA change from among WA Year Jefferson County Washington'State and Jefferson ofavtous year Counties 1980 $9,487 .91=}832 -$1,345 -- 23 . 1981 $10,308 91 8?-'9 -$1,566 8.7% 22 1982 $10,934 912.178 -$1,536 6.1% 19 1983 $12,121 913177 -$1,056 10.9% 13 1984 $13,282 $i402 -$781 9.6% I 1985 $13,480 $14,755 -$1,275 1.5% 14 1986 $13,954 $151947 -$1,588 3104 15 1987 $14,302 £18210 -$1.908 15 1988 $15,692 *i• "2 41 474 9.7% 8 1989 $16,592 'I' ,e< $1966 5.7% II 1990 $17,749 1 <-1- 7.0% 13 1991 $18,998 $./C 60-,•'? 7 1992 $19,824 $21,709 -$1,885 4.3% 9 1993 $20,373 $22214 -$1,841:$216-'9161 272:1:: II 1994 $21,269 5922,938 -$1,669 4.4% 8 1995 $21,515 .23,69Q -$2,175 1.2% 8 1996 $22,900 $25 273 -$2,173 6.4% 10 1997 $24,443 926 454 -$2011 6.7% 6 1998 $26,303 $28384 -$2,081 7.6% 5 1999 $27,567 1,030 0 30 -$2,470 4.8% 4 2000 $28,448 ii.,,3 ,77 i $3,329 3.2% 7 2001 $302 51 ..•92 < -$2,050 6.3% 6 2002 $30,654 -/r 1? -$1,919 1.3% 6 2003 $31,799 ;:i•• 54 -$1,367 3.7% 5 2004 $34,657 1,3', ,'..;' ,' $632 9.0% 4 ii• 2005 $35,610 11• 128 -$228 2.7% 4 2006 $38,004 i• 12 -$208 6.7% 4 2007 not available $ Jefferson CoutiptyecNiDemic6li ,011ffidahne i i Working Poor • Jefferson County and Washington State Source: US Census and American Community Survey Working poor measures the proportion of the population living below 185% of the poverty line. This population is known as the 'working poor' since they have some income, but remain in relative poverty due to low levels of pay. In 2007, a family of four (2307.adults, 2 children) earning less than $39,225 was living below 185% of the poverty line. About of the Jefferson County population lives below 185% of poverty compared to about 25% of the Washington State population. In 1989, 1999, and 2005 07, the proportion of the Jefferson County population living below 185% of poverty was higher than the proportion in Washington State. as i �^ . �,'e; . vx _1.. 4 a t �,. c„- sem '. r a a, . wo y, ,a o County. afshingta �� �e 4 ":,;,:-,,,0;,44,0'"0:,:,i5:&:,%0;00,,, �µ ry '` r nb K? a °x, 99 i¢ <^ 44:471-'6. fa �� --.'.'4‘,7C3';', a 4pW le +`a g q/ � f3iT/ F tib, , j qY'{ h�, rile4M11114;' 0 : ,a � w d .- � k y$e a v • pO �. `:. mow , . . e 0.8 t 4":@ O ,-e'"' '�.0b c+ "` �' Jefferson County Washington State Year # % # 1989 6,630 33.3% 1,170,806 24.7% 25.8% 1,358,839 1999 6,631 23.6% 2005-2007 8,513 29.9% 1,578,987 25.3% • Jefferson County Public Health December 2008 Poverty of All Residents Jefferson County and Washington State: 1989, 1993, 1995, 1997-2001 • Source: US Census Bureau Small Area Income and Poverty Estimates Poverty of all residents measures the proportion of the population living below 100%of the poverty line. In 2007, a family of four (2 adults, 2 children) earning $21,203 or less was living at 100% of the poverty line. In 2007, about 11%of both the Jefferson County and Washington State population lived in poverty. ,�� , 4,, _ a r 1r ' M1l o 911' w • Year Jefferson County Washington State 1989 12.6% 11.0% 1990 1991 1992 1993 12.3% 12.0% 1994 1995 11.4% 10.8% 1996 1997 11.4% 10.2% 1998 11.5% 9.9% 1999 11.0% 9.9% 2000 10.7% 9.6% 2001 11.1% 9.9% 2002 11.4% 10.3% 2003 11.1% 1 1.0% 2004 10.9% 11.6% 2005 11.5% 12.0% 2006 12.8% 11.8% 2007 10.9% 11.4% Note: Data were not available for 1990, 1991, 1992, 1994, and 1996. • Jefferson County Public Health December 2008 Children Age 5-17 •Living in Families in Poverty Jefferson County and Washington State: 1989, 1993, 1995, 1997-200 Source: US Census Bureau Small Area Income and Poverty Estimates • Children age 5-17 living in families in poverty measures the proportion of children age 5-7 in families living below 100%of the poverty line. In 2007, a family of four (2 adults, 2 children) earning $21,203 or less was living at 100% of the poverty line. The proportion of children living in families in poverty has consistently been higher in Jefferson County than in Washington State. P�'a ar ;#," ,� *- ( ,, ,Ayes.. _. ,....,,,,,„-:,,,,,,,„4- w„-...,--,,,,,:414,,N,041,-,,,,:ii:.., � 7 r� � E � � -`� s s _ Y ''6 YyS�� iawa. s. 2-Y 'z5. ')--4?-A-.... -- _ g a ®� nS k 4 t y a= "✓A �``si pg E Y 6 . Y ` x chi, fi'i,'�` t £a9v °k Tom- i p q '''''''. .,,i-,:f,„. ' i t Wei:- 9 3m'3 .Y' roily. �, "iY i Y O ;;�,-A is Pc .44 'ff `^ ,"'1- t '� A', x^'"'9 i„ - &�Y, S & • .gyp. a e Year Jefferson County Washington State 1989 23.7% 14.9% 1990 1991 1992 1993 19.8% 15.0% 1994 1995 18.1% 12.8% 1996 1997 18.2% 13.7% 1998 16.5% 12.7% 1999 16.9% 1 1.6% 2000 17.9% 1 1.4% 2001 17.2% 1 1.6% 2002 16.7% 12.1% 2003 18.4% 12.8% 2004 15.0% 13.5% 2005 16.6% 13.8% 2006 16.2% 13.9% 2007 15.6% 13.1% Note: Data were not available for 1990, 1991, 1992, 1994, and 1996. • Jefferson County Public Health December 2008 Public School Student Applications to the Free and Reduced Lunch Program Jefferson County School Districts, Jefferson County and Washington State, 1998-200i • Source: Washington State Office of the Superintendent of Public Instruction Eligibility for the public school free and reduced lunch program is based on family income. A family must be living at less than 185% of poverty for their child to qualify. In the 2007-08 school year, all Jefferson County school districts had higher application rates than Washington State. to ,� ,� 6k _ Ik f 100% 1t r L t „ ' baa bntry r re� .C- s ` 3 u�: 4dur t' uizt k 5 - . .'at��' "^ u`7 ,tt zF°'.:- .; �GiNi� Ire a�� ,. !a � � :z tt 1 f .r. ,�, ,;t4 '3 n; a. t,46 '"--","6.-66t491,6'.6”- �. 1, zk r. iit80%a � T.,..:',1'40,". 5 �� 6t- �`d �t ,�r r..,g, $1);:� x s g 'z"d � :01Z4,:,:,,,,-0,� y^ � zz a a `�8.. �` i x. ars �" + eia _ r *ai Jb '' v. ilinifiligi ff t a l f - aa a �ai��h�1 �� �. x � � s >�a .� x = ;� s' „ § �, a ' a `f ; e tea ' r.tr as z' 53 ,t #b : s' v ttt,t„ i, � r� !4`� aa... 1,` a r= 'err .*i ia� i,"` ptyy,+' P - gx�s v'`7 f" � a,-ec.'�Ace�yt r�' s(` e"a" �i4� , "eta 44 wa v r a v a rni an rx8 �0 a Po o a --, = � s t os 10 " i z s ` �rei }+ . � a �0 � 46 x a ra ern at af ie6 ia s `tg er aa �pa a d . a az1$ ! a s aa d t Que g ". Ws' ; 67 � 0 s a i ate ra flif aa r � ats' " - s e, a ,f ; o P ' .� f � 4i t ' Aa a. z a : f a ` r t'tte- 0 '1` aa di "4- Z ^�teY '1 E $ " _ - 4,1 .bs '". w k . i t za.� y'2.,' t O [ Y P a � rrya #ii a � - .tan ' a 7a , 5 I y *� , a G. Ma k _ p i- n .f1 tt t_ ,N C›! .� ' Jefferson County School Districts School Port Queets Jefferson Washington Year Townsend Chimacum Quilcene Brinnon Clearwater County State 1998 29% 28% 44% 74% 98% 31% 31% 1999 35% 29% 41% 78% 100% 35% 31% 2000 36% 26% 40% 49% 95% 33% 31% 2001 35% 26% 41% 76% 100% 34% 33% 2002 39% 30% 41% 77% 100% 37% 36% 2003 39% 31% 46% 63% 100% 38% 37% 2004 39% 36% 49% 60% 88% 39% 38% 2005 39% 37% 48% 63% 96% 40% 38% 2006 42% 36% 51% 60% 97% 41% 37% 2007 43% 40% 47% 76% 93% 43% 38% • Jefferson County Public Health December 2008 Medicaid-Paid Births Jefferson County and Washington State, 1991-2006 Source: First Steps Database, Department of Social and Health Services • Medicaid-paid births measuresthe proportion of parents giving birth with incomes below 185% the poverty line qualifying them for Medicaid-Paid Maternity Care. The Jefferson County rate hasof been consistently significantly higher than the Washington State rate. ;C'ttfih:4:;„,4144'5*5'f?t,'4::,":4›;,-;',,i'Vt:'1*:if.,i„:41;'74:7"'i414::;A::,till'';'?,'!:tti.;',:*:1:'''':::',:'':',.'.2'''';;ii10:1,?jrilitt;;:l''': Vi4:-&-'2'4:it!"+;;;""iriZi:'''.'''''.;.ft,',4:11: ';'''' '''kl2:-?Fe. 7.41841:30e*"'4:°.''''ic'llilf,,,.4:4,440-VAW:.7.7*-,My:::,,, -,440iit„:-Iitii:,;',.%i'q':'-t:„;,-4,,,,-;:::„7;,-..r-,.::: ::,!;1:4:1Z-'-'1: t„ -r0� -71 a ;®i,,i;; ; .gig ?. ,� 4';'f x .o� k � L d.. .;,Y m out!f ,` b� �° ® wz ww �x axa z r aro p a 4x e Jefferson Washington • Year County State 1991 51.0% 1992 57.0% 1993 62.0% 1994 59.0% 1995 64.0% 42.0% 1996 58.0% 43.0% 1997 62.1% 42.1% 1998 55.3% 41.0% 1999 62.7% 41.8% 2000 64.9% 42.4% 2001 59.0% 43.5% 2002 64.4% 43.3% 2003 59.5% 45.5% 2004 62.4% 45.8% 2005 60.8% 47.9% 2006 62.9% 47.1% Note: Washington State data were not available from 1991-1994. Jefferson County Public Health • December 2008 Median House Prices (based on sales of existing homes) Jefferson County and Washington State, 1995-2007, 2008 by quarter • Source: Washington State Center for Real Estate Research, Washington State University The median house price in Jefferson County has been above the median house price in Washington State since 2002, with the exception of the third quarter 2008. Median house prices in both Jefferson County and Washington State peaked in 2007, and have begun to fall in 2008. $350,0 f 4 x x .2 ,�r 1. t '{ ip fi} N^ 1 £Ny' 3c 3g k =rtat {�.. 5 g"° ,010. v" 'E 8 23441:l'illininiaNittao r ,gyp } y i M N F N Y Y"1 Yfi qui ,„,. ' sa $gip ' 4 u `.h k Y S a "n'�br '" d F�a k b ' ofl: xs a 4F a CO �(1, M ' 6 ,,,,,, {T, ° �- .rte, 140 {� � �7 'k yiy�.(, �a, ,,.;.�" :i x; 'iN rl A k �� 1.ae fist AP?;47 664-1 �A pf". 4 AI ,r}�1 4l ; iN .*PSq�". .^ , r- t"," a `r ii :Mir1, fN ti{� x - a, Jefferson Washington Change from Jefferson Washington Year County State previous year County State 1995 $127,300 $136,600 ** 1996 $142,100 $142,200 1995-1996 11.6% 4.1% 1997 $135,000 $150,000 1996-1997 5.0% 5.5% 1998 $136,300 $160,700 1997-1998 1.0% 7.1% 1999 $155,900 $166,600 1998-1999 14.4% 3.7% 2000 $176,400 $176,900 1999-2000 13.1% 6.2% 2001 $173,300 $178,200 2000-2001 1.8% 0.7% 2002 $184,900 $188,500 2001-2002 6.7% 5.8% 2003 $208,500 $203,800 2002-2003 12.8% 8.1% 2004 $245,000 $225,000 2003-2004 17.5% 10.4% 2005 $288,000 $260,900 2004-2005 17.6% 16.0% 2006 $326,300 $301,400 2005-2006 13.3% 15.5% 2007 $328,500 $309,600 2006-2007 0.7% 2.7% 2008Q1 $322,500 $293,600 2008Q2 $302,500 $291,900 2008Q3 $273,800 $281,500 2008Q4 $295,500 $266,700 • Jefferson County Public Health December 2008 Housing Affordability Gap Jefferson County, 1995-2008 • Source: Washington State Center for Real Estate Research, Washington State University Housing affordability measures the gap between what it would take to purchase an average priced home in Jefferson County given the average income of Jefferson County residents. The formula assumes that a purchaser will be able to put 20% down and that the remaining 80%of the price of the home is not more than three times the purchasers income. With the exception of 1998, since 1995 there has been an affordability gap for Jefferson County residents. The gap was greatest in 2006 and has decreased slightly since that time. °' Asir -' s --- x ani k1, s "ii. 4 s €r s. _ w r� , i t, $ CJx1 � ii ra'a'" �5."f�, s'� f,�a.� K��,y lii �,-�, t� ��� u.�i �s i � �, �n�'� �.. P,;t l � s" "' gyp° ® • � o .l r ' ?ai. is _ 3 ° s $`0000 Y tom. Q �s � �� Via= r ^ yy�� �d �4 /" , 9, # 111 T' S .1 Y'- x '`� � ,Y v"x � .. �s,l. sii %r� s� '4f,'iP - i " b . -y�^* , ..,*', Wrf - $ ' - . vt � �� ,I ,f� .I i N, oe to uy w •e '�� -i - s sr- v ,,,,-,4449AW:114114445N , vA ' - r a ,r"e L3 a - Pt544 "2s1 �s �, � ` o 4-r s bi,.( »'ETra s r ; .. -0,,-",-',-- d7x >� ,ii.,`' ' :r,'t Annual income needed to buy the Year Annual Income average priced house Gap 1995 $31,058 $33,947 $2,889 1996 $32,530 $37,893 $5,363 1997 $34,282 $36,000 $1,718 1998 $36,404 $36,347 -$57 1999 $37,869 $41,573 $3,704 2000 $39,185 $47,040 $7,855 2001 $41,110 $46,213 $5,103 2002 $41,548 $49,307 $7,759 2003 $42,018 $55,600 $13,582 2004 $44,047 $65,333 $21,286 2005 $45,722 $76,800 $31,078 2006 $47,303 $87,013 $39,710 2007 $48,112 $87,600 $39,488 2008* $48,069 $79,620 $31,551 *2008 data represent the average of the median prices for the four quarters of 2008. Jefferson County Public Health • December 2008 • Housing Affordability Jefferson County and Washington State: 2000, 2005-07 Source: US Census and American Community Survey Housing affordability measures the proportion of households with incomes that would allow them to purchase an average priced house. Fewer Jefferson County residents were able to purchase an average priced house in 2000 and 2005-07 compared to Washington State residents. In both Jefferson County and Washington State, fewer residents were able to purchase an average priced house in 2005-07 compared to 2000. 10th% � h M1 x e SIE d� W re � e e"'�A 0 n�aP.7 x as (• °� 'im y E 'ic i nt a[ "i gggio ,,,40,0t4 ,,:w06.16V441101010r 4i1:100.0 p of sic'" d;` y Y ,gk re . i,i ra • % V i x,rMV MtlrA v * r, Year Jefferson County Washington State 80%of average priced house 2000 $141,120 $141,520 2005-07 $262,213 $245,493 income needed to purchase 2000 $47,040 $47,173 average priced house 2005-07 $87,404 $81,831 % households able to afford 2000 36% 46% average priced house 2005-07* 23% 34% (household income$75,000+) *The proportion of households able to afford an average priced house is actually slightly lower than the proportion reported above. Limitations of the data do not allow us to look at more specific income groups. For 2005-07,rather than the actual income needed to purchase the average priced house,this analysis uses a lower income cutoff,$75,000. In Jefferson County, households earning between$75,000 and$87,404 would not be able to afford the average priced house, reducing by some percent the 23%reported above, and in Washington State, households earning between $75,000 and$81,831 would not be able to afford the average priced house, reducing by some percent the 34%reported above.. • Jefferson County Public Health December 2008 Owner-Occupied Housing • Jefferson County and Washington State: 1990, 2000, 2005-07 Source: US Census and American Community Survey Owner-occupied housing measures the proportion of residents who live in housing that they own vs. housing that they rent from another owner. A higher proportion of Jefferson County residents own their homes compared to Washington State residents. Compared to 1990 five percent more Jefferson County residents own their homes in 2005-07. «r c� - uta q- € arc " - ws 5" '` €1 ::: u _kh "`dYi 'g 4 fx , '. At Ilir* *IV sr:VW ifliCZlitir •4 ws :aw 3eti".n�.�.f'l`� r iaw«it,. ?w,. f,". "h_<m_ ,-m. _ -. ... Year Jefferson County Washington State Owner-occupied 1990 74% 63% 2000 76% 65% housing 2005-07 79% 66% • Jefferson County Public Health December 2008 • Housing Costs Jefferson County and Washington State: 1989, 1999, 2005-0? Source: US Census and American Community Survey Housing costs measures the proportion of residents who spend 35% or more of their monthly income on housing costs either for owned or rented housing. From 1989 to 2005-07, the proportion of both Jefferson County and Washington State reidents paying 35% or more of monthly income on rented housing increased slightly, while the proportion paying 35% or more on owned housing costs increased dramatically. When housing costs increase, there is less money available for other basic necessities. ‘4.iti-4-',.. f" :',14.MCPT:„;:'1,1r,,t-r,„'T:;,“, ,,.,,,I.11.f.*.77J,,,,...4:744,;,:.*:, -.,,,A.A!.,:,,, ''''',',. iz„t° rr' ' ''.., tAi4t4;4''''`''.145'4::''''''iC-;':'''er(:75'2'-'7,t � J t `a a, S 0,:, '.., « vs r tp ,,r;; 4 ' f. x ue w ', ; ,,,17::' —?' . r� .r, ry� fi F ' s2"''.e W iµ5 0' r A� -n Xio 989 ` :t „ffi� ��� :f.',044-k,„.''ev,I14-i-:...,,' ,-93,:› -:,_----A ,,,e:. ---',. ,,,,,,kft*- { .r a Year Jefferson County Washington State Spend 35%or 1989 8% 11% more of monthly income on owned 1999 19% 18% housing 2005-07 25% 24% Year Jefferson County Washington State Spend 35%or 1989 29% 31% more of monthly income on rented 1999 37% 33% housing 2005-07 31% 38% IP Jefferson County Public Health December 2008