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File Copy • Jefferson County Board of 3-CeaCth Agenda & Minutes • .April2l, 2011 • • JEFFERSON COUNTY BOARD OF HEALTH April 21,2011 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 March 17, 2011 Board of Health Meeting III. Public Comments IV. Old Business and Informational Items 1. Press Release Re: Japanese Nuclear Power Plant Disaster 2. Jefferson County Adult Tobacco Use 3. Our Kids: Our Business—April Update • 4. ACES Adverse Childhood Experiences article— "The Poverty Clinic" V. New Business 1. 2011 Public Health Heroes Awards 2. Washington State Budget—Local Health Department Impacts 3. County Health Ranking Report 4. Board Discussion: Jefferson County Food Safety Code Revisions 5. Other Legislative Updates VI. Activity Update VII. Agenda Planning Calendar: VIII. Next Scheduled Meeting: May 19,2011 2:30 —4:30 pm Jefferson County Public Health 41, 4 JEFFERSON COUNTY BOARD OF HEALTH ‘ 1MINUTES► Thursday, March 17, 2011 - 2:30 PM—4:30 PM Public Health Conference Room, 615 Sheridan Street, Port Townsend Board Members Staff Members Phil Johnson, Vice Chair, County Commissioner District#1 Thomas Locke,MD,MPH, Health Officer David Sullivan, County Commissioner, District#2 Jean Baldwin,Public Health Services Director John Austin, County Commissioner,District#3 Julia Danskin,Nursing Services Director Roberta Frissell, Citizen at large(County) Stuart Whitford,Environmental Health Services Director Kristen Nelson, Chair,Port Townsend City Council Sheila Westerman, Citizen at large(City) Jill Buhler,Hospital Commissioner,District#2 Chair Kristen Nelson called the meeting of the Jefferson County Board of Health to order at 2:30PM. A quorum was present. Members Present: David Sullivan, John Austin, Roberta Frissell, Kristen Nelson, Sheila Westerman, Jill Buhler Members Excused: Phil Johnson • Staff Present: Dr. Thomas Locke, Jean Baldwin, Julia Danskin, Veronica Shaw APPROVAL OF AGENDA Jean Baldwin asked to add two items to the end of the agenda as New Business; Item 6, An update on the environmental situation in Japan and Item 7, Discussion on the Data Steering Committee. Member Austin moved to approve the agenda as amended; Member Frissell seconded. The agenda was approved unanimously, as amended. APPROVAL OF MINUTES Member Austin moved to approve the February 17, 2010 BOH meeting minutes. The motion was seconded and approved unanimously. PUBLIC COMMENTS Mr. Thomas Brotherton, a resident of Quilcene, expressed his concern that JCPH is not doing enough to reduce tobacco use in Jefferson County. Mr.Brotherton handed out information showing the health risks of tobacco use, stating Jefferson County has a higher tobacco use rate than any other county in the State, copies of Jefferson and Clallam counties website for comparison and a comparison of the amount spent on public health in Jefferson vs. Clallam counties. • Page 1 of 8 BOH Minutes March 17,201 I Chair Nelson responded to Mr. Brotherton by stating that tobacco use along with alcohol and drug use, especially among the youth is a topic that is continually discussed and will be addressed in the future. Mike Whitaker, a resident of Quilcene, stated that he understands that all septic systems in the County must be on an inspection schedule by 2012 and that the County will be educating homeowners to inspect their own septic systems. Mr. Whitaker asked why the class will cost so much. Mr. Whitford offered to speak to Mr. Whitaker outside of the meeting and get him the requested information. OLD BUSINESS and INFORMATIONAL ITEMS Prevention Team Report Julia Danskin announced that JCPH will be doing the Our Kids Our Business campaign in April for National Child Abuse Prevention and Sexual Awareness Assault month. Part of the campaign involves an annual call to action to fill out a form stating you are committed to kids in Jefferson County. Ms. Danskin asked the Board to fill out the form stating they are committed to kids in Jefferson County. Ms. Danskin reported that JCPH is partnering with the City Library on a teen read event. The • book being read is"13 Reasons". JCPH has updated the 'help cards', which includes the signs of depression and important contact phone numbers to get help for teens with experiencing depression. The help cards will be inserted in all of the books that are being distributed to all Port Townsend High School students. Letter to Washington State Federal Delegation Dr. Locke addressed the letter that was included in the BOH packet. The letter is from Governor Gregoire and the presidents of the Washington Association of Cities and Counties. It points out the magnitude of the state impacts from the federal budget cuts enacted by the House of Representatives' HR 1 bill. Several of the proposed cutbacks are items that have very significant public health impacts. NEW BUSINESS 2010 Public Health Performance Measures Report Ms. Baldwin announced that staff members will be presenting some of the 2010 Public Health Performance Measures Report. • Page 2 of 8 BOH Minutes March 17,2011 Ms. Danskin reminded everyone that the performance measures were originally written in the • summer of 2009, 18 months ago, in preparation for the 2010 budget. The reports have been updated with 2010 data and analysis. Ms. Danskin encouraged everyone to review the Study/Analysis section of the reports, which was written by staff as they reviewed the Actual 2010 Performance Indicators. Lisa McKenzie, Communicable Disease program coordinator,reported on the Communicable Disease 2010 Performance Measures Report. Ms. McKenzie pointed out that one of the major changes in the budget in 2010 was the funding from the Department of Health to improve disease tracking and reporting timelines, increasing uptake on childhood immunizations and working with the schools on immunization compliance was decreased by $20.000 following de-funding of Washington State's universal distribution system for childhood vaccines, a system that was established in 2010 to allow clinics to continue to keep one supply of State supplied vaccine. The clinics then report which children had which insurance programs and those insurance programs reimburse the State. Next Ms. McKenzie reported that the number of publicly funded pediatric vaccine doses has decreased, although between 2006 and 2009 the numbers had increased each year. The increase had been due to new vaccines being added to the schedule in 2007 and 2008. By 2010 the new vaccines had been caught up so the number of doses decreased. Ms. McKenzie pointed out that the section of Human Papilloma Virus Vaccine (HPV) is a new section in report for 2010. The HPV vaccine is available to all adolescents age 11 through 18 and recommended for women through the age of 26. State supplied vaccine is only available to . adolescents ages 11 through 18. Privately purchased HPV vaccine is very expensive, so JCPH has worked with Merck vaccine company's Patient Assistance Program so that low income uninsured woman can receive the vaccine for free. Ms. McKenzie briefly explained that the County is working on increasing the number of Chlamydia screenings to go with the State and Federal guidelines. Ms. Baldwin pointed out that the Chlamydia screening is typically done at the same time as the PAP test. Many women are not having their routine PAP annually any more and are being told that a PAP test is only needed every 3 years. For young women PAP testing is being delayed until they have been sexually active for several years. Both of these trends make it harder to achieve the public health goal of screening for sexually transmitted infections on an annual basis for certain age groups. Next Ms. McKenzie addressed the syringe exchange program. The number of syringes being exchanged decreased from 2009 to 2010. Ms. McKenzie believes this is due to clients that used to exchange large amount of syringes are not clients any longer. They are finding that the new clients are exchanging a fewer number of syringes. In talking to clients they are finding that some clients are reusing their syringes several times, so JCPH is taking this as an opportunity to educate the clients on safe practices and offering referrals. JCPH will be submitting a competitive application to DOH to continue funding for the Syringe Exchange Program (SEP) around July 2011. 111111 Page 3 of 8 BOH Minutes March 17,2011 Member Frissell asked if it is in the funding for adolescent boys to receive the HPV vaccine since they can be carriers of the disease. Ms. McKenzie stated that the State has approved the • vaccine to be given to adolescent boys as well as girls. Member Nelson commented that she was surprised at a statistic she recently heard about, which stated that under 50% of the children entering kindergarten are properly immunized. Ms. McKenzie responded by stating that Jefferson County has a higher percentage than the rest of the state of parents who sign exemptions. This may also be due to children not being caught up on their immunizations at the time of school entry. Ms. McKenzie also stated that JCPH has been working with the school secretaries to help them get complete records. Ms. Baldwin reported on the Family Health 2010 Performance Measures report. In looking at the performance indicators it shows that the numbers significantly dropped. In the Study/Analysis section it shows a 30% cut in funding and JCPH has had to figure out a way to see fewer people. Instead of dropping people from services,they dropped people from universal services. Ms. Baldwin touched on the number of families served through the CPS/DSHS contract. The contract with DSHS is likely to end in July and JCPH may not be able to renew the contract. Ms. Baldwin explained how DSHS is changing their relationship with local health departments and they will be making one large vendor responsible for over one-third of the state. Most counties are not in favor of this change because the liability shifts from the State for a CPS case to the individual counties. She does not recommend continuing this relationship. This all comes at a time when public health nurses are seeing some of the most complicated families. • Member Nelson asked for clarification on what type of access women in their 1st trimester of pregnancy are being denied. Is it access because the women do not know what they need to do to qualify for Medicaid, access to Medicaid because it takes time to get through the system and get care, or access to the clinics? Ms. Baldwin responded that a group has been formed to get the answers to these questions. They are also looking at why one area of the county is showing lower levels of first trimester prenatal care than others. The group will be looking at data and taking it to the OB providers to ask their opinions as well. They also want to know why it is only women on Medicaid and women in South County that are not seeking medical care in their first trimester of pregnancy. Ms. Baldwin addressed the Targeted Clinical Health Services 2010 Performance Measures. JCPH is seeing more clients under the age of 19. The numbers on the performance measures all remain fairly stable. Ms. Baldwin stated that in the Healthy Youth Survey it showed that people in school felt they had access to services that they needed and they knew who to ask for help. These numbers were higher in Jefferson County than in the rest of the State. Ms. Baldwin reported that the teen pregnancy rate is very low in Jefferson County and has continued to drop. Ms. Danskin summarized the findings of the Population& Prevention 2010 Performance Measures. She stated that the tobacco prevention funds ended December 31, 2010, so that half time position has been eliminated, however Washington State will continue their Quit Line. Ms. • Page 4 of 8 BOH Minutes March 17,2011 Danskin reported that funding also ended December 31, 2010 for the Child Care Consultation • and State Oral Health Funds. Member Buhler asked why the number of school health classes was 243 when it was only planned to be 225. Ms. Danskin replied that classes were added because of funds received from Developmental Disabilities to do special classes for the developmental disability population at school. Member Nelson asked why JCPH is having so much success in decreasing the number of teen pregnancies and they are not having the same kind of success in tobacco use prevention. Ms. Danskin replied that she feels part of the reason for this is that JCPH has been in the schools doing human growth and development classes for over 20 years,there are school based clinics and family planning services and the girls know where to go for services. She also feels that teen pregnancies are not a community norm while tobacco and alcohol use are. Mr. Whitford reported on the Onsite Sewage and Operation and Monitoring Programs as well as the Water Quality Program. He pointed out that on the performance measures of the Onsite Sewage and Operation and Monitoring it shows that new system permitting is down, as it is across the state, and that repair applications are slightly higher. Because permitting is down,the staff has also been trained to do sanitary surveys under the water quality grants. Mr. Whitford pointed out that on the Water Quality Performance Measures Performance Indicators the goal was not met for the number of property surveys that were planned for 2010. He stated that even though permitting is down there continues to be grant monies available to do water quality • projects. Mr. Whitford also reported on the Food Safety Program,by stating that in 2010 their goal was not met,but the right infrastructure is in place to accomplish their goal for 2011. Ms. Baldwin urged the Board to look at the Solid&Hazardous Waste performance measures. Member Westerman asked for an explanation of Local Source Control. Mr. Whitford explained that Local Source Control is a Department of Ecology program to look at different sectors of business that typically generate hazardous waste and use hazardous substances. The point of the program is to prevent the waste from ending up in storm water and impacting the public and environmental health. JCPH is in the process of applying for additional funds to run their own program next year. Ms. Shaw presented the Administration Performance Measures of 2010. She stated that Administration supports the other divisions within Public Health, maintains other relationships outside the departments, and handles contracts and reports. Ms. Shaw also reported that JCPH and three other counties are writing a resource guide to help all local health jurisdictions bill private insurance companies for immunization services. Ms. Shaw also stated that since JCPH does not generate a profit so funding received from the ARRA grant allows the Department to bill their local partners less for internal services. IP Page 5 of 8 BOH Minutes March 17,2011 2011 Public Health Heroes Award Nominations • Ms. Danskin announced that the first week of April is National Public Health Week and time to nominate Public Health Heroes. Member Frissell volunteered to serve on the subcommittee with Ms. Danskin and will review all the nominations. The Nominees will be announced next month. Influenza Update and Notifiable Conditions Reports Dr. Locke reported that as a service to the health care providers, JCPH issues a Notifiable Conditions Report for the past year. A copy of the 2010 report was included in the agenda packet. He stated that influenza has shown a very slow increase in the number of cases week by week since late February. The schools have not shown absenteeism over 10%. Mandatory Healthcare Worker Immunization Dr. Locke announced that beginning February 21, 2011 influenza was circulating in the community to a point that he determined that all un-immunized healthcare workers in the three North Olympic Peninsula hospital districts must wear a masks when involved in direct patient care. This requirement is expected to continue at least through the end of March and possibly into April. Legislative Update Ms. Baldwin informed the Board that there are legislative hearings happening to maintain the • programs of home visits which would fund Nurse Family Partnership. She will be watching this very carefully to see if it goes from a hearing to an actual action item. Ms. Baldwin asked the Board that if this moves to an action item The Board write a letter of support. Member Austin moved that the Board authorize the Director of JCPH to draft a letter asking for legislative support to be signed by the Chair. Member Sullivan seconded and the motion passed unanimously. Update on Environmental Situation in Japan Dr. Locke reported that due to the amount of phone calls JCPH was receiving in connection with the nuclear power plant disaster in Japan an advisory was sent to local health care providers and pharmacists that urged them not to recommend people take over the counter medications, such as Potassium Iodide, Kelp and other medications with Iodine in them because they are unnecessary at this time and can have serious health risks. Dr. Locke also announced that JCPH put out a detailed press release,which gave a considerable amount of background information about radiation hazards and specific advice regarding the crisis in Japan. He stated that one positive outcome from this tragedy is that people are reviewing their emergency preparedness and disaster kits in preparation for a disaster here. • Page 6 of 8 BON Minutes March 17,2011 • Data Steering Committee Ms. Baldwin announced that that Data Steering Committee is coming to an end. Their next meeting,which is a summary meeting, will be held April 28, 2011. Ms. Baldwin feels that the committee is at a point where she will be able to bring the information before the Board to determine what additional actions should be taken. Member Frissell announced that an attendee at the Data Steering Committee meeting today reported that a$50,000.00 grant for the library was obtained using the data that is coming out. She feels that other agencies need to be made aware of these possibilities. Ms. Baldwin asked whether this is a big enough issue to pull together a few community leaders. Member Buhler suggested that they take the approach of it being a workshop with an outcome rather than a meeting. Member Westerman suggested that Ms. Baldwin go to different groups in the community with a presentation that is tailored to that specific group and their interests. ACTIVITY UPDATE Ms. Baldwin announced that Dr. Locke and Lori Clark will be attending the City Council meeting to speak about Local Source Control and other local public health issues. • Ms. Baldwin also stated that Public Health Heroes will be in the April meeting. AGENDA PLANNING CALENDAR The next scheduled BOH meeting will be held Thursday, April 21, 2011 from 2:30-4:30 PM at the Health Department, 615 Sheridan Street, Port Townsend, WA. ADJOURNMENT Chair Nelson adjourned the BOH meeting at 4:38 PM. O Page 7 of 8 BOH Minutes March 17,2011 JEFFERSON COUNTY BOARD OF HEALTH • Excused Kristen Nelson, Chair Phil Johnson, Vice-Chair Jill Buhler, Member John Austin, Member Roberta Frissell, Member David Sullivan, Member Sheila Westerman, Member • • Page 8 of 8 BOH Minutes March 17,2011 r • JEFFERSON COUNTY BOARD OF HEALTH MIND"1'ES Thursday, March 17, 2011 - 2:30 PM—4:30 PM Public Health Conference Room, 615 Sheridan Street, Port Townsend Board Members Staff Members Phil Johnson, Vice Chair,County Commissioner District#1 Thomas Locke,MD,MPH, Health Officer David Sullivan, County Commissioner,District#2 Jean Baldwin,Public Health Services Director John Austin, County Commissioner,District#3 Julia Danskin,Nursing Services Director Roberta Frissell, Citizen at large(County) Stuart Whitford,Environmental Health Services Director Kristen Nelson, Chair,Port Townsend City Council Sheila Westerman, Citizen at large(City) Jill Buhler, Hospital Commissioner,District#2 Chair Kristen Nelson called the meeting of the Jefferson County Board of Health to order at 2:30PM. A quorum was present. Members Present: David Sullivan, John Austin, Roberta Frissell, Kristen Nelson, Sheila Westerman, Jill Buhler Members Excused: Phil Johnson • Staff Present: Dr. Thomas Locke, Jean Baldwin, Julia Danskin, Veronica Shaw APPROVAL OF AGENDA Jean Baldwin asked to add two items to the end of the agenda as New Business; Item 6, An update on the environmental situation in Japan and Item 7, Discussion on the Data Steering Committee. Member Austin moved to approve the agenda as amended; Member Frissell seconded. The agenda was approved unanimously, as amended. APPROVAL OF MINUTES Member Austin moved to approve the February 17,2010 BOH meeting minutes. The motion was seconded and approved unanimously. PUBLIC COMMENTS Mr. Thomas Brotherton, a resident of Quilcene, expressed his concern that JCPH is not doing enough to reduce tobacco use in Jefferson County. Mr.Brotherton handed out information showing the health risks of tobacco use, stating Jefferson County has a higher tobacco use rate than any other county in the State, copies of Jefferson and Clallam counties website for comparison and a comparison of the amount spent on public health in Jefferson vs. Clallam counties. Page 1 of 8 BOH Minutes March 17,2011 Chair Nelson responded to Mr. Brotherton by stating that tobacco use along with alcohol and • drug use, especially among the youth is a topic that is continually discussed and will be addressed in the future. Mike Whitaker, a resident of Quilcene, stated that he understands that all septic systems in the County must be on an inspection schedule by 2012 and that the County will be educating homeowners to inspect their own septic systems. Mr. Whitaker asked why the class will cost so much. Mr. Whitford offered to speak to Mr. Whitaker outside of the meeting and get him the requested information. OLD BUSINESS and INFORMATIONAL ITEMS Prevention Team Report Julia Danskin announced that JCPH will be doing the Our Kids Our Business campaign in April for National Child Abuse Prevention and Sexual Awareness Assault month. Part of the campaign involves an annual call to action to fill out a form stating you are committed to kids in Jefferson County. Ms. Danskin asked the Board to fill out the form stating they are committed to kids in Jefferson County. • Ms. Danskin reported that JCPH is partnering with the City Library on a teen read event. The book being read is "13 Reasons". JCPH has updated the 'help cards', which includes the signs of depression and important contact phone numbers to get help for teens with experiencing depression. The help cards will be inserted in all of the books that are being distributed to all Port Townsend High School students. Letter to Washington State Federal Delegation Dr. Locke addressed the letter that was included in the BOH packet. The letter is from Governor Gregoire and the presidents of the Washington Association of Cities and Counties. It points out the magnitude of the state impacts from the federal budget cuts enacted by the House of Representatives' HR 1 bill. Several of the proposed cutbacks are items that have very significant public health impacts. NEW BUSINESS 2010 Public Health Performance Measures Report Ms. Baldwin announced that staff members will be presenting some of the 2010 Public Health Performance Measures Report. 1111 Page 2 of 8 BOH Minutes March 17,2011 s • Ms. Danskin reminded everyone that the performance measures were originally written in the summer of 2009, 18 months ago, in preparation for the 2010 budget. The reports have been updated with 2010 data and analysis. Ms. Danskin encouraged everyone to review the Study/Analysis section of the reports, which was written by staff as they reviewed the Actual 2010 Performance Indicators. Lisa McKenzie, Communicable Disease program coordinator, reported on the Communicable Disease 2010 Performance Measures Report. Ms. McKenzie pointed out that one of the major changes in the budget in 2010 was the funding from the Department of Health to improve disease tracking and reporting timelines, increasing uptake on childhood immunizations and working with the schools on immunization compliance was decreased by $20.000 following de-funding of Washington State's universal distribution system for childhood vaccines, a system that was established in 2010 to allow clinics to continue to keep one supply of State supplied vaccine. The clinics then report which children had which insurance programs and those insurance programs reimburse the State. Next Ms. McKenzie reported that the number of publicly funded pediatric vaccine doses has decreased, although between 2006 and 2009 the numbers had increased each year. The increase had been due to new vaccines being added to the schedule in 2007 and 2008. By 2010 the new vaccines had been caught up so the number of doses decreased. Ms. McKenzie pointed out that the section of Human Papilloma Virus Vaccine (HPV) is a new section in report for 2010. The HPV vaccine is available to all adolescents age 11 through 18 110 and recommended for women through the age of 26. State supplied vaccine is only available to adolescents ages 11 through 18. Privately purchased HPV vaccine is very expensive, so JCPH has worked with Merck vaccine company's Patient Assistance Program so that low income uninsured woman can receive the vaccine for free. Ms. McKenzie briefly explained that the County is working on increasing the number of Chlamydia screenings to go with the State and Federal guidelines. Ms. Baldwin pointed out that the Chlamydia screening is typically done at the same time as the PAP test. Many women are not having their routine PAP annually any more and are being told that a PAP test is only needed every 3 years. For young women PAP testing is being delayed until they have been sexually active for several years. Both of these trends make it harder to achieve the public health goal of screening for sexually transmitted infections on an annual basis for certain age groups. Next Ms. McKenzie addressed the syringe exchange program. The number of syringes being exchanged decreased from 2009 to 2010. Ms. McKenzie believes this is due to clients that used to exchange large amount of syringes are not clients any longer. They are finding that the new clients are exchanging a fewer number of syringes. In talking to clients they are finding that some clients are reusing their syringes several times, so JCPH is taking this as an opportunity to educate the clients on safe practices and offering referrals. JCPH will be submitting a competitive application to DOH to continue funding for the Syringe Exchange Program (SEP) around July 2011. • Page 3 of 8 BOH Minutes March 17,2011 Member Frissell asked if it is in the funding for adolescent boys to receive the HPV vaccine • since they can be carriers of the disease. Ms. McKenzie stated that the State has approved the vaccine to be given to adolescent boys as well as girls. Member Nelson commented that she was surprised at a statistic she recently heard about, which stated that under 50% of the children entering kindergarten are properly immunized. Ms. McKenzie responded by stating that Jefferson County has a higher percentage than the rest of the state of parents who sign exemptions. This may also be due to children not being caught up on their immunizations at the time of school entry. Ms. McKenzie also stated that JCPH has been working with the school secretaries to help them get complete records. Ms. Baldwin reported on the Family Health 2010 Performance Measures report. In looking at the performance indicators it shows that the numbers significantly dropped. In the Study/Analysis section it shows a 30% cut in funding and JCPH has had to figure out a way to see fewer people. Instead of dropping people from services, they dropped people from universal services. Ms. Baldwin touched on the number of families served through the CPS/DSHS contract. The contract with DSHS is likely to end in July and JCPH may not be able to renew the contract. Ms. Baldwin explained how DSHS is changing their relationship with local health departments and they will be making one large vendor responsible for over one-third of the state. Most counties are not in favor of this change because the liability shifts from the State for a CPS case to the individual counties. She does not recommend continuing this relationship. This all comes • at a time when public health nurses are seeing some of the most complicated families. Member Nelson asked for clarification on what type of access women in their 1st trimester of pregnancy are being denied. Is it access because the women do not know what they need to do to qualify for Medicaid, access to Medicaid because it takes time to get through the system and get care, or access to the clinics? Ms. Baldwin responded that a group has been formed to get the answers to these questions. They are also looking at why one area of the county is showing lower levels of first trimester prenatal care than others. The group will be looking at data and taking it to the OB providers to ask their opinions as well. They also want to know why it is only women on Medicaid and women in South County that are not seeking medical care in their first trimester of pregnancy. Ms. Baldwin addressed the Targeted Clinical Health Services 2010 Performance Measures. JCPH is seeing more clients under the age of 19. The numbers on the performance measures all remain fairly stable. Ms. Baldwin stated that in the Healthy Youth Survey it showed that people in school felt they had access to services that they needed and they knew who to ask for help. These numbers were higher in Jefferson County than in the rest of the State. Ms. Baldwin reported that the teen pregnancy rate is very low in Jefferson County and has continued to drop. Ms. Danskin summarized the findings of the Population &Prevention 2010 Performance Measures. She stated that the tobacco prevention funds ended December 31, 2010, so that half time position has been eliminated, however Washington State will continue their Quit Line. Ms. i Page 4 of 8 BOH Minutes March 17,2011 • Danskin reported that funding also ended December 31, 2010 for the Child Care Consultation and State Oral Health Funds. Member Buhler asked why the number of school health classes was 243 when it was only planned to be 225. Ms. Danskin replied that classes were added because of funds received from Developmental Disabilities to do special classes for the developmental disability population at school. Member Nelson asked why JCPH is having so much success in decreasing the number of teen pregnancies and they are not having the same kind of success in tobacco use prevention. Ms. Danskin replied that she feels part of the reason for this is that JCPH has been in the schools doing human growth and development classes for over 20 years, there are school based clinics and family planning services and the girls know where to go for services. She also feels that teen pregnancies are not a community norm while tobacco and alcohol use are. Mr. Whitford reported on the Onsite Sewage and Operation and Monitoring Programs as well as the Water Quality Program. He pointed out that on the performance measures of the Onsite Sewage and Operation and Monitoring it shows that new system permitting is down, as it is across the state, and that repair applications are slightly higher. Because permitting is down, the staff has also been trained to do sanitary surveys under the water quality grants. Mr. Whitford pointed out that on the Water Quality Performance Measures Performance Indicators the goal was not met for the number of property surveys that were planned for 2010. He stated that even • though permitting is down there continues to be grant monies available to do water quality projects. Mr. Whitford also reported on the Food Safety Program, by stating that in 2010 their goal was not met, but the right infrastructure is in place to accomplish their goal for 2011. Ms. Baldwin urged the Board to look at the Solid& Hazardous Waste performance measures. Member Westerman asked for an explanation of Local Source Control. Mr. Whitford explained that Local Source Control is a Department of Ecology program to look at different sectors of business that typically generate hazardous waste and use hazardous substances. The point of the program is to prevent the waste from ending up in storm water and impacting the public and environmental health. JCPH is in the process of applying for additional funds to run their own program next year. Ms. Shaw presented the Administration Performance Measures of 2010. She stated that Administration supports the other divisions within Public Health, maintains other relationships outside the departments, and handles contracts and reports. Ms. Shaw also reported that JCPH and three other counties are writing a resource guide to help all local health jurisdictions bill private insurance companies for immunization services. Ms. Shaw also stated that since JCPH does not generate a profit so funding received from the ARRA grant allows the Department to bill their local partners less for internal services. S Page 5 of 8 BOH Minutes March 17,2011 2011 Public Health Heroes Award Nominations • Ms. Danskin announced that the first week of April is National Public Health Week and time to nominate Public Health Heroes. Member Frissell volunteered to serve on the subcommittee with Ms. Danskin and will review all the nominations. The Nominees will be announced next month. Influenza Update and Notifiable Conditions Reports Dr. Locke reported that as a service to the health care providers, JCPH issues a Notifiable Conditions Report for the past year. A copy of the 2010 report was included in the agenda packet. He stated that influenza has shown a very slow increase in the number of cases week by week since late February. The schools have not shown absenteeism over 10%. Mandatory Healthcare Worker Immunization Dr. Locke announced that beginning February 21, 2011 influenza was circulating in the community to a point that he determined that all un-immunized healthcare workers in the three North Olympic Peninsula hospital districts must wear a masks when involved in direct patient care. This requirement is expected to continue at least through the end of March and possibly into April. Legislative Update • Ms. Baldwin informed the Board that there are legislative hearings happening to maintain the programs of home visits which would fund Nurse Family Partnership. She will be watching this very carefully to see if it goes from a hearing to an actual action item. Ms. Baldwin asked the Board that if this moves to an action item The Board write a letter of support. Member Austin moved that the Board authorize the Director of JCPH to draft a letter asking for legislative support to be signed by the Chair. Member Sullivan seconded and the motion passed unanimously. Update on Environmental Situation in Japan Dr. Locke reported that due to the amount of phone calls JCPH was receiving in connection with the nuclear power plant disaster in Japan an advisory was sent to local health care providers and pharmacists that urged them not to recommend people take over the counter medications, such as Potassium Iodide, Kelp and other medications with Iodine in them because they are unnecessary at this time and can have serious health risks. Dr. Locke also announced that JCPH put out a detailed press release, which gave a considerable amount of background information about radiation hazards and specific advice regarding the crisis in Japan. He stated that one positive outcome from this tragedy is that people are reviewing their emergency preparedness and disaster kits in preparation for a disaster here. • Page 6 of 8 BOH Minutes March 17,2011 • • Data Steering Committee Ms. Baldwin announced that that Data Steering Committee is coming to an end. Their next meeting, which is a summary meeting, will be held April 28, 2011. Ms. Baldwin feels that the committee is at a point where she will be able to bring the information before the Board to determine what additional actions should be taken. Member Frissell announced that an attendee at the Data Steering Committee meeting today reported that a$50,000.00 grant for the library was obtained using the data that is coming out. She feels that other agencies need to be made aware of these possibilities. Ms. Baldwin asked whether this is a big enough issue to pull together a few community leaders. Member Buhler suggested that they take the approach of it being a workshop with an outcome rather than a meeting. Member Westerman suggested that Ms. Baldwin go to different groups in the community with a presentation that is tailored to that specific group and their interests. ACTIVITY UPDATE Ms. Baldwin announced that Dr. Locke and Lori Clark will be attending the City Council meeting to speak about Local Source Control and other local public health issues. iMs. Baldwin also stated that Public Health Heroes will be in the April meeting. AGENDA PLANNING CALENDAR The next scheduled BOH meeting will be held Thursday,April 21, 2011 from 2:30-4:30 PM at the Health Department, 615 Sheridan Street, Port Townsend, WA. ADJOURNMENT Chair Nelson adjourned the BOH meeting at 4:38 PM. S Page 7 of 8 BOH Minutes March 17,2011 JEFFERSON COUNTYIB•ARD OF HEALTH ( Excused Kristen Nelson, Chair Phil Johnson,Vice-Chair J. 1 Buhler, Member Jo Austi , Member 4114/4-'41010Roberta Frissell, Member Davitpullivan e be $tit 14_ U3&AIX 1WA-- Sheila Westerman, Member r Page 8 of 8 BOH Minutes March 17,2011 r Board of 3fealth Old Business & Informational-Items .agenda Item # 1'V, 1. • Press Release: Japanese Nuclear Power PCant Disaster April2i, 2011 j c° JEFFERSON COUNTY PUBLIC HEALTH 615 Sheridan Street • Port Townsend •Washington • 98368 • ` `O° www.jeffersoncountypublichealth.org Health Department Provides Assessment of Radiation Exposure Risk and Health Recommendations Regarding the Nuclear Reactor Emergency in Japan Thomas Locke, MD, MPH Jefferson County Health Officer March 16, 2011 Port Townsend— We have all been touched by magnitude of damage and human suffering caused by the catastrophic earthquake and tsunami that struck Northeastern Japan last week. It is especially sobering when we realized that the Olympic Peninsula is an area of the world at risk for similar earthquakes and whose coastal communities are vulnerable to devastating tsunamis. We can imagine losing family members and friends, and we can picture being isolated for days, without power, food or water. Public health agencies at a local, state, and national level are closely monitoring the situation at Japan's Fukushima Daiichi Nuclear Station. Japan is facing a very serious emergency as they struggle to cool several heavily damaged nuclear reactor cores and prevent additional releases of radioactive material in the immediate vicinity of the plants. There is widespread agreement by U.S. public health experts that there is no current or potential radiation hazard to the mainland United States, including the Olympic Peninsula, even in the event of a catastrophic meltdown of the Japanese • reactors. Comparisons have been made with the 1986 Chernobyl accident which spread radiation over a wide area. These comparisons are inaccurate and misleading. The Chernobyl accident involved a runaway reactor that exploded and burned, sending massive amounts of radioactive materials into the upper atmosphere. The radiation that has been released in Japan is of a much smaller amount and was not at a high enough altitude to travel in the jet stream to the U.S. That said, there are a number of agencies continuously assessing the situation as it evolves, regularly measuring atmospheric conditions, and monitoring for dispersal of radioactive materials. Disasters often surprise us with their impacts, and it pays to stay alert and prepared, even when the potential impact seems minimal. As Health Officer for Jefferson County, I want to reassure you that the best available information indicates that there is currently no risk of harmful radiation exposure to residents of the continental U.S. as a result of the damaged Japanese nuclear reactors. Unless there are entirely new and unforeseeable developments in Japan, no future human health risk is anticipated. You may be hearing about taking potassium iodide or Prussian blue to protect you from possible radiation sickness. The Washington State Department of Health (DOH) and Centers for Disease Control (CDC) strongly recommend against this. COMMUNITY HEALTH HEALTH DEVELOPMENTAL DISABILITIES PUBLIC HEALTH ENVIRONWATERENTAL 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 • Potassium iodide is available as an over-the-counter drug. It has the potential for • significant side effects, and can be harmful for people with certain medical conditions. Its benefits do not outweigh its risks unless you have acute exposure to significant amounts of radioactive iodine in a situation where evacuation is not possible. • Prussian blue is available by prescription only. You SHOULD NOT consume Prussian blue artist's dye or paint pigments. This type of Prussian blue is not designed to treat radioactive contamination. If a radiation risk were to occur, local health departments would have access to both substances from the Strategic National Stockpile and would use our emergency procedures to make it available to our community. Washington's DOH serves as the state's expert agency in matters of radiation affecting public health. DOH is partnering with Federal agencies,the International Atomic Commission, other western state DOH's and Canadian agencies to monitor the situation in Japan. They are collecting air, crop and other samples 24/7 throughout the West Coast to ensure an early warning should the situation change. As part of our job to protect your health in the event of any natural disaster or man-made emergency, we have plans in place to handle many different types of emergency. We partner with other local and state agencies so that together, we can prevent harm where possible, and when harm is unavoidable, to contain it and limit its damage to you and your family. As part of this work, we are part of a 24/7 public health communication system that will inform us promptly if there are any increased risks from the events in • Japan. We will then activate our own emergency communication processes to promptly inform the public in Jefferson County. We are fortunate that the tsunami risk from last week's earthquake has passed and there is no significant risk of radiation reaching the continental U.S. We are in no way immune from a similar disaster occurring in Washington State. Accordingly, we strongly recommend that every family have a personal disaster plan in place. An excellent guide can be found at http://seattletimes.nwsource.com/news/local/links/disaster/prepare.pdf. This handy check list was published by the Seattle Times and will guide you through all the things you need to do to be as safe and healthy as possible after a disaster, until help arrives. Share it with your neighbors —and collaborate on how you could support one another. A safe community is a resilient community. For additional information, we recommend that you visit the DOH website at the link below. They are our most valuable and credible information source on this situation, and they update their website information around the clock. They have a helpful Frequently Asked Questions (FAQ) link that can answer many of your questions. Washington State Department of Health: http://www.doh.wa.gov/Topics/iapan2011.htm/ COMMUNITY HEALTH PUBLIC HEALTH ENVIRONMENTAL HEALTH • DEVELOPMENTAL DISABILITIES hL�i!IAYS'�ORKIidG FOR�,SAFER ANDWATER QUALITY MAIN: 694400 HEALTHIER COMMUNITY MFAX: 36()375-9444 79-4487 FAX 360-&38385-9401 • Board of Health Old Business & Informational ltems .Agenda Item # 2 • . Tefferson County AduCt 766acco Use ApriC2i, 2011 • • Jefferson County Adult Tobacco Use:Comparison and Explanation of Available Rates S Data Source: Washington State Behavioral Risk Factor Surveillance System (BRFSS) adult phone survey PURPOSE: The intent of this document is to describe adult smoking prevalence rates available from three online sources; considering and explaining the statistical analysis methods for each rate and overall survey limitations. SUMMARY: Readily available online Jefferson County smoking prevalence rates must be interpreted with caution -- ✓ Small survey sample size results is potential for wide variation in rates year-to-year, best to look at trend over time ✓ Multiple statistical methods are useful for different purposes, best to look at unadjusted, age specific and age adjusted rates to understand smoking prevalence Source 1: WA State Dept. of Health: "JEFFERSON COUNTY Tobacco Use Statistics" released: 3/10/2011. Available at: http://www.doh.vva.gov/tobacco/data_evaluation/Fact_Sheets/JeffTobStat.pdf STATISTICAL RESULTS SUMMARY: / Adult smoking prevalence in Jefferson County NOT statistically changed over time ✓ 2008 percent strange (very high) compared to other years • 40 2003-2009 Smoking Prevalence in Jefferson County 19.9 ▪ 30 - 18.4 • 12 5 12.6 15. 14.1 10 �1 24.0 0 2003 2004 2005 2006 2007 2008 2009 Year DEFINITION: The unadjusted percent of adults who report having smoked at least 100 cigarettes in their lifetime and now smoke some days or every day; single years 2003 through 2009 DATA NOTES: ➢ Data represent the estimated local percent at the time of the survey (single year point estimate) • Unadjusted rate comparisons with other places must be made with caution as differences in the distribution of population by age can influence local rates and limit comparability Source 2: WA State Dept. of Health, Local Public Health Indicators "Adult Cigarette Smoking." Available at: http://www.doh.wa.gov/phip/khi/Iphi A. STATISTICAL RESULTS SUMMARY (2007-2008): • ✓ Jefferson age adjusted percent statistically higher than WA State ✓ Jefferson age adjusted percent the highest of WA counties ✓ Jefferson age adjusted percent statistically higher than 22 other WA counties Jefferson County Public Health March 24,2011 Page 1 Category: PREVENTION AND HEALTH PROMOTION ina:icator• Adult cigarette smoking - Percent of adults age 18 or older who smoked at least 100 cigarettes in their • lifetime and are current smokers 2007 - 2008 Seattle King 12 + I , Whitman 12 Adams 12 I + Chelan-Douglas is I San Juan _15 I I Kititas 15 ' + Yakima 15 + Whatcom _15 K� Wahkiakum is I Walla Walla is I bggthan states Snohomish 16 + II Island L._ 95TTAil3.r tc state Klidutat 16 + Benton-Franklin 16 t I slats State 16 than state" Grant 16 +' I rrfic� Clark it I I + `Statistically significant - '- dagrg (P<.05) Kttsap i T Lincak► 18 f Spokane 16 �-{— Thurston 18 --I— Tacoma Pierce 19 , I Lewis Skamania 20 + Clallam 20 r Columbia 21 Skagit 21 I I I Garfield 23 i C owlkz 23 + 1 Northeast Tri _24 ,: I , Grays Harbor 24 Okanogan 25 '+ I , • Mason _25 I Asotut `25 !I Pacific 27 Jefferson 31 I I 0 5 10 15 20 25 30 35 40 45 A. DEFINITION: The age adjusted percent of adults who report having smoked at least 100 cigarettes in their lifetime and now smoke some days or every day;2-year period 2007-2008 DATA NOTES: D Age adjusted estimates adjust for differences in age distribution in different places D Age adjusted percent is not an actual local percent but a percent for comparison purposes only D Age adjusted percents are calculated by taking the age specific percents for a place, applying those to standard populations for the same age groups, and summing those to get an age- adjusted percent that is comparable across places D While comparable across places, the Jefferson County age adjusted rate has limitations- because Jefferson County has a small population of younger adults and an even smaller population of younger adults with landline telephones to participate in the survey-the age specific percent used to create the adjusted percent has an especially wide range of values B. STATISTICAL RESULTS SUMMARY (2004-2006 and 2007-2008): ✓ Jefferson age adjusted percent is statistically higher in 2007-2008 compared to 2004-2006 ✓ Jefferson is the only WA county with an age adjusted percent that is statistically higher over time-however, in 8 other counties, the age adjusted percent also increased over time ✓ Jefferson rate ranked #1 in 2007-2008, #20 in 2004-2006 Jefferson County Public Health March 24,2011 Page 2 C cec :l: Prevention and Health Promotion Sri carer Adult Cigarette Smoking IOC 0 ;.`ev .f ert_ adults ay.. 1s r sl`tr�'P' k srnaked at 3st IOC cigarattaa it'Chew lifetEne and are aarert sm:icens 2004-2006(Baseline) 2007-2008 Ka 953/4 Confidence 9S%Confidence rd Percent Internal Percent interval 3a:,,ar�'e,�r t3ma• x;{ ,r,'',--"" ".0‘44".'" fix; 1 t ,I,'i -�,4 n .z.,,,ara.er -a' (Ad ams 13.5 (10.0. 17.9) 12,4 (7.9, 18.9) a asY^=tea" kl A3atin 24.3 ((20.6.28.5) 2.5.4 (19,7,32,2) -c-.,,;:--`:raz-�,«•._.*,--+n.-. _;.,< '+�� Ran`ton-Fran klin 17,3 (15.1, 19.7) 15,8 (13.1. 19,0) ;., k, �" x.,illft.,: :-s ra"j* Z.:,.:7""1°2t° Cie am 18.6 (15.3.22,4) 20.4 `15.2, 26.8) 5m€rrca eta'!_aA'Gia•.T.aca D0.4.yen`s'{•a a.vq:S-"tor Clark 18.9 (17.4,20,4) 16,7 (15.0,18.6) v€rr.a sari- .cam Columbia 19.9 (15.4,25,4) 20.9 (15.5,27.6) Tartrrsicia nrtas COwiitz 24,5 (21,1,28,2) 23.1 (19,0.27.8) Garfield 17.9 (13,7,23,0) 22.9 (14.9.33.5) Grant 20.3 (17.2,23.8) 16.1 (12.9.20.0) Grays Harbor 27.5 (24.0, 31.3) 24.2 (19.5.29.6) Island 17.7 (14.8.21.2) 15.6 :'11.8.20.3) tea": • k , Kiteep 18.4 (16.7,20,2) 17.4 (15.1, 19.9) Kittitas 15,3 (12.5. 18.5) 14.9 (11.2. 19.6) Klickitat 19.5 (15.8.23.9) 15.7 (11,7.20.9) lewi:a 23.1 (19.7,26.8) 18.7 (14.5.23.8) Lincoln 25.0 (18.8,32.4) 17.6 (12..1,24.8) Matson 28.9 (24.7.33.6) 25.3 (20.2,31.1) • NE Tri-County 29.1 (25,4,33.2) 23.7 (19,7.28.3) Okanogan 2.3.6 (20.7,26.9) 24.5 (20.7.28,7) P$clfit 30,7 (25.8,36.0) 26.9 (220.1.34.9) San 3uan 19,5 (14,9,25.0) WEI (10.4, 19.9)��� Skagit 16.5 (13.7, 19.8; 21.1 16.7,26,5) Skamania 19.3 (14.8, 24.8) 20.3 15,8,25.7) is Thurston 20,2 ',18.7, 21.8) 18.3 1 h,4.20.2) Wee kiakum 19.8 (14.3.26.8) 15.3 (9.6,23.7) Wane walla 11.9 (9.5, 14,9) _ 15.4 (10,8,21,3) Whatcam 15.9 (13,5, 18,6) 15,2 (12.8,17.9) Whitman 12.8 (10.4. 15.7) 11.7 (8,7, 15.6) Yekirne 17.1 (15.2. 19.2) 14.9 (12,6, 17.5) B. DEFINITION: The age adjusted percent of adults who report having smoked at least 100 cigarettes in their lifetime and now smoke some days or every day; 3-year period 2004-2006 compared to 2- year period 2007-2008 DATA NOTES: > See notes in A. above (bottom of page 2) • Source 3: Jefferson County Public Health "Adult Current Smokers" Available at: http://www.jeffersoncountypublichealth.org/pdf/Pt4_Data_Births_Quality_Deaths.pdf Jefferson County Public Health March 24,2011 Page 3 STATISTICAL RESULTS SUMMARY: ✓ Jefferson unadjusted percent statistically unchanged since 2001 ✓ WA unadjusted percent statistically lower in 2009 compared to 2005 and 2001 ✓ Port Townsend and Jefferson County not statistically different ✓ Port Townsend and Jefferson County not statistically different than Washington State 301, Port Townsend ■Jefferson County Wash ngten State 121% 2.3% 20% 15 17% 18% l o 16% 15% :awx 2001 2D2-3-05(WA 05) 2007-09 09(WAO9) DEFINITION: The unadjusted percent of adults who report having smoked at least 100 cigarettes in their lifetime and now smoke some days or every day; Port Townsend/Jefferson County: 1-year period 2001; two 3-year periods 2003-2005, 2007-2009; Washington State three 1-year periods 2001, 2005, 2009 DATA NOTES: ➢ Data represent the estimated local percent at the time of the survey (single year and combined 3- year estimates) ➢ Unadjusted rate comparisons with other places must be made with caution as differences in the distribution of population by age can influence local rates and limit comparability • Data Source Notes: Washington State Behavioral Risk Factor Surveillance System (BRFSS) ✓ Data are self-reported responses weighted to represent the Jefferson County population by age and gender o Weights are calculated using population estimates produced by the WA State Office of Financial Management o Weighted survey data are designed to represent the age and gender distribution of the population not just those who participated in the survey ✓ Survey has some limitations: o sample of households with telephone landlines (unlisted numbers are included but as more and more people only have cell phones, sample becomes less representative of total adult population); o sample does not include cell phones (cell phone sample began in 2008 but not available at county level); o survey only available in English and Spanish V The sample size is determined by population size-because the population of Jefferson County is small, the BRFSS sample is small o Small sample size impacts rates in two notable ways: 1) each individual's responses have more influence over the combined estimate; 2) estimates are not very precise- have a wide range of possible values (the confidence interval) • o Sample size is increased by combining more than one year of survey data Jefferson County Public Health Page 4 March 24,2011 • Board of Cealth Old Business & Informational Items .agenda Item # IV., 3 • Our Xids: Our Business ApriC7,lpdate April2i, 2011 • April is National Child Abuse Prevention and Sexual Assault Awareness Month. This year Jefferson County is celebrating the 4th annual "Our Kids: Our Business," a social awareness and prevention campaign. Many community partners are collaborating to highlight the • things we can do as individuals, organizations, agencies, and businesses to prevent child abuse/neglect and sexual assault as well as celebrating Our what works in Jefferson County. It is our community's commitment to Kids: protect and nurture our children. Our Business No one person can do everything, But everyone can do something, and Together we can create change for the better. 2011 "Our Kids: Our Business" activities and events planned for April and May (stay tuned; more is developing each day. This update 4-5-11): • A "Call to Action" for the residents of Jefferson County inviting citizens to pledge an action that will make Jefferson County a more nurturing and safe environment for children. (The pledge is asking for action, not money.) • The City of Port Townsend and Jefferson County Commissioners are proclaiming April to be National Child Abuse Prevention Month. • Historical Society is sponsoring a History Game for children of all ages on Saturday, April 2nd from 11:00 to 3:30 pm. The game will be family friendly. There will be fun prizes. Admission is free for Jefferson County residences. For information call 360 385-1003 or Phyllisjchswa.org. • Jefferson County 4-H will sponsor a Parent/4-H Leader Round Table Discussion Group on Monday, April 4th from 6:15 to 7:00 pm at the WSU Jefferson County Extension, Spruce Room. Topics will be strategies to keep our children safe and happy in the community, at 4-H Club and at home. For more information call Sue Hay at WSU Jefferson County Extension at 379-5610, ext. 208. • Port Townsend Public Library was awarded a two year Paul Allen Family Foundation Grant for a • Teen Community Read. For the spring of 2011 the Teen Community Read book will be 13 Reasons Why by Jay Asher. Many community activities, ranging from book discussions, visual art workshops, a theatre forum, and poetry workshops, have been planned for Port Townsend High School and for the larger community. Events with the Community Read are: Book discussions Theater Forum Art Workshops April 12 —teens only, 3-4:30 pm April 9, 7-9 pm April 13, 2:30 —4 pm April 19 — all ages, 3-4:30 pm April 16, 7-9 pm April 20, 2:30-4 pm April 23, 11 am - 3 pm Teen Writing Readings April 30, 11 am — 3 pm May 6, PT Public Library May 7, Gallery Walk at Undertown Coffee Gallery Walk, May 7th Meet the Author, Jay Asher Boiler Room Jeff. Comm. School PTHS, May 6 PT Library Undertown Coffee PT Library, May 7, 2 — 3 pm. For more specific information about the events: 385-3181 and www.ptpubliclibary.org . • The Boiler Room will feature: All Tuesdays Game Night, 7pm — 9pm All Wednesdays Art Group 5-7 Movie Night 7-9 All Thursdays Open Mic, 7pm — 10pm All Fridays Free Food at 3 pm Live Music at 7 pm All Saturdays Food Not Bombs at 2 pm • Live Music at 7 pm All Sunday Free Soup, 3:00pm —4:30pm • The Food Co-Op and Sound Experience will host "Our Co-Op Kids," an Earth Day festival celebrating boats, planes, worms, fish and bicycles on Sunday April 17th from 1:00 to 4:00 pm in the OVER Food Co-Op parking lot. Other participants are Northwest Maritime Center/Wooden Boat Foundation, P.T. Sea Scouts, Northwest School of Wooden Boatbuilding, P.T. Marine Science Center, Schooner Martha, Community Boat Project, the Recylery, P.T. Aero Museum, Tri-Area RC Club and theTri-Area School Garden/Compost Program. • Crime Victims Service Center will host a free Family Fun Fest on Saturday, April 231d from 10 to • 3 pm at Mountain View. Children and families will be able to learn about health and safety and Community resources in a fun and interactive environment. Free child ID Kits will be available. • Dove House Advocacy Services will sponsor a "Walk a Mile In Her Shoes" event on Wednesday, April 27th to bring awareness to the issues of rape and sexual assault. This event is part of a national men's movement to bring an end to sexual violence. The walk will begin at 6:00 p.m. at Rotary Park next to the U.S. Bank Building. Men are encouraged to walk in women's shoes. Women and children are encouraged to take part as well. Preregistration forms are available at the Food Co-op, Jefferson Healthcare, Dove House, and Evergreen Fitness. Sponsors of the walk are Jefferson Healthcare, the YMCA, the Food Co-Op, the Northwest Maritime Center and Evergreen Fitness. The Port Townsend Light House Lion's Club will provide refreshments. For more information go to www.walkamileinhershoes.orq or call 360-385-5292. • Port Townsend High School and the OESD 114 are sponsoring a training by Dr. Dennis Embry, President of the Paxis Institute in Tucson, Arizona on Wednesday, April 27 from 5:30 to 7:00 pm at Port Townsend High School Library. Dr. Embry is a nationally recognized for his work in youth tobacco, alcohol, drug and violence prevention, and for the development of prevention policies. Since 1975 he has created, tested and produced more than 40 manuals, books and other procedures for primary prevention which have been tested in whole communities, counties, and states. In 2006 the Society for Prevention Research honored him as a national leader for bringing science into practice. For more information contact Kelly Matlock at 360-379-4476 or kmatlock(cr�co.lefferson.wa.us. • YMCA Building Futures is sponsoring a Dine Out for Kids on Wednesday, April 27th. Community members dine out or go see a movie and a percentage of the sale from their experience directly benefits YMCA Building Futures, a Jefferson County program. For more information contact Kim Hammers at 774-6342 or go to www.leffymca.org. • • The Port Townsend Police Department will participate in the National RX Takeback Day on April 30th. Between 10am and 2pm, the public may bring their expired, unused and unwanted medications and supplements (prescription or not) to the Police Department at 1925 Blaine Street, Port Townsend. Help prevent pill abuse, environmental damage and theft by ridding your home of potentially dangerous medication. The service is free and anonymous, no questions asked! *Please note that this event is in addition to the ongoing drug take back program offered by the Port Townsend Police Department* • Make Waves! and the Jefferson County YMCA are sponsoring a free pool party for families and children on Saturday, May 21st from 3:00 to 5:00 pm (right after the Rhody Run). Refreshments and a fun time will be provided. For more information contact Kim hammers or Jim Funaro with the YMCA at 385-5811. • The Developmental Disability Advisory Board, Jefferson County Tobacco Prevention and Control and other community partners are sponsoring a county-wide Posters & Coasters Campaign to Prevent Fetal Alcohol Spectrum Disorders" to educate the public about the risk of birth defects caused by drinking and smoking at any time during pregnancy. Look for the thoughtful posters and coasters in the community. • An ad will run at The Rose for the month of April. • Presented by: Jefferson County Community Network and Jefferson County Public Health Also Sponsored by: City of Port Townsend—All Departments, Jefferson County—All Departments, Board of Health, Dove House Advocacy Services, Jefferson County Historical Society, Jefferson County METH Action Team, Jefferson County 4-H, Jefferson County YMCA, Developmental Disabilities Advisory Board, the Boiler Room, Safe Harbor Recovery Center, Substance Abuse Advisory • Board, Jefferson Teen Center, Department of Children and Family Services/Children's Administration, Jumping Mouse Children's Center, Jefferson Mental Health Services, Jefferson Community School, Jefferson NAMI, Make Waves!, Sunfield Farm, OLYCAP, Brinnon School District, Chimacum School District, Port Townsend School District, Quilcene School District, DBHR, DSHS, PT Kiwanis, The Rose Theatre, the Elks Lodge and the Port Townsend &Jefferson County Leader and many, many more businesses, agencies and service clubs. I Board of 3-feaCth Olcl Business & Informational Items Agenda item # 1V., 4 ACES .adverse CCiiCdFioocC Experiences - "2he Poverty Clinic " i yrLC21, 2011 I r .i i idents disarms even the toughest cases. I A REPORTER AT LARGE It helps that she is dark-skinned,like I most of her patients, and young just 1 POVERTYIII CLINIC -five.But her childhood was very 1 T}-'E different from theirs.The daughter of 1 Jamaican professionals who moved from Can a stressful childhood make you a sick adult? Kingston to Silicon Valley when Burke a was four,she attended public school in I BY PAUL TOUGH Palo Alto,where the kids were mostly white and well-off,and where girls cried z' ` ._ SPif -r in the cafeteria if they didn't get the . x right car for their sixteenth birthday. � _ � � � � Like many children of immigrants, 1 IT.-,.J.:-'...--;;;;It� t r s-x Burke has learned to move fluidly be - = = tween cultures.She now lives in a house ---...-,,,,,-,-.1-,.--',-,&14 ,4*- --- ;,,,,,,., k , : -- � _ _:-r ,4� x in an upscale part of Potrero Hill,a San 1 -T Francisco neighborhood,with a closet frill of designer clothes, and she has a 4,. • fiance who is a wealthy solar-energy en- ;' - � trepreneur.But she seems just as tom r - - ` Y fortable among the mostly poor fami a ES f y lies she sees in her examination room: 1 "1� ; laughing,gossiping,hugging,and scold- j } z PA 5 ing, in Spanish as well as in English, 4 1 , f r ��, in a full-throated alto that echoes down rP the hall. _ At the clinic,Burke gently interro- yR gated Sullivan until she opened up about J her childhood: her mother was a co- �} , " moi. t .. r± 0 ` 4 -' � f ,>/:.,-,'„,s. "� �-'� '-..--,kir- `` Caine addict who had abandoned her Y `t / in the hospital only a few days after she f�, < - gipP. was born,prematurely,weighing just _'•' % - .- three and a half pounds. As a child, x r - '".: ,,,,.:.,,, ..:=.;:m ".. Sullivan lived with her father and her ��- older brother in a section of Hunters zx �E � Point that is notorious for its gang vio -----;;;.f$:73+.4f��. - lence; her father, too, began taking 1 4,.. -_ ., -- drugs,and at the age of ten she and her Nadine Burke at her San Francisco clinic.Photograph by Alessandra Sanguinetti. brother were removed from their home, E separated, and placed in foster care. =1 Sullivan first visited the would have been the end of the visit.But Since then,she had been in nine place Monisha Bayview Child Health Center Burke,who founded the center in 2007, ments,staying with a family or in a group a few days before Christmas,in 2008. was having a crisis of confidence regard- home until, inevitably,fights erupted ' Sixteen years old, she was an African- ing her practice, and Sullivan was the over food or homework or TV and Sul- American teen-age mother who had kind of patient who made her feel par- livan ran away—or her caregivers gave 1 grown up in the poorest and most vio titularly uneasy. Burke was diligently up.She longed to be with her father,de 1 lent neighborhood in San Francisco, ticking off each box on the inner-city spite his shortcomings,but there was al- 1 BayviewHunters Point,a bleak collage pediatrician's checklist,but Sullivan's ways some reason that he couldn't take of warehouses and one-story public- problems appeared to transcend mere her back For a long time, she had the I housing projects in the city's southeast- physical symptoms. She was depressed same dream at night:taking the No.44 ; em corner. Sullivan arrived at the clinic and listless, staring at the floor of the bus back to Hunters Point,walking into with ailments that the staff routinely ob- examination room and responding to her father's house,and returning to her sewed in patients:strep throat,asthma, Burke's questions in sullen monosyl- old bedroom, everything just as it used scabies,andaweight problem.The din- lables. She hated school,didn't like her to be.Then she'd wake up and realize I •o ic' s medical director,Nadine Burke,ex- foster mother,and seemed not to care that none of it was true. I o amined Sullivan and prescribed the usual one way or the other about her two- When I met Sullivan,last September, `remedies—penicillin for her strep throat, month-old daughter,Sarai. she had recently turned eighteen, and ProAir for her asthma,and permethrin Burke is charismatic and friendly, three days earlier she had been emanci I for her scabies--and at most clinics that and her palpable concern for her pa- pated from foster care.She was now liv- 1 THE NEW YORKER,MARCH 21,201125 1 a. t ing alone,in a subsidized apartment off health effects of childhood trauma,and her to respond more calmly to provoca- Fillmore Street In California,emanci- its tondusions had led her toward a new tion,it will help her make better choices. pated foster children are given a sum- way of thinking—not just about her She'll have a better life?' mary of their case file,which meant that clinical practice but about the entire Sullivan had just been handed an official field of pediatric medicine. T n 2005,when Burke completed her • history of her rootless adolescence."It As she listened to Sullivan, Burke medical residency,at a children's hos- brought up a lot of emotions,"she told found herself inching toward a diagnosis pital on the campus of Stanford Univer- me."I read it,and I kind of wanted to that,a year earlier,would have struck her sity,she was an idealistic twenty-nine- cry.But I was just,like,'It's over with. " as implausible.What if Sullivan's anxiety year-old with a medical degree from The most painful memory was of the wasn't merely an emotional side effect the University of California at Davis and day,in fifth grade,when she was pulled of her difficult life but the central issue a master's in public health from Har- out of class by a social worker ..... affecting her health?Accord- yard.She was recruited by the California she had never met and driven ing to-the research Burke had Pacific Medical Center,a private hospi- to a strange new home.It was ' . been reading,the traumatic tal group,to take on a vaguely defined months before she was able to T'n TAffy events that Sullivan expert- but noble-sounding job: identifying have contact with her father. To BE enced in childhood had likely and addressing health disparities in San "I still have dreams about it," c 5 i A/fir- caused significant and long- Francisco,where the poverty rate for she told me. "I feel like'Pm - . — lasting chemical changes in black families is five times as high as that going to be damaged forever." both her brain and her body, for white families.Much of the city's I asked Sullivan to ex- and these changes could well African-American population lives in plain what that damage felt ' be making her sick,and also Bayview-Hunters Point,a largely indus- like. For a teen-ager, Sulli- increasing her chances of se- trial area that has a sewage-treatruent l van is unusually articulate nous medical problems in facility and a sprawling Superfund site. about her emotional state— adulthood. And Sullivan's Rates of congestive heart failure are when she feels sad or de- case wasn't unusual;Burke nearly five times as high in Bayview- pressed, she writes poems—and she was seeing the same patterns of trauma, Hunters Point as in the Marina district, , evoked her symptoms with precision. stress,and symptoms every day in many a few miles away.Before Burke's clinic She had insomnia and nightmares,she of her patients. opened,there was only one pediatrician ; said,and at times her body inexplicably Two years after Sullivan's first visit, in private practice in a community with ' ! ached. Her hands sometimes shook Burke has transformed her practice.Her more than ten thousand children. uncontrollably. Her hair had recently methodologyremains rooted in science, At Harvard, Burke had studied • started falling out,and she was wearing but it goes beyond the typical boundar- health disparities, and she knew what II a pale-green head scarf to cover up a . ies of medicine.Burke believes that re- the public-health playbook recom- thin patch. More than anything, she garding childhood trauma as a medical mended: improving access to health felt anxious: about school,her daugh- issue helps her to treat more effectively care, especially primary care,for low- ter, even earthquakes. "I think about the symptoms of patients like Sullivan. income families.She persuaded her new the weirdest things,"she said. "I think Moreover, she believes,this approach, bosses at California Pacific to let her about the world ending.If a plane flies when applied to a large population, open a clinic in Bayview-Hunters Point over me,I think they're going to drop might help alleviate the broader dys- that would accept all patients,regardless a bomb.I think about my dad dying. function that plagues poor neighbor- of their ability to pay. She found some If I lose him,I don't know what I'm hoods.In the view of Burke and the re- empty office space on Evans Avenue, going to do." She was even anxious searchers she has been following,many across from a giant mail-sorting facility, about her anxiety."When I get scared,I of the problems that we think of as so- and had the place remodelled and re- start shaking,"she said."My heart starts cial issues and therefore the province painted in bright colors. beating.I start sweating.You know how of economists and sociologists—might When the clinic opened, in 2007, people say,'I was scared to death'?I get better be addressed on the molecular Burke focussed on health issues that par- scared that that's really going to hap- level, among neurons and cytokines titularly plagued poor children:asthma, pen to me one day." and interleukins.If these researchers are obesity,vaccination rates. In just a few Sullivan encountered Nadine Burke right,it could be time to reassess the re- months,she made significant headway. at a moment when Burke was just be- lationship between poverty,child devel- "It turned out to be surprisingly easy to a nning to think deeply about the phys- opment, and health, and the Bayview get our immunization rates way up and ical effects of anxiety. She was im- clinic may turn out to be a place where to get our asthma hospitalization rates mersing herself in the rapidly evolving a new kind of pediatric medicine is talc- way down,"she told me.And yet, she sciences of stress physiology and neuro- ing its tentative first steps. explained,"I felt like we weren't actually endocrinology, staying up late read- "With someone like Monisha,we addressing the roots of the disparity. I ing journals like Molecular Psychiatry can help her recognize the neurochem- mean,as far as I know,no child in this • and Nature Neuroscience.Burke had just ical dysregulation that her childhood has community has died of tetanus in a very, learned of a pioneering study, con- produced in her,"Burke told me."That very long time." ducted in San Diego,on the long-term will reduce her impulsivity,it will allow Burke found herself thinking in- 26 THE NEW YORKER,MARCH 21,2011 • creasingly about the problems that she faced every day were producing not just this generally well-off population.More couldn't immunize her patients against: emotional difficulties but also serious than a quarter of the patients said they homelessness, gang violence, physical medical consequences,both present and had grown up in a household in which abuse,and sexual abuse, as well as ab- future. Burke told me that when she there was an alcoholic or a drug user; • sent fathers, fathers beating mothers, finished reading about the ACE study about the same fraction had been beaten i brothers shot to death on the street,un- she"could hear the angels singing.The as children.The doctors used the data to des sent to prison.These problems were, clouds parted."She laughed."It was like assign patients an"ACE score,"giving technically,none of her business.If you that scene at the end of'The Matrix' them one point for each category of want to tackle violence and abuse and where Neo can see the whole universe trauma they had experienced. Two- - deprivation in the inner city,you don't bending and changing."Maybe social thirds of the patients had experienced at i go to public-health school;you become problems were her business after all. least one category;one in six had an ACE k asocial worker or a judge or a cop.What The ACE study was an ambitious score of 4 or higher.The second, and did the field of medicine really have to undertaking.Beginning in 1995,Kaiser more significant, surprise came when offer kids like Monisha Sullivan,be- H.M.O.members in the San Diego area Anda and Felitti compared the ACE sides a little ProAir and permethrin? who came in for a comprehensive medi- scores with the voluminous medical his- Then, one day in the fall of 2008, cal exam were later sent a questionnaire tories that Kaiser had collected on each Whitney Clarke, a psychologist who asking them to describe their personal patient.The correlations between ad- had recently joined the clinic's staff, history in various categories—first eight, verse childhood experiences and negative handed Burke a six-year-old medical then ten—of"adverse childhood ex- . adult outcomes were so powerful that article that he had read online.Titled periences,"including parental divorce, they"stunned us," Anda later wrote. "The Relationship of Adverse Child- physical abuse, emotional neglect, and And those correlations seemed to follow hood Experiences to Adult Health: sexual abuse,as well as growing up with a surprisingly linear"dose-response" I Turning Gold Into Lead,"its author was family members who suffered from men- model: the higher the ACE score, the Vincent J.Felitti,the head of the depart- tal illness,alcoholism,or drug problems. worse the outcome, on almost every ment of preventive medicine at Kaiser In the course of a few years,more than measure, from addictive behavior to Permanente, the health-management seventeen thousand patients completed chronic disease.Compared with people organization based in California.The and returned the questionnaire—a re- who had no history of ACEs,those with amide described the Adverse Childhood sponse rate of nearly seventy per cent.As ACE scores of 4 or higher were twice as i Experience study,commonly called the a group,the respondents represented a likely to smoke,seven times as likely to • ACE study,which assessed the health mainstream,middle-to-upper-middle- be alcoholics,and six times as likely to outcomes of patients enrolled in the class demographic: sixty-nine per cent have had sex before the age of fifteen. i Kaiser H.M.O.between 1994 and 1998. were Caucasian; seventy-four per cent They were twice as likely to have been Felitti had conducted the study with had attended college;their average age diagnosed with cancer,twice as likely to ;f Robert F.Anda,an epidemiologist at was fifty-seven. have heart disease, and four times as the Centers for Disease Control,in At- Anda and Felitti found a number of likely to suffer from emphysema or lanta.The study indicated to Burke that unexpected results. The first was the chronic bronchitis.Adults with an ACE the traumatic experiences her patients prevalence of adverse experiences among score -times as likely of 4to or higher teen were tweBuie de than those with an ACE score of 0.And men with an ACE score of 6 or higher were 11116..4 forty-six times as likely to have injected drugs than men who had no history of 0 ' ACEs. CI° Some of the results made intuitive 0 • �� 1 I sense. Sigmund Freud had argued that l., traumatic events in childhood could 10".°) �_: �'' ,��i rillrdp r produce negativefeelingsinadulthood, anditwasreasonabletoassumethat61'11111. '� �� �Athose feelings could lead to addiction, depression, and even suicide. But what 111111111Labout cancer and heart disease?Felitti 16 � ice, A and Anda started with the assumption I _. i �� that ACEs led to chronic illness through behaviors like smoking,heavy drinking, R1( and overeating,which would produce • I E increased rates of lung cancer,liver dis- ease, diabetes, and heart disease.The problem with this theory was that ACEs "This is Lawrence—he does something with right-wing smearing." had a profound negative effect on adult health even when those behaviors weren't evident.The researchers looked at pa- r tients with ACE scores of 7 or higher / — who didn't smoke, didn't drink to ex- - `L GTiy. • cess,and weren't overweight,and found Q% off ��� - y� that their risk of ischemic heart disease 9 `/ �I 1 (the most common cause of death in the United States)was three hundred and C ,-.,.(c, {y , , sixty per cent higher than it was for pa � ; `' _ �?�`r tients with a score of 0. Somehow,the -x / L- ti - 1 �t�. ' r /k tt`i �r Si i` " (41, . traumatic experiences of their child yf 1 f hoods were having a deleterious effect L�4 i,,`C. ,. /on their later health,through a path- .) �` ��� 1 7�li / waythat had nothingto do with bad _1i `t ---- ,�, f \ \ behavior.But Felitti and Anda couldn't �, ; V /`, /i I �� . A— figure out what it was. E 1lt) 1 �l q 6� — has not, on the 1�' `j - - • — The medical fieldis fL whole,been quick to embrace Anda and — _ �? ///,,,{{{_^^^ .adr -` , - p.`,.. ` c t� Y11I) Felitti's findings.The main critique of _ .- �- z' <- / + , &r _ n — the ACE study is that it is retrospective, c` _�--3- _ - meaning that it relies on the memory 8- S and the credibility of the original respon- dents.Maybe some patients misremem- `lire you looking to accentuate or camouflage?" bered or even invented their traumatic experiences; perhaps the respondents with the most wayward adult lives were the most eager to blame external forces, even imaginary ones, for their poor primary care medical practice in Amer- similar to that of the Kaiser respondents. health. (VVhy do I smoke and overeat? ica."And ifs true that,if the data set is The data in the Dunedin study,however, • Because my parents didn't love me.) accurate,it poses a significant challenge are prospective, not retrospective; in Anda and Felitti have responded to this to the way that we diagnose and treat other words, the adverse experiences criticism in subsequent papers, saying many diseases.For example,the Amen- were reported by children or parents,or that underreporting of trauma is more can medical system spends billions of observed by researchers,more or less as likely than overre ortin ; even in this dollars each year measuring and tryingto they happened,rather than recalled by j confessional age, people are often un- lower people's cholesterol,because we adult patients.The Dunedin researchers comfortable acknowledging childhood know that having a cholesterol reading didn't include some of the most common sexual abuse or an alcoholic parent. In above two hundred and forty milligrams adverse experiences counted by Anda the end,though,Anda and Felitti have per decilitre doubles your chance of heart and Felitti,like the alcoholism of a fain- no way of knowing for certain how hon- disease. But, according to the Kaiser ily member,but they still found that forty est the respondents were. -study,so does having four or more ACEs. per cent of the children encountered one Compounding this problem is the So if we trust the data,and we want to or more adverse experiences.And they 1 fact that Anda and Felitti,in their ini- prevent heart attacks,it makes as much found similar'correlations between early tial papers,were unable to come up with sense to try to reduce ACEs,or counter trauma and later health problems: the i a solid explanation for why adverse their effects, as it does to try to lower children who were victims of maltreat- childhood experiences produced serious cholesterol. ment, including maternal neglect and health problems in adulthood.Ifyou go physical and sexual abuse,were almost 1 to the main C.D.C.Web page dedi- I)uring the past decade, other re- three times as likely to experience major 1 cated to the ACE study,you'll see a sche- searchers have attempted to ad- depression by their early thirties, and 1 matic diagram that traces a path from dress many of the initial concerns about they were almost twice as likely to have adverse childhood experiences through the ACE data. One important source of an elevated risk of heart disease. "social, emotional, and cognitive im- corroboration has come from researchers Although the Dunedin study but- pairment"and"adoption of health-risk in Dunedin, New Zealand,who, for tressed some of the basic findings of the behaviors"to disease, disability, and more than thirtyyears,have been follow- Kaiser study,it didn't fully clarify the early death. But beside this diagram, ing a group of a thousand people born mechanisms at work. But,in the years • linking the causes to the effects,are big there between April, 1972,and March, since the first ACE paper was published, blue arrows labelled"Scientific Gaps." 1973.According to a recent analysis pub- other researchers,working with rats and Despite this uncertainty,Felitti has lished in the Archives ofPediatrics&Ad- primates as well as with humans,have written that the ACE data"have given us olescent Medicine, the incidence of early made advances in explaining how early reason to reconsider the very structure of trauma among the Dunedin cohort is trauma creates lasting changes-in the THE NEW YORKER,MARCH 21,2011 29 • shown high-sensitivity C-reactive pro- . :,h, / I tein to be a leading marker for cardiovas- V/ .,._ cular disease. S .:„ . �. - . "\\A J Such research provided Nadine Burke / z,-. � , u �� with a new way to evaluate what she was • ' ly`" � -i seeing in her clinic, and in Bayview- \,., \ \ \ as f \ \' 2 ` Hunters Point as a whole. "In many (.111v '-%. cases,what looks like a social situation is _ I ��' ' actually a neurochemical situation," � , o -- " Burke explained one afternoon at the Ate; clinic."You can trace the pathology as it �/!� tAP moves from the molecular level to the so- 'M` � *11 ;iii dal level.You have a girl who grows up sf . _ in a household where there's domestic vi- _ _ olence,or some kind of horrible arguing F�1��,,v,_ ,r 1-- between her parents.That triggers her > ' , .- "` - _-__' fight or-flight response,which affects } � := ' : �y -- - the way the hormone receptors in her SZ u-t,0"/U.N`""^^ `..+� , t101,-r . brain develop,and as she grows up her "Westminster's over,Shep it's all aboutpossums now." stress-regulation system goes off track Maybe she overreacts to confrontation, . • or maybe ifs the opposite—that she doesn't recognize risky situations, and feels comfortable only around a lot of 1 brain and the body.The key pathway is stress.In rat studies,Meaney has found drama. So she ends up with a partner the intricately interconnected system that signs that these methylation patterns can who's abusive. Then the pathology our brain deploys in reaction to stressful be reduced by parental nurturing.If the moves from the individual level to the 'II events.This system activates defenses on methylation isn't counteracted,however, household level, because that partner f many fronts at once,some of which we its effects can last a lifetime.Researchers beats their kids,and then their son goes ( can recognize as we experience them:it have observed that schoolchildren who to a school where ten out of thirty kids • produces emotions like fear and anxiety, experience early trauma find it harder to are experiencing the same thing.Those I as well as physical reactions,including in- sit still and to follow directions.As teen- kids create in the classroom a culture of creased blood pressure and heart rate, agers,they are more likely to be drawn to hitting,of fighting—not just for the ten , clammy skin,and a dry mouth. Other high-risk behaviors.As adults,they often kids but for all thirty.Then those kids get bodily reactions to stress are less evident: show increased aggression, impulsive a little older,and they're teen-agers,and hormones are secreted,neurotransmit- behavior,weakened cognition, and an they behave violently,and then they beat ters are activated,and inflammatory pro- inability to distinguish between real and their kids.And it's just accepted.It be- teins surge through the bloodstream. imagined threats. comes a cultural norm.It goes from the As a response to short-term threats, When it comes to adult health,the individual fight-or--flight adrenaline re- this system is beneficial,even essential. most important element of the stress re- sponse to a social culture where it's,like, But researchers like Bruce McEwen, a sponse is the immune system,which, 'Oh,black people beat our kids.That's neuroendocrinologist at Rockefeller during moments of acute anxiety,releases what we do.." University,and Frances Champagne,a a variety of proteins and other chemical In the nineteen-sixties,federal policy- neuroscientist at Columbia University, signals into the bloodstream.In the short makers were influenced by scientific re- have shown that repeated,full-scale acti- term,this process promotes resistance search that established direct connections vation of this stress system,especially in to infection and prepares the body to re- between childhood disadvantage and early childhood,can lead to deep physi- pair tissues that might be damaged. diminished educational outcomes. Re- cal changes.Michael Meaney,a neuro- After the short-term threat disappears, searchers of that period demonstrated biologist at McGill University,and his this inflammation subsides,unless the that disparities in early-childhood expe- colleagues have found that early adversity system gets overloaded, in which case rience produced disparities in cognitive actually alters the chemistry of DNA in these chemicals can build up,with toxic skill—most significant,in literacy—that the brain,through a process called meth- effects on the heart and other organs.The could be observed on the first day of ylation.Traumatic experiences can cause Dunedin researchers found that adults kindergarten and well into adulthood. tiny chemical markers called methyl in their thirties who had been mistreated Out of that science came a wave of early- groups to affix themselves to genes that as children were nearly twice as likely to childhood programs designed to address III govern the production of stress-hormone have elevated levels of an inflammatory those gaps,from Head Start to"Sesame receptors in the brain.This process dis- protein in their blood—high-sensitivity Street."Fifty years later,another genera- ables these genes,preventing the brain C-reactive protein—as adults who had tion of scientific advocates has begun to from properly regulating its response to not been mistreated.Many studies have make the case for a broader approach, 80 THE NEW YORKER,MARCH 21,2011 S.t one that aims at protecting children from ation in rat brains with doses of certain other doctors might talk about blood- both the mental and the physical conse- psychoactive drugs.Though scientists pressure readings;the ACE score is,for call these findings promising,they also them,a basic measure of health and an quences of early adversity. • Jack P.Shonkoff,a professor ofpedi- express caution.This kind ofpharmaco- essential tool in planning treatment.In at tics at Harvard Medical School,has logical assault on methylation in the early 2009,Burke made a modified ver- emerged as a leader of this campaign.He brain has never been tested in humans, sion of the Felitti-Anda ACE question- headed a group that produced,in 2000, and such a drug regimen would likely naire a standard part of the annual phys- ` "From Neurons to Neighborhoods," a have many side effects.In the Meaney ical exam for patients. She has now groundbreaking study from the National experiment,furthermore,the drugs were analyzed data on more than seven hun- Research Council that recommended injected directly into the rats'brains. dyed patients,which has allowed her to early intervention for disadvantaged chit- Other researchers have produced evi- draw some preliminary conclusions I dren.He is now the director of the Cen- dence that they can mend children's about the effect of ACEs on the local I ter on the Developing Child,an interdis- overtaxed stress-response systems by population. ciplinary group at Harvard that works changing the behavior of their parents It is difficult to directly compare ACE I` with scientists and legislators to translate or caregivers.A study in Oregon drew scores among Burke's patients with those research into policy. Shonkoff cites the this conclusion after assessing a program in the original Kaiser sample.The Kai- ACE study in his center's reports,and he that encouraged foster parents to be ser patients were looking back from 1 respects Anda and Felitti's work,but he more responsive to the emotional cues of adulthood on their entire childhood;the calls the research of McEwen,Meaney, the children in their care.Another study, median age of Burke's patients is a little and others a"revolution in biology."As in Delaware,tracked a program that pro- more than seven,and in many cases their he said to me recently,"It's not like we moted secure emotional attachment be- ACE scores are just starting to add up, need a strategy for learning and a strategy tween children and their foster parents. and will continue to rise through adoles- for health and a strategy for character. In each study,researchers measured, at cence. Their current scores may also The beauty of the science is that it's various points in the day, the children's often be artificially reduced by the fact showing us how all of these have corn- levels of cortisol, the main stress hor- that parents generally provide the re- mon roots.We now know that adversity mone,and then compared these cortisol sponses for young children,and they are I early in life can not only disrupt brain dr- patterns with those of a control group of unlikely to volunteer that their children cuits that lead to problems with literacy, foster kids whose parents weren't in the are the victims of,say,emotional neglect. it can also affect the development of the program.In both studies,the children Even so,Burke's data reveal some inter- cardiovascular • system and the immune whose foster parents received the inter- esting patterns. system and metabolic regulatory sys- vention subsequently showed cortisol Sixty-seven per cent of her patients tems, and lead to not only more prob- patterns that echoed those of children have had one or more ACEs,and twelve lems learning in school but also greater brought up in stable homes. per cent have had four or more. Al- risk for diabetes and hypertension and In terms of helping older children and though it is too early for Burke to study heart disease and cancer and depression adolescents who have experienced early chronic maladies, such as obstructive I and substance abuse.This is a very excit- trauma,the research is less solid.There is pulmonary disease,in her patients, she ing opportunity to bring biology into evidence that certain psychological regi- has been able to demonstrate a strong early-childhood policy." mens, especially cognitive-behavioral correlation between ACE scores and Shonkoff and Burke are still strug- therapy,can reduce anxiety and depres- problems in school In a paper that Burke gling to figure out how to put this new sion in patients who are suffering from and several co-authors will soon publish I theory into clinical practice.The science the stress of early trauma.But,beyond in ChilclAbuse&Neglect,they report that does provide powerful evidence that in- that,little is known,which means that, just three`per cent of her patients with an ;1 tervening early can improve later out- for now,Nadine Burke is trying to figure ACE score of 0 display learning or behav- I comes in an individual's health as well things out on her own. ioral problems.Among patients with an I as in his education and his behavior.And ACE score of 4 or higher,the figure is researchers working with rats say they F very Monday afternoon at one fifty-one per cent. have found indications that the physio- i o'clock, the staff of the Bayview At the Bayview clinic,having the pa- I logical effects of stress can be reversed clinic doctors,therapists,social work- tients'ACE data,and a theoretical frame- well into adolescence,or even adulthood. ers—meet in the therapy room for what work for discussing the effects of trauma, I But there's not yet a lot of good data to Burke has named "multidisciplinary has inspired Burke and her colleagues to tell us which kinds of interventions are rounds."The meeting is modelled on be more vigilant about abuse and neglect. most effective. the kind of dialogues between specialists It also makes them more likely to help One approach that scientists have ex- that almost never occur in primary-care children get the social services they need, amined is psychopharmacology.fighting facilities but that do take place in the best and better prepared to talk to parents • chemicals with chemicals,by directly tar- cancer centers,where a patient's oncolo- early about the importance of secure geting the mechanisms in the brain that gist coordinates care with surgeons and attachment j get overloaded by early stress.Research- other specialists. For some children,Burke prescribes ers in Meaneys lab found that they were Burke and her colleagues discuss var- one or more psychological therapies. able to counteract stress-related methyl- ious patients'ACE scores the way that Whitney Clarke, the psychologist who THE NEW YORKER,MARCH 21,2011 31 • ri introduced Burke to the ACE study,has reduction therapies.Soon after meeting slamming fights.Sullivan started therapy an office at the clinic,and regularly sees Burke,Harris helped direct two million with Whitney Clarke,and had so much about a dozen of Burke's patients.To dollars in city funds toward the new cen- to tell him each week that she asked if treat younger children growing up in ter.Last May,Tipping Point Commu- they could schedule sessions lasting • high-risk homes,Burke is collaborating nity raised four million dollars for the ninety minutes,instead of the usual fifty. „ with Alicia Lieberman, a leading San center in a single evening. Lurie and She worked hard to develop a stable re- Francisco psychologist who is a pioneer Burke say that the new center is on track lationship with her father,and her con- of child-parent psychotherapy,which to open next year. nection with her daughter grew tighter. enables therapists to work simultane- Burke's goal is a treatment protocol, "When I first had Sarai,I didn't hate her, ously with children under five and their like the one doctors use when they're but I didn't love her,"she told me last parents.Perhaps not surprisingly for a dealing with cancer or diabetes."For can- September."But I really love her now." resident of San Francisco, Burke em- cer patients, someone comes in, they Last spring, she graduated from high braces alternative therapies as well. She have stage-four breast cancer, they're school,and she started college in the fall, refers a few patients each month to a bio- BRCA-negative,they have these differ- taking classes in theatre and video pro- feedback clinic at a hospital in Presidio ent types of comorbid factors,"she ex- duction at a San Francisco art school. Heights, where the children practice plained one day last fall."As a doctor,you Yet,last fall,as I visited Sullivan every self-calming exercises while watching can look up that combination of indica- month or so,it seemed that each time we schematic representations of their vital tors,and you know what to do.I would spoke there was a new setback. School signs on a computer screen. She has love to see a treatment protocol that says, was a challenge.There was never enough steered some teen-age patients towardyou know,this child comes in,she's six money. She was assaulted, she said, meditation,yoga,and a relaxation tech- years old.She has a history of intrauter- by an ex-boyfriend she had invited over nique called Mind Body Awareness. ine drug exposure and domestic vio- one night,to stave off loneliness.Then The next step,according to Burke,is lence."Burke ticked her way down an the city told her that she had to move to combine these interventions.She has imaginary medical chart. "She is here out of her sunny apartment off Fill- • begun creating a network of resourceful today following removal from the home more Street to a small,dark place back and like-minded San Franciscans who and foster-care placement after six years in Hunters Point. want to expand the ambitions of her of physical and emotional abuse by dad When Sullivan started school,Holmes clinic.In 2006,Burke met a young lo- and neglect by mom.And she's mani- offered tokeep Sarai with her in Oakland j• cal philanthropist named Daniel Lurie, festing A,B,and C symptoms.And you during the week, so that Sullivan could • an heir to the Levi-Strauss fortune;his could say,'O.K.,let's start with twelve focus on her studies. Sullivan was grate- foundation,Tipping Point Community, weeks of biofeedback, overlaid with a ful,but it made her feel guilty and inad- began contributing to the clinic before one-year course of insight-oriented ther- equate, and she wondered if she would it had even opened. In the spring of apy,and go from there.'" One patient ever be ready to take care of Sarai on her 2008,Burke met Kamala Harris,then might need to be removed from an abu- own."I'm trying to be everything my par- the San Francisco district attorney(and sive home;another might benefit from ents weren't,"she told me."And it's not now the attorney general of a course of antidepressants or working." She was determined to im- California); Burke told her a better diet.Burke acknowl- prove her life—her cell-phone ringtone about the ACE research, and (' edges that it will take a lot of is the Miley Cyrus song"The Climb,"an Harris said that she wanted to A. ) work to get her field to the level inspirational ballad about overcoming ob- help. Harris then introduced lip iME of practical coherence where, stades—but her anxiety had not dimin- Burke to Victor G.Carron— LEs say,oncology is today.But she ished."Sometimes the stress is just too 11 LL ES. _� also contends that the only way much for me to bear,"she said one day."I the director of a research pro gram on early life stress at the to even approach that goal is don't see how people deal with it." Lucile Packard Children's to begin testing different corn- Burke is realistic about the challenges Hospital,a Stanford facility— binations of therapies in a din- that Sullivan and other patients face,and and Katie Albright,the daugh- ical setting. there are plenty of days,she says,when For many of Burke's pa- their problems feel overwhelming,even ter of Madeleine Albright, the former Secretary of State, ,, „t tients,especially the older ones, for her. Nevertheless, she is convinced and the executive director of it's going to be very difficult that her new methodology will give pa- the San Francisco Child Abuse Preven- to reverse the effects ofyears of adversity. tients a better chance at good health and tion Center.Now Burke,Lurie,Harris, In many ways, Monisha Sullivan has a good future."Look,ifs not the answer Carrion, and Albright are working to flourished under the care of the Bayview for a hundred per cent of everyone's so- open a new center for child services in clinic.Her asthma is under control,and cial problems,"she told me."Ifs not that Bayview-Hunters Point that would in- she has finally had a full set of immuni- if we poured all of our money into treat- ", dude a medical clinic, family-support zations.In 2009,she was assigned to yet ing ACEs the jails would empty out and services, a child-abuse-response pro- another foster home, in Oakland, and we would no longer have any kids in gram, and an expanded staff of social she and her new foster mother,a grand- special ed.But this is a huge,huge issue, workers and psychotherapists,as well as motherly type named Ethel Holmes, and as a society I don't think we've even space for biofeedback and other stress- found a way to coexist without door- come dose to grasping its significance."• 32 THE NEW YORKER,MARCH 21,2011 • Board of 3feaCth NewBusiness .agenda Item # T., 1 • 2011 Public afeaCth Heroes .Ativards AjoriC21, 2011 s .S., K JEFFERSON COUNTY PUBLIC HEALTH • 615 Sheridan Street • Port Townsend •Washington •98368 S'` www.jeffersoncountypublichealth.org For Immediate Release: April 11, 2011 Contact person: Jean Baldwin Jefferson County Public Health Phone: 360-385-9400 Public Health Hero Awards for 2011 "Safety is No Accident". Port Townsend, - In honor of National Public Health Week, Jefferson County Board of Health (BOH) will recognize individuals receiving the 2011 Public Health Heroes , awards for their contributions that make our community better. This year the theme for National Public Health Week is"Safety is No Accident". Once again the community has nominated amazing individuals - Local Public Health Heroes, who make our community safer. Awards will given at the April 21 BOH meeting. Heroes receiving a Special Recognition Award are: the Ecumenical Christian Helping Hands Organization (ECCHO) made up of 75 volunteers who drove 40,511 miles last year transporting elderly, disabled or low income residents of Jefferson County to medical appointments, critical errands or appointments. These heroes are the volunteers who served 849 residents in 2010 from Brinnon to Port Townsend. S Heroes in the Community Based Organization category are: the 400 individuals from the Community Outreach Association Shelter Team (COAST) who staff two shifts a night in the homeless shelter and provide meals. The group of 15 faith-based and service organizations, 14 businesses, and countless individuals all giving time, money and goods to keep this shelter open for 15-17 people a night in the winter - all serve to make this community a better place to live. Heroes in the Public Health Leadership category are: the 60 volunteers who work in the four Food Banks in Jefferson County. Their 26,500 hours of service in 2010 supplied a safety net to alleviate hunger in our community. Heroes provided 77,000 visits in 2010 alone, and drove 7,000 miles to acquire some of the food. Heroes in a business setting: represented by the Recyclery, run by Chancey and Dash Tudhope-Locklear. Their bike maintenance classes are offered at Grant Street, Boiler Room, and the Food Coop. Their recycled bikes and parts keep many people rolling safely to health, and they are role models to many kids - modeling safety through the use of a bike helmet. Hero in the Community Health Promotion category: Linda Pfafman, Jefferson County Sheriff's office, nominated for her work with Child Safety Seat training and instruction to individuals in the community. The 2011 Public Health Heroes will be recognized for their achievements April 21, 2011, 2:30 PM, at Jefferson County Public Health, 615 Sheridan, Port Townsend. Always Working for a Safer & Healthier Jefferson County S COMMUNITY HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIES PUBLIC HEALTH WATER QUALITY MAIN: (360)385-9400 ALWAYS WORKING FOR A SAFER AND MAIN: (360)385-9444 FAX (360)385-9401 HEALTHIER CO rry FAX: (360)379-4487 • Board of 3-fealth Netiv Business ,agenda Item #"V., 3 • County aCealth Ranking Report Apri12l, 2011 • County Health Rankings ,. ... , ..,,..: „,„,„,..„..,,,,,,,,,,„,,,„ Mobilizing Acti, , on Toward Community Health 2011 Washington • UNIVERSITY OF WISCONSIN iiii=i Population Health Institute nt Robert Wood Johnson Foundation iFfil Translating Research into Policy and Practice • County Health Rankings 2011:Washington Introduction • Where we live matters to our health.The health of a All of the County Health Rankings are based upon this community depends on many different factors,including model of population health improvement: quality of health care, individual behavior,education and jobs,and the environment.We can improve a Health Outcomes-, community's health through programs and policies. For example,people who live in communities with ample park and recreation space are more likely to exercise, which reduces heart disease risk. People who live in communities with smoke-free laws are less likely to Health Factors smoke or to be exposed to second-hand smoke,which reduces lung cancer risk. The problem is that there are big differences in health across communities,with some places being much Programs anti Paiicles healthier than others.And up to now, it has been hard to get a standard way to measure how healthy a county is In this model, health outcomes are measures that and see where they can improve. describe the current health status of a county.These health outcomes are influenced by a set of health factors. The Robert Wood Johnson Foundation and the These health factors and their outcomes may also be University of Wisconsin Population Health Institute are affected by community-based programs and policies pleased to present the 2011 County Health Rankings,a designed to alter their distribution in the community. collection of 50 reports that reflect the overall health of Counties can improve health outcomes by addressing all counties in every state across the country. For the health factors with effective,evidence-based programs second year in a row,counties can get a snapshot of and policies. how healthy their residents are by comparing their overall health and the factors that influence their health with To compile the Rankings,we built on our prior work in other counties in their state.This allows communities to Wisconsin,obtained input from a team of expert • see county-to-county where they are doing well and advisors,and worked closely with staff from the National where they need to improve. Center for Health Statistics.Together we selected a number of population health measures based on Everyone has a stake in community health.We all need scientific relevance,importance, and availability of data to work together to find solutions.The County Health at the county level. Rankings serve as both a call to action and a needed tool in this effort. For a more detailed explanation of our approach,the methods used to compile the Rankings, information on TAKEACTION the action steps communities can take to improve their WORK TOGETHER health, and examples of communities in action, see www.countvhealthrankings.orq Evaluate Assess Needs ENorts 8 Resources Grantmakers euatriess Publft Health community Healthcare Implement Pick Strategies Priorities Government EakilOrt Find Programs& Policies That work • www.countyhealthrankings.org/washington County Health Rankings 2011:Washington The Rankings This report ranks Washington counties according to their Our summary health outcomes rankings are based on • summary measures of health outcomes and health an equal weighting of mortality and morbidity measures. factors,as well as the components used to create each The summary health factors rankings are based on summary measure.The figure below depicts the weighted scores of four types of factors: behavioral, structure of the Rankings model.Counties receive a rank clinical,social and economic, and environmental.The for each population health component;those having high weights for the factors(shown in parentheses in the ranks(e.g., 1 or 2)are estimated to be the"healthiest." figure)are based upon a review of the literature and expert input,but represent just one way of combining these factors. Mortality(length of life)50% Health Outcomes Morbidity(quality of life)50% I Tobacco use i; t .., Diet&exercise IFP�4i4r.". >di a� a 4 watt } V .,. Alcohol use L. Unsafe sex 1 r r 44A- ` Access to care � y�A 4� F 6 * <,. «..,- Quality of care j F Health Factors Education is =- 1—.v, Employment �lys.L izt. tp, 1 .'ii l4 � VIncome ter,. Family&social support 1 Community safety t 1 4, ' t »,,, 1- Environmental quality Programsi.,—.:41,4?-7e,,•:',.:411.1� � tri ; �"`" " 1 Pries :` ''''. ....:-.',40.,1”,P7:' ,40,1-4:11,01'.w " Built environment County Health Rankings model©2010 UWPHI • www.countyhealthrankings.orglwashington County Health Rankings 2011:Washington The Rankings • This report ranks Washington counties according to their Our summary health outcomes rankings are based on summary measures of health outcomes and health an equal weighting of mortality and morbidity measures. factors, as well as the components used to create each The summary health factors rankings are based on summary measure.The figure below depicts the weighted scores of four types of factors:behavioral, structure of the Rankings model.Counties receive a rank clinical,social and economic, and environmental.The for each population health component;those having high weights for the factors(shown in parentheses in the ranks(e.g., 1 or 2)are estimated to be the"healthiest." figure)are based upon a review of the literature and expert input,but represent just one way of combining these factors. Mortality(length of life)50% Health Outcomes Morbidity(quality of life)50% Tobacco use Diet&exercise Alcohol use Unsafe sex • `'t rFj:! [ Accesstocare _ Quality of care 1 Health Factors "a Education Employment • , g 0 oIncome Family&social support Community safety � t :` Environmental quality Built environment County Health Rankings model©2010 UWPHI • www.countyhealthrankings.org/washington County Health Rankings 2011:Washington . Summary Health Outcomes & Health Factors Rankings Counties receive two summary ranks: Health outcomes represent how healthy a county is while * Health Outcomes health factors are what influences the health of the • * Health Factors county. Each of these ranks represents a weighted summary of a number of measures. Rank Health Outcomes Rank Health Factors 1 San Juan 1 San Juan 2 Kittitas 2 King 3 Whitman 3 Whitman 4 Island 4 Kittitas 5 King 5 Chelan 6 Whatcom 6 Whatcom 7 Chelan 7 Island 8 Douglas 8 Jefferson 9 Clark 9 Walla Walla 10 Franklin 10 Snohomish 11 Skagit 11 Thurston 12 Snohomish 12 Kitsap 13 Thurston 13 Benton 14 Benton 14 Spokane 15 Kitsap 15 Douglas 16 Skamania 16 Clallam • 17 Walla Walla 17 Columbia 18 Jefferson 18 Clark 19 Clallam 19 Skagit 20 Garfield 20 Garfield 21 Columbia 21 Lincoln 22 Spokane 22 Wahkiakum 23 Lincoln 23 Klickitat 24 Adams 24 Pierce 25 Pierce 25 Asotin 26 Klickitat 26 Franklin 27 Grant 27 Grant 28 Lewis 28 Lewis 29 Pacific 29 Stevens 30 Yakima 30 Mason 31 Grays Harbor 31 Skamania 32 Cowlitz 32 Okanogan 33 Stevens 33 Cowlitz 34 Pend Oreille 34 Yakima 35 Mason 35 Pend Oreille 36 Asotin 36 Adams 37 Okanogan 37 Pacific 38 Wahkiakum 38 Grays Harbor 39 Ferry 39 Ferry 11111 www.countyhealthrankings.org/washington County Health Rankings 2011:Washington Health Outcomes Rankings • The summary health outcomes ranking is based on The morbidity rank is based on measures that represent measures of mortality and morbidity. Each county's ranks health-related quality of life and birth outcomes.We for mortality and morbidity are displayed here.The combine four morbidity measures:self-reported fair or mortality rank,representing length of life, is based on a poor health,poor physical health days,poor mental measure of premature death:the years of potential life health days,and the percent of births with low lost prior to age 75. birthweight. Rank; Mortal' Rank; Morbid' `; 1 San Juan 1 San Juan 2 Whitman 2 Kittitas 3 Franklin 3 Douglas 4 King 4 Whatcom 5 Island 5 Island 6 Whatcom 6 Whitman 7 Chelan 7 Jefferson 8 Snohomish 8 King 9 Clark 9 Clallam 10 Kittitas 10 Chelan 11 Skagit 11 Skamania 12 Kitsap 12 Skagit 13 Benton 13 Clark 14 Thurston 14 Thurston • 15 Douglas Spokane 15 Garfield16 16 Pacific 17 Walla Walla 17 Snohomish 18 Adams 18 Lincoln 19 Pierce 19 Columbia 20 Columbia 20 Franklin 20 Garfield 21 Walla Walla 22 Skamania 22 Benton 23 Asotin 23 Kitsap 24 Lincoln 24 Klickitat 25 Grant 25 Lewis 26 Clallam 26 Grant 27 Klickitat 27 Spokane 28 Jefferson 28 Pierce 29 Yakima 29 Adams 30 Lewis 30 Stevens 31 Pend Oreille 31 Cowlitz 32 Grays Harbor 32 Grays Harbor 33 Cowlitz 33 Yakima 34 Mason 34 Mason 35 Okanogan 35 Wahkiakum 36 Pacific 36 Pend Oreille 37 Stevens 37 Okanogan 38 Wahkiakum 38 Ferry 39 Ferry 39 Asotin III www.countyhealthrankings.org/washington County Health Rankings 2011:Washington Health Factors Rankings The summary health factors ranking is based on four care includes measures of access to care and quality of • factors:health behaviors, clinical care,social and care.Social and economic factors include measures of economic,and physical environment factors. In turn, education,employment, income,family and social each of these factors is based on several measures. support,and community safety.The physical Health behaviors include measures of smoking,diet and environment includes measures of environmental quality exercise,alcohol use,and risky sex behavior.Clinical and the built environment. Rank Health Behaviors Clinical Care Social&Economic Factors Ph sical Environment 1 San Juan King Whitman Chelan 2 King Walla Walla San Juan Jefferson 3 Whitman Columbia King Kittitas 4 Jefferson San Juan Thurston Benton 5 Whatcom Chelan Kittitas Snohomish 6 Chelan Clallam Island Pacific 7 Walla Walla Spokane Kitsap Kitsap 8 Kittitas Asotin Benton Thurston 9 Franklin Cowlitz Lincoln Clallam 10 Island Kittitas Whatcom Walla Walla 11 Wahkiakum Whatcom Snohomish Whatcom 12 Clallam Snohomish Douglas Yakima 13 Klickitat Thurston Chelan Skagit 14 Douglas Jefferson Spokane Clark 15 Columbia Island Walla Walla Island 16 Snohomish Skagit Jefferson Spokane • 17 Clark Wahkiakum Clark Pend Oreille 18 Garfield Pierce Garfield Lewis 19 Thurston Kitsap Skagit Grant 20 Kitsap Okanogan Skamania Douglas 21 Benton Benton Columbia Grays Harbor 22 Skagit Pend Oreille Mason Garfield 23 Spokane Garfield Asotin Columbia 24 Lincoln Klickitat Lewis Franklin 25 Yakima Clark Clallam Cowlitz 26 Grant Lewis Pierce Skamania 27 Pierce Grant Stevens Stevens 28 Ferry Douglas Wahkiakum Adams 29 Adams Lincoln Grant San Juan 30 Stevens Mason Klickitat Asotin 31 Okanogan Stevens Adams Mason 32 Pend Oreille Yakima Cowlitz Whitman 33 Skamania Grays Harbor Franklin Klickitat 34 Asotin Skamania Pacific Pierce 35 Mason Adams Grays Harbor Ferry 36 Lewis Franklin Okanogan Okanogan 37 Pacific Whitman Yakima King 38 Grays Harbor Pacific Pend Oreille Wahkiakum 39 Cowlitz Ferry Ferry Lincoln • www.countyhealthrankings.org/washington County Health Rankings 2011:Washington 2011 County Health Rankings: Measures, Data Sources, and Years of Data • Measure Data Source Years of Data HEALTH OUTCOMES Mortality Premature death National Center for Health Statistics 2005-2007 Morbidity Poor or fair health Behavioral Risk Factor Surveillance System 2003-2009 Poor physical health days Behavioral Risk Factor Surveillance System 2003-2009 Poor mental health days Behavioral Risk Factor Surveillance System 2003-2009 Low birthweight National Center for Health Statistics 2001-2007 HEALTH FACTORS HEALTH BEHAVIORS Tobacco Adult smoking Behavioral Risk Factor Surveillance System 2003-2009 Diet and Exercise Adult obesity National Center for Chronic Disease 2008 Prevention and Health Promotion Alcohol Use Excessive drinking Behavioral Risk Factor Surveillance System 2003-2009 Motor vehicle crash death rate National Center for Health Statistics 2001-2007 High Risk Sexual Sexually transmitted infections National Center for Hepatitis,HIV,STD and 2008 Behavior TB Prevention Teen birth rate National Center for Health Statistics 2001-2007 CLINICAL CARE Access to Care Uninsured adults Small Area Health Insurance Estimates, 2007 U.S.Census Primary care providers Health Resources&Services 2008 Administration Quality of Care Preventable hospital stays Medicare/Dartmouth Institute 2006-2007 Diabetic screening Medicare/Dartmouth Institute 2006-2007 Mammography screening Medicare/Dartmouth Institute 2006-2007 • SOCIOECONOMIC FACTORS Education High school graduation National Center for Education Statistics' 2006-2007 Some college American Community Survey 2005-2009 Employment Unemployment Bureau of Labor Statistics 2009 Income Children in poverty Small Area Income and Poverty Estimates, 2008 U.S.Census Family and Social Inadequate social support Behavioral Risk Factor Surveillance System 2005-2009 Support Single-parent households American Community Survey 2005-2009 Community Safety Violent crimen Uniform Crime Reporting,Federal Bureau 2006-2008 of Investigation PHYSICAL ENVIRONMENT Air Quality3 Air pollution-particulate matter U.S.Environmental Protection Agency/ 2006 days Centers for Disease Control and Prevention Air pollution-ozone days U.S.Environmental Protection Agency/ 2006 Centers for Disease Control and Prevention Built Environment Access to healthy foods Census Zip Code Business Patterns 2008 Access to recreational facilities Census County Business Patterns 2008 State data sources for KY, NH, NC, PA, SC,and UT(2008-2009). 2 Homicide rate(2001-2007)from National Center for Health Statistics for AK,AZ,AR, CO,CT,GA, ID, IN, IA, KS, KY, LA, MN, MS, MT, NE, NH, NM, NC,ND,OH, SD, UT, and WV.State data source for IL. 3 Not available for AK and HI. www.countyhealthrankings.org/washington Jefferson, Washington I Archived Data Uounty Health xaniungs rage i 01'3 • 2010 I JEFFERSON, WASHINGTON I ARCHIVED DATA Population Estimate, 2009: 29,676 To see more details, click on a measure. Jefferson Error Target Rank Washington County Margin Value* (of 39) Health Outcomes 11 Mortality 24 Prematuredeath 7,129 5,857-8,401 5,245 5,979 -_-....-_. Morbidity 4 • Poor or fair health 13% 10-16% 11% 13% Poor physical health days 4.0 3.1-4.8 3.1 3.5 Poor mental health days 3.4 2.7-4.1 2.6 3.3 Low birthweight 4.2% 3.2-5.3% 4.7% 6.0% Health Factors 8 Health Behaviors 3 Adult smoking 17% 14-21% 14% 18% Adult obesity 21% 18-24% 22% 26% Binge drinking 14% 11-17% 11% 15% Motor vehicle crash death rate 21 14-27 10 12 Chlamydia rate 109 98 294 • httn://www.countyhealthrankings.org/washington/jefferson/archived-data/2010 4/14/2011 Jefferson, Washington I Archived Mata i i:ounty Health xanxings rage L ui • Teen birth rate 32 27-37 21 34 Clinical Care 18 Uninsured adults 19% 16-22% 13% 14% Primary care provider rate 143 163 136 Preventable hospital stays 43 39-47 37 50 Diabetic screening 80% 75-85% 88% 85% Hospice use 20% 14-27% 36% 29% Social & Economic Factors 5 High school graduation 85% 89% 73% College degrees 35% 31-39% 35% 30% Unemployment 6% 5-6% 5% 5% •!dren in poverty 18% 14-21% 12% 15% Income inequality 43 40 44 Inadequate social support 17% 14-21% 15% 17% Single-parent households 5% 3-7% 6% 9% Violent crime rate 253 82 342 Physical Environment 39 Air pollution-particulate matter days 10 0 2 Air pollution-ozone days 0 0 0 Access to healthy foods 29% 64% 47°k Liquor store density 1.4 0.5 * 90th percentile, i.e., only 10% are better Note: Blank values reflect unreliable or missing data • httn://www.countyhealthrankings.org/washington/jefferson/archived-data/2010 4/14/2011 Compare Counties I County Health Kanlungs rage i of i • 2011 I WASHINGTON I COMPARE COUNTIES Jefferson Washington County -idi1n- - � Kitsap Health Outcomes 18 19 15 Mortality 28 26 12 Premature death 5,915 7,560 7,418 5,734 Morbidity 7 9 23 Poor or fair health 13% 13% 14% 13° Poor physical health days 3.6 3.9 4.1 3.8 Poor mental health days 3.3 3.6 3.5 3.5 Low birthweight 6.1% 4.7% 4.7% 6.3% Health Factors 8 16 12 Health Behaviors 4 12 20 Adult smoking 17% 17% 17% 19% Adult obesity 27% 22% 27% 28% Excessive drinking 16% 17% 13% 17% Motor vehicle crash death rate 12 18 21 10 Sexually transmitted infections 331 149 225 333 • hnnJ/www.countvhealthrankings.org/washington/jefferson/compare?compare2=009&compare3=035 4/14/2011 Compare Counties 1 County Health Kankmgs rage z 01 i S Teen birth rate 34 31 34 32 Clinical Care 14 6 19 Uninsured adults 15% 17% 16% 14% Primary care providers 736:1 688:1 651:1 872:1 Preventable hospital stays 47 46 45 48 Diabetic screening 86% 85% 91% 84% Mammography screening 66% 68% 70% 62% Social & Economic Factors 16 25 7 High school graduation 75% 80% 70% 80% Some college 66% 60% 58% 67% •mPloyment 8.9% 8.5% 9.6% 7.4% Children in poverty 14% 20% 21% 12% Inadequate social support 17% 16% 15% 17% Single-parent households 28% 30% 37% 28% Violent crime rate 336 224 253 443 Physical Environment 2 9 7 Air pollution-particulate matter days 6 5 1 6 Air pollution-ozone days 3 0 0 0 Access to healthy foods 69% 57% 71% 88% Access to recreational facilities 11 24 8 11 S htto://www.countyhealthrankings.org/washington/jefferson/compare?compare2=009&compare3=035 4/14/2011 Chlamydia & Gonorrhea Diagnosis Rates, Teens age 15-19, Jefferson County 2000-2009 • FEMALES, age 15-19 Chlamydia Rate per 95%confidence Gonorrhea Rate 100,000 females interval per 100,000 Year chlamydia gonorrhea population age 15-19 lower upper females age 15-19 2000 12 0 727 1650.6 854.2 2873.4 2001 5 0 730 684.9 221.5 1573.0 2002 10 0 729 1371.7 658.7 2510.0 2000-02 270 2186 1235.1 815.0 1797.1 2003 15 0 725 2069.0 1159.9 3405.7 2004 13 0 728 1785.7 952.4 3044.9 2005 18 0 742 2425.9' 1439.9 3829.6 fewer than 5 cases therefore cannot 2003-05 46 0 2195 2095.7 1535.6 2797.0 calculate rate 2006 8 0 756 1058.2 457.2 2069.3 2007 6 0 763 786.4 288.2 1690.8 2008 19 0 760 2500.0 " 1507.4 3900.5 2006-08 33 0 2279 1448.0 997.8 2034.2 2009 17 0 751 2263.6 1320.7 3619.3 2010 17 0 738 2303.5 1344.0 3683.1 1 in 70 Jefferson County female residents age 15-19 was diagnosed with Chlamydia in 2006-2008 • MALES, age 15-19 Chlamydia Rate per Gonorrhea Rate 100,000 males age per 100,000 males Year chlamydia gonorrhea population 15-19 age 15-19 2000 2 0 828 2001 0 0 831 2002 0 0 827 fewer 5 cases fewer than 5 cases 2003 3 0 818 therefore cannot therefore cannot 2004 2 2 819 calculate rate calculate rate 2005 2 0 817 2006 0 0 813 2007 1 0 863 2008 2 0 861 2009 2 0 849 2010 4 0 832 Data Sources: 2000-2006: STD Report Records: Washington State Department of Health, STD/TB Services. March 2006. 2007-2008: Personal Communication, Julie Simon, Washington State Department of Health, April 2009. 2009: Washington State Dept. of Health, STD Data, Accessed in: Community Health Assessment Tool (CHAT) Population Estimates, Office of Financial Management 2010: Personal Communication, Julie Simon, Washington State Department of Health, April 2011. • Jefferson County Public Health updated:April 2011 sexually transmitted diseases Board of Health .Media Report • April2l, 2 01 • Jefferson County Public Health March/April 2011 NEWS ARTICLES 1. "Iodine products sought in wake of Japan crisis," Peninsula Daily News, March 16th, 2011. 2. "The scoop on poop," Port Townsend Leader, 2011 Home Improvement Supplement, March 16th, 2011. 3. "2011 Building Codes — Chapter 10: Septic Permits," Port Townsend Leader, 2011 Home Improvement Supplement, March 16th, 2011. 4. "Perspective: If you need the Food Bank, please use it" Port Townsend Leader, March 16th, 2011. 5. "Gun range aims to expand," Port Townsend Leader, March 23rd, 2011. 6. "Economy needs efficiency," Port Townsend Leader, March 30th, 2011. 7. "Jefferson stuck in the middle," Peninsula Daily News, April 1st, 2011. 8. "Teenagers teach younger kids dangers of smoking," Peninsula Daily News, April 4th, 2011. 9. "Car seat's position likely saved life of 4-year-old in crash," Peninsula Daily News, April 5th, 2011. 10. "Public health — no duplication; prevention is key to health care," Port Townsend health. 2011. 11. "Letter author wants efficiency or revenge?", Port Townsend Leader, April 6th, 2011. 12. "April: for kids," Peninsula Daily News, April 6th, 2011. 13. "Programs spread awareness of child abuse," Peninsula Daily News, April 6th, 2011. 14. "'No, stank you', Port Townsend Leader, April 13th, 2011. • • v • • , ,.. lag . 1 C • ..?-^?a .CD CO) } a .Q�t 1� , c. flui &H! •0 � yo uUi1j 4 Z C13 U) 11141. F n .~ y O 9 • -Do.! 4 � aUd .0, . 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Ul1 °a v5ddAm0aW. - cA. mR. ... • ^,,, k^' gess t 4 i b .` s - 1 ,,,,,,,,„,,,,,N. '4'4).1 - Sa A4 t � -4. �•-" ra s r .fr 5 i ti ,-,Y - r '"k� Is a 01 s ' ' -s r `b te . t +r Care and maintenance can stretch the life of your septic system By Linda Atkins drainfield area.Many areas of the age system. You can temporarily tern control panel for the pump, investment as well as the commu- county have shallow soils above connect your RV to the system or alarm and timer, as well as a nity and the environment. Protecting your on-site sewage glacial till,sometimes referred to dump your holding tank into the "safety" shutoff nearby. Check system during site development as"hardpan."The type of septic septic tank inlet. for blown fuses in the panel. DOWN THE DRAIN and construction - even before system that is permitted depends • Don't let any construe- What you put down the drain it is installed-and operating the largely on how deep the soil is don waste or wash water be dis- IN YOUR NEW HOUSE can have a huge impact on your system to extend its working life above the hardpan. Removal or charged into your system. Paint Most septic systems contain system's operation.The following after you move in are both keys to disturbance of even a few inches and drywall have very small solid two major components: a sep- items should never be put down the long-term success of the sys- can compromise the operation or particles that can clog up the tic tank and a drainfield or soil the drain: cat litter, degreasers, decrease the lifespan of your sep- soils in the drainfield and de- absorption field. If the soils are paints, solvents, chemical drain tem. Following are some "do's and tic system.Protect this important prive it of needed oxygen. The shallow or poor for treatment of cleaners, plastics, photographic don'ts" to ensure a septic sys- part of your home's infrastruc- targe amount of water required sewage,the system may also have chemicals and leftover medica- tem's longevity. For more de- ture; it will extend the life of to wash out brushes and tools atreatment unit.The septic tank tions (prescription or over the tails on how a septic system your system and save you money. can overload your system. is alive with microorganisms that counter).Medications can be tak- •Don't dig any utility trench- •Do be sure to turn the sys- break down the waste materials en to the Jefferson County Sher- operates and information on dif- ferent types of septic systems,visit es, curtain drains or drainage tern on-flip the breakers.Some that leave your home. The tank iffs Office or the Port Townsend jeffersoncountypublichealth.org. ditches in the vicinity of the septic systems include a pump allows the solids CO be separated Police Department office during drainfield unless approved on and electrical controls. If the from the wastewater. The waste- regular business hours.Both agen- During site development and your septic permit or building septic system was installed early water is the liquid portion that cies have drop boxes in the lobby construction: plans. in your project or existed before goes on to the drainfield for treat- for medications - no questions •Do block off the drainfield •Do plan to install your sep- you owned the property, it may merit(removal of disease-causing asked and no paperwork required. area and the repair area with flag- tic system during the months have been left in the"off" posi- organisms)and disposal. Food waste can lead to a ging or another barrier to keep it when the soil is drier-general generally cion. The breakers need to be Now that you are in your new buildup of solids in your tank, free from construction equipment June to October.Installing a sys- turned on to activate the system. home,there are four important el- requiring additional maintenance and materials from start to finish. tern when soil conditions are too There will be breakers in your ements that will contribute to the and expense. Jefferson County Your septic system is a living sys- wet can damage the soil through main electrical panel, probably long life and successful operation Public Health recommends that tern that contains organisms that compaction and smear the soil two:one for the pump and one of your system: operation, con- septic system users minimize the need an oxygen-rich environment pores,reducing the ability of the for the high water alarm.There servation, monitoring and main- -ContinuedonPage 19 in order to kill harmful bacteria soil to treat your wastewater. are also breakers in the septic sys- tenance. These will protect your your ll instasystem if Do D found in your wastewater.Heavy • • construction equipment compacts you plan to live on the property ` soil, making it difficult to car while you are building.If you re- J oxygen and disperse sewage.carry side on a property,you will need i. � `'' y E •Don't allow any grading or to dispose of all of your wastewa- I`\� ;,,i r r —': .,' removal of soils or plants in the ter into an approved on-sire sew- I . et , a i,',.''',.,...'''4.:,,.., 1I sr. } '� X444,;!:',i,'gyp. _ .r` 47 � s Ir �, `. a 'i' k't` v^` - s n .iz ,}s y`• as� °� ,,.,Jro.li jf"t'`ypf. +ram` sa G + 4.• 307:" -:,z e '":,-1 + 4y Y, r,,^r i5. { f 1 4-04 y.- cV x i *' • • w :v r 'i5�'� -...14'14,74";'-'a: ir istv t .7G � ' s=;., s„ ,7.t. y y -. s' 3 s i % ",,x.11 < tr, . . ff.f .1":,''.:4",. .-- f ' Y+' .Y i- F/: .s;'r, ,r r''.'7'1'.i, 7•-,....i"...- -,:-;.,-. x...R m ''°'•' x"'�k 6K wi * ...:45:-k,--,.f......:."4 .6 ,e'. • A. ,i` a y • j .". 5^ `a,- ''ak, a s '',,,,V1, - 3 i„ f ,,t ,y��+y^ ... ..?-4 .00.''',., . - 1-s,-i-,, . -.--4 , . i r , .' 44.7,; .' • i '`9 #, 'WF d/Zi [ 3h dv. i 1. r y fK� 2`.M " .' i7k ,,,,,bt',,..424;...,..cii- ...-f;!••,-,!'0,,,,,,,,.,,,,,41:‘,„0•1.4.,;4.•,;,,,k„:,•.,:.'`..".e,,,.'.A.F"..7sat•-0.1:w:s0 -114,1•,,,,f.,,,..? ,...,:t.:•',j.,'.`,..'`i t r, ,•.,'t.tiQfi....4tr.,,,'":,.;:t .1 ei. 1, ' ''',-;3-0 Atkins checks a newly installed septic system.Through site visits �.# � *..04•1',,b,fir ,,�' x a and seminars,she helps homeowners achieve the best results with a. 6 i , i....--.r.,./..:7„.1 ,' , . .....,.."ra.. ...._ Y:_. -rte. ': their septic systems. N^w, Atkins,an environmental health specialist with the county health department,discusses the finer points of onsite sewage systems during a Washington State University Water Watchers class.Photos courtesy of Linda Atkins • FT .r 1" uh,✓. A p i 4 �. an -CC ontinued from Page 18 +"� ii�� 0 following items going down the drain:food waste,coffee grounds, -Continued from Page 19 liquid fabric softeners, oils and grease from cooking,paper tow- MONITORING AND els and other "flushable" wipes. MAINTENANCE Garbage disposals add excess sol- Monitoring means having your ids and fine particles to the tank system inspected regularly by a that can get flushed out to the knowledgeable person. Inspec- drainfield. tions can reveal problems before Use water wisely.Water con- they become serious. Install in- servation is important, because spec-don ports over the septic tank excessive amounts of water can to make regular maintenance easi- shorten the life of your system er and less costly.Keep inspection by flushing solids through your ports in the drainfield clear for ob- tank and into the drainfield.This servation.By checking the depth can clog the soil and limit its of solids in the tank,you can de- ability to disperse wastewater,in termine when the tank needs to be turn reducing the treatment and pumped.Observation of monitor- removal of bacteria, viruses and ing ports in the drainfield lets you other pollutants in the wastewa- know if your system is functioning ter.Your septic system is designed properly and the soils are diapers- to treat and dispose of a specific ing the wastewater.Keep a record, number of gallons of wastewater such as a sketch, of where your in a day.Exceeding that amount tank and drainfield are located to can shorten the life of the system. assist you or the inspector in ob- Small drips add up and can re- serving the system. lease 100 gallons over a 24-hour Maintenance is required to re- period.You can take charge and move the solids that build up in save money by fixing dripping the septic tank.When you have faucets and running toilets, in- the tank pumped, everything stalling low-flow fixtures and should be removed from every spreading out loads of laundry compartment - "starter" is not over several days.If you are on a needed to reactivate the tank.The • public water system with a water tank should be refilled with water meter,you can compare your wa- to prevent"floating."Additives do ter use with your septic system's not prevent the need to pump and approved capacity.If you are on a are not recommended. well,the installation of a meter is Records for many septic sys- recommended. terns are available online at co.jefferson.wa.us. OUT SI DE THE HOME There are instructions at Protect the drainfield area from jeffersoncountypublichealth.org parking, driving and other land- for locating your files,as well as disturbing activities. Divert roof helpful tips, a list of inspectors drains and surface-water drainage and links to other resources. away from the system.This excess (Linda Atkins is an environmen- water can overload the system. tal health specialist with Jefferson Plant grass or other shallow-root- County Public Health.) ed plants over the drainfield area. Avoid trees and woody shrubs that will seek the water and nutrients in the drainfield and may result in : damage to the system. Don't cov- L_..-_.i er the drainfield area with barriers such as plastic,decks or buildings. The soil needs to"breathe"and al- low moisture to escape.Irrigation systems should be installed at least 10 feet from the edge of the drain- field to prevent excess water. -Continued on Page 23 • —Continued from page 29 mination under the State Environmental PolicyAct CHAPTER 10: Implementing Ordinance (Chapter 19.04 PTMC) allowed in the City of Port Townsend for new or c)permit requirements of the Environmentally C). single family residential development which is Sensitive Areas Ordinance(Chapter approved19.05 Pby the III greater than 260 feet from the nearest city sewer On-site septic systems must be by the Why Septic Is Needed Jefferson County Health Department. Because soil varies, the ability of main and which is not subject to anyof the follow- If an on-site septic system within the City of each soils to absorb thsewage effluentyoI Port Townsend fails (at any time),connection to ing.a) subdivision,short subdivision and planned the City'ssystem is required unless the nearest also varies. Serious health problems unit development(PUD)approvals subject to the ny q can arise from an overloaded or poorlyP PP � portion of the parcel is greater than 260 feet from cei rise septic Subdivision Ordinance PTMCTitle 18(as stated in the nearest sewer main, in which case the sep- g P system. PTMC 13.22.010)b) review and threshold deter- tic system mayP be repaired to serve the property, While most of us are acquainted be provided it canupgraded to Jefferson County with the tp soil on our property,sys- Health Departmentberequirements.gd temust rely on the lower soils.Gla- ciers left deposits of till and silt over much of the area.These and clay soils Septic Inspections can create hardpan soils which restrict Two inspection approvals are required for sep- water absorption. impermeable soils tic systems.One comes at the time of application keep sewage near or at the surface,or and includes a visit to the site.The second comes may cause back-up into the house. at time of installation. When Is a Permit Required? A Septic System Primer Any place where people live,work, Waste water and sewage (effluent) must be or congregate,which is not served by a treated to prevent disease.Effluent flows from the sanitary sewer needs to have a permit- house to a septic tank,from where it flows into ted on-site sewage system.New con- drain lines that carry it to absorbing soils.As it struction to replace or remodel an ex- filters down through the soil,it is purified by soil isting structure requires a new permit. bacteria.Two to four feet of good soil must exist Temporary uses (more than 30 days) below the drain field pipes to treat the effluent.The such as camps or recreational vehicles amount varies due to soil types. also require a permit. Soil types range from gravel to sand, sandy Applications must include plans de- loam,loam,to clays.If the effluent flows or per- signed by a licensed engineer or licensed colates (percs) too quickly, it may reach ground septic designer.Plans are drawn to scale water without adequate purification, polluting and show the required distances be- neighboring wells or springs. tween a well,septic tank,surface water, If it percs too slowly,the effluent backs up into • and buildings. the house or resurfaces.Sandy soil requires less Prior to approval, the Jefferson area than finer,loamy soils.Conventional septic sys- County Environmental Health Depart- tems cannot be used in clay or other impervious ment evaluates the soil on the site from soils.Approved alternative systems can overcome a minimum of four test holes. Often, some site limitations. soil evaluation must be conducted dur- On-Site-Septic systems (OSS) are effective if ing the wet season.Both primary and the following conditions exist reserve drain fields are required and I.Properly designed and installed system. soil must be approved for each.The 2.Adequate soil conditions. system should be designed for greater 3.System is not overloaded,neglected or im- than typical capacity. peded by excessive wastes from the house or if approved,permits are issued for business. the specific site,not the family or busi- 4.Solid wastes are kept at a minimum.Septic ness.Permits are valid for three years. systems can handle only human excrement,toilet Applications are made at the Jefferson paper and wash water.Garbage disposals may be County Department of Community too much. Development or Environmental Health 5.Clear liquid is visible through annual visual Department. inspections. New on-site septic systems are only 6.Pumped out every three to five years. 7.The drain field is protected from vehicles. • 620/7 4/29/2'e /47, 1VJ'P/y2c z jC,j,//e%/7Nr/f Daily news, connections for Port Townsend & Jefferson County, Washington 3/16/2011 6:00:00 AM Perspective: If you need the Food Bank, please use it 8y Shirley Moss As the assistant manager for the Port Townsend Food Bank, it's not unusual, as I'm doing pick-ups from our local grocery stores, for folks to stop and thank me for my service. What happens next in the conversation just simply breaks my heart. They ask a few questions and then say, "I've been thinking I might need to come see you at the Food Bank, but I don't want to be taking food from people who need it more than I do." The reason I'm writing this letter is to explain a few things about the food bank. Everybody who is part of the four food banks in Jefferson County is a volunteer. We're there because we care and we work our tails off to make sure there is enough for everybody who walks through our doors. The food banks share donations from QFC and Safeway. One of us goes in up to two times a day, every day, to retrieve older but produce,usable lke think of meat tas and hddairy. We re glean hundreds and hundreds of pounds of food every g Y We also can buy, once a week, a select list of items from Food Life Line for just the shipping fee of .11 a pound. The food comes free; we just pay the shipping. Food Life Line is an amazing nonprofit • organization that serves all the food banks. Churches and individuals come in aRol the lland ollandtime andtCath donate W. stafood. rted a gleane s group oget save thousands fresh produce from local gardens. Seth Y of pounds of fruit from yards that end up at the food banks instead of on the ground. People who can spare it donate money, and we try very hard to be good stewards and use their money wisely. What I'm saying here is with the help of lots of hard-working and generous people, there is enough. I'd like to try to change the imagined face of the folks who use the food banks. It's your friends, neighbors and coworkers, and it may be you. I realize most people never expected that they might need to use the food bank. For some they'd rather stress and skimp than ask for help, or even admit to themselves they need help. We see it on the news every day and read it in the paper: Times are hard. Financial stress is a huge burden. It keeps us up at night and makes us lose our sense of humor. How much easier would you be to live with if even a little of that weight could be lifted from your shoulders? • Port Townsend&Jefferson County Leader t' „r S Ys sT it 9 ''fie_' is ,'r 4M c "`gr ...4 ,.'y 4,7; -.,,-,..r..tv.t :.,„.,,,,w4,4.,,,-s--,-_,:..-'_':74-irki:27,*:_tt.:2,_,:4*.F...4,-ii' ..-.."349., -.-''''' '-'-r\-- '- 44..-:-.2:43-tc,..,,, t',-105,-",:fm`,ts' opitt'in .',"r• . t.st--:-.%:,,,Avi.ii-f..,, ,,,..:-.,?...f4.1.-...t.u-A,i'....,t,v..1..-:.,.,4.-:;i1,-,:'....-- -:,. _ 4 f. � r' ` � f� „yea c .�_. > �# r r .7.,,-14:-', A, � . ":.s �,. r ,Ake.4 . .,-. F • 111-'11,'TM_..F ,„r°�a .:(...,;-%., i,� a�z '.” .5�i ���+e., } '14* -*,,C. ti c t, .,.. #• -s; ♦ .f`. ; sk`4 __'•mak yA 14" 'a?E „�. ':- ,,ts. �'-'.^-,14,=„014:4A*—"--*--,,,.. -�p y,�r, F-,.,,#;.., -,.,,� b '~ ,i,"'.6 .. '.f ; ' .�,¢:�,y""''4'ol � 'Si s• k-q s '�� _ �s,` 2 f ^ -- .rT S 1�Y" .2: 1.:. 1;,Pz and G „,":',.$ Qy T�,k , X,i; x h;' '4 i}f' iY;c. l 5,-�, 1.. .. F <. F -;Ydp Oxy q. 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The Jefferson County Sportsmen's Association wants to excavate a 32,000-square-foot target area for competition handgun shooting.The range is on a 44-acre,L-shaped parcel owned by the county.In this view,the gun range's skeet shooting range is at lower left(the main clubhouse building is not visible),and the current rifle and pistol ranges are at upper right.Fire District l's Henry Miller Station along Jacob Miller Road is at the upper left. Leader photo by Patrick J.Sullivan;airplane piloted by Ed Kirkpatrick range ai ril s to expand• Public comment peri•od ends March 30 • By James Robinson of the Leader the licensing agreement, and county property. If this were •the public)using an indepen- that safety rules and best a closed gun range, the site dent professional authority on The Jefferson County practices have been violated. would need to be cleaned up shooting range management, Sportsmen's Association plans Hindes wrote to the to where everything is below and for the county to acquire a to expand its shooting range Environmental Protection MTCA levels. There are no Clean Water Act permit. to provide room for a corn- Agency in July 2010: "The hard and fast rules,however, While it remains to be seen petition handgun range, and county has created a legacy about levels of lead at active whether the commissioners the public has until March 30 of tons of lead in berms and gun ranges. The key is that will agree to Hindes'requests, to comment on the potential on the forest floor.The range the lead remains on county the county's planning depart- environmental impacts. sits on an aquifer recharge property. Because lead is ment has contracted with the There are no public meet- zone. A hundred wells pull heavy, it is the smallest lead City of Poulsbo for a third- ings or hearings required.The from this aquifer, including particles that have the great- party review to assess prob- environmental comment win- my own.The run-off from the est opportunity to travel.The able adverse environmental dow closes on March 30. rifle and pistol ranges goes trap range therefore would impacts.That review,however, The association operates onto my street. Shotguns provide a good idea of whether looks only at the association's the range—located at 112 Gun shoot into seasonal wetlands. the lead is traveling or not." pistol range proposal, not the Club Road — under license It is an ecological travesty Boyd continued, "Lead totality of health and safety from Jefferson County. The and a potential groundwater samples show that at 3 inch- issues Hindes alleges exist. shooting range is located just disaster." es below ground surface, one County documents indi- outside Port Townsend on a Just four months prior, of two samples was above tate City of Poulsbo officials 44-acre, county-owned parcel Hindes urged Jefferson MTCA,but at 6 to 12 inches, are likely to issue a mitigated near a fire station and the County Administrator Philip they•were far below MTCA. determination of nonsignifi- solid waste transfer facility.It Morley to take the issue of Our area wells are between tante regarding the project, is an old landfill site,with two lead pollution seriously. 150 to 250 feet in depth and which would fall short of unlined municipal landfills After his correspondence to are protected by a clay layer Hindes' broader request that and an unlined septic lagoon, Morley,Hindes then implored that would likely prevent any the range be closed,treated as according to Marjorie Boyd, Jean Baldwin, the director contamination of the aquifer. a Superfund site and shooting an environmental health spe- of the county's health depart- , There is some possibility of be moved to a location far- cialist with the county health ment, to help in suspending lead traveling by air, but the ther out into Jefferson County, department. the range's license while coun- range is kept well vegetated. where range design would As proposed, the ty leaders investigated. "The biggest likelihood of allow health and safety con- . Sportsmen's Association In addition to county leader- lead moving is when lead is cerns to be mitigated. intends to excavate a ship and the EPA,Hindes took mined from the berms and As of March 22, Linda 32,000-square-foot target his case to the Washington dust is created, which is why Mueller, the City of Poulsbo area and construct a covered State Department of Ecology we have recommended best planner tasked with the proj- • and paved firing line for corn- —with little satisfaction.In his management practices — per ect, said she has received a petition handgun shooting. correspondence with the EPA, the NRA and EPA manual comment letter from Hindes At least one Port Townsend Hindes criticized Ecology for — and encouraged using a and another letter regarding • resident has spoken out turning over a lead assess- professional contractor,"Boyd noise impacts. Mueller said strongly against the project. ment study to the county's said. the association has proposed Michael Hindes lives about health department—a branch Since the health depart- certain measures to mitigate a mile from the range and, of the same government agen- ment's initial investigation, shooting noise. since February 2010, has cy tasked with licensing and Hindes also asked the EPA to "The applicant is proposing urged federal, state and local overseeing the site. conduct an assessment, and a wall behind where they'll be leaders to consider the envi- The county's Marjorie Boyd the EPA agreed to do it by shooting,"Mueller said. ronmental and safety issues conducted an initial investi- August 2011. Mueller said the EPA has surrounding continued and gation on behalf of Ecology "My understanding is that also been notified of the pro- escalated levels of shooting. in June 2010 and found lead, Mr. Hindes appealed this to posed expansion. Specifically, Hindes' concerns polycyclic aromatic hydro- the EPA," Boyd said. "They In an email response to focus on noise and lead pol- carbons (PAHs), including did a tabletop review and are Hindes'concerns,Al Scalf,the lution issues. He alleges that benzo[a]pyrene—a carcinogen in the process of evaluating director of community devel- current and proposed future —at levels above state regula- whether they will do addition- opment,wrote,"DCD remains uses exceed those allowed in tions presented in the Model al evaluation and testing.The concerned with the possible Toxics Control Act(MTCA). EPA initially declined to take lead contamination at the site "PAHs come from the clay the case and deferred to the and will continue to monitor pigeons, which are no longer process Ecology had already the progress of the investiga- clay," Boyd said. "PAHs were begun. Then Mr. Hindes tions being conducted by DOE found on the trap range below launched a second request and the EPA."Scalfs email is MTCA cleanup levels with the higher up the chain of corn- dated Feb.3,2011. exception of benzo[a}pyrene, mand.We'll see what Ecology John Ebner, range mas- which was just over MTCA does." ter for the Jefferson County levels. Before the shooting range Sportsmen's Association. did "We also found lead, is allowed to expand. Hindes not return requests for coin- which is to be expected on asked the commissioners on ments by press time. gun ranges," Boyd told the March 21 to hold a public Comments on the pistol Leader."Five samples showed hearing.allow the completion range expansion can be sent lead levels very close to or of the EPA study and publicly to Linda Mueller, associate above MTCA levels, which disclose the EPA's findings, planner, Poulsbo City Hall, is 250 milligrams per kilo- conduct a safety assessment 200 NE Moe St..Poulsbo.WA gram,but all of these were on (and reveal the findings to 98370-7347. • • Economy needs efficiency • County administrator Philip Morley.confirmed that public health • will spend about 4.5 percent more•iri 2011 than 2010, in sharp contrast to the cuts absorbed by every other department.And the county still has not explained why it gave this largess to one department. A bigger question is"How well do they do their job?"All county health departments have the same duties by state statute. A comparisorr is appropriate. The Jefferson County Health Department is one of the county's largest departments;with 45 employ- ees and a 2011 budgeted expenditure of$5 million,counting pass-through grants such as chemical dependen- cy and mental health. That's about $168.70 for each of our almost 30,000 residents. Public health provides important services that benefit us all, but they need to be performed efficiently. Published budget information shows that the Jefferson County Health Department is not very efficient compared to the Clallam County Health Department.In 2011, Clallam County will spend $6.95 • million on the same public health services for its more than 71,000 citizens with only 36 staff. That's about $97.40 per resident, or about two-thirds of what we pay! Why should we pay the much more than our neighbors for the same services? We need to demand that our department gets as lean as Clallam County. They serve more than twice as many people with10 fewer staff. Our health department is not just fat,it's morbidly obese,and we need to put it on a crash diet.If we became as efficient as our neighbors, we could save over $2.1 million, rehire some laid-off employees, reopen our parks, repair our roads and lower our taxes. Just because our government has a statutory task to perform does not mean we can't be efficient. Most of our staff is efficient, competent and hard working. We just need bet- ter management. This department needs to run,not waddle. It is unacceptable for us to pay so much more than our neighbors in 111 Clallam County for the same service, and our commissioners need to know this. TOM BROTHERTON • Quilcene /D/.2e.2e.G,(.66, /1/ ,. , • al • . • . . • . . . scy w i.:--g:...14 d 4:0. 35:xp 28P)! !N a ?,do =rW 4UI Q .21 F U �., -Jeferson • . 1 ". g stuck fl m� 17.E�.�1 i' - -t 11. -111 the middleJ!IILIIJo �� o °"b� . �xA .,. D 2 1 •!� w � • -oayg72omd ,% F,-a c la, ' a, maaE,CO puts br•tp g > . 45 1 , . d `° > a,.<r a)c...) Wellness survey4 '� CD yea, y � aam •� ° oa � .� >o"�- a.� o ay.�a "..t o o .e 8 o t co , ac„ h o d a'1 county 18th in state \ _ ° _ s. C ^, " g 1'CUa •a -.a. '1.5 w C O r) g . qui, e�0(.. BY ROB Ou.nsA1NEN ` v 8 � lu,• cag.8a lig g §.c•o c�9 6 a g-gg m o N '.-3"g'5 _ _ PENINSULA DAILY NEWS I PORT ANGELES—Clallam and Jef- >..'g° 8' 6 'c� o ., ro . y�3 1 g C — ferson counties landed smack dab in the ^ o.� x 00 ��x a O o wv'bb db N 9 • middle of a state list that ranks the health a d ° b d d . , w b o. 1 m r0 S $.w� �Y -.� c of its residents. a'.r3 1 m kl v v V 03E (.44.g g x d Jefferson County ranked No. 18 and i-��{ m „ 0 w . a. o ,.. vs Z • °'o" § b I Clallam County was No.19 out of 39 coun- Ct E l >o,1' co y a,'� t'I'Si 2 P. ,Z 1 b §.() !..1.- ' :g ties in health outcomes,according to the y,ti d v iR.S 4.g d 4-,.......- V d E E 1 u o second annual County Health Rankings. ��i dog 3 d a, d d 0 r.,-, 6ca ..-- 1545- 0 ,,00 d 5,e,a ti y S x o San Juan County was the healthiest, �4 .5 o y a m . T � U w '' 7'n and Ferry County was the least healthy in M .b 2":3; a 21 8 w S. w S : a —.8 aU x Washington state in the report released ' w5•.3 o Tuesday by the University of Wisconsin �c c b o v ,S ,� ; c°a; m o 'x Population Health Institute and the Rob- �p g ' .,11 5 w g, a,_t E .� o ert Wood Johnson Foundation,which ana- y a m y, w .� . g lyzedT counties ys nationwide. The study examines factors such as life eb m �.-5w U o ,,o ti 'S w b m o y.t expectancy, smoking rates and doctor-to- .:0"“1 Y•-'i ,b z . o H ;-H 0 o - 3.s.~ a>Q o .s `�; • patient ratio to determine a county's over- A 3all health. E x .-, to Q Wnelppolicymakersgeta � v�� '� >, $,�1;� H� �' >,1 1 d �x w.o.�� a,� clear picture of the needs of their commu- r --. q� a a' ,1 d> , r� o`i.s a?0 o o.0 c. our • nities. Cl.) cs . Oil � 0.m i .a N m 3' E U S m w.-.-6.*-Zi 2:5-2 .c • 'Get people talking' n , 3 w z o v 2 u,ti , . o 1 , o �?> a , Dr.Tom Locke,public health officer for g,5 o 0 0 E g '1; o y a y g n w x v ° Clallam and Jefferson counties, said the 0 ,x 6will m a a N w U ca y 3co a goal of the research is to"get people talk- .1 v>�) v,:--. L3, e rn ; c , N inC about certain behaviors that affect 0 °"" o da = 7 , G ,y" a3,gi'O uF�.� W w C ° G 3 o$ " O ania' r, g > "'o 3... °~ m2 _,e Q.,0 A , . 8 health. u a,2 m a 3�. b 3 .k 3 ' • m C U o Phe whole point of this project is to try C g ,� u y E- ii .o,n m. o 0 w 0 a 8 o s a to get communities to work together to Q 0. - a 0 .1 w eo❑ g d 3, p,,- . ,,, .1...,..- . ,,.::. identify problems and do something abouta a g _ F. � them,"Locke said. i~ m u w o Y > 8 o c° 0•o a �" o U C c$ (NIQ N TuxNToHiM &A6 '3),.S1 t4375 °m m U O Y.�3-aN :o 0 0 . 8A o 0 Wb u m aa u N " .9 -' > a :r. . 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C-4 ?4 b0 a) w C01) �z Um2O s°'''a ? ow A oac>i �.4...�ot : dQ E" o" QG G � q�Y3o E"• ai.5.0aia> o 0 a) • C3z OwOGgate)E.- o .x Um a Iii ini w mwo c m n o ` � 0 as o(L YT3...0 O'C+�"O Y U : 3 U ,o -r seat'sposition ;ix saved Life of � likely . : 4- ...in .,,„,,, ,.,.„.. ear ®Idcrash { Vezicle was perpendicular to ground r,. *4 r g .,Y ,y,i s- .. g. BY CHARLIE BERMANT police reports. O -',:.„,r. .a -` i ,,,.., _.y PENINSULA DAILY Ness Sterling's daughter, Kylie, 4, was the +aag?'_ ,--.C,,,, ,. ...c _ .•„b. only passenger in the car. a .,r r 1,'-,:a......; • r ' PORT TOWNSEND—The decision to r �, - ....,.,4„.,1+.w East Jefferson Fire Rescue Public Infor- f~ place a 4-year-old old girl's car seat in the con- " _., n"w� ' * "'� " ter position in the backseat might have motion Officer Bill Beezley took several s .. .:a y- –. .. .`.4t,,-1.4-.. saved her life in a crash last week,.photo- pictures of the wreckage and the crash BILL BF.EJ.LFY/EAST JEFFERSON FIRE-RE.SCCE graphs taken by East Jefferson Fire Res- scene,and discovered that two trees had A Ford Taurus made contact with two trees white perpendicular to the cue show. markings that corresponded with large ground during a crash last week,but the space between the trees Authorities said the car driven by Kevin dents in the roof of the car that extended created a safe area for a child riding in the back seat. Sterling,33,of Quilcene was traveling at a down to the top of the front seats. one point the car was perpendicular to the center of the backseat as the safest location high speed north on Center Road two miles The raised area between the dents car- from Chimacum when it went into a responded to where the child's seat was ground. for a child's seat if there is only one child in 100-yard-skid,crossed the road and became positioned in the center of the backseat,'"' Jefferson County"Comidunity'Network''the car. ' airborne for about 50 feet before landing and the seat is visible in the pictures. Program Manager Ann Dean said that in the middle of the woods, according to That caused Beezley to conclude that at child-safety experts recommend that the TURN TO Cnnsn/A4 Crash: Driver, passenger airlifted to Ilarborview CONTINUED FROM Al warded to the Jefferson Chris Ashcraft. • County Prosecuting Attor- "We are now waiting for The driver made a cor- ney's Office, which will that information." rect decision in this case, decide what charges,if any, Both Sterling and his she said. to seek in connection with daughter spent more than The girl suffered critical the crash. eight hours in the emer- head and arm injuries along Vehicular assault can be gency room on Thursday, with possible internal inju- charged if a car is operated but were both discharged ries,while the driver had a in a reckless manner,under Saturday, according to the closed head injury,Beezley the influence of drug or hospital. said. alcohol or with disregard There has been no Both were airlifted to for the safety of others and answer or answering Harborview Medical Center causes substantial bodily machine pickup at a phone in Seattle. harm to another,according listed in Sterling's name for The Jefferson County to state law. several days. Sheriff's Department is still "A lot of mathematical investigating the incident aspects will need to be cal- Jefferson County Reporter and has nothing to report, culated before we deter- Charlie Bermant can be reached at Detective Joe Nole said mine which charges will 360-385-2335 or charlie. Monday. be filed," said Assistant bermant(peninsuladailynews. All reports are being for- Prosecuting Attorney corn. • Pit)IV e spe twwe Public health - no O ' duplication; prevention is i key to health care ,_\,; ..., By Tom Locke Jefferson County Health Officer Tom Brotherton's letter pub- instead,lose millions of dollars in lished in the March 30 issue of state and federally funded servic- the Leader compares the budgets es for women, infants, children, of public health departments in students and the community at Clalla m and Jefferson counties, large.And since most of these ser- and draws arguable conclusions vices are preventative in nature, about the relative "efficiencies" their absence would increase the of each. rates of communicable disease, As health officer for both coun- child abuse, unintended preg- ties, it is appropriate that I set nancies, low-birth-weight babies, the record straight. Local health hungry children and many other departments differ enormously preventable conditions. in their range of programs and Jefferson County has one of the services. Most have the same highest performing rural health core environmental health and departments in the state and is communicable-disease-control committed to public accountabil- programs,but differ greatly with ity, continuous quality improve- respect to other, non-mandatory ment and performance-based pro- services. gram review. As governmental Each county health depart- budgets have continued to shrink, ment reflects the unique needs Jefferson County has actively of the communities they serve. partnered with its neighboring Jefferson County Public Health counties, Clallam and Kitsap, has a number of programs that to provide high-quality services • are not provided by its counter- in efficient and innovative ways. part in Clallam County—family Duplicative services have been planning, foot care, nurse fam- eliminated, resources have been ily partnership,maternal support pooled,and we have actively part- services, school nurse and school- nered to face an ever-changing based clinics. series of threats to public health. In Clallam County, some of Mr. Brotherton's thinly veiled these programs are provided by attack on Jefferson County Public nonprofit organizations;others do Health is misinformed and off not exist. Comparing the total target. Lack of efficiency is not budget of such dissimilar county the problem facing local health department offers little insight departments — plummeting rev- into what is actually being done. enues from state,federal and local In this era of rapidly shrink- sources in the face of rising public ing budgets, it is important for health needs is creating the great- citizens to realize how little of est threat to local public health their local health department departments I have witnessed in budgets come from county gen- my 35-year preventive medicine eral fund (i.e., local taxpayers') •career. revenues. Sixteen percent of Public health is in the preven- Jefferson County Public Health's tion business—every dollar spent budget comes from the county saves many times that amount in general fund. The rest is state lower health-care costs, reduced or federal funding, with a sub- disability and increased healthy stantial portion being earned years of life. Failure to make through the provision of direct this investment has the opposite clinical services, grants and effect. various contracts. Jefferson County voters made Contrary to Mr. Brotherton's their choice last November in sup- assertion, Jefferson County porting Prop. 1 to preserve essen- would not "save over $2.1 mil- tial county services. We can only • lion"by curtailing or eliminating hope that our elected officials in its public health services. Nor Olympia and Washington, D.C., would these imagined savings be will show similar wisdom as they available to"repair our roads and deal with unprecedented budget lower our taxes.' deficits at a state and federal Jefferson County would, level. 7 Letter author wants efficiency . or revenge? Tom [Brotherton],I respect your judgment and enjoy our lively debates on the planning commission,but you —.—._ are off base with your assessment funds from sources other than our of our county health department local taxes to support public health [Leader,March 30 edition,"Economy programs.If you subtract the funds requires efficiency"]. from sources outside our county,you You have chosen facts that sup- will discover that we are actually port your resentment for their unwill- more efficient (based on your own ingness to approve the attachment of flawed accounting) than Clallam additional living quarters to your County. septic system. What's worse is that Now, if you want to debate the you are concealing your often-heard value of these programs, let's do it. comments that suggest you want But let's not use an accountant's revenge.To launch an attack on the approach to budget analysis that efficiency of the health department ignores what programs are involved. as your means for revenge is not only If you want to speak out,then tell us demeaning to your own integrity, exactly what programs you want to but a real danger to those who ben- eliminate efit from the county's public health TOM GISKE services. (For those who are inter- Port Ludlow ested,look at the details of case no. 09-2-00-345-8 in the Superior Court of Jefferson County to confirm that Tom was looking for an exception to the law that was unreasonable and which was subsequently denied in his appeal to the judge.) Your basic argument suggests . that all local health departments are limited to the duties specified by state law and that we should com- pare ourselves to Clallam County In Jefferson County,we have chosen to undertake a number of health pro- grams that do not exist in Clallam County. The justification for these pro- grams is financiaL They keep our citizens off of welfare programs and out of jail. They keep our mentally ill on medication that avoids poten- tial harm to themselves and others in our community. They avoid the spread of sickness in our schools and ensure pregnant women have access to maternity care.They give nursing services to citizens who would other- wise be dependent on our hospital's emergency room. By the way, a number of these programs are funded by grants that are not supported by local taxes. Our county health department has been very aggressive about seeking ■ • April : for kids April is both National (women and kids are invit- Child Abuse Prevention ed, too) Preregistration Month and Sexual Assault forms are available. Awareness Month, and Call 385-5292 or visit Jefferson County is partici- walkamileinhershoes.org. pating with the fourth annu- Dr.Dennis Embry,pres- al "Our Kids: Our Business" ident of the Paxis Institute, social awareness and preven- provides training in youth tion campaign. tobacco, alcohol, drug and The Port Townsend violence prevention, 5:30-7 Public Library Teen p.m., on April 27 at Port Community Read features Townsend High School. book discussions, forums, Call 379-4476 or email art workshops and read- kmatlock@co.jefferson. ings. Call 385-3181 or visit wa.us. ptpubliclibrary.org. "Dine Out for Kids," on The Boiler Room hosts April 27, benefits YMCA game nights, art groups, Building Futures. Call movie nights, live music and 360-774-6342 or visit freefood.Call379-8247orvisit jeffymca.org. ptbr.org. The Port Townsend "Our Co-op Kids" Earth Police Department partici- Day festival, hosted by pates in the national drug the Food Co-op and Sound take-back day from 10 a.m. Experience, celebrates boats, to 2 p.m.on Saturday,April planes, worms, fish and 30. Jefferson County's bicycles, 1-4 p.m. on Sunday, Developmental Disability • April 17 in the co-op park- Advisory Board, Tobacco ing lot. Prevention and Control Dove House Advocacy Program, and others are Services' "Walk a Mile in sponsoring a county- Her Shoes"-begins at 6 p.m. wide "Posters & Coasters on Wednesday, April 27 Campaign to Prevent at Rotary Park, with men• Fetal Alcohol Spectrum walking in women's shoes Disorders. • l / � CC',j✓ _. awareness abuse Programs spread3 f � • BY CHARLIE gERIVsnrrr "We want to get the effort can have a lasting "The result of this econ- or neglect. The promises are to be PENINSULA DAILY Nsws whole community involved positive effect by providing omy is that a lot of kids The awareness program caring adult, provide s in abuse prevention," said a positive balance for a don't get the attention they is the distribution of an places for constructi PORT TOWNSEND — Julia Danskin, Jefferson troubled youths, said Ann need." "Our Kids Our Business" activities, give children a Staff members with a pub- County Public Health nurs- Dean,manager of the Jef- Dean administers a pro- media kit, which provides healthy them wstart ith an effed o- lic health program will be ing director. ferson County Community gram operating out of the guidelines and includes Provide seen in businesses,schools It really takes a village Network Program,which is Jefferson County Health 'pledge forms"that outline tive education that gives and other agencies distrib- to make this happen." now in its fourth year. Department that seeks to five promises people can them marketable skills and uting kits and encouraging Preventing in-progress "A lot of parents are provide information, sup- make in order to under- provide opportunities to awareness of ways to pre- abuse is essential, but a doing the best they can," port and intervention when stand and prevent abuse serve. vent child abuse. kind action or a mentoring Dean said. necessary in cases of abuse and neglect. The promises are to be a caring adult, provide safe places for constructive activities, give children a "We want to hear about healthy start and future, any situation where the provide them with an effec- child is in danger,"Danskin tive education that gives said. them marketable skills and While extreme cases provide opportunities to should be reported to the serve. Health Department,the kit These promises are offers specific tips to defuse unspecific,but those pledg- a situation that may occur ing will be added to-a data- in a public place, like base that will allow people politely asking whether the to connect with instructions parent needs help or coco- on how to take concrete miserating about their own action,Dean said. children. The database.from pre- Any threat to a child's vious pledge years contains safe existence has lifelong about 300 people,a number consequences, program Dean hopes to double dur- staffers said. ing this year's campaign. Abuse and neglect are year-round problems but Symbol of prevention are getting special atten- Also . part of the cam- tion in April,as it has been paign is the distribution of designated Child Abuse badges and pinwheels, Prevention Month. which have become a sym- For more information, bol of child abusd proven- phone 360-3845-9400. tion. For a list of resources, Dean said the poor econ- visit http://tinyurl. omy has increased the fre- corn/3tskbhm to see a PDF. quency of abuse and neglect and also has impacted the Jefferson County Reporter program. Charlie Bermant can be reached at Dean said the program 360-385-2335 or at charlie. costs around $5,000 annu- bermant@peninsuladaitynews. ally and receives funding com. from four state sources, with staff time the only . expense for the county. While each parent may have their own child-rear- ing strategy,Dean is hoping that people who observe abusive situations will report them. • ,vac.,/„ • • --- - ---. -. '.,, ' *-- ,,, ,'ma/ - - --....„ , -,,,- •,rn".--"' .,:.4`A v' PROFC--SStr ' d ti ri ......,, „, _ _, „ ,..„...„, \ 9' 1 w lk d15' �/ dwnyag \ er ,, t tr.,: v _ i r ...-,,,-1„,,,,,,.� �wu wo 3x No, stank you "Yuck!I never want to smoke,"said a fourth-grader.That's exactly the reaction that Port Townsend High School Teens Against Tobacco Use(TATU)members(from left)Irina Lyons,Marko Herr,Gabbi Hossack and Maddie Sarff-Foden are hoping for.TATU members have been learning about the dangers of tobacco use and sharing the information through presentations to younger students.The program is a collaboration between Jefferson County Public Health,PTHS and the American Lung Association.Submitted photo • — 111111 /°7-Olzoef/v ././//d/// JCSO DRUG TAKE- BACK PROGRAM 0 Safely and legally dispose of your unwanted and expired medications. M, ,...3,::,....a.•.. er, .....,.,...v.« ,,x.:,iiRi3 �`;: .� ......� a#� � �rc`�mc � c-r � � �L .� �' a. .,:.., . ... r ....:.. � �, ... .,.r ..,.�_�;, � .,� ..oma...,A.'r. >. �i4 ,iii. 4.....it_. ,., ..... •air .. Jefferson County " , � __ �_... T Sheriff's Office - II 79 Elkins Road, Port Hadlock• ;� pit•a r .r..r ragsilir .. 360-385-3831 % 4 Office Hours: Monday-Friday 8:30 am-4:00 pm The following items are now being collected for disposal: • Prescription medications • Inhalers • . Over-the-counter medications • Unopened EpiPens • Vitamins **Please Note: Pills do not have be in original containers-Loose pills accepted** Present your items to the staff person at the front counter. Staff members are not allowed to touch any of the items brought in for disposal. The following items are UNACCEPTABLE: • Liquids • Bloody/Infectious Waste • Empty containers • Personal Care Products • Needles/Syringes Y5 - Hydrogen Peroxide/Other ''''l Chemicals • Thermometers 0 • IV Bags • ry,erosol Cans pened Ep **If you are presenting any items that are ineligible for disposal, a staff member wil, give you a handout directing you to other resources for safe disposal.** April 14, 20 1 Please call 360-385-3831 if you have any questions. PTPD DRUG TAKE- BACK PROGRAM S Safel y and legally dispose of your unwanted and expired medications. Port Townsend z '} I Police Department 44'c ii % 1925 Blaine Street, Port Townsend j 360-385-2322 Office Hours: Monday-Friday 44i ihoo 8:00 am-5:00 pm 0 Skr*' 1114 ' The following items are now being collected for disposal: • Prescription medications • Inhalers • . Over-the-counter medications . Unopened EpiPens • Vitamins **Please Note: Items Must be in Original Containers** Present your items to the staff person at the front counter. Loose pills will not be accepted. Staff members are not allowed to touch any of the items brought in for disposal. The following items are UNACCEPTABLE: • Liquids • Bloody/Infectious Waste • Empty containers • Personal Care Products • Needles/Syringes f0. h i • Hydrogen Peroxide/Other aux Chemicals • Thermometers • IV Bags • erosol Cans • , .4. , i .'a ned Ep F **If you are presenting any items that are ineligible for disposal, a staff member wil, give you a handout directing you to other resources for safe disposal.** April 14, 21 1 Please call 360-385-2322 if you have any questions.