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HomeMy WebLinkAboutM011509JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, January 15, 200'R 2:30 PM — 4:30 PM Health Department Conference Room, 615 Sheridan Street, Port Townsend Board Members Staff Members Phil Johnson, County Commissioner District #1 Thomas Locke, MD, Health Officer David Sullivan, County Commissioner, District #2 Jean Baldwin, Public Health Director John Austin, County Commissioner, District #3 Julia Danskin, Nursing Services Director Michelle Sandoval, Port Townsend City Council Chuck Russell, Vice Chair, Hospital Commissioner, District #2 Sheila Westerman, Chair, Citizen at large (City) Roberta Frissell, Citizen at large (County) Chair Westerman called the meeting of the Jefferson County Board of Health to order at 2:30 PM. Members Present: Roberta Frissell, Phil Johnson, Chuck Russell, David Sullivan, Michelle Sandoval, Sheila Westerman Members Absent: John Austin Guests Present: Frances Joswick, Substance Abuse Advisory Board Staff Present: Jean Baldwin, Dr. Thomas Locke, Julia Danskin A quorum was present. APPROVAL OF AGENDA Chair Westerman announced a change to the order of agenda items under section V; item 4 was placed ahead of item 3. Member Sullivan moved to approve the agenda, as changed; the motion was seconded by Member Johnson. The agenda was approved unanimously, as changed. APPROVAL OF MINUTES Corrections: page 2, second paragraph: "... school age children are ... factor in... ", not is. Page 3, last paragraph: Member Westerman, not Chair Westerman Member Johnson moved for approval of the minutes, as amended; Member Russell seconded. The minutes of December 18, 2008 were approved, as amended, by unanimous vote. Page 1 of 12 PUBLIC COMMENTS There were no public comments. Chair Westerman noted that, during her tenure as Chair, if members of the public are not present at the beginning and arrive during the meeting, she would add a Public Comment period at the end of the meeting, as possible. OLD BUSINESS December Provider Advisories: MRSA and Antiviral Medications Dr. Locke discussed the two provider advisories in the packet. He noted that he and fellow health officer Dr. Lindquist are attempting to increase regional outreach to hospitals and medical providers. Whenever such issues arise at the County level, they consider the regional implications and tailor their message for regional applicability. The Methicillin Resistant Staph Aureus (MRSA) advisory was prompted by a series of articles in the Seattle Times in mid November, entitled "Culture of Resistance". Dr. Locke pointed out several contentions in the article were not accurate. The article stated that hospital associated MRSA have gotten substantially worse when, in actuality, it is community acquired MRSA that has worsened. Rates of hospital transmission have been relatively stable for the last twenty years. Secondly, the article strongly suggested that, for this very complex problem, there is a simple solution: nasal cultures for patients before entering the hospital, with isolation of all MRSA carriers. This type of article presents a challenge for medical providers in communicating with their patients about MRSA. Dr. Locke noted that Dr. Scott Lindquist, Deputy Health Officer for Jefferson County, is an infectious disease specialist. The advisory he has written provides facts and advice for health care providers. Dr. Locke also discussed the Expert Panel recommendations referenced in the advisory, which reflect the complexity of hospital infection control. Dr. Locke noted that there is a bill before the legislature that would require nasal screening cultures for hospital patients. There is conflicting scientific evidence over whether this would be effective or not. Considerable international research efforts have been undertaken to resolve these issues. As the evidence emerges, hospitals are adopting these recommended practices. However, Dr. Locke noted that the problem will not be simply resolved. It is persistent problem created by the promiscuous use of antibiotics, not only in the treatment of humans, but also for livestock. Chair Westerman asked how the science -based viewpoints will be presented to the legislature, especially input/plans from the Washington State Department of Health. She noted that the newspaper series had generated a great deal of attention, and had appeared to be well researched. Dr. Locke said that infectious disease experts are taking the lead. Dr. Jeffery Duchin, Chief, Communicable Disease Control, for Seattle/King County had written a very good rebuttal editorial for the Seattle Times. Jean Baldwin added that. Dr. Duchin had also appeared on KUOW and on local talk shows. Dr. Locke said that Dr. Lindquist and other infectious disease specialists would likely be asked to testify before the legislature. Page 2 of 12 Dr. Locke also discussed the Health Advisory regarding influenza treatment guidance. This communication, which is a condensation of a ten page CDC document, provides specific advice for antiviral treatment. The main circulating strain of influenza, HIN1, appears to be resistant to the main antiviral medication in use — Oseltamivir ("Tamiflu"). Over the course of one year resistance rose from 11% to 98%. Dr. Locke explained that the more an anti-virus drug is used, the more resistant strains are selected out. Vaccination is the best way to control influenza, along with respiratory hygiene to reduce transmission. There was a brief discussion about the disposition of stock -piled oseltamivir for use in the event of an influenza pandemic. Dr. Locke said the shelf -life is about seven years. He said it will probably be useful in the first big wave of an influenza epidemic before resistant strains emerge. Tamiflu is not recommended for most flu patients; on average, it reduces the duration of illness by only one day. It is most useful in the very young (under 6 months of age), the very old, and those whose health is compromised. Public Health Impacts of Heavy Rain and Flooding Jean Baldwin pointed out the press release regarding drinking water safety was based on the Kitsap County release. There was little local damage in Jefferson County. She noted that in addition to the advantage of location within the rain shadow, Jefferson County has been planning ahead and has been moving people out of flood plain areas through Conservation Futures purchases and other means. Ms. Baldwin discussed a related problem, food distribution during prolonged closures of highways, particularly I-5. Local markets are normally restocked continually; closures of 1-5 do cause some disruptions in the flow of market supplies. She also discussed the impact on the Jefferson County transfer station. When solid waste and recyclables cannot be transported away, it accumulates rapidly. Recovery to normal levels requires considerable time, especially when other areas of the State are similarly affected. She said that system agreements between FEMA and local EOCs (Emergency Operations Centers) are not always fully worked out in advance to handle FEMA vouchers during periods of flooding. This could be a problem in the future if Jefferson County should experience serious flooding. She explained that normally the State Public Health system works with a local EOC group to identify issues that arise, such as animal disposal. Although not seriously affected by the recent floods, representatives of the Jefferson Health Department have been monitoring impacts in the other areas. Member Sandoval inquired about a recent problem at the EOC during a general power failure; apparently the emergency generator did not come online. She said that she had received an early morning phone call, informing her of an anticipated two to three day outage, but that a solution involving the Clallam PUD had been arranged, thereby shortening the outage. Julia Danskin noted that the City EOC/Fire Department had been able to mobilize as part of their back up function for the EOC. Page 3 of 12 Jean Baldwin noted that the Health Department had used their emergency power generator to ensure refrigeration for stored vaccines, based on information that the outage would be of short duration. The contingency plan for a longer outage would be to move vaccines to the hospital for storage. Chair Westerman asked how the information about water safety is disseminated. Jean Baldwin indicated that in addition to press releases, the information is posted on the web and in certain locations such as grocery stores. Copies are also sent to Bob Hamlin for dissemination to the emergency preparedness neighborhood groups via their e-mail distribution list. School-based Clinic Opening — January 2009 Jean Baldwin distributed copies of survey results, entitled "Jefferson County School Based Health Center Data, January 2009". This is a summary of the parent/student survey of Chimacum and Port Townsend Schools attendees to determine their opinions, needs and concerns related to the school-based clinic plans. She noted that of the 604 students responding, many recognized behavioral risk issues including nutrition, stress, tobacco use, lack of physical activity and depression, and their long term health impacts. Ms. Baldwin said she thought it important to share the perceptions of these families. Jean Baldwin also mentioned a Letter to the Editor, included in the Media Packet, from a Port Townsend High School ASB (American Student Body) member, expressing concerns about confidentiality and cost; this student had not been involved in planning/advisory efforts for this initiative. She recalled that both Chimacum and Port Townsend ASB members had been attending advisory meetings along with teachers, counselors, Health Department representatives, school administration from the spring of 2008 through the fall of 2009. They had explored ideas and options for the school based clinic including outreach, confidentiality and other important design/implementation issues. Ms. Baldwin then consulted with The Leader about the most appropriate way to publicize information about the program. A Leader journalist then spent several hours at Port Townsend High School interviewing students, Principal, Superintendent, and various staff to gather relevant information for a feature article. Ms. Baldwin said this approach is intended to convey how comprehensive this service will be and to convey as much information as possible. Copies of a one hour call-in program on school based clinics, aired on KUOW on January 12, are available and the program can be downloaded. She said local Seattle/King County people called in with questions/comments for a nurse practitioner, mental health counselor and clinic coordinator. The overall tenor of the program was very positive and provided an overview of the complexity of services available. Ms. Baldwin said that many callers were parents whose children had benefitted from the program over the long term. At this point, the school based clinic program, which took 8 months of planning, is ready to begin. There has been extraordinary outpouring of community and school support, including volunteer hours and business donations. Two local businesses, Carpet One and Peninsula Floors, are providing thousands of dollars of product, use of equipment and installation. The Boeing Page 4 of 12 Blue Bells remodeled Chimacum High School at no cost; both Chimacum and Port Townsend High School ASBs contributed $500. She said both spaces are up and running. An adolescent specialist from Kitsap Mental Health, paid from the Jefferson one tenth of one percent funding, has been seeing students since October. Jefferson Health Care and the Health Department are working together on funding. The goal is to open on February 2 at PTHS two days per week for medical primary care and family planning. Tobacco prevention will be added as soon as feasible. Parental information and consents are in place. She said it is not possible to anticipate exactly how the program will be accepted and utilized, but that signs are positive. One remaining challenge is to put billing capability into place for those services that can be billed. She added that staff members are touring selected sites in Seattle to observe their school clinic operations. Thank You Letters Julia Danskin reviewed the letters of appreciation to the owners of Chimacum Chevron for their $500 donation, which will be used for family support programs, and to the Port Ludlow Yacht Club Women's Group for their donation to the Breast and Cervical Health Program. Both donors have also supported Jefferson County Public Health in prior years. NEW BUSINESS Pharmaceuticals, Personal Care Products, and Water Quality Jean Baldwin introduced Tami Pokorny of Jefferson County Water Quality and Environmental Health, and called attention to the Rivers for Life, WRIA 16 Newsletter, in the packet. Ms. Pokorny explained that WRIA 16 stands for the Water Resource Inventory Area that spans southern Jefferson County including the Dosewallips and Duckabush Watersheds, as well as portions of Mason County along the west and south shores of Hood Canal. She noted that the newsletter has been published for about 5 years. The most recent issue contains an article about PPCPS (Pharmaceuticals and Personal Care Products) and their impact on water quality. As mentioned in the article, the Puget Sound Partnership, the EPA and the Washington State Department of Ecology are collaborating on a study of the effectiveness of municipal water treatment in removing PPCPs. She reviewed the extensive and nearly universal use of these substances, which include over the counter as well as prescription medicines, by-products of soaps, shampoos, cosmetics, aerosols, growth hormones used in livestock, veterinary medications, etc. The amount of these substances released into the environment is estimated to be about the same as the amount of pesticides used each year. The US accounts for about half of all pharmaceutical use in the world. In recent years, there has been increasing awareness of the presence of PPCPs in drinking water. She cited information from studies conducted in 2002 and 2004 that had identified chemicals in water downstream from urban areas and elevated antibiotic levels in rural areas. One serious issue is that water treatment facilities are not targeting many of these compounds for removal, and even very low levels can affect the growth and behavior of wildlife such as fish and oysters. Page 5 of 12 PPCPs enter the environment in gray water and in human and animal waste. It has also been common practice to dispose of unused medications by flushing them down the toilet. Ms. Pokorny said the newsletter is intended to raise awareness and to provide guidance as to the best means of in home disposal, i.e. via the trash. Ms. Pokorny noted that federal guidelines for disposal of prescription drugs are also posted on the Jefferson County Public Health website. Recommendations include obscuring the identification label/container and mixing contents with contaminating materials such as coffee grounds or kitty litter before sealing and concealing. Ms. Pokorny also briefly discussed a second newsletter article, The Hood Canal Clean Water Project. This is a 4 -year project initiated by Jefferson County Environmental Health to evaluate water quality and collect data on pollution and nitrogen sources entering the Hood Canal. She noted the multiple perspectives and contributors who assisted with this informational article, versions of which will also be submitted as press releases. Ms. Pokorny pointed out the notice regarding the "Who Speaks for Hood Canal" Video Newsletter on the last page of Rivers for Life. She described the video and its availability at http://hoodcanalwrial 6vide.blip.ty. Jean Baldwin requested suggestions from the BOH on distribution of this newsletter issue concerning PPCPs. Suggestions included: hospitals, health care provider waiting rooms and pharmacies. Frances Joswick noted that many people are not aware of proper disposal procedures for unused/expired pharmaceuticals. She suggested posters with disposal guidelines be hung in pharmacies and physician offices, and articles in the Leader and PDN. Dr. Locke explained that laws prohibiting pharmacies from accepting unused drugs for disposal were intended to prevent re -sale of expired drugs. He also noted that the Health Department recommendation is not in agreement with federal guidelines that continue to recommend flushing controlled substances down the toilet. In response to a question about incineration, Dr. Locke said that the efficacy of that disposal method would depend on the particular compounds involved and incineration temperature. School Immunization Trends — Jefferson County and Washington State Dr. Locke provided background information on the State program which has been supplying free vaccine for children. He said this would be the first in a series of reports this year regarding immunization for children, a program that is very much in flux. The focus of this report is to provide new local data regarding a worrisome statewide trend of increasing exemption levels in school age children. Washington State has a requirement in statute that children entering pre-schools or public schools have immunization stipulated by the State Board of Health. Not all childhood vaccines are mandated. Those vaccines that deal with diseases that potentially cause outbreaks in school settings have been placed on the mandatory list. Washington State also has a very broad immunization exemption policy in the same state statute. It says that a parent can exempt their child from this school entry requirement for one of three reasons: a religious exemption, a medical exemption, or a personal exemption. Over time, that exemption rate has been increasing Page 6 of 12 year across the State. The most recent data on K-12 exemption rates by county (2007-2008 School Year) was included in the Board's packet. About 10 to 15 years ago, the average exemption rate in Washington State was about 3 percent. Currently, there are significantly higher exemption levels. Jefferson County, at 11.9%, is among the highest; the rate has been rising from about 8 % within recent years. (Ferry and Stevens County in the northeast part of the State have the highest exemption rates, but very low populations.) The infectious diseases that we are most concerned about are measles, mumps, rubella, pertussis and diphtheria. In order to prevent outbreak of these diseases, between 90 -95% of children must be immunized. Dr. Locke explained that the levels of unimmunized children are reaching the point that will support localized outbreaks. Dr. Locke pointed out the data for the current school year for the Jefferson County Schools. He noted the ranges among the different schools and the exemption levels, and the fact that virtually all the exemptions are personal ones. Religious exemptions are very unusual, and medical exemptions are rare. Member Sullivan asked if there is a threshold percentage or number that would be considered alarming and indicative of possible outbreak. Dr. Locke said the threshold differs for each disease. Measles, which can be a deadly infection, is of greatest concern. Measles cases are now reported in Washington State on a routine basis; there was an outbreak in Grant County last year. The required immunization rate for measles is 95%; any exemption rate that exceeds 5% presents a risk for outbreak. For some diseases, the rate is lower. For example, with influenza, at least 90% of children should be immunized, although influenza is actually not mandated. The rates for mumps and rubella are around 90%. Member Russell inquired as to the meaning of personal exemptions. Dr. Locke stated that the current form is extremely simple and does not collect parental reasons for exempting the child. The exemption form has been redesigned for next year and will ask for reasons. He said that focus groups and surveys indicate that exemptions break down into two categories: One has been called philosophical objections, i.e. people believe that vaccines are harmful or unnecessary, or that some are vaccines are beneficial and some are not. People are making a conscious decision based on information they have received or values they hold. The other category has been called convenience exemptions. For these, it appears that people are not opposed to vaccinations but sign the exemption form to avoid the requirement to produce vaccine records. Their children may not be up to date on immunizations or they cannot immediately produce the vaccine records. Dr. Locke said that some of those children may subsequently get vaccinated, but there is not clear data. It is believed to be about a 50150 mix, half being philosophical opposition to vaccination and half being convenience issues. Public health officials are focusing on the latter group in order to identify barriers that may prevent or delay vaccinations or to obtaining records. The goal is to assure that all children whose parents consent to vaccination are fully immunized. Jean Baldwin said that, every other year, staff has investigated the issue of convenience exemptions. In doing so, they check to identify any changes in school personnel or procedures, or to identify areas that can be improved internally. She mentioned that the Chimacum Schools Page 7 of 12 now use an effective referral system. She also described the counseling work that is done in the weekly mothers' breast feeding group. The topic of immunizations has been discussed on several occasions, and every attempt is made to work with mothers by listening to concerns, providing guidance and assisting in stretching out immunizations, etc. Dr. Locke also discussed the related issue of the overall record on childhood vaccinations within the State. He said that the first three years of age are the most dangerous time for vaccine preventable diseases. The national standard for a fully vaccinated child is measures children between ages two and three. He referred to the National Immunization Coverage Rates (blue toned map) in the packet, which shows coverage for children in the 2-3 year old age group; numbers at the top refer what a fully vaccinated child at age 2 should have: 4 DPT shots; 3 Polio shots, 1 Mumps/ Measles/ rubella shot, 3 Haemophilus Influenzae Type B shots, 3 Hepatitis B shots, 1 Varicella (Chickenpox) shot. Washington State has one of the lowest rates of achieving that target in the USA. That is a particular challenge for Washington, despite the fact that it is one of only 6 or 7 states that pays for 100% of childhood vaccinations through a combination of state and federal funds. One of the problems with childhood vaccinations, as shown by the Environmental Change sheet in the packet, is the growing number of vaccines and the associated complexity. In 1985 there were only 7 antigens administered and several were combined: two or three shots with multiple boosters. By 1996 there were 10 antigens and by 2008, thirteen years later, there are 16. In the pipeline are still more; there are almost two dozen vaccines in development, not all of which are childhood vaccines. Dr. Locke said it may be possible to prevent multiple types of cancer through vaccine, and/or to prevent diabetes and certain types of autoimmune disease. Vaccination has become a very powerful medical tool. Chair Westerman added that some of these vaccines are not targeted to children; HPV for example is not administered until adolescence. She also said, in her opinion, that because vaccines have been so successful in preventing outbreaks, people are not worried. There is a sense of security in the general population. She said that, apparently, the issues are not being communicated clearly. She suggested that perhaps there should be more emphasis on the fact that these issues concern not just one's own children, but everybody's children. Jean Baldwin mentioned that there have been two outbreaks of pertussis in this county in the last three years in the same population of ten home schooled children, which consumed many hours of staff time. Members briefly discussed whether there should have been more public information disseminated in that case, and whether additional measures are needed related to at risk schools. Dr. Locke explained that if a child is not vaccinated and an outbreak occurs, the child is not allowed in school for the duration of the outbreak, unless they can be vaccinated. That is the reason these records are kept and there is a consequence. He mentioned a recent case where the Health Department was prepared to pull unvaccinated children out of school, but that tests had turned out to be negative. Chair Westerman asked about the process for home schooled children, and was told that there is no tracking of immunizations for those children. Page 8 of 12 Concept Mapping and Strategic Planning -- Overview Jean Baldwin said that before moving into concept mapping, she felt it important to discuss the larger context and the general economic uncertainty of the times. She discussed the larger picture of budget cuts that are currently under consideration at the State level, including how the shortfalls in the Governor's annual and long range budgets will be addressed. She discussed the types of information that is available with regard to proposed cuts, and cited the lack of a comprehensive picture as to how pending legislative decisions will actually impact State and local budgets and programs. She noted that layoffs and rollbacks are partially invisible and have a diffuse impact on the community. She said she was very concerned about what is going on in the community and how families are and will be affected Ms. Baldwin said that she believes it prudent to pull all the unfolding information together and examine it. She said she had brought the topic to this body because she believes the BOH has a broad community, non-partisan vision. The BOH is charged with, not just the Health Department, but also regulatory issues and other broader ones. She said she was seeking the BOH's guidance as to whether this scope of effort was appropriate. She offered several examples as to the difficulty of translating budget decreases for particular agencies, such as Mental Health, into real community impacts. She said that she was deeply concerned about the probable impacts over the next few years, but did not know if the collection and analysis of all the relevant information was necessary, or even possible, and appropriate at the Health Department level. BOH members sought clarification on the types of information that would be collected. Ms. Joswick stated that it is extremely important to know the numbers of people affected in order to assess the potential impact on the community. Jean Baldwin explained that the information would be essential in prioritizing how staff and other resources would be assigned and shifted according to changing needs. She noted that Medicaid and Medicare are very expensive systems and are at the brunt of recent cuts. She said the affected clients would not likely come forward directly, but would be evident in ER, police and jail statistics. She said that although there is clearly not enough public funding from City and County to meet these needs, there should at least be information to support decision making and prioritizing. There was a brief discussion about GAU (General Assistance for the Unemployable), a State DSHS assistance program for those temporarily unable to work, which has been cut completely from the Governor's 09-11 budget. It was noted that although the numbers of people in this program are relatively few, these individuals also use mental health, hospitalization and other treatment programs that will no longer be reimbursed. The idea of a shared web site for various agencies to post quantitative impact information was suggested and briefly explored. Some members questioned the feasibility of reducing the complexity of data to meaningful planning information. There was a suggestion that the State should be tracking this type of information. Ms. Baldwin noted that DSHS could/would not do this, since the money was already cut from their budget. Page 9 of 12 BOH members discussed the purpose and use of such a database and how it would inform policy discussion. One use would be assessment of needs and associated prioritization of resources at the City and County level. Another suggestion would be to support education/advocacy efforts at the State level and to provide justification for funding requests. In response to a question as to the extent of impact on health care for children, Julia Danskin summarized the provisions in the Governor's budget. She said the Healthy Kids Now program would continue to cover children (under age 19) up to 200% of the poverty level for free and up to 250% for families that pay a premium. The expansion to 300% of the federal poverty level that was planned to begin on January 1 was cut. She said that Washington State continues to have one of the best programs for children 18 and under. The federal government is also working on standardizing S -CHIP, which is promising. Ms. Danskin also provided an update on the previously announced cuts to the Department of Alcohol and Substance Abuse. After initial information that Ford Kessler from Safe Harbor Recovery Center would see a $60,000 cut between now and June, it was learned that smaller counties such as Jefferson would continue to receive their base allocations, while larger counties will see large cuts. She said Janet Polley, Jefferson Mental Health, and Ford Kessler had both confirmed that their budgets are stable through June, and they see no service reductions for the time being. There is no specific information about 09-11 budget as yet. With regard to funding for the developmentally disabled population, Ms. Danskin said there are some major cuts that do not affect this County due to our small size. She said she was not aware of any cuts in our current budget between the present and June 2009. Jean Baldwin stated that there is expectation of further cuts. Ms. Joswick suggested that the period between the present and June 30 be used to collect information and project the impacts to services and numbers of people. Chair Westerman asked if Ms. Baldwin would be able to pursue this data collection idea by deferring some other tasks and activities. Ms. Baldwin said she would attempt to develop some form of grid. Chair Westerman said that the BOH realized the pressures and did not wish to impose more work without adequate resources, but thought that the information would be valuable to the BOH as it faced prioritizing decisions in the future. Member Johnson agreed that the information would be valuable. Julia Danskin added that the Washington Association of County Commissioners is in the process of collecting this type of data. She said there is preparation and monitoring of the legislative process to determine if the DSHS and other cuts will be sustained. She said she expected that the BOCC would be lobbied by the Association. Member Sandoval expressed concern about retroactive provisions mentioned earlier. She questioned whether or not this included the electrical rates for the paper mill, and whether or not they would owe considerable money, having already laid off 28 people. Other members had no information on this issue. There were additional comments about the apparently limited nature of impacts at the present time. Member Sullivan suggested that one way to pick up the slack as a Page 10 of 12 community would be through volunteerism, donations and non-profit organizations. He acknowledged the symptoms of system failure, as well as the need to find crucial solutions. Member Russell added that volunteers had served 28,000 hours in the hospital last year. Ms. Joswick pointed out that some skilled needs cannot be met by volunteers alone. She restated that impact data or reasonable estimates are important for planning and responding. In summarizing, Jean Baldwin said that she would explore data collection further. She invited others who were interested to participate. Ms. Joswick volunteered to assist, as possible Flow Sheet — Boards and Committees related to Substance Abuse Treatment and Prevention Julia Danskin referred to the flow sheet in the packet, which had been developed as part of an orientation for the Substance Abuse Advisory Board; it is a representation of how various government and non-profit entities overlap/interact with one another with regard to substance abuse and treatment. She indicated that the Department of Social and Health Services is a huge department and has many programs. She said this is a way to explain the roles of various committees and why representation on them is important. Member Russell noted that the 1/10th of 1% Advisory Board seems central to many things. He asked what it is and who serves on it. Chair Westerman listed herself, John Austin, Conner Daily, Catherine Robinson, Ann Winegar, and Barbara Carr. She said they meet monthly and their role is to make recommendations on how the 1/10th of 1% tax revenues will be spent. She said they were developing a means to determine how effective those allocations to various organizations are. She confirmed that the members are appointed by the BOCC. Member Sullivan explained that the tax is authorized by the legislature for mental health and substance abuse. The 1/10th of 1% funds fall directly under the BOCC, not the BOH. Member Westerman pointed out that the importance of this fund lies in the fact that it is ongoing and can be depended on, and that its use is determined by local control. Ms. Danskin pointed out that the City receives significant funds from the Liquor Excise Tax revenue and $35,000 goes to the County drug and alcohol prevention programs. Member Sandoval asked if the Health Department receives any grants from the USDA. Ms. Danskin said that only the WIC program is funded by the USDA through the Washington State Department of Health. Health Care Community Discussion Forums — Jefferson County Input Julia Danskin reported that three health care meetings associated with the Obama-Biden Transition Project were held in the community, two in December and one in January. She noted that the perspective published in the packet summarizes well the issues and discussions at the meetings. The majority of people want a universal health care program and evidence -based Page 11 of 12 practice. Jean Baldwin said that all of these meetings were very well done. She commented on the quality of participation and the level of discussion at the meeting she attended. She said they are very well organized by the local Health Care Access committee, of which Julia Danskin is a member. Dr. Locke called attention to page 2 of the "Participant Guide" in the packet, which presents the three main priorities of the Obama Health Care Plan. He said that in his experience there has been a great tradition in health reform to pay lip service to prevention but not actually fund it. He said the real test will be the funding that is actually applied. He believes that Tom Daschle, who will head the new administration's initiatives on health care reform, does understand the economic argument for prevention. In response to a question, Jean Baldwin added that Mr. Daschle has been an advocate of health insurance reform, and is now working closely with many associates who hold broad perspectives. Agenda Planning The next BOH meeting is scheduled for February 19, 2009 at the Health Department. Vice Chair Russell will conduct the meeting since Chair Westerman will be unable to attend. The State Board of Health will be visiting on July 8 in Port Hadlock. Member Austin has conveyed that all are welcome to attend. Ms. Danskin noted that the 2008 Annual Report of the State Board of Health, of which John Austin is a member, was recently published. Adiournment Member Russell moved for adjournment and Member Frissell seconded. Chair Westerman adjourned the meeting at 4:31 PM. JEFFERSON COUNTY BOARD OF HEALTH Sheila terman, Cha' 00�hl huck Russell, Vice -Chair Roberta Frissell, Member Excused John Austin, Member Page 12 of 12 Phil J nson, Member d �k Michelle Sandoval, Member lz David Sullivan, Member