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HomeMy WebLinkAboutM021909JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, February 19, 2009 2:30 PM — 4:30 PM Health Department Conference Room, 615 Sheridan Street, Port Townsend Board Members Staff Members Phil Johnson, County Commissioner District #I Thomas Locke, MD, 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 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) Vice Chair Chuck Russell called the meeting of the Jefferson County Board of Health to order at 2:30 PM. Members Present: John Austin, Roberta Frissell, Chuck Russell, David Sullivan, Michelle Sandoval Excused: Phil Johnson and Sheila Westerman Staff Present: Jean Baldwin, Dr. Thomas Locke A quorum was present. APPROVAL OF AGENDA Vice -Chair Russell said there would be one change to the order of agenda items under Section V; Item 4 was placed ahead of Item 3. Member Austin moved to approve the agenda; the motion was seconded by Member Sullivan. The agenda was approved unanimously. APPROVAL OF MINUTES Correction: page 1, John Austin was excused from the meeting. Member Sullivan moved for approval of the minutes, as amended; Member Frissell seconded. The minutes of January 15, 2009 were approved, as amended, with abstention by John Austin. There were no public comments. PUBLIC COMMENTS Page 1 of 9 OLD BUSINESS Draft National Public Health Week Press Release Referring to the draft in the packet, Jean Baldwin said that the intention was to publish this press release and accept nominations for Public Health Heroes during the first half of March. This would allow the Board to approve nominations at the March 19 BOH meeting. Announcements will be made during National Public Health week in the first week of April and the awards will be given at the April BOH meeting. Nomination forms will be available on the web page, at the Courthouse and at the Public Health offices. John Austin suggested that former award recipients be listed in the press releases. Roberta Frissell agreed to work with Julia Danskin again this year to review the nominations and bringing them forward to the BOH. More Retailers Selling Tobacco to Minors Jean Baldwin introduced Karen Obermeyer, Health Educator. Ms. Obermeyer distributed a Fact Sheet on the Burden of Tobacco. Ms. Obermeyer noted that tobacco use costs society and individuals a great deal of money and heartache. She pointed out that each year in Washington state deaths due to tobacco -related illnesses surpass those from alcohol, drug use, car crashes, suicide, homicide, AIDS and fres combined. Tobacco- related illnesses include many types of cancer, heart attack, stroke, pulmonary disease and emphysema, which often involves prolonged suffering for patients and their families. She said that the good news is that these diseases are preventable and that 85% of Jefferson County adults do not smoke. She noted the disparity within the County that over 20% of pregnant women smoke. Statistics for youth show that less than I% of six graders smoke, which increases to 10% by eighth grade and to 24% by tenth grade. Smoking rates are higher in populations with lower income and educational levels. Because most people begin to smoke before the age of 18, prevention of smoking by youth is the highest priority. Ms. Obermeyer explained the Project Alert program for sixth and seventh graders in the County, which provides substance abuse education in Port Townsend, Chimacum and Quilcene school systems. The TATU (Teens Against Tobacco Use) program is a partnership involving the ninth grade teacher, Martina Haskins, the American Lung Association, and the Health Department, On March 9, Port Townsend High School students who have undergone the TATU training will visit Mountain View school to train fourth graders in tobacco prevention. Ms. Obermeyer also mentioned the No Stank You program which involves filming students at local schools for participation in a State-wide campaign, web -site and commercials. In Jefferson County last year, out of about 50 compliance checks, there were three sales to under age purchasers. In one case, there was no ID check at all. During January, Ms. Obermeyer focused on visiting retailers in Jefferson County and conveying three messages: it is illegal to sell tobacco to minors; there are resources for them to train staff and help them comply with the law; and to inform them of the consequences of non-compliance. Page 2 of 9 Member Sandoval noted that she has observed more teenage girls than boys who smoke. Ms. Obermeyer mentioned that, for males, the rates for chewless tobacco use are also up in Jefferson County. She also talked about the Washington State Tobacco Quit Line at 1 -800 -QUIT -NOW, as well as the web site, QUITLINE.COM, and the stickers used for advertising these services. Member Austin asked if the practice of publicly reporting illegal sales of cigarettes is actually providing youth with information on where to buy cigarettes. Ms. Obermeyer said that she shares that concern, and believes the stores that are compliant should be publicized instead; those stores that pass compliance checks do receive certificates for posting. Member Russell noted that the Federal S -CHIP program is funded by tobacco taxes. 2008 State Board of Health Annual Report — 2008 (Portions inaudiblel A copy of the State Board of Health Annual Report was provided in the meeting packet. Jean Baldwin noted that Member Austin serves on the State Board; he is pictured with other State Board members on page 15 of the report. Member Austin stated that the State Board of Health is not on the list of budget cuts, thus far, while the Ferry Advisory and Eco System Council and many other departments have been slated for budget reductions. It was noted that the State Board will meet in Jefferson County in July. Member Austin noted that environmental school rules changes are among the hottest topics for the Board, particularly the balancing of safety and cost. There are pending safety provisions that require annual reviews of programs by the local Medical Director. There was mention of existing water and air quality assurance measures. He said that new schools must meet the highest standards; there are retrofitting requirements for older schools. The total cost of the proposed program amounts to about $33 dollars per student over three years. New standards for venting of photocopy machines were briefly discussed. National Flu View Dr. Locke referred to the flu surveillance summary graphic included in the packet. He said the more recent full report from the CDC indicates that most of the states on the East Coast have upgraded from regional activity to widespread influenza activity. On the West Coast, Washington and Oregon have gone from sporadic to local outbreaks. The vaccine match with the influenza A strain seems to be a good one. However, the match with the influenza B strain may not be as good. The predominant A strain that is circulating is the one that is resistant to the leading anti-viral drug, oseltamivir (Tamiflu). Member Russell noted that many people were vaccinated early in the season. He asked if it is ever advisable to get more than one shot per season. Dr. Locke said there are no official recommendations for revaccination. He said that the period of protection may be as short as 2 to 3 months for certain individuals; there is no readily available way to test for the immune status of individuals. He said that for those vaccinated in September or October, with a peak season in March, this could be a problem for some individuals. Dr. Locke said a second shot would not be unsafe and may be appropriate, particularly for those with weak immune systems or on dialysis. Page 3 of 9 In response to a question, he said the mortality rate for seasonal influenza is about 1 per 1000 cases; an annualized average nationally is about 36,000 per years. The vast majority of those deaths are in the age 75 and older population. He noted that the mortality rate has been holding steady for many years. NEW BUSINESS Legislative Advocacy: Public Health Fundinz Letter Jean Baldwin first provided information from the most recent WSAC (Washington State Association of Counties) tracking of public health bills. She said there are three funding streams for Public Health that are non -categorical, which means there is local control in prioritizing. There are expected deliverables, but the funds can be allocated to staff or other budget line items. Public Health infrastructure money pays for the Director's salary. In the Governor's budget, these three sources have not been changed. She said that for the Department of Health, there have been few cuts. Some DSHS monies and other billables have been affected. There is an ongoing discussion state-wide about the possibility of having Public Health Departments become taxing authorities. Seattle/ King County and some other larger health departments wish to institute local options taxes for Health and Human Services, Public Health and some Sherriff services. Ms. Baldwin said she did not necessarily foresee that approach for Jefferson County, but that the evolving situation should be monitored and considered Dr. Locke added that there is a modified version of the public health funding bill, HB 1985, that did receive a hearing; this version removes the local option taxing authority and non -supplanting language and consolidates public health funding streams. Ms. Baldwin mentioned several issues that are under discussion: tobacco vendors, school rules and funding, voluntary health practitioners' licenses; children's mental health; exemptions for children's immunizations, petroleum pollution in storm water, etc. There is a Senate bill about monies deposited in local toxins control accounts. Another issue that is of local interest and importance addresses unwanted/unused drug disposal. Member Austin asked about the University of Washington study on the presence of drug compounds, fragrances/soaps etc. in the water. Ms. Baldwin said that the results would be posted on the web site shortly. Dr. Locke said that King County Board of Health is supporting the approach that drug manufacturers be required to accept the unused drugs and properly dispose of them. Ms. Baldwin noted that calls have been received from assisted living centers and other care facilities that have higher volumes than home use regarding proper disposal methods. Health Department advice on disposal methods is posted on the web. Jean Baldwin and Dr. Locke then discussed the draft letter to State legislators Kessler, Van de Wege and Hargrove regarding funding, particularly preservation of the three major funding streams and support for House Bill 1985. They asked the Board to consider and approve the letter; the letter would be signed by the Chair of the BOH on behalf of the entire Board. Dr. Locke said that, given the current economic crisis, there is no expectation of additional resources, but that existing funding lines must be retained. Page 4 of 9 Member Austin said that he supports the letter, and would suggest that the key recommendations be presented in bold typeface for emphasis. He moved that the letter, with bold highlighting, be approved and signed by the Chair; Member Sullivan seconded the motion. The motion was approved unanimously. It was agreed that Vice Chair Russell would sign the letter in Chair Westerman's absence. Syringe Exchange Program Report Dr. Locke noted the increasing demand for this program over the years, although there was a slight decrease in the number of syringes exchanged from 2007 to 2008. The volume of syringes exchanged in one year is over 20,000. Dr. Locke said that as of 2006, a national survey revealed that there were 156 syringe exchange programs in the United States and about 10% of those were in Washington State. Dr. Locke said that these programs, although very effective, are relatively rare. These exchange encounters sometimes result in treatment referrals; the best programs have referral rates of 10% at most. Ms. Baldwin said that the exchange rate is greater within the City. In response to questions, Dr. Locke emphasized that this is an exchange program — participants must bring in used syringes to obtain new ones. There was mention that new syringes are usually available at pharmacies and farm co-ops (for veterinary use). Dr. Locke said that the local BOH authority is authorized by law to distribute new syringes under this program, i.e., the local public health authority supersedes the State paraphernalia laws. Member Frissell stated that she had observed an incident at the hospital where a woman wished to turn in sharps, and was referred to the Health Department. Staff informed her that the proper disposal method for diabetic syringes is to insert syringes into a 2 liter pop bottle, seal the bottle, label it (special labels are downloadable from the website), and place in the trash for pick up. The process for handling materials in the syringe exchange program is much more rigorous. Special disposal containers are provided along with the exchange syringes, so that staff does not need to touch the used syringes. In response to a question about the number of participants in the program, Jean Baldwin said there are about 70 people but many of these are doing secondary exchanges on behalf of others. At this point, the department is not doing indicators by person. There has been consideration of tracking numbers by specific drug types in the future. She said that there are two scheduled times per week for this program, but walk-ins are allowed as staffing permits. Jefferson County Demographic Data Update Dr. Locke explained that the packet materials are an update of demographic measures that are displayed on the web site. He said that although the data can be of interest in its own right, it is most useful when viewed in the context of some issue or problem. For example, if one is attempting to project health care costs for some years into the future, then the age and income distributions of the population become significant. He noted that the epidemiologist who produces the report is always seeking better ways of presenting the information. Page 5 of 9 Dr. Locke pointed out the data regarding median household income and per capita income, which are indicators of a particular economic characteristic of Jefferson County. This county is almost $12,000 below the state level of median household income, but the per capita personal income figures are nearly the same for the County and State. He noted that the median household income figure more accurately reflects the real world. The per capita figure is skewed by the segment of the population with very high incomes. Jean Baldwin pointed out that, in contrast, about 30% of the County population is at or below 185% of the poverty level, compared to 25% of the State population. 16% of children live in homes at 100% of the poverty level, or about $20,000 household income, compared with 13% in the State. Two thirds of County births are covered by Medicaid, versus 47% in the State. Jean Baldwin pointed out that that the housing data is a new measure, although much of the data is from 2006. She pointed out the affordability gap; only 23% of households are at an income level that allows purchase of an average price house versus 34% in Washington State. Dr. Locke said that this data can be very useful in preparing grant applications and in evaluating program needs. Jean Baldwin pointed out the slowing of growth in population and the slight shifting in age. In - migration is staying about the same. She also noted the larger increases in the 50-64 and 85 + age groups during the years from 1990 to 2008. The number of seniors (age 65+) with disability status is comparatively low, 34% versus 43% in the State. With regards to education information, Ms. Baldwin noted that graduation data from high schools is now required by the State. This particular data is somewhat "soft" now, but will continue to improve. Ms. Baldwin said that the update would be placed on the web site, and that the information usually generates interesting and unexpected questions. She asked BOH members if they wished to have more detail or other views of the data. Member Austin said that the color version is somewhat easier to read. Ms. Baldwin said she would e-mail an updated color version to all BOH members, department heads, and other individuals who may be interested. She added that since epidemiologist Siri Kushner is contracting with OlyCap to do Clallam and Jefferson County data, there is an opportunity for inter -agency exchange of data reviews. There was a brief discussion about the rise in number of Medicaid births and the impact of any loss in Medicaid funding. Dr. Locke mentioned that there is another use of this data: the State is working with various forms of community health report cards. He also mentioned the Washington Health Foundation with its "Healthiest State in the Nation" campaign. Washington State has been rising in comparison to other states and is now ranked as the tenth healthiest state in the nation. He discussed the composite measure, Economic Well Being, that measures median household income, per capita income, and employment divided by population child poverty levels. Washington has a rank of 15 in this category. Page 6 of 9 Also measured are high school graduation rates; Washington is 32nd in the nation with a gradation rate of only about 70%. There was a brief discussion acknowledging the complexity of the school situation and of making effective improvements. Jean Baldwin again mentioned the fact that school graduation information is improving but data has been rather soft and difficult to interpret. For example, are youth who drop out in 9th, 10th, 11th or 12th grades all counted in the overall statistic, or just those who drop out at a certain time? Are high school GEDs (General Equivalency Diplomas) accounted for? Dr. Locke noted that, prior to 2000, the percentage of graduates included all those who ever graduated. After that time, the measurement changed to "percentage of on time graduations". He said the new measure was meant to evaluate the high schools on getting youth through all grades on time. John Austin questioned whether these parameters are measuring the effectiveness of the schools. Healthy Youth data is also displayed on the web page; this is derived from a test taken by Port Townsend, Chimacum and Quilcene high school students every two years. This provides a behavioral risk analysis and some demographic data about students. Ms. Baldwin said this has been a key driver for continuance of the school nursing program and school based clinic program. Jean Baldwin also pointed out the Jefferson County Statistic card in the packet. She noted that the number of women, ages 13-44, in need of publicly supported contraceptive supplies and services matches the number who were actually served. She also noted that the numbers have risen and that teen pregnancy rates are only about half of the State rates. In serving about one third of the female population, Public Health is seeing those most in need of services, i.e. those at the poverty level. Dr. Locke noted that the Chlamydia and Gonorrhea rates are down in Jefferson County compared to neighboring Clallam and Kitsap counties for the third consecutive year. The rates for Kitsap and Clallam are at about State averages, while Jefferson's are substantially lower. Dr. Locke said that there have been great efforts to get providers to screen at risk populations, and in tracing and treating contacts. He added that there is a one in four chance of contracting a sexually transmitted infection between the ages of 15 and 24. Member Austin asked if the rate per thousand shown on the statistics card measures only the 15-24 age range, or the entire population. Jean Baldwin said that she had verified that it is not age specific. Dr. Locke said that the rates for the 15-24 age range are 10 times higher than for the general population. Substance Abuse Advisory Board Report The report was deferred to a future meeting. Jean Baldwin said that there is an SAAB (Substance Abuse Advisory Board) applicant, who will be interviewed before the next BOH meeting. John Austin and Julia Danskin will participate in the interview process. Page 7 of 9 Public Health Mutual Assistance Agreements Updates Dr. Locke and Ms. Baldwin provided updated information on the two mutual assistance agreements that had been discussed at the December 18, 2008 meeting. The multi -county emergency preparedness multi -aid agreement approved by the BOH is currently under review by David Alvarez and will come before the BOCC for signatures within the next few weeks. Dr. Locke also discussed the pilot project, which may become a model for the State. This is a collaborative effort directed toward developing a mutual assistance agreement among the three counties of Public Health Region 2 and seven tribes of the Olympic and Kitsap Peninsulas. A second meeting was held in January. The working draft document, which contains all the potential issues, is about 60 pages long. An example of a simpler version of such an agreement had been included in the packet. This example between the Lummi Nation and the Whatcom County Health Department, dealing with communicable disease control, is more limited in scope. Ms. Baldwin said that it is well for the counties and tribes to work together since tribal jurisdictions often span multiple counties. She mentioned the Makah, Hoh and S'Klallam Tribes as examples. John Austin asked for clarification on the County relationship with the Hoh, who are completely within our County borders, and the Quinault and Queets/Clearwater tribes. Ms. Baldwin said that the Queets/Clearwater group was not included because, for consistency, they are affiliated with the Quinault Nation that share borders with Grays Harbor. Dr. Locke clarified that the Hoh are involved but were unable to attend the meeting due to West End flooding and road outages. He said it is a real challenge for the Hoh to participate because of their small size and limited numbers. However, they take emergency preparedness very seriously. He said the tribes are taking this opportunity to look at what community health capacity they need to develop within their jurisdictions. Legally, the county health officers have no authority within tribal jurisdictions. The federal government has some authority; for example, the FBI would have authority to investigate a homicide there. Dr. Locke said that the larger tribes are being encouraged to put in place some of the more formal processes and services typically covered at the County level. For example, management of a resort/casino benefits from a formal food code and other safety regulations. In the past, population health issues were the responsibility of the federal Indian Health Service; under self - governance, this has shifted to the individual tribes. ACTIVITY UPDATES Jean Baldwin announced an Open House for the Port Townsend School Based Health Clinic to be held on March 3 from 2:30 to 6:00 PM in the Gael Stuart Building, Port Townsend High School. Ms. Baldwin cited the many business and individual sponsors and contributors who have enabled the opening of this service. There was a brief discussion about the newspaper article on a recent norovirus outbreak. Dr. Locke said that this was formerly known as "winter vomiting disease" and is now known to be Page 8 of 9 caused by a very small virus. It is highly communicable, has a dramatic onset, but is fairly short- lived. He said 35-75% of exposed people will often get the disease in the first pass. He said that because of the rapidity, there is often no effective medical response, except sanitary measures to contain the infection and supportive measures for those infected. After having the infection, there is a period of immunity that is fairly short-lived. There are many different genetic variations of norovirus with associated variations in immunity and susceptibility. Dr. Locke explained that this is not a "Notifiable" condition, but that the Health Department will attempt to help, particularly if an institutional outbreak seems related to food service. It can be a serious disease in the elderly and special attention must be paid to maintaining adequate hydration. AGENDA PLANNING The next BOH meeting is schedule for March 19, 2009, location to be announced. Vice Chair Russell adjourned the meeting at 4:07 PM. JEFFERSON COUNTY BOARD OF HEALTH Excused Sheil,�Westerm , Chair t1' Chuck Russell, Vice -Chair /�464u Roberta Fris ell, Member J hn Austin, Mem er Page 9 of 9 Excused Phil Johnson, Member Michelle Sandoval, Member Davidu iv , eer