HomeMy WebLinkAboutBoard of Health Quarterly Update AGENDA ITEM SUMMARY
SPECIAL MEETING DATE: August 7t", 2012
AGENDA ITEM TITLE: Public and Environmental Health Quarterly Update
with the Board of Health
STAFF RESPONSIBLE: Nan Sundeen, Liz Stark
ISSUE STATEMENT:
This is the third Quarterly update for 2012 between the Board of Health(BOH),
Community Health Services, Inc. (CHS},Pitkin County Medical Officer, Pitkin County
Environmental Health, and the Environmental Public H:ealth Advocate. Today the
Director of Public Health will present the following: (see Attachment A)Community
Health Assessment update, Immunization and Family Planning billing changes,Aspen to
Parachute DenYal Health Alliance,the Tobacco Grant application and the Community
Paramedic project update. In addition,the Board of Health will review updates from
Kurt Dahl, Environmental Health manager and Tom Dunlop, Environmental Public
Health Advocate.Attachment B is a summary of the Community Paramedic Program for .
your information.
In addition, Dr. Morris Cohen, Pitkin County Medical Ot�icer has provided two articles from
the National Institutes of Health MedlinePlus titled"Understanding Cholesterol and Heart
Health". Also included is a patient guide titled`Blood Fats and Your Heart"which includes
advice for healthy eating and physica] activity. (Placed in BOCC "Read"box).
BACKGROUND:
The purpose of SB-08-194, the Public Health Reauthorization Act(The Act),was to
revitalize outdated Colorado public health statues and re-define statewide expectations
for the provision of health-related services in local communities. Under the Act, Pitkin
County Commissioners serve as the Board of Heaith. The Board of Health is responsible
to determine services to carry out the public health laws and rules, appoint the Public
Health Director, direct the public health agency to complete a community health
assessment every 5 years, approve the local public health plan and submit it to the state
Board of Health for review, and develop and promote public policies needed to secure
conditions necessary for a healthy community.
Colorado Revised statutes (25-1-508-b-I)require the Board of Health meet"on a regular
basis, at least quarterly."The Pitkin County BOH meets quarterly with Liz Stark, Pitkin
County Public Health Director,�r. Morris Cohen-Pitkin County Medical Officer(both
positions are reyuired by the Act). In addition, the BOH invited Tom Dunlop, Pitkin
County Environmental Health Advocate and Pitkin County Environmental Health to
incorporate environmental health updates into the public health quarterly report.This
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collaboration reflects the intention of the Act to integrate public and environmental health
on the local leveL
Community Health Services, Inc., a non-profit organization, is now in the final year of a
three-year grant partnership with Pitkin County to provide public health services for the
residents and workers of Pitkin County. In 2012, CHS will receive$271, 205 from the
� Pitkin County Healthy Community Fund. In addition, Pitkin County provides in-kind rent
and utilities to CHS in the amount of$43, 947. CHS has a Board of Directors that is
responsible for ensuring the general operations and fiscal viability of the agency. The
Board of Health is responsible to ensure the provision of essential public health services.
Today, Liz Stark,Pitkin County Public Heath Director, has submitted a memo
(Attachment A) identifying a few hot topics.Her team has made great progress on the
Community Health Assessment and it is notable that they remain on-track and on-time
with this project.Liz will present the Community Health Assessment progress to date and
outline what will happen before the end of the year. She will also present information on
Immunization and Family Planning billing changes,the Dental Health Alliance "Cavity
Free at Three"project and the tri-county Tobacco grant that was submitted.
During the past 4 months the Director of Public Health has been working with members
of the Aspen Ambulance District, Aspen Valley Hospital, Eagle County Community
Paramedics staff and other Pitkin Health and Human Services managers to consider
implementing a"Community Paramedics"project in Pitkin County.This project is in a
conceptual stage now as Aspen Ambulance District and AVH begin to share the concept
with community partners. Today, Liz will provide a brief description of the concept for
the Board of Health.
LINK TO STRATEGIC PLAN:
Livable and Supportive Community—Self Sufficient Individuals and Families
Prosperous Economy—Affordable and quality health care options
KEY DISCUSSION ITEMS:
1. Review and discuss updates and items presented by Liz Stark, Dr. Morris Cohen,
Tom Dunlop and Kurt Dahl.
BUDGETARY IMPACT: None
RECOMMENDED BOH ACTION: None, information only
ATTACHMENTS:
A) Memo from Public Health Director, Liz Stark
B) Community Paramedic Program information sheet
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0405 Castle Creek Rd.,Suite 6. Aspen,CO 81611,Phone: (970}920-5420. FAX:(970)920-5419
ATTACHMENT A
To: Pitkin County Board of Health
From: Liz Stark RN, Pitkin County Public Health Director; Director, Community Health
Services, Inc.; Tom Dunlop,Pitkin County Environmental Public Health Advocate,
� Kurt Dahl, Pitkin County Environmental Health Manager
Date: August 1 st, 2012
Re: Quarterly Board of Health meeting on August 7, 2012.
COMMCJNITY HEALTH SERVICES QUARTERLY UPDATE: Submitted by Liz Stark
Community Health Assessment/Public Health Improvement Plan:
Community Health Services, Inc. has been working with a Steering Committee on the
Community Health Assessment process since the fall of 20l 1. This group was made up of
community stakeholders that represent a wide range of topic areas and target populations such as
the young child, seniors,mental health and substance abuse, dental health, and health care. The
Steering Committee reviewed many data sources over the winter months that culminated in a
decision making process that selected the top Public Health priority for the Pitkin County Public
Health Improvement Plan(the Plan). CHS also conducted a Community Forum discussion on
July 18th to get community member input. Both processes ended up selecting the same topic as
an issue far the community. `Access to Care' was identified as the top priority area for the Public
Health Improvement Plan.
The Steering Committee also chose radon as an environmental health priority. The City of Aspen
Environmental Health Department has also selected radon as their priority as did Eagle County
Public Health. This will provide a great opportunity for collaboration between our local agencies
as well as regional collaboration.
During preliminary discussions with the community and the steering committee, issues related to
access to care included access for certain populations like seniors, the Latino population, and the
uninsured and also access to certain services like mental health and substance abuse and
preventive care.Based on this,we realize this is a very broad topic. Therefore, next steps include
convening another group of stakeholders to determine where to focus our resources. We will also
be researching evidenced based strategies that can be used to address the issue. Eagle County
Public Health has also selected this tapic as one of their priorities so work will include
opportunities to collaborate with them.
The goal is to submit the Plan by the end of 2012. CHS, as the Public Health Agency for Pitkin
County,will be responsible for convening appropriate groups to address these issues, reporting
progress to the State Health department and monitoring progress over the next 5 years.
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CHS has also selected an internal priority. We will address how to build internal capacity in
order to deliver the Core Public Health Services.The Core Public Health Services were
mandated by law in November of 2011 for all Local Public Health Agencies and include
Assessment and Planning;Prevention and Population Health Promotian; Communicable Disease
prevention, investigation and control;Emergency Preparedness and Response; Administration
and Governance and Environmental Health. The Assessment and Planning and the Population
Health promotion functions are new roles for CHS. Strategies to address these new mandates
will be outlined in the Plan.
Public Health agencies must assure that the Core Public Health Services are available to all �
citizens and the decision to provide all of them will be based on agency priorities, funding and
capacity.
Immunization and Family Planning Billing:
Health Care Reform is making its impact on Local Public Health Agencies (LPHA's). Both the
Immunization program and the Family Planning program are working with LPHA's to build
infrastructure that will allow us to bill public and private insurance companies for the preventive
services that we provide in these two programs.
The CDC recently mandated that, as of January l, 2013, publicly funded vaccine cannot be
administered to anyone who has health insurance. Most LPHA's have historically used their
federally funded Vaccine for Children's (VFC) vaccine for children whose parents report that
they are underinsured with high deductibles or could not afford copays or deductibles.This will
no longer be allowed in an effort to ensure that those who have benefits through their insurance
are using that as their payor source. It reserves the VFC vaccine for those who are truly
uninsured and helps preserve limited federal funds that support this program.
Anticipating Medicaid expansion and Health Insurance Exchanges and the increased number of
individuals who will be insured,the Family Planning Program is also assisting us in building the
infrastructure needed to bill both public and private insurances. It is anticipated that the demand
for our services will increase due to the inability of local health care providers to accommodate
the increased number of newly insured.
Needless to say,this will have an enormous impact on the operations of CHS. We are in
discussions with our Board and Staffto determine how to acquire the expertise, training and
capacity to take on this new function.
Aspen to Parachute Dental Health Alliance Update:
The Aspen to Parachute Dental Health Alliance(APDHA)held the launch of its Cavity Free at
Three pilot program in June. It was well attended by over l00 dental and health professionals in
the region as well as elected officials. Thank you to Rachel Richards for attending this exciting
event. This is a partnership with Caring for Colorado and the statewide initiative of Cavity Free
at Three. The goals are to increase the awareness of the need for oral health for children under
age 3 by educating dentists and primary care providers and to increase the number of dentists
who accept Medicaid in their practices. The Launch was successful in engaging local dentists to
receive the Cavity Free at Three training and to pursue training in Medicaid billing.The
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APDHA's Regional Oral Health Consultant is already working with several practices and
contacting others to participate in this initiative. Cavity Free at Three trainings are currently
scheduled at Mountain Family Health Centers' Dental clinic in Rifle and one will be held in the
Aspen area this fall for local dentists and other health care providers.
Tri-County Tobacco Grant:
Garfield, Eagle and Pitkin County Public Health have partnered to apply to the Colorado
Department of Public Health and Environment for a grant called the Tobacco Education,
Prevention and Cessation Grant Program made available by Amendment 35 funds. Our grant
has been recommended by the State Tobacco Review Committee to the State Board of Health
which will make a decision on August 15'�'. This will be the first formal collaboration of the three
Public Health agencies and provides an opportunity to build regional efforts in addressing public
health issues.The goal of the grant is to 1) help people who use tobacco quit; 2)prevent youth
from starting to use tobacco; 3)assist in the reduction of and protection from secondhand smoke;
and 4)reduce tobacco use among groups disproportionately affected and/or at high risk. If
granted, work will begin October l, 2012.
Community Paramedic Program:
CHS is partnering with the Aspen Ambulance District and Pitkin County Health and Human
Services to start a new program in Pitkin County called the Community Paramedic Program (CP
Program).This model was made famous by Western Eagle County Ambulance District over the
last year. Please see Attachment B, titled"Community Paramedic".The program is intended to
reduce health care costs, improve healthcare access and improve health outcomes for vulnerable
populations. This program allows Emergency Medical Services(EMS)personnel to provide
services in the home that are within their current scope of practice including: hospital discharge
follow-up, fall prevention in the home, blood draws,medication reconciliation or wound care.
The CP provides care and communicates back to the referring physician. In addition, CP's can
work with Public Health and Human Service agencies to provide preventive services and
medical support for home visits.
Aspen Ambulance District is taking the lead on this initiative and is currently putting together a
business plan and engaging stakeholders in the concept. Public Health will support them in the
development of the program and will be looking for opportunities to enhance the delivery of our
preventive services.
ENVIRONMENTAL HEALTH DEPARTMENT QUARTERLY UPDATE: Submitted by
Kurt Dahl
New EH Manager:
Kurt Dahl accepted the position of EH Manager and started with the Department June 25, 2012.
Kurt came from Teller County,where he was the EH Director for 8 years.
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Air Quality:
EH staff recently attended and obtained certification from "Smoke School"which certifies
attendees to perform vehicle exhaust opacity checks. Vehicle exhaust opacity is directly linked
to reduced air quality. While there are no plans to implement vehicle check programs, this
training is valuable knowledge in our efforts to protect air quality.
Consumer Protection Program:
The Consumer Protection contract with the Colorado Department of Public Health and
Environment(CDPHE)was recently completed for fiscal year 2011/2012 and a new contract
was approved for the next fiscal year. The Consumer Protection Program encompasses
inspections of retail food establishments, childcare facilities, and schools.
Onsite Wastewater Treatment System (OWTS)Program:
CDPHE Water Quality Control Division is in the process of drafting new OWTS regulations.
We have been participating as stakeholders in the process. Once these regulations are adopted,
counties will have an additional year to make any necessary changes to meet minimum standards
outlined in the new state regulations.
National Environmental Health Association (NEHA) 2012 Annual Education Conference:
I attended the 2012 NEHA annual education conference in San Diego, CA at the end of June. As
the president-elect of the Colorado Environmental Health Association(CEHA) I represented
Colorado at regional and national seminars.A recommendation that came out of the meetings
was for NEHA to explore creating"model codes" for several Environmental Health programs
like noise abatement and child care. I also attended a technology presentation that demonstrated
the use of a tablet computer at a restaurant inspection which is of interest to me since we are
looking at doing the same.
ENVIRONMENTAL PUBLIC HEALTH ADVOCATE QUARTERLY
UPDATE: Submitted by Tom Dunlop
CDC Food Safety Modernization Act:
As I presented to you at the October 2011 BOH meeting, I have accepted an appointment by the
Centers for Disease Control and Prevention to represent the National Environmental Health
Association on a committee called to help design the national response to the Act of Congress
mentioned above. I am a member of the Food Safety Modernization Act Surveillance Working
Group of the Office of Infectious Diseases, CDC Board of Scientific Counselors. This
appointment extends from July l, 2011 through June 30, 2014.
The two day meeting held mid-April was concentrated on identifying a progress report to offer
the Secretary of Health and Human Services on criteria necessary to select various states and
academic institutions that will act as resources to this project. The second day of this meeting
was sponsored by the Association of Public Health Laboratories. The discussion was how
reliable are new technologies being proposed for use in public health laboratories vs. older
proven technologies. I will be happy to discuss details of this work should the BOH express
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interest beyond this simple explanation.The third on-site m�eting in Atlanta will take place fall
2012.
CDC Environmental Public Heatth Tracking Network(EPHT):
I have reviewed this program with the BOH in past reports so will not go into a lot of detail. In
summary it is a national surveillance program designed to identify various illness and disease
associated with environmental exposures.
Last spring I completed work with the National Association of County and City Health Officials
and the Centers for Disease Control and Prevention. I facilitated meetings between two states
that have received federal funding to identify environmental exposures that may result in illness
and/or disease. Iowa and Minnesota were selected. My assignment was to have each state meet
with local health departments in their respective states to see how the local and state
governments could work closely together to implement the federal EPHT program.
Colorado State University (CS�:
I continue volunteer duties with the CSU Department of Environmental and Radiological Health
Sciences on their citizen advisory committee.To recap,this position may allow Pitkin Co. an
opportunity to entertain the option of placement of an Env Health intern from CSU to aid in
special projects. I am also actively engaged in curriculum design for the school.
The on-site meeting in Ft. Collins on the CSU campus held on April 2012 focused on curriculum
enhancement in the undergraduate environmental health school. The focus was to include non-
technical skills in the curriculum to better prepare students to enter the work force..
National Association of County and City Health Officials (NACCHO):
I continue offering voluntary service with the NACCHO Environmental Public Health Tracking
program and as a member of the Environmental Health Essential Services Committee. I
mentioned above my current work with the Tracking program.My activity with the Env. Health
Essential Services Committee has become more involved recently than in the previous quarter.
I submitted comments at the request by the Centers for Disease Control and Prevention on
possible health effects of the current drought on the public's health. In summary I mentioned that
wild fires have caused significant air and water quality issues. Air quality deterioration during
the actual fire plays a definite role exacerbating chronic lung conditions and also causing acute
insult to people closest to the fire. Erosion from denuded hillsides muddies receiving water
sources.Domestic water supplies and aquatic health of the streams and lakes directly impacts
health of people in the immediate watershed.
Serving on the NACCHO Brownfields work group, I am involved in writing policy that supports
funding for brownfields programs. Brownfields is a federal program that funds rehabilitation of
contaminated property for future uses. This program encourages re-use of land that may have
been written off as contaminated. Through private/public partnerships the land can be cleaned to
a defined standard and re-used without fear of enforcement actions by the federal government.
The idea behind Brownfields was to preserve"green fields" from development and encourage
inner city enhancement.
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I also serve on the NACCHO Mosquito Control work group. The NACCHO policy on
encouraging integrated pest management when controlling mosquitoes was revised in the past 6-
months. I was directly involved in this updating effort.
A couple of rnonths ago I was appointed to the NACCHO Food Safety work group. This
appointment fits well with my previous appointment to the Centers for Disease Control and
Prevention Food Safety Modernization Act committee. The latter appointment is mentioned
under the CDC heading in this report.
Colorado Health Assessment and Planning System (CHAPS):
I recently concluded my initial assignment as a committee member working on implementation
of the CHAPS planning tool. The conduding meeting was a recent gathering of inembers of the
community to identify top health needs in Pitkin County. The result of citizen input identified
access to health care and working with the aging population as the two top priorities. Other
important issues such as mental health and drug dependency were also earmarked as being of
great interest. This process of identifying health needs in Pitkin County is required by the Public
Health Act of 2008. Liz Stark will provide a more detailed report of the CHAPS process.
Colorado Environmental Health Association(CEHA):
I published an article in the spring 2012 CEHA Point Source Newsletter titled: Why Shoutd You
Advocate for Environmental Public Health?A Persona] Storv.The thought behind the article
was to encourage environmental public health practitioners to recognize their worth to society by
passing on their knowledge, skill, ability and wisdom to make the world a safer place; to
recognize they can make a difference.The article appears below.
County Health Ranking Project—University of Wisconsin:
I contributed to an article posted June 14, 2012 by Pitkin County to local news media on how
Pitkin County ranked in a recent release of statistics by the University of Wisconsin. As you may
ha�e read, Pitkin County is ranked healthiest in Colorado. While this is noteworthy, we must
understand the matrix used in this evaluation does not include every aspect of defining a healthy
person. Missing is the recognition that Pitkin Co. has a high suicide rate and we have a chronic -
drug involvement problem.
Given the above conditional explanation of the ranking it is important for us to celebrate what is
being done well. The overall health of citizens is a combination of many factors: health fairs,
awareness of what keeps us healthy, diet, exercise, loca] medical and mental health services,
Community Health Services, and living in a pristine environment to name a few.
This concludes this quarterly update. I am always prepared to receive advice from the Board of
Health, Community Health, and Environmentai Health should there be an issue of interest.
Thank you.
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Remembering back to July 2001 when I retired as the Environmental Health Director for Pitkin County,
many thoughts were flooding my mind. I was witness to the end of a career that began with the Larimer
County Public Health Department in 1970. I was also facing the unknown of a whole warld of
opportunity. The immediate euphoria of being free from the 8—5 work schedule was sobered by the fact
that I was leaving behind what I loved to da
It did not take long to decide that,even with the new found freedom, it felt haunting to completely
abandon what I had chosen as my]ife's career. I approached the Pitkin County Board of County
Commissioners and asked them to appoint me to a non-paid position of Environmental Public Health
Advocate. In exchange I committed to represent the county at various local,state,regional and national
meetings where discussions were shaping the future of the public health system.What I had experienced
during employment with the City of Aspen and Pitkin County included being an active participant with
various national non-profit health agencies and federal agencies, mostly under Health and Human
Services.My appointment allowed me to continue to participate in these most important conversations.
It is so significant to understand that the environmenta]public health system begins at the local level with
huge contributions made by states,federal partners,academic institutions and non-profit organizations.
Each of us plays such a vital role in helping shape the future, but that responsibility sometimes gets lost
during the daily grind of our jobs.Every time an environmental public health practitioner sets foot out of
the office and interacts with the public an advocacy responsibility goes on the street,too. When there is a
visceral belief in each of us that our jobs matter,that we can make a difference in the lives of others,that
standards in place to protect the public's health are our responsibility;the guiding principle of advocacy
has become part of the job.
There are practitioners who,when they retire or chose to leave the fietd,have made a realization that they
did their jobs and are content to make room for the emerging workfarce of leaders to pick up the job and
carry on. I have the highest respect for them as these decisions are decidedly personal and sometimes
difficult to make.What I urge everyone who has been or remains in the environmental public health
profession to contemplate is the vast bank of helpful knowledge,skill and ability in each of us. Equally, if
not more importantly is the wisdom that can be shared.Knowledge is strength beyond comprehension.
Advocacy for a healthy society is a responsibility that becomes exponential when people iike us
collectively share our experiences. When you ha�e a quiet moment,recognize and contemplate your
ability to make a difference.
Respectfully submitted,
Liz Stark RN
Pitkin County Public Health Director
Director, Community Health Services, Inc.
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