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ORANGE COUNTY BOARD OF HEALTH
March 22, 2017
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ORANGE COUNTY HEALTH DEPARTMENT MISSION STATEMENT: To enhance the quality
of life, promote the health, and preserve the environment for all people in the Orange County
community.
THE ORANGE COUNTY BOARD OF HEALTH MET ON March 22, 2017, at the Orange
County Health Department, 300 West Tryon Street, Hillsborough, NC.
BOARD OF HEALTH MEMBERS PRESENT: Liska Lackey – Chair, Susan Elmore, Vice-
Chair, Commissioner Mia Burroughs, Barbara Chavious, Paul Chelminski, Jennifer Deyo,
Jessica Frega, Sam Lasris, Reena Mehta and Timothy Smith.
BOARD OF HEALTH MEMBERS ABSENT: None.
STAFF PRESENT: Dr. Dorothy Cilenti, Interim Health Director; Alan Clapp, Environmental
Health Director; Rebecca Crawford, Finance & Administrative Services Division Director; Ashley
Mercer, Healthy Carolinians Coordinator; Pam McCall, Personal Health Services Director; Dr.
Erica Pettigrew, Medical Director; Kiana Redd, Healthy Communities Healthy Homes
Coordinator; Stacy Shelp, Communication Manager; Juliet Sheridan, Applied Public Health
Informatics Fellow; La Toya Strange, Administrative Assistant II and Allison Young, Health
Informatics Manager.
GUESTS PRESENT: None.
I. Welcome New Employees
Liska Lackey, Chair, called the meeting to order. Dr. Cilenti welcomed the new employees in
attendance: Teresa Clay, Katy Foust, Jennifer Reinert and Iulia Vann.
II. Public Comment for Items NOT on Printed Agenda: None
III. Approval of the March 22, 2017 Agenda
Motion was made by to Mia Burroughs approve the agenda, seconded by Susan Elmore
and carried without dissent.
IV. Action Items (Consent)
A. Minutes of February 22, 2017 Meeting
Motion was made by Susan Elmore to approve the minutes of February 2017, seconded
by Paul Chelminski and carried without dissent.
V. Educational Sessions
A. Strategic Plan/Patient Texting Update
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Rebecca Crawford, Financial and Administrative Services Director, began by informing the
Board that a new BOH liasion, Beverly Scurry, has been hired and will be starting on April 3rd.
Next, she presented highlights of the achievements accomplished to date centered around the
four priority areas of Social Determinants of Health, Physical Activity and Nutrition, Substance
Abuse and Mental Health and Engagement.
Highlights of Ms. Crawford’s presentation include:
Social Determinants of Health
Focus #1: Family Success Alliance (FSA)
o There will be an update later this fall.
Focus #2: Policies improving access to care
o Patient/Client text messenging
• The contract with the vendor is currently in our finance office awaiting signatures.
The staff has formed superuser groups. We’ve identified the initial phase one
groups (which patients we want to text). The focus will be in the medical and
dental clinics. We will be contacting patients via text, email and use automated
voice reminders of appointments. This low cost contract has the potential for
success as it will decrease patient no show rates and alleviate some of the
workload for the office assistants. We should also see some increased revenue
because of this service.
• On November 30th, UNC Public Policy Capstone students gave a presentation on
the availability of OTC birth control. We are following one of their
recommendations which was to wait to see how OTC birth control plays out in
California. We will revisit this issue in the fall.
Physical Activity and Nutrition
Focus #1: Advocate for policies, practices, partnerships
o Our new partnership is the Summer Feeding Program at Gateway Village
Apartments. We’re partnering with Orange County (OC) Schools, the FSA and local
churches and local non-profits to pilot this program. We’ve also partnered with OC
Libraries as they will offer literacy support during the Summer Feeding Program.
Focus #2: Evidence-based PA/nutrition interventions in schools
o Last fall, members of the Chapel Hill-Carrboro and OC school districts came and
gave presentations on physical activity assessments of their school districts. We are
still in communication with leadership at both school districts to determine how we
can partner with them. The Physical Nutrition and Activity subcommittee will continue
to work on this.
Substance Abuse and Mental Health
Focus #1: Catalyst for integrated care
Focus #2: Advocate for improved services for vulnerable pops
Updates were reported on at the January 2017 BOH meeting.
Engagement
o We’ll have an Advisory Group update at the April BOH Meeting.
Lastly, Ms. Crawford provided two exciting updates.
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• As of March 2017, 100% of law enforcement agencies in OC are equipped with
naloxone. The Sheriff’s office reported 3 reversals and Carrboro Police have reported 5
reversals with the use of naloxone.
• FIT (fecal immunochemical test) which look for blood in stool are being offered. The test
can be done at home.
The BOH members had questions that were addressed by Ms. Crawford.
B. Dashboard Review
Juliet Sheridan, Applied Public Health Informatics Fellow and Allison Young, Health Informatics
Manager, presented the 2017 annual public health dashboards for OC. The topic areas of the
nine dashboards were:
• Substance Abuse and Mental Health,
• Tobacco and Respiratory Disease,
• Chronic Disease,
• Physical Activity and Nutrition,
• Social Determinants of Health: Poverty Mitigation,
• Social Determinants of Health: Access to Care,
• Sexually Transmitted Infections,
• Maternal and Infant Health, and
• Injury and Violence.
The dashboard are published yearly and posted on the website. Some of the highlights from
the topics they presented on are as follows:
Drug and opioid overdose mortality rates in OC are increasing. More than a ¼ of OC
opioid deaths from 2009-2013 came from Hillsborough which makes up only 5% of OC’s
population. In OC, 1 in 3 high school students have tried e-vapor products; 1 in 5
students is a current user of e-vapor products.
OC performs well on most chronic disease indicators; however, the prevalence has
increased in the last decade. Diabetes mortality rate has increased 30% over the last
two years. Breast cancer mortality has been declining; while the incidence has been
steadily rising with a 15% increase per year.
The percentage of low income children who are uninsured (12%) is higher than in our
surrounding counties, the state and the nation.
OC has one of the highest rate of income inequality. There are fewer people with most
of the wealth.
The incidence of most STIs have increased. Gonorrhea has increased 10% and HIV
infection has increase 27%.
There has been a small decrease in infant mortality. African-American infants are more
than 3 times likely to die as non-Hispanic white babies in OC.
Ms. Young acknowledged some challenges and data gaps. She noted that there may be some
inconsistency as the base population may change year to year. The continuity of data collection
and methodology and data quality were also mentioned as challenges. She also stated that
they would prefer to have information that was aggregated by demographics and place-based
(i.e. where they live).
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Ms. Young continued by stating that their goals for next year include:
• Expanding the audience for dashboards
• Setting local targets for indicators
• Incorporating more equity measures
• Developing linkage between clinic and county indicators
• Continuing to build relationships with UNC hospitals
• Identifying alternative data sources
The BOH members had comments and questions that were addressed by Ms. Sheridan
and Ms. Young.
C. State of the County Health Review
Ashley Mercer, Healthy Carolinians Coordinator, presented the 2016 State of the County Health
Report (SOTCH). The SOTCH is a report that is produced every year in between the
Community Health Assessment (CHA). Social Determinants of Health, Physical Activity &
Nutrition and Mental Health & Substance Abuse are the three areas that are focused on in the
report. Below are highlights from Ms. Mercer’s presentation.
Social Determinants of Health
o Mortality rates have slightly decreased.
o 12.1% of the population under 65 years old is uninsured compared to 15.3% in 2013.
o 14.7% of our population lives in poverty and approximately 29% of OC families with
children cannot meet their basic needs.
o OC ranks 2nd among all counties in NC in income inequality.
o Pilot a transportation access improvement activity plan that would offer suggestions
such as: designate staff to answer questions regarding transportation or have a
space where this information can be displayed.
Physical Activity & Nutrition
o There are still approximately 50% of our community that is not physically active or
getting the recommended amount of exercise, ¾ of our community are not eating the
recommended servings of fruits and veggies and approximately 50% are not a
healthy weight.
o The BOH has action plans to advocate for and pursue policies, practices and
partnerships aimed at increasing access to healthy foods and safe places for
physical activity. One way of doing this is to explore the option to provide incentives
to food retailers to be present in and/or offer healthier food and beverage choices in
underserved areas (food deserts) with the help from the Orange County Food
Council of which Ms. Mercer is the OCHD representative.
o The BOH also has plans to work to increase physical activity and improve nutrition in
schools by seeking local funding partnerships to provide small grants, for school
staff, to implement in-class or other short activity breaks during the school day.
Mental Health & Substance Abuse
o We are ranked #1in the state when it comes to the number of opioid prescriptions
(.52) or pills prescribed per resident (34.5), in 2016 (this is an average). So for every
100 residents, 52 had an opioid prescription in 2016.
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o The rate of suicide has decreased from 10.4 to 8.8 in OC. By September 2017,
Healthy Carolinians of OC will implement a county-wide suicide prevention campaign
during Suicide Prevention Month which is in September that will encourage residents
to access 911, the Suicide Prevention Lifeline, and Cardinal Access line more as
sources of intervention, treatment and referral.
o Cigarette use is decreasing among NC youth, overall tobacco use is increasing,
driven in large part by use of e-cigarettes and hookah.
o There is a lot of work being done in this area that the community can benefit from
including:
• In March 2016, you the Board voted & approved – and forward to the BOCC
for action – a request for one additional Clinical Social Worker to provide
integrated behavioral health services as part of the Health Department’s
clinical services. Within its first 10 months, the OCHD served 145 patients,
with 341 patient visits.
• 5 lock boxes: all 3 law enforcement offices, sheriff office and the OC
Courthouse (which is likely going to be transferred to Hillsborough
pharmacy).
• The Health Department’s Medical Reserve Corps (MRC) was awarded
$15,000 in 2016, through the National Association of City and County Health
Officials (NAACHO) to prevent illegal access to opioids through the
distribution of home medicine lock boxes.
• OCHD became the first health department in NC to implement a Naloxone
program with Public Health Nurses providing kits, free of charge, to those in
need
• The Health Department has been exchanging needles for drug users and
patients of diabetes since April 2016. The syringe packages include an
immunity card accepted by local law enforcement, 20 syringes, condoms, and
information on drug abuse and overdose prevention, HIV, AIDS, and HCV
(Hepatitis C Virus) transmission prevention, and referral information for
services offered at the OCHD. In 2016, the Health Department distributed a
total of 22 kits.
Ms. Mercer added that this report is disseminated to the NC DPH, BOH, BOCC, HCOC
membership and OC Government employees. Electronic versions are available online via the
HCOC and OCHD websites. Lastly, Ms. Mercer reiterated that per Benchmark 38, Activity 38.2,
for accreditation purposes, the BOH minutes should reflect that the BOH member have received
and reviewed the SOTCH report.
The BOH members had comments and questions that were addressed by Ms. Mercer.
VI. Reports and Discussion with Possible Action
A. Health Director Report
In addition to her report, Dr. Cilenti added that the County Health Rankings will be released on
March 29th. Historically, OC ranked well amongst the counties in NC. The OCHD will celebrate
National Public Health Week from April 3rd through April 9th. Stacy Shelp will capture what the
OCHD is doing via social media.
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Dr. Cilenti mentioned the visit to the SHSC by the Office of Population Affairs (OPA) which
administer the Title X program. Dr. Cilenti also spoke about the new BOH appointment of
Johanna Birckmayer. There were also a few other bills of interest Dr. Cilenti mentioned. There
are:
• HB 387 Healthy Corner Store
• HB 250, S131, S24 – Allows restaurants to use outside grills
• SB 290 Medicaid Expansion Bill
B. Media Items
Media items were in the packet which focused on Orange County’s events and our
involvement in various efforts.
Susan Elmore motioned to move into closed session and Jessica Frega seconded.
VII. Closed Session to Discuss Health Director Recruitment
During the closed session, the Board of Health discussed candidates for the health director
position.
VIII. Adjourn to Open Session
Barbara Chavious motioned to move into open session and Paul Chelminski seconded.
IX. Board Comments.
Coby Jansen Austin (via phone) shared an opportunity for the BOH members to attend the
Racial Equity Institute training.
X. Adjournment
Susan Elmore moved to adjourn the meeting at 8:45pm and Sam Lasris seconded.
The next Board of Health Meeting will be held April 26, 2017 at the Orange County Health
Department, 300 West Tryon Street, Hillsborough, NC at 7:00 p.m.
Respectfully submitted,
Dorothy Cilenti, MSW, MPH, DrPH
Orange County Interim Health Director
Secretary to the Board