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ORANGE COUNTY BOARD OF HEALTH
MEETING AGENDA
DATE: March 22, 2017
TIME: 7:00 P.M.
PLACE: Whitted Building, 3rd Floor Meeting Rooms
300 West Tryon Street
Hillsborough, NC 27278
TIME ITEM
7:00 p.m. I. Welcome New Employees
7:00 – 7:05 II. Public Comment for Items NOT on Printed Agenda
Public Comment for Items ON Printed Agenda will be
handled during that agenda item
(Please sign up for both on sheet near the entrance to room.)
Please limit your comments to 3 minutes.
7:05 – 7:10 III. Approval of March 22, 2017 Agenda
7:10 – 7:15 IV. Actions Items (Consent)
A. Minutes of February 22, 2017 Liska Lackey
7:15 – 7:55 V. Educational Sessions
A. Strategic Plan/Patient Texting Update Coby Jansen Austin/Rebecca Crawford
B. Dashboard Review Allison Young/Juliet Sheridan
C. State of the County Health Review Ashley Mercer
7:55 – 8:00 VI. Reports and Discussion with Possible Action
A. Health Director Report Dorothy Cilenti
B. Media Items
8:00 – 8:30 VII. Closed Session to Discuss Health Director Recruitment
8:30 – 8:35 VIII. Adjourn to Open Session
8:35 – 8:40 IX. Board Comments
8:40 X. Adjournment
BOARD MEMBERS: To ensure a quorum, SEND E-MAIL to lstrange@orangecountync.gov advising her of
your attendance at this meeting OR CALL 919-245-2411.
Compliance with the “Americans with Disabilities Act” and Title VI - Interpreter services and/or special sound equipment
are available on request. Call the Immigrant and Refugee Health Program Manager at 919.245.2387 to request an interpreter
or other accommodation.
Conforme a la “Ley sobre Estadounidenses con Discapacidades” (ADA) y el Título VI – los servicios de intérprete y/o
equipo de sonido especial están disponibles a solicitud. Llame a la Administradora del Programa de Salud para Inmigrantes
y Refugiados al 919-245-2387 para solicitar un intérprete u otros arreglos o adaptaciones.
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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 February 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, Paul Chelminski, Jennifer Deyo, Reena Mehta and
Timothy Smith.
BOARD OF HEALTH MEMBERS ABSENT: Barbara Chavious, Jessica Frega and Sam Lasris.
STAFF PRESENT: Dr. Colleen Bridger, Health Director; Coby Jansen Austin, Director of
Programs and Policy; Alan Clapp, Environmental Health Director; Rebecca Crawford, Finance &
Administrative Services Division Director; Donna King, Health Promotion & Education Services
Director; Ashley Mercer, Healthy Carolinians Coordinator; Pam McCall, Personal Health
Services Director; Kiana Redd, Healthy Communities Healthy Homes Coordinator; April
Richard, Senior Public Health Educator, Tobacco Prevention and Control Coordinator; Stacy
Shelp, Communication Manager; Juliet Sheridan, Applied Public Health Informatics Fellow and
La Toya Strange, Administrative Assistant II.
GUESTS PRESENT: None.
I. Welcome
Liska Lackey, Chair, introduced the new Board of Health (BOH) member, Jennifer Deyo.
II. Public Comment for Items NOT on Printed Agenda: None
III. Approval of the February 22, 2017 Agenda
Motion was made by Susan Elmore to approve the agenda, seconded by Mia Burroughs
and carried without dissent.
IV. Action Items (Consent)
A. Minutes of January 25, 2017 Meeting
Motion was made by Susan Elmore to approve the minutes of January 2017, seconded by
Reena Mehta and carried without dissent.
V. Educational Sessions
A. Surgeon General E-cigarette Presentation
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April Richard, Tobacco Prevention and Control Coordinator, provided a summary of the
Surgeon General’s Report on e-cigarette use among youth and young adults. In advance, Ms.
Richard provided background information on e-cigarettes as well as a fact sheet on the Surgeon
General’s report entitled ‘’E-cigarette Use Among Youth and Young Adults‘’ that highlighted the
public health issue of e-cigarettes and their impact on U.S. youth and young adults.
Highlights of Ms. Richard’s presentation include:
• Varied terminology presents challenges for assessing use and raising awareness about
what these devices are and their health implications. Some common names are e-cigs,
cigalikes, vape pens, and hookah pens.
• Users refer to themselves as vapers rather than smokers.
• The Surgeon General’s Report presented five public health concerns.
1. Considerable increase in usage.
2. Usage strongly associated with use of other tobacco products.
3. Nicotine has a detrimental affect on the developing brain and fetuses. An
increased rate of SIDS is another harmful effect.
4. Aerosol and vapor produced is not harmless.
5. Product marketing mimics that of conventional cigarettes.
• E-cigarettes can give as high or higher doses of nicotine than conventional cigarettes.
• The aerosol, which is not water vapor, contains other toxicants that may be harmful,
some of which are known carcinogens.
Dual use (use of e-cigarettes and one or more other tobacco products) is common amongst
youth and young adults. Amongst high schoolers, as the grade level increases, so does the
prevalence of dual use. Dual use amongst young adults is more prevelant than exclusive use of
e-cigarettes.
Stategies to implement for prevention include:
• Employ consistent and accurate messaging to parents, youth, young adults, healthcare
providers, educators, and other stakeholders about the dangers of e-cigarette use.
• Address point of sale and point of delivery ageverification to minimize the ability for
youth to access these products.
• Regulate marketing and advertising practices.. Many strategies have been found to
target youth and young adults including ad placement and themes of rebellion, sex, and
independence.
• Restrict flavors as flavors are one of the leading reasons youth and young adults
iniatite use of these products. There are more than 7000 flavors available.
• Include e-cigarettes in smoke-free indoor air policies
The BOH members had questions that were addressed by Ms. Richard and Dr. Bridger.
B. Outside Agency Review Process
La Toya Strange, Administrative Assistant II, summarized the Outside Agency Review process
and the assignments required of Board of Health members for evaluating applications. The
Health Department received nine applications to review. Board members are to review the
applications assigned to them, record scores on the appropriate scoring cards and send the
completed scoring cards back to Ms. Strange by March 17th.
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VI. Action Items (Non Consent)
A. 2017-18 Budget Proposal
2017-2018 Budget, Fee Schedule & Requested Changes
Dr. Bridger presented the Board with a summary of the proposed FY 2017-2018 budget for the
Health Department which shows an increase in expenditures of $1,037,687; $228,173 of which
are expenditure increases related to the FY 16-17 wage increase and county-initiated increases
to the staff salaries for compression adjustments, market rate changes, FLSA wage increases,
and a temporary position made permanent, which are outside of the control of the department.
The remaining $809,514 of the total increase is the amount the Health Department requests
from the county, which is made up of increases to staffing and service levels increases such as
for the Family Success Alliance (FSA) and enhanced medical services. This also includes
budget increases approved during the FY 16-17 budget process for the FY 15-16 wage
increases, a Public Health Educator, a men’s Primary Care program, and FSA-related
programming among others. Staff projects a $525,116 increase in revenues for FY 17-18,
which will offset much of the $809,514 requested expenditure increase. The total FY17-18
Health Department request for County General Funds is $512,571. The proposed total budget
is $10,101,460 which includes $32,168 in grant funding for the Susan G. Komen program.
In relation to new staff requests, the Health Department requests a total of 4.5 FTE; a new 1.0
FTE Data Systems Manager to provide ongoing data analysis for FSA and Personal Health
Services, a 1.0 FTE Senior Public Health Educator to assist FSA, and a 1.0 FTE Public Health
Program Manager to Coordinate Behavioral Health Services for the county. In addition, the
Health Department requests to make a temporary 0.5 FTE Communications Specialist
permanent (as recommended by HR), and to make a time limited 1.0 FTE Property
Development Tech permanent. The Health Department will fund all of these new positions with
non-County funds except for the Property Development Tech.
In relation to state funding, the state has provided us with the FY 17-18 Consolidated
Agreement Addenda. Even though we will no longer receive funding for Ebola or Prescription
Drug Prevention as we did in FY 16-17, we will receive additional funding for Family Planning
and Speech and Hearing. Changes in funding for all other, ongoing Health Department
programs equals out to the prior fiscal year.
In relation to fee changes, the FY 2016-2017 requested budget includes fee changes for the
Personal Health, Dental Health, and Environmental Health divisions. Staff recommends multiple
fee changes for Personal Health to add three new fees for Child Health as required by DHHS
and Medicaid, and adjust the fees for 340B drugs according to changes in the state and federal
policies around 340B drugs. In addition, Medicaid has recently added a new Dental fee to their
allowable fee schedule for scaling, which staff would like added to the Dental Health fee
schedule. Also, during the FY 15-16 budget cycle, the Board of Health voted to enact Phase I of
a three year phased Environmental Health fee increase in order to reach full cost recovery for
Environmental Health. Staff recommends enacting Phase III of the three year fee increase by
raising fees an additional 11% over last year’s increases. All proposed fee increases are
described in more detail in a separate Fee Change abstract.
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Dr. Bridger facilitated a discussion about the proposed fee changes which touched briefly on the
fee changes in Personal Health, add a fee in Dental Health and continue with Phase III of the
planned fee increases in the Environmental Health division.
Personal Health requests fee increases for three child health fees required by NC DHHS and
Medicaid and scheduled adjustments to our fees for 340B drugs (Family Planning drugs not
including birth control pills) to make them match the county’s cost to purchase them, as required
by the state and federal government. This will have very little impact on both the department
and patients as only 10% of self-pay patients pay more than $0 for Family Planning drugs or
procedures and of that 10% we had no patients in prior years that have had to pay 100% of the
cost.
Dental Health requests to add an additional fee for scaling as this is a fee this has just been
added to the approved Medicaid list of fees. This will have very little impact on anticipated
revenue as staff projects only 30 procedures will be performed per fiscal year.
The Board of Health voted to enact Phase I of a three year phased Environmental Health fee
increase in order to reach full cost recovery for on-site and well services during the FY 15-16
budget process. Due to declining rate of development in Orange County, we will not reach full
cost recovery by FY 2017-18 but will do a full fee review during the fiscal year to study the
impact.
Motion to approve all fee changes for FY 2017-2018 as presented and forward to the
Board of County Commissioners for action as well as to approve the total budget
requested in the amount of $10,101,460 for 2017-2018 as presented which includes
$32,168 in grant funding for the Susan G. Komen project, and forward to the County
Manager or Board of County Commissioners for action without edits was made by Susan
Elmore, seconded by Paul Chelminski and carried without dissent.
B. Select Topics for BOCC Work Session
The Board of County Commissioners (BOCC) will review the Annual Work Plan reports from
their advisory boards and commissions, including the BOH, at their March 28th Work Session.
Liska Lackey, Chair, stated that she and Dorothy Cilenti, Interim Health Director, will attend and
update the BOCC on the Strategic Plan. Susan Elmore, Vice-chair, reminded Ms. Lackey to
remind the BOCC about the E-cigarettes rule which prompted Dr. Bridger to inform Ms. Lackey
to remind the BOCC that they have no say in the passing of the rule as it is E-cigarette use and
not cigarette.
VII. Reports and Discussion with Possible Action
A. BOH/BOCC Relationship
Liska Lackey, Chair, began by mentioning the BOCC’s recommendation for pharmacist at-large
position. The BOH does a thorough job in finding a candidate for the open Board positions
which includes reviewing all of the applications and interviewing the desired candidates. Paul
Chelminski, Susan Elmore and Ms. Lackey were involved with the interviewing process. Vice-
chair, Susan Elmore, spoke on the interviewing process. She expressed that it’s important for
the interviewees to know what they’re getting involved in, the BOH’s charge, understanding the
BOH’s responsibilities. The BOH’s interviewing process ensures that the interviewees have this
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understanding prior to being recommended for appointment. The interviewee also has the
opportunity to “interview” the interviewers. The BOH suggested that a few paragraphs be
included with their appointment recommendations to the BOCC to explain why the BOH chose a
particular individual. It may also shed light on the selection process that the BOH goes through
when recommending a new BOH member. Dr. Bridger suggested that having someone be
present at the BOCC meeting may also help.
The BOH bylaws stipulate that past OCHD employees can’t serve on the Board of Health. Dr.
Bridger added that the individual that the BOCC appointed was a past OCHD employee. Dr.
Bridger also shared that the individual was informed that she was not eligible to serve, per the
bylaws. Ms. Lackey stated that once the BOCC realized this, they stated that they would ask
the appointed individual to resign. The Chair of the BOCC will write a letter asking them to
remove their request. Ms. Elmore thanked Mia Burroughs, County Commissioner, for speaking
up on behalf of the BOH at the BOCC meeting. The BOH stated that they are fully aware that
the BOCC is not required to honor the BOH’s recommendations. For those who may be
unaware, Dr. Bridger stated that the BOH bylaws are posted on the BOH’s webpage. Lastly, the
Board stated that they will welcome whoever is appointed.
B. Health Director Report
There were no questions from the Board regarding the Health Director’s Report included in the
packet. Dr. Bridger gave an update on the OWASA water situation. She explained that it was
partly caused by human and mechanical error. There was a malfunction that resulted in too
much fluoride being added to the water which resulted in taking the water production offline.
They arranged to get water from Durham. None of the water with too much fluoride was
released into the drinking water system. Then there was a major water main break which
resulted in the loss of 1.2 million gallons of water. Due to the low water level and concern for
the potential of bacterial contamination, a Do Not Use and Do Not Drink Order were issued by
OWASA and the OCHD. Environmental Health staff went door to door notifying all food and
lodging facilities that they must close. Donna King, Rebecca Crawford and Dr. Bridger also took
shifts at the Emergency Operations Center. Stacy Shelp assisted with the communications side
of things. She fielded hundreds of call during the 24 hour period, 2pm Friday to 2pm Saturday,
in which the orders were issued. Dr. Bridger praised everyone for their assistance during this
time. One of the lessons learned was that there should be a hotline for businesses as many of
them needed information and support.
C. Media Items
Media items were in the packet which focused on Orange County’s events and our
involvement in various efforts.
VIII. Closed Session to Discuss Health Director Recruitment
During the closed session, the Board of Health reviewed and selected which applicants to
interview for the health director position. Four applicants were selected.
IX. Board Comments.
None.
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X. Adjournment
Susan Elmore moved to adjourn the meeting at 9:20pm and Mia Burroughs seconded.
The next Board of Health Meeting will be held March 22, 2017 at the Orange County
Health Department, 300 West Tryon Street, Hillsborough, NC at 7:00 p.m.
Respectfully submitted,
Colleen Bridger, MPH, PhD
Orange County Health Director
Secretary to the Board
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: March 22, 2017
Agenda Item Subject: 2016-18 Strategic Plan Update
Attachment(s): Strategic Plan Update - presentation
Staff or Board Member Reporting: Coby Jansen Austin & Rebecca Crawford
Purpose: ____ Action
_ x_ Information only
____ Information with possible action
Summary Information:
The Board of Health began implementing its new strategic plan in July 2016. This
presentation will review highlights of accomplishments so far, including the roll-out of
new patient/client text messaging capabilities.
Recommended Action: ___Approve
___Approve & forward to Board of Commissioners for action
___Approve & forward to _______________
_x_Accept as information
___Revise & schedule for future action
___Other (detail):
Orange County Board of Health
2016-2018 Strategic Plan
Update
MARCH 2017
Priority Areas
Social Determinants of Health
Physical Activity and Nutrition
Substance Abuse and Mental Health
Engagement
Priority #1:
Social Determinants
of Health
Focus #1: Family Success Alliance
Focus #2: Policies improving access to care
Priority: Social Determinants of Health
Official project roll-out of
patient/client text messaging.
Vendor selected
Texting policy developed
Training to begin soon!
Focus #1: Family Success Alliance
Focus #2: Policies improving access to care
Priority: Social Determinants of Health
Analysis by UNC Public Policy Capstone Team: Potential pathways and partnerships for making birth control pills available OTC
Literature Review
Case Studies
Policy Analysis
Feasibility Analysis
Priority #2:
Physical Activity
and Nutrition
Focus #1: Advocate for policies, practices, partnerships
Focus #2: Evidence-based PA/nutrition interventions in schools
School Data
Assessment
Presentations by both
school districts in fall
2016
New partnerships
Summer Feeding
Program at Gateway
Village Apartment
(Family Success Alliance
zone 4)
Priority: Physical Activity and Nutrition
Priority #3:
Substance Abuse &
Mental Health
Focus #1: Catalyst for integrated care
Focus #2: Advocate for improved services for vulnerable pops
Substance Abuse and Mental Health
OCHD Integrated Care
program successes!
(updated BOH in
January 2017)
OCHD exploring
behavioral health
pilot; participating in
newly formed jail re-
entry council and
Justice Advisory
Council
Engagement
Plus, two exciting
updates!
As of March 2017, 100% of law enforcement agencies in
Orange County now equipped with naloxone!
FIT test has
improved
accuracy,
compared to the
gFOBT tests, and
as it only
requires a single
specimen, is
likely easier for
our patients to
complete
FIT tests now offered for colorectal screening
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: 3-22-2017
Agenda Item Subject: Updated Dashboard Presentation
Attachment(s):
Staff or Board Member Reporting: Allison Young and Juliet Sheridan
Purpose: ____ Action
_ X_ Information only
____ Information with possible action
Summary Information:
The OCHD Health Informatics Team presents the 2017 annual public health
dashboards for Orange County. The purpose of these dashboards is to provide an
executive level view of how the county is performing on indicators in major public health
content areas as compared to the state, nation, peers, and available targets or goals.
There are 9 completed dashboards that make up the 2017 collection, which include the
topic areas of: Substance Abuse and Mental Health; Tobacco and Respiratory Disease;
Chronic Disease; Physical Activity, Nutrition and Health Weight; Social Determinants of
health (Poverty Mitigation and Access to Care); Sexually Transmitted Infections;
Maternal and Infant Health; and Injury and Violence.
The presentation will summarize key take-away findings from this year’s data and plans
for utilizing the dashboards to set targets and guide decision making in the coming year.
Packet includes:
1) Executive Summary of 2017 Public Health Dashboards
2) 10 Public Health Dashboards
Recommended Action: ___Approve
___Approve & forward to Board of Commissioners for action
___Approve & forward to ___________________________
_X_ Accept as information
___Revise & schedule for future action
___Other (detail):
March 13, 2017
2017 Public Health Dashboards: Executive Summary
The following is a summary of the key take-away findings from this year’s public health dashboards. There are
10 completed dashboards, available as separate documents. For FAQs on dashboard development, visit our
dashboard companion document at http://www.orangecountync.gov/Public_Health_Dashboards_FAQ.pdf
Substance Abuse and Mental Health
Drug use has emerged as an issue of concern in Orange County. The drug overdose mortality rate has increased
from 5.7 deaths per 100,000 residents in 2014 to 7.1 deaths per 100,000 residents in 2015. Opioid overdose
deaths are concentrated in Hillsborough, which has a higher opioid overdose mortality rate than the county and
the US. Orange County ranks first (best) in the state when it comes to the number of opioid prescriptions
prescribed per 100 residents (52, compared to 93 for NC), putting our county on par with the best state
averages in the US. Opioid and benzodiazepine prescribing rates have been stable over the past 6 years.
However, the stimulant prescribing rate has increased from 24 prescriptions per 100 residents to 30, placing
Orange County 96th out of 100 counties. Stimulant prescribing rates in NC only range from 10 to 40 per 100
residents, making this increasing trend significant.
Smoking prevalence in Orange County is lower than peers, NC, and the US, and teens who have smoked in the
past 30 days decreased in Chapel Hill Carrboro City Schools (CHCCS) from 2013 to 2015. However, new
indicators at the county level show higher rates of e-vapor use than smoking trends overall. In 2015, nearly half
of all NC high school students (49%) reported having tried an electronic vapor product, while more than a
quarter reported using these products currently (30%). In Orange County, more than a third of HS students
(CHCCS) have tried e-vapor products (37%), and nearly 1 in 5 students is a current user of e-vapor products
(18%).
Access to mental health services is reported as a priority concern by residents and subject matter experts alike.
In Orange County, hospitalization records from 2009-2015 demonstrate the percentage of visits due to mental
health for youth 0-24 years is increasing as a proportion of all mental health visits (an increase from around 18%
to 24% of all mental health visits).
Chronic Disease and Physical Activity, Nutrition
Orange County performs well on most chronic disease indicators compared to NC, the US, peers, and available
target values. However, prevalence of chronic diseases, such as cardiovascular disease and diabetes has
increased in the last decade. While death rates appear to be stable for deaths due to diseases of the heart from
2013-2015, the death rate due to diabetes has increased from 11.4 deaths per 100,000 people in 2013 to nearly
15 deaths per 100,000 people in 2015. Breast cancer mortality has been on a declining trend from 2013-2015;
however, breast cancer incidence has been steadily rising from around 160 new cases/100k in 2013-2014, to 180
new cases per 100,000 in 2015. Lung cancer and prostate cancer incidence rates have also been declining
during this time period, while mortality for each remains the same.
Hospital discharge rates for asthma increased significantly from 2013 to 2014, for both adults and children. The
overall discharge rate increased from 45 patients per 100,000 to 80 patients per 100,000. Similarly, child
discharge rates (0-14) for asthma increased from 76 patients per 100,000 to 115 patients per 100,000. While
this represents a significant increase, discharge data alone does not illustrate the full picture on if patients are
receiving quality preventative care and continuation of care to decrease re-admittance rates. More data are
needed on re-admittance rates for hospitals.
March 13, 2017
Orange County has shown improvements in residents with a healthy weight according to national surveys.
However, according to Community Health Assessment (CHA) results, 47% of survey respondents would be
considered overweight or obese based on their BMI. In contrast, only 30% of survey respondents reported
having been told by a doctor that they are overweight or obese. Sixty-five percent of CHA survey respondents
reported meeting exercise recommendations.
Social Determinants of Health and Access to Care
Orange County has the highest Gini Coefficient of Income Inequality of all counties in NC with a population
larger than 60,000 people (0.53). This means our county experiences high income dispersion, where fewer
people hold a lot of wealth and many people hold little wealth. While the median income for households in
Orange County is more than $59,000, 16% of residents are living in poverty, including 14% of children. Food
insecurity and affordable housing are key areas of emphasis for mitigating the effects of poverty in Orange
County. According to Feeding America, the percentage of the population that is food insecure (15%) stayed the
same from 2013 to 2014. Orange County saw a decline in the percent of renters paying more than 30% or more
of their income on rent, the definition of unaffordable housing. However, nearly half of Orange County renters
still pay unaffordable rates for housing.
North Carolina and Orange County each saw a decline in the percent of residents who are uninsured from 2013 to
2014 (age <65 years old). The percentage of low-income residents who were uninsured dropped the most drastically
in North Carolina, from 33% to 25%. Orange County dropped at a slightly lower rate from 32% to 26%, putting us
slightly behind the state and our peers. Orange County has seen a steady decline in uninsured rates across all
indicators from 2011 to 2014. However, the percentage of low income children who were uninsured (12%) is still
much higher than in our peer counties, the state, and the nation.
In terms of resources, Orange County leads the state in physician density, and the supply of physicians grew from
2013 to 2014. In 2013 and 2014, Orange County ranked first in dentist density. Although there was a large decrease
in the number of dentists in 2013, this trend reversed in 2014, with the dentist rate increasing by more than
6 dentists per 10,000 people.
Sexually Transmitted Infections (STIs)
The incidence of most STIs has increased in Orange County compared to previous years. Gonorrhea and HIV
Infection Rates in particular are higher for Orange County than our peers, and increasing at a significant rate.
Disaggregating this data by township has shown that these higher rates of STIs are affecting both urban and
rural areas of the county.
Maternal and Infant Health
Orange County performs well on most indicators of Maternal and Infant Health, including having the lowest
teen pregnancy rate in the state. However, many disparities exist for these indicators by race and ethnicity. For
example, African American infants are more than three times as likely to die as Non-Hispanic white babies
(disparity ratio of 3.2).
Injury and Violence
Injury and Violence statistics have remained generally stable in recent years. However, crime rates have
decreased over the past decade. Alcohol related vehicle injuries are an area of concern for Orange County. Both
alcohol related crash rates and reported drinking and driving behaviors among adults are more prevalent than
our peers and the state.
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Abstract March 2017.doc
Agenda Item Number: ____
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: March 22, 2017
Agenda Item Subject: 2016 State of the County Health Report
Attachment(s): 2016 State of the County Health Report
Staff or Board Member Reporting: Ashley Mercer, Healthy Carolinians Coordinator
Purpose/Recommended Action: ___ Approve
___ Approve & forward to Board of Commissioners
___ Information with possible action
_X_ Accept as information
___ Revise & schedule for future action
Summary Information:
The Orange County Health Department and Healthy Carolinians of Orange County are pleased
to release the 2016 State of the County Health Report (SOTCH).
This 2016 State of the County Health Report (SOTCH) provides an update on health concerns
and the actions being taken to address them. It uses the most recent data to highlight the
leading Orange County (OC) causes of death and disease and progress towards addressing the
leading health concerns identified in the 2015 Community Health Assessment (CHA). The
prioritized health issues are: 1) Social Determinants of Health with priority around access,
transportation and poverty; 2) Physical Activity and Nutrition with priority around chronic disease
prevention, and 3) Mental Health and Substance Abuse.
This report will educate and inform community members, community leaders, and organizations
about Orange County’s progress on these chosen priority health issues. This report will be
available electronically on the Healthy Carolinians of Orange County and Health Department’s
website, and paper copies will be available at the Health Department. The Orange County
Health Department will distribute this report to the Orange County Board of Health, Orange
County Board of County Commissioners, the Healthy Carolinians of Orange County
membership, Orange County Government employees, and others upon request.
Financial Considerations: None
Recommended Motion (if any):
Ashley Mercer, MPH
BOH Meeting
March 22, 2017
Purpose
Provide updates on health concerns and actions being taken to
address them.
Uses the most recent data to highlight the:
Leading causes of death & disease
Progress towards addressing the leading health concerns around:
Social Determinants of health with priority around access, poverty and
transportation
Physical Activity & Nutrition with priority around chronic disease
prevention
Mental health & Substance Abuse
Mortality
OC has a lower age adjusted death rate (per 100,000
population) than NC averages in all categories, which is a
decrease from the previous (2014) SOTCH, where OC led NC in
both breast cancer and suicide.
Rank Cause of Death 2009-2013
OC # of Deaths
2009 – 2013
OC Rate
2009 – 2013
NC Rate
2011 – 2015
OC # of Deaths
2011 – 2015
OC Rate
2011 – 2015
NC Rate
1 Cancer ( All Types) 911 156.1 173.3 932 152.0 169.1
2 Heart Disease 680 123.3 170.0 690 117.1 163.7
3 Cerebrovascular Disease 177 32.9 43.7 186 32.5 43.1
Social Determinants of Health
Access
12.1% of the population (under 65 years) is uninsured,
compared to 15.3% in 2013
Social Determinants of Health
Poverty
14.7% of our population lives in poverty, according to
federal poverty guidelines, and approximately 29% of OC
families with children cannot meet their basic needs.
When it comes to income inequality, OC ranks 2nd among all
counties in NC with a rate of 0.53, compared to our peers
(0.45), NC (0.47) and the US (0.48)
Social Determinants of Health
Community Benefit
Pilot a transportation access improvement activity plan
Physical Activity & Nutrition
% of adults experiencing physical activity and healthy
nutrition in OC
Physical Activity & Nutrition
Community Benefit
Partner with the OCFC to provide incentives to food
retailers to offer healthier food and beverage choices in
underserved areas (food deserts)
Seek partnerships (funding) to provide small grants, for
school staff, to implement in-class or other short activity
breaks during the school day
Physical Activity & Nutrition
Chronic Disease
The leading causes of death that are highly impacted by
individual behaviors such as physical activity and nutrition
Mental Health & Substance Abuse
Behavioral Health
One full time position was created and hired to provide
integrated behavioral health services to address:
Anxiety and depression,
Substance use,
Trauma and PTSD
Psychosocial risk factors (economic stress, underemployment,
relationship stress, and/or a change in culture).
Mental Health & Substance Abuse
Prescription Drug Misuse/Abuse
OC ranked #1 (best) in the state when it comes to the
number of Opioid prescriptions (.52) or pills prescribed per
resident (34.5)
In 2015, the drug overdose rate was 7.1 per 100,000
persons and the opioid rate was 4.2 per 100,000 persons.
Mental Health & Substance Abuse
Community Benefit
5 local monitored drop boxes
$15,000 awarded to MRC
Distribute 400 lock boxes over the next 4 years.
Naloxone Distribution Program
Distribute 300 Naloxone kits over the next 4 years
Safe Syringe Program
Mental Health & Substance Abuse
Suicide
The rate of suicide has decreased from 10.4 to 8.8 in OC,
but the concern among residents remains.
Community Benefit
Suicide Prevention Campaign
Mental Health & Substance Abuse
Tobacco
Cigarette use is decreasing among NC youth, overall tobacco use
is increasing, driven in large part by use of e-cigarettes and
hookah
Almost 4 out of 10 high school students in OC have tried an e-cigarette,
and about 2 out of 10 high school students currently use them
Community Benefit
Encourage enforcement of 100% tobacco free school policies
Ban of e-cig use in bars and restaurants
Dissemination
Distribution to:
NC DPH
BOH
BOCC
HCOC membership,
OC Government employees
Electronic version available online
HCOC and OCHD websites
Paper copies are available
Thank you
Ashley Mercer, Healthy Carolinians Coordinator
amercer@orangecountync.gov
Health Director’s Report
March 2017
• Met with Division Directors, Management Team and Leadership team for orientation to
program areas and outstanding issues
• Participated in FSA Advisory Council orientation with Coby Austin, Mia Burroughs and Mark
Marcoplos
• Provided guest lecture on Local Public Health to Anissa Vine’s graduate students enrolled in her
Introduction to Public Health course at UNC
• Met with County Manager and plan to attend her Department Directors’ Annual Retreat at the
end of the month
• Preparedness audit conducted by NC DPH resulted in no findings
• Bills of interest:
o HB 91/SB 66 Require Safety Helmets/Under 21
o HB 243/SB 175 Strengthen Opioid Misuse Prevention (STOP) Act
o HB 276 Strengthen Youth Tobacco Use Prevention/Funds
o SB 74 Update Rabies Control Laws
ESPN Basketball Broadcast Delayed Due to
North Carolina Water Shortage
By Laughing Place Disney Newsdesk -
Feb 3, 2017
Due to a water shortage at the UNC campus, the men’s college basketball game
where North Carolina is due to take on Notre Dame has been rescheduled from
6pm on Saturday to 1pm on Sunday. The game, which had been scheduled to
air on ESPN, will now air on ESPNEWS. Ohio State vs Michigan, which was
scheduled to air on ESPN2 will now move to ESPN to fill the void on Saturday.
The rescheduled game could not be accommodated on the main ESPN network
due to their airing of Postseason NFL Countdown ahead of the Super Bowl.
The Raleigh News and Observer reported that a “major water main” broke and
forced the university to cancel afternoon classes on Friday at 1 p.m. Campus
classes and offices remain closed. The Orange County Health Department
ordered local residents to NOT use water from the Orange Water and Sewer
Authority (OWASA) until further notice because it may not be safe.
Under this “Do Not Drink” order, only bottled water is recommended for all
water needs including flushing toilets, washing hands and cooking. Boiling water
is NOT recommended.
The order also applies to local restaurants. County officials made public
statements late this afternoon suggesting the emergency likely will extend at
least well into this weekend.
University departments had to think on
their feet to get through water crisis
Nicole Booth | Published 02/06/17 8:39pm
When Chapel Hill’s water source was shut down on Friday, the University didn't have a specific
procedure, but had to use other emergency plans to make the best of things.
Randy Young, UNC Department of Public Safety spokesperson, said safety was the University's
main priority and they use an "all hazards approach."
Young said actions are laid out for a large number of situations that are considered critical to the
campus and agencies worked hand in hand over the weekend.
“There was actually a table top drill that dealt specifically with a water crisis held at (Orange Water
and Sewer Authority) just a few years ago," Young said. "Various organizations within the University
were a part of that drill."
Young said drills may be specific to a certain kind of critical event. It could be an active shooter drill,
a toxic spill or a tornado on campus.
“Many of the same resources are brought into play and we were very pleased with the collaborative
effort on behalf of the University, the town, various departments and different agencies in
responding over the past weekend,” Young said.
When Associate Food Service Director Jerod Haxton first found classes were cancelled on Friday,
he said he knew the campus was going to be shut down.
“Rams worked closely with the Health Department and health inspector in Orange County to make
sure other places on campus were going to be able to supply us with the water that we needed,"
Haxton said. "We were given palettes of water from UNC Facilities, Orange County and our vendor,
Pepsi."
For the University, the safety of students may have been the biggest concern, but for the students
still on campus, not being able to use the bathroom was a big worry.
Rick Bradley, associate director of the Department of Housing and Residential Education, said the
University put up signs in the dorms prohibiting any water use which included using the bathrooms.
Alert Carolina messages were sent out to students to reinforce the no bathroom use.
“We were never worried about the students using their bathrooms," Bradley said. "We trusted that
they would listen to us like any good citizen would."
He said there were nearly 100 port-a-johns brought in and placed near residential communities all
around campus.
Finding sources for food and drinking water was also a concern. Rams Head Dining Hall and Rams
Head Market were the only open places on campus serving food.
Employees at the dining hall handed out almost 9,000 bottles of water to students as they came in
to the dining hall this weekend, Haxton said.
Hunter Stegall, food chef at Rams Head Dining Hall, said the staff had to go through the menu and
figure out what needed to be changed based on the new circumstances. There was no water to
wash raw chicken. There was no water to boil pasta or rice.
“We changed chicken to roast pork loin, we made bacon potato corn chowder with all milk and we
took rice off the menu and added tater tots, which the students loved,” Stegall said.
Learning from this past weekend, Haxton said the University gathered how much water the dining
hall needed to hand out to students and how much water was needed to provide people still on
campus with food, so it will have an action plan moving forward.
“We’ve never really had to worry about a plan such as this, which is exactly why they call it a crisis,”
Haxton said.
Helping hands plentiful
By the editorial board
Feb 6, 2017
The trouble started slowly, with a message Thursday evening from the Orange Water and Sewer
Authority asking its customers to “use water wisely” because an overfeed of fluoride at its
treatment plant had curtailed supply and forced the authority to turn to Durham for water.
By mid-day Friday, the situation had worsened considerably. A water main break near Dobbins
Road was disgorging water, dropping pressure in the system and raising health concerns. The
Orange County Health Department said the water was unsafe and ordered residents not to
drink it or use it for any purpose.
Businesses throughout southern Orange County shut down. The University of North Carolina at
Chapel Hill closed in the early afternoon and urged any students that could to leave campus for
the weekend.
While by Saturday afternoon the water supply was again usable, the disruption in and around
Chapel Hill was significant. Bars and restaurants lost a busy Friday night’s worth of business,
and Saturday’s sales were impacted, too. Residents rushed to secure bottled water; traffic out
of town, especially toward Durham, was heavy through Saturday afternoon. UNC’s basketball
game with Notre Dame was postponed to Sunday and moved to Greensboro.
As the work week began, things were pretty much back to normal, although it remained unclear
how the break could have shut down an entire system serving more than 80,000 customers.
OWASA officials will meet Tuesday with business owners to no doubt get an earful of dismay.
But there were, as often happens in events like this, plenty of reasons to be reassured about
people’s resilience and eagerness to help others. UNC administrators helped students stuck on
campus by distributing bottled water and setting up portable toilets. Volunteers rushed to help
distribute water at several sites in Chapel Hill and Carrboro.
Alejandro Alick III, a Chapel Hill resident, was at the Hargraves Community Center Saturday. “I
wanted to help because I know my community is in crisis,” he told The Herald -Sun’s Anna
Johnson. “I thought since my family -- we have enough to get where we need -- I thought I
would come out and be a help to the rest of the community.”
Orange County Health Director Colleen Bridger praised residents’ cooperation and willingness
to help one another, noting “there were a lot of moving parts behind the scenes.” She called
the response “one of the great things about working and being involved in Orange County.”
She said one of the most common questions from callers was “How can I help.”
For that response, we’re proud of the community.
OWASA meets privately with business community
CHAPEL HILL — Officials from the Orange Water and Sewer Authority and Orange County held a
private meeting with the business community on Tuesday to discuss the impacts and experiences of
a water crisis that caused businesses in Chapel Hill and Carrboro to close for more than 24 hours.
The meeting was organized by the Chapel Hill-Carrboro Chamber of Commerce, which barred the
media from attending the event. It was held at the Hampton Inn in Carrboro.
Chamber President and CEO Aaron Nelson said that around 90 members of the business
community came to the event to speak with OWASA Executive Director Ed Kerwin, Orange County
Health Department Director Colleen Bridger and Orange County Emergency Services Director Dinah
Jeffries.
On Thursday night, OWASA will present a preliminary report during a meeting that begins at 6 p.m.
in the Chapel Hill Town Council Chambers at Chapel Hill Town Hall, 405 Martin Luther King Jr. Blvd.
Community members may comment at the meeting or send comments in advance to
info@owasa.org or to Andrea Orbich, Clerk to the Board, 400 Jones Ferry Road, Carrboro, N.C.
27510.
Nelson described Tuesday’s meeting as positive and said it was good for the business community to
get detailed information from OWASA about the water problems. He said he was “not sensing that
anybody who had heard the information [from OWASA] would think the water ban didn’t need to be
issued.”
The discussion centered around different ways to improve communication and expectation
management between OWASA and the business community, Nelson said, with ideas such as a
separate communication channel for area businesses being brought up.
Kerwin added that the meeting was “very productive” and that the feedback the utility got was
important. “I think anything and everything we can do to improve communications … would be worth
doing,” he said.
Another issue brought up was whether OWASA could be responsible for covering any of the
damages caused by the water-related closures. Kerwin said it was too early to know if that would be
a possibility.
“Until we complete our investigation, particularly in regard to the fluoride overfeed and water main
break, only then would we be able to answer that,” Kerwin said.
Robert Epting, an attorney at the Chapel Hill law firm Epting and Hackney and legal counsel for
OWASA who was present at the meeting, did not immediately return a request for comment.
Nelson said that the Chamber is helping companies file insurance claims, but that it doesn’t look like
many plans will cover the event — though he added there was some optimism as well.
“This was a multi-million dollar hit on the business community,” Nelson said, noting that it was hard
to provide a concrete estimate on the economic impact of the closures. He said that one hotel told
him it estimated losses at $150,000 and another hotel said it was $60,000.
Scott Maitland, owner of TOPO Distillery and Top of the Hill restaurant in Chapel Hill, attended
Tuesday’s meeting. He said there were concerns, especially about how information was updated. As
a business owner, he would have liked more progress reports on the repairs and the timeline for
completing them, he said.
“The upshot is this was a freak occurrence, and I think that in general, things were handled pretty
well, and when you get all the facts, you realize why decisions were made the way they were,”
Maitland said. “I think particularly we realized, in the future, different constituencies need different
communications. A household can just turn the taps on and be back in action. A business can’t. A
business has to think about scheduling and that kind of stuff.”
While the water ban didn’t affect production at the distillery, TOPO did have to suspend tours of its
plant at 505 W. Franklin St., and business at the downtown restaurant was “an existential disaster,”
he said, estimating the two-day losses at $80,000.
He noted that Chapel Hill restaurants, bars and hotels “had some pretty hard luck this year,”
including Hurricane Matthew last fall and the N.C. State game postponed by a January snowstorm.
Jay Patel, general manager of The Franklin Hotel, was also at the meeting and said that insurance
will cover the hotel’s losses. He described the meeting as positive and that it centered around how to
improve communication.
“It was really just more of a chance to talk with folks [about what happened],” he said.
Bret Oliverio, the owner of Sup Dogs, a popular restaurant with UNC students on Franklin Street,
said the weekend’s closures cost the restaurant tens of thousands of dollars in revenue.
Oliverio, who was not at this morning’s meeting, agreed that the weekend’s closures were tough,
especially since the university asked students to leave town. He added that his insurance plan would
not cover the losses because it requires the restaurant to be closed more than 36 hours.
“It was bad timing that there was a big basketball game,” he said. “... All things considered, I thought
communication was fine. But for me, it was important to know if the ban was called because of a
shortage or because the water would make people ill. I think people were confused about that, and
we need to know 100 percent what it is.”
— The News & Observer’s Tammy Grubb contributed to this story
NEWS
OWASA Releases Water Shortage Timeline Ahead of
Board Meeting
Posted by John Thomas | Feb 9, 2017 | Health | 0
The Orange Water and Sewer Authority will address the recent Chapel Hill water shortage at its
Board of Directors meeting at six o’clock Thursday night.
The meeting will take place at Chapel Hill Town Hall instead of its usual location in Carrboro.
OWASA executive director Ed Kerwin said this change in location would ensure the people of
Chapel Hill have the chance to easily raise questions about what happened.
“It’s so important that we’re fully transparent and forthcoming with this information,” he said.
To aid with that goal, OWASA released a timeline of events Wednesday regarding the water
shortage.
The timeline breaks down each action taken by OWASA and the Orange County Health Department
from 3:00 p.m. on February 2 until 9:00 p.m. on February 4.
Those actions began with OWASA’s discovery of the fluoride overfeed at its Jones Ferry water
treatment plant. OWASA closed the plant in response.
Two hours later, OWASA began receiving portions of Durham’s water supply to sustain its own
reserves.
That problem was compounded just after 10:00 a.m. the following morning when a water main broke
in northeast Chapel Hill.
This severely affected OWASA’s already depleted water supply, forcing it to release a “Do Not Use”
warning to its customers about an hour later in order to guard against contamination and protect its
emergency water reserves.
Throughout the rest of the day, OWASA continued to receive large supplies of water from Durham,
while also activating connection lines with Chatham County.
Kerwin said OWASA received an estimated 12 million gallons of water from the city of Durham and
more than 400,000 gallons from Chatham County.
“There’s a long list of people to thank,” he said. “We’re so grateful for our partners.”
Repair work began on the break immediately after OWASA released the warning and concluded the
next morning, February 4, at 10:30.
OWASA removed the “Do Not Use” order later that afternoon.
Published: 2017-02-09 18:01:00
Updated: 2017-02-09 22:28:34
OWASA wants to 'reestablish trust' after
Orange County water emergency
8 Images
Orange Water and Sewer Authority gave customers an opportunity to discuss last week's water
emergency during a public meeting Thursday night.
Last Friday, OWASA warned customers not to use their water because of concerns it could be
contaminated.
"We want to reestablish your trust and confidence in our leadership, in our employees, our
infrastructure and our business practices," said OWASA board chair John A. Young.
Officials found high fluoride levels at one of their plants, so they had to shut it down. The next day, there
was a 12-inch water main break.
The Health Department shut down restaurants and hotels on Friday night and urged OWASA customers
to use bottled water for about 36 hours.
On Saturday afternoon, OWASA deemed its water safe and said operations are back to normal.
OWASA said they are still trying to determine how the emergency happened. They have hired outside
engineering consultants to investigate what cause the fluoride overfeed and water main break. The
expect to receive the results on Friday.
Thursday night, customers got the opportunity to ask questions and voice concerns. Some spoke about
the water main break's impact on their lives, including some University of North Carolina at Chapel Hill
students who were flooded out of their apartment.
"We are having ot start over in terms of moving into a new apartment and are having to pay for all
moving expenses out of our own pocket," the students said.
At least one person had some kind words for the board and the utility as a whole, saying "thank you for
getting it back as quick as you did. I really see how serious it was."
http://abc11.com/health/what-to-do-when-you-think-a-loved-one-is-using-heroin-/1756664/
ABC11 TOGETHER
WHAT TO DO WHEN YOU THINK
A LOVED ONE IS USING HEROIN
Email
(Shutterstock file)
Thursday, February 16, 2017 03:55PM
If you are worried someone close to you is using heroin, here's a list of resources to help you and
your family get the help needed.
Heroin use has increased across the US among men and women, most age groups, and all income
levels.
Some of the greatest increases occurred in demographic groups with historically low rates of
heroin use: women, the privately insured, and people with higher incomes, according to
the Centers for Disease Control and Prevention.
Who is most at risk of heroin addiction?
- People who are addicted to prescription opioid painkillers
- People who are addicted to cocaine
- People without insurance or enrolled in Medicaid
- Males
- People who are addicted to marijuana and alcohol
- People living in a large metropolitan area
- 18 to 25 year olds
(Centers for Disease Control and Prevention)
What to look for if you believe someone in your home is using heroin:
Heroin is usually smoked, snorted, or injected. You might find remnants of the drugs or the
paraphernalia of drug use left behind. Heroin itself may be a powdery substance that can look
either off-white or dark brown.
Black tar heroin is nearly black and is sticky instead of powdery.
You might find syringes or small pipes. A person dissolving the drug and injecting it might also
leave dirty spoons and lighters around. A person injecting also needs a device to cause the veins
to enlarge, so there may be rubber tubing or belts found in the area where he or she is using the
heroin.
Your child may have flushed skin, dry mouth, difficulty communicating or following a
conversation, nausea and/or vomiting, itchy skin, and slowed or shallow breathing.
If you suspect your child or someone in your home is using heroin, you need to get a Naloxone
rescue kit. Naloxone is a medication that reverses opioid overdoses.
(Centers for Disease Control and Prevention)
We sat down with experts in on our community to talk about the heroin epidemic. Meet the
panelists:
Colleen Bridger, MPH, Ph.D., Orange County Health Director
Colleen Bridger started as the Orange County Health Director in November 2011. In this
capacity she is responsible for implementing policy and programs aimed at improving the health
of the population of Orange County, North Carolina. She has 2 decades of experience as a Local
Health Director, first in Stokes County and then in Gaston County North Carolina.
In Gaston County, she ran one of the largest health departments in the state, managing over 20
different programs, 225 employees and a budget of nearly $20,000,000. Under her leadership,
all three Health Departments have won numerous awards including multiple consecutive Ralph
Ketner awards for Innovation in Government, and multiple GlaxoSmithKline Child Health
Recognition awards.
She is the current President of the North Carolina Health Director's Association where she runs
point on statewide issues affecting all 85 local health departments in the state. Dr. Bridger is
adjunct faculty at the Gilling Global School of Public health and teaches a course on Public
Health and Systems Thinking in the Health Policy and Management Department.
To get in touch with this panelist, click here.
Tessie Castillo, Advocacy and Communications Coordinator, Raleigh, NC
Since 2010, Tessie Castillo has served as Advocacy and Communication Coordinator for
NCHRC. She is the agency's only registered lobbyist and has successfully advocated for several
new laws pertaining to overdose prevention, naloxone access, law enforcement needle-stick
injury prevention, and the legalization of syringe exchange programs.
She produces the majority of NCHRC's media articles on harm reduction, drug policy reform,
criminal justice and law enforcement issues and has been published in Slate, Salon, The Fix, and
AlterNet. She is also a regular contributor on harm reduction topics to The Huffington Post.
Captain Chris Atack, Captain of Operations, Carrboro Police Department
Captain Atack is in charge of the Patrol Division and the Critical Incident Unit.
To contact this panelist, click here.
EMBEDMORE NEWS VIDEOS
ABC11 held a heroin discussion panel
List of treatment facilities around the Triangle:
Click on the treatment facility's name to visit its website
Raleigh treatment centers:
Legacy Freedom
North Carolina Alcohol Drug Treatment or call their 24-hour free helpline at (919) 670-5287.
First Step Services
Healing transitions
Durham treatment centers:
TROSA
BAART
Sunrise Recovery Resource Center
Chapel Hill treatment centers:
Freedom House Recovery
In-Patient Drug and Alcohol programs
Health Department to Present Mental Health
Priorities to County Commissioners
Posted by John Thomas | Feb 21, 2017 | Health | 0
The Orange County Health Department will present its three priority areas for mental
health services in the county to the Board of County Commissioners at the board’s
meeting at seven o’clock Tuesday night.
These areas include:
Restoring funding for mental health care from birth to age five
Enhancing in-school services for all grade levels, including having one or more
mental therapists per school in Chapel Hill-Carrboro City Schools and Orange
County Schools
Educating the community on how to navigate access to mental health care
The health department identified these areas via a report completed in January that
analyzed the barriers to mental health in Orange County for those 25 years old or
younger.
“If we can intervene early, which is such an integral part of mental health treatment,
then we can prepare these kids for life once they grow up,” said Rebecca Crawford,
Director of Financial and Administrative Services for the health departm ent.
Crawford said the priority areas will help address what the health department found to
be community members’ primary barriers to mental health care—affordability and
accessibility.
The health department assessed those barriers through a report that featured more
than 150 interviews and surveys with those closely involved with mental health in
Orange County, including mental health service providers, law enforcement and early
education representatives.
After that data was gathered, the health department then held focus groups with these
constituents to identify the most pressing concerns.
Crawford said the health department has compiled potential action steps to take in
response to these concerns to bring before the county commissioners.
“What we’re asking them is, ‘Are you ready for us to move forward?’” she said.
Moving forward would start by forming associations with the school systems and
community non-profits that are currently helping to provide mental health care.
These steps will address two of the three priority areas, but Crawford also emphasized
the importance of county-wide education to address some of the underlying issues
surrounding mental health care.
“People don’t know where to go to access care,” she said. “We see that as part of our
role. Mental health treatment nationwide is such a confusing problem that if we can do
anything to help clarify that, then I think we’re in the right direction.”
Third rabies case this year reminds Orange
County pet owners to vaccinate
Kaia Findlay | Published 02/23/17 12:47am
It all happened in a blur.
Susan Gladin entered her yard in rural Orange County Monday to see her dog playing
with a skunk. At first she thought it was cute, beautiful even, and snapped a picture of
it. Then she called her dog and stepped off the porch. That’s when the skunk attacked.
“I’m a very experienced animal person and I was just blindsided by how quickly the
thing moved,” she said.
The skunk scratched Gladin on the ankle, so she called 911. They put her through to
Orange County Animal Services, who brought the animal to their lab. The skunk tested
positive for rabies — the third positive test case this year.
Related Content
Seeing this third case isn’t cause for alarm, said Orange County Community Relations
Director Todd McGee. Instead, it provides an opportunity for education and awareness
in the community about rabies, vaccinations and what to do after an encounter with a
rabid animal.
Rabies affects the nervous system and gets transmitted through saliva or contact with
nervous system tissue. In the southeastern United States, raccoons act as the host
animal for the rabies virus. Other animals that contract the disease get infected due to
scratches or bites from an infected host.
The number of rabies cases ebbs and flows, said Bob Marotto, director of Animal
Services.
The lab saw six positive cases in 2016 and 10 positives in 2015. These totals are a
significant decline from the 23 laboratory-positive cases in 2014.
The fluctuations are a result of changes in the raccoon population and therefore the
genetic diversity, Marotto said. Changes in diversity include changes in the number of
traits governing sufficient immunity to diseases like rabies.
Marotto said monitoring pets outside and getting them vaccinated will help with any
size population of rabies-positive animals.
Animal Services requires rabies vaccinations for pets aged 4 months and older. The
center offers $10 vaccinations at clinics throughout the year.
“We usually provide more than 1,000 vaccinations to dogs and cats through those
clinics,” Marotto said.
If a vaccinated pet interacts with a potentially rabid animal, it receives a booster shot
and is quarantined from other animals. In the same situation, an unvaccinated pet must
be quarantined for four months or euthanized.
Humans who think they’ve been exposed to rabies should call 911. Seeing a bat flying
around the house or shooting a wild animal can indicate exposure. Taking action is key,
for though symptoms only show after three to eight weeks, the first preventative shot
must be taken within 48 hours of exposure.
Gladin said she was pleased with the immediacy and thoroughness of the response she
got from Animal Services and the Orange County Health Department. After the
incident, her dog, which was already vaccinated, got a booster shot. Gladin began her
own series of shots Tuesday, a treatment called post-exposure prophylaxis.
The Orange County Health Department does not administer the PEP treatment, so
patients must go to the emergency room at the hospital.
Stacy Shelp, communications manager of the Orange County Health Department, said
the cost of the treatment depends on a patient’s insurance, but hospitals in the area
have programs to help with bills.
Overall, Shelp and Marotto stressed the importance of vaccination to keeping rabies
cases at bay in the community.
“It keeps your pets with you,” Shelp said.
UNC professor will serve as Orange
County interim health director
CHAPEL HILL NEWS
MARCH 1, 2017 12:33 PM
HILLSBOROUGH - The Orange County Health Department has named UNC professor Dorothy
Cilenti as its interim health director while searching for a permanent leader.
Cilenti is on faculty at the UNC Gillings School of Global Public Health’s Department of Maternal and
Child Health and previously served as the North Carolina Local Public Health Agency Accreditation
Administrator at the North Carolina Institute for Public Health.
She has worked in leadership roles in local and state public health agencies for over 20 years,
including as health director for Chatham and Alamance counties and interim health director for
Orange County in 2011. Cilenti currently directs the National Maternal Child Health Workforce
Development Center under a cooperative agreement with Health Resources and Services
Administration.
“My main goal is to keep the health department operating as it is so a new health director can walk
into a well-functioning department,” Cilenti said.
The Orange County Board of Health is working with the county’s Human Resources Department to
hire a replacement for former Health Director Colleen Bridger, who left Feb. 23 for a new job in San
Antonio, Texas.
The county is reviewing applications and will begin the interview process in mid-March, health
department officials said.
Read more here: http://www.newsobserver.com/news/local/community/chapel-hill-
news/article135708688.html#storylink=cpy
Orange County Names Interim Health Director
Posted by Blake Hodge | Mar 2, 2017 | Health | 0
Orange County has named an interim health director while searching for a permanent replacement.
Dr. Dorothy Cilenti has been chosen to fill that role, which will be her second stint as interim director.
Cilenti is on faculty at the UNC Gillings School of Global Public Health in the Department of Maternal
and Child Health. She also previously served as the NC Local Public Health Agency Accredication
Administrator at the NC Institute of Public Health, according to a release announcing the hire.
Cilenti also has served as the health director for Chatham and Alamance counties.
“My main goal is to keep the health department operating as it is so a new health director can walk
into a well-functioning department,” says Dr. Cilenti of her role with the health department.
The Orange County Board of Health is reviewing application and will begin the interview process in
mid-March, according to officials.
Dr. Colleen Bridger recently left the department to take the same position in San Antonio, Texas.
Hillsborough police train to use naloxone in
opioid overdoses
Molly Horak | Published 03/06/17 12:51am
Duane Hampton is the chief of police for the town of Hillsborough.
Photo by Caroline Phillips / The Daily Tar Heel
The Hillsborough Police Department has joined the rest of Orange County’s law enforcement
agencies in combating opioid overdose deaths.
Stacy Shelp, spokesperson for the Orange County Health Department, said the Hillsborough Police
Department was the last agency in Orange County to be trained to use naloxone, the drug that
counteracts opioid medication. The Carrboro Police Department was the first to be trained in North
Carolina, followed by the Chapel Hill police.
“It’s not just about stopping an overdose when it happens, which is life-saving and critical, but we
have seen our local law enforcement saving lives and that’s really what it’s all about,” Shelp said.
Naloxone reverses the effects of an opioid overdose by blocking its effects. According to the
Orange County 2017 Public Health Dashboard, more than a quarter of opioid overdose deaths in
Orange County from 2009 to 2013 occurred in Hillsborough, though its population is smaller than
other towns in the county.
Kim Woodward, operations manager for Orange County Emergency Medical Services, said the
naloxone training involved a joint partnership between Orange County Emergency Services and the
Orange County Health Department. During training, officers learned about the scope of the opioid
problem in North Carolina and how naloxone works as a course of action.
“In each of the trainings, I asked officers to raise their hands if they’ve been on the scene and had to
wait for EMS to respond, and they all raised their hands,” Woodward said. “Knowing we were
getting this tool in the officers’ hands so they wouldn’t have to stand there and have nothing to do
— we’ve now given them a lifesaving tool.”
The naloxone program is funded by a grant through the Orange County Health Department and the
naloxone kits were provided to the police departments at no charge, Woodward said. She thinks the
cost is a barrier to similar systems in other counties.
Lt. Andy Simmons with the Hillsborough police said the department has only received positive
feedback about their use of naloxone.
“We haven’t had to use it yet, and I don’t want to say that I wish there was ever a time where we do
have to use it, but from this point forward we’re glad that we have it and it’s a tool that will help us
combat drug overdoses in the future,” Simmons said.
Woodward said she is proud of the efforts by police to adopt the new protocols.
“We’ve had eight reversals by law enforcement in Orange County, and all eight of those reversals
survived,” he said. “There are eight people walking around today because our law enforcement
stepped forward and really did an excellent job.”
@molly_horak
Orange County Health Department
names interim health director
Sarah Cheek | Published March 6, 2017
Dorothy Cilenti is the interim health director of the Orange County Health Department.
Following the departure of Colleen Bridger, Dorothy Cilenti has been appointed as the new interim
health director for the Orange County Health Department until a permanent replacement is hired.
The position for health director closed for potential applicants on Jan. 31, and the health
department will begin conducting interviews for a new director in the middle of March, said Stacy
Shelp, spokesperson for the Orange County Health Department.
Cilenti said she’s expecting the department to have a new health director by the end of June, at the
latest.
Cilenti is a professor at the UNC Gillings School of Global Public Health. She has served as a health
director for Chatham and Alamance counties.
She has also previously served as the interim health director for Orange County in 2011.
Bridger, the previous director of the health department, recently left to take a job as health director
for the San Antonio Metropolitan Health District in Texas.
Liska Lackey, chairperson for the Board of Health for Orange County, said the board approved
Cilenti, who was recommended by Bridger.
“She brings a wealth of experience and has served as interim health director previously, so we are in
good hands,” Lackey said.
Cilenti said she is looking forward to having the opportunity to practice local public health.
“I really get energized by being part of community health improvement initiatives,” Cilenti said.
Shelp said Cilenti will not be making any changes to the current health department, but overseeing
things and managing them as usual.
“The bonus of her working for UNC within Orange County is her understanding our partnerships
and public health law,” Shelp said.
Lackey said they needed an interim director who could continue to promote the hard work of the
staff and all the programs they had in place.
“We also need someone who has that leadership role in case events occur like the recent event with
OWASA,” Lackey said.
During the recent water shortage in Chapel Hill, the Orange County Health Department played a
crucial role in deciding to close down restaurants and businesses in Chapel Hill.
“I have great confidence that (Cilenti) will be able to respond to any of the events that might occur,”
Lackey said.
Cilenti said working with the health department helps keep her up to date with what is going on in
the field as a professor.
“I feel that being in a practice setting in a local health department makes me a better professor in
the classroom,” Cilenti said.
Lackey said having Cilenti work demonstrates a unique partnership between Orange County and the
University.
“One of the obvious reasons in choosing Dorothy is that it further illustrates the strong relationship
that the health department has with the University, a relationship that is of great value to both,”
Lackey said. “We want to continue to nurture that.”