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Home My WebLink AboutBOH agenda 062415 ORANGE COUNTY BOARD OF HEALTH MEETING AGENDA DATE: June 24, 2015 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 and New Board Member 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 June 24, 2015 Agenda 7:10 – 7:15 IV. Actions Items (Consent) A. Minutes of May 27, 2015 7:15 – 7:45 V. Educational Sessions A. Syringe Exchange Programs Leilani Attilio, NC Harm Reduction Coalition B. New Immunizations Requirements Judy Butler C. Communicable Disease Annual Report Judy Butler 7:45 – 8:15 VII. Reports and Discussion with Possible Action A. Orange County Advisory Board Summary Meredith Stewart B. Consideration of Expanding BOH Terms from 2 to 3 Colleen Bridger C. Health Director Report D. Media Items 8:15 – 8:20 VIII. Board Comments 8:20 VIIII. 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 accomm odation. 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. MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH May 27, 2015 S:\Managers Working Files\BOH\Agenda & Abstracts\2015 Agenda & Abstracts/ May Page 1 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 May 27, 2015, at the Orange County Health Department, 300 West Tryon Street, Hillsborough, NC. BOARD OF HEALTH MEMBERS PRESENT: Susan Elmore, Chair; Liska Lackey, Vice Chair; Commissioner Mia Burroughs, Mike Carstens, Paul Chelminski, Corey Davis, Dan Dewitya, Nick Galvez, and Tony Whitaker. BOARD OF HEALTH MEMBERS ABSENT: Sam Lasris. STAFF PRESENT: Dr. Colleen Bridger, Health Director, Alan Clapp, Environmental Health Director; Pam McCall, Public Health Nursing Director; Coby Austin, Senior Public Health Educator; Rebecca Crawford, Finance and Administrative Services Division Director; Stacy Shelp, Communications Manager; Jessica Salerno, Public Health Nurse; La Toya Strange, Administrative Assistant. GUESTS PRESENT: None I. Welcome Dr. Bridger introduced new staff members: La Toya Strange, Administrative Assistant and Jessica Salerno, Public Health Nurse. II. Public Comment for Items NOT on Printed Agenda: None III. Approval of the May 27, 2015 Agenda Motion was made by Liska Lackey to approve the agenda, seconded by Tony Whitaker and carried without dissent. IV. Action Items (Consent) A. Minutes Approval of March 25, 2015 Meeting Motion to approve Consent Agenda without corrections to the March 25, 2015 minutes was made by Paul Chelminski, seconded by Corey Davis and carried without dissent. V. Educational Sessions A. Community Health Assessment Update Liska Lackey began by encouraging Board members to review the Executive Summary regarding the 2011 Community Health Assessment and its process. She also specified purposes for completing community health assessments which included being mandated to complete a community assessment every four years and that the assessment aids in MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH May 27, 2015 S:\Managers Working Files\BOH\Agenda & Abstracts\2015 Agenda & Abstracts/ May Page 2 distinguishing our focus areas for the Board of Health. Currently, those focus areas are Access to Care, Child and Family Obesity, Mental Health and Substance Abuse. This joint effort between the Orange County Health Department (OCHD) and Healthy Carolinians of Orange County collects data to get a sense of the total health of Orange County and determine the community’s needs in addition to helping establish where the underserved areas are. This year’s survey will have less than half the questions of the 2011 survey, approximately 50 questions, and will be collected on laptops. Out of 75 block groups, 799 addresses have been identified to which postcards will be sent to those households requesting their participation in the upcoming survey. There will be 20 volunteers in teams of 10 that will be visiting these households over 9 days collecting between 300-400 surveys from June 18th to July 19th. Ms. Lackey asked each Board of Health member to participate in this process. The BOH members had several questions that were addressed by Liska Lackey and Colleen Bridger. B. Healthy Home Asthma Initiative Coby Austin and Alan Clapp gave a presentation on asthma and the implications of the non- management of the disease. They also described the Healthy Homes Approach, the implementation of models in other communities in North Carolina and provided information for possible execution in Orange County. They began with statistical data of asthma in North Carolina and its effect on children in relation to absenteeism, hospitalization and emergency room visits. An overview of the Healthy Homes Approach was given which consists of four steps: 1) Referral – By whom (e.g. school nurse, PCP, emergency department)? 2) Home Assessment – What are the triggers? Who performs the visit? How many visits? 3) Address Problems – By what measures (e.g. HEPA vacuums, pillow/mattress covers, green cleaning kit that consists of various non-toxic households items)? 4) Follow-up and Evaluate Impact Community-based, county-based and regional models in North Carolina were also discussed. Next steps include, determining which models to consider and the specific need for Orange County as well as continuing to collect data to consider how to move forward. This would be a cooperative undertaking, possibly collaborating with the Family Success Alliance and the school systems. The BOH members had several questions including funding sources and cost- effectiveness that were addressed by Coby Austin, Alan Clapp and Colleen Bridger. C. Quarterly Financial Reports Rebecca Crawford reported on the 3rd Quarter Financial report which was included in the packet. Average YTD monthly revenue in FY15 after the 3rd Quarter is $200k/month or $1.8M YTD, representing 74% of our overall budgeted revenue for the year. This is an increase from an average of $174k/month in FY14. Revenue is slightly below budget projection ($207k/m, $2.5M/y), however, some allocations, such as for Medicaid Maximization, will be transferred into the budget at the end of the fiscal year only if needed because expenses are lower than budgeted at 70%. MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH May 27, 2015 S:\Managers Working Files\BOH\Agenda & Abstracts\2015 Agenda & Abstracts/ May Page 3 After surpassing our billing accuracy goal of 80% in FY 13-14, we set a new goal of reaching 90% in FY 14-15. Current, combined accuracy this quarter in medical and dental clinics is 88.6% (medical: 82%, dental: 95%). Billing accuracy for most recent month is artificially reduced as many of the claims from the most recent quarter are still being processed. Monthly numbers from the most current quarter will increase (and less so with previous quarters) and will be updated on future dashboards as those back claims receive payment. Progress continues in refining our definition of billable claims, though the billing accuracy percent presented here always reflects a conservative estimate of accuracy. Though reducing the proportion of unpaid Self -Pay claims is a work in progress, it’s not likely we will ever recover 100% of those claims. Therefore, 90% is still an aggressive, but achievable goal. Dental earned revenue has consistently increased from year to year, and our current average monthly revenue ($34k/month) exceeds our budget projection ($32k/month). Medical earned revenue follows a similar trend as last FY. The monthly average after this quarter ($48.5k/month) is greater than FY14 ($44k/y) and FY13 ($25k/y), but slightly higher than our budget projection ($48k/month). Both expected seasonal increases in revenue (flu season) and additional staff filling vacant medical positions contributed to the Q3 increase in revenue. Staff turnover, however, decreased both expenses and revenues in clinic. The Board members received the report with no questions. VI. Action Items (Non Consent) A. General Public Seat Recommendation Susan Elmore, Chair, informed the BOH members that there is currently an opening for an At- Large position on the Board of Health, created by the resignation of Esther Earbin in April 2015. Jessica Frega was recommended by the Nominating Committee as the new General Public Seat representative for appointment by the Board of County Commissioners. Motion to recommend to the BOCC Jessica Frega for the current At-Large position was made by Michael Carstens, seconded by Nick Galvez, and carried without dissent. B. Reappointment Recommendation Susan Elmore, Chair, conveyed that Nick Galvez’ term expires on June 30, 2015; therefore, the Board of Health will vote to recommend him to his first full term starting June 2015. Motion to reappoint Nick Galvez was made by Paul Chelminski, seconded by Corey Davis, and carried without dissent. VII. Reports and Discussion with Possible Action A. Child Fatality Prevention Team Annual Report Pam McCall reported on a review of CFPT/CCPT 2014 Annual Report in Orange County, North Carolina. It included a description of membership, duties, procedures and activities. MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH May 27, 2015 S:\Managers Working Files\BOH\Agenda & Abstracts\2015 Agenda & Abstracts/ May Page 4 The BOH members had several questions including those related to the disclosure of the specificity of the causes of children’s’ deaths that were addressed by Pam McCall. B. Tobacco Preemption Resolution Update Coby Austin notified the Board that all local health departments were contacted by Dr. Bridger in reference to our Tobacco Preemption Resolution. She also informed the Board that Durham and Cumberland Counties’ Boards have passed the same resolution. Pitt and Chatham Counties have placed this resolution on their agenda for review by their boards. This will involve the establishment of a long-term strategy as preemption has been around for 20 years but yet, there’s been unhurried movement regarding this issue. Ms. Austin mentioned that Hawaii is poised to become the first state to increase the minimum legal sale age of tobacco to 21 years. She also stated that Durham County will be sending their resolution to their Board of County Commissioners to adopt it. Ms. Austin requested the BOH forward their passed resolution to the Orange County BOCC for adoption. She also requested BOH members to visit the General Assembly members, on a purely educational mission, to share information about this Resolution and the Institute of Medicine Report. Communication will be sent with potential dates and times, after the long session adjourns to the BOH seeking volunteers to speak with General Assembly members. The BOH members had several questions that were addressed by Coby Austin and Colleen Bridger. Motion was made by Corey Davis to forward the BOH Tobacco Preemption Resolution to the Board of County Commissioners to request adoption of the resolution, seconded by Liska Lackey and carried without dissent. C. Professional Engineer, Optometrist, and General Public Seat Recruitment Susan Elmore, Chair, informed the BOH members that Corey Davis will be leaving in June 2015. She also noted that Tony Whitaker and Michael Carstens’ second terms will be coming to an end in August 2015. She stressed that as the Engineer and Optometrist professions are very specific and there aren’t many candidates. Ms. Elmore also noted that Mr. Whitaker and Mr. Carstens have been kind enough to look within their own professions for candidates to recommend. Ms. Elmore requested volunteers to be on a selection committee to review applications for all vacancies including the General Public Seat, and bring recommendations to the August BOH meeting. Dan Dewitya and Nick Galvez volunteered to be on the committee. Michael Carstens also offered his assistance as he has reviewed many of the applications currently on file. D. Health Director’s Report There were no questions from the Board regarding the Health Director’s Report included in the packet. Dr. Bridger gave a brief overview of the Family Success Alliance’s trip to the Harlem Children’s Zone Practitioner’s Institute. Dr. Bridger stated that primary takeaway was that it is more important that we build trust right now within our community than a pipeline. She gave descriptions of the Harlem Children’s Zone Practitioner’s Institute successful model, practices and partnerships. She also expressed how they do whatever is required to ensure that every child is successful. MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH May 27, 2015 S:\Managers Working Files\BOH\Agenda & Abstracts\2015 Agenda & Abstracts/ May Page 5 E. Media Items Media items were in the packet which focused on Orange County’s events and our involvement in various efforts. VIII. Board Comments No additional comments given. VIIII. Adjournment A motion was made by Nick Galvez to adjourn the meeting at 8:30 p.m., was seconded by Mike Carstens and carried without dissent. The next Board of Health Meeting will be held June 24, 2015 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: June 24, 2015 Agenda Item Subject: Syringe Exchange Programs Attachment(s): 1) AMFAR Syringe Service Program Policy Brief 2) Syringe Exchange Programs in North Carolina Staff or Board Member Reporting: Tessie Castillo, North Carolina Harm Reduction Coalition Purpose: ___ Action _X_ Information only ___ Information with possible action Summary Information: Tessie Castillo* will provide an overview of Syringe Exchange Programs (SEPs) as an evidence-based practice to reduce the spread of communicable diseases such as HIV and hepatitis C. The overview will include an overview of the necessary components of an SEP, the benefits/risks of an SEP, and current national and state efforts and challenges to establishing SEPs. Two information items are included with this abstract as briefing materials before the meeting. They are a fact sheet and policy on syringe exchange both nationally in in North Carolina. *Advocacy and Communications Coordinator from the North Carolina Harm Reduction Coalition Background: In the 2014-2016 BOH Strategic Plan, the Substance Abuse & Mental Health subcommittee included researching methods to reduce infections passed through drug misuse and abuse as an action step. This presentation is an educational session for the full board on the topic before the subcommittee begins more in-depth work on the topic. Recommended Action: ___Approve ___Approve & forward to Board of Commissioners for action ___Approve & forward to ___________________________ ___Accept as information ___Revise & schedule for future action _X_Other (detail): Receive the information and provide general comments to help guide the BOH SAMH subcommittee in their consideration of this topic. www.amfar.org ISSUE BRIEF January 2013 The Foundation for AIDS Research amfAR Public Policy Office 1150 17th Street, NW • Suite 406 • Washington, DC 20036 • T: +1 202.331.8600 F: +1 202.331.8606 HIV/AIDS remains one of the country’s most serious health challenges. According to an overwhelming body of evidence, needle and syringe exchange programs not only reduce the spread of HIV, but also save money, encourage the safe disposal of syringes, minimize the risk of needlestick injuries to law enforcement officials, and help link chemically dependent individuals to vital drug treatment services. In difficult budgetary times, investments in syringe exchange are a wise use of tax dollars. Injection drug-related HIV and hepatitis C infections remain serious health crises in the United States Each year, 50,000 Americans are newly infected with HIV.1 Injection drug use remains a driving force in the national epidemic, accounting for 14 percent of new HIV infections among women and 7-11 percent of new HIV infections among men in the United States in 2010.2 Reaching the federal goal of an “AIDS-Free Generation”3 requires effective, sustained efforts to prevent new infections among injection drug users (IDUs). Approximately 3.2 million Americans are living with hepatitis C (HCV), and deaths related to HCV have increased substantially over the last decade.4 The evidence is clear: Syringe services programs prevent HIV transmission Sharing contaminated injecting equipment is one of the most efficient means of HIV transmission.5 Scores of studies have conclusively demonstrated that SSPs help prevent infection by reducing the re-use and circulation of injecting equipment without increasing drug use or resulting in other negative Federal Funding for Syringe Services Programs: Saving Money, Promoting Public Safety, and Improving Public Health SSPs provide free sterile syringes, an approach that reduces the likelihood that users will share injecting equipment.6 Although the provision of sterile syringes is the core service provided by SSPs, these programs also safely dispose of used syringes, and have much broader health benefits.7 Many offer a range of health and supportive services, including on-site medical care; screening and counseling for HIV, hepatitis C, and sexually transmitted infections; distribution of condoms, food, and clothing; and referrals to substance abuse treatment.8 In addition, many SSPs help save lives by providing medications to prevent overdose and support drug treatment.9 SSPs offer tailored services drug users need to keep themselves and others safer and healthier. As a result, drug users often view SSPs as more respectful and less discriminatory than traditional healthcare providers; this makes SSPs better able to connect drug users to health and supportive services they would otherwise not have accessed.10, 11, 12 How SSPs work • Syringe services programs (SSPs) save public resources, serve as vital “bridges” to treatment and prevention services, promote public safety, and reduce health disparities. • The ban on federal funding for SSPs under- mines local control and decision-making. • SSPs enjoy broad public and professional support. Key Points www.amfar.org Federal Funding for Syringe Services Programs: Saving Money, Promoting Public Safety, and Improving Public Health2 However, without federal funding, these SSPs are only able to provide sterile syringes for fewer than 3 percent of all injections estimated to occur each year.25 SSPs that receive state or local government funding distribute more sterile syringes and offer HIV tests more often than those that do not receive government funding.26 Federal support could amplify this increase in service capacity. In short, the federal funding ban on SSPs undermines national efforts to prevent new HIV infections. If the country is to realize the goal of an AIDS-Free Generation, coverage for these highly effective programs will need to increase. SSPs save lives and money, protect law enforcement and local communities, and support national efforts to reduce substance abuse Banning federal support for cost-effective needle exchange programs is contrary to the public interest. Although such programs were controversial when they first emerged in the 1980s, nearly three decades of experience has generated substantial support for the approach from local governments, public health officials, and scientific organizations. The public health benefits of SSPs have been well documented, but these programs generate other benefits that may be less familiar. 1. SSPs save public resources The lifetime cost of treating an HIV-positive person is estimated to be between $385,200 and $618,900.27 As HIV-positive IDUs are often uninsured or reliant on public sector programs (such as Medicaid, Medicare, and Ryan White) for their care, taxpayers bear the lion’s share of treatment costs associated with new infections related to injection drug use.28, 29 HIV is not the only costly infection associated with injection drug use. HCV costs hundreds of millions of dollars annually to treat.30 Needle sharing during injection drug use is the primary driver of hepatitis C infection in the U.S., with an estimated 50–80 percent of drug users becoming infected with HCV within five years of their first drug injection.31 A study of IDUs in New York City found that from 1990-2001, as SSPs grew substantially, HCV prevalence declined from 90 to 63 percent.32 With individual needles and syringes costing less than 50 cents,33 it is far cheaper to prevent a new case of HIV than to assume many years of treatment costs. According to a recent analysis, expanding SSP coverage to 10 percent of all consequences.13, 14, 15 SSPs have helped New York City—where 50 percent of all IDUs were living with HIV in the early 1980s— approach the elimination of new drug-related transmissions, saving federal and state taxpayers millions of dollars in treatment costs averted.16, 17, 18 SSPs make neighborhoods safer (for police, sanitation workers, and the general public) by supporting the safe disposal of potentially infectious needles and syringes.19, 20 SSPs also facilitate recovery from drug abuse by linking drug users to treatment services.21 Federal funds currently cannot be used to support syringe services programs In 2009, Congress removed a 21-year prohibition on the use of federal funds to support SSPs.22 Two years later, however, Congress re-imposed the ban on federal funding for SSPs.23 In 2013, even as injection drug use continues to contribute substantially to the spread of HIV, federal public health funds are unavailable for syringe exchange. SSPs are not illegal throughout most of the country, and more than 200 SSPs are currently operating in 34 states, the District of Columbia, and the Commonwealth of Puerto Rico.24 SSPs have helped New York City—where 50 percent of all IDUs were living with HIV in the early 1980s—approach the elimination of new drug-related transmissions. New York Harm Reduction Educators operates mobile syringe exchange sites that provide lifesaving services in communities throughout New York City. Federal Funding for Syringe Services Programs: Saving Money, Promoting Public Safety, and Improving Public Health 3 www.amfar.org injections (from the current level of 2.9 percent) would avert nearly 500 new HIV infections each year.34 Such an expansion in service coverage would cost an estimated $64 million—less than one-third the projected lifetime costs (an estimated $193 million) of treating these 500 cases.35 In other words, every dollar spent expanding service coverage to such a level would save at least an estimated three dollars in treatment costs averted.36 Further service expansion would save American taxpayers hundreds of millions of dollars. 2. SSPs serve as vital bridges to treatment and prevention services Supporting recovery and breaking the cycle of drug use are key principles of the National Drug Control Strategy.37 SSPs support these aims. They serve as critical entry points for drug users, and link individuals to comprehensive treatment and care, such as in New Jersey, where more than 22 percent (998 individuals) of the 4,482 people served by New Jersey’s five SSPs from 2007 to 2009 entered a drug treatment program.38 By facilitating recovery from drug addiction, SSPs help individuals struggling with chemical dependence to repair their lives and become productive members of society. In one study, employment increased 44.8 percent within six months among clients of SSPs who received certain federal funding while the funding ban was removed.39 Clients of these SSPs were 25 percent more likely than non-SSP clients to have been successfully referred to mental health treatment and prescribed medication.40 As bridges to comprehensive treatment, prevention, and social services, SSPs improve individual and public health. SSPs also help clients infected with HIV or hepatitis C learn their status: in 2010, 67 percent of SSPs surveyed nationally offered hepatitis C testing, and 87 percent offered HIV testing and counseling.41 SSP clients who test HIV positive can be connected to life- saving and cost-effective treatment, while those who test HIV negative receive HIV prevention counseling and access to condoms, helping interrupt the cycle of HIV transmission. Every dollar spent expanding service coverage to such a level would save at least an estimated three dollars in treatment costs averted. Source: Nguyen, T.Q., Weir, B.W., Pinkerton, S.D., Des Jarlais, D.C., & Holtgrave, D. (July 23, 2012). Increasing investment in syringe exchange is cost-saving HIV prevention: modeling hypothetical syringe coverage levels in the United States (MOAE0204 - Oral Abstract). Presented at the XIX International AIDS Conference, Washington D.C. Abstract available online at http://pag.aids2012.org/Abstracts.aspx?SID=198&AID=17268. (date last accessed: December 11, 2012) SSP syringe coverage Additional investment required & savings in HIV treatment costs (million 2011 USD) for each SSP syringe coverage level Selected Services Offered by SSPs in 2010 Source: www.amfar.org Federal Funding for Syringe Services Programs: Saving Money, Promoting Public Safety, and Improving Public Health4 3. The federal funding ban undermines local control and decision-making The federal government is by far the largest funder of HIV prevention services. Federal prevention funding adheres to recognized principles of federalism, providing essential health assistance while leaving it to states and localities to use limited federal dollars to address needs and priorities that are locally determined. While the federal ban was lifted, federal dollars were used to support SSPs in California, Connecticut, Delaware, Illinois, Massachusetts, Minnesota, New Jersey, New Mexico, New York, Puerto Rico, Vermont, and Washington.42 SSPs operate in 186 cities and a quarter of those surveyed in 2011 were run by state or local health departments.43, 44 Authorities in jurisdictions across the country have demonstrated that they believe SSPs promote public health and other local objectives. However, under current law, they are not allowed to decide for themselves whether federal funds they receive should be used to meet these objectives. While research consistently has found SSPs to be a cost-effective, evidence- based intervention, the federal funding ban continues to force localities facing difficult budgetary times to make a tough choice: if they wish to use limited state and local dollars to fund SSPs, they must do so at the expense of other important, public health programs dependent on local and state financing. In the brief two-year period during which federal funding became available for SSPs, the majority of programs that received federal support used those funds just to maintain or expand existing services; only 14 percent of programs that received federal SSP funding in 2011 were able to use that funding to add new services.45 4. SSPs promote public safety SSPs reduce circulation of contaminated syringes, collecting used syringes in puncture-proof containers. By discarding used syringes according to hazardous waste disposal procedures, SSPs keep contaminated in- jection equipment off the streets, protecting the public from potential exposure to infectious needles. SSPs actively encourage participants to return as many used syringes as possible.46 Research indicates that the majority of syringes distributed by SSPs are in fact returned.47, 48 In Baltimore, SSPs helped reduce the number of improperly discarded syringes by almost 50 percent.49 In Portland, Oregon, the number of improperly discarded syringes dropped by almost two-thirds after the implementation of an SSP.50 In 2008-2009, in Miami—where there are no syringe exchange programs— eight times more syringes were disposed of improperly than in San Francisco, where syringe exchanges are available.51 Safe disposal was much greater in San Francisco, even though the estimated number of injection drug users in San Francisco is more than twice the number in Miami. Keeping contaminated equipment off the streets improves public safety. SSPs reduce the risk that people—including children playing in parks, people putting trash in public trash cans, and medical personnel responding to emergencies—will accidentally come into contact with used and potentially dangerous needles and syringes. Law enforcement and public-safety personnel, who are often exposed to needlesticks on the job, are perhaps the most notable public safety beneficiaries of SSPs. In San Diego, nearly 30 percent of police officers surveyed had been stuck by a needle at least once, with more than 27 “In the cities that have adopted needle exchange programs, there is a dramatic reduction in needle sticks to firefighters who crawl on their hands and knees through smoke-filled rooms to search for victims.” —Charles Aughenbaugh, Jr., President, New Jersey Deputy Fire Chiefs Association, Retired Deputy Fire Chief, March 2011 SSPs operate in 186 cities. Authorities in jurisdictions across the country have demonstrated they believe SSPs promote public health. “Clearly needle exchange programs work. There is no doubt about that.” —Anthony Fauci, M.D., Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health. Testimony before the U.S. House of Representatives Committee on Oversight and Reform, September 16, 2008 Federal Funding for Syringe Services Programs: Saving Money, Promoting Public Safety, and Improving Public Health 5 www.amfar.org of AIDS-related deaths among African Americans and other people of color, the National HIV/AIDS Strategy prioritizes intensified efforts to reduce racial and ethnic disparities in HIV-related health outcomes.58 Given the role of injection drug use in contributing to the outsize HIV risks experienced by communities of color, SSPs represent a critical tool for minimizing HIV risks and addressing health disparities. 6. SSPs enjoy broad public and professional support As a result of their considerable public health, public safety, and fiscal benefits, SSPs enjoy robust support across the political spectrum, ranging from law enforcement officials to advocates seeking the reform of drug laws. Numerous national medical and public health organizations support SSPs, including the American Medical Association,59 the American Public Health Association,60 the National Academy of Sciences,61 and the American Academy of Pediatrics.62 So too do leading global bodies such as the World Health Organization (WHO),63 the World Bank,64 and the International Red Cross-Red Crescent Society.65 The American Bar Association strongly supports SSPs,66 as does the U.S. Conference of Mayors.67 In summary The evidence is clear and conclusive. SSPs prevent new HIV infections without leading to increased drug use. SSPs also promote broader health aims, save taxpayers money, promote public safety, and enjoy broad public support. Federal support for SSPs should be restored— not only to advance these important public policy aims, but also to provide the means for states and local communities to determine the best strategies to address their own health needs. percent of those injured experiencing two or more needlestick injuries.52 Syringe services programs have been found to reduce needlestick injuries among police officers.53 5. SSPs can help reduce health disparities Communities of color are at far greater risk for HIV than Americans overall. In 2010, 14 percent of the U.S. population was African American, but that year, 44 percent of all new HIV diagnoses in the U.S. were among African Americans—more than any other racial or ethnic group.54 In states surveyed from 2007 to 2010, the rate of new HIV infections was eight times higher among African Americans than whites, and three times higher among Latinos than whites.55 In 2010, people of color were overrepresented among both male and female injection drug users newly infected with HIV.56 While AIDS-related deaths for the broader U.S. population have sharply declined over the last 15–20 years, AIDS remains the ninth leading cause of death among African Americans overall and the third leading cause of death for African Americans aged 35–44.57 In light of the disproportionate risk of HIV infection and number Source: CDC. (2012). HIV surveillance in injection drug users (through 2010). Available online at http://www.cdc.gov/hiv/ idu/resources/slides/. (date last accessed: December 11, 2012) In San Diego, nearly 30 percent of police officers surveyed had been stuck by a needle at least once. www.amfar.org Federal Funding for Syringe Services Programs: Saving Money, Promoting Public Safety, and Improving Public Health6 “[SSPs] are widely considered to be an effective way of reducing HIV transmission among individuals who inject illicit drugs and there is ample evidence that [SSPs] also promote entry and retention into treatment.” —U.S. Surgeon General Dr. Regina Benjamin, Federal Register, February 2011 “Early in 1998 … I assembled the published studies ... and was convinced that there were strong data favoring reduced transmission of lethal viruses by needle-exchange programs....” —Harold Varmus, M.D., Nobel Laureate, Co-Chair, President’s Council of Advisors on Science and Technology, and former Director, National Institutes of Health. From The Art and Politics of Science (2009), by Harold Varmus “I understand there will be questions, but [syringe exchange] is common sense.” —Sister Maureen Joyce, CEO of Catholic Charities. In Achieve: A quarterly journal on HIV prevention, treatment, and politics (Winter 2010) “Needle exchange offered us a way to say that drug addicts are people and they have an illness that merits concern and love. Needle exchange was a reality. Until we get people in [drug] treatment then this is a way to take care of them.” —Father Errol Harvey, formerly of Manhattan’s St. Augustine Church. In Achieve: A quarterly journal on HIV prevention, treatment, and politics (Winter 2010) “[S]yringe exchange has helped protect law enforcement and first responders from injuries caused by syringes during body searches or rescue operations. We are particularly impressed that our local syringe exchanges have built a network of support for families and that they have provided a bridge to addiction treatment.” —Roseanne M. Sizer, Chief of Police, Portland, Oregon, July 2009 Federal Funding for Syringe Services Programs: Saving Money, Promoting Public Safety, and Improving Public Health 7 www.amfar.org References 1 CDC. (November 2011). HIV in the United States: At a glance. Available online at www.cdc.gov/hiv/resources/factsheets/us.htm. (date last accessed: December 12, 2012) 2 CDC. (2012). HIV surveillance in injection drug users (through 2010). (slide 3) Available online at http://www.cdc.gov/hiv/idu/resources/slides/. (date last accessed: December 11, 2012) 3 For more on the goal of an AIDS-Free Generation, see http://www.pepfar. gov/. 4 CDC. (2012). Hepatitis C FAQs for health professionals: Overview and statistics. Available online at http://www.cdc.gov/hepatitis/HCV/HCVfaq. htm . (date last accessed: November 9, 2012) 5 United Nations Office on Drugs and Crime. (2005). World drug report 2005: Chapter 3. HIV/AIDS and drugs. (page 149) Available online at http://www.unodc.org/pdf/WDR_2005/volume_1_chap3.pdf. (date last accessed: November 13, 2012) 6 Bluthenthal, R.N., Kral, A.H., Gee, L., Erringer, E.A., & Edlin, B.R. (2000). The effect of syringe exchange use on high-risk injection drug users: a cohort study. AIDS, 14(5), 605-11. 7 Des Jarlais, D.C., Guardino, V., Nugent, A., Arasteh, K., & Purchase, D. (2012). (unpublished data) 2010 National survey of syringe exchange programs: summary of results. North American Syringe Exchange Network. Available online at http://nasen.org/news/2012/jul/05/2010- beth-israel-survey-results-summary/. (date last accessed: November 16, 2012) 8 Ibid. 9 Des Jarlais, D.C., Guardino, V., Nugent, A., Arasteh, A., & Purchase, D. 2011 National Survey of Syringe Exchange Programs: Summary of Results. Presented at the 9th National Harm Reduction Conference: “From Public Health to Social Justice,” Portland, OR, November, 2012. 10 MacNeil, J., & Pauly, B. (2011). Needle exchange as a safe haven in an unsafe world. Drug and Alcohol Review, 30(1), 26-32. 11 Des Jarlais D.C., McKnight, C., Goldblatt, C., & Purchase, D. (2009). Doing harm reduction better: syringe exchange in the United States. Addiction, 104(9), 1441-6. 12 McNeil, R., Guirguis-Younger, M., Dilley, L.B., Aubry, T.D., Turnbull, J., & Hwang, S.W. (2012). Harm reduction services as a point-of-entry to and source of end-of-life care and support for homeless and marginally housed persons who use alcohol and/or illicit drugs: a qualitative analysis. BMC Public Health, 12, 312. 13 For this publication, the term “syringes” refers to both syringes and needles. 14 World Health Organization. (2004). Effectiveness of sterile needle and syringe programming in reducing HIV/AIDS among injecting drug users. Available online at http://www.unodc.org/documents/balticstates/Library/ NSP/EffectivenessNSP.pdf. (date last accessed: December 12, 2012) 15 National Institutes of Health. (February 11-13, 1997). Consensus Development Conference Statement: Interventions to prevent HIV risk behaviors. Available online at http://consensus.nih.gov/1997/1997Preven tHIVRisk104html.htm. (date last accessed: January 7, 2013) 16 Knox, R. (Posted July 24, 2012). Needle exchanges often overlooked in AIDS fight. NPR Shots: Health news from NPR. Available online at http:// www.npr.org/blogs/health/2012/07/24/157283038/needle-exchanges- often-overlooked-in-aids-fight. (date last accessed: December 12, 2012). 17 Cohen J. (13 July 2012). Miracle on 34th Street: Success with injectors. Science, 337(6091), 178-180. 18 Des Jarlais, D.C., Arasteh, K., & Friedman, S. R. (2011). HIV among drug users at Beth Israel Medical Center, New York City, the first 25 years. Substance Use & Misuse, 46(2-3), 131-139. 19 Groseclose, S.L., Weinstein, B., Jones, T.S., Valleroy, L.A., Fehrs, L.J., & Kassler, W.J. (1995). Impact of increased legal access to needles and syringes on practices of injecting-drug users and police officers--Connecticut, 1992-1993. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 10(1), 82-9. 20 Tookes, H.E., et al. (2012). A comparison of syringe disposal practices among injection drug users in a city with versus a city without needle and syringe programs. Drug and Alcohol Dependence, 123(1-3), 255-9. 21 Hagan, H., McGough, J.P., Thiede, H., Hopkins, S., Duchin, J., & Alexander, E.R. (2000). Reduced injection frequency and increased entry and retention in drug treatment associated with needle-exchange participation in Seattle drug injectors. Journal of Substance Abuse Treatment, 19, 247–252. 22 Consolidated Appropriations Act, 2010. Public law 111-117. (December 16, 2009. Sections 505 and 810.) Available online at http://www.gpo.gov/fdsys/pkg/ PLAW-111publ117/pdf/PLAW-111publ117.pdf. (date last accessed: November 19, 2012) 23 Consolidated Appropriations Act, 2012. Public law 112-74. (December 23, 2011. Section 523.) Available online at http://www.gpo.gov/fdsys/pkg/PLAW- 112publ74/pdf/PLAW-112publ74.pdf. (date last accessed: November 19, 2012) 24 amfAR. (2012). Syringe exchange programs in the United States, 2012 (map). Available online at http://www.amfar.org/uploadedFiles/_amfarorg/On_the_ Hill/3_29_12_SEP_Map_FINAL.pdf. (date last accessed: November 13, 2012) 25 Nguyen, T.Q., Weir, B.W., Pinkerton, S.D., Des Jarlais, D.C., & Holtgrave, D. (July 23, 2012). Increasing investment in syringe exchange is cost-saving HIV prevention: modeling hypothetical syringe coverage levels in the United States (MOAE0204). Presented at the XIX International AIDS Conference, Washington D.C. Session available online at http://pag.aids2012.org/session.aspx?s=198. (date last accessed: December 11, 2012) The model assumed that approximately 2,500 infections occur each year as a consequence of sharing injecting equipment in the United States. 26 Des Jarlais D.C., McKnight, C., & Milliken, J. (2004). Public funding of US syringe exchange programs. Journal of Urban Health, 81(1), 118-21. 27 Schackman, B.R., Gebo, K.A., & Walensky, R.P. et al. (November 2006). The lifetime cost of current Human Immunodeficiency Virus care in the United States. Medical Care, 44(11), 990-997. 28 Knowlton, A.R., Hoover, D.R., Chung, S.E., Celentano, D.D., Vlahov, D., & Latkin, C.A..(2001). Access to medical care and service utilization among injection drug users with HIV/AIDS. Drug and Alcohol Dependence, 64(1):55-62. 29 Mizuno, Y. et al. (2006). Correlates of health care utilization among HIV- seropositive injection drug users. AIDS Care, 18(5):417-25. 30 Ibid. 31 CDC. (September 2002). Fact sheet: Viral hepatitis and injection drug users. Available online at: http://www.cdc.gov/idu/hepatitis/viral_hep_drug_use.pdf. (date last accessed: December 12, 2012) 32 Des Jarlais, D.C., et al. (2005). Reductions in hepatitis C virus and HIV infections among injecting drug users in New York City, 1990-2001. AIDS, 19(suppl 3), S20-S25. 33 Des Jarlais, D.C. Personal communication. 34 Nguyen, T.Q., Weir, B.W., Pinkerton, S.D., Des Jarlais, D.C., & Holtgrave, D. (July 23, 2012). Increasing investment in syringe exchange is cost-saving HIV prevention: modeling hypothetical syringe coverage levels in the United States (MOAE0204). Presented at the XIX International AIDS Conference, Washington D.C. Session available online at http://pag.aids2012.org/session.aspx?s=198. (date last accessed: December 11, 2012) 35 Ibid. 36 Ibid. 37 Office of.National Drug Control Policy. (2012). 2012 National Drug Control Strategy. Available online at http://www.whitehouse.gov/ondcp/2012-national- drug-control-strategy. (date last accessed: December 12, 2012) 38 New Jersey Syringe Access Program Demonstration Project. (January 2010). Interim report: Implementation of P.L. 2006, c.99, “Blood-borne Disease Harm Reduction Act.” Available online at http://www.state.nj.us/health/ aids/documents/nj_sep_evaluation.pdf. (date last accessed: December 12, 2012) 39 Silverman, B., Thompson, D., Baxter, B., Jimenez, A.D., Hart, C., & Hartfield, C. (July 25, 2012). First federal support for community based syringe exchange programs: A panel presentation by SAMHSA grantees (Poster--WEPE234). Presented at the International AIDS Conference Poster Session, Washington, D.C. Poster and abstract available online at http://pag. aids2012.org/abstracts.aspx?aid=20133. (date last accessed: December 12, 2012) 40 Ibid. 41 Des Jarlais, D.C., Guardino, V., Nugent, A., Arasteh, K., & Purchase, D. (2012). (unpublished data) 2010 National survey of syringe exchange programs: summary of results. North American Syringe Exchange Network. Available online at http://nasen.org/news/2012/jul/05/2010-beth-israel- survey-results-summary/. (date last accessed: November 27, 2012) 42 Personal communication, state agency officials. 43 amfAR. (2012). Syringe exchange programs in the United States, 2012 (map). Available online at http://www.amfar.org/uploadedFiles/_amfarorg/ On_the_Hill/3_29_12_SEP_Map_FINAL.pdf. (date last accessed: November 13, 2012) 44 Des Jarlais, D.C., Guardino, V., Nugent, A., Arasteh, A., & Purchase, D. 2011 National Survey of Syringe Exchange Programs: Summary of Results. Presented at the 9th National Harm Reduction Conference: “From Public Health to Social Justice,” Portland, OR, November, 2012. 45 Ibid. 46 Harm Reduction Coalition. (2006). Fact sheet. Syringe exchange programs: Reducing the risks of needlestick injuries. Available online at http:// harmreduction.org/syringe-access/syringe-access-tools/seps-reduce- needlestick/. (date last accessed: December 12, 2012) 47 Ksobiech, K. (2004). Return rates for needle exchange programs: A common criticism answered. Harm Reduction Journal, 1(1), 2. 48 Des Jarlais, D.C., Guardino, V., Arasteh, K., McKnight, C., Milliken, J., & Purchase, D. (17 November 2010). Current state of syringe exchange in the known universe. As presented at the North American Syringe Exchange Conference 2010 in Austin, Texas. Slides available online at http://nasen. org/news/2010/nov/30/nasec-2010/. (date last accessed: November 13, 2012) 49 Doherty, M.C., Junge, B., Rathouz, P., Garfein, R.S., Riley, E., & Vlahov, D. (2000). The effect of a needle exchange program on numbers of discarded needles: A 2-year follow-up. American Journal of Public Health, 90(6), 936–939. 50 Oliver, K.J., Friedman, S.R., Maynard, H., Magnuson, L., & Des Jarlais, D.C. (1992). Impact of a needle exchange program on potentially infectious syringes in public places. Journal of Acquired Immune Deficiency Syndromes, 5, 534–535. 51 Tookes, H.E., et al. (2012). A comparison of syringe disposal practices among injection drug users in a city with versus a city without needle and syringe programs. Drug and Alcohol Dependence, 123(1-3), 255-9. 52 Lorentz, J., Hill, J., & Samini, B. (2000). Occupational needle stick injuries in a metropolitan police force. American Journal of Preventive Medicine,18, 146–150. 53 Groseclose, S.L., Weinstein, B., Jones, T.S., Valleroy, L.A., Fehrs, L.J., & Kassler, W.J. (1995). Impact of increased legal access to needles and syringes on practices of injecting-drug users and police officers- -Connecticut, 1992-1993. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 10(1), 82-9. 54 CDC. (December 2012). Fact sheet: New HIV infections in the United States. Available online at http://www.cdc.gov/nchhstp/newsroom/docs/2012/HIV- Infections-2007-2010.pdf. (date last accessed: January 4, 2013) 55 CDC. (December 2012). Estimated HIV incidence in the United States, 2007–2010. HIV Surveillance Supplemental Report 2012, 17(4), (6-7). Available online at http://www.cdc.gov/hiv/topics/surveillance/resources/ reports/#supplemental. Published December 2012. (date last accessed: January 4, 2013) 56 CDC. (2012). HIV surveillance in injection drug users (through 2010). (slide 3) Available online at http://www.cdc.gov/hiv/idu/resources/slides/. (date last accessed: December 11, 2012) 57 CDC. (November 2011). Fact sheet: HIV among African Americans. Available online at: http://www.cdc.gov/hiv/topics/aa/. (date last accessed: December 12, 2012) 58 Office of National AIDS Policy. (July 2010). National HIV/AIDS strategy for the United States. (pages 31-37) Available online at http://www.whitehouse.gov/ sites/default/files/uploads/NHAS.pdf . (date last accessed: November 27, 2012) 59 Towey, K., & Fleming, M., eds. (2006). Policy and resource guide: Alcohol use and adolescents (pp. 41). Chicago, IL: American College of Preventive Medicine and American Medical Association National Coalition for Adolescent Health. 60 American Public Health Association. (November 13, 2002). Syringe prescription to reduce disease related to injection drug use (Policy #2002- 12). Available online at http://www.apha.org/advocacy/policy/policysearch/ default.htm?id=288. (date last accessed: December 12, 2012) 61 Kolata, G. (1995, September 24). Sept. 17-23: the AIDS epidemic; scientists endorse needle exchanges. The New York Times. Available online at http:// www.nytimes.com/1995/09/24/weekinreview/sept-17-23-the-aids- epidemic-scientists-endorse-needle-exchanges.html. (date last accessed: December 12, 2012) 62 Provisional Committee on Pediatric AIDS. (1994). Reducing the risk of Human Immunodeficiency Virus infection associated with illicit drug use. Pediatrics, 94(6), 945-947. Available online at http://pediatrics. aappublications.org/content/94/6/945. (date last accessed: December 12, 2012) 63 World Health Organization. (2004). Effectiveness of sterile needle and syringe programming in reducing HIV/AIDS among injecting drug users. Available online at http://www.unodc.org/documents/balticstates/Library/ NSP/EffectivenessNSP.pdf. (date last accessed: December 12, 2012) 64 World Bank. (2003). Local government responses to HIV/AIDS: A handbook. (page 16) Available online at http://siteresources.worldbank.org/ INTURBANHEALTH/Resources/1090754-1242053198381/handbook.pdf. (date last accessed: December 12, 2012) 65 International Federation of Red Cross and Red Crescent Societies. (2003). Spreading the light of science: Guidelines on harm reduction related to injecting drug use. (page 31) Available online at http://www.ifrc.org/ PageFiles/96733/Red_Cross_spreading_the_light_of_science.pdf. (date last accessed: December 12, 2012) 66 American Bar Association. (April 2011). ABA Washington letter: ABA urges federal support for syringe exchange programs. Available online at http:// www.americanbar.org/publications/governmental_affairs_periodicals/ washingtonletter/2011/april/syringeexchange.html. (date last accessed: December 12, 2012). 67 United States Conference of Mayors, Health and Human Services Committee. (June 2000). Removal of legal barriers to access to sterile syringes by injection drugusers. Available online at http://usmayors.org/ uscm/resolutions/68th_conference/removal_hea.html. (date last accessed: December 12, 2012) Justification for a Needle Exchange Program as a HCV and HIV Prevention Strategy The cost of drug therapy for treating the Hepatitis C virus (HCV) and HIV/AIDS significantly impacts the North Carolina Medicaid budget, and continues to grow due to increased incidence of both diseases and cost of new drugs being introduced to the market. Drug therapy cost for HCV and HIV/AIDS represents the top two specialty drug classes by per member per year (PMPY) spend in 2014 for North Carolina Medicaid as well as all other state Medicaid programs. Because both are preventable diseases, prevention must be a strategy used to mitigate the budgetary impact of these drug therapies. An estimated 3.2 million Americans are chronically infected with HCV and deaths attributed to HCV far exceed those due to HIV/AIDS. Because the majority of HCV infections are asymptomatic, 65-75% of infected individuals are unaware of their status and more likely to spread the infection to others. Furthermore, between 15-20% of untreated persons with chronic HCV infections will develop chronic liver disease, including liver cirrhosis and hepatocellular carcinoma. In North Carolina, acute HCV is reportable and there has been an increase in the number of acute HCV cases throughout the state during the last five years (Figure 1). According to the Centers for Disease Control, Viral Hepatitis Surveillance Report End-of-year 2014 report, in 2014 North Carolina’s acute HCV rate exceeded that of the US (Figure 2). Injection drug use was by far the greatest risk factor for HCV acquisition. Data released by the North Carolina Injury and Violence Prevention Branch observed a 402% increase in heroin deaths in the state since 2010 (Figure 3). At this time, chronic HCV infection is not reportable in North Carolina. Therefore, the true burden of this epidemic on the state remains unknown. However, using a conservative national HCV prevalence estimate of 1.6%, an estimated 160,000 North Carolinians have been infected with HCV with at least 120,000 of those individuals representing chronic infections. This estimate is more than four times higher than the number of persons living with HIV/AIDS in the state. Due to significant morbidity associated with blood borne pathogens (such as HCV, HIV and HBV) as well as the exorbitant cost of treating these chronic diseases, preventing infection should be a public health priority. In addition to risk reduction counseling, referral to mental health and substance abuse services; needle and syringe exchange programs have proven to be effective in decreasing the transmission of HCV, HIV and HBV. The common practice of sharing syringe, and drug preparation equipment (such as cookers, cotton filters and water used to rinse the syringes) contributes greatly to disease transmission. Therefore, a Hepatitis C Medications Medicaid 2013 2014 Paid Amount $8,068,113 $50,840,276 HIV/AIDS Medications Medicaid 2013 2014 Paid Amount $65,612,098 $70,016,283 AIDS Drug Assistance Program (ADAP) 2013 2014 Paid Amount $40,454,317 $47,059,921 successful needle and syringe exchange program must also ensure that sterile ancillary equipment is available, in addition to immediate referral to substance abuse programs. Needle and syringe exchange programs are associated with a decrease in risky injection practices (such as sharing and reuse of drug paraphernalia) and have not been associated with an increase in the likelihood or frequency of illicit substance use. Furthermore, the safe removal of contaminated needles from circulation increases the safety of citizens, as well as law enforcement who risk accidentally coming into contact with improperly disposed needles. In summary, needle and syringe exchange programs are an important public health tool that can lead to significant reductions in the transmission of blood borne pathogens by providing sterile injection equipment and an opportunity to link individuals struggling with addiction to critical services, such as substance cessation programs. Benefits of a Needle Exchange Program  Needle exchange reduces blood-borne diseases without increasing drug use. Several studies have shown compelling evidence that needle exchange programs decrease HIV and HVC transmission without increasing the use of injectable drugs.1  Preventing HVC and HIV infection in people who inject drugs also prevents infections in women and newborn children. Many women are at risk for HVC and HIV because of their own injectable drug use or because they are sexual partners of injectable drug users.  By working with people who inject drugs, we can help get them into drug treatment and if infected with HVC or HIV, into primary care for the treatment and/or cure of their disease.  All contaminated syringes turned into the exchange are safely disposed of. The goal is to get used syringes out of circulation as quickly as possible. The longer a syringe remains in circulation, the more opportunities there are for that syringe to pass on a blood-borne disease. Are Needle Exchange Programs Effective? YES. HIV infection among injectable drug users has been shown to increase 6% per year on average in cities that do not have needle exchange. In contrast, HIV infection declined 6% per year among injectable drug users in cities that have exchange programs.2 New data released by The Foundation for AIDS Research observed significant decreases in HIV incidence in states with publicly funded needle exchange programs.3 An Australian survey found that HIV prevalence declined 19% per year in cites with needle exchange compared to an 8% increase in cities that did not have exchange programs.3 Figure 1: Reported Number of Acute HCV infections in North Carolina, 2010-2014 Figure 2. Acute Hepatitis C rates in 2014: North Carolina versus the US US rate North Carolina rate Figure 3. Increase in the number of Heroin deaths in North Carolina, 2008-2014 References 1. Wodak A, Cooney A (2006). Do Needle Syringe Programs Reduce HIV Infection Among Injecting Drug Users: A Comprehensive Review of the International Evidence. Journal of Substance Use & Misuse, 41:777-813. Studies cited include: National Commission on AIDS (1991), Centers for Disease Control and Prevention (1993), General Accounting Office (1994), Office of Technology Assessment of the U.S. Congress (1995), National Institutes of Health Consensus Panel (1997), U.S. Department of Health & Human Services (2001), Institute of Medicine of the National Academy of Science (2001). 2. Hurley, SF, Jolley, DJ, Kalidor, JM (1997). Effectiveness of needle-exchange programs for prevention of HIV infection. The Lancet, 348:987-991. 3. The Foundation for AIDS Research, Preventing HIV and Hepatitis C Among People Who Inject Drugs: Public Funding for Syringe Services Programs Makes the Difference. Issue Brief –April 2015 4. Health Outcomes International (HOI), National Center for HIV Epidemiology and Clinical Research, Drummond, M (2002). Return on Investment in Needle and Syringe Programs in Australia. Canberra: Commonwealth Department of Health and Ageing. 5. Klevens, R.M., et al., Evolving epidemiology of hepatitis C virus in the United States. Clin Infect Dis, 2012. 55 Suppl 1: p. S3-9. 6. Koh, H.K. Viral Hepatitis: The Secret Epidemic. accessed at: http://www.hhs.gov.asl/testify/2010/06/t20100617b.html. 2010 [cited 2012 July 18]. 7. Chak, E., et al., Hepatitis C virus infection in USA: an estimate of true prevalence. Liver Int, 2011. 31(8): p. 1090-101. 8. Monterroso, ER., et al. Prevention of HIV infection in street-recruited injection drug users. The Collaborative Injection Drug User Study (CIDUS). JAIDS. 2000 Sep 1;25(1):63-70. 9. Ouellet, L., Huo, D., Bailey SL. HIV risk practices among needle exchange users and nonusers in Chicago. JAIDS. 2004 Sep 1;37(1):1187-96. 10. Bluthenthal RN., et al., The effect of syringe exchange use on high-risk injection drug users: a cohort study. AIDS. 2000 Mar 31; 14(5):605-11. 11. Gibson DR., et al., Two-to sixfold decreased odds of HIV risk behavior associated with use of syringe exchange. JAIDS. 2002 Oct 1;31(2):237-42. 12. Hagan, H., et al., An interview study of participants in the Tacoma, Washington, syringe exchange. Addiction. 1993 Dec;88(12):1691-7. 13. Longshore, D., Bluthenthal, RN., Stein, MD. Needle exchange program attendance and injection risk in Providence, Rhode Island. AIDS Educ Prev. 2001 Feb;13(1):78-90 14. Vlahov, D., Reductions in high-risk drug use behaviors among participants in the Baltimore needle exchange program. J Acquir Immune Defic Syndr Hum Retrovirol. 1997 Dec 15;16(5):400- 6 15. Marmor, M., Drug injection rates and needle-exchange use in New York City, 1991-1996. J Urban Health. 2000 Sep;77(3):359-68 16. Hurley SF1, Jolley DJ, Kaldor JM. Effectiveness of needle-exchange programmes for prevention of HIV infection. Lancet. 1997 Jun 21; 349(9068): 1797-800 17. A Comprehensive Approach: Preventing Blood-Borne Infections Among Injection Drug Users. accessed at: http://www.cdc.gov/idu/pubs/ca/comprehensive-approach.pdf 18. Hagan, H., et al. Reduced risk of hepatitis B and hepatitis C among injection drug users in the Tacoma syringe exchange program. Am J Public Health. 1995 Nov; 85(11):1531-7. Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: June 24, 2015 Agenda Item Subject: Immunization law change Attachment(s): Immunization law change brochure Staff or Board Member Reporting: Purpose: ____ Action _ _x Information only ____ Information with possible action Summary Information: Information on NC Immunization Law changes that go into effect 7-1-14 will be presented. 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): North Carolina Department of Health and Human Services Division of Public Health Pat McCrory Aldona Z. Wos, M.D. Governor Ambassador (Ret.) Secretary Secretary DHHS Penelope Slade-Sawyer Division Director July 21, 2014 TO: North Carolina Immunization Program (NCIP) Participants FROM: Wendy Holmes, RN, Head Immunization Branch SUBJECT: New and Revised Immunization Rules and Requirements The purpose of this memo is to inform you that on May 14, 2014 the North Carolina Commission for Public Health approved new vaccine requirements and changes to existing requirements as documented in North Carolina Administrative Code 10A NCAC 41A .0401 Dosage and Age Requirements for Immunization. The changes were made to more closely align NC requirements with the current Advisory Committee on Immunization Practices (ACIP) recommendations. The new vaccine requirements and changes to previous vaccine requirements will become effective July 1, 2015. Documentation of a valid medical or religious exemption would exempt an individual from the requirements. Details of the rule changes are enclosed in the updated NCAC 10A. Highlights of the new vaccine requirements and the revised requirements are listed below. New Vaccine Requirements  Pneumococcal conjugate vaccine (PCV) – 4 doses by 15 months of age o The number of vaccine doses required depends on the age of the child when the vaccine series began. o No individual 5 years of age or older is required to receive PCV.  Meningococcal conjugate vaccine (MCV) – 2 doses o One dose for individuals is required entering the 7th grade or by 12 years of age whichever comes first. o Booster dose for individuals is required entering the 12th grade or 17 years of age beginning August 1, 2020. o If the first dose is administered on or after the 16th birthday the booster dose is not required. Changes to Previous Vaccine Requirements  Polio vaccine – the booster (4th) dose is required on or after the 4th birthday and before entering school for the first time.  Varicella vaccine – 2 doses administered at least 28 days apart o One dose is required on or after 12 months of age and before 19 months. o A second dose is required before entering school for the first time. o Documentation of disease must be from a physician, nurse practitioner, or physician’s assistant verifying history of varicella disease. Documentation must include the name of the individual with history of disease, approximate date or age of infection and a healthcare provider signature. www.ncdhhs.gov • www.publichealth.nc.gov Tel 919-707-5450 • Fax 919-870-4830 Location: 5605 Six Forks Road • Raleigh, NC 27609 Mailing Address: 1930 Mail Service Center • Raleigh, NC 27699-1930 An Equal Opportunity / Affirmative Action Employer  Tetanus, diphtheria, and pertussis (whooping cough) – Tdap o A booster dose of Tdap is required for individuals who have not previously received Tdap and who are entering 7th grade or by 12 years of age, whichever comes first.  School Entry from 6th to 7th Grade o Simultaneous administration of Tdap and MCV vaccines is allowed at the 11-12 year old recommendation. Continuing to follow the ACIP recommended schedule ensures providers are vaccinating clients age -appropriately to meet the new requirements. The North Carolina Immunization Program (NCIP) encourages providers to run reminder/recall reports from the North Carolina Immunization Registry (NCIR) to identify clients who need vaccines to meet the requirements. Please note: A Certificate of Immunization must be presented for children entering a public, private, or religious child care facility; kindergarten; grades seven or twelve; and college or university. An individual who is not age-appropriately vaccinated and who does not meet NC vaccine requirements shall have 30 calendar days to meet requirements or be excluded from the facility. For additional information regarding the new vaccine requirements please contact the Immunization Branch at 919-707- 5550 or via email at imminfo@dhhs.nc.gov. Thank you for all you do to assure that all North Carolinians are age-appropriately vaccinated. Enclosure cc: SMT CO Staff Vaccine Manufacturers Steve Shore RINs RICs Greg Griggs Desiree Elekwa-Izuakor Terri Pennington Jason Swartz Ann Nichols Frank Skwara Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: June 24, 2015 Agenda Item Subject: Communicable Disease Annual Report Attachment(s): Communicable Disease Statistics, January-December, 2014 Staff or Board Member Reporting: Purpose: ___ Action __ x Information only __ _ Information with possible action Summary Information: Communicable disease case and suspect information for January-December, 2014 will be provided to complete the presentation of data in November for January-September, 2014. The annual reporting of communicable disease data will be closer to this time of year in the future to for allow a full year’s worth of data. 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): Communicable Disease Report January-December, 2014 Total Cases 2014 Total Suspects 2014 Average Cases 2009-2013 Cases 2013 Brucellosis 0 1 0 0 Campylobacter 21 8 19.2 25 Creutzefeldt Jacob 0 1 .4 0 Cryptosporidiosis 7 0 3 8 Dengue 0 0 .4 0 Shigatoxin-producing Ecoli 5 5 2.6 4 Ehrlichiosis 4 10 7.6 4 Arboviral encephalitis 2 8 0 0 Invasive Haemophilus Influenza B (HIB) 2 0 1 1 Hemolytic Uremic Syndrome 0 0 .2 1 Hepatitis A 0 2 .6 1 Hepatitis B Acute 0 2 1 0 Hepatitis B Chronic 12 7 24.6 17 Hepatitis C Acute 0 4 .2 0 Legionellosis 2 0 .4 1 Listeriosis 0 2 0 0 Lyme 5 21 7.4 3 Malaria 3 0 .6 1 Measles 0 0 1.6 8 Meningococcal 1 0 .4 0 Mumps 0 2 1 0 Pertussis 10 13 10.2 4 Q Fever 1 0 .2 0 Rocky Mtn. Spotted Fever 19 29 16.8 16 Salmonellosis 27 22 21.2 21 Shigellosis 1 3 1.4 4 Group A Invasive Strep 5 10 2 5 Toxic Shock Syndrome 0 0 .4 1 TB 1 35 2.6 3 Typhoid 0 1 0 0 Vibrio Infection 0 1 .6 1 Does not include statistics on contacts Communicable Disease Report January-December, 2014 CD-Related Activities (January –December, 2014) Jan-Dec. 2014 Bloodborne Pathogen Exposures 1 Situations involving OCHD in the mandated testing (and compliance) of someone exposed to potentially infectious body fluids of another Quarantine Orders Issued* 0 Isolation Orders Issued* 1 (TB) Health Law Violators 2 Legally manadated testing as sources of BBP/sexual exposure CD Control Measure Orders Issued* 18 11 Hepatitis B, 1 TB, 6 Ebola Hepatitis B Perinatals Tracked 10 Infants Born to Hepatitis B Positive Moms 9 Infants Becoming Hepatitis B Infected at Birth 0 Infants born to Hepatitis B infected moms are very likely to be Hepatitis B positive for life (and at high risk for early death) unless a series of vaccines are received at appropriate times within the first 6 months of life; these vaccines must begin within 24 hours of birth; we track the moms and children in an effort to assure that these vaccines are received on time and that appropriate follow-up if obtained *Annual reporting is an accreditation requirement Historical Information* 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Rabies Contacts 15 27 17 4 36 241 398 358 370 268 303 301 333 418 523 Pertussis Cases 0 4 0 4 2 0 2 0 11 18 2 4 23 4 10 TB cases 7 5 2 5 (Jail) 5 4 2 7 (Jail) 7 (Jail) 1 4 3 2 3 1 Latent TB Infections Treated 11 24 32 29 44 53 35 85 72 65 41 64 53 59 50 Refugee Arrivals/ CD Screenings 227 118 51 87 78 73 76 Communicable Disease Report January-December, 2014 Outbreaks 2014 Date Cases Suspects Contacts Suspected Shigellosis in Long Term Care Facility (LTCF) 1/2014 0 1 ~50 Norovirus in Long Term Care Facility 2/2014 17 0 Entire facility and staff Norovirus-like illness in Retirement Community 2/2014 6 0 Entire facility and staff Meningococcal- Local High School 2/2014 1 0 35 Respiratory/GI illnesses local private school* 3/2014 154 0 307 Hepatitis B LTCF 3/2014 2 0 5 Influenza-like Illness - Retirement Community 4/2014 3 39 residents 12 staff Entire facility and staff Noro-like illness-LTCF/Rehab Center 4/2014 1 19 residents 12 staff Limited to a specific unit. Salmonella – Family Vacation 7/2014 3 4 suspects 8 in all; 7 became ill Retirement Community – Possible Meningococcal Disease 8/2014 0 1 6 Boy Scout Troop Nepal Trip- Crypto v. Giardia 9/2014 1 confirmed crypto; 1 confirmed giardia 9 11 7/16/14-8/20/14: Travel to Nepal- camped at 18,000 ft. Suspects may have had giardia, altitude sickness or crypto. Period of infectiousness for crypto was over by the time investigation initiated. Pertussis- Culbreth/Carrboro High 10/4- 11/16/2014 4 confirmed 7 suspects ruled out 11 close contacts to 4 confirmed cases, all given PEP. Approx. 255 classmates and teachers (casual contacts); 2 Religious Exempt, 2 Medical Exempt contacts did not need to be excluded and were not infected. Noro-like illness-Project Homestart 11/14- 11/20/14 0 confirmed 5 suspect Approx. 50 residents/staff. Illness limited to two rooms in 1 building. Pertussis-private pre-school 11/25-12/8 1 case/ (Durham Co) 2 suspects- tested neg., but symptomatic Approx. 40 contacts at school between 3 yr old and 4 yr old classrooms. Flu in Long Term Care Facility 12/2014 11 cases 1 hospitalized; 5 contacts treated prophylactically and did not develop disease *Illness with similar symptoms noted but the cause and source were never identified. There was an increased absenteeism during this time with reports of both respiratory and GI illnesses. Control measures implemented and absenteeism tracked. Communicable Disease Report January-December, 2014 Sexually Transmitted Disease (STDs) 2009 2010 2011 2012 2013 2014 Average 2009-2013 Gonorrhea 82 88 122 85 114 109 98.2 Chlamydia 379 336 544 456 470 467 437 Syphilis 7 1 4 3 5 16 4 HIV cases 13 8 13 15 17 16* 13.2 AIDS cases 2 2 3 2 7 12 3.2 Total 483 435 686 561 613 620 555.6 2009-2013 taken from Annual STD Data 2014 taken from Quarterly Date which is likely to change when converted to Annual Data (still not available as of mid-June): preliminary data *expectation based on line listing received from the State is that Orange Co. will have 11 cases for 2014; 5/16 of the cases on line listing credited to Orange Co. were from other counties; s:\personal health services\community health services section\communityhealth\cd stats\boh cd reports\2014\jan-dec 2014 final 6-15-15.doc Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: June 24, 2015 Agenda Item Subject: Orange County Advisory Board Summary Attachment(s): 1) Quarter 3 Update_Advisory Board Summary Staff or Board Member Reporting: Meredith Stewart, Program Manager Purpose: ___ Action _X_ Information only ___ Information with possible action Summary Information: The Board of Health identified action steps related to engagement in the 2014-2016 Strategic Plan. One of these action steps is to receive quarterly updates on actions of other Orange County advisory boards that relate to the BOH strategic plan priorities. The provided summary is of pertinent actions or information from Orange County advisory boards from February 2015 to May 2015, as available from the boards. Meredith will highlight a number of these activities and their connection to the BOH. Some boards being tracked do not have updates included because they do not pertain to the BOH’s priorities or they were not available at the time of the report. 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): Submitted June 15th, 2015 O RANGE C OUNTY A DVISORY B OARD S UMMARY F EBRUARY 201 5 – M AY 2015 Board of Health Engagement 10/13/14 1 Quarterly Report Board of Health Engagement BOARD BOH B OARD S UMMARY Orange County Schools Board of Education Access , Obesity At their February 26, 2015 meeting, the Board reviewed and approved the district strategic plan. Several of the goals align closely with the pipeline of services for the Family Success Alliance. At their May 11, 2015 meeting, the Board reviewed an increase in school lunch charges. The increase for elementary students is $2 .10 to $2.20 and for middle/high school students i s $2.50 to $2.70. Chapel Hill/Carrboro City Schools Board of Education Obesity At their May 7, 2015 meeting, the Board approved changes to the Student Wellness Policy to reflect the new State Board of Education requirements, new federal standards around wellness, and Smart Snacks. This will be a topic of more detailed review and discussion at the next BOH Obesity Prevention subcommittee meeting. Board of County Commissioners Obesity , SAMH At their March 3, 2015 meeting, the Commissioners received public comment on the Consolidated Housing Plan. Comments focused on the lack of affordable rental housing, the need for repairs to low-income elderly individuals, and the differences between Section 8, Housing Choice, and other home affordability options. Also at this meeting, the BOCC voted to include “the reclassification of Flavored Alcoholic Beverages (Alcopops) as distilled spirits rather than malt beverages” in their 2015 legislative agenda. Finally, at this meeting the BOCC approved the request 10/13/14 2 for social justice funds for the Family Success Alliance for their visit to the Harlem Children’s Zone. At their April 7, 2015 meeting, Commis sioner Pelissier asked the Cou nty Manager to get a detailed report on how Cardinal Innovations uses the $1.3 million in county funds for mental health services. She cited discussions with county stakeholders who state the need for increased mental health services, pre and post jail service s, and treatment for undocumented immigrant children. Also at this meeting, the Orange County Alcoholic Beverage Control Board presented to the BOCC. Their annual report showed:  Orange County is consistently in the top 10 in the state in revenue  Orange County saw a 5.4% increase in profit, and a 9.1% increase in profitability  The Board provides $156,550 to Alcohol Education and Rehabilitation and $130,000 to Alcohol Law Enforcement – double the statutory requirements in NC. Chapel Hill Town Council Obesity The March 9th meeting included a discussion of bike/pedestrian facilities as part of the Ephesus/Fordham Renewal District work. This is the intersection of 15-501/Fordham and Franklin street. A design firm provided several options ranging in cost. 10/13/14 3 Hillsborough Board of Commissioners Obesity At their February 9, 2015 meeting, Commissioner Ferguson reported that DSS is having trouble finding affordable housing for people with pets and passed this along to the Partnership to End Homelessness. The Board also discussed reports that drug activity is happening at the county park in Fairview, and that families do not feel safe bringing kids to the park sometimes. The Hillsborough Chief of Police and the Sheriff’s Department have outlined action steps to address the situation. Orange Unified Transportation Board (OUTBoard) Obesity , Access At their February 18, 2015 meeting, the OUTBoard reviewed a draft ADA plan to extend accessible transit for disabled persons within ¾ mile of its 3 fixed-routes (i.e. Hillsborough Circulator). It was approved by the BOCC. The route and process for a client to apply was shared with Health Department management in May 2015. Also at this meeting, the board provided comments on the Draft 2016-2025 Statewide Transportation Improvement Program (STIP). Comments on projects include the US 70 Bypass Bridge at Eno River, I-40 widening from I-85 to 15-501, South Churton Street, and Orange Grove Road on page 39 of the packet. At their November 6, 2014 meeting, the BOCC petitioned for Planning staff to work with the OUTBoard to discuss bicycle safety in the county. At the May 20, 2015 OUTBoard meeting, a subcommittee provided recommendations for the BOCC to improve pedestrian and bicycle safety. These recommendations include:  Provide a copy of County-endorsed bicycle routes  Continue to advocate for bike/ped facilities in NC DOT scheduled resurfacing projects  Locally implement state Watch for Me NC campaign  Educate law enforcement  Post current state laws at high-traffic motorist/bike incident areas  Reduce speed limits on rural county roads 10/13/14 4  Form Task Force for action planning and present to BOCC Healthy Carolinians of Orange County All Healthy Carolinians Coordinator Ashley Mercer is currently preparing for the 2015 Community Health Assessment. Survey collection dates are listed here, along with the registration form to participate. Family Success Alliance Access The Family Success Alliance completed the gap analysis in Zones 4 and 6 in April 2015. Community priorities were:  Zone 4 – Access to Childcare/Pre-K, Transportation, Support for Latino Families  Zone 6 – Parenting support, Literacy, Affordable Housing, Childcare/Pre-K, and Support for Families The FSA Council subsequently requested $90,000 from the Social Justice Fund to address some of these priorities. The interventions include: 1) A 4-week kindergarten prep program for kids who have not attended kindergarten or are otherwise at risk of starting or falling behind. Programs will run at New Hope Elementary, Frank Porter Graham Elementary, and Carrboro Elementary for a maximum of 90 children total. 2) Parental literacy classes offered to parents of children in kindergarten prep program that will begin during program and carry-on throughout fall 2015. 3) Piloting of 1 FTE navigator position in each zone to help with community outreach and connecting families with existing zone resources. Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: June 24, 2015 Agenda Item Subject: Consideration of Expanding BOH Terms from 2 to 3 Attachment(s): None Staff or Board Member Reporting: Colleen Bridger Purpose: ____ Action __X Information only ____Information with possible action Summary Information: The purpose of this discussion will be to gage the BOH’s reaction to changing their maximum allowable terms of service on the BOH from two, three-year terms to three, three-year terms. This change would be made in August with the annual update to the by-laws/policies and procedures. Recommended Action: ___Approve _X_Approve & forward to Board of Commissioners for action ___Approve & forward to ___________________________ ___Accept as information ___Revise & schedule for future action ___Other (detail): Health Director’s Report June, 2015 • Staff o Personal Health Services continues to interview and hire nurses and clinic managers. We are pleased by the caliber of applicants for these positions and excited about our latest round of new hires. o Dental is interviewing for their new Dental Team (Dentist, Dental Assistant and Office Assistant). All will be hired and start no later than July 6th. o All other Divisions are fully staffed. • Board of Health Priorities o The Family Success Alliance is the lead entity for a United Way collaborative. This year the United Way changed their funding process from funding “agencies” to funding collective impact work. This is an important change and I have seen it work tremendously well in other parts of the country. Like a lot of major change, however, it is difficult and uncertain and adds one more layer of complexity to our work of building the FSA pipeline. We will spend the summer working with our collaborative of non-profit agencies and others to determine the best way to use the $168,000 from the United Way and the other funds we have available. o We had an intriguing meeting with a group of UNC Chapel Hill researchers and representatives from the Provost’s office. The Provost is looking for a way for the University to be involved in addressing the issues of children living in poverty. The FSA has a lot of data, evaluation and other research needs we believe could be met well by the University as well as a comprehensive project that meets many of the criteria the Provost delineated. We should hear something later this summer. o We also had an interesting meeting with the national group that is responsible for coordinating the evaluation of all Promise Neighborhood initiatives across the nation. We identified some potential areas of intersect (including using the same evaluation measures, participating in learning collaboratives and potentially being able to utilize their evaluation software system). We will have another meeting with them in a few weeks to really hone in on what they can share with us. o The FSA Navigators are hired and the kindergarten jump start programs are rolling out in July. More great and speedy work from our FSA Team! • Various o For the first time since Ebola emerged on the scene, Orange County is not monitoring anybody. We don’t expect that to last, but it is a nice break. We did receive some funds from the state to cover the cost of planning and monitoring for the next fiscal year (not retroactively, however), so that will allow us to hire a temporary nurse to take some of the pressure off our CD nurses. o I was asked by the County Manager to participate on a panel to interview potential candidates for the County Finance Director/CFO. We interviewed 8 people and recommended two extremely qualified candidates for her further consideration. o Through some friendly teasing and feather fluffing via social media, we have decided to challenge Durham County Health Department to a walking competition. We’ll have more details in August, but we will see who can walk the length of the Appalachian Trail the quickest. The Durham Health Director and I are still working out our friendly wagers. o I am excited to announce that the ABC Board funded our grant request for $30,000. We asked for $40,000, but are still super excited about this project. We will combine $30,000 from the Health Department, the Town of Chapel Hill and the University with this grant and use the $120,000 plus some in-kind support to hire a project manager to implement the 21 recommendations from the Town and Gown Alcohol Task Force. o I’ve also been asked by the School of Public Health to re-design and teach a Master’s-level course, Spring Semester 2016. Both Susan and Liska have approved this outside employment as we all recognize this as a great opportunity to strengthen the relationship between the SPH and the Health Department. o Other items that kept me busy this month were:  Serving (again) as a member of the 3 person Orange County Personnel Hearing Board (where an employee can appeal the county’s decision to terminate them). We have another hearing scheduled in July.  Multiple meetings with leadership in Raleigh at the Division of Public Health, Department of Health and Human Services and elected members in the General Assembly. The Association of Local Health Directors (of which I am currently President-elect) is working hard to ensure Medicaid reform has a strong preventive and population health focus. We are also advocating for the best public health-related budget we can get.  Serving as the statewide Co-Chair of the Practice Based Research Network where we are planning for our part in the fall’s NCPHA educational conference.  Serving on other Boards such as the statewide Care Share Board of Directors, the NC Association of County Commissioners’ Health and Human Services Steering Committee and the Adolescent Pregnancy Prevention Council of North Carolina (now call SHIFT NC – Sexual Health Initiatives For Teens).  Serving on the National Research Advisory Group for NACCHO.  Attending the Grand Opening of UNC’s Hillsborough Hospital. The Emergency Department opens July 6th and we’ve had a few conversations with them about mutually beneficial referrals and space use. FSA gears up for new programs May. 31, 2015 @ 06:42 PM Katie Jansen ORANGE COUNTY — Armed with $90,000 from the Orange County social justice fund and inspired by a recent trip to New York City to learn from a successful anti-poverty organization, the Family Success Alliance is preparing to launch its first two programs to help area children succeed. The Family Success Alliance, geared toward creating a pipeline that supports children from the cradle all the way to college or a career, plans to fund two “zone navigator” positions to be filled by people from each pilot zone chosen for the program. The two pilot zones – referred to as Zones 4 and 6 – are east of I-40 and part of Chapel Hill and Carrboro, respectively. Colleen Bridger, health director at the Orange County Health Department, said the zone navigator is meant to be a “bi-directional navigator,” meaning that the navigator will both help families connect to services already available and report back about what additional services are needed. The Family Success Alliance will also implement a kindergarten readiness program – a four-week program available to children who have never been to preschool. The program will help children adjust to being in a classroom, Bridger said. Representatives of the Family Success Alliance recently visited the Harlem Children’s Zone, an organization that works to break the cycle of poverty for children in New York City. Now a national model for other organizations and serving more than 12,000 kids, the Harlem Children’s Zone started small – with a one-block pilot zone in the 1990s. “I was struck by how, even 20 years into the project, there’s this scrappiness in the ‘do whatever it t akes’ mentality,” Bridger said, adding that she feels this is what sets the Harlem Children’s Zone apart from other organizations. Although Bridger said she learned a lot by visiting various services and programs offered by the Harlem Children’s Zone, she sees the Family Success Alliance taking a slightly different approach. While the Harlem Children’s Zone is primarily a self-enclosed entity that offers services to its youth, the Family Success Alliance plans to partner with resources and services that already exist in the community. “Here in Orange County, we’re fortunate to have a lot of resources,” Bridger said. This, she said, could counteract the fact that the Family Success Alliance doesn’t have a large budget or startup grants for funding. But the group does have funding lined up for the future. The Orange County Board of Commissioners has allotted $250,000 next fiscal year for the Family Success Alliance, and founders are looking toward United Way as another potential funding source. While the setup in Orange County may stray from the approach at the Harlem Children’s Zone, Bridger said the goal is the same. At the Harlem Children’s Zone, she said, there are “so many opportunities for people to be actively involved in each kid’s life.” A major goal of the Family Success Alliance, she said, is to build this pipeline so that every child will have multiple touch points along the way to ensure success. News of Orange June 3, 2015 Large Disparities Exist Even in State’s Healthiest County By Jess Clark SHARE THIS: Posted June 10, 2015 at 9:45 am Photo Credit: Family Success Alliance Orange County children may be the healthiest in North Carolina, according to child-advocacy nonprofit NC Child. But a closer look at Orange County shows that the block you grow up on may matter more than your county. Orange County is the wealthiest and most educated county in the state, and overall its children are the healthiest. Orange County Health Director Colleen Bridger says that’s not a coincidence. “The more highly educated you are, the more likely you are to have a professional job that provides you with health insurance, time off to go to the doctor, time off to take your kids to the doctor and a living wage,” Bridger said. But Orange County’s wealth and college degrees aren’t divided equally among all its residents. Census estimates show wide socioeconomic gaps between adjacent blocks. “Even though Orange County in the aggregate is doing well, there are pockets of poverty and places where people are struggling that rivals any other place in the state,” Bridger warned. Bridger says the greatest health disparities within Orange County often come down to disparities in education. There are areas in the county where two-thirds of third-graders are reading below grade level. The county says it’s working to improve health outcomes by closing the education gap thro ugh a project called the Family Success Alliance. The program replicates an initiative out of Harlem in New York City. “They’ve basically said ‘anything a child needs from before she or he is born to the time he or she has a job after they’ve graduated from college, we want to provide it.’ And so we want to replicate that here so that we are able to ensure that every child in Orange County can succeed, regardless of where t hey live,” Bridger said. SHARE THIS: Volunteers sought for health opinion surveys Jun. 09, 2015 @ 01:44 PM ORANGE COUNTY HEALTH DEPARTMENT CHAPEL HILL — The Orange County Health Department is required to conduct a community health assessment every four years. The goal is to find where there are gaps in health, the health services available to people living in Orange County and to identify emerging issues or trends that may affect the health of residents. A community survey is a key component of the assessment process. Staff and volunteers from the Health Department will visit a random sample of households across the county to administer a 30-minute, confidential survey. The Health Department will compile the results of the survey and include them in the f inal report of the community health assessment, which will be completed in early 2016. Survey responses will help to determine the direction of future programs for the health department and other agencies across the county. Teams of surveyors will be in Hillsborough and the northern portion of the county June 18-20. The following weekend, teams will be in Chapel Hill and surrounding areas of the southern part of the county June 26-28. All volunteers will be wearing Orange County Health Department or Healthy Carolinians of Orange County T-shirts and identification badges; many will be driving county cars. If a surveyor comes to your door, please take the time to share your opinions with them. Also, please secure pets for the safety of the surveyor teams. Participants will not be paid, but will receive a small gift of appreciation and informational materials about Orange County services. Volunteers are needed to help conduct the surveys. If you are able to volunteer on any of the survey days listed above and would like to be involved in this community process, visit https://www.surveymonkey.com/r/5SBGQBV. Bilingual English/Spanish speakers are needed and volunteers need no prior experience; training will be offered on each survey day prior to going out into the community. Refreshments, lunch, and snacks will be provided to all volunteers. Guest column: It’s time to close the achievement gap Jun. 13, 2015 @ 03:27 PM BY SHELDON LANIER and JAKE HENRY, Family Success Alliance Jake Henry Sheldon Lanier CHAPEL HILL — Ensuring that all students in Orange County have the opportunity to learn, so they may achieve academic and individual success in life is a major goal of both Chapel Hill-Carrboro City Schools and Orange County Schools. However, it is a goal that our school districts cannot achieve on our own. In Orange County, some of our families are struggling to pay their bills, put fo od on the table and provide their children with adequate health care. We all know that what happens to our children outside of the classroom, like their neighborhoods, homes and nutrition, has a major impact on what happens inside the classroom. And ultimately, the future of our community depends on whether our children reach their full potential. That’s why we are so excited to be a part of a new initiative in our county that aims to bring a diverse group of elected officials, community organizations, non-profits and government partners together to provide our families and children with the support and resources they need to overcome any obstacles on their road to success, learn, and grow successfully. The Family Success Alliance will adapt lessons from suc cessful models such as the Harlem Children’s Zone to improve our children’s chances for educational and economic opportunities. These models serve a defined geographic area and its children with evidence-based programs, services and support from cradle to career. These opportunities are like charging stations that children depend on to “charge up” their developing brains and reach their full potential. The first charging station begins with every child beginning kindergarten healthy and ready to thrive. Hig h- quality early childhood experiences build the foundation for the future, and will make a tremendous difference for our at-risk students. As educators, we know that the academic achievement gap is greatly impacted by a child’s access to resources, beginni ng at a very early age. The Family Success Alliance will work to increase access to these resources for our families and children, which should be a big help in reducing, and possibly eliminating, the achievement gap in our schools. The charging continues through school and the community to make sure each child succeeds academically, receives support both in and out of school, graduates on time, begins college or a career and then ends by supporting these young adults with their life and career goals. Many families, who have felt unheard and unimportant in the past, have expressed excitement and anticipation for the work of the Family Success Alliance. By combining input from the families, children, service providers and leaders in the selected zones with decades of research, the Family Success Alliance will be able to greatly improve the odds of success for children and families in our county. When we all work together as a community, great things can be achieved. By surrounding children with dedicated organizations and individuals who are able to provide resources and support along the way, we feel confident that all children in Orange County schools will be able to achieve their true learning potential. EDITOR’S NOTES: Sheldon Lanier is director of equity and AVID for the Chapel Hill-Carrboro City Schools, and Jake Henry is the chief academic officer for Orange County Schools. ... For more information on the Family Success Alliance, visit www.orangecountync.gov/departments/health/FSA.php online.