HomeMy WebLinkAboutBOH minutes 062619MINUTES - Draft
ORANGE COUNTY BOARD OF HEALTH
June 26, 2019
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ORANGE COUNTY HEALTH DEPARTMENT MISSION STATEMENT: To enhance the quality
of life, promote the health, and preserve the environment for all people in the Orange County
community.
THE ORANGE COUNTY BOARD OF HEALTH MET ON June 26, 2019 at the Orange County
Health Department, 2501 Homestead Road, Chapel Hill, NC.
BOARD OF HEALTH MEMBERS PRESENT: Timothy Smith, Chair, Jessica Frega, Vice-
Chair, Keith Bagby, Bruce Baldwin, Paul Chelminski, Jennifer Deyo, Liska Lackey,
Commissioner Earl McKee and Sam Lasris.
BOARD OF HEALTH MEMBERS ABSENT: None.
STAFF PRESENT: Quintana Stewart, Health Director; Rebecca Crawford, Financial and
Administrative Services Director; Michael DeFranco, Public Health Services Manager; Henry
Green, Community Health Aide; Victoria Hudson, Environmental Health Director; Donna King,
Health Promotion & Education Services Director; Pam McCall, Public Health Nursing Director;
Kristin Prelipp, Communications Manager; Jennifer Riddle, Patient Account Technician; Beverly
Scurry, BOH Strategic Plan Manager; and La Toya Strange, Administrative Support I.
GUESTS PRESENT: None.
I. Welcome New Employees
Timothy Smith, Chair, called the meeting to order. Quintana Stewart, Health Director, introduced
Jennifer Riddle, the new employee in attendance.
II. Public Comment for Items NOT on Printed Agenda: None.
III. Approval of the June 26, 2019 Agenda
Motion was made by Jessica Frega to approve the agenda, seconded by Jennifer Deyo
and carried without dissent.
IV. Action Items (Consent)
A. Minutes of May 22, 2019 Meeting
Motion was made by Jennifer Deyo to approve the minutes of May 2019, seconded by
Sam Lasris and carried without dissent.
V. Educational Sessions
A. Public Health 3.0
Vaughn Upshaw, professor at UNC Gillings School of Public Health, gave a presentation on the
evolution of public health and future opportunities for public health leaders under Public Health
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3.0. Below are some highlights.
• Public Health 1.0 – Late 19th to 20th Century
o The 1st wave of public health preventative services emerged during this period. The
goal was to prevent and reduce communicable diseases by use of vaccinations,
chest x-rays, clinical inspections, etc.
o Mobile vans were used as a method to deliver vaccinations to people.
o In the 1960 state budget, only 9% of the budget was allocated to health care.
o During this period, epidemiology and laboratory science was expanded, food and
water safety was improved and systemized sanitation introduced.
• Public Health 2.0 – 1980s to Now
o The 10 essential health services emerged during this period. The goal was to
promote and contribute to the highest level of health possible by way of policy
development and patient education.
o The Community Health Assessment became a standard. Accreditation, policies and
prevention, management and treatment of diseases were the focus. Performance
standards were established.
o In the 1990 state budget, the health care budget doubled from 30 years prior to 18%
of the budget.
• Public Health 3.0 – Now to the Future
o The goal is to address the determinants of health by screening for unmet health-
related resources such as food insecurity, housing and transportation.
o Fiscal year 2020 state budget allocates 32% of state spending to health care.
o To strategically address the public’s needs, we should:
act as Chief Health Strategists,
engage with cross-sector partnerships,
ensure that every person is served by a nationally accredited health department
provide quality data and clear metrics so that all partners (school systems, public
safety, etc.) can understand the data, and
enhance funding.
• Evolution of the Public Health System
o Traditional Clinical Prevention
Examples include preventive services such as routine health screenings, weight
monitoring, scheduled immunizations.
o Innovative Clinical Prevention
Examples include health fairs, workplace health assessments.
o Community-wide Prevention
Examples include thinking about the policies, being held to certain standards,
ecology, pollution, living wages.
• Health determinants compared to health spending in the U.S.
• When determining one’s health status in the US:
o Environment equates to 36%
o Medical care equates to 11%
o Genetics/biology equates to 22%
o Social circumstance equates to 24%
o Individual behavior equates to 7%
• When comparing the elements that determines one’s health status to the percentage of
spending in the US:
o Environment equates to 5%
o Medical care equates to 60%
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o Social circumstance equates to 28%
o Individual behavior equates to 7%
• 3.0 Opportunities for Public Health Leaders
o Emphasize health for people, places and the planet
o Apply data and analytical tools
o Address disparities and inequalities
o Protect individuals, families, neighbors and communities
o Engage policy, practice and regulatory partnerships to protect and promote the
public’s health
The BOH had questions that were addressed by Ms. Upshaw.
B. Formerly Incarcerated Transition Program (FIT) Update
Henry “Tommy” Green, Community Health Aide, gave an update on the FIT program. He began
by defining the FIT program and its purpose. Below are some highlights:
• FIT program was designed to connect formerly incarcerated people with a chronic
condition to health care services via the help of a community health worker (CHW). It
mirrors the Transitions Clinic in California and involves CHWs that were more easily able
to relate to the clientele due to having had similar circumstances.
• Other community re-entry resources are available to help with a comprehensive re-entry
plan. The FIT program works with its partners and assists clients with finding housing,
employment and getting into substance abuse programs.
• FIT program partners include OC Local Reentry Council, Community Empowerment
Fund, NC Works, Interfaith Council and Dr. Bill Price.
• Currently, Orange, Durham, Wake and Mecklenburg counties have FIT programs.
• Some data given included:
o Serious mental illness is 2 to 4 times higher in state prisons than in the community.
o Out of a study of 1,100 people exiting imprisonment, 80% of men and 90% of
women had a chronic disease that required management including heart disease,
diabetes, HIV, Hepatitis C and kidney disease.
• To be eligible for the FIT program, one must be an Orange County resident, recently
released from prison or jail within the last 2 years and diagnosed with a chronic illness to
include mental health and substance abuse/misuse.
• Some of the challenges faced are homelessness, recidivism, food insecurity,
unemployment and mental health problems. Mr. Green stated that the FIT program has
a psychiatrist, Dr. Bill Price, who sees his clients for free.
• Current case load is 32 clients with 3 new intakes coming soon of which 26 are active
cases. The recidivism rate is almost 10%.
• Some of the desired outcomes to decrease recidivism for the FIT program include;
improve client health outcomes, empower clients to become knowledgeable about their
health and take control, and increase adherence to use of medications and treatment
plans.
• Some future goals for the FIT program include:
o By 2020, County Funds will represent 100% of the funding for the program.
o The Governor’s Reentry Council has taken a special interest in the FIT program.
There is the expectation that the FIT program will be included on the Final Reentry
Report as a top recommendation for the Statewide Reentry Effort.
o OC FIT CHW to be the lead FIT CHW for NC.
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The BOH had questions that were addressed by Mr. Green.
C. Annual Communicable Disease (CD) Report
Michael DeFranco, Public Health Services Manager, gave an overview of the communicable
disease data for the year 2018. Mr. DeFranco began with an overview of the CD department in
the OCHD. He also noted that this meets Accreditation Benchmark 2.5. Some of the highlights
from the information he gave during his presentation include:
Foodborne Illness – There was a 20% increase in Salmonella cases which was attributed to
home chicken coups.
Vaccine Preventable Diseases – There was an increase in Pertussis cases as there was a
school-age outbreak in which about 90% of the cases were fully vaccinated.
Vectorborne Illnesses – There was an increase in Rocky Mountain Spotted Fever cases;
however, the numbers may be somewhat inaccuate as most physicians don't test before
starting treatment if Rocky Mountain Spotted Fever is strongly suspected based on the patients’
symptoms.
Waterborne Illnesses – Cases of Cryptosporidium were attributed to foreign travel and exposure
to others with the illness.
Sexually Transmitted Diseases – There was a drop in chlamydia and gonorrhea. There were no
new HIV cases. We’ve pushed the use of PrEP in our clinics.
Outbreaks – The Pertussis outbreak took place in multiple middle and high schools in Orange
County and occurred from January to May 2018. There were 23 confirmed cases.
Other Relevant Data – Rabies investigations are plentiful. There were 2 TB cases last year; 1
resulted in death. The state has mandated that we report any cases of the Carbapenem-
resistant Enterobacteriaceae (CRE) superbug.
Mr. DeFranco briefly mentioned the Meningoccal outbreak that occurred during the tenure of his
predecessor that resulted in a mass vaccination of 16,000 people. He also spoke of a Hepatitis
A initiative in OC jail and prison that’s in its infancy that gives 1 free dose of the Hepatitis A
vaccine to high risk population. There’s 95% immunity after the 1st dose. Usually , the vaccine
is given as in 2 doses; they’re monitoring the initiative for its impact. Two weeks ago, there was
a Measles symposium attended by our medical director as well as providers and schools that
involved discussion around how to prepare and handle any outbreaks.
D. Innovation Grant Update
Victoria Hudson, Environmental Health Director, provided updates on the 2018-2019 projects,
the status on the 2019-2020 process and the sustainability of former projects. Below is a
summary:
• Trauma-Informed Services for Immigrants & Refugees Trainings
o Trauma & Resilience - There were 57 evaluations collected from the 104 people that
attended this service provider training. Comments included that there is a need for
more of this type of training.
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o Breaking Silence: Interpreting for Victim Services – There were 25 interpreters in
attendance which represented 15 different agencies and spoke 15 different
languages. A pre- and post-test was given with an average improvement of 34
points after the training.
• Intraoral Cameras
o They have been extremely helpful in treating our patients or any patient who has a
more complicated issue that would be better explained or documented with a photo.
It also adds a historical record.
• Transportation Assistance
o This project was to address the Access to Care component; however, the grant was
not fully implemented and is seeking new funding. There are important aspects
involving equity, maintaining confidentiality and HIPPA.
• Patient Education Toolkit
o This kit would be an accompaniment to the treatment patients receive in our clinics
helping to alleviate fear while building self confidence in their ability to control their
own health. It would involve mostly OTC products.
• 41 or below
o All of the Environmental Health staff were involved with this educational campaign to
inform food service establishments of the new requirement for refrigerated
temperatures effective 1/1/19. There has been a 10% reduction in violations for food
establishment for having temperatures over 41 degrees.
• Art for OCHD
o The common areas in OCHD have undergone aesthetic changes to make it more
appealing to staff, visitors and clients. A video of the changes was shown.
Next, Ms. Hudson spoke about the 2019-2020 cycle.
• The call for ideas resulted in 11 being submitted.
• All 11 were selected for full applications.
• Grant announcement early July.
• Implementation can begin early July.
• Mid-year progress is due December 31.
• Final report is due June 30.
Ms. Hudson briefly went over the 2019-2020 proposals and their leads are listed below.
Transportation Assistance - Renee Kemske, et al
Readiness Kits - Kristy Bassili & LaTosha Scott
Cell Phone Study - Angela Sowers
Randomized Lunch -Beverly Scurry
WTMP Repair Cost Share -Tracey Langley &John Davis
REC Library - Ashley Rawlinson
Mapping with Drone - John Davis
Decorative Lighting for Dental - Dr. George
Digital Questionnaire -Karen Kyes and Christy Bridges
Language Justice Summit - Susan Clifford
Exercise Subsidy - Karen Kyes, et al
Lastly, Ms. Hudson informed the BOH of those past ideas that have sustained over time.
They are Fitness Trackers, Baby Box, Septic Assist, Employee Health Cards, Suicide
Prevention, REI, and FOH Food Safety Training.
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E. Strategic Plan Update
Beverly Scurry presented changes to the BOH Strategic Plan Action Steps for the Board’s
approval that included:
• PAN Subcommittee – Changes were made to the first Focus Area and a third focus area
was added to address racial equity as discussed in meetings.
• SDH Subcommittee – Changes were made to the first Focus Area regarding trauma-
informed care. Minor changes made Focus Area #2 and a 3rd Focus Area was added to
address racial equity.
• SAMH Subcommittee – Minor change made to the first Focus Area. Changes were
made to Focus Area #2 regarding mental health screenings and a third Focus Areas was
added to address racial equity.
Motion was made by Liska Lackey to approve the changes to the 2019-2020 BOH
Strategic Plan Action Steps, seconded by Jessica Frega and carried without dissent.
VI. Reports and Discussion with Possible Action
A. Current BOH Recruitment
Jessica Frega, Co-chair, stated that the physician seat recommendation, Dr. Aparna Jonnal,
was approved by the BOCC. The BOH was hoping to interview to fill Barbara Chavious’ At-
large seat but time was an issue. The BOCC opted to fill her seat with Dr. Allison Stuebe.
Susan Elmore, Bob Marotto and Quintana Stewart will meet on July 5th to discuss the
Veterinary seat and the specifications needed for whomever fills that seat.
It was agreed by the BOH to form a subcommittee to fill the Veterinary seat. Bruce Baldwin,
Jessica Frega and Timothy Smith volunteered to serve.
B. Health Director Report
In the interest of time, Ms. Stewart asked if there were any questions regarding her report. None
were asked.
VII. Board Comments.
Keith Bagby would like a separate list of upcoming events. Timothy Smith mentioned that San
Francisco has banned the sale of e-cigarettes. Mr. Smith then presented Paul Chelminski with
a plaque of appreciation as this is his last Board of Health meeting after serving for over 9 years
which included 3 three-year full terms and a partial term. Dr. Chelminski was thanked for his
service. While acknowledging that the BOCC possesses the appointing power, Liska Lackey
mentioned recent BOH appointments by the BOCC which led to a short discussion about the
need to communicate BOH needs to ensure BOH priorities and general statutues are met.
VIII. Adjournment
Jessica Frega moved to adjourn the meeting at 9:19pm and Liska Lackey seconded.
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June 26, 2019
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The next Board of Health Meeting will be held August 28, 2019 at the Whitted Human
Services Center, 300 West Tryon Street, Hillsborough, NC at 7:00 p.m.
Respectfully submitted,
Quintana Stewart, MPA
Orange County Health Director
Secretary to the Board