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HomeMy WebLinkAboutApproved Minutes of June 25, 2025 MINUTES ORANGE COUNTY BOARD OF HEALTH June 25, 2025 ORANGE COUNTY HEALTH DEPARTMENT MISSION STATEMENT: To promote and protect health, enhance quality of life, and preserve the environment for everyone in Orange County. THE ORANGE COUNTY BOARD OF HEALTH MET ON June 25, 2025, at the Orange County Health Department, 300 West Tryon Street, Hillsborough, NC. BOARD OF HEALTH MEMBERS PRESENT: Tony Whitaker—Vice Chair, Keith Bagby, Commissioner Amy Fowler, Davia Nickelson, Lee Pickett, and Rachel Royce. Aparna Jonnal arrived later. BOARD OF HEALTH MEMBERS ABSENT: Alison Stuebe — Chair, Bruce Baldwin, Brian Crandell, and Shielda Rodgers. STAFF PRESENT: Quintana Stewart, Health Director; Erica Pettigrew, Medical Director; Dr. Stephanie George, Dental Services Director; Victoria Hudson, Environmental Health Director; Ashley Rawlinson, Compliance Manager; Frederick Perschau, Financial and Administrative Services Director; Libbie Hough, Communications Manager; Marcy Williams, Health Promotion and Education Services Manager; McKayla Creed, Healthy Carolinians Coordinator; and Jean Phillips-Weiner, BOH Strategic Plan Manager. GUESTS/VISITORS PRESENT: Chris Ringwalt. I. Welcome New Employees Quintana Stewart, Health Director, shared that there were no new employees in attendance this evening. II. Public Comment for Items NOT on Printed Agenda: None. III. Board Comments: Commissioner Amy Fowler Commissioner Fowler shared that she and Dr. Jonnal had a nice time speaking to 97.9 The Hill/WCHL and Chapelboro.com about screen time. Dr. Rachel Royce Dr. Royce announced that the first measles case has arrived in North Carolina and added that unfortunately they went to many public places before they were diagnosed, so there may be additional cases in the coming weeks. Tony Whitaker Mr. Whitaker presented Mr. Bagby with a plaque and thanked him for his service to the board. Mr. Whitaker said that Mr. Bagby has been a great asset to the Board of Health as well as many other boards around the county and expressed sadness to see him leave. Dr. Pickett added that Virginia is lucky to get him. S:\Managers Working Files\BOH\Agendas &Abstracts\2025 Agenda and Abstracts/ June Page 1 MINUTES ORANGE COUNTY BOARD OF HEALTH June 25, 2025 Mr. Bagby said that he recalls attending his first meeting of the Board of Health while he was gauging his interest in applying to serve. He added that at the time he was still working at Blue Cross and Blue Shield, and while a lot has changed since then he is glad to have had the opportunity to serve on the Board of Health. He added that it is currently a tough time for everyone, and he will keep doing whatever he can to help, but that he intends to reclaim his Saturdays, as he has been coaching or refereeing every weekend for forty years now. Ms. Stewart thanked Mr. Bagby for all his service and for always showing up for Health Department events, to which Mr. Bagby replied that it was his pleasure. IV. Priority Committee Updates Access to Care Committee Dr. Pickett provided an update for the Access to Care Committee. The Photovoice project is underway, and the committee is working with individuals experiencing homelessness, individuals living in low-income or public housing, and individuals with limited English proficiency (LEP). The committee has hosted two virtual photovoice sessions with a small group with LEP, and staff will be meeting with them a final time tomorrow to share back the findings. Additionally, staff met with a small group of folks living unhoused in the Southern part of the county last Monday and will meet with them again next Thursday to share back the findings. The committee had scheduled a session with a mixed group of individuals who are living either unhoused or in low-income/public housing but unfortunately, no community members were able to attend due to unexpected last-minute obstacles. The committee has contacted those folks and invited them to submit individual photographs and short explanations instead. The committee is also working with Family Success Alliance (FSA) navigators to encourage eligible community members to submit individual photographs with short descriptions. The discussions held with community members have been rich and complex and committee members are excited to analyze the findings and share them with others in the future. The committee will next meet in late August. Behavioral Health Committee Dr. Nickelson provided an update for the Behavioral Health Committee. The committee met earlier this month and made plans for Commissioner Fowler and Dr. Jonnal's interview on 97.9 The Hill WCHL/Chapelboro.com, which took place on June 20th. The group discussed additional ways to promote screen-free activities among community members and planned to pivot their primary focus to learning more about how to support an increase in the number of mental healthcare providers in Orange County, especially diverse providers. The committee will invite El Futuro to present on this topic at a future meeting. Committee members also planned a Hillsborough's Last Friday event for the end of September to promote Suicide Awareness Month. Regarding equity, Dr. Nickelson shared that the group specifically discussed the disproportionate impact of suicide on Black men and efforts to reach that population. The committee will next meet in early September. Commissioner Fowler added that she had invited members of the Healthy Carolinian's Behavioral Health subcommittee to collaborate on the Last Friday event. S:\Managers Working Files\BOH\Agendas &Abstracts\2025 Agenda and Abstracts/ June Page 2 MINUTES ORANGE COUNTY BOARD OF HEALTH June 25, 2025 Connections to Community Support Committee Mr. Whitaker provided the update for the Connections to Community Support Committee. The committee held a working meeting the night before to work on a draft of their resolution in support of promoting affordable/attainable housing. Committee members pulled together an outline with a variety of land use and zoning recommendations to improve the affordable housing supply in Orange County. The resolution is intended to target elected officials for both the county and municipalities. During the July break, Jean Phillips-Weiner, Board of Health Strategic Plan Manager, will further flesh out the draft and bring any subject matter questions to the group when they reconvene in early August. The committee is planning to present their draft resolution to the full board for a vote at the Board meeting in either August or September. Dr. Royce brought up some concerns related to heat-related illness and wondered if the board could work on a resolution related to heat-related illness, heat safety, and heat as a public health concern. Dr. Pickett commented that Dr. Jonnal may be interested in working on this, as she is an ER doctor and likely has a lot of experience treating heat-related illnesses. Ms. Stewart suggested that perhaps this could be a task for the Connections to Community Support Committee, as there are many existing resources focused on heat and heat safety and that the county already provides heat-related initiatives such as cooling centers. Dr. Royce clarified that her primary concern was for individuals who work outdoors, particularly those who may be members of the Latino/a/e community, as she has heard stories from friends about the exploitation of these groups in the informal employment sector and of community members succumbing to heat-related illness. Mr. Whitaker shared that, anecdotally, he knows many construction companies take heat safety seriously and make it a big part of their safety plans. Ms. Stewart added that the Environmental Health Division is diligent about heat safety and includes heat and weather forecasts in their weekly newsletter. Victoria Hudson, Environmental Health Director, shared that because of the current heat dome they have notified their contractors that inspections will be limited after 2pm until further notice due to the heat and that it would be easy to extend this to any contractors that are listed in Energov. Libbie Hough, Communications Manager, suggested connecting with the group who developed the Heat Action Plan, as one of their goals is to work with employers to ensure heat safety for all employees. Ms. Hough added that the countywide Beat the Heat Campaign is featured on the Health Department homepage. Commissioner Fowler shared that she recently heard the Beat the Heat Campaign referenced on NPR, so that information is being disseminated widely. She also agreed that it was important to ensure that outdoor workers are protected during extreme temperature events. In response to Mr. Whitaker's question, Dr. Royce expressed that while she is happy that there are programs working to address the issue, she would like more data about the scope and impact of heat on the population. Ms. Hough said that UNC Chapel Hill is doing some research on heat impact and heat-related illness, while Ms. Hudson shared that she receives a weekly Heat Related Illnesses Report from the Public Health Preparedness Staff at the Department of Health and Human Services (DHHS), which she offered to share with Dr. Royce. Mr. Whitaker suggested keeping a running analysis of the county heat data based on this resource and considering a resolution in the future. Dr. Jonnal arrived during this conversation. S:\Managers Working Files\BOH\Agendas &Abstracts\2025 Agenda and Abstracts/ June Page 3 MINUTES ORANGE COUNTY BOARD OF HEALTH June 25, 2025 Ad Hoc Committee on Well Rules Committee activities are on hiatus until after the ongoing litigation case is resolved. V. Approval of the June 25, 2025, Agenda Motion to approve the agenda of the June 25, 2025, BOH meeting was made by Commissioner Amy Fowler, seconded by Dr. Lee Pickett, and carried without dissent. VI. Approval of May 28, 2025 Meeting Minutes Motion to approve the minutes of the May 28, 2025 meeting was made by Commissioner Amy Fowler, seconded by Dr. Rachel Royce, and carried without dissent. VII. Educational Sessions A. 2024 State of the County's Health (SOTCH) Report McKayla Creed, Healthy Carolinians Coordinator, presented the 2024 State of the County's Health (SOTCH) Report. Some highlights of her presentation are below: • The State of the County's Health Report, or SOTCH, is an annual report prepared each year between Community Health Assessments (CHAs). One will be created for 2024, 2025, and 2026. Ms. Creed shared that the state requirements for the SOTCH have changed since 2022, and is now done primarily through a virtual scorecard, of which the Board members received a PDF. It also includes updates to the CHA. • The 2023 CHA identified three priority areas for the county: Access to Care, Behavioral Health, and Connections to Community Support, all which the Healthy Carolinians of Orange County Committee is working to address. The committee has identified indicators and strategies to track and improve health for each of these priority areas, which are captured in the Community Health Improvement Plans (CHIPs), approved by the Board last September. • There was an MPH Practicum student working on data for Orange County Community Health Advocacy Mobilization Partners (OC CHAMPs) over the summer of 2024, and more information about this program should be included in the 2025 SOTCH. • Ms. Creed spoke briefly about 211, a hotline that connects people to existing resources. Most people who call in are seeking resources for housing, food, or childcare. In response to Mr. Whitaker's question, Ms. Creed confirmed that all counties in North Carolina have a 211 line, as it is a service offered by United Way. She shared that she is connected with the individual who manages the 211 line for the Orange County region and added that the information needs to be updated regularly and by each individual organization, as United Way only keeps the records that they are given. Commissioner Fowler asked whether United Way offers its own services, to which Ms. Creed clarified that United Way does not provide its own services for Orange County, but keeps people informed of existing resources — however, she said that for some less well-resourced counties, United Way does offer its own services. In response to Dr. Nickelson's question, Ms. Creed said that there are generic promotional materials available for 211 such as magnets and flyers, and that people can also order customized materials, for example ones that say "Orange County" on them. Ms. Stewart added that it seems like S:\Managers Working Files\BOH\Agendas &Abstracts\2025 Agenda and Abstracts/ June Page 4 MINUTES ORANGE COUNTY BOARD OF HEALTH June 25, 2025 every department in the county has their own individual comprehensive list of resources in the county, and that there are ongoing efforts to streamline these. She said that it seems like community members prefer to use OC Connect over 211 and added that these tools are only as good as the data being updated. She noted that county leadership is considering whether they may need to hire a navigator to help keep the resource lists up-to-date and shared that there is a new IT project that has been approved to develop an Al bot to help pull information from the Orange County Website which may be available as a resource in the future. • Ms. Creed reviewed the morbidity and mortality data over the past year and shared that there were no substantial changes since the 2023 CHA. In response to Dr. Pickett's question, Ms. Creed clarified that the data covers people of all ages in the county, though infant mortality is also broken out separately. • New initiatives put forth in 2024 to address the health priorities include the hiring of an Opioid Response and Harm Reduction Coordinator, Tonya Stancil, at the Health Department, implementation of a pilot Post-Overdose Response Team (PORT) within Orange County Emergency Medical Services (EMS), a pilot program offering vaping prevention and cessation services at Orange County High School, an amendment to the Orange County Unified Development Ordinance (UDO) to restrict opening of new tobacco and vape shops near youth spaces, a bloodborne pathogen program to educate tattoo and body modification artists about health and safety, and the Bar Education Legislation (BELs) program to provide food safety education to bars that serve food. • Some current challenges highlighted by Ms. Creed include concerns about immigration, potential funding cuts to Medicaid and 988 phone lines, and the increasing cost of living. • Ms. Creed shared that Healthy Carolinians recently sponsored a Little Free Library in the Hillsborough community garden off the Riverwalk. This is the first of several planned Little Free Libraries designed to share books and resources in multiple languages, for all ages, and covering a variety of topics. She added that the board was invited to tour the garden, which donates food to PORCH Hillsborough. In response to the comment of Ms. Stewart, Ms. Creed shared that she had painted the Little Free Library. • Ms. Creed gave a shout-out to Commissioner Fowler for attending so many Healthy Carolinians meetings and for contributing to the development of the County Health Improvement Plans (CHIPs). • Mr. Whitaker asked about the size of the housing gap, as he has seen multiple conflicting figures for this estimate. Ms. Creed explained that the figure of 13,689 came from the Chamber of Commerce. She added that the number of units feels daunting. In response to Dr. Royce's question, Ms. Creed said that Orange County has a larger housing gap than its peer counties from the 2023 CHA, but she was not sure by how much and said she could find out. • Mr. Bagby applauded Ms. Creed, her presentation, and her growth as an employee. Vill. Reports and Discussion with Possible Action A. Media Items Libbie Hough, Communications Manager, presented the media packet to the board. Topics included: updates and improvements to the Orange County Health Department website; measles vaccination efforts amid outbreaks; the recent Measles Symposium hosted by the Orange County Health Department; news about the positive impact of warning labels on e- cigarette products; Heat Awareness Week; local dairy farmers advocating for the sale of raw S:\Managers Working Files\BOH\Agendas &Abstracts\2025 Agenda and Abstracts/ June Page 5 MINUTES ORANGE COUNTY BOARD OF HEALTH June 25, 2025 (unpasteurized) milk; a series of Mental Health Mondays being hosted in Hillsborough; and North Carolina Department of Environmental Quality efforts to remove hydrilla, an invasive aquatic plant, from the Eno River. Mr. Whitaker asked if the website updates are being made for both mobile and desktop formats, to which Ms. Hough clarified that the Orange County Government website is currently only available in desktop format, as converting it into a second format would be expensive and would need to be applied to the full county website, not just the Health Department. Ms. Hough added that in addition to improving navigation, one of the major priorities is to ensure that all PDFs and images have alt text and can be read by screen readers for individuals with low or no vision. Dr. Royce commented that the website improvements are noticeable, and Ms. Hough encouraged board members to share any further suggestions or feedback with her. Dr. Jonnal commented that measles outbreaks will be coming soon and that she feels concerned and a bit embarrassed, as her kids go to a private, screen-free school that also has a low vaccination rate and is likely to be an epicenter in an outbreak. She added that she is trying to link the school administrators to medical experts such as Medical Director Dr. Erica Pettigrew to help promote measles education. She said that she hopes that there is still time to avert this. Dr. Royce noted that vaccine hesitancy seems to be a very psychological or"groupthink" phenomenon, which worries her. Dr. Jonnal said that Mike DeFranco, Public Health Nurse for the Communicable Disease Team, worked a miracle during the COVID-19 pandemic and got parents at local schools with high vaccine hesitancy to consider vaccination against COVID and to take it seriously. Dr. Pickett wondered about the legal obligation for private schools to promote vaccine education to their students or the potential liability that they could face if many children get sick, to which Commissioner Fowler explained that they are not legally required to mandate vaccines and that while public schools will stop students who are not in vaccine compliance from attending, private schools will not. Dr. Royce added that people can also seek a vaccine exemption. In response to Dr. Royce's question, Ms. Stewart clarified that the recent pertussis outbreak has been concentrated in public schools, not private schools. Commissioner Fowler commented that awareness and testing are also relevant, as pertussis is frequently in circulation, but people are not often tested for it, leading to an undercount of cases. Dr. Royce suggested that the Board of Health write a letter promoting vaccines for children in all schools; Mr. Whitaker agreed and said that this would likely be an easy lift. In response to Dr. Jonnal's question, Dr. Pettigrew said that there are many preexisting resources about measles and measles vaccines available and that the board could share some alongside their letter. Dr. Royce offered to work on a draft, and the group agreed that they could work on something over email during the summer break, as time is of the essence and they did not want to wait until August to act on this. Media items were in the packet, which focused on Orange County's events, our involvement in various efforts, and various public health topics. B. Health Directors Report Ms. Stewart presented her report to the Board. Below are brief highlights of her report. • It has been an intense period for the Communicable Diseases team; as mentioned several times throughout the meeting, North Carolina has its first confirmed measles S:\Managers Working Files\BOH\Agendas &Abstracts\2025 Agenda and Abstracts/ June Page 6 MINUTES ORANGE COUNTY BOARD OF HEALTH June 25, 2025 case, as well as a pertussis outbreak and there is a case of an unhoused patient with tuberculosis (TB). Ms. Stewart shared that the measles case was in a child who was visiting North Carolina from overseas and unfortunately, they visited many public places while symptomatic before seeking medical care. However, there is good contact tracing in effect, and the emergency medical care dispatch in Forsyth County had been well trained on measles, were able to recognize the symptoms, and all staff used appropriate personal protective equipment (PPE), thus limiting further exposure after the case was identified on Sunday. Ms. Stewart shared that some challenges include language barriers and finding appropriate housing/shelter when a patient with a contagious illness does not have permanent housing. Dr. Pickett wondered if the Health Department could install a tiny house behind the Whitted Building to host individuals who need temporary shelter while isolating due to a contagious illness, to which Ms. Stewart explained that contagious patients who are unhoused in Orange County are typically put in a motel or other housing with an outside door that allows direct access to a private room. • In response to measles arriving in North Carolina, the Orange County Health Department and other local health departments have been holding multiple huddles and meetings to prepare. Orange County Health Department is planning to continue promoting MMR vaccines and to post signage about recognizing measles symptoms. Ms. Stewart added that the Health Department will share information with healthcare providers, pharmacies, and individuals. • Dr. Royce asked for details about the TB case and Dr. Pettigrew explained that it was a very complicated case and that they are unsure about how long the patient has had TB. Dr. Pettigrew explained that there is an ongoing series of contact investigations, but fortunately TB has a large window (approximately eight cumulative hours) during which people can be in contact before it is considered an exposure. She added that she likes the idea of installing a tiny home for medical isolation at the Health Department. • Ms. Stewart shared that the pertussis outbreak is on the downswing as schools are now out for the summer, but around 60-70 total cases were identified. Dr. Pettigrew reiterated Commissioner Fowler's point that the high number of identified cases could have easily been caused by the awareness campaign leading to an increase in testing, as pertussis is frequently in circulation without being tested for— higher testing rates means there will be a higher number of identified cases but does not actually affect the prevalence. • The Advisory Committee on Immunization Practices (ACIP) will be convening to evaluate childhood vaccine requirements; there is a lot of concern that the current panel of required vaccines will be changed, and that any vaccines dubbed voluntary may no longer be covered by insurance. Dr. Pickett noted that her tenure on the Animal Services Board had taught her that individual counties are allowed to have more stringent requirements than the state and wondered if Orange County could maintain the current slate of childhood vaccine requirements, but Dr. Royce pointed out that they would not be covered by insurance, creating a potential equity issue. Commissioner Fowler commented that the state-funded vaccine supply exists to help cover those without insurance, but that there is no guarantee that the state supply will continue to be funded. Dr. Pettigrew noted that interpretation around vaccine requirements also presents a problem, saying that some colleges have elected to interpret the state commission- recommended vaccine requirements for school admissions as a ceiling rather than the intended floor, thus requiring fewer vaccines for enrollment than truly recommended. Ms. Stewart said that this is being watched closely, as it will have implications for all Health Department operations. • Ms. Stewart referenced some wastewater data around monitoring respiratory viruses, noting that there is currently a decrease, and shared that as of July 1 st, Orange Water and Sewage Authority (OWASA)wastewater data will also be used to track measles S:\Managers Working Files\BOH\Agendas &Abstracts\2025 Agenda and Abstracts/ June Page 7 MINUTES ORANGE COUNTY BOARD OF HEALTH June 25, 2025 cases. In response to Dr. Royce's question, Ms. Stewart explained that the Town of Hillsborough does not have the infrastructure to add this water monitoring at this time. Ms. Hudson shared that about 60% of the county population is on public water systems. • The 2025-2026 County Budget has been approved, and Ms. Stewart thanked Travis Myren, County Manager, and the Board of County Commissioners (BOCC) for prioritizing employee benefits in a tight budget year. She noted that state and federal funding forecasts for public health and social service programs are bleak, and that there is a possibility that programs from other county departments, such as Department of Social Services (DSS), may lose their state funding and require county funding to stay afloat. One such program, the Supplemental Nutrition Assistance Program (SNAP), may lose state funding, causing harm to local businesses and the local economy as well as SNAP beneficiaries. Ms. Stewart said that if this should happen, the county manager may have to make some very difficult decisions. She added that she recently learned that the federal government reserves a tool called 'recission,' which allows them to cancel funding that has already been allocated, and any funds already spent may have to be paid back, making the current budget situation incredibly tenuous. • The Campus Community Coalition (CCC) was recently at risk of losing funding from one of their core funders, as the Town of Chapel Hill was considering reallocating their portion, but after some pushback ultimately decided not to. Ms. Stewart thanked the Board of Health for their consistent support of CCC and shared that the coalition is considering extending their focus more to polysubstance use. • Ms. Stewart shared mockups of name badges for the Board of Health members to wear at future community events and invited feedback from the Board. • In July, the Whitted Medical Clinic will be closed for renovations, and patients will be seen exclusively at Southern Human Services Center (SHSC) in Chapel Hill, while in August and September the SHSC clinic will be closed for renovations and patients will be seen exclusively at Whitted. Ms. Stewart shared that, due to staffing shortages, the clinic may have to scale back on patient care. In response to Dr. Royce's question, Ms. Stewart clarified that the hiring freeze is ongoing, but that it is possible to request an exception, with the process of doing so typically involving several rounds of appeals and justifications. She added that there is no priority given for revenue generating positions. • Carrboro has been designated as a Breastfeeding Family Friendly Community, and Orange County is aiming to also obtain this designation soon. IX. Adjournment A motion was made by Commissioner Amy Fowler to adjourn the meeting at 8:42 p.m., was seconded by Dr. Rachel Royce, and carried without dissent. The next Board of Health Meeting will be held August 27, 2025, at the Drakeford Library Complex, 203 South Greensboro Street, Carrboro, NC at 7:00 p.m. Respectfully submitted, Quintana Stewart, MPA Orange County Health Director Secretary to the Board S:\Managers Working Files\BOH\Agendas &Abstracts\2025 Agenda and Abstracts/ June Page 8