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10/04/2006 i i • New Hanover County Health Department Revenue and Expenditure Summaries for August 2006 Cumulative: 16.67% Month 2 of 12 Revenues Current Year Prior Year Type of Budgeted Revenue Balance % Budgeted Revenue Balance % Revenue Amount Earned Remaining Amount Earned Remaining Federal& State $ 1,832,127 $ 430,909 $ 1,401,218 23.52% $ 1,816,791 $ 583,393 $ 1,233,398 32.11% AC Fees $ 611,161 $ 100,104 $ 511,057 16.38% $ 659,496 $ 120,436 $ 539,060 18.26% Medicaid $ 1,839,994 $ - $ 1,839,994 0.00% $ 1,484,368 $ 153,837 $ 1,330,531 10.36% Medicaid Max $ 17,000 $ - $ 17,000 0.00% $ - $ - $ - EH Fees $ 310,000 $ 40,050 $ 269,950 12.92% $ 300,212 $ 41,477 $ 258,735 13.82% Health Fees $ 234,200 $ 38,183 $ 196,017 16.30% $ 128,000 $ 34,578. $ 93,422 27.01% Other is 2,763,985 $ 53,751 $ 2,710,234 1.94% $ 3,072,186 $ 227,697 $ 2,844,489 7.41% Totals $ 7,608,467 $ 662,998 $ 6,945,469 8.71% $ 7,461,053 $ 1,161,419 $ 6,299,634 15.57% I Expenditures Current Year Prior Year Type of Budgeted Expended Balance % Budgeted LE;pended Balance % • Expenditure Amount Amount Remaining Amount Remaining Salary & Fringe $ 12,089,429 $ 1,213,125 $ 10,876,304 10.03% $ 11,315,151 $ 9,927,947 12.26% Operating $ 2,154,269 $ 326,313 $ 1,827,957 15.15% $ 1,852,498 $ 1,636,050 11.68% Capital Outlay $ 88,585 $ 30,940 $ 57,645 34.93% $ 679,225 $ 669,410 1.45% Totals $ 14,332,283 $ 1,570,378 $ 12,761,906 10.96% $ 13,846,874 $ 1,613,467 $ 12,233,407 11.65% Summary Budgeted Actual % FY 06-07 FY 06-07 Expenditures: Salaries & Fringe $ 12,089,429 $ 1,213,125 Operating $ 2,154,269 $ 326,313 Capital Outlay $ 88,585 $ 30,940 Total Expenditures $ 14,332,283 $ 1,570,378 10.96% Revenue: $ 7,608,467 $ 662,998 8.71% Net County $ 6,723,816 $ 907,380 13.50% • Revenue and'Expenditure Summary For the Month of August 2006 13 NHCHD BOARD OF HEALTH APPROVED GRANT APPLICATION STATUS FY 05-06 Date BOH) Grant Req uested Pending - Received Denied 81212006 No Activi for Au ust 2006 • 7/5/2006 I ervice oor Ina ion Family Counseling Program (Cape Fear Memorial Foundation) - Funding for Licensed Clinical Social Worker for 3 ears $260,000 $260,000 Eat Smart Move ore - Community rant (NC Dept of Public Health Physical Activity and Nutrition Branch $16,495 $12,416 $4,079 - 617/2006 Living Well (Cape FearMemorial Foundation) Ratify grant received to produce Living Well publication $0 $12,000 5/3/2006 Diabetic Supplies (Cape Fear Memorial i *0 Foundation $21,000 $21,000 a~ NHCDHHS - Division of Medical Assistance - Health Check Coordination Funding $33,873 $33,873 4/5/2006 NC Pandemic Influenza Planning Funds - Pandemic Influenza planning. Ratification of grant application submitted for 3/2/06 deadline Note: Full funding expected per State notification; currently partial funding confirmed with additional award to follow. $49,030 $49,030 31112006 No Activity for March 2006 Child Care Nursing (Smart Start) Continuation funding for existing grant • 2/1/2006 program $186,600 $160,000 $26,600 Health Check Coord. (Smart Start) Continuation funding for existing grant pro ram $45,800 $12,000 amily ssessment oor mart Start) Continuation funding for FAC portion of Navigator program 'NOTE: May receive $44,000 in 2nd phase If funds avail. $113,000 $44,000 $69,000 NC Institute for Public Health - Accreditation - assistance with improvement in areas (policies/procedures & continuing ed training log). $17,034 $4,150 $12,884 Tabled by BOH Pediatric Primary Care (United not approved Way/NHRMC) Start-up funds to support new for submission primary care program for pediatric patients $30,000 $0 Cape Fear Memorial Foundation- Obesity 1/4/2006 Grant 3 year period $300,000 $225,000 $75,000 Cape Fear United Way- Panorex Grant $38,000 $38,000 NC Office of Minority Health & Health Disparities- Interpreter Grant $20,000 $20,000 NACCHO Grant-Addressing Disability in Local Public Health. Collaboration with 1217/2005 UNCW. $25,000 $25,000 • Office of Research, Demonstrations and 11/2/2005 Rural Health- Pediatric Prima Care Grant $50,000 $50,000 Health Carolinians- Contract Coordinator $5,000 $5,000 10/12/2005 No activity for October 2005. 9/7/2005 No activity for September 2005. As of 9112/2006 14 NOTE: Notification received sire last report. Program did not apply for grant. NHCHD BOARD OF HEALTH APPROVED GRANT APPLICATION STATUS FY 05.06 Date(BOH) Grant - - Requested Pending Received Denied Wolfe-NC Public Health Association Prenatal Grant for FY 05-06 and FY 06-07 - • 813/2005 assistance for diabetic prenatal patients. $5,000 $5,000 allocating North Carolina Alliance(NCAH) for $5,000 from Secondhand Smoke- Local Control existing PA Initiative-if approved and awarded PA funds ' allocating budget- ' Grant was $5,000 from approved by not approved to be used for educational purposes and existing PA NHC-CC by RWJ media campaigns only. budget 9119105 Foundation 716/2005"'"---_-- No activity forJuly2005.-'-___... NC Dept of Insurance- Office of State Fire 6/1/2005 Marshall- Risk Watch Continuation Grant $ 25,000 $ 25,000 HUD (partnership with City of Wilmington) Lead Outreach and Education Program (3 year funding) $ 275,000 $275,000 Ministering Circle- Good Shepherd Ministries Clinic supply & Equipment $ 15,000 $ 15,000 $ - No activity for May 2005. Cape Fear Memorial Foundation- Living 4/6/2005 Well Program $ 20,000 $ 20,000 $ - National Safe Kids Coalition-Mobile Van for 3/212005 Car Seat Checks $ 49,500 $ 49,500 $ - Smart Start- Child Care Nursing Program $ 239,000 $ 170,000 $ 69,000 Smart Start- Health Check Coordination Program $ 43,800 $ 43,800 Smart Start- Navigator Program $ 155,000 $ 44,000 $111,000 2/2/2005 No activity for February 2005. Champion McDowell Davis Charitable 1/5/2005 Foundation - Good Shepherd Clinic $ 56,400 $ 56,400 • 12/1/2004 No activity for December 2004. March of Dimes-Maternity Care Coordination Program educational supplies and incentives 11/7/2004 for pregnant women. $ 3,000 $ 3,000 $ - 10/6/2004 No activity to report for October 2004. 91112004 No activity to report for September 2004. Office of the State Fire Marshal- NC Department of Insurance- Risk Watch 814/2004 continuation funding (3 years) $ 25,000 $ 25,000 NC Physical Activity and Nutrition Branch Eat Smart Move More North Carolina $ 20,000 $ 20,000 NC March of Dimes Community Grant _ 717/2004 Program- Smoking Cessation- $ 50,000 $ - $ - $ Wolfe-NCPHA Prenatal Grant- Diabetic Supplies for Prenatal Patients $ 5,000 $ 5,000 Totals $2,197,532 $281,000 $1,067,169 $747,563 12.79% 48.56% 34.02% Pending Grants 2 7% Funded Total Request 14 47% Partial) Funded 8 27% Denied Total Request 6 20% Numbers of Grants A lied For 30 100% As of 9/12/2006 15 NOTE: Notification received since last report. Program did not apply for grant. • NEW HANOVER COUNTY BOARD OF COMMISSIONERS Request for Board Action Agenda: Consent Meeting Date: 10/16/06 Agenda: ® BOH Mt g. 10/4/06 Department: Health Presenter: Janet McCumbee, Personal Health Services Manager Contact: Janet McCumbee 798-6559 Subject: Grant Application - March of Dimes (MOD) - Maternity Care Coordination - Personal Health Services - $3000 Brief Summary: Maternal Health staff would like to apply for March of Dimes funds to help with expenses for their incentive program offered to participants in the Baby Love Maternity Care Coordination (MCC) program. The participants in the Baby Love program are encouraged to keep prenatal appointments, follow care plans related to their pregnancy, and keep in contact with their Maternity Care Coordinator. The Baby Love Maternity Care Coordination program currently serves at least 300 pregnant women per month. To enroll, pregnant women must meet guidelines through the Medicaid program and complete a risk assessment questionnaire that identifies risk factors with their current pregnancy. The incentive program, called the Baby Boutique and Learning Center, allows participants to earn points which can be redeemed at the Boutique throughout their • pregnancy after completing educational activities. The Learning Center offers perspective mothers educational topics encouraging healthy pregnancy outcomes. We are requesting the maximum MOD Community Award amount of $3,000. This grant money will be used to help restock the materials in the Boutique with baby items. We will also provide refreshments at each event which averages 25 to 35 people. This is not a budgeted -program, but has been supported b donations and ants. Recommended Motion and Requested Actions: To accept and approve the submission of the March of Dimes - Maternal Health - Grant for Baby Boutique and Learning Center expenses and to approve any resulting budget amendment upon receipt of the grant and to submit to the New Hanover Count Commissioners for their consideration. Funding Source: March of Dimes - no Count matching funds are re wired. Will above action result in: ?New Position (1) Number of Position(s) ?Position(s) Modification or change ®No Change in Position(s) Explanation: Funds to be used for supplies for monthly Baby Boutique and Learning Center for Maternal Health patients. • Attachments: ant 16 t NEW HANOVER COUNTY HEALTH DEPARTMENT 2029 SOUTH 17THSTREET 91114 WILMINGTON, NC 284014946 "`"00 TELEPHONE (910) 798-6500 FAX (910) 341-4146 TO: March of Dimes FROM: Sylvia Brown, SW Baby Boutique & Learning Center Coordinator DATE: August 14, 2006 RE: Community Award Grant Foundation. The New Hanover County Health Department Maternal Health Program is requesting your continue support of funding through the Community Award Grant Foundation. This is a request to help fund an incentive program offered to participants in the Baby Love • Maternity Care Coordination (MCC) program. The participants in the Baby Love program are encouraged to keep prenatal appointments, follow care plans related to their pregnancy, and keep in contact with their Maternity Care Coordinator. The Baby Love Maternity Care Coordination program currently serves at least 300 pregnant women per month with a waiting list of approximately 75. To enroll, pregnant women must meet guidelines through the Medicaid program and complete a risk assessment questionnaire that identifies risks factors with their current pregnancy. These risks factors include but not limited to issues such as housing, lack of food, substance abuse, depression, transportation, safety, domestic violence, smoking, previous health issues, health insurance, and etc. Maternity Care Coordination services include monthly contacts at prenatal appointments or home visits to address risk factors associated with pregnancy. Topics reviewed included, but not limited to, are nutrition, breastfeeding, birth control, parenting issues, safety, and self esteem building. Educational topics and materials are distributed and reviewed with the patients to develop alternatives to their situation. Referrals are made to community agencies to help with the obtainment of supplies. The Maternal Health Team consists of 5 full time RNs, 3 full time Social Workers, and 2 full time Maternal Outreach Workers. The Maternity Care Coordinators are out posted at Coastal OB at New Hanover Regional Hospital, Cape Fear OB/ GYN, and Coastal Family Medicine clinics. The Maternal Outreach workers, referred by the MCC or CSC, work on a continuum • care plan with the patient to address factors, such as homeliness, employment, transportation, housing, parenting, budgeting, and obtainment of baby supplies. "Healthy People, Healthy Environment, Healthy Community" 17 r I will address the March of Dimes priorities to support the Baby Boutique and Learning Center • objectives. The focus will be on Increasing Access to and Quality of Health Care for Women and Infants. The Maternal Health Coordination Program will use the March of Dimes Community Awards to help fund an incentive program called the Baby Boutique and Learning Center. This is an incentive program for pregnant women who have identified ri sks, a history of risk behaviors and/or exposed to others in their family with certain risks factors. Participants earn points which can be redeemed at the Boutique through out their pregnancy after completing educational activities. The Learning Center offers perspective mothers educational topics encouraging healthy pregnancy outcomes. Topics include smoking cessation, breastfeeding, dental care, diet and exercising, nutrition for adults and children, car seat safety, relationships, myths of pregnancy, and other health related issues. a) Enhancing education and support services for high risk pregnant women: The MCC program utilizes the Baby Boutique and Learning Center incentive program to encourage compliance with program objectives outlined with their Maternity Care Coordinator and/ or the Maternal Outreach Worker. These objectives include but are not limited to following care plans, completing worksheets related to pregnancy and human anatomy, attending post partum appointments, well child appointments, and getting the child immunized. b) Increasing participation in state or local maternal child health programs: • The MCC program assists clients with Medicaid applications by referring to a Department of Social Services representative. The Maternal Outreach Workers attend community activities and provide knowledge and educational materials about MCC and MOW programs. Media interviews are conducted through radio, television, and newspapers to communicate about the MCC and Baby Boutique Learning Center program. The MCC program refers regularly to the Women Infant and Children (WIC) and Child Services Coordination (CSC) programs to provide services to the baby and mother after delivery and other community agencies as appropriate. c) Enhancing preconception/interception education and support services for women at high risk due to poor outcomes, chronic conditions or other risk factors. The Maternal Health Team continues to develop educational packages to address issues of preconception, family planning, SIDS, and other health related issue. Lunch and learn educational session has been developed to address these issues though utilizing Doctors and other health care professionals as guest speakers. The Baby Boutique and Learning Center has been established since November 2004 to pregnant women in the Baby Love MCC program. This monthly enrichment and educational group is • geared towards positive feelings about self and family, and to teach basic skills to promote healthy pregnancy outcome. 18 "Healthy People, Healthy Environment, Healthy Community" 1 ' • The "Baby Boutique and Learning Center" was funded initially by donations made by the Health Department staff, community groups, and various fundraisers. Due to the Health Department status of the Environment Health Dept. inspects food supplier, we are unable to solicit funds from anyone who serves food. We at the Health Dept. are very supportive of the MOD projects and priorities throughout the years. We ask for your continue support to offer pregnant women this incentive program called the "Baby Boutique and Learning Center." We are requesting the maximum Community Award amount of $3,000. This grant money will be used to help restock the materials in the Boutique with baby items. We will also need to use approximately $35 per month for refreshments served at each event which averages 25 to 35 people which includes significant other, children, friends, family and volunteers. Enclosed you will find the prepared materials used to orient clients to this incentive program. The increased awareness within the community of this wonderful program and active participation continues to grow. The participants and guest evaluates each session (evaluation form enclosed) and the reviews have been very positive. Clients are expected to keep track of their folders each month in order to receive credit for their participation. Their children are provided with stimulating educational activities at each session in order to allow them to have an enjoyable afternoon. Some of the items purchased for the Baby Boutique and Learning Center include but not limited to be: • Baby wipes, books, clothing, blankets, bottles, diapers, toys, pacifiers, teething rings, wash cloths, lotions, car seats, powder, tubs, brushes, bags, carriers, shampoo, frames, plug covers, booties, warmers, headrests, genies, monitors, etc. With the continue growth of this program, the utilization of these funds will be exhausted within a year. We greatly appreciate the March of Dimes consideration to help fund this incentive program. Please be advised that Rebecca Balthazar, RN an employee with the New Hanover County Maternal Health Program serves on the March of Dimes Grant Review Committee. Thank you again on behalf of the Maternal Health Team. • 19 "Healthy People, Healthy Environment, Healthy Community" NEW HANOVER COUNTY 3 ; HEALTH DEPARTMENT • 2029 SOUTH 17THSTREET WILMINGTON, NC 28401-4946 , 0o" TELEPHONE (910) 798-6500 FAX (910) 798-4146 Proposed Expenditures for Baby Boutique and Learning Center Items for Baby Boutique: $180 x 12 months = $2160 year Baby Blankets, wash clothes, booties, bibs, bottles, bouncers, baby wipes, books, clothing, diapers, toys, pacifiers, teething rings, shampoo, picture frames, head rests, monitors, bottle warmer, lotions, powder, tubs, combs and brushes, carriers, etc. Refreshments/Food $35 x 12 months = $385 year • Supplies and Door Prizes $25 x 12 months = $300 year End of Year Celebration $155 x 1 month = $155 year Total Proposed Expenditures: $3,000.00 • 20 "Healthy People, Healthy Environment, Healthy Community" • NEW HANOVER COUNTY BOARD OF COMMISSIONERS . Request for Board Action Agenda: Consent Meeting Date: Board of Agenda: ? Health Meeting 10/04/06 Department: Health; Health Programs Presenter: Scott Harrelson, Deputy Health Administration; Health Planner Director Contact: Scott Harrelson 798-6592 Subject: Budget Amendment - Phase II Pandemic Influenza Funds - $20,000 Brief Summary: The NC Division of Public Health (NCDPH) has announced plans to provide all of NC's 85 health departments with Pan Flu Phase II funding. This funding is meant to further the Phase I efforts which included a self assessment and a prior spending plan. The priority areas for Phase II funding include: 1) Pandemic preparedness planning, 2) Medical surge capacity development, 3) Mass prophylaxis, 4) Isolation and Quarantine, and 5) Communication. CDC's critical tasks related to these priorities include 1) Prevention, 2) Detection and Reporting, 3) Investigation and 4) Control at local levels. Recommended Motion and Requested Actions: BOH approval to accept the second • round of Pandemic Influenza Phase II funding in the amount of $20,000 to support local preparedness efforts in regard to a pandemic flu event and any associated budget amendment upon receipt. This is not an agenda item for the County Commissioner's -Meeting. Funding Source: North Carolina Division of Public Health, Epidemiology Section. No Count matching funds are re wired. Will above action result in: ?New Position Number of Position(s) ?Position(s) Modification or change ®No Change in Position(s) Explanation: A spending plan will be developed and submitted to NCDPH for approval for existing staff to utilize these funds to address the priority areas for pandemic flu preparedness for New Hanover County. Attachments: eement Addendum; Budget Amendment • 21 DIVISION OF PUBLIC HEALTH OFFICE OF PUBLIC HEALTH PREPAREDNESS AND RESPONSE • AGREEMENT ADDENDUM This Agreement Addendum replaces any and all previous Agreement Addenda issued or distributed to Local Health Departments/Counties for SFY 06-07. County Health Department Epidemiology Contractor Name Section PHP&R/GCDC Branch Activity # 814 PH Emer. Prep. Supplemental Kate Abell 919-715-1389 and Brant Goode 919-715-6738 Activity Number and Title Program Contact Name and Telephone Number June 1, 2006 - May 31, 2007 Original June 1 2006-May 31, 2007 Effective Period (Beginning and Ending Date) Date Scone of Work: The North Carolina Division of Public Health (NCDPH) announced plans to provide North Carolina's 85 local health departments (LHDs) Pandemic Influenza Phase II funding. During the Phase I application process, LHDs completed a local pandemic influenza self assessment (as provided by the Centers for Disease Control), performed gap analyses based on these self-assessments and submitted requests for • funding based on gap analyses. North Carolina's Phase II Pandemic Influenza Supplemental application for funds with the CDC includes funding for NC LHDs to further accomplish and extend their Phase I efforts and focus on Priorities and Critical Tasks identified by CDC for Phase H. CDC and North Carolina priorities for Phase II include: 1) Pandemic preparedness planning, 2) Medical surge capacity development, 3) Mass prophylaxis, 4) Isolation and Quarantine, and 5) Communication. CDC's Critical Tasks related to these priorities include 1) Prevention, 2) Detection and Reporting, 3) Investigation and 4) Control at local levels. Activities supported by this funding are to continue to accomplish planning, exercising of control and response measures, communications and recovery capacities for pandemic influenza response on a local, regional and statewide level The purpose of this Agreement Addendum is to document deliverables required for receipt of funding in SFY 06-07, and for continuation of unexpended funding during SFY 05-06. The following requirements govern the eMwnditure of these funds: 1. Pandemic Influenza funds may not be used to purchase antiviral drugs, seasonal influenza or pneumococcal vaccine, vehicles of any description or incentive items. 2. Local health departments who receive pandemic preparedness funding are permitted to hive temporary staff in order to allow planning activities to proceed without interrupting normal health department business. 3. Public information projects must utilize approved pandemic influenza messages from NCDPH or CDC. Projects which deviate from existing NCDPH or CDC messages must receive prior approval from the General Communicable Disease and Control Branch (GCDC). Requests for approval should be submitted to pandemicflu.plan@ncmail.net. Addition of county-specific information to public information messages (such as location of mass dispensing clinics, hours of operation, etc.) is acceptable without prior approval. • Page 1 of 2 Local Health Director Signature and Date 22 DIVISION OF PUBLIC HEALTH OFFICE OF PUBLIC HEALTH PREPAREDNESS AND RESPONSE AGREEMENT ADDENDUM 4. Purchase of Personal Protective Equipment (PPE) in advance of mass dispensing is an approved • activity. PPE must be purchased for and distributed only to defined priority populations as a control measure during a pandemic. 5. Local Pandemic Influenza Plans shall be sent to pandemicnu.planOlnemail.netforreview and maintenance. Assistance in developing pandemic influenza response plans will be made available. Local plans will remain on file in PHP&1L 6. LHD Pandemic Influenza Planning must include joint planning with schools. 7. LHD Pandemic Influenza Planning must include draft Isolation and Quarantine orders. 8. Exercises may be conducted while plans are in development. 9. LHDs will continue to complete educational awareness activities to increase the rate of annual flu vaccination of its community health care workers. 10. LHDs will continue to train staff in preparedness activities, including Incident Command System. if. Pandemic Influenza Supplemental Funds from CDC (for both Phase I and Phase 11) are non recurring funds. Plans for use of this funding for long term staffing support are discouraged. 12. Pandemic Influenza Supplemental funds may not be used to supplant any current local or state expenditures. The Public Health Service Act, Title I, Section 319c (e) (42 USC 247d-3(e)) specifically states "SUPPLEMENT NOT SUPPLANT - funds appropriated under this section shall be used to supplement and not supplant other federal, state and local public fund's provided for activities under this section". Contract Deliverables and Method of Accountability: Accountability will be documented as evidenced by receipt of. 1. An approved Pandemic Influenza Preparedness Plan or Pandemic Influenza Preparedness Annex to an existing all-hazards plan sent to pandemicfluylanrtncmail.net no later than March 31, 2007. Plans must include documentation of items 6 and 7 above. a. Exception: A draft plan submitted for review if unable to incorporate recommended revisions into an approved plan by March 31, 2007. 2. Documentation that at least one component of the Pandemic Influenza Preparedness Plan was • exercised during the timeframe governing this addendum.. a. This exercise may be a table top, functional or frill field exercise. b. This exercise can be used to fulfill one of the two exercises required under the Aid to County Grant for Public Health Preparedness. c. After action report(s) (AAR) will be generated from efforts to exercise the Pandemic Influenza Preparedness Plan. d. AARs must be sent to pandeuricflu plana?ncmail.net within 30 days of the exercise along with a Corrective Action Plan that addresses AAR findings. 3. Documentation of the total mrmber of seasonal influenza vaccinations provided through the LHD during the 2006-2007 flu season sent to pandemicflu.plan 0inemai1. net, a. In addition data about seasonal influenza vaccinations provided in earlier year; will be submitted when available. 4. Local (County) Health Department will submit monthly Expenditure Monitoring Reports (EMRs). 5. Quarterly Narrative Reporting (web based) by project staff are to be submitted to the Office of Public Health Preparedness & Response. Pandemic Flu activities should be noted in the text boxes of the QNR for any quarter with activities. 6. Local Health Departments which received Phase I funding in SFY 05-06 are approved for use of unexpended Phase I funds (per SFY 06-07 budgetary authorization) for activities previously approved using Phase I funds. Phase I activities and expenditures should be reported as per Items #4 and #5. • Page 2 of 2 Local Health Director Signature and Date 23 d N C U N «D N d d /~l O` N 's L yd T N N C E p' C L r C y j N C C O N y r N O w 7 U- y N yy E a f, ~SLy~ ~j fj (0 « U N O X N« C. N v L N O y _ m C N . C A 4) cL U O y N O O X U 'O YO O N U co 7 a N U O d N '~p Op O w N> pLL' C J N ~'d N N y a) C ~ 0 2 V a t O r r .r N O N C 'O E c~ rn~ m E yXe'or- 0 V d N E d c O F o m o n Z E 2 E .c E E 2 ~cnN N»mD~`o GLID «co • a c 0 .2 o c y° E > E o c d c U n a `o y '20 U p N N V y m o D a (D 2- a O V U G N co n m a) p 0-0 3 (~0 N E2 d C L_ d 5 C Y a y LnY l0 O 00- -o d r~ y c E E a) 0 3 oL °'E72 0 -O a o E 2 y c ~p c c nn E 4000 H0 ~ co-9 o °O C) °o °O °O °O a °O °O 0 0 0 0 0 0 0 6 o ci c°'MM~NN O O V 00 S r r r NZ N vi O N u> 40 f9 u> ur 6% <a vs fA fA CL TO (Tp v N p p W y > o y E 'E c p awo d) (D 0 w O L d¢ W C A a m m 'a r H c_ a E Q a d c r o 'c E d U m C~a.LLLLLH H 24 • NEW HANOVER COUNTY BOARD OF COMMISSIONERS Request for Board Action Agenda-E] 1 Consent Meeting Date: 10/16/2006 A enda: ? BOH Mt g. 10/4/06 Depart nent: Health Presenter: David E. Rice, Health Director Contact: David Rice 798-6591 Subject: Resolution to Support Legislation Authorizing Counties to Set Fees for Local Environmental Health Food and Lodging Services Brief Summary: The North Carolina Association of Local Health Directors, at its meeting on September 21, 2006, requested local boards of health and county boards of commissioners to adopt a resolution to support legislation authorizing counties to set fees for local environmental health food and lodging services. North Carolina Department of Environment and Natural Resources mandates sanitation inspections and permitting of food and lodging facilities to be performed by local public health department personnel, acting as Agents of the State. The State currently charges an annual fee ($50) to all permitted food and lodging facilities and disburses a portion of the fees collected to local health departments. Current fees are not adequate to conduct the mandated services. State support for the food and lodging services in New Hanover County is less than 2.4 percent. The cost associated with the permitting and inspections is bome almost • exclusively by the county as an unfunded mandate by the State. Recommended Motion and j~ County Board of Health R(_ Fees for Local Environmer resolution to the New Han( Funding Source: Will above action result ink - New Position ?Position(s) Modi ®No Change in Pc Explanation: i Attachments: NHC Board of Health Resolution to Support Legislation Authorizing Counties to Set Fees for Local Environmental Health Food and Lodging Services. • 25 NEW HANOVER COUNTY • HEALTH DEPARTMENT 2029 SOUTH 171" STREET WILMINGTON, NC 28401-4946 NEWXgNOVEECOVNTYNEP~O TELEPHONE (910) 798-6500 FAX (910) 772-7805 NEW HANOVER COUNTY BOARD OF HEALTH RESOLUTION TO SUPPORT LEGISLATION AUTHORIZING COUNTIES TO SET FEES FOR LOCAL ENVIRONMENTAL HEALTH FOOD AND LODGING SERVICES WHEREAS, Environmental Health Specialists employed by New Hanover County Health Department serve as regulatory agents of the North Carolina Department of Environment and Natural Resources, Division of Environmental Health to assure compliance with established environmental/public health standards; and WHEREAS, Environmental Health Specialists evaluate food service and lodging facilities to identify risks in operations or practices that may jeopardize the public's health and safety; and WHEREAS, North Carolina general statutes mandate at least quarterly inspections of all restaurants and other similar types of food service establishments; and WHEREAS, New Hanover County Health Department will receive $24,000 as its State's portion during fiscal year 2006-07; and the costs for providing these services during Fiscal Year 2006-07 will be $1,012,150, with the primary source of revenue being property taxes; and WHEREAS, local health departments are allowed to charge fees to support the on-site sewage program • in their counties; and WHEREAS, the practice of local food and lodging fees is currently utilized in other states; and WHEREAS, legislative action is required to allow local health departments to charge fees for food and lodging activity. WHEREAS, local health departments fully support holding the Division of Environmental Health harmless for the funding to develop and maintain the environmental health data system; and WHEREAS, the New Hanover County Board of Health believes user fees for food and lodging facilities would be more equitable than asking county residents to bear the cost of this State mandated service through the use of local taxes; now THEREFORE, the New Hanover County Board of Health hereby requests the General Assembly to enact legislation to expand General Statutel30A-39 (g) to include food and lodging fees. Adopted the _ day of , 2006. (Seal) Donald P. Blake, Chairman New Hanover County Board of Health • Attest: David E. Rice Secretary to the Board of Health 26 "Healthy People, Healthy Environment, Healthy Community" NEW HANOVER COUNTY HEALTH DEPARTMENT 2029 SOUTH 17' STREET WILMINGTON, NC 28401-4946 TELEPHONE (910)_798-6500 FAX (910) 772-7805 Memorandum To: Members of the New Hanover County Board of Health From: Donald P. Blake, Chairman New Hanover County Board of Health Date: October 4, 2006 Re: Performance Appraisal - Health Director Enclosed is an evaluation form I am asking you to complete. After you complete this form, please return it to me in the enclosed addressed stamped envelope by October 13, 2006. • The Executive Committee will review these evaluations on October 24. Upon completion of the review, we will submit our recommendations and findings to the Board of Health on November 1. If you give a rating of anything other than "expected" on a performance factor, please give specific reasons (positive or negative) in comment area of the evaluation form. Please call me regarding your concerns. My telephone number is 784-9191. Thank you. • R W .L 'a 3 C + 0 _ C O 3 N O) o V m C O l0 V m w c0 vl O r m CT c m v, • m ^ o O v c m H m m E N o 0 CL m m^o o v, °~'m n m -DO =1 €c0m` d m o~ Ca O O00 C °o a m V d m m maoi x w o~ o o u, 't m m m . o m v c c t SadoE _ m ~E (D 0 g m 0 C m c O E C 0 CD m m C O m m L ` m c0 % w ~m m U c N _ C O E m i. O w. CNmI U mom •.y.. .0. m R m -co 2 x OL E m E ° n m v m 0 w o m o~ U) co o E Lu LL >1 .0 Q m C f0 m m O. N ca A- co .0 a 0. m^ m ; °Yp 2 3 (A o lu CLm m n= U)om a a u, n x O O w ami m v m o m O C CL0 c G ,Y 2 O m m c !On C W d E O R. . W X W Q W Z D U c9 • Q' • 0 0 0 • M C t .T C N C N 'a 7 ami 8 S c o .°t m 0 c _ - m w a o N ° >>1 m rn 12 CD a v ? a ° • m m m m l0 C C N C C >1 E 4) cm ca 'c L t a d E L fA U 'p CL U E m Qm a 0 c .G O 7 U m o m O U CL 'a E 0. 4) w E m o ° m rn c E L E - c 0 co p f0 O m y m N o w ° v a v Cl Vl - d m 7 vi N m N E Q L N C w CO c C C O 7 w U l0 m O N N E a a 3 a a c N a a w f6 c m € 9 o c (n 0) 1 a) 0) w Q) 0 4) 4) .C N E C 41 a s N N LL C u h C c U O C > ,O ,N - m cm: R ) M C N r m CO 2 C n. = m m 7 c -0 CL m C m (0 w fQ C' N U 7 m j5 > C D O w Y cn D m uww . d r vi v vi v ,,G iii 6 °o o~ o. x v x z r 0 M v R"- m W 3 V 4V m 0 U) W W p J Z W p w m p aia d o v > W w ,C X.. °W N NU A r ° E FORT 2005/ 2006 00. o~ O NEW HANOVER COUNTY HEP?~~~ @fflMft MWD MM Over 125 Years of Public Health Service 2029 South 17th Street Wilmington, NC 28401 910.798.6500 ~ ~ www.nhchd.org Director's Message Management Team • Established in 1879, the New Assistant Health Director Hanover County Health Department Scott Harrelson, MPA provides administrative, animal control, environmental health, personal health, and support Administrative Support Coordinator services for visitors and residents of Marilyn 0. Roberts r, New Hanover County. The Health Department mission statement is plain and true to public health: Animal Control Services Manager To Assure a Safe and Healthy Jean P. McNeil, DVM Community. Our motto is demonstrated through our exceptional customer service: Your Health Our Priority. Business Manager This report is the result of much thought and deliberation by the Kimberly A. Roane members of the New Hanover County Board of Health and the staff of the New Hanover County Health Department. During fiscal Dental Health Services Manager year 2005-06 the Health Department experienced many challenges David W. McDaniel, DDS and opportunities, including: • Seizure of 137 Dachsunds Environmental Health Services Manager • Regulation of public swimming pools Dianne M. Harvell, REHS • New customer service program • Implementation of the National Incident Personal Health Services Manager Management System (NIMS) Janet B. McCumbee, RN, BSN • Pandemic. Flu planning • Arrival of the Mobile Dental Unit • Laboratory Computerization Physician Epidemiologist • WIC program exceptional performance Thomas Morris, MD, MPH • Clinic additions and improvements With the support of our community, we will meet the current and future public health needs of New Hanover County as we experience the satisfaction of promoting health and preventing Our Mission and Vision disease. For a more detailed account of the Health Department, please visit our website at: http://www.nhchd.org. The mission of the New Hanover County Health Department is to assure a safe and healthy community. The vision of the New Hanover County Health / Department is: Healthy People, Healthy Environment, Healthy Community. David E. Rice, MPH, MA Motto Health Director "Your Health -Our Priority" "From the Northeast River to Federal Point, and from • the Cape Fear to the Sea-City, Suburb, Village and Farm-we are one people striving for healthful and useful living." ~nimal Control Services The year for Animal Control Services (ACS) began with a major Spring of 2006 brought changes to Section Five of the New search and seizure operation, which resulted in the impoundment Hanover County Code. Most notable was the countywide leash of 137 Dachshunds from a single residential address in the county. law. This addition to our local ordinance was a response to Resolution of the case resulted quickly, thanks to diligent work by numerous citizen complaints regarding people walking their dogs staff and the District Attorney's office. In exchange for a guilty through neighborhoods unattended. Most were surprised that such plea with specific stipulations, the defendant recovered twenty an urban community did not already have such a law to enforce. of his stock dogs. The remainder of the animals became the Other added laws included the following: specifics on kennel property of ACS, which led to a month long season of neutering size, raising the dollar amount of severe injury to $250, required and adopting. On day one, close to 200 interested parties arrived neutering of dogs that have been declared dangerous/potentially on-site for a chance dangerous and commit to take home only a violations of their handful of available restrictions, and dogs. Adoption dates provision of proof of continued over the next neutering by any group several weeks, until all that adopts animals in had been relocated to r our county. new homes. _ Regulation changes The ease of this were all targeted at exchange was enhanced more responsible by our ability to do !t pet ownership and a surgical alterations at reduction in the number our new spay/neuter of unwanted pets in our facility. Animals did area. This has long Oot need to be relocated been a goal of the ACS r transported to division, and progress another facility for the Animal Control OfficerAnthony Williams holds up one of the dachsunds is being made year-to- procedure. On-site available for adoption after a large seizure of animals. year. Every endeavor surgery proved to be Photo courtesy of Wilmington Star-News. we pursue coincides a welcome solution with our motto, "your to affording officers pet, our priority." greater time in the field and also allowing new pet owners to take their family addition home at the point of adoption. Procedures done at the shelter also give staff better leverage in collaborating with partner animal agencies and rescue groups. Computer laptops were fitted into ACS vehicles this fiscal year. Animals Adopted The software database can be accessed while officers are at the area households, so animal information is readily available. This has 1000 decreased support services and field workloads, since information 800 can be added to dispatch calls in the system versus calling via hand- 600 -*-Dogs held radios. We loob: forward to future technological advances that -4- Cats will inevitably enhance the effectiveness of customer service. 200 -e -Total Although we have seen a decrease in the number of positive rabies 0 cases, five were identified this past fiscal year. Several significant 2003/04 2004105 2005/06 attacks occurred in the community, where rabid foxes assaulted k the victims. Fortunately, the animals were secured and tested, so the individuals were certain of their need to pursue post-exposure accinations. The majority of our 87 cases (through 07/31/06) lave been raccoon, but foxes constitute the more recent positives. According to state rabies personnel, this species is more susceptible to the virus. In time it may become the primary vector in this county. environmental Health Services Swimming, one of the most popular activities in the area, is a fun, active, and healthy way to spend leisure time. Every year, thousands of people in New Hanover County visit "recreational water" sites, such as hot tubs, spas, swimming pools, water parks, creeks, rivers, estuaries or the ocean. Over the past century, the use of modern disinfection systems in pools and environmental improvements in our creeks, rivers, estuaries and the ocean has improved the quality of recreational water. Despite this effort on a national scale, the CDC advises there has been an increase over the past decade in the number of outbreaks of illness associated with swimming. Environmental Health Services plays a strong role in protecting New Hanover County's citizens, tourists and other visitors from the risk of waterborne illness through education and enforcement responsibilities. Regulation of public swimming pools, spas and hot tubs along with surveillance of municipal and other large wastewater treatment operations are the two activities comprising the pinnacle Environmental Health Specialist Christopher Murray is of this public health effort, determining if safety equipment (ring bout') is constructed to Public Swimming Pools, Spas And Hot Tubs necessary Coast Guard standards. While standards for the construction and operation of these It often comes as a surprise when records show the number of facilities are currently established by the state legislature and permitted facilities approaches 400 on an annual basis. The term Commission for Health Services, the New Hanover County Board public brings virtually all swimming pools except those in residential of Health had the vision to adopt and implement local regulations backyards into this regulatory category. Approximately 36 of these in the early 1980's. As a result, there have been few suspected operate year round, while the remaining outdoor operations see *swimming of health effects or illness associated with the use of public peak use during late spring, summer and fall. The initial visit by swimming pools, spas and hot tubs in New Hanover County during Environmental Health Services staff each year is for he purpose the past twenty five.years. Also, when the state enacted laws and of determining if the facility complies with standards including rules governing the construction and operation of these facilities any added or new requirements, and qualifies for an annual during the early 1990's, the transition from interpretation solely by operation permit. Further visits are made to observe operation and county staff to state practitioners was an almost unnoticed change maintenance during high usage periods, and when complaints are for owners/operators. filed. Testing various water quality parameters with a field test kit is only a small facet of the evaluation conducted by Environmental Health Specialists. Mechanical and safety equipment along with ~I essential signage are also closely examined. Recreational Water Quality A high volume wastewater spill by the City of Wilmington just ahead ofthe July fourth holiday weekend this past summer brought heavy scrutiny to surface water quality. Staff participated in a number of conferences with state and local officials to assure that " - every measure would be taken during and after future events to - ~ notify the public and protect the health of the community. As a safeguard, Environmental Health Services are available twenty- fours daily to take calls from county and municipal representatives as they become aware of system failure resulting in spills. A t' procedure has also been developed and affected to post eyecatching advisory signage when NCDENR staff for whatever reason are not able to post the location of heavily impacted swimming sites nvironmental Health Specialist Catherine Burdick is evaluating the due to an inadvertent discharge. Wafey vacuum release system on a public swimming pool, anew requirement for the 2006 calendar year on existing pools having a single main drain. This new component functions to prevent swimmers being sunctionecito the main drain, and drowned or injured. ®Health Programs Administration Customer Service Be the Difference! This is what we are challenging our staff to do this year. There is only a small difference between being good and being great. Often the small things make the difference. With this in mind the quality assurance team began searching for a customer service program that would be ongoing and apply to our medical and non-medical staff. We believe that we have found that program and it is also geared toward local government. Beginning in the spring of 2006, managerial staff participated in a seminar entitled "Leading Empowered Teams through Service Excellence". Eight staff members were identified to be trained as facilitators to lead customer service sessions, and will begin showing their fellow employees what we mean by "Be the difference". The word "be" is a verb meaning to show action and "difference" means to not be ordinary, thus "Be the difference!!". The intent of this program is to help our employees deliver great customer service. There is not a place of business that does not need to keep customer service in the forefront and we intend to do just that. We want to treat our external customers (the members of the community we serve daily), and our internal customers (our staff members), with the care and treatment they deserve. The National Incident Management System (NIMS) In Homeland Security Presidential Directive (HSPD)-5, Management of Domestic Incidents, the President directed the Department of Homeland Security (DHS) to develop and administer the National Incident Management System (NIMS). On March 1, 2004, the Department of Homeland Security issued the NIMS to provide a comprehensive national approach to incident management, applicable at all jurisdictional levels and across functional disciplines. The NIMS provides a consistent nationwide approach for Federal, State, territorial, tribal, and local governments to work effectively and efficiently together to prepare for, prevent, respond to, and recover from domestic incidents, regardless of cause, size, or complexity. On May 11, 2005, Governor Michael Easley signed the Proclamation for Adoption of National Incident Management System (NIMS) for North Carolina. As part of this proclamation, all counties and departments have been directed to adopt and apply the NIMS for all routine, multi-company and agency incidents. On November 21, 2005, the New Hanover County Board of Commissioners adopted the resolution approving NIMS as the standard practice for emergency response and management. Jurisdictions are required to meet the NIMS implementation requirements as a condition of receiving federal preparedness funding assistance. The NIMS is a dynamic system, and the doctrine as well as the implementation requirements will continue to evolve as our prevention, preparedness, response, and recovery capabilities improve and our homeland security landscape changes. Implementation of and compliance with the NIMS is critical to ensuring full and robust preparedness across the nation. Below please find the Progress Report for NIMS Training completed by NHCHD staff through June 30, 2006. Percent Percent Number of Program - NHCHD NIMS Training Progress Report Executmve Managermal Responders IS-100 IntrodLintion to the IndriprA Command Systern 0 ion% 55 ICS-200 Rngir. InrAripnt Command System 0 0 19 ICS-300 Intermediate Incident Command Systern 0 0 Exempt 0 Fxpmpt Exempt 0 97% 0 53% pxp m~nt Pandemic Influenza - The "Silent Menace" he New Hanover County Health Department takes an `all-hazards' approach to incident & disaster response, as many response functions overlap between the possible intentional incident and a large scale natural occurrence. Since 2003, the `bird flu', or HSNI avian influenza virus, continues to make a huge impact on the world's poultry industry in Asia, Europe, and Africa, and the likelihood of this virus becoming easily spread from human-to-human is considered significant. Since another pandemic flu event, like the 1918 Spanish flu, would greatly impact the community not seen in decades, the Public Health agencies continues to place a lot of energy into pre-event planning and exercises. The issues surrounding a public health response requires not just the Health Department but several county agencies plus state and federal partners for civil support, information dissemination, and logistical assistance. In March, 2006, New Hanover County Emergency Management organized and co-facilitated with the NC Dept ofAgriculture's Emergency Programs Division a scenario with the question `how would everyone respond when avian (`bird') flu comes to New Hanover County?" This all-day exercise, called "Silent Menace" was held in an auditorium with over 40 representatives from 14 city & county agencies, 7 state & federal agencies, and 4 non-governmental entities based in New Hanover County. Based on this scenario, each agency would state how they would respond, including the plan they have, who else would they involve, how they would set up an Incident Command Structure (a requirement by federal grant rules), and what kind of communications message they would coordinate and release to the other agencies and the public at large. In bringing together the agencies, participants had the opportunity to meet one another and see how each agency plays a role in an integrated response. As a lead technical agency, the NHCHD response detailed considerations for Quarantine & Isolation declarations, active surveillance for human cases, possible deployment of the county Strategic National Stockpile (SNS) plan, and risk communications on the disease and prevention strategies. The strengths of every participant's discussion were recorded and the weaknesses were analyzed. Though no plan is ever perfect, the "Silent Menace" tabletop exercise was a successful collaboration, and everyone in New Hanover County who participated now have a better idea on how well their plan is, and what others can bring to the table. .Personal Health Services Mobile Dental Unit Arrives The mobile dental unit "Miles of Smiles" arrived in New Hanover without dental insurance. A sliding scale fee schedule is available County on Friday, Jttne 9, 2006 (the last day of traditional school) for the uninsured. Our dental team consists ofa contract dentist, two and saw the first patient on Monday, June 12, 2006. The first to dental assistants and one administrative support technician. Services benefit from this exciting and much needed program were Freeman provided on the unit include screening, oral examinations, x-rays, Elementary School students and children in that local neighborhood. sealants, extractions, fillings and basic dental care. The mobile unit When the mobile dental unit arrived there was approximately 40 will be parked at various schools in New Hanover and Brunswick children with signed parental consent for treatment. During 11 work Counties. Sponsors include Kate B. Reynolds Foundation, Cape days in June, 44 children were seen. The dental program serves Fear Memorial Foundation, Cape Fear Area United Way, and children ages 3-18 years old with Medicaid, Health Choice, and those Brunswick County Health Department. 9G~ a • ati - Thenew mobile dental unit, "Miles of Smil s es"atts first location, Rachel C. Freeman Elementary School in Wilmington. WIC Exceeds State Requirements Laboratory Computerization hen WIC (Women Infants and Children) Nutrition Programs A Laboratory Information System was installed in May 2006 eet and exceed the state assigned caseload for their county, there and by June 1 test results were being generated exclusively in are additional funde provided. The caseload requirement is then LabNet. Staff in WIC and the clinic areas, including specialty increased. Our WIC program didjust that this past fiscal year, and programs such as neurology and TB, initiate the orders. LabNet exceeded their new assigned caseload. We have been able to staff is interfaced with the in-house patient information system, a part time, temporary Nutritionist to keep the caseload up. called QS, to automatically download demographic records. It is also interfaced with the two automated laboratory instruments, transferring multiple result profiles seamlessly to LabNet for technicians' approval. Immediate results are printed in the appropriate patient area, dramatically improving efficiency. The 50 people trained can also search patient records for previous results generated in this lab or various other reference labs. Clinical Services Additions and Improvements Forthe first time, NHCHD took appointments for Flu Clinic, which p, has been set up separately in the auditorium over the last several years. Having appointments made a great deal of difference in the ='z- flow and wait time for our clients. As we became fully operational with the new internet based statewide immunization registry, we also used it (the North Carolina Immunization Registry) to document the Fi Flu vaccines. This created a paperless system for the nurses. z 1 ~I . Other clinical services were added this fiscal year: Family Planning ! Waiver services for males and females; limited physical exams for d~ special requests (Kindergarten, jobs, college, sports, camps, foster • m , u r1i family); new vaccine called Tdap, which includes an adult pertussis Carmen Larkins, Administrative Support Technician component; and late evening appointments on Tuesdays. with WIC, registers a client for her appointment. Additional Interpreters Needed Clinical services had a total of 3755 client visits with Spanish is Interpreters. Eight percent of all clinical patients were Hispanic and 76% of those needed an interpreter at each visit. Our department applied for and received funds from the state to supplement a new interpreter position. In addition, our Women Infants and Children Nutrition Program served 1179 Hispanics (unduplicated number of clients) this year. This has continuously increased from fiscal year 99-00, when they served 181. Unduplicated WIC Hispanic Clients Trends # increased % increase = from year prior from year prior 4 FY 99/00: 181 FY 00/01: 273 92 51% FY 01/02: 348 75 27% Judd Caudell, Physician Extender, provides an FY 02/03: 418 70 20% employment physical. Limited physical FY 03104: 590 172 41% exams became available in June. ~Y 04/05: 869 279 47% r Y 05/06: 1179 310 36% Communicable Disease Trends Reportable Communicable Diseases (diseases with more than 1 case reported) July 1, 2005 -June 30, 2006 AIDS 38 HNlnfectidn 75 Caimylohacter 22 Legionellosis 3 Cry'Pfosporidib_sis 4 Malaria 2 Chi'amydia 582 Pertussis 3 E -coli-0157iH7 3 Rocky Mountain Spotted Fever 7 Gonorrhea 303 Salmonella 121 Hej~afifis B _ Acute 11 ShigeUa 2 Hepatitis B - Chronic 22 Syphilis - Total 44 Hepatitis C -Acute 3 100 f 80~ 800 1 60 tAIDs ;f -Or HIV q~ 40 600 I -A-ByPhllls 20 ~Chlamytl(a 400 ~Gonorrhaa r 0 2001102 2002103 2003104 2004/05 2005106 • 200 0- 2001/02 2002103 2003104 2004105 2005106 Financial Management The New Hanover County Health Department Amended Expenditure Budget (Adopted Budget plus any amendments that were processed during the fiscal year) for FY 2005-2006 was $14,104,293. Actual expenditures for FY 2005-2006 were $13,005,257. The :Health Department's budget was composed of 33 individual programs. Division Managers submitted a line item budget for each program within their respective divisions. The Health Director and Business Manager reviewed all budget requests. Budget hearings were conducted and a Budget Workbook including all programs with line item narrative justifications was prepared and submitted to the Board of Health for approval. The Health Department's Business Manager was responsible for preparing expenditure reports that ensured billing and receipt of the Health Department's state grant funds. The Health Department complied with New Hanover County Financial Policies and Procedures, which included an annual audit. The Health Department's total amended revenue Budget for FY 2005-2006 was $7,718,472. Actual revenues collected for FY 2005-2006 were 7,522,289, representing 97% of budget. The new Mobile Dental Unit's delayed arrival in June 2006, resulted the inability to earn budget revenues for dental services. This represented a significant impact on actual revenues collected. Exclusion of the Mobile Dental Unit's budgeted revenues presents a more realistic view of the total department's revenue collections and results in a revised figure of 103% of budgeted revenues earned in all other programs. Financial Charts • Total Actual Expenditures for FY 2005-2006 Operating: Capital Outlay: $1,694,955 $719,785 13% f 6% mosalary& Fringe: $10,590,517 81% Figure 1: illustrates how the Actual Expenditure Budget is divided among Salaries/Fringes, Operating and Capital Outlay items. Figure 2: illustrates the breakdown of the Total Revenue Earned FY2005.2006 Health Department's total earned revenue Anirrel Control ($7,522,289) through Health Fees, Medicaid, Federal & State: Fees: $716,457 County Environmental Health Fees, Animal Control $1,889,738 6% Approprlatons: Fees, and Other (including miscellaneous 15% $5,482,968 grants and school contributions). It also shows 41% Federal and State Grants through the North other: Carolina Department of Health and Human $3,070,464 Services ($1,889„738, which is included in 24i, the above total revenue figure) and County Health Fees: Medicaid: Appropriations ($5,482,968). $377,332 Environmental $1,191,547 3% Health Fees: 9% $276,752, 2% Total Revenue Earned vs. Budgeted FY 2005-2006 $3,000,000 $2,500,000 $2,000,000 $1,500,000 ¦ Budgeted ¦ Earned $1,000,000 $500,000 - Federal & AC Fees: Medicaid: EH Fees: Flealth Other: State: Fees: Figure 3 represents total revenues earned versus total revenue budget, excluding the Mobile Dental Unit. PUBLIC HEALTH TASK FORCE 2006 North Carolina Public Health Improvement Plan Final Report September 2006 • `c G ?l l North Carolina Department of Health and Human Services • 2001 Mad Service Center Raleigh, North Carolina 27699-2001 Tel 919-733-4534 • Fax 919-715-4645 Michael F. Easley, Governor Carmen Hooker Odom, Secretary September 27, 2006 It is with great pleasure and pride that I commend to you this Final Report of the Public Health Task Force 2006. The recommendations in this report are the foundation of the North Carolina Public Health Improvement Plan. They provide strategic guidance for our continuing efforts to improve the health of North Carolinians everywhere through increased capacity in core public health infrastructure and services. Three years ago we created the Public Health Task Force 2004 using Senate Bill 672, Strengthen Public Health Infrastructure, as the foundation for the work of the Task Force. I charged the Task Force with developing recommendations on how to strengthen North Carolina's public health system, improve health status for North Carolinians and eliminate health disparities. With the generous support of the North Carolina General Assembly and a coordinated effort from our public health system, significant progress has been made. These accomplishments are outlined in the beginning of this 2006 report. Important challenges and needs remain, however, and to address these issues we reconvened the Public Health Task Force 2006 and charged them.with reviewing . progress made on the original recommendations, documenting remaining needs, and drafting revised recommendations. The 2006 Task Force has been at work since January of this year, held two regional public forums, heard testimony, and reviewed research and lessons from the field during the course of their work. Each of the six committees - Accreditation, Accountability, Workforce Development, Structure & Organization, Planning & Outcomes and Finance - has developed targeted recommendations that address critical needs. I encourage readers of this 2006 report to give thoughtful consideration to its content as it will inform future efforts in this area. In spite of the new resources for our public health infrastructure that became available as a result of terrorist attacks on our country, and significant support from the North Carolina General Assembly over the past three years, North Carolina's public health infrastructure remains critically underdeveloped in a number of important areas. This 2006 report will help us make difficult decisions regarding the allocation of scarce resources. I am confident that the proper foundation for this work has been created with this report. I congratulate the members of the Task Force for their hard work and commitment to improve the public's health in North Carolina. Sincerely, Carmen Hooker Odom U ® Location: 101 Blair Drive • Adams Building • Dorothea Dix Hospital Campus • Raleigh, N.C. 27603 An Equal Opportunity / Affirmative Action Employer r ~v..d • North Carolina Department of Health and Human Services Division of Public Health 1931 Mail Service Center • Raleigh, North Carolina 27699-1931 Michael F. Easley, Governor Leah Devlin, DDS, MPH Carmen Hooker Odom, Secretary - State Health Director September 27,2006 As North Carolina's State Health Director, I want to acknowledge the work and planning that has gone into the development of the Final Report of the Public Health Task Force 2006. This document is the foundation of a comprehensive public health improvement plan that will guide our efforts in strengthen North Carolina's public health system, improve health status and eliminate health disparities. I am grateful for the leadership of Secretary Carmen Hooker Odom, whose vision created the original Public Health Task Force 2004, and the dedicated work of the task force, task force committees, and state and local public health staff whose wisdom and experience informed these recommendations. The Public Health Task Force 2006 was charged with reviewing the original recommendations of the 2004 task force, documenting progress, identifying remaining or critical emerging needs, and developing revised recommendations. These revised recommendations represent deliberation, research, discussion and debate. Each of the six working committees was faced with developing consensus around critically important issues facing public health in North Carolina. Their process was deliberative, open and * informed by current research, best practice and practical experience both at the state and local level. I am proud to commend their work to you. Significant progress has been made on a number of recommendations since the 2004 Task Force Final Report was issued (January 2005). Much credit should be given to the North Carolina General Assembly for their generous support in the areas of critical public health concerns. This report includes a summary of the accomplishments we've achieved together. These achievements represent an important milestone in our efforts to improve North Carolina's public health system. These new, revised recommendations are a foundation upon which we can continue to develop creative and effective strategies for supporting public health work in our state. I hope you will continue to be involved in this process as we move forward. I want to extend a special thank you to the Task Force staff from the Division of Public Health and the North Carolina Institute for Public Health at the University of North Carolina at Chapel Hill. Without their support, this work would not have been possible. Sinc ely, L ah M. Devlin, DD , MPH State Health Director Nortb CU~lina Public Health working fine hnkhieraM sskr N.. Caroh. Everyabere. V<ryEay. EVerWoey. Location: 5605 Six Forks Rd. • Raleigh, NC. 27609-3811. An Equal Opporlumily Employer TABLE OF CONTENTS Introduction 3 . Introduction (p 3) . Public Health Mission and Essential Services (p 4) Accomplishments: Public Health Task Force 2004 5 • Core Infrastructure (p 5) • Core Service Gaps (p 7) Executive Summary 9 • Core Infrastructure (p 9) • Core Service Gaps (p 13) Part I: Core Infrastructure Recommendations ................................14 • Accreditation Committee (p 14) • Accountability Committee (p 16) • Structure & Organization Committee (p 17) • . Workforce Development Committee (p 19) • Planning & Outcomes Committee (p 24) • Finance Committee (p 28) Part II Core Service Gap Recommendations .....:..........................33 • School Nurse Services (p 34) . HIV/AIDS Prevention and Control (p 37) . AIDS/ADAP (p 38) • Eliminating Health Disparities: Title VI Compliance (p 39) • Eliminating Health Disparities: Community Grants (p 41) • Chronic Disease Prevention and Control (p 43) • Injury and Violence Prevention (p 45) • Immunizations/Universal Vaccine Program (p 47) • Environmental Health (p 50) • Early Intervention (p 51) Addenda ..................................................................................52 Automation Report: Public Health Information Network (p 53) • 2 INTRODUCTION Since the final report of the Public Health Task Force 2004 was issued (North Carolina's Public Health Improvement Plan, January 2005), and with the generous assistance of the North Carolina General Assembly, progress has been made in strengthening North Carolina's governmental public health system. This system continues to respond to new and serious public health emergencies, significant changes in population, unacceptable health disparities, decreasing funding and significant variations in public health protection between counties and regions. As a result, North Carolina's State Health Director has reconvened the Public Health Task Force 2006. The charge to the task force is: • Review and document progress made on the 2004 recommendations; • Identify remaining resource needs and any critical emerging needs; and • Draft a revised set of recommendations. An increased, and ongoing, reinvestment in the state's public health infrastructure remains critical to providing the essential public health services that will assure public health protection for all North Carolinians. Recent terrorist events, along with outbreaks of new and often fatal infectious diseases, have been a wakeup call to North Carolina. The state's governmental public health system must be continually strengthened in order to promote and protect the public's health. New federal resources for bioterrorism preparedness that have created some additional capacity to detect and respond to certain public health emergencies -these resources, while necessary, are not sufficient. • The state's role in supporting these national preparedness efforts is to continue to reinvest in the core public health infrastructure. A new infusion of support will enable the system to respond to all public health emergencies and threats to the health and prosperity of all North Carolinians. Recent reinvestments of resources in the state and local public health system by the North Carolina General Assembly have coincided with increases in public health accountability. Further development of these new systems of accountability, accreditation, and data collection will provide the tools necessary to measure success and allow the state to invest with confidence. The re-convened Public Health Task Force 2006 has considered the original setof recommendations, reviewed progress made, and noted remaining resource needs. Their updated recommendations follow, and are divided into two parts: 1. Core Infrastructure - Recommendations addressing critical structural and system component deficits; and 2. Core Service Gaps - Recommendations addressing crucial deficiencies in priority public health services and programs. Strengthening public health infrastructure is important. Either we are all protected or we are all at risk. The Public Health Foundation 3 THE MISSION OF NORTH CAROLINA PUBLIC HEALTH To promote and contribute . to the highest possible level of health for the people of North Carolina. THREE PUBLIC HEALTH CORE FUNCTIONS AND 1 O.ESSENTIAL SERVICES I. Assessment 1. Monitor health status to identify and solve community health problems (e.g., community health profiles, vital statistics and health status). 2. Diagnose and investigate health problems and health hazards in the community (e.g., epidemiologic surveillance systems, laboratory support). II. Policy Development 3. Inform, educate, and empower people about health issues (e.g., health promotion and social marketing). 4. Mobilize community partnerships and action to identify and solve health problems (e.g., convening and facilitating community groups to promote health). • 5. Develop policies and plans that support individual and community health efforts (e.g., leadership development and health system planning). III. Assurance 6. Enforce laws and regulations that protect health and ensure safety (e.g., environmental health rules). 7. Link people to needed personal health services and ensure the provision of health care when otherwise unavailable (e.g., services that increase access to health care). 8. Assure competent public and personal health care workforce (e.g., education and training for health care providers). 9. Evaluate effectiveness, accessibility, and quality of personal and population-based health services (e.g., continuous evaluation of public health programs). 10. Research for new insights and innovative solutions to health problems (e.g., links with academic institutions and capacity for epidemiologic and economic analyses). • 4 PUBLIC HEALTH TASK FORCE 2004 • Accomplishments Core Infrastructure Accreditation • A mandatory system of accreditation for local/district health departments has been established with the passage of legislation and the subsequent adoption of rules by the Commission for Health Services. • Current legislation provides $700,000 per year in recurring funds for the accreditation process. Local health departments in North Carolina will receive one-time funding in the year that they seek initial accreditation. . Accountability • An Office of Performance Improvement and Accountability has been established within the North Carolina Division of Public Health that is implementing a formal reporting and accountability process for state and local public health agencies. • The Division of Environmental -Health is working with the Division. of Public Health to identify and incorporate appropriate measures of environmental health into the formal reporting and -accountability process for state and local public health agencies. • • A set of Best Practice Indicators has been established that will provide county- specific data about the effectiveness of public health efforts to promote population health. Structure & Organization • The North Carolina General Assembly has budgeted $1,000,000 in recurring funds to establish and support public health incubators. A total of six public health incubators have been established and the. Incubator Advisory Board supports a shared project. • The State Health Director and the Director of the Division of Environmental Health are now meeting on a monthly basis and the Secretaries of the Departments now meet on a quarterly basis to ensure better coordination. The Memorandum of Understanding (MOU) between the Departments has been updated and revised, and now includes a detailed work plan. • The State Health Director now reports directly to the Deputy Secretary of the Department of Health and Human Services and meets weekly with the Secretary of the Department. • A State Health Department Accreditation Team has been established. The team has developed an accreditation tool using the National Public Health Performance Standards. The State Health Department will perform a self-assessment utilizing this tool and an external accrediting body will perform a site visit as part of the 5 accreditation process. The state self-assessment will occur between September 1, • 2006 and November 30, 2006 with the site visit occurring in January 2007. • 'Fhe accreditation process for local health departments is used to promote collaboration among local health departments and any related voluntary structural changes at the local and state level. Workforce Development • The Public Health Workforce Development system's assessment of local public health workers was completed and published in 2004. • Two non-degree training and education efforts at the North Carolina Institute for Public Health - the Lifelong Learning Initiative and the Public Health Academy - will enable public health professionals to locate and access needed training and development resources. Planning & Outcomes • The North Carolina General Assembly (NCGA) appropriated $400,000 non- recurring funds for local Healthy Carolinians capacity. • The NCGA appropriated 1.0 FTE and $100,000 in recurring funds to support the Office of Healthy Carolinians. • The Office of Healthy Carolinians/Health Education was awarded a 2-year Prevention Specialist position from CDC. • Finance • A one-year cap on the local share of the state's Medicaid match was put into place in 2006. • Local health departments received $545,419 in FY '06 to increase access to preventative and primary care services for uninsured or medically indigent patients. • The NC General Assembly approved funding of $101,000,000 for a new state laboratory to be built in Raleigh. • 6 Public Health Task Force 2004 • ACCOMPLISHMENTS Core Service Gaps School Nurse Services • The School Nurse Funding Initiative (SNFI) provided by the General Assembly in HB 1414 on July 18, 2004 provided 80 permanent and 65 two-year school nurse positions. This initiative improved the nurse to student ratio front 1:1897 in the 2003-04 school year to 1:1593 in 2004-05. • All LEAs in the state now have at least two school nurse positions. Twenty-one LEAs now meet the recommended 1:750 ratio in 2004-05 compared to 10 LEAs that met the recommendation prior to SNFI implementation. HIV/AIDS Drug Assistance Program (ADAP) • There has been an increase of $1,000,000 in state appropriations for ADAP in SFY 2006. • Close to 1,000 PLWHA in NC were served through the Special Presidential ADAP Initiative between October 2004 and December 2005. All individuals still eligible at that time were transitioned into the State. Eliminating Health Disparities: Title VI Compliance • • The North Carolina General Assembly appropriated recurring funds for a program aimed at creating new full-time positions for interpreter services at the local health departments to enhance their capacity to serve LEP clients. With the allocated funding, 11 health departments were funded through the NCOMHHD (NC Office of Minority Health and Health Disparities) for a 3-year period beginning FY05/06. Eliminating Health Disparities: Community Grants • The Office of Minority Health received $2,000,000 in recurring funds for community-focused initiatives targeting the elimination of health disparities. Tobacco Tax • As of September 1, 2005, the General Assembly raised the tobacco tax from 5 cents/pack (50th in the nation) to 30 cents/pack (45th in the nation). An additional 5 cents/pack increase on July 1, 2006 brought the total cigarette tax to 35 cents/pack. • As of September 1, 2005, the excise tax on "spit" tobacco products in NC also increased from 2% to 3% of the actual cost. 7 Immunizations/Universal Vaccine Program • • The North Carolina General Assembly increased state support for the universal vaccine program by appropriating $5,526,095 to support the provision of influenza and Tdap vaccines. • The North Carolina Immunization Registry (NCIR) was implemented in all 100 local health departments from June to September 2005. Hands on training and technical assistance were provided at every local health department to ensure use of the NCIR as a clinical tool. As of the summer of 2006, 200 private providers are using the NCIR. Environmental Health • The regulation of private wells has been added as a mandated program, effective July 1, 2008. Early Intervention • The General Assembly has responded to increased need in this area with additional appropriations in both 2005-2006 and 2006-2007. For 2005-2006, $5,000,000 in new appropriations was provided for services through appropriately qualified, community-based providers. • For 2006-2007, $7,061,108 is being provided that includes 141 positions and permission for 56 receipt-supported positions. • Automation: Public Health Information Network • The North Carolina Immunization Registry (NCIR) was implemented in 2005. • The North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) went into production in 2005. • The North Carolina Hospital Emergency Surveillance System (NCHESS) was implemented in 2005. • Based on funding provided by local health departments, implementation for the new Health Information System (HIS) begins in 2006. • The National Electronic Disease Surveillance System (NEDSS) began implementation in 2006. • 8 EXECUTIVE SUMMARY Core Infrastructure Recommendations • Accreditation Committee 1. Fund local health departments on an ongoing basis for accreditation and related continuous quality improvement activities. Resources Needed: $750,000 in FY '08 (see full schedule) for local support of essential services. 2. Fund the accreditation process to cover the additional costs of re- accrediting agencies beginning in 2008. Resources Needed: $ 54.000 in additional funding for FY '08 (see full schedule) for accreditation administrator. Accountability Committee 3. Create a Community Wellness Index that will assess state and county- specific health status - a state and county health report card. 4. Implement a Performance Improvement and Accountability process that. will use accountability data to support and evaluate the effectiveness of state/local efforts to improve the health of the residents of NC. 5. Compile a set of the State Public Health Performance Indicators that • funders and other stakeholders use to hold DPH accountable. Resources Needed: $243,000 Structure & Organization Committee 6. The current balance of responsibility and authority between state and local government over the organization and structure of the local public health delivery system, as set out in North Carolina General Statutes, should be sustained. 7. Fund and create public health incubators for all North Carolina counties to support voluntary and locally driven regional collaboration and economies of scale. Resources Needed: $2,000,000 annually 8. Establish a Local Health Department Voluntary Consolidation Incentive Fund in the Division of Public Health with initial funding of $250,000 for use by the State Health Director. Resources Needed: $250,000 annually 9 Workforce Development Committee • 9. The pay and compensation requirements of the Public Health workforce should be fully funded so that: Staff in critical and difficult to retain positions are not lost; Hiring managers are able to compete in recruiting for the best qualified employees; • Hiring managers are able to compete in recruiting a diversified Public Health workforce; • Current and future public health services to citizens are not negatively impacted by staffing shortages; • A workable, functioning career progression ladder is achieved; and • Equity funding is budgeted to address historic pay inequities. Resources Needed: $2,000,000 10. An assessment of the needs of the North Carolina public health workforce should be conducted that includes: • A short-term workforce assessment study; and • The identification and dissemination of core public health competencies. Resources Needed: $168,000 11. North Carolina should commit to achieving an adequately trained public health workforce by: • Developing and implementing an outreach and recruitment marketing plan to ensure an adequate, capable, culturally competent and diverse public health workforce; • Fully funding necessary maintenance and operational needs of the Public Health Training & Information Network (PHTIN); • Creating public health internships at the state and local level; • Creating public health scholarships and loan repayment programs; and • Requiring training for Board of Health members. Resources Needed: $ 1,179,150 Planning & Outcomes Committee 12., Improve the data and epidemiology to guide state and local decision- making and allocation of resources. ¦ Establish a common set of core health indicators. ¦ Build capacity to conduct the Behavioral Risk Factor Surveillance Survey (BRFSS) and Child Health Assessment Monitoring Program (CHAMP) to provide county-specific or multi-county data. • 10 • Enhance the opportunities to collect and report county- specific or multi-county. behavioral and physical health • information on children. Specific examples include greater local school system participation in the Youth Risk Behavior Survey and physical health indicator data surrounding the childhood obesity problem in North Carolina. • Identify and analyze existing state and local public health problems, health disparities, and potential threats. ¦ Identify the best scientific and evidence-based strategies to address identified public health problems at the local level. ¦ Provide epidemiology training for local partners. Resources Needed: $1,050,000 annually 13. Fund local health departments to assess and document community health needs and provide critical information and resources for state and local health planning. • Establish a uniform statewide process for community health assessment to be conducted on a four-year cycle. • Support for the State Center for Health Statistics to provide county specific health data. • Build capacity of the Office of Healthy Carolinians • Establish annual integrated planning cycle. • Establish ongoing funding support for Healthy Carolinians partnerships. Resources Needed: $1,623,000 for Community Health Assessment and $2,000,000 for Healthy Carolinians annually 14. Fund increased information technology capacity at the local level to collect, compile, analyze, and report essential public health data. • Build local capacity to collect, analyze and report critical public health data electronically. • Assure compliance with relevant data standards of confidentiality, security, accessibility, and availability - Public Health Information Network (PHIN). • Build the IT interface between state and local public health and key community partners - hospitals, healthcare providers, emergency management, and others. Resources Needed: $5,160,000 ($60,000 per LHD) annually Finance Committee 15. Increase non-categorical General Aid to County funds to improve the delivery of the ten essential public health services in all counties and to include an emphasis on low wealth and economically distressed counties. Resources Needed: $25,000,000 annually 11 • 16. Support Legislation to Create a New Permanent Funding Source for the Universal Vaccine Program. 17. Authorize local health departments to charge fees for food and lodging . program activities at the local level to help cover operational costs. 18. Assure that a mechanism is developed that allows LHD and CDSA Medicaid rates to be updated annually to more accurately reflect the cost of providing services in these settings. Resources Needed: $11,050,000 (state) 19. The state should fund the county Medicaid share and direct that an appropriate portion of freed-up county revenue be appropriated for local public health core infrastructure and service needs. 20. Secure state funding to continue the development of the Health Information System (HIS) as a partnership with local health departments. Resources Needed: $13,200,000 (state); $ 4,800,000 (local) 21. Re-convene and charge the public health study commission to assess the broad issues of funding Public Health in North Carolina, including: • Conducting an analysis of the funding of public health at all • levels of government within NC (state and local responsibilities) The study should determine "who should pay for public health" and include an assessment of how other states support public health. • Documenting the "real costs" of under funding public health by identifying decreased health outcomes and health promotion/ disease prevention activities curtailed or not offered as a result of under funding. 12 EXECUTIVE SUMMARY • CORE SERVICE GAP RECOMMENDATIONS Budget Summary • School Nurse Services $ 13,000,000 (2007 - 2008)* • HIV/AIDS Prevention & Control $ 3,341,656 • HIV/AIDS Drug Assistance Program (ADAP) No new funding requested. • Eliminating Health Disparities: Title VI Compliance $ 4,815,000 • Eliminating Health Disparities: Community Grants $ 3,055,000 • Chronic Disease Prevention $ 8,099,200 • Injury Prevention & Control $ 970,000 • Immunizations/Universal Vaccine Program $ 35,900,569 • Environmental Health $ 5,428,111 • Early Intervention $ 10,600,000 * First year (2007 - 2008) of Five- (or Ten-) Year Plan (see following section) • 13 CORE INFRASTRUCTURE RECOMMENDATIONS • Accreditation Committee 1. Fund local health departments on an ongoing basis for accreditation and related continuous quality improvement activities.. Needs Addressed/Rationale The goal of Accreditation of Local Health Departments is to: • Demonstrate core capacity to respond to public health challenges in local communities; • Assure all citizens of North Carolina access to a standard of quality in core functions and essential services of public health; • Improve efficiency and effectiveness of public health services as well as health outcomes across the state; • Increase accountability for newly emerging diseases; and • Recognize that access to an agreed upon minimum standard of quality in delivery of core functions is essential to public health services. Infrastructure/Capacity Improvement The Accreditation system put into place by our General Assembly is already making a • difference at the local level. The ability to present themselves to other health care facilities is opening doors to new partnerships within communities. It allows accredited departments to apply for some grant funds that are restricted to agencies that are accredited. In addition, it is leading to a better understanding of how all employees contribute to the accomplishment of the essential services of public health, greater understanding and commitment by Boards of Health and County Commissioners of their role in improving the public's health, and teambuilding within the agencies resulting in more efficient services to clients. Perhaps most important, it is enhancing the credibility and the perception of local health departments in our state. One local health director shared that a pediatrician in private practice in her community contacted her to say how impressed he was that the health department was accredited and how different that Health Department was from those in the state from which he came. Budget* FY'08: Need an additional $750,000 in on-going funding for 30 accredited local health departments. F`./'09: Need an additional recurring $250,000 on-going funding for 10 additional accredited health departments. FYI 0: Need an additional recurring $250,000 in on-going funding for 10 additional accredited health departments. • FYI l : Need an additional recurring $250,000 (on-going funding for 10 additional accredited health departments). 14 FY'12: Need an additional recurring $250,000 in on-going funding for 10 additional accredited health departments. • FY'13: Need an additional recurring $250,000 (on-going funding for 10 additional accredited health departments). * All figures assume that previous funding is recurring and these are only additional funds (not total funding) needed per year. 2. Fund the accreditation process to cover the additional costs of re-accrediting agencies beginning in 2008.. Needs Addressed/Rationale See Recommendation #1 above. Budget* FY'08: $54,000 for the additional costs of re-accrediting 6 local health departments. FY'09: No new funds requested. FY'10: $124,000 for the additional costs of re-accreditation of 10 local health departments. FY'l 1: No new funds requested. FY'12: $55,000 for additional costs for re-accreditation. FY'l3: No new funds requested. • FY'14: Need an additional recurring $33,500 (for additional re- accreditation costs as it is anticipated that all local health departments will be initially accredited and seeking re-accreditation at this point). * All figures assume that previous funding is recurring and these are only additional funds (not total funding) needed per year. 15 • Accountability Committee 3. Create a Community Wellness Index that will assess stage and county-specific health status - a state and county health report card. Needs Addressed/Rationale The Office of Performance Improvement and Accountability will work on creating the Community Wellness Index for county/state-specific health status. The Community Wellness Index will take into account how the county is meeting the benchmarks set for the Community Wellness Indicators. 4. Implement a Performance Improvement and Accountability process that will use accountability data to support and evaluate the effectiveness of state/local efforts to improve the health of the residents of NC. Needs Addressed/Rationale Once the finalized version of the Best Practice Indicators and benchmarks are established and adopted by the NCALHD through the Policy and Planning Committee, the Performance Improvement and Accountability process will be implemented. • 5. Compile a set of the State Public Health Performance Measures that funders and other stakeholders use to hold DPH accountable. Needs Addressed/Rationale Before the Performance Indicators for the state can be compiled, the State Health Department needs to complete an Agency Self-Assessment and pilot accreditation process similar to the Local Health Department's process. The site visit will occur in the January-February 2007 timeframe. Once the accreditation is completed, Performance Indicators will be identified, benchmarks established, and a Community Wellness Index calculated. Budget (Recommendations 3-5) • $243,000 • FTE's - 2 (state) • 16 Structure & Organization Committee Guiding Principle • Collaboration, partnership and voluntary organizational change rather than mandated consolidation of local health departments are inherent in all task force recommendations. 6. In order to protect the citizens of North Carolina in an age of bioterrorism and emerging infections, the current structure of the state and local public health delivery system, as set out in North Carolina General Statutes, should be sustained. Needs Addressed/Rationale The current environment of heightened concerns about bioterrorism and emerging infections such as SARS and Pandemic Flu has prompted feedback from the national level that a state-run and administered Public Health system would provide better protection of the public. Consequently, the existing structure in North Carolina accomplishes this federal goal while maintaining local flexibility. No new funding requested. 7. Fund and create public health incubators for all North Carolina counties to support voluntary and locally driven regional collaboration and economies of scale. • Needs Addressed/Rationale Implementation of this recommendation will result in the addition and continuation of regional voluntary partnerships to enable local public health agencies to cooperate on service delivery, management, organization, preparedness, and special projects. It is expected that these public health incubators will require funds to support regional project priorities and staff that can work to establish and carry out program activities and fundraising efforts that will leverage state funds appropriated to public health incubators. Infrastructure/Capacity Improvement As the work of these regions continues and the NC-PHICs increases in size and complexity, we recognize the need for increased funding to create and sustain regional efforts and outcomes in both new and current public health incubators. Expansion funds for "public health incubators" will support the regional staffing, evaluation, and marketing necessary to reach project goals, assess effectiveness, and disseminate findings for the current and new incubator collaboratives such that all North Carolina counties can participate in the NC-PHICs. These funds will also allow the continued support of innovative "shared projects" that impact the entire state. In addition to building and sustaining regional collaboration and public health capacity, funding for public health incubators will continue to support the coordination • 17 of the overall NC-PHICs program and assure that regions are not only working within • their voluntary associations, but among incubators state-wide to prevent duplication of effort and encourage sharing of lessons learned and effective public health practices. Budget • $2,000,000 in recurring funds to support regional public health incubators for all North Carolina counties. • FTEs - (2) state; (8) regional 8. Establish a Local Health Department Voluntary Consolidation Incentive Fund in the Division of Public Health with initial funding of $250,000 for use by the State Health Director. Needs Addressed/Rationale For the past 30 years various efforts have been made to consolidate local health departments into a fewer number. North Carolina's strong tradition of local control has constantly resulted in the decision to maintain county health departments with the exception of a few, well established district health departments. After thorough discussion it was the unanimous decision of the Committee that the drive for efficiency, effectiveness and possible structural change should rest on the shoulders of accreditation. Committee members voiced strongly the need for maintaining autonomous, individual departments in counties so desiring, unless • a structured accreditation and competent follow-up proves that the individual agency cannot provide quality essential services for the county's residents. In the early 1970's, the NC General Assembly appropriated funding that was used to encourage the voluntary consolidation of local health departments in the state. New incentive funds will help further the voluntary consolidation effort and help build a stronger, more efficient local public health delivery system. Infrastructure/Capacity Improvement Implementation of this recommendation would help strengthen some local health departments that may struggle to provide core public health services in their current structure. This recommendation is a new approach which, through increased accountability and the implementation of an accreditation system, would allow locally determined collaborations to evolve to include the creation of new district health departments. Budget • $ 250,000 annually • FTEs: State (0); Local (0) • 18 Workforce Development Committee • 9. The pay and compensation requirements of the Public Health workforce should be fully funded so that: • Staff in critical and difficult to retain positions are not lost; • Hiring managers are able to compete in recruiting for the best qualified employees; • Hiring managers are able to compete in recruiting a diversified Public Health workforce; • Current and future public health services to citizens are not negatively impacted by staffing shortages; • A workable, functioning career progression ladder is achieved; and Equity funding is budgeted to address historic pay inequities. Needs Addressed/Rationale The most frequently cited reason for staff turnover given by state and local public health managers is their inability to retain qualified, seasoned staff. It is the noncompetitive, inflexible salary structure of most state and local public health jobs that leads to the loss of highly qualified and experienced staff. Critical public health staff often leave because an adjacent county, an adjacent state or the private sector heavily competes for well trained and experienced public health staff. Federal labor • data estimates that by 2010, the U.S. will have a ten million-worker shortfall. The heaviest.demand for workers will be in the technical and scientific fields. Human Resource Offices report that voluntary tum-over rates are already expressing this shortfall estimate; for FY 05-06 these Public Health classifications are experiencing high rates of turnover, Medical Laboratory Technologist 1 (30%); Staff Nurse (36.36%); Physical Therapist Il (13.64%) and Occupational Therapist I (13.33%). A significant constraint for public health hiring managers is the fact that salary funds in many professional, technical and scientific positions are so low that only the minimum hiring rate can be offered. For public health to be successful in recruiting and retaining these valuable workers, full salary funding must be available to hire at the mid-range of salaries or above. Infrastructure/Capacity Improvement Fully funding the state Career Banding Plan is critical to improving pay/compensation and building a career ladder in public health jobs. Should the state take the lead in this area, there should be similar adoption of progressive workforce development and planning simultaneously at the local level. • 19 Recommendation # 9, Cont'd. • Budget FTEs $2,000,000 (0) State (0) Local .o $1,000,000 - Funding for salary budget increases to offer key positions at the mid-range or above in competitive recruitment and for equity funding to retain critical staff (Technical and professional public health workforce) b $1,000,000 - Currently Public Health has identified $912,052 ($504,618 in appropriated funds) needed to fulfill range revision, special minimum rates and "right to reserve" reallocations. Balance is for additional salary adjustments and special entry rates already approved but not funded. • • 20 10. An assessment of the needs of the North Carolina public • health workforce should be conducted that includes: e A short-term workforce assessment study; and Identification and dissemination of core public health competencies. Needs Addressed/Rationale The information collected in the learning management system and in the state center's facility survey should be analyzed for data gaps about the public health workforce. Additional questions/data fields should be added to these existing data collection processes to ensure that needed data on the public health workforce is available. Funding is requested to integrate the two surveys and add missing data fields. Recent studies have shown that the current public health workforce is unevenly prepared to meet today's challenges. An estimated 80% of the workforce lacks formal training in public health [Centers for Disease Control - Agency for Toxic Substances and Disease Registry (CDC-ATSDR, 2001)]. Changes in technology, biomedical science, informatics, and community expectations will continue to redefine the practice of public health, requiring that current public health practitioners receive training and support to update their skills (Pew Health Professions Commission, 1998). This lack of current knowledge about what key positions and roles constitute the North Carolina Public Health workforce heightens the need to have a true counting or enumeration of the workforce in public health. • Budget FTEs $ 168,000 to conduct workforce assessment study, (0) State develop and disseminate core competencies. (0) Local (Assumes 5% increase above 2004 request) 11. North Carolina should commit to achieving an adequately trained public health workforce. Needs Addressed/Rationale The public health workforce is aging, and many are approaching retirement. According to the NC Center for Public Health Preparedness, the average age of the workforce is 45+ years of age. Recruitment is more difficult in public health because of a lack of clarity about what public health does. Turnover in the public health workplace also is a major issue that complicates workforce preparedness planning. Currently there are 188 public health job titles in the state public health personnel system (DHHS) and 173 in local public health personnel systems. There are also public health classifications within DENR for which numbers are not available at this time. This has created many difficulties in workforce preparation. Often titles differ only in level, not in • 21 function, and are simply designed to create a pseudo career ladder for public health • workers. As mentioned above, recent studies have shown that the current public health workforce is unevenly prepared to meet the challenges in the practice of public health today. Infrastructure/Capacity Improvement Implementation of this recommendation will include: • Developing and implementing an outreach and recruitment marketing plan to ensure an adequate, capable, culturally competent and diverse public health workforce. Funds to be used as a recruitment tool for professionals in other fields, not for students enrolled in a degree program. Three to five people a year would be selected for a limited time exposure to public health professionals in local and/or state agencies. Details for program to be developed and administered by state public health division's office. • Fully funding necessary maintenance and operational needs of the Public Health Training & Information Network (PHTIN). The Reconvened 2006 Committee on Workforce Development members fully support that the PHTIN network be fully funded, with recurring funds, at an appropriate level determined by a new review. This review, along with an updated "blueprint of the future," should identify the technology and human resource needs of a new PHTIN to meet emerging public health workforce training needs. Such a review should also explore Webinar, Webcasting, and computer-to-computer • options for future incorporation into PHTIN, or as new routes of system development. • Creating public health internships at the state and local level; • Creating public health scholarships and loan repayment programs. Scholarships do not cover need, but should be considered a starting point. Service to state/local agencies for both scholarships and loan repayment for a specified period of time is required in return. • Requiring training for Board of Health members. Particular emphasis was noted from committee members that continuing funding remains a critical need for sustaining and enhancing Board of Health Training to ensure the existing training is positioned to better prepare local boards to meet emerging public health challenges. This will ensure that all public health practitioners have a basic set of competencies involving general knowledge, skills, and abilities to function as part of their public health organization or system (CDC-ATSDR, 2000; DHHS, 2000; CDC, 2001d). • 22 Budget FTEs $ 10,500 Recruitment Marketing Plan (0) State • $ 486,150 PHTIN (0) Local $ 157,500 Internships • $ 210,000 Scholarships • $ 210,000 Loan Repayment • $ 105,000 Board of Health Training (Assumes 5% increase above 2004 request) • 23 • Planning and Outcomes Committee 12. Improve the data and epidemiology to guide state and local decision-making and allocation of resources. Needs Addressed/Rationale A cornerstone of good public health practice is sound epidemiology utilizing the best available data to make the best evidence-based decisions that benefit the most people. The range of data needs to provide a solid scientific basis for public health decision making it broad and ever growing. Primary data collection such as community surveys is the best way to get valuable information on health directly from our citizens. Information technology advances make more and better data available on a much timelier basis, however public health lacks sufficient capacity to collect and analyze even the existing data. Additionally, the lack of a common set of public health indicators makes it difficult to monitor the State's health, identify and communicate gaps and priorities, develop and implement statewide plans, and adequately correlate resources to high priority issues. Establishing a common set of indicators will provide a clear statement for public health business and can be used to monitor the health of the state and manage state/local resources. Building the epidemiology capacity at the state level will ensure that consistent quality data is available to all counties. Infrastructure/Capacity Improvement Implementation of this recommendation would: • Establish a common set of core health indicators. • Build capacity to collect additional Behavioral Risk Factor Surveillance Survey (BRFSS) and Child Health Assessment Monitoring Program (CHAMP) data that will provide county- specific or multi-county data through increased funding. and establishing two new statisticians. • Enhance the opportunities to collect and report county-specific or multi-county behavioral and physical health information on children. Specific examples include greater local school system participation in the Youth Risk Behavior Survey and physical health indicator data surrounding the childhood obesity problem in North Carolina. • Establish two epidemiologist positions to work directly with local health departments to identify and analyze existing state and local public health problems, health disparities, and potential threats. • Identify the best scientific and evidence-based strategies to address identified public health problems at the local level. • Disseminate quality public health data for utilization by local partners. • Provide Epidemiology training for local partners. • Budget $450,000 BRFSS • $200,000 PH problem and threat assessment capacity • $200,000 Best Practices 24 $200,000 Epidemiology training 13. Fund local health departments to assess and document • community health needs and provide critical information and resources for state and local health planning. Needs Addressed/Rationale Community Health Assessment (CHA) is a public health core function. It interfaces with several essential services that guide public health practice. CHA is also a critical part of the accreditation of public health agencies. Local public health agencies are mandated to conduct a collaborative, comprehensive CHA every four years that must include a review and analysis of secondary data, collection of primary data, and development of community action plans. Primary data collection is key in engaging community members in the discussion and planning for community health improvement. During the interim three years, the local health department is required to issue a State of the County's Health report to inform the community of emerging health issues, new initiatives that address health issues, and update the residents about the priority issues. Currently, there are no state funds to support this critical function at either the state or local level. Without funding, local public health departments are compromised in conducting quality CHA. A fully funded CHA system will inform each county of its health status, provide information for planning both at the local and state levels, support accountability and continuous quality improvement in public health, and enable the local health agency to be accredited. North Carolina's local public health agencies work within a comprehensive, collaborative planning process called Healthy Carolinians. Healthy Carolinians (HC) is a partnership representing local public health agencies, hospitals, health and human service organizations, businesses, churches, schools, media, elected officials and community members. HC Partnerships participate in the CHA process at the county HC partnerships identify priorities based on the findings of the CHA and through a collaborative planning process develop effective strategies, mobilize resources for programs, and evaluate the strategies to measure health outcomes. This collaborative process fosters good communication within public health and human services, coordination of programs and services, and cooperation toward health improvement outcomes. This collective process supports good fiscal management and avoids duplication of services and careful articulation of gaps and emerging issues. Healthy Carolinians has the potential of becoming the health promotion/disease prevention arm for the Community Care Network (CCN). Funding will enable HC partnerships to work with collaborative with CCN to help achieve the common goal of community health improvement and management of health care dollars. While the General Assembly has provided funding for Healthy Carolinians, the appropriations have not been recurring. Ongoing funding is essential to assure comprehensive planning for community health improvement based on CHA. • 25 • Infrastructure/Capacity Improvement Implementation of this recommendation will: • Fund a uniform statewide process for community health assessment to tie conducted on a four-year cycle (comprehensive Community Health Assessment) and updated annually (State of the County Report). Develop and implement a collaborative four-year State Public Health Plan, which will be updated annually. • Build capacity of the state Office of Healthy Carolinians/Health Education (OHC/HE) which will support local CHA through local graining, technical assistance, and provide reports to state programs to inform state level planning. OHC/1-IE will compile and report information on local needs, community priorities, and action plans for state level programs. • :Establish an annual integrated planning cycle to inform state and local decision makers regarding program priorities and funding allocations. OHC/IIE will facilitate the state level planning cycle and develop. Permanent funding to support Community Health Assessment: $ 2,885,000 • $ 2,150,000 ($25,000/LHD/year) funding for local health departments to support ongoing Community Health Assessment and planning once • every four years, as well as the State of the County's Report (SOTCH) during the interim three years. This is critical to assure that the LHD meets the requirements for Accreditation and the obligations of the Consolidated Agreement with the State. • $ 85,000 (1 FTE) permanent position at the state level that will take on the work that is currently being accomplished by CDC Prevention Specialist. • $ 600,000 for seven regional epidemiologists to train and provide technical assistance for LHD personnel. Because it is critical that data collection and analysis follow the practice of epidemiology so assessment and identification of priorities are accurate and the community is well informed, each LHD should have access to an Epidemiologist. These positions will be state employees, but live in the region that he/she supports. • $ 50,000 will be needed to provide overhead support, travel, training expenses, etc. for Community Health Assessment. Permanent funding to support Healthy Carolinians: • $2,000,000 in recurring funding for HC Partnerships to support collaborative community health planning to address CHA priorities • aligned with North Carolina's 2010 health objectives (e.g., chronic diseases, injury, communicable diseases, adolescent health, access to 26 health care, health issues of older adults). These funds will also be used to develop the health promotion/disease prevention arm for • Community Care North Carolina. Budget Fl'Es $ 2,885,000 Community Health Assessment (8) State • $ 735,000 (state) • $85,000 1 FTE in OCH-HE . $50,000 Overhead, travel, training $600,000 7 Epidemiologists • $ 2,150,000 (local) (0) Local $ 2,000,000 Healthy Carolinians 14. Fund increased information technology capacity at the local level to collect, compile, analyze, and report essential public health data. Needs Addressed/Rationale Technology capacity is critical for all phases of public health practice, especially community health assessment. The need to collect, compile, analyze, report data is key to fully providing the essential services required by public health. Because technology capacity has been left to community resources, it is not uniform across the state. With accreditation, required community assessment, and other reporting requirements, it is critical to assure that all local public health agencies have a minimum standard of technology capacity. Infrastructure/Capacity Improvement • Build local capacity to collect, analyze, and report critical public health information electronically. • Assure compliance with HIPAA guidelines • Build the local interface with the Public Health Information Network to enhance the ability of local health departments, hospitals, healthcare providers, and community partners to, communicate electronically in a secure environment. Budget $ 5,160,000 - local information management FI'Es (0) State (0) Local • 27 • Finance Committee 15. Increase non-categorical General Aid to County funds to improve the delivery of the ten essential public health services in all counties and to include an emphasis on low wealth and economically distressed counties. Needs Addressed/Rationale The original allocation of $5,200,000/year, set in 1972, has never been adjusted for inflation. Based on the Consumer Price Index, $5,000,000 in 1972 would have been worth $23,400,000 in 2005. Non-categorical aid is essential for supporting needed flexibility at the local level and ensuring adequate and timely delivery of public health services. North Carolina counties vary greatly in their ability to pay for essential public services. This concept has been recognized in the public school funding to enable students across the state to have a more equal educational opportunity. Low wealth status of counties was factored into the school health nurses' distribution formula. Components of this formula could be used as a starting point for consideration in awarding other funds obtained for public health since it does include the concept of ability to pay (low wealth) in the calculation. Residents from Murphy to Manteo deserve consistent high quality public health • services. In some areas, it clearly costs more to provide the same services well. Some counties have more funding available for essential and optional services. To provide for consistent public health services, additional targeted funding must be obtained and a distribution methodology must be identified and implemented to account for these low wealth differences. Infrastructure/Capacity Improvement Public schools funding models could be used to develop appropriate public health funding models in disadvantaged areas where health disparities are often the greatest. The PH school nursing funding formula also includes low wealth as a concept for allocation of scarce resources. This study should to be done in concert with local public health, county commissioners and state officials. Sources of good data include hospital uncompensated care data, the school funding formula, and the new school health nurse funding formula for distribution of funds in poorer counties. Budget $2.5,000,000 annually, to be adjusted for inflation on an annual basis. • 28 16. Support Legislation to Create a New Permanent Funding • Source for the Universal Vaccine Program. Needs Addressed/Rationale While vaccines are among the most cost-effective interventions in health care, the ongoing development of effective but costly new vaccines creates a great challenge to policymakers who strive to sustain a universal vaccine program in North Carolina. While the main beneficiaries of the universal program are the people of the state, insurance companies doing business in North Carolina also benefit from the presence of a program that provides critical services to persons enrolled in private insurance plans free of charge to these insurers. Cost of vaccines, especially at the retail level, are significantly higher than those purchased by the state on a federal contract. Therefore, legislation that secured a small percentage of each commercial insurance premium to defray the costs of universal vaccine provision would be equitable and would provide a reliable source of ongoing funding to support the universal provision of vaccines. 17. Authorize local health departments to charge fees for food and lodging program activities at the local level to help cover operational costs. Needs Addressed/Rationale • Local health directors and county commissioners on the finance committee highlighted the tremendous local burden that environmental health services/ programs place on county governments. It is clear from several of the documents reviewed, as well as the review of DPH funding, that the amount of funding that the state provides to local health departments to support environmental health is extremely small. Local health departments are allowed to charge a fee to support the on-site sewage program (septic tank permitting) in their counties. This fee is set by the Board of Health and varies by health department. However, it is the local option to determine how much fee base they choose to have and how much local appropriations they use to support this activity. In contrast, local public health agencies are currently prohibited by state statute to charge a fee to support the Food and Lodging Program. Each food establishment is charged a $50 annual state fee. Those funds come to the state and are redistributed to locals according to a base of $5,500 with an additional amount provided if 100% of the county's restaurants are inspected the appropriate number of times. The total amount that any health department receives is significantly below the cost of the program - ranging from .07 to .66 cents per capita. • 29 • Infrastructure/Capacity Improvement Legislative action is required to allow local health departments to charge fees for food and lodging activity. State fees could be eliminated if local fee options were implemented, but additional state appropriations would be needed to replace the funding that DENREH retains for state activity. Budget No new funds required. 18. Assure that a mechanism is developed that allows LHD and CDSA Medicaid rates to be updated annually to more accurately reflect the cost of providing services in these settings. Needs Addressed/Rationale Currently, LHDs and CDSAs receive federal payment of only 70% of their costs not covered by Medicaid reimbursements. This causes LHDs to not generate the Medicaid receipts/revenues in keeping with the actual cost of providing services. Medicaid rate adjustments for these services are not on any routine schedule for updating. This combined situation costs LHDs ($13,385,628) and CDSAs ($4,944,419) a total of $18,330,047/year. • Infrastructure/ Capacity Improvement Unrecovered cost reimbursement and enhanced capabilities for documentation of associated Medicaid costs and services. Budget - $18,330,047/yr. $ 15,275,039 (state/25%); $ 3,065,007 (local/5%) FT1Es (0) State (0) Local 19. The state should fund the county Medicaid share and direct that an appropriate portion of freed-up county revenue be appropriated for local public health core infrastructure and service needs. Needs Addressed/Rationale County commissioners and local health directors on the Finance Committee repeatedly stressed the burden that the local Medicaid match inflicts on county government, denying adequate funding to support many critical services needed by local residents. • The majority of committee members agreed that this burden should be relieved by the state. There was no consensus on whether a percentage of the resulting county funds 30 should be designated by the state for public health purposes. Or, if a percentage were to be designated, there was no consensus on what percentage should be designated. • Final consensus was that all agencies of county government would benefit from this relief, including public health and that this Task Force must recommend that a significant percentage of the local revenue freed up be directed to local public health for infrastructure and core service gaps. North Carolina is the only state with a county Medicaid match. Estimated cost from research done by various legislative committees and stated in multiple legislation that has been introduced for this purpose is approximately $500,000,000 per year. Budget Exact costs to be determined. FTEs (0) State (0) Local 20. Secure state funding to continue the development of Health Information System (HIS) as a partnership with local health departments. Needs Addressed/Rationale • The state's Health Services Information System (HSIS) is totally outdated and does not meet state or local health department needs. Sixty-five county departments are totally dependent on HSIS for all reporting and billing activities. These departments provide one third of the total services reportedibilled to the state from local public health. The remaining 20 departments, which are larger and better funded, have purchased propriety software applications that provide them a much more robust management information system. But, those departments must send their statistics to the state DPH through an interface with HSIS, the only system that DPH has for this activity. The seven individual vendor applications of these health departments must interface with HSIS and are essential for the state and local health departments. It is becoming more and more difficult to get the HSIS state system to appropriately interface with these newer systems. If failed transmissions of data occur for whatever reason, it impacts county Medicaid cash flow and requires extensive staff time to resolve and resend the information. Local health departments have already begun to provide funding to the state in support of this project. Two other divisions in DHHS have been involved in the development of detailed business requirements and may participate in its funding. Budget Note: FY '07 is the highest year of development costs - approximately $18,000,000. Local health departments are to contribute approximately $5,000,000 through the • 31 Random Moment Studies earnings, with the remaining $13,000,000 to come from state • appropriations. • $13,200,000 (state) • $ 4,800,000 (local) 21. Re-convene and charge the public health study commission to assess the broad issues of funding Public Health in North Carolina, including: • Conducting an analysis of the funding of public health at all levels of government within NC (state and local responsibilities). The study should determine "who should pay for public health" and include an assessment of how other states support public health. • Documenting the "real costs" of under funding public health by identifying decreased health outcomes and health promotion/ disease prevention activities curtailed or not offered as a result of under funding. Conducting oversight of the implementation of a revised system of public health financing in North Carolina. • Needs Addressed/Rationale There is a critical need for an updated review and assessment of the state's system of public health financing. The evolution of funding for public health has not always reflected an adequate appraisal of needs nor a thorough assessment of potential funding sources particularly with regard to equity and state-local contributions. The review called for in this recommendation needs to be conducted by a body with the necessary expertise, experience and authority to ensure that progress will occur. • 32 CORE SERVICE GAP RECOMMENDATIONS • Budget Summary • School Nurse Services $ 13,000,000 (2007 - 2008)* • HIV/AIDS Prevention & Control $ 3,341,656 HIV/AIDS Drug Assistance Program (ADAP) No new funding requested. • Eliminating Health Disparities: Title VI Compliance $ 4,815,000 • Eliminating Health Disparities: Community Grants $ 3,000,000 • Chronic Disease Prevention $ 8,099,200 • Injury Prevention $ 970,000 • Immunizations/Universal Vaccine Program $ 35,900,569 • Environmental Health $ 5,428,111 • Early Intervention $ 10,600,000 * First year (2007 - 2008) of Five- (or Ten-) Year Plan (see following section) • 33 School Nurse Services • Need Addressed/Rationale The School Nurse Funding Initiative (SNFI) provided by the General Assembly in HB 1414 on July 18, 2004 provided 80 permanent and 65 two-year school nurse positions. This initiative improved the nurse to student ratio from 1:1897 in the 2003-04 school year to 1:1593 in 2004-05. The highest nurse to student ratio in a local education agency (LEA) was 1:4537 after the first year of implementation, compared to 1:7082 before implementation. All LEAs in the state now have at least two school nurse positions. Twenty-one LEAs met the recommended 1:750 ratio in 2004-05, compared to 10 LEAs that met the recommendation prior to SNFI implementation. Despite a 31,686 student enrollment increase in 2005-06, the nurse/student ratio improved slightly, from 1:1593 to 1:1571, due to an increase of 30 school nurse FTEs. Most positions were provided by new local or foundation funds. A few were previously funded vacant positions that were filled in 05-06. • The 65 two year positions were made permanent for 2006-07 and beyond. However, the 227 additional positions recommended by the Public Health Task Force for FY 05-06 and 292 positions recommended for 06-07 were not funded. The SNFI funding helped focus an emphasis on school nurses at the local level and a few LEAs increased local funding in 2005-06. • Attached are two options for reaching the 1:750 school nurse to student ratio. One is a five-year plan and the second is a ten-year plan: For discussion purposes, $60,000 per position was used in the cost projections. Hiring at the $50,000 funding level has been difficult. Some LEAs have added local funds in order to attract experienced school nurses. • 34 Infrastructure/Capacity Improvement • The table below depicts a five-year plan to achieve the national standard of 1:750 school nurse to student ratio. Five Year Plan for Reaching 1:750 School Nurse to Student Ratio School School Nurse School Student Nurse Year Enrollment to Student FTEs Ratio 2004-05 1,332,009 836 1:1593 New School FTEs if Positions FY Cost** ected Ratio if no Nurse SN to Pro jeded Student pono Position Nereachto FTEs with Student (forlNew) Enrollment* Increase New Ratio Increase 1:750 by positions Positions 2015 2005-06 1,353,483 836 1:1619 .0 0 1:1619 2006-07 1,371,636 836 1:1641 0 0 1:1641 2007-08 1,385,365 836 1:1657 217 1053 1:1309 $13.0 2008-09 1,396,467 836 1:1670 217 1270 1:1092 $26.0 2009-10 1,408,815 836 1:1685 217 1487 1:947 $39.0 2010-11 1,423,144 836 1:1702 217 1704 1:835 $52.0 2011-12 1,441,848 836 1:1724 218 1922 1:750 $65.1 1,086 * Department of Public Instruction **$60,000 per position Budget Funds required: $13,000,000 per year for five years. • 35 Infrastructure/Capacity Improvement . The table below depicts a ten-year plan to achieve the national standard of 1:750 school nurse to student ratio. Ten Year Plan for Reaching 1:750 School Nurse to Student Ratio School School School Student Nurse Nurse to Year Enrollment urs Student FTEs Ratio 2004-05 1,332,009 836 1:1593 New School FTEs if Positions FY Cost" Projected Ratio if no Nurse SN to no Needed to (millions) Student Position Position reach FTEs with Student for New E`.nrollment* Increase Increase 1:750 b New Ratio Positions 2015 by Positions 2005-06 1,353,483 836 1:1619 0 0 1:1619 2006-07 1,371,636 836 1:1641 0 0 1:1641 2007-08 1,385,365 836 1:1657 120 956 1:1449 $7.2 2008-09 1,396,467 836 1:1670 120 1076 1:1298 $14.4 2009-10 1,408,815 836 1:1685. 120 1196 1:1177 $21.6 2010-11 1,423,144 836 1:1702 120 1316 1:1081 $28.8 2011-12 1,441,848 836 1:1725 121 1437 1:1003 $36.1 • 2012-13 1,461,843 836 1:1749 121 1558 1:938 $43.4 2013-14 1,484,584 836 1:1776 121 1679 1:884 $50.7 2014-15 1,509,550 836 1:1806 121 1800 1:838 $58.0 2015-16 1,514,610 836 1:1812 121 1921 1:788 $65.3 2016-17 1,531,144 836 1:1831 121 2042 1:750 $72.6 1,206 Department of Public Instruction thru 2015 (2016-2017 projected growth trend) "$60,000 per position Budget Funds required: $7,200,000 per year for first four years, $7,300,000 for each of next six years. • 36 HIMIDS Prevention & Control • Needs Addressed/Rationale The number of new HIV and AIDS cases reported in North Carolina has increased annually since 2000. Although great strides have been made, much remains to be done. HIV and other STDs disproportionately affect minority populations. Local health departments, community- based organizations, historically black colleges and universities and HIV care consortia provide the most direct, appropriate and effective links to the communities and populations at highest risk. These organizations and agencies are not adequately funded, equipped or staffed to provide the variety and magnitude of services required to effectively slow the spread of the disease in the affected communities and populations. African Americans currently comprise 70% of the persons living with HIV/AIDS in NC; the rate of HIV infection among Hispanics has increased from 12.3 per 100,000 in 2000 to 24.2 per 100,000 in 2005. Infrastructure/Capacity Improvement This multi-faceted initiative will increase the capacity of local health departments, community-based organizations, historically black colleges and universities and the state agency charged with HIV/STD prevention and care. The goal will be to significantly increase the number of persons that benefit from the full spectrum of HIV prevention activities - risk reduction and awareness education, counseling and testing and early medical intervention. Community and campus-based access to HIV counseling and testing using a combination of rapid and serologic testing techniques will enhance both community and individual awareness • and help ensure early access to care. Once identified, infected persons will, benefit from "prevention for positives" activities that will include the hiring of care coordinators at the local level to help ensure that clients remain in care. This effort will decrease the number of person who are unknowingly infected with HIV/AIDS, assist them with early access to care services and keep them in care. Also required is legislation that authorizes the State Health Director to approve the implementation of Clean Syringe Exchange Projects (CSEP) in selected counties. In order for such an initiative to be approved, a county plan would need to be developed and agreed upon by selected individuals/officials within the county and approved by the County/District Health Director. The State Public Health Agency would be authorized to provide technical assistance to interested counties and would develop and implement an evaluation plan for the project. These combined and expanded community-based strategies will reduce the on-going spread of HIV/AIDS in North Carolina, especially in poverty- stricken, minority communities who are disproportionately affected. Budget Total funds required: $ 3,441,656 $2,000,000 for community-based organizations and historically black colleges and universities $1,341,656 for local health departments . $ 100,000 for the evaluation of the CSEP 37 1 1 HIV/AIDS Drug Assistance Program (ADAP) • Needs Addressed/Rationale The NC AIDS Drug Assistance Program (ADAP) has had a waiting list for services for a significant portion of the past ten years (since fall 1996). At several points during this ten- year period, the number of low-income North Carolinians living with HIV disease that were on the Waiting List approached 1,000. Individuals that need but are not able to access the ADAP Program to obtain their essential, life-sustaining medications often show up in hospital emergency rooms and/or other health care facilities requiring more intensive - and more expensive - medical care. The deterioration of their health status often leads to their becoming eligible for other public programs such as Medicaid, and resulting in significantly larger and longer-term public payments than if they had been participating in the ADAP Program. People who can't get their medications on a regular basis are typically sicker, and frequently become unable to work. This may increase their dependence on unemployment insurance and other public programs as well as on Medicaid. HIV prevention efforts are also hindered when infected individuals cannot obtain their medications on an ongoing basis. Persons living with HIV/AIDS that are on medications tend to have lower viral loads (i.e., less virus in their blood), which reduces the probability of transmitting the disease to others. Individuals on medication are also more likely to be in medical care:, providing an opportunity for ongoing monitoring and prevention counseling.. Infrastructure/Capacity Improvement • Increasing the financial eligibility criterion for the program to at least 200% (and preferably 250%) of the federal poverty level is required if the Program is to be able to serve the majority of low-income North Carolinians living with HIV disease that are without any other source of payment for access to their medications; current legislative budgetary efforts indicate that an eligibility increase may be possible in SFY 2007. Budget • For SFY 2007 eligibility can be raised without additional funding; for the longer tern, additional funding will be required. • No increase in state/federal appropriations is required to increase the financial eligibility criterion to 200% of the federal poverty level. • Any increase in state/federal appropriations that may be required to increase the financial eligibility criterion to 250% of the federal poverty level will be determined based upon analysis of the impact of the spending increase to 200%. FTEs • 0 state • 0local • 38 Eliminating Health Disparities: Title VI Compliance Needs Addressed/Rationale • In August 2000, President Bill Clinton signed Executive Order 13166, "Improving Access to Services for Persons with Limited English Proficiency (LEP)." The Executive Order also requires federal agencies to examine the services they provide, identify any need for services to those with Limited English Proficiency, and create a system to provide those services. The Executive Order also requires that federal agencies work to ensure that recipients of. federal financial assistance (like public health departments) provide meaningful access to their LEP clients. Title VI of the Civil Rights Act says that a program receiving federal dollars cannot discriminate against any client because of race, color or national origin. The courts have held that Title VI prohibits recipients of federal financial assistance from denying LEP persons access to programs, on the basis of their national origin. North Carolina has a diverse population - 21.4% African Americans, 4.7% Hispanic/Latinos, 1.4% Asian, and 1.2% American Indians. According to the 2000 U.S. Census figures, the Latino population grew by 394% between 1990 and 2000, the largest increase of any state in the country. The report, The Economic Impact of the Hispanic Population on the State of North Carolina, published by John D. Kasarda and James H Johnson, Jr., January 2006, revealed that in 2004, the North Carolina Hispanic/Latino population comprised 7% of the state's population for a total of 600,913. Hispanic/Latino accounted for 27.5% of the state's population growth from 1990 to 2004. The demand for providers in the health and human service fields who are culturally and • linguistically qualified has increased. The growing number of Latinos in North Carolina has presented new challenges to health and human service providers. Language is the most significant barrier to providing adequate care for Latino clients. In a December 2003 assessment of local health departments and community based organizations, the need for cultural diversity training and interpreters were identified as resources needed to support their efforts to provide effective services to clients. In a January 2006, an interpreter services survey was disseminated to all local health departments in North Carolina by NCALHD (NC Association of Local Health Directors) in a joint effort with the NCOMHHD. The development of the survey was in response to a request from MHAC (Minority Health Advisory Council). Seventy-four (74) out of 85 local health departments responded to the survey (87%). The survey addressed the following issues: • The number of full time, part time, and contract interpreters • The estimated annual cost for interpreter services • The ways that interpreter services positions are funded • The ways that health departments communicate with LEP clients, if an interpreter is not on-site Infrastructure/Capacity Improvement The North Carolina General Assembly appropriated a recurrent amount to fund a program aimed at creating new full time positions for interpreter services at the local health departments to enhance their capacity to serve LEP clients. With the allocated funding, 11 • 39 health departments were funded through the NCOMHHD (NC Office of Minority Health and • Health Disparities), for a 3-year period beginning FY05/06. An end of year report was requested from all the grantees to show their outcomes, challenges, and/or successes. The report showed that the new interpreters reach 7,506 LEP clients in a two to four month period. It would be beneficial to LEP clients if we could expand the program statewide. In order to expand the program statewide additional funding is being recommended to increase the number of health departments from 11 to 85. It is a federal mandate to comply with the 1964 Civil Rights Act, Title VI. It is recommended that one (1) full-time position be created to: • Train compliance officers at local health departments and other DPH agencies; and • Address Title VI issues to ensure that health departments are complying with the mandate. Additional funding is needed to provide training, resource materials, and travel reimbursement. Budget 4 • *Minority Health - Interpreters $4,750,000.00 FT Es • One (1) Title VI Position $ 65,000.00 * This amount is to further support the Minority Health-Interpreter grant that is providing • funding for the local health departments. • 40 Eliminating Health Disparities: Community Grants Needs Addressed/Rationale • North Carolina has a long history of defining and addressing issues related to minority health and health disparities. Key state and national policies have played a pivotal role in elevating the issue of eliminating health disparities in our state. Focused attention on the disproportionate burden of disease among racial/ethnic minorities has been gaining momentum since the first minority health report was published in 1985 for the nation, "Report of the Secretary's Task Force on Black and Minority Health" and in 1987 for the state, "The Health of Minorities in North Carolina". These reports set the wheels in motion for the establishment of the Office of Minority Health and Health and Disparities (OMHHD) and the Minority Health Advisory Council (MHAC) in 1992 by House Bill 1340, part 24, Section165-166. The mission of OMHHD and MHAC is to promote and advocate for the elimination of health disparities among all racial and ethnic minorities and underserved populations in North Carolina. The MHAC is further mandated to advise the Governor and cabinet Secretary of Health and Human Services on minority health issues. In 1998, Surgeon General, Dr. David Satcher refrained the issues of minority health by challenging the nation to reduce and eliminate disparities in health by 2010 in six categories. These categories include cardiovascular disease, cancer screening and management, infant mortality, diabetes, HIV/AIDS, and immunizations. In 2000, the U.S. Department of Health and Human Services launched the new Healthy • People 2010 goals and objectives. The goal of the national initiative is to bring together national, state and local government agencies, non-profits, volunteer, and other public/private health agencies to improve the health of all Americans, improve years and quality of life, and eliminate disparities in health. This agenda was embraced by the N.C Department of Health and Human Services (DHHS) in 2001, with the appointment of Secretary Hooker Odom. She elevated the issues by challenging the Divisions and Offices in DHHS to identify and implement strategies to address access, service and health disparities. Health disparities are defined by the National Institutes of Health as "the difference in the incidence, prevalence, mortality, and burden of disease and other adverse health conditions that exists among specific population groups in the United States". OMHHD's working definition is "significant differences or inequalities in health that exist between whites and racial/ethnic minorities". The six areas in health with the greatest disparities in North Carolina include HIV/AIDS and sexually transmitted infections, diabetes, cancer, infant mortality, homicides and motor vehicle deaths. The State Center for Health Statistics has documented the plight of minorities for years. In 2003 and 2006, the Office of Minority Health and Health Disparities and the State Center for Health Statistics issued the "Racial and Ethnic Health Disparities in North Carolina Report Card". The purpose of the Report Card is to establish a baseline and set a framework to monitor progress towards eliminating the health status gap between racial and ethnic 41 minorities and the white majority population. This card sets out 37 indicators of health status • for racial and ethnic groups. It uses letter grades (A, B, C, D or F) to compare health status indicators. The health status of the white population is used as a point of comparison to determine the disparity ratio. The grades are based on the ratio of the measure for a specific racial or ethnic group to the measure for the state's majority white Population. Some highlights from the 2006 Report Card notes that the percent of African American families living below the federal poverty level is 3.4 times higher than that of the white population yielding a grade of an F, American Indian and Hispanic/Latinos 2.3 times higher, both with a grade of D; the African American infant mortality rate is 2.5 times higher than that of the White population. Grades of D and F are noted for a number of indicators in the Report Card. These include Diabetes Deaths with a grade of D for African Americans; HIV disease deaths with a grade of F for African Americans (13.7 ratio) and a grade of D for Hispanic/Latinos (2.4 ratio) and American Indians (1.9 ratio); For Homicide deaths there is a grade of F' African Americans (3.6 ratio) and American Indians (3.5 ratio) and a D for Hispanic/Latinos (2.5 ratio). In May 2004, the State Center for Health Statistics and the Office of Minority Health and Health Disparities published a report, Racial and Ethnic Differences in Health in North Carolina: 2004 Update. This report demonstrates generally poorer health among African Americans and American Indians in North Carolina compared to Whites, across a variety of measures. This report looks at deaths, incidence or risks factors among adults, related to injuries, cancer, HIV and sexually transmitted diseases, teen pregnancies, maternal and infant health etc. These reports strongly assert that, "describing racial and ethnic differences in • health is crucial because it allows the targeting of resources and culturally appropriate health improvement programs toward populations in need." Infrastructure/Capacity Improvement In response, the 2005 General Assembly appropriated two million dollars ($2,000,000) to support the Community Focused Eliminating Health Disparities Initiative (Senate bill 1741, Ratified bill, Section 10.18). The Community-Focused Eliminating Health Disparities Initiative (CFEHDI) provides grants-in-aid to local public health departments, American Indian tribes, and faith-based and community-based organizations to close the gap in the health status of African-Americans, Hispanics/Latinos, and American Indians as compared to white persons. These grants focus on building the capacity of eligible organizations to develop, implement and evaluate preventive measures to support healthy lifestyles. The areas of focus on health status include infant mortality, HIV-AIDS and sexually transmitted infections, cancer, diabetes, and homicides and motor vehicle deaths. These funds are also used to support an Epidemiologist position to monitor, track, and evaluate grantees' progress in meeting performance-based standards and outcomes established by the program. Additional funds to support this effort are needed. Budget • CFEHDI Grants: $3,000,000.00 (recurring) FTEs • One Project Manager: $ 55,000.00 • 42 Chronic Disease Prevention & Control Needs Addressed/Rationale • Chronic diseases are one of the most important public health issues of our time. Just as infectious diseases threatened the health and well being of communities in the early 20`h century, chronic diseases are now the greatest threat of the 2151. Heart disease, stroke, diabetes, and cancer are responsible for the deaths of 15,000 North Carolinians each year. This represents 35% of deaths in the state annually. The prolonged course of illness from chronic diseases results in extraordinary direct and indirect costs, pain and suffering, poor quality of life, and disability for millions of Americans. It is becoming increasingly clear that we, as a society, cannot afford the current healthcare cost trajectory. These health problems must be prevented. It is important that every local health department in the state has some resources to engage in evidence-based intervention strategies and the capacity to effectively compete for additional sources of funding from other philanthropic and public sector institutions.. A $1,000,000 reduction in state funding in 2001, and a $1,100,000 reduction in federal funding in 2006, has reduced the baseline level of general health promotion funding that has traditionally been invested in every local health department in the state. A comprehensive approach to chronic disease prevention also includes state-wide screening programs. Early detection of breast and cervical cancer is one of the most effective public health interventions available. The North Carolina breast and cervical cancer control program increases access to screening and treatment services among the state's uninsured population. • It is estimated that over $7 billion per year is spent in the United States on the treatment of breast cancer, and over $2 billion per year on the treatment of cervical cancer. Increased screening significantly reduces breast and cervical cancer mortality. Expansion of this valuable program will allow the program to provide cancer screening to more women throughout the state. Reducing tobacco use has the potential to dramatically reduce the two main causes of death in North Carolina, heart disease and cancer. Conservative estimates from CDC show that tobacco use costs North Carolina's Medicaid program at least $600 million. A solid body of literature demonstrates the effectiveness of tobacco quitlines in treating tobacco addiction.. Quitline services have been able to double or in some cases triple quit rates at a very low cost. Quitlines offer exceptional convenience and flexibility and can reach low income, rural, elderly, uninsured and racial and ethnic minorities that otherwise may not have access to cessation services. North Carolina currently does not have adequate resources to fund quit line services for the adult population on an ongoing basis. Infrastructure/Capacity Improvement Chronic Disease Prevention and Control • This proposal builds on the existing Statewide Health Promotion Program to allow each county in NC to reach a minimum capacity level of one FTE Health Educator (valued at $50,000) and funds for pilot projects (valued at $20,000). Local programs will be expected to generate additional local 43 • funding to implement evidence-based interventions to control chronic disease risk factors and eliminate health disparities. • Technical assistance to the counties would be expanded by increasing the number of state regional consultants from 3 to 4 (valued at $60,000) and expanding operating expenses by $25,000. Expand Access to Evidence-Based Screening • This proposal will expand eligibility from 200% to 250% of the federal poverty level for participation in the Breast and Cervical Cancer Control Program. The proposed funding will augment current federal funds to provide breast and cervical cancer screening and follow up services for at least 8,000 additional underserved women in North Carolina through the work of local health departments and other providers including comraunity and rural health centers. The funds will also increase the . number of women between 40-49 who are eligible for breast cancer screening. Improve Control of Chronic Disease Risk Factors . This proposal requests basic operational expenses necessary to implement and maintain a quitline for residents across the state who are highly motivated to quit smoking (valued at $1 million). A modest promotional nicotine replacement therapy campaign for disparate, low-income populations is also proposed (valued at approximately $575,000). • Budget Intervention Budget Statewide Capacity for Chronic Disease $4,287,700 Prevention and Control: Expand Access to Evidence-Based $2,236,500 Screening Improve Control of Chronic Disease $1,575,000 Risk Factors Total $8,099,200 • 44 Injury & Violence Prevention • Needs Addressed/Rationale Injuries are pervasive. Injuries are not accidental, random or unpredictable. Injuries that occurred in 2000 will cost the U.S. health care system $80.2 billion in lifetime medical care costs. There will be an estimated 700,000 visits to North Carolina emergency departments for injuries in 2006. They are the leading cause of death in North Carolina residents ages 1 through 44 and the 4`h leading cause of death for all ages. More than 5,000 North Carolinians die from their injuries each year. Because fatal injuries occur most often in our younger residents, they result in over 1.5 million years of potential life lost to our families and communities every decade. Loss of life from injuries disproportionately affects our minority populations. And, the disparity in fatal injury mortality rates by race/ethnicity is often even greater at the county level than reported for the state. For example, since 1999, mortality rates per 100,000 residents for motor vehicle crashes were 60% higher for African Americans, 40% higher for American Indians and almost 300% higher in Latinos of any race living in Robeson County when compared to the motor vehicle crash rates for their race/ethnic groups for the state. In 1999, an Institute of Medicine report called for significantly increased funding to strengthen injury surveillance and prevention programs in each state. The ability of public health workers at the state and local levels to be involved in injury prevention is undermined by lack of rapid and comprehensive injury surveillance data and the lack of access to programmatic guidance from injury prevention experts. Their ability to perform the essential • services/core functions of public health has been compromised because there is limited local infrastructure for an effective public health approach to injury and violence prevention. There is no state support to local health departments to develop, implement or evaluate priority, evidence-based injury and violence prevention programs. Infrastructure/Capacity Improvement Surveillance The Injury and Violence Prevention Branch routinely reports the prevalence, incidence and trends of all fatal and non-fatal injuries in North Carolina and its counties. Special reports are provided when surveillance indicates injuries of epidemic proportions or indicate other areas of concern. Epidemiologists use data obtained from death certificates, the hospital discharge database, medical examiner records, law enforcement reports and the emergency department database in their surveillance and reporting. Federal funding for core injury surveillance that funded the injury epidemiologists in the Injury Surveillance Unit of the Injury and Violence Prevention Branch in 2000 ended in 2005. No reliable funding has been obtained to support these positions. This may ultimately undermine the generation of standard and topic-specific injury mortality and morbidity reports for the Division of Public Health, extant injury-related task forces, councils and leadership teams, and other key injury prevention partners at the state and local levels, thus undermining the capacity of local health departments and other injury stakeholders to fund, develop, implement and evaluate evidence-based injury and violence prevention programs. The ability 45 to prevent injuries requires adequate surveillance for monitoring injuries, their causes, and • their consequences. Funds for 2.0 FTE Public Health Epidemiologists will ensure the capacity to routinely monitor injury and violence events from multiple sources of data, to report findings to stakeholders in prevention, and to organize task forces or other appropriate groups to plan and lead prevention strategies. One prevention program development coordinator at the state level also should be funded. Prevention In North Carolina there is no state support to local health departments for injury and violence prevention activities, and limited training and technical assistance from state agencies including the Division of Public Health. Evidence-based prevention strategies exist for many causes of unintentional injury. Strategies for other causes of injury, and particularly violence, are under development and need to be implemented and evaluated. Injuries will continue to exact a large toll on individuals, their families and health care systems unless prevention strategies are more widely implemented and evaluated throughout the state. Seven regional injury prevention programs will be funded at $100,000 each. A State Injury Prevention Coordinator will be based in the Injury and Violence Prevention Branch and will identify and access the many prevention resources at the state and federal level and share them with the local coordinators through a regular and on-going regimen of training and technical assistance. • Budget Injur? Surveillance: 2.0 FTE Injury Epidemiologists (existing positions) $ 150,704 Surveillance reporting and operations $ 40,000 Prevention Program Development: 1.0 FTE Program Coordinator $ 64,296 Program development and operations $ 15,000 Regional Injury Prevention Programs (7) $ 700,000 C Total $ 970,000 Finkelstein EA, Corso PS, Miller TR, and Associates. The Incidence and Economic Burden of Iniuries in the United States. Oxford University Press, NY, 2006. • 46 C Immunizations/Universal Vaccine Program Need Addressed/Rationale • The General Assembly has determined that providing all vaccines required by the state free of charge to all children, regardless of family income, is sound public policy. Several reasons support this public policy. First, universal provision of required vaccines has been shown to effectively increase immunization rates. A disproportionate percentage of the states that have the highest rates of vaccine coverage in the US are "universal" states. This has been our experience in North Carolina as well: prior to the implementation of the universal program, vaccination rates, among two-year-olds were approximately 58%. Since the implementation of universal coverage, North Carolina's rates have increased to 84%, typically among the very best in the nation. Second, universal provision of required vaccines is sound public policy because it helps protect members of the public who would otherwise be vulnerable to morbidity and mortality due to preventable communicable diseases. These immunizations create "group immunity" which protects those who cannot be vaccinated for medical reasons, including people with cancer, organ transplants and HIV/AIDS. Third, immunizations are among the most cost-effective activities engaged in by government, saving $15 for each $1 spent. Supporting the cost of a universal program as a strategy for increasing rates of coverage and preventing disease among both the vaccinated and the • unvaccinated (protected because of group immunity) is a cost-saving investment the General Assembly was wise to make. Fourth, universal provision of required vaccines is a strategy that helps keep children in their medical home, a key public health and medical goal. Additional rationales for the universal vaccine program include: . • Cost of vaccines, especially at the retail level, are significantly higher than those purchased by the state on a federal contract. • Studies have shown that children are most likely to get immunized on time if they have a single medical home and a few visits with providers as necessary. • If parents of children have to pay out-of-pocket each time their child is vaccinated, this can be a barrier to keeping well-child visits and age appropriate vaccinations. All North Carolina children are eligible to receive at no cost all vaccines required to enter the public school system. At the present time, there are five childhood vaccines recommended by the CDC which • cannot be provided universally in North Carolina because of insufficient funding. They are: 47 • influenza vaccine, PCV7 ("pneumococcal" rotavirus, MCV4 ("meningococcal" and HPV (human papillomavirus). Capsule descriptions of the benefits of each of these vaccines are provided below. Influenza Vaccine According to the CDC, every year in the United States, on average, 5% to 20% of the population becomes infected with influenza. More than 200,000 people are hospitalized from flu complications, and about 36,000 people die from flu every year. Influenza vaccine has been shown to substantially decrease morbidity and mortality in target populations as well as to decrease morbidity and associated complications in individuals who are not vaccinated. Although this is not a new vaccine, funding is needed for children 2-5 years old as recommended by the ACIP. ($2,582,606) PCV7 Vaccine The streptococcus pneumonia bacterium is the leading cause of bacterial meningitis in the U.S., striking children under one year of age the hardest. About 200 U.S. children die each year from invasive pneumococcal disease. Also, pneumococcal disease causes 25% - 40% of middle ear infections in children. ($9,733,654) Rotavirus Vaccine Rotavirus vaccine protects infants and young children against rotavirus, an intestinal virus. Rotavirus is one of the most common causes of childhood illness; many ailments that parents or pediatricians describe as "stomach flu" are caused by rotavirus infection. Virtually every • child in the world contracts the virus repeatedly by age 5, gradually building immunity. Most children recover from rotavirus at home, but at least 55,000 U.S. children are hospitalized every year after becoming dehydrated from vomiting and diarrhea associated with the infection. ($9,793,293) MCV4 Vaccine Invasive meningococcal disease strikes adolescents and college-aged students most often and can have a very abrupt onset with very rapid progression of disease. The case fatality rate is 10% - 14%; up to 19% of survivors suffer serious sequelae including deafness, neurological deficit or limb loss. ($2,717,056) HPV Vaccine HPV vaccine is the first vaccine developed to prevent cervical cancer, precancerous genital lesions and genital warts due to HPV. The vaccine is highly effective against four types of the HPV virus, including two that cause about 70 percent of cervical cancer. On average, there are 6.2 million new HPV infections each year, 9,710 new cases of cervical cancer and 3,700 cervical cancer deaths in the United States each year. Three doses of HPV vaccine should be routinely given to girls when they are 11 or 12 years old. However, the vaccination series can be started as early as nine years old at the discretion of the physician or health care provider. The recommendation also includes girls and women 13-26 years old because they will benefit from getting the vaccine. This budget request is calculated based on covering one full birth • cohort of females (eleven or twelve year olds). ($11,073,960) 48 Infrastructure/Capacity Improvement This funding request is restricted to funding for vaccines. • Budget • Influenza vaccine $2,582,606 • PCV7 vaccine $9,733,654 • Rotavirus vaccine $9,793,293 • MCV4 vaccine $2,717,056 • HPV vaccine $11,073,960 Total $35,900,569 • • 49 Environmental Health • Needs Addressed/Rationale The Division of Environmental Health and local health departments administer and enforce the NC General Statutes and the sanitation rules of the Commission of Health Services. These mandated programs serve to protect the public health in the areas of. (a) Child-Care Centers, (b) Childhood Lead Poisoning Prevention, (c) Food, Lodging and Institutions, (d) Migrant Housing (MH), (e) On-Site Wastewater (OSWW), (f) Public Swimming Pools, and (g) Tattoos. As North Carolina grows, there is a direct relationship in the increased workload in local health departments. The burden of funding this increased workload and enforcement has impacted county finances. Additional state support is needed at the local level. Funding is requested to provide each county with an additional environmental health specialist. Infrastructure/Capacity Improvement An increase in the number of environmental health specialists (FTEs) in local health departments will require legislative action to provide additional funds. Each county will receive one additional environmental health specialist (1 FTE) to meet community needs. An increase in local capacity also is requested, with resource needs determined on a $50,000/county basis. Budget • $ 428,111 - Office of Accreditation Support & Accountability • 9; 5,000,000 - Local Environmental Health Core Services • FTEs • (7) State • (100) Local • 50 Early Intervention Needs Addressed/Rationale • The Early Intervention Program for infants and toddlers (also known as the Part C program, from the federal legislation, the Individuals with Disabilities Education Act (IDEA), which governs the program) serves infants and toddlers who have problems with their development. These very young children (birth to 3 years of age) can be referred to the program by anyone families, childcare teachers, pediatricians, or other people who work with children. Many children have a disability, but any child who seems to have a disability can be referred. The program is open in all 100 North Carolina counties. Many children are served for multiple years in the program. Children may stay with the program (unless they make enough developmental progress that they are no longer eligible) until they turn three years of age. Infrastructure/Capacity Improvement The reason that this new recommendation is being included at this time is that there has been a significant increase (approximately 270%) in the number of children and families referred to the program. In FY2003-04, there were 4,719 referrals to the program, which.is consistent with the number of referrals in previous years. In 2004-2005, however, there were 17,263 referrals. During 2005-2006, referrals continued at a rate. that annualized to over 17,000 a year. There are several reasons for this increase in the number of referrals. New federal legislation (the Child Abuse and Treatment Act (CAPTA)) requires that all infants and toddlers substantiated for abuse or neglect be referred to the program. Medical providers such as • pediatricians and family medicine physicians have markedly increased their use of validated screening tools when performing well-child developmental screens, and these evidence-based practices have more effectively identified infants and toddlers for referral to the program. Finally, the program has worked hard to ensure that parents, caretakers, child care providers and others who interact with infants and toddlers are aware of the program and understand the value of what the program can offer to infants and toddlers with developmental delay and conditions associated with developmental delay. The marked increase in referrals experienced by the program does not represent a sharp increase in the prevalence of developmental delay in infants and toddlers, but rather clearly represents more effective identification of these children. As such, it represents a great opportunity for the state to serve more children in need during the most formative period of their lives, before these problems worsen and become more intractable. The marked increase in referrals experienced by the program presents two serious challenges. The first is the inability of the program, given the resources currently available, to serve the number of children referred. The second is the inability of the program to move children in a timely fashion from referral into the program. In this way a critical cornerstone of best practice in El-to intervene early-is compromised. Budget $ 10,600,000 • FTE Positions: 76 (state); 84 (receipt supported) • 51 ADDENDA • Automation Report: Public Health Information Network • • 52 AUTOMATION REPORT: PUBLIC HEALTH INFORMATION NETWORK Improved information technology is one of the most critical infrastructure capacity • improvements that the public health system must undertake. The North Carolina Division of Public Health has several information technology initiatives currently in place and in development that will significantly enhance the state's ability to monitor, manage, and respond to the health needs of its citizens. These systems are being developed as a part of the North Carolina Health Information Network (NC-PHIN). These statewide systems will be developed using state and federal resources with the exception of the Health Information System, which will be developed in partnership with local health department. These systems will provide new functionality and linkages to all local users. Below is a synopsis of each initiative and the timeline for development and /or implementation. North Carolina Public Health Information Network (NC PHIN) The North Carolina Public Health Information Network (NC-PHIN) is a set of enterprise level standards of functionality and security under which critical information systems can be developed and shared appropriately. The NC Division of Public Health has developed a base technology infrastructure that supports NC-PHIN. The technology infrastructure allows for enhanced communications and the bringing together of functions and organizations that are public health. It is the overriding goal of information technology efforts within the NC DPH. The infrastructure will be adapted and expanded as applications are implemented. • Estimated Implementation: As needed Health Alert Network (HAN) • The North Carolina Health Alert Network was the first component built using the NC- PHIN standards. It was funded by the CDC Bioterrorism Grant Program. NC-HAN was deployed October 2002. It allows secure Internet browser-based communications among key public health officials . and their partners on information about public health emergencies confirmed or suspected communicable diseases, and other health threats. It does notification by phone, fax, pager and email. The system has proved valuable in dealing with issues such as SARS, E-Coli, and West Nile virus. NC-HAN also has a public web site (www.nchan.orp) that provides timely and accurate information about public health threats to citizens. The Enhanced Public Health Surveillance initiative will utilize HAN as the alerting and communications system. • Implemented October 2002 Health Information System (HIS) This initiative will provide an automated means of capturing, monitoring, reporting and billing services provided in Local Health Departments (LHDs), Child Development Services Agencies (CDSAs) and the State Laboratory of Public Health (SLPH). It will allow for interfaces to LHDs owned systems. It will replace the outdated Health Services Information System (HSIS). A contract has been awarded to Covansys Corporation and the software to be installed is Netsmart Avatar suite of products. The Division of Public Health is currently working with vendor on deliverables and schedule. • • Estimated Implementation: Schedule Pending 53 • NC Immunization Registry (NCIR) A more robust and feature rich immunization registry has been implemented. The NCIR contains a single consolidated immunization record for each North Carolina child, regardless of how many immunization providers have treated the child. The information is shared, as required by state law, among immunization providers and. other authorized organizations and is used to assure timely and appropriate treatment and to provide official documentation of immunizations given. The consolidated record will help to assure timely and accurate administration of needed vaccines and prompt access in the event of an outbreak, vaccine recall and other situations that require rapid identification of immunizations administered. The NCIR provides information that facilitates the safe practice of vaccine service delivery through the analysis of side effects and contraindications specific to the patient. • Implemented 2005 Vital Records (VR) The Vital Records Automation Project will improve the birth registration process, along with associated efficiencies in data base management. Longer term improvements are expected in the death registration process along with associated reporting. A contract has been awarded to Genesis. A timeline has been agreed and numerous planning and configuration meetings have taken place since mid 2005. • Estimated Implementation: Spring 2007 • Laboratory Information Management System (LIMS) A contract has been awarded to StarLims to install and implement a new laboratory information management system. This is a direct purchase through the CDC/GSA. The new LIMS will improve internal controls and reporting and contribute toward PHIN compliance. • Estimated Implementation: Environmental March 2007, Clinical and Cytology-Oct 2007, NBS and Lab Certifications-May 2008 North Carolina Disease Event Tracking and Epidemiologie Collection Tool (NC DETECT) This CDC funded pilot project did the initial work with NC hospital emergency departments to understand how information can be collected, stored, analyzed and shared appropriately. The work was done under contract with the UNC School of Medicine, Department of Emergency medicine was the basis for subsequent development of the North Carolina Bioterrorism and Emerging Infection Prevention System (NCBEIPS). The name has been changed from NC BEIPS to NC DETECT to reflect the system can be used for a myriad of public health surveillance needs. NC DETECT was created by the North Carolina Division of Public Health (NC DPH) in 2004 to address the need for early event detection in North Carolina using a variety of secondary data sources. Authorized users are currently able to view data from the North Carolina Emergency Department Database • (NCEDD) and the Carolinas Poison Center. Data from the Pre-hospital Medical Information System (PreMIS), the Piedmont Wildlife Center and the NCSU College of 54 r L Veterinary Medicine Laboratories are in final testing and will soon be available for user analysis. NC DETECT analyzes these data sources with the Early Aberration Reporting • System (EARS), a SAS-based software package developed by the Centers for Disease Control and Prevention. • In production - 2005 North Carolina Hospital Emergency Surveillance System (NCHESS) North Carolina Emergency Surveillance System (NCHESS) is a system to electronically collect, report, monitor, and investigate emergency department (ED) and hospital data in near-real time from all participating hospitals in North Carolina. Data from NCHESS will allow public health professionals to detect unusual trends and public health emergencies earlier than current reporting systems so that appropriate action can be initiated. This system has been developed in partnership with the North Carolina Hospital Association. NCHESS will allow hospitals to fully comply with the mandatory hospital reporting law effective January 1, 2005. • Implemented 2005 North Carolina Electronic Disease Surveillance System (NC-EDSS) NC-EDSS is the North Carolina version of the National Electronic Disease Surveillance System. It will allow local health department, laboratories, hospitals, and individual providers to electronically notify the NC Division of Public Health whenever a case of reportable disease or condition occurs in NC. The system will assist health care providers in complying with existing NC disease reporting laws. The timeliness, reliability, and accuracy of reportable disease data in NC will improve significantly. NC-EDSS will be . fully integrated with the state's Health Alert Network. A contract for the application has been awarded to Consilience. • Estimated Implementation: TB Pilot-Sept 2006, Begin rollout March 2007 55 David E Rice/NHC To Kim Roane/NHC 09/26/2006 08:28 AM cc Janet McCumbee/NHC@NHC, NHCBH, bcc Subject Re: Fw: Flu/Pneumonia Rates[) Approved $30 for Flu and $45 for Pneumonia. Kim R08ne/NHC Kim Roane/NHC - - --09/25/2006 02:26 PM To David -E-Rice/NHC@NHC cc Janet McCumbee/NHC@NHC Subject Re: Fw: Flu/Pneumonia RatesQ Flu..... Medicare has not yet released their full reimbursement amounts. Last year's full reimbursement amount was $29.55, but we were only able to collect $25.00 because that's the amount we billed as our fee. Pneumonia... current Medicare reimbursement amount is $44.52. Based on the concept that this year's Medicare reimbursement will be at least as high as last year's, that's how I arrived at a possible fee of $30 for Flu for this year, and $45 for pneumonia. Kim Roane ® Business Manager New Hanover County Health Department (910) 798-6522 fax (910) 341-4146 David E Rice/NHC David E Rice/NHC 09125/2006 01:45 PM To Kim Roane/NHC@NHC cc Janet McCumbee/NHC@NHC Subject Re: Fw: Flu/Pneumonia Rates(D What will Medicare allow? Kim Roane/NHC Kim Roane/NHC 09/25/2006 11:43 AM To David E Rice/NHC@NHC cc Janet McCumbee/NHC@NHC Subject Fw: Flu/Pneumonia Rates Dave, We need to set our price for flu and pneumonia vaccine. We've been trying to gather as much information as possible. Thus far, we have only an educated guess about the reimbursement rates from Medicare, and it looks like it will be close to $30 for flu and just under $45 for pneumonia. Last year, the price we charged for flu was $25, and $40 for pneumonia. We had to set our fees last year without knowing the reimbursement rate, and so it was set at $25, and we lost revenues as a result, because we could have collected almost $5 more/dose from Medicare had we set our fee at $30. This year, we're probably in a slightly different environment. It appears the vaccine will • be more plentiful. Maxim Healthcare is charging $25/dose, but those with BCBS pay nothing up front. Brunswick County is charging $30/dose this year, and Pander has not yet set their fee. Private doc offices won't say what they'll charge this year. If Maxim is charging $25, that will likely be the amount charged at drug stores giving the vaccine, since Maxim is the likely provider there. - -We.should probably.charge_$30/dose for flu and $451dose for pneumonia if we want to receive the maximum reimbursement/dose from Medicare, unless you prefer to hold it to $25/dose for flu for marketing purposes so we don't get stuck with a lot of doses in light of the availability of the vaccine this year. It's a bit of a gamble this year. Please let me know how you'd like to proceed. We'll need to get the word out this week in our announcements... we're opening the appointment lines next Monday. Thanks, Kim Kim Roane Business Manager New Hanover County Health Department (910) 798-6522 fax (910) 341-4146 Forwarded by Kim Roane/NHC on 09/25/2006 11:34 AM - Paula Jenkins/NHC To Kim Roane/NHC@NHC, Rob Neilson/NHC@NHC 09/25/2006 10:49 cc 4k • AM Subject Flu/Pneumonia Rates I am still receiving the same information from Provider Services which is to check the webshe and automated system. Information is still the same as last report. The lady I spoke with stated they will probably post the new "drug" pricing in October. Flu (90658): $12.06 Adm (G0008): $17.49 Pneumonia (90732): $27.03 Adm (G0009): $17.49 I'll continue to check periodically. Paula Jenkins Billing Unit Supervisor Health Department Phone: 910-798-6501 Email: pjenkins@nhcgov.com Mission: To assure a safe and healthy community. • Vision: Health People, Healthy Environment, Healthy Community Motto: Your Health - Our Priority David E Rice/NHC To Kim Roane/NHC 0926/2006 08:27 AM cc NHCBH, Marilyn Roberts/NHC, bcc Subject Re: Request for Approval of Fee Policy Changes • Approved. Kim Roane/NHC Kim Roane/NHC 09/25/2006 04:28 PM To David E Rice/NHC@NHC cc Subject Request for Approval of Fee Policy Changes Dave, The F.A.C.T. (Fee and Coding Team) met and are requesting your approval of the following changes to the NHCHD fee policy, as allowed per authority granted to you by the Board of Health and County Commissioners: • Change fee for Limited Physical/Daycare visits from $45 to $35 due to removal of requirement for a hemoglobin test. Annual revenue impact expected to be less than $300. • Change in fee for CPT code 88076 (hepatic panel) from $60 to $15, based on actual cost of service. Annual revenue impact expected to be less than $200. • Addition of serum pregnancy test (CPT 84703) at a fee of $20. Annual revenue • impact expected to be less than $200. • Addition of CPT code 90710-52 with a fee of $20 for new MMRV vaccine (measles, mumps, rubella and varicella). The $20 fee is only for administration of the vaccine... actual vaccine is free from the State. Annual revenue impact expected to be less than $1,000. Please let me know if you have any questions about these items. I recommend approval under your authority as Health Director. Thanks, Kim Kim Roane Business Manager New Hanover County Health Department (910) 798-6522 fax (910) 3414146 NEW HANOVER COUNTY HEALTH DEPARTMENT • 2029 SOUTH 17TH STREET WHZYUNGTON,NC 28401-4946 TELEPHONE (910) 798-6500 FAX (910) 772-7805 October 2, 2006 Senator Julia Boseman 5917 Oleander Drive Unit 200 Wilmington, NC 28403 Dear Senator Boseman: At the request of the New Hanover County Board of Health, we are inviting you to its November 1, 2006, beginning at 8:00 a.m. The purpose of our invitation is to address concerns regarding secondhand tobacco smoke. In recent years a groundswell of support for smoke-free policies in worksites, restaurants and bars has developed in states and localities across the country, including North Carolina. Currently, more than one-third of the U.S. population, or more than 100 million people, are now covered by strong smoke-free laws - a figure that has more • than doubled in roughly two years. Strong smoke-free laws are important because: • There is overwhelming scientific evidence that secondhand tobacco smoke is a direct cause of lung cancer (causing an estimated 3,000 nonsmokers to die each year), heart disease (35,000 deaths each year), and lung and bronchial infections (affecting a quarter million children every year). • In June 2006 the US Surgeon General issued a report on involuntary smoking stating that nonsmokers who are exposed to secondhand smoke at home or at work increase their risk of developing heart disease by 25-30% and increase their risk of developing lung cancer by 20-30%. Also, according to the new report, breathing secondhand smoke for even a short time can have immediate adverse effects on the cardiovascular system and interferes with normal function of the heart, blood and vascular systems in ways that increase the risk of a heart attack. Heart attack rates declined nearly 30% at two Pueblo, Colorado hospitals following the enactment of a citywide smoke-free workplace and public place ordinance. Researchers found that 399 heart attack patients were admitted to hospitals in the 18 months before the July 2003 smoke free law and only 291 after. • Smoke-free laws help protect restaurant and bar employees and patrons from the harms of secondhand smoke. • • Smoke-free laws help the seven out of every ten smokers who want to quit smoking by providing them with public environments free from any pressure or temptation to smoke. • Secondhand smoke can cause asthma in small children, and worsen asthma attacks in all who suffer. It's a known trigger for asthma attacks. • The CDC issued a commentary to doctors in 2004 warning that anyone who suffers from heart disease or has risk factors for heart disease can have a heart attack after as little as 30 minutes of exposure to secondhand smoke. You may know that the North Carolina General Assembly passed a law in 1993 preventing any local government from prohibiting smoking in public places in their county, city or town. Recently, a grassroots coalition of concerned citizens, businesses, health care professionals and non-profit organizations in Mecklenburg County began working to make Mecklenburg County restaurants, bars, and workplaces smoke-free. The coalition, Smoke-Free Mecklenburg, is asking that the state allow Mecklenburg County an exemption from this law so that the residents of Mecklenburg County can decide for themselves on making restaurants, bars and workplaces smoke-free. Tobacco prevention coalitions across the state, including New Hanover County's Project ASSIST, are closely watching the activities taking place in Mecklenburg County. The hope is that Mecklenburg will serve as a catalyst for change across the state, and soon New Hanover County's citizens will be able follow suit and vote on whether or not they would be in favor of a smoke free county. The New Hanover County Board of Health looks forward to your attendance to discuss this important issue and what can be done locally to support this worthwhile initiative. Your time, presence and input will all be greatly appreciated. Thank you very much for your kind attention. Please RSVP to David Rice, Health Director at the above addressor or contact him at 910-798-6591. • Sincerely, Donald P. Blake, Chairman New Hanover County Board of Health Debbie Crane To Ihd@ncmail.net <Debbie.Crane@ncm ail.net> 10/03/2006 04:00 PM bcc Subject elon college poll on tobacco THOUGHT V ALL WOULD BE INTERESTED IN THIS NEWS RELEASE Elon Poll finds support for N.C. smoking ban at 65 percent A new Elon University Poll shows 65 percent of respondents said they _ would support or strongly support a statewide law in North Carolina that would prohibit smoking in public places. Details... The poll also found 31 percent said they would oppose or strongly oppose the same statewide law. The poll, conducted September 24-28 by the Elon University Institute for Politics and Public Affairs, surveyed 649 North Carolina residents. The poll has a margin of error of plus or minus 3.9 percent. For this survey, public places were defined as public buildings, offices, restaurants and bars. It appears that the historical ties to tobacco in this state are now essentially severed, as anti-smoking sentiments prevail among North ® Carolinians, said Hunter Bacot, director of the Elon University Poll. Eighty-six percent said they agree or strongly agree that employees in North Carolina should be able to work in a smoke-free environment, while 7 percent of respondents said they disagree or strongly disagree. Some resistance to the smoking ban is evident, with 42 percent of respondents indicating they disagree or strongly disagree that all restaurants and bars should ban smoking. ItOs obvious from these results that North Carolinians prefer smoke free environments, said Bacot. The only resistance to a statewide ban appears when respondents are presented with the prospect of such a smoking ban being imposed unilaterally on all restaurants and bars. Seventy-nine percent of respondents said restaurant employees should be able to work in a smoke-free environment. Eighty-four percent said people eating in a restaurant should be free from second-hand smoke and 57 percent said they are either more likely or much more likely to visit ® a place for eating or entertainment where smoking is not allowed. Sixty-one percent of respondents said they were more likely or much more likely to keep visiting their favorite place for eating or entertainment if smoking were not allowed. Sixty percent of respondents said they prefer to visit restaurants and entertainment places that do not allow smoking, and 69 percent said they request a non-smoking table when they visit a restaurant that permits smoking. • The Elon University Poll has conducted several polls annually since 2000. The non-partisan Elon University Poll conducts frequent scientific telephone polls on issues of importance to citizens. The poll -results are shared with media, citizens and researchers to facilitate representative democracy and public policy making through the better understanding of the opinions and needs of citizens in the state and region. Community Services Co nrnun4 Development 305 Chestnut Street PO Bar 1810 Wihningtwr, NC 28402-1810 MY or 9103417836 910 3417802 fat L,Ly1^11~I G j Ol V Whningtonnc.gov NORTH CAROLINA Dial 711 TTYNoioe We are pleased to announce that Mayor Bill Saffo, Wilmington City Council, has appointed us to serve as Co-Chairs of a Steering Committee overseeing the development of a 10-Year Plan to End Chronic Homelessness. At the national level, the U.S. Department of .Housing and Urban Development (HUD) in conjunction with the United States Interagency Council on Homelessness is encouraging local communities to develop 10-Year Plans to End Chronic Homelessness. The City of Wilmington, along with over 200 communities across the country, has committed to developing such a plan. ® However, it is apparent that the issue extends beyond the City and is indeed a regional challenge, and as such requires a regional solution. At the local level, there are annual reports that on any given night in New Hanover, Pender, and Brunswick Counties there are approximately 500 homeless citizens who sleep in shelters, transitional housing and on streets. We know that a small segment of this population fits the definition of "chronically homeless" people who are unaccompanied with disabling conditions that have been continuously homeless for over one year or have had four episodes of homelessness in the past three years. While the chronic homeless represent only 10% of the homeless population, they consume over 50% of resources including emergency rooms,' mental health services, shelters, and jails. You have been identified as a key leader from the region to serve on the Steering Committee for this most important project. The meeting will be held on at the downtown branch of the New Hanover County Library. Please RSVP by calling Ms. Christine Campel at (910) 341-3233 or e-mail at christine.campel (c)wilminatonnc. oov. During this meeting you will be provided with more detailed information on the . purpose and timetable for developing a 10 Year Plan to End Chronic Homelessness. Subject to consideration of the Steering Committee, we envision limiting your time commitment to no more than five hours per month and expect to complete the plan by June 2007. Thank you in advance for your time and we look forward to working with you. Sincerely, Wendell Daniels Spiro Macris Go-Chair Co-Chair Cc: Sterling Cheatham, Wilmington City Manager Bruce Shell, New Hanover County Manager John Bauer, Pander County Manager Marty Lawing, Brunswick County Manager :ra o Awl e l+ 8 a~ ~ ''X a is] 0 1A Y • x A in/in 'A RQ71QRmTA 'nN YY4 Fil IHa{7 iHlAiai.IAln1IinAla nuu I.IN b7 In naln onro_tn_Inn National Association • Local Boards o Health Ne wsBrief 'United-We Stand rA...r "t.y.- Published for Members of Boards of Health Third Quarter, 2006 - What's -mica 0-77T-M- SATISFACTION just returned home from a superb National Association of Local Boards of Health (NALBOH) Annual Conference in San Antonio, Texas and, am I satisfed with what we have done? You bet. Am I satisfied that this is the best we can ' ' Directors & Staff do? The answer to that is no. Can we do better next year? I think the answer to that question is yes. There are those who think that these conferences • • just happen with little, if any effort. After all what is the big deal about having ail We lunch together or going to a training or orientation session? Membersh A large number of people spent many hours putting this conference together. It would take a book to explain the intricacies of planning and executing such a monumental task. The NALBOH Board of Directors, Staff, Committee Chairs, and Committee 4 Annual • members, with input from the membership, worked long hours to make this a successful conference. Silent • The member orientation presenters were charged with the task of presenting a comprehensive session to help new, as well as seasoned board members, understand the important position to which they have volunteered or have been elected to serve. The Program and the Education and Training • NALBOH Committees played a most vital role in mapping out what would come first and who would play what role. These are_ just a few of the committees that organized this endeavor. Each committee was assigned a staff member to provide guidance and arrange the timetable to facilitate the flow, as the Tobacco-Free USA conference involves many simultaneous activities. Planning for the conference was made more complex due to our co-location with the National 10 • Association of County and City Health Officials (NACCHO). Participants from both organizations enjoyed Emergency Preparedness the joint sessions. The joint social event was thoroughly enjoyed by all who attended it. All of those involved are to be commended for using their time and talents to make this such a successful conference. Congratulations and many thanks to each of you! 11 Calendar of Events We must now start the planning process for our conference next year. The first questions are what worked and where can we make improvements? We hope that answers to these questions and some suggestions with workable solutions will come from you, the membership. With a dedicated staff members and Board of Directors and our increasing membership, the future of NALBOH is bright. Our fifteenth annual conference is to be held on September 19 - 22, 2007 in Anchorage, Alaska. How many opportunities do people get to visit our 49th state? I'm looking forward to it. How about you? Keep safe and stay healthy, EIr.G 6E44... Lee Kyle Allen President National Association of Local Boards of Health 1840 East Gypsy Lane NALBOH Bowling Green, OH 43402 Phone: (419) 353-7714; Fax: (419) 352-6278 Email: <nalboh@nalboh.org> Website: <www.nalboh.org> Page 2 NALBOH NewsBrief Third Quarter 2006 Share Your Experiences ' @ Z ' With NALBOH VISION: The Vision of this Association is to represent the grassroots foundation of public health in America, actively NALBOH relies on board members and other volunteers to guide engaging and serving the public by empowering boards o its work. Committees meet monthly via conference calls. health through education and training. NALBOH will continue Members have an active role in recommending, reviewing and to expand its influence on public health policy, increase directing NALBOH activities and products. If you are interesting in resource allocation, and improve the clarity and volume of its serving on a committee, please contact the NALBOH office at national voice for our members. (419) 353-7714 for a committee form or you can download a form from the NALBOH website at <www.nalboh.org>. MISSION: The Mission of the Association is to prepare and strengthen boards of health, empowering them to promote ? Awards Committee and protect the health of their communities through Directs the search for award nominations. Reviews nominees and education, training, and technical assistance. selects award recipients. Coordinates awards and their presentation at the annual conference. Board of Directors ? Board Development Committee President President-Elect Oversees the election process for new Board of Director Lee Kyle Allen (NC) John Gwinn (OH) members. Facilitates orientation of new Board members and Secretary/Treasurer Past President conducts an annual self-evaluation of the Board. Gladys Curley (MD) Ronald Burger (FL) By-laws Committee Annually reviews NALBOH By-laws and submits draft and proposed East Great Lakes Region Mid Atlantic Region amendments. Presents revisions to the Board of Directors and the Alice Davis (OH) Walter Stein (NJ) association membership for vote at the annual conference. Midwest Region New England Region Larry Hudkins (NE) Shepard Cohen (MA) ? Education & Training Committee Southeast Region West Region Coordinates and reviews all education efforts between the James Gallenstein (KY) Carolyn Meline (ID) subcommittees: West Great Lakes Region Environmental Health & Emergency Preparedness Sharon Hampson (WI) Ex-Officio Performance Standards & Workforce Development Ned E. Baker (OH) Z Tobacco Control and Prevention State Affiliates Marie M. Fallon (OH) Works with the Program Committee in planning the annual Donna Rozar (WI) Janice McMichael (GA) conference and develops educational resources and training Ed Schneider (NE) Anthony Santarsiero (GA) materials to strengthen boards of health. Staff ? Finance Committee Executive Director Oversees the development and, implementation of financial policies Marie M. Fallon, MHSA and procedures. Explores additional income opportunities. DC Director Liaison Reviews financial statements, prepares the annual budget and Vacant coordinates the annual external audit. Project Director-Environmental Health & Emergency Preparedness ? Legislative Committee Jeff Neistadt, MS, RS Develops procedures for proposing legislation and programs to keep Project Director-Tobacco Use Prevention & Control national legislators informed on public health issues. Encourages Lauren Dimitrov, MPH legislative efforts at the state level to promote local public health Director-Education & Training advocacy efforts. Jennifer O'Brien, MPH, MA Membership Coordinator/ Publications Manager ? Membership Committee Grace Serrato Plans and organizes the annual membership drive and all follow-up NewsBrief Editor activities. Establishes targeted membership drives and explores Fleming Fallon, MD, DrPH joint membersKip ventures. Reviews dues structure and membership benefits. The NALBOH NewsBrief is published by the ? Program Committee National Association of Local Boards of Health Plans, organizes, and implements the annual conference; reviews past evaluations; presents draft conference schedules to the Board 1840 East Gypsy Lane Road, Bowling Green, OH 43402 of Directors for approval. Phone: (419) 353-7714; Fax: (419) 352-6278 Email: <nalboh@nalboh.org>; Website: <www.nalboh.org> ? State Association of Local Boards of Health (SALBOH) Development Committee The production and distribution" of this publication Identifies states with the potential to develop new SALBOH's; is supported by funds from the helps develop and establish state associations; provides or Centers for Disease Control and Prevention. identifies resources to organize state associations. Must be a president or executive director of a SALBOH to volunteer for this Reproduction or use of any contents enclosed must committee. O be requested in writing to the NALBOH office. ? Third Quarter 2006 NALBOH NewsBrief Page 3 • • • • - 2007 NALBOH Membership On CNN recently, I heard a reporter It is time to consider your 2007 NALBOH membership. A announce the most membership in NALBOH provides an opportunity for you and your mu commonly used board of health to: m( English word the. Have an input into national health policy; _ Sounds right, though Receive copies of the NALBOH NewsBrief for each board APF ~{~qqy ` = in Washington, member; r+.d r r 1111` sometimes I think Receive discounts for NALBOH educational materials; and the most common • Participate in NALBOH's exceptional Annual Conference at word is funding. a member rate. The Trust for America's Health reports that funding levels for The 2007 annual conference is planned for Anchorage, Alaska, programs intended to protect the health of U.S. citizens vary September 19-22, 2007. Plan on being part of this great dramatically among states. Shortchanging America's Health: A State conference designed specifically for those serving on boards of By State Look at How Federal Public Health Dollars are Spent-2006, health. reviews key health statistics and key federal public health funding at the state level. The study emphasizes that the country is falling Join NALBOH now by sending in the membership application short on achieving federally established goals for reducing disease below or return the invoice that will be mailed to you in and improving health. It also notes that there has been insufficient November, along with payment to: NALBOH, 1840 East Gypsy funding to result in wide-scab positive change. Lane Road, Bowling Green, OH 43402. Call the office (419) 353-7714 if you need a replacement invoice. O Programs in the state federal funding totals for public health include: cancer prevention, chronic disease prevention, diabetes Application for Membership control, environmental health, HIV prevention, immunizations, infectious diseases, bioterrorism preparedness for states and hospitals, health professions grants, the Ryan White 2003 AIDS Date: CARE Act, and the Maternal and Child Health Block Grant. The Membership Year: 2007 (January 1 - December 31, 2007) ort demonstrates how federal funding generally is not based on ease levels or needs. For the full report with state-by-state ~roofHealmfflr9a,rcanoolNan ofinevmuat pages of health indicators and funding information visit TFAH's web site, <www.healthyamericans.org>. Maoin Aeea~ For more information on federal funding of health programs through cry see zp code the Department of Health and Human Services, stay tuned. Fortunately, both the House and Senate have recognized the need m e Fax Emad to restore health and education program funding. A Senate amendment restored 7 billion in funding for health services. The conraR Ve on one rne° House approved a budget resolution that provides 4 billion more for Check type of desired membership: health services than requested by the president. Still, we'll have to ? Institutional ($120) work to make sure a restored funding level is enacted. In this era of Any board of health or other governing body that oversees increasing threats, it is essential that local public health systems and local public health services or programs or the federal funds that back them are strong. O ($95) a local board of health whose state association is an affiliate member of NALBOH (GA, ID, IL, MA, NC, NE, NJ, OH, UT, WI) ? Affiliate ($300) State association of local boards of health (SALBOH) Requests for Articles and O Associate ($60) Any individual committed to NALBOH's goals and objectives Meeting Announcements O Retired ($12) Any former member of a board of health, state board of NALBOH publishes articles about the successes, health, local governing body, state, territorial or tribal board challenges, and accomplishments of boards of health of health as well as upcoming conference announcements O Sponsor ($60) and meeting dates. To submit an article or A non-profit organization, agency or corporation committed announcement, please contact the NALBOH office to NALBOH's goals and objectives or at 1840 East Gypsy Lane Road, Bowling Green, OH ($300) a for-profit organization,. agency or corporation 43402, fax to (419) 352-6278, or email us at committed to NALBOH's goals and objectives <nalboh@nalboh.org>. A NewsBrief submission O Student ($20) form is available online at <www.nalboh.org/news- Any currently enrolled student committed to NALBOH's goals brief/newsbrief.htm>. 0 and objectives Page 4 NALBOH New.sBrief Third ~ Quarter 2006 ~ L1' i.rlYlU Lil~l~J~'..C:JJ L`~..1° JLl~1l~A19~~ e \ r ~ . + ELI lqr '"aS T\`Y t I 91\\ © l+f t t P ° o 00 . ~ 1 ~ ~ L•r.~TO C ~ L'- ~p Gl~ (bL E3~~~ PGM= OD=Z p G=ta 96 ~ Third Quarter 2006 NALBOH New,sBrief Page 5 u ' . e e Congratualtions to the following Award Recipients: 0 New England Regional Director Award presented to $ Michael Hugo (MA) _ 0 Legislator of the Year Award presented to United States Senator, Tom Harkin (D) (IA) a 2006 MacNeal Scholarships presented to David Conley (OH) Nasir Mushtaq (OK) t Jennifer Gilchrist Walker (NC) Silent Auction Results NALBOH's 2nd annual silent auction was a great success! We are s pleased to have had a great response, both from our contributors and bidders. All auction proceeds will benefit the MacNeal Scholarship Fund. We are glad to announce $1,600 was raised. The Winning Bid Goes To: • Alaska Airfare • New Jersey Gift Items Joy Goldin (NY) , . LeAnn Trautman (ID) • Anchorage Alaska Rufus Cherry (NC) Ij Gift Bag 0 New Jersey Theme Alice Davis (OH) Gift Basket c..:~ Grace Serrato (OH) Judy McDonald (IL) Kathy Taylor (UT) • North Carolina Lap Cover o Aspen Grove Picture James Stecker (WI) Ted Bowlus (OH) 0 North Carolina Theme a fir; ' 1, a CDC T-Shirt Gift Basket Steve Scanlin (ID) Kay Banta (IL) 4,q • Contemporary Statue Westelle Cherry (NC) Bill Lydon (TX) • Norwegian Troll 0 Crow's Nest Restaurant Lee Kyle Allen (NC) Gift Certificate a Omaha Steaks t o Marie Fallon (OH) Gift Certificate $ 0 Garden Smile Statue Marie Fallon (OH) ' t. Sharon Hampson (WI) 0 Precious Moments Statue o Houston Street Bistro Brian Cook (UT) - Gift Certificate o Sea World San Antonio Marie Fallon (OH) Admission Tickets e Illinois Theme Gift Basket Tabatha Polley (TX) Donna Rozar (WI) 0 Sentinel for Health- 0 Kentucky Treats A History of the CDC " 0, Carol Remington OH Lorraine Salois-Deane NC p° m o Longaberger Basket o Stained Glass Lunch Box Set Hanging Picture . Betty Woods (OH) Cathy Agel (GA) f o o Louisville Stoneware G Talavera Dish Brian Cook (UT) Janine Amon (AK) o Mules Ears in Bloom © Wooden Carved Frog ° Picture Janice McMichael (GA) "I Alice Davis (OH) ' 0 Nebraska Golf Shirt Larry Hudkins (NE) Lee Kyle Allen (NC) Ted Bowlus (OH) 0 Nebraska Golf Shirt & Golf Cover Set Alice Davis (OH) ti . Page 6 NALBOH NewsBrief Third Quarter 2006 • Oral Health - A New Project! NALBOH is now partnering with the Centers for Disease Con and Prevention's Oral Health Program to begin addressing local boards of health can assist and support the national oral hea ' ' • • agenda. Specifically, the Guide to Community Preventive Services • <www.thecommunityguide.org> recommends two interventions, community water fluoridation and school-based dental sealant programs.. NALBOH will be focusing on the role that local boards of ' health and state associations have in addressing oral health in their ~ • ~ communities. , Local boards of health should participate in the dialogue to ' ' ' ' • ' ' ' improve oral health in the United States. As volunteer leaders in . - ~ public health, you not only make the necessary policy and regulatory changes to introduce or institutionalize oral health • ' ' ' ' programs into local public health agency practice, but are ' ' ' • ' also advocates for and liaisons to your peers, partners, and the city. ' • NA CHO ' " s were a b to stakeholders. Because board members speak with authority, you ' ' ' ' ' can be a familiar and trusted resource for the community as well accreditation. as a motivating force for change. ' ' ' ' ' • Resources are posted on the NALBOH website and additional ' ' ' project resources will be provided in the near future. Please ' • " ' ' contact Lauren Dimitrov via email at <lauren@nalboh.org> or ' - ' ' " " ' ' • (202) 218-4412 with any comments or questions. O • current trends and immediately agreed. Many of the presentations addressed public conveyed health issues and subjective experiences learning to the process. 2006 Annual Conference Winners . . _ ed ease. with recognized Thank you to all of those who turned in their confere evaluations. • . . . . • • • . _ • Two Winners were randomly selected from the evaluations their presentations. -Regardless of the varying degrees • returned, livery, AND THE WINNERS ARE - • • • • ~ _ ~ 2007 Waived Registration Fee: Phil Mohler, Mesa County, CO speakers. Several sessions carried over into the hallways and to 2007 Conference Hotel Stay: Joy Godin, Dutchess County, NY the dining facility as interested attendees sought further elaboration • concepts and ideas outside allotted time. The Thank you again and we hope to see you in 2007 in conference allowed'those in attendance to view variousi • • • Anchorage, Alaska!! O • • • • - • '>s' i Third Quarter 2006 NALBOH NewsBrief Page 7 The Nail Salon Controlling Odors within the Salon What Neighboring Businesses Can Do The most efficient method for protecting Owners of neighboring businesses should Next Door nail technicians and clients from inhaling EMA inspect all the common walls between the 0 Ellen Galloway, writer/Editor, and other airborne chemicals and nail salon and their buildings and seal any Greg Burr, an Industrial Hygienist reducing nuisance chemical odors is to openings that could allow odors to enter. National Institute for Occupational apply artificial nails at a ventilated A potentially overlooked area in buildings safety and Health worktable. A ventilated table helps control with multiple tenants and shared walls is In the past decade, the National Institute chemical odors in the salon by placing local the space above suspended ceiling panels for Occupational Safety and Health (NIOSH) exhaust ventilation close to the work area where wall openings or gaps often exist. where EMA is used. Such a table works best To ensure that nail salon odors do not be- has responded to several requests for health if the client's side of the table is a little high- come a problem, building owners should hazard evaluations of nail salons and er than the nail technician's side. This al- also implement an indoor environmental adjacent businesses due to concerns about lows the client's hands to hang over the quality (IEQ) exposure to the chemicals nail technicians local exhaust ventilation. The air the management plan. The owners should use. Considerable information is available ventilated worktable captures should be select an IEQ manager and provide that about health hazards associated with exhausted outside the building, not exposure to chemicals from nail salons and 9, person clearly defined responsibilities, recirculated. Optimally, exhaust air should authority, and resources. This individual methods for controlling these exposures. be vented to the roof. should derstand the building's structure This article describes the causes of salon and function and should be able to odors, outlines what nail salons can do to One of the most important ways to communicate effectively with occupants. keep odors to a minimum, and offers prevent nuisance odors from leaving a nail This proactive approach can help prevent measures to prevent these odors from salon is to keep the salon at negative IEQ problems. The elements of a good plan migrating to adjacent businesses. pressure relative to neighboring businesses. include: This means that air flows into the salon from • Operating and maintaining HVAC Chemical Hazards in Nail Salons surrounding areas, which helps prevent equipment properly Ethyl methacrylate (EMA) is the chief nuisance odors from spreading. Correctly • Overseeing the activities of occupants chemical used to produce artificial nails. operating the heating, ventilation, and air and contractors that affect IEQ (e.g., Methyl methacrylate (MMA), a similar conditioning (HVAC) system can help housekeeping, chemical product use, and Drug Administration in 1974 after it create and maintain this negative pressure. special processes) proved harmful to nail technicians and Discussing this with the maintenance staff • Maintaining and ensuring effective and nts. However, illegal MMA use may be helpful. Another way to control odors timely communication with employees etm especially in salons that offer low is by diluting them with outside air. The regarding IEQ American Society of Heating, Refrigerating, • Educating employees and building Woes for acrylic nails, as MMA costs much and Air-Conditioning Engineers (ASHRAE) contractors about their responsibilities less than EMA. Both chemicals have low recommend 25 cubic feet per minute of in relation to IEQ odor thresholds, meaning that most outside air for each person in the shop. 0 Identifying and managing people can smell them at low levels. These p' projects pro chemicals can also irritate the eyes, no actively that may affect IEQ such as se, Better work practices may also decrease the redecoration, renovation, the use of and other mucous membranes and cause amount of airborne chemicals and thus new chemicals or equipment, or skin irritation, skin inflammation and decrease odors. For example, nail relocation of personnel asthma in some people. technicians should place EMA-soaked gauze Like EMA and MMA, exposure to acetone, pads in sealed plastic bags before placing The NIOSH document, Controlling them in the trash can. Changing trash can Chemical Hazards during the Application of another chemical commonly used in nail liners daily should further minimize release Artificial Fingernails, is available online at salons, can also irritate the eyes, nose, and of EMA into the air. Acetone dispenser <www.cdc.gov/niosh/hc28.html>. It can throat. Acetone can also dry the skin, and bottles should have small openings, only also be obtained by calling (800) 35-NIOSH upon repeated contact can result in skin large enough for the application brush to and asking for NIOSH publication 99-112. irritation and inflammation. At higher enter. The bottle stoppers should also be The NIOSH/Environmental Protection concentrations, acetone can affect the pressure sensitive. A dispenser bottle with Agency nervous system and may cause drowsiness (EPA) document, Building Air a pressure-sensitive stopper and small Quality: A Guide for Building Owners and or sleepiness. Like EMA, acetone has a low opening should result in less liquid Facility Managers is available online at odor threshold (approximately 2 parts per evaporation and less odor. Finally, the <www.epa.gov/iaq/largebldgs/graphics/ million), well below the NIOSH dispenser bottle should contain no more than iaq.pdf>. This 228-page document may be Recommended Exposure Limit, a criterion the needed amount of liquid. purchased or downloaded as a PDF. The set up to protect workers from harmful exposures EPA's IEQ information clearinghouse . (800) 438-4318 can provide information on other IEQ-related topics. O Onsite Wastewater Collaboration QLBOH has recently collaborated with the Ohio Department of Health to provide a guide to onsite wastewater treatment systems to boards of health in Ohio. Because new onsite sewage regulations have been approved in the state of Ohio, the guide will prove to be a valuable resource for all board members. Board members must actively seek to understand how onsite wastewater systems function,, proactively work to assess their communities' needs, develop policies and programs to meet those needs, and assure that support is available to implement policies and programs. The guide also provides valuable information for environmental health specialists. Two continuing education units have been applied for through the Ohio State Board of Sanitarian Registration. 11 4 Page 8 NALBOH New.sBrief Third Quarter 2006 13th World Conference on Tobacco OR Health 41 Submitted by Sharon Hampson, Chair, Tobacco Use Prevention and Control Committee Imagine an Irish pub with no pall of smoke inside. The Irish no longer have to imagine it, they live it. Irish pubs around the world, however, continue to allow smoking. It's a crazy, patchwork world when it comes to the status of tobacco. 13th World Conference e~. As tobacco products become less welcome in our country, the tobacco industry on Tobacco OR Health has shifted its profit focus to the developing countries in the world. Nearly half of building capacity for the adults in China smoke, while children in South America go to school with their a tobacco-free world supplies in colorful and distinctive Marlboro® backpacks. While we, individually and in groups, work towards cleaner air and better health policies, it was fascinating to see the fight from an international perspective. More Image Source <www.worldcan2ercongress.org/t-index.php> than 4,400 people attended the 13th World Conference on Tobacco OR Health in Washington, DC in July. Participants included representatives from several of the many nations who have full or partial bans on public smoking, several of the states in our country who have also gone smokefree, as well as many from the developing nations who are just beginning their battles. It was reassuring to heat that the strategies we are promoting have been successful worldwide. The most effective strategies towards smokefree workplaces seem to be these: 1) increase the cost of tobacco, which results in an immediate drop in usage, 2) work with youth to prevent tobacco use, 3) offer cessation along with tighter controls, so that smokers can get the help they need to quit, and 4) outlaw advertising. Also, it was confirmed that after smokefree protections are put into place, communities see some of these same results: 1) community health improves immediately, evidenced by lower rates of doctor and hospital visits and decreased rates of ht attacks, 2) 100% smokefree workplace laws actually improve the economic conditions where they are in place, often after an initial small drop in business, and 3) public opinion is overwhelmingly supportive of clean air laws. Smoking and related illnesses were reframed at the conference as a worldwide pandemic, with the tobacco industry as the vector. When public health looks at the problem in this light, it is obvious that we need to continue to work for better public health through smokefree legislation. ? The Health Consequences of Involuntary Exposure to Tobacco Smoke, A Report of the Surgeon General U.S. DHHS: www.surgeongeneral.gov/library/secondhandsmoke The most recent Surgeon General's Report was released on June 27, 2006. This is the most comprehensive report produced on the harms of secondhand smoke and concludes that there is no risk-free level of exposure to secondhand smoke. Major findings include: • Secondhand smoke causes premature death and disease in children and adults who do not smoke. Its, • Children exposed to secondhand smoke are at an increased risk for sudden i infant death syndrome (SIDS), acute respiratory infections, ear problems, and more severe asthma. • Secondhand smoke causes serious diseases including lung cancer and heart disease. • There is no risk-free level of exposure to secondhand smoke. • Establishing smoke-free workplaces is the only effective way to ensure that secondhand smoke exposure does not occur in the workplace. • Smoke-free workplace policies are effective in reducing secondhand smoke exposure. Separating smokers from nonsmokers in the same air space, cleaning the air, and ventilating buildings are not effective in eliminating exposure of nonsmokers to secondhand smoke. • Smoke-free policies and regulations do not have an adverse economic impact on the hospitality industry. ? Third Quarter 2006 NALBOH NewsBrief Page 9 Tob cco-Fre USA Continuetl Lung Cancer Declared a National New CDC Study Shows Youth Public Health Priority Smoking Rates Increase Slightly Centers for Disease Control and Prevention Senators Chuck Hagel (R, NE) and Hillary Clinton (D, NY) Youth Risk Behavior Surveillance System introduced a resolution that declares lung cancer as a National On June 9, the Centers for Disease Control and Prevention (CDC) Public Health Priority. This resolution was passed in May and calls for released the results of its 2005 Youth Risk Behavior Survey (YRBS), federal agencies to work together to combat this public health which is conducted every other year and involves about 14,000 problem through research, screening, and education. ? high school students. The 2005 results reveal that smoking rates in high school increased slightly between 2003 and 2005. Tobacco Companies Specifically, the rate increased to Test Smoke-free Products 23.0 percent in 2005 from 21.9 Excerpts from USA Today, June 9, 2006 percent in 2003. Although the increase is not statistically signif- R.J. Reynolds Tobacco Co. began selling Camel Snus (snoose'), a cant, the survey produced similar powdered form of smokelesb results to other surveys over the tobacco, in Portland, OR and Austin, \ past several years that showed the TX. Ta ok pouches omo ced decline in youth smoking rates tobacco meant to be pla <a stalling. Previously, smoking rates between the lips and gums, a had product by Philip Morris, goes on sale been declining steadily in these in July in Indianapolis. Both cost surveys from a high 36.4 percent in 1997. More information on iabout the same and have about the the 2005 Youth Risk k Behavior Survey data are available at same amount of nicotine as a pack <www.cdc.gov/yrbs>. ? of cigarettes. As more cities and states pass American Lung Association smoke-free laws cigarette companies Releases Report on are increasing smokeless tobacco products. The companies face a declining cigarette market due to Alcohol-Flavored Cigarettes health concerns, price increases, and smoking bans. The new products will carry warnings that they are not safe alternatives to The American Lung Association, cigarettes. ? AMERICAN Tobacco Control Tribune May LUNG 2006. On May 30, a new 40 States Seek to Limit Little Cigar' ASSOCIATIONS report, Alcohol-Flavored Cigarettes-Continuing the Marketing Flavored Cigarette Trend, was released. This report describes how Excerpts from Washington Post May 19, 2006 R.J. Reynolds sold alcohol flavored cigarettes as part of a recent promotional campaign linking smoking with alcohol use and Forty states have asked the U.S. Treas{ry Department to bar gambling. This report also contains the status of state and federal tobacco companies from marketing products as "little cigars," a legislation prohibiting flavored cigarettes/tobacco products, and a designation the states say lets the firms evade taxes and target few recent studies. A PDF copy of the report is available at <http:/ younger consumers. Attorneys general from the 40 states want /slati.lungusa.org/alerts/Alcohol-Flavored-Addendum.pdf>. ? the department's Alcohol and Tobacco Tax and Trade Bureau to reverse rules that permit products the size, shape and weight of ANR Smokefree Air Challenge Award cigarettes, but have brown rather than white wrappers, to be labeled as little cigars. Americans for Nonsmokers' Rights, June 26, 2006 Americans for Nonsmokers' Rights (ANR) announced the winner of Representatives of four nonprofit groups the American Heart the ANR Smokefree Challenge Award, which recognizes states that Association, Americans for Nonsmokers Rights, the American Lung have passed the most and strongest 100% Smokefree local laws. Association and the Campaign for Tobacco-Free Kids disagreed. The winner for 2005 was West Virginia, which led the nation with In a joint statement the said, "many of these 'little cigars' are 17 counties enacting strong local smokefree laws. Ohio took blatantly aimed at our children. They are cheaper and more second place with eight, and third was a tie between Indiana and affordable to kids than regular cigarettes because they have lower Louisiana, with six new laws each. Illinois is leading the nation so far excise tax rates, and they are often sold individually rather than in for 2006 with 14 new smokefree cities. packs because their classification exempts them from state laws setting minimum pack sizes for cigarettes." tha Hallett, ANR Executive Director, said, "local control and local A spokesman for the Tax and Trade Bureau said the agency can kefree workplace policies are the foundation of this national write rules so there is a line drawn between cigarettes and little community movement leveso we l t to o protect recognize people's those right to states breathe working at smokefree the air cigars but that the release of the rules is months away at best. O in workplaces and public indoor places." Congratulations to these states and continue the great work! ? d Page 10 NALBOH NewsBrief Third Quarter 2006 r r . during an emergency. This can include interpreters, chaplains, I al advisors, data entry professionals, or even amateur radio ope • to assist in communication efforts. Local boards must under that just because a volunteer may not be medical or public health •.Y ~.~r'; professional, they can still be extremely valuable asset in the event Y r.'~ • of an emergency. ` Responsibilities of Volunteers The primary role of MRC volunteers is to supplement existing public health resources. They can serve their communities in many public health initiatives including educating the public on prevention Medical Reserve Corps methods, assisting in immunization programs or blood drives, and emergency response functions such as exercise planning and Local boards of health are in an excellent position as part of their participation. Their primary roles and responsibilities will change governance role of local public health to assist in the development according to an individual community's needs. Regardless of their of the Medical Reserve Corps (MRC) units in their jurisdiction. With primary responsibilities, MRC volunteers must always work in an aging and depleting public health workforce, local MRC units not coordination with the existing local emergency response programs only can assist in the event of an emergency, but may be and initiatives. imperative to successfully mitigate emerging public health threats. Resources Needed to Start and Sustain a Program Background Local boards are strongly encouraged to play a lead role in ensuring The MRC officially started as a national community-based civilian that local MRC programs have clear policies and procedures to volunteer recruitment effort in 2002. It was formed in response to operate effectively. Developing policies and procedures is a core President Bush's call for all Americans to provide two years, or 4,000 function of local boards of health so this is an excellent opportunity hours over a lifetime, of volunteer service in their community. The for local boards to lead their community's volunteer recruitment ef- MRC is a partner with the White House's USA Freedom Corps and forts. In developing these policies and procedures, internal leader- the Department of Homeland Security's Citizen Corps, which are ship roles must be well established and defined. Additional resourc- devoted to ensuring the safety of all Americans. The MRC es to get started include operating funds, space to conduct meet- strengthens local communities by establishing an organized system ings, and a data entry system to keep track of volunteers. for medical and public health volunteers to assist in promoting local public health initiatives and during times of need. In next quarter's NewsBrief, information on how to develop a for your local MRC unit will be included. For more information on Who Can Volunteer how to form a MRC unit, please visit the MRC website at Volunteers for the MRC can be any medical, public health <www•medicalreservecorps.gov/startmrc> and read through professional or any other volunteer who can offer specialized skills Getting Started: A Guide for Local Leaders. ? Centers for Disease Control and National Swimming Pool Foundation's Prevention Concerned with World Aquatic Health Conference Flu Vaccine Supply This conference will be held from September 19 -21 at the Radisson Town Lake in Austin, Texas. For board of health members who The Centers for Disease Control and Prevention (CDC) is concerned can't get enough of Texas, this will be an excellent educational and that the U.S. may not have an adequate supply of flu vaccine networking opportunity. If unable to attend, the conference will available in time for this year's fiy season. The concern stems from also be available online so your recreational water program staff can an FDA warning over contamination problems at a sanofi pasteur view the presentations. For more information about NSPF and its manufacturing facility in Pennsylvania. sanof pasteur informed the annual conference, visit <www.nspf.org> or contact the NALBOH FDA in late March of sterility failures in 11 batches of flu vaccine office at (419) 353-7714. ? which were in early development stages. A site visit conducted by the FDA revealed inappropriate actions by the manufacturer to United States Department of address the contamination problems. A warning letter was then F issued by the FDA which included the possibility of revoking the Homeland Security (DHS) manufacturer's license to produce this much needed vaccine. The Completes National Infrastructure CDC is monitoring this situation closely as this manufacturing facility produces approximately 40% of the U.S. Flu vaccine supply and the Protection Plan vaccine for children younger than four. ? The U.S. Department of Homeland Security has completed the National Infrastructure Protection Plan (NIPP) which provide comprehensive risk management framework defining crit infrastructure protection goals and responsibilities for all levels of government, private industry, nongovernmental agencies and tribal partners. The plan is intended to integrate critical infrastructure security efforts among all parties, establish protection goals and supporting objectives, and focus resources according to risk level. Third Quarter 2006 NALBOH NewsBrief Page 11 I I NAIDON- The 1A/ Grass Boots 01PUblic Nealth September 2006 2006 Public Health Association of Nebraska The Powerful Voice of Public Health - YOU! September 22, 2006 Interstate Holiday Inn, Grand Island, NE Sponsored by the Public Health Association of Nebraska The Public Health Association of Nebraska (PHAN) exists to protect and promote personal, community and environmental health throughout a variety of public health networks. The organization exercises leadership in public health policy development and advocacy, provides a forum for the discussion of emerging public health issues, and enhances the profgssional growth of members and other health professionals across the state. For more information visit <www.publichealthne.org> The Food Safety and Inspection Service 2006 Food Safety Education Conference Reaching At-Risk Audiences and Today's Other Food Safety Challenges September 27-29, 2006 Adam's Mark Hotel, Denver, Colorado Sponsored by the United States Department of Agriculture The Food Safety and Inspection Service (FSIS) is the public health agency in the U.S. Department of A6~iculture responsible for ensuring that the nation's commercial supply of meat, poultry, and egg products is safe, wholesome, and correctly labeled and packaged. For more information visit <www.fsis.usda.gov> November 2006 American Public Health As 134th Annual Meeting and Exposition Public Health & Human Rights November 4-8, 2006 Boston, Massachusetts Sponsored by the American Public Health Association The APHA Annual Meeting is the premier platform to share successes and failures, discover exceptional best practices and learn from expert colleagues and the latest research in the field. For more information visit <www.apha.org> Future Events Ned E. Baker Lecture in Public Health Co-Sponsored by National Association of Local Boards of Health and Bowling Green State University, College of Health & Human Services For information on previous and/or future Lectures in Public Health, visit <www.nalboh.org> NALBOH's 8th Annual Lecture in Public Health ' Leslie Beitsch, MD, ]D Director, Center for Medicine and Public Health xy Florida State University Law and Ethics in Public Health Friday, March 30, 2007 NALBOH's 9th Annual Lecture in Public Health Hugh H. TIlson MID, DrPH Senior Advisor to the Dean, Public Health Leadership Program y University of North Carolina at Chapel Hill Institute of Medicine's Future of Public Health 10 Years Later Friday, April 4, 2008 w rM 15th Annual Conference National Association of Local Boards of Health September 18-21, 2007 The Hotel Captain Cook ANCHORAGE 0 i ` ALA%V Kit l , All photos ate (o u'tesi of ACVB The Hotel Captain Cook in Alaska is Anchorage's only true luxury hotel and is located in what is now the bustling hub of America's gateway to the Pacific Rim. For more information on the Hotel Captain Cook visit <www.captaincook.com/>. For more information on NALBOH's 15th annual conference, visist <www.nalboh.org>. NON PROFIT ORG 1840 East Gypsy Lane Road U.S.Postage NALBOH Bowling Green, OH 43402 PAID Website: www.nalboh.org Bowling Green, OH Pero it47