May 2019 Board of Health Meeting Minutes
Coalition/Group Board of Health Name: Date of Meeting: May 2, 2019 Location: GF Public Health, Conf. Room #2
1. Purpose of Meeting Approval of January meeting minutes, discuss Old and New Business, Director’s Report and confirm meeting details for the next meeting.
2. Attendees Board members present: Dr. Sally Pyle, Cindy Pic, Dr. Joel Walz & Dr. Grant Korsmo (via conference call). Board member absent: Jeannie Mock. Others present: Debbie Swanson, Michael Dulitz, Theresa Knox, Haley Thorson, Sarah Odegard and Kristie Hegg (all from GF Public Health). Guest: Brian Schill.
3. Meeting Agenda
1. Call To Order 2. Approval of January 10, 2019 meeting minutes 3. Old Business 4. New Business 5. Director’s Report 6. Next meeting details 7. Adjournment
4. Meeting Notes, Decisions, Issues
Call To Order Dr. Sally Pyle called the meeting to order at 4:15 p.m.
Approval of Minutes of Dr. Walz made a motion to approve the minutes. Cindy seconded. All Meeting held on 1/10/19 board members approved. Motion passed.
Old Business – Joint • Debbie S. informed the board the Joint Powers Agreement
May 2019 Board of Health Meeting Minutes Page 1 of 7
May 2019 Board of Health Meeting Minutes Powers Agreement between the City and County of Grand Forks is finalized and between GF City & GF signed. County – Debbie S.
Old Business – Public • Debbie S. & Theresa attended a two day accreditation workshop Health Accreditation with the PHAB board in Washington, DC. Update – Theresa • Accreditation Specialist assigned to GF Public Health • Have one year to upload all of our documentation as evidence we meet standards of accreditation (deadline is March 2020). • All documents need to be in a pdf format, scanned and uploaded into PHAB system • Accreditation costs have been paid • Work continues and 12 domain groups meeting regularly • Showed a 6 minute video to those present entitled “Reaping the Benefits of Accreditation across the Nation” (https://www.phaboard.org/2018/11/19/reaping-the-benefits-of- accreditation-across-the-nation/ • Accreditation period lasts 5 years before need to get reaccredited is necessary
Old Business – QI Update • Launched a new QI project to improve grant process. The on Current Projects – benefit from this project is it’s leading to better communication Debbie S. between departments on other finance topics (City Hall, Finance Dept. & Public Health). • Kate Goldade is the facilitator for this project. • Our department’s emphasis on QI showed up in a recent NACCHO workforce survey.
Old Business – 2019 • Four main priorities for GFPH in the 2019 Legislative session Legislative Session were tobacco tax, addiction care, public health funding and Update on Public Health environmental health. Priorities – Debbie S. • Tobacco tax bill did not pass but was referred for an interim study. • An E-cigarette bill passed that limits the sale of flavored electronic products and provides for a fine of $500 to the clerk. • Many pre-emptive bills were introduced this year which could affect tobacco prevention efforts in the future. • Additional funding was provided for SUD vouchers - we are awaiting funding allocation for our social detox. • The legislature allocated level funding for public health with some of the funds coming from the Tobacco Control Trust Fund which will eventually be depleted. • Radon & septic systems bills did not pass and will require additional advocacy. The food safety bill had two good hearings,
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May 2019 Board of Health Meeting Minutes one of which Javin ended up testifying at regarding the cottage food law. This bill passed the Senate but got significantly amended in the House and then failed on the House floor. • There has been discussion on raising the age for purchase of tobacco products from 18 to 21. We are following current efforts in Minnesota and across the nation.
Old Business – NALBOH • Distributed Powers of Resolution of Support (see attached Annual Conference – handout) Haley T. • Haley Thorson will give an oral presentation at the NALBOH conference in Denver in August. Dr. Pyle will also attend the conference. • Involving Board of Health is vital by engaging other stakeholders and partners to help support policy
Other Old Business (NONE)
New Business – 2019 • Using similar process that was used in 2016 for the 2019 CHA Community Health • Requirement for Altru under ACA to do CHA every 3 years while Assessment – Debbie S. it’s required for GFPH to do a CHA every 5 years • Will be engaging services, students and faculty of the UND MPH Program to do our research • Will be doing secondary data, review, focus groups and a community survey
2019 National Public • Mayor Brown’s proclamation (see attached handout) Health Week – Sarah O. • National Public Health Week - April 1st -7th – “Creating the Healthiest Nation: For Science. For Action. For Health.” • Week’s events discussed included the Billion Step Challenge (see attached handout), a live forum, a walk break, a twitter chat, a lunch & learn session & healthy selfie winner • GFPH team ranked 45th out of 407 teams for the Billion Steps Challenge with a total of 6,907,695 steps
Overview of GF County • County Health Rankings booklet was distributed Health Rankings – • GF County data sheet was distributed (see attached handout) Debbie S. and discussion followed • More information is available at: http://www.countyhealthrankings.org/app/north- dakota/2019/rankings/grand- forks/county/outcomes/overall/snapshot
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May 2019 Board of Health Meeting Minutes Citizen Request on Health • Brian Schill introduced himself to everyone. He works at UND Care Resolution – Brian School of Medicine but also volunteers with an organization Schill called HealthCare Now ND (state chapter of a national organization based out of Boston). Their charge is advocating for a single payer health system for the U.S. • This organization is interested in exploring municipal and state level policies that increases access to health care. • He plans to bring a resolution to the GF City Council for endorsement (see attached draft). He is also eliciting support from other groups such as the Northlands Rescue Mission, VCHC, etc. before taking it to the City Council. • Brian asked the board for their consideration of support for this resolution; however, he is not expecting a decision today. • The level of support he’s been receiving from other entities varies on the group’s orientation. • Cindy suggested bringing this resolution to a County Commission meeting for their input. • Debbie reminded everyone that a resolution is a statement of belief. In the public health field, we believe everyone should have healthcare coverage and a medical home. • Debbie mentioned that City Council and the County Commission cannot change health care law but adopted resolutions can help show support. • ACTION: Sally asked the board for input on what they would like to do regarding this resolution. Consensus was to revisit this resolution at the July meeting so as to allow more time for the board to review the resolution and suggest any possible changes. • Would like to get the mayor’s thought on this resolution – not only as a mayor but as a doctor • Brian indicated he would like to attend the July Board of Health meeting to discuss the resolution again
Syringe Service Program • Distributed two handouts (see attached handouts) – Michael D. • Concern now: Spread of infectious disease due to substance use • Hepatitis C rate in GF county has increased (30 additional cases in 2018) • GF county is lower in Hepatitis C cases compared to Cass County and Burleigh & Ward counties • Hepatitis C is a chronic disease but can be treated successfully through a 3 month treatment however it costs around $40,000 for the treatment.
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May 2019 Board of Health Meeting Minutes • The expense of Hepatitis C treatment can create a hefty burden on ND Medicaid. • World Health Organization has a goal to have Hepatitis C eliminated by 2030 • Hepatitis C is a hearty virus and can live a long time on certain surfaces. For example, Hepatitis C can live in a syringe up to 60 days. • 88 percent of the new cases in people under the age of 35 had injection drug use as a risk factor • CDC now recommends syringe service programs in communities at risk for disease outbreaks. North Dakota is considered at risk. • There are currently 3 syringe service programs in operation in ND and they are in Mandan, Fargo and Minot. Valley City is close to approval but not operating yet. • Meth treatment & recovery is more difficult – treatment generally takes longer and there are no medications to help with cravings and withdrawal • Discussed handout statistics • Asking for the board to approve implementing a syringe service program in Grand Forks • Cost of the program would be $75,000 a year including 2 part time staff (federal funds would cover majority of cost with private funds assisting with injection equipment) • Use a public health model for this program – recognize that individuals are at various stages of change, yet risk for disease transmission and overdose remains. • This program does not condone substance use. This helps keeps the people using healthy as well as protecting the community. • Two models used in North Dakota are: o 1 for 1 + model: To receive 20 syringes you have to bring 10 back in o Needs based model: Provide syringes based on your need • The preferred model is the Needs based model as the person is more likely to properly dispose of the used syringe rather than carry around several used syringes increasing the likelihood of the possible spread of disease • ACTION: Dr. Walz made a motion to support the GF Health Department’s efforts to establish a syringe service program and recommend approval to other governing entities as required by law. Cindy seconded the motion. All in favor – motion passed.
May 2019 Board of Health Meeting Minutes Page 5 of 7
May 2019 Board of Health Meeting Minutes Election of Officers and • Reminded the board that there are two terms expiring in July – Appointments to Terms – Dr. Korsmo and Jeannie Mock Debbie S. • Dr. Korsmo indicated he would like to continue serving on the board • Debbie indicated paperwork will be sent to the Mayor to formalize the appointments • Election of officers will take place at the July meeting
Other New Business (NONE)
Director’s Report – • Two resignations were submitted recently: Debbie S. o Shannon Ng – Emergency Response Coordinator o Curtis Scanson – Social Detox Project Coordinator • An Interim Project Coordinator will be appointed for the Social Detox Center • Recruitment efforts will begin to fill these positions • Debbie & Michael Dulitz met with the First Lady at the Grand Forks Youth Commission meeting which was a great opportunity to tell her about our department’s behavioral health initiatives.
Adjournment • Dr. Pyle adjourned the meeting at 5:44 p.m.
May 2019 Board of Health Meeting Minutes Page 6 of 7
May 2019 Board of Health Meeting Minutes 5. Action Items
Action Owner Estimated Completion
Support adopting a Health Care Resolution Brian Schill Revisit at July 11th BOH mtg
Support adopting a Syringe Service Program Michael Dulitz 5/2/19
6. Next Meeting
Date: July 11, 2019 Location/Time Grand Forks Public Health Conf. Rm #2
@ 4:15 pm
Agenda: TBA
Attachments: 1. The Power of Resolutions of Support 2. Mayor Brown’s Proclamation for National Public Health Week 3. National Public Health Week Schedule 4. Grand Forks County Health Rankings & Roadmaps 5. Healthcare Resolution Draft 6. Syringe Service Program 7. Grand Forks County Hepatitis C/HIV Data Request 8. Issue Statements 9. Director’s Report 10. Branch Activities Report
May 2019 Board of Health Meeting Minutes Page 7 of 7
The Power of Resolutions of Support: Engaging Your Local Board of Health
A resolution is an official expression of the decision or opinion of an official body. Often,theyarea statement about an issue that is so important; the official body wants written record of said decision/opinion. Engaging a local Board of Health to formally resolve to support action on health- related issues can be the spark necessary to ignite a cascade of movement in accomplishing policy outcomes.
Since the mid-1990s, the Grand Forks Tobacco Free Coalition has collaborated with the Grand Forks Public Health Department on tobacco prevention policy efforts. Localadvocates have naviBated the development of dozens of local and state tobacco prevention policies and they have come to find that the foundation of successful policy planning begins with support from the Grand Forks Board of Health.
Through educating and garnering preliminary endorsement from the Grand Forks Board of Health, advocates were able to demonstrate to other agencies, organizations and stakeholders the importance of specific tobacco prevention policy issues and therefore, gain the additional support necessary to inform policymakers of the necessity of the intervention.
It is also important to note that the Grand Forks advocates were trailblazers in terms of localtobacco prevention policy, and would often be the first city to implement cutting-edge tobacco prevention policies. Other North Dakota cities would take note of the success in Grand Forks and implement similar interventions which in turn have led to state-wide policy development, helpinB to protect all citizens of North Dakota from the dangers of tobacco use.
The success of these policy interventions can be visualized by reviewing tobacco use data. Whether it's adopting a comprehensive smoke-free ordinance, the passage of ordinances restricting youth electronic cigarette sales, a comprehensive tobacco-free parks policy, or most importantly maintaining tobacco prevention infrastructure; by plotting these past policy interventions along the downward trend in tobacco use rates, it is clear to see that tobacco prevention policy works, and Grand Forks advocates have found the best foot-hold of these policies is a resolution of support from the Grand Forks Board of Hea lth. い rE OF ttAVOR L L BROn …
City of Grand Forks (703)762" FAX"(70:)7173"3 255 Nonh F。 ●●is― 。P0 0oぉ S200・ Grand Fo"曲ヽヽD581略S100 PROCLAMAT10N NAT10NAL PUBLIC HEALTH WEEK
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NOW. THEREFORE. I Michcl R. Brown Mayor of Grrod Fortr by virtuc of tlre authority vcsted ia rae by dre b*r of Grand Fort& ND do hcrcby proclrirn thc wccl of Aprit l-7. 2019. ss Nllion l hrblic Hcdth WccI 2019 in Grud Foits ud crll upoo 6e pcoplc of Gnd Forltr o obrervc this ureck by helping our hmilies' frieds' mi&bors. co-wortes sd lesdErs berEr uderst nd rhc vrlrr of pblic hcstth ad supporting grert opportunitics Natiool Fc scieoce. For to @t prcvcntivc tifcrcyb hebirs in ligtt of this ycrr's rtrcnr. treating th€ Hcrlthicsl rtioo. Fa herlth.
lN WITNESS WHEREOF. I havc hrcunto scr my hed this lst &y of April. two thous.rd niDc&co' and of thc hdcpcodcnce of thc United Surcs of Anrerica rhc two hundred rod fortieih. National Public Health Week 鵬壇 April 1 -7,2019 郷 Creating the Heahhiest Nation: For science. For action. For heahh.
Health Prevent Promotc Protect … Grand tr'orks Publlc Hedth Monday, April rst 12-2pm Live NPHW Forum presented by APHA. The official National Public Health Week Forum, hosted by the American Public posted Health Association, kicks offNPHW 2oLg with Porticipqnls an exciting keynote address. selfies of rondom ocls of heolth. One winner wos Tuesday, April end chosen for o prize bundle ll5pm Walk at Work after lunch walk break. Wednesday, April srd 1-2pm This year, APHA will host its ninth an- nual National Public Health Week Twitter Chat. Thursday, April ath 12-1:15pm Lunch & Learn "Hilleman: A Peri- lous Quest to Save the Worlds Children" Friday, April sth 12pm Potluck to celebrate all of us! 1315pm GF Public Health Facebook Live drawing of the +HealthySelfie winner.
Billion Step Challenge ★ Team Grand Forks Public Health It's a double Placed 45 of 4oT teams Average weekly steps Trtzz #healthyselfi e for #NPHW. Total team steps 619o71965 And check out the vintage Power Total group steps rr56orr87ra29 inst Secondhand Smoke t-shirt.
Ｅ Ｔ HAUTE(C)YOGIS ハ Ｉ Ｔ 旧 Ｎ HOTYOGA Ｉ 4/5/2019 Grand Forks County, North Dakota | County Health Rankings & Roadmaps
Grand Forks (GF)
County Demographics
County State Population 70,795 755,393 % below 18 years of age 20.7% 23.3% % 65 and older 12.2% 15.0% % Non-Hispanic African American 4.3% 3.0% % American Indian and Alaskan Native 2.8% 5.5% % Asian 2.8% 1.6% % Native Hawaiian/Other Paci c Islander 0.1% 0.1% % Hispanic 4.2% 3.7% % Non-Hispanic white 83.8% 84.6% % not pro cient in English 1% 1% % Females 48.4% 48.7% % Rural 16.8% 40.1%
Grand Forks Error Top U.S. Performers North Dakota Rank (of 49) County Margin Health Outcomes 21 Length of Life 3 Premature death 5,700 5,100-6,400 5,400 6,700 Quality of Life 44 Poor or fair health ** 14% 14-15% 12% 14% Poor physical health days ** 3.4 3.3-3.6 3.0 3.0 Poor mental health days ** 3.1 3.0-3.3 3.1 3.1 Low birthweight 7% 6-7% 6% 6% Additional Health Outcomes (not included in overall ranking) Life expectancy 80.0 79.3-80.7 81.0 79.8 Premature age-adjusted mortality 290 270-320 280 320 Child mortality 40 30-60 40 60 Infant mortality 5 4-7 4 6 Frequent physical distress 10% 10-11% 9% 9% Frequent mental distress 10% 10-10% 10% 9% Diabetes prevalence 8% 7-10% 9% 9% HIV prevalence 52 49 53
Health Factors 17 Health Behaviors 21 Adult smoking ** 18% 17-18% 14% 20% Adult obesity 31% 28-34% 26% 32% Food environment index 8.1 8.7 9.1 Physical inactivity 21% 19-24% 19% 22% Access to exercise opportunities 83% 91% 74% Excessive drinking ** 26% 25-27% 13% 26% Alcohol-impaired driving deaths 27% 16-39% 13% 46% Sexually transmitted infections 507.6 152.8 456.5 Teen births 14 12-16 14 23 Additional Health Behaviors (not included in overall ranking) Food insecurity 10% 9% 7% Limited access to healthy foods 9% 2% 7% Drug overdose deaths 10 7-16 10 9 Motor vehicle crash deaths 8 6-11 9 16 Insuf cient sleep 31% 30-32% 27% 29% Clinical Care 3 Uninsured 7% 6-8% 6% 8% Primary care physicians 770:1 1,050:1 1,320:1 Dentists 1,240:1 1,260:1 1,530:1 Mental health providers 350:1 310:1 570:1 Preventable hospital stays 4,087 2,765 4,452 Mammography screening 49% 49% 50% Flu vaccinations 53% 52% 47% Additional Clinical Care (not included in overall ranking) Uninsured adults 7% 6-8% 6% 8% Uninsured children 6% 5-8% 3% 7% Other primary care providers 668:1 726:1 775:1
Social & Economic Factors 20 Highwww schoo.countyhealthrankings.org/app/north-dakota/2019/county/snapshots/035/printl graduation 86% 96% 85% 1/2 4/5/2019 Grand Forks County, North Dakota | County Health Rankings & Roadmaps Grand Forks Error Top U.S. Performers North Dakota Rank (of 49) County Margin Some college 78% 74-82% 73% 73% Unemployment 2.2% 2.9% 2.6% Children in poverty 12% 9-15% 11% 11% Income inequality 5.4 4.9-5.8 3.7 4.4 Children in single-parent households 33% 28-39% 20% 27% Social associations 11.7 21.9 16.0 Violent crime 243 63 258 Injury deaths 53 46-61 57 69 Additional Social & Economic Factors (not included in overall ranking) Disconnected youth 4% 5% Median household income $50,900 $46,300-55,600 $67,100 $62,400 Children eligible for free or reduced price lunch 34% 32% 31% Residential segregation - black/white 50 23 53 Residential segregation - non-white/white 40 15 45 Homicides 2 2 Firearm fatalities 10 7-14 7 13 Physical Environment 47 Air pollution - particulate matter ** 6.9 6.1 5.4 Drinking water violations No Severe housing problems 16% 14-18% 9% 11% Driving alone to work 82% 81-83% 72% 81% Long commute - driving alone 9% 8-10% 15% 13% Additional Physical Environment (not included in overall ranking) Homeownership 49% 48-51% 61% 63% Severe housing cost burden 16% 14-18% 7% 10%
Areas to Explore Areas of Strength
^ 10th/90th percentile, i.e., only 10% are better. Note: Blank values re ect unreliable or missing data 2019 ** Data should not be compared with prior years
www.countyhealthrankings.org/app/north-dakota/2019/county/snapshots/035/print 2/2 A RESOLUTION OF THE CITY COUNCIL OF GRAND FORKS, NORTH DAKOTA, URGING THE NORTH DAKOTA LEGISLATIVE ASSEMBLY AND/OR THE STATE’S WASHINGTON DELEGATION TO SUPPORT LEGISLATION THAT WILL PROVIDE EQUITABLE, COMPREHENSIVE, AFFORDABLE, HIGH QUALITY, PUBLICLY FUNDED HEALTH CARE COVERAGE FOR ALL LONG-TERM RESIDENTS OF NORTH DAKOTA. WHEREAS, our Founders’ vision of the right to “Life, Liberty, and the pursuit of Happiness” is hampered for individuals who cannot access quality health care to prevent and treat disease or injury; and WHEREAS, individuals and families are negatively affected when their health concerns impact their ability to work, endangering their economic stability and increasing their risk for bankruptcy or homelessness; and WHEREAS, medical debt remains among the top reasons that Americans declare bankruptcy; and WHEREAS, the rising cost of health insurance is pricing many individuals and families out of the market; and WHEREAS, the percentage of Americans getting their health insurance through their employer is declining; and WHEREAS, the United States is the only industrialized, free-market democracy on earth that does not offer any form of universal health care coverage for its citizens; and WHEREAS, universal health care coverage can be achieved while preserving an individual's right to choose his or her health care provider and exercise control over health care decisions; and WHEREAS, multiple reports have confirmed that universal health programs are achievable and not only improve population health generally but reduce health costs for citizens, businesses, and governments by reducing multiple insurance and billing structures and administrative expenses and increasing governing agencies’ power to negotiate with suppliers; and WHEREAS a majority of Americans support some type of national, single-payer health insurance program; and WHEREAS, the State of North Dakota has already established goals meant to achieve improved health care at lower cost for its citizens, evidenced by its expansion of Medicaid in 2013 and the passage of bills such as HB 1028 (re: North Dakota’s self-insurance plan for health benefits coverage) in 2019; and WHEREAS, nearly 10 percent of North Dakotans still lack health insurance; and WHEREAS, helping North Dakota businesses, farmers, and entrepreneurs reduce health care expenditures will free them to invest in themselves, raise wages, expand operations, and recruit and retain workers; and WHEREAS, honorary North Dakotan and Republican President Teddy Roosevelt was among the first American politicians to advocate for a national health care program over a century ago; and WHEREAS, the state of North Dakota has the unique opportunity to: 1) be the first state to pass legislation ensuring that all legal residents are protected through universal health coverage; and 2) finance such a program through the North Dakota Legacy Fund. Therefore, be it Resolved that the City Council of the City of Grand Forks urges the North Dakota Legislative Assembly and/or North Dakota’s Washington delegation to support and help develop legislation that will provide equitable, comprehensive, affordable, high quality, publicly funded health care coverage to all legal and long-term residents of North Dakota, in a manner that is transparent, accountable, and involves meaningful public participation. Introduced and adopted by the City Council on DATE. This resolution is effective immediately…
August 2017 Reducing Harms from lnjection Drug Use & Opioid Use Disorder with Syringe Services Programs
What Is a Syringe Services Program (SSP)?
A communhu-bosed pubUc heolth progrom thot provldes comprehenslve horm reductlon seMces such os . Sterite needtes, suringes, ond other injection equipment . Referrol to substonce use disorder treotment' . sofe disposot contoiners for needles ond sgringes incLuding medicotion-ossisted treotment ond sociot services ・H:V ond hepotitis testing ond hnkoge to treotment . Referrol. to medicoL mento[ heolth, . prevent HIV STDS, ond virot hepotitis ・[ducotion obout overdose prevention ond sofer Toots to inctuding counseting, condoms, ond voccinotions in」 ection proctices
How Do SSPs Benefit Communities and Public Safety?
SSPs Increase Entry Into Substance Use SSPs Reduce Needlestick Iniuries: Disorder Treatment: SSPs reduce needlestlck SSPs reduce drug use. Peopte who inject drugs (PWID) inJurles omong first responders ore 5 times os tike[g to enter treotment for substonce bU providing proper disposol. use dlsorder ond more tikelu to reduce or stop lnjecting One in three officers mou be when theg use on SSP stuck with o needle during their coreer. lncreosing sofe disposoI o[so protects the pubtic from needtestick injuries. SSPs do not increose LocoI crime in the oreos where theg ore locoted.
SSPsReduceOverdoseDeaths: 3,600 HIV Diagnoses Prevention Saves Money: SSPs g PWID In 2015: reduce overdose deoths bg Amon SSPS sove heotth cqre dottors teoching PWID how to prevent ond SSPS reduce new HIV ond bU preventing infections. The respond to drug overdose. TheU vlrol hepotlus intectlonr bU estimoted tifetime cost of treoting otso leorn how to use notoxone, o decreosing the shoring of one person living with HIV is more medicotion used to reverse overdose. sUringes ond other injection thon $400,000. Testing tinked -\ equipment. About 1 in 3 to hepotitis C treotment con sove (,.1 goung PWID (oged 18-30) on estimoted 320,000 tives. J hove hepotitis C. 〜 ， r\-1 \ ″ な ● ′ い ０ \) こ ０ 漁 ． ● ● /b で 、 SSPs DON'TINCRttASE DRUC USE OR CRIME.
Learn more at www.cdc.gov/hiv/risk/ssps.html |ン ロ Bibliography
1. CDC. HIV ond injection drug use: Sgringe services progroms for HIV prevention foct sheetl. Accessed MoU i5, 20 17 www.cdc. gov/vitotsi gns/pdfl 2Ot6-12-vitol.signs.pdt
2. Seot KH, Thowteg R, Gee L, et o[. Noloxone dlstrlbution ond cordiopuLmonorg resuscltotlon trolning for lnjection drug users to prevent heroin overdose deoth: A pitot intervenflon studg. J urban Heolt/, 2oo5;82(2):303-11.
3. Tobin KE, Shermon SG, Beilenson e webh C, Loikln CA. Evol.uotion of the stogtng otive progromme: Troining lnjection drug users to properlg odminister notoxone ond sove Lives. /rt J Drug poltcy 2oog:20(2)l3j-6.
4. wodok A, cooneg A. Do needte sgringe progroms reduce Hlv infection omong injec ng drug users: A comprehensive review of the internotionoI evidence. Subst l)se Misuse 2OO6t41l6_4:7Tt_A1B.
5. lnstitute of Medicine. Hepotitis ond Liver concer: A notionot strotegg for prevention ond controt of Hepotitis B ond C [report]. Accessed June 6,2017 www.cdc.gov/hepotitis/pdfs/iom-hepotitisondtiverconcerreport.pdt
6. Hohn JA, Evons JL, Dovidson PJ, Lum PJ, Poge K. Hepotitis C virus risk behoviors within the portnerships of Uoung injecting drug users. /4ddiclion 2O1O;1e5(4:j254-64.
7 Dovis CS, Johnston J, De Soxe Zerden L, Ctork K, Costitto T, Childs R. Attitudes of North Corotino tow enforcement officers toword sgringe decrimino[izotion. Drug Alcohol Depend 2014:144:265-9.
8. Lorentz J, Hitl L, Somimi B. Occupotionot needte stick injuries in o metropoliton police lo(ce. Am J Prev Med 2000;18(2)J46-50.
9. CDC. Fy 2017 president's budget request ffoct sheetl. Accessed June 6, 2Ol7 https://www.cdc.gov/budgeV docu menls/f 920'17/hivoidsjoctsheet.pdf.
10. Heimer R, Khoshnood K, Bigg D, Gugdish J, Junge B. Sgringe use ond reuse: Effects of sgringe exchonge '18:537-44. progroms in four clties. J Acg uir lnmune Defic ,ynd, 1998;5uppt
11. Bl.uthenthot RN, Gogineni A, Longshore D, stein M. Foctors ossocioted with reodiness to chonge drug use omong needte-exchonge users. Drug Ilcohol Depend 2oo'l;62(3):225-3o'
i2. Kidorf M, King VL, Peirce J, Kotodner K, Brooner RK. Benefits of concurrent sgringe exchonge ond substonce obuse treotment porticipotion. -,/ Subst Abuse freot 2O11',4O(3):265-71
13. Strothdee SA, Cetentono DD, Shoh N, et ol.. Needte-exchonge ottendonce ond heotth core utitizotion promote entru into detoxificolion. J lhbon Heolth 1999;76(4):448-60.
14. Hogon H, McGough JP, Thjede H, Hopkins s, Duchin J, Atexonder ER. Reduced injection frequenca ond increosed entrg ond retention in drug treotment ossocloted with needte-exchonge porticipotion in Seottte drug injectors. J Subst Ibuse heot 2000',19|.3];.247-52.
15. Morx MA, Crope B, Brookmeger RS, et ot. Trends in crime ond the introduction of o needle exchonge progrom. Am J Public Heolth 2O0O:90(12)1933-36.
16. Goteo S, Ahern J, Ful.ter C, Freudenberg N, Vl.ohov D. Needte exchonge progroms ond experience ofviolence in on inner citg neighborhood. J Acqufi lnmune Deflc Syn* 200t,28(3l.:242-4.
17 CDC. Diognoses of HIV infection in the United Stotes ond dependent oreos,2015. HIV Sutveillonce Repott 2016:27 Accessed Mog 1, 2O'17 https://www.cdc.gov/hiv/pdf/tibrorg/reports/surveiltonce/cdc-hiv-survei[[once- report-20 15-vot-27.pdt ‖TTSTEI恥 Data Request ViRAL‖ EPAWS PROGRAM Grand Forks Gounty
HttV and Hepatitis C Data by North Dakota and Crand Forks County Data in bar charts represent the total number of cases reported. Data presented in the line graph represent the rate of infection utilizing American Community Survey Census Estimates for the respective years as available (www.census.gov).
Hepatitis C Cases and Rates,North Dakota 2014‐2018 ■400 1800
1600 ０ ゛ 1200 ０ ０ 1400 ０ り ． ０ 1000 Ｏ ０ 1200 Ｏ 」 ｕ ０ 800 1000 、 」 ０ Φ 800 ０ Ｏ 600 Ｅ ０ 600 ″ Ｄ 400 ０ Ｚ 400 “ 200 69 200 0N 0 00 2014 2015 2016 2017 20■ 8
North Dakota ■■■■Grand Forks Coun, ― ―‐ Rate North Dakota Rate “ Grand Forks Coun″ 一 SourCe:NDDoH Division of Disease Control ln 2017, the North Dakota Department of Health (NDDoH) started enhanced surveillance activities for hepatitis C' Cases aged 35 and younger qualify for enhanced surveillance and it includes gathering additional clinical information as well as risk factors. The goal of hepatitis C enhanced surveillance is to identify acute and chronic pertains hepatitis C cases as well as understand transmission risk in North Dakota. The data below to the individuals that were interviewed, 94% of qualifying individuals in Grand Forks County and 67% of qualifying individuals in North Dakota in 2017.
Percent of cases interviewed reporting injection drug use, North Dakota 20L7
Grand Forks County
North Dakota
80・/。 90% 0% 10% 30% 40% 50・ t 60% 70%
Source:NDDOH D visiOn of Oisease Control
For more information,ca‖ 8004722■80 or visit NORTH 響職降窯鰤 ヽVWW.nJI'・・ath ttOV1111, prarted o4/■ 0/20■ 9 Dokoto I n*ttr ‖樹TWi」樹D Datanequest ‖RALHEPAmSPROGRAM Grand Forks County
!ncident HIV Cases and Rates,North Dakota
60 2014-2018 12.0 50 ∽ 50 Φ 10.0 0 ∽ 0 “ ０ 40 8.03 」 〇 0 」 ① 30 6.0 1 Ｏ 1D Ｌ 」 っ 20 4.03 Ｚ ■ ７ ∞ ■0 ∝ ■ ■ 2.0
0 0.0 ２ 。 ・ ７ 2014 20■ 5 2016 20■ 8 -North Dakota rGrand Forks County North Dakota Rate Forks County 一 Rate Soure:NDDoH Division of Disease Control -Qp66fl
The data below represents the total number of individuals newly diagnosed in North Dakota with HIV by risk factor. The risk factor presented was self-reported by the individual as their likely risk of infection.
HiV lncidence by Risk Factor,North Dakota 2014-2018 60 ∽ Φ ∽ 50 ∞ ０ 40 」 Ｏ 」 30 ■ Φ ■ Ｏ Ｃ 」 20 ⊃ Ｚ 10 0 ２ ． 。 ４ ２ ． 。 ５ 2016 2017 2018
■MSM ■Heterosexual ■IDU ■MSM/IDU ■Other/NR:
Source: NDDoH Division of Disease Control
For more information, call 8OO.472.218O or visit NORTH Ulww_.JlCheAth.gorl h tu. Drafted 04/ 70/ 20 tg な職露富囮 DokOfO IH∞‖h Ba tegondory.- BOARD OF HEALTH ISSUE STATEMENTS May 2019
Topic: 2019 Community Health Assessment
Contact: Debbie Swanson, 701-787-8101, [email protected]
Background: The Grand Forks Public Health partnered with Altru Health System in 2016 to produce a community health assessment for Grand Forks and Polk County. Altru is required to complete an assessment every three years with involvement of public health agencies, and Public Health Accreditation requires a completed one every five years. We will collaborate with Altru in 2019 to provide leadership on the process of completing a new community health assessment. The first meeting of the advisory was held on March 21, 2019. Board of Health members Jeannie Mock and Cynthia Pic are members of the advisory committee along with several Grand Forks Public Health Department staff members.
Action: For information only.
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Topic: Report on National Public Health Week Activities
Contact: Sarah Odegard, 701-787-8140, [email protected]
Background: During the first full week of April each year, APHA along with communities across the United States come together to observe National Public Health Week. Each year, APHA develops a national campaign to educate the public, policymakers, and practitioners about issues related to each year’s theme. This year’s theme is: “Creating the Healthiest Nation: For Science. For Action. For Health.” Grand Forks Public Health celebrated the contributions of public health from April 1st to 5th by highlighting issues that are important to our nation and community. Please see provided handout for the list of the week’s events.
Action: For information only.
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Topic: Syringe Service Program
Contact: Michael Dulitz, [email protected]
Background: The 2017 North Dakota Legislature enacted laws to allow syringe service programs (SSP) to be established in communities and subsequently the ND Department of Health developed rules to assist organizations interested in providing this service. This harm reduction initiative has the goal of meeting clients where they are in order to prevent disease, create access to health services and build relationships of trust and respect in a nonjudgmental environment. Public health intern, Ashlee Nelson has worked with Michael Dulitz, Opioid Response Coordinator, to develop a plan for a syringe service program at Grand Forks Public Health Department including potential funding sources. See additional handout for more information and data on increases in Hepatitis C cases in Grand Forks County.
Action: Support the Health Department’s efforts to establish a syringe service program and recommend approval to other governing entities as required by law.
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Topic: Health Care Resolution
Contact: Sally Pyle, Debbie Swanson, [email protected]
Background: Brian Schill contacted the Health Department about a draft resolution to present to the City Council of Grand Forks, ND, urging the North Dakota Legislative Assembly and the state’s Congressional Delegation to support legislation that will provide equitable, comprehensive, affordable, high quality, publicly funded health care coverage for all residents of North Dakota. Brian requested time to present this idea to the Grand Forks Board of Health on strategies for advancing this resolution. This concept is part of a larger grassroots advocacy effort by Health Care – Now!
Action: At discretion of the members of the Board of Health.
Director’s Report January – March 2019
Two staff members have achieved milestones in the employment with the City of Grand Forks this quarter: Marcus Lee – 5 years in public health emergency preparedness and Eric Nelson – 15 years in the mosquito control program.
Theresa Knox and I attended an orientation at the Public Health Accreditation Board (PHAB) offices in Alexandria, VA, February 12 - 13. We were able to learn more about the process and had an opportunity to meet our assigned accreditation specialist and public health colleagues from across the U.S. who are also seeking public health accreditation.
I attended Public Health Day at the Legislature on February 6 and Grand Forks Day at the Capitol February 28 – March 1. Both visits to Bismarck provided opportunities to visit with Grand Forks area legislators and state agency leaders to discuss our public health priorities. Governor Burgum was complimentary of our behavioral health initiatives and the partnerships that have led to progress in the community.
The Grand Forks Withdrawal Management (Social Detox) Center achieved licensure from the ND Department of Human Services to provide American Society of Addiction Medicine (ASAM) Level 1 care such as outpatient assessments and evaluations. This will allow the Center to bill Medicaid for services.
The Grand Forks Public Health Department was inducted in the Immunization Action Coalition’s Honor Roll for organizations that have a mandatory flu vaccination policy. A news release was sent to local media announcing this achievement.
I attended the Altru Leadership Development Institute on March 20 to learn about their efforts to improve quality and safety in the health system. The focus on quality improvement translates well to our public health accreditation process and there were ample opportunities to network with leaders at Altru.
The Community Health Assessment process, a collaboration between Altru and Grand Forks Public Health Department, has been initiated for 2019 and will continue throughout 2019. Twenty eight participants attended the first meeting on March 21. The UND MPH program will assist with research for the assessment, conducting secondary data analysis, focus groups and a survey.
Ashlee Nelson joined our department as a Public Health Intern working in the opioid response program and also providing technical assistance on the creation of a workforce development survey.
Public Health Intern Abbie Bachman presented her posters on Substance Use in Grand Forks County and Systems Dynamic Model in Opioid Use Disorder at the ND State Capitol on March 25.
DS 4.1.19 Board of Health Branch Activities Highlights January, February, and March 2019
ADMINISTRATIVE • Alyssa Barclay was reassigned to the Public Health Administrative Coordinator Position.
ENVIRONMENTAL HEALTH • Shannon Ng attended the Healthcare Leadership for Mass Casualty Incidents course at the Center for Domestic Preparedness in February. • Marcus Lee and Shannon Ng attended the NACCHO Preparedness Summit in St. Louis in March. • Javin Bedard & Ana Ebbert attended the House Agriculture Committee on SB 2269 regarding cottage foods on March 22nd. Javin provided testimony in favor of the bill. • The Environmental Health Section is in the progress of hiring a summer intern to assist in responding to grass nuisance complaints. • Javin Bedard presented information about radon to employees of Northern Plains Rail Services in Fordville, and First Care Health Center in Park River in conjunction with Walsh County Public Health. • Established MOU’s for septic work with Pembina and Walsh Counties. Walsh County updated their septic code to the model code this spring. • Richard Klockmann finished the certified training standards recommended by the FDA for food inspections. All EHS staff doing food inspections have now finished this training and initial standardization.
MOSQUITO CONTROL • Completed evaluation of the 2018 program, reviewed equipment needs, and addressed issues that affect the daily operations of mosquito control.
NURSING & NUTRITION • Haley Bruhn moved from the Health Services Team Leader Position to the Disease Prevention Team Leader role when Carrie Kaltenberg retired after 17 years of working for the Health Dept. Kate Goldade was promoted in January to the open Health Services Team Leader role in January. • Terri Keehr retired from her role at the TB Program Manager in January, after working for the Health Department for 26 years and Ashley Krone now fulfills that role. • Theresa Knox attended the Public Health Accreditation Board Training in Alexandria, Va., February 12-13, 2019. • Betty Otteson worked closely with the Grand Forks School District to pass Administrative Guidelines for breastfeeding employees and students in February. • Chantel Vasquez began working as a Public Health Nurse on the Health Services Team performing Office Nurse Duties and Adult Home Visits, on March 25. • Mary Barrett conducted Certified Medication Technician 1 and 2 Training for 12 Correctional Center Officers at the Grand Forks Correctional Center in February. • Haley Bruhn, Immunization Program Manager, met with the state visitor to complete the Vaccine for Children (VFC) site visit in February. The site visit went well.
WITHDRAWAL MANAGEMENT CENTER & OPIOID RESPONSE • The Grand Forks Withdrawal Management (Social Detox) Center was licensed to provide ASAM Level 1 services including screenings and assessments. • Agassiz Associates began offering addiction counseling services at no cost to inmates eligible for the North Dakota SUD Voucher at the Grand Forks County Correctional Center. • Ashlee Nelson was hired as an Opioid Response Intern through the City’s Internship program. She is a first year MPH student at UND. • The F5 Project opened their first house in Grand Forks, to provide housing and support for males leaving the criminal justice system. The Opioid STR grant provided seed funding for their expansion to Grand Forks. • Face It TOGETHER has established a new office in Grand Forks in the River’s Edge Building. They promoted Kal Datz, a volunteer recovery coach to a part time care coordinator through the Free Through Recovery program. Face It TOGETHER’s expansion to Grand Forks has been made possible through the Opioid STR grant. • Opioid overdoses, as reported by Altru, decreased by 43% in 2018 compared to 2017.