MEETING PACKET OCTOBER 2017 OCTOBER 2017
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET,4'H FLOOR Pub&EWn
Prerent.Promote.Protect.
TEL. (978) 741-1800 FAx(978) 745-0343
KIMBERLEY DRISCOLL lramdin@salem.com
URRY RA.MD.IN,RS/REDS,CHO,CP-FS
MAYOR HE.1I,T"H AGENT"
NOTICE OF MEETING
You are hereby notified that the Salem Board of Health will hold its regularly scheduled
meeting Tuesday, October 10, 2017 at 7.00 PM
City Hall Annex 120 Washington Street Room 314
MEETING AGENDA
�t a
1. Call to order5>2 to c
2. Approval of Minutes rn-<
3. Chairperson Communications
rn
4. Public Health Announcements/Reports/Updates '
a. PHN Report
b. Health Agent
c. Administrative
d. Council Liaison Updates
5. Board of Health program planning & city health status discussion
a. Presentation by Kimberly Waller, Salem State University, on how Boards of
Health across MA approach health/social 'issues
b. Discuss health assessment by Sarah Corley, Health Department summer intern
6. New Business/Scheduling of future agenda items
• Items that could not be anticipated prior to the posting of the agenda
Larry Ramdin, Health Agent
cc: Mayor Kimberley Driscoll, Board of Health, City Councilors
Next regularly scheduled meeting is November 14, 2017 at 7:00pm at City Hall Annex,
120 Washington Street 3'd Floor Room 313.
Know your rights under the open meeting law,MGL chapter 30A ss 18-25 and City
Ordinance section 2-2028 through 2-2033 `
This notice posted on "OfficiaallBullll tin 01 Board"
City Hall, Salem, Mass. on
at /0e1u 41-4 in accordance with MGL Chap. 30A,
Sections 18-25.
I
CITY OF SALEM
BOARD OF HEALTH
MEETING MINUTES
September 12, 2017
MEMBERS PRESENT: Paul Kirby, Chair, Mary Lauby, Kerry Murphy
EXCUSED: Dr. Jeremy Schiller,Nancy Crowder, Beth Gerard, Council Liaison
OTHERS PRESENT: Larry Ramdin, Health Agent, Suzanne Doty, Public Health Nurse,Maureen Davis,
Clerk of the Board, Chris Lohring &Mary Ellen Leahy,Notch Brewery
TOPIC DISCUSSION/ACTION o
1. Call to Order 7:OOpm ,
y
Mary Lauby motioned to takeagenda item #6 out of order.
Kerry Murphy.,- All in favor Motion passed.
�4
2. Chris Lohring-Notch Brewery: All were provided With cope,:of Food Cod6 ages related to
Request for Board to review surfacing requiremetts.'
Outdoor dining area surfacing C 'Lohrig, owner of Notch, described his patio surface as hard-
requirements as defined by packed;gravel;-.angular in shape so they can pack tight and is the
2013 Food Code size of pea stone`:,,
When asked how he cleans the surface, he stated he hoses it off
{ .;and remowes}_dirty gravel, ifnecessary.
f. L=:Ramdin mfofiried the Board}that Notch was originally only
F serving pretzels:and sausage. Now there are lots of pop-ups with
different kinds of:food. Gravel cannot be sanitized.
rv,'C Lohnrig stated there is nothing in the Code regarding outdoor
dining.
LRamdin saialthe Code applies to all surfaces where food
esiablishment patrons are dining, both indoors and outdoors.
C. Lohrig said he "Googled" several places within the state that
t"r , ;_have gravel or grass outdoor surfaces who are also doing pop-ups.
, He provided printed pictures of his research to the Board. He also
-_cited Antique Table (old Grapevine restaurant) and the Clam
Shack at the Willows as both having gravel in their outdoor dining
areas.
r L. Ramdin asked if his research was just tap rooms.
C. Lohring said they were all tap rooms with pop-ups like his.
P. Kirby asked how many pop-ups they had.
C. Lohring said they average about two per month. His landlord
limits him to two per month. He said he is just trying to provide
customers with more than just pretzels. He can survive without
pop-ups, but it's more fun with them.
K. Murphy referred to page 527 of the Food Code handout
• regarding less stringent requirements for surface characteristics for
temporary food establishments. She admits the clause is not clear.
C. Lohring asked L. Ramdin how a temporary event at the
Common, on grass, is different from his pop-ups.
L. Ramdin said seating is not provided by the food vendors.
M. Lauby asked if the issue is about food prep or where the food is
eaten.
L. Ramdin said a food establishment includes both food prep and a
dining area. Eating areas that are not under the direct control of an
establishment do not have to comply to surface requirements.
Notch's patio is under their direct control.
L. Ramdin said Antique Table will be told to cast (concrete)their
outdoor dining area.
P. Kirby asked what steps would need to be taken in order to put
concrete or tile in place of the=gravel.
C. Lohring said he would,j av io go before the Conservation
Commission.
P. Kirby asked if he,has:gotten any estimates for changing the
outdoor dining surface.
C. Lohring said:A6,`because his is trying to maintain the aesthetic
of a Germari;;hi tgarten, much like Boston Beer Garden.
M. Lauby suggested to find out if the Conservation Commission
would allow hard surfaces; as'they cause r'un of£ She also stated
she has eaten food ali Fovef ilye country that had:gravel surfaces.
P.'Kith -wants to ensur&a;level playing field for all.
C. L'ohring said so many other businesses similar to Notch in the
state have gravel b �do but Salemes not allow it.
L. Ramdin,said a few other things;have come up in addition to this
issue, such as outdoor storage of trash, that also needs clarification.
He will be sending'quite a few questions for consideration to the
`f. conference of food protection because he agrees that there is a lot
4 �
y of ambiguity.
The Board agreed that if the Conservation Commission won't
`allow hard surfaces,°then we can't ask businesses to change.
C:Lohring said4he Harbor Walk will be cantilevering out, so he is
waitug,to see what happens. He will ask his landlord Tim Clark
for an"update on the time frame for the Harbor Walk construction..
K. Murphy suggested we contact MAHB for guidelines of outdoor
dining surfaces.
. Ramdin said he will call Boston to see what they allow. He said
Boston does not allow dogs on outdoor patios, but Salem does.
He suggested the Board should not require changes to businesses
until we have more information to make an informed decision, and
instead should take the matter under advisement and revisit it at a
later date after more information has been gathered.
K. Murphy motioned to continue at a later date. M. Lauby 2nd
All in favor. Motion passed.
P. Kirby said he learned some new information about the issue; the
possible wrinkle with the Conservation Commission, as well as
aesthetics being the reason for Notch not wishing to change the
surface.
P. Kirby said he understands why gravel is not ok for permanent
food establishments, but not sure about for temporary pop-ups. He
would prefer there be a smooth surface if they are serving food.
L. Ramdin suggested the possibility of using the green
indoor/outdoor fake grass rugs as an option. It is a cleanable/
washable surface.
K. Murphy asked if they could put clear rubber mats under the
tables.
L. Ramdin said the mats would have to be on the entire surface
area,not just where people are eating.
P. Kirby stated he was blindsided by some pieces of information
that made him have doubts,:,asAhere are a lot of moving parts. He
reiterated his respect for Larry: Both he and the Board appreciate
his knowledge and passion and the intention was not to undermine
him in any way. =+r
M. Lauby said shelheard the Mayor talk of wanting Salem to have
a certain aesthetic and feels that soifetimes we will need to filter
through interpretations and look at alternatives and other
considerations;ia.order for us to be able tog_ive people options.
We will run into-stuations where aesthetics-,,V"s.:traditional
interpretation while sti11'mantaining standards
L.'R- m n stated that�whlle we all like that vision of Salem, he
cannot base his decisions-off-political opinions or wants, but must
base it,on a sound;public health:regulation. He does a lot of
researchon-. * ,regulations and'codd"' etc.
•
.3
3. Minutes of Last Meeting Mary Lauby moved to approve minutes. Kerry Murphy 2°1
(July 11, 2017) All-in.favor. Motion passed.
4. Chairperson Announcements'y Nothing new to-report.
4
5. Monthly Reports-Updates tt .
a. Public Health S. Doty noted that August was a busy month with events. It was
Nurse's Report nice to be a part of them.
Y A(` She has started a contact investigation on an active Tuberculosis
case with 20 contacts. Sees them Monday through Friday for
directly observed therapies (DOTs).
L. Ramdin affirmed that Suzanne is extremely cautious.
K. Murphy noted lots of flu cases compared to last year.
Copy available at the BOH office
b. Health Agent's Report L. Ramdin enjoyed the NEHA educational conference in Grand
Rapids, MI. His main take-away was about the spread of
norovirus and just how much good hand hygiene and covering
icoughs can reduce the spread. Use hand sanitizer when available.
A brewery will be opening up in the basement of Nick's Firehouse
Coffee Shop building on Church Street. They will put in a patio
. with taps outside between the building and the parking lot. They
would like to open soon. It is in the initial stages of plan review.
Our concern will be where their spent grain will go/how they will
store it because it is a huge attractor for rodents.
P. Kirby asked about the film company use policies.
L. Ramdin said caterers need permits from us and we need to
know about their plans to deal with waste on their site, etc. He
feels smaller productions are better for the City. He and other
department heads wanted to establish ground rules. Discussions
will continue and eventually we will be able to hand a packet over
to the production companies Jetailing what they can expect should
they choose to film in Salem 4.ro
M. Lauby asked for an update on our syringe service program.
L. Ramdin said the Board did the right thing in approving it. He
also agreed that starting with a 114or-1 exchange for now is best.
He says Health'-,Stireets has already:`started the program. It is a
mobile program to enhance the outreach..,No people lining up.
P. Kirby asked if we will start getting reports.
L. Ramdin will ask Mary TWheeler for repoi"tsand will incorporate
them,as part of his Health Agent report.
Chief.Butler will let us-know if there is an increase in needle
waste
At a recent safety;meeting, th&Park&Rec Director was told if a
needle is found not t.O pick it up'-`call the police to dispose of it.
• We got sharps containers'from a grant, so every police cruiser has
P Kirby asked about UMass Extension School doing cooking
demos.at the Farmers' Market.
L: Ramd n,said theyhave been there for a couple of weeks now
;and will be there:,until the end of September. To promote the
healthy incentives program where people get double credits for
produce.
y,M. Lauby,asked about the Harbor Walk expansion project.
L. Ramdin said we got final approval from the state. He believes
there are more details on the Planning Department's website.
>t Mosquito cases in surrounding communities: Lynn, Peabody and
i -Beverly had West Nile. Beverly had human-biters—they sprayed
last week. There has been one human case of West Nile in Bristol
County. Mosquito season usually wraps-up in October.
Copy available at the BOH office
c. Administrative M. Davis showed the Board the physical temporary food permit
Report files to compare the number of permits issued this year since the
permit fee was lowered vs. the number issued in previous years.
So far, there are over 120 this year vs.just a couple in years past.
P. Kirby asked about the impact on workload and if we are losing
• money on every pop-up.
L. Ramdin said yes, we are losing money on every pop-up. Plus, it
is taxing on the inspectors' time. There is now an expectation that
they have to put in a couple of hours on Saturday and/or Sunday.
• P. Kirby asked what the back-up plan is if all inspectors are busy
on weekends and cannot inspect pop-ups.
L. Ramdin said we have a part-time inspector who also works for
Beverly, but on occasion he cannot cover for us due to other events
in Beverly. We really need additional staff for weekends.
M. Lauby suggested we should report the substantial increase in
pop-ups to the Mayor and discuss the need for additional part-time
inspectors.
M. Lauby asked about the rejected pop-up application in July.
L. Ramdin said it was a food truck-there was conflict about where
they were operating out of, and also their permit was suspended by
Boston because the truck,wa's dirty and not in compliance with the
Food Code.
Copy available at the-- OH:office
K. Murphy motioned to accept We'reports. M. Lauby 2"1
All in favory Motion passed.
d. City Council Liaison Beth Gerard not present. ,
Updates
;.µ
6. Reaffirmation of M.Lauby movedto reaffirm the Salem Board of Health's
participation in North participation in North,Shore/Caape Ann Tobacco Alcohol
Shore/Cape Ann Tobacco = ` Policy Program. -1VYurphy 2"tl''All in favor. Motion passed.
Alcohol Policy Program
7. Board of Health Program Iannmg _'
& city health status discussion"
a. Review health,assessment by., P Kiby asked L. Ramdin to tell the Board about the intern.
Sarah Corley,, alth ,L. Ramdin said we lucked out with her. Our first scheduled intern
Department summer intern ;got another internship. The second intern scheduled was selected
by CDC to go to Ethiopia. Finally, they gave us Sarah Corley and
j., she was a perfect fit for our department. She is a student at Boston
' 'University who will graduate next year with a Master's degree in
Public Health. Her concentration is in public policy. She is
planning to get her PhD. She went out on inspections with our
inspectors and worked with Suzanne at the Farmers' Market. She
did a lot of good work and she got a good overview of what we do.
P. Kirby will send an electronic copy of Sarah's health assessment
to Kimberly Waller at Salem State University who will join us at
the October BOH meeting. She was unable to make it to this
meeting(item#7-b of this meeting's agenda).
M. Lauby asked if Larry met with Lisa Salerno this summer who
was working with the Mayor's office.
L. Ramdin said yes, she was a summer intern from Harvard. The
Harvard students developed a tool for problem properties. The
tool has helped us identify several uninhabited or problem
properties because data is gathered from all departments to help
• identify problems. Before each problem properties meeting,
Vickie Caldwell generates a list for us so we know which
properties are foreclosed upon. We can go out and see the
property and get in touch with whoever is in charge of
maintenance and get the property taken care of. It is an on-going
project for the Harvard students.
M. Lauby noted that there was no mention of noise under the
Environmental Health category on page 30 of the health
assessment.
L. Ramdin wanted the Board-fo:know, since he was not present at
the meeting in July, that Councilor Heather Famico has been
speaking with other city departments, who essentially told her
there is not anythingrtley`can'do,about the HVAC noise issues she
has raised. He went out with Heather Famico to the mall and to
Salem Five Salem_Five was in the process of replacing units. The
rattling sound of the units downtown is'normal and is due to non-
use in winter`.'_'After the units are serviced:'they are ok. He also
went to the Hawthorne Hotel:`:You can hear_ar,but the units are
checked by HVAC compames and are operating'within normal
parameters. t
He also pointed�out that if something has been open and notorious
for over 1.0 yeaxs;'places have:an easement. What he heard was
• part of normal downtown noise
As part of new construetion,;he is'asking how HVAC units will be
' shielded for noise:absorption and feels the responses he has
received are appropriate.
P Kirby said he;thinks it is admirable that Larry was more
responsive4o Heather than other city departments.
4.t
8. New Business/Scheduling of future Item.#7 regarding city health status will be continued in October.
agenda items
P. Kirby wondered if we should add the continued discussions on
the Notch item to next month's agenda, or continue work on it
iz r 'outside the forum.
L. Ramdin.suggested if we compile enough new information by
then we will add it to the agenda. He will speak with the
Conservation Commission.
P. Kirby will continue discussions with Asst. City Solicitor, Vickie
Caldwell.
K. Murphy will contact the MAHB.
L. Ramdin reminded the Board that MAHB training is coming up
in October or November. He will send specifics to the Board
members. City rules are that the Board members initially pay for
the seminar, and once the certificate of participation is provided to
• us we will reimburse you.
M. Lauby asked how we will gather info and updates for the Notch
item.
L. Ramdin said to send all new info to him, then he will compile it
• and send it back out to the Board. He also reminded Board
members that they can't discuss anything that requires a formal
decision outside of the public meeting setting.
9. MEETING ADJOURNED: M. Lauby moved to adjourn the meeting. K. Murphy 2°d
All in favor. Motion passed.
9:16pm
Respectfully submitted,
r=
Maureen Davis
Clerk of the Board
Next regularly scheduled meeting is Tuesday, Octoher 10, 2017 at 7OOpm
At City Hall Annex, 120 Washington Street;:-Room 314, Salem,MA=
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•
Suzanne Doty RN BSN
Salem Board of Health
Public Health Nurse
Public Health Nurse Report
Reporting on September 7, 2017 through October 2, 2017
Disease Prevention and Health Promotion
• Investigated reportable diseases and reported case information to MDPH.
• Coordinating follow up with North Shore Pulmonary Clinic on tuberculosis cases.
• Continually recording and submitting refrigerator temperature logs, flu doses and clinic
information into the Massachusetts Immunization Information System(MIIS) for up to
date vaccine records and better continuity of care between clinics and providers.
• Posted Facebook, Twitter and Instagram posts regarding the Household Hazardous
Waste day event.
• Flu clinics planning has been on going, clinics for Salem will be at the City Hall Annex
building on October 12`' for all city employees, family members and retirees. A second
flu clinic will be held at the Council on Aging on October 18"which is open to the
public.
• I will be assisting with staffing flu clinics throughout October and November for
surrounding towns as well.
• On site clinics dates to be determined for Police, Fire and DPS.
Meetin2s/Trainings
• Continued modules, conference calls and Working on Wellness webinars. Submitting on
going assignments as plans become more finalized. First round of seed funding of$2,000
awarded on December 15`"and arrived mid-January. Second round of seed funding for
$7,000 has also been awarded and arrived mid-February. The program launched on
Monday May ls`, Mayor Kim Driscoll sent out an all staff launch email. More programs
have been added such as a weekly lunchtime workout class and nutritionist classes.
Weight Watchers program to begin at the Council on Aging in October.
I am submitted the evaluation report and will be sent out a second Needs and Interest
survey.
• Continuing to attend the Thursday Farmers Markets with displays of a weekly of health
topic, blood pressure checks, public health information and materials and availability for
any questions the residents may have. The Farmers Market's last day will be October
12`".
• Lunchtime fitness classes at 120 Washington St continuing through October 10`".
• Diane Dube, a local Registered Dietitian Nutritionist held her second nutrition class on
August 23`a and taught reading nutrition labels and grocery store shopping, she is
scheduled to return for another class on November 1S`
• Attended the Northshore Cape Ann Emergency Preparedness meeting on September 20th
for collaborations with health agents and nurses from surrounding towns for emergency
preparedness and current events.
• Marliyatou Diallo, A Salem State University RN to BSN student has begun her clinical
hours, she will complete 70 hours between September and December.
• Participated in Salem's Household Hazardous Waste Day event at Salem High School on
September 30"'.
Monthly Report of Communicable Diseases: September 2017
Disease New Carry Over Discharged/ Total# Of Running Total for Total for
Reported Cases this Total for 2016 2015
Closed Month 2017
Tuberculosis 1 1 0 2 2 4 4
(Active)
Latent 7 0 7 7 (8 suspect) 33 31 47
uberculosis*
Arbovirus* 0 0 0 0 0 0 0
Babesiosis 0 0 0 0 0 0 1
Calicivirus/No 0 0 0 0 1 0 1
rovirus
Campylobacte 0 0 0 0 1 15 11
riosis
Chikungunya 0 0 0 0 0 0 0
Dengue* 0 0 0 0 0 0 0
Ehrlichiosis 0 0 0 0 0 0 0
Enterovirus 0 0 0 0 0 0 1
Group A 1 0 1 1 3 0 4
Streptococcus
Group B* 0 0 0 0 4 2 7
ep tococcus
WDisease New Carry Over Discharged/ Total# Of Running Total for Total for
eported Cases this Total for 2016 2015
Closed Month 2017
Human 0 0 0 0 0 1 1
Granulocytic
Anaplasmosis
Haemophilus 0 0 0 0 2 2 1
Influenzae
Hansen's 0 0 0 0 0 0 0
Disease
Hepatitis A 0 0 0 0 0 0 0
Hepatitis B* 0 0 0 0 4 8 0
Hepatitis C* 2 0 2 2 24 30 29
Influenza* 0 0 0 0 65 19 29
Legionellosis 0 0 0 0 0 2 1
Lyme 0 0 0 0 0 0 2
Disease*
(22) (27**)
(Probable)
Malaria 0 0 0 0 0 2 0
Measles 0 0 0 0 0 1 0
Meningitis 0 0 0 0 0 0 0
Mumps 0 0 0 0 0 1 0
Pertussis 0 0 0 0 0 1 1
Salmonellosis 0 1 1 1 8 11 6
Shigellosis 0 0 0 0 0 3 0
Streptococcus 0 0 0 0 3 8 3
Pneumoniae*
Varicella* 0 0 0 0 0 1 0
0 Vibrio 0 0 0 0 0 1 0
Disease New Carry Over Discharged/ Total#Of Running Total for Total for
Weported Cases this Total for 2016 2015
Closed Month 2017
West Nile 0 0 0 0 0 0 0
Yersomosis 0 0 0 0 0 0 1
Zika Virus 0 0 0 0 0 1 0
Infection
Total 11 1 11 13 148 204 140
September 2017
*Notifications only, LBOH not required to follow up or investigation per DPH.
**Total reflects cases that have also been reported as suspect cases.
All Communicable disease totals above are subject to change in the event that the follow-up investigation
• results in the revocation of the diagnosis.
Yearly totals,for 2016 have been updated,for year end with the number of CONFIRMED cases.
Summary of Current Communicable Diseases
Tuberculosis:
Active Case 1:
I was contacted on August 24'h regarding an active case of Tuberculosis infection in a Salem resident.
This resident has started the appropriate antibiotics and discharged home. Direct Observed Therapy
(D.O.T.)has begun and consists of home visits 5 days per week during the course of treatment which is
typically 9 to 12 months.
In the meantime, 20 close and household contacts have been identified. I have been completed
Tuberculosis testing on all of these contacts and placed referrals to the North Shore Pulmonary Clinic.
Active Case 2:
As part of the follow up contact investigation, all patients with positive PPDs (tuberculosis skin tests)
were referred to the NSMC pulmonary clinic for chest x-rays. This case had an x-ray suggestive of
• Tuberculosis in conjunction with a large positive skin test. Medications and D.O.T. has been started 5
days per week. Sputum samples are pending final results for 60 days. However, the patient is smear
• negative for acid fast bacilli and is not considered contagious. This patient will continue to be treated by
NSMC.
Group A Streptococcus:
This case began with an injected wound sustained in the community which developed into to sepsis. This
is not considered a nosocomial case due to the origin of the infection and the case has been closed per
MDPH epidemiology and no further follow up is necessary.
Salmonella:
Case 4 (carried over from August): This case was hospitalized after returning home from traveling out of
the country. They do work in a profession that is considered food handling in a town outside of Salem. I
contacted this case's place of employment and withheld them from working until a negative stool sample
resulted. This case has now been able to return to work and a letter has been issued to their employer. The
case is fully recovered, no further cases have developed and this case is now closed requiring no further
follow up.
•
•
f
• Health Agent report September 2017
Announcements/Update
• The staff attended the Mayor's "All staff Meeting" which provided us with updates on
events, city projects and Mayor's vision.
• The Expect Program has started we are assigned 4 students and they will be working on
developing messaging around de stigmatizing opiate overdoses and advising on Health
Department messaging.
• I will be attending the Yankee Conference on Environmental Health from October 4-5, 1
will be out of office from October 3. Additionally, I will be doing a CEPH Accreditation
visit from October 29-31 at Northwestern University Chicago.
Community Outreach
• The Health Department provided advice to the Northshore CDC on hosting a Block party
on Peabody Street.
• A three (Salem, Lynn and Peabody) City Opiate Caucus was held in Peabody on
September 14. The mayors of all three cities attended and discussions were held on
progress of the ongoing efforts and future plans for combating the opiate crisis.
•
Meetings and Trainings
• The Environmental Health Staff attended the MHOA Seminar that discussed the updated
Food Borne illness Investigation Manual
• Larry Ramdin participated in the Bloomberg Challenge Workshop. At the workshop we
discussed issues related the opiate crisis in Salem ad developed Logic models to guide the
application process.
• Larry Ramdin attended a meeting with the City Engineer and team to review the Fats Oils
and Grease monitoring project and discuss outcomes of past monitoring results and future
plans
Environmental Health Activities
• Household Hazardous Waste day was held on September 30 at total of 152
Household/vehicles participated. Additionally, we recycled 132 Propane tanks.
• The trash issues are constant we have place cameras at the main dumping sites and these
areas are under constant surveillance.
• I attended the Woodlands project pre-construction meeting and discussed Board of
Health requirements with the developer, especially rodent control, noise and dust issues.
•
• Inspections
Item Monthly Total YTD 2016 Total
Certificate of Fitness 38 302 506
Inspection
Certificate of Fitness 5 44 42
re-inspection
Food Inspection 31 200 241
Food Re-inspections 7 64 31
Retail Food 6 23 17
Inspections
Retail Food 7 8 12
re-inspection
• Temporary Food 46 117 48
General Nuisance 9 29 26
Inspections
Food— 0 0 2
Administrative
Hearings
Housing Inspections 4 71 94
Housing re- 4 40 25
inspections
Rodent Complaints 8 40 24
Court 0 2 3
Hearings/filings
Item YTD 2016
Trash Inspections 92 712 574
Orders served by 0 1 3
Constable
Tanning Inspections 0 0 0
Body Art 0 0 0
Swimming pools 0 22 9
Bathing Beach 0 123 108
Inspection/testing
Recreational Camps 0 6 6
•
Lead Determination 0 1 2
Septic Abandonment 0 0 0
Septic System Plan 0 0 0
Review
Soil Evaluation 0 0 0
Percolation tests 0 0 0
Total 254 1796 1699
•
Health Dept. Clerical Report FY 08
Burial Permits Permits Plan Reviews Certificate of Copies / Fines Revenue Permit Fees
July-1 7 $900.00 $4,350.00 $630.00 $1,800.00 $300.00 $7,980.00 Food Service Est. <25seats $140
August $700.00 $1,670.00 $270.00 $1,500.00 $4,140.00 25-99seats $28o >99seats $420
September $900.00 $4,530.10 $270.00 $2,350.00 $200.00 $8,250.10 Retail Food <l000sq' s70
October $0.00 1000-10,000 $28o >lo,000 $420
November $0.00 Temp. Food 1-3 days s35
December $0.00 4-7 days s7o >7 days s
January-1 Example of>7day temp food permit:
$0.00 1 14(days)divided bY7=2 x$70=$140
February $0.00 Frozen Desserts $25
March $0.00 Mobile Food $210
April $0.00 Plan Reviews New $180
May $0.00 Remodel s90
Catering
$25 per event/$zoo
une
� $0.00 catering kitchen
Body Art Est. $315
Total $2,500.00 $10,550.10 $1,170.00 $5,650.00 $500.00� $20,370.10 Body Art Practitioner $135
Review Plans s18o
Fiscal Year Budget 2018 suntan Est. $140
Rec.Day Camp $10
Salary Starting Ending Expenses Ext.Paint Removal $35
Full Time $412,115.00 $328,043.61 Starting Ending Transport Off.Subst. slo5
Part Time $43,354.00 $36,689.91 $32,500.00 $28,372.31 Tobacco Vendors $135
Overtime $2,000.00 $723.69 Swimming Pools Seasonal $140
Balance $457,469.00 $365,457.21 Health Clinic Revolving Account Annual$210 Nonprofit$40
$9,437.73 Title V Review $180
Well Application s18o
Disposal works $2251180
Breakdown of Permits and Fines
September 2017
Permit Description Total Permits Issued Permit Cost Total
Annual Food - Retail <1,000sq' 1 $70.00 $70.00
Annual Food - Retail 1,000-10,000sq' 2 $280.00 $560.00
Burial Permit 36 $25.00 $900.00
Catering 1 $25.00 $25.00
Certificate of Fitness 47 $50.00 $2,350.00
Exterior Paint Removal 3 $35.00 $105.00
Plan Review 1 $180.00 $180.00
Plan Review- Remodel 1 $90.00 $90.00
Temporary Food - Pop Up(1-3 days) 89 $35.00 $3,115.00
Temporary Food - Pop Up(1-3 days)- Non-Profit 3 $25.00 $75.00
Temporary Food - >7 days 1 $310.10 $310.10
Tobacco Fine 1 $200.00 $200.00
Tobacco Permit 2 $135.00 $270.00
Total $8,250.101
J
CONTRIBUTING FACTORS:
PREVENTABLE CAUSES OF FOODBORNE ILLNESS , =
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Learn about contributing factors to outbreaks and how you can identify them during
outbreak investigations. Each year, more than 800 foodborne illness outbreaks are
reported in the United States. More than half of these are linked to restaurants.
• • 1
• Contributing factors are behaviors, practices, and
. . ,
environmental conditions that lead to outbreaks. Knowing the
contributing factors can help us stop outbreaks and prevent
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THERE ARE3 • • r
TYPES OF PREPARATION
EXAMPLE...
CONTRIBUTING PRACTICES
FACTORS • •
Pathogens and A sick food worker
Contamination other hazards handles food with their
getting into food bare hands
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Proliferation growing faster refrigerator that is too
warm
Survival Pathogens surviving a Food is not cooked long
process to kill or enough or to a hot
reduce them enough temperature
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Environmental assessments conducted during outbreak
investigations identify contributing factors.These assessments
help us learn how pathogens are spread in the environment to
cause foodborne illness.
State and local food regulatory programs should conduct environmental
assessments as soon as they learn a restaurant may be linked with an outbreak.
Environmental assessment activities include
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Interviewing kitchen managers and Observing how restaurants prepare
food workers food (for example, food temperatures)
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example, records of food cooking restaurant kitchen
temperatures, traceback records)
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State and local food regulatory programs should
Learn more about Join CDC's
environmental National
assessments and Environmental
contributing Assessment
factors with Reporting System
CDC's training (NEARS)
• � �� Use the FDA Food
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environmental Code as the
assessments for model for
a regulation of
all foodborne
illness restaurants and
outbreaks retail food
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ACCESS THESE RESOURCES AND MORE AT
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U.S.Department of 1
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���� Centers for Disease
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Massachusetts Department of Public Health Arbovirus
Surveillance Program Report
Key Public Risk Communication Messages for This Week:
This is the final MDPH Arbovirus Surveillance report of 2017.Mosquito testing at the State Public Health Laboratory
Wded on 10/6/17. Last week,one sample of West Nile virus positive mosquitoes was collected from Middlesex County.A
ingle detection of Eastern Equine Encephalitis(EEE)was made in Bristol County on 8/16/17.Daily temperatures will be
above average for the next two weeks. Given the high level of West Nile virus activity this year residents should continue
to avoid mosquito bites regardless of where they live until the first hard frost.Check final risk levels by visiting
www.mass.L-ov/dph/mosquito.
Establish good mosquito avoidance habits now
•Teach children to be aware of mosquito activity around them and avoid it
•Pick a repellent with an EPA-approved active ingredient •Use long sleeves to cover up when possible
•Remove standing water to help reduce mosquito populations •Repair screens
Remember that several 30 second PSA videos are available for download and use on your website to help promote
prevention activities to your residents. These can be found at www.mass.gov/mosquitoesandticks
NOTE: Zika virus continues to be spread in Africa,the Caribbean,Mexico,India,and Central and South America.The
mosquitoes that spread this disease are active during the day.
Travelers who are pregnant or part of a couple planning on becoming pregnant soon are advised not to travel to areas
with ongoing Zika virus transmission. The most current information about locations at risk can be found here
http://www.cdc.2ov/zika/2eo/active-countries.html. If residents choose to travel,prevent mosquito exposure by: using
EPA registered mosquito repellents,cover exposed skin by wearing long-sleeved shirts and pants,stay in places with
screens and air-conditioning,or sleep under mosquito netting.
0 order to avoid sexual transmission of Zika virus from a partner who has recently traveled to an area where Zika
transmission is occurring,abstain from sexual contact or use condoms consistently and correctly during all sexual
activity.Talk to your healthcare provider for more information.
WNV and EEE Virus Surveillance Summary
Results contained in this report reflect data inclusive of
MMWR Week 40 (Sunday, 10/1/2017—Saturday, 10/7/2017)
Mosquito Surveillance
Number of Mosquito Pools Tested 5495
Number of WNV Positive Pools 290
Number of EEE Positive Pools 1
Equine/Mammal Surveillance
Number of Mammal Specimens Tested 4
Number of WNV Positive Horses 0
Number of EEE Positive Horses 0
Number of other EEE Positive Mammals 0
• Human Surveillance
Number of Human Specimens Tested 251
1
Number of Human WNV Cases 2
Number of Human EEE Cases 0
Summary of 2017 Mosquito Samples Tested
Massachusetts State Public Health Laboratory
Berkshire Bristol Cape Central Dukes East Norfolk Northeast Plymouth. Suffolk
M WR Week: - Total
County County Cod - MA County Middlesex Country MA County SLI - County
(Specimens Tested) MCP MCP MCP MCP MCP MCP MCP MCP MCP MCP Tested
24(6/11-6/1712017) 3 7 23 38 6 0 0 15 10 7 0 103
25(6/18-6/24/2017) 2 19 16 81 0 0 12 10 7 97 0 244
26(6/25-7/l/2017) 21 2S 18 79 0 0 121 8 10 . 44 0 217
27(7/2J/812017) 0 27 20 64 4 0 20 0 0 85 _6 226
28(7/9-7/1512017) 61 24 33 54 0 27 16 26 38 115 10 404
29(7716-7/22/2017) 31 48 23 90 3 34 . 29 22 47. 121 •16 470
30(7/23-7/29/2017) 35 52 14 85 .0.1 28 321 35 135. 0 - 416
31(7130.8/5/2017) 33 47 23, 96 -1 36 18 421 42 184 11 '632
32(8/6-8112/2017) 31 57 30 116 2 37 23 62 52 131 0 541
33(8113-8119/2017) 31 53 - 26 98 2 30 27 68 56 132 11 534
34(8/20-8/26/2017) 30 '45 21 98 3 22 17 80 .41 44 27 428
35(8/27-9/2/2017) 24 37 7 92 0 15 16 '63 28 80 6 .368
36(9/3-9/9/2017) 25 24 27 r, 73 3 13 8 61 0 34. 13 281
37(9/10-9/1612017) 0 . 15 19 73 ` ;. 1 7, 14 45. 40 `55 ` `4 273
38(9117-912312017) 13 17 .9 '. 78 0 6 7 18 11 , ,., 42 0 201
39(9124-913012017) 3 '7 0 `" 66 2 .10 2 44 10 „27 0 171
40(10/01-10/0712017) 0 17 0; 51 0 8 0 0 0 10 0 86
Total 343 521 309 'U311 21 2451 2491 596 421 1349 104 5495
Numbers reflect finalized results;data are subject to change as additional test results are finalized
Cumulative Confirmed and Probable Human Chikungunya Virus Infections and Dengue Fever Cases
• Reported in Massachusetts by County of Residence, 2017
(these data are current as of 10/10/2017 and are subject to change)
County Chikungunya virus infection Dengue Fever
Barnstable 0 0
Berkshire 0 0
Bristol 0 0
Dukes 0 0
Essex 1 0
Franklin 0 0
Hampden 0 0
Hampshire 0 0
Middlesex 2 1
Nantucket 0 0
Norfolk 0 0
Plymouth 0 0
Suffolk 0 0
Worcester 0 0
Total 3 1
�te: Although local transmission of the mosquito-borne viruses dengue or chikungunya is extremely unlikely at this time due to
Timited establishment of populations of Aedes albopictus,surveillance for cases of human infection with these diseases is occurring.
All confirmed and probable cases listed above were travel-acquired unless otherwise noted.
2
Massachusetts WNV Risk Categories
dam"m�''•'; - r �a3'��^s ,9,.,y,. �-sl;
�FCurrent WNV Risk Level
L^ Low
C Moderate Current Risk Levels—as of October 1.0, 2017
High
-Critical A4rurnupiu Sre P.d4t NC�M t�eor�bry
NOwiw SwwWera Pnp�m
Figure 1: Current WNV Risk Categories as described in Table 1 of the 2017 MDPH Surveillance and Response Plan
Massachusetts EEE Risk Categories
T 1
+ i e.w ti wri
Current EEE Risk Level '
r Remotes
-- - �: ✓
. ;Low ,
:Moderate '
y High Current Risk Levels°—as ofOctober'10, 2017
Critical
x
Figure 2: Current EEE Risk Categories as described in Table 2 of the 2017 MDPH Surveillance and Response Plan
•
3
City of Salem Health Assessment- 1
City of Salem Health Assessment
Summer 2017
v���ONDIT9��
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Overview
Salem is located approximately 16 miles north of Boston, at latitude 42-33-10 N and longitude
53-40 W. It is 8.2 square miles and is bordered by Beverly, Danvers, Lynn, Marblehead, Peabody,
Swampscott,and the Atlantic Ocean (Location and Access, n.d.).The population of Salem is 42,499
people(American Community Survey[ACS], 2015). Current major routes through Salem include 1A, 107,
and 114.The MBTA maintains a commuter rail stop and bus services.There is also a Salem Ferry to
Boston (Location and Access, n.d.).
The land of Salem averages elevation of 100 feet or less,with coastal areas under 50 feet, and
some interior hills around 200 feet(Massachusetts Historical Commission [MHC], 1985). Land surfaces
are irregular and slope west to east,towards the coast(MHC, 1985). Within Salem's 8.2 square miles
are 18.5 miles of tidal shoreline Community Profile, n.d.).The city consists of 43.3%of green space
combining agriculture(0.2%),forest(26.4%),open space (10.6%),and recreation (6.1%),while urban
area takes up 54.6%of the city, and water the remaining 1.6%of Salem (MDPH, Bureau of
Environmental Health, 2017).The structures in Salem are quite old,with 55.0% built in 1939 or earlier
(ACS,2015).
City of Salem.Health Assessment-2
MV), CITY OF SALEM WARD&PRECINCT BOUNDARIES
a m, MASSACHUSETTS EFFECTIVE JANUARY 1, 2015
-
Beverly s Beverly
'4. f
Danversf`
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Figure 1. Map of Salem's Political Wards
City of Salem Health Assessment-3
History
Salem was founded in 1629 when a meetinghouse was erected (Historical Profile, n.d.).The
original boundary of Salem included the towns of Beverly, Danvers, Manchester, Marblehead,
Middleton, Peabody,and parts of Topsfield,Wenham,and Lynn.This area was inhabited by the
Pawtucket group of Native Americans, often referred to as the Naumkeags(MHC, 1985).The first
European settlement was in 1626 by Roger Conant,and the first colony of settlers arrived in 1628 with
Captain John Endiocott. In April of 1836 the city was incorporated,and is the second oldest settlement
in Massachusetts(Community Profile, n.d.).
Maritime Trade
Early settlers were farmers, but the maritime trade grew quickly during the Colonial period due
to Salem's coastline and port. Fishing,shipbuilding,commerce, and other businesses related to the
maritime trades overtook the previously agricultural economy. During this time,the finest residences
were located close to the wharves and warehouse by the waterfront,with development along Essex
Street from the North River to the South River. Landfilling of small streams, swamps,coves,and some of
the North and South Rivers gave more area in the center of town (MHC, 1985).Throughout the 181h
century and into the beginning of the 191h century trade was the main business in Salem,with ships
sailing to China, India, Europe,Africa, Russia,Japan,and Australia,and bringing back pepper,tea,silk,
porcelain,and more(MHC, 1985; Historical Profile, n.d.).
In 1799,sea captains and traders established the city's East India Marine Society to bring back
"natural and artificial curiosities,"some of which are now in the Peabody Essex Museum (Stewart,
2004). Underscoring the importance of trade to Salem is the City of Salem seal featuring a ship under full
sail approaching a coast,a palm tree,and the words Divitis Indiae usque ad aultimum sinum,translating
as"to the farthest port of the rich east" (Historical Profile, n.d.).The embargo of 1807 and the War of
1812 hurt Salem's trade and maritime businesses. Following these events,the Salem port could not
compete with those of larger cities,such as Boston and Philadelphia (Stewart,2004; MHC, 1985).
Industry
In 1636,the first water mill for grinding corn was built by the North River.The work of Ebenezer
Mann's shipyard from 1783 to 1800 brought others to the area.The 1830s and 1840s saw substantial
growth of industry and manufacturing(Curley, 2011).Shoe manufacturing and leather tanning were
major industries in this period. Cordage, lead paint,whale oil,candles,gums,and glues were also
significant industries(MHC, 1985).While businesses were originally located by downtown and the
Common,they moved further away to the Grove Street and Goodhue Street area. Blubber Hollow was
the main area for the leather industry(MHC, 1985). Industry continued with the American Hair Felt
Company in the 1890s and the Salem Oil and Grease Company from 1912 to 2003 (Curley,2011).
During the process of industrialization the North River became a dumping ground full of
pollution,with some organized cleanups in recent years(Curley, 2011). From 1946 to 1969 the Salem
Acres site had an agreement with the South Essex Sewerage District to receive sludge containing
City of Salem Health Assessment-4
tannery waste,grit,and grease on four of its 235 acres. Polychlorinated biphenyls(PCBs),volatile
organic compounds (VOCs), semi-VOCs, arsenic,and chromium were present in the uncovered sludge.
Additional fly ash disposal and landfill areas next to this made for a total of 13 contaminated acres.After
initial cleanup and long-term planning,the EPA took the area off the National Priorities List in 1999
(Environmental Protection Agency [EPA], 2017).
The Salem Harbor Power Plant, located on the waterfront,was a 720-megawatt coal-and oil-
fired power plant for 63 years. In June of 2014 this plant stopped using coal and is being replaced with a
smaller,gas-fired plant(Ailworth, 2014).The top employers in Salem in 2017 are the North Shore
Medical Center,Salem State University,the City of Salem,and the Commonwealth of Massachusetts
offices, indicating a change from the previously industrial businesses in the city(Salem's Top Employers,
n.d.).
General History
The Great Fire of 1914 destroyed over 1,800 buildings, including 41 factories and 1,600 homes,
covering almost 80 streets,40,000 feet of curbing,and leaving 15,000 homeless. Following this,the City
Plan Commission was used to rebuild and change the layout of the streets. Roads were widened and/or
extended,alignments straightened,sharp curves rounded, property set aside for parks, and 925 new
trees planted. Other changes to the roads occurred in the 1930s as a result of the Works Progress
Administration (MHC, 1985).
Immigration accounted for much of the growth from 1875 to 1915 in the city. During the
beginning of this period the Irish-born were the majority of immigrants,while the Canadian-born
(particularly French Canadian) became the majority into the 20th century. Immigrants also came in
significant numbers from Poland, Russia, Italy,Greece,Turkey, England,Scotland, Sweden, and Germany
(MHC, 1985). The French Canadian immigrants first moved to the Point neighborhood off of Lafayette
Street, but this is now likely to be home to the new wave of immigrants from the Dominican Republic
(Walker,2014).Salem's Latino population increased about 76%from 2000 to 2010—a similar increase to
the state's—with much of this population specifically from the Dominican Republic(Burge,2013).
Most of the housing constructed before 1940 was in the downtown area (MHC, 1985). Of
Salem's current structures,55.0%of them were built in 1939 or earlier(ACS,2015).While residential
construction is located throughout the city,the highest density housing was in the Point area. Housing
for single families was increasingly built in the 1950s and 1960s following World War II, primarily for
veterans throughout the city(MHC, 1985). Starting in 1970,the city established its historical significance
with seven historic districts and thousands of individual buildings and properties(MHC, 1985).
Government
Salem operated under a town government until the City Charter was accepted on March 23,
1836 as the second chartered city in Massachusetts.This original charter was replaced by the
Commission form of four commissioners and a mayor in 1913.This form of government was replaced in
1916 by its present form of a "Plan B Government"with the Mayor as the Chief Executive of Salem and
City of Salem Health Assessment-5
Sthe City Council as a separate legislative body(Government and Municipal Information, n.d.).The Mayor
is elected for a four year term and is the administrative head of the city and chairman ex-officio of the
School Committee, Board of Library Trustees,and the Board of Trust Fund Commissions.She acts with
the City Council and School Committee to carry out the city's business(Government and Municipal
Information, n.d.).Appointments and reappointments to serve on a city board,committee,commission,
task force,or authority are made by the Mayor,with City Council confirmation required for most
appointments and reappointments(Mayor's Filings with City Council, n.d.).
The City Council consists of 11 members, seven of whom are elected from the seven different
wards of Salem and four who are elected at large (see Figure 1 for wards).Terms are two years,with the
President of the City Council serving for one year(City Government,2017).The City Council confirms the
Mayor's appointments, appropriates money,and serves on subcommittees(City Council, n.d.).A
majority of the City Council constitutes a quorum and is necessary for the adoption of any motion,
resolution,or ordinance. In some instances a two-thirds majority vote is required by statute(Historical
Profile, n.d.). City Council subcommittees include:Administration & Finance; Community& Economic
Development;Government Services;Ordinance, Licenses&Legal Affairs;and Public Health,Safety&
Environment(City Council Subcommittees, n.d.).
Education System
The School Committee for Salem Public Schools consists of the Mayor of Salem as the Chair,a
Superintendent,six Members including a Vice Chair, and the School Committee Secretary. Members are
elected at large for four year terms,with three seats opening every two years.The Superintendent of
Salem Public Schools is appointed by the Mayor.There are regular meetings of the School Committee on
the first and third Monday of the month (Salem Public Schools, n.d.).
12 public schools in Salem include one early elementary school (Salem Early Childhood Center),
five elementary schools(Bates Elementary, Bentley Academy Charter, Carlton Elementary, Horace Mann
Laboratory School,Witchcraft Heights Elementary),two elementary-middle schools(Nathaniel Bowditch
Elementary,Saltonstall Elementary),one middle school (Collins Middle), and three high schools(Salem
High,Salem Prep High School, New Liberty Innovation Charter School) (Salem Public Schools, n.d.; MA
Department of Elementary and Secondary Education, n.d.). In the 2014-2015 academic year there were
4,199 students enrolled and 419.7 teachers employed in the Salem Public School system (MA
Department of Elementary and Secondary Education, n.d.).This same year the per-pupil expenditure
was$16,895 (Luca, 2017).
In May of 2017,the Salem School Committee accepted school choice to allow students from
outside of Salem to attend Salem High School,with the original school district of the student paying 75%
of the student's cost to Salem,joining six neighboring districts in the program (Luca, 2017). In the 2016-
2017 school year 72 Salem students already went to schools in other districts under school choice
programs.The Salem program will set a cap of 20 students from outside districts attending Salem
schools(Luca,2017).
Board of Health
City of Salem Health Assessment-6
Salem's Board of Health is made up of five Members, including a Chair, as well as the City
Physician, Health Agent,City Council Liaison, and Clerk of the Board (Board of Health, n.d.).The Mayor
appoints the Board of Health members and physician for three year terms,with confirmation by the City
Council (Code of Ordinances, 2017). Meetings of the Board of Health occur once a month on the second
Tuesday of the month (Board of Health, n.d.).
The Board of Health must work on food safety, communicable disease safety,and community
sanitation. It makes rules and regulations about:food being sold in city limits; house drainage and sewer
connections; removal of solid wastes and other offensive substances; all nuisances,sources of filth and
causes of sickness in the city or harbor. It supervises and controls vaccination of citizens, appoints a milk
inspector, and is in charge of certificates of fitness for rented units, apartments,and tenements(Code of
Ordinances,2017). In conjunction with home rule amendment, local governments, including the Board
of Health, have more power than what is specifically authorized by the state in non-prohibited areas of
state law.The Board of Health must meet minimum state standards, and can choose to make these
standards stricter with its regulations(MA BOH Guidebook, 1997). It also acts in an advisory capacity
with the Salem Health Department.
Required duties of local boards of health are in the following Massachusetts laws and regulations,as
related to activity(Massachusetts BOH Guidebook, 1997):
• Records, Recordkeeping and Reports
o M.G.L. c.111,s.28
o M.G.L.c.46,s.11
• Health Care and Disease Control
o M.G.L.c.164 s.124A
0 220 CMR 25.03
o M.G.L. c.111,s.111
0 105 CMR 300
o M.G.L.c.111, s.112
0 105 CMR 300.100
o M.G.L.c.111,s.7
o M.G.L. c.111,s.29
o M.G.L. c.71,s.55A
0 105 CMR 310.100-110
o M.G.L.c.111, s.110
o M.G.L.c.111,s.111A
o M.G.L. c.140,s.145A
0 105 CMR 335
o M.G.L.c.111, s.109
0 105 CMR 300.000
o M.G.L. c.149,s.136
• Housing and Dwellings
o M.G.L.c.111, ss.127A and 127E
City of Salem Health Assessment-7
• o 105 CM R 410.000
o M.G.L. c.111,s.1981 105 CMR 460.000
o M.G.L.c.41,ss.81S-81V
o M.G.L.c.140, s.36
• Hazardous Wastes
o M.G.L. c.111,s.150B
o M.G.L. c.21C, s.4
• Solid Waste
o M.G.L.c.111, s.150A
0 310 CMR 19.16
0 310 CMR 19.18; 18.15(I)
0 310 CMR 19.25
0 210 CMR 19.26(3)
0 310 CMR 19.32; 18.27
0 310 CMR 18.21
• Septage and Garbage
o 310CMR15.00
o M.G.L. c.111,s.3113
o M.G.L.c.111,s.31A
• Nuisances
o M.G.L.c.111,s.122
o M.G.L.c.111,s.151
o M.G.L.c.111,s.143
• Food
0 105 CMR 590.052
0 105 CMR 590.00
o M.G.L. c.94,s.89
o M.G.L.c.94,s.48A
o M.G.L.c.94,s.33 and s.40
o M.G.L. c.94,s.10A
o M.G.L.94s.10C
0 105 CMR 570
0 105 CMR 570.002
o M.G.L.c.94,s.10C
o M.G.L.c.94,s.94F
0 105 CMR 550.000
0 105 CMR 551.000
0 105 CMR 550.001
o M.G.L.c.94,s.65H
0 105 CMR 561.000
o M.G.L.c.94,s.67
City of Salem Health Assessment-8
o M.G.L.c.130, s.81
o M.G.L. c.94,ss.186-95
• Pools and Beaches
0 105 CM 435.000
0 105 CM 445.000
0 105 CMR 445.10(1-3)
0 105 CM 445.16
• Camps, Motels and Mobile Home Parks
o M.G.L.c.140,ss.32B and 32C
0 105 CM 440.000
0 105 CM 430.000
• Miscellaneous
0 102 CMR 3.06(I)(d)
0 102 CMR 6.08(3)
0 102 CMR 7.11(2)
o M.G.L. c.132B
0 333 CMR 2.00
o Wendell v.Attorney General,476 NE 2"d 585,394, Mass 518(1985)
0 333 CMR 11.07
o M.G.L.c.129,s.15
o M.G.L.c.140, s.51 •
o M.G.L.c.114, s.45
o M.G.L. c.114,s.49
o M.G.L.c.114,s.34
o M.G.L.c.111,s.32
o M.G.L. c.111, s.31
• Smoking
o M.G.L.c.270 s.22 (Massachusetts BOH Guidebook, 1997)
Most laws for local boards of health are under Massachusetts General Laws (MGL), Chapter 94:
Inspection and Sale of Food, Drugs,and Various Articles; and Chapter 111: Public Health. Code of
Massachusetts Regulations(CMR) primarily used are CMR 102: Early Education and Care;CMR 105:
Department of Public Health;and CMR 310: Department of Environmental Protection.
Health Department
The Health Agent,three full-time and two part-time Sanitarians, Public Health Nurse,and
Principal Clerk are the officers of the Board of Health,and comprise the Health Department. Its mission
statement states:
"The mission of the Salem Health Department is to deliver public health services to residents,
businesses and visitors to benefit the culturally diverse population of the City of Salem. Public
health includes preventing and monitoring disease,providing health education and enforcing •
City of Salem Health Assessment-9
. public health codes and regulations. This mission is accomplished through the core values of
public health which are to prevent,promote, and protect"(Health, n.d.).
The Health Department functions based on the Massachusetts State Codes and Services, and
the City of Salem Regulations,working with the Board of Health (Health, n.d.).Officers process
applications and perform inspections according to the regulations that the Board of Health sets.These
include Certificate of Fitness for apartment rentals,food establishment permits,temporary food
permits,tobacco sale permits, swimming pool permits, recreational camp permits,tanning facility
permits, hotel/motel permits,exterior paint removal permits,well construction permits, body art
establishment and practitioner permits, disposal systems installers permits,and more(Applications and
Permit Information, 2016).The Health Department does not offer clinical services. It does provide public
health outreach and education to citizens, businesses,and visitors of Salem, as well as track disease and
environmental health information in the City of Salem.The following are some common activities of the
Health Department.
• 506 certificates of fitness were issued in 2016
• 52 unique tobacco permits were issued in 2016,with up to 65 being allowed per year
• 26 rodent complaints were responded to for extermination
• 685 food permits were issued in 2016, including those for food establishments, retail stores,and
temporary food permits
o These permits likely include duplicates due to renewing permits at the end of the year,
so additional data is available:
■ January 1-October 31,2016:477 food permits issued
■ January 1-November 30, 2016:484 food permits issued
• Total revenue for the Health Department based on permit fees is approximately two-thirds from
food permits,with the next highest proportion general health licenses,which includes
certificates of fitness, burial permits,and more(Salem Board of Health Report, 2017).
In 2016,five types of inspections made up 88%of all Health Department inspections(see Figure 2a).
These included:
• 574 trash inspections(33.3%)
• 506 certificate of fitness inspections(29.3%)
• 241 food inspections(14.0%)
• 108 bathing beach inspections/tests(6.26%)
• 94 housing inspections(5.5%) (Health Agent Report,2017)
Trash inspections increased 416%from 2015 to 2016 from 138 to 574 inspections a year(Health Agent
Report, 2017). In November 2015, automated cart trash collection started, changing the way trash goes
out and rearranging recycling pickup to every other week(Waste Management Automated Collection
FACI's, n.d.). It is possible that during the switch,there were problems in implementation or compliance
and this contributed to the increase in trash inspections. If the high amount of inspections continues
• through 2017,then there is likely a different reason for the increase and decreasing trash is a priority.
City of Salem Health Assessment- 10
Regular trash collection in Salem is weekly,with recycling pickup every other week by Waste
Management(Trash Pickup, 2017). Bulk items must be scheduled for pickup.There are two selected
dates for household hazardous wastes,four selected dates for E-waste,and five weeks for yard waste
pickups,though yard waste may also be dropped off at Salem's Transfer Station (Trash Pickup, 2017).
Smaller changes were evident in increasing certificate of fitness re-inspections, and fewer food
re-inspections. In 2015 and 2016 there were very few inspections for lead determination, body art, and
food administration hearings,and zero inspections for septic abandonment, septic system plan review,
soil evaluation, and percolation tests(see Figure 2b).
Top Inspections by the Salem Health
Department
700
600
500 --__
400 — `° 02016
300 0 2015
200
100
-TJ
.0 0t` ch cy .CQo
5Qe`�\ 5Qe`\ eye\
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��`��e 10° 0J�`�� ��ar \�yQe° Data Source:
0 r Salem Health
SF, lea Agent Report,
2017
�a
2a. Most Common Inspections b the Salem Health Department
p Y p
•
City of Salem Health Assessment-11
Other Inspections b the Salem Health Department
p Y p
60
50
40
02016
30
0 2015
20
k
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10
0
o °io �•?0 e� p
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-10 -10c-1� ail\ 61 °10 �Al QO eJa '73 Source
:-, cQe o a\ Fo a o `°
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yy o <Ja �°al`�, e pwyeyeaeQ` e Health
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"° ao° c� � e ,� c Agent
oJ -�e0 ��e�a�era\aPa��,o L`ae�y �`c Report,
eel
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Le
• Figure 2b. Inspections by the Salem Health Department
Demographics
• 2015 population of Salem:42,499 (ACS,2015)
0 19,778 males and 22,721 females
o Median age:36.5 years
o Under 18 years old: 18%of population
0 18-29 years old: 22%of population
0 30-44 years old: 20%of population
0 45-64 year olds: 27%of population
0 65+years old: 13%of population
The highest proportion of residents in Salem are between 45 and 64 years old,with more than a
quarter of the population in this age range.A greater percent of Salem residents are between 18 and 29
years old,compared to MA residents,demonstrating that Salem is popular with young adults.Senior
citizens are the lowest proportion of Salem residents, but only about 1.5% less than MA residents(ACS,
2015). From 2000 to 2012,the population in Salem increased 3.1%, similar to the state's increase of
3.3%(North Shore District Incentive Grant[DIG] Partners, 2014).
•
City of Salem Health Assessment- 12
Distribution of Age
g
30.00%
25.00% .
20.00
15.00% *'
O Salem
(N=42,499)
10.00% �
0
• D Massachusetts
(N=6,705,586)
5.00% k .F '
w Data Source:
0.00% ACS,2015 5-
Under 18 18 to 29 30 to 44 45 to 64 65 years Year Estimates
years years years years and older
Figure 3.Age Distribution in Salem and MA
• Race/Ethnicity(ACS, 2015)
The racial makeup of Salem is relatively similar to that of MA.White is the clear majority race,
composing nearly 80%of the population in both Salem and MA.Salem has a slightly lower proportion of
Black or African Americans, and Asians than the state.About twice as large a percentage of citizens
classify themselves as"some other race" in Salem (8.75%),than the state(4.20%),with slightly higher
percentage of two or more races in Salem as well.There are also a higher proportion of people of
Hispanic or Latino origin in Salem,compared to the state(ACS, 2015).See Table 1.
Table 1. Race and Ethnicity in Salem and Massachusetts
2015 ACS 5 year estimate
Salem MA
78.63% 79.56%
White alone (n=33,416) (n=5,334,859)
5.42% 7.14%
Black or African American alone (n=2,305) (n=478,947)
American Indian and Alaska 0.59% 0.2%
Native alone (n=249) (n=13,189)
2.3% 5.98%
Asian alone (n=976) (n=400,675)
•
City of Salem Health Assessment- 13
Native Hawaiian and Other Pacific 0% 0.02%
Islander alone (n=0) (n=1644)
8.75% 4.2%
Some other race alone (n=3,717) (n=281,595)
4.32% 2.9%
Two or more races: (n=1,836) (n=194,677)
Two races including'some other 1.17% 0.49%
race' (n=499) (n=33,178)
Two races excluding'some other 3.15% 2.41%
race,'and three or more races (n=1,337) (n=161,499)
16.53% 10.56%
Hispanic or Latino (n=7,025) (n=707,928)
81.12% 89.44%
Not Hispanic or Latino (n=34,474) (5,997,658)
• Income in Salem (ACS, 2015)
o Median income in Salem for 12 months in 2015:$60,690
■ Median income in MA for 12 months in 2015:$68,563
o Incomes under$40,000: 36%of the population
o Incomes from$40,000-60,000: 14%of the population
o Incomes above$60,000: 51%of the population
o Incomes below the poverty line: 14.4%
0 2,947 households(16.3%) received food stamps/Supplemental Nutrition Assistance
Program benefits
•
City of Salem Health Assessment- 14
Percent of Incomes in Past 12 Months Below
Poverty Level By Race and Ethnicity
45.00%
40.00%
35.00%
30.00%
25.00% f^ M Salem
20.00% E
0 Massachusetts
15.00% "
10.00% 4
5.00%
0.00%
a� . e e c ec e e5 0 0
r` a a��, c
yea a�N
e
� a� Q \c e
a c�a ��,
�P a� �o Der \Soy `0° \°o Data Source:ACS,
011 yQa� yQa� 2015 5-Year
0�P crei `�° ��° ��`� 1•� Estimates
\a& \0�`a °t� e�0 *All races are of a
`ac \\ac No single race unless
specified;Hispanic
�e or Latino are
enthcity categories •
Figure 4. Incomes Below Poverty Level in Salem and MA
Income at or above the poverty line is the majority in Salem, but there are differences
corresponding to race and ethnicity within Salem's population.American Indian and Alaska Native,
White,and Asian racial groups have high percentages above the poverty line,as well as the ethnic group
White Alone, not Hispanic or Latino. "Some Other Race" has 40.3%of its population below the poverty
line, one-third of the Hispanic or Latino population is below the poverty line, and the percentage of
Black or African Americans below the poverty line is twice as much as the city average,and above the
corresponding state percentage of 22.0%(ACS,2015). Income is a social determinate of health, and
having such disparities among racial and ethnic groups should be further examined.
• Environment Justice Areas
An environmental justice area is a census block group where "median annual household
income is at or below 65%of the statewide median annual household income; 25%or more of
the residents are a minority;or 25% more of the residents are not fluent in the English
language" (MDPH, Bureau of Environmental Health,2017).This is an issue because those who
•
City of Salem Health Assessment- 15
• live in environmental justice areas are more likely to live near toxic waste sites, in areas with
high air pollution,and in substandard housing(MDPH, Bureau of Environmental Health, 2017).
0 31.4%of Salem residents live in an environmental justice area(MDPH, Bureau of
Environmental Health,2017).
0 12.1%of MA residents live in an environmental justice area (MDPH, Bureau of
Environmental Health, 2017).
o In Salem, all environmental justice areas consist of 25%or more of the residents a
minority in an area,with some additional areas combining minority and income,or
minority, income and English isolation (MassGIS,2017).See Figure 5 below.
0 23.3%of Salem residents speak a language other than English, and 7.8%of Salem
residents do not speak English very well (ACS,2015).
o Environmental justice areas are located primarily in the Point neighborhood,
Downtown,and in parts of South Salem.The largest yellow area is part of South Salem,
but is more scarcely populated and includes some conservation areas.
•
•
City of Salem Health Assessment- 16
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Census 2010 Environmental Justice
Populations
O M inority
[3 Income
[]English Isolation
®Minority and Income
®Minority and English Isolation
(Income and English Isolation
Minority, Income and English Isolation
Detailed Features
MassGIS Statewide Basemap
MassGIS Topographic Features Basemap
Figure S. Environmental Justice Areas in Salem. Data Source: Mass GIS
• Educational Level Attained (ACS, 2015)
0 90.9%of all Salem residents are high school graduates
0 38%of all Salem residents hold a bachelor's degree or higher
0 18-24 years old:
■ High school graduate or equivalent: 32.5%
■ Some college or an associate's degree:40.8%
■ Bachelor's degree or higher: 17.2%
0 25 years or older:
0 Completed less than 91h grade:4.7%
City of Salem Health Assessment- 17
■ High school graduate or equivalent: 25.7%
■ Some college without a degree: 19.4%
■ Associate's degree:7.7%
■ Bachelor's degree: 24.1%
■ Graduate or professional degree: 14%
The level of education in Salem for those 25 years and older is similar to that of Massachusetts,
making Salem a well-educated city for the majority of residents completing high school and
many getting some college education and degrees.
Educational Attainment, Population 25 Years and
Over
30.0%
25.0%
20.0% r,
15.0% ''
• # x �` s,� O Salem
10.0% n .
13Massachusetts
- f " Data Source:ACS
0.0% ' 2015 5-year
Less Than 9th to 12th High School Some Associate's Bachelor's Graduate or Estimates
9th Grade Grade(No Grad College(No Degree Degree Professional
Diploma) (Includes Degree) Degree
Equivalency)
Figure 6. Education Level Reached by Salem and MA Residents.
• Types of Schooling(ACS,2015)
0 10,949 residents aged 3 years and over are enrolled in school
0 5,562 are enrolled in Kindergarten to 12th grade
■ Public school:92.1%
■ Private school:7.9%
0 3,895 students enrolled in undergraduate college
■ Public college: 81.8%
■ Private college: 18.2%
0 797 students enrolled in graduate or professional school
• 0 Public school:66.1%
City of Salem Health Assessment- 18
■ Private school:33.9% •
• Health Insurance Coverage(ACS, 2015)
0 40,602 out of 42,350 residents are privately or publically insured
0 100%of children under 6 years old are insured
0 100%of senior citizens aged 65 and older are insured
0
o Under 18 years old:98.9/insured
0 19-25 year-olds: 89.8%insured—the lowest insured age group
o The uninsured rate fell as education level attained increased
• Housing(ACS,2015)
o 51.9%of housing units in Salem are renter-occupied.
0 25.6%of housing units are single units, detached from other housing structures.
o 66.3%of units are apartments
Occupied Housing Units in Salem
30.0%
25.0%
20.0%
15.0/o
10.0%
5.0% t,
Lt0.0%
1 Unit, 1 Unit, 2 Apartments 3 or 4 5 to 9 10 or More Mobile Home
detached attached Apartments Apartments Apartments or Other Type
of Housing
Figure 7.Types of Housing Units in Salem. Data Source:ACS,S-Year Estimates
The large number of apartments/multifamily housing units comes with its own environmental health
concerns. By having high numbers of people living in a smaller area,sanitary issues can affect a larger
proportion of people,trash disposal becomes an issue with more refuse being picked-up in a small area,
and apartments switching tenants require certificates of fitness, adding to the work of the Health
Department. As seen in Figure 8's Zoning Map,the multifamily housing tends to be in Salem's
environmental justice areas(see Figure 5),which may affect health of residents.
•
City of Salem Health Assessment- 19
•
CITY OF SALEM ZONING MAP
;��Y, tiva.w:agsY.ecis.r .,:
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"�
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• Figure 8.Zoning Map of Salem. Data Source:City of Salem
City of Salem Health Assessment-20
Disease Burden •
All-cause mortality rate for Salem is 672.6 per 100,000, slightly less than MA's rate of 679.1 per
100,000(rate not age-adjusted); however,the 95%confidence intervals for these rates overlap, making
them not significantly different from one another(MassCHIP, Mortality Standard Report, 2013).This
puts Salem and MA at approximately the same level for serious health outcomes.The top causes of
death in Massachusetts in 2014 were:
1. Cancer
2. Heart disease
3. Unintentional injuries
4. Chronic lower respiratory disease(CLRD)
5. Stroke
6. Alzheimer's disease
7. Influenza & pneumonia
8. Nephritis
9. Diabetes
10. III-defined conditions, signs and symptoms(MassCHIP, Mortality Standard Report,
2013).
The data for number of deaths in Salem for all of these causes is not known, but based on known data
much seems the same,with a few differences. Deaths due to cancer,followed by heart disease are •
leading causes of death in Salem,accounting for almost half(47.8%)of deaths in 2014(MDPH,Office of
Data Management, 2016).Some leading causes for deaths are in different order,such as more deaths
due to stroke-16 deaths at 5.42%in Salem,versus 4.46%in MA—than CLRD-11 deaths at 3.73%in
Salem,versus 4.71% in MA. Additionally,there was one more opioid-related death in Salem (12 total)
than due to CLRD or influenza/pneumonia (11 each) (MDPH, Office of Data Management,2016).While
opioid-related deaths may be counted within unintentional injuries,which is the state's third leading
cause of death,the percentage of deaths related to opioids is higher in Salem (4.07%)than in MA
(2.42%) (MDPH, Office of Data Management, 2016).
•
City of Salem Health Assessment-21
•
Percent of Deaths By Cause, 2014
40.00%
35.00%
30.00%
25.00%
20.00%
15.00%
10.00%
5.00% OSalem(N=295)
0.00% D Massachusetts(N=55,157)
ye et ec ei �e 5e e�
ea �° g0 Oo c° ea e` o�
R�`a �`� ��a� e�� Je �°� ��•ale\ O
lea �J 0�ea �Q`�a`°' 4yQo °moo OQ`°�
e"Ie �\oe� Data Source:MDPH,Office of Data
Management and Outcomes
Assessment,2016. 'Massachusetts
ell Deaths 2014.'
• Figure 9.Selected Causes of Death in Salem and MA
Chronic Non-Communicable Disease
*all mortality/incidence rates are age-adjusted per 100,000 unless otherwise stated
Chronic Non-Communicable diseases are the majority of the ten leading causes of death in
Massachusetts,and therefore a major health concern for citizens in Salem and greater MA.
Cancer
Cancer is the leading cause of death in Massachusetts,and can come in many different forms.
Cancer accounted for 79,or 26.8%,of Salem deaths in 2014,a slightly higher percentage than MA
(23.2%) (MDPH, Office of Data Management). Of cancer deaths in Salem, lung cancer was almost a
quarter of cases(22.8%)with 18 deaths.The mortality rate for bronchus and lung cancer in Salem males
was 56.1,just slightly less than the MA rate of 58.8, but markedly higher than the female rate in Salem
of 27.7,which is also less than the female state rate of 41.3 (MassCHIP, Cancer Data, 2013).Salem
females must have something particular about them for the lower mortality rate.The incidence rate of
bronchus and lung cancer for males in Salem is much higher than the state's rate however, at 113.4 in
Salem and 83.0 in MA.The rate for females is about equal at 65.4 in Salem and 65.1 in MA(MassCHIP,
Cancer Data 2013). Higher incidence rates in Salem with lower mortality rates could indicate that Salem
residents are better able to catch the cancer earlier to treat it,or with following through with treatment.
40
City of Salem Health Assessment-22
Of the cancers examined in this report, breast cancer had the next highest mortality rate at 22.9, •
with an incidence rate of 136.3.This is just slightly above the MA rates(see Table 2)(MassCHIP,Cancer
Data, 2013). Five people in Salem died of breast cancer in 2014(MDPH, Office of Data Management,
2016).The next highest cancer mortality rate examined in Salem was prostate cancer with a mortality
rate of 22.7,slightly above the MA rate of 21.6,and an incidence rate of 138.8, less than the MA rate of
163.8 (MassCHIP,Cancer Data, 2013).
Both the mortality rate and incidence rate of leukemia in males was higher in Salem than MA by
almost twice as much.The mortality rate in Salem males is 15.2,compared to MA's 8.8, and the
incidence rates are 26.9 in Salem and 16.1 in MA(MassCHIP, Cancer Data, 2013).The rates are slightly
lower for females in Salem compared to the state however,with rates significantly higher for males in
both Salem and MA,compared to females. Risk factors for males may be more prevalent in Salem,
based on this disparity. Exposure to certain chemicals common in factories may contribute to the higher
rate in Salem's males considering the industrial past,as a risk factor for leukemia(American Cancer
Society,2016).
Table 2.Cancers in Salem and Massachusetts
MA Salem MA
Salem Deaths Salem Mortality Incidence Incidence
Type (3 Year Count) Mortality Rate Rate Rate Rate
Breast Cancer 19 22.9 20.8 136.3 134.5
Bronchus and Lung .
Cancer MALES 33 56.1 58.8 113.4 83.0
Bronchus and Lung
Cancer FEMALES 23 27.7 41.3 65.4 65.1
Cervical Cancer 2 3.2 1.4 8.8 6.0
Colon/Rectum Cancer
MALES 6 10.3 18.0 54.7 57.1
Colon/Rectum Cancer
FEMALES 18 22.1 13.1 52.6 42.5
Leukemia MALES 8 15.2 8.8 26.9 16.1
Leukemia FEMALES 2 2.8 5.3 7.6 9.8
Melanoma MALES 3 5.2 4.2 22.4 28.2
Melanoma FEMALES 2 2.1 2.0 17.4 19.3
Non-Hodgkins
Lymphoma MALES 1 1.8 7.6 29.0 24.7
Non-Hodgkins
Lymphoma FEMALES 4 4.7 4.6 16.9 16.8
Oral Cavity and
Pharynx Cancer
MALES 2 3.8 4.0 14.8 16.5
Oral Cavity and
Pharynx Cancer 0 0 1.4 6.4 6.5
City of Salem Health Assessment-23
• FEMALES
Ovary Cancer 7 8.9 7.4 13.5 13.0
Prostate Cancer 12 22.7 21.6 138.8 163.8
Testis Cancer 0 0 0.1 NA 6.2
Urinary Bladder
Cancer MALES 7 12.8 9.6 49.6 45.6
Urinary Bladder
Cancer FEMALES 6 7.1 2.9 18.7 12.9
Uterine Cancer 0 0 4.3 26.8 30.0
* Rates: 3-year age-adjusted per 100,000;MassCHIP, Cancer Report,2013
Heart Disease
The second-leading cause of death in MA is heart disease. Salem's mortality rate due to heart
disease is 170.5,which is higher than the MA mortality rate of 155.0(MassCHIP, Mortality Standard
Report, 2013).Over one-fifth of Salem deaths in 2014 were due to heart disease, making this a serious
concern for Salem residents(MDPH,Office of Data Management, 2016).
One measurement of heart disease is through heart attacks.The rate of hospitalization for heart
attacks for those over 35 years is lower in Salem than MA,with rates of 23.6 per 10,000 and 30.7 per
10,000, respectively, according to MA Center for Health Information and Analysis(CHIA) 2012 data.
Females in Salem have a rate less than half that of statewide females(11.1 and 22.9 per 10,000). Males
in Salem have a less than 1 per 10,000 difference with the statewide male population rate, indicating
that the total difference between city and state is mainly driven by the difference in female rates
(MDPH, Bureau of Environmental Health, 2017).
For overall circulatory system diseases, including coronary heart disease, cerebrovascular
disease and acute myocardial infarction,Salem's mortality rate of 219.8 is higher than MA's rate of
201.6,though Salem's hospitalization rate is lower(MassCHIP,Cardiovascular Health Report,2013). It is
possible Salem residents do not go to the hospital as frequently when necessary,contributing to a
higher mortality rate. Both the three-year hospitalization (3746.8)and mortality(860.3)rates, are higher
amongst black, non-Hispanics than white, non-Hispanics(1370.5 and 222.3) in Salem.The MA black,
non-Hispanic population has hospitalization and mortality rates significantly lower than Salem
(MassCHIP,Cardiovascular Health Report, 2013). Considering the higher percentage of Black residents
below the poverty line,this could also influence the population's health outcomes. This is a large
disparity and could account for Salem's mortality rate being higher than the states,though the rates for
white, non-Hispanics and Asian/Pacific Islander, non-Hispanic in Salem is higher than the state's rate as
well,though not at such a great difference. (See table 3 for all rates.)
Table 3.Circulatory System Diseases(3 year age-adjusted rate per 100,000)
•
City of Salem Health Assessment-24
Salem MA
Salem Mortality MA Mortality Hospitalization Hospitalization
Rate Rate Rate Rate
Total 219.8 201.6 1442.2 1536.8
White, Non-Hispanic 222.3 204.0 1370.5 1456.4
Black, Non-Hispanic 860.3 244.1 3746.8 2195.9
Hispanic 77.0 110.7 2093.7 1698.8
Asian/Pacific Islander,
Non-Hispanic 263.3 99.9 1008.0 723.4
American Indian, Non-
Hispanic 0.0 109.7 0.0 457.5
*3 year age-adjusted rate per 100,000;
MassCHIP, Cardiovascular Health Report, 2013
Diabetes
Diabetes is the ninth leading cause of death in MA,and accounted for seven deaths in Salem in
2014(MDPH,Office of Data Management, 2016).The rate of diabetes-related (diabetes as the principal
diagnosis or complications of diabetes) ED visits was a bit higher in Salem at 128.7,compared to MA's
111.2. Hispanics in Salem had the highest rate of ED visits at 513.2,twice as much as Hispanics in MA at
244.9,with White Non-Hispanic rate slightly higher than the state counterpart and Black Non-Hispanic •
rate too low to calculate (MassCHIP, Diabetes Report, 2013). Diabetes related emergencies must be
better controlled in Salem, particularly among Hispanics.
For inpatient hospitalizations however,which were more prevalent,Salem's rate was lower
than MA's rate at 451.8 and 488.5, respectively(MassCHIP, Diabetes Report,2013). In this measure,
White Non-Hispanics, and Hispanics had lower rates of hospitalization in Salem than MA et Black Non
-
Hispanics p p Y
Hispanics in Salem had almost twice the rate of hospitalization than MA,at 2337.1 in Salem and 1294.1
in MA. Both of these rates were the highest for racial groups.
Asthma
Asthma ED visits occur at a higher rate in Salem than in MA.The rate for Salem is 95.1 per
10,000, and the rate for MA is 73.9 per 10,000. Both male and female visit rates in Salem are higher than
their state equivalent,with males in Salem having a higher rate than Salem females,yet statewide
females have higher asthma ED visit rates than males(MDPH, Bureau of Environmental Health,2017).
Pediatric asthma prevalence in K-8 students is slightly better in Salem than the state. 10.8%of Salem K-8
students have asthma,compared to 12.4%of MA K-8 students(MDPH, Bureau of Environmental Health,
2017). It is possible that Salem has more triggers for asthma related trips to the ED,or that there is an
increasing amount of asthma related problems in the older than eighth grade population.The air quality
in Salem according to National Ambient Air Quality standards is rather good, so if environmental triggers
are causing more ED visits in Salem, it is most likely not due to poor air quality outside.
•
City of Salem Health Assessment-25
• The Salem Health Department received a grant from the North Shore Community Health
Network and Essex County Community Foundation (ECCF) in 2014.This included participating in the
"Room to Breathe"asthma prevention initiative, and instituting integrated pest management programs
in eight communities(ECCF, 2014—letter?).Working on improving environmental asthma prevention
with neighboring communities is an important step to reducing the burden of this disease in Salem.
Obesity
Obesity and the health behaviors that contribute to it, including unhealthy eating and lack of
physical exercise, can lead to health problems. For school-age children in Salem,a higher percentage of
the population is obese (24.0%)compared to the state (16.3%),with about the same proportion
overweight(17.0%and 17.1%, respectively). Only 58.1%of children in Salem are a healthy weight,
defined as the 5th to 85th percentile(North Shore DIG Partners, 2014). Healthy behaviors are learned
starting in childhood.With over 40%of children overweight or obese, more resources may be necessary
to teach children healthy behaviors at or after school,and/or to provide parents with information.
Substance Use
Alcohol and other drug related hospital discharges occurred at a higher crude rate in Salem
(477.8)than MA(344.7).The crude rate of admissions to DPH funded treatment programs in Salem was
2,204.2,also higher than the MA rate of 1,532.4(MassCHIP, Health Status Indicators,2013).This could
• indicate that alcohol and drugs are a larger issue in Salem than MA, but that a greater percentage of
Salem residents are seeking help in treatment programs.
775 people in Salem were admitted to Bureau of Substance Abuse Services(BSAS)
contracted/licensed programs during the 2014 fiscal year,an increase from 2005 when 533 people were
admitted,though lower than admissions from 2010 to 2013(MDPH BSAS, 2015).
• 60.3%of people admitted were male and 39.7%female.
• Disproportionate amounts were white,with 88.4%of admissions,yet only 78.6%of
Salem residents classified as white.
• Those who completed high school were 42.7%,and more than high school were 36.7%,
making those admitted less educated past high school than Salem's average.Of those
over 25 years old in Salem,65.2% have some education more than high school (ACS,
2015).
• 26 to 40 year olds made up almost half of those admitted (26-30 years: 24.3%; 31-40
years: 24.4%)
• 18 to 25 year olds were more than one-fifth (21.4%).
• Almost half(44.9%) had prior mental health treatment
• The primary substance of use was mainly heroin at 47.3%, a great increase from 2005 in
which only 27.4%of admissions were primarily for heroin.About half(51.5%)of people
admitted had used heroin at all in the year preceding admission.
•
City of Salem Health Assessment-26
• Alcohol was the next highest primary substance at 38.9%of admissions,and 56.7%of •
people using alcohol in the preceding year.
• All other opioids, including non-Rx methadone,other opiates,oxycodone, non-Rx
suboxone, Rx opiates,and non-Rx opiates,were 6.1%of primary substance admissions.
• Crack/cocaine use in the year preceding admission decreased by almost half from 33.2%
in 2005 to 17.6%in 2014.
Primary Substance of Use at Treatment
Admission, Salem 2014 (N=768)
1% 1%
I
j 0 Heroin
6%
®Alcohol
I
O All Other Opioids
III Marijuana
0 Crack/Cocaine
E3 Other
•
Data Source:MDPH, Bureau of
Substance Abuse Services,
2015
Figure 10.Salem Admissions to BSAS Programs
•
City of Salem Health Assessment-27
PrimarySubstance of U Use at Treatment
Admission, Massachusetts 2014
(N=104,233)
4%
3% 2 ®Heroin
®Alcohol
6% o All Other Opioids
M Marijuana
0 Crack/Cocaine
13 Other
0 None
Data Source:MDPH, Bureau of
Substance Abuse Serives,2015
Figure 11. Massachusetts Admissions to BSAS Programs
• Opioid-related deaths accounted for 12 deaths in Salem in 2014(MDPH, Office of Data Management,
2016),for a crude rate of 28.2 in Salem, higher than the MA rate of 19.9.This makes opioid abuse,
particularly heroin as the substance used most,a major issue for Salem. Salem is part of the Overdose
and Substance Use Prevention Coalition, providing education to city residents about overdoses,
treatment, recovery,and prevention (Salem Overdose and Substance Use Prevention Coalition
Resources, n.d.).This coalition works with the state and neighboring communities to reduce the harm of
overdose and substance abuse. Salem joined the Massachusetts Opioid Abuse Prevention Collaborative
(MOAPC),and the Substance Abuse Prevention Collaborative(SAPC)through a cluster within the City of
Lynn's grants(MDPH-BSAS,2017).
Disabilities
13.0%of Salem's civilian non-instutionalized residents live with a hearing,vision, cognitive,
ambulatory,self-care, and/or independent living difficulty.The percentage of residents with disabilities
increases with age,with about half(49.4%)of those 75 years and older with a disability(ACS, 2015).
Communicable Disease
Communicable diseases are preventable by vaccinations, antimicrobials,and proper control of
known infections to prevent further spread. While communicable diseases have decreased over the past
City of Salem Health Assessment-28
decades,they still pose a threat to the public health, must be treated seriously,and people educated •
about the possibilities of infections.
There are 34 communicable diseases that must be reported to the DPH and Salem Board of
Health.Of these 34 diseases, 21* had cases reported in 2016 in Salem (*including probable, but not
confirmed cases of Lyme Disease).These included:
• Active Tuberculosis(TB)
• Latent TB
• Camplylocteriosis
• Group B Streptococcus
• Human Granulocytic Anaplasmosis
• Haemophilus Influenzae
• Hepatitis B
• Hepatitis C
• Influenza
• Lehionellosis
• probable Lyme Disease
• Malaria
• Measles
• Mumps
p
• Pertussis •
• Salmonellosis
• Shigellosis
• Streptococcus Pneumoniae
• Varicella
• Vibrio
• Zika Virus Infection (Doty, 2017).
The most common of these diseases in 2016 were latent TB,Campylobacteriosis, Hepatitis C, Influenza,
Salmonellosis, and probable Lyme Disease.These six diseases accounted for 77.8%of the reportable
communicable diseases in 2016(Doty, 2017).
City of Salem Health Assessment-29
•
Reported Communicable Diseases, Salem 2016
35
30
25
20
0 Total cases=171
15
10 *Reportable
diseases with
5 zero cases in
2016 not
p included in graph
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10
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• Figure 12.Communicable Diseases Reported to the Salem Public Health Nurse
In 2014,there were 11 deaths due to influenza and pneumonia in Salem (MDPH,Office of Data
Management,2016). Hepatitis C infection left untreated and be a chronic health condition, requiring
continual health care services(MDPH,2010). Pertussis, hepatitis B, mumps,and measles are vaccine-
preventable diseases (MDPH, 2010). Having any cases of these diseases can and should be avoided.
Seven Salem schools completed a survey about the immunizations of kindergarteners, looking at
Dtap, polio, MMR, Hep B, immunity to chickenpox,and series(includes all the preceding)immunizations
for the 2013-2014 school year.Two schools had 100%vaccination rates for the 5 Dtap vaccinations;
three schools for the 4 Polio vaccinations, 2 MMR vaccinations,and immunity to chickenpox; and five
schools for the 3 Hep B vaccinations(MDPH, Kindergarten Immunizations Survey, 2014). Only one
school (Bates Elementary) had 100% immunization for all vaccinations this school year.Two schools had
medical and/or religious exemptions. Horace Mann Laboratory had 99%immunization for each of the
vaccinations and does have 1.4%of students with exemptions. Bentley School is the other school with
exemptions; 1.6%of students are exempt,and its immunizations range from 75%to 95%depending on
the vaccine(MDPH, Kindergarten Immunization Survey, 2014). For other schools,the lowest percent of
vaccinations is 84%, but most are in the high 90's percentages(MDPH, Kindergarten Immunization
Survey,2014).
The HIV/AIDS prevalence in Salem is 256.9(rates not age-adjusted),which is less than the MA
>� rate of 261.0,with Salem having no deaths related to AIDS or HIV(MassCHIP, Health Status Indicators,
City of Salem Health Assessment-30
2013).The crude rates of syphilis and chlamydia were higher in Salem than in MA,though Salem's rate •
of gonorrhea was lower than the rate in MA.The crude rate of syphilis in Salem was 12.0; gonorrhea
was 28.8,and chlamydia was 369.8(MassCHIP, Health Status Indicators,2013).The reported rate of
chlamydia has increased for the past decade, partly due to screening of asymptomatic individuals
(MDPH, 2010).This could also be part of the reason that the rate of chlamydia is much higher than
syphilis and gonorrhea,and screening should continue,along with more education about preventing all
sexually transmitted infections, as well.
Environmental Health
Housing
Houses built before 1978 must be deleaded if children under 6 years old live there as children
are more vulnerable to the consequences of lead poisoning. 79%of homes in Salem were built before
1978,compared to the state's 71%of homes.The amount of children 9 to 48 months-old screened for
lead is approximately equal to the state with 76.9%of Salem children screened. Salem has a lower level
of confirmed blood lead levels than MA,and based on these three factors is not considered a high-risk
community(MDPH, Bureau of Environmental Health, 2017). 55%of structures in Salem were built in
1939 or earlier,and without appropriate upkeep,these buildings may deteriorate and cause additional
problems (ACS,2015).
More than half(66.3%)of occupied housing units are apartments of some kind and 51.9%of all
housing units are renter occupied (ACS, 2015). In 2016, 501 certificate of fitness permits were issued by
the Salem Health Department, and 26 rodent complaints were resolved with extermination (Salem
Health Department Report, 2017).All people in a housing unit must work to rid the unit of pests or to
keep it clean.Additional concerns over trash and sanitation accompany multi-family housing, as there is
more refuse to be picked up in smaller area and problems with sanitation will be felt by the higher
amount of people in the area.
Air Quality
In Essex County,where Salem is located,there was only one day in 2015 in which ozone levels
were above the 8-hour National Ambient Air Quality Standards(NAAQS)of 0.075ppm, and no
monitoring days of PM2.5 levels above the 24-hour level of 35 µg/m3(MDPH, Bureau of Environmental
Health, 2017). County levels may not be completely compatible with the city of Salem's levels, but
indicates that the overall air quality in the area is good.
Drinking Water Quality
Drinking water information tested for arsenic, atrazine, DEHP,disinfection byproducts, lead,
nitrates, PCE,TCE, and uranium is tracked by the Environmental Public Health Tracking program. No
violations of these containments were reported for water systems servicing Salem (MDPH, Bureau of
Environmental Health, 2017).Salem residents have good water systems that are unlikely to cause health
problems.
City of Salem Health Assessment-31
Smoking
Smoking in the North Shore Community Health Network is at 16.7%(95%Cl: 13.7-18.7),
compared to MA smoking levels of 15.0%(95%Cl: 14.5-15.6)(MassCHIP,Smoking Report, 2013).These
values have overlapping confidence intervals,so are not significantly different and does not show Salem
specific rates,so differences between Salem and the states'smoking status cannot be determined from
this. It is a good sign that the levels near and including Salem are not significantly higher than the state's.
Salem's history with smoking has been progressive. In 2000 the Salem Board of Health voted to
implement a ban in restaurants and bars for April 2001. Salem was the first city on the North Shore to
adopt such a ban.This was years before Massachusetts prohibited smoking in these places in 2004(NBC
News, 2004).
Pests
In 2016,there were 24 rodent complaints inspected,approximately the same amount as 2015
(25), showing that rodents are a continuing problem in Salem (Salem Health Agent Report, 2017). Pest
can negatively affect people with asthma who are more sensitive to their environment.There were 27
probable cases of Lyme disease in 2016, and 2 confirmed and 34 probable cases in 2015 as of June 2017,
and continuing cases found this year(Doty, 2017).There were no cases in 2016, but one case of the tick-
borne disease Babesiosis in Salem in 2015 (Doty, 2017).There are reservoirs for pests,such as ticks and
mosquitoes in Salem and surrounding areas and residents should take appropriate precautions when
outdoors.Throughout the summer the Public Health Nurse has included information on ticks and
mosquitos at the Salem Farmer's Market and Night Out events to educate the public on preventing
bites.
References:
• Massachusetts Historical Commission,W. F. (1985)MHC Reconnaissance Survey Town Report:
Salem. Retrieved from: https://www.sec.state.ma.us/mhc/mhcpdf/townreports/Essex/sal.pdf
City of Salem Health Assessment-32
o (MHC, 1985)
• City of Salem. (n.d.) Community Profile. Retrieved from:
http://www.salem.com/about/pages/community-profile
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clerk/pages/historical-profile
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o (Stewart, 2004)
• Curley,J. (July 17, 2011)Then & Now: Down By the Mill.Salem Patch. Retrieved from:
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27#Status
o (Environmental Protection Agency [EPA], 2017)
o (EPA,2017) •
• City of Salem. (n.d.)Salem's Top Employers. Retrieved from: http://www.salem.com/business-
and-economic-development/pages/salems-top-emplovers
o (City of Salem, n.d.)
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• City of Salem. (n.d.)Location and Access. Retrieved from:
http://www.salem.com/about/pages/location-and-access
o (City of Salem, n.d.)
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https://www.salem.com/home/pages/government-and-municipal-information
o (City of Salem, n.d.)
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http://www.salem.com/mayors-office/pages/mayors-filings-city-council
o (City of Salem, n.d.)
o (Mayor's Filings with City Council, n.d.)
• City of Salem. (n.d.) City Council. Retrieved from: http://www.salem.com/city-council
o (City of Salem, n.d.)
o (City Council, n.d.)
City of Salem Health Assessment-33
• City of Salem. (2017) City Government 2017. Retrieved from:
http://www.salem.com/sites/salemma/files/uploads/2017 city government card.pdf
o (City of Salem,2017)
o (City Government,2017)
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council/city-council-subcommittees
o (City of Salem, n.d.)
o (City Council Subcommittees, n.d.)
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http://salemkl2.org/pages/SPS DistSchoolCom/index
o (Salem Public Schools, n.d.)
• Massachusetts Department of Elementary and Secondary Education. (n.d.)School and District
Profiles:Salem. Retrieved from:
http://profiles.doe.mass.edu/reportcard/rc.aspx?linkid=38&orgcode=02580000&fvcode=2015&
orgtvpecode=5&
o (MA Department of Elementary and Secondary Education, n.d.)
0 2015 as date???
• City of Salem. (n.d.)Board of Health. Retrieved from: https://www.salem.com/board-health
o (City of Salem, n.d.)
o (Board of Health, n.d.)
• • City of Salem. (n.d.)Health. Retrieved from: https://www.salem.com/health
o (City of Salem, (n.d.)
o (Health, n.d.)
• City of Salem. (October 4, 2016)Applications and Permit Information. Retrieved from:
https://www.salem.com/health/pages/applications-and-permit-information
o (City of Salem, 2016)
• Ailworth, E. (March 22, 2014) Coal plants challenged by natural gas,tough regulations. The
Boston Globe. Retrieved from: https://www.bostonglobe.com/business/2014/03/21/coal-
plants-closing-here-and-across-nation/B3m6a0ABuLTF7xrse0eBoM/story.html
o (Ailworth, 2014)
• Wade, C. M. (June 1, 2017) Coal-fired era ends in Massachusetts. The Salem News. Retrieved
from: http://www.salemnews.com/news/local news/coal-fired-era-ends-in-
massachusetts/article 4cfaedl4-916a-5865-87b8-02a7e317e722.html
o (Wade, 2017)
• Walker, D. G. (July 21,2014)Salem's forgotten immigrants. Wicked Local Salem. Retrieved from:
http://salem.wickedlocal.com/article/20140717/ENTERTAINMENTLIFE/140716879
o (Walker, 2014)
• Burge, K. (July 28, 2013) Civic doors opening for Latinos. The Boston Globe. Retrieved from:
http://www.bostonglobe.com/metro/regionals/north/2013/07/27/massachusetts-cities-and-
towns-change-their-latino-populations-
• grow/piJlwhrFr7BL3beAmzkRBH/story.html?event=eventl2
City of Salem Health Assessment-34
o (Burge, 2013) •
• Code of Ordinances City of Salem, Massachusetts(April 28, 2017)Supplement 19. Retrieved
from:
https://Iibrary.municode.com/MA/Salem/codes/code of ordinances?nodeld=PTIIICOOR CH2A
D ARTIVBOCOCOAU DIV3BOHE
o (Code of Ordinances, 2017) Part III, Chapter 2,Article IV, Division 3
• Massachusetts BOH Guidebook(May 1997) Chapter 2:Legal Authority and Procedures.
o (MA BOH Guidebook, 1997) [in folder than Larry gave]
• Massachusetts Department of Public Health—Bureau of Environmental Health [MDPH] (June 29,
2017)Massachusetts Environmental Public Health Tracking Community Profile for:Salem.
Retrieved from: https:Hcognosl0.hhs.state.ma.us/cvl0pub/cgi-bin/cognosisapi.dil
o (MDPH, Bureau of Environmental Health, 2017)
• US Census Bureau. (2015)American FactFinder. Retrieved from:
https://factfinder.census.gov/faces/nav/isf/pages/searchresults.xhtml?refresh=t#
o (US Census Bureau,American FactFinder 2015)
o (ACS, 2015)
• MassCHIP, Massachusetts Department of Public Health (June 4,2013). Cardiovascular Health
Report forSalem. Retrieved from: http://www.mass.gov/eohhs/researcher/communitY-
health/masschip/cardiovascular-health.html
o MassCHIP Cardiovascular Health 2013
• MassCHIP, Massachusetts Department of Public Health. (June 6,2013) Mortality Standard
Report:All Large Cities/Towns Sorted by Rate. Retrieved from:
htt www.mass. ov eohhs researcher communit -health masschi mortalit -standard-
i
p // g / / / Y / p/ V
report.html
o (MassCHIP, Mortality Standard Report 2013)
• MassCHIP, Massachusetts Department of Public Health (June 4,2013) Cardiovascular Health
Report for Salem. Retrieved from: http://www.mass.gov/eohhs/researcher/communitY-
health/masschip/cardiovascular-health.html
o (MassCHIP, Cardiovascular Health Report, 2013)
• MassCHIP, Massachusetts Department of Public Health (June 4, 2013)Diabetes Report for
Salem. Retrieved from: http://www.mass.gov/eohhs/researcher/communitY-
health/masschip/diabetes.html#cities towns
o (MassCHIP, Diabetes Report, 2013)
• MassCHIP, Massachusetts Department of Public Health (June 4,2013)Health Status Indicators
Report forSalem. Retrieved from: http://www.mass.gov/eohhs/researcher/`communitY-
health/masschip/health-status-indicators.html#cities towns
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Disease Prevention (2016)Incidence of Tuberculosis Disease by Counties in Massachusetts, in the
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Assessment. (October 2016)Massachusetts Deaths 2014. Retrieved from:
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•
City of Salem Health Assessment-35
• o (MDPH,Office of Data Management,2016)
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health/masschip/smoking.html#cities towns
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principles/state-and-city-town-admissions-fyl4.pdf
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prevention-coalition-resources
o (Salem Overdose and Substance Use Prevention Coalition Resources, n.d.)
• Massachusetts Department of Public Health (MDPH)—Bureau of Substance Abuse Services
(BSAS) (January 2017).Prevention Programs Directory. Retrieved from:
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resources-overview.pdf
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from:
http://www.salem.com/sites/salemma/files/uploads/wm 00532 salem 6pnl brochure rf3.pdf
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City of Salem Health Assessment-36
o (Waste Management Automated Collection FAQ's, n.d.) •
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