MEETING PACKET SEPTEMBER 2017 SEPTEMB.ER 201
711
� � s
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET,411 FLOOR - Prevent,Promote.Protect.
TEL. (978) 741-1800 FAX(978) NOW?-7 FM 6.
KIMBERLEY DRISCOLL lramdin@salem.com CITY
Y CLERKRRY RAMDIN,RS/REHS,CHO,Cl. FS
MAYOR SALEM. PASS HE., rHAGENT
NOTICE OF MEETING
You are hereby notified that the Salem Board of Health will hold its regularly scheduled meeting
Tuesday, September 12, 2017 at 7.00 PM
City Hall Annex 120 Washington Street Room 313
MEETING AGENDA
1. Call to order
This notice posted on "Official Bulletin Board"
2. Approval of Minutes City Hall, Salem, Mass. on
�.Q�MbY
3. Chairperson Communications at (., -0,*,V'A in accordance J(rith MGL Chap. 30A,
Sections 18-25.
4. Public Health Announcements/Reports/Updates
a. PHN Report
b. Health Agent
c. Administrative
d. Council Liaison Updates
40 5. Reaffirmation of participation in North Shore/Cape Ann Tobacco Alcohol Policy Program
G. Chris Lohririg-Notch Brewery: Request for Board to review outdoor dining area
surfacing requirements as defined by 2013 Food Code
7. Board of Health program planning & city health status discussion-
a. Review health assessment by Sarah Corley, Health Department summer intern
b. Presentation by Kimberly Waller, Salem State University, on how Boards of Health
across MA approach health/social issues
8. New Business/Scheduling of future agenda items
• Items that could not be anticipated prior to the posting of the agenda
• Discuss summer meeting schedule
L e
Larry amdin, Health Agent
cc: Mayor Kimberley Driscoll, Board of Health, City Councilors
Nextrggularly scheduled meeting is October 10, 2017 at 7:00pm at City Hall Annex,
120 Washington Street 3rd Floor Room 314.
Know your rights under the open meeting law MGL chapter 30A ss. 18-25 and City Ordinance
section 2-2028 through 2-2033
CITY OF SALEM
BOARD OF HEALTH
MEETING MINUTES
July 11, 2017
MEMBERS PRESENT: Chairman Paul Kirby, Dr. Jeremy Schiller, Nancy Crowder, Mary Lauby,
Kerry Murphy
EXCUSED: Council Liaison Beth Gerard
OTHERS PRESENT: Elizabeth Gagakis, Senior Sanitarian, Suzanne Doty, Public Health Nurse,
Maureen Davis, Clerk of the Board, Mary Wheeler, Director, Healthy Streets, Denny, Outreach, Healthy
Streets, Josh, Intern for Healthy Streets from MA College of Pharmacy, Diane Wolf, Owner, Lobster
Shanty and Ugly Mug Diner '°
TOPIC DISCUSSION/ACTION
1. Call to Order 7:00pm
2. Approval of Minutes N. Crowder motioned to accept minutes as written.
(June 13, 2017) K. Murphy 2"d. Allsin favor. Motion passed
3. Chairperson Announcements No meet ing�m* August.
4. Monthly Reports-Updates
u�.
A. Public Health S:dD9ty reported lots of camp'uspections in June. This year all the
Nurse's Report YMCA camps have a nurse, including the Marblehead Y and
Children''s Island.
J..Scl iller:pointed outxthere were much more flu cases than last year,
even though'it:was reported that the vaccine was good. Perhaps less
people.are beingvaccinated?
;.,K. Murphy asked if there is data on the number of people in Salem
who got the vaccine.
,41W;
S 'Doty said not yet because doctor's offices are still reporting.
Salem State camp issue is all set. It seemed to be a transition period
for them. They have structured differently for next year.
P. Kirby inquired as to how many hours it takes to inspect a camp.
E. Gagakis and S. Doty said it varies, but usually about three hours.
There is a 4 to 5-page check list for camps, including such items as
CORIs, SORls, immunization records, physicals, plans and policies
in place, medication logs, etc.
M. Lauby asked how the City staff wellness programs are going.
S. Doty announced that nutritionist Diane Dube will be speaking at a
meeting for all employees on July 26t' at 4:30pm at 120 Washington
Street, Room 313.
M. Lauby asked what the Public Health Nurses meetings entail.
S. Doty said they discuss what they see on MAVEN, reportable
diseases, camps, vaccine clinic dates, etc.
Copy available at the BOH office
B. Health Agent's E. Gagakis reported the department has been busy with the Farmers'
Report Market, camp inspections, pools, beach testing. Mosquito control
program did not put on any meetings for us this year. No positive
pools for anything. Last year the mosquitoes were mostly bird-
biters, not human-biters.
Beach testing - we test 11 beaches weekly mid-June to Labor Day.
Children's Island has three beaches and one more semi-private
beach that test themselves bi-weekly, as long as they don't have any
failures for 2 or 3 years.
Had a really high failure for beach testing at one beach. High
bacterial content. Had not had a test come back that high in years.
It was fine the next week. It was a beach off a neighborhood, not a
beach people would sit and swim at.
P. Kirby offered his thanks for the quick response to the Salem State
situation.
P. Kirby asked about the proposalefor late night food trucks.
E. Gagakis said it would be for people7to get a bite to eat after the
bars close. Possible sites Riley Plaza and the city lot by Speedway.
We would need to inspect and permit them. Could be a strain on the
department for nights and weekends. Zoning prohibits food trucks
at this time.
H. Famico asked if we get an inspector for the Certificates of Fitness
ordinance, could they help with food trucks?
E. Gagakis said they could if they are trained in food inspections.
Copy available at the BOH office
C. Administrative J. Schiller again requested that we show the number of temporary
Report pop-up permits @$300 in 2015 and 2016 to compare to the number
of permits now A$35. M. Davis will include in next report.
P. Kirby offered his'appreciation to the inspectors for their work on
nights and weekends--for pop-ups.
J. Schiller offered for the official record based on the Salem State
complaints that were levied on Facebook,that the proper channel of
communication should there be a complaint about the department
;should really be with the Board of Health.
1VL'Lauby said it is really annoying, especially for someone in a
leadership role.
Copy available at the BOH office
J. Schiller motioned to approve the reports. M. Lauby 2"d. All
in favor. Motion passed.
5. Mary Wheeler, Healthy Streets M. Wheeler brought items given out at the needle exchange
Continued discussion on program, including syringes and other safe injection items.
allowing Needle Exchange P. Kirby said the state DPH funds needle exchange programs.
programs M. Wheeler said in the last 30 days, the Supreme Court in MA has
• ruled in favor of syringe distribution, so anyone can set up a syringe
exchange service without any approval of city or town officials, as
long as they are not selling syringes, but still requires BOH
i
approval.
Five people a day are dying from drug use in MA.
• Syringe exchange service allows users access to help and education
and helps to decrease the spread of Hepatitis C and continue to
decrease the spread of HIV among injection drug users and more
Narcan programs.
Healthy Streets has subcontracted with Salem Police through a
DMH grant. Officer Vaillancourt does overdose follow-ups, also
called doorknocks, with Denny from Healthy Streets. Currently
collect used syringes, but they can't give them back clean ones.
J. Schiller asked about what happened in Barnstable.
M Wheeler said that was in Hyannis and was a satellite.program of
the Provincetown program. The city councilors sued ASGCC in
supreme court and lost. The BOH approved it, and the city
councilors did not.
Governor Baker ruled no longer need community approval,just
BOH approval for a DPH funded program.
J. Schiller asked about any negative impacts on needle exchange
programs and the health impact.
M. Wheeler states over the last 20+years, data shows syringe
d.
service programs don't increase crime, they reduce rates of overdose
and spread of infection,increase feelings of self-respect and
empowerment of users.
M. Wheeler said people have a "not in my back yard" kind of
• -attitude about the programs. Public injection is blamed on the
program, but that happens anyway—with or without a program.
Healthy Streets does overdose doorknocks in surrounding
communities. Officer Vaillancourt and Denny pick up syringes.
M.�Lauby was interested in home visits and asked how many users
take up offers for their help.
M. Wheeler said they feed them, give them a safe place to rest, even
rub their sore feet if need be and try to steer them toward treatment,
counseling, etc.
-They have a drop-in center in Lynn and mobile services either by car
or on-foot.
Hepatitis C cases are five times higher in MA than other states in the
A-country, mostly from sharing other injection items, such as water,
cotton, containers, etc. Infection is usually not from sharing needles.
"N. Crowder asked if we can stipulate no drop-in center without BOH
approval. M. Wheeler said yes.
P. Kirby said Chief Butler emailed Larry Ramdin to say she is all for
the program, but prefers 1 for 1 exchange vs. 5 for 1.
M. Wheeler prefers not to have 1 for 1 because she feels it increases
needle sharing and reuse.
In Lynn, the police dept. suggested 1 for 1, but Healthy Streets has a
voucher program with the pharmacy so users can get 10 needles, but
no other items. Healthy Streets gives out sharps containers and kits
• with clean injection items.
H. Famico asked how they establish mobile unit locations.
M. Wheeler said it would not be anywhere residential. Most likely
would be a van with no signage on it. Not looking to advertise it.
Denny pointed out it is embarrassing for users to do needle
• exchange. He pointed out that people are desperate in their
situations and will use whatever, whenever.
P. Kirby asked M. Wheeler if she has talked with Chief Butler about
the 1 for 1 vs. 1 for 5 exchanges.
M. Wheeler said not yet, but she spoke to Lt. King. She will speak
to Chief Butler.
M. Lauby asked if users are using every day, how is 1 for 1 helpful.
M. Wheeler said, "exactly".
J. Schiller asked if it is proven that if you give someone an alcohol
swab and a clean needle they will use it.
M. Wheeler said yes, educate them and they will take care of
themselves.
P. Kirby asked what Salem's program would be.
M. Wheeler said probably a mobile unit, 1-2 days a week, plus home
visits, aka"doorknocks". Home delivery and pick-ups.
M. Lauby asked if Healthy Streets reports data. M. Wheeler said
yes, they report to DPH all the time.
M. Wheeler said there is no.syringe statute in MA.
K. Murphy asked if we could approve the program and talk details
later. M. Wheeler said we could specify it's approved, but we want
reports.
P. Kirby suggested that based°oWthe reports, we as a board could
revoke it.
• N.,Crowder,liked the idea of just saying we approve it.
J. Schiller said it's a no-brainer to approve it. There could be a lot of
backlash, but we could respond that we approved it based on the
data presented.
Y
P. Kirby'asked M.'Wheeler to confirm that we can't start until DPH
gives the go-ahead. M. Wheeler said yes.
M. Wheeler had previously provided a template of a letter to Kevin
Cranston.at DPH requesting a syringe exchange service. L. Ramdin
would needAo send the letter.
P Kirby asked how quickly could you start the program.
M ,Wheeler said as soon as she receives a letter from DPH. Usually
about a month.
M. Lauby asked M. Wheeler if DPH RFR doesn't come for a year,
do you currently have funding to serve Salem? M. Wheeler said yes.
M. Lauby motioned to approve a syringe service program to be
established in Salem, with a vendor to be approved by the Salem
Department of Health, with data and ongoing reporting to be
provided to the Board of Health at the Board of Health's
request.
N. Crowder 2"d. All in favor. Motion passed.
•
6. Ward 2 City Councilor, H. Famico passed out packets to members.
Heather Famico Noise:
• She would like to establish an acceptable sound level for the ambient
a. Sound level limits on noise downtown.
non-residential HVAC She put into committee at the council to establish an ordinance
and other large surrounding ambient noise to add levels. Every ordinance change
mechanical units in the requires two city council passages. The BOH could require it to be a
downtown part of inspections. Noise levels are currently not included in food
b. Non-residential establishment inspections.
trash/recycling storage The licensing board has been exploring setting up sound levels for
dimensions and pick-up outdoor entertaining.
requirements The sounds downtown are affecting sleep and quality of life.
Ambient noise levels are hard to check during the day due to all the
other noise downtown. _
Showed emails with the�Health,,Dept. since January requesting help.
H. Famico said she'and Larry Ramdin went to the roof of the mall to
listen to the HVAC unit and he agreed it was loud. He said he
would do a measurement the next week. She never heard back. He
did tell her volume-was discussed and they are required to control
noise.
H. Famico started contacting the state to see what else can be done.
Would like to imbed HVAC,sound levels to requirements to include
noise reduction-around units; not just coverings for aesthetics.
1). Wolf, owner oftwo restaurants downtown, would like to see all
commercial'buildings required,not dust restaurants.
• ^? J. Schiller asked under which office would sound level inspections
be done.
D.:Wolf said this issue has been discussed since 2009, with the
question of which department would be responsible for enforcement.
E: Gagakis"said we inspect residential units for complaints or
,,,,Certificates*of Fitness 'but we do not inspect commercial buildings.
H.Famico says'the DEP is responsible for addressing noise
complaints, therefore the BOH is responsible.
Schiller would like to hear from Larry about his follow-up and
;;whether there is a potential health code violation or a noise violation.
P. Kirby will speak with Larry about this issue upon his return.
/P.;Kirby agreed the ambient noise is loud, especially at the Essex
..,mall. We will work on this issue.
H. Famico asks that the Board let the City Solicitor know there is
interest in the subject, and not just for outdoor music.
Trash:
At next council meeting, at second passages on zoning that now
recycling has to be shown on site plans.
No requirement within the city of dimensions for trash storage. Just
says adequacy of trash storage.
Currently recycling is not mandatory for properties that are not part
• of the City contract.
No BOH regulations requiring recycling area.
Sometimes trash is picked up at 5:OOam—there is noise downtown
i
until 1:30am, then very early trash pick-ups.
Showed several photos of overflowing trash.
• Sometimes restaurants get blamed for overflows of trash they have
no control of—maybe the landlord is not handling the situation.
H. Famico would like to define what "adequate" is. She showed a
plan with a very small, parking space sized, trash area for a 61-unit
housing structure— far from adequate.
P. Kirby asked if he could send some of her photos to the state for
their tool kit that will work together with the City to solve the issue.
D. Wolf feels training for overflow recycling would be helpful, i.e.
box breakdown, etc.
The state, as part of the tool kit ,will provide training for businesses.
Composting by restaurants would also help. Some are already
composting.
H. Famico would appreciate a continuation of this topic and any
I
updates.
7. 'Board of Health program M. Lauby has an idea, but she would like to speak to Larry Ramdin
planning & city health status and Paul Kirby about it first,before she presents.
discussion CDC's Healthy 2020 hasrthe`outline of everything that matters.
Would like to talk about consider the possibility of inviting centers
of community"Programs to come in and talk to us and educate us so
we can talk about,priorities
K. Murphy said Mass in Motion,is doing a community health
• assessment that will be.done by�December.
8. New Business/Scheduling of As discussed, the Board will not be meeting in August.
future agenda items ,
MEETING ADJOURNED: J. Schiller motioned to adjourn the meeting. N. Crowder 2nd,
5 All in favor. Motion passed.
9:14pm,
Respectfully submitted,
Xe
Maureen Davis
Clerk of the Board of Health
Next regularly scheduled meeting is September 12, 2017 at 7:OOpm at City Hall Annex,
120 Washington Street, 3rd floor, Room 313
• Suzanne Doty RN BSN
Salem Board of Health
Public Health Nurse
Public Health Nurse Report
Reporting on July 4, 2017 through August 1, 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.
• Continued camp inspections for The Schooner Fame sailing camp and Salem State
University's sports camps. and consulted with camp directors regarding on going issues.
• Posted Facebook and Instagram posts regarding information on our educational materials
and blood pressure screenings at the Salem Farmers Market.
Meetings/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 151n 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 I", Mayor Kim Driscoll send out an all staff launch email. More programs
are being planned such as a weekly lunchtime workout class and nutritionist classes.
• Continuing to attend the Thursday Farmers Markets displays weekly of give-a-ways,
blood pressure checks, public health information and materials and availability for any
questions the residents may have.
• Simmons student nurse, Nancy Nguyen, is continuing her clinical hours for the summer.
She will be shadowing me and she created an educational poster regarding Ticks and
tickborne disease. Nancy and 3 of her follow classmates displayed the poster and
provided education at the Famers Market on July 271n
• Attended the Salem Overdose Prevention coalition meeting on July 11`n, updates given
regarding ongoing efforts by stakeholders. A summit will be held in early fall for
community leaders and key stakeholders from Salem, Lynn and Peabody.
• Met with fitness instructors for beginning lunchtime fitness classes at 120 Washington St
on July 161n
• Diane Dube, a local Registered Dietitian Nutritionist, held a nutrition class for Salem
employees on July 26`n, this class was an introduction to diet and nutrition basics and 10
• employees attended.
Monthly Report of Communicable Diseases: July 2017
Disease New Carry Over Discharged/ Total# Of Running Total for Total for
Reported Cases this Total for 2016 2015
Closed Month 2017
Tuberculosis 0 0 0 0 0 4 4
(Active)
Latent 5 0 5 5 21 31 47
Tuberculosis*
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
0 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 0 0 0 0 2 0 4'
Streptococcus
Group B* 0 0 0 0 4 2 7
Streptococcus
Human 0 0 0 0 0 1 1
Granulocytic
Anaplasmosis
Haemophilus 0 0 0 0 2 2 1
Influenzae
0
Disease New Carry Over Discharged/ Total# Of Running Total for Total for
eported Cases this Total for 2016 2015
Closed Month 2017
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* 4 0 4 4 24 30 29
Influenza* 0 0 0 0 65 19 29
Legionellosis 1 0 1 1 1 2 1
Lyme 0 0 0 0 0 0 2
Disease*
(7) (7) (7) (16) (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 1 0 1 1 1 1 1
Salmonellosis 0 0 0 0 4 11 6
Shigellosis 1 0 1 1 1 3 0
Streptococcus 0 0 0 0 3 8 3
Pneumoniae*
Varicella* 0 0 0 0 0 1 0
Vibrio 0 0 0 0 0 1 0
West Nile 0 0 0 0 0 0 0
Yersoniosis 0 0 0 0 0 0 1
Zika Virus 0 0 0 0 0 1 0
6-201.11 Floors, Walls,and Ceilings. Except as specified under§ 6-201.14 and except for antislip
floor coverings or applications that may be used for safety reasons,floors,floor coverings,walls,
wall coverings,and ceilings shall be designed,constructed, and installed so they are SMOOTH and
• EASILY CLEANABLE.
Rationale from Food code :Floors that are of smooth, durable construction and that are
nonabsorbent are more easily cleaned. Requirements and restrictions regarding floor coverings,
utility lines,and floor/wall junctures are intended to ensure that regular and effective cleaning is
possible and that insect and rodent harborage is minimized.
6-201.14 Floor Carpeting, Restrictions and Installation. (A)A floor covering such as carpeting or
similar material may not be installed as a floor covering in FOOD preparation areas,walkin
refrigerators,WAREWASHING areas,toilet room areas where handwashing lavatories,toilets,and
urinals are located, REFUSE storage rooms, or other areas where the floor is subject to moisture,
flushing,or spray cleaning methods. (B) If carpeting is installed as a floor covering in areas other
than those specified under¶ (A) of this section, it shall be: (1)Securely attached to the floor with a
durable mastic, by using a stretch and tack method, or by another method; and (2) Installed tightly
against the wall under the coving or installed away from the wall with a space between the carpet
and the wall and with the edges of the carpet secured by metal stripping or some other means.
• Public Health Rationale: Requirements and restrictions regarding floor carpeting are intended to
ensure that regular and effective cleaning is possible and that insect harborage is minimized.The
restrictions for areas not suited for carpeting materials are designed to ensure cleanabliity of
surfaces where accumulation of moisture or waste is likely.
Sincerely
Larry Ramdin MPH, MA, REHS, CHO, CP-FS, HHS
Health Agent/Vice President NEHA Region 9
Salem Board of Health
120 Washington Street
Salem MA 01970
• 978-741-1800 (office)
978-745-0343(Fax)
6
Office Hours
• Monday- Wednesday 8:00 am—4:OOpm
Thursday 8:00— 7:00 pm
Friday 8:00 am- 12:00 noon
From: Chris Lohring [mai Ito:chrisO notch brewing.com]
Sent: Monday, May 08, 2017 5:52 PM
To: Larry Ramdin
Cc: Elizabeth McCarthy; Mary Ellen Leahy
Subject: Patio
Larry,
Could you please give me clarification, in writing, on what types of food are allowed to be
served on our patio based on our outdoor surface of crushed grave?
•
Could you also provide to me, either in writing or by referneing code, the regulations
governing the outdoor surfaces allowable for food service and types of food service?
Respectfully,
Chris Lohring Notch Brewing 978-853-9138 Sent from Gmail Mobile
Please note the.Massachusetts Secretary of State's office has determined that most emails to and from
municipal officials are public records.FMI please refer to: http://www.sec.state.ma.us/pre/preidx.htm.
Please consider the environment before printing this email.
7
Maureen Davis
• From: Paul Kirby <pkirby@Salem.com>
Sent: Friday, September 01, 2017 3:36 PM
To: Chris Lohring
Cc: Maureen Davis
Subject: RE: Patio
Hello Chris, yes indeed, we will put you on the agenda for September. I am copying Maureen Davis, the health
department's clerk, who does the agendas. Maureen, Chris wants to discuss the outdoor dining area surfacing
requirements at Notch with the Board.
The meeting should be September 12th at 7 PM - Maureen could you please confirm this?
Thanks, Paul
From: Chris Lohring [chris@notchbrewing.com]
Sent: Thursday, August 31, 2017 4:20 PM
To: Paul Kirby
Subject: Re: Patio
Paul.
Looking to confirm we are on the agenda for Sept. Can you also share the date and time?
Cheers,
Chris Lohring
Notch Brewing
283R Derby Street
Salem MA 01970
chrisgnotchbrewing, com
978-853-9138
On Wed, Jun 21, 2017 at 3:27 PM, Paul Kirby<pkirby ,salem.com>wrote:
Sure thing, we'll see you in September, thanks. -Paul
From: Chris Lohring [chris@)notchbrewing.com]
Sent: Tuesday, June 20, 2017 2:32 PM
To: Paul Kirby
Subject: Re: Patio
Paul,
September is great. Thanks for getting back to me.
i
Maureen Davis
From: Paul Kirby <pkirby@Salem.com>
Sent: Wednesday, June 21, 2017 3:29 PM
To: Maureen Davis; Larry Ramdin
Subject: FW: Patio
Hi Maureen, would you please add Chris Lohring/Notch patio to the eptember meeting Benda? Thanks, Paul
From: Chris Lohring [chris@notchbrewing.com]
Sent: Tuesday, June 20, 2017 2:32 PM
To: Paul Kirby
Subject: Re: Patio
Paul,
September is great. Thanks for getting back to me.
Chris Lohring
Notch Brewing
283R Derby Street
Salem MA 01970
chriska notchbrewing com
978-853-9138
On Fri, Jun 16, 2017 at 4:34 PM, Paul Kirby<pkirb salem.com>wrote:
Hi Chris, you're certainly welcome to come and discuss with the Board of Health at a meeting. Our July agenda is pretty
full already, and we don't meet in August, so what about the September meeting? It should be on the 12th (always the
second Tuesday of the month).
Let me know and we'll certainly be happy to put you on the agenda for a discussion... Thanks, Paul
From: Chris Lohring [chris@ notch brewing.com]
Sent: Wednesday, June 14, 2017 4:15 PM
To: Paul Kirby
Subject: Re: Patio
Paul,
What is the process to appeal a decision by the Health Agent? Larry feels he is following the code,but I
believe there is room to argue against his decision. I realize Larry is doing his job,but would like an
opportunity to present our case to another audience.
Cheers,
i
i
Chris Lohring
Notch Brewing
283R Derby Street
Salem MA 01970
chris@notchbrewing.com
978-853-9138
On Wed, May 17, 2017 at 10:09 AM, Paul Kirby <pkirby(c�salem.com>wrote:
Certainly, Chris, and I hope that you and Larry are able to resolve this in a way that works for everybody. I'm sorry for
the misunderstanding (that you thought the events you had scheduled for this season were in jeopardy -that was
never the case as I understand it). Please don't hesitate to contact me as you move forward working with him.
Best, Paul
From: Chris Lohring [chrisCa@ notch brewing.com]
Sent: Tuesday, May 16, 2017 1:31 PM
To: Paul Kirby
Subject: Re: Patio
Paul,
I appreciate the email and follow-up. I will wait for Larry to provide further direction on the expectations after
the 2017 season.
In all honesty, if this is enforced and the gravel is deemed to be out of code, we'll most likely stop food
service. The cost to rectify will be too great,the ability to police what food can be taken outside too great, and
• our license does not require food service at all(small brewers pouring permit to serve beer). It's unfortunate
I'm finding out 10 months after we opened for business.
Cheers,
Chris Lohring
Notch Brewing
283R Derby Street
Salem MA 01970
chris@notchbrewing.com
978-853-9138
On Fri, May 12, 2017 at 3:42 PM, Paul Kirby<pkirby@a salem.com>wrote:
Hello Chris,
Paul Kirby here, I'm the chair of the Board of Health. Jeremy forwarded me the email exchange below. I think there's
a misunderstanding here. I've just spoken to Larry and he clarified a statement that he had made to us (the Board) at
our most recent meeting on Tuesday. Larry confirmed that he wants to revisit the gravel surface issue with you after
this year's patio season, and that he has no problem with any of the pop-up or other special/private events in your list
below.
In terms of the specific types of food that are OK on gravel and what are not acceptable, I'm not up on the technical
definitions, but my layperson understanding is that it's a "dry" versus "wet" food distinction. It sounds like I'm talking
about cat food here but I hope the distinction makes sense; I have no idea if those terms are technically
correct. "Dry" in my mind means things like pretzels or dried sausages, versus "wet" being freshly prepared food,
such that food failing on the surface would leave residues of grease, sauces, dressings, and such. Larry, please feel
2
free to chime in here. I would stress again that what I'm writing here is my layperson's understanding, and that Larry
is the technical expert here.
• I hope that this clears things up -to reiterate, there's no issue with any of the events in your list below. You can
proceed with confidence. Our understanding is that Larry will wish to revisit the outdoor surface issue with you after
the 2017 patio season. (Of course, there's no reason discussions could not start sooner if desired, I just mean that
there will be no issues with your events scheduled for the 2017 patio season.) As that discussion unfolds, please
know that the Board stands ready to work with you and Larry to resolve the issue in the best way possible.
Best wishes, Paul
From: Chris Lohring <ch ris@ notch brewi ng.com>
Date: May 12, 2017 at 1:35:38 PM EDT
To: Kim Driscoll <kdriscollCasalem.com>
Cc: <jschiller@salem.com>, Beth Gerard <beth4erard.ward60gmail.com>
Begin forwarded message:
From: Chris Lohring <chris@notchbrewing com>
Date: May 12, 2017 at 1:35:38 PM EDT
To: Kim Driscoll <kdriscoll&salem.com>
Cc: <jschiller e,salem.com>, Beth Gerard <bethgerard.ward6@gmail.com>
Subject: Fwd: Patio
Kim,
• I know you reached out to Mary Ellen on this, and I just got this email form Larry. He has
denied pop-ups and private event caterers from serving food in our beer garden due to the
gravel surface. Some background:
We have had our food menu revised and approved twice by Larry(first for Landjager and
then for dairy), and the gravel beer garden surface was never an issue. We have also
conducted at least 12 events, private and public with permitting approved by the Health
Agent, where the surface of the beer garden was not an issue with other food items
Why now? Larry never inspected our outdoor surface on his initial inspection. He only
became aware of it when another restaurant applied for a permit with a gravel surface. He
denied that surface, and the restaurant asked why Notch was allowed one. Now, we are being
denied.
As an aside - Pretzels and sausage are allowed on that surface, but chicken wings are not?
The following will need to be cancelled or severely restricted in scope:
- Private wedding on 5/21 (this is a major hardship and disappointment for the couple)
- Polish Fest on 6/10
- Bon Chon pop-up this Saturday
- Father's Day hot dog pop-up
- 6 other pop-ups scheduled in early summer
3
I�
The alternative is we place signage leading to the beer garden that certain types of food are
not allowable for consumption in the beer garden per the Salem Health Agent. That will go
over well.
I can't help but feel this payback for our vocal criticism of the food permit structure. The
impact on our business will be significant, and it will be great loss for our customers who
enjoy the pop-ups.
Let me know what we can do /help.
Chris Lohring
Notch Brewing
283R Derby Street
Salem MA 01970
chris@notchbrewinp,.com
978-853-9138
---------- Forwarded message ----------
From: Larry Ramdin <lramdinnsalem.com>
Date: Fri, May 12, 2017 at 12:48 PM
Subject: RE: Patio
To: Chris Lohring <chris@notchbrewing.com>
Cc: Elizabeth McCarthy<liz@notchbrewing com>, Mary Ellen Leahy
<mar. ellen(cr�,notchbrewin .com>, Beth Rennard <BRennard@salem.com>
• Chris,
At the time the Taproom was built and in the plan review process you indicated the only foods that
would be served would be Pretzels and the sausage,you wanted to keep it simple. Both were
acceptable on a crushed stone surface. There are different food offerings than were originally
proposed and with that there are other requirements.
I am more than happy to meet with you to discuss options in light of the additional foods being
served at your facility.
The code references are
2013 Food Code
6-201.11 Floors,Walls,and Ceilings. Except as specified under§6-201.14 and except for antislip floor
coverings or applications that may be used for safety reasons,floors,floor coverings,walls,wall
• coverings,and ceilings shall be designed,constructed, and installed so they are SMOOTH and EASILY
CLEANABLE.
4
Rationale from Food code :Floors that are of smooth, durable construction and that are
• nonabsorbent are more easily cleaned. Requirements and restrictions regarding floor coverings,
utility lines, and floor/wall junctures are intended to ensure that regular and effective cleaning is
possible and that insect and rodent harborage is minimized.
6-201.14 Floor Carpeting, Restrictions and Installation. (A)A floor covering such as carpeting or
similar material may not be installed as a floor covering in FOOD preparation areas,walkin
refrigerators,WAREWASHING areas,toilet room areas where handwashing lavatories,toilets, and
urinals are located, REFUSE storage rooms, or other areas where the floor is subject to moisture,
flushing, or spray cleaning methods. (B) If carpeting is installed as a floor covering in areas other than
those specified under¶ (A) of this section, it shall be: (1)Securely attached to the floor with a
durable mastic, by using a stretch and tack method, or by another method; and (2) Installed tightly
against the wall under the coving or installed away from the wall with a space between the carpet
and the wall and with the edges of the carpet secured by metal stripping or some other means.
Public Health Rationale: Requirements and restrictions regarding floor carpeting are intended to
ensure that regular and effective cleaning is possible and that insect harborage is minimized.The
restrictions for areas not suited for carpeting materials are designed to ensure cleanabliity of
surfaces where accumulation of moisture or waste is likely.
Sincerely
Eau*
Larry Ramdin MPH, MA, REHS, CHO, CP-FS, HHS
Health Agent/Vice President NEHA Region 9
Salem Board of Health
120 Washington Street
Salem MA 01970
978-741-1800 (office)
978-745-0343(Fax)
• Office Hours
Monday- Wednesday 8:00 am—4:00pm
5
Thursday 8:00— 7:00 pm
Friday 8:00 am- 12:00 noon
•
From: Chris Lohring [mai Ito:ch risCd notch brewi ng.corn
Sent: Monday, May 08, 2017 5:52 PM
To: Larry Ramdin
Cc: Elizabeth McCarthy; Mary Ellen Leahy
Subject: Patio
Larry,
Could you please give me clarification, in writing, on what types of food are allowed to be
served on our patio based on our outdoor surface of crushed grave?
Could you also provide to me, either in writing or by referncing code, the regulations
governing the outdoor surfaces allowable for food service and types of food service?
•
Respectfully,
Chris Lohring Notch Brewing 978-853-9138 Sent from Gmail Mobile
Please note the Massachusetts Secretary of State's office has determined that most emails to and from
municipal officials are public records.FMI please refer to: http://www.sec.state.ma.us/pre/preidx.htm.
Please consider the environment before printing this email.
•
6
i
Maureen Davis
• From: Paul Kirby <pkirby@Salem.com>
Sent: Wednesday, September 13, 2017 1:10 PM
To: Chris Lohring
Cc: Maureen Davis;Jeremy Schiller; Mary Ellen Leahy
Subject: RE: Patio
Chris and Mary Ellen, thank you again for coming and speaking with us. I learned a lot of new and helpful information
about your situation, as I'm sure the other members did as well. I did not come away from last night's meeting with the
sense that you needed to stop having outdoor pop-ups at this time. The previous understanding that you and Larry had
reached is, to my mind at least, still in effect - specifically, that you are free to continue having outdoor pop-ups for the
duration of this year's warm season. (Subject of course to temporary permitting requirements and the other limitation
you had mentioned, that your landlord only allows two events per month.)
Let me speak with Larry about this and get back to you, but again, nothing in the discussion last night suggested to me
that you need to cease hosting outdoor pop-ups at this time. My understanding was that we as a Board need more time
to research the issue before deciding on a course of action that would cover the 2018 outdoor season, but I see no
reason why the previous agreement between you and Larry would be voided.
I (and the Board) appreciate your coming and sharing information with us. I will be back in touch soon.
Thanks, Paul
From: Chris Lohring [chris@notchbrewing.com]
Sent: Wednesday, September 13, 2017 8:48 AM
• To: Paul Kirby
Cc: Maureen Davis; Jeremy Schiller; Mary Ellen Leahy
Subject: Re: Patio
Paul,
Thank you for the opportunity to discuss the outdoor surface issue last night. At this point I am withdrawing any
objection to the health agent's ruling. Based on direction from Larry, we (Notch) can continue with our current
menu and outdoor surface, but not allow pop-ups on that surface, unless that surface is changed. We will abide
by that ruling.
I am concerned about the repercussions of Larry contacting the other cities and towns with brewery tap rooms
with outdoor surfaces similar to Notch(at least a dozen examples I gave last night). First, it would be placing
hardship and expense on these businesses who have already been operating with gravel/grass surfaces if they
are forced to change, and second, I'm concerned about the reputation Salem will gain if these cities and towns
force changes based on Larry's communication. Larry was very clear that this is a possible outcome when he
starts to investigate, and I would ask you to cease any of these conversations.
I am disappointed in the outcome, as we see dozens of communities allowing such surfaces, but I will not put
other businesses at risk by forcing the issue with Salem.
Again, thank you for the opportunity.
i
Maureen Davis
From: Chris Lohring <chris@notchbrewing.com>
Sent: Wednesday, September 13, 2017 8:48 AM
To: Paul Kirby
Cc: Maureen Davis;Jeremy Schiller; Mary Ellen Leahy
Subject: Re: Patio
Paul,
Thank you for the opportunity to discuss the outdoor surface issue last night.At this point I am withdrawing any
objection to the health agent's ruling. Based on direction from Larry,we (Notch)can continue with our current menu
and outdoor surface, but not allow pop-ups on that surface, unless that surface is changed. We will abide by that ruling.
I am concerned about the repercussions of Larry contacting the other cities and towns with brewery tap rooms with
outdoor surfaces similar to Notch (at least a dozen examples I gave last night). First, it would be placing hardship and
expense on these businesses who have already been operating with gravel/grass surfaces if they are forced to change,
and second, I'm concerned about the reputation Salem will gain if these cities and towns force changes based on Larry's
communication. Larry was very clear that this is a possible outcome when he starts to investigate,and I would ask you to
cease any of these conversations.
I am disappointed in the outcome, as we see dozens of communities allowing such surfaces, but I will not put other
businesses at risk by forcing the issue with Salem.
Again,thank you for the opportunity.
Chris Lohring
Notch Brewing
283R Derby Street
Salem MA 01970
chris@notchbrewing.com
978-853-9138
On Fri,Sep 1, 2017 at 3:36 PM, Paul Kirby<pkirby@salem.com>wrote:
Hello Chris, yes indeed, we will put you on the agenda for September. I am copying Maureen Davis, the health
department's clerk, who does the agendas. Maureen, Chris wants to discuss the outdoor dining area surfacing
requirements at Notch with the Board.
The meeting should be September 12th at 7 PM - Maureen could you please confirm this?
Thanks, Paul
From: Chris Lohring [chris(c)notchbrewinQ.com]
Sent: Thursday, August 31, 2017 4:20 PM
To: Paul Kirby
Subject: Re: Patio
1
Paul.
Looking to confirm we are on the agenda for Sept. Can you also share the date and time?
Cheers,
Chris Lohring
Notch Brewing
283R Derby Street
Salem MA 01970
chris@notchbrewin,g.com
978-853-9138
On Wed, Jun 21, 2017 at 3:27 PM, Paul Kirby<pkirby@salem.com>wrote:
Sure thing, we'll see you in September, thanks. -Paul
From: Chris Lohring [chris@ notch brewina.com]
Sent: Tuesday, June 20, 2017 2:32 PM
To: Paul Kirby
Subject: Re: Patio
Paul,
September is great. Thanks for getting back to me.
Chris Lohring
Notch Brewing
283R Derby Street
Salem MA 01970
chris@notchbrewing.com
978-853-9138
On Fri, Jun 16, 2017 at 4:34 PM, Paul Kirby<pkirbyCc�salem.com>wrote:
Hi Chris, you're certainly welcome to come and discuss with the Board of Health at a meeting. Our July agenda is
pretty full already, and we don't meet in August, so what about the September meeting? It should be on the 12th
(always the second Tuesday of the month).
Let me know and we'll certainly be happy to put you on the agenda for a discussion... Thanks, Paul
From: Chris Lohring [chrisanotchbrewinQ.com]
Sent: Wednesday, June 14, 2017 4:15 PM
To: Paul Kirby
Subject: Re: Patio
Paul,
2
What is the process to appeal a decision by the Health Agent?Larry feels he is following the code,but I
believe there is room to argue against his decision. I realize Larry is doing his job, but would like an
opportunity to present our case to another audience.
iCheers,
Chris Lohring
Notch Brewing
283R Derby Street
Salem MA 01970
chris@notchbrewing.com
978-853-9138
On Wed, May 17, 2017 at 10:09 AM, Paul Kirby<pkirby(cr�salem.com>wrote:
Certainly, Chris, and I hope that you and Larry are able to resolve this in a way that works for everybody. I'm sorry
for the misunderstanding (that you thought the events you had scheduled for this season were in jeopardy -that was
never the case as I understand it). Please don't hesitate to contact me as you move forward working with him.
Best, Paul
From: Chris Lohring [ch ris(a notch brewing.com]
Sent: Tuesday, May 16, 2017 1:31 PM
To: Paul Kirby
• Subject: Re: Patio
Paul,
I appreciate the email and follow-up. I will wait for Larry to provide further direction on the expectations
after the 2017 season.
In all honesty, if this is enforced and the gravel is deemed to be out of code, we'll most likely stop food
service. The cost to rectify will be too great,the ability to police what food can be taken outside too great,
and our license does not require food service at all (small brewers pouring permit to serve beer). It's
unfortunate I'm fording out 10 months after we opened for business.
Cheers,
Chris Lohring
Notch Brewing
283R Derby Street
Salem MA 01970
chrisgnotchbrewing com
978-853-9138
On Fri, May 12, 2017 at 3:42 PM, Paul Kirby<pkirby�ea salem.com>wrote:
Hello Chris,
Paul Kirby here, I'm the chair of the Board of Health. Jeremy forwarded me the email exchange below. I think
there's a misunderstanding here. I've just spoken to Larry and he clarified a statement that he had made to us (the
3
Board) at our most recent meeting'on Tuesday. Larry confirmed that he wants to revisit the gravel surface issue
with you after this year's patio season, and that he has no problem with any of the pop-up or other special/private
events in your list below.
• In terms of the specific types of food that are OK on gravel and what are not acceptable, I'm not up on the technical
definitions, but my layperson understanding is that it's a "dry" versus "wet" food distinction. It sounds like I'm
talking about cat food here but I hope the distinction makes sense; I have no idea if those terms are technically
correct. "Dry" in my mind means things like pretzels or dried sausages, versus "wet" being freshly prepared food,
such that food falling on the surface would leave residues of grease, sauces, dressings, and such. Larry, please feel
free to chime in here. I would stress again that what I'm writing here is my layperson's understanding, and that
Larry is the technical expert here.
I hope that this clears things up -to reiterate, there's no issue with any of the events in your list below. You can
proceed with confidence. Our understanding is that Larry will wish to revisit the outdoor surface issue with you
after the 2017 patio season. (Of course, there's no reason discussions could not start sooner if desired, I just mean
that there will be no issues with your events scheduled for the 2017 patio season.) As that discussion unfolds,
please know that the Board stands ready to work with you and Larry to resolve the issue in the best way possible.
Best wishes, Paul
From: Chris Lohring <chris@ notch brewinQ.com>
Date: May 12, 2017 at 1:35:38 PM EDT
To: Kim Driscoll <kdriscollOsalem.com>
Cc: <jschiller@salem.com>, Beth Gerard <bethaerard.ward6Ca gmail.com>
Begin forwarded message:
From: Chris Lohring <chris¬chbrewing com>
• Date: May 12, 2017 at 1:35:38 PM EDT
To: Kim Driscoll <kdriscoll@salem.com>
Cc: <jschiller@salem.com>, Beth Gerard <bethgerard.ward6gJZmai1.com>
Subject: Fwd: Patio
Kim,
I know you reached out to Mary Ellen on this, and I just got this email form Larry. He has
denied pop-ups and private event caterers from serving food in our beer garden due to the
gravel surface. Some background:
We have had our food menu revised and approved twice by Larry(first for Landjager and
then for dairy), and the gravel beer garden surface was never an issue. We have also
conducted at least 12 events, private and public with permitting approved by the Health
Agent, where the surface of the beer garden was not an issue with other food items
Why now?Larry never inspected our outdoor surface on his initial inspection. He only
became aware of it when another restaurant applied for a permit with a gravel surface. He
denied that surface, and the restaurant asked why Notch was allowed one. Now, we are
being denied.
As an aside - Pretzels and sausage are allowed on that surface,but chicken wings are not?
•+ 4 The following will need to be cancelled or severely restricted in scope:
II
4
- Private wedding on 5/21 (this is a major hardship and disappointment for the couple)
- Polish Fest on 6/10
- Bon Chon pop-up this Saturday
• - Father's Day hot dog pop-up
- 6 other pop-ups scheduled in early summer
The alternative is we place signage leading to the beer garden that certain types of food are
not allowable for consumption in the beer garden per the Salem Health Agent. That will go
over well.
I can't help but feel this payback for our vocal criticism of the food permit structure. The
impact on our business will be significant, and it will be great loss for our customers who
enjoy the pop-ups.
Let me know what we can do /help.
Chris Lohring
Notch Brewing
283R Derby Street
Salem MA 01970
chris@notchbrewing.com
978-853-9138
---------- Forwarded message ----------
From: Larry Ramdin <lramdin(a-),salem.com>
• Date: Fri, May 12, 2017 at 12:48 PM
Subject: RE: Patio
To: Chris Lohring <chris@notchbrewing com>
Cc: Elizabeth McCarthy<liz@notchbrewing_com>, Mary Ellen Leahy
<maryellen@notchbrewing com>, Beth Rennard <BRennard@salem.com>
Chris,
At the time the Taproom was built and in the plan review process you indicated the only foods that
would be served would be Pretzels and the sausage,you wanted to keep it simple. Both were
acceptable on a crushed stone surface. There are different food offerings than were originally
proposed and with that there are other requirements.
I am more than happy to meet with you to discuss options in light of the additional foods being
served at your facility.
The code references are
2013 Food Code
5
Health Dept. C p Clerical Report FYIA8
Burial ermits 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 25-99 seats $28o >99 seats $420
September $0.00 Retail Food <l000sq' $70
October $0.00 1000-10,000 $28o >io,000 $420
November $0.00 Temp.Food 1 3 days $35
December $0.00 4-7 days $7a >7 days $
January-18 Example of>7 day temp food permit:
$0.00 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 s18o
May $0.00
Remodel $90
June Catering $25Pereventl$200
$0.00 catering kitchen
Body Art Est. $315
Total $1,600.00 $6,020.00 $900.00 $3,300.00 $300.00 $12,120.00 Body Art Practitioner $135
Review Plans s18o
Fiscal Year Budget 2018 Suntan Est. $140
Rec. Day Camp $10
Salary Star in Ending Expenses Ext.Paint Removal $35
Full Time $412,115.00 $356,491.77 Starting Ending Transport Off.Subst. $1o5
Part Time $43,354.00 $39,287.05 $32,500.00 $30,990.17 Tobacco Vendors $135
Overtime $2,000.00 $1,074.70 Swimming Pools Seasonal $140
Balance $457,469.00 $396,853.52 Health Clinic Revolving Account �Annual$210 Nonprofit$40
S16,941.09 Title V Review $180
Well Application $180
Disposal works $225118o
Breakdown of Permits and Fines
July +August 2017
Permit Description Total Permits Issued Permit Cost Total
Annual Food -25-99 seats 2 $280.00 $560.00
Annual Food - <25 seats 1 $140.00 $140.00
Annual Food - Retail <1000sq' 2 $70.00 $140.00
Body Art Establishment 2 $315.00 $630.00
Body Art Practitioner/Apprentice/Piercing 9 $135.00 $1,215.00
Burial Permit 64 $25.00 $1,600.00
Camp Permit 2 $10.00 $20.00
Certificate of Fitness 66 $50.00 $3,300.00
Exterior Paint Removal 11 $35.00 $385.00
Funeral Director License 3 $75.00 $225.00
Plan Review 3 $180.00 $540.00
Plan Review- Remodel 4 $90.00 $360.00
Pool Permit- Non-Profit 1 $40.00 $40.00
Temporary Food - Pop Up(1-3 days) 51 $35.00 $1,785.00
Temporary Food - Pop Up(1-3 days) - Non-Profit 19 $25.00 $475.00
Tobacco Permit 3 $135.00 $405.00
Tobacco Fine 3 $100.00 $300.00
Total $12,120.00
Note: Rejected temporary food application on 7/18/17 for North East of the Border food truck @ Far From the Tree for lack of valid base of operations
Non-Event Related Pop-Ups
2015: 1 temporary permit @ $300.00 = $300.00
2016: 3 temporary permits @ $300.00 = $900.00
eltp of *a 1pm, Aa!9.qarbUq9SC VED
orfce Mepartment AUG 0 92017
CITY OF SALEM
� �ea��uarter�
95 margin 6treet BOARD OF HEALTH
Mary E. Butler *alem, 0a,5.5arbU9;ett5S 01970
Chief of Police (97S) 744-2204
04 August 2017
Board of Health
120 Washington Street, 4 h Floor
Salem, Massachusetts 01970
Dear Board of Health Colleagues,
On behalf of the men and women of the Salem Police Department, I would like to express my
sincere appreciation for your participation in Salem's 2017 National Night Out festivities.
The August 1"event, which focused on brining the police together with the people we serve,
drew well over a thousand guests of all ages from Salem and our surrounding communities.
National Night Out 2017 was an outstanding success because of organizations like yours.
• Once again, thank you for your support to the Salem Police Department and our community.
We look forward to your participation in National Night Out 2018.
Sincerely,
,p Mary E. tler
(X Chief of Police
MEB/rdm
•
I
CO Of *MCM, A1a,55atbU.5dWCE1VED
office� Mepartmeut J0eabquarter� AUG. . 012017
95 filar giu 6treet CITY OF SALEM
Mar E. Butler
y *alem, f laoarbugetto 01970 BOARD OF HEALTH
Chief of Police (978) 744-2204
04 August 2017
Salem Overdose and Substance Abuse Prevention Coalition
120 Washington Street, 4th Floor
Salem, Massachusetts 01970
Dear Salem Overdose and Substance Abuse Prevention Coalition,
On behalf of the men and women of the Salem Police Department, I would like to express my
sincere appreciation for your participation in Salem's 2017 National Night Out festivities.
The August I`event, which focused on brining the police together with the people we serve,
drew well over a thousand guests of all ages from Salem and our surrounding communities.
National Night Out 2017 was an outstanding success because of organizations like yours.
Once again, thank you for your support to the Salem Police Department and our community.
• We look forward to your participation in National Night Out 2018.
Sincerely,
ua�—
Mary E. utler
Chief of Police
`0
MEB/rdm
•
Maureen Davis
From: Paul Kirby <pkirby@Salem.com>
Sent: Wednesday, September 13, 2017 9:52 PM
To: Chris Lohring
Cc: Maureen Davis;Jeremy Schiller; Mary Ellen Leahy
Subject: RE: Patio
Hi Chris, I spoke with Larry and he informed me that he's decided not to go forward with contacting other cities and
towns regarding their policies. So I would urge you to not let that concern be a deterrent to sticking with the original
plan (that you all can continue outdoor popups for the duration of 2017). Obviously your call, but just wanted to
reassure you on this point.
Thanks, Paul
From: Chris Lohring [chris@notchbrewing.com]
Sent: Wednesday, September 13, 2017 1:36 PM
To: Paul Kirby
Cc: Maureen Davis; Jeremy Schiller; Mary Ellen Leahy
Subject: Re: Patio
Hi Paul,
Appreciate the follow-up.
. I understand the time frame and our ability to keep conducting them until the issue is resolved. My concern is
that in seeking a resolution, we cause brewers and restaurants in other towns to lose their ability to serve on the
outdoor surface they now have. That was an outcome that Larry said was possible, and in no way do I want
Notch efforts to save our outdoor surface to facilitate that.
I am happy to ride out the year conducting pop ups(or through the harbor walk construction), but do not want
Salem to investigate other city and towns where gravel tap room patios exist, as it may have an impact existing
breweries. The possible upside for Notch is not worth the risk to dozens of other businesses.
Cheers,
Chris Lohring
Notch Brewing
283R Derby Street
Salem MA 01970
chris@notchbrewing.com
978-853-9138
•On Wed, Sep 13, 2017 at 1:10 PM, Paul Kirby<pkirby@salem.com>wrote:
Chris and Mary Ellen, thank you again for coming and speaking with us. I learned a lot of new and helpful information
about your situation, as I'm sure the other members did as well. I did not come away from last night's meeting with the
sense that you needed to stop having outdoor pop-ups at this time. The previous understanding that you and Larry had
i
i
Maureen Davis
• From: Paul Kirby <pkirby@Salem.com>
Sent: Wednesday, September 13, 2017 1:24 PM
To: Chris Lohring
Cc: Maureen Davis;Jeremy Schiller; Mary Ellen Leahy
Subject: RE: Patio
Chris and Mary Ellen, I've confirmed with Larry that he is not asking you to cease hosting pop-ups at this time, so that is
the same understanding I had based on the meeting last night. Obviously it's your call, but please know that neither
Larry nor the Board has this expectation. Thanks, Paul
From: Chris Lohring [chris@notchbrewing.com]
Sent: Wednesday, September 13, 2017 8:48 AM
To: Paul Kirby
Cc: Maureen Davis; Jeremy Schiller; Mary Ellen Leahy
Subject: Re: Patio
Paul,
Thank you for the opportunity to discuss the outdoor surface issue last night. At this point I am withdrawing any
objection to the health agent's ruling. Based on direction from Larry, we (Notch) can continue with our current
menu and outdoor surface, but not allow pop-ups on that surface, unless that surface is changed. We will abide
• by that ruling.
I am concerned about the repercussions of Larry contacting the other cities and towns with brewery tap rooms
with outdoor surfaces similar to Notch(at least a dozen examples I gave last night). First, it would be placing
hardship and expense on these businesses who have already been operating with gravel/grass surfaces if they
are forced to change, and second, I'm concerned about the reputation Salem will gain if these cities and towns
force changes based on Larry's communication. Larry was very clear that this is a possible outcome when he
starts to investigate, and I would ask you to cease any of these conversations.
I am disappointed in the outcome, as we see dozens of communities allowing such surfaces, but I will not put
other businesses at risk by forcing the issue with Salem.
Again, thank you for the opportunity.
Chris Lohring
Notch Brewing
283R Derby Street
Salem MA 01970
chris@notchbrewing.com
„•978-853-9138
On Fri, Sep 1, 2017 at 3:36 PM, Paul Kirby<pkirby�a�salem.com>wrote:
i
• Attended the Northshore Public Health nurses meeting on August 81h where we continued
discussion on ongoing public health issues in our communities, camp updates and
scheduled our flu clinics and booked our schedules to staff each other's clinics.
• • Lunchtime fitness classes at 120 Washington St started on August 8th.
• Attended the Council on Aging health fair on Wednesday August 9th, I brought a poster
board with information on the importance of knowing when you are dehydrated and how
to stay hydrated and distributed Salem Board of Health reusable water bottles.
• Attended the Vaccines reimbursement training in August 15th•this training is mandatory
to bill insurance companies for flu shots since the UMASS Medical School Center for
Health Care Financing has been the institution negotiating contracts with insurance
companies and completing the billing process for local board of health.
• Attended the North Shore Medical Center Pulmonary Clinics quarterly meeting to discuss
ongoing developments and changes regarding the DPH Tuberculosis program as well as
best practices and opportunities for collaboration with the clinics and public health
nurses. Current case studies are reviewed as well.
• Diane Dube, a local Registered Dietitian Nutritionist held her second nutrition class on
August 23rd and taught reading nutrition labels and grocery store shopping.
• Attended the Northshore Cape Ann Emergency Preparedness meeting on August 23rd for
collaborations with health agents and nurses from surrounding towns for emergency
preparedness and current events.
• Attended the Salem REACT meeting on August 24th to collaborate with Police and the
Council on Aging social workers regarding elderly residents whom we may be able to
provide or find assistance services for.
• A Salem State University RN to BSN student has been signed up for clinical hours to
• begin in September.
Monthly Report of Communicable Diseases: August 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 0 0 1 0 4 4
(Active)
Latent 4 0 4 4 26 31 47
Tuberculosis*
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
0 rovirus
Campylobacte 0 0 0 0 1 15 11
riosis
Disease New Carry Over Discharged/ Total#Of Running Total for Total for
Reported Cases this Total for 2016 2015
Closed Month 2017
ukungunya 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 0 0 0 0 2 0 4
Streptococcus
Group B* 0 0 0 0 4 2 7
Streptococcus
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
lepatitis A 0 0 0 0 0 0 0
Hepatitis B* 0 0 0 0 4 8 0
Hepatitis C* 2 0 2 2 22 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*
(13) (13) (13) (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
kalmonellosis 4 0 3 4 8 11 6
Shigellosis 0 0 0 0 0 3 0
Disease New Carry Over Discharged/ Total#Of Running Total for Total for
Reported Cases this Total for 2016 2015
Closed Month 2017
eptococcus 0 0 0 0 3 8 3
Pneumoniae*
Varicella* 0 0 0 0 0 1 0
Vibrio 0 0 0 0 0 1 0
West Nile 0 0 0 0 0 0 0
Yersoniosis 0 0 0 0 0 0 1
Zika Virus 0 0 0 0 0 1 0
Infection
Total 11 0 9 11 135 204 140
August 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"'regarding an active case of Tuberculosis infection in a Salem resident.
This resident has started the appropriate antibiotics, is currently hospitalized in a hospital outside of
Salem, and will not be discharged until they are no longer contagious. Direct Observed Therapy(D.O.T.)
will be done by 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 completing
Tuberculosis testing on all of these contacts and placing referrals to the North Shore Pulmonary Clinic. At
this time, there is no evidence of any other residents have active Tuberculosis, all contacts who test
• positive to Tuberculosis (likely latent infections since all contacts are asymptomatic)are referred to clinic,
given a chest x-ray and will be seen by a Pulmonologist to discuss the risks and treatments regimen.
Salmonella:
Case 1: This case has traveled out of the country during the incubation period, no known contacts are ill.
They do not work or attended a care setting or work in a food establishment. No further follow up is
required and this case is closed.
Case 2: This case was also being treated for another gastrointestinal infection with an antibiotic. They did
not have any recent travel and ate mostly at home, an interview and Foodborne Illness Complaint
Worksheet was completed and filed with the food protection program. There are no linked cases and no
known contacts are ill. This case does not work in a food establishment or in a patient care setting. This
case is closed.
Case 3: This case was treated outpatient. They did recently travel within the country. An interview and
Foodborne Illness Complaint Worksheet was completed and filed with the food protection program.
There are no linked cases and no known contacts are ill. This case does not work in a food establishment
or in a patient care setting. No further follow up is required and this case is closed.
Case 4: This case is currently open as I complete follow up.
Giardia(probable)
Case 1: This case required follow up though it was not a confirmed diagnosis per MDPH.Per the
patients' primary care physician, they had no recent travel. I confirmed this with the patient and there are
no known contacts. This case was requested to remain home until gastrointestinal symptoms had resolved
and they are now recovered.No further follow up is required and this case is closed.
•
•
Health Agent report July/August 2017
Announcements/Updates
• Household Hazardous Waste Day is scheduled for September 30, from 8:00 AM-12:00
noon at the Salem High School, electronic waste collection will run concurrently with the
event.
• Positive West Nile Virus pools were identified in Lynn, Peabody and Beverly in August
• Sarah Corley Intern and Mia Piccirallo, summer student worker,have completed their
time with us the experience was enriching to both the department and the participants.
We look forward to hosting student next year.
Community Outreach
• The Department participated in the Overdose awareness day that was held on August 31,
at Old Town Hall.
• The Overdose and opiate use coalition has begun a new discussion series that will be
hosted on SATV .
• The Department continues to have an ongoing presence at the Farmers Market providing
timely information on a variety of health topics
Meetings and Trainings
• Larry Ramdin attended the NEHA annual Educational Conference in Grand Rapids
Michigan
• Larry Ramdin attended a meeting to discuss Policies around using Salem for film
production
Environmental Health Activities
• Cameras were sited on various locations where illegal dumping was observed.
Additionally signage was installed to indicate the area was under video surveillance
• Larry Ramdin met with a Salem State Student who developed a paper on contaminated
soils at the Community garden located at Palmer cove. We are satisfied that the results do
not show a risk at the community garden
• Food permit was issued to A&K King for their new location on Boston Street
• Plans were submitted for a Brewery on Church Street and remodel for the Antique Table
on Congress Street.
• Trash continues to be an ongoing issue and the Department is making significant effort to
respond to the issues so that the quality of life for Salem resident are maintained at high
levels
Inspections
Item Monthly Total YTD 2016 Total
Certificate of Fitness 83 264 506
Inspection
Certificate of Fitness 5 39 42
re-inspection
Food Inspection 46 169 241
Food Re-inspections 17 57 31
Retail Food 12 17 17
Inspections
Retail Food 7 8 12
re-inspection
Temporary Food 16 71 48
General Nuisance 9 20 26
Inspections
Food— 0 0 2
Administrative
Hearings
Housing Inspections 13 67 94
Housing re- 4 36 25
inspections
Rodent Complaints 25 32 24
Court 1 2 3
Hearings/filings
Item YTD 2016
Trash Inspections 162 620 574
Orders served by 1 1 3
Constable
Tanning Inspections 0 0 0
Body Art 0 0 0
Swimming pools 1 22 9
Bathing Beach 85 123 108
Inspection/testing
Recreational Camps 1 6 6
Lead Determination 1 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 486 1542 1699
•
Total 12 0 12 12 124 204 140
July 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
Legionella
Case 1: This patient was treated inpatient and it was ruled out as a nosocomial transmission and was
acquired in the community, there has been no link to other cases. The patient did not have a history of
recent travel and is currently unemployed. There is no further follow up required and this case is closed.
Pertussis
Case 1: This case was treated outpatient by their primary care, household contacts were given
preventative treatment. The case had been mostly home during the infectious period and did not have
close contacts outside of the home. They did travel out of the country for the month of June, the family is
unaware of any none contacts having pertussis. The case completed treatment and is no longer infectious,
there are no linked cases and this case is closed.
Shigella
Case 1: I was unable to reach this patient and the physician information provided did not match the
facilities records. This patient was lost to follow up and this case is not associated with an outbreak. This
case is currently closed.
Suzanne Doty RN BSN
Salem Board of Health
Public Health Nurse
• Public Health Nurse Report
Reporting on August 2, 2017 through September 6, 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(M11S) for up to
date vaccine records and better continuity of care between clinics and providers.
• Posted Facebook and Instagram posts regarding information on mosquitos,National
Overdose Awareness day and the upcoming Household Hazardous Waste day event.
Meetings/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 15th 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 15t, 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.
Allocated funding to reducing the cost of Weight Watchers program participation, we are
still looking for enough people to sign up in order for them to be able to hold the
meetings on site.
I am currently working on an evaluation report and will be sending 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.
• Met with owners whom are planning to open new tattoo establishments. Discussed plans
and met with owner on August 1st. Another meeting was held on August 9th with the
owners of the second establishment planning to open on Salem as well.
• Attended National Night Out on the Salem Commons on August I't, this event is held
annually by the Police department. I brought a display called the"Bite Lab"which is
shared by health departments and is used for education about ticks and mosquitos
includes a poster board, slideshow and glass display box. I also brought ticks cards,
booklets, stickers and tick spoons.
• Provided PPD (for Tuberculosis testing)to the Lydia Pinkham Memorial as they see an
increase of business before the start of school for vaccinations and TB screening.
• Simmons student nurse,Nancy Nguyen, completed her clinical hours for the summer on
• August P.
• Attended the"Touch-a-Truck"fair on Sunday August 6th at the Salem Willows. This is a
family event and I provided"My Plates"which are plates for children that have sections
for each food group. It was a great opportunity to show children the importance of having
enough fruits and vegetables and for families to discuss a balanced diet.
Chapter
6 Ph sisal Facilities
Y
— Parts
6-1 MATERIALS FOR CONSTRUCTION AND REPAIR
6-2 DESIGN,CONSTRUCTION,AND INSTALLATION
6-3 NUMBERS AND CAPACITIES
6-4 LOCATION AND PLACEMENT
6-5 MAINTENANCE AND OPERATION
6-1 MATERIALS FOR CONSTRUCTION AND REPAIR
Subparts
9_ I
_ 6-101 Indoor Areas
Y � 6-102 Outdoor Areas
_ Indoor Areas 6-101.11 Surface Characteristics.
(A)Except as specified in¶(B)of this section,materials for
* indoor floor,wall,and ceiling surfaces under conditions of normal
use shall be:
('1)SMOOTH,durable,and EASILY CLEANABLE for areas where
_ FOOD ESTABLISHMENT operations are conducted;
(2)Closely woven and EASILY CLEANABLE carpet for carpeted
areas;and
(3)Nonabsorbent for areas subject to moisture such as FOOD
y-M^ preparation areas,walk-in refrigerators,wAREwASHING areas,
toilet rooms,mobile FOOD ESTABLISHMENT SERVICING AREAS,
-y^ and areas subject to flushing or spray cleaning methods.
M (B)In a TEMPORARY FOOD ESTABLISHMENT.
(1)If graded to drain,a floor may be concrete,machine-laid
asphalt,or dirt or gravel if it is covered with mats,removable
7 platforms, duckboards, or other APPROVED materials that are
effectively treated to control dust and mud,and
173
and
WV
(B)Exposed utility service lines and pipes shall be installed so
do not obstruct or prevent cleaning of the floors,walls,or
the P 9
(2)Walls and ceilings maybe constructed of a material that
Y
ceilings.
Protects the interior from the weather and windblown dust �' g
and debris. '`-'„,�
(C)Exposed horizontal utility service lines and pipes may not be
installed on the floor.
Outdoor Areas 6-102.11 Surface Characteristics. ��""`
`� 1 6-201.13 Floor and Wall Junctures,Coved,and Enclosed
(A)The outdoor walking and driving areas shall be surfaced with �— ' or Sealed.
concrete,asphalt,or gravel or other materials that have been
effectively treated to minimize dust,facilitate maintenance, and —"prevent muddy conditions. (A)In F000 ESTABLISHMENTS in which cleaning methods other
than water flushing are used for cleaning floors,the floor and
(B)Exterior surfaces of buildings and mobile FOOD wall junctures shall be coved and closed to no larger than 1 mm
(one thirty-second inch).
ESTABLISHMENTS shall be of weather-resistant materials and shall
comply with LAw.
(B)The fI00rS In FOOD ESTABLISHMENTS In which Water flush
cleaning methods are used shall be provided with drains and be
(C)Outdoor storage areas for REFUSE,recyclables,or graded to drain,and the floor and wall junctures shall be coved
returnables shall be of materials specified under§§5-501.11 ,,J and SEALED.
and 5-501.12.
6-2 DESIGN,CONSTRUCTION,AND INSTALLATION 6-201.14 Floor Carpeting, Restrictions and Installation.
rj (A)A floor covering such as carpeting or similar material may not
Subparts " be installed as a floor covering in FOOD preparation areas,walk-
in refrigerators,WAREWASHING areas,toilet room areas where
6-201 Cleanability handwashing lavatories,toilets,and urinals are located,REFUSE
6-202 Functionality 1 storage rooms,or other areas where the floor is subject to
- � moisture,flushing,or spray cleaning methods.
=L .
C/eanabi/ity 6'-201.11 Floors,Walls,and Ceilings.9 (B)If carpeting is installed as a floor covering in areas other than
Except as specified under§6-201.14 and except for antislip floor those specified under¶(A)of this section,it shall be:
coverings or applications that may be used for safety reasons, " (1)Securely attached to the floor with a durable mastic,by
floors,floor coverings,walls,wall coverings,and ceilings shall be using a stretch and tack method,or by another method;and
designed,constructed,and installed so they are SMOOTH and
EASILY CLEANABLE.
(2)Installed tightly against the wall under the cooing or
`-�"' installed away from the wall with a space between the carpet
_. and the wall and with the edges of the carpet secured by
6-201.12 Floors,Walls,and Ceilings, Utility Lines. metal stripping or some other means.
(A)Utility service lines and pipes may not be unnecessarily
—
exposed.
Cam'
174 &___ 175
6-201.15 Floor Covering, Mats and Duckboards. (1) The integrity of the packages cannot be affected by
M-� broken glass falling onto them,and
Mats and duckboards shall be designed to be removable and ,jam
EASILY CLEANABLE.
C��� (2) The packages are capable of being cleaned of debris
from broken bulbs before the packages are opened.
6-201.16 Wall and CeilingCoverings and Coatings.g g (C)An infrared or other heat lamp shall be protected against
breakage by a shield surrounding and extending beyond the bulb
(A)Wall and ceiling covering materials shall be attached so that , so that only the face of the bulb is exposed.
they are EASILY CLEANABLE.
(B)Except in areas used only for dry storage,concrete,porous ^`
6-202.12 Heating,Ventilating,Air Conditioning System
blocks,or bricks used for indoor wall construction shall be Vents.
finished and SEALED to provide a SMOOTH,nonabsorbent,EASILY
CLEANABLE Surface. Heating,ventilating,and air conditioning systems shall be
designed and installed so that make-up air intake and exhaust
6-201.17 Walls and Ceilings,Attachments. vents do not cause contamination of FOOD,FOOD-CONTACT
SURFACES,EQUIPMENT,or UTENSILS.
(A)Except as specified in¶(B)of this section,attachments to .
walls and ceilings such as light fixtures,mechanical room„ 6-202.13 Insect Control Devices,Design and Installation.
ventilation system components,vent covers,wall mounted fans,
decorative items,and other attachments shall be EASILY . (A)Insect control devices that are used to electrocute or stun
CLEANABLE.
flying insects shall be designed to retain the insect within the
(B)In a CONSUMER area, wall and ceiling surfaces and decorative device...�,:�`�
items and attachments that are provided for ambiance need not (B)Insect control devices shall be installed so that:
meet this requirement if they are kept clean.
(1)The devices are not located over a FOOD preparation area;
6-201.18 Walls and Ceilings,Studs,Joists,and Rafters. �7- and
(2)Dead insects and insect fragments are prevented from
Except for TEMPORARY FOOD ESTABLISHMENTS,studs,joists,and _� being impelled onto or falling on exposed FOOD;clean
rafters may not be exposed in areas subject to moisture. �/
��"--.' EQUIPMENT,UTENSILS,and LINENS;and Unwrapped SINGLE-
SERVICE and SINGLE-USE ARTICLES.
Functionality 6-202.11 Light Bulbs,Protective Shielding. ��,
(A)Except as specified in¶(B)of this section,light bulbs shall
6-202.14 Toilet Rooms,Enclosed.
be shielded,coated,or otherwise shatter-resistant in areas _ Except where a toilet room is located outside a FOOD
Where there Is exposed FOOD;clean EQUIPMENT,UTENSILS,and ESTABLISHMENT and does not open directly into the FOOD
LINENS;or unwrapped SINGLE-SERVICE and SINGLE-USE ARTICLES. ESTABLISHMENT such as a toilet room that is provided by the
(B)Shielded, coated, or otherwise shatter-resistant bulbs need management of a shopping mall, a toilet room located on the
not be used in areas used only for storing FOOD in unopened 4 PREMISES shall be completely enclosed and provided with a tight-
packages,it. Fli fitting and self-closing door.
176 177
O
¢ (3)Other effective means.
6-202.15 Outer Openings,Protected.
^� (E) Paragraph(D)of this section does not apply if flying insects
�I and other pests are absent due to the location of the
(A)Except as specified in¶¶(B),(C),and(E)and under¶(D)of ESTABLISHMENT, the weather, or other limiting condition.
this section,outer openings of a FOOD ESTABLISHMENT shall be
protected against the entry of insects and rodents by:
(1)Filling or closing holes and other gaps along floors,walls, 6-202.16 Exterior Walls and Roofs,Protective Barrier.
and ceilings;
Perimeter walls and roofs of a FOOD ESTABLISHMENT shall
(2)Closed,tight-fitting windows;and effectively protect the establishment from the weather and the
entry of insects,rodents,and other animals.
(3)Solid,self-closing,tight-fitting doors.
■ 17 Outdoor Food Vending Areas,Overhead
(B)Paragraph(A)of this section does not apply if a FOOD 6-202. Protection.
ESTABLISHMENT opens into a larger structure,such as a mall, '
airport,or office building, or into an attached structure,such as a Except for machines that vend canned BEVERAGES,if located
porch,and the outer openings from the larger or attached
structure are protected against the entry of insects and rodents. outside,a machine used to vend FOOD shall be provided withoverhead protection.
(C)Exterior doors used as exits need not be self-closing if they +
are:
6-202.18 Outdoor Servicing Areas,Overhead Protection.
(1)Solid and tight-fitting;
Except for areas used only for the loading of water or the
(2)Designated for use on/ when an emergency exists b discharge of SEWAGE and other liquid waste,through the use of a
y g y y -`� closed system of hoses,SERVICING AREAS shall be provided with
the fire protection authority that has jurisdiction over the overhead protection.
FOOD ESTABLISHMENT,'and
(3)Limited-use so they are not used for entrance or exit 6-202.19 Outdoor Walking and Driving Surfaces,Graded
from the building for purposes other than the designated •�
emergency exit use. to Drain.
(D)Except as specified in¶¶(B)and(E)of this section,if the Exterior walking and driving surfaces shall be graded to drain.
windows or doors of a FOOD ESTABLISHMENT,or of a larger '
structure within which a FOOD ESTABLISHMENT Is located,are kept . 6-202.110 Outdoor Refuse Areas,Curbed and Graded to
Open for Ventilation Or Other purposes Or a TEMPORARY FOOD �;_� Drain.
ESTABLISHMENT is not provided with windows and doors as
specified under¶(A)of this section,the openings shall be
protected against the entry of insects and rodents by: Outdoor REFUSE areas shall be constructed in accordance with
LAw and shall be curbed and graded to drain to collect and
(1)16 mesh to 25.4 mm(16 mesh to 1 inch)screens; _ dispose of liquid waste that results from the REFUSE and from
cleaning the area and waste receptacles.
(2)Properly designed and installed air curtains to control �•
flying insects;or
178 �" 179
�z
sir
6-202.111 Private Homes and Living or Sleeping Quarters,
Use Prohibition. „-
A private home,a room used as living or sleeping quarters,or an
area directly opening into a room used as living or sleeping
quarters may not be used for conducting FOOD ESTABLISHMENT *R:7r
operations.R
6-202.112 Living or Sleeping Quarters,Separation.
Living or sleeping quarters located on the PREMISES of a FOOD
ESTABLISHMENT such as those provided for lodging registration --
clerks or resident managers shall be separated from rooms and
areas used for FOOD ESTABLISHMENT operations by complete
partitioning and solid self-closing doors.
6-3 NUMBERS AND CAPACITIES rp
Subparts
6-301 Handwashing Sinks
6-302 Toilets and Urinals
6-303 Lighting
6-304 Ventilation
6-305 Dressing Areas and Lockers
6-306 Service Sinks low
Handwashing 6-301.10 Minimum Number.
Sinks r
HANDWASHING SINKS shall be provided as specified under
§5-203.11. E
6-301.11 Handwashing Cleanser,Availability. 11Z1
r-
Each HANDWASHING SINK or group of 2 adjacent HANDWASHING �Ic1/
SINKS shall be provided with a supply of hand cleaning liquid, - -
powder,or bar soap.P` i[zw
180
• F
Floor surfaces that are graded to drain and consist of effectively treated materials will
Storage areas for garbage and refuse containers must be constructed so that they can .,� prevent contamination of foods from dust and organisms from pooled moisture.
be thoroughly cleaned in order to avoid creating an attractant or harborage for insects
or rodents. In addition,such storage areas must be large enough to accommodate all , The special requirements for carpeting materials and nonabsorbent materials in areas
the containers necessitated by the operation in order to prevent scattering of the J
isture are intended to ensure that the cleanability of these surfaces is
garbage and refuse. subject to mo
retained.
All containers must be maintained in good repair and cleaned as necessary in order to Although food served from temporary food establishments is subject to the same
store garbage and refuse under sanitary conditions as well as to prevent the breeding ��.,� potential for contamination as food served in permanent establishments,the limited
of flies. - J capabilities and short duration of operation are recognized by less stringent
Garbage containers should be available wherever garbage is generated to aid in the
requirements for surface characteristics.
proper disposal of refuse. . Outdoor Areas 6-102.11 Surface Characteristics.
Outside receptacles must be constructed with tight-fitting lids or covers to prevent the The requirements concerning surface characteristics of outdoor areas are intended to
scattering of the garbage or refuse by birds,the breeding a flies,or the entry of �,,�.,•
. L� facilitate maintenance and minimize the accumulation of dust and mud on walking and
rodents.Proper per cle equipment and supplies must be made available to accomplish �� driving areas,provide durable exterior building surfaces,and prevent the attracting,
thorough and proper cleaning of garbage storage areas and receptacles so that �_,,,_ harboring,or breeding of insects,rodents,and other pests where refuse,recyclables,or
unsanitary conditions can be eliminated. returnables are stored.
Removal 5-502.11 Frequency. Cleanability 6-201.11 Floors,Walls,and Ceilings.
5-502.12 Receptacles or Vehicles.
6-201.12 Floors,Walls,and Ceilings,Utility Lines.
Refuse,recyclables,and returnable items,such as beverage cans and bottles, usually Floors that are of smooth,durable construction and that are nonabsorbent are more
contain a residue of the original contents. Spillage from these containers soils easily cleaned. Requirements and restrictions regarding floor coverings, utility lines,
rodents and and effective cleaning is
attractant for insects, t regular a
becomes an attra ensure that s and bec intended to 9
receptacles and storage area and floor/wall junctures are ante
other pests. The handling of these materials entails some of the same problems and �.-_ - possible and that insect and rodent harborage is minimized.
solutions as the handling of garbage and refuse. Problems are minimized when all of
these materials are removed from the premises at a reasonable frequency. - - 6-201.13 Floor and Wall Junctures,Coved,and
Enclosed or Sealed.
Facilities 5-503.11 Community or Individual Facility. •
for Disposal and When cleaning is accomplished by spraying or flushing,coving and sealing of the
Recycling =- floor/wall junctures is required to provide a surface that is conducive to water flushing.
Alternative means of solid waste disposal must be conducted properly to prevent •~_ Grading of the floor to drain allows liquid wastes to be quickly carried away,thereby
environmental consequences and the attraction of insects,rodents,and other pests. preventing pooling which could attract pests such as insects and rodents or contribute
■— to problems with certain pathogens such as Listeria monocytogenes.
s. 6-201.14 Floor Carpeting,Restrictions and Installation.
Chapter 6 Physical Facilities
.-�- Requirements and restrictions regarding floor carpeting are intended to ensure that
regular and effective cleaning is possible and that insect harborage is minimized. The
Indoor Areas 6-101.11 Surface Characteristics. `T-- restrictions for areas not suited for carpeting materials are designed to ensure
cleanability of surfaces where accumulation of moisture or waste is likely.
Floors,walls,and ceilings that are constructed of smooth and durable surface materials "-
are more easily cleaned. _
..
Annex 3—Public Health Reasons/Administrative Guidelines
Annex 3—Public Health Reasons/Administrative Guidelines 527
526
•
6-201.15 Floor Covering,Mats and Duckboards. t_ 6-202.14 Toilet Rooms,Enclosed.
Requirements regarding mats and duckboards are intended to ensure that regular and Completely enclosed toilet facilities minimize the potential for the spread of disease by
effective cleaning is possible and that accumulation of dirt and waste is prevented. ���,,,,� the movem
ent of fli
es and other insects between the toilet facility and food preparation
- areas.
6-201.16 Wall and Ceiling Coverings and Coatings. 6-202.15 Outer Openings,Protected.
6-201.17 Walls and Ceilings,Attachments.
6-201.18 Walls and Ceilings,Studs,Joists,and �5
Rafters. Insects and rodents are vectors of disease-causing microorganisms which may be
transmitted to humans by contamination of food and food-contact surfaces. The
Walls and ceilings that are of smooth construction, nonabsorbent,and in good repair
presence of insects and rodents is minimized by protecting outer openings to the food
�,., establishment.
can be easily and effectively cleaned. Special requirements related to the attachment �-
of accessories and exposure of wall and ceiling studs,joists,and rafters are intended to
ensure the cleanability of these surfaces. In the National Fire Protection Association's NFPA 101,Life Safety Code,2009 Edition,
doors to exit enclosures such as stairs,horizontal exits,or exit passageways are
Functionality 6-202.11 Light Bulbs,Protective Shielding. required to be self closing. The Life Safety Code does not require exterior doors used
as exits to be self closing but they can be.
Shielding of light bulbs helps prevent breakage. Light bulbs that are shielded,coated,
'�� The intent of subparagraph 6-202.15(A)(3)is to protect food establishments from the
or otherwise shatter-resistant are necessary to protect exposed food,clean equipment,
utensils and linens,and unwrapped single-service and single-use articles from glass entry of insects and rodents by keeping doors closed when not in use. Self-closing
fragments should the bulb break. fD devices allow a door to return to its closed position after use. If an exterior door is not
routinely used for entry or exit because its use is restricted by the fire protection
6-202.12 Heating,Ventilating,Air Conditioning System authority for emergency use only,it is not a portal for the entry of pests and does not
Vents. need a self-closing device. Doors not requiring a self-closing device include exterior
emergency exit doors that open into a public way from a fire and that meet the criteria
Heating and air conditioning system vents that are not properly designed and located in¶6-202.15(C).
may be difficult to clean and result in the contamination of food,food preparation
6-202.16 Exterior Walls and Roofs,Protective Barrier.
surfaces,equipment,or utensils by dust or other accumulated soil from the exhaust
vents. �- "�
Walls and roofs provide a barrier to protect the interior and foods from the weather,
6-202.13 Insect Control Devices,Design and - windblown dirt and debris,and flying insects.
Installation.
6-202.17 Outdoor Food Vending Areas,Overhead
Insect electrocution devices are considered supplemental to good sanitation practices ��-----
_: Protection.
in meeting the Code requirement for controlling the presence of flies and other insects �-�v The potential for contamination from airborne dust and particulates or inclement
in a food establishment.
�" �" weather is present in outside areas. Overhead protection minimizes the potential for
Improper desi n of the device and dead insect collection tray could allow dead insect contamination of food under such conditions.
9 Y �— ��
parts and injured insects to escape,rendering the device itself a source of 6-202.18 Outdoor Servicing Areas,Overhead
contamination. '"'
Protection.
Exposed food and food-contact surfaces must be protected from contamination by C� _
insects or insect parts. Installation of the device over food preparation areas or in close _-r Pooled water,which may result if overhead protection is not provided for outdoor
proximity to exposed food and/or food-contact surfaces could allow dead insects and/or �-�- - servicing areas,attracts wild animals and birds and creates a condition suitable for the
insect parts to be impelled by the electric charge,fall,or be blown from the device onto �4 breeding of insects.
food or food-contact surfaces.
Annex 3-Public Health Reasons/Administrative Guidelines Annex 3-Public Health Reasons/Administrative Guidelines
528 � � 529
P
6-202.19 Outdoor Walking and Driving Surfaces,
Graded to Drain.
If foot traffic is allowed to occur from undrained areas,contamination will be tracked into
the establishment. Surfaces graded to drain minimize these conditions. Pooled water
on exterior walking and driving surfaces may also attract rodents and breed insects.
6-202.110 Outdoor Refuse Areas,Curbed and Graded to
Drain.
If refuse areas are not graded properly,waste water will pool and attract insects and
rodents. ` •^`
6-202.111 Private Homes and Living or Sleeping *�
Quarters,Use Prohibited. --
6-202.112 Living or Sleeping Quarters,Separation.
Areas or facilities that are not compatible with sanitary food establishment operations
must be located or separated from other areas of the establishment to preclude
potential contamination of food and food-contact surfaces from poisonous or toxic
materials,dust or debris,the presence of improperly designed facilities and equipment,
and the traffic of unauthorized and/or unnecessary persons or pets.
yam,.
Further,Article IV of the Amendments to the U.S.Constitution ensures the right of
persons to be secure in their homes against unreasonable search and seizure. This
provision could hinder the regulatory authority's access to conduct routine inspections
of a food establishment operated in the living area of a private home. A search warrant
may be the only mechanism by which to gain entry;yet, it may be difficult to obtain and
might not authorize the necessary inspectional activities. --
Handwashing 6-301.10 Minimum Number.
Sinks
Refer to the public health reason for§5-203.11. - '
6-301.11 Handwashing Cleanser,Availability. "'
Hand cleanser must always be present to aid in reducing microorganisms and
particulate matter found on hands. .__.
6-301.12 Hand Drying Provision.
Provisions must be provided for hand drying so that employees will not dry their hands
on their clothing or other unclean materials.
Annex 3-Public Health Reasons/Administrative Guidelines
530 `. :»
City of Salem Health Assessment- 1
City of Salem Health Assessment
Summer 2017
NDlT,��
coo
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
1 CITY OF SALEM WARD&PRECINCT BOUNDARIES
MASSACHUSETTS ` EFFECTIVE JANUARY 1, 2015
Beverly Beverly
Danvers
Collins
~L
North �_ � Cove
River
\
Salem
Harbor
Peabody
r..�., e\
t•A
r
F3/
tz� Marblehead
p ^3ir.. .✓
r
r j
Siva ampscori
Lynn
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 18th
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 grindirigcorn 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
aorganic 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
the 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 CMR 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
0 310 CMR 15.00
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 CMR 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
o 105 CMR 440.000
o 105 CMR 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
FAQ'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 ■2016
300 02015
µ
200
100
0
KI
`cey °° oy��oo <<ar hQe� Data Source:
°kQ �° roc Salem Health
e
lea Agent Report,
Lei\ r�c��O 2017
0
2a. Most Common Inspections by the Salem Health Department
i
City of Salem Health Assessment- 11
Other Inspections by the Salem Health Department
60
50
40
®2016
30
■2015
20
10
0
°� °� oy ��, oy. oay oy 0" Q� of �ti 41 .oR �`l Data
Qom`Q0�` C�`° *\o �`o ai`� e`o -a`��\\� h�a� `o a�P Q° a� ate` �� e;�e ate` ��5
C. Source:
t``' C``' hQe yQ2 yQ0 �e yQe O�Q �h\ L°� SQ0 �° `�� a\ t�\ a°C o� Jlb '(`°�
�a ago eo `�e e a��� 'pA ��c .�c�1`°� V `Pao Qua o��c.`°�a Salem
eyy Pa �°O aZ a�P 5��a �� ago �e Q; �.o �� �� a0 P �acc ec Health
o° �``' •S� �`� �° J� ��Sao ��° yea-Z4 "A Q Agent
a
eo`��` �e�awa�eta��Pam °J � Report,
2017
L�
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).
•
iCity of Salem Health Assessment- 12
Distribution of Age
30.00%
25.00
20.00%
15.00% ®Salem
(N=42,499)
10.00% ®Massachusetts
(N=6,705,586)
5.00%
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% 714%
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=1,644)
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% ®Salem
20.00%
®Massachusetts
15.00
10.00
5.00% N/A
0.00 11
%
41 r\tie ``Gac
�e a� Q \tea et �� c�a `tea
pwr °c o ",o Data Source:ACS,
�`.°a �Q� Qa° e oil Qao lac 2015 5-Year
P°� �re� `:°� .�,° ��`�y ��� Estimates
�\& \�b,a o� e�° *All races are of a
`ate ``ate roc single race unless
specified;Hispanic
P ,a 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
ICI
i
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
r��"'��ntb^-��j�r��•v--rA-v -sg� p - ,ice+
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�� 1 ✓4 M} t � y.'y!7
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4
^fi 1w
':,. (1. T `. { j �r � y � ,/S�t'2 ter' .. "^S"5 trtiJ `�El�f�►j•V� ,
a pt'"'{,r yw�.it i • t '0 r J i, ,
u r •� /"'�. R Wit+ � y ..� � �.: t
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a 1 Y. qyt �.: M"RBbLEHEAD�
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Census 2010 Environmental Justice
•' Populations
C3Mlnority
Income
English Isolation
EMinorityand income
OMinorityand English Isolation
Income and English Isolation
Minority, income and English Isolation
Detailed Features
MassGIS Statewide Basemap
MassGIS Topographic Features Basemap
Figure 5. Environmental Justice Areas in Salem.Data Source: Mass GIS
• Educational Level Attained (ACS, 2015)
o 90.9%of all Salem residents are high school graduates
o 38%of all Salem residents hold a bachelor's degree or higher
o 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%
• o 25 years or older:
■ Completed less than 9th 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%
:ducation
Graduate or professional degree: 14%
The level of 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%
15.0%
• ■Salem
10.0% ®Massachusetts
5.0%
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
• Public school:66.1%
i�
r
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
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.
o 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%
10.0%
5.0%
0.0%
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,5-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.
•
i
City of Salem Health Assessment- 19
cmr of snLEM ZONING MAP
M�aYW g9wm�wa 1
6. +ra.e AWWas
Alt �.
fi
.sF
I �� nn�lsi dmaMen i�4
a m rI� slm �wC' 1�/e�i= 1a� Onnr.�e�newmyaL
ti !�,r.. t/ «i M ? ��{,�/,�'►{ ..rr�' � �1m�aml Yi�Amb-WU
�r� �tfr 1�:tk� euaospWmmu�tl
sf �, at�IJ i ice~ f
k � _9sobe�hYwrelwl
t
�
aw '� sorseaRon.aw.d�rap
.k_ +�, S" ww mm�asaunar4M10�
.r e
r
,u
i
+tr
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% M Ell ■Massachusetts(N=55,157)
ea et
O`yZa�La�c, �J\L� �e�aw �r
eat P �J�� ceay � O Q�e o�ot �° `ova
Data Source:MDPH,Office of Data
Management and Outcomes
Assessment,2016. 'Massachusetts
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.
'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 e'23, 2�.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` e. =18s, °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 23:8' 4.0 14.8 16.5,
Oral Cavity and
Pharynx Cancer° 0 0 1.4 1 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 state's, 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,yet Black Non-
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 envir
onmental 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 51h 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%
■Heroin
■Alcohol
®All Other Opioids
■Marijuana
■Crack/Cocaine
o Other
Data Source:MDPH,Bureau of
Substance Abuse Services,
2015
Figure 10.Salem Admissions to BSAS Programs
•
City of Salem Health Assessment-27
Primary Substance of Use at Treatment
Admission, Massachusetts 2014
(N=104,233)
3% 2% 0% ■Heroin
4% ■Alcohol
s
®All Other Opioids
■Marijuana
®Crack/Cocaine
o Other
C3 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
• 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
lie Reported Communicable Diseases, Salem 2016
35
30
25
20
■Total cases=171
15
*Reportable
10 diseases with
5 zero cases in
2016 not
0 included in graph
,\ 41 5$1 `41 41 as � G tia I'll,
\ 1.1a �Qy Qy y15 I'll, C115 .`ae \�a two .°o
+? Jam° t`° oF' �`° Pik~ c?`y ��y J?'�?,�\°•O'a� a\a �a5 J� J� ?,�° 0��° o� l`Ge J� ?,�K`
�P ecc Lie,roc may �o lee e� Sao cc Ja �`� Data Source:
�o�a�c�Q �aQ J��o ♦�,eaO ye�Q Q a Q�eJ �J�\ Doty,Salem
QJ�5 .`cP,�`� �a `� oy J`
e cc Q �h cc �a Board of Health,
JQ�ocaF° �e0 ,�°c° ti� Public Health
�seQ Nurse Report,
ao h 2017
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 states.
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.
I
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:
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clerk/pages/historical-profile
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27#Status
o (Environmental Protection Agency [EPA], 2017)
• o (EPA,2017)
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•
City of Salem Health Assessment-33
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council/city-council-subcommittees
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http://salemkl2.org/pages/SPS DistSchoolCom/index
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Profiles:Salem. Retrieved from:
http://profiles.doe.mass.edu/reportcard/rc.aspx?linkid=38&orgcode=02580000&fycode=2015&
orgtypecode=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
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• • City of Salem. (n.d.) Health. Retrieved from: https://www.salem.com/health
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o (Health, n.d.)
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• 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.saIemnews.com/news/locaI 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:
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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/piJlwhrFr7BL3beAmzkR8H/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
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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://cognos10.hhs.state.ma.us/cvlOpub/cgi-bin/cognosisapi.dlI
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• US Census Bureau. (2015)Americdn FactFinder. Retrieved from:
https://factfinder.census.gov/faces/nav/isf/pages/searchresults.xhtmI?refresh=t#
o (US Census Bureau,American FactFinder 2015)
o (ACS,2015)
• MassCHIP, Massachusetts Department of Public Health (June 4, 2013). Cardiovascular Health
ReportforSalem. 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:
http://www.mass.gov/eohhs/researcher/community-health/masschip/mortality-standard-
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, Card iovascular'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
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• MassCHIP, Massachusetts Department of Public Health (June 4, 2013) Health Status Indicators
Reportfor Salem. Retrieved from: http://www.mass.gov/eohhs/researcher/community-
health/masschip/health-status-indicators.html#cities towns
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• Massachusetts Department of Public Health, Division of Global Populations and Infectious
Disease Prevention (2016) Incidence of Tuberculosis Disease by Counties in Massachusetts, in the
State of Massachusetts and the United States. Retrieved from:
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Assessment. (October 2016)Massachusetts Deaths 2014. Retrieved from:
. http://www.mass.gov/eohhs/docs/dph/research-epi/death-data/death-report-2014.pdf
City of Salem Health Assessment-35
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• • MassCHIP, Massachusetts Department of Public Health (June 4, 2013)Smoking Report for
Salem. Retrieved from: http: /www.mass.pov/eohhs/researcher/community-
health/masschip/smoking.html#cities towns
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(BSAS) (January 2017). Prevention Programs Directory. Retrieved from:
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resou rces-overview.pdf
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i
City of Salem Health Assessment-36
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•