MEETING PACKET FEBRUARY 2018 FEBRiJARY 2018
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CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET,4"m FLOOR PubUcH
Preveromote.Protect.
TEL. (978)741-1800 FAX(978) 745-0343
KIMBERLEY DRISCOLL Iramdin@salem.com
Lt1R1tY RAMDIN,RS/RT';L-TS,(,ITO,Cl?-I,S
MAYOR HF,AI,T'H A(i;EN'r'
NOTICE OF MEETING
You are hereby notified that the Salem Board of Health will hold its regularly scheduled
meeting Tuesday, February 13, 2018 at 7.00 PM
City Hall Annex 120 Washington Street Room 313
MEETING AGENDA
1. Call to order
2. Approval of Minutes
3. Chairperson Communications
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4. Public Health Announcements/Reports/Updates r� ,
a. PHN Report 3
b. Health Agent b r s,.
c. Administrative X
d. Council Liaison Updates
5. Mary Wheeler, Healthy Streets— Syringe Service Program
6. Michele Sweeney, Salem State University—Healthcare Studies Program at SSU N °' n -q
N
7. Board of Health program planning o 0 2
a. Discussion of FY 2019 Health Department budget request w
b. Kimberly Waller—recap meeting with Lynn Health Department on o C
inspectional services model r4 0 'a
y
8. New Business/Scheduling of future agenda items n a
• Items that could not be anticipated prior to the posting of the agenda c N
CL o -
"AHealth
Larry R Agent xo CD
cc: Mayor Kimberley Driscoll, Board of Health, City Councilors
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Next regularly scheduled meeting is March 13, 2018 at 7:00pm at City Hall Annex, cu W
120 Washington Street 3`d Floor Room 313. 0
a
+' Know your rights under the open meeting law MGL chapter 30A ss. 18-25 and City p -
Ordinance section 2-2028 through 2-2033 8
CITY OF SALEM
BOARD OF HEALTH
MEETING MINUTES
January 9, 2018
MEMBERS PRESENT: Paul Kirby, Chair, Dr. Jeremy Schiller, Mary Lauby, Nancy Crowder, Kerry Murphy
OTHERS PRESENT: Larry Ramdin, Health Agent, Suzanne Darmody, Public Health Nurse, Maureen Davis, Clerk
of the Board, Beth Gerard, City Council Liaison, Dr. Kimberly Waller, Salem State University
TOPIC DISCUSSION/ACTION
1. Call to Order 7:04pm `
2. Minutes of Last Meeting J. Schiller motioned to approve minutes. K.Murphy 2"d All in
ss
(December 12
2017) favor. Motion passed:
3. Chairperson Announcements Nancy Crowder s friend; Geri Yuhas, is still interested in replacing Nancy
on the Board.
L. Ramdin said any interested person should submit a letter of interest
with their resume;.to the Mayor.',,,"
4. Monthly Reports-Updates
a. Public Health S.'Darmody just received a reportathat the flu season will be bad this year
Nurse's Report vs thetpast two years. This year's flu shot will only be about 32%
��effective toward the H3N2 strain that is showing up this year.
>~lu;'cases are higher mthe Northeast compared to the rest of the state. It
is,better to have.some protection than none, so she is encouraging people
e& to get the flu vaccine'. Good hand washing helps. Keep distance from
,people who are sick.
Schiller said he is starting to see some severe cases.
Kirby asked about the table top training referenced in S. Darmody's
a•. report.
Mr L. Ramdin said he and S. Darmody presented a simulation of a salmonella
case for inspectional staff training purposes. They learned a lot. Planning
.,to have a series of in-service training sessions with the staff.
Copy available at the BOH office.
b. Health Agent's P. Kirby noted that garbage and recycling throughout the City seemed out
Report of control over the last couple of weeks.
L. Ramdin said the snow was part of the problem. It was forecasted we
would get 8-10 inches, but we got 17 inches. The Engineering Dept.
manages the contract with the trash company. No health issues regarding
the trash at this time.
The LEAP for Education students who met with Larry said they would
distribute flyers as part of their project to educate people on proper trash
disposal and rules.
N. Crowder said the city-wide phone messages helped to keep citizens
updated about trash and recycling delays and schedule changes.
• P. Kirbystated that marijuana regulations came out.
� g
L. Ramdin sent it to the Board electronically. Very lengthy.
Concerned about edibles and how they are going to be marketed and what
the local powers are around regulations.
Gave a hand-out about second-hand marijuana smoke and its impact on
individuals, along with a schedule of the public hearings.
M. Lauby asked if the initial measure had a provision that you couldn't
control or regulate edibles.
L. Ramdin said not to his knowledge—you cannot prevent consumption
of edibles. f'+
Denver requires that a marijuana,,leaf be stamped on any edibles so it is
clearly marked as containing 11
marijuana.
J. Schiller said ER physicians noted,30% increase in ER visits for
marijuana intoxication: He pointed ouf'there is no lethal dose of
marijuana. r
L. Ramdin saidotherstates that have legalized�have seen an increase in
calls to poison controVicenters'for,overconsumption of edibles.
There°is a hearing for the'drat.marijuana regulations on February 7th at
North,Shore,Community�College in Danvers.
P. Kirby sugg ted members�look at the regulations and forward any
issues of concern to L.Ramdmwho will gather and circulate to members.
Schiller'said we could look at�any"regulations that involve the Board of
Health and Health Department:
L:°R�mdin saidrwe deed to concern ourselves with the safety of this
product.
We also need to look;into onsite consumption and how it impacts
,`surrounding.buildmgs/spaces.
.w.. The,Health Dept sand"all other City offices at 120 Washington Street will
move across the street from City Hall in March.
' "L. Ramdin,said the SSU Expect students did an excellent presentation on
IX.opiates. They did a video which included interviews with nurses at the
health center, Officer Vaillancourt, our outreach police officer, and
. , Denny from Healthy Streets who goes out with him on door knocks.
They also did a demonstration on administering Narcan. He will share
1/' the presentation with the Board.
Asthma Awareness Day is going to be on May 1st at the State House.
L. Ramdin joined the board of the Asthma Action Partnership.
Copy available at the BOH office.
c. Administrative J. Schiller asked about revenue this year vs. last year.
Report P. Kirby noted the handouts from a previous meeting which compared
permits, costs, etc.
He noted that revenue from the Health Dept. goes into the general fund
and is therefore irrelevant to the budgeting.
B. Gerard said income from the general fund offsets taxes.
M. Lauby said the concern is if revenue is going down, that would be
punishing.
L. Ramdin pointed out that decreased fees= increased business =
increased demands and workload for the Department.
M. Davis thanked N. Crowder for pointing out the discrepancy in the
burial permits for October at last month's meeting. Indeed, online burial
permits were not included in the total. Updated, corrected reports were
emailed to members.
Copy available at the BOH office.
d. City Council B. Gerard said the plastic bag reduction went into effect January I't and
Liaison Updates she has not heard many complaints. Paper bags being used by most
stores. The smaller tourist shops are having the biggest issue. Councilor
Lovely asked that the matter be-b ought to Ordinances, Licenses and
Legal Affairs to review, but for now the reduction is in effect.
A lot of promotion was done' 'Coastwatch did a fantastic job with posters
and bags. x
One of the requirements was that bags had to be larger than 4 mils, but
they are really difficult to find. That's,why OLLA will revisit the issue.
J. Schiller asked what was going on witEalternative Salem-oriented bags
people could buy,-;Marblehead had a design'logo and distributed reusable
bags throughout their, really IAQlt.
B. Gerard said Salem Recyclesalso did some outreach promotion with
posters;etc' There was d`� rant to give out some bags, but it ran out.
�
People`'say paperbags break°down too easily, but they can double up.
B. Gerard,said the,Council will be finishing up marijuana zoning. There
was a jomVpublic hearingwith the Planning Board and they just sent their
• �'' -,recommendations toA.thi aCouncil. They will review them and either send
it back to Committee or vote"on;it;on Thursday night. Initially the
Mayor's office was.recommending not having it in the B5 (downtown)
zone, but.the argument was made that it was like a package store and if
its being'treated like a'-package store it should be in B5. People in
'residential neighborhoods that have mixed zoning could potentially have
a pot'shop next door"to them. Recommended that BI will be by special
,, ,,permit: Rol (residential) will be a no.
44� � There is not'much talk about cultivation.
"^ P.,"Kirby asked if there are limits to the number of licenses we can issue.
` B Gerard said MA General Law states it can be up to 20%of package
(store licenses, so that would mean up to five licenses in Salem.
3 ATG (Alternative Therapies Group) - medical gets first offer.
N. Crowder moved to approve the reports. M. Lauby 2°d• All in
favor. Motion passed.
5. Reorganization of the Board P. Kirby said he has enjoyed being the Chair and has learned a lot. It is
time-consuming, but he is willing to serve again.
M. Lauby gave high praise and appreciation to him for the outstanding
job he has done and for the trust and respect he has earned from all. All
present agreed.
M. Lauby motioned to nominate P. Kirby as Chair. N. Crowder 2nd.
All in favor. Motion passed.
N. Crowder motioned to nominate M. Davis to remain as Clerk of the
Board. K. Murphy 2"d. All in favor. Motion passed.
6. Discussion of the Health With regard to the review of the budget letter to the Mayor, a new full-
Department's budget request for time inspector will be needed due to increased Certificate of Fitness
next year inspections from the new ordinance, as well as increased pop-ups.
L. Ramdin will get Certificate of Fitness number details to P. Kirby, but
roughly 9,400 apartments need to be inspected. Each inspection takes a
half hour or more of the inspector's time.
N. Crowder asked if we need three permanent people as opposed to
catching up.
M. Lauby said the argumentis creating permanent salary positions, not
,
just the need for overtime"' hich costs more because we have to pay the
inspectors time and.dhalf."'Y
L. Ramdin pointed out that See, Click, Fix has also increased the
workload for the Department.
J. Schiller said the trajectory, based on the shared vision with the Mayor,
A}is successful, but as,MPale
`Lauby"saaid, have now we ha to pay for it.
L. Ramdm will go over his°projections and send the-math and rationale to
M. Lauby who offered to-rework the language.
J. Schiller,,aske&B. Gerard if she thought a meeting with the Mayor
would be more effective than just"a,letter. She agreed a meeting would be
better.
S u �
J. Schiller said we can present the letter to the Mayor at the meeting.
L Ramdin feels the Mayor is receptive to a meeting. He met with her
and she is willing to;go to Council to make the current part-time inspector
position a full-time position.
z L Ratndm saidwinspectional services (building and health) is a good
<� business model, but,,is°not a good functional model. The Health Dept. is
i the oily�department-with jurisdiction to enforce the state sanitary code.
M. Laub tasked what we would lose with an inspectional services
�department '
\ , L"Ramdi said there would be no oversight or guidance.
M.",Lauby feels the integrity of the Department would be tampered with
and the vision of public health of the City would be affected.
L..Ramdin said the Mayor wants to discuss the idea of an inspectional
services department with the Board.
M. Lauby said she understands the Mayor wants greater cohesion with
departments, but feels it is more of a ripping apart.
K. Waller said she can give us info on other cities using the inspectional
services model.
N. Crowder asked if that would mean the City would not have a Health
Agent. L. Ramdin said maybe not.
L. Ramdin said there are different skill sets, knowledge base, regulatory
responsibilities, etc. for building inspectors and health inspectors.
• P. Kirby said the Mayor has been actively advocating for the idea of an
inspectional services model as a policy goal, but there is an immediate
term with the Department and we need to work it out.
P. Kirby asked if a different department can take on Certificates of
Fitness to take the pressure off the Department.
• L. Ramdin said no, because the Health Dept. is empowered to enforce the
state sanitary code.
M. Lauby asked if the Health Agent is required to do inspections, or to
oversee the health and well-being of the City. L. Ramdin said it is not a
requirement for him to do inspections, but the quality of the work coming
out of the Department would suffer without a Health Agent.
J. Schiller asked if the meeting with the Mayor should be private. The
meeting should be with the Mayor and the Board,but not a quorum. He
feels the meeting should take place in the next couple of weeks, but
definitely before L. Ramdin submits his budget. We should present a
detailed letter to her at the meeting. Budget meetings with the Mayor are
in March/April. L. Ramdin feels he should not attend, but he will ask for
guidance from Vickie Caldwell R b,%
B. Gerard suggested thatt-pFerhaps the Finance Director should be at the
meeting. :;''
P. Kirby will set up'the meeting and contact..Board members to see who
can attend. , ' +
L. Ramdin reminded members that at his meeting with the Mayor she
indicated.she is verymuch£aware that she needs'to provide more
resources to public health;;
g .
•7. Board of Health program \`
planning & city health status","
discussion
...gig �...
a. Discussion of `' Tabled review/discussion of health report due to time constraints.
Sarah Corley,s
community T r N
health report �� s
b. Kimberly Waller',.: Waller�.Will get us some background on inspectional services models.
Salem-specific M;`',Lauby suggested we discuss the model issue at a later date, after the
data presentation I, budget meeting with the Mayor.
8. New Business /Scheduling of • Mary Wheeler, syringe exchange program updates
future agenda items • Kimberly Waller, inspectional services models
• Personal use of marijuana
9. MEETING ADJOURNED: K. Murphy motioned to adjourn the meeting. M. Lauby 2"A.
• All in favor. Motion passed.
8:48pm
Respectfully submitted,
Oaureen Davis
Clerk of the Board
Next regularly scheduled meeting is Tuesday, February 13, 2018 at 7.00pm
At City Hall Annex, 120 Washington Street,Room 313, Salem,MA
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• Suzanne Darmody RN BSN
Salem Board of Health
Public Health Nurse
Public Health Nurse Report
Reporting on January 2, 2017 through February 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(MIIS) for up to
date vaccine records and better continuity of care between clinics and providers.
• Posted Facebook, Twitter and Instagram posts regarding Flu prevention, opiate recovery
resources and the E. coli outbreak possibly associated with romaine lettuce.
• January 22nd and 25"held open office hours for flu vaccines, an additionl4 people were
vaccinated.
• Planning flu clinic at the Salem YMCA on Thursday February 8th during the after-school
• programs.
• Participating in a region wide flu clinic in Danvers on Thursday February 8`"as well.
*The month of January has shown a significant increase in the amount of reported flu
cases. This is likely to continue through the month of February as it is typically the peak
of flu season. Additional flu clinics are being held and messaging around flu prevention
and treatment is being done. I will continue to watch the trends and follow the weekly
reports.
Meetings/Trainin2s
• Attended the Northshore Cape Ann Emergency Preparedness meeting on January 10th
for discussion regarding Emergency Preparedness deliverables and alert systems.
• Held clinic at the Council on Aging January 10t" for blood pressure screenings and health
education with materials on hypertension and flu prevention and care at home.
• Conducted Body Art Establishment inspection for an establishment, RN Esthetics.
• Attended the Laserfiche training on January 171"required for users to learn the new
electronic file system that will be used in the new City Hall Annex building.
• Attended the"Stop the Bleed"training at Beverly Hospital on January 18"'with the
public health nurses for information on responding to emergency's which require wound
packing and tourniquets. This training is provided by Lahey hospitals in response to the
• growing number and severity of active shooter and intentional mass casualty events.
• Monthly Report of Communicable Diseases: January 2018
Disease New Carry Over Discharged/ Total# Of Running Total for
Reported Cases this Total for 2017
Closed Month 2018
Tuberculosis 1 1 0 2 2 2
(Active)
Latent 4 0 4 4 4 45
Tuberculosis*
Arbovirus* 0 0 0 0 0 0
Babesiosis 0 0 0 0 0 0
Calicivirus/No 0 0 0 0 0 4
rovirus
Campylobacte 0 0 0 0 0 8
Oriosis
Chikungunya 0 0 0 0 0 0
Dengue* 0 0 0 0 0 0
Ehrlichiosis 0 0 0 0 0 0
Enterovirus 0 0 0 0 0 0
Giardia 0 0 0 0 0 3
Group A 0 0 0 0 0 4
Streptococcus
Group B* 0 0 0 0 0 4
Streptococcus
Human 0 0 0 0 0 0
Granulocytic
Anaplasmosis
Haemophilus 0 0 0 0 0 4
Influenzae
•
Disease New Carry Over Discharged/ Total# Of Running Running
Reported Cases this Total for Total for
Closed Month 2018 2017
Hansen's 0 0 0 0 0 0
Disease
Hepatitis A 0 0 0 0 0 0
Hepatitis B* 0 0 0 0 0 1
Hepatitis C* 4 0 4 4 4 30
Influenza* 67 0 67 67 67 74
Legionellosis 0 0 0 0 0 1
Lyme 0 0 0 0 0 0
Disease*
(0) (0) (0) (24)
(Probable)
Malaria 0 0 0 0 0 0
SMeasles 0 0 0 0 0 0
Meningitis 0 0 0 0 0 1
Mumps 0 0 0 0 0 0
Pertussis 0 1 1 0 0 2
Salmonellosis 0 0 0 0 0 7
Shigellosis 0 0 0 0 0 2
Streptococcus 0 0 0 0 0 5
Pneumoniae*
Varicella* 0 0 0 0 0 0
Vibrio 0 0 0 0 0 0
West Nile 0 0 0 0 0 0
•
I
• Disease New Carry Over Discharged/ Total#Of Running Running
Reported Cases this Total for Total for
Closed Month 2018 2017
Yersiniosis 0 0 0 0 0 0
Zika Virus 0 0 0 0 0 0
Infection
Total 76 2 76 77 77 197
January 2018
*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 2017 have been updated for year end with the number of CONFIRMED cases.
0
Summary of Current Communicable Diseases
Tuberculosis:
New arrival: I have been notified of a new arrival to the U.S. whom requires a PPD test indicated by the
Office of Immigration and Refugees. I have coordinated with MDPH for PPD and an outreach worker to
provide translating assistance.
Active Case 1:
As part of the follow up contact investigation, all patients with positive PPDs (tuberculosis skin tests)
were referred to the NSMC pulmonary clinic for chest x-rays.This case had an x-ray suggestive of
Tuberculosis in conjunction with a large positive skin test. Medications and D.O.T.has been started 5
days per week. Sputum samples are pending final results for 60 days. However, the patient is smear
negative for acid fast bacilli and is not considered contagious. This patient will continue to be treated by
NSMC. D.O.T. and medication management has been continued until treatment in completed. A follow-
up chest x-ray showed improvement while on the Tuberculosis treatment. This patient continues to attend
their clinic appts however has been inconsistently compliant with D.O.T., I have reported my attempts
and follow up to MDPH as well as the nurse and doctors at the clinic.
• A second round of contact testing is ongoing, 5 contacts have been re-tested and all results were negative,
4 others still need to be tested but have been away for vacations.
• Active Case 2: This case was diagnosed in the hospital and started on D.O.T. on January 1 lth. They
extrapulmonary tuberculosis (infection is not in the lungs) so there is no contact testing required as the
bacteria is not able to be airborne. I am seeing this patient Monday-Friday for medication management,
they are currently not working and are being followed by the pulmonary clinic and surgeon.
Suspect Pertussis:
Case 1: This case diagnosed from an Emergency room visit, at this time this is a suspect case and they
have been treated. Due to the timing of the cough onset the infectious period has passed and contacts are
not able to be treated prophylactically, however, they are to be on symptom surveillance. I received a
follow up call from this patient after mailing a letter home. They recovered with treatment and follow up
teaching has been completed. There are no further cases and this case is now closed.
•
•
Suzanne Darmody
From: Cohen,Joyce (DPH) <joyce.cohen@state.ma.us>
Sent: Friday, February 09, 2018 11:58 AM
To: Suzanne Darmody
Subject: Flu Update February 9, 2018
• National Influenza Activity: During week 5(January 28-February 3,2018), influenza activity increased in the United
States.
• Viral Surveillance: The most frequently identified influenza virus subtype reported by public health laboratories during
week 5 was influenza A(H3). The percentage of respiratory specimens testing positive for influenza in clinical laboratories
remained elevated.
• Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza(P&I)was
above the system-specific epidemic threshold in the National Center for Health Statistics(NCHS) Mortality Surveillance System.
• Influenza-associated Pediatric Deaths: Ten influenza-associated pediatric deaths were reported.
• Influenza-associated Hospitalizations:A cumulative rate of 59.9 laboratory-confirmed influenza-associated
hospitalizations per 100,000 population was reported.
• Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness(ILI)was 7.7%,which
is above the national baseline of 2.2%.All 10 regions reported ILI at or above region-specific baseline levels. New York City,the
District of Columbia, Puerto Rico and 43 states experienced high ILI activity; three states experienced moderate ILI activity;two
states experienced low ILI activity;and two states experienced minimal ILI
0activity.
• Geographic Spread of Influenza: The geographic spread of influenza in Puerto Rico and 48 states was reported
as widespread; two states reported regional activity;the District of Columbia and Guam reported local activity;and the U.S.
Virgin Islands reported sporadic activity.
Influenza Activity in Massachusetts
For week 5, influenza-like illness(ILI,defined by fever>100°F and cough and/or sore throat)activity was reported
as Widespread in Massachusetts,at High intensity.
•
1
Figure 1:Percentage of ILI visits reported by sentinel provider sites
z.o
s.5
• 2015.2016 2016-2017 2012-2010
o.o
s.s
s.o
*
a 4.6
d
4.0
d
3.5
a
a 3.0
2.5
2.0
1.5
1,0
O.S.
0.0-
40 42 44 48 48 50 52 2 4 6 $ 10 12 14 16 18 20 22 24 26 28 30 32 34 3B 30
MMWR Reporting Week
*InHnenxaAke illness(ILI,defined by fever>10OF and tough and/or sore throat),as reported by.Massackusetits sentinel
surveillance sites
Figure 2 below shows a geographical distribution of reported ILI in Massachusetts. Figure 2 shows that all regions of the state
are reporting increased ILI.
•
2
Figure 2: Percent ILI Activity Level Reported Weekly by
Massachusetts Sentinel Sites
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Detailed weekly flu surveillance reports are posted on the Mass Public Health Bloq.
*Questions and Resources
•MDPH Influenza Vaccine Guidelines and Tools. This webpage contains information about influenza vaccine and
links to guidance about planning flu and other mass immunization campaigns, standing orders, screening forms,
consent forms, and MDPH-specific vaccine management guidance.
•One&Only Campaign. The One&Only Campaign is a public health campaign, led by the Centers for Disease
Control and Prevention(CDC)and the Safe Injection Practices Coalition(SIPC),to raise awareness among patients
and healthcare providers about safe injection practices.
MDPH Recommendations and Resources for the Control of Influenza and Pneumococcal Disease(2017-2018).
MDPH Control of Influenza and Pneumococcal Disease in Long-Term Care Facilities(2017-2018)
CDC Make a Strong Flu Vaccine Recommendation
CDC Know the Site.Get it Right!
Vaccine Ordering and Locating Clinics
Providers Wishing to Order Flu Vaccine for Private Purchase:
The national Influenza Vaccine Availability Tracking System (IVATS)assists providers wishing to privately purchase flu
vaccine. IVATS identifies available doses of influenza vaccine by formulation and distributor/vendor throughout the
• season.
• Location of Flu and Adult Vaccination Services:
3
HealthMap Vaccine Finder assists the public with locating influenza and adult vaccination services within their
communities. It is a free, online service where users can search for locations that offer immunizations. Its staff works
with partners such as clinics, pharmacies,and local health departments to provide accurate and up-to-date information
about vaccination services. MDPH urges providers and other agencies to register their locations on the HealthMap
Vaccine Finder site too.
• For questions about influenza please call the Massachusetts Department of Public Health Immunization Program at 617-983-
6800 or your local board of health.
For questions about state-supplied influenza vaccine,please call the Vaccine Unit at 617-983-6828.
Joyce Cohen, MPH
Epidemiologist
Influenza Coordinator
Massachusetts Department of Public Health
Phone: 617 983-6839
Fax: 617 983-6840
Website: www.mass.4ov/dph
Blog: http://publichealth.blog.state.ma.us
This email and/or attachment may contain confidential information.If you have received this message in error and are not the
intended recipient, please notify the sender.
You are currently subscribed to dph-adult flu-users as: sdoty@salem.com.
To unsubscribe send a blank email to leave-737217-
25547720.26720c7e5cee3f3b304ee6dc5148d5ad@listserv.state.ma.us
•
4
Health Agent Report January 2018
Announcements/Update
• The Mayor has appointed Geri Yuhas to serve on the Board of Health, term ending April
14, 2019. Geri's first appointment hearing with City Council was held on January 28 and
her confirmation hearing will be held on February 8`"2018.
• Budget Documents were provided by the Finance Director and have to be updated and
sent back to Finance Dept. by February 8, 2018
Community Outreach
• On January 31, Suzanne Darmody RN and Larry Ramdin, staffed a heating station at the
Collins Middle school for residents who were impacted by the water main break and lost
heat.
Meetings and Trainings
• A percolation test review was conducted with staff as part of ongoing in-house training series.
Next on the agenda will be use of a pH meter and checking pH of sushi rice.
• Food Establishment permit was issued to Mr. Crepe
• Meetings were held with the owners of food establishments to discuss upgrades to their facility
and procedures for obtaining food permits
Environmental Health Activities
• Staff responded to a water main break on Highland Avenue on January 31, to provide advice to
food establishments and multi- unit dwellings. Pequot Highlands was the only multi-unit
residence impacted by the break as they lost heat. The businesses in the affected area closed for
the day and reopened on February 1 after water service was restored. Water was restored at
approx. 3:00 am on 2/1.
• The Department resolved 2 court filings there was a difficult issue at 79 Columbus Avenue that
as resolved before the court hearing and the case was dismissed. The other was an ongoing issue
accumulated trash at 36 Loring Avenue the owner cleaned up and the judge dismissed the case.
Inspections
Item Monthly Total 2018 YTD 2017 Total
Certificate of Fitness 62 62 383
Inspection
Certificate of Fitness 1 1 47
re-inspection
Food Inspection 26 26 249
Food Re-inspections 8 8 83
Retail Food 0 0 33
Inspections
Retail Food 0 0 14
re-inspection
Temporary Food 1 1 249
General Nuisance 4 4 34
Inspections
Food— 1 1
Administrative
Hearings
Housing Inspections 10 10 99
Housing re- 3 3 46
inspections
Rodent Complaints 0 0 46
Court 2 2 4
• Hearings/filings
Item Monthly Total YTD 2018 2017 Total
Trash Inspections 47 47 906
Orders served by 2 2 4
Constable
Tanning Inspections 0 0
Body Art 1 1 0
Swimming pools 0 0 22
Bathing Beach 0 0 123
Inspection/testing
Recreational Camps 0 0 6
Lead Determination 0 0 1
Septic Abandonment 0 0 2
Septic System Plan 0 0 0
Review
Soil Evaluation 0 0 0
Percolation tests 0 0 0
Total 122 122 2338
•
Health Dept. Clerical Report FY 18 0
BuriaTPermits Permits Plan Reviews Certificate 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. <2sseats $140
August $700.00 $1,670.00 $270.00 $1,500.00 $4,140.00 25-99 seats $280 >99 seats $420
September $900.00 $4,530.10 $270.00 $2,350.00 $200.00 $8,250.10 Retail Food <l000sq' s70
October $1,225.00 $2,910.80 $540.00 $1,550.00 $6,225.80 1000-10,000 $28o >Io,000 $420
November $1,075.00 $10,620.00 $90.00 $1,450.00 $50.00 $13,285.00 Temp.Food 1-3 days s3s
December $825.00 $64,390.00 $0.00 $1,400.00 $900.00 $67,515.00 4-7days s70 >7days s
January-18 Example of>7 day tempfood permit:
$1,625.00 $7,845.00 $180.00 $2,450.00 $1,600.00 $13,700.00 14(days)divided by7=2 x s7o=$140
February $0.00 Frozen Desserts $25
March $0.00 Mobile Food $210
April $0.00 Plan Reviews New $180
May $0.00 Remodel sgo
June Catering s25pereventl$200
$0.00 catering kitchen
Body Art Est. $315
Total $7,250.00 $96,315.90 $1,980.00 $12,500.00 $3,050.00 $121,095.90 Body Art Practitioner $135
Review Plans s18o
Fiscal Year Budget 2018 Suntan Est. $140
Rec.Day Camp $10
Salary Starting Ending Expenses Ext.Paint Removal s35
Full Time $412,115.00 $208,763.95 Startinq Ending Transport Off.Subst. $105
Part Time $43,354.00 $26,672.37 $32,500.00 $16,552.54 Tobacco Vendors $135
Overtime $5,800.00 $1,694.67 Sw�Pools Seasonal $140
Balance $461,269.00 $237,130.99 Health Clinic Revolving Account Annual$210 Nonprofit$40
S12,007.27 Title V Review s18o
Well Application s18o
Disposal works s225/i8o
Breakdown of Permits and Fines
January 2018
Permit Description Total Permits Issued Permit Cost Total
Annual Food - Non-Profit 5 $25.00 $125.00
Annual Food - <25 seats 9 $140.00 $1,260.00
Annual Food - 25-99 seats 4 $280.00 $1,120.00
Annual Food - >99 seats 4 $420.00 $1,680.00
Annual Food - Retail <1,000sq' 7 $70.00 $490.00
Annual Food - Retail 1,000-10,000sq' 3 $280.00 $840.00
Annual Food - Retail >10,000sq' 1 $420.00 $420.00
Food -Temporary Pop Up (1-3 days) 11 $35.00 $385.00
Food -Temporary Pop Up (1-3 days)- Non-Profit 1 $25.00 $25.00
Body Art Establishment 1 $315.00 $315.00
Body Art Practitioner 6 $135.00 $810.00
Burial Permit 65 $25.00 $1,625.00
Certificate of Fitness 49 $50.00 $2,450.00
Frozen Dessert 3 $25.00 $75.00
Late Filing Fee 16 $100.00 $1,600.00
Pasteurization 1 $25.00 $25.00
Plan Review 1 $180.00 $180.00
Tanning 1 $140.00 $140.00
Tobacco 1 $135.00 $135.00
Total #= 189 Total = 13,700.00
Salem Syringe Service Program
Start date: December 5th, 2017
Syringes Syringes #of Contacts #of Unduplicated Treatment Referrals Naloxone Distribution
Disposed Distributed Contacts
1215 1075 31 11 2 individuals started MAT 5 Naloxone Kits
Race/Ethnicity:
10 people identified as white
1 person identified as black
Gender Identity:
3 people identified as female
8 people identified as male
Housing:
4 individuals reside outside
7 individuals are housed
Currently the program operates once a week using home delivery and street outreach. The only advertising that Healthy Streets does is on our
master list of Massachusetts SSPs listing Salem as home delivery and street outreach only.
Our next steps after this meeting is to start discussing the service openly with local providers who have clients and patients that may benefit
from the service.
MassachAfts Syringe Service Programs • Massachusetts Syringe Service Programs •
Boston Boston
AHOPE— 774 Albany Street, 1st floor— (617)534-3976 AHOPE— 774 Albany Street, 1st floor— (617)534-3976
AIDS Action -75 Amory Street—(617)437-6200 AIDS Action -75 Amory Street—(617)437-6200
Cambridge Cambridge
AIDS Action -359 Green Street—(617) 661-3040 AIDS Action -359 Green Street—(617)661-3040
Lynn Lynn
Healthy Streets-100 Willow Street-2nd floor/mobile van—(339)440-5633 Healthy Streets-100 Willow Street-2nd floor/mobile van—(339)440-5633
Lynn Community Health Center-269 Union Street—(781)581-3900 Lynn Community Health Center-269 Union Street—(781)581-3900
Salem Salem
Healthy Streets—home visits/outreach on Tuesdays only—(339)987-2306 Healthy Streets—home visits/outreach on Tuesdays only—(339)987-2306
Chelsea Chelsea
Healthy Streets—home visits/outreach only—(774)434-5810 Healthy Streets—home visits/outreach only—(774)434-5810
Lawrence Lawrence
Greater Lawrence Family Health Center-100 Water Street—(978) 685-7663 Greater Lawrence Family Health Center-100 Water Street—(978) 685-7663
Lowell/Lawrence Lowell/Lawrence
Mobile Syringe Exchange —Lawrence T/Th 1pm-3pm and Lowell 4pm-5pm Mobile Syringe Exchange—Lawrence T/Th ipm-3pm and Lowell 4pm-5pm
Gloucester Gloucester
One Stop/North Shore Health Project-302 Washington St.—(978)865-3924 One Stop/North Shore Health Project-302 Washington St.—(978)865-3924
Worcester Worcester
AIDS Project Worcester-85 Green Street—(508) 755-3773 AIDS Project Worcester-85 Green Street—(508) 755-3773
Brockton Brockton
COPE Center/BAMSI-81 Pleasant Street—(508) 583-3405 COPE Center/BAMSI-81 Pleasant Street—(508)583-3405
Fall River/Taunton Fall River/Taunton
Seven Hills—please call for location and time—(508)996-0546 Seven Hills—please call for location and time—(508)996-0546
Fall River Fall River
SSTAR-386 Stanley Street Building 3— SSTAR-386 Stanley Street Building 3—
Northampton Northampton
Tapestry Health— 16 Center Street Suite 423—(413) 586-0310 Tapestry Health— 16 Center Street Suite 423—(413)586-0310
Holyoke Holyoke
Tapestry Health-15A Main Street—(413)315-3732 ext. 1 Tapestry Health-15A Main Street—(413)315-3732 ext. 1
Greenfield Greenfield
Tapestry Health-8 Church Street—(413) 221-7722 Tapestry Health-8 Church Street—(413) 221-7722
North Adams— North Adams—
Tapestry Health-6 West Main Street—(413) 398-5603 Tapestry Health-6 West Main Street—(413) 398-5603
Provincetown Provincetown
AIDS Support Group of Cape Cod-14a Commercial Street—(508)487-8311 AIDS Support Group of Cape Cod-14a Commercial Street—(508)487-8311
Hyannis Hyannis
AIDS Support Group of Cape Cod-428 South Street—(508)778-1954 AIDS Support Group of Cape Cod-428 South Street—(508) 778-1954
CITY OF SALEM,
MASSACHUSETTS lu
• BOARD OF HEALTH
PubhcHealth
120 WASHINGTON.STREET,4 i i'FLOOR Prevent.Promote,Protect.
TEL. (978) 741-1800 FAX(978) 745-
KIMBERLEY DRISCOLL 0343 LARRY RAMDIN,RS/RP'l IS,CI IO,CP-VS
MAYOR Iramdin(cl�,salem.com HI iA TI i AGENT
January 30,2018
Los Amigos Supermarket
122 Lafayette Street
Salem, MA 01970
SENT CERTIFIED MAIL: 7012 1640 0002 3313 1789
Dear Owner:
Los Amigos Supermarket is in violation of the Salem Board of Health Regulation affecting sales to a minor.
According to this section,the sale of cigarettes,chewing tobacco,snuff,or any tobacco in any of its forms to any
person under the age of twenty-one shall be punished by a fine of$100.00 Hundred Dollars for the first offense.
On Wednesday, 12/27/2017 at 1:29pm personnel from the Tobacco Control Program conducted a compliance
check. During that compliance check,a 17-year old male,a minor,was sold tobacco from a clerk in your store.
Documentation is now on file at the Board of Health regarding that sale.
FOLLOWING THE SECOND(2ND)OFFENSE WITHIN A 3 YEAR(36 MONTH)PERIOD,A$200 FINE WILL BE
SET ALONG WITH A 7 DAY SUSPENSION OF YOUR TOBACCO PERMIT.
Therefore,you are ordered to pay a fine of$100.00 for the violations stated above. A check or money order
payable to the City of Salem must be at the Board of Health office, 120 Washington Street,4th floor,within ten
days of receipt of this notice.
Should you be aggrieved by this Order,you have the right to request a hearing before the Board of Health. A
request for such a hearing must be received in writing in this office of the Board of Health within seven(7)days of
receipt of this Order. At said hearing,you will be given the opportunity to be heard and to present witness and
documentary evidence as to why this Order should be modified or withdrawn. You may be represented by an
attorney. Please also be informed that you have the right to inspect and obtain copies of all relevant inspection or
investigation reports, orders,and other documentary information in the possession of this Board, and that any
adverse party has the right to be present at the hearing.
If you have any questions regarding this notification, please call me at 978-741-1800.
Sincerely yours,
Larry Ramdin
Health Agent
LR/md
cc: North Shore/Cape Ann Tobacco and Alcohol Policy Program
Paul Kirby, Board of Health Chair and Members
�,. CITY OF SALEM,
t
I SSACHUSETTS
• BOARD OF HEALTH
120 WASHINGTON STREET,41",FLOOR Pl1hi1CHP�.Promote. �1
TEL. (978) 741-1800 FAX(978) 745-
KIMBERLEY DRISCOLL 0343 Lmon,IUMDIN,RS/RE?L IS,CI IO,CP-FS
MAYOR ltamdin cgsalem.com Hi�"A] l i AGENT
January 30,2018
Speedway
90 North Street
Salem, MA 01970
SENT CERTIFIED MAIL:7017 1450 0001 5936 3473
Dear Owner:
Speedway is in violation of the Salem Board of Health Regulation affecting sales to a minor. According to this
section,the sale of cigarettes, chewing tobacco, snuff,or any tobacco in any of its forms to any person under the
age of twenty-one shall be punished by a fine of$100.00 Hundred Dollars for the first offense.
On Wednesday, 1/10/2018 at 3:46pm personnel from the Tobacco Control Program conducted a compliance check.
During that compliance check,a 17-year old female, a minor,was sold tobacco from a clerk in your store.
Documentation is now on file at the Board of Health regarding that sale.
FOLLOWING THE SECOND(2ND)OFFENSE WITHIN A.3 YEAR(36 MONTH)PERIOD,A$200 FINE WILL BE
SET ALONG WITH A 7 DAY SUSPENSION OF YOUR TOBACCO PERMIT.
Therefore,you are ordered to pay a fine of$100.00 for the violations stated above. A check or money order
payable to the City of Salem must be at the Board of Health office, 120 Washington Street,4th floor,within ten
days of receipt of this notice.
Should you be aggrieved by this Order,you have the right to request a hearing before the Board of Health. A
request for such a hearing must be received in writing in this office of the Board of Health within seven(7)days of
receipt of this Order. At said hearing,you will be given the opportunity to be heard and to present witness and
documentary evidence as to why this Order should be modified or withdrawn. You may be represented by an
attorney. Please also be informed that you have the right to inspect and obtain copies of all relevant inspection or
investigation reports,orders,and other documentary information in the possession of this Board,and that any
adverse party has the right to be present at the hearing.
If you have any questions regarding this notification, please call me at 978-741-1800.
Sincerely yours,
Larry Ramdin
Health Agent
LR/md
cc: North Shore/Cape Ann Tobacco and Alcohol Policy Program
Paul Kirby, Board of Health Chair and Members
•
CITY OF SALEM,
1VIASSACHUSETTS
• BOARD OF HEALTH
PublicHealth
120 WASHINGTON STREET,4""FLOOR Prevent.Promote.Protect.
TEL. (978) 741-1800 FAX(978) 745-
KIMBERLEY DRISCOLL 0343 LARRY RA,\4DIN,RS/RI?EIS,C110,CP-FS
MAYOR 1ramdinQsa1em.com H1 A r'1IAGr.N'1'
January 30,2018
White Dove Market
59 Loring Avenue
Salem, MA 01970
SENT CERTIFIED MAIL: 7017 1450 0001 5936 3466
Dear Owner:
White Dove Market is in violation of the Salem Board of Health Regulation affecting sales to a minor. According to
this section,the sale of cigarettes,chewing tobacco, snuff,or any tobacco in any of its forms to any person under the
age of twenty-one shall be punished by a fine of$100.00 Hundred Dollars for the first offense.
On Wednesday, 12/27/2017 at 2:02pm personnel from the Tobacco Control Program conducted a compliance
• check. During that compliance check,a 17-year old female,a minor,was sold tobacco from a clerk in your
store. Documentation is now on file at the Board of Health regarding that sale.
FOLLOWING THE SECOND(2ND)OFFENSE WITHIN A 3 YEAR(36 MONTH)PERIOD,A$200 FINE WILL BE
SET ALONG WITH A 7 DAY SUSPENSION OF YOUR TOBACCO PERMIT.
Therefore,you are ordered to pay a fine of$100.00 for the violations stated above. A check or money order
payable to the City of Salem must be at the Board of Health office, 120 Washington Street,4th floor,within ten
days of receipt of this notice.
Should you be aggrieved by this Order,you have the right to request a hearing before the Board of Health. A
request for such a hearing must be received in writing in this office of the Board of Health within seven(7)days of
receipt of this Order. At said hearing,you will be given the opportunity to be heard and to present witness and
documentary evidence as to why this Order should be modified or withdrawn. You may be represented by an
attorney. Please also be informed that you have the right to inspect and obtain copies of all relevant inspection or
investigation reports,orders,and other documentary information in the possession of this Board,and that any
adverse party has the right to be present at the hearing.
If you have any questions regarding this notification, please call me at 978-741-1800.
Sincerely yours,
Larry Ramdin
Health Agent
LR/md
cc: North Shore/Cape Ann Tobacco and Alcohol Policy Program
Paul Kirby, Board of Health Chair and Members
CITY OF SALEM,
Mf1SSACHUSETTS
BOARD OF HEALTH
Public Health
120 WASHINGTON STREET,4111 FLOOR Prevent.Promote.Protect.
TEL. (978) 741-1800 FAX(978) 745-
KIMBERLEY DRISCOLL 0343
Lr\RRI Rr1MDIN,RS/RI`I IS,C110,CP-FS
MAYOR Iramdin@salem.com HF"AL;I'F I AGENT
January 30,2018
Shell
146 Boston Street
Salem, MA 01970
SENT CERTIFIED MAIL: 7017 1450 0001 5936 3480
Dear Owner:
Shell is in violation of the Salem Board of Health Regulation affecting sales to a minor. According to this section,the
sale of cigarettes,chewing tobacco,snuff, or any tobacco in any of its forms to any person under the age of twenty-
one shall be punished by a fine of$200.00 Hundred Dollars for the second offense plus a 7-day suspension.
You will be advised of the dates of the suspension by the Health Agent.
• On Thursday, 12/28/2017 at 11:23am personnel from the Tobacco Control Program conducted a compliance check.
During that compliance check, a 16-year old female,a minor,was sold tobacco from a clerk in your store.
Documentation is now on file at the Board of Health regarding that sale.
FOLLOWING THE THIRD(3RD)OFFENSE,THE BOARD MAY CONSIDER POSSIBLE REVOCATION OR
SUSPENSION OF THE PERMIT.
Therefore,you are ordered to pay a fine of$200.00 for the violations.A check or money order payable to the
City of Salem must be at the Board of Health office, 120 Washington Street,4th floor,within ten days of
receipt of this notice.
Should you be aggrieved by this Order,you have the right to request a hearing before the Board of Health. A
request for such a hearing must be received in writing in this office of the Board of Health within seven(7)days of
receipt of this Order. At said hearing,you will be given the opportunity to be heard and to present witness and
documentary evidence as to why this Order should be modified or withdrawn. You may be represented by an
attorney. Please also be informed that you have the right to inspect and obtain copies of all relevant inspection or
investigation reports, orders, and other documentary information in the possession of this Board,and that any
adverse party has the right to be present at the hearing.
If you have any questions regarding this notification, please call me at 978-741-1800.
Sincerely yours,
Larry Ramdin
Health Agent
LR/md
• cc: North Shore/Cape Ann Tobacco and Alcohol Policy Program
Paul Kirby, Board of Health Chair and Members
r
The
Governmental
High Achieving
Health Department 2020
Community Chief Health Strategist
Public Health Leadership Forum
This paper was prepared by RESOLVE as part of the Public Health
Leadership Forum with funding from the Robert Wood Johnson
Foundation. John Auerbach, Director o Northeast '
f ern University's
Y
Institute on Urban Health Research, also put substantial time and effort
into authoring the document with our staff. The concepts put forth are
based on several working group session (See Appendix B for members)
and are not attributable to any one participant or his/her organization.
RESOLVE
May 2014
The High Achieving Governmental Health
Department in 2020 as the Community
Chief Health Strategist
Public Health Leadership Forum
Background
Local and state health departments need to adapt and evolve if governmental public health is
to address emerging health demands, minimize current as well as looming pitfalls, and take
advantage of new and promising opportunities.To succeed requires a view into the future.This
paper provides that vision. And, importantly, it zeroes in on what a high achieving public health
department of the future will be doing differently. It does so not with a comprehensive
inventory of tasks but rather with a distillation of the most important new skills and activities
essential to be high achieving and serve in the role of the community chief health strategist.
A working group of public health practitioners and policy experts was convened by RESOLVE as
part of the Public Health Leadership Forum with funding from the Robert Wood Johnson
Foundation (See Appendix B for a list of members). The working group purposely set a time
frame of public health in 2020—just six years into the future—in order to look far enough
ahead to provide a compelling beacon, while staying close enough to the present to emphasize
the urgency of taking immediate steps to start the process of change and build the leadership
necessary to be successful.
Vision
The core mission of public health remains the same: the reduction of the leading causes of
preventable death and disability, with a special emphasis on underserved populations and
health disparities. This is our perpetual north star. But how we achieve that mission has to
change, and change dramatically, because the world in which we find ourselves is very different
than just a few years ago, and it will continue to rapidly change. Unless we recognize the new
circumstances and adapt accordingly, public health will not just be ineffective, it runs the risk of
becoming obsolete.
Just what are the conditions that have brought about the need for this overhaul and a call for
new practices and skills?A short list includes:
The health care needs of the population are changing. The prevalence of chronic disease
has skyrocketed as life expectancy has increased and other causes of death have
The High Achieving Governmental Health Department in 2020 as the Community Chief Health Strategist
decreased. Much attention has appropriately focused on obesity and asthma in the last
several years, and health departments have scrambled to find the necessary resources
to respond. In the coming years these diseases are likely to continue to remain
priorities, but in addition, health departments will need to focus on other chronic
diseases that are leading preventable causes of morbidity as well such as those
associated with behavioral and oral health and sensory-related disabilities.
• The demographics of the country are changing. The increased prevalence of the chronic
conditions mentioned above will continue as the elderly and very elderly (over 85 years
of age) population grows. Public health departments will face the challenge of
developing strategies to help elders maintain their independence and quality of life.
The continuing growth of the Latino population and other populations of color could
intensify the already existing health disparities even as access to care increases for
many.To date, our public health successes have not often been evenly effective by class
and race. As a consequence and particularly in poorly resourced areas the preventable
disease burden of the future will require new approaches perhaps drawn from the
global health arena.
• Access to clinical care will change in a post Affordable Care Act (ACA)environment.
Although there will be differences from community to community, access to clinical care
will likely grow everywhere due to an increase in public and private health insurance
coverage. As a result some services traditionally provided by public health departments
will be covered by health insurance. This change will mean that the role of public health
departments as the safety net provider will be diminished and in some instances
eliminated entirely.At the same time there will likely be an enhanced role of such
departments in assuring that the care provided by others is accessible as well as high
quality, prevention-oriented and affordable.
• An information and data revolution is underway as the world changes to an internet-
based, consumer-driven communications environment. Public health's role as the
primary collector of population health information will be reduced as new, diverse and
real-time databases emerge. However, the public health role as interpreter and
distributor of information will become more pronounced. Governmental public health
will have the responsibility for surveying and aggregating the many sources and
ensuring accessibility of the essential information in understandable formats.
• As attention to the factors contributing to chronic diseases increases, the non-health
sectors will often be the key to optimizing the health of the public. Public health's role
will involve working collaboratively with these diverse sectors—be they city planners,
transportation officials or employers—to create conditions that are likely to promote
the health and well-being of the public.
The High Achieving Governmental Health Department in 2020 as the Community Chief Health Strategist
In combination,these new required practices might be characterized as creating a sweeping
new role, one we are calling the "chief health strategist"of a community.This new role builds
upon the past and present functions of health departments and is a critical evolution necessary
to be a high achieving health department in the near future.
Public health departments functioning as chief health strategists should retain, refine and
defend the programs that are currently successful, such as environmental health, infectious
disease control, all hazards preparedness and response, and other skills, strategies and
programs essential for protecting and improving the health of.communities. But as the chief
health strategist, public health departments' roles will differ in significant ways.
Departmental representatives will be more likely to design policies than provide direct services;
will be more likely to convene coalitions than work alone; and be more likely to access and have
real-time data than await the next annual survey. Additionally, chief health strategists will lead
their community's health promotion efforts in partnership with health care clinicians and
leaders in widely diverse sectors,from social services to education to transportation to public
safety and community development.The emphasis will be on catalyzing and taking actions that
improve community well being, and such high achieving health departments will play a vital
role in promoting the reorientation of the health care system towards prevention and wellness.
Health departments will also be deeply engaged in addressing the causes underlying
tomorrow's health imperatives.
While it won't be easy for health departments, even those with the most resources, to achieve
this vision of becoming chief health strategists in their communities, it is imperative. Even the
smallest of health departments can take partial steps, and some departments are already
changing to meet the new demands, and can provide examples for others to follow.
The vision of high achieving health departments serving as community chief health strategists
may seem ambitious, particularly for those health departments that are small or under-
resourced, and we recognize that many agencies will not be able to adapt quickly. Change
across our nation's diverse health departments will occur at different times and at different
paces, nut beginning the process is necessary for departments of all sizes whether or not they
have lost resources.The demands of the future are unavoidable. Governmental public health
must be ready to meet them.
The High Achieving Governmental Health Department in 2020 as the Community Chief Health Strategist
Key Practices of the Chief Health Strategists of the Future
High-achieving local and state governmental health departments of 2020 serving as the
community's chief health strategists will share several key practices, seven the working group
identified as the newest or most unique are highlighted below. Following the description of the
practices, we suggest a beginning menu of steps that health departments large and small can
take in order to begin to work toward at least the first practice in the next few years.'
PRACTICE #1: Adopt and adapt strategies to combat the
evolving leading causes of illness, injury and premature death.
Starting in the first few decades of the 20th century, public health departments focused great
attention and received considerable funding to fight infectious disease. This orientation of
funding reflected the dominance of such diseases as tuberculosis, food-borne illness, and
influenza as causes of death in the early part of the century. While improved water and sewage-
system regulations, widespread public education, and medical interventions helped address
those illnesses,the HIV and then the H1N1 epidemics made clear the continuing health threat
posed by infectious diseases, which remain serious health concerns in the U.S. These health
threats will require adequate resources to maintain the progress that has already been made,
as well as address new infectious disease challenges.
But health departments lack the equivalent capacity to prevent and respond to today's leading
causes of illness and death: heart disease, cancer, lower respiratory illness, stroke, and
unintentional injuries and overdoses. Unlike infectious diseases, many of these involve chronic
conditions that require years if not decades of expensive care and control. Today's public health
budgets are not properly aligned or sufficiently funded to tackle these now leading causes of
illness, injury, and premature death. Current funding and programs are in fact more reflective
of the health concerns of the past than of the present, let alone the future.
Here is where health departments of the future need to shift their focus and the funding
streams must follow. Chief health strategists of the future will be able not only to anticipate
those factors contributing to death and disease in a community, but be able to identify and
secure the essential resources necessary to focus attention on chronic disease prevention.The
health department strategists of the future will need to focus on the ongoing as well as
emerging leading health concerns with the same intensity and strategic skills they once directed
toward eliminating tuberculosis.
The most effective preventive solutions for these chronic conditions are often similar across
disease categories.The widespread benefits associated with modified and improved conditions
at community work places or schools, such as infrastructure for fresh fruits and vegetables and
'We look forward to gathering additional action steps for the other practices as this paper is disseminated more broadly.
The High Achieving Governmental Health Department in 2020 as the Community Chief Health Strategist
I
ocating near parks and other open spaces, to support the concurrent behavioral changes of
improved diet and exercise,for example, can help individuals and communities that share
multiple and interacting risks and health conditions. But prevention efforts that would
substantially reduce deaths by addressing tobacco use and obesity are currently underfunded—
dangerously so.
And while more needs to be done to address tobacco, obesity, heart disease, cancer and stroke,
there are other challenges that will be increasingly appearing on our radar screen. For example,
the lack of progress that has been made in reducing the prevalence of disabilities related to
behavioral health, musculoskeletal disorders, and sensory loss, will become ever-growing
problems if unaddressed as the make up of our communities change and as life expectancy
increases.To effectively and efficiently improve community health, public health departments
as chief health strategists must keep up to date not only with what is threatening people's
health, but also who is most at risk—discussed in Practice#2 below.
To summarize:the high-achieving health department of 2020 serving as the chief health
strategists must understand and address the primary causes of illness, injury, and premature
death.These departments will ensure that their efforts are aligned with the needs of the
growing prevalence of disabilities; that they have developed expertise in the prevention and/or
treatment of chronic conditions;that they are continually looking to and preparing for the
newly emerging health trends; and that they are seeking, securing and channeling resources to
be successful.
PRACTICE #2: Develop strategies for promoting health and well-being
that work most effectively for communities of today and tomorrow.
Demographic trends are shifting the make-up of our communities, rendering some of our focus
and community health strategies outdated. If not updated, these changes will potentially
compound some of our current weaknesses. By 2020, baby boomers will be over 65, and the
percentage of the population that is elderly will be larger than ever before.This shift will
intensify the need to focus on the health of the elderly,the importance of preserving their
quality of life and the prevalence of such conditions as dementia, as well as paying more
attention to their preventable health concerns, such as the injuries resulting from falls.
The country will also be more racially and ethnically diverse, as the non-white population edges
toward outnumbering the white population for the first time. And unless we tap new strategies
to more effectively confront and reduce health disparities, not only will these disparities
increase,they will jeopardize the overall health and well-being of our communities even more
extensively. To date our public health advances have often been less successful at reducing
class and racial disparities. The preventable burden of the future will differentially require new,
The High Achieving Governmental Health Department in 2020 as the Community Chief Health Strategist •
health equity approaches including those that specifically improve health in poorly resourced
areas.
These and other changes will compel the health departments of 2020 as the chief health
strategists to focus on the health needs and concerns of the fastest-growing populations.
Health departments that have historically focused on maternal and child health activities—
understandable as high level of death and disability were occurring in infants and pregnant
women in communities of the past. However, now—in communities of today and because of
successes we have had with maternal and child health issues - health departments will need to
broaden their vision to include the elderly as they become a larger proportion of the
community and the injuries and illnesses they experience become a more significant variable of
overall community health. Health departments also will need to pay greater and greater
attention to people of color and Latinos, Asian-Americans, and other immigrants. Demographic
shifts may also be accompanied by socioeconomic changes such as a growing income gap and
concurrent inequalities in health outcomes.The state and local health departments as chief
health strategists should be the trusted source regarding emerging demographic and health
trends.
The high achieving health department and health strategist must address the needs related to
emerging demographic patterns, and the health inequities experienced by specific sub-
populations. Chief health strategists need to answers these questions for each community:
• What are (and will in the future be) the greatest health threats, and who is (and will be)
most at risk?
• What will it take to reduce these threats and reach the greatest number of high risk
populations with whatever resources are available?
A starting point is to have access to accurate,timely, and understandable data. And that leads
to the next essential practice.
PRACTICE #3: Chief health strategists will identify, analyze and
distribute information from new, big, and real time data
sources.
Public health has always been an information-based discipline.That's its stock in trade. But the
old ways of collecting and analyzing information are no longer sufficient.The nature of
information technology, information sources, and public expectations of accessibility are
changing, and public health needs to rapidly adapt and evolve in response.
Other new and often big data sources can help correct that. Future health departments as
strategists should be able to retrieve certain up-to-date clinical data from Electronic Health
Records. Among the other sources used will be "big data," data sets so large and complex that
The High Achieving Governmental Health Department in 2020 as the Community Chief Health Strategist
traditional processing and management approaches don't apply. Health departments are
unlikely to have data systems within their control that are large enough to capture all the
necessary behaviors, attributes, and community determinants of health.
Instead, by 2020 health departments as chief health strategists may submit regular requests for
data from Medicaid, Medicare, from all payer claims, or even outside of the health arena,from
city planners, schools, and public safety officials. The strategist will need to look beyond the
usual health-related data sources to patient-initiated feedback from social media and to extract
data from search engines.
Once these data are collected, assessed, and aggregated,the public health departments as
chief health strategist will not just make these data available but analyze them and translate
the health implications of identified trends and hot spots, as well as share this information with
the public, providers, partnering agencies, and policy makers to inform community-wide
decision making and actions collaboratively in order to improve overall health and well being.
The chief health strategist's responsibility is to the community it serves, and communities will
want and should have meaningful interpretations of what information means for them and
their health. The goal, in addition to informing the broad community,will be to offer a more
comprehensive picture of health that will deepen their and their partners' understanding of the
complex factors affecting the health of a community.
But by 2020, the obligation of health departments as strategists will go beyond accessing and
analyzing data to providing information. Health departments will make information accessible
for users to customize questions whenever they are needed for whatever purpose they are
needed. Data collection and analysis must move closer and closer to real time. It will be
unrealistic and unacceptable, in 2020,to wait one year or longer to have the latest reported
information on,for example, infant mortality and diabetes rates, as is currently the case.
The health department as the chief health strategist will be prepared to answer what is
happening in the current year and not what was happening one, two, or even three years ago.
How will the health department as strategist get that information? One way is for clinicians,
hospitals, and health departments to look to up-to-the-minute reporting of dangerous
infectious disease outbreaks and the response to them. In recent years there have also been
numerous examples of the value of rapid responses to clusters of health care associated
infections. Access to such information might not require the regulatory-imposed reporting
systems of infectious disease thanks to the evolving opportunities to access such data through
meaningful usage agreements. In a growing number of communities there are local health
information exchanges that can become intermediaries, collecting the data in a format that is
usable by a health department without requiring unrealistically sophisticated IT capacity.
The High Achieving Governmental Health Department in 2020 as the Community Chief Health Strategist �'.
The range, freshness, and subtlety of new data sources can make the health department as
strategist of the future far more responsive and effective than in the past. With such data
health departments can, and good strategists will,focus interventions to more effectively serve
populations with disparities.They will be able to evaluate ongoing interventions with more
precision and accuracy. And with access to new kinds of data, the high achieving health
department as strategist can respond quickly and inventively to chronic disease diagnoses, not
just infectious disease outbreaks. If clinicians identify clusters of newly diagnosed asthma cases
in one neighborhood,for instance,the public health department can determine which
neighborhood environmental factors can be altered in order to reduce future incidence. This
means that health departments as chief health strategists of the high achieving departments
will need new kinds of skills. Mobilizing the department's existing resources to respond most
effectively to the new health priorities will require familiarity with multiple data sources,the
ability to advocate for access to those data sources, and then the ability to extract and interpret
new data and share the most meaningful findings with the health department's partners and
the public. Analysis, energy, and imagination will be essential characteristics; so will clear
communication and the ability to make the complex seem simple.
Clear, accurate, and well-analyzed data will be especially important as health departments as
strategists expand their partnerships to include multiple governmental agencies and
community-based organizations that may be less familiar with health indicators and disease
causation—as the next section will make clear. And above all, health departments as strategists
will strive for increased accessibility of information to the community by such means as tapping
friendly interfaces to accessible information and increasing sophistication in the use of social
media.
In these efforts, high achieving health departments will rely heavily on one particular segment
of the larger community—health care providers and facilities. The chief health strategist will
understand, reach out to and collaborate with key partners in the health care community.
These key allies and alliances promote good health, of course. But they may also be crucial in
answering the all-important question of how high achieving health departments as chief health
strategists of the future will fund community mobilization and policy-oriented campaigns—
namely by redirecting funding from services for which they no longer need to pay.This leads to
the next practice.
PRACTICE #4: Build a more integrated, effective health system
through collaboration between clinical care and public health.
With some notable exceptions,the American public health and the clinical care systems have
long been separate and distinct. One is focused on population groups and the other on
individual patients; one is largely funded by the government,the other mostly by insurers.
The High Achieving Governmental Health Department in 2020 as the Community Chief Health Strategist '
Today, the two systems sometimes interact -for example,through infectious disease reporting
during an outbreak like measles or pertussis, or when a community health center or a hospital
needs a license. Numerous health departments directly provide or fund a limited number of
clinical services such as immunizations or treatment for sexually transmitted infections. A few
departments even run their own federally qualified community health centers. But these are
the exceptions, not the rule.
This separation of public health and
Collaboration with Clinical Partners health care has not served us well in our
In Massachusetts, a Prevention and Wellness overall goal to create a system that
Trust was created in 2012 by the state improves health.That can and must
legislature, which awarded $60 million to the finally change.The high achieving health
Department of Public Health to oversee a department as chief health strategist in
process of establishing community-clinical 2020 will form close and interactive
partnerships to promote health and reduce relationships with the clinical providers
costs. With this resource,the health department and health insurers in its municipality.
has funded 9 collaborative initiatives made up of The chief health strategist will know who
municipalities, community-based organizations, to connect with and how best to make
healthcare providers, health plans, regional these connections, as well as work within
planning agencies, and worksites.The activities the financing network to make respective
funded include enhancing community-clinical efforts viable.
relationships, lowering community members'
There are several reasons why this
barriers to optimal health, identifying health- change will occur. The ACA is increasing
related community resources, tracking referrals
health care access to millions of
to and the use of community resources in
additional Americans and decreasing
clinical records, and using quality improvement
(although not eliminating) the need for
to strengthen community-clinical process and
the public health system to provide
linkage.) safety-net services such as
immunizations, STD treatment, and
family planning services.
By 2020, health departments as chief health strategists will have conducted careful analyses of
the available and accessible clinical services in their communities and determined if their
departments should continue to provide them, at what level, and for whom. The high-achieving
health department will reduce, eliminate, or significantly adapt its provision of direct services,
implement billing practices where services are still needed, and may shift to primary care
providers some activities such as tuberculosis care and disease intervention so they are more
integrated.
The High Achieving Governmental Health Department in 2020 as the Community Chief Health Strategist
As more people have access to care through expanded health insurance benefits,governmental
public health can increasingly serve an expanded health assurance function —linking those in
need with potential providers rather than offering the services themselves. And they can play
an increased role in monitoring and reporting on community access, cost, and quality of
treatment care.
Departments may identify certain new services they can provide to complement those offered
by clinical providers. One example: bundled packages of home visits by educators and risk
reduction specialists to women with high-risk pregnancies or to families with a child who has
moderate to severe asthma. Such services can be new generators of revenue, offered to
insurers and clinicians in exchange for reimbursement.A second example involves using
community health workers or other strategies to help patients address the social determinants
of health, linking with opportunities for improved housing, employment training, or family
unification.
Another dynamic changing the landscape is the continuing rise of health care costs and
associated interest by the health care community in turning to partnerships to leverage their
ability to improve health. The widening range of state and national payment reform initiatives
will bring with it new possibilities for linkage between public health and clinical medicine. The
movement away from the predominant fee-for-service to a global, value-based system of
reimbursement should open the door for greater partnership and to the allocation of new
revenue to support public health efforts. New global payment systems can potentially add
population-:based outcome measures to the list of quality measures that must be met to
maximize reimbursement. For example, if clinicians have a financial incentive for their patients
to stop smoking,they may seek the involvement of the local or state health department. And in
turn, departments can share in the revenue incentives.
Such possibilities also build upon the momentum created by the ACA's provision that hospitals
must develop community health assessment reports or face penalties from the IRS. Many
hospitals have sought the guidance of and/or collaborated with their public health departments
to meet that requirement. The health departments of the future will strive to solidify those
connections, and to ensure that those connections result in the investment of hospital
resources in population health initiatives. In addition, health departments may seek out or
solicit new strategies for innovative investment in community prevention, for example through
the use of wellness trusts and social impact bonds.
High-achieving health departments as chief health strategists will fight for a seat at the table
where payment reform and insurance expansion are being determined in their states and
localities, alongside the usual participants of Medicaid, private insurers, and providers. To
achieve this goal by 2020, chief health strategists must develop new knowledge and skills in
The High Achieving Governmental Health Department in 2020 as the Community Chief Health Strategist
such areas as benefit package design, identification and analysis of health metrics, and analyses
of return on investment.
Finally, the movement to near-universal use of electronic medical records (EMRs) governed by
the ACA's required "meaningful use" provisions will offer access to new and timely data, as
discussed in Practice#3. And EMRs may assist in the tracking of patient referrals and the usage
of community-level services supported by public health such as smoking cessation services,
chronic disease self-management training, and home visits by community health workers.
In summary,the high achieving health department as chief health strategist,then, will take
advantage of the numerous opportunities to join the efforts of public health, clinical providers
and insurers. Health care and payment reform will allow for innovative collaboration such as
linking smoking cessation treatment with community level cessation groups and expanding
smoke-free regulations. Departments will face challenges in the process, as they reduce their
own direct services and refer newly insured residents to primary care medical homes and as
they strive to acquire a new understanding and appreciation of insurance practices.
Additionally, as health departments work more closely with clinical partners,they may also
learn useful lessons about quality improvement measures and transparent goal setting and
monitoring—aspects of the health care business model that can be integrated into the high
achieving health department's in 2020 and beyond. They can then look inward and identify
some of the organizational system changes in their own departments that will help them
function more efficiently and effectively.The following practice highlights why it will be
important for departments to be on the lookout for those lessons, as well as Practice #6 which
pushes further the need for improved business systems.
PRACTICE #5: Collaborate with a broad array of allies -
including those at the neighborhood-level and the non-health
sectors - to build healthier and more vital communities.
A century ago, as public health advocates grappled with deadly infectious diseases,they looked
to other disciplines for assistance.They knew they would need the involvement of other kinds
of authorities if they were going to solve the problems associated with,for example, water-
borne and air-borne infections, which spread rapidly in the living conditions of the poor. It was
changes in housing codes and municipal investments in sewer systems, plumbing infrastructure,
swamp drainage, and aerial insecticide spraying that saved more lives, faster,than public
information campaigns or even medical breakthroughs could.
The conditions today and in the future are clearly different. As mentioned in Practice#1, it
takes more focused teamwork within the public health community, with new and different
skills and strategies, as well as cooperation and coordination with the health care community,
when grappling with chronic conditions instead of infectious disease. But there are some
The High Achieving Governmental Health_Department in WNW as the Community Chief Health Strategist
additional lessons in the past successes worth learning from and adapting to the present.And
among them is the importance of working
beyond a limited circle of partnerships—even a
more expanded team among health and humanFBuilding Community Coalitions
service organizations.There is once again the ert Wood Johnson Foundation's
need for cross-disciplinary collaboration and County Health Rankings initiative has
close partnerships with non-health-oriented prompted the creation of a number of
organizations. broad-based community coalitions to
tackle local health problems. One such
Environmental irritants in the home, the effort was in Scioto County, Ohio, which
workplace, and the community contribute to was ranked last among all 88 Ohio
ever-rising asthma rates, to choose one current counties in 2012.That ranking motivated
and pressing example of an illness that requires community leaders to convene meetings
collaborations among diverse non-health— of stakeholders to set the agenda for
oriented agencies and community leaders as helping improve the county's health. Local
well as those in the public health and health health departments played a key role in
care sectors. In order to reduce these asthma providing data, identifying needs and
triggers, health departments need to align their gaps, and highlighting other efforts that
particular skill sets, as well as form partnerships were already underway.The initial
with the medical community, landlords and coalition members decided to broaden
housing code inspectors, employers and unions, the group so it would include people from
polluting businesses and environmental contiguous counties in urban Kentucky
regulators—to name just a few. that were facing similar issues. While the
But developing the needed partnerships with meetings were initially primarily of health
other sectors takes time,training, and professionals, they soon included
specialized personnel, and those partnerships teachers, superintendents of schools,
will happen only if they are made to be clergy, law enforcement officials, and
priorities. Much of our work with these sectors large employers.An early project involved
will need to be through adaptive leadership and improving childhood immunizations by
influencing without direct authority. These linking schools and electronic medical
partnerships will require developing experience records.)
and skills among non-governmental
organizations and other community leaders
with how to effectively navigate regulatory and legal processes at the local and state levels and
to influence policy. But they will also require understanding and respecting the priorities, goals,
and objectives of other public and private, governmental and non-governmental agencies and
organizations.
The High Achieving Governmental Health Department in 2020 as the Community Chief Health Strategist
:�, �",`
It is not just diseases that require cross-disciplinary partnerships. It is the socio-economic
conditions that foster them and make them worse. As health departments confront and
address health disparities caused by economic inequality, racism, and discrimination,they need
to take a broader approach. Factors as diverse as housing segregation, high school dropout
rates, gang violence, and unemployment contribute to elevated risk for illness, injury, and
premature death in low-income and minority communities. Working on these issues can, it is
true, push most health departments out of their comfort zones. Nonetheless,the high
achieving health departments as chief health strategists of the future will speak out
compellingly on the connection between these issues and specific health outcomes, and then
work collaboratively to change those factors to improve health outcomes.
The health department of the future will also encourage and support the leadership of
community members in the efforts to promote healthy conditions. By training, informing, and
nurturing leadership in neighborhoods with elevated health problems,the chief health
strategists can develop a valuable and long-term resource for health promotion and, in essence,
expand the public health base.
The Surgeon General's National Prevention Strategy of 2011 touts the importance of a health
department's active engagement with community members and organizations. Community
efforts, the report says, help people "take an active role in improving their health, support their
families and friends in making healthy choices, and lead community change."'
Health departments should thus explore the possibility that federal resources can support local
and state health departments in convening broad-based collaborative efforts at the community
level. But with or without federal funding, such convening is necessary.
In summary, by 2020 chief health strategists will identify, pursue and establish effective
partnerships with those in positions to make a difference in the community's health. In addition
to partnerships with others in the health system, as well as other governmental agencies, chief
health strategists will participate in and support community-based coalitions that examine
health data, set goals, and develop plans to improve health.They will enlist civic and other
community leaders such as key local businesses and the Chamber of Commerce as well as
leaders at the grass roots level to help carry out those plans. In community-based collaborative
efforts, health departments will'hare the latest findings on evidence-based action steps and, if
possible, give community coalitions grants and other resources.
Partnerships can be catalyzed and fostered through the provision of access to information and
unique skills that others see as adding value to their respective endeavors, as well as joining in
meaningful collaborations. Additionally, potential and ongoing partners and patrons alike are
drawn to professional practice and conduct, and business practices are key elements in
demonstrating value.
The High Achieving Governmental Health Department in 2020 as the Community Chief Health Strategist
PRACTICE #6: Replace outdated organizational practices with
state-of-the-art business, accountability, and financing
systems.
Not surprisingly,the training most public health professionals received in school and on the job
is insufficient to handle the challenges of the future and as the health enterprise changes.
Mining big data?Tapping social media for epidemiological information? Embedding population
health metrics within value-based insurance contracting? Participating in designing bidding
packages for major transportation projects?These aren't in the job description or the skill sets
of the
employees in most public health departments. But they need to be... and soon.
To assume the mantle of chief health strategist, health departments need to retool and retrain
and seek new employees with updated required skills.The high achieving health department of
2020 will have the personnel, know-how, and technological tools to handle the variety of
required tasks. By 2020, the health departments as chief health strategist will have assessed the
necessary skills - particularly the newer ones required —and compared them with the skills of
the current workforce. Where they don't match,the health department will develop a plan to
either rewrite job descriptions or hire people with the needed skills as positions become
available. Or, it will investigate and pursue re-training opportunities for the current workforce,
prioritizing the skills that are most essential.
Public health programs operate inefficiently for a number of reasons. One is that they are
simply following the practices that have previously been put in place. But these outdated
modes need to be replaced with current business practices.These include being efficient,
effective, transparent, and accountable— in other words, being good stewards of public
resources. Among the necessary practices will be establishing visible goals (perhaps with the
use of an online dashboard), measuring and analyzing the progress in meeting them, and
striving for continuous improvement using a thorough analysis of the lessons learned in the
process. Such practices are now common in the private sector. Health departments would do
well to study and learn from the best of such models.
A second reason for the inefficiency of public health departments is the size and structure of
some departments. Some are too small to capture the efficiencies that come with scale or to
have the degree of specialization that is needed. So a key task of the chief health strategist will
be to examine if such limitations can be overcome by sharing agreements across jurisdictions.
This may necessitate and lead to formal affiliations and even mergers of health departments.
Health departments will need to make the business case for public health activities—that is,
using health economics to highlight examples when public health interventions save money in
the short, as well as the long,term. It will no longer be sufficient to simply claim that
prevention saves money without the economic analysis to demonstrate that this is the case for
^5
The High Achieving Governmental Health Department in 2020 as the Community Chief Health Strategist
each specific activity. Such analyses will also be needed to demonstrate that health
departments are wisely using their own resources and translating them into positive health and
economic outcomes. One way to prove that they are will be to achieve accreditation from
PHAB.
The health department as chief health strategist in 2020 will diversify the funding base for
public health. In addition to relying on local, state, and federal grant funding, health
departments will establish mechanisms to bill insurers and providers whenever possible.
However, newly identified funding might or might not come to the health department itself,
depending on an assessment by the department of where the funding can be of most use. Part
of the role of the chief health strategist will be assuring that resources are directed to others.
For example, departments of the future will collaborate with non-health related government
agencies to encourage that they direct their own resources towards practices which will directly
improve community conditions.
Accomplishing this expected practice is a tall order for any health department.To acquire this
and the other goals for skills and practices mentioned previously, health departments need to
help create and become part of a learning health system in which science, informatics,
incentives, and culture are aligned for continuous improvement and innovation, with best
practices seamlessly embedded in the delivery of public health, and community health overall,
and new knowledge captured as an integral by-product of the ongoing experience of becoming
chief health strategists.
Health departments as chief health strategists also need guidance, support, and
encouragement from what for many is their largest(under and most important technical
assistance and policy partner... the federal government.The next section explores why the
federal public health system is so important for the health departments of the future.
s
PRACTICE #7: Work with corresponding federal partners -
ideally, a federal Chief Health Strategist - to effectively meet
the needs of their communities.
Chief health strategists require the support (financial and policy) and architecture of the federal
government. Without this support—and, moreover, leadership—from the federal government,
it will be difficult for local and state health departments to adequately prepare for 2020 and
become chief health strategists. Locals and states can and must be their own agents of change
to become the health departments of the future.
But the necessary transformation is not something they can make entirely on their own.
Certainly,they need financial support from the U.S. Department of Health and Human Services.
The federal government, as a major(sometimes THE major)(under of state and local public
The High Achieving Governmental Health Department in 2020 as the Community Chief Health Strategist �'
health, sets the tone and drives the structure and function of public health at the state and
local level.
In order for local and state health departments to function cohesively,they need greater
flexibility in funding than federal agencies currently provide coupled with the skills and tools to
take advantage of that flexibility. Grant awards with narrowly segmented focuses—a short-
term work plan for asthma, a separate one for tobacco, a third one for diabetes —lead to
organizational silos and more limited external partnerships. If locals are to bring together all
who can affect health,then federal health agencies need to make it easier to braid federal
funding, and the federal health and non-health agencies need to design their programs to
permit closer coordination of funding.
Such flexibility will encourage health departments to address community,workplace, and
school conditions in ways that havee-a positive impact on many health problems. Prevention-
related activities that encourage healthy eating and active living decrease a number of many
health risks, including diabetes and heart disease. Efforts have been underway at the Centers
for Disease Control and Prevention (CDC)to provide more coordinated funding in such areas as
HIV and other sexually transmitted diseases and has piloted integrated chronic disease grants.
Such approaches enhance the likelihood of improving health outcomes.
An additional example that will be of growing relevance to the health department of the future
is the potential to use funding for what might be referred to as foundational public health
services such as the needed steps to update Health Information Technology, develop broad-
based partnerships, and collaborate with clinical systems.
To be clear,flexibility in the use of funding should not be confused with the lack of
accountability. But the chief health strategist will be hampered in accomplishing specific
necessary (and measurable) tasks if the funding continues to be awarded in an overly restrictive
manner.
But the federal government's role in fostering change at the state and local level is not simply .
about funding. Transformation also requires a change in the way the federal agencies interact
with the local and state officials.To begin with, a unified set of policies and practices, including
but not limited to funding, would provide a consistent system within which to function.
One obvious challenge to such cohesive structure is that the current federal health enterprise is
not a single "health department" with a unified set of policies and practices. Rather, it is a
diffuse set of agencies charged with different aspects of health services that drive state and
local public health activities through different funding streams and associated requirements,
regulatory authorities, and legislative efforts.
The High Achieving Governmental Health Department in 2020 as the Community Chief Health Strategist
The federal system needs to establish and embrace a goal and a plan to function as a "virtual"
federal health department and be a chief health strategist at the national level. Federal inter-
agency coordination that gives consistent and unified guidance, resources, and training to
support local and state changes is invaluable. In fact, without such support, the necessary
changes mentioned in each section of this report are more difficult to achieve. It may be too
ambitious to propose that within the next six years (our 2020 time frame)there should be a
federal equivalent to the chief health strategist at the local or state level. But,the closer the
federal health system can come to operate with a single voice, uniform procedures, and a
common set of priorities, the better.
i
There is opportunity and evidence that federal leaders recognize the changes needed for the
future. The National Prevention Strategy paints an ambitious picture of what public health and
prevention efforts need to be. And that picture looks startlingly and encouragingly familiar to a
number of the themes identified above. For instance, it strongly reinforces Theme #4 regarding
the importance of seeking broad-based meaningful partnerships, as indicated by its language
that "Aligning and coordinating prevention efforts across a wide range of partners is central to
the success of the National Prevention Strategy. Engaging partners across disciplines, sectors,
and institutions can change the way communities conceptualize and solve problems, enhance
implementation of innovative strategies, and improve individual and community well-being."Z A
consistent message throughout the National Prevention Strategy is the importance of bringing
all societal and governmental resources together to address the determinants of health and
their direct health consequences.
The same observation applies to the six practices discussed above. For example, if locals and
states are to harness health information technology and mine new data sources, they can't be
sidetracked by outdated national approaches to surveillance and other data collection. Or by
conflicting reporting requirements that narrowly define what are the acceptable data for each
federal agency and/or program. This means that the same vision of innovation and
diversification in data sources needed at the local and state levels must occur at the federal
level. Dozens of federal data collection efforts, surveys and registries need to be modernized.
Cross-agency conferences and webinars should be held to identify promising practices.
Partnerships with those managing useful big data sites should be brokered at the national level
in ways that ease access to the data at the state and local levels. National and regional training
for state and local health information technology staff should be frequent. And all federal
agencies that fund public health should commit to abide by the outcome of such efforts, so that
local and state health departments are not required to maintain the current, inefficient
patchwork quilt of agency-specific data sources.
Similarly, if locals are going to succeed in bringing the community and clinical world together,
then the federal government needs to incentivize both public health and the clinical world to
The High Achieving Governmental Health Department in 2020 as the Community Chief Health Strategist =_
7l work together. Promising steps in that direction are beginning with the growing collaboration
of CDC and the Center for Medicare and Medicaid Innovation, and the inter-agency support for
Million Hearts and ABCS campaigns. But the funding,training, and prioritization of such efforts
is imited.
One final point mentioned earlier but worth reiterating is the magnitude of the challenges
faced by the health department of the future. It is unrealistic that a small and under-resourced
department can achieve these.Therefore, an additional role for federal agencies might be to
create incentives for health departments to consider municipal partnerships across local and
state lines.Just as the ACA opens up whole new vistas for chief health strategists to collaborate
across previously separated public-private lines, state and federal agencies should look to break
down bureaucratic barriers.
In summary,the previous sections have called for the rethinking of the role of new local and
state chief health strategists, suggesting a sweeping set of responsibilities that should be
adapted to meet the actual conditions of the future.This final practice suggests not only that
the state and local health departments as chief health strategists form a more effective
partnership with the federal government agencies, but also necessitates that the federal
government modify and adapt as well, as a virtual federal chief health strategist with the whole
nation as its community, both to meet the new health needs and conditions, and to optimize,
through unified goals, policies, and funding, the likelihood that local and state health
departments will be modernized and well prepared. A few obvious starting points for such a
federal health transformation would include the translation of the National Prevention Strategy
into the terms and practices by which federal government and health agencies actually do
business, and the creation of new, more unified working relationships across the federal
departments and sectors.
Action Steps and Conclusion
It is not that long between now and 2020. Even as health departments persevere under the
stressful conditions of several years of budget cuts and the simultaneous increase in the
number of issues they must address,they must evolve. For some health departments, their
limited size and relatively narrow scope of activities may potentially require combining
resources with others in their state or region. It may simply be unrealistic for health
departments below a certain size to become the chief health strategist and manage the
necessary division of labor and flexibility to adapt to the new circumstances.
However, some health departments are already embracing the new opportunities outlined in
this paper—whether through strategic planning, preparing for the Public Health Accreditation
Board process, and considering the departmental changes they must make. They will recognize
in our concept of a chief health strategist the new roles they have begun to assume.
The High Achieving Governmental Health Department in 2020 as the Community Chief Health Strategist ® .a:
These seven proposed practices are a tall order and require action that starts today if it is not
already underway. Given the urgency of this need, we offer the following menu of suggested
action steps, which are designed to stimulate discussion, idea development and additional to-
dos. Some of the suggestions are intended to be scalable to the circumstances faced by any
department.They emphasize processes that can be undertaken to assess new and future
conditions, compare current practices to future needs, begin to explore new data sources, start
one or more new partnerships, mobilize leadership at the community level, and strengthen
management systems. Health departments can undertake necessary exploratory work—even
without new resources. As more and more health departments engage in these efforts, there
will be success stories and lessons from which all can learn.
The High Achieving Governmental Health Department in 2020 as the Community Chief Health Strategist
Appendix A: Becoming the High Achieving Public Health
Department as the Chief Health Strategist by 2020 and Beyond
1. The first practice mentioned above involved understanding and addressing the primary
causes of illness, injury, and premature death, while the second practice highlights the
needs related to emerging demographic patterns, and the health inequities experienced
by specific sub-populations.
To achieve both objectives of a health department as a chief health strategist of any
size could begin with a planning process both internally and in partnership with others
to determine the likely needs of 2020 and consider how best to meet them. Some of
the steps could include:
a. Collecting the most comprehensive available data on health and demographics
including that prepared by area hospitals to meet the new IRS regulations;
b. Assessing data for increasing prevalence of illness and injury and for changing
demographics in the coming decade. Focus on the major causes of illness, injury
and premature death; what's changing and what's problematic now and
unaddressed.
c. Convening an advisory group with external members to review data and
determine if there are likely future trends and needs of the most prevalent
current and future conditions not captured by the data; consider open public
meetings to solicit additional input.
d. Reviewing internal distribution of staff and resources relative to the issues of
growing concern; assess ability to redistribute existing resources to better reflect
these issues.
e. Discussing possible steps to address the future needs with the advisory group;
prepare materials highlighting the dilemma
2. Assess the diagnoses, trends, and underlying causes of the leading illnesses, injuries, and
premature deaths within a municipality and analyze their significance in relation to the
current distribution of public health funding.
3. Assess the demographic trends for the municipality as well as the populations with the
greatest health disparities, and analyze their significance in relation to the current
distribution of public health funding for the area.
4. Examine existing and emerging databases in the area that can offer information relevant
to the health department's planning, programs, and policies. Select one or two
promising databases such as open-source, social media, or big data systems and invest
in exploring what it would take to gain access to and analyze the data they hold. Learn
to analyze aggregated information to better understand the health determinants in your
area.
The High Achieving Governmental Health Department in 2020 as the Community Chief Health Strategist
7
5. Convene meetings of clinical providers and insurers to discuss potential linkages between
population health and clinical care. Develop at least one pilot program to strengthen
these connections.
6. Collaborate with new non-health-sector partners such as police officers and educators
who have the potential to make an impact on the living conditions of some of the more
vulnerable segments of the community.
7. Invent or adapt job descriptions for positions likely to be needed in the future. These
include:information technology, with expertise in big data systems, social media, and
analyzing claims data from insurers;building coalitions and organizing communities;
building bridges with other sectors including health care providers, non-health
governmental agencies, large employers, and community-based organizations.
8. Initiate an effort to strengthen internal management systems in ways that create
transparent goals, and establish ways to measure progress in achieving them.
The High Achieving Governmental Health Department in 2020 as the Community Chief Health Strategist
Appendix B-Working Group Members
John Auerbach Jeff Levi
Institute on Urban Health Research and Trust for America's Health
Practice, Northeastern University
Herminia Palacio
David Fleming Robert Wood Johnson Foundation
Seattle King County Public Health
Karen Remley
Thomas Goetz Eastern Virginia Medical School
Robert Wood Johnson Foundation
Josh Sharfstein
Katherine Hayes Maryland Department of Health and Mental
Bipartisan Policy Center Hygiene
Paul Kuehnert Lisa Simpson
Robert Wood Johnson Foundation Academy Health
RESOLVE Staff
Abby Dilley
Chrissie Juliano
Sherry Kaiman
Rachel Nelson
End Notes
1 http://www.surgeongeneral.gov/initiatives/prevention/strategy/
2 Ibid.
The High Achieving Governmental Health Department in 2020 as the Community Chief Health Strategist
Inspectional Services Department
Proposed Organizational Chart
Chief/BuOdi Commissioner&
Planning Director `
Coordinator Project Manager
Capital Projects
Inspectional DivWon Public Health Division
FaciTdy Division
Deputy Sulldng
Commissioner Heatttr director Director of Budding&Grounds
See notes AdmGdstrative Assistants tStWaftMgWes)
Payroll Supervisor
gerical Stag Assisfard Supervisors
Chief Budding Sanitarian Liason toInspector Public Health
Maintenance Crew
Sanitary Inspectors
El.bftMas
s Lead Paird Inspector tlutodial Staff
s weights&Measures
tor Code Inspector
Food Inspectors(cont ad)
Notes:
1.Clerical staff placed within Inspectional Division for budgetary Purposes. '
2 Coordinator reports directly to Chief of the Deparanent
3.Clerical st2df reports to Coordinator.
I
•
INSPECTIONAL SERVICES DEPARTMENT
PERSONNEL STRUCTURE
CHIEF/BUILDING COMMISSIONER/PLANNING AGENT
Coordinator
Project Manager
Inspectional Division Facility Division Health Division
Deputy Building Commissioner Director Building &Grounds Health Director
Division Head Division Head Division Head
Administrative Assistant Assistant Supervisors Nurses
Payroll Supervisor Maintenance Cr
ew Doctors_part time
Clerical Custodial Staff Public Health Coordinator
Chief Building Inspector Clerical Staff Grant Employees
Sanitarian
Building Inspector
Plumbing/Gas Inspector
Wire Inspector
Health Inspectors
Weights&Measures
Food Inspection
S
DIVISION RESPONSIBILITIES
• Inspectional Division Facility Division
Health Division
Building inspections Facility Maintenance Health Clinic Services
Planning Board Electrical Repairs School Doctors
Occupancy Inspections Plumbing Repairs Public Health Initiatives
Conservation Commission HVAC Maintenance Emergency Preparedness i
Board of Appeals Grounds Maintenance Public Health Awareness
Plumbing/Gas Inspections Custodial Operations State Reporting
Building Inspections Street Light Maintenance City Veterinarian
Zoning Compliance. Traffic Signal Maintenance Grant Acquisitions
Food Service Inspections Grant Management
Sanitary Enforcement Infectious Disease
Code Inspections Tobacco Control
Wire Inspection
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I Healthcare Studies r
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Michele M.Sweeney,EdD
Professor
msweeney@salemstate.edu
tel 978.542.6582 fax 978.542.6953
Lafayette Street
Sal S a l e m t— •
Salem,Massachusetts 01970-5353 t� I
salemstate.edu - 8 T A T E iuN � vEws � Tr e
ALII f.
y i J. �
February 13, 2018
Dear Healthcare Professional,
We, at Salem State University(SSU), are introducing you to a new major Healthcare Studies!This major
captures the non-clinical healthcare interests of our students. Students will be prepared to execute
lin m introductory leadership skills within the industry, having had explored a multidisciplinary, comprehensive e
study of healthcare. Students are also required to obtain specialized knowledge in a 15-18 credit minor
ranging from areas such as computer science, business management, social work, health promotion, and
psychology. Over 75 minors are available for students where a study of focused expertise can contribute to a
thorough knowledge in healthcare.
One of the highlights of this exciting major is our career sequence.Starting in a student's first year and in
conjunction with an academic class, students participate in developmental workforce experiences with a
culminating senior year internship. We are currently searching for organizations within the area of healthcare
who would be interested in sharing their worksite knowledge and professional demeanor with our students.
Below are experiences that you and our students would enjoy.
o Welcome our students to volunteer within your organization
o Invite students to conduct a 15-20 min interview with you about your work role and career pursuits
o Attend a one-hour class on campus, either as a single speaker or as part of a career panel
o Invite our academic classes to your worksite for a tour and/or conversation
o Welcome one student to shadow you at work for a minimum 3+hour experience
o Mentor an upper level student in a 5 hour, 2 day/week worksite experience (120 hours total)
We are very excited about working with professionals like yourself as we introduce and prepare our students
for the field of healthcare.Your work informs our students to the many skills, knowledge, and professional
behavior necessary for a supportive and leading role in the industry. Please consider any one of these
experiences. From previous experience,we know that our students cherish these employer interactions and
rate them as some of their most"influential experiences" of their studies while at Salem State University.
If you are interested in developing a relationship with our students, please contact me as Fieldwork
Coordinator for Healthcare Studies at.msweenev@salemstate.edu or Steve Maser, Employer Relations at
smaser@salemstate.edu.We look forward to hearing from you!
Sincerely,
Michele M.Sweeney, Ed.D.
Healthcare Studies Department
978-542-6582
Healthcare Studies Major
OCourses for the major
• Health Systems in the US
• Technology for Healthcare
• Academic and Professional Writing for Healthcare
• Healthcare Seminar
o Job shadow opportunity
• Statistics for the Health Professional
• Understanding Diversity and Cultural Competence in Human Services
• Introduction to Healthcare Research
• Health Policy
• Internship Preparation
• Health and Disability Across the Lifespan
• Principles of Leadership and Management in Healthcare
• Internship
o 120 hours over the semester + seminar
o Lists of possible intern sites or possible to find your own
Examples of electives to support the major
• Health Economics Introduction to Business
• Health Psychology Introduction to Music Therapy
• Consumer Health Intro to Health Education & Health Promotion
• Sociology of Aging Issues in Public and Community Health
• Violence and Children Social Inequality: Race, Class and Gender
• Medical Sociology Poverty: Implications for Social Services
• Health and Wellness Introduction to Social Psychology
• Basic Nutrition Introduction to Public Policy
• On Death and Dying Spanish for Healthcare Professionals
Adult and Old Age Psychology Industrial and Organizational Psychology
• Management Theory and Practice Introduction to Medical Humanities
• Stress and Health Empowerment Introduction to International Relations
•
Bachelor of Science Degree in Healthcare Studies •
The Bachelor of Science degree in Healthcare Studies is a non-clinical degree
preparing students to work in a variety of settings in the health and human service
industry. Designed with an interdisciplinary approach, students will complete a core
P rY PP P
of healthcare studies courses before completing a mandatory minor in their chosen
concentration. There is also a completion option for allied health care workers with
an associate degree or certificate to finish their bachelor's degree.
An entry level student will be required to complete 34-35 credits in the university's
general education curriculum and 11-15 credits of free electives. There are several
required support courses such as psychology,` sociology, and ethics. The healthcare
studies core consists of 33 credits. Courses in the core include healthcare systems,
health policy, professional writing, statistics, leadership and management, cultural
competency, health and disability, and research. Students will also have a
healthcare seminar that provides job shadow opportunities as well as an internship
of 120 hours in the final semester. The course of study also includes 12 credits of
electives from a specific group of courses that complement the healthcare studies
degree. Students complete a mandatory minor from the minors offered at Salem
State University such as:
- Accounting - Advertising - Communication Studies
Public Relations - Economics - Computer/Information Studies
- Marketing - Management - Public or Applied Sociology •
- Journalism - Social Work - Public Policy & Administration
- Health Promotion - Psychology - World Languages
- Educational Services and many more
The Bachelor of Science Degree in Healthcare Studies prepares students who would
like to enter occupations in the health and human services field. These jobs may
include but are not limited to:
• Health Care Advocate or Lobbyist
• Child and Youth Services Specialist
• Elderly or Disability Service Specialist
• Insurance Claims Reviewer or Case Management
• Health and Wellness Coordinator or Coaching
• Social Services Case Manager
• Policy Development or Analysis
• Non-Government Organizations (NGOs) or Non-Profit Organizations
Medical and Health Service Managers
• Medical Equipment or Pharmaceutical Marketing and Sales
• Employee Health and Wellness Coordinator or Coaching
• Health Data Informatics
And many other areas in health and human services
•
The major prepares students for careers in the multifaceted, non-clinical healthcare industry.
`i
Our students complete a multi-disciplinary, progressive curriculum centered on leadership, critical thinking, oral and written :i�
skills, collaboration and team building skills.
Students academic work strategically integrates career-focused courses. =!
Students participate in developmental workforce experiences mitnTaTc.ulminating 1►20711our internship. iL
- I WINT01 10 La 114i
Healthcare Studies provides a year-round source of highly motivated pre-professionals for employers.
Our students provide new perspectives to old problems.
Working collaboratively with us can create varied student experiences that will reduce the current skills gap of recent graduates/new employees.
University experts iQqreeiTnatfacouir,inataniinternsniniisitneiDesttwaV for students to master essential skills before graduation.
Internships are proven, cost-effective ways to evaluate and recruit our students as potential employees.
� at
Share your expertise with our students as a guest speaker or on a career panel.
Participate in a student interview about your career path.
Provide civic engagement opportunities for our students.
Identify questions or challenges where our students can provide data-driven solutions.
Invite academic classes to your worksite for tours and conversation. • �,
Welcome a student to shadow you at your place of employment.
r
Mentor an upper level student in a five hour, two days per week internship experience at your worksite.