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MEETING PACKET MAY 2018 MAY 2018 im • • CITY OF SALEM, MASSACHUSETTS 1P BOARD OF HEALTH 120 WASHINGTON STREET,4"i FLOOR Pub&Hean TEL. (978) 741-1800 FAx(978) 745-0343 Prevent.Promote.Protect. KiMBERLEY DRISCOLL health@salem.com LARRY RA.m DIN,RS/RL:HS,CIIO,(;P-FS MAYOR HEALTH AGENT NOTICE OF MEETING You are hereby notified that the Salem Board of Health will hold its regularly scheduled meeting Tuesday, May 8, 2018 at 7.00 PM City Hall Annex, 98 Washington Street, I S`Floor Meeting Room (Please note new address above) MEETING AGENDA o , 1. Call to order . 2. Approval of Minutes 3. Chairperson Communications 3�`av 4. Public Health Announcements/Reports/Updates CA a. PHN Report ;} • b. Health Agent c. Administrative d. Council Liaison Updates 5. Kelsey Currier-Dougherty- Health risks of polystyrene G. Period of public comment for amendment to Regulation 7 - Solid Waste m zr 7. Board of Health program planning o 8. New Business/Scheduling of future agenda items clun • Items that could not be anticipated prior to the posting of the agenda , 3 0 � a d n N O O y CL 00 Larry Ramdin, Health Agent 3C cc: Mayor Kimberley Driscoll, Board of Health, City Councilors — Next regularly scheduled meeting is June 12, 2018 at 7:00pm at City Hall Annex, 98 Washington Street, V Floor Meeting Room. ro '• Know your rights under the open meeting law MGL chapter 30A ss. 18-25 and City T- 0 Ordinance section 2-2028 through 2-2033 • CITY OF SALEM BOARD OF HEALTH MEETING MINUTES April 10, 2018 MEMBERS PRESENT: Paul Kirby, Chair, Dr. Jeremy Schiller, Mary Lauby, Kerry Murphy, Geraldine Yuhas ABSENT: Beth Gerard, City Council Liaison OTHERS PRESENT: Larry Ramdin, Health Agent, Suzanne Darmody, Public Health Nurse, Maureen Davis, Clerk of the Board, Dr. Kimberly Waller, Salem State University, clinical rotation students at Salem State University present to observe TOPIC DISCUSSION/ACTION 1. Call to Order 7:00pm 2. Approval of Minutes M. Lauby moved to approve minutes. K. Murphy 2"d. All in favor. (February 13, 2018) Motion passed. 3. Chairperson Communications P. Kirby welcomed Geri Yuhas to the Board and congratulated J. Schiller on his reappointment. P. Kirby met with Michele Sweeney and Patrice DeLeon from Salem 0 State University. L. Ramdin met with one of their students and stated he is always willing to help in any way he can. 4. Monthly Reports-Updates a. Public Health S. Darmody shared that flu rates are finally matching up with last year's Nurse's Report now. In January, the flu rates were significantly higher than last year. We used most of the flu vaccine we p except t for pediatric. Will most likely order the same amount for next year. The state only supplies vaccines for under 19 years old. Vaccines are shipped directly from the state to providers (pediatricians). Copy available at the BOH office. b. Health Agent's The Health Department is moving to 98 Washington Street next Tuesday, Report April 17"'. Next month's meeting will be held there in the first-floor meeting room. Meeting rooms will have built-in presentation equipment. Janice Orta is attending Registered Environmental Health Specialist/Sanitarian credential review classes. Liz Gagakis and Jeffrey Barosy are attending on-site waste water disposal systems training. Jeffrey will also attend lead determinator training. L. Ramdin will meet with the City Council Finance Committee on June • 51"to discuss the department's budget. P. Kirby will try to go. P. Kirby asked about North Shore Shared Health Services. L. Ramdin explained it is a collaborative of eight communities. They use grant money for such things as signs about ticks, etc. They developed an Operations Manual for health departments. He will share it with the • Board. He would like to add the MAHB Guidebook and the Operations Manual to the members' flash drives. K. Murphy asked what the story was with the Palmer Cove garden. L. Ramdin said some geology students found suspect findings in the soil. He met with a student, who seemed more concerned with contaminant uptake by nut trees. Cornell University gave them guidelines; they took some samples and had no concerns. Raised beds are best as they are not affected by the ground soil. Not sure of the impact of the sea water from the flooding during the storms. Alyssa Rosemartin and Patricia Hale of Salem Community Gardens are putting together a letter of bestpractices, which L. Ramdin will ok first. P g g Pequot Highlands water main break affected the heat in the building, during the visit L Ramdin observed the pipes were labeled incorrectly— "in" labeled as "out", etc. They will fix the problem. L. Ramdin asked for two additional inspectors to be added to his budget to help with the increase of Certificate of Fitness inspections. He also requested a Public Health Programs Coordinator, but was told no. Emily Chi is preparing to apply for a 5-year Healthy Communities opiate use reduction grant. It takes about a year to prepare for such a grant, and that is an example of what a programs coordinator could do for us, along with research. L. Ramdin recently went to a slam poetry session of mostly young people. • They really expressed their pain and hurt. A lot of them said the poetry helps with healing. M. Lauby is a grant writer and said she is happy to help L. Ramdin any time. We work together with community agencies. Social determinants of health should be used as a guideline. We need a planning process with needs and hard data from many sources. We can use Mass in Motion's data. M. Lauby is moving and therefore resigning from the Board. May will be her last meeting. She would like a person of color to replace her. L.Ramdin will give her some contacts. M. Lauby said she knows faculty at BU and is happy to call to see if they have people to provide us with social determinants of health. The gateway cities data is not an asset-based approach and seemed to have just problems. Copy available at the BOH office. c. Administrative No comments/questions. Report Copy available at the BOH office. d. City Council B. Gerard not present. Liaison Updates J. Schiller moved to approve the reports. K. Murphy 2"d. All in • favor. Motion passed. 5. Update of Regulation The amendment is moving from city trash pick-up for homes only to now 7— Solid Waste include multi-unit housing and businesses. • There will be an increase in cost but will eventually save money through less waste. People can put out as much recycling as need be and can use any other containers to do so in addition to the recycling totes provided. Anyone on city trash pick-up must recycle. L. Ramdin stated the regulation changes must be passed by the June meeting because of deadlines for the grant. By the Board accepting the regulation tonight, it opens it up for discussion. At the next meeting in May we will invite public comment and vote. We are sending notice to multi-unit housing owners and agents by mail and business owners through the Chamber of Commerce. J. Schiller motioned to accept the amendment to Regulation 7. M. Lauby 2"d. All in favor. Motion passed. M. Lauby moved to place on the agenda for the May meeting a period of public comment. K. Murphy 2"d. All in favor. Motion passed. A local advisor from DEP and the City Solicitor will be asked to attend the public comment meeting. • 6. Recreational L. Ramdin said marijuana is legal for retail sale on Jul 1 2018. J g Y � i Marijuana Currently there is one license in Salem, the dispensary. L. Ramdin will get the Board zoning relevant to marijuana. This is state law, so we are bound by it, but are concerned about edibles and consumption(smoking) in closed spaces and shared spaces. J. Schiller pointed out that the Cannabis Control Commission has not weighed in on social consumption yet. Beverly included no smoking on beaches, including marijuana. It was a case of smoke free vs. tobacco free. J. Schiller commented that we should consider the fact that 70%of Salem voted for marijuana. There is reduced opiate use and deaths in communities with legal marijuana. We need to be data-driven. The Cannabis Control Commission will begin retail sales and recreational use on July 1st. It will be a year for social use, so people can't use it where they purchase it. Denver wanted to know what chemicals were being used in the growing of marijuana. Traces of chemicals were found in edibles. Per the FDA, marijuana is not approved as a safe substance. G. Yuhas asked if the Board would get involved in regulation of growing of marijuana. L. Ramdin said no, because that is covered under a state regulation. • L. Ramdin pointed out that most local boards are changing their tobacco regulations to say"smoking", not tobacco. P. Kirby felt there is no need for us to take any action at this time, but asked Larry to keep the Board informed as the issue develops. 7. Board of Health program • planning a. Kimberly Waller— Presentation on Health K. Waller stated there was a lack of information on health boards. Department organizational She called the Governor's office and was told there is a MA DEP task models force for establishing standards for boards of health and they are creating a database called FIT, by town. She showed a PowerPoint presentation comparing Lynn, Chelsea and Salem. She reviewed three boards of health/health departments with inspectional services divisions (ISDs). J. Schiller said the building commissioner does not know about health. K. Waller stated it takes communities five to seven years to put together an inspectional services division.. J. Schiller asked if the Lynn people are new to ISD. We run the same grant programs as Lynn. K. Murphy noted the loss of oversight and communication with health inspections for both"Chelsea and Lynn. K. Waller pointed out the public health side became more isolated and diminished. L. Ramdin said the skill sets required of the building inspector and health inspector are very different. Health inspectors need a bachelor degree and other credentials. The building commissioner has no public health training. • J. Schiller said we need to understand the rationale of looking into ISD. P. Kirby said the decision of ISD is with the City Council. We would have an advisory role J. Schiller agreed but said we do have an opinion. P. Kirby feels Mayor Driscoll is looking to improve government. J. Schiller asked if there is a model that shows a very successful, positive ISD model. K. Waller said she is looking at different dynamic models, not just ISDs. P. Kirby said there is not anything for us to do now. If the City Council votes on it, we will give our opinion. J.'Schiller suggested we ask the Mayor to come to a meeting some time and share her concerns. M.'Lauby said it seems like it's an assumption that we would have more time for public health. L. Ramdin said we have to look at authorities of building inspectors. One cannot make a building inspector into a housing inspector. P. Kirby said he will invite the Mayor to the July meeting. He will let her know we have started the discussion and need some clarity. If it's hard to get resources as an,independent department, it wouldn't be any easier to get more as an ISD. K. Murphy suggested we consider re-staff as opposed to reorganization. •8. New Business/Scheduling of future agenda items Put on agenda for next month period of public comment for Regulation 7 and written comment to be received by May 18t" M. Lauby suggested we look into stand-alone departments and what they are doing. L. Ramdin said Barnstable has a good program. Their population increases significantly in the summer months. They have temporary inspectors for pools, etc. We should also look into Newton and Brookline's programs. L. Ramdin will call Sharon in Peabody to have our members' names added to the letter of support for gun violence. 9. MEETING ADJOURNED: M. Lauby moved to adjourn the meeting. K. Murphy 2"d. All in favor. Motion passed. 9:45pm Respectfully submitted, . Maureen Davis r . Clerk of the Board ,sy Next regularly scheduled meeting is Tuesday,May 8, 2018 at 7.00pm A� t City Hall Annex, 98 Washington Street, I'Floor, Salem,HA • M. ,bra • Suzanne Darmody RN BSN Salem Board of Health Public Health Nurse Public Health Nurse Report Reporting on April 3, 2018 through May 2, 2018 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 regarding Medication takeback day, the CDC post regarding the E.coli outbreak associated with romaine lettuce and Administrative professionals week. Meetings/Trainings • • Attended the Northshore Cape Ann Emergency Preparedness meeting on April 24th for discussion regarding Emergency Preparedness deliverables and alert systems. Meetings to be held with EDS planner and social media contractor with individual community in the next couple months. • Held clinic at the Council on Aging on April 11"' for blood pressure screenings and health education, attendance has increased from the last session to about 20 screenings done. • Attended the Community Sanitation Seminar on April 3rd for updates on several topics handled by local public health departments, including Camps, Christians Law, beach testing etc. • Attended the NSPHN meeting in Danvers on April 10"', the Bite Lab was presented by Hamilton-Wenham nurse Chris Lee as she has been designated responsible on the supplies/display for our region by MDPH. • Completed packing for move to 98 Washington St on Friday April 161" • Attended the quarterly meeting at the Northshore Pulmonary Clinic at Salem hospital for updates and local Tuberculosis case review with providers at MDPH TB staff. • Picked up PPD (tuberculosis testing solution) for the Lydia Pinkham clinic April 25th, as per MDHP, local public health must order, coordinate and supply all PPD to qualifying clinics in their city/town as well as report all doses administered. • • Held the Regional Camp Seminar in conjunction with MDPH for the camps of the north shore in Beverly on April 30d'. We had 70 attendees and representation from all but one camp in Salem. Monthly Report of Communicable Diseases: April 2018 • Disease New Carry Over Discharged/ Total# Of Running Total for Reported Cases this Total for 2017 Closed Month 2018 Tuberculosis 0 2 1 2 2 2 (Active) Latent 6 0 6 6 16 45 Tuberculosis* Arbovirus* 0 0 0 0 0 0 Babesiosis 0 0 0 0 0 0 Calicivirus/No 1 0 1 1 1 4 rovirus Campylobacte 1 0 1 1 1 8 riosis • Cryptosporidi 0 0 0 0 1 0 osis 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 1 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* 6 0 6 6 13 30 Influenza* 15 0 15 15 236 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 • Measles 0 0 0 0 0 0 Meningitis 0 0 0 0 0 1 Mumps 0 0 0 0 0 0 Pertussis 0 0 0 0 0 2 Salmonellosis 1 0 1 1 2 7 Shigellosis 1 0 1 1 1 2 Streptococcus 0 0 0 0 1 5 Pneumoniae* Varicella* 0 0 0 0 0 0 Vibrio 0 0 0 0 0 0 West Nile 0 0 0 0 0 0 • • 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 31 2 32 33 276 197 April 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. 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 coordinated with MDPH for PPD and an outreach worker to provide translating assistance and completed Tuberculosis testing and have referred them to the Northshore Pulmonary Clinic. Clinic appts found abnormalities and follow up is pending sputum culture. 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. Treatment completed in April. • 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. 3 PPDs completed in the month of March, one contact failed to be available for the reading and 2 others had negative results. Active Case 2: This case was diagnosed in the hospital and started on D.O.T. on January 11"'. 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. Norovirus: Case 1: This case was reported 3 weeks after onset of illness. They currently are recovered and they do not work in food handling or in a care setting. They did say that other persons in the home had similar symptoms around the same time though they did not seek medical care. They prepare food in the home together. At this time all illnesses have resolved and there are no further cases. This case is now closed. Campylobacteriosis: Casel: This case was hospitalized due to this illness and other complications from on ongoing chronic illness. I was able to conduct follow up with the hospital however after ongoing efforts for several weeks I was unable to directly reach the patient. They are currently unemployed and there have been no further cases. This case is now closed. Salmonellosis: Case 1: This case traveled out of the country and returned just prior to seeking medical treatment, however there is question the symptoms may have started prior to leaving. A food history was done and reported to the food protection program. This case was looked at as possibly related to a cluster in the area,however at this time there is not a confirmed match on the bacteria isolates or similar confirmed foods consumed. At this time, there is no known contacts that have been ill and there are no further cases. They are not a care taker or food handler, teaching has been done and this case is closed at this time. If a confirmed connection is found further follow up may need to be conducted. Shigellosis: Case 1: This case was treated in a hospital setting and discharged home after 2 days. I conducted follow up, obtained a food history and notified the food protection program. I did require that they follow up with their primary care physician to retest a stool sample after completing treatment. I was able to allow them to return to work with the negative stool result. They have no know ill contacts and there are no further cases. Teaching was done and this case is now closed. • Health Agent report April 2018 Announcements/Update • The move to 98 Washington Street was completed, and we are settling in and it will take time, to get fully packed away. A decision was made by the IT department not to provide fax lines at this location. However, after discussions with City Solicitor Beth Rennard and Matt Killen, Chief Information. There is an agreement to provide a fax line so the Public Health Nurse can receive secure documents. Faxes will be sent to the City Solicitors Office in the interim. Community Outreach • A regional training for Camp Managers was hosted to discuss protocols for licensure and changes to Recreational Camps regulation. Suzanne Darmody and Janet Mancini participated in the program. • Larry Ramdin participated in an interview for the NSMC Community Health Assessment • Larry Ramdin interviewed Police Chief Mary Butler in the first program in the Recovering in Salem 2018 Series • Meetings and Trainings • EH Team and Suzanne Darmody attended the Community Sanitation workshop that discussed Recreational camp updates. • Jaffrey Barosy completed his Lead Determinator training • Janice Orta completed her Registered Sanitarian Review course • Elizabeth Gagakis and Jeffrey Barosy attended a 3 day course on Introduction to Onsite waste water systems • Larry Ramdin and Suzanne Doty met with Kerry Murphy of the Salem MassinMotion project to discuss their Food survey and discuss strategies to collaborate with the program Environmental Health Activities • Elizabeth Gagakis and Suzanne Doty conducted a Salmonella Food-Borne Illness outbreak investigation at a local supermarket. Samples were collected but were not tested as the samples were outside of required temperatures when they arrived at the lab. • As the warm weather settles in and college semester comes to an end we will be looking at increased trash complaints and rodent activity. The department is messaging to resident's information on proper trash handling and disposal. • • Inspections Item Monthly Total 2018 YTD 2017 Total Certificate of Fitness 42 212 383 Inspection Certificate of Fitness 0 1 47 re-inspection Food Inspection 15 77 249 Food Re-inspections 1 26 83 Retail Food 3 13 33 Inspections Retail Food 2 7 14 re-inspection • Temporary Food 6 9 249 General Nuisance 1 10 34 Inspections Food— 0 0 1 Administrative Hearings Housing Inspections 4 23 99 Housing re- 0 6 46 inspections Rodent Complaints 4 8 46 Court 0 3 4 Hearings/filings • Item YTD 2018 2017 Total Trash Inspections 55 223 906 Orders served by 0 1 4 Constable Tanning Inspections 0 0 0 Body Art 0 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 133 577 2338 Health Dept. Clerical Report FY 8 Burial 5 Permits CertPermits Plan Reviews Ain s&$icate50 of Copies / Fines Revenue Permit Fees July-1 7 $900.00 $4,350.00 $630.00 $1,800.00 $300.00 $7,980.00 Food Service Est. <25seats $140 August $700.00 $1,670.00 $270.00 $1,500.00 $4,140.00 25-99seats $28o >99seats $420 September $900.00 $4,530.10 $270.00 $2,350.00 $200.00 $8,250.10 Retail Food <l000sq' $70 October $1,225.00 $2,910.80 $540.00 $1,550.00 $6,225.80 1000-10,000 $28o >1o,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 s7o >7days s January-18 Example of>7 day temp food permit: $1,625.00 $7,845.00 $180.00 $2,450.00 $1,600.00 $13,700.00 14(days)divided by7=2x$70=$140 February $1,025.00 $1,695.00 $270.00 $4,100.00 $600.00 $7,690.00 Frozen Desserts $2s March $925.00 $2,325.00 $720.00 $2,150.00 $100.00 $6,220.00 Mobile Food $210 April $1,125.00 $835.00 $270.00 $1,050.00 $175.00 $3,455.00 Plan Reviews New s18o May $0.00 Remodel $go June Catering $25 pereventl$20o $0.00 catering kitchen Body Art Est. $315 Total $10,325.00 $101,170.90 $3,240.00 $19,800.00 $3,925.00 $138,460.90 Body Art Practitioner s135 Review Plans s18o Fiscal Year Budget 2018 Suntan Est. $140 Rec. Day Camp $10 Salary $tartinq Ending Expenses Ext.Paint Removal s35 Full Time $412,115.00 $117,432.42 Starting Ending Transport Off.Subst. s1o5 Part Time $43,354.00 $19,002.24 $32,500.00 $13,407.65 Tobacco Vendors $135 Overtime $5,800.00 $724.83 Swimming Pools Seasonal $140 Balance $461,269.00 $137,159.49 Health Clinic Revolving Account Annual$210 Nonprofit$40 511,221.19 Title V Review s18o Well Application s18o Disposal works $2251180 Breakdown of Permits and Fines April 2018 Permit Description Total Permits Issued Permit Cost Total Annual Food - <25 seats 2 $140.00 $280.00 Annual Food - Retail <1,OOOsq' 1 $70.00 $70.00 Food -Temporary Pop Up (1-3 days) 5 $35.00 $175.00 Burial Permit 45 $25.00 $1,125.00 Certificate of Fitness 21 $50.00 $1,050.00 Frozen Dessert 1 $25.00 $25.00 Funeral Director License 2 $75.00 $150.00 Plan Review- New or Major Renovation 1 $180.00 $180.00 Plan Review- Retail - New Owner 1 $90.00 $90.00 Tobacco Permit 1 $135.00 $135.00 Tobacco Violation 1 1 $75.00 $75.00 Tobacco Violation 1 $100.00 $100.00 Total #= 82 YTD = 1,676 Total $3,455.00 • CITY OF SALEM PUBLIC HEALTH REGULATION#7 Requirements for Placement, Collection and Disposal of Solid Waste by Residents, Mandatory Recycling for Residents and Businesses within the City of Salem and Solid Waste Disposal/Recycling Haulers Licensing and Operations Section I. Scope of Authority The Salem Health Department adopts the following regulation pursuant to authorization granted by M.G.L. c 111 s. 31 and 31B, 310 CMR 11.02 and 310 CMR 19.0 et seq. The regulation shall apply, as specified herein, to all residents, institutions and businesses, existing and new, within the City of Salem. This regulation was adopted on and shall be effective November 1, 2018. Section II. Purpose of the Regulation These regulations are intended to preserve the public and environmental health and are designed to 1) keep banned recyclable materials and certain toxic materials out of the solid waste stream, 2)regulate and license haulers of solid waste and recyclables and 3) establish requirements for the proper placement, collection and disposal of solid waste by residents and allowed small businesses in order to prevent public health nuisances that could lead to disease and/or environmental contamination. Section III. Definitions • For the purpose of this regulation, the following words and phrases shall have the following meanings: A. Allowed Small Business: Those small businesses as listed in the "City of Salem, Massachusetts, Contract for Solid Waste and Recyclable Materials, Collection and Transportation, dated July 1, 2015." B. Bag-Official Overflow Bag: 35 Gallon Plastic bag for excess solid waste that does not fit in the City carts. Bags are available for purchase at local stores including Crosby's and Winer Brothers. Volume shall not exceed 35 gallons and total weight of a bag and its contents shall not exceed 50 lbs. C. Bulky Waste: Included,but is not limited to, items weighing over 50 pounds or too large to place in a solid waste barrel such as furniture or a mattress/box spring,but excludes yard waste and construction debris and other waste ban items per 105CMR310 D. Construction Debris: Waste building materials resulting from construction, remodeling, repair and demolition operations and as set forth in the Department's Regulations relative to waste bans. E. Containers: A receptacle for solid waste or recycling. For the purposes of curbside • collection of solid waste, a Contractor designated and supplied 64-gallon cart. For purposes of recycling, a Contractor designated and supplied 96-gallon cart. The term • "cart" shall mean a 64-gallon(solid waste) or 96-gallon (recyclables) commercially manufactured plastic container with wheels and attached lid provided by the City's Solid Waste Collection Contractor(Contractor) for the storage and setout of solid waste and recyclables. An acceptable container may also include smaller containers, approved by the Contractor on a case by case basis. F. Department: The City of Salem Board of Health Office. G. Facility: A licensed solid waste resource recovery or recycling plant, transfer station or approved sanitary landfill or assigned or permitted composting site. H. Hazardous Waste or Material: Any waste that is defined and regulated under 310 CMR 30.00. I. Household: The single residential unit within a single or multi-family complex. J. Leaf and Yard Waste: Any deciduous and coniferous seasonal deposition, grass clippings, weeds, hedge clippings, garden materials and brush. Licensee: Any person(s) or company, which has applied for and obtained the appropriate license to collect solid waste within the limits of the City of Salem. K. Recyclables: As established set forth in 310 CMR 19.00 including,but not limited to glass containers, plastic containers, aluminum,metal containers and newspapers. Glass containers as defined shall be made of clear,brown or green glass, and shall exclude blue and flat glass (commonly known as window glass), dishes, pottery and crockery. Plastic containers shall be household plastic containers #s 1, 2, 3, 4, 5, and 7, excluding plastic film(plastic bags, for example). Aluminum as defined shall include cans,but exclude foil and containers or trays used in the packaging of food. Metal containers as defined shall be made entirely of ferrous metal (iron or steel) and • may exclude all pressurized cans and cans which have contained hazardous materials. Paper, cardboard and paperboard products including newspaper as defined shall mean unsoiled newsprint, including newspaper advertisements, supplements, comics, enclosures,magazines, catalogues and telephone books. L. Restricted Materials: As set forth in 310 CMR 19.00 including,but not limited to lead batteries, leaves, tires, white goods, other yard waste, aluminum containers,metal or glass containers, single polymer plastics, recyclable paper, cathode ray tubes, asphalt pavement,brick and concrete,metal and wood. M. Solid Waste collection vehicle: Any vehicle used for the delivery of solid waste and/or recyclable material. Said vehicle shall be in a safe, clean condition and in good repair, and appropriately marked identifying the haulers name, working phone number and place of business. N. Solid Waste: Useless,unwanted or discarded solid material, resulting from municipal or household activities that is abandoned by being disposed or incinerated or is stored, treated or transferred pending such disposal, not including any hazardous waste, special wastes. O. Special Waste: A solid waste that requires special handling(i.e. demolition/ construction material) or disposal techniques or methodologies to protect the public health or safety or the environment. P. White Goods: Stoves, refrigerators, water coolers, bubblers, dishwashers, clothes dryers, washing machines, freezers, air conditioners, and dehumidifiers. White Goods shall be classified as either Freon/refrigerant containing or non-Freon/refrigerant • containing types. 2 • Section IV. Requirements for Placement, Collection and Disposal of Solid Waste A. Time of Placement: City issued carts may be placed curbside for municipal collection no sooner than 6 PM the evening before the scheduled collection. All carts and overflow bags must be placed curbside no later than 7 AM on the day of collection and must be removed from the sidewalk on the same day as the collection. B. Solid Waste Acceptable Materials: Only items included in the solid waste definition in this regulation may be placed curbside in carts or overflow bags for collection. C. Bulky: Two bulky waste items per household per recycling week may be placed for collection per household and allowed small businesses. D. Hazardous Materials: Hazardous materials, such as those banned from regular solid waste disposal in accordance with 310 CMR 19.017, must be handled according to local, state and federal rules and regulations. E. Recyclable Materials: Recyclable materials may be placed curbside in City or Contractor issued carts for collection on the same day as regular solid waste collection on a bi-weekly schedule, see city website for schedule. Material placed in the cart must have the potential to be recycled and is identified, listed and accepted as such and which is not commingled with non-recyclable solid waste or contaminated by toxic substances as per 310 CMR 19.006. Up-to-date information regarding handling recyclable materials is located at www. salem.com/recycling-and-trash or by calling the City Engineer's office(978) 619-5673. F. E-Waste: May be disposed of privately. The City provides quarterly e-waste • collection. Most items are free. See city website for details. G. Yard Waste: Yard waste may not be included in regular municipal collection. It will be collected on a schedule agreed upon by the city and the city's contractor or brought to the Transfer Station on Swampscott Road seasonally. Yard waste must be placed in yard waste paper bags or open containers clearly marked as "yard waste." Trimmings may be bundled in lengths no more than three feet long. Branches may not have a diameter greater than 3 inches long and weigh no more than 50 pounds. H. Miscellaneous: 1. No person shall disturb, remove or collect any solid waste,bulky waste, recyclable material, white goods, or yard waste from any premises without consent of the owner, nor any waste placed out for collection upon any sidewalk or way except employees or contractors of the City. 2. No person, firm,business, or corporation shall place or keep any container, bag, box, crate, or any other receptacle containing solid waste or recyclable materials on any sidewalk in the City except for removal or collection by the City, its Contractor or a private collector. Waste or recyclable material may be placed curbside adjacent to the place such person, firm,business, or corporation resides or has a place of business. 1. Commercial collection: • 3 The owner of every business, other than the small businesses which have been • provided bins by the City and who follow the rules established for municipal curbside collection, shall provide, keep clean and in good repair proper and sufficient solid waste receptacles for the storage of solid waste and recycling. Such owner shall provide for the collection and removal of the solid waste and recycling by him/herself or by a private collector, at sufficient intervals, and in a manner to prevent a nuisance as may be determined by the Board of Health. Tightly covered containers may be placed curbside for private collection no sooner than 6PM the evening before the scheduled collection and must be removed from the sidewalk on the same day as the collection. In the event bags are utilized for private collection,bags may be placed curbside for collection no sooner than 6 AM the morning of the scheduled collection and must be removed from the sidewalk on the same day as the collection. Section V. Mandatory Recycling Regulation A. Solid waste collected by the City of Salem or any licensed rubbish hauler shall not contain recyclables or restricted materials. Each generator of waste and/or property owner/manager shall separate from non-recyclable rubbish all recyclables, as defined. B. Waste generators are responsible for ensuring that they do not contract for the disposal of recyclables or restricted materials with their solid waste. C. Owner/Manager of a property shall be responsible for immediate removal of all solid • waste and/or recyclables placed on or near the side of a street for collection which does not comply with the rules and regulations of the Salem Health Department. Failure to remove within 24 hours shall result in a fine being issued. D. No person shall willfully or maliciously disturb or handle the contents of or tip over or upset any container placed for the collection of solid waste or recycling. Section VI. Solid Waste Disposal/Recycling Haulers Licensing and Operations A. General: 1. Any person or company engaged in the collection of solid waste and recyclables shall obtain a license from the City of Salem. Solid waste and recyclables collected shall be brought to a Department of Environmental Protection(DEP) approved solid waste disposal facility. 2. The licensee shall provide Integrated Solid Waste Services, defined as providing bundled service for the collection of both Solid Waste and Recyclables for each Customer to allow compliance with the DEP solid waste bans found at 310 CMR 19. 3. All licensed solid waste disposal/recycling companies serving residential, municipal and commercial/industrial/institutional customers in the City of Salem shall provide customers with bundled service for the collection of both solid waste and recyclables at a rate that reflects the cost of both services. An approved recycling • service consist of a recycling collection, minimum bi-monthly(twice a month). 4 4. Individuals engaging in yard waste collection and/or removal of bio-degradable • waste shall obtain a permit from the Health Department and shall indicate the site of final disposal and maintain records on an annual basis for examination. B. Licensing procedure: 1. All persons collecting solid wastes in the City of Salem shall obtain a license from the Health Department prior to commencing with its collection. 2. At the time of application or as otherwise specified, the licensee shall submit to the Health Department the following information: a. A completed application form. b. A non-refundable $100 application fee for each vehicle. c. A list of the residential, municipal and commercial/industrial customers serviced by the collection. Supplied yearly. d. A description of the collection vehicle(s) to be used, including the make,model, registration, year, type and size of compactor, and the company name appearing on the vehicle(s). 3. An exact figure of the tonnage of solid waste and recyclables that have been collected from residential/commercial sites shall be submitted to the Health Department monthly on company letterhead and signed by company representative. 4. The Health Department reserves the right to require all vehicles collecting solid waste in Salem to have a marking thereon indicating they are licensed in Salem. 5. A licensee has the right to be heard by the Board of Health to discuss its application by making written request to the Department. • C. Insurance: 1. Each applicant shall furnish the Health Department with certificates from an insurance company, licensed to do business in the Commonwealth of Massachusetts showing the applicant carries public liability and property insurance. Certificates of insurance shall be furnished each year upon the renewal of the license. 2. The applicant shall make certain that the above insurance policy is not cancelled prior to notification of the Health Department. This notification shall be not less than(30) days prior to the cancellation. D. Operation Procedures: 1. The license shall expire on December 31 sc following the date of issue unless sooner revoked and shall be renewable annually on the first day of January subject to review and approval by the Health Department 2. No license shall be transferable except with the approval of the Health Department. 3. The licensee shall deliver all solid waste collected within the corporate limits of Salem to a licensed solid waste resource recovery plant, transfer station or approved sanitary landfill. 4. The licensee shall provide recycling service to allow compliance with the DEP solid waste bans and the Board of Health bans by the effective dates of those bans. 5. All recyclables must be collected at a minimum bi-monthly(twice a month). Licensees are required to collect both paper products and co-mingled • (glass/plastic/metal) at each pickup. 5 • 6. The licensee shall take all reasonable care in the collection of solid waste and recyclables. Solid waste and recyclables shall not be scattered about the streets or onto private property. Solid waste and recyclables which are spilled, shall be immediately picked up by the licensee and removed with other wastes. Failure to comply may result in fines up to $100.00 per incident. 7. The Health Department reserves the right to inspect collection vehicles and loads at reasonable times in order to ensure that they comply with all applicable state and local laws,by-laws and regulations. 8. Any violation of these regulations or any other applicable laws or regulations by the licensee will be grounds for suspension, modification or revocation of said license. 9. The individuals empowered to enforce the provisions of these regulations shall be the Agent of the Health Department and any member of the Department, or any Police Officer of the City. 10.Licensees are required to provide their customers with a list of acceptable waste types and recyclables according to Department regulation and with a list or description of proper packaging or bundling methods. 11. The licensee shall pick up from residential, commercial, institutional and industrial service recipients within the city limits between the hours of 7:OOam and 8:OOpm. 12. The licensee shall provide adequately sized receptacles for solid waste and recycling if necessary and maintain in a clean insect resistant manner free from odors, leaks, rodents and insects. 13.Licensees shall not store recyclables or solid waste in the vehicle on public ways overnight without permission of the Board of Health. • E. Indemnification: 1. Licensees may enter into arrangements for the collection of solid waste and recyclables with condominium units, residential apartment complexes in excess of six (6)units and commercial/industrial/institutional customers of the City. The licensee will be paid directly by the customer. The City shall have no liability for payment to the licensee for any residential or commercial/industrial/institutional collection and disposal work that is not included in the City's contract. 2. The licensee shall take all responsibility for the work and take all reasonable precautions for preventing injuries to persons or damage to property; shall bear all losses resulting to the collection company on account of the quantity or character of the work; shall indemnify and hold harmless the City of Salem, its officers, agents and servants from all claims relating to labor and materials furnished to do the work, and for all injuries to any person or corporation received or sustained by or from the licensee and its employees doing the work, in consequence of any improper materials, implements or labor used therein: and to any act, omission or neglect of the licensee and its employees. 3. The licensee agrees to indemnify the City for any liability that may arise from the improper treatment, storage or disposal of hazardous wastes collected within the City. F. Suspension, Modification or Revocation of licenses: • 6 • Any solid waste/recycling collection license may be suspended, modified or revoked by the Health Department upon receipt of evidence satisfactory that the licensee has not conformed to the requirements of these regulations or to any applicable state or federal statute, regulation, rule or order regarding the transportation or disposal of solid waste or the collection and disposal of solid waste or recycling. Appeals of any such suspension, modification or revocation may be directed to the Board of Health within ten(10)business days of said suspension,modification or revocation. Section VII. Enforcement Enforcement of this regulation shall be by criminal complaint in the district court and/or non- criminal disposition ticket M.G.L. Chapter 40, § 21D. Agents of the Health Department shall have the power to enforce the provisions of this regulation. The City shall also have the option of seeking equitable relief to enjoin violations of the rules and regulations of the Board of Health. Section VIII. Penalties A violation of these regulations may be punished by a fine set forth in City Ordinance Chapter 1- 10. Each day of failure to comply with the regulations shall constitute a separate violation. Section IX. Severability In case any section,paragraph or part of this regulation is for any reason declared invalid or unconstitutional by any court of last resort, every other section, paragraph or part shall continue in full force and effect. • 7 f Tobacco Community Fact Sheet Salem, Massachusetts Updated 03/19/18 The Massachusetts Tobacco Cessation and Prevention Program The mission of the Massachusetts Tobacco Cessation and Prevention Program(MTCP) is to reduce the health and economic burden of tobacco use by preventing young people from starting to smoke,helping current smokers to quit,and protecting children and adults from secondhand smoke.The following provides data and information on the impact tobacco use has on your city or town,and the strategies being used in your community to combat these issues. Cigarette Smoking . ., 40 %of Adult Smokers An estimated 5,290 smokers live in Salem(15.74% of adults, 30 age 18+). The adult smoking rate is about the same in Salem than 20 15.74 15.1 statewide (15.74% in Salem compared to 15.1% statewide). 10 The rate of smoking during pregnancy in Salem is about the same than statewide (6.8% in Salem compared to 6.8% 0 —M statewide). Salem MA Health Effects of Smoking • Evidence has linked smoking to diseases of nearly all organs of the body.The Surgeon General's report concludes that smoking causes: lung cancer,chronic obstructive pulmonary disease or lung disease, coronary heart disease,stroke,diabetes mellitus,rheumatoid arthritis and immune system weakness, increased risk for tuberculosis disease and death,ectopic (tubal) pregnancy and impaired fertility,erectile dysfunction,and age-related macular degeneration.Smoking can also trigger or make an asthma attack worse (2014 U.S. Surgeon General's Report). In Salem,lung cancer incidence is 11% higher among males compared to the state of Massachusetts. Lung cancer incidence in Salem is 10% lower among females compared to the state of Massachusetts. Mortality from lung cancer is about the same in Salem compared to Massachusetts. Men who smoke are 23 times more likely to develop lung cancer,and women are 13 times more likely, compared to never smokers (2004 U.S. Surgeon General's Report). QuitWorks and the Massachusetts Smokers' Helpline From January 2015 to December 2017,190 smokers enrolled in QuitWorks,a program for clinicians to refer their patients to the Massachusetts Smokers'Helpline. In addition,38 people from Salem called and completed an intake with the Massachusetts Smokers'Helpline to quit smoking. For more information on how to quit smoking,contact 1-800-QuitNow or talk with your health care provider about the QuitWorks program. ",,of • V� \� Massachusetts Department of Public Health Tobacco Cessation and Prevention Progra Make smoking history, m (617) 624-5900 www.mass.gov/dph/mtcp e�,,or v Tobacco Community Fact Sheet Salem, Massachusetts Updated 03/19/18 Illegal Tobacco Sales to Minors The rate of illegal sales to minors (those under age 18) is 169% higher in Salem(19.05%) compared to the state of Massachusetts (7.09%) based on data from fiscal year 2017. Number of tobacco retail stores Tobacco retail stores In Salem,there are 56 tobacco retailers.The number of retailers in a 3 per 1,000 adults community impacts the exposure youth have to tobacco industry tactics. An increased exposure can lead to an increase in use of tobacco products. 2 1.67 1.48 Considering the population in Salem,this is a high number of retailers when compared to the average of other Massachusetts 1 municipalities. For every 1,000 adults living in Salem,there are 1.67 tobacco retailers;the Massachusetts average is 1.47. 0 0 Salem MA Regulations in Salem addressing tobacco industry tactics Many municipalities in Massachusetts have exercised their authority to pass local health regulations. The following are policies that have been adopted throughout the Commonwealth to protect youth from exposure to tobacco industry tactics and whether they have been enacted in this community. Regulation prohibiting the sale of cheap single cigars: Y Regulation restricting the sale of flavored tobacco products to adult-only tobacco retail stores: Y Regulation prohibiting the sale of e-cigarettes to minors: Y Regulation capping the number of retailers with a license to sell tobacco: Y Regulation prohibiting the sale of tobacco products to individuals under age 21: Y Regulation prohibiting the sale of tobacco products in pharmacies: Y The Tobacco-Free Community Partnership The Tobacco-free Community Partnership programs educate local groups on tobacco issues and work with the Board of Health tobacco control programs to support local tobacco prevention strategies. Community Partnership Contact: Diane Knight,Dknight@glfhc.org, (978) 722-2864 Board of Health The Board of Health tobacco control programs educate decision makers and enforce all municipal tobacco regulations in 184 municipalities covering 65% of the Massachusetts population. Board of Health contact: Joyce Redford,putitout@lynnma.gov, (781) 598-4000 CF • � Massachusetts Department of Public Health Tobacco Cessation and Prevention Program - Make smoking history. (617) 624-5900 www.mass.gov/dph/mtcp �r ar Wa' e Tobacco Community Fact Sheet Salem, Massachusetts Updated 03/19/18 Data Sources Smoking figures are small area estimates based on data from 2013-2016 Behavioral Risk Factor Surveillance System,Massachusetts Department of Public Health. Smoking during pregnancy figures based on 2008-2012 Births(Vital Records),Massachusetts Department of Public Health. Health effects of smoking facts based on the 2014 U.S.Surgeon General's Report. U.S.Department of Health and Human Services.The Health Consequences of Smoking:50 Years of Progress. A Report of the Surgeon General. Atlanta,GA:U.S.Department of Health and Human Services,Centers for Disease Control and Prevention,National Center for Chronic Disease Prevention and Health Promotion,Office on Smoking and Health,2014.Printed with corrections,January 2014. Rates of lung cancer incidence are based on age-adjusted rates from 2006 to 2010 Cancer Registry maintained by the Massachusetts Department of Public Health. Figures on lung cancer mortality are based on comparability modified age-adjusted rates for 2008 to 2012 (Vital Records),Massachusetts Department of Public Health. Smoking and lung cancer health effects facts based on the 2004 U.S.Surgeon General's Report. • U.S.Department of Health and Human Services.The Health Consequences of Smoking: A Report of the Surgeon General.Atlanta,GA: U.S.Department of Health and Human Services,Centers for Disease Control and Prevention,National Center for Chronic Disease Prevention and Health Promotion,Office on Smoking and Health,2004. The number of completed screeners from the QuitWorks program and calls to the Massachusetts Smokers' Helpline is based on data collected by the Massachusetts Tobaccco Cessation and Prevention Program from calendar years 2015 to 2017. Illegal sales to minors is based on 63 compliance checks performed during fiscal year 2017.These checks were conducted with youth under the age of 18,regardless of the minimum legal age. Tobacco retail density counts are based on data received by the MA Department of Public Health as of 03/07/2018. Density is categorized based on the number of stores per 1,000 adults. -Low: 1.0 or fewer stores per 1000 adults -Medium:1.01 to 1.48 stores per 1000 adults -High: 1.49 to 2.0 stores per 1000 adults -Very high:Greater than 2.0 stores per 1000 adults Local tobacco regulation is based on information received by the MA Department of Public Health as of 02/28/2018. OF \vV Massachusetts Department of Public Health Tobacco Cessation and Prevention Program Make smoking history. (617) 624-5900 www.mass.gov/dph/mtcp L f a C t s h e e t Your Business and the Waste Bans: What You Need to Know Massachusetts What are waste bans? D e p a r t m e n t "Waste bans"are restrictions on the disposal,transfer for disposal and contracting for If E N V I R O N M E N T A L disposal of certain hazardous items and recyclable materials at solid waste facilities in P R O T E C T I O N Massachusetts. The waste bans are designed to: • Conserve capacity at existing disposal facilities. • Minimize the need for new facility construction. • Provide recycling markets with large volumes of material on a consistent basis. • Keep certain toxic substances or materials from adversely affecting our environment when landfilled or combusted. • Promote business and residential recycling efforts. What do I need to do? Remove& Recycle! Business managers should remove and recycle any banned materials they generate or run the risk that waste loads will be rejected at a disposal site, charged an additional handling fee or face potential enforcement penalties. Recycling at businesses can be easier and more economical than recycling at home, because the materials are generated in larger quantities and are easier to keep separate from the rest of the • trash. Recycling prevents unnecessary disposal of usable raw materials, saves energy and reduces air and water pollution. Recycling also reduces disposal costs and can save businesses money by diverting materials from the trash dumpster to the recycling bin. Your waste hauler may be able to help you establish a recycling program. Also, the Massachusetts Materials Trader has an extensive list of companies that collect or process recyclable materials. What is banned? Asphalt Pavement, Brick, and Concrete: asphalt pavement, brick and concrete from construction and demolition of buildings, roads, bridges, and similar sources. Batteries: Lead-acid batteries used in motor vehicles or stationary applications. Cathode Ray Tubes: Any intact, broken or processed glass tube used to provide the visual display in televisions, computer monitors and certain scientific instruments. Clean Gypsum Wallboard: A panel (known as drywall)with a gypsum core and faced with a heavy paper or other material on both sides that is not contaminated with paint, wallpaper,joint compound, adhesives, nails, or other substances after manufacture. Glass Containers: Glass bottles and jars. The ban does not cover light bulbs, Pyrex cookware, plate glass, drinking glasses, windows, windshields and ceramics. Leaves &Yard Waste: Leaves, grass clippings, weeds, garden materials, shrub trimmings, and brush one-inch or less in diameter(excluding diseased plants). •Page 1 of 2 Metal: Ferrous and non-ferrous metals derived from used appliances, building • materials, industrial equipment, vehicles, and manufacturing processes. Metal Containers:Aluminum, steel or bi-metal beverage and food containers. Recyclable Paper: All paper, cardboard, and paperboard products (EXCEPT tissue paper, toweling, paper plates and cups, wax-coated cardboard and other low-grade paper products). Single Resin Narrow-Necked Plastics:A soda bottle is narrow-necked but a yogurt container is not. White Goods:Appliances employing electricity, oil, natural gas or liquefied petroleum gas.These include refrigerators,freezers, dishwashers, clothes washers, clothes dryers, gas or electric ovens and ranges, and hot water heaters. Whole Tires: Motor vehicle tires of all types (Combustion facilities can accept whole tires for disposal. Shredded tires are not restricted). Wood: Treated and untreated wood, clean wood (trees, stumps, and brush, including but not limited to sawdust, chips, shavings and bark). (Combustion facilities can accept wood for disposal.) Massachusetts Department of Commercial Organic Material: Food and vegetative material from businesses and Environmental Protection institutions that dispose of one ton or more organic material per week. One Winter Street Did You Know? Boston,MA 02108-4746 The waste bans apply to all solid waste destined for a Massachusetts landfill, Commonwealth of combustion facility, or transfer station. Massachusetts Waste generators are responsible for ensuring that they do not contract for the disposal of banned items. Executive Office of Environmental Affairs Waste facility operators are responsible for ensuring that unallowable quantities of banned materials are not disposed or transferred for disposal from their facilities. Department of Facilities must check incoming waste in two ways. First, all loads must be visually Environmental Protection monitored for the presence of banned materials. Second, random inspections of waste load contents must be conducted. Produced by the MassDEP conducts inspections at solid waste facilities to identify haulers and Bureau of Air and Waste generators (businesses, institutions, municipalities, etc.)that dispose of banned March 2017 materials. Businesses and municipalities that do not divert banned items from their waste run the This information is available in risk of having solid waste facilities reject their waste and charge additional handling alternate format by calling our ADA fees, and potential enforcement penalties from MassDEP. Coordinator at (617)574-6872. For more information: Visit the MassDEP Waste Bans home page: http://www.mass.gov/eea/agencies/massdep/recycle/solid/massachusetts-waste- disposal-bans.html For assistance with finding a recycling service provider, contact the RecyclingWorks in Massachusetts program at(888)254-5525, via email at info(o)recyclingworksma.com, or visit the program website at www.recyclingworksma.com. •Page 2 of 2 �Y. r a m .e Y Y W,P x � 1 'Alk 4,- orl M f A t 74 kk x II r 6 , � •Aar, yn MID, • Guam A Healthy People 2020 , o � � `��° www.healthypeople.gov Healthy People 2020 Leading Health Indicators: Progress Update Executive Summary Healthy People 2020 (HP2020) provides a comprehensive set of 10-year, national goals and objectives for improving the health of all Americans.The initiative tracks the nation's health through over 1,200 objectives that span 42 distinct public health topic areas.The HP2020 Leading Health Indicators (LHIs) are a select subset of Healthy People objectives chosen to communicate high-priority health issues and actions that can be taken to address them. There are 26 LHIs organized into 12 topics. As of March 2014, progress generally has been positive toward achieving the HP2020 targets for the 26 LHIs, with 14 indicators (53.9%) having either met their target or shown improvement: • 4 indicators (15.4%) have met or exceeded their HP2020 targets. • 10 indicators (38.5%) are improving. • 8 indicators (30.8%) show little or no detectable change. • 3 indicators (11.5%) are getting worse. • 1 indicator (3.8%) has only baseline data. Noteworthy progress has been made for many of the indicators. • • Fewer adults smoking cigarettes • Fewer children exposed to secondhand smoke • More adults meeting physical activity targets • Fewer adolescents using alcohol or illicit drugs Status of the 26 HP2020 Leading Health Indicators March 2014 3 3.8% 4 11.5% R ■Target met ■ Improving 13 Little or no detectable change 8 t0 ■ Getting worse 30.8% 38.5% Q Baseline data only r r r r • 2 March 2014 a t h Healthy People 2020 Leading Health Indicators: Progress Update Target met' Improving' Little or no detectable change3 Getting worse' I Progress TopicToward Target',' Leading Health . - Access to Health Services AHS-1.1 Persons with medical insurance(percent, <65 years) 83.2% 83.1% 100.0% RE (2008) (2012) AHS-3 Persons with a usual primary care provider(percent) 76.3% 77.3% 83.9% (2007) (2011) Clinical Preventive Services © C-16 Adults receiving colorectal cancer screening based on 52.1% 59.2% 70.5% most recent guidelines(age adjusted, percent,50-75 years) (2008) (2010) HDS-12 Adults with hypertension whose blood pressure is 43.7% 48.9% 61.2% under control(age adjusted, percent, 18+years) (2005-08) (2009-12) D-5.1 Persons with diagnosed diabetes whose A1c value is 17.9% 21.0% 16.1% >9 percent(age adjusted, percen{,'18+years) (2005-08) (2009-12) © IID-8 Children receiving the recommended doses of DTaP, 44.3% 68.5% 80.0% polio, MMR, Hib, hepatitis 3, varicella and PCV vaccines (2009) (2011) (percent, aged 19-35 months) Environmental Quality EH-1 Air Quality Index(AQI)exceeding 100(number of billion 2.237 1.252 1.980 • person days,weighted by population and Air Quality Index value) (2006-08) (2009-11) TU-11.1 Children exposed to secondhand smoke(percent; 52.2% 41.3% 47.0% nonsmokers, 3-11 years) (2005-08) (2009-12) Injury and Violence © IVP-1.1 Injury deaths(age adjusted, per 100,000 population) 59.7 57.1 53.7 (2007) (2010) IVP-29 Homicides(age adjusted, per 100,000 population) 6.1 5.3 5.5 (2007) (2010) Maternal,Infant,and Child Health MICH-1.3 Infant deaths(per 1,000 live births, <1 year) 6.7 6.1 6.0 © (2006) (2010) © MICH-9.1 Total preterm live births(percent, <37 weeks 12.7% 11.5% 11.4% gestation) (2007) (2012) Mental Health ® MHMD-1 Suicide(age adjusted, per 100,000 population) 11.3 12.1 10.2 (2007) (2010) ® MHMD-4.1 Adolescents with major depressive episodes 8.3% 9.1% 7.5% (percent, 12-17 years) (2008) (2012) Nutrition,Physical Activity,and Obesity PA-2.4 Adults meeting aerobic physical activity and muscle- 18.2% 20.6% 20.1% strengthening Federal guidelines(age adjusted,percent, 18+years) (2008) (2012) ® NWS-9 Obesity among adults(age adjusted, percent, 33.9% 35.3% 30.5% 20+ years) (2005-08) (2009-12) © NWS-10.4 Obesity among children and adolescents(percent, 16.1% 16.9% 14.5% 2-19 years) 2005-08 2009-12 • NWS-15.1 Mean daily intake of total vegetables(age adjusted, 0.8 0.8 1.1 cup equivalents per 1,000 calories, 2+years) (2001-04) (2007-10) March 2014 3 i Healthy People 2020 Leading Health Indicators: Progress Update (continued) it • Target met' © Improvingz © Little or no detectable change3 Getting worse° TopicProgress Baseline Most Recent Toward Target'," Leading Health Oral Health ® OH-7 Persons who visited the dentist in the past year(age 44.5% 41.8% 49.0% adjusted, percent, 2+years) (2007) (2011) Reproductive and Sexual Health Baseline data only? FP-7.1 Sexually experienced females receiving reproductive 78.6% Not available 86.5% health services in the past 12 months(percent, 15-44 years) (2006-10) © HIV-13 Knowledge of serostatus among HIV-positive persons 80.9% 84.2% 90.0% (percent, 13+years) (2006) (2010) Social Determinants © AH-5.1 Students awarded a high school diploma 4 years after 74.9% 78.2% 82.4% starting 9th grade(percent) (2007-08) (2009-10) Substance Abuse SA-13.1 Adolescents using alcohol or illicit drugs in past 30 18.4% 17.4% 16.6% days(percent, 12-17 years) (2008) (2012) SA-14.3 Binge drinking in past 30 days-Adults(percent, 27.1% 27.1% 24.4% 18+years) (2008) (2012) Tobacco © TU-1.1 Adult cigarette smoking(age adjusted, percent, 20.6% 18.2% 12.0% 18+years) (2008) (2012) • TU-2.2 Adolescent cigarette smoking in past 30 days(percent, 19.5% 18.1% 16.0% grades 9-12) (2009) (2011) NOTES DATA SOURCES Target met or exceeded AH-5.1 Common Core of Data(CCD),ED/NCES z Movement is toward the target and is: AHS-1.1 National Health Interview Survey(NHIS),CDC/NCHS -Statistically significant when measures of variability are available*-OR- AHS-3 Medical Expenditure Panel Survey(MEPS),AHRQ -10%or more of the targeted change when measures of variability are C-16 National Health Interview Survey(NHIS),CDC/NCHS unavailable* D-5.1 National Health and Nutrition Examination Survey(NHANES), a Objective demonstrates little or no detectable change,because either: CDC/NCHS -Movement toward/away from the target is not statistically significant when EH-1 Air Quality System(AQS),EPA measures of variability are available*-OR- FP-7.1 National Survey of Family Growth(NSFG),CDC/NCHS -Movement is toward the target but the objective has achieved less than HDS-12 National Health and Nutrition Examination Survey(NHANES), 10%of the targeted change when measures of variability are unavailable* CDC/NCHS -OR- HIV-13 National HIV Surveillance System(NHSS),CDC/NCHHSTP -Movement is away from the target but the objective has moved less than IID-8 National Immunization Survey(NIS),CDC/NCIRD and 10%relative to its baseline when measures of variability are unavailable* CDC/NCHS -OR- IVP-1.1 National Vital Statistics System-Mortality(NVSS-M),CDC/NCHS -No change between baseline and most recent data point IVP-29 National Vital Statistics System-Mortality(NVSS-M),CDC/NCHS Movement is away from the target and is: MHMD-1 National Vital Statistics System-Mortality(NVSS-M),CDC/NCHS -Statistically significant when measures of variability are available*-OR- MHMD-4.1 National Survey on Drug Use and Health(NSDUH),SAMHSA -10%or more relative to the baseline when measures of variability are MICH-1.3 Linked Birth/Infant Death Data Set,CDC/NCHS unavailable* MICH-9.1 National Vital Statistics System-Natality(NVSS-N),CDC/NCHS s For objectives moving away from their baselines(and,therefore,their NWS-9 National Health and Nutrition Examination Survey(NHANES), targets)progress is measured as the magnitude of the percent change from CDC/NCHS baseline,quantified as follows: NWS-10.4 National Health and Nutrition Examination Survey(NHANES), CDC/NCHS Magnitude of percent change Most recent value-Baseline value) NWS-15.1 National Health and Nutrition Examination Survey(NHANES), from baseline = x100. CDC/NCHS Baseline value OH-7 Medical Expenditure Panel Survey(MEPS),AHRQ For objectives moving toward their targets,progress is measured as the PA-2.4 National Health Interview Survey(NHIS),CDC/NCHS percent of targeted change achieved,quantified as follows: SA-13.1 National Survey on Drug Use and Health(NSDUH),SAMHSA Most recent value-Baseline value SA-14.3 National Survey on Drug Use and Health(NSDUH),SAMHSA Percent of targeted change achieved= x100. TU-1.1 National Health Interview Survey(NHIS),CDC/NCHS HP2020 target-Baseline value TU-2.2 Youth Risk Behavior Surveillance System(YRBSS), Baseline data only;progress cannot be assessed CDC/NCHHSTP *When measures of variability are available,statistical significance of the percent TU-11.1 National Health and Nutrition Examination Survey(NHANES), of targeted change achieved or the magnitude of the percent change from CDC/NCHS baseline is assessed at the 0.05 level using a one-sided test.When measures of variability are unavailable,the percent of targeted change achieved and Ado the percent change from baseline are assessed only for their magnitude(e.g., <10%or 210%). U.S.Department of Health and Human Services a t7(� Office of Disease Prevention and Health Promotion v • https://www.healthypeople.gov/2020/leading-health-indicators/Leading-Health-I ndicators-Development-and-Framework Leading Health Indicators Development and Framework Leading Health Indicators Development and Selection Process The process of selecting the Leading Health Indicators (LHIs)mirrored the extensive collaborative efforts undertaken to develop Healthy People 2020. The process was led by the Healthy People 2020 Federal Interagency Workgroup, with approximately 50 members from across the U.S. Department of Health and Human Services (HHS) and other Federal departments. Reports by the Institute of Medicine of the National Academy of Sciences and the Secretary Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020 • provided several recommendations for HHS to consider in developing the final set of LHIs. In addition, consideration was given to other indicator sets, such as the National Prevention Strategy mandated by the Affordable Care Act, as well as to key priorities of the secretary and the assistant secretary for health, to ensure alignment among,the various prevention initiatives within HHS and across the Federal government. Leading Health Indicators Framework The Healthy People 2020 LHIs were selected and organized using a Health Determinants and Health Outcomes by Life Stages conceptual framework. This approach is intended to draw attention to both individual and societal determinants that affect the public's health and contribute to health disparities from infancy through old age, thereby highlighting strategic opportunities to promote health and improve quality of life for all Americans. • Determinants of Health and Health Disparities Biological, social, economic, and environmental factors—and their interrelationships— influence the ability of individuals and communities to make progress on these indicators. Addressing these determinants is key to improving population health, eliminating health disparities, and meeting the overarching goals of Healthy People 2020. • Health Across Life Stages LHIs are being examined using a life stages perspective. This approach recognizes that specific risk factors and determinants of health vary across the life span. Health and disease result from the accumulation(over time) of the effects of risk factors and • determinants. Intervening at specific points in the life course can help reduce risk factors ti • and promote health. The life stages perspective addresses 1 of the 4 overarching goals of Healthy People 2020: "Promote quality life, healthy development, and health behaviors across all life stages." 2020 LHI Topics Are You Leading the Leading Health Indicators? Healthy People 2020 is looking for real stories from organizations implementing innovative programs to target specific Leading Health Indicators. Share your story! The Leading Health Indicators (LHIs) are composed of 26 indicators organized under 12 topics. The Healthy People 2020 LHIs are: Access to Health Services • Persons with medical insurance (AHS-1.1) • Persons with a usual primary care provider(AHS-3) Clinical Preventive Services • Adults receiving colorectal cancer screening based on the most recent guidelines C-16 • Adults with hypertension whose blood pressure is under control (HD S-12) • Persons with diagnosed diabetes whose Al c value is greater than 9% (D-5.1) • Children receiving the recommended doses of DTaP, polio, MMR, Hib, HepB, varicella and PCV vaccines by age 19-35 months (IID-8) Environmental Quality, • Air Quality Index>100 (EH-1) • Children exposed to secondhand smoke(TU-11.1) Injury and Violence • Injury deaths (IVP-1.1) • Homicides (IVP-29) Maternal, Infant, and Child Health • All Infant deaths (MICH-1.3) • 0 Total preterm live births (MICH-9.1) Mental Health • Suicide(MHMD-1) • Adolescents with a major depressive episode in the past 12 months (MHMD-4.1) Nutrition, Physical Activity, and Obesity • Adults meeting aerobic physical activity and muscle-strengthening objectives (PA-2.4) • Obesity among adults (NWS-9) • Obesity among children and adolescents (NWS-10.4) • Mean daily intake of total vegetables (NWS-15.1) Oral Health • Children, adolescents, and adults who visited the dentist in the past year(OH-7) Reproductive and Sexual Health • Sexually active females receiving reproductive health services (FP-7.1) • Knowledge of serostatus among HIV-positive persons (HIV-13) Social Determinants • Students graduating from high school 4 years after starting 9th grade(AH-5.1) Substance Abuse • Adolescents using alcohol or illicit drugs in past 30 days (SA-13.1) • Binge drinking in past month—Adults (SA-14.3) Tobacco • Adult cigarette smoking(TU-1.1) • Adolescent cigarette smoking in past 30 days (TU-2.2) A Styrofoa m Ban in Salem s Kelsey Currier-Dougherty, } Salem Sound Coastwatch Intern °°Rtl12009bacv Salem High School Junior p mp* What is Styrofoam made out of? 0 PS, PVC • PETE are the three more • plastics within codes • PETE HDPE PVC LDPE PP PS OTHER polyethylene high-density polyvinyl low-density polypropylene polystyrene ! other plastics, terephthalate polyethylene chloride polyethylene [ including acrylic, soft drink milk jugs, � trays for crushed furniture, toys,hard M polycarbonate, bottles, cleaning sweets,fruit, bottles, consumers, packing, polyactic mineral water, ' agents, , plastic packing shopping bags, luggage,toys refrigerator � fibers,nylon, fruite juice laundry (bubble foil) highly- as well as trays,cosmetic � fiberglass container, detergents, and food foils resistant sacks bumpers, bags,costume I cooking oil bleaching to wrap the and most of lining and jewellery, ', agents, foodstuff the wrappings external CD cases, h shampoo borders of the vending cups bottles, cars washing and ' shower soaps i Why Ban Styrofoam , or Expanded Polystyrene ( EPS)? • Styrene is reasonably anticipated to be a carcinogen by the US Board of Health, 2002 and the International Agency for Research on Cancer (IARC) • EPA: styrene is related to damage to nervous and respiratory systems, and possibly kidney issues. Ci— • When heated, EPS can leach into foods and beverages Styrene o Students tend to stab at plates while they eat- ._ . increasing the chance of leaching. • PS factory worker exposure can be dangerous. • All trash in Salem is incinerated, releasing PAHs, which are linked to kidney and liver damage among other health effects. (Illinois Board of Health). Why Ban Styrofoam , or Expanded Polystyrene ( EPS)? ENVIRONMENTAL EFFECTS • EPS is a large part of marine debris • Styrofoam is not recyclable by normal means. • EPS is non biodegradable. • Because it is porous, Styrofoam can soak up many harmfulT r tn5 '- substances like DDT. • Styrofoam is made out of petroleum, which has to be _ --- -�- mined. Mining is not usually an environmentally friendly practice. Who are the biggest styrofoam offenders in Salem? • Dunkin Donuts o Promises to stop using styrofoam by 2020 o Has 13 locations in Salem • School System o Uses 3000 styrofoam trays each school day o Has several options including paper or reusable trays, or paper boats. • Other restaurants / coffee shops • Transportation o Packaging is hard to regulate since things are often shipped from other towns The Proposition • Create aboard of health regulation banning all polystyrene used citing both environmental and health reasons, similar to the one passed in Abington, Massachusetts: unicipalities in « No food Establishment shall use disposable food MA have EPS bans. containers made from polystyrene or expanded Ipswich, Marblehead, polystyrene to serve prepared food. No person shall Gloucester purchase, sell or distribute any polystyrene containers HamiltonILL - EPS from a food establishment. » legislation. Goals for the future Compost PVC Program in PETE Ban Salem Public Ban ffordable Schools alternative for school lunch DD tsrays suppor Get City support Ban on EPS and an - packaging E panded Polystyrene in Ban on Salem all PS TrIT i • . • • • - • • • 0 WON • • • • . • . ti Cl • �� � �„tir i i' � 1 r r � • ,�fr`''.� `�,.' 1,. {r` , tea, r x .---mow i • There are many types of plastics,the most harmful of which are PVC, PETE and Polystyrene. Health Effects • Styrene is reasonably considered to be a carcinogen by the US Board of Health, 2002 and the International Agency for Research on Cancer(IARC) • EPA: related to damage to nervous and respiratory systems,and possibly kidney issues. • All Salem trash is incinerated. Incinerated polystyrene gives off Polycyclic Aromatic Hydrocarbons(PAHs)."Possible long-term health effects caused by exposure to PAHs may include cataracts,kidney and liver damage and jaundice"-IL department of health • When heated, EPS can leach into foods and beverages o Students,a sensitive population that is directly exposed to EPS,tend to stab at plates while they eat-increasing the chance of leaching. o Students get repeated exposure to the petroleum,since most students (80%) eat lunch and often breakfast at school-all of which contain similar amounts of plastic. • PS factory worker exposure can be dangerous. o Styrene is linked to leukemia,lymphoma,and other blood cell cancers. It has also been linked to genetic damage and increased risk of cancer of the esophagus and pancreas.(EPA) https://www.epa.gov/sites/production/files/2016-09/documents/Styrene.p df 0 Environmental Effects • EPS is a large part of marine debris • Styrofoam is not recyclable by normal means. • EPS is non biodegradable. o Because of this,it is long lasting pollution. • Because it is porous,Styrofoam can soak up many harmful substances like DDT. • Styrofoam is made out of petroleum o Petroleum isn't a sustainable resource-it is limited,compared to bioplastics, which can be regrown. o Mining is often an environmentally harmful practice,causing everything • from land recontour and habitat destruction to greenhouse gases to air pollution. I i Offenders • Dunkin Donuts-there are 13 in Salem alone. o Has promised to get rid of styrofoam by 2020 • The School system o Uses approximately 3000 styrofoam trays per day,80%of students are exposed. • Other restaurants,(Reds, Honey Dew,etc.) Proposition • We should ban styrofoam through the board of health • Abington made a ban through the board of health,(most towns create ordinances.) o Abington Ban: http://nebula.wsimg.com/028cfcelb435ed84celb6ba39af7a7l4?AccessK eyld=1C31A3B4B1A73412F089&disposition=0&alloworigin=l • 29 municipalities have legislated polystyrene: o Link to Mass Green Network Polystyrene Legislation: o http://www.massgreen.org/polystyrene-legislation.html There are ways to expand on a possible ban, like Brookline did, now banning PVC and transportation styrofoam in addition to their original ban.