Loading...
WC CWF Health District Board Minutes - 10/28/2016WICHITA FALLS -WICHITA COUNTY PUBLIC HEALTH BOARD MINUTES October 28, 2016 Wichita Falls -Wichita County Public Health District 1700 Third Street - Parker Conference Room Wichita Falls, Texas BOARD MEMBERS PRESENT: Scott Plowman, Chair Restaurant Association -City Robin Moreno, MHA -HSA, ACHE Citizen At -Large -City Keith Williamson, M.D. David Carlston, Ph.D. Larry Rains, D.D.S BOARD MEMBER EXCUSED ABSENCE: Julie Gibson, D.V.M., Vice -Chair BOARD MEMBER UNEXCUSED ABSENCE: Diane Stewart, R.N., Secretary OTHERS PRESENT: Lou Kreidler, R.N., B.S.N. Amy Fagan, M.P.A. Ahmed A. Mattar, M.D. Stephan Santellana Physician -City Citizen At -Large -County Dentist -County Veterinarian -City Registered Nurse -City Director of Health Assistant Director of Health Local Health Authority Council Liaison I. CALL TO ORDER Scott Plowman called the Health Board meeting to order at 12:05 pm after a quorum of members was attained. II. APPROVAL OF MINUTES AND ABSENCES Scott Plowman called for the review and approval of minutes from the meeting held on Friday August 5, 2016. Dr. Williamson introduced a motion to approve the minutes and Dr. Rains seconded the motion. The motion passed unanimously. At this time it was noted the excused absence of Dr. Gibson and the unexcused absence of Diane Stewart. III. HEALTHY COMMUNITIES UPDATE Amy Fagan, Assistant Director of Health presented an update of the Strategic Planning and Action in Public Health. The Public Health District VISION is Healthy People, Healthy Community the MISSION is Preventing Illness and Injury, Promoting a Healthy and Safe Community, Protecting All Members of Our Community the CORE VALUES are Professional Staff, Progressive Programs. The Health District offers a variety of services and programs to aid in the achievement of the healthy people, healthy community vision goal. Internal endeavors are to better educate staff on what the Health District does and the overall role of public health. An all staff meeting was held in September that involved each staff member on their job performance, their overall purpose, and how that evolves all staff into the same public health goal. The ten essential public health services are the National Public Health Performance Standards from the Centers for Disease Control and Prevention (CDC). 1) Monitor Health Status 2) Diagnose and Investigate Health Problems 3) Inform, Educate and Empower People 4) Mobilize Community Partnerships 5) Develop Policies and Plans 6) Enforce Laws and Regulations 7) Link People to Needed Health Services 8) Assure a Competent Workforce — Public Health and Personal Care 9) Evaluate Health Services 10) Conduct Research for New Innovations In 2009 the National Association of County & City Health Officials (NACCHO) developed the Mobilizing for Action through Planning & Partnership (MAPP) process a widely used framework for public health planning. The first iteration of the MAPP process started in 2009 and the second iteration started in 2015. The process includes four assessments: 1) Community Themes and Strengths Assessment, 2) Local Public Health System Assessment, 3) Community Health Status Assessment, and 4) Forces of Change Assessment. These assessments are used to identity strategic issues for which goals and strategies are then identified. The health of the community is a shared responsibility not only for health care providers and public health officials but also for community residents. The Community Health Improvement Plan (CHIP) sets out the goals and strategies of the Health Coalition of Wichita County to help create a healthier community. CHIP provides a framework for the community to use to come together to improve its health, wellbeing, and quality of life. The first CHIP for Wichita County was a publication of 3,000 copies in 2013 setting forth goals, objectives and strategies for 2013-2015. The second CHIP was a publication in 2016 of 6,000 copies that provided goals, objectives, and strategies for 2016-2018. It not only incorporated accomplishments and lessons learned from the first iteration but took a new look at Wichita County. The Health Coalition of Wichita County was formed in 2012 that continues today with many of the same participants plus additional new organizations and members. The Coalition structure has evolved with a hub surrounded by working sub -groups focused on specific interest areas tied to the goals and objectives of the CHIP. The sub -groups include members of the Coalition and other interested community members. The hub and sub structure has greatly expanded with the involvement of community members that must continue to evolve to achieve the goals. Led by co- chairs and the Assistant Director of the Health District an Executive Committee was established in 2014 as a way to ensure continuity and collaboration. Coalition and working group members participated in many aspects of the four assessments which were used to determine how to best move forward. Improving the health and quality of life in the community requires pooling the community's resources to target areas with the most need as a united force. Everyone in the community possesses unique expertise and resources to fill a specific need and complement each other in meeting the goals of the Wichita County Health Coalition. The purpose of a Community Health Assessment (CHA) is to identify the health needs and issues of a community. A detailed Wichita County CHA was completed in 2011 and updated in 2012. A new CHA was conducted in late 2015 and early 2016. The completion of a CHA involves gathering information about the health status and quality of life of the residents of Wichita County. Information on disease and injury morbidity and mortality, health behaviors, and social and economic wellbeing is examined to develop a health status and quality of life profile of Wichita County. A summary of the results of the CHA should be viewed as one tool for understanding the health and wellbeing of Wichita County. Positive Factors: • High rate of high school graduation 2 • Low rate of unemployment • Gradual decline in tobacco use • Leveling off of obesity rates • Leveling off or gradual decline in diabetes prevalence • Excellent availability of and access to mary health services • Decreasing number of uninsured Negative Factors: • High birth rate to women under 18 • High obesity rates • High proportion of physically inactive adults • High proportion of uninsured • Low median household income • High proportion of children living in poverty • High tobacco use rate • High incidence of sexually transmitted infections Health Status and Outcomes Problem Areas • High excess mortality across most disease and injury categories • High cardiovascular disease morbidity and mortality rates • High cancer morbidity and mortality rates • High infant mortality rates • High low -birth weight rates • High prevalence of depressive disorders • Emerging morbidity and mortality associated with an increasing population over age 65 including Alzheimer's disease Population Risk Issues • Higher risk of morbidity and mortality in most diseases among men • Higher morbidity and mortality among those with lower incomes • Higher rates of obesity, cigarette use, and inactivity among those with lower incomes • Higher low birth weight births among Blacks and Hispanics • Higher infant mortality rates among Blacks • Higher overall mortality among Blacks ages 4 or less and 25 or older Wichita County's overall "Health Outcomes" rank in the 2016 County Health Rankings was 144 out of the 241 Texas counties included. Outcome rankings have fallen into the third quartile, the bottom 51% of 75% of Texas counties over the past five years. The rankings suggest there is room for improvement and the areas on which to focus to make improvements in health status and outcomes. Health Behaviors Scores from 2016 County Health Rankings *Index of factors that contribute to a healthy food environment where 0 is worst and 10 is best **Rate per 100,000 population Wichita Count Texas Top U.S. Performers Adult Smoking19% 15% 14% Adult obesity29% 28% 25% Food environment index* 5.5 6.4 8.3 Physical inactivity29% 24% 20% Access to exercise opportunities 84% 84% 91% Excessive drink 17% 18"/0 12% Alcohol -impaired drivin deaths 30% 32% 14% Sexual]transmitted infections**1 515.4 498.3 134.1 Teen births 1 58 52 52 *Index of factors that contribute to a healthy food environment where 0 is worst and 10 is best **Rate per 100,000 population Scott Plowman asked with the new smoking ban how long would it be for the new rankings Amy Fagan replied the 19% only reflects 1,100 people of our 140,000 population because the Behavioral Risk Factor Surveillance System (BRFSS) survey does a percentage base that is not necessarily representative but is operable under those assumptions. Tobacco Prevention & Control Coalition (TPCC) program does a real time data collection from kids in the community. The Surgeon General said a few years ago that it is around 80-90% of those that have smoked prior to the age of 18 are smokers now that those over the age of 18 very few start smoking and had never smoked as a child. One of the top goals of TPCC is to reach out to those kids the hope is to get into the schools to influence and impact those kids to never start and if started to stop tobacco usage to include cigarettes and e -cigarettes which has seen substantial usage. The real time data is collected through the youth tobacco survey now in year 3 of collecting data the data reflects a decrease across the board in cigarette and other tobacco product usage over those 3 years. Scott Plowman said he had seen a difference with his employee usage. In Clinical Care Wichita County was ranked 13t" out of the 241 counties. The clinical care area of the assessment is an examination of the availability of and access to various health services. The evidence suggests that the county is doing well with the needed primary care physicians and dentists, although there may be need for more mental health providers. The Uninsured rankings; Wichita County 22%, Texas 25%, Top U.S. Performers 11%. The results indicate that people without insurance are more likely to delay or not receive needed care due to cost. Also it indicates the uninsured population has declined that should reduce the number of individual who cannot afford needed care. Wichita County ranks 132 in the Social and Economic Factors. The county has a number of areas of strength; low unemployment rate, high rate of high school graduation, fairly low income inequality ratio. A community with higher income inequality may experience a lower sense of community and more distrust among segments of the community. There are areas of weakness with high rates; children living in poverty, children in single -parent households, poverty rates among ethnic groups and injury deaths. The Health Coalition met and discussed how to proceed with the Community Health Improvement Plan (CHIP) second iteration for the next 3 years. The verbiage was changed to a culture of health it is about embracing an overall culture of health whereby we hold each other accountable. One thing done around building a culture of health is encourage health changes or improvements within community business and organizations to put people together for that accountability piece that is a culture of health. CHIP: PUBLIC HEALTH SYSTEM STRATEGIC GOALS Goal 1 — Create a culture in the community that supports and encourages healthy behaviors, positive attitudes towards preventive health and access to resources needed for health and well- being. • 5-2-1-0=8 Program • For Vida Program • Access to Healthy Foods • Diabetes Prevention Program (DPP), D;abetes Empowerment Education Program (DEEP), Improved Collaboration for Diabetes • TATU, Fresh Start, Reduce Exposure to Second Hand Smoke Goal 2 — Increase early identification and treatment of individuals with behavioral/mental health issues to include substance abuse. • Mental Health First Aid Program • Improve Attitudes for Treatment • Improve Integration between Physical Health and Mental Health Services 12 Goal 3 — Strengthen the health service delivery system to better meet community needs. • Recruitment and Retention • Collaboration Across the Continuum of Care • Health Resources and Health Literacy There is a need to look 5 to 10 years ahead are get crushed. Everything has changed so much in the last 5 to10 years the District has done well to stay ahead of the curve to make changes in prevention to form the Health Coalition to maintain operational. The budget is about 5.6 million dollars which 40% come from grants with that being only 60% of the overall City budget that is not very much. The Health District has been engaged in the development of a strategic plan over the past several years to identify the public health needs of the community, how to service those needs and how best to move forward into the future. A five year strategic plan has been developed to define the purpose, direction, and guiding principles of the department. The plan details the strategic targets, goals and strategies that are essential to improving the organization and supporting the community in an effort to improve health outcomes in Wichita County. The Health District is diverse in the work that is performed each employee brings to public health the importance of partnership and collaboration. The strategic planning process is presented in three primary outputs: strategic targets, goals, and strategies. Strategic targets are the focus of strategic action to address community and organizational needs and enable the Health District to effectively carry out its mission and accomplish its vision. The goals are statements of the results that should occur with respect to the strategic targets, and the strategies are the broad approaches for accomplishing the goals. STRATEGIC TARGETS Health Status - Health status of the community in terms of disease morbidity and mortality o Chronic diseases including cancer, heart disease, and diabetes mortality and morbidity o Infant mortality and low birth weight rates o Resistant and emergent infectious diseases o Food borne disease Behavioral — Health related behaviors that contribute to the health of individuals and the community o Poor dietary choices, infrequent exercise, tobacco use, and alcohol abuse o Resistance to immunizing children for childhood diseases Public Safety and Environmental - Environmental issues and hazards that affect community health o Water quality and water resources o Exotic animals o Dangerous dogs and feral cats o Hazardous materials o Severe weather conditions and consequences Operational — Factors affecting the performance of the organization o Financial resource constraints o Changing reimbursement approaches for clinical services o Recruiting and retaining qualified staff o Ongoing professional development of staff o Communication, collaboration, and problem solving across all staff o Quality improvement and evidence -based programs and practices o Public awareness of the Health District's role in and value to the community o Rapid technological changes Public Health System — Needs to strengthen the public health system o Information exchange across health service providers o Public knowledge of navigating the health service delivery system o Collaboration among members of the public health system 5 GOALS AND STRATEGIES Goal 1— Foster an organizational culture of excellence and continuous improvement. The goal is to be an organization that is focused on excellence to do better every day with continuous improvements. Staff has been encouraged to embrace the ideology. A quality improvement team was established with division heads and leaders to also engage the front line staff. The team implemented a new employee orientation within the department that has been good to see from their level of concern of what they thought were important. Goal 2 — Build knowledge among community members and stakeholder groups of the value the Health District contributes to Wichita County. A most important goal other than the day to day operation is for people to understand the value that the Health District contributes to the community. Whether it is internally with staff or their own families it is easier when your family actually has a clue of what you do as the same in the community it is easier for people to understand who and what the Health District does when it is communicated. The staff has been challenged to be a public health advocate the more that can be reached the more to teach. As example; an Animal Control Officer in the field is interfacing with a mom and babies ask if she knows about WIC or you hear someone in WIC say their kid does not have immunizations send them over to immunizations give the information out on the Health District services. Goal 3 — Strengthen the capacity for the Health District to sustain and/or expand its services to ensure community needs are met. To strengthen the people within the department, marshal resources, and focus on being good stewards of the tax payer dollars. The Nursing division has been reorganized three times in the last 5 years to be able to do the work around what needs to happen based on the overall culture of health. Goal 4 — Increase use of technology to improve operational efficiency and service quality. To implement an electronic public health information management system to include electronic health records. Develop a technology improvement plan to identify additions and improvements in technical support systems. Increase use of social media to communicate and engage the public. Goal 5 — Strengthen the capacity for the Health District to sustain and/or expand its services to ensure community needs are met. Increase the proportion of populations at risk for chronic disease engaging in primary and secondary prevention to reduce the effects of chronic disease on quality of life. Continue to work with the Health Coalition of Wichita County to initiate and enhance prevention activities. Goal 6 — Ensure effective responses to prevent and control infectious disease, environmental hazards, and threats to public health and safety. Work with local governments to ensure that codes and ordinances are up to date and consistent with federal and state guidelines. Engage in review and update of operations including inspection and enforcement that are consistent with current federal and state guidelines. The strategic plan serves to ensure that the diverse and complex components of the Health District are all moving in the same direction. A successful accomplishment of the goals and strategies depend on the continued commitment of the Health District staff and the Wichita County citizens involved to improving the health and quality of life. Dr. Williamson asked what the overall health score was. Amy Fagan replied the lower one-third in Texas and Texas is the lower one-third in the United States. The bottom 51 % of 75% of Texas counties over the past five years the ranking reflects the need for improvement. Councilor Santellana questioned that over the years as the Hispanic population grows does the 1.9 health score go down. Dr. Mattar answered no that it has been traditionally very low In addition Amy Fagan stated the percentage of Hispanic and African-American in the community had increased over time. Also the Vietnamese population which is a different assessment challenge because it is a hard community to engage and interact when they keep to themselves you need to have an insider track. Dr. Mattar asked if the Vietnamese was a very big community Amy Fagan responded bigger than you would think. It is challenging to even get the right percentage there are populations here whom are not documented and may not be adequately reflected. The Health District survey work was expanded to ask people about their race and ethnicity and found in the most recent that 40% identified with more than 3 races. Councilor Santellana asked if the scores effect grants. Amy Fagan replied yes because of poor health outcomes the District has gotten several grants. Lou Kreidler said that one of the items she takes to council Tuesday is the Healthiest Cities and Communities challenge. Wichita Falls was 1 of 50 cities and counties in the Nation and 3 in the State of Texas along with Waco and Brownsville to be challenged to improve health outcomes in the community part of the reason chosen was because of the bad health outcomes. It is a 2 year cycle period they are to look at innovative projects with prizes to be awarded up to $500,000. There are 3 different projects in review. The Health District has a lot of work to do within the community it is just not us but working with the Health Coalition and Community Partners because it cannot be done alone. Scott Plowman asked how the Animal Control Center is coming along Lou Kreidler said it was due to be finished August 1, 2016 now it is October the last letter that went out was the contractors are about $17,000 in liquidated damages. A bad job was done on the flooring poured in back it appeared they had never done it before the trench for all the waste matter to go was pitted everything was going to catch and hang. It is a continuous floor so there can be no place for bacteria to grow. Animal Services can take pride that there has not been any major outbreak of disease and it is because of the dedicated kennel staff that do a great job of cleaning but they cannot if the surfaces are not what they need to be. Also the color chosen because it matched was not the color used so they had to come in grind all the color off and redo it then they did a horrible cock job around the windows they have to take that out to redo they have a lot of issues with quality control. Larry Rains asked if it was a local contractor and are they going to make it right. Lou Kreidler replied that it is a local contractor and we want it right they will make it right. Councilor Santellana said with the liquidated damages when they go in punch list all the items they are losing x -amount of dollars every day that money is a pretty big incentive to get it right. Lou Kreidler said the issue is until they get the floor poured in the back right the kennels cannot be put in. The kennels have to come out of Oklahoma City which is about a 2-3 week turnaround time to get in so expectations are the end of November but it will be awesome once it gets open. Lou Kreidler stated that in her 15 years at the Health Department there had never been a case of tularemia in Wichita County. Tularemia is a bacterial disease that is spread from animal to man. Generally it is in rabbits called rabbit fever seen in people hunting rabbits. When a person cleans 7 the infected rabbits without any gloves they come in contact with the blood. It can be aerosolized so it can be a weapon of mass destruction not being easily recognized aerosolized. An individual that was diagnosed with tularemia had run over some baby rabbits that the dog got ahold. The dog became sick was taken to the vet treated for what was thought cancer the individual was shoving medicine down the dogs throat. The individual and wife took a trip to Colorado where tularemia is epidemic on return the wife was ill for a few dais. He went out mowed ran over some dead rats that he cleaned out from underneath the mower without any gloves or protection then he became ill. The incubation period is 3-14 days so it could have been Colorado, the dog is further out from that it can take longer but the normal incubation period is there. It was a trick public health investigation in trying to put all the pieces together to determine whether it was a local infection or picked up in Colorado. The wife was never tested but went back for tests based on the fact she was negative and he was positive it was more than likely it was a local exposure given the series of events. It was interesting to go through the investigative process it was unusual. He may have picked it up in Colorado it will never be known but with the incubation period felt it was probably a local exposure and handled it that way with the media. It can be deadly last heard he was recovering going to be released from Baylor where he had been transferred. Board of Health rocked red ribbons in support of YOLO.be drug free (You Only Live Once) for a picture to be posted on social media. IV. NEXT MEETING DATE Friday December 16, 2016 was noted as the next meeting date. V. ADJOURN Scott Plowman adjourned the meeting at 1:00 pm. o,�4 01 a�,ov,�t� Scott Plowman, Chair Julie Gibson D.V.M. Vice -Chair, or Diane StewartR N Secretary Wichita Falls -Wichita County Public Health Board City -County Board