AGENDA ITEM SUMMARY. WORK SESSION DATE: February 9, 2016 Public and Environmental Health Quarterly Update with the Board of Health

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1 AGENDA ITEM SUMMARY WORK SESSION DATE: February 9, 2016 AGENDA ITEM TITLE: STAFF RESPONSIBLE: Public and Environmental Health Quarterly Update with the Board of Health Nan Sundeen, Liz Stark ISSUE STATEMENT: This is the first quarter 2016 Board of Health meeting with Pitkin County Public Health Director, the Local Medical Officer, Pitkin County Environmental Public Health Advocate and Pitkin County Environmental Health Manager. Today the focus will be on general updates from the Public Health Director including the LARC (Long-Acting Reversible Contraceptives) legislation and budget impacts; Emergency Support Function 8 - Public Health and Medical Services Exercise; Current Infectious Disease Updates, the current Public Health Assessment by Keystone Policy Center; the Pitkin County Environmental Health manager; the Pitkin County Environmental Public Health Advocate, and the Local Medical Officer. BACKGROUND: In 2008 the State of Colorado formalized expectations for state-wide public health services through SB (the Public Health Reauthorization Act). The act outlined the primary public health duties which include: Prevention and population health Communicable disease prevention, investigation and control Assessment and planning Emergency preparedness and response Environmental Health Administration and Governance Today, Liz Stark, Pitkin County Public Health Director, will provide several updates. Dr. Levin will present a brief overview of the changing landscape of public health in Pitkin County and the Roaring Fork Valley to assist the Board of Health in understanding the work being done by the Keystone Policy Center. In addition, the public health team (including Kurt Dahl-Pitkin County Environmental Health Manager and Tom Dunlop- Pitkin County Public and Environmental Health Advocate) will be presenting a variety of issues. LINK TO STRATEGIC PLAN: Livable and Supportive Community: Self-sufficient individuals and families Prosperous Economy: Affordable and high quality health care options KEY DISCUSSION ITEMS: 1. Review and discuss updates presented by Public Health Director, Liz Stark 2. Review and discuss presentations from Kurt Dahl, Tom Dunlop and Dr. Kimberly Levin. BUDGETARY IMPACT: None at this time RECOMMENDED BOH ACTION: None ATTACHMENTS: A. Liz Stark memo B. LARC Fact Sheet C. Dr. Levin Overview on Public Health Landscape

2 ATTACHMENT A To: From: Pitkin County Board of Health Liz Stark RN, Pitkin County Public Health Director; Director, Community Health Services, Inc.; Kurt Dahl, Pitkin County Environmental Health Manager; CJ Oliver, City of Aspen Environmental Health Director Dr. Kimberly Levin, Pitkin County Medical Officer; Tom Dunlop, Pitkin County Environmental Public Health Advocate, Date: February 3, 2016 Re: Quarterly Board of Health meeting on February 9, 2016 At this 1 st quarterly Board of Health meeting of 2016, the public health representatives of Pitkin County will present information regarding a variety of topics related to each of our respective departments as well as items of joint interest. PUBLIC HEALTH LEGISLATION: Included in your packet (ATTACHMENT B) is a fact sheet regarding the new LARC (long acting reversible contraceptives) budget proposal for the Colorado Department of Public Health s Governors budget of $2.5M to support the significant success in reducing unintended pregnancies, abortions and Medicaid costs through the family planning line item. The Pitkin County Board of County Commissioners supported the legislation that was defeated in 2015 so I would like to ask for the Board of Health s support for this new budget request to sustain this funding. For more information, go to the link below. PUBLIC HEALTH EMERGENCY PREPAREDNESS FUNCTIONAL EXERCISE: On January 14 th, 2016 Community Health Services (CHS) and Eagle County Public Health hosted a functional exercise which was planned statewide and implemented separately in each of the hazard regions in Colorado. The Colorado Department of Public Health s Office of Emergency Preparedness and Response designed the exercise and Mesa County Regional Emergency Preparedness staff supported all the Northwest counties in the planning and execution. The exercise took place at the North Forty Fire Station and was attended by 32 public health partners. A functional exercise simulates an emergency in the most realistic manner possible, short of moving real people and equipment to an actual site. The goal is to test the capabilities of one or more functions in the context of an emergency event. Activities for a functional exercise are scenario-driven and the role of the players is to respond to the messages they receive as part of the exercise as they would in a real emergency. In this case the scenario was a communicable disease outbreak of pneumonic plague (a fast spreading, deadly lung infection) occurring on the western slope 1

3 All ESF (Emergency Support Function) 8 partners participated as well as a variety of other community response partners. ESF 8 partners included Aspen Valley Hospital, Aspen Ambulance District, Mind Springs Health, Pitkin County Emergency Management, Pitkin and City of Aspen Environmental Health, Pitkin County coroner, Pitkin County Medical Officer and Eagle County Public Health. Other partners in attendance were Eagle County Emergency Management, Aspen Fire, Aspen Police Public Information Officer (PIO), Aspen School District PIO, Snowmass Village PIO, Pitkin County Health and Human Services, Pitkin County Procurement Officer, Pitkin County Sheriff and Basalt Fire. The objectives of the exercise were as follows: 1. Healthcare system recovery monitoring public health, medical and behavioral health needs of the community throughout the incident response. 2. Emergency Operations Center coordination- demonstrating the ability to activate a local emergency operations center 3. Information sharing evaluate our ability to disseminate pertinent event information throughout the incident response and recovery. 4. Medical surge evaluate the ability of ESF 8 to maintain activation of local healthcare emergency response processes such as tracking patients and monitoring status of other healthcare facilities. The after-action report will be completed within the next month but below is feedback received from the evaluators. Transitioning from a department incident management team (IMT) to a County IMT was challenging and should happen promptly to reduce confusion and duplication. Use existing plans! Coordination between agencies and activation of Pitkin County IMT and EOC (Emergency Operations Center) went well once the decision was made to do so. A lesson learned from public health s perspective, and one that has been demonstrated in other real events, is that we have an amazing group of first responders who provide a great deal of support and expertise in a response effort of any kind. Also, within public health, we need to deepen our bench so more staff are informed and prepared to take the lead in the absence of the director. I want to thank all those who participated and added value to this exercise. CURRENT INFECTIOUS DISEASE UPDATES: On February 1, 2016, The World Health Organization (WHO) declared outbreaks of microcephaly and other neurologic abnormalities that may be linked to the Zika virus a "public health emergency of international concern," the same designation given to the Ebola outbreak 2 years ago. The virus, spread by the Aedes aegypti mosquito, is strongly suspected of causing microcephaly in thousands of newborns in Brazil. Public health authorities also are investigating whether the virus has triggered cases of Guillain-Barré syndrome. Zika is a disease caused by Zika virus that is spread to people primarily through the bite of an infected Aedes species mosquito. The most common symptoms of Zika are fever, rash, joint pain, 2

4 and conjunctivitis (red eyes). The illness is usually mild with symptoms lasting for several days to a week. There is no vaccine to prevent Zika. The best way to prevent diseases spread by mosquitoes is to avoid being bitten. Protect yourself and your family from mosquito bites by covering exposed skin, using EPA-registered insect repellents, using permethrin-treated clothing, and staying in screened-in or air-conditioned rooms. The WHO's declaration of a global emergency will set in motion coordinated efforts to intensify mosquito control, develop tests and vaccines for the virus, and determine whether Zika indeed causes microcephaly and other neurologic problems. The CDC has issued Alert Level 2 notices (practice enhanced precautions) for the following countries: Cape Verde Caribbean Central America Mexico Pacific Islands South America (Bolivia, Brazil, Colombia, Ecuador, French Guiana, Guyana, Suriname, Venezuela) It is important to note that the two types of mosquitos responsible for spreading the Zika virus do not live in Colorado at any time of the year due to the cold, dry climate. Until more is known, CDC recommends special precautions for pregnant women and women trying to become pregnant: Pregnant women in any trimester should consider postponing travel to the areas where Zika virus transmission is ongoing. Pregnant women who do travel to one of these areas should talk to their doctor or other healthcare provider first and strictly follow steps to avoid mosquito bites during the trip. Women trying to become pregnant or who are thinking about becoming pregnant should consult with their healthcare provider before traveling to these areas and strictly follow steps to prevent mosquito bites during the trip. For more information, go to the CDC links below. PUBLIC HEALTH ANALYSIS WITH KEYSTONE POLICY CENTER In December 2015, Pitkin County hired Keystone Policy Center to perform an in-depth analysis of the structure and function of public health in Pitkin County. Staff from Keystone came to Aspen during the week of January 25 th to hold stakeholder interviews with many different groups and individuals. Thank you to Board of Health members Markey, Patti, Ann and Rachel for participating in those interviews. Other interviews that were conducted include: Nan Sundeen 3

5 Liz Stark Pitkin and City of Aspen Environmental Health Garfield and Eagle County Public Health Directors Mountain Family Health Centers Executive Team CHS Staff CHS Board of Directors Health and Human Services Managers Jon Peacock Dr. Kim Scheuer Aspen Medical Care Dr. Levin will present an overview of the changing landscape of public health to assist in the understanding of the work being done by the Keystone Policy Center. ATTACHMENT C includes a PowerPoint that Dr. Levin will review at the meeting. ENVIRONMENTAL HEALTH QUARTERLY UPDATE: Submitted by Kurt Dahl Pitkin County Environmental Health Manager Consumer Protection Program: Inspections The department has completed about 36% of the inspections during the first quarter of our CDPHE contract (term is July 2015-June 2016). We continue to inspect temporary and special events and had a relatively busy summer. We inspected the staff cafeteria for the X- games and will inspect the athlete and food vendors prior to the start of the X-games. Fees bill The stakeholder process has concluded and we are now waiting for a bill to be introduced. The agreement to increase the retail food fees included specific outcomes required of each local department that will require additional staff time. Water Quality: New Construction permits- We issued 69 new construction/repair permits in We issued 64 construction/repair permits in 2014 (8% increase) Use Permits We have issued 63 use permits in In 2014 we issued 72 use permits (13% decrease). We believe not all property transfers where the building is served by an OWTS are getting a use permit. We are working with other departments in the state with use permit programs to identify a better strategy to ensure use permits are obtained when a property transaction occurs. Graywater The State has amended the Plumbing code (effective February 14, 2016) and we are now in the early stages of creating a greywater regulation for Pitkin County. We anticipate bringing the new code to the BOCC for adoption in the fall of Disease Control: Mosquito Control Mosquito surveillance in Pitkin County was completed over the summer Due to the warm and wet spring forecast we have agreed to contract for surveillance this coming summer. The surveillance data is used to determine the risk of mosquito borne diseases 4

6 being spread in our county by looking at what species of mosquitoes and their overall numbers that are caught in the 4 traps in the county. Air Quality: PM10 Monitors We continue to maintain the PM10 monitors on the roof of the Red Brick for the State Health Department. Radon January is radon action month and we continue to give out free testing kits for Pitkin County residents, including Snowmass Village and Basalt. Noise: EH continues to work with the consultant to amend the noise code. We anticipate bringing the amended code before the BOCC in late spring 2016 for adoption. Marijuana: We have contracted with a local company to perform odor monitoring for High Valley Farms. His logs indicated no odor detected at the monitoring times in November and December. We have also done some outreach to residents in Holland Hills and they are reporting no odor. High Valley Farms did set up a complaint line last November and it has been turned over the Pitkin EH for use. The system is set up for voice to text and when a complainant calls the phone number, the system will send an and text to Kurt and our odor contractor for further investigation. The phone number is We continue to work with the Pitkin County staff on licensing referrals with respect to grow operations and in an advisory role with edible(s) production. ENVIRONMENTAL PUBLIC HEALTH ADVOCATE QUARTERLY UPDATE: Submitted by Tom Dunlop Tom Dunlop will provide brief updates on the following topics at the meeting as time allows. Reconnecting Urban Planning and Public Health - Foundation for Public Health Fluoride - US Surgeon General s findings Colorado State University possible merging Environmental Health School - loss of identity Food Safety Modernization Act update San Bernardino shooting - Public health impacts - National Network of Public Health Institutes Respectfully submitted, Liz Stark RN BSN Pitkin County Public Health Director Director, Community Health Services, Inc. 5

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8 1 PITKIN COUNTY BOARD OF HEALTH MEETING ATTACHMENT C CHS, Pitkin Environmental Health, City of Aspen Environmental Health, Pitkin Environmental Health Advocate and Pitkin Medical Officer

9 2 The Changing landscape of Public Health

10 3 The Public Health System

11 4 Core and Essential Public Health Services

12 5 The Health Impact Pyramid