MINUTES OF THE JOINT INFORMAL MEETING OF JOHNSON COUNTY BOARD OF SUPERVISORS AND BOARD OF HEALTH:
FEBRUARY 23, 2009
TABLE OF CONTENTS
Page
Department of Public Health Director Douglas Beardsley: Annual Report/Strategic Plan
Board of Health Chairperson Paul Deaton: Remarks
Board of Health Member Dr. Maureen Mccue: Remarks from the Medical Officer
Board of Health Member Dr. Maureen Mccue: Bottle Water Issue
Board of Health: Vulnerable Populations and Access to Health Care
Board of Health: Issues Related to Public Health
Board of Supervisors: Strategic Planning
Board of Supervisors: Health and Human Services Building
Chairperson Neuzil called the Johnson County Board of Supervisors to order in the Johnson County Administration Building at 5:05 p.m. Members present were: Pat Harney, Larry Meyers, Terrence Neuzil, Sally Stutsman, and Rod Sullivan.
Board of Health members present were: Board of Health Chairperson Paul Deaton, Stuart Thomas, and Dr. Maureen McCue. Also present: Department of Public Health Director Douglas Beardsley,
Public Health Director Doug Beardsley said he gave the Board members a packet including an Annual Report from FY08 highlighting activities in public health. A Strategic Plan is also included in the materials because the Board of Health members requested it. The focus of the plan is inward. Public Health is in a period where they need to determine how they work together, function, and develop staff to achieve their goals. There are several areas where they want to improve. By recognizing that each staff member has unique knowledge, they work to improve development of staff by training each other. In conjunction with emergency preparedness, each staff member is going online to do an assessment of their general and emergency response public health skills.
Beardsley said another area to discuss is regarding redesign standards and accreditation. In the last couple of years the State has pushed towards a set of public health standards. It was called Redesign Public Health Iowa. The name changed to Public Health Modernization and the Public Health Modernization Act was introduced this year that will set the public health standards and process for how local boards of health and health departments can meet those standards. The State has set the goal of having the State Department of Public Health and at least one local health department accredited under those standards by July 1, 2011. The Johnson County Public Health Department has made an internal goal to be one of the local health departments accredited. The management staff has explored the standards and broken them into different sections such as governance, administration, communication and information technology (IT), and workforce. He included a handout of the areas and a summary of the standards and indicators. Based on the proposed standards, Johnson County fully met or partially met each one. With a few minor changes in certain areas the percentages would change drastically. He and management staff are going through and selecting those that are partially met and setting priorities. They are also doing a lot of quality improvement training.
R. Sullivan said he knows this is something that former Board of Health Chair Pam Willard was working on at the State and local level. At a recent Iowa State Association of Counties (ISAC) meeting there were only a couple of counties defending a higher level of public health and Johnson County was one of them. Beardsley said some of the smaller county health departments are opposing the standards, because they see them as a need for an influx of resources or money. There is also fear that this is an attempt for larger county regionalization. Cooperative agreements are certainly in the works. Johnson County is already doing it with Muscatine, Louisa, Washington, and Iowa Counties sharing Memorandums of Understanding and services.
Harney said he noticed there are tattoo facility inspections and asked if there is a State or local regulation on them for health purposes. Beardsley said those are State regulations. The Johnson County Department of Public Health is under contract and the designated enforcer of those regulations. Stutsman asked for clarification about the promotion of healthy behavior and the associated goal achievement percentages. Beardsley said they fully met 14% of the standards and partially met 86%.
Board of Health Chairperson Paul Deaton said he wants to discuss the redesign process. Even though Willard has left the Board of Health, she has agreed to work with them and represent Johnson County on the statewide initiative. A concern he has as a citizen is when they discuss redesign and credentials, people wonder where funding will come from. When they talk about consolidation of functions and credentials, there is a conversation that the funding will come from somewhere else. He said his disappointment with the redesign process is that they did not adequately address the issue of consolidation for reducing costs and from an economic standpoint may make the issue of additional costs more difficult For the Board of Health, 2008 was a transition year, because they had to search for a new director. There were not too many applicants with a Masters of Public Health degree, which was a requirement for the job. When they mix the redesign and new standards with the availability of the marketplace, this is an issue they need to watch. The 2008 transition began with the appointment of Beardsley and the Board of Health has curtailed some of their involvement in the department to give him the freedom to manage and organize. They did ask Beardsley to complete the Strategic Plan he presented earlier. They went through a reorganization and hired Deputy Public Health Director Tricia Kitzman. The Board of Health modified slightly the plan they presented the last time they met with the Board and Annette Scheib is now Community Health Manager and the Environmental Health function now reports to Kitzman. With the new director and organization, they also had the challenge of the flood. According to reports, Beardsley did a good job of representing the department during that period.
Deaton said he works in Linn County and the approach used in Johnson County was science based and appropriate for the Public Health Department. The transition to the new Health and Human Services Building is underway and the Board of Health just completed Beardsley’s first year review. They have switched to a self review process that was successful, because it holds Beardsley accountable for the work he does in the department and gives the Board of Health the ability to work collaboratively with him to be sure they are meeting the needs of the County.
Deaton said he is addressing how the coal fired power plant in Marshalltown will contribute to health consequences in Johnson County. If they build the plant, the coal ash depository will be right on the Iowa River and the first stopping point will be the Coralville Reservoir.
Deaton said the public comment period on the air permit is now open. The concerns have to do with the Particulate Matter Study the State conducted last year. Johnson County was just on the border of meeting the national standards for attainment of fine particulate matter. Two counties, Muscatine and Scott, were found in non-attainment. Since then the rules have changed, because the Governor asked for a one year delay and now they are in attainment.
Neuzil asked if this is a warning sign for the county. Deaton said the current regulations refer to particulate matter - 10 micrograms (PM10). He noted that PM2.5 is obviously smaller. Public Health, as a profession, is finding that places with higher amounts of fine particulate matter have higher incidences of asthma and cardiorespiratory disease. It is an emerging science and study that the Iowa Department of Natural Resources (DNR) has commissioned to Public Health. The issue is not trivial. The State of California decided to regulate the ports based on the issue. They found people who grew up around the port area in Los Angeles had a higher incidence of asthma and cardiorespiratory disease related to the higher amounts of fine particulates. He raised the issue with the Iowa DNR, because they are currently unregulated.
Harney said it has been reported to the Board of Supervisors that there is a high incidence of poor air quality particularly in the Iowa City area. Deaton said, when they did the study, the monitor in Johnson County was placed on Hoover School. The device monitors over time how many of these fine particulates are actually in the air. They conducted 14 different tests in the State and Johnson County was the third or fourth highest. The county met Federal standards, but he wonders why it is so high in Iowa City. At the last Board of Health meeting he asked the Department to verify that the monitor is still at Hoover School and if the readings are available for their review. He cannot draw any conclusions about what is causing the high incidence, but he will send a copy of the report to the Board of Supervisors.
R. Sullivan said they need to have some idea what non-attainment means. He is wondering if it is the same as Los Angeles where they have alerts and people are not supposed to be outside. Deaton said they are not as severe as Los Angeles. R. Sullivan said he assumes non-attainment comes with restrictions. Deaton said, when the report came out, he was contacted by the Governor’s office and Congressman Loebsack's office. The solution they came up with was the Governor delayed enforcement of non-attainment until they had an additional year’s data. This is an emerging science that is worth watching and then developing regulatory responses.
Neuzil said, if they can identify where some of these things are happening, the Board may be able to help make changes. Deaton said the study in Los Angeles was related to carbon fuels from ships harbored off the coast with unregulated fuels. In addition, truck traffic in the port area, coal power generating plants, and burning of carbon based fuels contributed to the problem. There are a lot of cars driving around Iowa City, so that may be a contributing factor. He will keep the Board updated on any results they find. Stutsman asked Deaton how much longer he is going to watch this before they can reach some conclusions. Deaton said they will watch it until the end of 2010 and see what the readings indicate. There is a formal reporting process, but it is worthwhile to get a preview of the report before it is published. R. Sullivan said it would be nice to identify the sources. Stutsman said they need to identify the problem and then move to the next step, which sounds like what they are doing. Harney asked how long the monitor has been in place. Deaton said they have been in place since 2005 and the Governor wanted to wait until 2009's data is available to resubmit it to the EPA.
Deaton said one thing they learned from the flood is the Board of Health taking a different role and they may be more active in the future.
Board of Health Member Dr. Maureen McCue said there are DNR hearings about the coal fired power plant proposed for Marshalltown, which is upwind and upriver from Iowa City. Regarding PM10 versus PM2.5, the science is somewhat different because PM2.5, which is the evolving science, refers to particles that cannot be seen. They are inhaled, go through the lung into the circulating blood, and may be part of the picture of lung cancer. It is interesting that Iowa has managed to get the smoking rate down, which is assumed will be associated with a correspondingly lower lung cancer rate, but there is the question about air quality. It is known that particulate matter goes a very long way. The highest rates of disease are usually within several miles of point sources, however the disease streams can be seen much further away. Some of the particulate matter picked up in California comes from the other side of globe. Anything that is put up in the air that can travel will travel. Standards have been developed for PM10, but they are evolving over PM2.5 because the science is evolving. There are multiple sources, with coal fired power plants being a major source, with very tiny particulate matter. Some particulate matter comes from car exhaust and tires as they wear down on the concrete, but a huge portion comes from the burning of coal. The DNR hearings are in Marshalltown and Tama March 16 and 17, 2009. The data they have on coal fired plants only considers larger plants and not smaller ones like the one at The University of Iowa.
McCue said around the world they are seeing an increasing scarcity of potable water. Iowa has very contaminated water with all of the rivers being cited. One of the big contributors to the problem is bottled water. Increasingly cities and counties are taking different methods to address bottled water. She provided materials for the Board. She said this issue resonates with people who have health, economic, and environmental concerns. She attended a speech given by Des Moines Mayor Frank Cownie, before the flood, about how he wanted to pass a resolution banning bottled water from public buildings in Des Moines. Bottled water costs about 1,000 times more than tap water. A lot of money has been put into a new water treatment facility and yet each year more people are spending money on bottled water. It is creating a huge amount of plastic waste, which is a threat to wildlife and does not ensure better health for individuals. There are differences between FDA and EPA rulings on the quality of water that goes into bottled water. There is no consistent oversight. In some ways, bottled water can contain more microbial materials or chemical contaminants than tap water. The public does not know that because there are glitzy advertisements. Much of it is tap water. Some of the water does come from Fiji and other places where they have to ship it. Meanwhile Fijians are running out of water, because they are exporting. In sum, she does not feel Iowans need bottled water and tap is better for the economy, environment, and health.
McCue said some actions that a county or city can do is to ban bottled water at City Council or County functions. They can also eliminate or cancel bottled single water contracts for city buildings or vending machines. They can institute a tax on plastic water bottles elsewhere throughout the county. Distribute, provide, promote, and sell reusable water bottles to City/County staff and visitors is another way to eliminate bottle water use. They can increase the number of well maintained water fountains in public parks, schools, and public buildings to symbolically encourage people to use this resource. The environmental containments, lack of good oversight for bottles, and outrageous cost differential make it an equity issue. Increasingly, people feel less secure drinking tap water, there is a widening gap of those who can afford it and those who cannot, and meanwhile it creates waste.
Harney asked McCue to repeat the cost difference. McCue said the cost is about 1,000% more. In 2003 the Natural Resources Defense Council recorded that a five year supply of bottled water would cost $1,000, while the same amount of tap water cost $1.65. Harney asked about the bulk water in gallon jugs. McCue said it is a variation on a theme, because there are not as many individual bottles but there is still plastic trash. About 80% of plastic bottles are not recycled, they simply enter the waste stream. The creation of plastic to make the bottles requires more water than the amount that is put in it. She noted the petroleum wasted shipping bottled water.
Neuzil said the idea of taking those away might be a difficult task, but on the recycling end, do they advocate in the State legislature adding these to the nickel deposit incentives. Beardsley said they have not, but there was a bill to increase the deposit and adding on the water. Stutsman said it seems that so much of this is education. If people knew the facts on the waste of other resources to make the bottles they might reconsider the choice. R. Sullivan said the City of Iowa City switched from handing out bottles of water to serving pitchers of water to their guests. McCue said whatever they can do to raise awareness is important. 1.5 million tons of plastic waste goes into landfills or as roadside litter every day in the U.S. 100 million disposable water bottles are thrown in the trash, enough, if laid end to end, to reach from New York to China and back. It takes 24 gallons of water to make a pound of plastic. To produce the average water bottle takes 1.5 gallons of water. R. Sullivan asked if McCue would leave brochures for the Board. McCue replied she would. Stutsman asked if bottled water is banned in San Francisco. McCue said they were successful in banning it there and it is banned in a number of places. There is a web site called Bottled Water - Get the Facts and there is a map that shows all the places that have done some sort of banning, referendum or taxing.
Deaton said they have had presentations from the Iowa City Free Medical Clinic and from Proteus Inc. The health problems of transient or migrant people are the same as the general population. The Iowa City Free Medical Clinic continues to see the same type of issues like obesity and Type II Diabetes. The Proteus group has seen a high incidence of foot fungus, which is easily fixed by changing socks and shoes, but presents a problem for the population they serve. They are good programs that should be supported because they address people in Johnson County who need help.
Neuzil said the Board of Supervisors often has the opportunity to communicate with legislators, and it would be nice to know what the public health priorities are, so they can help advocate. If the Board of Health or Public Health could compile a list for them, it would be helpful. An example would be the ballot initiative for 2010 to increase the sales tax. If the increase takes place the first three eighths of every penny would go towards environmental initiatives. It would be helpful to know what the priorities are.
Deaton said the issue that comes to mind is smoking cessation. Last year they were able to pass the Smoke Free Iowa Act. They received a large settlement from the tobacco industry that was put into the general fund. Now they are at a point to have to budget these dollars. On the one hand citizens are not allowed to smoke in public places, but the cost of operating the Quitline Iowa has increased dramatically, because there is much more activity. The money from the tobacco settlement was spent, now it needs to be appropriated from the Legislature. He and the group from CAFÉ are trying to advocate with the Legislature to be sure they preserve some of those funds, so they can continue the good work they were able to do last year.
Harney asked if Public Health is going to continue to press for no smoking in casinos and other places where smoking is currently allowed. Beardsley said there is not a specific proposal this session, but they do want to see that. The legislation was passed on the basis that it is unhealthy for workers. He does not think there is a vehicle in this current session to push it forward. Deaton said he talked with legislators and both sides are in favor of this push, but they are going to let it go for a year or two to see how it plays out. He said their advocacy group will be back to discuss casinos and veterans home exemptions to the law. Neuzil asked why smoking is allowed in the place that sells tobacco downtown. Beardsley said, if 80% or more of businesses revenues are from the sale of tobacco products, then they can smoke it that area.
Stutsman asked if the Health Department is involved in dealing with underage drinking. Beardsley said it is one of the priorities of the Community Health Needs Assessment. He has been involved with a new steering committee from the University of Iowa and also with the Stepping Up group that was involved with the 21 and under legislation that was not passed. The new group is taking an educational and community view. The University has committed substantial resources to the new steering committee to look at strategies. He has been asked to be on the committee. What he wants to do is pull the community, because it is not just a University problem. When they look at the majority of arrests, the majority are not students. There are significant amounts that are, but they do not comprise the majority. There will be a push for the community to address the issue.
Harney said there was an advertisement for a program where some university presidents were encouraging lowering the age. Stutsman said it was on 60 Minutes regarding Boulder, Colorado. Beardsley said some universities have decided the best way to curb underage drinking is to lower the age. He said he does not agree with that approach. There is a pretty big rift between some of the universities pertaining to their views on the topic and which way they are advocating. McCue said it would be interesting to review the literature, because part of her family lives in Europe and no one makes a big deal out of drinking and they do not have public drunkenness. She wonders what it is about this society, that criminalizing drinking doesn’t make a difference. Stutsman said it is the unhealthy attitude toward overdrinking that goes beyond social drinking. She said on the 60 Minutes program it showed websites where people can find ways to get intoxicated in 20 minutes. Beardsley said the new issue is that people are not drinking to be social, they are drinking to get drunk. It is a cultural thing with a lot of the youth. McCue said she wonders what is promoting it. She said there used to be advertisements of people going out and getting drunk on the beach during spring break. Harney said some of the European countries have more severe penalties for things like drunk driving.
Board of Health member Stuart Thomas said one argument made in the program the prior night is many people drink at home before going out, so they can experience the effects of having had a drink while out with their friends, because they cannot purchase alcohol at a bar. R. Sullivan said he appreciates the fact that the Board of Health has been willing to take on things that are controversial. Smoking and drinking in Johnson County have been big issues. McCue asked what types of things the Board will discuss with legislators the next time they meet. Neuzil said they have the ISAC meetings on the hill next week in Des Moines. The Counties are meeting again on March 25, 2009, to communicate county issues with legislators.
Harney said the League of Women Voters has a Saturday morning meeting once a month, which is a great forum to bring up issues. McCue said she is trying to figure out the difference between writing a note to legislators versus talking to the Board of Supervisors. Neuzil said it helps getting the message from more than one person. He said when he worked as a clerk in the legislature the squeaky wheels were heard. A lot of times legislators share constituent’s concerns with one another based on the district involved. Stutsman said a lot of it is just informing the Board of Supervisors on the concerns.
Neuzil said strategic planning was already discussed. There is one and they are in the process of putting their own strategic plan together. This time around it is more budget related.
Neuzil asked if there are issues pertaining to the building that need to be addressed. Beardsley said he is just wondering when it will be finished. He added, the facility is great and it shows a lot of foresight with the ability to expand the second floor, up to the third floor. It poses some new challenges that staff has been able to work through. R. Sullivan asked if the public has had any trouble finding them and what are the general opinions. Beardsley said he has not heard anything from anyone. The canopy over the door has helped people find them, but they need to get signage posted. Neuzil said one difficulty is going in one door and not being able to go through the whole building. When the signs are up it will help with the confusion. Stutsman said it will be nice to get the landscaping done, because people still ask her when the building will open, even though they have been in there for awhile. Beardsley said they are excited for the skywalk to be open. He has yet to hear complaints about the building. It is much nicer than what they had before.
Stutsman said she and Harney are on the Committee for the Open House. The date has been set for April 18, 2009, from 1:00 – 4:00 p.m. Neuzil asked the Board if there were any more questions. Stutsman asked for an update regarding pandemic flu. Deaton said they raised the issue at a recent Board of Health meeting and they are going to revisit the plan based on what they learned from the floods last year. Beardsley said they have a plan, but have not had any cases. Stutsman asked if it is still a concern. Beardsley said yes and he just returned from the Public Health Preparedness Summit in San Diego, California. The focus of one of the sessions dealt primarily with Medication Distribution Plans. A regional functional exercise will be held on March 14, 2009, to roll out a Medication Distribution Plan for manmade bioterrorist substances like anthrax or biological/natural consequences. R. Sullivan asked if the plan addresses livestock. Beardsley said they do not address livestock in terms of treatment. They do not have jurisdiction over the animals until it becomes zoonotic, meaning there is a human health risk. If there was something in the animal population that required medication distribution to the human population then they would become involved.
Adjourned at 6:07 p.m.
______________________________________________________________________
Attest: Tom Slockett, Auditor
By:
On the _______ day of _____________________, 2009
By Nancy Tomkovicz, Recording Secretary
Sent to the Board of Supervisors on August 21, 2009.