Joint Meetings with Dept of Ecology on Mill Issues
Dr. Berry, Apple Martine, and BoCC got a public comment that didn’t come in via the BoH channel from Citizens for Safe Water and Air regarding the recent mill spill of toxic chemicals. PH again referred complaints to the Dept of Ecology. Even though there are health concerns that are being tracked by the group, the WA Dept of Ecology has jurisdiction and regulatory authority. BoH believes it is important for the BoH and PH to be advised of things that impact people’s health and safety. The Safe Water organization is suggesting that BoH and PH monitor the complaints coming in so that they can improve their awareness. It was noted that BoH would a reasonable place for Dept of Ecology folks to engage since the BoCC is part of the BoH. It was suggested that Dept of Ecology give a quarterly report on issues related to the mill and it was also suggested that the Dept of Ecology use that time to brief on the number and frequency of the health complaints. Dept of Ecology goes to BoH meetings in Cowlitz County on a monthly basis since the Longview disaster. There was the suggestion to have Dept of Ecology present at the December BoH meeting. It was also suggested that the Agency that measures toxic output (ATSDR) be included in BoH meetings that talk about the mill.
Budget Update:
In September PH submitted their proposed budget for 2027 to the county. This week the county held a special meeting on the budget that lasted 7 hours that included presentations by every department. It was considered a good way to speak together about the hardships across departments. Most of the budgets are staffing (salaries and benefits). There were useful discussions on ways to optimize the lower amount of money that the county has to work with and how collaboration can support multiple departments. There is a lot of deep thinking and strategizing on how to make it work. PH is 96% grant funded (federal and state). PH has asked the county for funds to keep the lake monitoring program in place, as that work is not supported by any grants. PH is launching a new way for collaborating on data assessment, assisted by the epidemiologist, to look at the strains and successes in the system and get clearer on the budget needs. There currently is very little funding to be had at the state and federal level but there is a hope for a rebound in FY2028-2029. In the meantime, PH will be looking to shift their work around. There may be programs that have to go away, and that is hard because all of their work matter in the community.
PH has some fundamental budget issues to solve in the long term. In the short term, FOPH donations are keeping the clinics open. PH gets no county support for the Title X clinic, so while federal and state funds have been cut, PH has not had to cut services or cut providers.
A special thanks to everyone who has worked this past year on behalf of Friends of Public Health. Despite all the budget cuts, none of the six clinics PH runs will have to close this fiscal year. The money you donated during the past year is filling the gaps. FOPH will soon be kicking off planning for the December 2026 Give the Gift of Healthcare effort, so please contact FOPH if you want to be a part of it.
Community Health Improvement
Calling it CHI moves it away from a report or a single plan and into a space where the process is about continuing community relationships and communication. Many times in the past, CHA/CHIP efforts were done by outside consultants who came in, did the study, and left their results in a binder.
This was the Phase 1 update on the 3-5 year initiative that is a Community Health Improvement (CHI). Phase 1 is about building community capacity to participate in the process and building a collaborative effort to assess the community. There are eight steps in Phase 1 as designed by the MAPP 2.0 protocol. PH is focusing on a partnerships and power analysis with the goal of creating a steering committee to guide the effort. PH is looking at who are the existing partners in the community, which partners are missing, and how PH might engage with communities that have not participated in the past. This initial effort leads to a community-based steering committee that engages in the community and works in full partnership with PH and their own communities to do the work. A chart was shared that showed the existing PH links with different groups and communities in Jefferson County. There were other partners identified that don’t yet have active links to PH. The diagram of community partners will be online and community members will be able to submit more possible community partners.
The next step will be key partner conversations, which will include the taking of specifically structured notes, followed by a group analysis to pull out themes and insights. This will get at key issues in each community and will help determine key trusted people to help bring local knowledge into data work. Funding cuts means the existing data sources are becoming less reliable because they are not being updated and/or they are not being done in a complete manner. The qualitative piece is important for filling the gaps.
The starting point assessment reflects on past cycles, identifies resources for the current cycle, and looks at goals for process improvements. PH connected with some PH grad students who will do the analysis of the past cycles. They will be reaching out to people who participated in the last cycle to give their input. The goal is to have a steering committee for 2027 to begin the process and by mid-2028, there will be a CHI plan to monitor through 2031.
Other PH News
Flu and covid are here earlier than in past years. Get your flu vaccine and covid vaccine as soon as possible. Talk to your provider for vaccines for your kids, particularly those with underlying health issues. The FA has slowed the distribution of pediatric vaccines, but PH has gotten their requested doses. There are no measles cases in Jefferson or Clallam.
The November BoH meeting will include a conversation about the impact of the encampment removal. The after action reports from the county will be available. There was a request to have community members come to the November meeting to share their observations about the encampment clearing and its implications.
We are nearing the end of bat season on the peninsula. If a bat has landed near you or you find one in your home, try to capture it without touching it. Bats are the primary source of rabies in the county.
Board of Health 101 Briefing
WSALPHO (WA State Association of Local Public Health Officials) is the organization that supports PH departments across the state. There are 39 counties in WA and 35 health departments. Jefferson is a department of the county. Kitsap is a Public Health District that is stand-alone, although it gets funding from the county. Apple Martine went through the Board of Health 101 slides. In a PH context, “upstream health” work is understanding community conditions (aka the CHI work), “midstream health” work is looking at individual needs, and “downstream health” work is clinical care. PH does more clinical work than most other public health departments because we are in a small population, rural isolated area.
“Healthcare is vital to all of us some of the time, but public health is vital to all of us all of the time” -C. Everett Koop
The slides used the opioid overdose issue to identify the upstream, midstream, and downstream aspects of how opioid issues play out in the community, including policy work, public awareness campaigns, access to treatment, community resources and responses, first responder training, harm reduction strategies, screening & assessment, and behavioral health counseling and treatment. PH has more than 100 programs, and nearly all of them have an upstream, midstream, and downstream components.
There was a slide on the history of public health going back to the 1800 where the focus was on sanitation, improving living conditions, and controlling epidemics with the beginning work on vaccinations. The late 1900s shifted to health promotion and disease prevention, and moved toward addressing chronic disease and defining healthy behaviors. This time frame included the shift toward data. The shift now is toward community engagement and a comprehensive approach to addressing systems that impact health and well-being.
Jefferson Healthcare Update
There were good discussions on the efforts to mitigate the cuts from the federal administration. JH is feeling hopeful about their efforts, as their commercial payer mix went above 25% for the first time in a while. (FOPH comment: Commercial insurance companies reimburse hospitals at a higher rate than Medicaid or Medicare. Every hospital has a “sweet spot” of the ratio between commercial and government payers that it needs to balance the books. Back in 2023, JH briefed that they had only 23% commercial payers). JH is also looking at renegotiating their contracts with insurance companies, as insurance companies reimburse rural hospitals less than their larger urban counterparts. Premera reimburses JH at 113% of Medicaid rates, while urban hospitals get 180% of Medicaid rates.
JH’s retail pharmacy space has been completed in the upstairs part of the Sheridan clinic. This will be handy for those who travel to see their JH providers. There is already a JH pharmacy in Port Ludlow.
In response to a question about the JH dental van, it has gotten the final permits needed and worked out the rural health billing issues, as there are separate regulations for rural clinics. In response to the question on whether the van will dispense vaccines, it was not clear. JH’s meeting is next week. PH used to have access to a mobile van for vaccines via the Care-a-Van program, and this van would go to Brinnon so that folks there did not have to travel to get their kids vaccinated. PH gets questions about whether there is a way to get vaccines into the community now that Care-a-Van isn’t doing the same work as it used to.
Mini-Grant After Action Briefs
Youth Corps at Jefferson Land Trust used a mini-grant to fund a paid high school internship program that happens each year over spring break. Any student in Jefferson age 16+ regardless of academic level is accepted into the program. During spring break the students go out on the nature preserves and work on land management tasks on those preserves. Students learn to work as a team, troubleshoot, and think critically. The students get a $350 stipend and they get a meal provided at lunch. Each day there is a guest speaker at lunch. There is a partnership with a local bank to help the students get basic financial literacy before they get their checks. This program has run for 7 years.
4-H grant: The 4-H students work on their projects for a full year. One 9th grade student who was in her 4th year in 4-H used the grant to attend the statewide leadership conference. The students attending the conference take workshops over several days. This year the WA and Idaho conferences were at the same time and only 8 miles apart, so there were buses organized to get the teens together. One student briefed her program via video and anther student briefed on her appreciation of the awards the grant funded. 4-H covers a wide range of skills, including programs based on home-skills like changing a tire or baking. There are students doing welding and forging. It was noted that anyone in the community can volunteer with 4-H to help kids develop their passions.
