Board of Health - Regular Meeting

and just Oh, that's a good sign, right? We have started the recording. Caitlyn, just let us know when Yep, it's loading. Give me one second. So, while that's loading, just to let the board members know. So, Mike Lane is not able to join us today.

Oh, wait. Sorry, I have to restart it. It just auto went to the public health. Sorry. Give me one second. Okay, good to go. Thank you.

All set. Yes. Great. All right. Well, good morning everyone. Happy September. Um, so thank you for joining us. Thanks for the public community members who joined us as well. also will begin our board meeting. Um and um also Dr. is Dr. J. Raj can't join us either, right Christina? My understanding was that he was planning to join. Okay. Okay. Um so I'd like to ask for approval of the minutes. So moved. Thank you. Second. Steve raised his hand. I'm going to take that as a second.

Second. Yeah, thank you. Uh any comments or changes? All in favor? I I thank you. Um okay, so we're going to jump right in. Uh we have quite an agenda. Um and everything was posted on the website. Uh all the materials including the agenda, the minutes, and the OP program summary report. So we'll start with Christina this morning giving the health administrators report.

Good morning everyone. Thank you for joining us this morning. Uh the administrator's report is an opportunity for me to share with you all key personnel changes. Um and actually if we can go to the next slide, it'll give a little bit of an outline of what I I'll be sharing this morning. There we go. Um key personnel changes, updates about new funding that supports our work, contracts or grants that we have issued in our county to support local capacity. And it also gives me a chance for a chance for me to update you all on trends, emerging issues, policy changes that we're seeing at the state and national level and how that impacts us locally. Um you'll hear from Dr. Lorraine in a little while about fall respiratory season. That is one of those emerging issues or um challenges or opportunities that we're seeing at the um at the national, state, and local level uh for us to uh be communicative about what we're observing and uh what we're uh what we're offering and how we're supporting our local community. I do want to take a little bit of a moment to share and talk through some of the things that we're noticing at the federal level uh particularly with the CDC because you know uh we've received some questions about how what's happening at the federal level affects us locally. So as you know there have been a lot there's been quite a bit of upheaval at the CDC in the past few weeks and um in our our nation this is our the sort of central aspect of our nation's public health infrastructure. I'm not sure if all of you are aware, but there was a shooting at the CEC um in August in which an individual fired hundreds of bullets at the buildings on the CEC campus from a CBC uh CBS, I'm sorry, across the street. While no one on the campus was injured, a responding officer lost his life and the gunman um also died as a result of self-inflicted wounds. Um, two weeks ago we saw uh the firing of of Susan Manares and CDC director followed by the resignation of several high level leaders who have dedicated their careers to protecting the health and well-being of our country. In addition, we're seeing quite a bit of

confusion about um access to uh co vaccinations and concerns about um access to and uh recommendations for other uh vaci vaccinations that keep our our nation uh healthy and well. And I'll tell you that, you know, it has an impact um on us locally um particularly in so far as it affects morale. Um the work that we do continues every single day, every single day. Um in spite of what is happening at the federal level, um in spite of the staffing changes, the staffing losses at the CDC. And while we do heavily rely on the CDC for guidance, uh for technical expertise, uh the work that we do continues here every day in very important ways. It makes the work that we do locally um even more, I think, important. Um, and it's critical that we maintain our local public health infrastructure, our state public health infrastructure, particularly during this time. We hear stories every single day uh from our staff, from our residents about the impact of our work locally. Uh just yesterday um I heard a story from um from our staff about um two of our staff, Meg and Alyssa, from our communicable disease team um who you know really worked to create a strong and trusting relationship with a family that they were interacting with as a result of a a case investigation. um they were able to create that trusting relationship and really from what we heard you know change uh change a families uh sort of understanding of what local public health does and what our public health infrastructure does. this happens uh you know at a time where there are questions and there's confusion and there's you know mistrust um in a lot of ways about public health and so the work that happens locally really is uh the

bedrock of of of um of that trust relationship and how and how folks perceive and understand what public health does. And so I really want to say thank you to our our staff, our team here for to our residents who contact us all the time with stories about um how they've found support and and uh resource and help uh through local public health infrastructure. And also say thank you to our state and our federal colleagues who are uh continuing to persevere and and work through uh the many challenges that we're facing every single day. I'll take a beat there. Are there any questions about what's happening federally?

Okay. Hearing none.

Yeah. And Christina, I don't have any questions, but I do think um you know uh as a healthcare leader for me it does it is difficult and we're getting questions you know about the COVID vaccine and access and um you know there's just things happening every single day. So, it's very important that we, you know, try to pay attention and try to be available to answer questions and make sure that um, you know, again, it's just it's it's a fluid time and I have infection prevention physicians um, saying, you know, it's a it's a difficult uh it's difficult when people think they can't get a vaccine or that they they fall into the category and they need a physician prescription, but then they go to CVS and they don't need their prescription and you know, so again, I think it's a little unsettling for people and to the degree that we can put things on the website to inform people or if we can tell people where they could get what the necessary vaccines they want at in within Montgomery County. I think that would be helpful. I don't know if we have that available now, but maybe that's something we could think about doing.

Absolutely. And I appreciate that and and agreed right uh the information that we're sharing, the information that we can share. Uh I think you know it's important for us to have uh trusted evidence-based sources of information. Um we will be sharing information actually about our our fall community vaccine clinics uh within the next few weeks and opening up appointments for those. Um so I appreciate your call out particularly around the co vaccines and access and making sure that all of our residents have access when they need it. Um we'll be we will actually be adding information about that to our website uh within the next week or two. So thank you for calling that. also locally um I would say that we are uh while we're witnessing these you know concerning developments at the federal level uh public health work and infrastructure you know again becomes all the more important at our local level um here we are building our capacity internally uh at the office of public health and we're also building capacity in our community uh again this is an opportunity for me to share a little bit about um key personnel changes new contracts and awards funding updates uh we did receive our year three notice of award uh from the CDC for our um overdose data to action project. Uh we are in year three of this uh five-year program. We don't quite know yet about year four funding and and we'll know that uh we'll know a little bit more about that after the FY26 federal budget is passed. Um but we have received full funding uh for our year three work and this is work that allows us to really uh take a targeted datadriven approach to preventing overdoses in Montgomery County. Uh this is a represents a partnership uh between the office of public health and the office of drug and alcohol and a really um uh an opportunity for us to really invest in on the ground resources that help connect people with uh with treatment with other care supports uh collect uh connect people with uh resources like Narcan and training on the lock zone administration and again use that datadriven approach to really focus our investments in places where they're needed most. In addition to

that, uh last week uh our commissioners approved three new contracts uh from the office of public health to community- based organizations uh to develop and expand community health worker programs. The overarching goals of this work are really to increase access to and utilization of health care by reducing barriers to care and increasing knowledge uh about health and health literacy. Uh this RFP was actually issued earlier this year in direct response to what we learned through our community health assessment and some of the needs that we observed and noticed in that report. We expect that the organizations that were approved for funding uh will address some of the specific needs and barriers that came up in that report. Um we are uh issuing those notifications uh to those uh awardes uh this week and so we'll be excited to share a little bit more about the work that they're doing in the in the meetings ahead. In addition, the board of commissioners last week approved 13 grants uh totaling $610,000 to community- based organizations serving Montgomery County. Uh this grant program was initially conceived uh under uh through our prior commissioners uh during the ARPA grant application process. At that time, several applications addressing food system gaps and needs were received. And in response, um we formed uh a food policy council and allocated $600,000 for food system projects identified by that council. So since that time, we've hired a food policy program coordinator, Sam Applefield, who joined us, I believe, at the last meeting. Um and he's led the development and implementation of that food policy council, as well as a grant process to award uh the funds that I just mentioned. Uh earlier this year, the food policy council leadership team uh designed and then launched uh an application process. There were six more than 60 applications requesting more than $3 million in grants. And it was a very difficult uh but rigorous uh review process. Uh difficult choices uh but 13 applications were then recommended for funding and we were uh fortunate to be able to announce that in partnership

with uh our commissioners last Friday um at the Upper Marriott food cupboard. The projects are diverse in their scale and their geography and they include increased capacity at food pantries um infrastructure grants at uh food pantries so that they can offer more perishable foods, fresh foods um development of new commercial kitchens and infrastructure projects at farms that enable them to extend their growing season. Last, in terms of key personnel, uh, we've added a workforce development manager. Uh, she is responsible, Emily Kramer, she's responsible for leading the implementation and, uh, of recommendations that came out of our workforce assessment. So, this is our internal capacity building. uh she'll be prioritizing development of a an OPwide onboarding process for all of our new staff, development and implementation of training and professional development for our team to build skills and advance uh professional advancement within public health and development of uh an internship program so that we can continue to welcome new folks into the public health pipeline. Those are my updates quite lengthy for today but uh thank you very much for your time. Any questions or comments?

There's a lot. Thank you.

Okay, Christina, I think that uh we're good. Um so we're going to move on to Denise uh the OP 2026 budget review. Good morning everyone.

Good morning. Here's a snapshot of our overall budget for 2026. And as you can see, our proposed budget reflects an increase um in expenses to 19.4 million and a decrease in revenue. Um this is results in an increase in county contribution. Next slide. So our total revenue is projected to decrease by 3.6%. Um this is our feebased revenue is increasing driven by our annual 2% increase or fee increases. Um and then our grant revenue is anticipated to decline because of loss of some funding. Our total expenses are projected to rise less than 2%. Our wages remain to be the largest expense category. Um, our controllable expenses show a slight decrease and our non-controllable remain relatively stable. Next slide. This slide outlines our funding sources with the county contribution being the largest um at 32.4% 4% grant revenue following um alongside of our act 315 funding. Additional funding comes from um our fees and our act 12 uh source. Next slide. Okay. here. Here's a list of our complete um categorical contracts. This is based on all of our uh contract terms. It's not based on for 2026

calendar year. I just wanted to give everybody a picture of how much money contractually comes in and the terms and how that is funded, whether it's state and or federal dollars. So I also wanted to take a minute to look at our uh budget landscape over the past couple years showing the key shifts over time. So as you can see here um both expenses and revenue experienced significant increases in 2021 and 2022 due to the pandemic. Revenue peaked in 2022 primarily again driven by COVID 19 related funding. Expenses surged in 2021 again as a result of the pandemic. Um and now we're seeing a gradual um uh reduction to baseline to where uh public health uh operational funding is more stable. Now next slide. Okay. So bottom line here is our impact is our revenue is decreasing, expenses remain relatively stable, but ultimately this increases county contribution. Does anyone have any questions about changes to um or the trends I guess in our our budget, both revenue and expenses over the past few years?

No, I want to go into it a little more depth, but no, thank you. And sort of coming back to you know those changes at the federal level. A lot of folks have asked you know how the um you know how federal funding uh is changing for us here locally. And you'll see there that you know quite a substantial amount of our funding does come from the federal level uh either directly through pro projects like um uh the overdose data to action project. We also receive funding directly from the uh US department of housing and urban development. Uh but we also receive funding that goes from the CDC to the state uh to the local level. In fact, quite a substantial proportion of CDC CDC's funding goes uh out to states um or to local levels or or both. Um so, you know, what we're noticing right now is that, you know, we have confirmed reductions in funding for things like immunizations. Uh we have projected uh for next year uh reductions in funding for things like public health emergency preparedness. Um but we haven't yet noticed um changes in other grant funding from the CDC uh or from the federal level uh like the work that we do with housing uh some of the work that we do with lead abatement for example um maternal and child health work um we're watching very closely the FY26 budget process um to see what changes uh might occur uh for future um budget periods uh but at this time we haven't quite noticed those changes. Um, if you have questions about specifics, you know, what comes from the federal level, what comes from the state level, um, you know, we're happy to field those or we can, um, you know, let you think on them, think on them a little bit more and, uh, take those at another time. Okay. Uh, I think we'll move on, uh, Christina. So, we're going to move on to Dr. Lorraine um and his report on headed

for a fall update on respiratory illnesses and immunizations. Thank you Barbara and good morning to everyone and thank you to the members of the public who have joined us as well.

U very happy to be able to share this information with you. Um so I'm going to be giving you an update on um the respiratory illness season that we are about to enter into and specifically looking at um the vaccinereventable diseases and where we are with immunizations for those. Um the subtitle of the presentation is headed for a fall and it's interesting to me how one single letter can kind of change meaning. Um and I will elucidate on that a little bit more as I go along. Next slide please. So putting it all together, what I'm what I of what I'll be talking about the outlook for this year is that we're going to expect to see something similar to last year. So the peak hospitalizations for flu, RSV, and COVID are likely to be pretty much the same as it was last year. Um, COVID is always a little bit of a wild card and if we see a variant emerge that escapes immune control, the cases could go up. Um, obviously there's no specific way of predicting this, so we just have to see what happens. Um, CO is constantly constantly mutating. Uh, and other viruses do that as well, but um, CO does it very very frequently. Um the current variant that we're seeing actually is not quite the same one that's in the vaccine that's uh been approved for this year, but it is similar enough that we do expect there to be fairly robust protection. It's of note that last year the influenza season was significantly larger than the prior year. Um, we don't have final numbers yet for the season because actually the official u end of the season for all respiratory illnesses is the end of September. So, we're actually still accumulating data for 2025.

The part that refers is referred to in my subtitle heading for a fall is this one. the vaccine uptake um for flu and COVID is still suboptimal. Uh it has been and likely will continue to be so. Uh and uh flu in particular, we've had compa campaigns for many many years um describing the importance of annual flu vaccination. Uh yet the uptake seems to remain fairly consistently um slightly below 50%. Um, for the last few years, we've also had RSV vaccine available and millions and millions of doses have been distributed and it's very likely that we're starting to see some effect of that RSV vaccine at this point and we'll take a look at some of those numbers as we go along. Next, please. So, here's where we stand at the moment. Not surprisingly, it's a pretty good map across the United States. There's very low or low incidence of respiratory illness uh pretty much across the country with the exception of Louisiana. Uh there may be some things going on in New Orleans that lead to spread of communicable diseases, but I don't know that that's necessarily different than usual. But for the most part, we're in a good state right now. In most cases, we are at a very low level. In early September, a couple years back, we did have a very er early peak of respiratory illnesses. If you recall the the triple demic that we referred to a few years back. Next, please. So, here's what we were looking at for the last two years in terms of influenza burden. Now, um let me put a caveat on all of these slides where I'm going to show these numbers. These are estimates

particularly when it gets down to the state and the county level. Uh some of the data is not entirely reported or is aggregated. So a lot of these are estimates. They um do have fairly good validity. Um for ones where I felt that there was a little bit of lack of reliability, I have not included them. But the ones that I will be showing you, we can pretty much rely on just keeping in the back of our mind that they are estimates. Um, total flu illnesses for last for last year uh in the United States roughly 56 million as compared to 40 million the year before and both the state and the county numbers reflect that as well. uh the number of hospitalizations remains significant and it's estimated that we could decrease these numbers significantly also deaths um by a more robust vaccine acceptance. So we continue to strongly strongly recommend vaccination. Next please. So RSV I've only limited limited this to the symptomatic illnesses because I felt that the uh data for hospitalizations and deaths was not entirely reliable. Um there's significant numbers. Um if you'll note the preliminary numbers at least for um the country seem to be a bit low for this year but we don't have final reporting yet and the year has yet to finish out and I really really expect within the next year or two we'll be seeing the effect of the RSV vaccines and the monoconal antibodies that are given to children. Next please. And this is um a good graphical representation of where we see things over the past few years. Um I really only looked a lot at the last two to

three years because prior to that uh the pandemic had really really altered these numbers significantly. But you're starting to see pretty much the resumption of the curves that we saw prior to the pandemic. Um, note that very very early spike in uh flu and RSV from a couple years back. That was the triple demic that I referred to before and the fairly large spike for influenza for last year. Um, right now we are expecting that we could see that similar spike in influenza. Next, please. And looking at the CO 19 burden over the last couple of years, um looking at both looking at the uh the country, the state and the county, uh the numbers stay relatively consistent. Um and if you look at the ratio of hospitalizations and deaths, it's higher than it was for influenza, which is not surprising. uh people who are hospitalized for COVID tend to be fairly severely affected and there's a fairly higher rate of mortality with that. Uh but the numbers that we see are significant. You know, even within Montgomery County, we saw over a 100 deaths due to COVID for the current year. Next, please. Moving on to immunization. So here's um a metric for the country in terms of total doses that were given for uh influenza for COVID and for RSV. As you can see the the amounts are significant. The total for the country 147 million uh given that the total population is somewhere I believe about three 380 million uh something fairly close to that. So it's it's a little bit less

than 50% as I was talking about before. Uh COVID vaccine we see those doses uh 30 million that's a a significant amount but at this point uh the uptake is relatively low and RSV the last couple years are really actually aggregated here because that's when it really first became available. So that's referring to pretty much the total number of doses that have been given since the approval in 2023. Next, please. Here we're looking at the vaccines that were administered directly by the Montgomery County Office of Public Health. On the top, you'll see our total, and this is between both our community clinics and our ongoing office clinics in Pottstown and in Norristown. Uh we're a we were able to break it down by age group for the total. And in our community sites, uh, we have pharmacy partners that allow us to give, uh, vaccine to un to insured individuals as well as uninsured, which is our mandate. Um, so we have that breakdown there. And you can see that in our community sites, we're actually immunizing roughly half and half uh, insured and uninsured. and the participation of our community partners which allows us to use their vaccine and for that to be appropriately reimbursed by insurance is very very important both in terms of the amount of vaccines that we can administer and for um extending our operating uh ability to be able to vaccinate as many uninsured folks as possible. Next please. Starting off with the easy recommendation, influenza vaccine really hasn't changed very much. So the current guidance that we're receiving is everyone 6 months and older is

recommended to get an influenza vaccine for this season. Special cases, older adults are supposed to get a higher dose or a recombinant/adaggmented influenza vaccine. And the reason it's preferred for this group is because we want to make sure they have a good immune response. People 65 and older do tend to have a somewhat attenuated immune response to vaccination. Children six months to eight years, if they haven't received a flu vaccine at all, it is recommended they get two doses four weeks apart. If they have received a flu vaccine in the past, then they would just simply get a regular influenza vaccine. For pregnant women, the official recommendation is a single dose uh thyarosfree flu vaccine. I'm going to digress for just a second and talk about thyosol. Um, thyrasol is a mercurybased preservative and it had been used a lot in vaccines up until about 1999 2000 where it was recommended to be removed over concerns about mercury as a potential neurotoxin uh a um a problem for the uh central nervous system. The thing about the mercury that's in thyol um and forgive me for doing a little bit of organic chemistry but I'm going to keep it quite uh as straightforward as possible. So the mercury that is in thyarisol is something called ethyl mercury. It's combined with a an ethyl molecule. The mercury that for example is in tuna that we consume is methyl mercury. a a methyl molecule as opposed to an ethl molecule and there's a one carbon difference on this. The studies have shown fairly clearly that the ethyl mercury that comes fromol is very quickly cleared from the body and does

not accumulate. The methyl mercury stays in the body for a while and potentially can accumulate. We also have definitive studies which show very clearly that thyosol when used as a preservative in the vaccine actually does not accumulate does not cause mercury toxicity really doesn't cause a problem at all. Yet in 1999 and 2000 out of an abundance of caution uh the recommendation was made by the FDA to remove thyrol from all childhood vaccines which was done. The only vaccine actually that still continued to have the thyosol in it was the multi was one of the multid-dosese flu vaccines. Uh recently the current secretary of HHS in Washington uh raised the issue and at his behest uh the recommendation was to remove from all vaccines. It really is kind of a moot point because we we as a county weren't using it. um most organizations weren't using it and it really wasn't much available and it really doesn't cause a problem. But yet it's still being raised as a potential issue with vaccines. It is my personal belief that that's being used to raise a spectre of questions of safety regarding vaccine that is inappropriate and inaccurate. Okay. Off the soap box. Um imunompromised individuals. So people who are significantly imunocmpromised by the use of the imunosuppressant medications uh basically follow the same guideline as adults 65 and older to get the higher dose. Next please. All right. RSV vaccine. So the guidelines for the RSV vaccine did change a little bit recently. So, it's really important for older adults to get

this RSV vaccine and right now the recommendation is all adults 75 and older. Um, it is approved for 60 and older. So, the current recommendation is for adults who are 60 to 74 to get the RSD vaccine if they are at increased risk. So, if they have additional conditions, heart disease, lung disease, diabetes, things like that. Um this is usually done after consultation with their individual provider and right now again it is a single dose vaccine. It is quite possible in the future that a booster may be recommended as the immunity does seem to wan after two or three years but right now it is a single dose. So adults who have previously received it should not get a second dose. Um the chronic conditions the higher risk are uh elucidated in the third bullet point there. As I already discussed, pregnant women are also recommended to get one of the specific RSV vaccines during their pregnancy. And the reason for this is not only for the pregnant woman to be protected but also the child up to age 6 months because we don't im we don't immunize actually we don't immunize children at all for RSV but there is what's called a monoconal antibbody available for them but that's not given under the age of 6 months. So the protection that a an infant up to 6 months would have would be the passive immunity the antibodies passing through from the mother from this vaccination. So it is strongly recommended and as we'll as you see in the final bullet point the monoconal antibbody that is available and a new one was rel relatively recently approved is recommended to be given to all infants who had not received that all young infants who had not received that passive immunity from the mother or if

they're high at high risk for RSV illness and we are seeing the effect of this on the decreased number of children being admitted to hospitals with severe RSV infection. Next, please. All right. So, we had two of the three vaccinereventable diseases with relatively straightforward information as to who who is recommended to get it. And as has been alluded to before, right now in terms of COVID vaccine, there's a lot of confusion out there. The big step that happened was at the end of August the FDA um issued an approval for the updated COVID vaccine for this year and there are specifically um four vaccines. So uh Madna and Fizer have the uh mRNA vaccine uh Novivvax has a different more traditional type of vaccine. Um as an interesting sidlight uh Madna now has a second COVID vaccine. The first one was called Spikevax. The next one is now MEX spike. Um it actually targets more specific parts of the spike protein. Seems to produce a a somewhat more robust response, maybe a little bit less side effects as well. And I'll get into the recommendation for that later on. Now the big change here was that the emergency use authorization for um children for the Fiser vaccine um and um was removed. The specific groups for whom the COVID vaccine is now approved again are 65 and older and younger than 65 with a chronic condition that puts them at higher risk for severe COVID disease. for everyone else. There is no longer an approved COVID vaccine.

That's the big difference. Um, the ACIP, the the Advisory Committee on Immunization Practices, which is an arm of the CDC, was scheduled initially to give its recommendation in June, which they did not do. and they have a meeting scheduled coming up on September 18th and 19th where if they do meet it is likely they will issue their recommendations. This is kind of a little bit of a backwards process. In the past what's happened is the FDA issues an approval for a vaccine. Then the ACIP kind of hones in a little bit and gives specific recommendations on who should get the vaccine. This time the FDA restricted access to the vaccine by approving it only for certain high-risk groups. I will tell you that to a certain extent that's not a bad thing. Um, I have noted and many others in the medical field have noted for the past couple of years that we really do have a little bit we really do need to have a little bit more of a targeted approach in terms of our recommendation for COVID vaccine and look more at the risk versus benefit that we use in everything that we do in medicine. But it has the effect now of restricting access for those who are not at high risk yet still want to get the vaccine and have made that their individual decision on that risk versus benefit. So especially given our mechanism of providing immunization it has created a lot of confusion. Next please. Um I I really went through this already. So the um the Madna vaccine and the Fiser vaccine are recommended for people at high risk. The Madna vaccine uh is still approved for children. The

Novivvax has the approval um for individuals 12 and older at high risk as well. Next, please. So I talked about that you know risk factor for higher a higher risk of severe illness of COVID. This slide is taken from a presentation by the chairman of the ACIP um back in uh February uh and she specifically listed uh the conditions that are conclusively proven by the data to put people at higher risk of severe illness of COVID. Um there there's a lot of things there that we think are fairly obvious. I would draw your attention in the final column to three particular things. Obesity, physical an inactivity, pregnancy and recent pregnancy. So these are things that the CDC considers to be conclusively present concl excuse me conclusively proved to cause higher risk of severe illness of COVID 19. Next, please. So, if we we apply that to the general population, if we look at only just one of those risk factors, how many people does that affect? Well, the answer is a lot. Uh if you look across the adult population, roughly 3/4, 74% have at least one of those conditions. If you pull out people 65 and older for whom it's specifically recommended, you still have a relatively high percentage. The lowest that it really goes is about 2/3, 65% of adults have one of those conditions. So, one of the things going forward that people really need to look at very closely is to look at that list of high-risisk conditions and try and self-identify if they have one of those things which would make them eligible

under the current FDA approval to get a COVID vaccine. Next, please. Well, the FDA approvals were somewhat restrictive and organizations uh of physicians and medical organizations that have looked at this issue closely have come out with their own recommendations which now differ a little bit from the CDC. Most prominent among them is the American Academy of Pediatrics. Uh the thing that the American Academy of Pediatrics looked at and based on clear scientific data, they noted that of the hospitalizations of children for COVID, the majority of them are children under the age of two and therefore they felt that given the risk benefit analysis for that age group, all children under the age of two should receive a COVID vaccine. um for those two to 18 years they said that somewhat in agreement with the CDC recommendation if the children were at high risk they should receive a COVID vaccine. However, they expanded that high risk assert to a certain extent. Um, that's also including if they are resident of a long-term care facility or a congregate setting, if they've never been vaccinated at all, or if they have household contacts who are at high risk for severe COVID disease. Next, please. The American College of Obstetrics and Gynecology still makes a strong recommendation that pregnant women receive COVID vaccine.

Dr. Lorraine, you're froze, but I don't know if it's just my computer or not. I think it's Dr. Lorraine's feed coming in.

Okay, give him a moment. I sent him a note just to let him know cuz he may not be aware. And it looks like he's disconnected and hopefully is reconnecting in a moment. Yep.

Okay, I'm back in. There he is. Are you able to see me? Okay.

Sorry about that. Um I don't know. I just dropped completely for some reason. The the grounds are attacking me. Um, so going over the American College of Betrics and Gynecology guidelines, they do strongly recommend that pregnant women still get a COVID vaccine. The CDC is inconsistent in its own recommendation right now. Uh, with great fanfare, Secretary Kennedy announced the removal of that recommendation for pregnant women back in May. They did take it off of their website. However, if you go on their website even now and look at the high risk factors for um severe uh COVID illness, pregnancy is still on there. So, the ACOG still makes the strong recommendation that pregnant women should receive COVID vaccine. Next, please. What we saw as a result of this was there's a lot of confusion. uh mostly with the pharmacies who are were uh distributing COVID vaccine and because so they figured so many people either would be confused about whether they fit the criteria for the FDA approval or they don't fit the criteria and it would become what's called an off label use. In Pennsylvania, they made the announcement they were going to withdraw completely from administering COVID vaccine and that caused a lot of uproar and confusion. Um, Governor Shapiro about two weeks ago um issued a statement which you can see there and he called upon the state board of pharmacy to meet in special session and try to clarify this and make sure that um we do have access to co vaccines in the Commonwealth of Pennsylvania. So the board took action about a week ago and we'll see specifically on the next slide what their statement said, but it did

now allow the pharmacies to resume administering COVID vaccines without requiring a prescription from a physician. And most specifically, it now allows guidance from professional medical associations. Next slide, please. Here's their press release. And the big difference is that prior the guidelines for pharmacies were that they could administer vaccines according to the ACIP recommendation only. And what they've done now is they've added other valid sources of authority such as the American Academy of Pediatrics, the American Academy of Family Physicians, American College of Cetric Gynecology, and the Food and Drug Administration. Um, so that now gave enough freedom for them to to come back at least into the market and say that they will be administering vaccines. There still is a little bit of work to be done on figuring out exactly the logistics of this and again what we're going to be doing in return in in regards to those individuals who do not fit any of those criteria. Next slide, please. So having said that, here is a proposal which has not yet been approved by our solicitors and our commission commissioners in terms of what we will be doing as far as the Montgomery County Office of Public Health in our community clinics. It's a combination of the FDA approval, the AAP recommendations, and the ACOG recommendations. And it also does follow along with the latest state board of pharmacy guidance. Next, please. Excuse me. So, the proposed eligibility for COVID vaccine, ages 65 and older and those at high risk are first two bullet points. The next three bullet points are the additions. So, all children up to the age of two who do not have a specific

contraindication to the vaccine. The children who are residents of long-term facil uh care facilities or other congregate settings have never been vaccinated vaccinated or have household contacts who are at high risk for severe COVID. So those are the AAP recommendations. All pregnant and lactating women which are the ACOG recommendations. Next please. The way that we're going to be administering this is that anyone who does not fit the FDA approved guidelines. So that would be anyone younger than age 65 essentially. Um we we will ask them to review a list of those approved indications for high risk of of COVID disease and attest that they have at least one of those conditions. We will not be asking what that condition is. We will not be asking for documentation or a physician's note. We just ask them to attest that they have one of those conditions. This is very similar to procedure that we used earlier on in the pandemic when the boosters first came out. Also, when the vaccine first came out and it was limited to certain groups, we asked for self attestation at that time. So, it's a very similar process. Right now, we're still determining if we will be able to administer COVID vaccine to healthy individuals under age 65 who don't have one of those at risk conditions. We don't have a final answer on that yet. Uh there will be absolutely individuals who do not meet one of those high-risisk criteria who still desire to get a COVID vaccine and we are cognizant of our responsibility as a public health agency to try to assist them with that. We're still working on that and we're looking at the regulations, the legalities, and our other obligations in

terms of language with uh contracts with the federal government. So, more to come on that next, please. And with that, I've hopefully taken a situation which is clear as mud and maybe stirred it up a little bit. But I'll be happy to take any questions if I can answer them. The one thing I can assure you is that we are actively working on this and as new developments come along, we are incorporating that into our procedure. We're discussing it. We're doing what we can do within the boundaries of regulations, within the boundaries of the legal responsibilities and within the boundaries of our responsibility as a public health agency. We are cognizant of all of these things and we are trying to put it all together in the best way to serve the public that we can. Thanks.

Any questions for Dr. Lorraine? That was a lot of things that you covered. Um, sorry I took longer than I expected. No, it's okay. It's okay. Uh, questions. I'm exhausted and that's how I feel. It's not a question, but Rich, really good job. Excellent. Excellent presentation. It was really good. It really is good.

Okay. So, so one thing um do we anticipate and maybe this is a repeat of my earlier question, but will we um as as we get more clarity potentially from the CDC, will we update the website so that people know whether they um fall into the category um etc? Oh, absolutely. Absolutely. We want to try and make it as clear as possible on the website which will really facilitate um scheduling at our clinics or going to one of the pharmacies wherever people choose to get their uh immunizations. But we we will we will strive for clarity.

Yeah. And the newest COVID booster is available like it's it's the updated version, right? So that's actually available today. Yes, it has been shipped. Um, not everyone has received it yet, but I know that there are certainarmacies that are administering it. Once this new one is available, the old ones are not used at all anymore. This is an updated vaccine more specific to current variants. That's great. Okay. Thank you. All right. All right. Thank you. I think we're going to move on um to the Office of Public Health Priorities with uh Jay Kim.

Yes. Good morning. Uh next uh each division director uh will provide a mid-year update uh on their 2025 division uh priorities uh that will cover activities from quarter 1 and two. Okay. And we'll start with clinical services. Uh Ruth Cole.

Okay. Good morning everybody. Um so for the first um priority is involving our electronic medical record. We are still pursuing a switching. Uh currently we use Patagonia as our EMR. We are uh considering another EMR and we are planning a site visit um to um see a review of the EPIC system. Um so stay tuned for that. We're excited at the possibilities of transitioning, but as you are well aware, it's a long process. Um secondly, we are uh continuing to work um with the communicable dis disease division um for assisting pregnant women who are diagnosed with syphilis. Um at times uh private providers do not have uh the treatment uh that they're needed. We work with uh the uh providers to provide them with the treatment for pregnant women. Um and lastly, I am very excited to say that in terms of our staffing capacity, we are on the increase. We are in the process currently of hiring uh three part-time/pool nurse positions that will start in October. Um they're on track for that. Uh excitedly, they are three people that worked full-time for us in the past. So, they're public health nurse um nurses in their training and two of them are bilingual, English, Spanish. So, we're we're very excited to add them to our compliment. Uh that will mean that we have um just about full capacity for our part-time slots um with six out of seven filled. And in terms of our full-time positions, we have 14 out of our 18 um public health nurse uh positions uh filled, which is a 78% um uh capacity rate. So, we we feel like we are making good headway at this point.

Ruth, that sounds really good. um compared to what I recall previously. So that is very exciting to hear that you've been able to fill your positions. That's great. Yeah. And we have a great team. Yeah. Thank you, Ruth. Next slide, please. We'll go to communical disease. Michelle Masters.

Good morning, everyone. Um so we for our three priorities first one we've talked about several times is developing a training and resource uh educational webinar for our acute caring long-term care facilities around healthcare associated infections um containment strategies and infection prevention control. So, what we've been working on is making sure that our staff here have the training to be able to provide that educational webinar as well as engagement with our acute care and long-term care facilities that we work with on a frequent basis to assess what they need and what they're looking for with educational webinars. So, we want their input um so that they are able to engage with those sessions. So, we did that research in quarter 1 and quarter two. Um second which links back to what Ruth had talked about um with interdep departmental collaboration is a partnership with clinical and the maternal and child health program to support pregnant women that are diagnosed with syphilis to to make sure that they um are linked to care they receive treatment and try to reduce uh congenital syphilis. So again, we are in the implementation phase. We've done some research. We are training staff here. Um we did have new staff this year that had to complete CDC required trainings. Um and then working forward with clinical to make sure we have a referral process for treatment. And then lastly, um trying to utilize technology in these times, uh we wanted to develop, pilot, and evaluate an online salmonella case investigation questionnaire form. Um so typically we do uh case investigations over the phone with residents that are diagnosed with salmonella. Um that is very intensive and it takes around 45 minutes plus uh for our residents to go through that. That is a long time for people to have throughout their workday. Um so we uh started to develop a salmonella questionnaire. So we've done research uh for questionnaires that are out there

already. We've also engaged P AOH and other health departments to see how they've been utilizing online surveys uh to see how we can be successful. So really overview in quarter one and quarter two is we've really tried to spake time to make sure staff are trained and we've done research to see what has worked and not worked uh in other entities. Michelle, that's great. Do you would this survey be texted to patient to people? Yeah. Yeah. So the hope is that it could be email, text or we consent it to healthcare providers to integrate into their electronic medical record and their messaging so increase the ability of contacting our residents.

That's great. Thank you. Questions for Michelle. Okay. Thank you. Thank you Michelle. Next we'll go to environmental health services with Pam Long.

Good morning. I will give you a quick update on our goals and priorities. Um so our first one is to research and identify a new inspection system. Um we've been working on this for a little bit of time. It does take time to find something that will um work with our group and what we do. Um so we are in the progress right now of um finding a vendor that will support the work that we do. Um, so right now we use uh digital health department and digital health department will no longer be supported as of December of 2026. So we have to find something soon. So we have time to develop it. So we are in the pro in in working on that right now. Um our other goal was to reorganize our territories and staff structure. So in Montgomery County um you know it's six over 60 municipalities we had that um broken up into like three different regions but based on our staff and workload we were able to now reorganize everything and we are going to break down the county into four different regions. We are officially fully staffed. So we just are in the progress of training staff and trying to onboard everybody and maintain um our our staff levels. So hopefully we can do that and um it probably in the new year they will be up and running and working in the new regions. So that's where we're at right now. Thank you.

Thank you, Pam. Any questions for Pam? Pam. Next we'll go to health equity and epidemiology with Chantel Mason.

Good morning everyone. Just some quick updates. So um we are still working on uh streamlining our data collection process including revising our data request form and SOP. So um in response to that we have hired a data manager who will be supporting the streamlining of the data request process. Uh that's Dr. David Walsh. um and also participating in the HHS data governance meetings just to make sure that um uh anything OP is doing around data collection aligns with HHS standards. Uh next we have the health equity framework and the development of the health equity profile. So we did select two health equity frameworks to work with here. That's the Massachusetts Health Policy Commission and the CDC communicating about health policy concepts. So, um, the report is slated to be released at the beginning of the year. Uh, really quickly, the Massachusetts Health Policy Commission, it focuses on a few things. Um, we wanted to make sure that whatever framework we selected, it could align with things that we were already doing. So, it wasn't a heavy lift to get it done. Um, it does focus on research and reporting on specific health um, indicators. Um, also partnering with uh stakeholders including community- based organizations and other government entities. And then watchd dogging. That includes just keeping an eye on those same health indicators so we can see are things improving? Um, are the things we're putting in place actually working? And then lastly, convening again to to bring that same group back to say, all right, did things work out? Do we need to pivot? um it is um a cyclical process which is great because it has the checks and balances in place. Um and then there's also the um CDC communicating about health policy concept which is um

a great uh framework because instead of focusing on the disparities, it focuses on the inequities that cause it causes the disparities. Um so the goal here is to not stigmatize groups that are experiencing the disparities. And so an example here would be um looking at infant and maternal mortality. Um African-American women do not um have the same rates as far as u maybe experiencing higher rates of mortality as opposed to their Caucasian counterparts. So instead of just saying that African-American women um are not experiencing the same rates, you would focus on what's the driver for um causing that uh disparity. So um it takes the the blame away from looking at the group and it more focuses on how we create how we can create a healthy community. So again um we are slated to release the uh health equity profile beginning of 2026. And lastly uh increasing public access to health data by creating data dashboards. Again our data manager Dr. David Walsh um who is part of the OP team u will meet with the divisions to see um what areas uh what metrics that they have that they would like to have included in a data dashboard. The goal here is to increase transparency wherever it's appropriate to make sure that we are sharing data and then he'll also be reporting out some opioid data to action grant data as well as appropriate. That's all I got. Pentel. Next we'll go to health promotion. David Ganova.

Thank you Jay and good morning everybody. Um our first priority uh is to address and prioritize the major health issues uh identified through the community health uh assessment. Uh we created two objectives for quarter 1 and quarter two. Uh the first objective was to create uh awareness of the uh community uh health assessment key findings. Uh we measured this through the number of views on our website, the number of social media uh interactions. Um we used four social media platforms uh including Facebook, LinkedIn, Instagram and X which is formerly known as Twitter. Uh 12 posts were shared uh from March to June. Facebook was the most consistently active platform with all post showing measurable reach and interactions. Uh looking at the number of views on our website, uh in quarter 1 we had 3,773 views. In quarter two we had 2,973 views. Uh the second objective was to uh share results and collective feedback of the CHA through community conversations. Uh we measured this by the number of community conversations held uh as well as the number of attendees. Uh we facilitated seven community conversations with 90 total people uh attending. Our second priority uh is to develop strategies to improve the overall health and well-being of residents uh through prevention and education. We are doing this in collaboration with division of uh communicable disease. Uh we're focusing on infectious disease outreach and education. Uh health promotion and communicable uh have scheduled standing meetings. Uh we create a cross divisional we created a cross-divisional channel uh on Microsoft

teams to improve communication. Uh we added a shared calendar that lists upcoming health fairs and different community events. Um, we're measuring this through, you know, who's attending, materials distributed, number of people that that we uh interact with. Communicable is also creating a general uh STD PowerPoint presentation geared towards uh high school children uh for our health educators to present on. Uh our third priority uh is to engage community health workers to provide health education uh outreach and navigation services uh to targeted populations in the county. Uh we are at the very beginning stages of this priority as we recently solicited prof uh uh proposals uh from qualified vendors through an RFP process. We received uh proposals from five uh different organizations. We are funding three of them uh at $80,000 each. Uh the contract term is from uh October 1st, 2025 uh through September 30th, 2026 uh with the possibility of a one-year renewal. Thank you.

Any questions? Okay. Thank you, David. Thanks, David. Next we'll go to emergency preparedness with Megan Young.

Morning everybody. Um couple highlights for the first half of this year for um FEP. Uh we continue to onboard our new public points of dispensing. So we've had a points of dispensing program for um distribution of vaccines and antibiotics and emergencies for quite a long time. Um after the COVID response, we uh quickly figured out we needed to change that delivery um improve that delivery based on what we learned from COVID. So the team has been doing a lot of really hard work this year um to kind of figure out what the best place is to put these public points of dispensing and how to best administer that program. So they've made some great progress uh in the first six months of this year. Currently, we have one fully executed agreement uh with two more close to execution. Uh I would say within the next two months they should be fully executed. Uh and we have meetings set up with at least three to four additional locations and we're constantly looking uh to make sure we have adequate coverage. Um we also continue to improve all the response plans for the office of public health. Um we have had several responses this year uh which have created the generation of some new response plans around things like uh highly pathogenic aven influenza. Um, of course, we've improved our measles response plan this year. Um, and we're looking ahead to 2026. Um, there's a lot of activities that we're potentially going to be asked to support. Um, so we are ensuring that the the response plans for emergencies are well short up long before we get to 2026. Um, we also have some response annexes that we hope to develop in the next year. Um, including arbo viruses, West Nile, viral hemorrhagic fever is a constant threat. uh things like Ebola and Marberg virus um and then hepatitis A. So those are the the goals for the rest of 2025. Um our other really big goal this year is to just continue to

grow the medical reserve core and and recruit new volunteers. Um we have a great medical reserve core. It has grown a lot um since COVID especially. Um they have been a constant source of support around vaccine clinics uh emergency responses. Um, so we have a great core group of volunteers. Um, but admittedly that core group of volunteers is retired, um, older age, um, and they're not going to be here forever. So, we are going to look, uh, to recruit some some new talent, some, um, additional specialties and things like that. So, uh, there's plans in place to, uh, create a marketing campaign, um, and just continue to to recruit new volunteers.

So, Megan, it's Barbara. So, what would be the appropriate number of volunteers that you would that you would feel good about? I don't have a set number in my mind. Um, you know, I think where we're at right now, I believe we have somewhere in the area of about 200 rostered volunteers. I would say about 45 to 50 that are consistently active. Um, and that feels like a good

I feel okay about that right now. I think we could do a lot of really good things with the numbers that we have. Um, you know, our our MRC volunteers have showed up consistently for the last five years. They staff all of our community vaccine clinics. They're staffing our health centers um when we start to see surges for things like back to school vaccine. Um, they are being asked to uh evaluate whether or not we could assist with things like homebound vaccines um to increase some delivery of services throughout the county. So, they they get to do a lot um and they do a really great job, but I also know that some of them will eventually actually want to retire uh for real. So, you know, we have to keep some some folks in the pipeline. So,

you know, we're going to probably be recruiting new retirees um from the health care systems um as well as hopefully some college students and younger professionals. I think that's great. Thank you for that. Um, I'm not sure we had awareness that there were 200. So, I think that's terrific and we should be sure that we thank them for the support that they give us, but that's great. Thank you. Any other questions for Megan? Okay. Thank you. And lastly, uh, water quality management with Keshmeck.

Good morning everyone. Uh, I apologize. My for an hour for an hour now my video has been uploading. So, you're going to have to look at a my name right now. Um, I uh first I I'll start with a a plan for a Legionella training for my staff. Over time, it I tended to do most of the work for when there's a a Legionella outbreak, but I'd like to involve my staff uh more in these cases. So, uh by yours end, I plan to present and it's it's being planned a uh to to present an updated and approved SOP for the uh for Legionella investigations. We've had some in the past, but we're updating it. uh and it's almost it's practically complete. Uh I'd like to present on past experience that I've uh encountered since the early 2000s doing these regional investigations which includes facility assessments, sampling and then providing recommendations to the facility and then uh I'd like to also provide professional training as well. Mo I know that some of it can be found online. So all of that should be completed by year's end. So I'm going to do it have it done this fall. Uh next is uh succession planning. Uh no worries. It's still several years away, but Jay and I discussed uh making sure that others know of my things that I kind of do myself and I'd like to to involve the staff more in in especially private well or groundwater contamination cases that I tend to do the sampling and provide recommendations. And uh also when we have public water

contamination uh cases that I I tend to be the uh the main point person for water quality. So I'm going to start training and handing off those assignments to to my staff and and there's other other topics as well. And then finally, similar to Pam, I'm working on or we we all are working on uh securing the services of a new vendor for our electronic database. So, we hopefully will have that in place and completed by the end of next year, which is the the DHD sunsets at the end of next year. So, we want to have that in place and ready to go before that occurs. So, any questions?

Thank you, Kyle. Um, and Jay, in in interest of time, um, is there anything else we need to cover? No, I think that's it. Um, other than the community health improvement plan, which is next. Yes. Yes. Which is next. Um, so let's jump into that. Um, and again, I think that, you know, we we have about 15 minutes left. Um, I'm not sure that's enough time, but let's jump in and uh let's see how far we get. If Christina agrees,

I think we should proceed. Um, I'm going to invite uh my colleague Christy Goodwin. She's our community health program manager to join me for this conversation. U Christie has been leading our community health assessment process and has been uh working towards the development of our community health improvement plan. Christie, are you with us? Yep. Awesome. Is it okay if I turn it over to you? Sure. Awesome.

All right. So, I'll go through this um as quickly as I can. That way, we have some time uh to talk and get your insight. So, we are um in the process of transferring from the CHA to the chip um and setting our priorities and then eventually uh determining our goals and their structure. So the top community concerns from uh the CHA were mental health, chronic disease, and environmental health. Um they're pretty similar across age groups and races. Um for mental health, it might have been higher in a younger age group, and chronic disease might have taken precedence with an older age group, but nonetheless, these were the three priorities uh that remained strong uh throughout that uh population that took uh the survey. Uh you can go to the next slide. Um the next three slides just have some of the highlights of that data. Um so you can see that uh slightly more than half of the survey respondents rated their mental health as excellent or very good. Uh we also noticed that perceived mental health improved steadily with age. uh 81% of non-binary uh respondents reported a need for mental health services in the past year. It was also higher uh for female respondents um as well as black or Africanamean. Uh you can go to the next slide uh for chronic disease. uh about 24% of survey respondents had met the recommended minimum um 150 minutes uh per week of moderate to vigorous physical activity. Um almost 89% were always or mostly able to access medical care when needed. um and

younger adults. So the 18 to 24, 25 to 34, and 35 to 44 age groups were the most likely to report difficulty um accessing care. Um it was also higher in the Hispanic or Latino population as well with about 46% um reporting that they had a personal health care provider compared to about 82% of non-Hispanic or Latino respondents. Go to the next one. for environmental health. Um it's a very wide definition. So the way we phrase it in the survey um was food or water, neighborhood, roadway, safe and clean housing. Um and so it incorporated the built environment along with feelings of safety and also of being able to have uh access to clean water and food. Um, so 75% said it was easy or somewhat easy to find safe sidewalks and streets for biking and walking near their homes. Uh, 90% reported that safe outdoor spaces were easy or somewhat easy to find. And then we had 59% agree or strongly agree um with a statement that they felt safe while driving on the road. Uh part of what I've been doing is taking a look at um other community health assessments in and uh CHIPS. So these are a few examples of uh CHIPS surrounding Montgomery County and examples of their priority areas. Uh for us, we have uh mental health, chronic disease, and environmental health as our priorities. Delaware County um also recently uh completed a CHAW and began their CHIP uh earlier this year. Uh their priority

areas are whole person health, substance use and mental health. So they group that all into one. Um also promote maternal, parental and infant health and then prevent chronic disease. I highlighted um where like some mental health was in yellow. So you can see where that over overlapped with chronic disease being in green. Uh for Philadelphia their chip was in 2022. Their priorities were social determinance of violence, public health preparedness and then access to care community health linkages. Uh Lancaster did one uh through their hospital system in 2023 and their priorities for safe and healthy environment uh healthcare access and quality and then again mental health. You can do the next slide. So this is an example from Delaware Countyy's CHIP. Um I just grabbed a few of the goals around mental health just to give you an example of how they structured uh their goals. So where we would like your insight and guidance um and I believe that'll be coming up in the next slide um will be how broad or narrow to set the goals. Um so under mental health uh one of their objectives is to decrease the proportion of Delaware County adults who experience poor mental health by 5%. Um and they also have improved mental health ratings among youth. Uh goal two for increased primary care access. Their objective there uh focuses on adults uh ages 18 and older. So, uh, increasing the proportion of who visit the doctor for a routine checkup.

Um, and then goal four is reduce obesity. And that's pretty broad. Uh, just decreasing the rate of obesity in Delaware County by 5%. You can go to the next slide. Okay. So, this is where we can get into our discussion. So, we'd like your feedback um on the priority areas. So to find out what you're noticing uh within the categories of mental health, environmental health, and chronic disease. And then again on goal setting. So wide versus narrow um are your recommendations to go countywide. So for Delaware County, um they were focusing just on the rate of adult obesity in the county. Um or it could be specific geography or specific population. So again, it could be um youth, it could be uh done by by race, it could be LGBTQ. Um so we'd like to hear what you have to say about again goal setting and then just also your feedback on those priority areas. So do people have um suggestions or ideas? Does anybody who joined us in the community have anything that they'd like to raise at this point around these three priority areas or any any other topic related to this? I mean, one thing Christie that I think about, so for mental health, like that's such a um important category, like I wonder um and I was glad you looked at what other uh health departments um have seen, but you know, I wonder what does what does addressing or looking at mental health in Montgomery County, like

what does that look like? What are the options for us? like is this part of you know community when in any setting where we're interfacing with the community do we touch on behavioral health and we do we touch on what's available um within Montgomery County to support people who have a behavioral health crisis um like I I don't I don't know all the potential things but maybe there there's a way where we make sure that resources are available and easily accessible as far as like where do you find support what kind of mental health crisis are you having like if you're suicidal like here's how you get immediate help 24/7. if you're concerned about someone who is a harm to the or danger to themsel or others, here's how you get help. Like, is that what it like? I don't know. I don't know what the to me it's it's a very big bucket. Um, and I wonder if we can put resources and make them available to people and even guide people of like if you're having this situation, this is what you should do. This you should go to the emergency department, you should call the crisis team, you should call the suiciderevention hotline. Barbara.

Yes.

Um I think obviously with mental health, the earlier you go at it, the better. So that um like obviously those of us who are in hospital-based, you know, we're seeing the tail end when they're in the emergency room and it's a suicide crisis, etc. Um, obviously from my standpoint, I would think more of a a broad-based approach of trying to, as you say, access mental health, but not in the endstages, but in the earlier stages. I don't know if there's a way to monitor because you get into a lot of significant HIPPA issues, but if there was a way to see whether or not there was ongoing mental health work being done in the youth earlier on. And I don't know if there's a way to construct that where you could say certain number of people have been having mental health appointments and we've seen an increase in those. But again, I'm not sure how much you can access those. But obviously in in this one, prevention is so much better than being able to get somebody out of an ER when they're in acute uh suicidal crisis. I mean again that's the one that we feel the pain of but it's probably better addressed on the earlier side rather than the later side. Uh and then on my second thing uh I would just was going to say I kind of like uh in terms of chronic diseases to talk about the obesity thing because things like even hypertension and even um uh issues with regard to uh diabetes there's not as much that you can sort of monitor and possibly what you can do. So the obesity one is a good one. Uh I do know that on the um state level there's more and more activity being done focused on uh hypertension as a chronic condition within pregnancies and providing uh blood pressure monitors and that kind of stuff. And I don't know if we can dovetail into any of that kind of uh thing but those would be the the you know when you're asking for the feedback. Mental health would be my

number one. Earlier the better, but if you can't do earlier even later is fine. and and the broader on those would be possible. And then as I said, um I don't know nearly as much about environmental health. So going into chronic diseases, I do like uh the obesity uh choice. And if we are going to do something in the hypertension realm, dovetailing with some of those people who are doing those programs to provide blood pressure cuffs to pregnant women, you know, on the state level would be where I would go. And that's all I got.

Thank you, Marty. I agree. I I agree with you. I think earlier so maybe we partner with the schools around mental health uh for children and and young adults um and also identify places for acute care um and then I agree with you about the chronic disease so obesity diabetes uh heart disease uh hypertension those are all really important spots which you can definitely make an impact so I think that's a great point so Christina I I think that we're going to have to talk about this again. Like I don't think we and maybe we need to move it up in the agenda so that we have a little bit more time. Um

and and I also wonder, you know, again, are there places where we can create sort of a draft of what we think is the way to spend our time in these three areas where we could partner and or make an impact and socialize that with other groups of individuals to say, does this resonate? What do you think? Um, and I think partnering with the health systems and the schools is a way. Um, because we, you know, I know that at our health system, we are focused on, uh, all three of those things. Probably more focused on behavioral health, mental health, and chronic disease. Um, environmental health is important, too. Um, but yeah, I think we should probably talk more about this because we're gonna we don't have we didn't give it ample time. So, Christie, I apologize. You're at the end. Uh we so you know it's a good thing we have so many things to talk about. It's a bad thing that if you're at the end um your time gets cut short. So I apologize but I think we're going to bring you back and put you at the top of the agenda right after Christina.

So other comments in our last few minutes. Okay. Oh so that's great. Thank you Teresa for putting um so members of the community who attended um you can submit your con comments. That'd be great. So, okay, Christina, anything else that we should try to cover in the last uh 60 seconds?

No, I don't think so. I think that this really has been a a packed agenda. There there really is so much for us to talk about, not only at the federal level, but also at the local level. This work is ongoing. It is critical. It's important. And I think the work that we're doing across the entire office of public health is not only you know uh directed towards you know supporting the health and wellness of our entire county but also building uh you know strong and uh trusting relationships with our with our residents. Um so you know I'm so delighted and grateful for all of you uh to be here today the time that you take to be a part of this work and your guidance and your support. Uh thank you very much and I hope you all have a a great great week ahead.

Yeah. So, um I'm gonna so thank I'll thank as well the entire team. Uh you all did a great job presenting. Thank you for the comm to the community members for joining us and thank you to our board members. Uh our next meeting is December 3rd. Uh it is in person to be very exciting. And if I have a motion for um adjournment, that'd be great. Motion. Thank you. Second. Second. Thanks, Marty. All right. Uh thank you everybody. Be well and we'll see you in December. Thank you. Thank you.