Board of Health

CITY OF SALEM BOARD OF HEALTH MEETING MINUTES January 14, 2020 MEMBERS PRESENT: Dr. Jeremy Schiller, Paul Kirby, Geraldine Yuhas, Datanis Elias, Sara Moore OTHERS PRESENT: David Greenbaum, Health Agent, Suzanne Darmody, Public Health Nurse, Maureen Davis, Clerk of the Board, Patti Morsillo, City Council Liaison, Kerry Murphy, Health and Wellness Coordinator TOPIC DISCUSSION/ACTION 1. Call to Order 7:01pm P. Kirby motioned to move the agenda out of order to move K. Murphy’s item until she arrives. G. Yuhas 2nd. All in favor. Motion passed. 2. Reorganization of the Board P. Kirby moved to re-elect J. Schiller as Chair. G. Yuhas 2 nd. All in favor. Motion passed. G. Yuhas motioned to re-appoint M. Davis as Clerk of the Board. D. Elias 2nd. All in favor. Motion passed. 3. Chairperson Communications J. Schiller welcomed Patti Morsillo to the Board as our new City Council Liaison. J. Schiller reported that he read the Open Meeting Law about the reasons to go into executive session and found that none of it applies to what we discussed about D. Greenbaum’s evaluation. Kim Waller will be at the next meeting to discuss vaping and the research and work that she is doing at Salem State that may be in line with some agenda items and areas of possible focus. D. Greenbaum will reach out to Joyce Redford of NSCATAPP to see if she can attend the meeting. She forwarded the new regulation for the State regarding vaping sales and he would like to see if we can incorporate them into our regulation and implement the additional restrictions that the Youth Commission asked the Board to look at and include the State’s most current language. 4. Approval of Minutes (December 10, 2019) D. Elias motioned to approve the minutes. P. Kirby 2 nd. All in favor. Motion passed. 5. Monthly Reports-Updates a. Public Health Nurse’s Report J. Schiller asked for updates on the flu. He is not seeing a lot of cases at the hospital. S. Darmody said between 12/1 and 12/31 there were 18 cases reported. There have been about a dozen new cases in the last week, so the numbers are going up. G. Yuhas asked where she gets her numbers from. S. Darmody said through DPH’s online MAVEN program. Any Salem resident that is diagnosed with a communicable disease that is on the 1|Page  reportable disease list will come to her through the MAVEN program. J. Schiller said it still seems low compared to 2018. P. Kirby asked about the severity of this year’s flu. S. Darmody heard it is at a moderate level. G. Yuhas asked about the mother/baby program. S. Darmody reported she had her first alone visit and it was a mom with twins. The visit went well, and it was a very positive experience. P. Morsillo asked about the purpose of the visits. S. Darmody explained they are trying to fill a gap because there is not a lot of follow up for postpartum after leaving the hospital. She said it is a six- community collaborative program that began over a year ago. The program is an outreach and connects the moms to local resources. Copy available at the BOH office. b. Health Agent’s Report D. Greenbaum reported he and some staff members attended emergency preparedness pre-plan meetings in November and December. They also participated in the DPH tabletop exercise at Beverly Airport on Thursday. There was a really good turnout from Salem, and he was pleasantly surprised at the response that we got from the other City departments. The public health emergency scenario they gave us was botulism; after a 5k run there was a cookout on the Common and people were exposed to botulism from the potato salad. They had to set up to treat people with an anti-toxin. G. Yuhas asked about beer at the food truck festival. D. Greenbaum said licensing and the police are responsible for alcohol. The police do a great job. J. Schiller asked if we get opioid stats regularly. He thought we used to get reports once in a while of Narcan use and overdoses in the City. D. Greenbaum said we do not, but he can get the statistics from the police. We have had no additional complaints of syringes on the street. Healthy Streets does a really good job of exchanging new needles for old ones. The idea is to provide clean syringes and take the dirty needles back to try to avoid any communicable disease outbreaks like Hepatitis A or HIV. J. Schiller asked if there have been any issues with the second dispensary on Highland Avenue. D. Greenbaum said he has not heard any complaints. Copy available at the BOH office. c. Administrative Report G. Yuhas asked if any other waste haulers have paid for permits. D. Greenbaum said when we know a hauler is in the City, we can send correspondence to them about the regulation and permitting. Copy available at the BOH office. d. Council Liaison Updates P. Kirby asked P. Morsillo to tell us about her health-related, professional background and what drew her to the Board of Health. P. Morsillo said she has been involved with the League of Women Voters and personally she has been the chair of the gun sense working group, working closely with a group in Marblehead to push legislation and bring aggressive attention to the issue. She thinks we could get behind education on the red flag law. MA has a red flag law, but it’s not very well used yet. She thinks it is because people just don’t know enough about it and how to report a violent situation in their house. 2|Page  D. Greenbaum attended the League of Women Voters’ forum on gun violence. He said the center is pretty impressive and it was a good forum. He was glad he was able to attend. Some doctors from Mass General spoke of their experiences with gun violence. He was told that some doctors go to places and hand out gun locks so guns can be stored safely when not in use. The gun can’t be fired with the lock on. He talked about having a doctor come to Salem in the summertime to be one of our guest attendees at the farmers’ market. P. Morsillo said there is a new group at MGH, the Center for Gun Violence Prevention. They are working hard in the medical community to attack it as a public health issue. They get doctors trained on how to talk to their patients about guns. J. Schiller asked if it is allowed for doctors to talk to patients about guns. P. Morsillo said it is banned in Florida, but it may be a state-by-state ban. She said SATV taped the forum. She will send it to the Board. P. Kirby motioned to approve the reports. G. Yuhas 2 nd. All in favor. Motion passed. 6. Kerry Murphy – Updates of Health K. Murphy provided a slideshow presentation of the many programs she is and Wellness Projects working on, as well as data showing the relationship between food and health. The Food is Medicine State Plan program is based in Boston and provides medically tailored meals and food packages that are reimbursed by insurance. They were delivering as far as Lynn but starting this month they are going to be statewide. She has been talking to NSMC and gave the presentation in December about this State Plan and ways that we might be able to partner with them to launch some sort of initiative in Salem. It would take a lot of grant money to get a pilot program started here. Healthcare costs can be drastically reduced. For example, 92% of Type 2 diabetes cases are completely preventable through diet. She got her information from a Food is Medicine seminar she attended at a symposium at Tufts School for Nutrition. Food is Medicine incorporates interventions, including nutritious food referrals which are basically fruit and vegetable prescriptions. Doctors prescribe produce and patients can go to food pantries. Some organizations will give a card similar to the SNAP card so patients can go to a grocery store and get produce. The idea is that once providers start seeing the reduction in health care costs they will start reimbursing for these types of programs. The Fresh Food Farmacy program is a mobile farmers’ market/mobile pantry at Boston Medical Center and NSMC is very interested in pursuing hosting a similar type of mobile market on their campus every other week, or monthly to start, where doctors can write prescriptions for patients to go to these markets. The program is based on a one-year pilot program for diabetics. It was very successful. It showed that these types of interventions really work, it’s just a matter of getting medical centers and insurance providers on board. Healthy eating reduces medical costs. The information used was taken directly from the North Shore Medical Center 2018 Community Health Needs Assessment. There is a growing concern about the level of food insecurity in their coverage area. This is where we 3|Page think we might be able to start partnering with NSMC with some type of Food is Medicine intervention. They would screen patients for food insecurity and any nutritional-related chronic disease and those who screen positive would get an immediate referral to a mobile market. She is hoping also that anyone who is housebound with some sort of nutrition-related chronic disease can get into the Community Servings meal delivery service, too. Close to a million people will be dropped from the SNAP program due to new work eligibility criteria. Able-bodied adults without dependents will no longer be eligible and could potentially be dropped. It could also affect the school lunch programs here because if enough people get dropped from SNAP it may affect our eligibility for free breakfasts and lunches. There is a grant that is coming up and we have been talking about partnering with Citizens Inn in Peabody and the hospital. This would be a 3-year grant for a Food is Medicine-type intervention. The Mack Park Food Farm is a program supported by the Mayor. One of the Food Policy Council recommendations was to identify unused municipal land to grow food. The Mayor said if we went before the Park & Rec Commission, she would support us in using a large area of Mack Park to grow food. We had the soil tested and it was totally fine. The Mayor came with us when we presented to the Park and Rec Commission in October. We also had to go before the Conservation Commission in December, and everything was approved. They’ve already started turning the soil. There will also be a small community food forest at Mack Park. The vegetable garden would be closed off to the public, but the food forest would be completely open to the public and planted with fruit and nut trees and different kinds of edible plants. We can have workshops there on how to grow food. We could have a weekly farmers’ market with the vegetables grown in the vegetable garden. Food Forests are planted like a forest and are therefore very low maintenance. It won’t require pesticides and will improve the ecosystems near the wetlands. The Conservation Commission was actually excited about this because they thought it would be really beneficial to that area. J. Schiller asked who is going to be tending to the garden. K. Murphy said they have an agricultural subcommittee with Andy Varela from Maitland Mountain Farm, Matt Buchanan, who was running Salem Greenspace garden, and Pat Schultz, who used to own Howling Wolf and is now a certified horticulturist and owns his own gardening business. The three of them will be taking the lead on the design, so we will be relying on them, as well as volunteers, to run it. Somerville’s health department has a mobile farmers’ market. She would love to do that in Salem someday. Taste & Talks is a community nutrition education program that is through the Jewish Family & Children’s Service based in Waltham, but they have a program in Salem called Aging Well at Home. They do a free farmers’ market during the summer and we talked to them about expanding it to be year-round so people could get food from local pantries. Once a month she goes to a different housing site for low-income, older adults and does a short nutrition lecture and cooking demonstration. There 4|Page is also food that they can take home after the demonstration. She has also been doing nutrition education for youth and young adults whose food choices are affected by food industry marketing. Sometimes she goes to Root and does nutrition talks for the kids in their program or to YouthBuild at the NS CDC. It’s harder with kids because they don’t really care what’s going to happen to them in 30 years when it comes to unhealthy eating, so she tried a different tactic. There was a study that showed when kids, mainly teenagers, were educated on how the food industry manipulates their food choices and exploits kids, especially in low-income and minority populations, they were more likely to make healthier choices. The advertising really affects them. She could tell the students were angry when they realized they were being manipulated by adults in the food industry. She and D. Greenbaum were talking about the idea of maybe partnering with the Y for some sort of education program that combines exercise with some marketing education. S. Moore said it made her think of the presentation the Salem Youth Commission did around vaping and trying to bring attention to the fact that marketing is targeting people of color, etc. They may want to be involved in this, too. Her sociology students at Salem State worked with students at Horace Mann and brought them to grocery stores to walk through and notice the products they see displayed at eye level, etc. Her students did some research about marketing towards young kids. The kids realized they were being duped by marketing. K. Murphy said she also chairs the health committee of Salem for All Ages. They still need to find ways to engage the Latino community. They are trying to work with the health clinic and NS CDC, and they have agreed to start letting the CLC go to Espacio and offer programming there as a way to try to draw people to the CLC. The COA vans have offered to provide transportation from the health clinic or Espacio to the CLC to give them tours and try to involve them in the programming. The Program Director at the CLC speaks Spanish and they do have Spanish-speaking classes there. It’s just a matter of making the Latino community more aware that all these resources exist because if a person doesn’t have transportation, the CLC is not the easiest place to get to. We are also working on a medical escort program, which will be a volunteer program, for older adults who might be on their own and not have people to accompany them to medical procedures or appointments where they might need assistance. They will meet with Beth Rennard next week to work out the legal issues and see what might be required as far as a waiver, etc. It is unclear if volunteers can use their own vehicles, so we may have to provide a COA van to get started. This service is very much needed here. There are so many older adults living by themselves. S. Darmody is also on the subcommittee for Salem for All Ages now too, so it has been great. Salem for All Ages has their own website and they have a health page that currently just has pdf fliers posted, but there is a plan to once a month have different members of the subcommittee write an article so there will be a different health article every month. Walk with a Doc is a national program that is a free walking program for the community. She really wants to get started by this spring and was 5|Page hoping to partner with the hospital. A different physician every time would volunteer for an hour and give a short 5-10-minute talk, then walk with the participants and be able to answer their questions along the way. J. Schiller said he would be totally into that program. She is on the Wellness Committee for Salem Public Schools with D. Greenbaum and they are trying to update the wellness policy, which is sorely outdated. She is trying to get school nurses and other stakeholders and parents together. The wellness policy is about healthy eating, active living which is mandated by the USDA. They have also been working on creating guidelines for different nutrition programs that are popping up in the schools, like the backpack program, some school food pantries, etc. Salem Food for All, Salem’s Food Policy Council, will go before the School Committee and advocate for a school garden coordinator to work and run all the school gardens. There is a lot of evidence showing what a huge benefit school gardens are for kids. Salem Meet & Eats at Saltonstall is the second Wednesday of the month from 5:30-7:00pm and the meals are prepared by Root, who does a fantastic job. We are hoping to open another location so there will be two meals a month. The Salem Food for Thought Festival, a Food Policy Council event, fed lunch to well over 100 people at Espacio in September 2019 with rescued food from restaurants that would otherwise have gone to waste. It also raises awareness of the amount of food that goes to waste. Haven from Hunger does a ton of food rescue and repurposes it and Root served a really good meal. The Longest Table Event is tentatively planned for September 2020. The location may be at Charlotte Forten Park on Derby Street. There are a number of cities around the country that do these events. They just set up a huge line of tables and it is open to the entire community. We are hoping to get 200 people at this event. P. Kirby asked K. Murphy if she needs any volunteers for the many programs she has going. K. Murphy thanked him and said she will reach out for volunteers on salemvolunteers.org whenever needed. Salem Food for All has its own Facebook page, too. She can also put people on her volunteer sign-ups. D. Greenbaum said the City will be participating in the Healing Communities Study around the opioid crisis. There are four states involved. They will look at how information intersects and affects the opioid crisis. K. Murphy spoke to the health center and they indicated they wanted her to be involved in it. He thinks it’s an ideal fit and branches us out to do other things, not just the food things. D. Greenbaum said as part of our efforts with the hospital and the Homeless Committee, we’re looking at what kinds of things we can do around the vaping crisis. The Mayor really wanted to get a buyback program for e-cigarettes going when the Governor announced his ban. It 6|Page  took a little time to get it, but we have a structure in place for a pilot program at the high school. We are waiting for permission from the high school to allow kids to bring them onto school property. Participants would first have to sit in on a cessation talk with the director of the school- based health center and then they would receive a $50.00 gift card to Target or some other store where they can’t re-purchase vaping products. NSMC has agreed to donate money to purchase the gift cards. He is hoping that sometime in the next week or two we can get the program up and running. He said it has been a real struggle to get the administration at the high school to allow it to go forward. The Board thanked K. Murphy for sharing all of the information. D. Greenbaum said the Health and Wellness Coordinator position is one we never had in the past and it is the ideal time for it because there is so much going on in community health and wellness. Having somebody in place to oversee all these programs is a huge boost to the Department. S. Moore commented that programs are good to promote good health in the community, but without systemic changes in policies it is hard to sustain them. K. Murphy reported she met with the Medical Director at the health clinic on Friday about the Salem for All Ages and trying to get someone from there on the Committee. The director told her they would love to have some sort of prescription program and nutrition education there and they don’t have access to any of that. She said it would have to be someone culturally competent to show people how to cook healthier versions of Dominican food, etc. They would need to be Spanish speaking. D. Greenbaum said we could look to see if a local chef would be willing to donate some time to help. He said it only makes sense since we are dealing with a large population in this City that are not English-speakers and enjoy culturally diverse foods. K. Murphy suggested it could be rolled into the grant to pay someone to do it. The health clinic said their rates of hypertension and diabetes are going through the roof in that population. K. Murphy distributed copies of the Salem Community Food Assessment Recommendations and said if anyone sees anything they feel we should be focusing more on, just let her know. 7. Discussion of Health Assessment S. Moore asked what the Board’s capacity is to address issues, such as in schools where some teachers are bringing in junk food for kids in schools and using food for an incentive for so many things in the schools. What kind of influence can we have over shaping discussions on nutrition, transportation, etc. D. Greenbaum said we are very fortunate to have a good relationship with the schools, in particular food services, and have a fantastic Food Services Director, Deb Jeffers. She makes sure the food she is serving in the schools is not just out of a box and into the microwave. A lot of it is cooked-to-order meals. He is co-chair of the School Wellness Committee and S. Darmody and K. Murphy are also members. The school nurse leader is the other chair of the Committee and she asked him for agenda items, so he can suggest 7|Page agenda items around food and healthy eating. He and K. Murphy talked a lot about working with the Y and the Boys and Girls Club because they have a large population of low-income young people who are struggling to find food and when they do find it, it is not the best food for them. Any policy decisions go through the School Committee. We could see about getting on the School Committee agenda. J. Schiller suggested if we can see the agendas from those meetings, we can be more connected to what’s going on. D. Greenbaum suggested S. Moore email him if she thinks of something she would like us to pursue. She thought of maybe having peer-to-peer nutrition education programs. Acknowledging behavior and eating patterns need to change and the idea of getting more active is important, but there is a fine line between educating and shaming students, which can have the complete opposite effect and have worse health outcomes. Maybe it can have a mental health stress reduction component. They may be able to see how all those things are tied together and the message would be coming from their peers. She would be happy to look into places where that has worked. D. Greenbaum thinks peer-to-peer is a great idea and would be much more impactful. S. Moore said she uses a collaborative, community-based approach to things and said in the larger community, too, such as older adults, we could create a structure where people are helping each other to achieve health goals. G. Yuhas said eating healthy is very expensive and not everyone can afford it, especially if you have a large family and a low income. S. Moore agreed that cost is a real issue. Her students worked with the YMCA Greenspace garden. People would come to the farmers’ market to get produce, but they didn’t know what to do with it. She asked her students to come up with low-cost recipes using ingredients from the garden. Buying the produce would be very expensive. D. Greenbaum said one of the things he really liked that K. Murphy brought up was Somerville’s mobile market. He would love to get a mobile market here in Salem. They have an actual truck that he believes Stop & Shop donated. Somerville fixed it up and bring fruit, vegetables and other food around for people who need it. There is no cost. He said a lot of the elementary schools have their own food pantries now, but the food is junk. How do we flip that around to make it healthier without singling out the student and make it more anonymous? S. Moore said because the SSU farmers’ market is called a mobile market and not a pantry, it de-stigmatizes. Students come, residents of Rainbow Terrace come and residents from the Point walk down. S. Moore is working on a grant that might be able to use money to implement a mobile market. It is a $400K Spencer Foundation 3-year grant meant to bring together providers from all around Salem to provide opportunities for students to succeed in many areas, not just academically. The goal of the grant is trying to get money to create a stronger infrastructure and allow us to use some funds to do research around programs that speak to particular indicators like health, housing, mental health and academic outcomes, early childhood, afterschool, etc. She thought a letter of support from the Board would be very helpful. D. Greenbaum feels the Mayor would be very passionate about it and 8|Page  supportive of it with the School Committee. J. Schiller feels it would weigh heavy if the Board of Health showed up or lobbied on behalf of it. The Board coming to support what D. Greenbaum says is also really important. D. Greenbaum said the Mayor is passionate about community health and wellness and she would be happy to see the Board is advocating. He feels we should focus on one issue, such as advocating for a school garden coordinator and that should be our first goal. As time goes on, we can look at other things and advocate for them as well. S. Moore said the Food Policy Council will soon be drafting a statement about the benefits of that kind of curriculum which will be read at public comment before the School Committee. Maybe the School Committee can hear support from the Board on the same day. D. Greenbaum updated the Board about the MPH student from UVM who has started to review the body art regulations and the model code from NEHA. Hopefully in the next few months there will be a document that we can provide to the Board to see how we may be able to amend the regulations to include some of the advances in the industry. 8. New Business/Scheduling of Future - Kim Waller presentation on vaping Agenda Items - Joyce Redford – update on vaping regulations MEETING ADJOURNED: P. Kirby motioned to adjourn. G. Yuhas 2nd. All in favor. Motion passed. 8:30pm Respectfully submitted, Maureen Davis Clerk of the Board Next regularly scheduled meeting is Tuesday, February 11, 2020 at 7:00pm At City Hall Annex, 98 Washington Street, 1st Floor, Salem, MA 9|Page