Public Health in Our Town

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Public Health in Our Town

• Urgent Needs
• Shrinking Resources

2
Public Health in the News Everyday
Third Man confirmed dead from Whittier Farms Milk
contamination
S. Boston house of squalor condemned City gives
owners 30 days to clean
SENATE PASSES TRANS FAT BILL
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Public Health Protection and Prevention

• Doctors treat individuals Public health
  professionals prevent disease for whole
  communities
• West Nile, hepatitis, listeria, AIDS, etc
• Public health officials protect and inspect our
  food establishments, keep our indoor air quality
  safe, well and beach water safe, sewage and
  septic systems installed correctly
• Emergency preparedness/health responders
• During extreme weather events, chemical,
  biological, radioactive attacks or accidents
• Coordinate and administer mass vaccines, antidotes

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Public HealthPublic Protection

• Protect our families from communicable diseases
• Ensure safe drinking water private wells and
  groundwater
• Responsible for proper sewage and septic
  installation
• License and inspect food distribution
• local farms, restaurants, supermarkets, senior
  centers
• Investigate consumer complaints
• housing, garbage, food, illegal dumping
• Ensure water quality in beaches and pools
• Ensure safe and sanitary summer camps, motels and
  campgrounds
• Safe operation of landfills housing inspections
• Coordinating Emergency response public health
  aspects chemical exposures

5
Public Health Nurses

• Prevent, monitor and control communicable
  infectious diseases (meningitis, flu, hepatitis)
• Work with day care centers, nursing homes,
  medical offices, school nurses and municipal and
  state authorities to prevent and control
  outbreaks
• Document and report trends West Nile, SARS,
  whooping cough, chicken pox, measles
• Reach vulnerable, high risk populations including
  children and the elderly

6
Restaurant and Food Safety

• Restaurant inspections proper food preparation
  and storage, food temperatures, pest control,
  hand washing, clean bathrooms
• Legal requirement to inspect all food
  establishments between 2 and 4 times per year
• Milk and dairy inspections
• Chemical and microbial contaminants
• Other food handling wholesale distributors,
  bakeries, summer camp kitchens

7
MA General Law Title 5 Septic Responsibilities
and Liabilities

• Todays septic plans and installations are much
  more complex than they were in earlier eras
• More training and computer skills are now
  required to review and approve plans
• Fallout of an improperly installed or inspected
  septic system is polluted groundwater and
  drinking water
• Presents a huge liability for towns
• DEP budget cuts over the last 2 years mean the
  entire municipal protection system has minimal
  support/oversight for septic issues

8
A New Mandate Post 9-11 Emergency
Preparedness

• Officials have adopted an all hazards approach
  to prepare for chemical, biological, radiological
  incidents
• Public health and Public safety agencies all work
  together EMTs, Police, Fire and Medical
  personnel all receive training on same equipment
• Coordinate local emergency plans shelter,
  telephone call in lines, mass immunizations

9
Emergency PreparednessLocalized responses and
solutions

• Plymouth and Franklin counties and northeastern
  MA are close to nuclear reactors
• -potassium iodine tablet distribution
• Berkshire County-
• -coordinates efforts in many towns with limited
  resources
• Cambridge
• - coordinates 27 cities and towns with training
  and drills
• Boston
• - the largest city and port in NE a potential
  target

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A variety of new mandates arrive annually

• Beaver removal permits
• Sharps Collection and Disposal
• Mercury risks and safe disposal
• Body arts, tanning salon
• inspections

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PROPOSED PEAK POWER PLANT, CHELSEA MA
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Environmental Example Chelsea

• Issue a new peak energy facility plant proposed
• In May of 2007 examined pediatric asthma
  prevalence from four elementary schools (complex
  of 1,800 students) located ¼ mile from the
  proposed site
• 3 out of 4 schools at the complex had pediatric
  asthma rates statistically significantly higher
  than the statewide rate
• MDPH/BEH evaluated proponents estimate of impacts
  on community for facility related emissions and
  recommended a number of additional analyses to
  better characterize potential impact
• MDPH/BEH also recommended that various mitigation
  efforts to reduce the proposed impacts should be
  considered once the more refined impact estimates
  were created
• In Nov 2007, the proponent withdrew proposed
  facility at this location

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Ever Increasing MandatesFlat Lined Staffing
Levels

• Many municipalities are seeing over 100
  increases in septic plan reviews
• Number of food establishments has exploded in
  last 5 years
• Many municipalities operate with volunteer Boards
  who do inspections on their own time
• Housing violations are very time consuming.
  Extreme hoarding, a mental illness, creates
  gruesome dangers for neighbors and emergency
  responders and is on the rise
• Emergency preparedness the straw that broke the
  camels back must coordinate drills with other
  agencies and towns
• Board members so busy doing inspections they
  cant focus on policy making such as requiring
  well testing, disease reporting

14
State Auditor Joe DeNuccis Report On DPH Food
Protection Program An Increasing Risk

• Highly decentralized system of food inspections
  is very inefficient and must be modernized.
• Must add sufficient state and local staff to
  oversee and conduct the required inspections.
  This is an essential step toward improving food
  safety in Massachusetts.
• 11 of 13 local authorities visited were not in
  compliance with federal and state standards that
  call for inspections at least every six months
  for most food establishments, and three to four
  times a year for high-risk establishments, such
  as large restaurants, hospitals and nursing
  homes. March 2007

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FURTHER AUDIT FINDINGS

• Local health authority food inspection activities
  are significantly understaffed in most
  municipalities.
• In many instances, staffing levels are at least a
  third less than the federally-recommended levels.
  
• Only 8 percent of inspectors meet the preferred
  Certified Food Safety Professional qualifications
  standard
• The state programs inspections of wholesale
  firms were also found to be inadequate, as more
  than 2,000 of these businesses were inspected an
  average of only once every four years.

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Public health and town budgets

• While responsibilities and mandates have
  increased local and state public health budgets
  are holding flat or decreasing
• Budgets are being cut an average of 10 across
  the board
• Resources are already below what is needed to be
  to keep up with current mandates
• Cant keep up with inspections that help prevent
  disease and stem financial and other
  consequences these are liabilities waiting to
  happen
• US FDA guidelines state that each inspector can
  only perform 250 food inspections per year
  (thats 125 establishments X 2)
• What if a town has more than 125 establishments?
• Resources and needs vary pool inspections take 3
  hours a water park can take 2 days

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Public Health Budget

• Local Public Health budget statistics
• MA State Budget devoted to Health Care and Public
  Health

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Municipal Liability

• Towns are left open to potentially catastrophic
  liabilities if they are not able to keep up with
  mandatory inspections
• EXAMPLES Need the facts on these cases
• Ludlow food handler who died from hepatitis
• Indoor air quality at Peabody High
• Hepatitis A in Arlington
• Restaurants, county fairs, camps all pose
  potential hazards
• The costs of dealing with an outbreak to a
  community are far greater than the costs of
  surveillance to prevent one

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Public Health Smart Investment

• Prevents outbreaks of disease, food poisoning,
  cancers, other diseases and deaths
• Reduces liability for cities and towns
• Increases life span by promoting healthy
  behaviors
• Identifies trends early to develop response and
  controls
• Efficient public health assessment and response
  in emergencies

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• Every day we deal with bacteria,
  viruses, environmental contamination, molds,
  vermin, and drinking water hazards.
• And we do it with a smile.
• Unsafe housing, tattoo artists,
  flu pandemic preparedness, illegal dumping, and
  rabid animal response. Its all in a days work.
• We work to keep our community safe from
  disease and health hazards. The more resources
  we have, the better equipped we are to protect
  everyones quality of life.
• Public health is often taken for granted an
  essential service like public safety that merits
  strong support.