1. Public Health in Our Town Urgent Needs Shrinking Resources

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

3. 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

4. Public Health=Public 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 Preparedness: Localized 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

10. A variety of new mandates arrive annually… Beaver removal permits Sharps Collection and Disposal Mercury risks and safe disposal Body arts, tanning salon inspections

11. PROPOSED PEAK POWER PLANT, CHELSEA MA

12. 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 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 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 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 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 In Nov 2007, the proponent withdrew proposed facility at this location

13. Ever Increasing Mandates: Flat 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

15. 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.

16. 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

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

18. 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

19. 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

20. 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.