Board of Health - August 11, 2023 Minutes
Regular Meeting: August 11, 2023
Opening: The regular Meeting of the Board of Health of the City of Fargo, North Dakota, was held in the City Commission Chambers at City Hall at 12:00 o’clock p.m., Friday, August 11, 2023. Chair Lyn Telford presiding.
Present: Lyn Telford, MSN, RN, CPHQ; Nyamal Dei, MPH; Arlette Preston; Grant Syverson, MD
Absent: Jayme Steig, PharmD; Avish Nagpal, MD; Kayla Nelson, DNP, APRN, FNP-C; Bernie Dardis
Others Attending: Tracie Newman, MD, MPH, FAAP, Desi Fleming, Rachael Johnson, Jan Eliassen, Jordan Joshua, Grant Larson, Sydni May, Justin Bohrer, Chandler Esslinger
Announcements:
There is not a quorum so there will be no voting today.
Walkability and Neighborhood Design Arlette Preston presenting as she has both the planning department and the health department in her portfolio. Bringing awareness to the importance of neighborhood design, walkability and neighborhood design. Walkability means active transportation, using your own body power, short trips. Neighborhood that encourages people to walk and cycle. Smart street design to accommodate walking and bikes. Walk/bike to be able to shop, eat, work and recreation. Attempt to move away from car dependency. Not a neighborhood design everyone wants but more of these neighborhoods will be available for those who do want that.
Review of local plans. Comprehensive plan GO2030 fine grain blocks to make sure that trips are a short as possible for pedestrians and bicyclists, and walkable mixed-use centers. Moorhead Comprehensive Plan--Onward Moorhead incorporate a “complete streets” design philosophy into all aspects of mobility planning and design. The West Fargo Comprehensive Plan is to have safe, efficient, reliable transportation that encourages active transportation balancing through all seasons with a network of walkable streets.
Current design is normally car centered, which is not friendly to pedestrians and cyclists, it can be life-threatening, a sense of insecurity, wide streets, and too fast traffic. There is a link between having a good public health status and having walkable neighborhoods. Promotes a greater sense of community, more opportunities to mingle, higher walkability in neighborhood associated with decreased rates of obesity and diabetes. Walkable communities provide more easy access to groceries. Supporting research, correlation between walkability and heart status. Higher cardiovascular risk if not walking enough. Low intensity walking is good exercise. It is associated with lower respiratory disease rates in children, rural environment, better mental health in urban areas, and reduced smoking. Additional benefits: economic cost of owning a car, environmental build neighborhoods where the employment centers are in the center. Attract new workers and new economy workers. Cost burdened with housing, so it is helpful to take off that car cost, it can make a huge difference. Reduces pollution carbon emission with reduced amount of cars. Decrease needs for more and wider streets etc. Younger generations want environments where they can get out and meet their neighbors. Current efforts: incorporate walkability in the future plans, such as Fargo Growth Plan 2023. Create a common understanding and a local group called Strong Towns is working to bring a walkability expert here. Strong Towns is based out of Brainerd, Minnesota and they are trying to address how streets interact with their neighborhoods. The intent is to help create common understanding.
Dr. Syverson mentioned in order for this to work we would need a robust mass transit system, so in Fargo in order to reduce the number of cars we would need to improve our mass transit.
Ms. Preston responded that right alongside this walkability is to improve our mass transit system. It is not a user-friendly system right now. There is a study right now on University and 10th street (where there are 3 schools in the area), in order to work on these arterials, we have to do very thoughtful planning. Fargo Cass Public Health has been working with the planning department for their growth plan for approximately two months. We have been involved before in walkability before in our Health Protection and Promotion Department with the Streets Alive program. Issues about walkability also include discussions regarding distracted driving and speeding.
Nursing Program Updates/ Fit and Strong/ Gun Storage Education Ms. Fleming presented some updates regarding the Nursing Division. First regarding gun storage safety. We have been working with Sarah Kemp Tabbut from the VA in order to get cable gun locks for some of our programming. We are still working on the details on this partnership. We are still working on getting resources and starting with home visiting clients and maternal child health clients. Rachael Johnson presented information regarding FCPH’s Fit and Strong program, which is to combat chronic health issues in our over 60 population. We had two RNs attend the training. The program is an evidence-based program brought to us by NDSU extension, it was created at the University of Chicago. It was found that there was a great increase in flexibility, better mobility, decrease in lower extremity pain, it also has a positive affect on mental health. The first class was done in the spring of 2023 with 11 participants. We now have two classes with a total of 25 people. Some of the feedback from participants: “decreased the need for Tylenol, has built up strength, enjoying the social component.” The class is a free resource for people over 60. There is a twice a week class for 12 weeks, one at Fargo Cass and one at a church location. Weight training is very important as we age. The class is made up of 60 minutes of physical activity and 30 minutes to do discussion and share personal experiences. We started with FCPH retirees and then we did media releases to encourage people to join but word of mouth is also very helpful.
Environmental Health Update Grant Larson presented information regarding the Environmental Health Division. Discussing the staff employed, the multiple programs that they inspect and license, as well as the fact they cover 6 and assist southeast counties: Cass, Richland, Traill, Ransom, Sargent and Steele.
There is financial support for covering these other counties with supplemental state funding. The state recognizes that there are larger health departments that have more resources, funding and staffing. A smaller health department may have difficulty, which is where the larger health departments step in and help. Some of the highlights have been the implementation of the Animal Boarding Program that was implemented in 2020. Before that the police department was responsible for these places when there became an issue, then the health department stepped into help be more proactive and look after the health of these pets before there is an issue. There are 12 current facilities licensed in Fargo. Their department also enforces the 2013 FDA food code, we are waiting for the 2017 guideline when adopted by the state of North Dakota. They did 1,407 food related licenses, 75 mobile food vendors and 29 temporary events for 2023. They license categories based on risk, tiers I, II, III. Tier I is a gas station heating food, II is fast food (heat and serve), III restaurant that process more, where there are leftovers etc.
Massage Therapy Establishment Program was implemented in 2021. There are currently 99 licensed establishments. The state board licenses the practitioner, FCPH licenses the establishment where they are working. We also have the Nuisance Complaint Program. This is primarily tall grass/weeds complaints. This is a complaint driven program, they have had 700 so far in Fargo this year, (last year they had 1100). They have good collaboration with city departments for example: inspections: to deal with hoarding garbage/junk in a yard, police department: unlicensed vehicles. Homeowners are given an opportunity to correct nuisance violations. If they do not and we have to mow they will be charged a fixed fee per hour for the mowing and an administrative fee. If this fee does not get paid it will be assessed to the property tax.
Harm Reduction Update Jan Eliassen addressed the calls about reports of the increasing amounts of the unhoused hanging out in public spaces and camps down by the river. We do take a count of the unhoused people in the shelter, and we generally have pretty good numbers, but getting a number for those outside of the shelter is more difficult. We sent teams out to the community downtown area, and we found over 40 people who were unsheltered. Representative of what we are seeing everywhere. We have much higher numbers than we had in the past. People are setting up spots outside the library and civic center. A lot of them are young that we haven’t known for very long. They think they can stay on public property which is concerning to the public because of garbage being left behind and the sheer number of people being seen who are experiencing homelessness. The numbers increasing is not because the DEC is there, the DEC was located to be where the people who needed assistance where at. Chandler Esslinger spoke about myth busting. We are aware that homelessness has been a part of our downtown for a long time. Nationally, the data shows that the need for shelter far outweighs what is available, about 40% not finding shelter, up to 60% are chronically unhoused. Those people are the most visible. We are in alignment with national trends. Usually in January every year they do a count for HUD. We are looking for the activation of a winter warming center. We are working with a stakeholder group to use the lower level of the engagement center. It would not be a traditional shelter; it would just be to keep people out of the elements. Lyn Telford took a tour of the DEC with Chandler and Jan and was impressed by the laundry/showers/vending machines for hygiene supplies. They are currently looking for personal hygiene supplies. The Day of Dignity (8/27/2023) is partnering with Fargo Parks, where there will a personal care item drive to get the items and then the Day of Dignity event where there are resource tables, free haircuts/shaves, a meal, free food and fresh produce, and personal care products.
Health Officer Report Dr. Newman presented information about the rates of childhood immunizations. Childhood immunizations are increasing, worldwide, 4 million more kids received childhood vaccines than in the previous year. This may be the first sign that the trend is reversing. We are not back to pre-COVID numbers, but we are going in the right direction. This hasn’t been the case in North Dakota. Overall decline that has continued, for example in Kindergarten age children the MMR rate was 99.75 and now it is at 91.83. We do have counties that have MMR rates as low as 50-60%. ND’s vaccine exemption rates are staying high, personal belief and religious exemptions have been increasing. Cass County does look a little better, last year our MMR rate was 92.7% and this year so far we are already at 94.5% and our exemption rates are dropping and have remained lower than the rest of ND. Another item that is important to note is that in North Dakota the percentage of children who are 19-35 months is only 65% for children who have all the recommended doses, and for MMR we are at 81% which leaves us at risk for a measles outbreak. Cass County is also low at 68% for all doses, but for MMR we are at 84.08% which is better but we still aren’t were we would like to be which is 95% to have herd immunity.
FDA has approved and ACIP recommends RSV prevention vaccination for infants and children. Beyfortus (Nirsevimab-alip). Trial data showed reduced RSV associated lower respiratory tract infections (70%) and lower hospitalization rates. It is approved for newborns and infants born during or entering the 1st RSV season and children up to age 2 who are at risk of severe RSV. It is already available in Canada and Europe and the safety has been monitored for a long time. CDC and ACIP recommend older adults consider getting the RSV vaccination. There are two RSV vaccines for this age group (Pfizer and GSK). Talk to your doctor about your personal risk.
Dr. Syverson asked about the hospitalization rate difference between Beyfortus and other similar products. Dr. Newman responded the rates are very similar to Synagis rates. The difference is Synagis has very strict usage criteria. Ms. Preston asked about why immunization rates are low. Dr. Newman responded that it is unclear, there is pandemic fatigue, people catching up on wellness visits, hoping the back-to-school push might help vaccine intake.
There will be a back-to-school immunization walk in clinic at Fargo Cass Public Health on August 23 and 24 from 8:00 am to 4:00 pm. Ms. Fleming mentioned that Dr. Newman has been asked by Dr. Wehbi (our state health officer) to be a part of the state health counsel.
No Public Comments
Adjournment: 1:13 pm
Next Meeting: November 17, 2023