Board of Health

Boards, Commissions & Committees

Board of Health - November 17, 2023 Minutes

Regular Meeting: November 17, 2023

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, November 17, 2023.

Present: Jayme Steig, PharmD; Avish Nagpal, MD; Arlette Preston; Lyn Telford, MSN, RN, CPHQ; Nyamal Dei, MPH; Bernie Dardis; Tony Grindberg

Absent: Avish Nagpal, MD; Kayla Nelson, DNP, APRN, FNP-C; Grant Syverson, MD

Others: Tracie Newman, MD, MPH, FAAP; Desi Fleming, Jan Eliassen, Chandler Esslinger, Brenda Derrig, Kim Citrowske

Announcements: None

Approval of Agenda: Motion to approve by Ms. Telford, move to approve by Commissioner Preston, seconded by Nyamal Dei. All members voted aye, and the motion was declared carried.

Approval of Meeting minutes: From August 11, 2023; motion to approve by Ms. Telford, move to approve by Nyamal Dei, seconded by Bernie Dardis. All members voted aye, and the motion was declared carried.

Approve Proposed 2024 Schedule: Motion to approve by Ms. Telford, move to approve by Mr. Grindberg, seconded by Nyamal Dei. All members voted aye, and the motion was declared carried.

Growth Plan Brief: Kim Citrowske from the City’s Planning and Development Department provided an update on the City’s Growth Plan. Ms. Citrowske provided an insight into the discussion on the previous planning efforts from the former plan, which focused on the edges of the city, in comparison to the new plan which focuses on redevelopment areas and where community preferences are on the edge. Ms. Citrowske also reminded everyone of the online public survey regarding the growth plan, which closes tonight (Friday November 17th at 11:59 pm). Ms. Telford responded with her appreciation of the update given to the board. Ms. Preston shared how the growth plan relates to the Board especially since it has significant impact to residents’ wellbeing and overall health, especially with overall design. Ms. Preston shared her appreciation for the updates.

Health Officer Report: Dr. Tracie Newman presented a slide show report providing updates related to the Health of the City. Dr. Newman presented the significant points from the recent U.S. Surgeon General’s report on the Epidemic of Loneliness. Dr. Newman pointed out that social connection plays a critical role in an individual’s community and societal health. This report highlights a framework and specific recommendations for various groups. Pointing out that poor social connections can have consequences not only for mental health but physical health as well. Specific examples included depression, anxiety, etc. This report showed that evidence has shown that increased social connection can reduce the risk of serious health conditions like heart disease, stroke, dementia, etc. Dr. Newman pointed out ways this framework provides tasks to communities to advance their social connections. Those tasks include strengthening social infrastructure (e.g., enhancing community physical elements like parks), enacting pro-connection public policies (e.g., policies to support accessibility, etc.) and mobilizing the health sector. Ms. Preston noted that the former growth plan includes parks/social gathering spots and suggests all future growth plans should consider this. Chair Telford commented that updating and maintaining these public spaces is important. Ms. Preston stated that regulating neighborhood design standards should be considered, as some may lack interaction among neighbors. Ms. Dei commented on the importance of safety, especially around children and families. Also pointing out some framework ideas to advance social connection among communities like reforming our digital environments, deepening our knowledge, and cultivating culture of connection. Dr. Newman then discussed the current rates for influenza and influenza-like illness over time in comparison to pre-pandemic levels. Dr. Newman mentioned that currently we are meeting an epidemic threshold throughout the country for influenza-like illnesses. Dr. Newman noted typical patterns across the country of illnesses and that it has increased countrywide. She compared this data to vaccine coverage noting that vaccine coverage is not as high as hoped across the nation and within the state. She then discusses data from the State for Flu Coverage from the 2022-2023 season. Statewide flu vaccine coverage is below 50% for all age groups. Ms. Nyamal asked why vaccine coverage rates in our state is so low. Dr. Newman responded to this question by noting that since the Covid-19 pandemic, these numbers have changed. Prior to the pandemic, the coverage rates in North Dakota were some of the highest in the country. But since the pandemic, overall, there has been vaccine hesitancy, and the reasons vary from person to person. Chair Telford points out that the recent vaccine hesitancy we are noting now is not limited to the Covid vaccines. Dr. Newman displayed the Covid-19 Cases Overview graphic and the Covid-19 Vaccine Coverage rates from the state. Dr. Newman noted the coverage rates from the initial Covid vaccine versus the booster shot rates across the age groups. The data shows that not many people who received their covid vaccine are receiving their booster shot, especially in 65 years and older age group. Dr. Newman presented Covid-19 Vaccine Coverage Rates for Cass County. She also noted that there is a supply shortage of the RSV vaccines, and the state is not expected to receive any more. The current supply will be prioritized for high-risk infants. Dr. Newman noted that the state is experiencing an increase in confirmed and reported Pertussis cases and states that vaccines are our best form of protection for these. Chair Telford asked if healthcare organizations are starting to include the risk for loneliness assessment screening in their screening procedures. Dr. Newman responded that this specific resource is not widely used currently, however, in her work similar questions are asked. Questions are related to basic anxiety or depression questions. Chair Telford asks if Public Health has any resources or campaigns on digital safety. Director Fleming is not aware of any currently. Chair Telford states she can share with the department the resources she has received. Director Fleming notes that the department is adding more information and awareness resources are being added to the department’s work. Ms. Nyamal notes the importance of mental health and how it takes a team, and we need to educate everyone. Mr. Steig commented about the importance and ability to co-administer vaccines, which may limit the number of times a patient visits a healthcare provider to receive vaccines. Rather, they can receive several in one visit. Mr. Steig also commented on the discussion around the “blue-zone “campaign. Director Fleming notes that the blue zone did not move forward, however various initiatives are being spearheaded by different healthcare groups. Chair Telford noted that even though this has been put on hold, there still is an opportunity to continue these ideas, especially as we move forward in planning efforts.

Winter Warming Initiative: Assistant City Administrator, Brenda Derick, discussed the Winter Warming Initiative. Ms. Derick discussed her collaboration with various City Departments (Public Health, Fire, Planning & Emergency Management) on a plan for winter weather and its impact on the unhoused. As noted by Ms. Derick, this collaboration looked at various planning options before moving forward with a final plan using the funds which were dedicated to winter sheltering. This initiative includes providing updates on the maintenance of the plan throughout the winter season and at the end of the season. Director Fleming discussed the plan in further detail and showed her appreciation for City Leadership’s support. Director Fleming discussed the impacts from the previous winter season and the need for more resources because of the weather. Ms. Fleming also noted this initiative will not solve the entire problem, but this overflow space can provide some help for the weather. Winter Warming Initiatives is situated on the main floor of the Downtown Engagement Center (DEC) site and is meant to be a temporary space, much like airport seating style. There will be a transition period to provide services following normal business hours of the DEC. Those who do not receive or find shelters can stay, though it is not a full functioning shelter. This is now until May 1, 2024, and the capacity is around 30-40 people. Director Fleming noted that workforce funding is being used for staffing of this overnight site. Ms. Preston questions the logistics of this space and the reasoning behind the airport-style seating arrangements. Director Fleming noted that due to spacing regulations and fire codes, and the temporary nature of this site, this was the intent.

Ending Homelessness discussion: Chandler Esslinger, the Community Liaison from the Harm Reduction Division, provided an update from the division on the efforts of the division’s work in the community as they attempt to end homelessness in the city. Ms. Esslinger shared that the Harm Reduction Division received three awards from the FM Coalition to End Homelessness conference. Ms. Esslinger noted the takeaways from the FM Coalition to End Homelessness conference which included how strategic and collaborative action plans can solve homelessness and our area is well situated to address chronic homelessness. Noting the upward trends in homelessness in the nation in recent years, certain systems, when put into place, can immediately address these issues if they do not have to start from scratch. Ms. Esslinger shared an upcoming event with a visitor from a different state that has completed great efforts in addressing homelessness in their jurisdiction, more information to follow. Ms. Esslinger highlighted the Ending Homelessness Task Force (Public Health working with City Administration) which has recently released a structure for working on homelessness, which focuses on two groups. The first is people dedicated to creating policies that allow Homelessness Response to steer people effectively and efficiently to stable housing. The second group is subject matter experts, along with technical recommendation, working to maximize housing and the efficiency of the response system. Ms. Esslinger provided a high-level overview of the data of national and local trends on homelessness. National trends include an increase in homelessness since 2017 after a decrease from the previous ten years. A report, which has not been released yet, will be provided to the Board once published, as noted by Ms. Esslinger. Ms. Preston questioned if there is any rationale about the increase in unsheltered and the difference in the rates. Ms. Esslinger noted there are many factors, but the pandemic does have some influence, especially social-distancing factors. Ms. Esslinger also noted that many unsheltered people have experienced chronic homelessness, which she explains is defined as long-term instances or repeated occurrences of homelessness. Ms. Esslinger noted that within the Fargo-Moorhead area there are on average 330 Emergency Shelter Beds available, though the need outweighs the availability throughout the year. She also noted that since summer, shelters have been serving at an overflow capacity. Which is abnormal since there has not been much winter weather which goes to show the increase in the need for more housing is not happening as fast as people are experiencing homelessness. Ms. Esslinger noted the congested and long wait lists for housing, some people wait several months before accessing some form of housing, most of which are in Fargo, but homelessness impacts the entire community. Mr. Grindberg asked about the best practices for solving homelessness and is interested in learning more about who those communities are. Mr. Grindberg also asked about the engagement with law enforcement in data collection. Ms. Esslinger stated ongoing collaboration with law enforcement is occurring but is unsure if they are supplying data to these numbers. Mr. Grinberg also discusses how various jurisdictions might have homeless people migrate to other places and how that looks in the data. Ms. Esslinger answers by noting the collaborations across the region and working strategically to provide stable housing for those experiencing homelessness. She also notes that addressing homelessness would benefit the entire community not just those experiencing homelessness. Ms. Dei questions how we can expand our current resources to include more people from various backgrounds. Ms. Esslinger points out that the goal of the Harm Reduction Division is to be as low-barrier as possible when providing services and finding resources for people and notes that the whole community should consider adopting these factors which help address homelessness. Ms. Preston noted that addressing these situations is a collaborative effort from various departments and stakeholders. Ms. Preston noted that incidents of mental health issues within the community and asks Ms. Esslinger to discuss the concept of housing first and how it relates to addressing other issues that potentially contribute to homelessness. Ms. Esslinger answered that it does take a coordinated response and enough resources
throughout the community. Without these, law enforcement becomes the default to respond to these, with or without the proper resources. She notes that law enforcement does not have to be the de facto response if we as a community have the resources and services to provide to people facing mental health occurrences. She stated that providing housing first, regardless of barriers, could help people focus on other issues in their life that they may need to overcome. Ms. Preston agreed that a safe environment will give individuals time to focus on improving other aspects of their lives. Chair Telford noted that this relates back to Maslow’s hierarchy of needs. Mr. Dardis asks about involvement from other agencies, noting that various people across the region experience homelessness. Ms. Esslinger responded noting that historically faith-based organizations play a significant role in collaborating with local government agencies in providing housing for people and providing donations to shelters for people to have more services. Chair Telford shares her appreciation for the dialogue and shares the importance of using our voices to have this objective conversation and asks for talking points to continue this conversation. Mr. Steig stated the importance of social determinants and questioned how we can address homelessness further upstream. Ms. Preston asked about the ability to establish a goal and vision for what we want homelessness and notes this board would be a great space to do so to garner a sense of this issue typically being procrastinated due to lack of understanding.

Public Comments: None were received.
Adjourn at: 1:14 pm
Next Meeting: Tentative 03/08/2024