Board of Health - March 8, 2024 Minutes
Regular Meeting: March 8, 2024
The regular Meeting of the Board of Health of the City of Fargo, North Dakota, was held at 12:00 p.m., on Friday March 08, 2024.
Present: Jayme Steig, PharmD; Avis Nagpal, MD; Arlette Preston; Kayla Nelson, DNP, APRN, FNP-C; Lyn Telford, MSN, RN, CPHQ; Bernie Dardis
Absent: Nyamal Dei, MPH; Grant Syverson, MD; Jim Kapitan
Others Present: Dr. Tracie Newman; Desi Fleming; Michelle Draxten; Chandler Esslinger; Jan Eliassen; Beth Olson (Presentation and Partners in Housing Organization); Brenda Derrig; Archie Ingersoll
Announcements: None.
Minutes Approved: Ms. Preston moved to approve the minutes of the two previous meetings with amendments. Seconded by Mr. Dardis. No members objected and the motion was declared carried.
Department Update: Director Fleming provided updates to the Board regarding the recently posted Director Position. She notes the intent of the posting and the process for hiring for this position, which includes the position being open for a month and the process for the selection committee to begin the interviewing process. Director Fleming states she will provide more information at the next meeting. Hoping to have someone hired by July 5. Commissioner Preston asks about how many markets the ads for the position had been placed in for the position. Director Fleming notes that this is a national search and applications have been received from various regions since it opened on March 1, 2024.
Cass Clay Food System Update: Michelle Draxten, a nutritionist from the Health Promotion Division of Fargo Cass Public Health provides an update on the Cass Clay Food System. Her presentation, “Food is Medicine” is reviewing a national health initiative whose goal is to sustain health throughout various communities. The presentation begins with national statistics around nutrition security and health, including 33.8 million people who live in food-insecure households. Ms. Draxten notes that the national initiative was created in 2022 from the U.S. Department of Health and Human Services who received funding in 2023 from an Omnibus Appropriations Bill to implement the effort to sustain and improve health. This initiative is coordinating partnerships to expand access to nutritious foods and bridging the gap between private and public sectors. The Food is Medicine Summit launched partnerships between Feeding America, Instacart and the Rockefeller Foundation. According to Ms. Draxten, national efforts for Food is Medicine primarily consist of requesting more research for implementation to expand access to nutritious foods. Ms. Draxten continues her presentation by discussing additional Food is Medicine efforts including the pilot program from the Indian Health Service that is a Produce Prescription plan. Other efforts include The Administration for Community Living creating resources to suggest best practices for Food is Medicine Activities, Centers for Medicare and Medicaid Services giving more opportunity for jurisdictions to implement Food is Medicine efforts through Medicaid. Ms. Draxten then summarized the next steps which include continuing the conversation about the Food is Medicine Initiative, exploring funding opportunities to implement activities, and defining what this initiative should look like locally. Ms. Draxten spoke regarding our local food policy council, Cass Clay Food Partners. Their mission is to improve all levels of the community food system to assure that residents have access to safe, nutritious, affordable, and culturally based foods. Ms. Draxten provided an overview of what a food system is and its intricacies including the interconnected systems that influence nutrition, food, public health, community development and agriculture. Ms. Draxten provides a background, history and timeline for Cass Clay Food Partners and its regional reach around the area. This includes a steering committee that advises and provides organization and management to the Cass Clay Food Commission as well as the Action Network which formed in 2010. The food commission focuses on addressing and discussing policies related to the local food system with seven elected officials and several at-large members from around the Fargo-Moorhead region. Ms. Draxten also discusses the Food of the North - First Friday’s program that occurred from 2018 to 2023. This program provided monthly engagement meetings to discuss important food topics. Current work of the Cass Clay Food Partners includes focusing efforts on school meals, food insecurity, social determinants of health, civil engagement and food systems, community of practice – goal to understand food policy systems to hopefully develop a larger framework, and strategic planning. Specifically, work of the commission has included focusing on blueprints and integrating food systems into comprehensive planning for urban agriculture, food access and sustainability. For example, backyard chickens in the area, community gardens, farmer’s markets, food waste, gardening, and much more.
Additionally, she discussed the robust COVID-19 Response from the partnership, which includes efforts for food resource lists, guides, and videos on various food topics.
Discussion:
Dr. Nagpal asked about the logistics the department is taking to plan for food insecurity and what this planning is based off. Ms. Draxten discussed how it is based on availability and not income related. Ms. Telford asked for more information about the Prescription for Produce Pilot Program and Ms. Draxten provided more insight into the funding and use of the program.
Ms. Preston asked if any grants would be available if the city were to participate in a program like this. Ms. Draxten responded that grants are available for research but not yet available for implementation. Mr. Dardis asked about how we identify those who are food insecure, and it is noted by Ms. Draxten that information is typically from people who are signed up for food benefit programs such as WIC, SNAP, or those who visit food banks/pantries that require a sign-up/application. Ms. Nelson noted that screening recipients of these services may help capture accurate information and is also done at many clinics or other service provider visits. Dr. Newman also noted that Sandford Hospital is included in tracking some of this information on some screening questionnaires. It was noted that another way to track this data could be from the health systems Community Needs Assessment to showcase the usage of these services.
Ending Homelessness Together Event Recap: Chandler Esslinger, the Community Liaison of the Harm Reduction Division for FCPH, provided an overview of Ending Homelessness events that they hosted recently. Ms. Esslinger provided an overview of the events with a video produced by the City’s Communication team. There were four total public and private discussions. Ms. Esslinger pointed out they encouraged public engagement and support, which was also noted by the guest speaker of these events, James Mathy (Milwaukee County Housing Authority). Ms. Esslinger also overviewed the next steps following this event. Some examples of potential next steps include housing subsidy, education, coordination, shared approach, etc. These actions were learned from the guest speaker’s “recipe for success”. Ms. Esslinger notes the process currently used, or the “traditional” housing model and the various steps that are taken and where there might be room for flaws. Ms. Esslinger compares this to a housing first model that leads to more stability. The presentation continues with statistics from Milwaukee County’s success for utilizing the housing first model. Specific statistics include cost savings in law enforcement, healthcare, etc. Ms. Esslinger closes her portion of the presentation by discussing the takeaways from the events. Items include focuses on a shared approach and vision, local investments and coordination, public education and a point person for accountability and implementation. Beth Olson, the Housing Navigation Program Director for Presentation and Partners in Housing, also provided a presentation regarding the theme of ending homelessness. Following an introduction to the organization, Ms. Olson introduced an assessment done by various organizations which measured the most vulnerable of those experiencing homelessness. This assessment found that finding housing for people is one effort, but maintaining housing for the people they are serving is more difficult. Because of this assessment, the Housing Navigation Program was created to focus on effectively serving the “hardest to house” population. According to Ms. Olson, this program includes intensive case management for housing people who have the most barriers or who have been homeless the longest with the most issues. Ms. Olson highlights the importance of strong partnerships, especially with community landlords is important to flip the traditional model of housing the chronically homeless population, which this program is aiming to do. The presentation continues by noting that the housing first model can be more effective fiscally as well as morally versus the traditional model that is widely used. The organization tracked these ideas by following the people they served one year before and after housing. The presentation displays the specific findings. For example, jail savings were $69,170, shelter usage was decreased, etc. Ms. Olson notes the key program components of this model which includes small caseloads, community-based, hands-on support in participants’ homes, refer and connect for additional supports or resources, and intensive case management.
Discussion:
Ms. Telford notes interest in the downstream effects of these savings, especially for ambulance calls, police calls and other responses.
Ms. Nelson notes that in her current role, she notices that there is a return for use and a difficulty for maintaining housing. Commissioner Preston notes the importance of these ideas and discusses that the infrastructure currently in place is beneficial to moving forward with these practices. Commissioner Preston also seeks Mr. Dardis’s perspective, and he speaks about the importance of coordination, resources, and partnerships in the community from an economic standpoint. More specifically, tracking data and tracking expenses could be beneficial.
Dr. Nagpaal discusses the importance of medicine to people and how many barriers there are to accessing medical care. Medical services have become more inclusive, using virtual visits, or conducting home visits as an example, but yet none of these modern services are accessible to those experiencing homelessness. Ms. Telford discusses the “basic healthcare on-wheels idea” which is a mobile effort to bring services to people in the interim so those receiving this service can focus on other aspects and other efforts.
Health Officer Update: Dr. Tracie Newman provided an infectious disease update to the board. Dr. Newman’s first point is focused on the increase of Pertussis (whooping cough) cases locally (39 cases in Cass County) and nationally. As noted in her presentation, there have been 19 cases since February 1st. Typically in Cass County, there are on average only 6-8 pertussis cases each year. Dr. Newman shares with the board a confirmed Hepatitis A case that occurred in Grand Forks, ND, but no additional cases have been reported to date and the local public health agency did a great job in tracking and contact tracing. Information regarding the Measles outbreaks increase nationwide was also presented at this time along with points of interest occurring in other jurisdictions. To close her presentation, Dr. Newman reviewed the current immunization rates within the State. She noted that while flu cases have been increasing, RSV and Covid-19 cases are decreasing at this time nationally. She agrees that this is the same locally.
Public Comments: None.
Adjourn at: 1:24 pm
Next Meeting: Scheduled for May 10, 2024