Community Health Commission

A Vibrant and Healthy Berkeley for All

1947 Center Street, 2nd

Floor, Berkeley, CA 94704 Tel: 510. 981.5300 TDD: 510.981.6903 Fax: 510. 981.5395 E-mail: publichealth@ci.berkeley.ca.us - - http://www.cityofberkeley.info/health/

Agenda Thursday, October 9, 2014

6:30pm-9:00pm

This meeting is being held in a wheelchair accessible location. SECTION A. PRELIMINARY MATTERS

1. Roll Call 2. Announcements from Commissioners, introductions of any new members 3. Approval of the September 2014 CHC meeting minutes 4. Designation of Commissioner to take monthly meeting notes of agreements and

assignments (provide handwritten copy to Commission Secretary to scan and email to all commissioners within 4 days of the meeting.)

5. Comments from the Public

SECTION B. PRESENTATIONS

1. Alameda County Health Commission Health Economics and Obesity Report http://www.acphd.org/media/351716/health-economic-obesity-full-rpt.pdf – Linda Franklin

SECTION C. ACTION ITEMS

1. OLD BUSINESS:

a. Subcommittee and Commissioner Reports on: i. Health Equity ii. Alta Bates Charity Care and Community Benefit iii. Public Education and Marketing iv. GMO labeling v. Conducted Energy Devices

b. Discuss and take possible action on appointing subcommittee members,

designating subcommittee chairs, specific charge and target dates for report back to Commission, and subcommittee meeting notification procedures.

c. Discuss and take possible action on recommendations from the subcommittees regarding the Public Health Division’s Health Priorities and Budgeting Report dated June 10, 2014 and the “Health Happens in Berkeley” Initiative.(see attachment #5)

Community Health Commission Meeting Location: South Berkeley Senior Center

2939 Ellis Street, Berkeley, CA 94709

COMMUNITY HEALTH COMMISSION AGENDA – October 9, 2014 Page 2 of 3

d. Discuss and take possible action on Conducted Energy Devices (CED) Subcommittee recommendation on Council referral to research the use of CEDs (Tasers) by Berkeley Police Department.

2. NEW BUSINESS a. Discuss and take possible action to change the regular meeting date of the

Community Health Commission. Options for consideration but not limited to are: another day during the 2nd week of the month or a Thursday on the 1st, 3rd or the 4th Thursday of the month. (Stein)

SECTION D. INFORMATION ITEMS

1. Health Officer Report – Dr. Janet Berreman

SECTION E. FUTURE AGENDA ITEMS

1. Alta Bates Medical Center data and quality issues 2. Presentation on Public Health Division programs including the High School Clinic,

and Tobacco Enforcement 3. Presentations on Alta Bates Charity Care

The next meeting of the Community Health Commission is tentatively scheduled for Thursday, November 13, 2014, with a deadline of October 31, 2014 for public’s submission of agenda items and materials for the agenda packet. Dates are subject to change; please contact the Commission Secretary to confirm. SECTION G. ADJOURNMENT Attachments:

1. Draft CHC Minutes September 2014 2. Correspondence from CPHA in Support of Measure D 3. Correspondence from Diana Teremzawi regarding hand sanitizer implementation 4. Free Blood Pressure Clinic Flyer 5. Public Health Priorities Report June 10, 2014 6. Alameda County Pharmaceutical Take Back Program Upheld in Court 7. Breathmobile Update report to City Council 9/16/14 8. Commission Roster October 2014

COMMUNICATION ACCESS INFORMATION To request a disability-related accommodation(s) to participate in the meeting, including auxiliary aids or services, please contact the Disability Services specialist at 981-6346 (V) or 981-7075 (TDD) at least three business days before the meeting date.

COMMUNITY HEALTH COMMISSION AGENDA – October 9, 2014 Page 3 of 3

ADA Disclaimer

“This meeting is being held in a wheelchair accessible location. To request a disability-related accommodation(s) to participate in the meeting, including auxiliary aids or services, please contact the Disability Services specialist at 981-6342 (V) or 981-6345 (TDD) at least three business days before the meeting date. Please refrain from wearing scented products to this meeting.” SB 343 Disclaimer “Any writings or documents provided to a majority of the Commission regarding any item on this agenda will be made available for public inspection at the Health, Housing & Community Services Department located at 2180 Milvia Street, 2nd Floor, Berkeley, CA 94704.” Communications Disclaimer “Communications to Berkeley boards, commissions or committees are public record and will become part of the City’s electronic records, which are accessible through the City’s website. Please note: e-mail addresses, names, addresses, and other contact information are not required, but if included in any communication to a City board, commission or committee, will become part of the public record. If you do not want your e-mail address or any other contact information to be made public, you may deliver communications via U.S. Postal Service or in person to the secretary of the relevant board, commission or committee. If you do not want your contact information included in the public record, please do not include that information in your communication. Please contact the secretary to the relevant board, commission or committee for further information.”

Community Health Commission

A Vibrant and Healthy Berkeley for All

1947 Center Street, 2nd

Floor, Berkeley, CA 94704 Tel: 510. 981.5300 TDD: 510.981.6903 Fax: 510. 981.5395 E-mail: publichealth@ci.berkeley.ca.us - - http://www.cityofberkeley.info/health/

Minutes Regular Meeting, Thursday September 11, 2014

The meeting convened at 6:38 p.m. with Chair Franklin presiding. ROLL CALL Present: Commissioners Collins, Franklin, Kwanele ( arrived 6:43)

Lee (arrived 6:41 pm) Nathan, Neuhauser, Rosales, Shaw, Stein, M. Wong

Absent: Commissioners Delgadilo, Namkung,Tempelis Excused: Commissioners Barry, Speich, A. Wong Staff present: Gail Feldman, Janet Berreman COMMENTS FROM THE PUBLIC Rosalina Gutman regarding heart disease in women and petition to restore heart catheterization lab at Alta Bates Rhiannon and Beth Montano regarding Berkeley Asphalt Plant PRESENTATIONS None ACTION ON MINUTES 1. M/S/C (Rosales/Nathan) Approval of July 2014 meeting minutes Ayes: Commissioners Franklin,Kwanele,Lee, Neuhauser,Rosales,

Shaw, Stein, M. Wong Noes: None Abstain: Commissioner Nathan Absent from vote: None

Community Health Commission

Meeting Location: South Berkeley Senior Center 2939 Ellis Street, Berkeley, CA

Community Health Commission Minutes September 11, 2014 Page 2 of 3

Excused: Commissioners Barry, Speich, A. Wong Motion Passed. ACTION ITEMS 2. M/S/C (Nathan/Rosales) Motion to appoint Neal Nathan to the Conductive Energy

Device (tasers) Subcommittee

Ayes: Commissioners Franklin, Kwanele, Lee, Nathan, Neuhauser, Rosales, Shaw, Stein, M. Wong

Noes: None Abstain: None Absent from vote: None Excused: Commissioners Barry, Speich, A. Wong Motion passed. 3. M/S/C (Nathan/Kwanele) Motion to recommend to City Council that:

1. The City Council hold a Public Hearing regarding air quality complaints on the West Berkeley Lehigh Hanson Asphalt Company plant, Bayline Concrete Cutting Company and Pacific Steel Casting Company; and that the City provide relevant health information.

2. Direct the City Manager to complete the compliance check list based on the 1999 Settlement Agreement with the Oceanview Neighborhood Association; and

3. If the City Manager and delegated staff or department finds the West Berkeley Lehigh Asphalt Company plant is not compliant with the compliance check list based on the 1999 Settlement Agreement with the Oceanview Neighborhood Association, the City and its jurisdictional bodies or the appropriate authority implements corrective action and enforces the 1999 Settlement Agreement compliance checklist immediately.

Ayes: Commissioners Franklin, Kwanele, Lee, Nathan, Neuhauser,

Rosales, Shaw, Stein, M. Wong Noes: None Abstain: None Absent from vote: None

Community Health Commission Minutes September 11, 2014 Page 3 of 3

Excused: Commissioners: Barry, Speich, A. Wong Motion passed. 4. M/S/C (Rosales/Stein ) Motion to support the Community Environmental Advisory

Commission (CEAC) request to support SB1014 and send as a communication to City Council

Ayes: Commissioners Franklin, Kwanele, Nathan,Rosales, Shaw, Stein,

M. Wong Noes: Commissioner Neuhauser Absent from vote: Commissioner Lee Excused: Commissioners: Barry, Speich, A. Wong Motion passed. Future Agenda Items (MAY change) Alta Bates Medical Center data and quality issues Presentation by Public Health Division on High School Health Clinic and Tobacco Enforcement Presentations on Alta Bates Charity Care NEXT MEETING The next regular meeting will be on October 9, 2014 at 6:30 at the South Berkeley Senior Center. This meeting was adjourned at 9:05 p.m. Respectfully Submitted, Gail Feldman, Secretary

Office of the City Manager

2180 Milvia Street, Berkeley, CA 94704 ● Tel: (510) 981-7000 ● TDD: (510) 981-6903 ● Fax: (510) 981-7099 E-Mail: manager@CityofBerkeley.info Website: http://www.CityofBerkeley.info/Manager

INFORMATION CALENDAR June 10, 2014

To: Honorable Mayor and Members of the City Council

From: Christine Daniel, City Manager

Submitted by: Jane Micallef, Director, Health, Housing & Community Services

Subject: Public Health Priorities and Budgeting

INTRODUCTION In response to Berkeley’s Health Status Report 2013 (HSR 2013), presented at the October 29, 2013 Council worksession, City Council asked the Public Health Division (PHD) to ensure that the City’s public health activities effectively address health inequities identified in the report. Council suggested a priority-based budgeting approach. The Public Health Division and Health, Housing & Community Services (HH&CS) Department fully embrace the need to focus their work, maximize their impact, and improve their accountability for health outcomes and have embarked on a comprehensive initiative to do so. The initiative is called “Health Happens in Berkeley.” This report presents staff work to date, including:

I. Preliminary list of health priorities,

II. Analysis of a priority-based budgeting approach, including assessment of funding and programmatic flexibility,

III. Timeline, and

IV. Program examples.

Spurred by Council’s call to action, the Division is assessing what is already working well, which programs have the strongest basis in evidence, and how resources can be directed to have even more impact going forward. The work may include both fortifying existing efforts which have proven effective and initiating new efforts to close identified gaps.

SUMMARY On October 29, 2013, City Council asked the PHD to ensure that the City’s public health activities effectively address health inequities identified in the HSR 2013. PHD has begun work on an initiative to identify community-established health priorities, align PHD activities to these priorities using evidence-based practices, and establish outcome measures to gauge its impact.

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Since the October meeting, PHD completed an internal priority-setting process in order to prepare for engaging the community in refining and/or confirming these priorities. Initially identified priorities described in more detail in the report are summarized below. Each of these is a health outcome for which Berkeley has significant racial/ethnic health inequities and for which the City does not fully meet national Healthy People 2020 (HP2020) goals:

Cardiovascular disease, including heart conditions, high blood pressure, and stroke. All of these diseases are closely linked to the underlying health conditions of obesity and diabetes, which in turn are related to nutrition, physical activity, tobacco use, and environmental stress.

Asthma hospitalizations among Berkeley children under 15 years of age are higher than in Alameda County. For all children under 5 years of age, asthma hospitalizations exceed HP2020 goals.

Low birth weight (LBW) and prematurity put infants at increased risk for health problems during infancy and for long-term disability. The last decade has seen significant reduction of health inequities in these areas, but African American infants are still more than twice as likely as others to be born too small or too soon.

Reproductive and Sexual Health refers to family planning, pregnancy, and sexually transmitted infections (STIs). Teen births, chlamydia rates among young women and syphilis rates among men are of particular concern.

Once the priorities have been established, PHD will identify upstream factors that help determine health outcomes, and then identify evidence-based practices for addressing those factors. The priorities will inform which current PHD programs will be retained and strengthened, and where activities should be expanded to maximize impact. This work will leverage existing resources and will require new resources to fund new or expanded activities. The goal will be to incorporate evidence-based practices into all PHD programs to improve outcomes in the identified priority areas. An example of this strategy is as follows: If cardiovascular disease were adopted as a priority, PHD could focus division activities on preventing overweight and obesity, since these are known to increase the risks of cardiovascular disease. Evidence shows that improving access to affordable, appealing, fresh produce improves healthy eating and helps prevent obesity and overweight. PHD could use existing resources to continue and strengthen its related work in WIC, Heart 2 Heart (H2H), and the Nutrition Education/Obesity Prevention programs, while seeking opportunities for funding and partnerships to expand H2H to additional neighborhoods. The PHD currently provides services related to all of the priority areas outlined above, but the HSR 2013 shows that there is much more work to be done. PHD’s ability to re-focus its efforts on the selected priorities is limited by certain constraints:

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Categorical (non-flexible) funding and programs, with narrowly defined eligible activities established at the State and Federal levels;

Mandated activities (including unfunded mandates) required of all local health jurisdictions; and

Labor agreements and the civil service context in which the City operates. Due to the constraints outlined above, a wholesale restructuring of PHD activities is not feasible. But the re-focusing of Public Health programs incrementally can occur in many ways. In order of increasing time and effort to implement, these steps are as follows:

Revising workplans in existing categorical programs;

Re-directing General Funds to strategic priorities;

Building strategic partnerships; and

Identifying new resources.

It is important to note that all PHD funding is fully allocated to the Division’s twenty programs. Any redirection of those funds will require reduction or elimination of an equivalent level of current services. PHD plans to return to Council in October 2014 for a worksession to further discuss the Health Happens in Berkeley priority-based budgeting approach and to finalize the community-identified priorities.

CURRENT SITUATION AND ITS EFFECTS Public Health Priorities Since the October 29, 2013 Council worksession, Public Health completed an internal priority-setting process in order to prepare for engaging the community in refining and/or confirming these priorities. The top four public health priorities the Division identified are:

Cardiovascular disease (heart disease and high blood pressure);

Asthma hospitalizations in children (up to 15 years of age);

Low birth weight and prematurity; and

Reproductive and sexual health (including teen births and sexually transmitted infections).

All PHD staff participated in the process to select these priorities, which included an analysis of where, according to the HSR 2013, Berkeley is falling short of the national HP2020 goals and where significant health inequities exist. Clear consensus about these four priority areas arose out of the many areas of concern considered. A brief discussion of each priority follows.

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Cardiovascular disease includes heart conditions, high blood pressure, and stroke. All of these diseases are closely linked to the underlying health conditions of obesity and diabetes, which in turn are related to nutrition, physical activity, tobacco use, and environmental stress. Cardiovascular diseases are a leading cause of death in Berkeley, and are areas of significant health inequities. The HSR2013 shows health inequities in high blood pressure, heart disease, stroke, diabetes, and tobacco use. Berkeley’s death rates from stroke and coronary heart disease in the African American population do not meet HP2020 goals. Over 40% of BUSD 9th graders are overweight—setting the stage for cardiovascular disease in adulthood. Asthma hospitalizations among Berkeley children under 5 years of age, and school-aged children from 5 to 15 years of age, are higher than in Alameda County. For children under 5 years of age, asthma hospitalizations exceed HP2020 goals for all children. Hospitalization rates are higher for African American and Latino children and youth than for other racial/ethnic groups, with the largest inequity being among African American children younger than five. Poorly controlled asthma affects school attendance and performance, physical activity, and daily quality of life. Low birth weight (LBW) and prematurity put infants at increased risk for health problems during infancy and for long-term disability. Berkeley has made significant improvement in this area, with marked decreases in the rates of LBW and premature infants and a narrowing of the gap between African American infants and others. Nevertheless, African American infants are more than twice as likely as others to be born too small or too soon. African American infants do not meet the HP2020 goal for preterm births. Reproductive and Sexual Health refers to family planning, pregnancy, and sexually transmitted infections (STIs). Although the number of births to teen mothers in Berkeley is consistently among the lowest in the State, the vast majority of those births occur among African American young women. Teen mothers and their infants in Berkeley do not meet HP2020 goals for prenatal care and birth weight. STIs, and particularly chlamydia infections, disproportionately affect young women of color. These infections can affect future fertility and reproductive health. Rates of new syphilis infections among men in Berkeley do not meet HP2020 goals.

Although existing public health programs target many aspects of these priorities and serve the populations bearing the burden of health inequities, it is clear that their impact has not been as great as hoped and that more progress is needed. See Attachment 1 for a brief description of current PHD programs. PHD staff-developed priorities are a first step in setting City public health priorities. In the coming months, the Division will seek input from City Council, relevant

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Commissions, partner agencies, and other stakeholders via a series of Commission presentations, partner meetings, and a Community Health Forum. Input will be sought within the same framework the PHD used: a focus on the data, informed by the experiences in and of the community. PHD plans to return to Council for a worksession in October 2014 to confirm the priorities identified.

Priority-Based Budgeting Given a number of constraints, PHD cannot approach this work with a clean slate. Public Health programming and budgeting limit the ways available resources can be directed to locally determined health priorities. These constraints are:

Categorical (non-flexible) funding and programs, with narrowly defined eligible activities established at the State and Federal levels;

Mandated activities (including unfunded mandates) required of all local health jurisdictions; and

Labor agreements and the civil service context in which the City operates. The PHD has been successful in leveraging categorical funds and in working within program constraints to provide services appropriate to Berkeley. The Division commits General Fund to the support of these programs, as explicit matching funds, as in-kind administrative and management support, and to meet personnel costs which exceed levels allowed by funders. As the City re-focuses its priorities and strategies it will seek funding to support new programs and initiatives. The PHD has a successful track record raising funds to support its work, and this effort takes time. Interim steps are necessary to ensure progress in addressing health inequities and will involve assessing the flexibility of existing funding sources and the activities they support, so that resources can be allocated for maximum impact. This effort includes determining how best to:

Focus resources on priorities while ensuring mandated functions;

Enhance or incorporate priority area work in existing categorical programs;

Leverage categorical funding to meet priority needs;

Assess appropriate levels of mandated activities.

Funding Assessment The annual PHD budget is $8.7 million for twenty programs. City General Fund and State Realignment funds together account for approximately $4.3 million of this budget. Special funds including State grants, Alameda County grants, and other program grants make up the remaining $4.4 million of the budget. For the most part only City General Fund and State Realignment are flexible in the programmatic activities they support. The bulk of the special funds are categorical, meaning they only support specific

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activities. Within categorical grants, there are varying—but limited—degrees of local flexibility at the program level. City General Fund and State Realignment in the PHD budget support a variety of specific functions.

First, they provide the matching local expenditures required to leverage State and other categorical funds. For example, the City receives approximately $430,000 in State funds for Targeted Case Management annually, and must spend an equal amount in local funds as match.

Second, these funds cover the costs of unfunded mandates that the PHD is required to meet as a public health jurisdiction. For example, communicable disease control is a mandatory function costing approximately $600,000 annually. Only $42,000 of these annual costs are covered by categorical funding sources.

Third, City General Fund supports Council-identified priority programs, such as Hypertension and Health Disparities (the Heart 2 Heart program), and the Black Infant Health program.

Finally, City General Fund is used to provide $150,000 in annual public health grants to community agency programs. These grants are $50,000 each to the Berkeley Free Clinic, the NEED needle exchange program, and the Oral Health program at Berkeley Unified School District (BUSD) schools.

The level of General Fund and State Realignment support varies significantly from program to program, but when the full costs—including Division management and administration—are taken into account, every PHD program relies on these non-categorical funding sources. The following table provides examples of the extent to which PH programs require General Fund and State Realignment support.

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Public Health Program Examples by Proportion of City General Fund/State Realignment Support

General Fund/Realignment Support

Program Examples

High General Fund/Realignment (>80%)

Heart 2 Heart hypertension and cardiovascular disease prevention program

Communicable disease, Tuberculosis, and STD control (mandatory function)

Immunization Clinic

Mix of Categorical Grants and City General Fund/Realignment

Public Health Clinics (Ann Chandler, Berkeley High School, Berkeley Technology Academy)

Public Health Emergency Preparedness

Vital Statistics1 (mandatory function)

Low General Fund/Realignment (<20%)

Women, Infants, and Children (WIC)

Tobacco Prevention

Nutrition Education and Obesity Prevention

General Fund and State Realignment are essential to the support of priority Berkeley programs and mandated PHD functions. State Realignment funds supplement City General Fund in supporting PHD mandates and priorities. Although City General Fund and State Realignment are flexible sources of funding, it is important to note that all PHD funding, including these flexible sources, is fully committed to existing programs. Any redirection of those funds will require reduction or elimination of an equivalent level of current services. Program Flexibility PHD programs have varying levels of flexibility in the activities they undertake. The degree of flexibility influences the PHD’s ability to tailor programs to address locally identified priorities.

Highly flexible programs present opportunities to respond to emerging needs by re-focusing the scope of work. For example, the School Linked Health Services (SLHS) program, supported by funds from Alameda County to enable PHD to work with BUSD on public health issues, allows PHD complete discretion over the scope of that work. In consultation with BUSD, the scope of work can change year-to-year and can be tailored to address local priorities. Recent SLHS efforts to bring the Breathmobile asthma clinic to BUSD students by facilitating

1 Vital Statistics is fully funded out of City General Fund, and it generates revenue that covers

approximately 35% of the cost of providing the service. Reducing costs in this program would necessitate significant reductions in local birth and death certificate services, such as increased wait times, elimination of same-day service option, and/or fees for mailing or expedited services.

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collaboration between BUSD and the Prescott-Joseph Center exemplify this flexibility.

Somewhat flexible programs have more constraints on the scope of work, but do include opportunities to shape proscribed activities to align with local priorities. For example, the Nutrition Education/Obesity Prevention program offers a selection of workplan options for delivery to eligible populations, allowing Berkeley to participate in the State and National “Rethink Your Drink” campaign for healthier beverages. Thus the PHD took advantage of an opportunity to align the program with local priorities.

Programs with no flexibility are not amenable to adaptation to fit local priorities. Public Health Emergency Preparedness grants are an example of highly proscribed programs, with very little room for local flexibility. The annual scopes of work are set by the State and must be met in order to receive local funding.

Over time the number, complexity, and specificity of mandated tasks in the Division’s funding portfolio have increased while the number of staff in the PHD has decreased. Despite dramatic cuts in funding, the PHD has strived to continue to meet the public health needs of the community. The result is that today half of PHD programs have 2.0 or fewer FTEs to provide direct services, and fewer administrative staff to assimilate new and increasingly strict programmatic regulatory requirements, as well as to explore and implement opportunities to adapt scopes of work to changing priorities. Some categorical funds can be passed on to community partners. The PHD is experienced at taking advantage of such opportunities. Examples this year are $70,000 contracted to Berkeley Youth Alternatives for tobacco prevention work with Berkeley youth and $100,000 contracted to BUSD for school-based nutrition education and obesity prevention.

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Timeline The following table shows the PHD’s proposed timeline for this initiative:

Proposed Timeline for Health Happens in Berkeley

Summer 2014 Community input into PH Priorities

Fall 2014 Finalize PH Priorities; Council Worksession October 2014

Winter 2014 Select upstream factors to target with PH interventions

Remainder FY2015

Identify evidence-based and best practices Identify measurable indicators and outcomes Identify and enhance existing PH program work that aligns with priorities

FY2016/ FY2017

Identify opportunities to implement and fund evidence-based and best practices to fill program gaps Strengthen outcomes measures and indicators Further focus and enhance priority work within existing PH programs. Re-direct resources as necessary to support priority work.

Program Examples Once priorities have been determined, PHD will propose intervention strategies by analyzing upstream factors, then identifying evidence-based interventions, possible program changes, and outcome measures that can be used to evaluate their effectiveness. Following is an illustration of this work, based on the example of cardiovascular disease:

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Health Priority Illustration: Cardiovascular Disease2

Upstream factors

influencing priority area:

Evidence-based practices which affect

each factor

Current Public Health Programs

Opportunities to add or enhance program activities

Outcome Measures and Indicators3

Overweight & obesity , in childhood and adulthood, increase the risk of cardiovascular disease

Ready access to affordable, appealing fresh produce

Safe and walkable neighborhoods and parks

Breastfeeding for the first year of life decreases lifetime risk of obesity and overweight

WIC

Nutrition Education/Obesity Prevention

Heart 2 Heart (H2H)

Black Infant Health

Nursing Case Management

Expansion of H2H place-based work to all Berkeley neighborhoods bearing burdens of health inequities

Community-based physical activity initiative

Healthy food & beverage/healthy procurement policy for City-sponsored events and city-funded community agencies

Community based breastfeeding peer support program

Overweight & obesity in Berkeley youth & adults

Indicators of healthy diet: rates of consumption of sugar-sweetened beverages, fresh fruits & vegetables, whole grains, etc.

Rates of breastfeeding among Berkeley infants from birth to 1 year of age

Poorly controlled diabetes increases the risk of cardiovascular disease

Early screening and intervention

Ready access to affordable, culturally and linguistically appropriate primary health care

Heart 2 Heart

Nursing Case Management linkage to care

Diabetes registry for tracking all Berkeley residents with diabetes

Community-based diabetes management collaborative including health care and education partners

“Medical homes” among residents with diabetes

Rates of diabetes screening in the population

Diabetes rates among Berkeley youth & adults

Tobacco use & exposure increase the risk of cardiovascular disease

Smoke-free multi-unit housing

Smoking cessation counseling by health care providers

Healthy Homes initiatives

Smoke-free multi-unit housing ordinance effective 5/1/14

Free smoking cessation classes

Smoking assessment & brief counseling at PH clinic visits

Restrict tobacco sales and marketing near schools

Regulate e-cigarettes as other forms of tobacco use

Tobacco cessation initiatives specifically designed for vulnerable populations

Rates of indoor smoking or exposure to 2

nd hand smoke

Tobacco cessation program completion and “quit rates”

Tobacco use among residents (youth and adults)

2 This table contains examples only. These are not final recommendations or plans.

3 Data sources and data collection methodologies need to be developed for most measures. Outcomes will be selected to measure the

impact of selected interventions.

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The selection of specific evidence-based or best practices in each priority area will require consideration of a number of factors, including:

Anticipated impact in Berkeley

Fit with existing programs and staffing

Fit with work of partner organizations

Fit with regional initiatives

Impact on more than one priority

Cost

Expertise/experience in Berkeley Conclusion Due to the challenges outlined above, a wholesale restructuring of PHD activities is not feasible. But the re-focusing of Public Health programs incrementally can occur in many ways. In order of increasing time and effort to implement, these are as follows.

Revise existing workplans (in categorical programs). Existing activities that are well-aligned with priorities, and are evidence-based or best practices, form a foundation on which to build the priority work. See column 3 in the above table for examples. Additionally, some existing programs are flexible enough to allow the incorporation of new activities related to priorities. For example, the Public Health Clinic has incorporated tobacco cessation assessment and referrals into its baseline reproductive and sexual health services. Other PH programs can incorporate priority work without jeopardizing their proscribed activities.

Re-Direct General Fund to strategic priorities. One option to support new programs is to re-direct City General Fund from lower priority work. Re-directing City General Fund will require decreasing or giving up existing activities. In addition, freeing up and re-directing General Fund could undermine the viability of existing programs which rely on General Fund as required match or to support the actual cost of program delivery.

Building strategic partnerships. Partnerships are an essential part of PHD work and are another path to implementing new programs. Partner organizations are in some cases better situated than PHD to do priority work, and may have access to funding streams that the City does not. Health Happens in Berkeley will provide direction for health interventions by all sectors in the City.

Identifying new resources. Implementing new programs requires sustainable funding streams. New programs can be supported by seeking new grant funding. The funding climate is improving, and the Health Happens in Berkeley initiative, along with HSR 2013 data, put Berkeley in a strong position to seek new sources of grant funding for programs to address priority health inequities.

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FISCAL IMPACTS The approach described for Health Happens in Berkeley is budget neutral. Current funding will be leveraged so that its use is more strategic and is aligned with public health priorities. Shifting funding toward new uses and priorities may mean decreasing or giving up existing activities that are less directly connected with or not as effective at addressing the priorities identified. New funding sources to support additional priority work will be actively pursued. BACKGROUND The HSR 2013 shows striking health inequities. Health inequities by race and ethnicity are a consistent feature of the health landscape in this country, reflecting long-established and deeply embedded patterns of unequal access to opportunities and resources. Berkeley has a long commitment to addressing and eliminating health inequities. Existing public health programs, and indeed programs throughout HH&CS, serve the populations identified in the HSR 2013 as bearing the burden of health inequities. These programs address issues identified in the report: heart disease, nutrition and obesity, health during pregnancy and infancy, asthma, reproductive and sexual health, and more.

There has been improvement in many of these areas: most notable is the narrowing of the disparities in rates of low birth weight infants. Despite the City’s commitment, programming, and progress to date, it is clear that the impact has not been as great as hoped and that more progress is needed.

The City has a long history and strong public health and community foundation on which to build. Thus the City is positioned to make sure that “Health Happens” for everyone in Berkeley. The City Council asked the division to reconfigure its work to address these findings. This report is the initial response to the directive. In recent years the PHD has had considerable experience with priority-setting and re-configuration, driven by budget reductions. It welcomes the opportunity to apply that experience to enhancing the impact and effectiveness of the Division’s work.

ENVIRONMENTAL SUSTAINABILITY There are no specific identifiable environmental effects or opportunities associated with the subject of this report. However, PHD and HH&CS are committed to identifying such opportunities as Health Happens in Berkeley evolves. Environmental sustainability is closely linked to healthy communities. CONTACT PERSON Janet Berreman, Health Officer, Health, HHCS, (510) 981-5301

Attachments: 1. Public Health Program Summary

Attachment 2

Attachment 1: Public Health Division Programs FY 2014

by Program Goal and Full Time Equivalents (FTE)

Program Goals FTE

Public Health Clinic: Reproductive & Sexual Health

Provide pregnancy testing/counseling, birth control, reproductive health exams; sexually transmitted infection testing, diagnosis, treatment, and prevention; and HPV and Hepatitis (A & B) vaccinations

6.65

High School Health Centers

Provide BUSD high school students access to first aid; reproductive and sexual health services; medical care and insurance referrals; and Mental Health services provided on-site by HHCS Mental Health Division

5.25

Nursing Case Management

1) Home-based case management for underserved and underinsured individuals and families

2) Nurse of the Day telephone service 3) Surge capacity for the communicable disease and emergency

preparedness programs

5.15

Women, Infants and Children (WIC)

Provide supplemental food, nutrition education, breastfeeding support, and referrals for low-income women and their children under 5 years of age

3.85

Child Health and Disability Prevention

1) Quality assurance and follow-up for pediatric well care for Medi-Cal and Medi-Cal eligible children

2) Assure access and continuity of care for foster youth

3.63

Communicable Disease, Tuberculosis & Sexually Transmitted Disease Control

Track and control the spread of communicable diseases, including tuberculosis, sexually transmitted diseases, HIV/AIDS, and other reportable and novel conditions.

3.10

Public Health Emergency Preparedness

1) Plan for public health emergencies such as pandemic influenza and health aspects of a natural disaster such as earthquake, fire, or flood.

2) Ensure coordination with health care providers, clinics and hospitals on issues such as emergency surge capacity and distribution of medications or vaccines.

3) Build and maintain capacity of the HHCS Department Operations Center

2.95

Vital Statistics Register all births and deaths occurring in Berkeley; issue birth and death certificates; collect and analyze related data

2.60

Attachment 2

Program Goals FTE

Tobacco Prevention Prevent tobacco use and its health consequences

2.24

Black Infant Health Improve Perinatal health and birth outcomes among African American mothers and infants and achieve health equity in pregnancy outcomes

1.85

Nutrition Education & Obesity Prevention

Provide nutrition education and obesity prevention to residents in income-qualifying census tracts or equivalent populations

1.15

Measure GG (Emergency Preparedness)

Improve disaster preparedness in the Community, with specific focus on vulnerable populations.

1.10

Maternal, Child & Adolescent Health

Identify and link eligible populations to Medi-Cal services and providers; Perinatal services coordination and SIDS prevention

1.10

School Linked Health Services

Partner with Berkeley Unified School District to improve health and education outcomes in BUSD Kindergarten through 5

th grade

students

1.05

Hypertension/Heart 2 Heart

Eliminate cardiovascular disease health inequities by focusing on community health improvement in a south Berkeley neighborhood

0.95

Immunization Clinic Provide immunizations to adults and middle- and high-school age youth; provide seasonal influenza vaccine and tuberculosis testing; provide immunizations to control disease outbreaks.

0.90

Be A STAR Ensure periodic, standardized developmental screening of infants and toddlers ages birth to 5 years

0.80

Lead Poisoning Prevention

Prevent lead poisoning in high-risk populations, and provide nursing case management for individuals determined to have lead poisoning

0.78

Epidemiology and Surveillance

Monitor community health status and maintain awareness of local public health conditions, such as health inequities and disease outbreaks

0.45

Immunization Program

Provide immunization resources to Berkeley health care providers and assess immunization rates among Berkeley preschool and school-age children

0.25

Attachment 2

From: Davis M.D., Muntu, Public Health, OOD Sent: Thursday, October 02, 2014 8:31 AM To: ALL PH - Public Health Staff Subject: BREAKING NEWS: Alameda County's pioneering drug disposal law upheld in federal court

Alameda County's pioneering drug disposal law upheld in federal court A federal appeals court rejected a challenge Tuesday by the pharmaceutical industry to an Alameda County ordinance, the first in the nation to require drug manufacturers to pay disposal costs for consumers' unused medications. Drug companies, backed by trade associations and the U.S. Chamber of Commerce, argued that the 2012 ordinance illegally shifts local costs to out-of-state producers and interferes with interstate commerce. But the Ninth U.S. Circuit Court of Appeals in San Francisco said the county's measure treats all manufacturers equally and imposes no substantial burden on interstate businesses. The ordinance "applies to all manufacturers that make their drugs available in Alameda County - without respect to the geographic location of the manufacturer," Judge N. Randy Smith said in the 3-0 ruling, which upheld a federal judge's decision in the county's favor. "Given that the ordinance applies across the board, it does not discriminate at all," nor does it regulate conduct outside the county, he said. Smith also noted that pharmaceutical companies collect $950 million a year in sales revenue in Alameda County and could comply with the ordinance at an annual cost of $1.2 million, by the comnpanies' estimate, or $330,000 by the county's estimate. The companies could recoup their costs by raising prices in Alameda County by one cent for each $10 in sales, said Arthur Shartsis, a lawyer for the county. The court's affirmance of local regulation was crucial, Shartsis said, because "the pharmaceutical industry has the lobbying power to stop these kinds of programs at the state level. It does not have the power to stop them at the county level." Pharmaceutical Research and Manufacturers of America, which sued to overturn the ordinance, was not immediately available for comment. The organization could ask the U.S. Supreme Court to review the ruling. The ordinance was approved by county supervisors in July 2012 and is still in the process of being implemented. It requires makers of prescription drugs sold in the county to fund a program that picks up and disposes of leftover drugs. Alameda County now operates and pays for about 30 drop-off sites where consumers can discard their pills. County officials who backed the ordinance said drug companies should bear the cost of cleaning up their products for the sake of the environment and

their customers' health. The Natural Resources Defense Council, city and county governments and Attorney General Kamala Harris filed arguments asking the court to uphold the ordinance. Bob Egelko is a San Francisco Chronicle staff writer. E-mail: begelko@sfchronicle.com. Twitter: @egelko For the ruling: UNITED STATES COURT OF APPEALS FOR THE NINTH CIRCUIT - PHARMACEUTICAL RESEARCH & MANU V. COUNTY OF ALAMEDA Opinion http://cdn.ca9.uscourts.gov/datastore/opinions/2014/09/30/13-16833.pdf

Office of the City Manager

2180 Milvia Street, Berkeley, CA 94704 ● Tel: (510) 981-7000 ● TDD: (510) 981-6903 ● Fax: (510) 981-7099 E-Mail: manager@CityofBerkeley.info Website: http://www.CityofBerkeley.info/Manager

INFORMATION CALENDAR September 16, 2014

To: Honorable Mayor and Members of the City Council

From: Christine Daniel, City Manager

Submitted by: Jane Micallef, Director, Health, Housing & Community Services

Subject: Breathmobile Update

INTRODUCTION In June 2014, the Breathmobile finished its second year of providing asthma-related services to Berkeley Unified School District (BUSD) elementary and preschool students. This report provides updated outcome data, highlights the importance of the collaborative partnership, and explains how this service aligns with the Public Health Division priority setting related to asthma.

CURRENT SITUATION AND ITS EFFECTS During the 2013-2014 school year, BUSD students receiving care at the Breathmobile missed 142 fewer days of school than in the previous year. They had 53 fewer emergency room visits and no hospitalizations (compared with 21 the year before). Health care savings from the Breathmobile are estimated to be over $415,000 for the year. Improved attendance increased BUSD Average Daily Attendance (ADA) income by nearly $5,000. For school year 2014-2015, City staff will continue to partner with BUSD and the Breathmobile to enhance the impact of this service by increasing student participation at all three school sites. Although the Breathmobile is currently at capacity in terms of number of BUSD schools served, City staff will work with clinic and school staff to identify students who could benefit from this service and maximize utilization of the Breathmobile. Public Health Priorities and Partnership The new “Health Happens in Berkeley” initiative has identified asthma hospitalizations in children (up to 15 years of age) as one of four preliminary Public Health priorities. The Public Health Division is committed to addressing the asthma health inequities seen in Berkeley’s Health Status Report 2013. The partnership among BUSD, Public Health, and the Breathmobile is an excellent example of aligning programmatic work with community agencies to leverage resources and impact targeted health inequities.

Breathmobile Update INFORMATION CALENDAR September 16, 2014

Page 2

BACKGROUND Asthma is a leading health cause of school absenteeism, especially among elementary students. Chronic absenteeism can have a direct effect on school performance and engagement. In Berkeley, asthma hospitalization rates for school-aged children exceed the national Healthy People 2020 goals. The rates are higher for African American and Latino children than for any other racial/ethnic group. Children younger than five years of age have even higher rates of asthma hospitalization, with similar patterns of racial/ethnic inequities. Educational attainment is closely correlated with health over the life course: children who are successful in school live longer, healthier lives than those who are not. The Breathmobile has been providing asthma-related health care services to three BUSD schools since October 2012. Two BUSD elementary schools (Malcolm X and Rosa Parks) and one preschool (King Child Development Center) were selected based on the high asthma prevalence at these sites. The Breathmobile and BUSD school staff work closely with the Public Health Division to identify students with asthma who could benefit from this community resource. This past school year, 59 students received services. Overall, visits to the emergency room, hospitalizations, and school-days missed significantly decreased. Due to these reductions, for 2013-2014, the estimated total cost savings from the Breathmobile is $420,470. Attachment 1 provides detailed outcomes and impact information. The partnership demonstrates the value of community agencies working together to address health inequities and the achievement gap.

Breathmobile Berkeley Report 2013-2014:

Students Served by Race/Ethnicity (percent)

Breathmobile The Breathmobile, owned and operated by the Prescott-Joseph Center for Community Excellence, is a free mobile asthma clinic that provides diagnosis, education, and

42

31

5 3

19

0

10

20

30

40

50

African Am. Latino White Asian Other

N= 59

Breathmobile Update INFORMATION CALENDAR September 16, 2014

Page 3

treatment for children with asthma at school sites throughout the Bay Area. It is equipped with an intake station, testing area for vital signs including lung function measurement, allergy testing, and an exam room. It is staffed by asthma and allergy specialists including a pediatric allergist, registered nurse, and respiratory therapist. Also on board are two computer systems: a health risk assessment system and an electronic medical records system. The Breathmobile staff engages parents in their child’s care, and reaches out to the students’ primary health-care providers. The goal of the program is to provide comprehensive and accessible asthma care to keep children healthy so that they are able to participate and learn in school. Asthma Hospitalization Hospitalization for asthma occurs when asthma is inadequately controlled. This is usually the result of a combination of exposure to asthma “triggers,” lack of access to affordable, culturally appropriate, effective primary health care, and the severity of asthma in the individual. Racial and ethnic inequities in asthma hospitalization rates are a reflection of factors such as differences in environmental conditions, such as dampness (and associated mold and mildew) and air quality (both indoor and outdoor), and health care access issues including geographic, financial, and cultural accessibility. ENVIRONMENTAL SUSTAINABILITY There are no specific identifiable environmental effects associated with the subject of this report. POSSIBLE FUTURE ACTION The Breathmobile could expand services to additional BUSD schools, based on asthma prevalence and on Breathmobile van capacity.

FISCAL IMPACTS OF POSSIBLE FUTURE ACTION No direct fiscal impact to the City, but continued health-care cost savings for the community and improved ADA income for BUSD.

CONTACT PERSON Janet Berreman, Health Officer, HHCS 510-981-5301

Attachments: 1. Breathmobile Results for School Year 2013-2014

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2014 Member Roster

Community Health Commission

CEAC LiaisonConductive

Energy DevicesHealth Equity ALBSMC GMO Labeling

Public

Education &

Marketing

2 Barry Sean

5 Collins Mallory X

7 vacant

6 Franklin Linda X X

3 Kwanele Babalwa X X X

1 Lee Charles X X

8 Namkung Poki X

7 Nathan Neal X

8 Neuhauser Frank X

M Rosales Ces X X

M Shaw Mia

2 Speich Pamela X X X

4 Stein Antoinette X X X X

3 vacant

7 Wong Andrew

4 Wong Marilyn X

1 VACANT MAIO

5 Soichet Emma

6 VACANT

UPDATED 10/2/2014

DIST. Last First

SubCommittees

10/2/2014