Public Health 3.0 in Boston

October 31, 2016

Monica Valdes Lupi, JD, MPHExecutive Director

Boston Public Health Commission

Agenda

Career path Key health indicators Importance of partnerships and collaboration Strategic priorities and Public Health 3.0 Discussion

How did I get here?

Boston is a great city #1 best tasting tap water #1 best access to healthcare #1 city for active living #3 city for sports #3 on walkable cities list #6 on best places to go to college

…but Boston also ranks at the top of other lists

#1 in income inequality (& the gap is growing!) #3 in highest average rent #9 on the list of most segregated cities #10 on the list of poorest cities

We also have persistent racial health inequities

% of Population Categorized as Black

Heart Disease Hospitalizations per 1,000 Population

Asthma Hospitalizations per 1,000 Population

SOURCE: Inpatient Hospital Discharge Database, Massachusetts Center for Health Information and Analysis, 2010 DATA ANALYSIS: Boston Public Health Commission Research and Evaluation Office

Premature Mortality

Foreclosure Petitions, 2013

Three Strategic Priorities

Treating and preventing prescription drug abuse Prevention Treatment and recovery support Access to care

Strategic Priority 1

Strategic Priority 2

Strengthening partnerships between BPHC and health care community to improve population health

Public health integration/health transformation

Opportunities: MassHealthACOs/Community Partners; MDPH DoN

Advancing health equity

Strategic Priority 3

New Community Engagement Plan

Public Health 3.0: Creating a 21st Century Public Health Infrastructure

PH3.0 – 5 Themes

1. Strong leadership and workforce: Chief Health Strategist

2. Strategic partnerships: cross-sector

3. Flexible and sustainable funding: blending/braiding/recapturing/re-investing

4. Timely and locally relevant data, metrics, and analytics: actionable

5. Foundational infrastructure: public health accreditation

Public Health 3.0

Community Initiatives HelpStepsBreathe Easy at Home

Homeless Services HUES to Home: High

Utilizers of Emergency Services

Health Impact Assessment: Boston Living Wage Ordinance

Enacted in 1998 to ensure city contractor employees earn hourly wage that family of four can live on or above the poverty line

Goal to attach millions of dollars in city contracts to some benefit for employees of the contracted companies

Applies to firms with city service contracts over $25,000 and employ more than 25 hourly employees

Current wage = $14.11 per hour

Source: Boston Office of Workforce Development, 2015

Public Health 3.0 - HIA

CDC HI-5 Initiative

BPHC Cross-walk to HI-5

Safe Routes to School – Boston Safe Routes to SchoolTobacco Control – Tobacco 21 Access to Clean Syringes – AHOPE

Boston’s Safe Routes to School (SRTS) Initiative Three year-initiative to increase walking funded

through BPHC federal CDC grant. School level (n=18 in year 2)

‘Wellness champions’ coordinate school efforts Pedestrian safety module required in PE class Walk-to-School Days and other special events Communication with parents, faculty and staff

Tobacco Control – Tobacco 21

Dec 2015: adopted this policy change through our Board of Health.

Tobacco control efforts in Boston have led to a substantial reduction in youth cigarette use. Among Boston high school students, the

rate of cigarette use declined from 15.3% in 2005 to 7.9% in 2013. National average is 15.7%.

State legislation pending before the Massachusetts legislature would establish 21 as statewide standard.

Access to Clean Syringes – AHOPE

Timeline of activities 1993: Legislature allowed for 10 needle

exchanges to be created around the state, dependent on local approval. Local opposition blocked implementation of

new needle exchanges, so up until 2016, there were only 5 needle exchanges in MA.

2006: decriminalized possession and allowed for the over-the-counter sale of syringes at all pharmacies in the state but access to clean syringes remains challenging.

2016: Legislature lifted the “cap” and amended language around local approval.

Impact on health from NEPs

In MA, HIV prevention efforts with IDUs have resulted in 92% reduction over the past decade [MDPH, “Shifting Epidemics” published 2012]

Decrease in HIV prevalence largely attributed to syringe access + harm reduction programming.

Huge accomplishment, given the state of the HIV epidemic 20 years ago, when IDU was the leading mode of HIV transmission.

BPHC Cross-walk to HI-5

Home Improvement Loans and Grants: Lead, Prevention Wellness Trust FundWater Fluoridation: Promotion of drinking tap H20; advocacy

Home Improvement Loans and Grants

Provided landlords with free Moderate Risk Deleading (MRD) training which helps significantly reduce the overall costs of eliminating lead in their rental properties.

Conducted healthy home visit and assessments. Provided Section 8 landlords with window guards for their tenants with

small children through HUD Healthy Section 8 & Affordable Housing Project.

Provided IPM kits through the DND/BPHC Healthy Homes Integration Project.

Through PWTF, referrals made to senior repair programs to receive home modifications to prevent falls.

Water Fluoridation Community water fluoridation adds a controlled

amount of fluoride to the water supply to prevent dental caries (cavities).

Boston has fluoridated water from an excellent water supply (MWRA, Quabbin Reservoir), yet many residents decline to drink tap water.

Efforts to promote tap water consumption are a triple win: Benefits of fluoride Decrease sugary drink intake Environmental benefit of fewer discarded drink

containers

Tap Water Promotion:Signage in Organizations

Tap Water Promotion:Northeastern University’s ReThinkDrinkNEU

Let’s Get Healthy, Boston! collaboration with NEU School of Pharmacy students and faculty on ReThinkDrinkNEU

Encourages NEU community to “rethink” consumption of sugary beverages and switch to water

Pharmacy students have promoted 190 filtered water stations on campus and advocated for the inclusion of their locations on the NUGo app.

Pharmacy students had outreach displays at Earth Day, Sustainability Day, and Bouvé Health Day Collected input from 375 individuals

about additional placement locations for water stations.

Distributed 300 water bottles with ReThinkDrink NEU logos

Thank you + Discussion

Monica Valdes Lupi, JD, MPHExecutive Directormvaldeslupi@bphc.org617.534.5264

Additional Slides

Fatal overdoses

11.9

19.4

8.6

16.4

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15.0

20.0

25.0

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

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Unintentional Heroin/Opioid Overdose Mortality Boston Residents, 2002-2013

n=767 (64 per year avg.)

TOTAL Deaths2012: 622013: 812014: 87

BPHC Cross-walk to HI-5

Safe Routes to School – Boston Safe Routes to SchoolMotorcycle Injury Prevention – Vision ZeroTobacco Control – Tobacco 21 Access to Clean Syringes – AHOPE

Motorcycle injury prevention

VISION ZERO BOSTON: Mayor J. Walsh’s plan to eliminate fatal and serious crashes in Boston by 2030 includes reducing speed limits, building safer streets, and engaging Bostonians by providing resources to reduce distracted and impaired driving.

BPHC Injury Prevention Program, Emergency Medical Services and Chronic Disease Division working with the Boston Transportation Department and the Boston City Council to lower the default speed limit in the City of Boston from 30 mph to 25 mph. Pending approval from the City Council, the new default speed limit is expected to take effect on January 1, 2017. This comes after Boston and other municipalities worked with the state legislature to give municipalities control over setting default speed limits.

Driving at 25 mph allows drivers and pedestrians more time to see each other making crashes unlikely to occur but in the event they do occur are less likely to cause serious injury or death. Reducing the default speed limit to 25 mph will help make Boston safer for all people walking, driving, and bicycling.

Additional services through NEPs

Integrated HIV/HCV/STD testing, and referral to treatment Overdose prevention and education + naloxone distribution Primary care and behavioral health referrals Patient navigation when accessing medical care HIV medical case management Referral to substance use treatment: detox, CSS, TSS, aftercare,

MAT On average, AHOPE places 3-4 people in treatment every day

Housing search + advocacy Mental health Legal assistance On-site medical care, wound care

Future Challenges to NEPs

Hepatitis C (HCV): substantial increase in HCV infection among youth in MA

that may be a marker for the future direction of the HIV epidemic.

HCV diagnoses between 15 -24 age group increased by 74% between 2002 and 2009.

Overdose: Between 2000 (338) and 2014 (1256), overdoses increased

by 227%. Education of medical and social service providers is

critical to ensure that the needs of PWID populations are adequately addressed.

We need to ensure stigma surrounding injection drug use does not contribute to health disparities.

BPHC Cross-walk to HI-5

Home Improvement Loans and Grants: Lead, PWTF, Home visiting with DND

Water Fluoridation: Promotion of drinking tap H20; advocacy

Tap Water Promotion: Policy and Practice Change BPHC helped BPS draft the most comprehensive

drinking water policy to ensure safe drinking water in 130 schools.

Discussion of tap water benefits included in trainings for early childcare and afterschool program staff Give free water pitchers as incentives

BPHC changes Eliminated purchased water coolers in favor of filtered

piped tap water stations Recently distributed free re-usable water bottles to all

employees

Tap Water Promotion:Videos The Story of Boston’s Tap Water: Started from the

Quabbin Test the Tap Soda Free Summer Challenge