Davidson County Board of Health Minutes Regular Meeting of the Board of Health Health Department Boardroom March 4, 2025 Board of Health Present Staff Present Visitors Present Dr. Terry Ellington, Chair Lillian Koontz Adam Jones, County Attorney Mr. Calvin Odom, Vice Chair Janna Walker Ryan Hargrave, Asst. County Commissioner Tripp Kester Corinne Bates Attorney Ms. Tammy Troublefield Stacy Hull Dr. Christian Brandyberry Randy Swicegood Mr. Joseph Thomas Kristen Beanblossom Dr. Mark Hamrick Michelle Allen Mr. Jason Gibson Belinda Wilson Ms. Datra Delk-Patrick . Welcome, Introductions, Announcements = Dr. Terry Ellington Dr. Ellington called the meeting to order at 3:01 and welcomed everyone to the meeting. Mr. Adam Jones introduced Mr. Ryan Hargrave, Assistant County Attorney, who will be a substitute for Mr. Jones if he is unable to attend a Board of Health meeting. All of the Board of Health (BOH) members and staff introduced themselves for the benefit of Mr. Hargrave and Commissioner Kester, who is the newest member of the BOH. Ms. Lillian Koontz, Health Director, asked Ms. Janna Walker, Health Promotions Director, to speak about the marketing materials she brought to share with the BOH regarding the Community Health Needs Assessment (CHNA). Ms. Walker stated that the CHNA has begun for Davidson County, and the marketing materials she brought to share with the BOH are flyers with information about the CHNA survey. The flyers are in English and Spanish which you can post in offices or anywhere you wish to distribute them. There are also postcard size flyers you can leave in places for people to pick up, and - - will be pushing out digital marketing tools tomorrow. Please share with your neighbors, those in your community, and on social media platforms to help people to engage with the survey. The data collected from the surveys is how we determine the needs in our community and how we can better meet those needs as it pertains to public health. II. Agenda = Discussion and Amendments = Dr. Terry Ellington Dr. Ellington asked if there was any discussion regarding the agenda. Mr. Jones mentioned that he wanted to add an item to section VII, Old Business, regarding the BOH members' assignments to subcommittees. There was no further discussion. Commissioner Tripp Kester made a motion to accept the amended agenda, and Dr. Mark Hamrick seconded the motion. The motion was approved without dissent. III. Public Comment None IV. Consent Agenda = Dr. Terry Ellington The consent agenda, which is part of the BOH information packet, was presented and included the February 4, 2025 meeting minutes, the February 25, 2025 budget subcommittee minutes, the financial report as presented, and policies 100.1 Policy and Procedure Development and 100.14 Workforce Development. Dr. Ellington asked if there was any discussion regarding the consent agenda. Ms. Koontz pointed out that the budget subcommittee minutes included in the BOH packet were titled as general subcommittee minutes in error due to the use of an old template, but the error has been corrected. Dr. Christian Brandyberry made a motion to accept the consent agenda, and Dr. Hamrick seconded the motion. The motion was approved without dissent. V. Commissioner's Report Commissioner Kester did not have anything to report. VI. Health Director's Report (Including Program Reports) = Ms. Lillian Koontz Ms. Koontz reviewed the open positions that we are recruiting for and those that we are holding for now. She also mentioned that the school nurse team is fully staffed. Ms. Koontz also shared the following: the downstairs breakroom remodel is going great; we continue to see increased flu; however, school absences are improving; budget planning has kept us very busy, and we have a rabies clinic scheduled for April 5. Program Reports: Ms. Koontz shared that we recently had an immunization audit which went really well. WIC is also preparing for their annual audit. The Food and Lodging (F&L) team is on track to meet 100% compliance on inspections. The Onsite Water Protection (OSWP) team is seeing fewer than anticipated applications. Ms. Koontz presented a graph prepared by Mr. Randy Swicegood, OSWP Director, and Mr. Swicegood gave a brief explanation of the graph which showed the trends of the improvement permit construction authorization (IPCA) applications by type for 2024. VII. Old Business a. BOH Subcommittee Assignments = Mr. Adam Jones Mr. Jones wanted to clarify some confusion regarding conflict of interest in BOH members serving on certain subcommittees. He stated that people are brought on to the BOH oecause of their subject matter expertise. If a subcommittee calls on your subject matter expertise, it would be expected that you would be able to serve on that committee. The only limitation that could come up is voting on matters. He then gave examples of different situations of what would or would not constitute a conflict of interest. If there is a conflict of interest, you would recuse yourself from voting. Dr. Ellington asked Mr. Jones what we would do if a conflict of interest arose and the BOH member did not recuse himself/herself from voting. If the BOH member did not recuse himself/herselt, another BOH member would bring it before the BOH, and then the BOH would decide whether that person should be recused from voting. VIII. New Business a. Program Spotlight School Nursing - Ms. Kristen Beanblossom Ms. Kristen Beanblossom, School Nurse Supervisor, shared with the BOH that a current hot topic with the schools is earlier start dates. Lexington and Davidson will be starting earlier for the 2025/2026 school year, and Thomasville has plans to start earlier in 2026/2027. There are a lot of pros and cons for an earlier start date. School nurses typically start a week earlier than the schools to prepare and get everything in place for when students start. She also stated that there are effects of having different start dates for the 3 school systems, but they make it work. Mr. Jason Gibson asked how the county school nurses handle a sick child since the nurses are SO spread out between the schools. Ms. Beanblossom explained that they have first responders and diabetic care managers (school staff) in the schools who are recommended by the principal and who have been trained. If they come across something that they are not sure about, they will call us. Most things we can handle over the phone, but if we are needed in person, we will go. Another member asked if first responders are in each school, and Ms. Beanblossom responded that yes, they are and that it is a state requirement. Dr. Ellington asked if the diabetic care managers are overtaxed even more than the school nurse program is in general. Ms. Beanblossom responded that no, the training they receive is very thorough and those that have done it for several years have gained a lot of experience. Also, the nurses continue to monitor and follow up with each student under a diabetic care plan throughout the year. b. Presentation FY 25-26 Budget = Ms. Corinne Bates, Ms. Lillian Koontz Ms. Koontz shared a chart showing the different areas from which the Health Department receives its funding, noting that we get our largest amount of funds (52%) from the county. Some of the other sources of funding come in the form of agreement addenda's which are very prescribed with no flexibility in how the funds are used. Also changes made by the county annually regarding cost-of-living increases, and changes in travel reimbursement and insurance affect the budgets for all departments. Ms. Koontz shared that the Health Department's total ask for county funding this year increased from 51% to 52%. The increase is due to some of the state funding expiring and a reduction of expected Environmental Health (EH) revenue. New to the budget this year is a request for a new position. We are requesting an additional social worker position on the Care Management for At Risk Children (CMARC) team. Ms. Koontz explained the reasoning behind this request which includes how the program is funded, the amount of revenue that has accumulated since the program is not fully staffed, and the amount of workload carried by the staff. The salary for this position would be $70,986.00 which includes salary and fringe. If approved in the budget, it will not increase the county ask since this is a separate line item of business. Ms. Koontz shared more about the CMARC team, what they do, and how an added social worker position would benefit the team. Mr. Gibson asked if there were just four people on the CMARC team, and Ms. Koontz replied yes, just four. There are other social workers that are on the Care Management for High-Risk Pregnancies (CMHRP) team, but the two teams cannot cross over in duties. Ms. Tammy Troublefield asked if they have a set time for home visits, such as every quarter. Ms. Koontz replied that yes, they do, and she went on to explain in more detail how the program works. In conclusion, Ms. Koontz stated that the dollar amount we are asking for is $9,472,700.00, which is less than last year. Last year we had 6 school nurses in our budget, and we only received 2. Also with salary calculations, the salaries fluctuate. Ms. Koontz also shared changes to our fees for the upcoming budget year. Due to the increased cost of providing services, there will be a 2 to 8 dollar per service fee increase for personal health. This is in keeping with what other counties charge. Food and lodging fees, which include fees to permit pushcarts, mobile food units, and year-round pool permits, were increased to be more reflective of the actual work involved. The revisit fee was also changed to $50.00. The OSWP fees were increased by a small amount to be comparable with what other counties charge and to reflect the cost of doing business. Ms. Koontz also shared that in the budget subcommittee, we were asked to speak about expedited permitting and how that would work. She stated that Mr. Swicegood has prepared some slides regarding this and will share the information with the BOH. He explained that an expedited permitting fee would basically be a faster line to wait in. He also gave a brief overview of the number of staff on the OSWP team, their positions, and the services they provide. Currently OSWP operates on a first come first serve basis, and in 2024, we did a total of 508 site and soil evaluations. For the 2024-2025 Quarter 2, we averaged 23 days to the first visit. We are currently operating around a 4 week wait for someone to get out to the site which could come sooner or later. Mr. Swicegood also provided a comparison of Guilford County's OSWP program. They are very similar to us, and they do not have an expedited application process currently. In 2018, legislation was introduced providing private options to "speed up the process"; : however, it just slowed things down for those choosing the public option. He explained that even when private permitting is used there are things the health department needs to do to complete the process. Mr. Swicegood also shared information regarding the two private permitting options and provided a comparison between the public and private sector. He also shared what it might look like, questions that would need to be answered and the challenges we would face if the Health Department chose to implement an expedited permitting process. He pointed out that we already offer a somewhat expedited application process in regards to repairs, and we do that based on need. Mr. Swicegood asked if anyone had any questions. Dr. Ellington stated that he didn't see a way that an expedited process wouldn't slow down the regular application process. Ms. Koontz replied that we could not have an expedited process with the staff we have now, who are great, but they are new and have limited experience. We would need to hire someone with a lot of experience if we implemented an expedited process. Ms. Koontz shared that it would cost around $115,000.00 annually including fringe benefits, and then you would need to decide how much to charge for the applications to cover the cost of the salary for the additional staff member. She also mentioned other complications that could occur. Ms. Koontz explained that we are looking at this now because of the amount of work that still falls on EH and the complications caused when the private option is used. The thought was that maybe we could discourage people from using the private option if the Health Department offered an expedited application process. Mr. Gibson asked Mr. Swicegood if the expedited application process would help or make things worse. Mr. Swicegood replied that it would not make things worse if he could hire two more staff to handle it. Mr. Joseph Thomas stated that the two biggest challenges he sees are hiring experienced staff and having the revenue to hire that help. More discussion followed regarding the concerns of implementing an expedited application process including comparisons between the public and private sector, reasons why the private option is preferred over the public option, state legislation and upcoming changes in the next year. To summarize, Ms. Koontz stated that when we presented the budget, it did not include an expedited application process. This is something that we were not even thinking about yet. It seems it could be a potential to bring revenue into the Health Department to support more EH staff members; however, there are issues we don't have answers on and some confusion on how we would make this program work. More discussion followed with a couple of board members stating that they didn't feel it would be feasible at this time to implement an expedited application process. Ms. Koontz shared some concluding remarks regarding the budget. Ms. Koontz explained that we are tracking to bank our Performance Based Budgeting (PBB) savings, but the EH PBB savings will be smaller than anticipated which is due to the following reasons: when we submitted our budget last year, EH's budget was cut by $200,000.00, and we had to move funds from our larger general budget to EH. Since we are operating on such a slim budget for EH, we are not anticipating a large amount to be going into PBB. The personal health PBB funds were used to renovate the downstairs breakroom. Also, since we have a limited amount for overtime, Mr. Swicegood and Ms. Hull, Food & Lodging Director, have been encouraging their employees to use comp time instead of overtime. Also, revenues for EH are lower than was anticipated. Ms. Koontz shared that the budget presented to the budget subcommittee included the social worker position but did not include an expedited application system for EH. However, we did want to discuss it due to a potential new fee for EH. The subcommittee made a motion to accept the budget as presented including the Care Management job details with a discussion of an expedited application system for EH which we have done. As it stands now, the motion from the subcommittee will just need to be discussed, and a vote will need to be taken. Dr. Ellington asked if there was any discussion. There was some discussion to clarify why the budget was less this year in regard to the school nurse positions that were part of last year's budget. The discussion was closed, and Dr. Ellington asked for a vote to approve the budget. The budget was approved without dissent. Dr. Ellington changed the order of the meeting. Dr. Brandyberry will present the NC Dental Care update before we hear the 10 Essential Services and 13 Mandated Services. C. NC Dental Care Update - Dr. Christian Brandyberry Dr. Brandyberry gave a brief presentation of the meeting he attended on the state of dental care in North Carolina. They only touched on two hot topics, one of which is the ouprenorphine patch that goes inside the cheek which is used to treat opioid use disorder and pain. This can increase the risk of cavities. In the meeting they stressed the importance of dentists educating their patients of the risk and what they can do to minimize it. The other hot topic was fluoride and the concern that fluoride in drinking water is not safe. Dr. Brandyberry shared the benefits of fluoride and provided a handout on fluoride to the BOH. He also shared how concern regarding fluoride came about, and he expects that concern to grow in the next several years. This is why the ADA is trying to be proactive about getting the message out on the safety and benefits of fluoride in our drinking water. Dr Ellington asked about those on well water and if the fluoride in toothpaste is enough to protect their teeth. Dr. Brandyberry replied that there are products out there such as mouthwashes and prescription strength toothpastes that you can use, but the question is whether people will use them. Mr. Gibson asked if this was already in our water and when it was introduced. Dr. Brandyberry replied that yes, fluoride is in our water, but he did not know when it was introduced. We would have to reach out to someone else for the data on that. There was further discussion regarding bottled water and the negative side effects of certain soft drinks/energy drinks. Someone also asked if the filtration system on refrigerators removes fluoride from the water, and Dr. Brandyberry replied yes, it could, depending on the type of filter that was used. d. 10 Essential Services and 13 Mandated Services - Ms. Corinne Bates Ms. Corinne Bates, Business Officer, shared that each year we keep the BOH updated on what the essential services in public health are and the mandatory services that must be provided to communities through the local health department. Ms. Bates shared that the framework of the essential services was revamped in 2020 to revolve around equity in healthcare and community health for everyone. A slide was presented showing the 10 essential services. Ms. Bates also stated that more detailed information was included in the BOH packet. She also shared a slide of the 13 mandated services. There are 5 services that must be provided directly by the local health department and 8 services that may be provided by the health department directly, by contract, or by certifying availability from other providers. Ms. Bates asked if anyone had any questions. Dr. Ellington asked if vital records were exclusively electronic now, and Ms. Bates responded yes, they are. She also shared which vital records are handled at the Register of Deeds and which ones the Health Department takes care of. IX. Closed Session $ 143-318.11 (a) (6) Dr. Ellington requested a motion to go into closed session. Ms. Troublefield made a motion to go into closed session, and Mr. Gibson seconded. The motion was approved without dissent. After returning to open session, Attorney Jones reported the following: during closed session a personnel matter was discussed, and instruction was given to staff on how to proceed. No formal action was taken by the board. X. Adjournment Mr. Gibson made a motion to adjourn. Mr. Thomas seconded the motion. The motion carried without dissent. The next BOH meeting will be held on April 1, 2025. This meeting was recorded and is available for viewing in its entirety on the Health Department website at htps/www.codaidiondionacuhsmicenter/BardolHeall, These minutes reflect actions and an overview of conversation during the meeting. The presentation slides from the meeting are also attached to these minutes. This is a true and accurate copy of the March 4, 2025, Board of Health Minutes. Respectfully submitted, Sllio Konh Ms. Lillian Koontz, MPH, REHS Secretary to the Board /. Dr. Terfy Ellington Chair to the Board Health Director's Report: State of the Agency NEWS Open Positions, Recruiting Remodel of downstairs breakroom WIC: Office Support II, Medical Office Assistant: Laba and Peer Counselor Communicable Disease: PHNI Continue to see increased Flu activity EH:F Processing Assistant IV Budget has kept us very busy Open Positions, Holding Rabies Clinic, April 5 linic: Provider linic: Nurse Office Support Clinic: Office Support IV Progress on remodel 4 Program Reports . Budget season is upon us, Clinic team is business as usual. Business Office is incredibly busy OSWP fewer than anticipated . Food and Lodging we are applications tracking to meet 100% inspection compliance Immunization audit went well . WIC has been preparing for annual audit EH: OSWP Application Trend AllMonthlyl IPCAtrend TotalIPCA Tiv vat Jan-2 24 Feb-2 Mar-2 24 24 4 IPCAA Applications by Type Apr-24 5 40 May:24 4 25 Jun-24 Jul-24 52 5 10 23 20 Aug-24 4 21 20 Sep:24 9 18 Oct-24 30 23 Nov-24 Dec-24 T Jan-2 25 124 82 Fe24 Mar24 Apr 2 2025/26 School System When will schools dismiss Start Dates students for summer? *Davidson County-August 11, 2025 (Nurses return August 4) Davidson County May 21, 2026 *Lexington City-August 11, 2025 (Nurses Lexington City - May 22, 2026 return August 4) Thomasville City = June 4, 2026 *Thomasville City-August 25, 2025 (Nurses return August 18) Does early start affect school health? THOMASVILLE CITY IS * Trainings PLANNING FOR EARLY *Nurse Start Dates START 2026/27 SCHOOL *Families YEAR. We work things out!! FY 25-26 Budget Presentation Quick Glance Medicaid Max Medicaid 5% 1% Schools 5% CCNC 10% County State Collections Collections 5% CCNC County 52% Schools Medicaid Max Medicaid State 22% County Wide Changes 4 & 6 d & - o - R $500.00 +4.0% I L 5 4 A 5 Currently a decrease from last FY, but Personal $0.67 * $0.70 fluctuates during budgeting process. TRAVEL County Funding Percentage of County ask increased from 51% to 52% $ 4,901,052 Expiration of State funding, AA546, AA121, AA716, AA719 Reduction of expected Environmental Health revenue New to this budget Request to add social worker position on Care Management (CMARC) Salary/Fringe is $70,986 total (FY24-25 minimum for SWII is $37,605/18.0791 hourly) CMARC (Care Management for at Risk Children) Current Data 2024: 416 new referrals 2025:1 to date 137 new referrals Current Caseloads for Total Caseloads as of February 2025: 25 from outside agencies Care Managers 2/28/2025= 171 (primary care providers, DSS, WIC, etc.) February 2025: 65 from the Prepaid Nishiara Taylor 42 Health Plans (PHP) 7 days to reach out Gabrielle Leslie 33 Comprehensive assessment, WIC, Value Cathy Hubbard 51 Added Service, PC, immunization Home visits, attend physician Tashara Williams 45 appointments, assess needs and make referrals Conclusion $ 9,472,700 * $9 9,611,142 last year *F Requested (6) additional School Nurse positions, only (2) were approved.) *Salary Calculations Fees Personal Health: Budget/Fee Setting 2025-2026 Clinic fees are established using Medicaid rates, cost of supplies needed, and staffing costs. This year most fees increased slightly due to staff and supply costs. Approximately $2-$8 per service After thorough work done by the fee committee, including completing a cost analysis of our visit codes, we continue to offer services at an affordable rate to our community. Environmental Health (Food): Fee Setting 2025-2026 Current Suggested Inl line with comparable counties. Pushcart $90 $100 MFU $90 $150 More reflective of the different needs (Pushcart VS. MFU; Seasonal VS. Annual Pool Permit $170 $170 (same) Year Around) Seasonal Annual Pooll Permit $170 $200 Year Around Re-visit Fee $300 $50 Environmental Health Budgeting : OSWP Fees OSWP Current Suggested January 1, 2024 IP<600GPD $330.00 $350.00 increased fees by IP6 600GPD>1500GPD $450.00 $500.00 50% IP> >1500GPM $750.00 $800.00 . No fee changes CA <600GPD $270.00 $290.00 recommended for CA6 600GPD>1500GPD $270.00 $320.00 FY: 24-25 CA> >1500GPM $270.00 $350.00 Recommendations IPCA 600G GPD $510.00 $550.00 IPCA 600-1 1500GPD $630.00 $730.00 keep Davidson IPCA1 1500GPD+ $930.00 $1,060.00 County in line with BA/MHF Release 1 120.00 SAME comparable ChemicalT Toilet $35.00 $35.00 counties LAYOUT: SYSTEM $120.00 $120.00 Site plano changed(i (ino office) $120.00 $120.00 Sitep pland changed (Field' Visit) $300.00 Removed: reapply Returnv Visit, increases by $50€ ch time $50.00 SAME Ribbon $1.00 $5.00 Expedited Permitting A Faster Line to WAIT in.. What does this look like? Disney World "Fast Pass-Lighting Lane" ExpeditedWaitingl Lines Standard Lane Upgraded Lane withr reduced wait Wasf freer now $$$ Sieg Must bes scheduledi in advance Cannotj just show up and pay more $$s that day Price Changes on day and depends on demand Ky Seems difficult tor navigate??? Nop personal experience Davidson County OSWP 7FTETotal- Director, Program Specialist, 5- REHS . 2F FTEF ProcessingA Assistants OSWW, Wells, RWFs, Migrant Housing, Vectors-Rabies, MHPS, PMES, Complaints First come First Serve 2024-Apications-Site and Soil Evaluations- IPCAS-381, IPs- 127=508Total 2024-2025Quarter: 2 Average 23 days to 15tVisit Weekly Report 2/22/25 4-weekv wait toy visit: site (age of oldest application waiting att thet time) Av wayt to give peoplea ar number with a disclaimer Weather, illness or other unexpectedi influencer may delay- sites not readyr nowa are Coulds gett there faster Guilford County 19 FTE1 total OSWP- Program Manager, Supervisors, Programs Specialists, Field Staff (4 are vacant) 51 Management Support 2- 4 Week Back-log 2024 -580-630 Site and Soil Evaluations NO Expedited. Application process - Reduced wait time by providing machine to dig pits- scheduled in advance "Lighting Lane" Proposed Private Permitting Private Options- Legislative changes to "Speed Up"t the process... SLOWS DOWNTHE STANDARD LANE EOP or AOWE- Deemedp permitted when received by LHD( (all private) Stillt takes time for data entry A2tiyen6SSAOWELHD: issues OP) 5 days from: submission Private VS. Public Private Mosto only Site ands soil Evaluations- some do Wetlands, Stormwater, Fertility Management, ESAS Choose your clients, make referrals, sety your prices Public More thanj just OSWW being done, checkingAz1 finals Wes serve anyone who can apply and pay our setf fees DCHD- Lane" Piedmont Environmental "Lighting officesi in NC- Piedmont and Eastern-Greenvile OPtonsfmougpntsChalenyes Piedmont Office 6-weekl backlog getting tos site LSS/AOWE Charger more moneyf fort the permit. How Much? How Fast? 7Technicians (2a arel LSS in-training) Office Support Needr more stafft to meete expectations- needs seasoned: staff- need $$$ AOWEF Permits $2000-$3000 ExpeditedF Program Specialist-r more: $$$ Location dependent . Morep pressure todeliver Complexity Over-timet ton meet demand org goals AzF PermitA AVG. $1700 Preliminary Soil Work-N NOI PERMIT Profits sharing- Incentive $80or min ($200/hr.) Willt taker more than one persont to deliver PBB Reports We are tracking to bank our PBB savings, small savings anticipated in EH budget - Personal Health PBB funds used to renovate downstairs breakroom To date FY 24-25 A State of Affairs Dental Public Health in NC Moved funds to cover shortfalls in EH lines . Monday February 10 Limited remaining in OT budget Rhonda Stephens, DDS, MPH Revenues down in EH . Attended by Dr. Brandyberry - NORTH CAROLINA DENTAL SOCIETY. FLUORIDE FACTS AND FIGURES The Benefits of Community Water Fluoridation The North Carolina Dental Society, which represents the majority of dentists across the state, recognizes and supports the use of fluoride in community water as safe and effective for preventing tooth decay in children and adults. How Does Fluoride Help Prevent Tooth Decay? IS FLUORIDATION SAFE? Fluoride makes tooth enamel stronger, helping to protect teeth from acids that cause cavities. It also Yes. Here's why: helps repair early damage tot teeth and reduces the bacteria that lead to decay: 75+ years of research and experience along with thousands of What is Community studies in peer-reviewed Water Fluoridation? scientific journals Fluoride is a natural mineral already found finds community water in water. Community water fluoridation is the fluoridation is safe. process of adjusting those fluoride levels to the recommended amount of 0.7 milligrams per liter to Public health policies help prevent tooth decay. rely on the weight of scientific evidence, not a single study. What Does Fluoridation Cost? Decades of research find a The lifetime cost of fluoridation per person is less 25% reduction in cavities than the cost of a single filling. Community water those who drink among fluoridation saves money and time. Fewer dental S problems means fewer dental visits and less time fluoridated water. away from school or work. The National Academies of Sciences weighs in After a peer review, The National Academies of Sciences rejected claims linking fluoride to poor cognitive development, or low IQ. The group determined that fluoride at 0.7 milligrams per liter (the recommended level) and even up to 1.5 mg per liter has no impact on IQ. Small Tweaks. FLUORIDE: Big Results. The U.S. Department of Health and Human Services Tooth decay is the most common announced a recommendation that community water systems adjust the amount of flouride to 0.7 mg/L to achieve an chronic disease for adults and optimal flouride level to help prevent tooth decay. children So, just how much is 0.7 milligrams per liter of water? It's like... Children lose 34 million hours of school annually costs the 1 inch 1 minute 10 cent U.S. economy more than $45 in 23 miles in 1,000 days in $14,000 billion Fluoride is a natural mineral Named one of ten great public health achievements of the - 20th century by the Centers for Disease Control and Prevention, community water fluoridation has strengthens tooth played a vital role in reducing enamel and reduces cavities by tooth decay. 25% Fluoride in water and toothpaste Nearly 73% of the U.S. work together, population on community water systems- 209 million 73% people--benefit from fluoridation. The facts speak for themselves. In Calgary, one of Canada's largest cities, cavity rates rose significantly after fluoridation ended in 2011, despite people's access to fluoride toothpaste, and surpassed those in a similar city that kept fluoridated water. As a result, Calgary's city council voted to restore community water fluoridation. "The North Carolina Dental Society supports decades of valid scientific research confirming the safety and efficacy of proper fluoride levels in drinking water. Dentists across North Carolina and the nation are committed to improving oral and overall health, recognizing fluoridated water as a proven solution--despte financial disincentives." -Jim Goodman, chief executive officer and executive director, NC Dental Society Davidson County Board of Health Essential Services & Budget Report March 4, 2025 ESSENTIAL PUBLIC MEALTHS SERVICE THE 10 ESSENTIAL E s cor PUBLIC HEALTH nd m munity needs SERVICES 2 AMe ESSENTIAL PURLICI MEALTH SERVICE Toprotecto and promotet the! health ofa all people in hoan orol bi lagn andh azards allo communities flocting the population Assess and ESSENTIAL PUBLIC MEALTH monitor The1 10E Essential Public Health Services provide Build and maintain a population frameworkf for public health to protect and promote acto ors strong organizational health Investigate, thel health of all people in all communities. To achleve pn infrastructuref for diagnose, and equity. theE EssentialP Public Health Services actively promote public health AL address! TH health policies, systems, and overallo community conditionst that SSENTIA PUBLIC HEALT RVI ncE rer po hazards andr root enableo optimalh health for alla and seek toremove systemic partners causes ands structuralt barrierst that haver resultedi inhealthi inequities. pn Improve and innovate Suchb barriers includep poverty, racism, gender discrimination, throughe evaluation, ableism, ando otherf forms ofc oppression.E Everyones should ESSENTIAL PUBLN HEALT ERVICE research, ande quality havea afaira andjust opportunityt toz achieve optimal health eate, ws improvement andy wellbeing. oamn Cor nmu unicate effectively to inform ESSENTI AL uRLC EA ALT aV ICE and educate 2e andr 09 ui tic on Equity and Build diverse and oublics oalth skilled workforce a - SSENTI TIAL PUBUC HEALT RVICE Assure ct tivo ystom hat Strengthen, upport, and indua dus : are oed mobilize com nities tobeh healt thy and partr Enable ESSENTIAL UBL HEALTH SERVIC ty uida ive s equitable blic ith vor orkforce access Create, champion, and ESSENTIAL PURLCH MEALTH SERVICE Utilize legal implement en ve and / regulatory ng policies, plans, an nd continuo quality actions and laws pn ESSENTIAL PUBL MIALTN SERVICE uld rastruct ublich ea eoted 2020 Ten Essential Services of Public Health (NC GS 130A-34.1) Monitoring health status to identify community Enforcing laws and regulations that protect health health concerns and ensure safety Diagnosing and investigating health hazards in the Linking people to needed health services community and assuring the. provision health care when pepioalh otherwise unavailable Informing, educating, and empowering people about health issues Assuring competent public health workforce and personal care workforce Reamp Mobilizing çommunity partnerships to identify and solve health problems Eyaluating effeçtiveness, acçessibility, and quality of personal and population-based héalth services Developing policies and plans that support individual and community efforts Conducting research 13 Mandated Services for Local Health Departments (10A NCAC 46.0201) 5 must be provided directly by the local health 8 may be provided by the health department department: directly or by contract or by certifying > Communicable disease control availability from other providers: > Food, lodging and institutional sanitation > Adult Health > Individual on-site water supply > Home Health > Sanitary sewage collection, treatment > Maternal Health and disposal > Child Health > Vital records registration > Family Planning > Dental Public Health > Grade "A" Milk Sanitation > Public Health Laboratory Support Green: MOU/Contract Yellow: Provide