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87-1488 WMITE - CITV CLERK I, PINK - FINANCE � G I TY O F SA I NT PA U L Council CANARV - DEPARTMENY File NO. �� /�� BLUE - MAYOR � ' Council Resolution -\ Presented B ��/�`' ;`/' Y Referred Tp Committee: Date Out of Corrymittee By Date I WHEREAS, the City of Saint Paul through its Division of Public Health is required b�y Statute to prepare a bienial Corrr�nnunity Health Services Plan to recieve a �ommunity Health Services Subsidy; and, WHEREAS, this plan was presented for public review and comment and there were no I changes re�ommended by the public; and �� WHEREAS, This plan must be approved by the City Council as the Board of Health; ! THEREFORE E IT RESOVED, that the City Council sitting as the Board of Health does accep this plan for submission to the Ramsey County Board for their � inclusion f this plan in the Ramsey County Community Health Services Plan for Saint Paul and Suburban Ramsey County to be transmitted to the Minnesota i Commission r of Health. � I COUNCILMEN Requested by Department of: Yeas N ys °feN' � [n Favor ��R��- Nicosia Scheibel - __ Against BY ' �� a Wilson ��j j '� �8 Form Approve by it torne I Adopted by Council: Date (� , Certifie P :sed by Co ncil , cretary B `� sy n t�pprov y iNavor. a u�� 07 Appro by Mayor for Su ss' n to Council I By _ 8 ' P�.E$�.� ?� � n s t��:� I I : �'.'. HOW TO USE THE GRE�N SI�ET The GREEN SHEET has several PURPOSES: � ' � � 1. to assist in routing documents and in securing required signatures 2. to brief the reviewers of documents on the i.mpacts of approval - � 3. to help ensure that necessary supportin�c materials are prepared, and, if . - ,; � required, ettached. .. . , Providing complete informa'tion under the li:sted headin.gs enables reviewers to make decisions on the documents and eliminates follow-up contacts that may delay execution. The COST/BENEFIT, BUDGETARY AND PERSONNEL IMPACTS T�eading provides space to explain the cost/benefit aspects of the decision. Costs and benefits related both to City budget (General Fund and/or Special Funds) and to broac�er financial impacts (cost to users, homeowners or other groups affected by the action) . T3�e personnel impact is a description of change or shift of Full-Time Equivalent (FTE) positions. � If a CONTRACT amount i� less than $10,d00; the Mayor's s�.gna��ire' is nOt required, if the departm�nt directar signs. A contract musti always be first signed by-the outside ag�ncy before 'routing�through` City offices. �� Below is the preferred ROUTING for the five most frequent types of documents: . CONTRACTS (assumes authorized budget exists) ' � 1. Outside Agency 4. Mayor 2. Initiating Department 5. Finance Director 3. City Attorney 6. Finance Accounting � , ADMINISTRATIVE ORDER (Budget Revision) AD�IINISTRATIVE�ORDERS ,(all others) . 1. Activ�;ty Manac�er ; 1. ,Initiating DQpaxtment � 2. Department Accountant , ; 2. City Attorney, 3. Department Director 3. Director of Management/Mayor 4. Budget Director 4. City Clerk ' 5. City Clerk 6. Chief Accountant, F&MS COUNCIL RESO�UTION (Amend. Bdgts./Accept. Grants) COUNCIL RESOLUTION (all others) 1. Department Director 1. Initiating Department 2. Budget Director 2. City Attorney 3. City Attorney 3. Director of Manaqement/Mayor 4. Director of Management/Mayor 4. City Clerk 5. Chair, Finance, Mngmt. & Personnel Com. 5. City Council 6. City Clerk 7. City Council 8. Chief Accountant, F&MS SUPPORTING MATERIALS. In the ATTACHMENTS section, identify all attachments. ' If the Green Sheet is well done, no let�er of transmittal need be ine�luded (unl�s§ "signing such a letter is one of the requested actions) . Note: If an agreement requires evidence of insurance/co-insurance, a Certificate of Insurance should be one of the attachments at time of routing. Note: Actions which require City Council Resolutions include: 1. Contractual relationship with another governmental unit. 2.. Collective bargaining contracts. � . 3. Purchase, sale or lease of'land. 4. Issuance of bonds by City. 5. Eminent domain. 6. Assumption of liability by City, or granting by City of indemnific�tion. : 7. Agreements with State or Federgl Goverr�ment under which they are providing funding. � • . 8. Budget amendments. . , �?��/�� TABL� OF CONTENTS PAGE Secti'on 1 Forms } Applilcation Cover Form 166 � � . Ass�nrtancES �d -Agr�eemer�ts .1b7 . Code Changes 1985-1987 197-198 Sectipn 2 � Saint Paul Profile 200-217 Sectio�n 3 Environmental Health 220 Family, Health 230 Health� Promotion 238 • Disease Prevention and Control 243 Sect i or� 4 Index 254 II 164 . , � /�/�'�' � �r � APPLICATION COVER FORM INDENTIFICATION AND AUTHORIZATION ::g::::::i::::i:::»>;::;�:;::;:<:?:<::h:i:::::;<:<:;?:;::<.:::i<::::�:::::::::::;::i:::::::?>:«:;:::>::»::>:::<::<?:>:«�::: �v AN1E OF A PLICANT ORGANIZATION '�'>`�:1 `>::>::::>:<::::::>;»:?:: �.;:«::;;:.;:.:.;;:;:.::.::.:.:::.::::.::.::;;::;;:.;;:;.;;:::.>�.«.>::.; I' .;:<:»:>�E3<>i?�E�'�>:�?V�ti��>:1�<'>TH::�::::.:::::::::::::.: `::<::<:::�S�AC�.::y.:��}H,;��;�.1N#.Y�.;:::::;.:::::>: 1' H alth P Division of Pub ic e t aul Sain ?�<:::>�»`�3A1'�:::'l��;:�Y��`'<:�;::::::�:�<:>::»;�>:::<:<::>':;:>::�;;:;>'<�::::» .<:;:::.::.::.:::.::.:;:�;;;;:.»:;;;�;:�;;:.;::.:.;:.:;:;;:.;;:.,:.;;:.:;;:;:.>:.;:.;:;.:.;:.;:.;>;;:.;;:.;:.: :{:;:::`:::::::::::««:;:<:::: . »:>::»�::<�.>... ..... ....................................:...............:.:......... ..w..�„�:::;�>:::"«:>::::>�>::�><>��:::>:��::>:':;::>�<::::::�:`::::>:::<::<>':>:::>::»::>:»>�><::>:<:: - .4:;:>:::>:.>�.;:.;::.;:.;:;.:;.:.:::;:.::.>:.:.:.;::.::.;:.;:;:.;:.>::::;.:��;.:>.::.:::::::::::::.;>:<:.:::,;».::::.;::;; SPONSORING UNITS OF GOVERNMENT FLTNDING PERIOD CiryJCounty Date Approved 1 / 1 / 88 to 12/ 3]/ 89 City of Sa�nt Paul SUBSIUY REQUEST Name of Counties 1988 Local Budget 1988 CHS Subsidy Budgct c�y o s pnt Pa� ��it�,� �r.1�0,R5R (=nmm�r�ril Rn�,?�9 ('� nf �ap nt Pai�l i al) 3,035.487 (prot�osedl � TOTAL 6,156,345 802,239 1989 SUBSIDIY REQUFST S 802.239 ALL APPRO�RIATE REGIONAL REVIEW AGENCIES (LIST EACH RDC) WERE SENT COPIES OF TH1S . APPLICATION: Director ��Qlm Mitchell Director Agency 1viPtmnolitan Council Agency _ Address �nn r�t-,m Srn�arE? Address �— �aint Pai�l� Mi_nnesota 55101_ ' Date Sent Oct,obex 30, 1987 Date Sent Dircctor Director Abcncy Agency AdJress Address Datc Sent Date Sent Application is made for a subsidy under the provisions of the Local Public Health Ac[ in Ihe amount and for the purposes state� herein. By signature, the Authorized Official agrees and has the authority to agree to comply �vith the conditions and reporting requuements, consistent with applicable MDH Rules and Minnesota Statute stated herein. Authorized Official � r�gma ignature Tille p� ti c He?1 th ��rvi c-�G Mar,aqPr Date �cert�}w'' �A-i �987 � Subsidy Application Materials and Forms 11 166 � � �L%��4 ��= 7 ASSURANCES AND AGREEMENTS BY SIGNATURE, THE AUTHORIZED OFFICIAL AGREED AND ASSURES THAT: 1. Services w+ill be provided :n accordance with State and Federal laws, rules and policies. 2. ' The Board of Health will comply with state and federal requirements for equal opportunity employment. . . . . . -3. �� -Y'��am��-eoa�ply-a�t�-st�te �d �fedes� �roq+�+s�ts��]atiag�ta•data..�riirac� nr . confidentiality of informadon collected on individuals. 4. The Board will provide the Minnesota Department of Health with information referenced in the CHS plan where applicable. � 5. . Standards for programs or activities will be used in carrying out affected programs or activities where those standards exist. 6. The requirements for full community participation, as deGned in Minnesota Rules 4700.1800, have been met. . 7. The Health Advisory Committee or Health Task Force of any Human Services Board Advisory Committee in the county where applicabie (Minn. Stat. 402.03), shall meet the composition and re�orting requirements of the Community Health Services Advisory Committee required by Minnesota Statute. 8. The Board will comply with all standards relating to fiscal accountability that apply to the Minnesota Depaztment of Health, specitically, a. The local match identitied in the budget submission complies with the definition specified in Minnesota Rules 4700.0100, Subpart 15 and meet the following tests: ' ' 1) Cash contributions are cash oudays, including the outlay of money contributed by other public agencies and institutions and private organizations and , individuals. ' 2) In-kind/Direct Assistance contributions represent the value of non-cash contributions provided by (1) the applicant, (21 other public agencies and institutions, and (3) private organizations and mdividuals. Such goods and ' services directly benefit and are identitiable from the applicant's records. SpeciFcally, the agency calculates the hours of volunteer services by the same method used by the agency for its employees, and the Board documents the basis for determining charges for personal services, supplies and expenses. b. The Board will submit budget revisions to the Commissioner for prior approval in accordance with CHS Policy No. 4 (S/1/78). (Attached) ' c. Reports will be filed with the Commissioner of Health in accordance with Mianesota Rules 4700.1700. d. The Board will maintain a Financial Management System that provides: 1) Accurate, current, and complete disclosure of the financial results of each activity. � 2) Records that identify adequately the source and application of funds for subsidy supported activities. These records shall contain information pertaining to subsidy awards and authorizations, obligations, unobligated balances, liabilities (encombrances), outlays and income. 3) Demonstration that the Board has effective control over the accountability for all funds, property and other assets. 4) Compazison of actual obligations with budget amounts for each activity. � Subsidy Application Materials and Forms 13 167 � i.�" ,�' /`�� - C� . � Accounting records that are supported by source documentation. 6) Audits that can be made by or at the direction of the Board or the Department of Health. CHS fmancial records will be retained until audited, _ with the following qualifications: _ aa) The records will be retained beyond this period if sudit Fmdings have not been resolved. - bb) Records for non-expendable property which was acquired with subsidy funds will be retained for three years after its fmal disposition. AUTHORIZED OFFICIAL ' • TITLE Pt�hl i r HPaI th �Pn�i ma ManagPr DATE Septgnber 10 , 1987 • 14 ' Subsidy Application Materials and Forms • 168 _ _ . C� ��,��, MDH-�HS AGENCY IMMUNIZATION PROGRAM AGREEMENT INSTRU�TIONS: Z'he Saint Paul Division of Public Health CHS Agenry agrees to: 1) Adaiinister Department-supplied vaccine in accordance with MDHpo licy to use federally supported vaccines for children whose families are unable to pay for them and who aze not � . . . . . �.,:ca+errd..,�or ..b�r.tbi:�d.�arty.,�a�rers . ;2) Provide the a�propriate "Important Information" forms to all vaccinees (parents or �guardians) receiving vaccinations m public clinic settings and to private physicians if Ghey elect �to use the forms in accordance with the conditioas specified in the 'Private Physician Certi6Cation" form. CHS ageneies may include appropriate identificatioa on the forms. Any other addition to the forms, or variations from the language must have the prior written approval of the Director, Centers for Disease Control CDC). Any re4uest for change must ' be submitted to the Minnesota Department of Health �MDH) which will forward the request to the Centers. The a propriate Important Information forms at the time of this agreement are dated: Polio - 3/1�3; MMR - 3/1/83; DTP/Td - 2/6/86. If updated forms become available, the MDH agrees to provide these to the CHS agency at the earliest possible date. 3) Obtain documentation of the recei�t by vaccinees (parents or guardians) of the Important Informadon form relating to the vaccuie administered.� The documentation shall consist of the signed lowerpo rtion of the Important Information form or a separate signature card which contains the following: 'I have read the information contained in the Important Information form(s) about the ' disease(s) and the vaccine(s). I have had a chance to ask quesdons which were answercd to my satisfaction. I believe I understand the benefits and risks of the vaccine(s) and request that the vaccine(s) indicated below be given to me or to the person named below for whom I am authorized to make this request" • This statement must appear at the top of the signature card or 1og sheet and the form must include at minimum the following entnes: Name, address, date of birth, age, type of vaccine(s), � clinic identification, date of vaccination, manufacturer and lo[ number, s�gnature of person to receive vaccine or person authorized to make the request, date of signature, and date prin[ed on the appropriate Important Information form. 4) Obtain a signed copy of the "Private Physician Certification" form from all physicians to - whom the CHS agency furnished vaccine which is to be used in private pract�ce. A new Certitication must be obtained every two years, corresponding to each CHS Biennial Plan. 5) Establish �rocedures for the retention of the signed portion of the Important Information form and Prrvate Physician Certification form, and other types of approved documentation for at least ten years followin� the end of the calendar year in which the forms aze signed and, upon written request, furn�sh copies of the forms to the MDH or the CDC. 6) Assure that public clinics, schools and other a�encies to which the CHS agency redistributes vaccane agree to the use and retention of Important Information forms as specified in 2, 3, and 5- 7) Assure that, in the case of a school-based program or other programs where the iaformation form is to be read and signed in advance of the vaccine by a parent, guazdian or other suthorized person who will not be present at the immunization clinic when the vaccination is given, procedures shall be established and made known for answering questions � by telephone or otherwise. 8) Assure that person(s) are available at each immunization clinic to ensure that prospective vaccinees (parents or guardians) can read the information provided, and to answer questions about the vaccine, its expected benefits, its normal risks, its contraindications (special warnin�s , to vaccinees with low res�stance to infections), alternatives to vaccination, and to provide adv�ce Subsidy Application Materials and Forms 17 ; . 169 � `�'� �'7_ ,��,�;1� regarding medical assistance in the event of suspected vaccine reacdons. Clinics serving large pumbers of persons for whom English is not a first language. must provide Important Information statements in theu native language. Translations of Important Information forms iare available from the Minnesota Depaztment of Health. �9) Assure that the persoa administering the Important Information form(s) routinely asks iwaccinees (parents or guardians) if they understand the informatioa provided to them and if Wey have any questions. �0) Designate a vaccine reaction coordinator and place the telephone number on each Important Information form as the number to call regarding vaccme reactions. The reaction wordmator(s) for thc agency is/are: Muriel Staanson, Peq C� 11) Report to the MDH all illnesses in vaccinees which be�an within 4 weeks of receipt of vacc�ne and which aze severe enough to require hospitalizat�on or a visit to a physician or other modical care personnel. Use the CDC Report form "Report of Adverse Event Following ' Immunization." 12) Provide the vaccine, whether administered in public clinics or by private physicians, without charging the recipient for the cost of the vaccines. 13) Submit a quarterly vaccine usage and inventory report by the lOth of the month following �he report penod. A report must be fded even if no vaccines were administered or distributed. Use the MDH form 'Quarterly Report of Vaccines Administered and Distributed' By signature, the Authorized Official agrees and has the authority to agree to comply with �6ese conditions and reporting requirements consistent with applicable MDH Rules and the �HS Act. In addition, by signature below, the Authoriud Official assures full compliance with �11 items statcd herein. �'��C � • u�i t iTor��C�'c� ency. cal Director Sept�il�r 10. 1987 it e ISate I , 18 Subsidy Application Materials and Forms 170 . � ��_ ,��' �� STATUTE AND RULE COMPLIANCE INFORMATION The 'following information is needed to determine compliance with the Statute and Rules established for ComRnuni:y I':oak� Services: Age�tcy Name: saint Paul Division of Public xealth . ,f . . ,,-.,l�t�"CSS' _ . 555 Cedar Street Saint Paul, Minnesota 55101 Telephone Number: ' 612-292-7712 • C�m.munity Health Board's Organization and Composition 1. How is your Community Health Board Organized? � _�_ Single city Single county Joint powers Board composed of: (number o� cities (number o� counties � 2. Is your Board organized under the Human Services Ad? � YES a NO • 3. Are there any other Boards of Health within your Community Health Boazd's jurisdiction? � YES � NO If yes, please indicate the number of Boards authorized for each statutory source of authority. Joint Powers Agreement (Minn. Laws (198'n, Chapter 309, Section 3, subd. 2, and Section 10, subd. 2 (a)). Delegation Agreement (Minn. Laws (198'n, Chapter 309, Section 7, subd. 2) Eligibility for CHS Subsidy (Minn. Laws (198'�, Chapter 309, Section 10, subd. 2 (b)) . Existing CHS pro�ram in a county of 300,000 or more persons (Minn. Laws (198�, Chapter 309, Secaon 10, subd. 2 (c)) 4. Indicate the composition of your Board and the number of inembers who serve on it: a. City council(s); 7 members � b. County Board(s); members c. Administrative Board; members (describe the Administratrve Board's composition; i.e., "One third county commissioners, one third general public, one thud providers") d. Other; members (Describe): Subsidy Application Materials and Forms 19 180 � / �`� �,�_ �7_ '� Coritmunity Participation 1. On what date was the written notice of the initiation of the planning process sent to , interested persons? g� C��, ��on 2. To whom was the notice sent? (Categories are acceptable, i.e., newspapers, physicians, city council members and etc.) See County Section 3. ' Date of Public Meeting(s)? g� C�ty ��on 4. CHS Advisory Committee: a. Was the public notified of all advisory committee meetings? � YES � NO .' b. Are there minutes and records of attendance on fde? � YES � NO c. On what dates did the advisory committce meet during 1986/87? , d. Are the advisory committee's bylaws or operating procedures � YES � NO on fde? 5. , Are the following materials available for monitor review? a Copies of public notices and miautes? � . YFS � NO ' b. Ctirrent roster for Community Health Services mailing? a YES � NO . Date it was last updated �� „�„- 19R'7 ' c. Inventor�+ of existin� health-related services in the a YFS � NO community? Date it was last updated�eptenber 1987 Special Project Grants List all'Special Project Grants submitted to MDH and the Date they were submitted. Special Project Grant: Date Submitted: � 6/12/87 1�Ft� Z/�i�R7 t�I — c�FrrrrvF; Q/'�i/£i7 E'AMILY PLANLQ , 7�'�1�R7 �'T� �I� _ 10/30/87 � S[TPPT FMFTITAT. FYY)T� p�p�M F+OR inX�IF�T� TNFAT'FP$ �� 6/ 1/87 � � i Subsidy Application Materials snd Forms . 190 � �,c ��- ;�i,r� C PERSpNNEL Providd name, address, telephone for the following CHS key personnel: Where one person holds more than one positioq repeat the. name only, where address is the agency address, write "Agency". CHS 1Administrator: Judith Barr 292-7712 Agency Directnr Community Nursing: Joa�n R. Forar�an 292-7727 Ager�cy Directpr Home Health Services: � Director Disease Prevention and Control: Dr. Neal Holtan 292-7726 Agency Directbr Emergency Medical Services: Director Health Education: Catlnerine Lyman-0nkka 292-7714 A9��Y Directqr Environmental Health: � Frank A. Staffenson 292-7771 Agency Do the above staff ineet the minimum standards established in Rule 4700.1600 Subpart 3? � 1'�S � NO If no, please identify and explain. I Subsid A lication Materials and Forms 21 Y PP 191 Z6T ZZ � ��, 8 � � � � `� '� � �n ' o �c �_`; � �= � �o � \� � . � � � � tr. � � m � O O N �'1 O ,,,w � N c+� �--1 N s � � �� o � o 0 0 0 ts• �--I M N N �--I lf1 � $ . s' � �' � � �' � o 0 0 0 .�, � �--1 O N L'1 �i� ri rl � h' � � � � � � - E ` �y � � Vl � � � ` . � d' d' N O M � .... . . . , , � . . • � _ .. . N , , . � . � _ _ _ � , ,; ._:, ''"� C p � � i � � � e ` � ,"' � , J�i Z•2 y o .� � Z' J�i = A , .� '.!•e _ :� � � i .. � r e � � � c ± � �ga � � � � � �� s �� .y H � C.� � '.� � op� '+ � .� w = Z y � ++ E� •E e y S� � � i •�� .� .Y .Y � e e � � u. A V �. d L Y �t L r'I e < � t� c� r:. O S S�"" 2— 2 s i O � = O � , O = N �; e � � � �o a ° _ � = ,: � .� � �t."�7- �'f�� Title of class: DIRECTOR OF MEDICAL SERVICES DES�CRIPTION OF WORK Gleneral Statement of Duties: Performs managerial work in planning and , directing the Medical Services of the Division of Public Health� and performs related prof�ssional duties as required. S�pervision Received: Works under the general guidance and administrative direction of the Public Health Services Manager. S�pervision Exercised: Exercises within the Division's Medical Service unit medical superviaion directly and through subordinate supervisors over professional, technical and clerical staff. TYPICAL DUTIES PERFORMID The listed examples may not include all duties performed by all positions in this class. Organizes, plans, delegates and directa the medical activities of the Division of Public Health including family planning, iIIanunization, venereal disease control, tuberculosis control, child health, nutrition, ' geriatric health and other medical programs. ,. Pr,ovides and directs the operation of a communicable disease surveillance and control program for the City of St. Paul. Prpvides professional supervision for other physicians working within the Division. Acits as a consultant for divisional health education and prevention programs. Prpvidea technical advice in the operation of the medical laboratory. Es�tablishes medical priorities and develops new medical service programs for the .Division of Public Health. Provides physician support services when needed in one or more of the medical activities operated by the Division of Public Health. Prpvides professional liaison between the Division and the Ramsey County 'Medical Society, St. Paul-Ramsey Hospital, and other professional medical establiehmenta in the community. As�iste in the development of the annual budget for the Medical Services 'programe. Paxticipates Qe a member of the Division's Management Team. Makea reports and recommendations to the Division's manager. KNOWLEDGES, SKILLS AND ABILITIES Tharough knowledge of the practice of inedicine. Conlsiderable knowledge of public health principles, practices and programso Co�siderable ability to plan, organize and delegate work. Co�siderable ability to deal tactfully and efficiently with the public and istaff personnel. (�ontinued on reverse aide) ' Effective September 13, 1980 DIRECTOR OF MEDICAL SERVICES , , 193 �� ' ,�� ' ��f� DIRECTOR OF MEDICAL SERVICES , (continued) Considerable ability to deal effectively with local care institutions and medical groups. MINIMUM QU�4�LIFICATIONS Graduation from a recognized medical school and two (2) years of professional experience in the field of internal medicine, pediatrics, family practice, or ob#tetrics and gynecology. A Master's Degree in Public Health may be subetituted for up to one (1) year of professional experience. Must be licensed to practice medicine in the State of Minnesota. t � � � � I 194 � CU� �7 ��. � CHS i BUDGET FORM INSTRUCTIONS: This fbrm is the CHS budget form to be included in the CHS plan. The fo�rm is divided into the following general fund categories: Local; CHS Subsidy, Vaccine AllocaCioa; and Special Projed Grants, Other State, Other Federal. . ,. ,_'i�eesi , Report the amount of local dollazs budgeted by program category. "Local" includes local tax levies, gifts, f es for scrvices and revenues from contracts vv�th or gran[s from local organizations (i.e., schools, ' social �ervice agencies, community action agencies, hospitals, regional groups), or from foundations. CHS Subsidy Foi eaeh program, report the budgeted amount of dollars expected from MDH based on the formula in the Local Public Health Act. Vacciae AllocafSon For thq Disease Prevention and Control program, budget the value of the vaccine that the agency expects to receive from MDH. Also report this amount as an in-kind contribution. Special Project Grants Report, for each pr am, the bud�eted amount of dollars expeUed from each of the Minnesota Department of Heal�s special pro�ect grants. Other 5tate Report jdollars expected from any other State agency, other than those identified as special project . grants. Other Federal Report dollars expected from the Federal government under any program not previously specified. DEFINI�TIONS: Special �Project Grants: Those grants awarded by the Minnesota Depar[ment of Health for a special purpose: Grants included in this category are: • Women, Infan[s and Children Supplemental Food Program • Family Planning Grants • Maternal and Child Health Grants • Refugee Health • 'Indiaa Health • Nonsmoking and Health � • AIDS Prevention Other State Grants: Revenue received from any other state agency or source other than those identifie� as special projeet grants. Federal Grants: Revenue received from the federal government under any program not specified above. In-Kind: Non-cash .effort on the part of, or on the behalf of those programs addressed in the CHS Plan. F�ram�le: Volunteer sernces, supplies, facilities, equipment, and state-supplied vaccibne are to be included 'as m-kind. Budgeting and reportin$ in-kind expenditures are oPtiona! except in the case of MDH-supplied vaccine. Also, ple�se note that d the CHS budget includes m-kind amounts, in-kind expenditures must be reported. ! . Subsidy Application Ma[erials and Forms 23 195 . , 96T � � tiZ ,� � , . i � � ��' °o °o rn � a0°o � o�o w 01 O O� M c'7 � u� �. . . . . . . c. �1' O M 00 d' t0 00 � l0 O N O l� 01 l!� d1 00 00 01 N r-I 01 � . � �-i � e-i l0 � � �' � � � . ,p 's ` � � � � N N O u w N � i 0 Q M � . . . �� s � � � 0 _� � � o . C � 2.�i;xo::>:i � . :iY'ti>.�}j<;:' i'r,:�,� i i;�'{.:}'{:}: ��.�.. .r•.. , ::jty,-...;;.:: . a,. :.:k:£i>""'Y:;�'i;!. "�:7' Mi�:3:i i".a..� 0 •::?j::X�S<it � . ::..W/.•��.ti :�?Y1:S•��ti('i?l�• .v.:Y.i4:•iX�:.�.: v�v,#.. ytiv�i:' T:::•.{. '>Y�.wSn�{:}'� �'f�'�'•"F....�.�� :•:�•;Z' . .� :'vFr:::.'�?^+i.,q� 'i;AS9�' .<�.j'�;::•�: . r�r�::i;.r:`L.;.';�;: �.� :;'Cq}:'�..;•Y,.:.. '•k,'�r �;�n;�; ..": . +>,• .' :;_:rx'r.'•:,`..: ...{;';iS: .;.i'.,x.,;i: 'r.::o:�u;i.'•:ti':: :v;:z:i'i:�c>.ti,•r�,.�i." O O O r-i 00 '� 4 :•::x.::•>: :::�^�;:::�: •'•;•.�;`:�:::�;�:'•:::::;:'?:v::>.;;:;:::: t� {.., .`:�::?r�•.; <;:,ss5�?'; ,#.•:'r,';:�><.�:;; .... ri��.:`+.:?:;::;?�k;r:i• O O l� �O r5:, � ;Y f v.'..<`:;iyF'',f.,',+,r.�,.�,,`.'�•`: ;:�;:,•�,::k;:;: }^�.`;;<.::'3i�� `�'•`'•'"•"`o.,^.•r::::��':� N O O C M . . .:: .}::':::.,•.':�•" " «�.�..''': ,, � "'s,.�,�ifY&:<: .r`; .�ic;"`.iii;s .. >��,'.::k '' . f'�) .c::� •'<��i; •<.%�.3::e:.:.. +�y�.::?: to�=; .•a:'`Y.�,��.;'•Y.::::"�t��. O Lfl d' CO .4'i?��i:t:}:i�+IJ,:'•:fi':}:::.,t4ii:;:;i: irri+i:::i•',?ir�i�v'i ' v v. v:,.N'y�...y' •:c?i::ci:::� '.:::5::; :;%•s{:�;r:�:: ; ri••;�,`s:.;.::;:�.}:,i N ln �--1 ri y 'r:; :' •:;: .:;x•:r::•r:� ::•::;: �• �..: I ";�Y.'t%:::�i,•yL:•'•;ryf:;. ';�:p.;:o.;ov:.::�.:':fi.,`:�.�x.'':;%A%�f3%:'�i%L� ;,`;::�' , w•+;•�' ..�.',tl�,x�� •..,>`... ,•r.•::.: /.'%�'% �O .;^.:;..a.>::::. <-•.:• „';e;:;:;ty:;:;: ;.£;,.;�. ;;: ... �.v O..:. 4::i:v:}'>:�:i:},::;.,y:��''v:.•:. ' ?. , •.;n.;?:;r.;..:r: .J...... �+• ....::n...i.:.�v..::-.�:n�::..,- : .. ..:........:�..:: .8.:•.;. ' .......... ...... ...:.•s......�::::::.v: ?Y'.�..% �q O � :ir•.<•: � M l0 �i� M l0 r-I .�'j�� CV ~ y ' N rl "::%i:•,•: :..;x,,,�. :;x:%�:!::. N y Ll1 t11 :�:::;c�>:;v. p V N :>'�.:�� :;i;;;::•:. .r...aa � . ::g.;:,"',. 01 ln 01 N t 01 (� `� � � � ri � � � r ��. . � . . _� _ . . . . . .. , . . . . � . .. �. .. . . . g a � � i w ` .S 2 .� $ � . � � . Lt. � � � � s �E _ _ � � � t _ � � m E y � � � g � � � �� a. = 2 c3° � 5 F � � .{� e�i wi i �i �d e� ad et ° . ' I I ��-=�-�- ;�� ENVIRONMENTAL HEALTH CODE CHANGES 1985-7 � -------�------------------------------------------------------------------- CODE CHANGES SECTION -------------------------------------------------------------------------- SNOW , 113 REMOVES EXEMPTION FOR WEEKENDS AND HOLIDAYS IN TIME ALLOWED FOR SNOW REMOVAL. SNOW MUST BE � REMOVED IN 3 DAYS. JUNK CARS 163 NEW DEFINITION OF ABANDONED VEHICLES INCLUDES: -VEHICLES WITH PLATES MORE THAN 90 DAYS OVERDUE, -INOPERABLE VEHICLES ON PRIVATE PROPERTY (WITH AN EXEMPTION ALLOWING ONE INOPERABLE VEHICLE TO REMAIN ON OWNER'S PROPERTY FOR 30 DAYS FOR REPAIR) . -ANTIQUE CARS BEYOND REPAIR, AND ' -VEHICLES WHICH ARE NOT SECURE GENERALLY THE DEFINITION MORE CLOSELY RESPONDS , TO THE PROBLEMS CAUSED BY ABANDONED VEHICLES. NUISANCE$ 45 COLLECTS AND COORDINATES ALL CITY ABATEMENT ON PROPERTY RELATED NUISANCES EXCEPT CARS AND SNOW. ' REFINES DEFINITIONS OF NUISANCES TO AID . ' ENFORCEMENT. EXPANDS DEFINITION OF NUISANCES TO INCLUDE VACANT BUILDINGS, HAZARDOUS WASTES, HAZARDOUS BUILDING PARTS, ETC. . ' EXPANDS ABATEMENT AUTHORITY TO INCLUDE ' DEMOLITION, REMOVAL OF DANGEROUS BUILDING PARTS, AND BARRICADING OF HAZARDS. IMPROVES ENFORCEMENT PROCEDURES HOUSING CODE 34 ALL PREAMBLES CHANGED TO CLARIFY WHICH SECTIONS ' APPLY TO WHICH TYPES OF BUILDINGS. 34.01 EXPANDS AREA OF CONCERN TO INCLUDE ENERGY 34. 02 STANDARDS. 34. 03 CLARIFIES SCOPE TO INCLUDE BED & BREAKFASTS AND EXCLUDE HOTELS. ' 34. 07 CLARIFIES DEFINITIONS FOR ROOMING TYPE UNITS. 34. 08 REQUIRES THAT THE YARD AREA AROUND A RESIDENTIAL BUILDING MUST BE KEPT CLEAN EVEN IF THE BUILDING IS VACANT. 197 , '� ��;-- �7_ ,��.�� 34. 09 REQUIRES THAT: -EXTERIOR WOOD BE PAINTED, -WINDOW HAVE LOCKS, AND -ALL LIVING UNITS HAVE DEADBOLT LOCKS (EXCEPT BED & BREAKFAST UNITS. ) 34. 11 CLARIFIES REQUIREMENTS FOR ROOMING UNITS. 34. 13 , . 3�.17 34. 18 SHORTENS THE PERIOD FOR APPEAL OF "UNFIT FOR HUMAN HABITATION" PLACARD ACTION FROM 30 DAYS TO 10 DAYS. STUDENT �iOUSING 321 EXEMPTS SOME COLLEGE DORMS FROM ROOMING AND BOARDING HOUSE LICENSING REQUIREMENT. MUST , STILL HAVE FOOD SERVICE LICENSE AND CERTIFICATE OF OCCUPANCY. LIMITED TO DORMS WITHIN CAMPUS BOUNDARIES AS SET FORTH IN SPECIAL CONDITION USE ' PERMIT. DOES NOT INCLUDE FRATERNITIES OR SORORITIES. BED & BREAKFAST 378 PROVIDES NEW LICENSE CATEGORY FOR BED & � BREAKFASTS ESTABLISHMENTS. ' ESTABLISHES STANDARDS FOR BED & BREAKFASTS. RABIES CONTROL 199 ESTABLISHES GUIDELINES FOR HANDLING UNCLAIMED ' ANIMALS WHICH HAVE BITTEN. DOG RESTRAINTS 206 REQUIRES THAT DOGS IN UNFENCED YARDS MUST BE RESTRAINED BY A LEASH OR CHAIN. THE NEW ELECTRONIC DOGS FENCES ARE INADEQUATE. 198 �� ,� �_j_ REVIEW OF SAINT PAUL SPECIFIC NEEDS A oaa�lete needs assessment for Ramsey County as a whole can be four�d in Secti�n A. The follvwing section highlights sarne of the special problems facir� the City of Saint Paul. DII�IOGRAPF�C SUNIl"�,RY TOTAL POP(TLATION The Cfty of Saisit Paul is a divexse c�urna.nity. St. Paul acx.ot�nts for 58$ of the papulation of Ramsey Caunty. The St. Paul pop�lation is 4.8� Black, 2.9� Hispanic, 0.9� Native American, 0.8� Asian, and 1.8$ "other" based on 1980 census figures. Non-white Population as $ of Total Population Native Black Hispanic American Asian Other Saint Paul 4.8$ 2.9� 0.9� 0.8$ 1.8� Suburkk�n Ratnsey 0.7� 0.7$ 0.2� 1.4$ 0.3� � ', Ramsey Ooiuzty 8.1$ non-white • ' Saint Paul 11.5$ non�ahite Suburban Ramsey County 3.5� non-white (� may differ frcan swn of table due to rounding) In acklition to the differences in racial oamposition betwePn the City of Saint Paul a�nd the si.�burbs, there is a major difference in pwerty status. Of eleven health planning areas in suburban Ramsey Co�nty, none has more than 10� of its resid�ts belaw 1979 pc7verty level (1980 census data) . Of the seventeen health planning areas in St. Paul, seven have 12$ or more residents (1980 data) below 1979 paverty levels. January 1986 data also irxlicates that the bulk of those receiving public assistance are Saint Paul Residents. PUBLTIC ASSISTANCE UI'ILIZATION F+OR ST. PAUL & � ARF�A - JANUARY 1986 Zbtal Cases Proara�n Families St. Paul Suburban AFDC I 7,814 88$ 12$ Genera�h. Assistance 3,198 95� 5$ Medica(1 Assistanoe 9,214 81� 19� Food Sltamps 11,691 85� 15� Source: Ramsey Crnmty Ooammuzity Ht,mian Sesices Department 200 /�,�-,��7- � ��' 730 731 732 727 728 : ., �26 729 722 724 723 725 720 � . 602 6 ,3 604 605 ��'" 606 - ' 607 60 0 61 611 14 _ 612 613 �-' 1 618 616 " 615 � 20� o� more of residents belvw 1979 povexty level (1980 Census) �15-20� of residents belaw 1979 paverty level (1980 Census) �10-15� of residents belvw 1979 pwerty level (1980 Census) CHAF�I' 2 201 i . � �,��,�/ ��`�'� The pe�rce,nt of the aoianty's elderly (65 ar�d aver) residing in the city of Sai,nt Paul in 1980 was 76�. This has declined slightly based on 1983 estimaltes (Mirmesota Depaztment of Health) to 74�. SauZt �Paul has 82$ of the minority residents of Ramsey Caunty, 90$ of the Bllacks, 84$ of the Hispanics, 86� of the Native Americans, ar�d 88� , . , . . �.c�f thase classified as ��other" (primarily Sautheast Asian RefugePS) . The suD�urban areas of the county house 53� of the Asian-Paci�ic Islar�ers. �ile pur poor, elderly, an�d m.inority residents represent large grnups with special neec].s, a smaller yr�up with substantial needs has been identi�fied in th�e hoaneless pc�pulation. These de�og�raphic differences create needs for more health servioes within, the city to provide law-cost service.s to these high risk graup. This is particularly important in light of the studies of insuranoe caverage of Minnesota residents. Those groups who are most likely to be uninsured are fv�.u7d in greater nwmbers within the city. While the Divisibn does not provide primary care, except to Refugees, it does ac�nini�tex oontracts to five c�mminity clinics to provide primary care to law-incxane and minority populations. During the second quarter of 1987, 1,500 Division of Public Health client� were surveyed to determine levels of insurance oaverage. SuYVey . firidiriqs are shcx�m graphically on chart 4. Criart � describes the City's best projections of pc�x�lation changes aver the next five years. With the projected increase of �z in the work foroe (Chart 6) and an increase in rnnnbers of children under 10, the Divisiqn ariticipates day care will be an increasing challenge in the second'half of this decade. Additionally the increase in the "oldest . old" n�y strain public health as they require greater support to ren�ain in the aa�mnmity. As anticipated in the 1986-87 CHS Plan, AIAS has begLUZ to require increa5ing r�sources. Z7ie alternate test site continues to see 150 clientS a n�nth. Epidemiology and health education staff each spe.r�d approximately half of their time on AID6 related activities. The follaaing sec.�tion highlights sarne health indicators for the city. II 202 . __ _ . �;,�"� �_ !u�� , SPDPH Clients Covered by Third Party Payers March-April 1986 No 298% .„.;;:,{:. No ,., �;::: . ''y�F��.,�.,,�,. � ,.,�.,.�,"a....��;:� ;. ;r�:•;.,•;::•.5.::.•.��.,�;�' �.,:. N:<:�::.:..;.,....:� 28°/ .... >:<.�'�.�.•r. o �r{h�:�f ;�;�;�:: ;:;•�::'�#'s�'"4:?:a• 4�.,:.;: .� .. .. ... . .. , :_ •:7:+:;r'x.•: A?£ . . :::;t;�:;,t.,.{ +'� r. :;:::';t.'t.;r�..y;;`•;:,�r:;� `' - . . - _.. .. ._ ..� . ... . x..�.:�y::.�; c..%;a�;?;��'•;,'•.''.'•w�:t:;;•.;�L+,_:y: ;::;.:,zr>�:•;:,:k�.�`,,.•,; �' :•,;:.>::^.:;y:;•,x••3Y,�xti;:,,�`.`•'�:' fi ir\�>'v:�'w:•MrO:;},�;•'.,.i.iC.+�\ }+��y+': � •':�::i:titi}?:��ti;i%;:�(•:•:{'ry>':.<.Z 'O•., .<;,,:;ty�.:.ti:;;,:;'>:n.;iti vif;'a\:, �\ .,,r�;.;;::,;.,:�.<;��'';. :»�,:...�>;;::�:.t.,�::.:�f��<>��:� .��..,.:.....:.. Yes �;ry:>�:;.:::;c:<:..�:� ..... ;x::. . .i:.R,:aY. .� �••:\s��yi>:`'•:?,•::•:;;�.;. ,.:y�;..y:�t•w:tX ot�::,? :�....'�• „;;: :�� , ,•.:..<;... :�:.:::•�". �+ ^,�i , .. ' .... nCiti.: .Ci. , v..2ry �'+f¢�kv:`k}•:k:iii:. '��:,it�::;>:%�.., :s:.^,�r,.•`q�... ::\ �`•'C,'A'K;.J.. � �. . '� v�;• x t�{�:r'?''''";. ::>.:�>»:.:>;,.�::.;:;�. ..,.,>..v. � 97.02 �;:;:�..•:z:: ::.o;;.;.., ;N;.•;t>:;;;�;::•.;>;::>'�:•'•e::;.>.:;::' % :.:::'i'. . K:•::{.• ... .. yi'.::::.?;:{:.;.:�:•t M1�.,y...i.}• ..;;.}ti,r.....:: :;+.::j•s:;;.;;,:y..:•�•>. ��w:�,,+'£',.�x::.::y.•,•':::i':;:'`i:�:' .•r.:�,�::;:::OR:`.� ' .�:�i.,;:a4...: . ... ;:�:�::::::::r::;:�;;..;.::::::k ,�ti;.;;;:�.f'�:�:•:;;.;:;r?ti;>:;:;;:;:: .�y;n•.;hf Yg;.;i,;,.«,•..#:�•`•:k:•>ii�s:>':::.y:>:•: Yes :»>:::::>:;:<::�::::>:;<::�:::�<;;<:::�� ...':•>;::::.>;..::.:.::,>.:::::::;. < �;:. . O :{'�::'?:'k'`.Y```::"'h::�sY;.:>�:C��:\..`.A'..�,£t,.�..�'.;°:?iV;��;;s:�' . 7//� i:;,�.::);;r f�•',�.•,',F,t�%',.�.,.:.t.•:.;'.,•'..;»S, `/0 '''�:�i::�y:+:L'{9f4��T}•.,•.?��.\;:•ii•i.:n+ :;:{•i:i:: ��::?::�:;;t;k<,;.�.kgy' 'r?$*\•'^,::."•`.;+.;{;i.•^'•' . >�:;;:��`�2i>�� . �. :::�5>R.;.H+r73,.�`;::�::;�:�•°•'%" k::<.•+�k ::x„� ;::i4::.,-;:: ' Ail Clients Gertatrics Clinic N a �.7JG N m �G70 . �.� � . No No t::; � �'.; . 0 21.43/e -. . ..� . ._ ,; ., o E:: 53.92/o ;;: ;,. ; . . :.�..:._,..x;.. . :::::.�::::;:........... :.::.;:........ :�::...:. . ....:..... . .....�. .:.:.�::;::::::::.�::.. . : ::.;::::.::.::.::.;>::.::;:.;:.;>: ; �> .,. ,�. ...................�::. .�a::.�.�:..�.... :: . :<:<::>::::::>::;:::::::<;:::»:::::;::;: �; :� :..: _ .. I ;� >� �sk.<;��4 ; 1> ` � • . � • 4'�ri iYt�. •'n"v ;:'f�i'i . .'.'�O� �� '�: . � � . .i .:::��ii::;:::v::j"•:i:v:::},:jii:::>�i:ii •:. y . .. :. �� ,. J�2�'v 4:1�f• . :- . . :.; ::�� .. . :: ' ' •�<i�{�:ti•:i.Y ��' �:�. ..:. .. . : •.,•'• ;�. .y ;: .......::.....::.:...... � . • :::•:::::.�.:._:� `�x'•�•' ..�•.' �. I:: ::::::..:::::...:::.�:..:. ... . . . ;:}: , ............:.::::::.�:::::�>:;>:::<a�:?:»>::�>:x:.;... Y , , .. . .,.. :::<.;:..»:.:,::::::::::�::::::<:::::::::�::�::�: . . . :::...::...:..::... ... .... ..............::..: , .. .......... -::::::.. ............... ::::::::::::::::::::>::<:::. .:>;:>;:.;::::::......::.:>::.;;�::::::..... ....:_::::::::.::._::: es � �. .::::.:,:.:::::::::::..::.::.::::::<.:;.::.::.::>,>:<:>:::::>::»::»:�`:;:;:>:::::'�:;;;:��;; ,.f<.:a..:'.�: ; ,. ..::>;:;::::::>;::,:;:;>::.;::.: . . .,...:,.::..• .,:: :::::.:::.................»:r;:.........: ....... .. ` /'• � ;,:_: :::::.•. :::.::::::�: >�hz ry -...:. ,., : :: •i`.a' '�� :rr ...'..n.f, Y'9�.;:•:. :.:..:...::::.: . .....,, ........::::. O �� :�;�� t ..'$�,�.:.�..•• .....,.;ao-:>:� . . :�:�:i:J;.. � :::�::::::.:�. -.�';:�..;:.,.,.,,�._';i�.... . �r..a.Y:>: ...:......::.: �.>::<:o::.::..: 47 � :::>:»�::::��:>:<.::<;;:;.;:�:;>::::>:>:::>::::>:::::>;;::;<>::::>::;::::::::<<::>::»::<>:;::;;:;. .0 8/o _ .....:..... . <.:::>;:.::.;::;::. ............ ....... ....... ° �. � �<:::::<>:::::<�>:::<:::::<::<::::::::>�<:>::::<::::>:'>::>::>:::::::::::>?::::<?:;:<::<:>:?<::;;;>: �>:: ::: ::> Yes 7 8. 57 0 /o Fami�ly Planning Clintc TB Clinic N=34r'J Ns2.�8 Source: Client Syrvey � 4 � 203 �� .� y_ '`f�'�►' . Clinic Summary No. in Insurance Type Sampie Yes No Insur Co HVI� Govt Asst Ciinic 1B 238 78.6 21.4 16.0 21.4 61.0 STD 206 47.6 52.4 60.2 31.6 22.4 Immuni- 274 80.7 19.3 26.7 14.5 58.0 ti0n � D�ntal 29 27.6 72.4 50.0 25.0 25.0 ' Reliability of Da#a . Clinic Q1 C� C�3 Total with Insurance TB 99.9 96.7 91.2 77.3 STD 100 96.7 68.1 44.6 Immuni- 99.9 100 10.1 79.9 - zation . Derital 100 100 100 27.6 SOU�tC,'E: DPH CLIF�Pr SLIRVEY 1986 .CHAFZT 4 204 �'�- �.-�-��r�'�' � � ao- u . �E- � rq• �� SAIN�T PAUL POPUTATION PYRA.��6 �s - �s . 1980 - 1990 i0 ' � s� so- s� tS- y IG• M ' 7S,- ?9 70,- 3t I980 - 1985 ASSUI�TIONS �• � . �- ri. Birth Rate 18.84 live births �?- i� ;per 1000 people or !'� +25,303 births � � Dea_�te 10.5 cZeaths per . u: �os a a a a o a a a as sos us 1000 pecple or ""� � �ES � - +-14,006 deaths � Net M�c�ratian 95$ of 1975-1980 �t of -20,361 or �. -16,442 _ �, - ts , �- �� ts - � �o- � I985 $stimated papulation: 265,085 s - s9 so- s� IS- q ' �o u , � � 1985 -, 1990 ASSUI�TIONS is. r - :• Birth te 20.50 live births ls - 19 � r 1000 people or 1;- �� +Q6,677 births • � Death te 10.7 c�eaths per u: io: u �a a ts o � r. �s n ioz ir. 1 00 people ar � � � �� - ,819 deaths Net Mi ation 95$ of assun�ed ' 1 75-1980 aanunt of -19,343 _.. � o� -18,376 . � _ M �� - n �o - �. iS • i9 1990 Fsitineted Populatian: 257,720 s . sµs _ so s� �d h �o a � � � - u n r m . :. is . i� �o- �i d- r � sr_ u: u �: 4s 2z o a a r. u �o: iz: rwca i�so r�c� Scurce: , U.S. Census, 1980 and PID staff estimates ' Chart 5 � 205 �� ,��i . 1�Iinnesota FernaIe and Male L.aIior Force ParticipatiQn Rates I960-1990 � ParUcipatJon Rate . lOG � . _ � , . ------s� . gp . . ' 80 • * 70 ' � 60 = ' � SO � 40 ' 30 ' 20 ' O 1990 women ■ 1980 womai � 10 • 1970 wcmes� � 1990 mea , � + 1960 womw• * 2980 men ' � 0 1619 20-24 • 25-34 35-41 45-54 55-64 65� -' A9e swree otns.•r sat.D.iwy..M...w�.w...t,sut•n...1��A p.e� Qiart 6 II 206 I� ��-'��-1�%�-�' �� FAN�LY AND OdNIl�JNITY HEALTH Infant� mortality contiriues to be a problem, especially for Saint Paul's minority papulation. 'Ihe mortality rate among blacac infants has, for at least the lalst thirteen years, been declining at a slawer paoe than that among the ge.nera�l population - it has typically been higher than the overall rate of infant, mortality. The death rate among all infants born between 1970 ar�d 1983 ,.:. . ., ,� ,.._�•i�`:+� �er .i,•0t30�-�ive-�rirt��tal'liit!-t�eTate-�tm�olig-3��ndc��aes 26.1. _ _ . The fo�llvwiryg table provides Saint Paul resident live b�rth ar�d infarit death statistics by raoe. INF'FANT DFATKS BY RACE, 1970-1985 ' TdI'AL WHITE SLAQC IldDIAN* Orli�Et* YEAR , NO. RA'I'E* NO. RA'I'E* N0. RATE* N0. NO. 1970 107 17.9 100 18.3 6 15.8 1 0 1971 ' 109 21.1 95 20.4 10 27.7 2 2 1972 80 18.1 68 17.1 12 34.3 0 0 1973 , 68 17.3 58 16.4 9 28.8 0 1 1974 55 13.6 46 12.8 5 14.5 1 3 1975 62 16.0 48 13.9 11 36.2 2 1 1976 74 19.5 64 19.1 9 28.0 0 1 1977 44 10.9 37 10.4 5 15.1 1 1 1978 55 12.7 47 13.4 7 19.6 1 0 � 1979 42 9.7 29 7.7 10 28.1 2 1 1980 ' 53 11.0 41 10.4 7 19.5 0 5 1981 61 11.9 38 9.5 16 42.1 0 7 1982 54 10.8 38 9.8 10 24.9 1 5 1983 48 9.7 34 8.6 12 32.9 0 2 1984 53 10.5 42 10.6 6 14.3 1 4 1985 38 7.4 29 7.3 6 13.4 0 3 Source: City of Saint Paul Department of Canammity Services. Division of Public Health + Tata1 Infant Deaths per 1000 Live Birth.s * The rnunbers here are too laa to produoe a meaningful rate statistic ' HIGH RISK B�S The peYrent of all Saint Paul births characterized as high risk began to climb between 1980 and 1981 after stayirx� at 20-21 percent for most of the last decade. ' In 1982, one in four Saint Paul births involved one of the followitzg high risk oonditions: (1) mother's age less than 18 or wer 39; (2) pre-natal care beginnirig in third trimester or not at all, (3) birth weight less than 2500 gr�ns, (4) cc¢nplicating illness for the mother, (5) prolonged labor; and (6) birth injuries or vongenital anvmalies. i 207 , � ��`" �'7- ��'� The r�sk factor which changed the most between the mid 1970s ar�d 1981 was the freqtxency of prenatal care. �ile the pezroentage of births where there was littl� prenatal care dropped to a lcxa of 4-5 peroe.nt between 1977 at�d 1979, it climb�d to 7.8 percent in 1981. Conce�n abaut these rates can be seen in the Advisory Cca�omittees' ident�fication of priorities for Family Health A�ctivities. Of th�e faur ca�egories in faini'1y health, three have as �-heir highest priorities seivi� - . related to high risk child bearing. 'Ihis is consistent with the Stat�wide Goal #I�1 "'rb prr�vide optimal birth outcames for all M�ruiesota infants." �he Divisilon provides family planniryg services to lvw in�ene, high risk woanen. Zhe city, thiro�gh the Division, provides financial support to several ocs�muzity cliniqs which provide a broad rarige of services, inclwdirig pre-natal care, at laa aost to lvw incoQr►e wrnttien. Over the past decade, the pe.rcentage of all births that wpxe low w�eight births declinied in 12 of the city's 18 health planning areas. Six areas, hawever, experi�enc�ed an increase: Rice Street: Hayden Heic�ts; Thc�mas Dale; Mt. Airy: Drayton,'s Bluff; and Hazel Park. The hic�est incide.noe of laa w�ic�t births �ras in the da�mtc�m where lvw birth weight charac�texized or�e in ten birth.s in 1982-�lvwn fr�an one in five in 1972-75. I Il�FAAFr NR�RTALITY �ile there have been annual fluctuations, the infarit mortality rate in Saint Paul has bee.n declinirig for at least thirty years. Zhe 39 peroent drop bet�reen ' 1970 arhd 1980 was a].most three tim�e.s the rate of decline which characterized the pr�via�s tw�o decades. In 1984, the infant death rate in the city stood at 10.5 per 1,000 live births. In 1970, the rate was 17.9. � Il�Il`�JNIZATION STAZ[JS Over 9'� percent of Saint Paul school children have been inm�ninized against seven nlajor inm�unizable diseases. State legislation passed in 1980 requires that a]:1 children be fully iamtunized unless exe�npted. The Div,isions inmiunization program addresses the statewide goal V, ��Zb reduoe, to the extent possible, the incidence of preventable and controllable oo�mminicable disease in the State." 208 ��.�-' � !� � �_ _ HC�LESS Hoanel�ssness oontinues t,fl be a probl�m. This is particularly ap�arent in dawn taHm �aint Paul where three of four shelters providing health servioes are locat.�d. No firm data or actual nw�nbers of hcaneless are available, hawever it is of ooncern that 22� of those seen in the shelter clinics are under 18 ar�d that cyver 10� are under age 5. The follawing s�mmiarizes data frcan 280 health . . __. , _ � c��'`n��_ held in.fa�ur shelters. FiC�'�S CLII�IICS 1986 1985 Zbtal Clinic visits 2174 771 new Clients 1051 438 return visits 1123 333 ' Age (new clients only) 5 years 127 , 5-17 ye.ars 103 82 18-64 ye�.� 781 334 ' 65 years 25 15 , Pay sauroe (all visits) rio source of payment 1068 400 ' MA 889 133 . HI�'B� 35 0 , vouchexs 325 DK Mental Health Services ' (4 mo. of data on1Y) total visits 348 DK* ; new clients 78 DK* follaw-up visits 270' DK* *DK - Data not ]mvHm , Source: Saint Paul/Ramsey County Hca�neless Services. 209 � %' `��- �7 /�`�`�� CAUSE OF DEATH Alm�st one half of all deaths of Saint Paul residents in 1982 w�ere attributable to camdio-vascular disease, altho�ugh that percentage had cli.ro�q�ed by six percer�tage points sinc�e 1970. A slcxaly growirig share of all deaths, oa� the o�ther har�d, wpxe related to malignarit r�eaplasms (cancer)--the seoond leadiryg cause 'of death in the city. Rsspiratory diseases claimed 19 percent mr�re lives ...in 1982 than they did in 1970 and was the only disease category to see an increase against the backdrop of an 18 perce.nt decline in the ac�tual ntunber of � deaths in the city. The leaading causes of death varied by age group. Children under the age of five m�st often fell victim to vongenital conditions or those clevelaping shortly after birth. Accidents were the leadir�g cause of death for those between 5 and 44 while 15 percent of all deaths in this age group were attri.bl�table to canoer. Suicides also fiqured more proaminently in this age group than in ariy other-- claiming 13 percent of the deaths an►ong pezsons betweeri 5 and 44. Heart tlisease begins to take its greatest t;oll am�rig the poptalation aver 45 causir�g 40 percent of all deaths in that age group. Cancer, again, was the seoond� leading cause of death. Zhe perc�ntage of deaths related to c.ancex was twioe �s high among those between 45 and 64 than it was amor�g those aver 75. DEATHS OF SAIN'r PAUL RESIDEN'!'S, 1970-1984 � Total Year Deaths Rate 1970 3,328 10.7 1971 3,306 10.8 1972 3,457 11.5 ' 1973 3,260 11.1 1974 3,154 10.9 1975 2,899 10.2 1976 2,904 10.3 1977 2,787 10.0 ' 1978 2,935 10.6 1979 2,735 10.0 , 1980 2,871 10.6 1981 2,739 10.2 1982 2,719 10.2 ' 1983 2,762 10.3 1984 2,663 9.9 Source: City of Saint Paul Depar�ent of Ccn�rnxnity Servic�s, Division of Public Health I� 210 � %:;L �-7- j�� Whilelthe figures below do not identfy �IIV infection related deaths, by 1990 the l�ading cause of YPLL for Males 25-44 will be AID6 or FIIV related causes. It is'anticipated that this will surpass the ooanbined total for all ather diseases. ' ZEADING CAUSFS OF DEATH BY AGE GROUP, 1984 Under 5 Years Ntmibe.r $ 1. Perinatal Cor�ditions 21 37 2. Congenital Anc�nalies 12 21 3. I11-Defined Condition 7 12 4. Other 17 30 'ICyI'AL 57 100 5 - 24 Yeax's N�unber $ 1. A�:cidents 19 43 , 2. Malign�nt Neoplasms 8 18 3. S�icide 6 14 ' 4. Other 11 25 TOTAL 44 100 25-44 Years NLm�ber $ ' ' 1. Aocidents 21 22 2. Malignant Neoplasms 14 14 3. Heart Disease 14 14 4. Suicide 13 13 5. Other 36 37 TdI'AL 98 100 45-64 Years Ntunber $ 1. Heart Disease 157 36 2. Malignant Neoplasms 147 34 3. Accidents 16 4 4. Others 114 26 ' TOr!'AL 434 100 65+ Years Ntmiber $ 1. Heart Disease 877 41 2. Malignant Neoplasms 412 19 ' 3. Cerebrovascular Disease 204 10 4. Other 636 30 'POTAL 2,129 lOQ Souroes City of Saint Paul, Department of C.omm��nity Services, Division of Public Health. ' 211 �� ' -- �7- ��" �F � �v�oru�r� �Tx During 1985-1986, tw�o exivirornnetztal health needs assessm�zts were ccenpleted. The Sa�nt Paul City Council hired a oonsultant to produce the Saint Paul E�vironmental Study. Zhe Ramsey County CiiS advisory canunittee considered the findinc�s of that study in preparation of its exrvirormn�ztal health needs . , t :r.:�--r7FisP�crtwnt, The relevance of envirornnental health issues to both the City arxl the County was oorLsidered. Haaever, due to the inmtediate need for CI�S Advisozy Ck�unittee ii�put into tne cauncil-sponsorea saint Paul �virormnental study, tne issue review �and rankings are focused on the need for new or c�ontinued action on the part o� the City, rather than the County. These programs relate to Statewide Goal II, "To pravide health prot:ection to car�uminilties by ensuririg sanitary conditions of lioen.sed public establisrnments t�urough education, suzveillance and regulation. SOLID WASTE Among issues ranked by the six subcamnittee m�embers, Solid Waste was unanima,usly ranked as a high priority, shawing the least variability in rank position among these 16 issues. Solid waste was a topic of disc.�ussion at nearly evexy, if not all, of the subcoa�unittee meetings. The Minizesota Waste Management A,ct direcfis the Camty to assi mee leadeYShip in � solid waste management, b�t delineates a significant role for the City in waste management. Ongoitzg discussions indicate th,at there is considerable work to be done to' coordinate City and County finances and actions to comply with Waste Management Act mandates r�garding waste reduction� recYc1�J, P�S�J � disposal. Restrictions on tire disposal arid the acxeptability of lan�e quantities of yanl waste, Waste appliances, and tires at the Refuse-Derived-FLiel (RDF) facility may i�act the effectiveness of the City Housing Sanitation Program (Priority Area #5a in cleaning up large scale residential rruisances. � QUALITY There a�e approximately 200 private water wells in the City of Saint Paul which do not �eceive ariy regular monitoring. There a�e approximately 25 landfills in Saint Paul, of whirh only seven have wells monitored by the Minnesota Follution Control Agency and the Minnesota Depaztment of Health. These landfills have potential for contaminating grour�lwatex'• The Minrie.sota Departiment of Health (N�i) recently found small amounts of volatile� organic ahemicals in two of five non-canumuzity public water supply wells (s�eervirig more th�n 25 people) . 'IY�e an�wzts detected were not oonsidered by N�i to pose an imn�ecliate health concern. Nonetheless they indicate�d a potential for pollution, which is especially critical given the difficultty of monitoririg and clean up of grow�dwater. Graundwater Quality has been designated in the City Council sponsored Saint paul Envirormnental Study as the rnmibex two priority. The Study rec�x�ds regular monitoring of private wells arid landfill sites. ' 212 � �� r- :<<<�� FnUD SANITATION Food s�nitation is a maridated activity of the Saint Paul Division of Public Health (DPH) , which has been performing this activity for wer 100 years. Only a' fraction (1� - 10�) of food borne illness are reported. Food borne illnes�es can result in death, hospitalization, or, more co�tunonly, severe . ..intestinal distress of one or two day duration which may preclude the normal activi�ies of daily Yiving such as work and school. Food s�nitation was not considered by the Saint Paul F�virornnental Study. It is an issue that is rarely considered, except when it mak,es front page r�ws during a large autbreak. It is i�ortant to maintain an adequate level of sexvice in this maridated activity as DPH turns its attention to more subtle and possi.bxy more marginal hazards in the envirormtient. , AIl2 QUALITY Air Zbxics is the rnm�ber one priority of the Saint Paul IIYVirornnental Study, due largely to ooncerns about the inadequacy of state re.sources to address this issue. The City Council Study reca�ed lol�bying by the City to increase funding for state air toxics control efforts. Locally, there have been a significant rnm�ber of citizen oca�laints r+egardirig odor and potential health effects frcAn the Ford MAtor C�npany Assembly Plant. The PCA; has requested Ford to initiate an odor abatement study ar�d an update of ' a previausly cc�mpleted non-criteria pollutant emissions stwdy. The City Council is in the proce.ss of directing the Division of Public Health to assi�t in studying the health effects associated with the emissions. 'Ihis irYVOlve�nent will most likely irYVOlve an analysis by the DPH epidemiologist of va�laii�ants'diaries of e.xposures and effects. HOUSIl�TG SANI'rATION (Gtlapter 34 Legislative Code) This mandated activity enforces the Housirig Code, which establishes minumun star�ds which are essential to make dwellings safe, sanitaxy and fit for hwnan h�bitation. � , PRIORITY ARFrP, NU1�Eft 6 - II�II�1CY RESPONSE The tragedy in Bhapal, India has made officials and the ooamnunity aware of the possi.bility of seri�as chemical accidents and the need for local ocemmini.ties to have in place an effective program to deal with chemicals that can cause death or seriaus injury if an accidental release occurs. The recet�tly enacted U.S. nnergency Planning and C.ceimm�nity RightJlb-Knc�w Act of 1986, within the U.S. Superfund Amex�nts of 1985, requires each State to establish a State Canm�ission, emergency planning districts and local emer�gency planning ocatrtn.ittees to develop an�cl facilitate the it�lementation of emen�ency response'plans with participation of facilities who produce, use, or store extremely hazardous substances. Applicat�.on is beirx� made for City participation on the State Carmnission, with City par�icipation in local emPa�gency planning caRanissions to follaw. 'Ihe Saint Pa�l Departrnent of Fire and Safety Services, the lead emerger�y r�sponse agency, �as and maintains ar�d updates an emergencY Plan. The Saint Paul �i� /� �- /�'�`� T'� xAZ�DOUS � Hazan�ous wastes may contaminate drinkirig water suppplies, release toxic vapors to the air and create explosive d�anp sites. Significant advances can be made in preivention of grow�d�rater and air pollution utilizir�g available technology for icll�ntifying and abating haza�lous wastes. _ " " ,."The abat.�in�nt 'of �11 qu�a't�titi�"s b'f hazardous waste has been a�pr�itln fvr _ � the City Hausi.ng Code Inspec�tion staff. Zhe rruisance oniinance is expectsd to expedite the effective and proanpt handliizg of small quantities of hazanlous waste. In add,ition, the Saint Paul Deparbment of Fire ar�d Safety Services is malting available well trained and equipped hazardous materials teahnicians to respond to rec�ests froan the Housirig Code Inspection staff for the safe sampliryg of un�a�m waste materials. ANIl�i� OONTROL Rabies is deadly. Animal attacks can be disfiguring. Barking and free roamir�g dogs c�►n be a public nuisance. The Division of Public Health operates a longstanding, effective animal c�ontro� program. The oontinuing high n�unb�x of animal ooamplaints, inclwding a substantial rn�nbex of urban wildlife �laints regarding animals such as skunks and ra0000ns, reflects the priority of animal oontrol in the czemm�nity. . T F.AI� UOI�I'I'P��iA'I'IODT Concerns about lead contamination reflects simultaneously the scientific uncertainty of health effects frc�m ccmm�riplace and moderate to lvw-level exposure to lead and the grcxaing evidence and amount of research activity ir�clicating effects frcan lcxa and moderate-level exposures. Lead, a useful but toxic metal, is an integral part of the econoar�y. As a result, the erivi.rormeent is pervasively contaminated with lead. In response to the public's concern over possible chronic effects of erYViror�mental exposure to lead, State legislation was passed requiriryg the Minneso�a Pollution Control Agency (N�C'A) to sample soils for lead and to report �oil-lead concentrations in excess of 1,000 p�¢n to the Minnesota Departm�,nt of Health (N�i) . As a part of this study, N�1Ei is required to sa�le tthe blood-lead levels of children livirig in the areas with soil leads in excess of 1000 p�nn and to examine sites for all sources of lead where elevated blood-lead levels are found. To protect the health and welfare of susceptible populations, the N�C'A is further �chan�ed with the task of developing a soil lead staridard and of adoptirx� rules to establish priorities for response action. DPH has 'routinely ooriducted screenings for high blood-lead levels in its Suppleme�tal Food for Wo�[�en, Infants ar�d Children (WIC) Program and abated identifi�ble saurces of residential lead for children with high blood leads. DPH oontracted with N�CA and N�i to perform soil ar�d blood lead screenirig. DPH will also participate with N�C'A and NIDEi in applying for federal monies for removal bf lead contaminated soils. 214 C� � `� �,r-�7- �t�'.�' HO[JSEHOLD HA7,ARDOUS S�II�.STE Hazarc�aus wastes are not restricted to industrial or �rcial settir�gs. Minnesota's households generate wastes such as solvents, pesticides, oils, paint�, thinners, corrosives ar�d other material which are as hazardaus as highl�t regulated it�dustrial waste. At this tiune there are no means for Minne�ota citizens to prop�xly and safely dispose of most household hazardaus wastes. `As' a resul� they are'sent to._s�nita��1�'ills, po��d dvHm`t�e sewe.r , .". or onto the gra�uxl, or stored for long periods under generally unsafe conditions. The N�1C'A is conductirig a study of ways to best manage household haza�laus waste. N�C'A has designated household haza�rlous waste as one of five priority issues for 1987. They are approaching the legislature to establish a perntian�ent program inc.orporating the follawing three elements. l. Co�lection proj ects for at least scat�e types of waste; 2. A �ystem for answering citizen telphone inquiries about hau�sehold hazaniaus waste, �avoidance, storage, hoane treatinent and disposal; 3. Pul�lic information education efforts aimed at waste prevention, pro�pex product� use ar�d storage, and responsible disposal. NOISE POLIIJTION ' Noise pollution is more than a rruisance. The link between noise and specific disabilities or diseases has not yet bee.n clearly d�monstrated. Nonetheless, existiryg evidence indicates the danger is real for increased risk of hearing loss, sleep disruption, distress, educational disruption, work inefficiency arid aacider�ts. A City bn3inance is movirig through the legislative process to expand City Health �nd Police Department authority to control noise pollution. IAWN P�'.STICIDES A study! rega�lirig the most c�om�mionly used weedlciller, 2,4,D, conducted by the Natiorial Cancer Institute arid a private laboratory rhosen by a group of ch�mica�l manufacturers, shvws that Kansas farmers exposed to 2,4,D while usi.ng the chemical to fight weeds among crops were six times more likely to develap non Hod�kin's lymphc�na, a ttunor of the lymph system, than farmers who had not been ex�OSed to the chemical. The EPA is reviewing the new findings. Before turnirig to other alternatives, most of'the ch�mical arxl lawn care industries are waitirig for the EPA revic�a. The popullarity of 2,4,D stems from the fact that it is less to}cic than soane other w�edkillers, less expealsive and extxemely effective. CnemLawrr, the leading lawn care servioe, suspe,nded all use of 2,4,D. ChemLawn chose t.� make the susper�sion announc�xnent in Saint Paul in reoognition of the strong rtegul.ation of lawn pesticides adopted by the City Council. 215 , �� . -r_ /�-��:� SIJRFACE 4�,TER QUAL►ITY Untreated sewage fromn both ssewwer werflows and animal wastes threaten himian health because they carry potentially harmful bacteria and vinises. The City Water Utility and Ramsey County Public Works monitor surface�aater _quality�. While there is sarne evidence of degradation of surface�water ytza].ity, _ the ex�stincl Pr'oc�'ams for surface�aater quality protection are maintainirig the _ werall quality of surface-water in a good condition which does nat pose a problem for health. HAZARDOUS N�,'I�RIALS The reaeiztly enacted U.S. En�ezgency Plannirig and Cartmn�nity Right�!'o-Knaw Act of 198�, within the U.S. S�.iperfund Amenckrrents of 1985, requires awners/ operato�rs of facilities to pravide information on the manufacture, use, and storage of chemicals present at their facilities. This information is required to be pravided to the State Ccmm�ission, local ccmunittees, and local fire dep�nts ar�d must be made available to the general pa�blic. Haza�lous materials in transit pc�se a greater prablem for regulation. A reoent report by the U.S. Office of Teclznology Assessnent irxlicates that, at present, no one ]mvws for cextain the total quantities and ty�es of haza�lous matQxials that ar� being transported. The report further states that confusion exists wer how safe the transportation process is or ought to be. The report recarmnP.�nds better public ccarnminication and training of emergency-response ' personnel. A hazardous materials ordinance is one of a select rnnnber of ordinances beirig oonsidezced currently by the City Council. I.1�7iJRY OONI'ROL Injuries are the leadirig cause of death and disability in cniiaren ar� your� adults. They destroy the health, lives and livelihoods of millions of people, yet they receive scant attention c�pared with diseases and other hazards. Injuries have traditionally been rega�rled primarily as an unavoidable accident or a beh�avioral problem rather than a health problem. Three general strategies are available to prevent injuries: Persuade persons at risk of injury to alter their behavior for increased self- protection -- for example, to use seat belts or install smoke detectors. R�equire individual behavior change by achninistrative rule or law, such as the City vehicle seat belt rule arid the housing code onlinance pravision for smok,e detector5. Provide autoanatic protectian by product ar�d erivirorrmental design such as built-in sprinkler systems that autarnatically extinguish fires. i 216 � `'�� ,%- �� oc��x�c�r-�ro-xi�ow Conce�ns about Lawn Pesticides reflect a recognition of inadequate regulation ar�d cqntrol. In addition to the e�ency response and hazardous materials, reportirig measur,es mentioned previously, the recexitly enacted U.S. F�ne.rgency Plannir�g and Gartmwnity Right-To-Knvw Act of 1986, requires facilities to notify the state . . _ -��reapanse-�o��si�cros-�mcl sioca�-�er�cY°��e�e•-�.a�t� ,: regarding the accidental release of extremely hazardous ch�micals. Beginnling in 1988, routine emissions irrventories will be required of facilities that a¢�uzually manufacture, process, or use more than a threshold amaunt of certai.ri toxic chEmicals. EPA is required to ocanpile this information ar�d make it ava�ilable to the public through a�uterized data bases. . ' 217 �� _ � �� ' ,� SECTION 3 , PROGRAM DESCRIPTIONS, GOAIS, OBJECTIVES . 218 �� d �--�- � �� r ENVIROMIENTAL HEALTH . ! 219 ' ��1- ��' ENVIROI�IENTAL HEALTH - Activities intended to achieve an environment conductive to human health, comfort, safety, and well being: these activities include the coordination or provision of education, regulation, and consultation related to food protection, hazardous substances and prOduct safety, water supply sanitation, waste disposal , environmental pollution control , occupational health and safety, public health nuisance control, institutional sanitation, recreational s.anitation, and housing code enforcement for health and safety purposes. � RELATED RAMSEY COUNTY PROGRAMS -Hazardous waste -Solid waste -Community environmental sanitation ' RE�ATED DPH PROGRAMS -Food regulation -Environmental sanitation -Housing code enforcement -Animal control PROGRAMS THIS SECTION ACTZVITY: Food Regulation GOA�: The community will be protected f rom foodborne illness. TAR6ET AREA: Saint Paul ACTIVITY: Environmental Sanitation • GOAL' : Persons residing in community institutions will be at a mi nimcm ri sk of i 1 lness and i nj ury from t hese environments. The public will have access to non-community water supplies free from harmful contaminants. ' Residents of Saint Paul will have the necessary knowledge, skills, motivation, and opportunity to protect and improve ' the environmental health of the City of Saint Paul . TARGET AREA: Saint Paul ACTI'VITY: Housing Code Enforement GOAL: Housing in Saint Paul will not deteriorate below the minimum standards established in the Housing Code. TARG�T AREA: Saint Paul ACTINITY: Animal Control GOAL: Residents of Saint Paul will be at minumum risk of animal related attack, disease and nuisance. TARG�T AREA: Saint Paul I 220 I ,� ��- i��' FOOD REGULATION The Food Regulation Program addresses environmental priority three, food sanitatio�. The program performs facility plan review and on-site inspection on all new or remodeled food establishments before they are allowed to open. Once opened, ongoing inspections are conducted to insure compliance with all food and health ordinances. Complaints and suspected foodborne illnesses are immediately investigated and corrective action is taken if necessary. Educational materials are developed for use by the sanitari•ans in instruction of food handlers and managers on the safe handling of food. Food regulation also addresses injury control and hazardous materials priorities by inspection for correct practices of injury control and handling and storage of hazardous materials in food establishments. 221 C� � %-l y�� FOOD REGULATION On oin Pro ram Objectives On oin Pro ram Indicator o protect the health o t. Paul * ost per ood related residents arld visitors by ensuring inspection 68.91 the safety of food and beverages sold/ consumed in St. Paul food and beverage Illness outbreak investigation 40 establishments. Complaint investigation 260 Investigate and report 100% of all real . or suspected foodborne illness out- Food-beverage establishments breaks. investigations 900 Investigate '100% of all complaints re- Itinerant Food License reviews 300 garding real� or suspected food ordinance violations. Food-beverage establishment Investigate 100� of all applications inspections 1,800 for food and beverage establishment Food-beverage establishment licenses. ' inspection/frequency/year 2.00 Inspect 100%, of all food-beverage establishments at least twice a year *Total Food related inspection 5,000 or more frequently if warranted. (includes above mandated food- Abate 90% of all food code violations beverage inspections plus bakery, Reduce by 10% the number of serious grocery, butcher store inspection (grade 4 & 5) violations that could as well as all reinspections, contribute to foodborne illness, plan reviews & on-site short term Reduce by 10% the number of food estab- consults) lishments with serious violations or rating scores less than 90 at the most Violations found 10,000 recent inspection. Violations abated 9,000 � ' % Violations abated 90% ,1988-89 # of serious violations 641 # of estab.with serious To microfilm 50% of records in 1988. violations or scores of 90 170 Revise the food inspection management information system, to include a category sys�em for food establishments based on violation frequency & severity. Implement a aharge for restaurant re- views which would cover the cost of this consultaitive service by 1989. � 222 �� - � `�� ENVIRONMENTAL SANITATION This prpgram addresses the #2 priority of ground water quality through its routine �� inspection and monitoring of non-community public water supplies. Samples drawn from these supplies undergo bacteriologic and nitrate testing. lead contamination is addressed through soil lead sampling conducted in conjunc�ion with State studies. This program also conducts envirormental assessments of homes of chi ldren with elevated bl ood 1 ead 1 evels. Educatianal activities include presentations to City policy makers, management and the 'public on hazards and/or current control strategy developments associated with the priority areas of air quality, emergency response, lead contamination, hazardous materials, household hazardous wate, and community right-to-know. Surface 'water quality is addressed through routine swimming pool inspections, routine bacteriologic and chemical testing of pool water and educational ' seminars for pool operators. Injury control is addressed through routine inspections of schools for health and safety hazards. � i 223 � �7-- ,��-� � ' Environmental Sanitation Ongoing Program Objectives Ongoing Program Indicator To protect he health of t. Paul Cost/Contact residents arid visitors by ensuring (Total Activity Cost/*Insp.) 177.67 the safety of public swimming pools, noncommunit,y public water supplies, Oisease outbreak institutions, school buildings, and investigation 1 rooming houses in St. Paul through *Noncorr�nunity public water food inspection, enforcement and supply inspections 68 educational efforts. Investigate and report 100% of all Swirraning Pools real or suspected waterborne disease Complaints investigated 15 outbreaks. license application investig. 115 Investigate 100% of all complaints *Inspections 230 regarding real or suspected swimming Violations found 500 pool ordinance violations. % Violations abated 90% Investigate 100% of all applications Institutional Food for swimning pool licenses. Complaints investigated 15 Inspect 100� of the 34 noncommunity License Application investig. 225 public water supplies in St. Paul . *Inspections 450 Inspect 100� of all swirrrning pools at Violations found 2,100 least twice 'a year or more frequently � Violations abated 90% if warranted. School Buildings � Inspect 100� of all institutional food Complaints investigated 2 establishments at least twice a year License application investig 85 or more frequently if warranted. *Inspections 85 Inspect 100� of all school buildings Violations found 150 at least once a year to screen for X violations abated 90% health and safety hazards. Abate 90% of all water, pool , instit- utional food, school building, rooming house violations and hazards. *Total Inspections 833 1988-89 Objectives To implement annually, in a unified approach, City Council, Mayoral and CHS Advisory Committee recommendations for environr�ental education and protection. ', 224 ��-- �-�- i'��' ' HOUSING CODE ENFORCEMENT This program directly relates to environmental priority five, housing sanitation. This program inspects residential dwellings, and all properties on a complaint basis, to determine compliance with the Housing Codes. The program is authorized to order remedial action for code violations, which may include injury control, to enforce penalty provisions, to condemn buildings as unfit for human habitation, and take direct corrective action (sumnary abatement) in removing public health nuisances, which may involve solid waste, hazardous waste, and hazardous materials, all of which represent areas of environmental priority as defined by CHS Advisory Committee. This program also monitors compliance with the lawn pesticide posting requirements of the Saint Paul Lawn Pesticide Ordinance. lead Con�amination is addressed through home survey and lead abatement visits to homes of children identified as having lead poisoning. Educatior�al activities include development of educational materials and regular presenta�ions to City policy makers, management, corr�nunity organizations and the public on hazards and/or current control strategy developments associated with the priority areas of housing sanitation, solid waste, hazardous waste and lawn ' pesticid�s. 225 '� , �7- ��' � HOUSING INSPECTION 1988-89 Ongoing Pragram Objectives Ongoing Program Indicator Promised Investigate 100% of all complaints *Cost/Housing Complaint regarding i�nterior and exterior Inspection 23.97 violations pf the St. Paul Housing Code and issue order to correct the # of inspections/complaint 2.36 violation ih a timely manner. Housing Code Complaints 8,200 Investigate 100% of all complaints *complaint inspections 19,500 regarding r�ntal property suspected Violations 8,800 of not complying with State energy Violations corrected 7,920 conservation standards. % Uiolations corrected 90 90% of Housing Code violations Structures condemned 90 detected will be corrected. ' Violation tags issued 215 50% of energy conservation violations detected will be corrected. Court appearances 25 City Council appearances 156 Survey and �orrect lead hazards with- Lead Hazard Surveys 40 in 14 days, ,in homes of children detected wi�h high blood lead levels. Energy Conservation �° Complaints 140 To maintain the average number of Energy conservation inspections 200 ' inspections to less than 2.5 per Energy conservation violations 600 complaint fi''led. Energy conservation violations , corrected 400 X Violations corrected 67 *Total Housing costs/by Housing complaint inspections �I � 226 I ' � �� C��=- ��- ANIMAL/PEST CONTROL This program directly relates to environmental priority eight, animal control . The program enforces ordinance concerns such as rabies .vaccination, leashing, disease transmission and noise. The program impounds dogs running at large. Dangerous dog cases (attack and/or bites) are investigated, a hearing is conducted and a decision is made regarding appropriate disposition of dogs determined to be dangerous. The program also investigates complaints of nuisnace animals, traps these animals where appropriate and may examine them for rabies. Community wide sewer baiting, broken residential sewer line testing, trapping and extermination activities are also conducted. Educational programs on animal control and pet owner responsibilities are regularly conducted for the public. 227 � �U�- �7- ��, ANIMAL/PEST CONTROL � 1988-89 Ongoing Pro,gram Objectives Ongoing Program indicator Promised To respond �promptly to all citizen *Cost per major work units 18.61 animal complaints and facilitate reduction in pests/rodents and stray Animal Bites 530 animals with the City. *Animal complaints pests/pets 7,000 Barking dog complaints 700 To provide 24 hour emergency animal *Dog/cat quarantine calls 700 control services. *Cats impounded 900 To investigate 100% of all reported *Dogs impounded 2,000 bites by pest nuisance animals *Summonses issued 700 (raccoons,slkunks, bats, squirrels, rats, Dangerous dog hearings 40 muskrats,and woodchucks). Dogs disposed of 1,300 To investigate 100% of all public pro- Dogs redeemed 800 perty roden� complaints. Education pamphlets 5,500 To maintain ,the number of dog bites at Animal care talks & tours 15 the current level of 475 or less. Emergencies after hours 30 To loan anir�al traps to private *Warning tags 1,600 citizens for stray cats and nuisance Dog licenses issued-pound 1,430 animals. Animals examined for rabies 16 To abate 90� of pest and nuisance animal complaints. *8ite Investigations 10 To maintain an ongoing vehicle replace- Rabies examinations 10 ment cycle of one vehicle per year. *Nuisance animals trapped 300 . *Broken sewer line check 50 1988-89 Objectives *Catch basins baited/rebaited 3,000 *Traps set 400 To provide w�ekend coverage of 10 hours/ Traps loaned 350 days on Saturdays and Sundays in 1988 if one additional FTE is funded. Receipts collected by DPH 30,000 ' Receipts % of To conduct a rodent census in six Budget 11.2 selected area of the City using rodent activity in Catch basins as an indi- cator of area infestation. To increase the number of dogs licensed at the pound by 10%. � Comments h�r separation project has increased the demand on our rodent control activity. ' 228 FAMILY HEALTH - Activities intended to promote optimal health outcomes �rd� 7-�� related to human reproduction and child growth and development; t hese activities include the coordination or provision of education, counseling, screening, clinical services, school health services, nutrition services, f amily planning services as defined in section 145.925, and other inter- ventions directed at improving family health. �I RELATED RAMSEY COUNTY PROGRAMS: ', -Child health screening and assessment ', -Child abuse prevention ' -High risk parenting -Child health -Parent health -Comprehensive prenatal/postpartum/inf ant care -Southeast Asian services REIATED DPH PROGRAMS: -Dental health -Family planning -WIC -Chi ldhood 1 ead poisoni ng prevention program RELATED JOINT PROGRAMS: -Nutrition -Homeless -Day Care ' PROGRAMS THIS SECTION , ACTIVITY: Dental Health , GOAiL: To ensure, promote, and protect the oral health of the people in the City of Saint Paul . TARGET AREA: Saint Paul ACTIVITY: Family Planning GOAL: To provide comprehensive family planning services to residents of Saint Paul and Ramsey County. TARGET AREA: Ramsey County ACTIVITY: Supplement Food Program for Women, Infants and Children , (MIC) GOAjL: To provi de suppl emental foods and nutrit ion educat ion to ' eligible pregnant and breastfeeding women, ir�f ants, and ' children to ameliorate and/or prevent nutrition related health problems. TARGET AREA: Ramsey County ACTIVITY: Childhood Lead Poisoning Prevention GOAI: To eliminate all sources of lead-based paint which may contribute to undue lead absorption by small children residing in Saint Paul . To reduce childhood lead poisoning so that it is no longer a public health concern. TARGET AREA: Saint Paul ��n � �i,�� -i�� DENTAL HEALTH The Dental Health Program provides services which fit under both the Family Health an�d Health Promotion categories. Both areas are included in this section. The DPH Dental Program provides comprehensive and therapeutic services to low income ch;ildren 2 1/2 - 21 years of age who live in the City of Saint Paul. Eligibili�y is determined by income and size of family. Services are provided on a sliding fee scale according to financial ability to pay. Statistics show that one third pay 10% to 75% of the total charges. The remainder are on Medical A�sistance and are seen at the clinic because of the limited number of private pi�actice dentists that will take Medical Assistance. Dental se'rvices for the majority of the elderly and handicapped are provided by dentists in private practice. Others obtain services at community clinics on a sliding f�e basis according to eligibility. The DPH D�ntal Program provides dental education to children and their parents who receive services at the clinic. Education is provided to target groups such as refuge�s and group homes residents as staff and time permit. Movies, slides and printed material are used to convey the dental message and identify resources 'available for dental care. Dental as�essment, referral and education is provided on a limited basis to children in day care centers and their parents. Dental staff reductions in 1987 prohibit rtlore than a limited approach. No other agency provides similar . services. These services reflect the priorities of the RCCHS Advisory Committee for dental health acc'essability. II � �' I 231 ; C�--�7- i�� I� DENTAL HEALTH ' 1988 1989 On oin Pro ram Objectives Ongoing Pro�ram Indicators Estimated Promised o provide education, assessment, re- *Cost relative value unit —6 8 —�7p ferral & follow+up annually for 95% of preschoolers in attendance. To screen, assess and refer 92% of Preschool children assessed 500 500 refugees attending the Refugee and referred 50 50 Screening C1iniC. To provide information to community Refugees assessed 470 423 groups regarding the most effective Refugees referred 100% 100% methods of preventing oral disease. To provide preventive and thera- # preschool ed. programs 12 12 peutic services 'at least annually to children and certain adults who would not otherwise receive care. To maintain dental liaison with # in attendance 650 700 public and private health and welfare agencies''. Monitor the level of fluoride in Preventive encounters 1,150 1,170 the St. Paul water supply. Therapeutic encounters 1,_280 1,280 Total Visits 2,203 2,250 1988-89 Project Dbjective (by Priority) Completed patients 625 625 o provide a wor plan including mod- Relative Value Units 968 9,000 ification of program work schedules in Prophylaxis 953 970 prder to accomodate for staff re- Fluoride treatments 700 750 ductions and yet maintain both edu- X-Rays 1,575 1,590 cation and treatment aspects of Surfaces of sealants 620 650 program. Tooth surfaces filled 3,409 3,408 ' Root canal treatments 20 20 , Extractions 100 100 To develop a modified plan for # of homeless referred to dental 28 32 maintaining community agency contacts # keeping appointments 26 30 regarding availability of dental Total Visits 30 35 clinic resources ,at OPH Community agency contacts 60 65 232 C��7 c��' FAMILY PLANNING The activities of the Family Planning Program reflect the highest priority of the RCCHSAC for family planning service accessability for those without other resource�. The goaliof the Family Planning Program is to promotP and to improve the general public health of the community, especially that of women and infants, by assisting individuals in determining family size, spacing children, achieving desired pregnancy, and avoiding unwanted pregnancy. Within the Division of Public Health, the Family Planning Program contributes significantly to the Maternal Child Health component. It is one of the largest providers of inedical and education services, second only to the WIC Program. The Program provides reproductive health care with particular emphasis on voluntary contraception. Other services include pregnancy testing, counseling and referral, natural family planning (NFP), education, and infertility counseling. Services available to males include contraceptive supplies, NFP, vasectomy, education, and infertility counseling. Program data demonstrates that 86.5� of clients are at or below 150� of federal poverty levels; 8% are Title XIX recipients. Thirty percent of clients a�re under 20 years of age. I 233 /�i (�.� ,r- �7- � FAMILY PLANNING PROJECT ' 1988 1989 On oin Pro ra Objective On oin Pro ram Indicators Estimated Promised o provide acc ssible, confidential *Cost me ical encounter 6�0 �— family planning services to 6,900 users each calendar year. To provide a mi'nimum of one documented Medical/education users 6,900 6,900 reproductive h�alth education/counseling Medical users 3,500 3,500 session for 100% of staff and initial Medical Visits 8,000 8,000 and annual patients during each calendar Encounters 19,500 I9,500 year. Pregnancy tests 1,300 1,300 To provide 15 offsite community ed- Users at or below 150% poverty 85� 85� ucation/outreach programs each Users 19 years or under 30X 30% calendar year. To maximize pragram effectiveness by Program generated revenue 85,000 90,000 adhering to the Department of Health & Users 19 years or under 30� 30% Human Services' reporting requirements, Cost attributable to utilizing consu�ner input & generating administration 14% 14% program income throughout 1988 & 1989. Community Education programs 40 40 participants 3,000 3,000 Project Objecti,ves (by priority) Comments The above objec�tives are consistent h�amily Planning Project is primarily funded by with the prograpn, Title X Grant Title X, PHS. An additional grant is submitted bi- Application, as submitted to the annually to the MN Dept of Health. The • Department of Hlealth & Human Services. State funds are used solely for provision of female Objectives are �vritten for the project voluntary sterilization. The program has realized period. reduced Title X funds for the past 3 years. Despite In addition to voluntary contraceptive the reduced funds, the caseload continue to grow services & related medical procedures, significantly. There is concern regarding ability other program services include follow- to maintain quality in the face of shrinking up, pregnancy testing and counseling, dollars, decreased staff, and increased program referral , infertility counseling, demand. Emphasis placed on alternate funding sterilizations, community education, sources. morning after care, Natural Family Planning(NFP). Medical services are offered at three sites; Division of Public Health & the Health Education & Screening Cen�ters in White Bear Lake & Moun�sview. Special clinics are available for tieens & refugees. ', *Cost per encounter based on BCRR report. ' Comments ' h�e program will explore the feasibility of obtaining City and/or Community Health Services funds. 234 �.' . _1- �`�f9� � � SUP!PLEMENTAL FOOD PROGRAM FOR WOMEN INFANTS AND CHILDREN - WIC The WIC Program serves eligible persons throughout the county. The program reflects, the high priority the RCCHSAC places on addressing inadequate nutrition in mothers and infants. On oin ro ram Objectives & 1987 On oin Pro ram Indicators o provide nutrition education and food Cost per W c ient contact 6.52 6.52 vouchers to 7,500 WIC participants monthly. , Number of WIC client contacts 95,200 95,200 per year To screen, assess intervene with and/ Monthly WIC participation 7,500 7,500 or counsels 16,300 pregnant women infants and children to achieve the Clients screened, assessed, 16,950 16,950 following ou�comes after 6 months of intervened, counseled nutrition in�ervention: - 70% of anemic clients will have normal Nutrition outcome after 6 mo. hct, levels of intervention: - 30� of unde�rweight clients will -anemia to normal levels 70% 70� achieve ag� >5th percentile -underweight to quality assurance - 15% of short stature clients will standards 30% 30� achieve age, >5th percentile -short stature to >5%ile - 25� of overweight clients will length of stature/age 15% 15% achieve qua'lity assurance standard -overweight to the quality - less than 5% of infants born to women assurance standards 25� 25% enrolled in WIC at least 3 months -WIC infants breastfed 6 weeks will be low birth weight, or longer 25� 25% . -Low birth weights <5% WIC infants 5% 5% Food Cost 2,745,348 2,841,435 City Grant 538,816 538,816 TOTAL 3,284,164 3,3$0,251 I City Costs of Program 17.4� 17.4% 1 88-89 To increase tNe percentage of pregnant WIC participants to 13.5% annually. To investiage alternative service de- livery methods & negotiate with the State WIC offi'ce for permission to implement alte'rnate methods (if any are found to b�e better than current methods). ' 235 i / �,�- �7- ��'� � ' CHILOHOOD IEAD SCREENING The ChildYhood Lead Screening Program does follow-up on all abnormal blood tests preformed on WIC clients. An environmental component of the program inspects �he home environment for possible source of the lead. A PHN interview$ the parents and educates the family on how to avoid lead contamination. CHILDHOOD LEAD POISONING PREVENTION ' 1988 1989 �On oi�n Program Objectives Ongoing Program Indicators Estimated Promised o c tinue emythrocyte protoporphyrin *Cost per test 9.99 0 90 (EP) testing, evaluation monitoring and treatment to reduce problems of lead *Children Tested (EP) 6,000 6,000 toxicity in children in St. Paul Elevated EP tests 500 800 To better infprm the public of effects of lead toxicity' in children in St. Paul . *Blood Lead Tests 450 640 To identify lpad sources other than New cases identified BL>25 ug/dl 50 50 paint. 1988-9 Project Objectives (by Priority) Children retested EP 45-74 1,700 1,700 To test 4,880� children 9mos-5yrs of age Children referred for medical . with EP test. evaluation (ABC or PMD) EP>75 550 550 To do blood l�ad (BL) tests on 90% of Children with identified lead children with elevated EP 45-74 & toxicity followed at DPH for monitor at 3 mos. EBL >25ug/dl 50 50 To refer children with EP >75 and/or Children with reduced ZEP and/or HCT <30 for medical evaluation to rule BL in 6 mos by chart audit 70% 70% out lead toxi�city (ABC Clinic at SPDPH) Referred for environmental To identify 5b children with undue lead surveys 100% 100� absorption (Blood Lead >25ug/dl ). Community & Staff Education To monitor 90� of children with Programs 8 8 elevated blood lead (EBL) levels every Persons attending 210 210 3 months. 70% of childrien with identified EBL WIC performs EP on 100% of children in their program will have documented reduction in BL annually. in 6 months. � To refer 100% of dwelling units of newly identified lead cases for environmental' evalaution. To provide at least 8 community edu- cation & staf,f inservice programs. 236 ' / �� ;�-7-/�{;{'�' HEALTH PROMOTION . � � � ��, C�:�--`�7- ��' HEALTH PROMOTION - Activities intended to reduce the prevelance of risk cpnditions or behaviors of individuals or communities for the purposes of p►�eventing chroni c di sease and effecting other defi nabl e advances in heal th status; these activities include the coordination or provision of community organization, regulation, targeted screening and education, as well as informational and other scientifically supported interventions to foster health by affecting related conditions and behaviors. , RELATEO RAMSEY COUNTY PROGRAMS: ' -Adult health mini-clinics and occupational health -Mental health -Community health education and consultation -Community planning and system development RELATED DPH PROGRAMS: ', -Health services for the elderly: Mini-Clinics, Walking program -Community health education -Employee health -Firefighter Fitness -Dental health RELATED JOINT PROGRAMS: ' -Community Nutrition ' -Homeless PROGRAMS THIS SECTION ACTIVITY: Health Services for the Elderly G014!: To maintain and/or improve the level of wellness among the elderly population in order to enable them to continue to . live independently as long as possible. TARGET AREA: Saint Paul ACI�IVITY: Corr�nunity Health Education GOAL : To provide health education to the residents of Saint Paul that informs people about health, i l lness, di sabi 1 ity, and ways in which they can improve and protect their own health, i ncl udi ng more eff i ci ent use of the del i very system. TA�GET AREA: Saint Paul AC7IVITY: Employee Health GOAI: City of Saint Paul employees will be physically fit to ' perform their jobs. TARGET AREA: Employees of the City of Saint Paul ACTIVITY: FIRE FIGHTERS fITNESS GOP�L: Fire fighters will be fit to perform their jobs and will reduce their risk f actors for cardiovascular disease. TARGET AREA: City of Saint Paul Fire Fighters I 238 �� I` j ��k. I HEALTH SERVICES FOR THE ELDERLY The Health Services for the Elderly offers Health Promotion for Seniors through Free mini-�linics offered in Community Centers and high rises where anyone can consult wi$h health professionals, have their blood pressure evaluated, pulse and weight monitored and receive health education on a variety of topics. Assessment�, referrals and follow-ups are done as needed, sometimes during a home visit. This staff also gives flu shots each fall and administers a walking Program for Seniors. This program reflects the Advisory Committees priorities of developing personal responsibil,ity for one's health and of promoting wellness in the Elderly. 1988 1989 Ongoing Progr,am Objectives Ongoing Program Indicators Estimated Promised Operate 231 mini-clinic sessions in *Cost per visit 7.72 7.72 11 locations in St. Paul with 4,850 visits by 575' clients. Mini clinic sessions 135 132 To do health iassessments of 100% new Mini clinic visits 4,850 4,850 clients and periodic follow-up assess- Clients served 575 575 ments annuall�. Health Assessments (new) 154 150 ' Follow-up health assessments 1,930 1,930 To continue hypertension screening, *Visits for HTN monitoring 4,826 4,826 monitoring, clounseling follow-up & Counseled for HTN 1,930 1,930 , education. Referrals made 80 80 *Home visits by PHN 70 70 ' Screened & counseled in health education areas 575 575 1988-89 Objec�ives (by priority) Participating in walking To screen and monitor 1,930 persons program 55 55 for hypertens�on & refer 80 for Exhibiting increased endurance 75% 75% treatment. ' To continue tMe Walking Program, involving 55 people. ��o � /� ,(''� /�� .:� COMMUNITY HEATLH EDUCATION The Health 'Education program provides technical assistance to health division staff as w�ll as education and technical assistance to the community at large. This program reflects the Advisory Committee's priorities of developing personal responsibility for one's own health as well as the priority to reduce comnunicable diseases through education of at risk populations. 1988-89 On9�o—in Pro ram Objectives Ongoing Program Indicator Promised �prov�de hea th education support for Health education programs Division of P!ublic Health (DPH) Programs for the community 400 including: assigned priority programs Participants in Health requests from other programs Education programs 12,000 general public health promotion Total number persons served 19,575 To provide 404 health education programs for 12,000 cohmunity residents in areas that support DPH programs and public health. To provide technical assistance/expertise for: ' ' community agencies/residents & staff school teachers/administrators community agency planners student interns information �nd referral requests other City Departments 1988-89 Objectives To establish � cost per contact system for health education by end of first quarter 1988, , and maintain the system throughout th� years. Provide healtN education services to a minimum of 19,575 persons through the community, cl �nical and administrative sectors. To identify a 'policy and charges for non-St. Paul health education services provided by DPH health educators. ' Comments he ivision of Public Health reorganized its Health Education section in 1987 to emphasize the role of educational efforts in the promotion of public healtF initiatives. 240 , I �� -j- PREVENTIVE HEALTH SERVICES The Firefighters Wellness Program is a Health Promotion program done under contract 'with the Saint Paul Fire Department offering health screening, monitoring, evaluation, referral and education to maintain physical fitness among firefighters. This pro�ram of Employee Health and Firefighters Fitness are primarily designed to meet the RCCHSAC priority of developing personal responsibility for one's health. EMPLOYEE HEALTH/FIREFIGHTER FITNESS ' 1988-89 On oin Pro ram Objectives Ongoing Program Indicators Promised To provide sp cialized primary care Hours of service provided health physician services to identified by support staff in this residents/empl�oyees in St. Paul . activity City Staff 4,000 1988-89 Objectives Urban Corp Students 4,000 Physician 450 To provide publlic health learning experiences through Urban Corps for undergraduate/graduate students which contribute to public health services in St. Paul through 1988-89. � To provide Div�sion sponsored training Number of individual employees to 200 employees in 1988 & in 1989 attending Division sponsored training 200 To provide mantoux tests, hearing tests Employees tested 560 and firefighter fitness exams to 560 DPH employee mantoux tests 70 employees in 1988 & in 1989 Chest X-ray 4 Chemoprophylaxis for positive mantoux 0 To provide appropriate health record Audiometric (hearing) tests 60 documentation pf health status and Firefighters exams 430 improvement on a timely basis. Comments ThiTactivity will coordinate non-programmed needs, consolidate student and contractual services and serve as the fund for increased health services , based on changing volumes of services. 241 �'� �� _ �� DISEASE PREVENTION AND CONTROL 242 DISEASE PREVENTION AND CONTROL - Activities intended to prevent or ��?-/�/� control communicable diseases; these activities include the coordination or provision of disease surveillance, investigation, reporting, and related cou�nseling, education, screening, immunization, case management and related services. RELATED RAMSEY COUNTY PROGRAMS: � -Communicable disease control RELATED OPH PROGRAMS: -AIDS screening/Sexually transmitted disease control , -Epidemiology and communicable disease control - -Immunizations , -Tuberculosis control -Refugee health care -Occupational health and safety ' -Supervised rooming and boarding inspection program -Public health laboratory REl ATED JOINT PROGRAMS: ' -Homeless -Day Care PROGRAMS THIS SECTION ACTIVITY: AIDS Screening and Prevention/Sexually Transn�itted Disease ' Control GOAL': To reduce the incidence of all sexually transmitted diseases. , TARGET AREA: Saint Paul ACTIV'VITY: Epidemiology and Cormnunicable Disease Control GOAL: To reduce mor bi di ty and mort al i ty from communi cabl e di sease in Saint Paul . TARGET AREA: Saint Paul ACTI�IITY: Immunizations GOAL c To el i mi nate al l cases of vacci ne preventabl e di sease in Saint Paul and achieve and maintain a level of disease resistance. TARGET AREA: Saint Paul ACTIWITY: Tubrculosis Control GOAi_s To interrupt transmi ssion of tubercul osi s infection, prevent , tuberculosis infection from progressing to disease, and protect the non-infected person from becoming infected. TARG�T AREA: Saint Paul 243 DISEASE PREVENTION AND CONTROL - PROGRAMS THIS SECTION - Continued �'�7-/U,�. ACTIVITY: Refugee Health Care GOAL: To achieve a level of health in the newly arrived refugee which prevents the transmission of communicable diseases and facilitates the refugee's resettlement. TAR!GET AREA: Saint Paul ACT'IVITY: Occupational Health and Safety GOA�: City of Sai nt Paul gnpl oyees wi 11 have a worki ng envi ronment free from recognized hazards. TAR�ET AREA: Saint Paul ACT,IVITY: Supervised Rooming and Boarding Inspection Program GOAL: Persons residing in community institutions will have minimum risk of illness and injury from these environments. TARGET AREA: Saint Paul ACTTVITY: Isolated Adults Program GOAI.: To intervene in crisis situations for isolated and/or • ' vulnerable adults to prevent illness, injury or death. TARC�ET AREA: Saint Paul 244 C�.,f�_ ,�� AIDS/SEXUALLY TRANSMITTED DISEASE CONTROL DPH has a�ternate test sites which serve clients from Ramsey County and surrounding areas. Counseling is provided both pre and post testing. A physician is available for consultation, further testing, treatment referral , additional counseling. The STD W�lk-in Clinic provides diagnosis and treament of STD' s and contact follow-up of syphilis, 'gonorrhea and chlaymdia. Test of cure is done as indicated. Physician services are ava i l abl e if needed. AIDS SCRE�NING AND PREVENTION _ � 1988 1989 On oin Pno ram Ob 'ectives Ongoing Program Indicators Estimated Promised o provide, HIV screening & counseling Cost per visit 20.40 20.40 & referral service as an alternate test site through 8,800 clinic visits Total clinic visits 8,800 8,800 in 1988 anid 1989. Initial screening visits 3,750 3,750 Follow-up visits 4,200 4,200 Referral s made for pos i t ive test results 100� 100% To increasie awareness of the AIDS epi- Physici an vi sits 300 300 demic & prpventive measures through 100 Commun7ty Education Programs in Community Education both 1988 �nd 1989. presentations 100 100 Community Education ' participants 10,000 10,000 Community based test sites 2 2 • 1988-89 Prpjectives (by priority) Comments � To review annually City's AIDS policy This program is funded in part via a contract with f or City gnployees. the Minnesota Department of Health. To monitor prevalence of AIDS & AIDS related conditions in the community. To refer or provide medical services to 100% of persons who test positive for the AIDS virus. To provide training and support to develop oth�er Community test sites in Ramsey County. , 245 I � _.�� SEXUALLY TRANSMITTED DISEASE CONTROL 1988 1989 On oin Pro ram Objectives Ongoing Program Indicators Estimated Promisec To provi e 6,0 0 v� sits to persons *Cost per patient vi sit 2— 4.�� seeking 5exually Transmitted Disease Clinic service. *Total clinic visits 6,000 6,000 To treat 500 cases with positive diag- nosis of gonnorhea Total gonnorhea treated 500 500 To treat ,20 cases with positive di ag- nosis of syphilis Total syphilis treated 20 20 To treat 2,500 cases with positive diagnosed� of other STD' s. Total Chlamydia treated 500 500 To provide STD education to 10 com- munity groups. Other STD 2,300 23,00 To treat 500 cases of diagnosed chlamydia during 1987. Community Education ' presentations 109 10 1988-1989 Project Objectives (by Patient contributions 20,000 20,000 priority � To maintain patient contributions at Community Education Data may include AIDS Infor- a level of at least $22,000 year, mation with STD: patient contribut ions were for bot • To seek remuneration for chlamydia HIV and other STD. testing. � ; 246 I �� / ��. IMMUNIZATION PROGRAM Immunization has daily walk-in clinics. The program provides routine child and adult immunizati''ons, DPT, OPV, Td, MMR, with informed consent, as well as immunizations and informatian for foreign travel . (Cholera, typhoid, yellow fever, Immune serus globulin, Salk polio. Prescriptions for malaria, validation of Certificate for International Travel) . A referral system exists with SPRMC for meningitis vaccine. Validation is done of Health Certificat,es required in specific instances by foreign countries. Special vaccines are offered su'�ch as Hepatitis B Vaccine; Rabies vaccine; Hemophilis Influenza B vaccine and, Influenza !vaccine yearly for at risk groups. Follow-up is done of preschool children to complete immunization series. IMMUNIZATIQN 1988 1989 Ongoing Prpgram Objectives Ongoing Program Indicators Estimated Promised To provide�' immunizations against vac- *Cost per immunization 4.44 4.44 cine preventable diseases to St. Paul residents. ' Clinic visits 4,400 4,400 To provide immunization & health in- formation $or foreign travel. *Immun. given D PH 7,000 7,000 1988-1989 Project Objectives (by Doses vaccine dispensed to • priority) other providers 4,000 4,000 To provi e ,approximately 1,000 immuni- zations to St. Paul residents at the Traveler visits 1,000 1,000 Publ ic Heal��th Center. To dispense approximately 4,000 doses Immunizations given to of vaccine to neighborhood clinics. travelers 2,000 2,000 To provide immunizations & health counseling to 1,000 travelers to Influenza Immunizations 2,500 2,500 foreign countries. To provide irr�nunization against in- Imm. levels of St. Paul fluenza for 2,500 senior citizens & preschool enterers 98� 98� high risk individuals. ' Average imm, levels of , K-12 students-St. Paul 99� 99% *Cost per Immunization �cpenditures + t otal ' immuni2ations. 247 ,� /�t�'. �� - ' TUBERCULOSIS Maintaining informed, trained staff to receive reports, doctor-diagnose disease registry; do contact fol'low-up. The physician treats disease; a�ninisters ch�no-prophylaxis, provides education, information and consultation services. This progra�n works closely with the Refugee Screening Program. TUBERCULOSI6 CONTROL 1988 1989 Ongoing Program Objectives Ongoing Proqram Indicators Estimated Promised To maintain TB case finding & follow- *Cost per patient 56�5 5g,�5 up. To obtain r�ports of all cases of TB cases newly dx in tuberculosis occurring in St. Paul St. Paul 20 20 within 1 wee�k after they are detected. Cases on regi ster at end To have 95% �of active TB cases with of year 20 20 positive bac�teriology convert to neg- Cases with positive bacter- ative within 6 months. iology converted to negative 95% 95% To have 90% of cases complete pres- Cases completing Chemo. 90% gp% cribed cours�e of treatment & follow-up. Contacts identified 100 100 To conduct contact follow-up on al l Cl inic sessions PHP-U(��I 350 350 new cases wi�hin 2 weeks. *Patient vi sits (PHP-U(��I) 4,000 4,000 To have 75% pf new significant mantoux Refugee visits 40% 40% . reactors under age 35 complete 1 year County patient visits 150 150 prophylactic ' chemotherapy. Screened (mts tests) 1,650 1,600 To provide specific clinic services to Chest x-rays PHC-U(�I 1,000 1,000 county resid�nts under contract to T6. Significant mtx reactions 200 200 Patient starting chemo 150 150 1988-1989 Ob�ectives (by priority) Refugees 70% 70% Selected persons requesting HIV testing Completing prophylaxis 7p% 7p% are also being screened f or T6. PPD dispensed (doses) 1,800 1,800 To use interpreters to increase Consultation with MD 600 550 chemoprophylaxis compliance in Refugee 60% 50� refugee patiehts. *Home visits by PHN 150 150 *Program costs = activity 03216 costs + patients & home vi sits. 248 %��y��' � REFUGEE HEALTH CARE The clinic �does screening for TB, parasites, physical inspection with treatment of diseases and test of cure as indicated. Immunizations are given as indicated and follow-up is done as needed f�r 1 year with referrals as needed for speciality care, including WIC, dental and various cli�ics at SPRMC. The Refugee clinic provides screening for entire family and follow-up for 1 year. Ongoing well baby csre for 1 year for refugees. Referrals to MIC made to pregnant refugee women. Referrals ar,e made from Refugee Clinic to Ramsey County Nursing Services for every new family scre�ned f or follow-up, education, assistance and further referrals as needed. The Refugee 'Program has a primary function of communicable disease control. This population often arriv�s with numerous communicable disease problerr�s and the program reflects the high priority the RCCHSAC gives to this function. REFUGEE HEALTH CARE 1988 1989 Ongoing Prog�ram Objectives Ongoing Program Indicators Estimated Promised To locate 96� of refugees in St. Paul *Cost per patient vi sit �2 54.90 within 2 weeks of arrival . To provide screening for 75% of new New refugees 950 950 refugees loc�ted in St. Paul within % of refugees located 96% 96% 1 month. New refugees who left area 50 50 . To assure that screening is received *Refugees screened at DPH 350 300 from other providers for remaining 25% Screened elsewhere in St. Paul 100 100 within 1 mon�h. Primary care users 900 1,200 To submit encounter forms for 100% of *Primary care visits 1,300 1,800 refugees screened in St. Paul to State Refugees referred for Surveillance'System 1 month after special problems 150 150 screening. Encounter forms submitted To offer dir�ct primary care services to State Surveillance system 100% 100% for 100% of newly arrived refugees for Children referred to ABC Clinic 200 200 1 year after arrival . Chi ldren screened at DPH 75% 75% To evaluate Children with abnormal Referred to other providers 20 20 blood chemis�ry referred from WIC & *Visits to ABC Clinic 400 700 Lead Programs for lead poisoning. 1988-1989 Praject Objectives (by riorit To o tain int'erpreter services for refugee popul�ation to be used also by other program�s - eg. Lead & TB. To seek 1 ong ,term fundi ng sourc es for the provi sion of refugee health services. ' 249 �� ,� i�'�" � OCCUPATIONAL SAFETY AND HEALTH ' 1988 1989 On oin Pro ram Objectives On oin Pro ram Indicators Estimated Promised o con uct training courses for vari- W.C. cost per city emp oyee 556.92 556.92 ous groups 'of city employes in re- sponse to the requirement of the No. of city employees 3,250 3,250 "Employee Right To Know Laws" lst occurrence lost time injury . To investig�ate city owned worksites frequency ratea 4.6 4.6 for compliance with OSHA standards, lst occurrence lost time injury Clean Indoor Air Act requirements & severity rateb 39.0 39.0 Hazardous W�ste Generator require- Cost of Workers Comp� 1,810,000 1,900,000 ments. ' Field visits/work site To monitor worksites & employee ex- inspections 180 180 posed to high noise levels. Noise studies made 60 60 To conduct �annual audiograms for all Complaints investigated con- employees in job titles determined to cerning toxic-noxious agents 50 50 have high nbise exposure. Reported injuries 780 780 To reduce t�e incidence of injuries Lost time injuries inves- among city employees. tigated 80 80 To provide assistance to all Depart- Employees fitted for eye ments in establishing safety com- protection 310 310 mittees, conducting worksite in- Employees training in "Right spections & accident analysis. To Know Law" 450 450 ' Employees given audiometric 1988-1989 P�roject Objectives (by testing 200 200 priority • To decrease the prevalence of non- Comments compliance with State/Federal OSHA Fr� equency Rate = # of disabling injuries/200,000 standards by 2�. manhours of exposure To conduct industrial hygiene studies bSeverity Rate = # of days lost per 200,000/man- for noise problems, CO levels, ven- hours of exposure tilation prpblems & miscellaneous en- �Does not include special fund and WCRA premiums vironmental complaints. To collect, 'tabulate, analyze & in- vestigate reported accident & injury reports. To establish hearing conservation pro- grams for those employees exposed to noise levelg exceeding OSHA standards. To establish base-line audiograms for selected grdups of employees (200 em- ployees to ae tested). To develop & institute a system for em- ployees to request an investigation of worksite problem. 250 i C`�=� ��-'�'�. PREVENTIVE HEALTH SERVICES 1988 1989 On oin Prb ram Ob'ectives On oin Pro ram Indicators Estimated Promised upervise ! oomin Boar in upervise ooming oar ing o inspect 00 of licensed supervised Licensed SBR homes 35 35 Rooming & Boarding Homes (SRB) twice Residents 360 360 a year. Inspections 70 70 To abate 9�% of orders issued within Orders abated (%) in 3 months 95% 95% 3 months. ' Seminars offered 2 2 To provide consultation for all SRB Persons attending 36 40 home operators. Consultations with SRB home operators 45 45 Day Care Centers Day Care Centers o assure hat 00% of day care cen- Licensed day care centers 108 108 ters are l�censed. Children enrolled 5200 5,200 To inspect �100% of day care centers Inspections 210 210 twice a year (3-4 times for those Orders abated {%) in 6 months day care centers with infants in Educational seminars offered 3 3 diapers). Day care providers attending 45 45 To have 95� of orders abated within Consultation with day care 6 months. providers 130 130 To provide consultation for 100% of day care pr,oviders regarding special Corronents problems. ls�o see Joint City/County Programs • 1988-1989 Ph^oject Ob 'ectives (by priorit uperv�sed Roomin & Boardin o provide ;two educational seminars for Supervised Rooming & Boarding Home op- erators and staff. To computertize Rooming & Boarding Home inspection process. Da Care Centers To provide hree educational seminars for day care providers. To computerize day care center licen- ing & inspe�tion process. To work witb joint City/County public health day �are committee, metro day care nurse Consultants & Human Services Council on child care. � 251 ' ii ,/(�/%. ' ' '_'"i /� L�� l-- �- i-- ISOLATED ADULT HEALTH PROGRAM The Isol'ated Adult Program offers Emergency Care and Crisis Intervention to persons living in isolation, condemned housing and/or refusing needed medical care. It is a model program coordinating services of a Public Health Nurse, Adult Protect ion, Pol i ce, Fire, Housi ng Code, Animal Control and Sai nt Paul Ramsey Social S�rvices. PREVENTIVE HEALTH SERVICES 1988 1989 Ongoing Program Objectives Ongoing Program Indicators Estimated Promised Isolated `Adults Isolated Adults �o respor�d t�00� of requests for Timely responses to requests 100% 100� health assessment of isolated adults Persons served 100 100 within 24 hours, if necessary. Persons receiving assistance(%) 100% 100% To assess, the health status of 100 (hospitals, nursing homes, persons i�n potential crisis situ- Adult Protection, In-home ations. Program, Catholic Charities ' MD, Housing Code) 1988-89 �roject Objectives (by Isolated Adults Team Meetings 12 12 riority) Isolated Adults o etermine after 30 days that 100% Comments of isolat�ed adults were contacted/ Requests for health assessment of isolated adults received assistance form the referral came from H&HBCE, Adult Protection, Police, Para- service. ' medics, & individuals - i .e., landlords, neighbors, • To faci 1 i tate Isol ated Adul ts Cri si s rel at ives. A cri si s intervention team of profes- Interventpon Team meetings. sionals evaluate responses to crisis situation and facilitate timely care acceptable to the client and or compliance with guidelines of Minnesota Commit- ment Act. 252 i i �--�--�- j�',�� Program/�Goal Area Method Page ENVIRONM�NTAL HEALTH Food Reg�lation Investigation 222 Inspection 222 ' Abatement 222 Environm�ntal Sanitation Investigation 224 Inspection 224 Abatement 224 Housing Code Enforcement Investigation 226 ' Survey and Correction 226 Animal/Pest Control Investigation 228 ' Equipment Loan 228 Abatement 228 Rodent Census 228 FAMILY H�ALTH ✓ Dental Heal th ;�-�--� Assessment 232 Referral 232 Monitoring 232 Family P�anning Education 234 Medical Service 234 , Counseling 234 . WIC ' Screening 235 Assessment 235 Intervention 235 Counseling 235 � Childhood Lead Screening /� '�~ � Testing 236 Education 236 , Monitoring 236 Follow-up 236 ' Referral 236 HEALTH PRpMOTION � Health Services for the Elderly Assessment 239 Screening 239 Education 239 ' Follow-up �Community, Health Education Education Programs 240 Technical Assistance 240 Employee Niealth/Firefighters Fitness Testing 241 Training 241 ' Clinical Services 241 254 ; _ ��'.� � C,�- � I Program/G'oal Area Method Page DISEASE P�tEYENTION AND CONTROL �- AI DS Scre�eni ng '�y�-�-� �) Screen i ng 245 ° Counseling 245 ' Referral 245 , Community Education 245 Training 245 STD Control �-� \ Screening 246 ' ` Treatment 246 , Community Education 246 � Irranunizat�on Program -✓f��`�- �- ' Dispense Vaccine 247 Immunize 247 _ Tuberculo5is �'�-°Y° ' ' Case Finding & Follow-up 248 Treatment 248 Refugee z- � Screening 249 Referral 249 Occupatiorhal Safety and Health �=� Investigation 250 , Screening 250 Technical Assistance 250 Training and Education 250 Preventiv� Health Services: Supervised �,��° Insepction 251 Rooming/Boarding and Day Care Abatement 251 -- --- Consultation 251 Education and Training 251 � Isolated Adults Assessment 252 Follow-up 252 � 255 _________�______________________ AGENDA ITEMS - ------------------------ ID�: [295 ] DATE REC: [09/29/87] AGENDA DATE: [00/00/00] ITEM �: [ ] SUBJECT: [�OMMUNITY HEALTH SERVICES PLAN - BIENNIAL REPORT TO STATE ] STAFF ASSIGNED: [ �� __S �� 0 7 SIG:[ ] OUT-[ ) TO CLERK [00/00/00� ORIGINATORt[COMMUNITY SERVICES ] CONTACT:[JUDY BARR (292-7712) ] ACTION:[ ] C 7 C.F.� [ ] ORD.� [ ] FILE COMPLETE="X" [ ] � s � +� � � � � a � � ■ � FILE INFO: ',[RESOLUTION/REPORT FOR 1988-89 ] [ 7 [ ] _____________________________________________________�R� '_____-_______ 4eT 5 1981 JAA4 S S�IH�AN 1eEL � �. 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