NACCHO Board of Directors Meeting - DOC by malj


									                            NACCHO Board of Directors Meeting
                                Wednesday July 29, 2009
                                    Orlando, FL
                                   Meeting Minutes

Present:      Terrance Allan                          Rene R. LeBlanc
              John R. Baird                           Yvonne S. Madlock
              Kim E. Barnhill                         Carol M. Moehrle
              Epi Bodhi                               Poki Stewart Namkung
              Terry Brandenburg                       Herminia Palacio
              Lou K. Brewer                           Lillian M. Shirley
              Gary Cox                                William J. Smith
              Bruce D. Dart                           Covia L. Stanley (Conference Call)
              Martin Fenstersheib                     Matthew A. Stefanak
              John A. Horensky                        Ulder J. Tillman (Conference Call)
              Steve Huleatt                           Adewale Troutman
              Anthony Iton                            Pierre N. Vigilance
              Larry D. Jones                          Richard L. Vogt
              Paul Kuehnert                           John Wiesman

Absent:       Paul Beddoe                             Andrew Dennis McBride (excused)
              Vonna J. Henry                          Crystal D. Swann (excused)
              Franklin “Pete” Jackson                 Wilma Wooten


Call to Order
Bruce Dart called the meeting to order at 1:05 p.m.

Gary announced that the 2009 Profile of Local Health Departments is hot off the presses and is
available for review, and encouraged everyone to read it.

A quorum was established.

Nancy Mills made a welcome and introduction to the state of Florida.

Board Leadership Transition
Gary Cox led the discussion to acknowledge the out-going board members and welcome the new
board members. Bobby and Gary presented the outgoing board members with tokens of our

Outgoing board members include:
Past President - Poki Namkung
Epi Bodhi
Tony Iton
Terry Brandenburg
Vonna Henry
Matt Stefanak
Ulder Tillman
Leon Vinci

Seating of new board members
Lillian Shirley was welcomed as incoming vice president
New board members include
Terry Allan
John Baird
Kim Barnhill
Lou Brewer
Steve Huleatt
Rene LeBlanc
Yvonne Madlock
Bill Smith
Adewale Troutman
Wilma Wooten

Gary passed the gavel to Bruce as 2009-2010 NACCHO president.
Bobby presented Gary with a token of the staff and boards appreciation.

Bruce made a statement of appreciation and Bobby presented Bruce with the Traditional
NACCHO President Tote Bag.

Approval of Minutes
Bruce asked if any of the items on the consent agenda should be removed from the consent
agenda for later discussion.
Lillian Shirley asked to have Medical Home and Asthma Policy removed for discussion
John Wiesman asked to have Student Health Policy removed for discussion
Herminia Palacio asked to that have International Trade Policy Statement removed for

Larry Jones moved to have the remainder of the consent agenda passed
Terry Brandenburg seconded
Motion passed unanimously


Policy and Process to Elect Three Members of NACCHO Board to the Executive
Dart indicated that the Structure and Governance Committee determined a new policy to select
the three members of the Executive Committee to take the place of the forum chairs.
Carol moved the policy
John Wiesman seconded
Dart indicated that the policy specifically lays out the process for adding three new members to
the executive committee
The motion was approved unanimously.

Election of Officers to Executive Committee
Dart indicated that the policy indicates nominations are being taken from the floor.

Herminia asked to get a list of who is already on the Executive Committee already. Bruce and
Bobby shared that the current members of the Executive Committee are:
Gary Cox
Carol Moehrle
Bruce Dart
Lillian Shirley
Dart specified that nominations were needed for communities of under 100,000 or over 1 million
Kim Barnhill nominated Martin Fenstersheib for >1 million
Terry Brandenburg nominated Herminia Palacio for >1 million
Herminia Palacio nominated Steve Huleatt for <100,000
Marty Fenstersheib nominated Kim Barnhill for <100,000
John Wiesman nominated Yvonne Madlock for >1 million
Members of the board asked the staff to develop a ballot that indicated the part of the country
and the race and ethnicity that the nominees represent as well as the parts of the county
represented by the current members of the Executive Committee

John Wiesman stated that it is critical that the Executive Committee represents as much diversity
as possible.
As there were no more nominations, Bruce Dart close the nominations.

FY 2010 NACCHO Operating Budget
Carol Moehrle presented the 2010 budget. She indicated that the 2010 budget shows a net loss
for the year. The net loss was generated by $250,000 that the Executive Committee approved to
purchase a professional lobbying firm to assist us with the work on health reform. The cost for
this external firm has put NACCHO slightly over budget.

Other than the additional cost of the lobbying, the total that is calculated is on page 66 of the
packet. Before the total funds being spent on lobbying, there is $181,000 in net income. Once
NACCHO calculated the net income, then subtracted the cost for the lobbying, there was a slight
deficit. Otherwise we are projecting minor overall growth because of the current economic

Motion was made to approve the budget Carol Moehrle and Martin Fenstersheib seconded.
Richard Vogt asked how we were determining to make up the deficit? John Mericsko indicated
that we will take it out of the bottom line fund balance. The intent is not to leave it as a negative

Kim Barnhill asked about the status of the $250,000 for lobbying services. Bobby stated that the
funding has not been completely expended. He indicated that NACCHO is determining how
much of that total will need to be spent to do the work that NACCHO wants to do. The
$250,000 was only an initial estimate.

Steve Huleatt, referring to the document and asked how NACCHO intends to make up the
difference when the costs for services for members are 1.5 million more than the membership

John Mericsko indicated that on page A6 of the budget there is a great deal of detail including a
list of costs. The unrestricted activities are those that are provided for the Association itself and
the revenue that offsets those costs. We have support from any number of other activities not the
least of which are the two major national meetings each year.

John Wiesman asked for information about the scope of work for the lobbyist.
Bobby responded by indicating that the scope of work is to support the NACCHO legislative
agenda with specific attention to the health reform debate going on in DC.
John Wiesman asked if the oversight of the lobbying firm is happening at the Executive
Committee level? Bobby responded by stating that one of the things that we want to do at this
meeting is try to get more input about what the lobbyist should be working on.
John Wiesman asked about the pace of spending for the CDC bundle. He indicated that the CDC
bundle according to the documents is expected to be approximate 20% more than last year, and
he wanted to assure that the money was being spent appropriately.
John Mericsko explained that he agreed and that we received authorization from CDC to spend
the money late. NACCHO has already submitted estimated carry over requests to CDC and are
waiting to receive indication of next steps.
The budget was approved unanimously.

Strategic Map Approval
The Strategic Map was on the Mission and Vision and Core Values and was reviewed by a small
sub-group of the board that was led by Tony Iton
Tony Iton presented the work that the group had done. He stated that the group tried to ensure
that we came to consensus on the vision mission and values statement.
Kim Barnhill made a motion to approve the Mission, Vision and Values and was seconded by
Herminia Palacio.

Steve Huleatt stated that in his perception, the Vision, Mission and Core Values have moved
away from our branding label from the three P’s Prevention, Promotion and Protection.
Tony Iton stated that he did not recall that the three P’s were part of the discussion at all during
their small group discussions. The small group got guidance from the consultant at the
Leadership Conference and followed that guidance and reviewed statements from other
organizations like NACCHO that seemed appropriate to develop the framework of our mission
vision and values.
Bruce Dart indicated that the work of this small group came together and though it might not
state the works directly, our Vision, Mission and Values emphasizes prevention, promotion and
protection, and in his mind focuses on the core work of NACCHO and not so much on the work
of local health departments

Herminia Palacio: Thanked Tony for chairing the committee and appreciated the work that they

John Horensky asked for some clarification on the difference between lengthening of life and
improving the quality of life.
Tony Iton stated that the term length of life was determined to be a metric for determining health
within a particular community and focuses on the conditions that allow people to lead long and
healthy life. Tony stated that he would encourage everyone to read the context of quality of life
issues into the context of the words that have been crafted.

John Horensky indicated that if there is not context, you might get the wrong impression if you
focus only on the lengthening life. Perhaps there should be more of a connection.
Larry Jones added that now that we are in the generation of time that children are expected to
have shorter life expectancies than their parents. We have a responsibility to deal with things
that are greater than just quality of life. We are in a very difficult situation right now and we are
seeing longer term issues in our cities today. Larry stated that he would like to keep the statement
the way that it is.

Yvonne Madlock offered a wordsmithing option: To combat disease and to improve the quality
and length of all lives. This statement is crisper and gets to improving quality and length of all
Tony Iton was more than happy to accept Yvonne’s change as a friendly amendment.
John Wiesman added that he was very supporting of the work that was done and was wondering
if the group is willing to take out the words in “strategic collaborative efforts.” In addition, he
recommended that when this document gets officially printed, the values should be listed in
bullet format so that you can quickly see what the values are.
Tony Iton responded by saying that the workgroup felt that there must be a way to distinguish
NACCHO from the work of the Local Health Departments in the field.
Adewale Troutman made a recommendation that if we include the wording assuring conditions
in which people can be healthy. That would make it clear that we were focusing on social
determinants of health along with everything else that we do.
Bruce Dart indicated that Tony was very committed to insuring that those issues were highly
prioritized in the discussion.
Tony Iton responded by stating that the group tried to capture the essence of everything that was
being discussed and whenever you work that is an exercise some compromise of the phraseology
may have been sacrificed to achieve consensus.
Adewale: The essence of this is really that we create the opportunity for people to be healthy.
Poki Namkung weighed in by making a final recommendation A leader, partner, catalyst and
voice and assuring community conditions that promote equity in health that improve quality and
lengthen all lives.
A leader partner catalyst and voice for LPHDs to assure the conditions which promote health and
equity combat disease and to improve the quality and length of all lives.

This recommendation was approved by Tony Iton.

John Wiesman indicated that one of the critical things to discuss is to assure that we are not
focused just on lengthening all lives but that we are addressing the gaps between life expectancy
in one group versus another.

Adewale Troutman wrapped up the conversation by stating that what ever we finalize needs to
be something that 10 years from now it is still meaningful for the organization.
Motion was approved unanimously.

International Membership to NACCHO
John Baird presented the International Policy by explaining that in 2007 NACCHO approved 13
LHDs in Israel to become members of NACCHO. In response to the inclusion of these
international entities the International Public Health Workgroup was formed. The IPHW thought
that a statement of policy should be developed to address international membership in
NACCHO. We wanted to have a policy on the books to support international membership.
Motion to approve policy
Lillian Shirley made a motion to approve the policy
John Horensky seconded the motion.

Larry Jones asked if there have been additional inquiries for international membership from
other countries or if Israel the only country that has membership with us?
John Baird answered by stating that the IPHW is starting to work with other countries and gauge
interest and determine what those other countries might be interested in. Because of this work
the Workgroup wanted to have a policy on the books.
Nancy Mills added that there is one Canadian member.
Martin Fenstersheib asked for clarification on the role of the Affiliate members.
Nancy Mills explained that an Affiliate Member can be anyone who is interested in the work of
NACCHO. They cannot serve on a committee or vote, but can be assigned as a subject matter
expert to any workgroup or committee.
Adewale Troutman was very excited to see the International Public Health Workgroup working
on this policy because the greatest interactions have always been the engagement between local
and local. This involvement with other countries is an important step for us especially because
there is a tremendous need around the world. The fact that this is an open door policy is a great
step. The majority of the work that has been done on the social determinants of health has come
from the global community to us.
Terry Brandenburg asked if the workgroup is considering doing kind of active recruitment of
international affiliates
John Baird responded by indicating that the workgroup has been discussing an approach to
interacting with the global community.
Nancy Mills added that one of the concerns of the membership committee is making sure that we
do not lose our focus as a domestic organization but that we want to have a mechanism for
exchange of ideas. The membership committee wants to support these efforts, but wants to
ensure that the work is mutually beneficial for the international organizations and for NACCHO.
Adewale Troutman shared that we have to be conscientious that the globe is shrinking and many
issues that we care about have a global scope. There are a lot of national organizations that are
more clinically oriented (AMA) and what is currently missing is that there is not much of a
public health connection going on at a global level so that concept is an important one for
NACCHO to consider
Motion was passed unanimously.

Membership Committee Report
Nancy Mills presented on membership committee. She shared that we are holding on
membership and she thinks that some declines will occur in the next few months due to the
economy. Beyond the committee report Nancy reported about what the membership committee
has done to work on several initiatives to increase membership and member commitment.

McKinley report compared data to the decision to join NACCHO and the data that was collected
and have made a recommendation to engage in a membership plan. We have decided that we do
need a way to approach membership that is data driven. The data shows that very active
members are very satisfied with the organization. This transcends other important things. It
leads to loyalty, renewal of membership, etc.

Lowest rung of the ladder is our lowest engagement members. On the very top of the ladder are
the most loyal members.

Project proposes to develop an engagement ladder to increase knowledge of our members and
enhance member value, including peer-to-peer learning and collaborative.
The report on the membership plan was included in the packet

Data has never been reviewed and looked at before in this way – the plan is to have the data
analyzed by September and strategies will be based on the data and then decide who to target and
how to target their engagement.

We can utilize this data in a Quality Improvement process and evaluate the strategies to ensure
that the foundation that we create can focus on engaging members and providing them with the
services that they want and need

Lillian Shirley asked several key questions including the timeline for this process and what data
we will be mining from this process. In addition she asked which staff is responsible for this

Richard Vogt asked if through this process if NACCHO has asked our members about what they
would like to see. He thinks that perhaps it is difficult to negotiate NACCHO as an organization
and perhaps there is a way to tailor the organization better to the members needs.

Bobby responded by indicating that we are responsible as an organization for doing a better job
in determining what members need and want. And we have to continue to improve our ability to
collect that information. We have much more information about our members and what might be
useful for them than we currently use. We should put processes in place to make sure that we are
effectively using that data. Part of the restructuring of the organization is to create and utilize
that knowledge and to figure out what is useful and then use the data we have most effectively.
Nancy Mills stated that one of the objectives is enhancing the peer to one of the tactics is to
conduct research and learn if the members expectations are different than what we think they are.
Shelley Sanner from McKinley presented the findings. She indicated that there are a lot of
different approaches to learn about members. Perhaps we can do this by mining data and being
more proactive
Herminia Palacio added that however this membership process unfolds that we work to
remember what we are recruiting for and remember to compare that recruitment with our
mission. What ever we do, we need to ensure that membership fits well into the overall mission
of our organization.

Larry Jones mentioned that membership in their state has been much easier because of the
SACCHO. Communication continues to be the primary way that people negotiate the system.
In Missouri having a SACCHO has helped with communication and membership in NACCHO
has increased because of improved communication.

Discussion of Dashboard Metrics for Strategic Map
Bobby indicated that he has been working on a dashboard that might look at the NACCHO work
over time related to the strategic map. Bobby has created this draft and would be most interested
in peoples thoughts about what kinds of metrics the board would like to see.
Terry Allan suggested that we consider using the Regional/Roadshows as a potential
consideration for metrics.
Lillian Shirley added that many people are struggling with meaningful measurement. If we look
at providing effective national advocacy. Those are measures of activity and if we could think
more from this perspective what are the outcomes or the legislative agendas. The work that we
did in March really helps us to begin to think about measures, but there need to be more
outcomes listed on the dashboard.
Adewale Troutman asked about how we measure some of the functions of the work that
NACCHO does that are not easy to report on the dashboard.
Bobby answered by explaining that we have not exactly figured that out yet and we are
considering a variety of ways to measure the NACCHO functions. Part of what we report
depends on what the board wants to see if the board wants to see process or if the board wants to
see outcomes. It is very much a work in progress. To produce reports about the broad range of
projects is a large and overwhelming task. Every member both staff and board want to have their
work represented, but the critical issue is figuring out what information is most important to be
presented to the board and then refine it over time. How good it is the first time is going to
depend on how much input we get from the board

Tony Iton asked how the Strategic Direction Teams and the dashboard of progress be related to
each other?
Bobby responded by indicating that this is something that the staff is looking at and this is
something that is going to have be addressed and restructured over time and possibly restructured
as a result of the strategic plan.
Rene LeBlanc said that he was very supportive of the dashboard concept and that it potentially
gives people a quick feel about what NACCHO is doing at the moment. He suggested that
NACCHO could ask the advisory committees to put their information into a similar dashboard.
He indicated that we are only as strong as our membership and we start going off on a tangent,
the dashboard could give us immediate feedback. He then suggested that we could potentially
give colors to items on the dashboard and the board could consider moving resources into
focusing on the areas that need to be addressed.

Bruce Dart mentioned that we know that the dashboard will be a fluid document until we get it
right over time,
Martin Fenstersheib added that the challenge with any large organization is that there are so
many ongoing activities that it is hard to have a snapshot about what is going on at any one time.
He asked if we have some specific priority areas that we can report on to see if we are headed in
the right direction

Bobby: The answer is yes, but we are trying to figure out what we are going to measure
Health Reform. We are trying to figure out if what we have been working on is successful or not
and reporting on it to a level that is satisfactory to the board and to other organizations. This
would be valuable to the board, but also to funders, and others who are interested in our work.
Assuming that the general nature of reporting is acceptable to the board and now we have to
figure out how to make it useful.

Health Reform Discussion

Donna gave a report on health reform. She explained that one problem with reporting on health
reform and having a discussion is that the story changes on a daily basis. The House democrats
have reached an agreement between the blue dogs and that bill is going back to mark up later

Memo in the board book lays out strategic issues that are critical in the discussion. All of the
different bills have one thing in common. They all have public health and wellness trust specific
line item included. Population based prevention and public health need a stable funding stream.
Donna explained that the congress in this phase did the best that they could within the limitations
of what they had to work with. There is much outcry about the expense associate with the health
reform bills generally. The prevention and public health piece are not necessarily huge amounts
of money. As costs get cut and costs get pared down so they can pass the public health portions
could be at risk. Only one member of blue dog democrats wanted to get rid of the prevention
and wellness trust but that has been countered by others. There is no big movement to cut this
out we have to remain vigilant.

If this does get cut out how do we feel about the new programs that have been developed in the
bill? It is therefore a larger policy decision that we potentially have to face.

Donna also pointed out the elements of what NACCHO is focusing on in the lobbying efforts
around health reform
   1) The core public health infrastructure program
   2) Community Preventive Services and community transformation
   3) Public Health workforce development

Are they the right things to be focusing on? We want to make sure that we are reflecting the
sense of the board

Bruce Dart asked if the board felt like we were going in the right direction.
Terry Allan asked if it is possible that the trust would still be there without any funding to
support it.
Poki Namkung responded by saying that if this becomes an unfunded mandate it would impact
critical programs.
Donna Brown explained that there are many programs on the books now that have been
authorized without appropriations. Some would say that you are better arguing for
appropriations if you have the policy on the books. However, in the short term you have created
Poki Namkung indicated that she would support the very careful framing of that policy but be
very clear that especially with H1N1 currently going on, there is no money to do other critical
public health concerns

John Wiesman indicated that he agrees with the direction that NACCHO is taking
Larry Jones added that the only caveat for his is that we have to understand that there are times
that perhaps we might have to throw NACCHO support to some other issues that we may not
otherwise support to ensure that we get people and organizations behind the bill.

Oral Reports
Annual Conference Workgroup
John Wiesman reported on the status of the annual conference. He gave special thanks to the
Florida Local Health Departments and recognized that the economy does have a negative impact
on the conference overall. The Annual Conference Workgroup set a goal of 20% reduction in
the conference attendance which was 953. As of the board meeting there were 815 registrants
and so we are a little off the 20% reduction mark.
Staff has done a great job targeting folks to get them here. Preparedness people, health equity
and informatics and we have done targeting marketing to bring those numbers up. Thanks to
staff for all the work that they do to get the sessions up and running.

The transition in administration made it difficult to make invitations and get people here who are
new to the administration.
71 vendors now and about 100 last time we had an independent conference without ASTHO.
Some vendors this year only took one spot instead of multiple spots and even though this was not
unanticipated, it is still something that NACCHO tried to avoid. John indicated that we looked
forward to being in Memphis next year.

Finance Committee
Update in the packet but about ten months into fiscal year. We are showing net income of about
$200,000 we have a reserve account of 1.7 million dollars and the documentation for all of that is
in the packet. In the previous year the Finance Committee has been charged with looking into a
for-profit subsidiary for NACCHO. The work that is being done on this issue will come back to
the board in March of 2010.

Membership dues are on an automatic calculated formula and the recommendations came
forward that we would wave the increase for 2010 and that recommendation was passed and
there was no increase in our dues and will not be increased in the coming year.
During the last 2 years the finance committee has been working on a long term investment in a
socially responsible equity investment. Since July 1 we have put in about 100,000 (6% of
NACCHO reserve) the Calvert Social Investment Fund.

Audit Committee
Terry Brandenburg reported on the work of the audit committee. The major finding is that there
are no material weaknesses found in the audit for the year ending June 2008. That being said,
there are always findings. They have reviewed all the staff responses to the audit review. It was
noted that the findings that were resolved. We are currently switching auditors and working with
a new auditor. One of the things that the committee is developing is a policy to act on
anonymous reports of wrong doing. That policy is still under development and will be brought
to the board at a future meeting.

Written Reports

Membership Committee
Nomination Committee
Presidents Report
Executive Directors Report
Government Affairs Report
Alliance to Make US Healthiest

Four items removed from consent agenda

Patient Centered Medical Homes

One of the concerns raised is that Couple of things reading it through. One concern is that
sometimes we say physicians and sometimes we say providers and Lillian would like to make a
motion to be consistent and say only providers instead of physicians
One of the major thrusts of Patient Centered Medical Homes is comprehensive care and we do
not say anything about mental health, oral health. We would like NACCHO to define medical
home more broadly. After primary care insert oral health, mental health

Herminia Palacio asked for clarification as the justification seems to center around compensation
strategy and the policy seems a bit disconnected. Did seem like a lot of the focus in the policy
was about reimbursement and compensation and we want to be clear about what we are asking
the board to do. Rework the justification to clarify compensation aspect.
Poki Namkung stated that there has to be a very clear statement made about how the
compensation structure that exists now is a disincentive to the patient.
Herminia Palacio added that a tighter linkage between what we say we are supporting and the
Winnie Holland asked if the board wanted this to be sent back to the committee. This is a fairly
new concept for some of the people that are on the committee and we can make sure to address
all the specific points and we want to make it bigger than just a compensation thing.

Larry Jones made a motion to take the statement back to the committee
Adewale seconded the motion.
Move the policy back to the committee

Protecting School Health
John Weisberg pulled this policy because he was confused about what the real issues are that
we are trying to address in the policy. The policy seems very broadly written. From his
perspective John does not sense that there are problems working with schools and getting data
about schools. In his community, there is a great deal of engagement with schools. There are
immunization registries, and there is a great deal of information about health behaviors. So what
is the actual problem that we are trying to solve?
Winnie Holland responded that it was the understanding of the Essential Services Committee
that some places have had pretty intractable situations within their communities and have been
approached by other organizations that they would like NACCHO to join with them in advocacy
around better data sharing.
John Wiesman asked if there are other policy statements that NACCHO has that are the same as
this particular statement.
Eli Briggs explained that the overall issue is that now we have a new administration do you all
still have the same interpretation of FERPA
Tony Iton said that trying to get around FERPA for immunization records is critical for health
departments. FERPA is a real and potential barrier for good public health at the local level. Tony
wants to see the Education Department and the Health Department to be working together across
the country.
Policy Passed Unanimously

Healthy International Trade
Herminia Palacio indicated that she did not have any questions with the concept of the policy,
but her question is that the language struck her as unyielding. Thinking about ways that we want
public health issues to be highly considered in these negotiations and some of the language
seemed too strident to make that happen. What we tried to do with this update was to make the
language less strident.
Susan Palchick stated that the workgroup tried to make the language more flexible and less
Herminia Palacio recognized that there was a change in the last bullet in the policy because it
talks about ensuring regulatory protections and an active engaged relevant voice at the table,
however, bullet number 2 does not support any trade agreement that would focus on the public’s
health and safety.
John Wiesman indicated that one of the things that would be helpful is to make more comments
about what impact a policy has. John agrees that in this form, the policy might be too black and
Marty Fenstersheib stated that NACCHO should be sure not to compromise on this policy as we
are not currently at the table in these conversations.
Yvonne Madlock clarified that the board seems to be in support of the policy overall and that if
the tone could be modified and made more positive it would be helpful.
Rene LeBlanc recommended that the staff turn some of the sentences around to make the policy
more inclusionary.
Poki Namkung wrapped up the discussion by saying that she is familiar with a global trade
advocacy group in the San Francisco Bay area and she just wants to make sure that NACCHO
can juxtapose being less strident and also make sure that we do not lose the fact that the health of
people is paramount.
Tony Iton made a motion to pass the policy with changes being made
Carol Moehrle seconded the motion
The motion passed with the changes to the policy.

Asthma Policy
Lillian Shirley asked for the asthma policy to be pulled for several reasons
    1) Because of the release of a new report that reports that African Americans are 3 times
        more likely to die from Asthma compared to whites.
    2) Because of another new report released that links childhood asthma rates with amount of
        stress in their adult care takers. Lillian felt that it was critical to get the citation for that
        report into the policy because although we do have two citations in the policy, we do not
        have any citations that focus on the role of stress and social determinants.
Larry Jones added that even though he realizes that this is the updating of a policy, he is not a fan
of a “disease du jour”. He has trouble with us taking up specific conditions. He would much
rather see us take on more broad based health conditions.
Lillian Made motion to move policy with changes
John Wiesman seconded the motion
Motion passed with one nay

Election results for Executive Committee
Marty Fenstersheib
Kim Barnhill
And Herminia Palacio will sit on the Executive Committee

Meeting Reminder
Sunday November 8th in collaboration with APHA

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