But really, #BlackLivesMatter.

#BlackLivesMatter.  Yes, all lives matter, but really, #BlackLivesMatter.  Because white Americans have not been subject to the institutional racism that was mixed into the mortar that holds together the bricks of our country’s foundation.  Because being white means we have the luxury of avoiding long-term health effects of the toxic stress caused by institutional racism.

By saying #AllLivesMatter, we diminish our neighbors of colors’ lived experience. This experience makes it necessary for parents of color to teach their sons not to wear hooded sweatshirts at night. Parents of color worry that their child may not receive the same medical treatment as the fair-skinned girl next to them in a waiting room.  Concerns for their children are underpinned by their justified worries that their children they might not be able to get a job they are qualified for because of their skin color, natural hair texture, or accent.

I am consumed with sadness that we must again ask the question  asked in response to the Orlando shooting.  What venue, what shooter, what motive will finally shine the light on the root of all these devastating stories?  What will it take for our elected leaders to acknowledge and begin a meaningful narrative on the role privilege and oppression has played in this sadness and how we can fix our systems to impact change.

We can point fingers and pass judgment and blame. We can mourn the police officers killed in Dallas, but still be outraged at the larger narrative of the story.

Validated research shows that privilege and oppression manifests itself everywhere - in our hospitals, our schools, our social programs. How many more black men will worry about getting out of a traffic stop alive, compared to a white man worrying about how he will avoid getting a ticket?  How many children of color will be administered inadequate pain medication because of their doctors' implicit biases? How many more teens of color will end up in a stereotypical downward spiral because of the impact their families' skin color has had on their parents' ability to get an education, get a job, get safe housing? Enough is enough.

In the words of Minnesotan blogger Ryan Williams-Virden, "we need to… stand up and demand fundamental, radical, structural changes. To fail to do this is to betray humanity, it is to betray ourselves.”  The NH Public Health Association is working to achieve optimal health and equity for ALL NH residents, and urges strong leadership from our elected officials to guide peaceful action to begin to unravel the policies and systems that damage the health, lives, and souls of so many Americans.

Submitted by Katie Robert
NH Public Health Association
Board President

By Jeanie Holt, NHPHA Public Policy Committee Co-Chair

The Public Policy Committee has begun its work to update our policy position statements. We also have a couple of topics on which we plan to write new statements. Here is an opportunity for you to be involved in a time limited project. Below I list the statements to be revised and the topics for which we will draft new statements. You can participate in this process in one or more of several ways: participate on the sub-committee working on the statement; you can volunteer to review draft statements to see that they make sense, read smoothly, etc.; and/or you can be a subject matter expert reviewing the scientific basis cited in the statement. Please let me or JJ Smith know how you’d like to help.

Child Health and Safety: this statement needs a complete overhaul. Karen Welford, Children’s Trust Fund, is leading this sub-committee.

Alcohol and Other Drugs: We last reviewed this position in 2013. Given that opioid misuse has become a crisis, and we anticipate efforts to legalize marijuana, we need a current and robust position statement.

Sexual and Reproductive Health: As with other statements, new developments and new debates in this field require an up-dated statement that provides the evidence of public health benefits to such policies as requiring coverage for contraceptives. Our current statement also does not include a position on access to abortion services. We will hold a Public Policy meeting dedicated to this topic on August 26.

Tobacco: We wrote and approved our current statement before the introduction of e-cigarettes and vaping. We have some catching up to do!!

Disabilities and Public Health: Working with folks at the Disabilities and Public Health project (Institute on Disabilities, UNH), we will draft a new policy statement.

Food Security, Food Systems, Nutrition: We have a statement on food safety which we may update to cover these important issues; or we may end up drafting a new statement or more than one to establish a science-based position from which NHPHA can act on these important issues.

As you can see, Public Policy Committee has plenty to do—and this does not cover all the work we have outlined for ourselves. Our work is interesting, even fun! We hope more NHPHA members will get involved.

An article from the June issue of the NHPHA e-Newsletter

Meet Sophia Japhet.  Sophia is a grant writer at Families In Transition in Manchester as well as a student at UNH with one year left to finish her Master's in Public Health   More recently, she joined the NHPHA Board Sophia Japhetof Directors, taking on the role of Treasurer.

Sophia's journey in public health began at Arcadia University, where she majored in Healthcare Administration and was exposed to numerous public health electives (epidemiology, global public health, etc.).  "I became hooked", she said, even picking up a Global Public Health minor and taking an opportunity to study abroad at Stellenbosch University in South Africa as well as visit the Mothers2Mothers HIV clinic.  After graduating, she joined the Americorps program in New Hampshire at Families in Transition (FIT) where she assisted in multiple resource development, fund raising and grant writing initiatives in addressing homelessness.  Shortly after transitioning into her new role, she was accepted into the Masters of Public Health Program at UNH.

Working at a local non-profit organization is what Sophia likes most about the work that she does.  "I have the opportunity to directly make a difference in the community I also call my home."   She feels it is extremely rewarding to be part of an organization on the front lines of addressing homelessness in our state. " I think the same is true with the Public Health field in general – our initiatives and our interventions directly engage and impact community members."

New projects are always developing at FIT.  As a grant writer, Sophia helps to raise money for many of the different new initiatives FIT takes on.  "One of the projects I am most excited about is our Hollows Community Garden and Learning Center."  The Hollows Community Garden and Learning Center is a half acre community garden, park and learning center being developed in the Hollows neighborhood of Manchester to help engage local vulnerable families in the growing, cooking, and eating of healthy foods.  "To develop this project, we are working with numerous partners including the UNH Cooperative Extension, the Manchester Health Department, and the Organization for Refugee and Immigrant Success."

Sophia first got involved with NHPHA as a student in UNH's Masters of Public Health program.  "I wanted to extend my understanding of public health beyond the borders of the classroom and learn about real time issues and initiatives in our State."  The student annual membership at NHPHA gave her the opportunity to join the association at a discounted rate, but still provide all the benefits of being a member.  "In particular, I enjoyed (and still do) getting the frequent HIAP emails and policy newsletters to stay on top of all the great work that is being done in our state."

When Sophia is not hard at work with FIT, or studying for her Masters, she enjoys kayaking and hiking with her dog.

NHPHA is thankful and most fortunate to have such talent and dedication from its volunteers and we look forward to having Sophia join us on the Board of Directors.

By Gail Brown, Director, NHOHC
OHC Roadtrip 2
There is still time to join the NHOHC on our statewide Road Trip.  The Coalition is presenting “Charting the Course: Developing the Roadmap to Advance Oral Health in New Hampshire.”  Funded by the Concord-based Endowment for Health, this program is to disseminate and plan for implementation of the NH Oral Health Plan 2015 Update.  The Road Trip offers opportunities for local community programs and providers to learn about the updated plan and to share how their programs link into the State-wide plan.

Presentations include information on the 2015 NH Oral Health Plan Update, the 2015 NH Oral Health Communication Plan, links for NH-specific oral health data reports and introductory techniques on effective message framing. 

To-date, presentations have been held in 3 locally-hosted locations; the Manchester Health Department, the North Country Health Consortium, and Cheshire Medical Center.  You can still register to join us at the following.

The Foundation for Seacoast Health/Community Campus in Portsmouth on June 20 at 10:00 a.m.; Alice Peck Day Memorial Hospital in Lebanon on July 11 at 9:00 a.m.; and at Speare Memorial Hospital in Plymouth on July 21 at 9:00 a.m.  Register at http://nhoralhealth.org/events-2/   

For more information email info@nhoralhealth.org or call 603-415-5550.  If you are interested in including a presentation at your locale or meeting, please let us know.

The 2015 NH Oral Health Plan was a joint-funding effort between the Endowment for Health, the Healthy New Hampshire Foundation, and Northeast Delta Dental to update our statewide oral health plan through stakeholder collaborative convenings.

By Jeanie Holt, NHPHA Public Policy Committee Co-Chair

Now that the legislative session is concluding, the Public Policy Committee begins to focus on its other important job: keeping NHPHA’s position statements updated with the most current evidence and drafting statements for new/emerging public health issues. This work involves more research and proceeds at a slower pace than our work during the legislative session. If research is your forte we’d love to get your help. A number of work groups are forming—take your pick. One group will look at public health through the lens of disabilities communities and either draft a new statement or add something to many of our current statements. Another group will rewrite our Child Health and Safety statement while yet another is needed to update our Smoking and Tobacco statement or write a new one. If there is enough interest, we’d like to draft a statement on food systems and food security. And our August 26 Committee meeting will be a discussion of public health perspectives on abortion and how to include this in our Reproductive Health position statement. Please join us in this work. Advocacy is a core function of NHPHA, which is, after all, a membership organization so your ideas and energies are the heart of NHPHA.

APHA Strategic Plan
On May 12th, I listened to a presentation of APHA’s Strategic Plan. They are updating their Plan to align with their Healthiest Nation in One Generation Campaign. APHA’s Strategic Plan focuses on initiatives that are meant to improve overall health in order to become the healthiest nation in one generation. If you are interested in listening to the 30-minute Strategic Plan presentation, you can find the webinar recording here

Community Pevention and Multi-Sector Stakeholder Web Forum Series
Please join APHA on Wednesday, June 1st from 2:30 PM to 4:00 PM for their Web Forum where lessons learned are discussed from communities taking action to leverage community development efforts through diverse partnerships to improve population health and equity. The conversation will highlight the role of partnerships in financing, evaluating, and sustaining population health improvements. Presenters will also provide recommendations for success and take participant questions. To RSVP, click here

2016 GIS and Health Symposium
The Urban and Regional Information Systems Association (URISA), in partnership with the American Public Health Association (APHA), is pleased to share the details of the 2016 GIS and Health Symposium. The theme for this year's Symposium is “Mapping the Way to Healthy Communities”. The event will take place June 1-3, 2016 in Washington, DC. To register, click here

An article by the Bureau of Infectious Disease Control, NH Division of Public Health Services, DHHS

Lyme disease and other tickborne diseases are considered reportable diseases in New Hampshire.  The NH Bureau of Infectious Disease Control (BIDC) investigates suspect cases of Lyme and other tickborne black legged tickdiseases and closely monitors tickborne disease rates. Lyme disease maps and reports by county can be found on the Department of Health and Human Service webpage,

Lyme and other tickborne diseases are spread to humans and animals by the bite of an infected blacklegged tick, formerly known as the deer tick. In NH, and across the United States, Lyme disease is the most commonly reported tickborne disease; in 2015 there were an estimated 1,371 confirmed and probable cases of Lyme disease in NH.

Family CampingBlacklegged ticks have four life stages: eggs, larvae, nymphs and adults. The blacklegged tick nymphs are most active in the late spring through summer months (usually May through August) and are the most likely to infect humans with tickborne diseases.

Tickborne diseases can be serious illnesses and can affect people of any age. The best way to prevent being infected with a tickborne disease is to take precautions to avoid being bitten by a tick, including using insect repellents containing 20-30% DEET or oil of lemon eucalyptus, doing daily tick checks on you and your pets, staying on cleared paths or trails, wearing light colored clothing, showering soon after returning indoors to wash off any unattached ticks, and placing clothes in the dryer on high heat for up to an hour to effectively kill ticks. If you are bitten by a tick, it is important to remove the tick as soon as possible using tweezers or another tick removal device.

For more information on diagnosis, treatment and prevention, click here 

FPU LogoThis month, NHPHA shines the spotlight on and welcomes the Franklin Pierce University (FPU) Public Health Program and Dr. Angela Ekwonye, Visiting Assistant Professor of Natural Sciences.

The Franklin Pierce University Public Health Program began in September 2015.  Their mission is to impart in their students a broad understanding of the factors that shape the health of the population and equip students with evaluative tools for improving the health of the FPU AEkwonyecommunity.  The curriculum is analytically focused and conceptually grounded and, as such, prepares their students for careers in Public Health, Health Service Administration, Health Education, or entry into graduate and professional programs  in public health, healthcare management, international policy, communication, medicine, physical therapy, occupational therapy, etc. FPU Team Photo

When asked about her involvement with FPU, Dr. Ekwonye stated, "As a faculty in the program, I teach different public health courses and have been actively involved in developing courses and activities for the program."  More recently, Dr. Ekwonye has moderated and helped develop the FPU Public Health Club and describes her work at FPU as very satisfying.  "I enjoy working with my students in the classroom and outside the classroom.  We hold weekly club meetings in which we discuss various health issues in our community and ways we can contribute to solving the problems.

In the coming fall, the FPU Public Health Club will be conducting a panel discussion on "Living a Healthy Lifestyle Away From Home" with the hope of creating awareness of different activities that individuals can do to improve their personal health and wellness and the overall health of the college community.  In the spring, they will organize and host a health fair to FPU Campus Photocreate greater awareness of healthy living among members of our community.  "Throughout the school year we will be taking photos of public health efforts, issues or events and will share the photos on our Twitter and Instagram accounts ", said Dr. Ekwonye.  Find the FPU Public Health Club on Twitter at @FPU_PubHClub or on Instagram at @FPU_PUBHCLUB.

To learn more about the Franklin Pierce University Public Health Program, visit their website.


An article by the NH Department of Health and Human Services, Division of Public Health Services
Boy 1
The New Hampshire Department of Health and Human Services (NH DHHS), Division of Public Health Services, will be running four public service advertisements (PSA) previously run in other states that educate the viewer of the dangers of secondhand smoke (SHS) exposure and promote cessation:  “It’s Like They’re Smoking”, “Nowhere To Hide”, “Trapped” and “Cigarettes Are Eating You Alive”.  All the ads highlight the dangers of secondhand smoke (SHS) exposure to children in various environments:  the home, in vehicles, during pregnancy and anywhere. Secondhand smoke is tobacco Boy 2smoke that is exhaled by a smoker or is given off by burning tobacco (as of a cigarette); thirdhand smoke is residual nicotine and other chemicals left on a variety of indoor surfaces by tobacco smoke. The PSAs will provide an educational/information resource for viewers to learn about protecting children from SHS exposure and (www.QuitNowNH.org/ProtectKids) and promote the New Hampshire Tobacco Helpline for cessation (1-800-QUIT-NOW).

On average, children are exposed to more secondhand smoke than nonsmoking adults. The primary source of secondhand smoke exposure for children is the home, but children are also exposed to secondhand smoke in other places as well, such as vehicles and some childcare centers. Exposure to secondhand smoke increases the chances children will suffer from smoke-caused coughs and wheezing, bronchitis, pneumonia, potentially fatal lower respiratory tract infections, eye and ear problems and other problems including Attention-Deficit/Hyperactivity Disorder (ADHD) and other conduct disorders. To protect children, never allow smoking around your children, in your home or where they are cared for, in a vehicle they travel in, or where they sleep.Girl 2

The PSAs are scheduled to air May 16th and to potentially run for 12 months pending available funding after March 2017. The PSAs will be on television, statewide radio and web/mobile. NH DHHS encourages people who smoke to quit and offers free help quitting via the NH Tobacco Helpline, 1-800-QUIT-NOW.

What Happens When the Funding Ends?  In Nashua, the Work Continues!

The Plan4Health Nashua coalition was recently recognized for its Complete Streets work by Mayor Jim Donchess, among others, at the Greater Nashua Public Health Annual Meeting.  The meeting was held during National Public Health Week in April and attracted nearly 100 attendees representing health providers, municipal departments, nonprofit organizations, faith communities, state agencies and schools.  Plan4Health Nashua has also been chosen to receive a NADO 2016 Excellence in Regional Transportation Award.

In early 2015, a partnership formed in Nashua between public health and planning to advance street design that supports health by providing safer and easier ways to get around for pedestrians and bicyclists. The Plan4Health Nashua coalition was formed after receiving a $125,000 grant from the American Planning Association (APA) to help fund a 15-month program to support Complete Streets planning in Nashua. Founding partners included the Nashua Regional Planning Commission (NRPC), the City of Nashua, New Hampshire Public Health Association (NHPHA), and Healthy Eating Active Living (HEAL NH).  The project immediately gained support by the Greater Nashua Public Health Advisory Council and was selected as a priority project for implementation in Nashua's 2015 Community Health Improvement Plan.

During the 15-month grant period, the Plan4Health Nashua coalition conducted a street study to assess the bikability and walkability of Nashua streets, developed a Complete Streets guidebook and policy recommendations, and providing training to city staff, planners, elected officials and other community members.  The project has gained momentum and the coalition has grown to include community partners beyond public health and planning, including NeighborWorks of Southern New Hampshire, Great American Downtown, YMCA, Police Athletic League, and Boys & Girls Club of Greater Nashua.  And while the APA funding period is about to end, the efforts to support a healthy, economically vibrant community in Nashua continue!

With one project, Plan4Health Nashua is working with city departments, local artists, and the Silver Knights baseball team to install a "creative crosswalk" at Holman Stadium in downtown Nashua. This installation puts a fun, new spin on standard crosswalk design, while maintaining crosswalk safety standards and supporting safe, active transportation activities such as walking to the ballgame.

Another project will be led by NRPC which recently received funding from the HNH Foundation for a "Planning for Parks and Playgrounds" project in Nashua and throughout the region.  The project works to improve walking and biking access to safe places to play through a combination of planning and education. In yet another project, a charrette is being planned in June to discuss opportunities for community revitalization - including walkability - in the Lock Street area in Nashua's French Hill neighborhood. And on the healthy eating front, Nashua was selected as a New Hampshire Farm to School Beacon Community.  One of only three communities included in this new program, Nashua will help pilot how to move innovative farm to school practices forward and serve as a model for other communities across the state. Healthy eating and active living work continues to expand in Nashua, bringing in more partners and more funding opportunities.

Plan4Health Nashua illustrates how community planning and public health have common ground when promoting policies that ensure safe and equitable access to physical activity and healthy eating.  The project has also demonstrated that community members from all sectors will come together - from elected officials to a baseball team - because they care about public health, economic growth, and livability.  Furthermore, in Nashua and in many other HEAL communities, the great work has continued well after the original funding period.

An article from the April issue of the NHPHA e-Newsletter

This month, the spotlight shines on and welcomes Shannon Bresaw and Granite United Way, a new organizational member and public health friend to NHPHA.  GUW Logo

Granite United Way currently serves as host agency for three (3) out of the thirteen (13) regional public health networks in the state, including the Capital Area, Carroll County and South Central (formerly Greater Derry).  Funded in part by NH DHHS, these networks work to convene, coordinate and facilitate an ongoing network of partners to address regional public health needs.  Granite United Way is committed to improving the lives of individuals and families by supporting programs in the areas of education, income and health.

ShannonMeet Shannon Bresaw, Director of Public Health Services and Prevention for Granite United Way, In her role, Shannon oversees the public health network contracts held with NH DHHS, including the following scopes of service for which each network is responsible: Substance Misuse Prevention; Continuum of Care for Substance Use Disorders; Public Health Emergency Preparedness; Public Health Advisory Council and Community Health Improvement Plan Development.  Shannon graduated with a Master's Degree in Social Work in 2004 with a focus on Community and Administrative Practice.  "I have been connected to the public health network system since 2004 working in Franklin and the Belknap County region before coming to United Way in 2007."  When asked what she liked most about the work that she does, the assessment, strategic planning, and evaluation components of the work as well as grant writing and research were a few of her favorite things.  "I am very focused on understanding the root causes of the problems we face in our communities, followed by the development of a comprehensive plan that is based on research and best practices."
Current projects for Granite United Way include the South Central Public Health Network that has recently developed a Public Health Advisory Council and is working on developing the region's Community Health Improvement Plan.  The Carroll County and Capital Area Public Health Networks are in the process of implementing their Community Health Improvement Plans.  "Each network is also working on an assessment and plan to address gaps and barriers related to the full continuum of care for substance use disorders, from prevention to treatment to recovery supports and services.", Shannon said.  "Priority issues in the regions align with the State Health Improvement Plan and include the misuse of alcohol and drugs, public health emergency preparedness, behavioral health, injury prevention, and more."

As a past member of APHA and having presented at their Annual Meeting, Shannon became very interested in being more connected with NHPHA, particularly concerning advocacy efforts and connecting their public health network members to those types of opportunities moving forward.  In the Capital Area Public Health Network, they are working to implement "Health In All Policies" in the region and will feature a presentation on this strategy at their annual meeting in June.  "We recognize the influence of laws and policies on our public health outcomes and believe that advocacy is a crucial component of our work."


By Kim McNamara, NH Health Officer

This opioid crisis communities across New Hampshire are facing, is a whole community issue because the entirety of our communities is suffering.  This has rapidly reached unprecedented levels, and continues to accelerate.  From 2010 to 2014, deaths from all drugs in NH increased by 177.8%.  In that same period, heroin deaths increased by 653.8% and fentanyl deaths rose by 663.2%.  Throughout our state, individuals, families, and neighborhoods have been tormented by the personal loss of a relative, friend, or neighbor, affecting the physical and mental health and well-being of our entire communities. 

The heartbreaking loss of life, although the worst outcome possible, is just the tip of the iceberg.  There are innumerable additional poor outcomes piled up beneath.  Accidents and injury rates also increase while people are under the influence.  The effects on the brain and respiration can lead to short- and long-term psychological and neurological effects, including coma and permanent brain damage leading to life-long disability.   There are additional mental health and medical comorbidities that accompany opioid use, such as mood and anxiety disorders, cardiovascular and pulmonary disease, dermatological conditions and GI complications.  Public health strives for healthy people and healthy communities.  With the rising rates of opioid use and misuse, it is clear we are moving away from that most basic tenet on many levels.

Often the largest group of people with substance use disorders are of child-bearing age.  Children of addicted mothers may face neonatal abstinence syndrome (NAS), birth defects and developmental disabilities.   Opiates pass through the placenta to the baby during gestation.  When the mother is addicted, so is the child.  NAS is a painful withdrawal process leaving babies suffering from excessive crying, fever, vomiting, diarrhea, hyperactive reflexes, rapid breathing, seizures, trembling, poor feeding, slow weight gain, increased muscle tone, and other symptoms.  A most awful welcoming into the world.  Among the possible birth defects associated with opioid use, even when carefully prescribed, are spina bifida, hydrocephaly, glaucoma, abdominal wall and congenital heart defects.  

Parents who are incapacitated cannot care for or support their families, leading to children at risk at home, and children in placement outside of the home.  When children lose parents, due to death, incapacitation or incarceration, a heavy toll is paid emotionally and socioeconomically.

There is also significant risk of escalating infectious disease rates with this epidemic.  In January of 2015 a small rural town in Indiana experienced a spike of 11 cases of newly diagnosed HIV infections linked to shared needles used to inject the prescription opioid oxymorphone.  By April, 4 months later, 135 new cases of HIV were diagnosed in a community with a population of only 4,200 persons.  These patients ranged in age from 18-57, and 114 of them (84.4%) were co-infected with Hepatitis C.  373 people with contact with these patients were also identified as potentially at risk.  Of those, 247 were located, 230 tested, and 109, or 47.4% also tested HIV positive.   These people now have an even more difficult medical profile than substance use disorder alone to surmount.  

Devastating resource, economic and social consequences to their community occurred as well.  Businesses suffered because visitors would not come to town to eat in their restaurants, or receive services.  Neighboring school teams refused to play against their sports teams.  Local resources were not enough to adequately address this outbreak.  This small town in rural Indiana has a higher HIV infection rate than many developing nations.  It doesn’t take much imagination to see how those additional community effects could happen in many places in our own state. 

This outbreak requires we think differently about who is at risk of co-occurring morbidity.  It occurred in a rural population, historically at low-risk for HIV.  Infection spread rapidly because of a large network of people injecting prescription opioids within a community that lacked resources to adequately prevent and treat the substance misuse that was brewing within. 

The Indiana outbreak highlights the vulnerability of many rural, resource-poor populations to drug use, misuse, and addiction nationwide, and highlights the need for expanded mental health and substance use treatment programs in medically underserved rural areas.  Although much work is being done to build capacity here, most of New Hampshire has large gaps in prevention, treatment and recovery services, particularly in rural areas.

This calamity also illustrates why a public health response to this crisis is necessary. Intervention requires a coordinated and rapid response of different branches of public health; disease surveillance, drug monitoring, and behavioral health services.   However, other community resources separate and distinct from public health are also vital for a comprehensive and effective response.  Education and prevention efforts require involvement of our educators.  Law enforcement continues to be a vital partner with drug courts, diversion programs, drug take back, community outreach, and the all-important stemming the tide of illicit drugs within our communities.  Our EMS, community and regional medical and behavioral health partners carry a significant role in detox, treatment, and recovery services. Non-governmental organizations are also an important ally.

There are numerous other community consequences.  Crime increases to support addiction or due to the effects of substance misuse.  Our EMS, emergency departments, health care providers and legal systems are under considerable stress with the pace and breadth of this issue.  The far reaching affects are too numerous to list and many are unquantifiable, but the fabric of communities is in jeopardy.

A key social measure that requires community buy-in is eliminating the stigma which is a significant barrier to care and recovery of individuals and their families.  Even if services exist, because of public attitudes, there is reluctance to seek treatment.  Communities must embrace, care for and protect those among us who are struggling and suffering.  This acceptance and support often brings non-traditional partners such as the arts and humanities groups into the fold. They quite frankly often bring heart to the issue and are better at telling stories, raising awareness and raising capital than the more clinical and statistical approach of traditional public health and law enforcement groups.

Significant barriers to treatment and recovery remain.  The importance of evidence-based therapies cannot be overstated.  Medication Assisted Treatment (MAT) has been proven to be an effective intervention for opioid addiction.  MAT was originally developed in response to the proven ineffective treatment regime of detox followed by abstinence, which did little to slow relapse.  MAT began with the use of Methadone in 1964, and in 2000 buprenorphine under the brand names Subutex and Suboxone was FDA approved.  Naltrexone followed in 2014.  MAT has been show to allow patients to remain abstinent, or greatly reduce the use of illicit opiates, reduce the use of other illicit drugs, decrease criminal and risky behaviors, and with careful monitoring, improve neonatal outcomes.

Although MAT has been proven to be clinically and cost effective, and significantly reduce the need for detox and inpatient services, it is still underutilized.  Reimbursement, regulatory and workforce barriers have been cited for these lost opportunities.  The requirement for prior authorization, limitations on time during treatment medications can be used, and a lack of reimbursement are some of the financial barriers.  These issues are being worked on, but legislation always lags behind need.

A more perplexing barrier is the specific restriction on MAT practices.  In 2000 the DATA 2000 law was passed, allowing physicians to prescribe these newer (buprenorphine and naloxone) opioid-based medications for the treatment of addiction.  However, for unclear reasons, this law restricts the number of patients a physician can treat in the first year of their new certification to 30.  After one year of providing MAT, providers can expand their treatment to 100 patients.  This arbitrary limitation is specific to medications used in MAT only.  No other prescription practices are similarly restricted, including those that govern the prescription opioids that are at the heart of this crisis.  

Numerous other barriers exist and the State of New Hampshire’s Department of Health and Human Services, through regional public health networks are embarking on an updated assessment of NH gaps and assets, due out this summer.  The goal of public health is to assist in building a state-wide Continuum of Care for all persons struggling with substance use disorders. The continuum spans health promotion and prevention, early identification and intervention, detox and treatment, and recovery supports.  Some pieces of the puzzle are falling into place in NH, but there is a long way to go and it takes our collective effort to help ourselves.

Acute emergency treatment for overdose/detox is short-term. Inpatient rehabilitation centers, intensive outpatient programs, and recovery support services are very much needed beyond the acute phase of the Continuum of Care to help individuals remain safe and rebuild their lives.  A few inpatient treatment facilities and recovery centers currently exist in NH, and a few more are on the horizon.

Recovery centers bring together a system of prevention and recovery, and meet the need of ongoing care after formal short-term treatment.  Recovery centers follow a national model, and provide vital education, training, referral, and support services to persons in recovery, their families and loved ones. Peer Recovery and Support Services efforts are most effective when leadership in the peer recovery organization are people who are in long term treatment themselves, and success can be measured.   Indicators of effectiveness include numbers of people participating in long-term recovery, fewer incidents of recidivism in judicial system, reduced Emergency Department visits and, number of trained individuals in recovery and peer support services. 

Peer recovery and support centers meet people where they are in their illness or recovery.  Not everyone’s needs are the same, therefore, not every step on the Continuum of Care is needed for every person.  A person can step in and out in the areas that fit their particular situation.  A multi-purpose recovery center responds to the specific needs of the community and as such services will evolve as indicated.  Therefore, because of the wide variety of services they provide these have the potential to serve a large portion of our population.

It is easy to get overwhelmed in the face of the opioid crisis.  The challenges seem insurmountable.  The seriousness of this epidemic is haunting.  However, part of the message to our communities has to be that SUDs are treatable.  Many people do recover and lead happy, healthy and productive lives.  There are countless members of our own communities that are living proof of that and we, as a community must help those who are caught in this struggle to believe that they too will have a successful recovery.  There are a lot of good souls working hard towards that.  Hang in there.

By Gail Brown, Director, NHOHC

The NH Oral Health Coalition is pleased to be working with Hugh Silk, M.D.,  University of Massachusetts and the NH-based North Country Health Consortium in Littleton to be providing statewide training for the implementation of fluoride varnish in the medical setting.
OHC Update Photo In accordance with the Affordable Care Act, the US Preventive Services Task Force, and recent changes within the NH Medicaid program, NH’s primary care medical providers for children age 6 months through 5 years, can provide an oral health risk assessment and, if indicated, fluoride varnish as a preventive oral health measure. 

Dental decay, the #1 chronic disease in children within NH and the nation, is caused by bacteria and is thus both transmittable and preventable with proper care and prevention. 

Fluoride varnish is considered a simple, cost-effective and efficient part of the prevention toolkit and within NH can be applied by dentists, hygienists, and trained medical primary care providers. 

The availability of fluoride varnish application in many schools, WICs, Head Starts, and now, primary care settings brings this important intervention to the locations that young children and their families frequent naturally in early childhood. 

For more information on fluoride varnish and the prevention of early childhood caries, please see: www.fromthefirsttooth.org.  For specific information regarding NH benefits and reimbursement CLICK on “My State” and then the “New Hampshire” page.  Medical providers interested in a no-cost training for their staff, contact info@nhoralhealth.org

By Shasta Jorgensen

As NPHA’s new Affiliate Representative to the Governing Council (ARGC), I’m excited to share with NHPHA members all things APHA. If you have questions regarding APHA or want more information about a specific topic covered in this newsletter, please feel free to drop me a line at shasta.jorgensen@gmail.com.  Here are a few things that have crossed my inbox related to APHA recently . . .

The Flint Water Crisis and Beyond
APHA is assisting with the Flint, Michigan, water issue by hosting webinars, facilitating resources for residents and community leaders, printing news stories/article in AJPH, working with APHA Environmental Health Section, and collaborating with other organizations. To view the webinar series, The Flint Water Crisis and Beyond, click here

Recognize National Health Observances with Plan4Health

Plan4Health is working in partnership with the national organizations involved in the Partnering4Health project to create grab-and-go packets for select National Health Observances.  These packets are full of great resources, including sample social media posts and other templates.

APHA Launches 1 Billion Steps Challenge
Join APHA and take small steps for big change. With a goal of reaching 1 billion steps by May 31, the challenge is the perfect way to jumpstart healthy changes in our own lives and encourage our friends, families and co-workers to do the same. Now, we know that 1 billion steps sounds like a lot. But if we all come together and start logging our steps, we can easily reach 1 billion and beyond. Join us in taking small, but meaningful, steps toward creating the healthiest nation in one generation. Let’s step into a healthier future together! Learn more about the 1 Billion Steps Challenge, including how to sign up, log your steps, and win prizes!

Healthiest Cities & Counties Challenge Launched
APHA, the Aetna Foundation, and the National Association of Counties, in partnership with CEOs for Cities, have launched the Healthiest Cities & Counties Challenge.  This multi-year program will award more than $1.5 million in prizes for cross-sector work that results in measurable changes in a variety of health-related areas, including tobacco use, walkability and community safety.

APHA Stories on Storify
Be sure to check out APHA on Storify, a platform that uses social media to crate compelling stories.  Make sure to chekc out the recent recap of NPHW and the NPHW Twitter chat.


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