January marks the start of the legislative session at the NH Statehouse and NHPHA is on the move! For a professional organization with as broad a reach as ours, it is always a challenge to limit our legislative activity to where we can have the greatest impact. In December we defined three priority areas for action to give clarity to our vision for our legislative work this year. This January was the typical flurry for our policy committee of reviewing bill language and speaking to partners to decide which bills in the NH Statehouse would receive most of our attention during the session. The bills we attend to may shift as the session progresses, but for now we have two to three bills in each of the priority areas that we will seek your help to educate legislators on the public health impacts. Our priority areas are as follows with the proposed legislation we are targeting listed underneath:

Equity & Health Outcomes – NHPHA will seek to address inequities in education, housing, pay, benefits, social inclusion, etc., that result in a substantial burden of avoidable illness. All people who live in New Hampshire should have a fair and just opportunity to be healthier. This session we will work to:
  • pass the Family and Medical Leave Insurance Program that will support low-income, hourly wage-earners who do not currently have access to such benefits,
  • ensure Medicaid Expansion does not sunset or cover fewer lives, and
  • remove work requirements that limit access to public assistance programs.
Healthy Environments – Natural, Built and Social - NHPHA will seek to address the environments in which we live, learn, work, and play to ensure a healthy population. We will join in efforts this session with other fellow advocates to:
  • support legislation to make our roadways safer supporting a seatbelt bill,
  • oppose a bill seeking to reduce limits on cell phone use while driving,
  • support the Tobacco 21 legislation that seeks to increase the age of purchase for tobacco products.
Substance Misuse – Improving Prevention, Treatment, & Recovery - NHPHA believes the high rate of Opioid Use Disorders, a preventable and treatable disease of the brain, is the number one public health crisis facing the State of New Hampshire in 2018. We will seek to support an appropriate legislative response. We will:
  • oppose reducing the age for legally possessing alcohol, and
  • support increasing the distribution of funds to the Alcohol Abuse Prevention and Treatment Fund.
To learn more about our vision for our legislative action, see detailed descriptions of our priority areas on our website: https://nhpha.org/advocacy/legislative-priorities.

Thank you to Rachel Maxwell for chairing the public policy committee and to JJ Smith for already committing hours of time as the NHPHA Advocacy Lead. Please contact Rachel Maxwell if you would like to get involved on these issues or others. And please keep an eye out for information about our Legislative Breakfast, Wednesday, March 7th, 7:00 to 8:30 AM. There is nothing like talking to your legislator over coffee!
The New Hampshire Public Health Association is seeking a part-time (20 hours per week) Workforce Development Coordinator to coordinate and expand its continuing education offerings and the Rising Stars Initiative to connect public health students, young professionals and employers through recruitment, job fairs, internship and mentoring programs. This is a one-year grant funded position with potential to continue beyond the first year. Duties include developing and coordinating: public health webinars; student intern and mentoring programs; recruitment opportunities for public health professionals; and the Rising Stars Advisory Committee.

You can review more information and the requirements for the position here.
NHPHA is able to pursue its mission through a variety of funding sources - such as membership dues, donations, registration fees and grants. Without such support we would not be able to provide opportunities for public health professionals to network and share ideas; cultivate and nurture our "rising stars" (young professionals just launching their careers); or provide professional development opportunities for those who are currently working in the public health field.

We are pleased to announce we have recently been awarded two grants to support our work.


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We are grateful to the New England Public Health Training Center (NEPHTC) for funding a new grant proposal we recently submitted. These funds will allow us to provide a variety of training and work force development opportunities designed to benefit future and present public health professionals.  


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We are also appreciative of the New Hampshire Charitable Foundation's grant that will allow us to grow our Rising Stars program. The supported project will connect public health students, young professionals and employers through recruitment, job fairs, internship and mentoring programs. We anticipate making strong and lasting connections between academic settings, students and employers.
For many of us in the clinical and public health field receiving a flu shot is an annual occurrence. Each one of us makes the decision to receive the influenza vaccination for a number of reasons. Perhaps we do not want to become ill, we want to protect our loved ones, or this is one of the ways we support antimicrobial stewardship efforts on a personal level. Regardless we make these decisions because we are informed, we know how important the influenzae vaccine is not only for ourselves but to the health of the public too.

girl fluBut what if you didn’t go to school for public health or the medical field? Would you still get the flu vaccine? What if you read in a newspaper the influenzae vaccine is only predicted to be 10% effective this year? Many people this year have been in this situation, unsure if receiving the influenzae vaccination is a good choice. While the statistic of 10% effectiveness is not wrong in its entirety, the value does not convey to the public how the value was arrived upon nor what exactly the number means. While the public may interpret the information to mean there is only a 10% chance this year's vaccine will protect them from the flu, this is not the case.

The value was an estimate of the vaccine’s effectiveness against only one of the circulating strains of flu (H3N2) in Australia, and does not take into account the protection provided against other flu strains targeted this year . Vaccine effectiveness also varies by geographic location, since circulating strains differ depending on the region examined. Additionally, the Centers for Disease Control and Prevention (CDC) have utilized their robust projection tools to study the common H3N2 strain in the United States and have found it to be similar to the virus used to create the vaccine1. The CDC will continue to monitor and collect data as the flu season progresses1.

The media’s portrayal of information regarding the effectiveness of the current influenzae vaccine is a symptom of the larger issue of communicating health information to the public. Providing correct yet easily understandable information to patients and the public about health information can be difficult, but can have a large impact on the engagement of the patient in their own healthcare. We can make a difference everyday by directing patients and those you serve to credible unbiased sources of information with appropriate health literacy levels. Utilize already existing resources to promote influenzae vaccinations in common areas. Or perhaps share with your patients or clients what your reason was for getting the flu vaccine and encourage questions. When the devastation of the 1918 influenza pandemic is no longer within the memory of the public, we as public health professionals need to remember and share the importance of influenzae vaccinations.

Written by NHPHA Member and subject expert Carly Zimmermann MPH MLS(ASCP)
Lisa Bujno has been dedicated to the health of northern New England residents throughout her career. She spent 15 years with the New Hampshire Division of Public Health Services, L Bujno 150x188serving as deputy director and Title V director. Her nursing career led her next to White River Junction, Vermont, where she was associate chief nurse for quality and performance at the Veterans Administration Medical Center. Currently, she is the assistant medical director at Ammonoosuc Community Health Center in Littleton, New Hampshire. She also is medical director of the Integrated Delivery Network in the North Country and is involved in work groups for the North Country Health Consortium. “Maternal and child health issues are very important to me,” she says, “as is access for people with behavioral and substance use disorders.” A native of Maine, Lisa earned her nursing credentials at the University of Pennsylvania. She now lives in Littleton, where she enjoys hitting the slopes at Loon Mountain. She is a returning board member, having served a term as treasurer.

Joan Ascheim Small  This article was written by Joan Ascheim, Interim Executive Director

 As 2017 draws to a close it provides time to pause and reflect and, at the same time, contemplate the year before us. During 2017 we said thank you to Katie Robert for her years of dedicated, exemplary leadership as Board President. We welcomed Rebecca Sky as our new and highly capable Board President. Rebecca has hit the ground running and brings a keen intellect, analytic mind and tremendous commitment to the role. Beth D’Ovidio joined our staff in the spring as program assistant extraordinaire. We have benefited greatly from her tremendous organizational skills and her vast communications experience.

Our annual meeting in April drew our largest number of participants to date with 225 in attendance, with 100 of those being students who presented 27 poster sessions. We saw record attendance too at our Team Up, Take Action: Partnering for Health Equity conference. It was a highly successful collaboration with the Vermont Health Department and Dartmouth-Hitchcock.

We maintained a visible presence at the legislature thanks to dedicated cadre of volunteers. We did our best to stay connected to you, our members, through this newsletter, the Health in All Policies newsletter and Facebook.

As you know, NHPHA is a relatively small non-profit and volunteers have been and remain the mainstay of our activities and success. On behalf of the board, I would like to extend a heartfelt thanks to all our volunteers for the giving of their time, wisdom, expertise and dedication.

I am grateful for the decision made by the board to bring me on as Interim Executive Director to assist in realizing its strategic imperatives and to grow the organization. To that end, the board has just approved a growth plan that charts a course for expansion and sustainability. We anticipate increasing and diversifying our funding base which will allow us to expand our staff and enhance our work in our three key areas: workforce development, policy and advocacy and public health messaging. We look forward to sharing this journey with you.
On behalf of the board and staff, we thank you for being part of our NHPHA family and wish you health, happiness, peace and joy in the New Year.

Best, Joan
Two weeks ago NHPHA co-hosted with the Vermont Public Health Association and Dartmouth Hitchcock Medical Center a first ever bi-state public health conference.  The Team Up, Take Action:  Partnering for Health Equity event built on last year’s successful collaboration with Dartmouth Hitchcock.  The result was an outstanding, inspirational day. 

Dr. Jim Weinstein, DO, MS kicked off the morning with a far reaching talk that began with sharing his experience leading the committee for the National Academies of Sciences, Engineering, and Medicine to develop the Communities in Action: Pathways to Health Equity Report.  Dr. Weinstein spoke of the drivers that are pushing health care out of hospitals and into communities and homes.  He called for public health entities and other health sector organizations to build internal capacity to engage community partners and coalitions to address the social and economic determinants of health.   He made clear the importance of building trust to be successful in this work.   

The day featured 12 breakout sessions highlighting the amazing work of our colleagues from NH, VT and CT.  There were opportunities to learn new ideas and skills to broaden our impact for both the seasoned professionals and the students in attendance.  

The day concluded, thanks to our partnership with Dartmouth Hitchcock Medical Center and the Schumann Lecture, with a talk by Camara Jones, MD, MPH, PhD.  She shared her thoughts on the impacts of racism on the health and well-being of our nation through the telling of her own allegories.  If you missed her, definitely check out her Tedx Talk.  As the adage goes, “It may not be our responsibility to finish the work of perfecting the world, but we are not free to desist either.” Dr. Jones stressed the necessity of long-term commitment to this work to have impact.

This event could not have happened without such a dedicated and flexible planning team.  A special thank you to NHPHA leaders Neil Twitchell our Program Planning Committee Chair, Board Member Mary Ann Aldrich, our Interim Executive Director Joan Ascheim, and Beth D’Ovidio our Program Assistant.  And thank you to our planning partners from Dartmouth including, Sally Kraft, Karen Borgstrom, and Cathy Marrow, along with the VTPHA folks, Jessica French, Sally Kerschner, and Burt Wilcke. 

And a heartfelt thank you to our event sponsors for their commitment towards events like this that develop the public health workforce:  Dartmouth Hitchcock Medical Center, UVM Medical Center, New England Public Health Training Center, Delta Dental, Foundation for Healthy Communities, Community Health Institute/JSI, Vermont Department of Health, New Hampshire Charitable Foundation, New Hampshire Pediatric Society, Southern New Hampshire Area Health Education Center, Master of Public Health University of New Hampshire, HNH Foundation, Ammonoosuc Community Health Services, NH Coalition Against Domestic & Sexual Violence, NH Division of Public Health Services,  UNH Department of Health Management and Policy, Mid-State Health Center, NH Nurses Association, NAMI New Hampshire.

Happy Holidays,

Rebecca
(Written by Meghan Farrell, Communications Coordinator, New-Futures)

The Affordable Care Act (ACA) includes critical provisions that have been instrumental in keeping New Hampshire healthy, like prohibiting health insurance companies from refusing coverage, mandating individual health insurance coverage, and providing financial assistance to those who have difficulty affording health care. Potentially the most crucial benefit that New Hampshire gained from the ACA, though, was the state’s ability to expand Medicaid coverage to low-income adults.
Since New Hampshire expanded Medicaid in 2014, more than 120,000 low-income Granite Staters have been able to access the healthcare they need and deserve. Currently, more than 50,000 of our state’s most vulnerable citizens have access to critical healthcare, including substance use disorder treatment services, thanks to the New Hampshire Health Protection Program (NHHPP), New Hampshire’s version of Medicaid expansion.

There is no doubt that New Hampshire’s opioid epidemic is the number one public health issue we are currently facing as a state. The epidemic resulted in the loss of almost 500 lives in 2016 and has cost New Hampshire approximately $2.3 billion annually.

Experts agree that the NHHPP is among the state’s most critical tools in combatting our devastating opioid epidemic, since it includes one of the most robust substance use disorder benefit arrays in the country. Specifically, the NHHPP, which has been created and funded in New Hampshire only because of the ACA, allows substance use disorder treatment and recovery in two very important ways:
  • Increasing New Hampshire’s treatment capacity: The NHHPP has more than doubled our state’s treatment capacity, with more than 11,000 Granite Staters utilizing their NHHPP coverage to access addiction treatment. Before Medicaid Expansion, New Hampshire had a treatment capacity of only 4,000 – 6,000. Luckily, when the crisis reached its height, the state was able to provide services to twice as many individuals as just two years earlier, thanks to the ACA.
  • Allowing access to drug court programs: Drug court programs have proven to be incredibly effective in helping those with substance use disorders enter recovery. In order to participate, those seeking treatment must pay for their services or have insurance coverage that does. Without the NHHPP, a large percentage of drug court participants who are now working and in recovery would have been unable to get the supports they needed.
Advocates, experts, and lawmakers all agree that we need innovative solutions to the opioid epidemic, which is dramatically affecting children, families, and individuals in the Granite State at alarming levels. The NHHPP, and as a result the ACA, is one of New Hampshire’s most effective and innovative solutions to this public health crisis. As a state, we have come too far in our fight against addiction to turn back now.
Hello! What an exciting time to step into the role of President of NHPHA. Just around the corner on November 15th is the Team Up, Take Action Conference. This year we are collaborating with the Vermont Public Health Association and Dartmouth Hitchcock Medical Center to create a fabulous event focused on the theme of Partnering for Health Equity. Come to cultivate new ideas to advance health equity and network with colleagues within and across state boundaries. Bookending the impressive set of breakout session speakers will be keynotes James Weinstein, D.O., who chaired the Committee on Community-Based Solutions to Promote Health Equity in the United States for the National Academy of Sciences M.S., and Camara P. Jones, M.D., M.P.H., Ph.D., past APHA President and powerhouse speaker who shares simple allegories to grow understanding about the many layers and nuances of racism, societal inequities and the impact on our communities. Register now and get ready to be blown away.

The topic of advancing health equity is near and dear to the core of why I became a public health profession. Throughout my career I have sought opportunities to contribute towards creating physically, mentally, socially, environmentally and economically thriving communities. I truly believe as Paul Wellstone once said, “We all do better when we all do better.” I am passionate about the work of public health - research and action based on the science of what works.

Thank you for the warm welcome I have received to date in my new role as President. Katie Robert left an incredible legacy that deserves all our efforts to sustain and grow. I look forward to partnering with you to expand the impact of NHPHA on ourselves, our organizations, our profession, and the health of every New Hampshire resident.

-Rebecca
Mary Ann Aldrich, a NHPHA Board of Directors member received recognition from Pastoral Counseling Services (PCS) early this month along with three other individuals.

Over 200 people attended the PCS 22st Annual Good Samaritan Awards Dinner at the Manchester Country Club in Bedford, N.H. Over the past two decades, PCS has honored more than 125 individuals who have gone above and beyond in their community. This year’s event honored four individuals who were all nominated by their peers for the distinguished recognition of a Good Samaritan.

"The Good Samaritan Awards are an annual tradition to honor individuals who pursue extraordinary measures to strengthen communities and improve life in New Hampshire," said Dr. David Reynolds, PCS Executive Director. "Each honoree has a different story, different backgrounds, but they each have a common outlook on how to live their lives - and that's helping others. We are honored to come together and celebrate them."

We extend our congratulations to Mary Ann!



Photo Caption: L-R David Reynolds, D.Min., LPP, PCS Executive Director, Hon. John T. Broderick Jr., Change Direction & Dartmouth-Hitchcock, Susan A. Manchester, ESQ., Sheehan, Phinney Bass & Green, PA, Dan Forbes, Meelia Center, Saint Anselm College, Mary Ann Aldrich, RN, MS, Dartmouth-Hitchcock and Cal Genzel Ph.D. LP, PCS Director of Clinical Services
Following a series of failed attempts to repeal the Affordable Care Act, the bi-partisan Alexander- Murray proposal is an encouraging and important move in the right direction to maintain health care coverage for millions of Americans and tens of thousands of New Hampshire residents. The agreement would continue cost-sharing reductions (CSRs) through 2019. This means that insurers would continue to receive funds to lower flagACA 1deductibles and co-pays for lower-income consumers thus avoiding higher premiums or forcing insurers to leave the ACA marketplace. The latter would leave people with limited insurance options. Both New Hampshire Senators Shaheen and Hassan were co-authors of the bill with 10 other Democrats and 12 Republicans. They have both been ardent supporters of a collaborative approach to health care reform that continues to cover New Hampshire residents in need, that is affordable and sustainable, that continues to provide for those with pre-existing conditions and that covers preventive services.

The proposed agreement restores partial funding for outreach and education for consumers and enrollment assistance that has been cut by the US Department of Health and Human Services. Therefore, we as advocates for assuring the health of the public, need to get the word out to consumers relative to open enrollment.

The NH Department of Insurance has distributed a press release providing information on how New Hampshire residents can sign up for insurance for 2018. Open enrollment runs from November 1, 2017 to December 15, 2017 through the federally facilitated Health Insurance Marketplace (www.Healthcare.gov) Individuals who are currently covered through the federal Marketplace must go through the enrollment process again. There have been changes in insurers for 2018 so some people will need to choose a new health plan.

Help is Available

This process can be confusing and unwieldy. Fortunately, there is help for those trying to find their way through.

  • Health insurance assisters are available, free of charge, in communities throughout the state to answer any questions about health insurance and enrollment through the Bi-State Primary Care Association.
  • Those enrolled in the New Hampshire Health Protection Program will receive information from the New Hampshire Department of Health and Human Services about how to select a plan for 2018
  • If individuals are enrolled in the federal Marketplace for 2017, they will receive renewal information from their insurance company and the Marketplace
  • The NH Insurance Department website can help people find an enrollment assistant to walk through the how to use the Marketplace or a licensed agent who can help select a plan.
  • If people have questions in using the Marketplace and obtaining coverage they can call the federal government at (800)318-2596 Once they have coverage they can call the Insurance Department with questions or concerns at 1-800-852-3416 or contact outreach coordinator Eireann Apsell at 603-217-3781 or Eireann.aspell@ins.nh.gov
Marilyn Sullivan, Project Coordinator for Outreach and Enrollment at Bi-State Primary Care Association emphasizes, “The New Hampshire Health Insurance Marketplace is open for business. Consumers still have options for a valuable and important insurance product. People looking for insurance can call one of our assisters to help them through the process.”

Let’s keep New Hampshire residents insured and assure they have access to health care by letting consumers know about the enrollment dates and resources available to help.

Team Up, Take Action: Partnering for Health Equity
Breakout Session


Presenter: Donna Burkett, MD

This session will introduce attendees to the six new contraceptive National Quality Forum (NQF) quality measures, their history and development, and the response of the Reproductive Justice community to them. These NQF measures were developed to measure disparities in access to quality reproductive and perinatal care and in outcomes among different racial and ethnic groups as well as sociodemographic disparities. There is concern that the new NQF contraceptive care measures may be misused, thus impacting access to care.

The workshop will include an illustrative and practical discussion of how the measures are being used and might be used across New England. We will use Planned Parenthood of Northern New England’s internal practice and the Vermont Blueprint for Health’s Women’s Health Initiative as examples of regional use of the measures.

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Team Up, Take Action: Partnering for Health Equity
Breakout Session


Presenters: Matthew Houde, Vice President of Government Relations at Dartmouth-Hitchcock and Kevin C. Stone, Helms & Company

This session will include a comparison of the two states’ approaches, discussion of the direction they are taking, including the All-Payer Model in VT and scenarios with respect to Medicaid expansion reauthorization in NH, as well as implications for health of relevant populations.

Work in the mental health and substance use disorder arenas will also be discussed.

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Team Up, Take Action: Partnering for Health Equity
Breakout Session


Presenters: Kalyn Rosenberg; Jazmin Miranda, MAE, CHW; Jennifer Goulet, CHW; and Wanda Castillo, CHW

This session will highlight two exciting service delivery models that seek to improve health outcomes by addressing individual and systemic barriers to optimal health.

Vermont will describe its work with immigrant farmworkers as it relates to linguistic barriers, rural setting, financial challenges, work schedule conflicts, and health care policies. Utilizing a care coordination model carried out by regional Migrant Health Promoters, the program, Bridges to Health, empowers farmworkers to make timely health decisions. In addition to offering care coordination to migrant farmworkers in need of health care services, Bridges to Health creates capacity building opportunities for local health entities to implement linguistically and culturally appropriate services.

The New Hampshire panel will provide an overview of the Community Health Worker movement and discuss different service delivery models that incorporate CHWs in systems to improve the health of our communities. CHWs support community members by assisting with navigating the health care system, providing peer education, and addressing social determinants of health. CHW panelists will describe the setting in which they work, explain how they act as the bridge between the community and the health care system and provide insights into the opportunities and challenges they face in their day to day work.

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