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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Team Up, Take Action: Partnering for Health Equity

Breakout Session

Presenters: Terry Johnson, Foundation for Healthy Communities; Dan Quinlan, Vermont Climate and Health Alliance; Rob Werner, NH League of Conservation Voters

The impacts of climate change are increasingly evident. Vulnerable and underrepresented communities are at particular risk, with health equity and social justice implications that must be considered within public policy. Many of these same communities lack safe, complete sidewalks or bike paths, and convenient access to transit, making walking and biking difficult.

The session will review community engagement efforts to address climate change adaptation planning, transportation system planning, and developing public policy actions at the state and local level that decrease inequities.

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Team Up, Take Action: Partnering for Health Equity

Breakout Session

Presenters: Greg Crowley and Alice Ely

In this workshop attendees will be presented a tool for convening and facilitating a conversation with members of your community on how to collaborate to achieve health equity. This tool is inspired by the Health Equity Lab of Reos Partners, funded by the Robert Wood Johnson Foundation. The Lab seeks to give momentum to a nationwide movement to create the conditions in which everyone has equal opportunity to achieve optimal health and well-being. The workshop utilizes a peer learning approach to help you gain insight into how you can think and act differently in order to successfully address health equity in your community.

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

Presenters: Mary Evanofski, MPH, MHCDS and Sally Kraft, MD, MPH

In this workshop, participants will learn how to collect and analyze data to inform local improvement projects and implementation of interventions. Participants will consider the strengths and limitations of data that is used to inform improvement work and will apply that knowledge to create a data collection plan. Participants will explore the association between variation and equity and how variation can signal opportunities for improvement.

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Team Up, Take Action: Partnering for Health Equity

Breakout Session

Presenters: Trinidad Tellez, M.D., Director, NH Office of Health Equity and Amy Parece-Grogan, M.Ed., Cultural and Linguistic Competence Coordinator, NH Office of Health Equity

Culturally effective organizations enable, cultivate, and support the delivery of high-quality care and services for all people. This session will review disparities data and recognize that changes in policies and procedures are needed to improve equity in access, use andoutcomes across social determinant of health domains. The session will explore the elements of a culturally effective organization and discuss helpful strategies and resources for implementing them.

Participants will explore enhancements to their organization’s policies and procedures, and consider how to operationalize the various evidence-informed elements of a culturally effective organization for systems improvement resulting inenhanced care and services for all.

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Rare and Beneficial Opportunity for Students

Students will have the unique opportunity to interact with Camara Jones, M.D., M.P.H., PhD  They will be able to meet Dr. Jones in a small group setting; and will have the chance to ask questions and share thoughts with Dr. Jones, a renowned subject expert regarding matters pertaining to all aspects of health equity. Dr. Jones is the immediate past president of the American Public Health Association.

Click here to download a full-sized flyer to share with your colleagues and peers.

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Closed POD Drill resizedSullivan County Health Care and the Greater Sullivan County Public Health Network recently conducted a public health emergency preparedness drill. The drill, which took place at the Sullivan County Unity complex on September 13-14, 2017, simulated a large-scale influenza outbreak creating a need for Sullivan County, which serves as a closed Point of Dispensing (POD), to open and provide medication to their residents and essential personnel.

Public health emergencies can result from various hazards including natural disasters like hurricanes and tornados, disease outbreaks like pandemic flu, and deliberate acts such as aerosolized release of anthrax. If a public health emergency did occur, residents in the Greater Sullivan County region would be directed to an open POD to receive medication. “When looking at the geography of this region and taking into account the logistics of providing lifesaving medications to upwards of 47,000 people through one or two open POD locations, it became clear we needed to look at more options,” said Kirsten Vigneault, Director of Community Health Preparedness.

Closed PODs are not open to the community members at large; instead, they serve a specific type of place/person. Agencies that choose to become closed PODs benefit the community by decreasing the number of people accessing designated open POD locations, and helping the region dispense medication more rapidly. Sullivan County employs about 300 people, cares for 156 residents in the Sullivan County Nursing Home, and 155 inmates at the Department of Corrections. Including employees’ immediate family members, Sullivan County could provide medications to over 1,000 people and is currently the only closed POD in the region.

“It was a pleasure to work with Kirsten from the Greater Sullivan County Public Health Network as well as Golden Cross Ambulance Service and many of our SCHC staff during this emergency preparedness drill,” said Patti Henderson, Director of Nursing for Sullivan County Health Care. “It is comforting to know we have a plan in place for our residents, inmates, employees, and their families should there be a medical emergency requiring mass dispensing of medications or vaccines.”

The Greater Sullivan County Public Health Network appreciates the time and efforts of Sullivan County Health Care as well as Golden Cross Ambulance who also participated in the emergency preparedness drill. “This exercise is an excellent example of how the County works with its partners to support the people of Sullivan County,” said Derek Ferland, Manager for Sullivan County. “By utilizing the County’s Unity complex as a closed dispensing point, we could provide lifesaving medications to our staff, their family members, residents, and inmates without interfering with normal operations or patient care.”

The Greater Sullivan County Public Health Network is an affiliate of Dartmouth-Hitchcock and serves as a system of organizations and individuals that work together to identify and address public health challenges in the region. The network is made up of educational institutions, community organizations, healthcare systems, first responders, law enforcement, government agencies, businesses, and volunteers dedicated to improving the health and wellbeing of our community. You can follow the Network on Twitter and Facebook at @GSCPHN.
Friends and colleagues,

For the last two and half years, I have had the great pleasure of working with and learning from so many dedicated and passionate public health professionals through my NHPHA work. As of October 1, I am pleased to pass the proverbial Board Chair baton to Rebecca Sky, Project Director at the Foundation for Healthy Communities.

As I reflect upon my time serving NHPHA and our members, a few memories notable memories come to mind, as does the recognition of personal growth - in particular, a deepened understanding and internalization of the multi-faceted equity issues facing our nation today.

In 2015, NHPHA celebrated its 20th anniversary in a joint celebration with the Community Health Institute JSI. We celebrated our colleagues in the field with poster sessions and Ignite-style presentations at the Red River Theater. And in 2016, our policy efforts contributed to the continued funding for Medicaid Expansion, protecting the health of tens of thousands of NH residents, and ultimately the continued vibrancy of our economy.

Last year, we also shared a collective gasp of concern when an incredible shift in national politics shook the ground beneath us, potentially threatening the public health, climate, and social justice advances of the previous eight years. From that perceived political rubble rose a powerful, unified voice speaking on behalf of our neighbors who face inequitable barriers to health, social, and economic prosperity for any number of reasons.

That collective voice was never louder than at the NH Women’s Day of Action and Unity rally on January 21, attended by more than 5,000 people in Concord and many more around the world. I had the incredible honor to speak on behalf of public health and climate, and what I remember being most proud of was seeing my NHPHA colleagues in the crowd, carrying an NHPHA banner and a multitude of posters, adding our message to the developing narrative. As the underlying injustices and systemic inequities built into our country’s fabric continue to be brought to light and are more widely understood, I hope NHPHA continues to promote the health equity message and impact real change at all levels of government, and across all sectors.

I realize what has made these particular memories so meaningful is the sense of community and common purpose that we all share – to make sure that everyone has equitable opportunities to achieve their best health and best lives. And I strongly believe that NHPHA is in a better position than ever to contribute to that purpose, by supporting and enhancing all the public health work and continuing our promotion of sound public health policy.

As I close this final President’s Message, I think back to a recent conversation with a colleague for whom I have great respect. We were discussing what inspires us to volunteer for various purposes, and recognizing the privileges in our lives that allow us to do so. This colleague shared a motto passed down by a parent, likened to a certain athletic brand’s slogan – “Just do it.” I have had great privilege in my life affording me the opportunity to “just do it”. At the risk of sounding like an award ceremony speech, I must thank my husband, my children, the NHPHA Board of Directors, and my incredibly supportive employer, JSI for giving me space to serve and grow and support the public health field and our constituents.

Thank you, for this space and this time.

Be well,
Submitted by Adelaide Murray, Project Associate, Community Health Institute/JSI

My name is Sabryna Therrien, and I am a senior at Rivier University in Nashua, New Hampshire studying public health, and minoring in biology. I have always been passionate about investing my time in the needs of others, and how I could help them better, which is what prompted me to major in public health my sophomore year. Studying public health at Rivier has taught me how vast the public health field is, and what people like me can do to make our communities healthier.
Since taking a collection of classes at Rivier that ranged from Food Safety and Hygiene to Epidemiology, I soon found myself interested in Public Health Research and Health Promotion, Marketing, and Communication. During those classes I invested my studies in researching maternal health care initiatives in refugee camps due to recent international multimedia events in 2016. Karyn Madore, Operations and Communications Director at
JSI Research & Training Institute, heard that I was interested in Maternal and Child Health, through her class at Rivier, and invited me to intern with her at JSI and CHI in Bow, New Hampshire. This opportunity has landed me a yearlong internship until I graduate in the spring, working on Multimedia Services for a Maternal and Child Health Program called Healthy Families America. So far I have researched and worked on a literature review for our team to analyze and determine better ways of retaining and configuring the Healthy Families America Program. Overall this internship has taught me the importance of group work and diligent research, and I am elated to see what my next steps will be through this internship.
After many years of service, NHPHA Bookkeeper Ginger Fraser has moved on. Ginger graciously worked with her replacement to make the transition as smooth as possible. We are grateful to Ginger for her many contributions to the success of our organization and wish her the very best in her new endeavors.

Now, we would like to introduce you to our new bookkeeper - Liz Durant.

"My name is Liz Durant and I am excited to be working with NHPHA. As an entrepreneur with excellent mission-driven business and leadership skills in both non-profit and for-profit organizations, I split my time between several Liz Durantventures.

My background is in finance and accounting and for the last 5 years, I was the Business Manager at Red River Theatres. As a strong leader with “outside the box” creativity to identify challenges and offer solutions, I loved the opportunity to connect with members, donors and other community members regularly. I am looking forward to meeting many of you in the coming months!

My alter ego is as the owner of Well Balanced, a fitness and nutrition coaching business. I am passionate about working with clients in an individual and group setting - by providing guidance and expertise, I can work with them to create an action plan to successfully achieve their goals. I teach classes in several places in the Concord area and do personal training in person and online.

In addition, I am currently serving in my 10th year on the Hopkinton School Board, this year as the Chair.

This month we became members of the empty nest club - our children, Maddie (Franklin & Marshall - 2012) is currently living and working in Austin, TX; Hannah (St. Lawrence University-2016) works at Boston Children's Hospital; and Justin (RIT) was just dropped off for his freshman year. My husband, Jud, works for DHL Logistics and currently commutes to Ohio, leaving me with three cats, five chickens and fish...."
The Coalition is proud to announce that we were selected to host a John G. Winant Fellow for the 2017 summer session. The Fellowship honors former NH Governor and U.S. Ambassador to Great Britain John G. Winant. Please see Mr. Panesar’s introduction below.

Sameer Panesar resizedHi! My name is Sameer Panesar and I am very excited to be an intern for the New Hampshire Oral Health Coalition. My work is being supported by the University of New Hampshire’s Carsey School of Public Policy through the John G. Winant Fellowship. The Fellowship aims to “encourage the professional development of undergraduates with a strong commitment to public service.” As such, I am appreciative of the work that the OHC has done and inspired to improve oral health care access and delivery for citizens of our state. I am honored to contribute to this work and mission as a 2017 Winant Fellow.

A little bit about me - I grew up in northern Maine but currently live in the seacoast region of New Hampshire. I went to high school here and graduated from UNH this past May with a BA in Political Science. While in college, I had the opportunity to work for the Institute for Health Policy and Practice on a variety of research projects spanning multiple focal areas. The one that has the greatest relation to oral health care was a project entitled “Identifying Priorities for and Strategies to Optimize Oral Preventive Service Delivery in Pediatric Primary Care Settings in New Hampshire.” The focus of the project was to assess the current status and barriers and facilitators to the delivery of oral preventive services (including fluoride varnish) in pediatric primary care practices in New Hampshire, with a particular focus on children under six years. Additionally, the project aimed to identify strategies to optimize the delivery of oral preventive services in pediatric primary care settings.

I am interested in oral health care as well as its place in the broader American health care delivery system. The broad and systemic challenges and opportunities facing our health care system fascinate me and I hope to contribute to solving these problems as a future health care professional. Of great interest to me is the aging of the U.S. population and how that will affect the prioritization and distribution of future resources. At OHC, I am focusing my work on the status of oral health care delivery to the senior/elderly population in New Hampshire. I think that oral health is an often overlooked area of care delivery for seniors and I hope to leave the OHC (and all stakeholders) with a white paper and various briefs on what the current status is like and challenges and opportunities moving forward to improve such care delivery - and also review models that are currently being implemented throughout the state. This work should leave the OHC and stakeholders with a current overview of the state of oral health care delivery and recommendations, challenges, and opportunities moving forward.
I, like you I am certain, watched in horror as the violence and hate erupted during the white nationalist rally in Charlottesville this month. I had a visceral reaction to the images as they unfolded on the screen; first because it was so terrifying and repulsive to witness the level of hate expressed by the white nationalists and secondly because I attended the University of Virginian and it hit too close to home. Charlottesville is a bucolic, architecturally beautiful city situated in the foothills of the Blue Ridge Mountains. It is steeped in tradition, academic excellence and the influences of Thomas Jefferson – who admittedly is not beyond controversy. But seeing this happen in Charlottesville made it clear, this type of expression of racism could happen anywhere. It leaves us with so many questions about how we find ourselves in this place, right now in this country and what we can do to confront the overwhelming issue of racism.

In a recent article in CNN (August 15, 2017) several health organizations (the American Academy of Family Physicians, the American Psychological Association and the American Public Health Association) were noted to acknowledge racism as a public health issue. It was reported that multiple studies suggest that the risk for health issues such as depression, hypertension, heart disease and death can be increased for individuals experiencing racism or discrimination.

But what can we do about racism? The American Public Health Association campaign against racism suggests three approaches to address racism.

  1. Put racism on the agenda. Name racism as a force determining the social determinants of health.
  2. Ask “How is racism operating here?” Identify how racism drives past and current policies, practices, norms and values that create the inequitable conditions in which we are born, grow, live, learn and age.
  3. Organize and strategize to act. Promote and facilitate conversation, research and intervention to address racism and its negative impact on the health of our nation.

Having recently revisited its values, NHPHA pledges to become a part of the solution in New Hampshire. Our pertinent revised values are:

Equity- We believe in fair and just opportunities that will allow people to achieve their full health potential
Community – We believe that everyone has a right to live, work and play in healthy and safe communities that foster well-being and prosperity
Collaboration – We mobilize partners for collective action to advance the public’s health

We have the opportunity to participate in this conversation with two upcoming events in New Hampshire. First is the Inaugural Symposium on Race and Equity: Building Foundations for the Future sponsored by the Endowment for Health. The symposium is currently at capacity due to the tremendous interest but is seeking to increase that capacity to accommodate interested participants. Secondly, NHPHA is holding its annual fall forum on November 15, 2017 and will focus on strategies to advance health equity in the state. A save the date can be found in our August newsletter.

In a recent interview on NPR, Brittany Packnett, educator and activist provides some guidance and encouragement for taking on something as massive as racism. “Get in community with other people. It might be a book group. It might be you and your neighbors. It might be members of your family. But get together and figure out how you're going to work on this together.” Packnett goes on to talk about the importance of awareness first. “Educate yourself as to the fact that racism is not only real but that it's more than extremes like the KKK or even the individual, everyday slights. There are tools like Peggy McIntosh's "Unpacking The Invisible Knapsack" that gives you 50 ways in which white privilege can manifest in your life.” Packnett notes that we can confront racism when it pops up in many ways, “It's about making sure that when you see a colleague of color being spoken over, that you acknowledge that in the moment…. It means …. checking yourself when you see a black man walking down the street and you decide to cross it. Having the dialogue within yourself to say, why did I have that reaction, and how can I hold myself accountable to my own biases and disrupting those? …We need to make covert forms of racism as socially unacceptable as what we saw in Charlottesville.”

We at NHPHA look forward to working with our partners to have these difficult conversations and taking action to confront racism in New Hampshire.

Written by Joan Ascheim, Interim Executive Director NHPHA
Dear Governor Sununu: 

We are writing on behalf of the board and membership of the New Hampshire Public Health Association, a trusted voice that has worked to promote and protect the health of the people of New Hampshire for the last 25 years. 

We are asking that you join with your fellow governors, both Democratic and Republican, who are calling for a bipartisan Senate approach on healthcare reform to preserve critical health benefits for millions of Americans. All of the governors who have signed a letter urging this collaboration are from states like, New Hampshire, that have expanded Medicaid under the Affordable Care Act. The Republican bill in both chambers will phase out federal funding for that expansion.
As you well know, nearly 190,000 individuals have enrolled in Medicaid and the Children's Health Insurance Program as of March 2107 and thus have had access to essential preventive and acute care health services. 

We are most concerned about the following in the Senate version of the American Health Care Act:
  • With the phasing out of Medicaid Expansion, the loss of health care coverage for NH adults and children and their inability to access essential health benefits such as maternity care, mental health and substance abuse disorder services and prescription drug coverage.
  • The loss of these services would hamper New Hampshire's ability to assist individuals to receive behavioral health services and address some of the root causes leading to the state's growing opioid epidemic.
  • The blocking of Medicaid reimbursement to Planned Parenthood, which provides quality reproductive health services for both men and women. This will result in less access to care and potentially more unintended births and increased spending for the Medicaid program. 
  • The maintenance of the Prevention and Public Health Fund for state and local prevention activities that has brought over $23.3 million to New Hampshire since 2010 for programs to: reduce tobacco use; address childhood lead poisoning; prevent falls among the elderly; reduce health disparities; prevent diabetes, heart disease and obesity; respond to disease outbreaks and improve access to vaccines. These are critical prevention funds for New Hampshire that allow the state flexibility to address its most pressing public health needs. The loss of these prevention funds would be devastating and potentially lead to higher health care costs.

New Hampshire is projected to see Medicaid costs that are $111,316,000 over their projected federal funding cap as proposed in the House passed AHCA. We urge you to consider joining your colleagues to assure a bi-partisan approach to assure that all Americans continue to receive critical health benefits and can lead healthy, productive lives.

Sincerely,Katie Robert, President NH Public Health Association
Joan Ascheim, Executive Director NH Public Health Association
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