Public Health Challenges in the Upper Valley: Insights and Policy Pathways

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Working Together for a Healthier Community

The Public Health Council of the Upper Valley (PHC) recently brought together local policymakers, public health leaders, and community advocates for its annual legislative event. This gathering is all about finding solutions to some of our region’s most pressing health challenges—and sparking collaboration to create lasting change. By sharing real-life stories and practical recommendations, PHC empowers leaders to make informed choices that improve lives in the Upper Valley.

Advocacy that Educates and Inspires

At PHC, we see ourselves as a bridge between communities and policymakers. While we don’t engage in lobbying, we focus on raising awareness, sharing resources, and equipping our Partners to advocate effectively. By hosting events like these and providing advocacy training, we aim to inspire action and create a shared understanding of what’s needed to improve public health. 

Highlights from this year’s event:

Homelessness: Our Community-Wide Challenge 
  • What we can do:
    • Remove penalties for camping or sleeping in vehicles
    • Expand access to legal support, low-barrier shelter, and affordable housing
    • Encourage policies that support recovery housing
  • What we heard: Angela Zhang from LISTEN highlighted that the real key to homelessness is affordable housing. She shared that about one-third of unhoused people are employed, another third rely on disability or retirement income, and the rest have no income at all. Unfortunately, the shortage of legal aid attorneys makes it even harder to fight wrongful evictions.
  • Takeaways for Legislators: Leaders left the session with ideas for innovative solutions—like moving from short-term fixes to sustainable housing initiatives. 
Strengthening our Nursing Workforce
  • What we can do: 
    • Waive renewal fees for retired nurses who return to work part-time.
    • Promote easier licensing between New Hampshire and Vermont.
  • What we heard: With more older adults needing care at home, community nursing is critical. Many nurses filling these gaps are retired professionals who work part-time. But renewal fees can discourage them from returning. Alice Ely, PHC’s Executive Director, stressed how important it is to reduce these barriers to keep skilled nurses in the field.
  • Takeaways for Legislators: Policymakers were encouraged to explore policy changes that could make a big difference in strengthening our workforce and supporting vulnerable populations.
Hidden Risks of Vaping Devices
  • What we can do:
    • Develop statewide programs for safe disposal of vaping devices.
    • Expand hazardous waste policies to include these items.
    • Invest in education campaigns about vaping dangers.
  • What we heard: Andrea Smith from Dartmouth Hitchcock shed light on a growing problem: the chemicals and batteries in vaping devices pose health and environmental risks. Schools confiscate many devices but struggle with how to dispose of them safely. Vermont’s recent legislation requiring manufacturers to cover disposal costs offers a promising model.
  • Takeaways for Legislators: Policymakers were urged to take a closer look at disposal solutions and education efforts to tackle vaping’s hidden dangers.
Other Public Health Priorities
  • Expanding treatment and recovery options for substance misuse.
  • Improving dental care access for Medicaid patients.
  • Enhancing behavioral health services for children.
  • Supporting policies for universal school meals and more outdoor playtime.

The Power of Collaboration 

The feedback from this year’s event was overwhelmingly positive. Attendees appreciated the practical ideas, stories, and data shared. Looking ahead, PHC will continue to provide legislators with resources and policy briefs, ensuring they have the tools they need to create meaningful change. Together, we can tackle the challenges facing the Upper Valley and make it a healthier, more equitable place for everyone.

Let’s Keep the Momentum Going 

PHC’s annual legislative event is a reminder of what we can achieve when we come together. By focusing on solutions that work and sharing knowledge, we’re building a brighter future for our communities. To read the full report, you can find it at: PHC Bi-State Legislative Event Report Dec 2024.

— Written by Vismaya Gopalan, ’82 UVCI Fellow to the PHC, Dartmouth College

Awards and New Members at PHC Annual Meeting 2024

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On November 15, 2024, the Public Health Council of the Upper Valley (PHC) Board of Directors held their annual meeting at Hypertherm with 54 community members and public health advocates in attendance.

During the business portion of the meeting, Bise Wood Saint Eugene, of Lebanon, was elected to serve a 3-year term on the Board. Suellen Griffin was elected to serve as Board Chair for 2025, taking the reins from W. Brett Mayfield, who steps aside after 2 years in the role.

2024 Public Health Hall of Fame Awards

Each year, the PHC Board of Directors also solicits nominations for our Public Health Hall of Fame Award. This year, we celebrated the noteworthy work of two Upper Valley institutions: Community Nurse Connections and the Upper Valley Medical Reserve Corp.

Board Chair Brett Mayfield presents Kristin Barnum with the award as CNC Board Members, Laurie Harding and Don Kollisch, look on.

Community Nurse Connections: Under the capable leadership of Kristin Barnum, CNC advocates for and supports a growing network of Community Nurses who care for people, especially older adults, who struggle to live on their own, and who are not accessing needed services. Kristin plays a critical role in guiding communities interested in Community Nursing and collaborating with health care organizations to help them understand the role of the nurse. CNC also helps sustain Community Nursing through a robust documentation system and structured mutual support for Community Nurses. CNC understands vulnerable people are falling through the cracks of our health care system and works tirelessly to fill the need.

Misha McNabb, MRC Unit Leader from the Vermont Department of Health — WRJ District, accepts the Public Health Hall of Fame Award from Brett Mayfield, PHC Board Chair and UVMRC Member.

Upper Valley Medical Reserve Corps: The award was given in recognition of our region’s MRC Unit 1776, formed in 2008, which includes more than 150 medical and non-medical volunteers. This rare bistate MRC Unit is led by coordinators from the Vermont Department of Health – Springfield, Vermont Department of Health – WRJ, and Dartmouth Hitchcock Medical Center Population Health. From Tropical Storm Irene to the COVID-19 pandemic to recent flooding events, the UV MRC has supported regional emergency response capacity. The unit also promotes community health through event support at vaccination clinics, road races, fairs, and training such as Stop the Bleed, Be Bright at Night, and Narcan administration education. In these activities, the UV MRC builds resilience in our communities to buffer the effects of the health threats we all face.

A Regional Vision for Public Health

The meeting included a panel presentation exploring ways to build a more regional approach to public health. Panelists included Shaun Mulholland, Lebanon City Manager; Leigh Hayes, Chief Building Official and Health Officer, City of Lebanon; Heather Rigney, Emergency Preparedness Coordinator/Medical Reserve Corps Statewide Coordinator, Vermont Department of Health; Elizabeth Austin, Executive Director, Good Neighbor Health Clinic/Red Logan Dental Clinic; and Alice Ely, Public Health Council.

PHC is our region’s trusted leader in public health, supporting the people, professionals, and organizations who, together, make our communities healthier places to live, work, and play. Our mission is to improve the health of all Upper Valley residents.

2025 Schedule of Meetings Begins January 17

The next meeting of the Public Health Council is Friday, January 17, 2025, from 9:00 to 11:00 am. The meeting will be virtual. The agenda and login information can be found on the PHC website at www.uvpublichealth.org. All meetings are open to the public.

Cross-Class Collaboration for Action on Poverty and Inequity

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Cross Class Training in Lebanon, November 2023

There are so many important conversations happening about poverty and inequality in the Upper Valley, but how often do we get to have them as peers in an intentionally cross-class space?

Over the past two years, a group of partners has introduced Cross-Class Collaboration for Action on Poverty and Inequity as a training program for building collaboration across differences of status, power, class, race, and more. The program includes at least one day-long training each year. We also support people who are interested in facilitating deeper conversation about the roots of inequities with additional training and guidance as they host small group discussions in their communities.

Cross Class Collaboration Partners

This Cross Class Collaboration Program is supported by Dartmouth Health, LISTEN Community Services, Public Health Council of the Upper Valley, the Upper Valley Haven, Vital Communities, and Willing Hands.

Building a Stronger Upper Valley

This program is for people who are involved in health and human services – as professionals, direct service providers, peer leaders, community leaders, and program participants.  The goal is to collaborate effectively with each other, across differences of status, power, class, race, and more, to take effective action within their roles to alleviate poverty and inequity. 

Often those who are most impacted by a problem have the best insight into how to address it, but just as often, those people are not at the decision-making table. It is crucial that we can come together across differences to benefit from all the perspectives, wisdom, skills and resources in our communities, in ways that leave everyone feeling respected, appreciated, and connected. 

As I do more and more work with people in our communities who have experienced health inequities and want to be able to live their best lives here in the Upper Valley, I am convinced this training is the logical next step to help us address the individual and systemic barriers that currently exist.

Next Training on December 9, 2024

That’s why we are inviting you to our Cross-Class Collaboration for Action on Poverty and Inequity, a day-long conversation on these conversations, so that we can build collaboration across differences of status, power, class, race, and more. We invite community organizers, peer leaders, service providers, nonprofit leaders, and anyone who is interested in taking action on poverty and inequality to join us!

In this day-long training, we will build a shared understanding together of how poverty and inequality work at individual, community and systemic levels – not only how people act and why, but also how community patterns, organizational policies, and government structures can constrain choices and keep inequalities in place. We’ll explore tools for addressing inequality in all our different roles in the community, and for collaborating to have a positive impact greater than we could have separately.

Monday, December 9, 9 am to 4 pm
Hypertherm, 71 Heater Road, Lebanon, NH
Free to Attend, Lunch Provided

Registering

Register Here 
Registration Deadline: November 27 (all applications after 11/27 will be put on a waiting list)

  • For larger organizations, we invite you to sign up a team of 3-4 folks (ideally 1-2 front line/peer leaders, 1 direct service provider, 1 senior leadership). For others, we welcome you as single participants.
  • Even if you cannot make this date, you can still fill out the registration link to be put on the waitlist for a future training date!

Working to Get the Lead Out of our Kids!

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The Greater Upper Valley Integrated Services Team (GUVIST) has recently convened a Lead Poisoning Prevention Network to explore ways to reduce the risk of lead poisoning in the Upper Valley.  Membership includes representatives from the Public Health Council of the Upper Valley, the Vermont Department of Health (VDH), The Vermont and New Hampshire WIC Programs, Little Rivers Health Care, Gifford Health Care, the NH Lead Prevention Program, Vermont’s Healthy Homes Program, and the Vermont Child Health Improvement Program (VCHIP). 

Lead Exposure is Dangerous at Any Level

Lead is a dangerous metal, especially when ingested by children, and there is no safe level of lead in the body.  Though lead paint was banned in 1978, the most common childhood exposure to lead in the United States remains from old peeling paint, paint dust, and contaminated soil, since toddlers are quick to put objects in their mouths.  Occasionally, lead is detected in imported foods and children’s toys, like in a recent scare regarding lead found in some cinnamon products.  Lead can also contaminate drinking water through plumbing systems containing lead pipes, solders, and fittings. 

Children aged 1 and 2 years old are required to be tested for lead by both Vermont and New Hampshire law.  Testing can be by a finger prick for blood or drawing blood from a vein.  

Too Many Children Go Untested

2022 data from the Vermont Department of Health for the 22 towns of the White River Junction District revealed a concerning 29% of children tested positive for some amount of lead in their blood.  Nearly 1 in 13 Upper Valley children have lead levels high enough (over 3.5 micrograms per deciliter) for VDH to offer home visits to families to investigate for sources of lead. Still, about 1 in 8 of our region’s 1- and 2-year-olds (more than 70 children) remain untested for lead.

Lead poisoning can have serious consequences for health.  Very high levels can severely damage the brain causing coma, convulsions, and even death.  In 2000, a two-year old child in Manchester, NH died from exposure to peeling paint from her apartment’s porch.  Lower levels of lead can permanently affect children’s brain development, resulting in lower IQ scores, learning problems, short attention spans, behavior problems, and poor school performance.  Lead exposure during pregnancy can cross from mother to the developing baby and cause reduced fetal growth and premature birth.

How We Prevent the Harms of Lead Poisoning

Early actions of the Lead Poisoning Prevention Network included a summer college intern from the University of Vermont working with area medical practices to optimize lead testing and result reporting.

There is treatment for severe lead poisoning called chelation therapy using medications that bind the lead so it can be excreted from the body, though the damage to the brain and vital organs is not reparable.  There are also some simple precautions our community can take to help protect from lead exposure before harm is done.

This includes efforts like: 

  • ensuring parents and medical providers overcome barriers to testing all children at age 1 and 2 
  • removing lead-containing items from the home, including lead paint, which requires specialized certification and equipment
  • painting over old paint and installing plastic bite-guards to windowsills to help keep lead away from toddlers 
  • removing lead from drinking water – several years ago, the Vermont Department of Health assisted schools and childcare facilities to test drinking water sources and replace faucets or plumbing if these were found to be sources of contamination 
  • supporting federal and state policies which help ban lead in common products such as paint, gasoline, ammunition, wheel weights, and fishing weights, and improve workplace safety for workers who work with lead
Taking the Next Steps

In the coming months, the GUVIST Lead Poisoning Prevention Network will take a multifaceted approach to strengthen prevention efforts across the border: streamlining communication between clinics and state registries for accurate reporting, expanding our network to partners with wide reaches such as town leaders and schools, lowering barriers to testing so parents can make well informed decisions for their child, and supporting providers with best practices around lead testing. All of these efforts will continue to increase testing rates, raise awareness of the importance of lead testing, and explore ways for communities to make the home environment safer. With a collective approach to lead poisoning prevention, our partners will make an impact in getting the lead out of our kids.

Understanding Recovery and Substance Use Disorder Better

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Would having a better understanding of how the recovery process works for people with substance misuse disorders make you more supportive of the services they need? Are you open to learning a new way to think about addiction and what people need for recovery?

As an intern for the Public Health Council, Hattie Kahl conducted an assessment to explore the need for more recovery housing in the Upper Valley of New Hampshire and Vermont.  According to Hattie’s research, the Upper Valley offers numerous substance misuse treatment options and supportive services; however, housing that supports an abstinent lifestyle is hard to find – or afford.

Recovery Housing Report

You can review Hattie’s full report here: Upper Valley Recovery Housing Assessment 2024. Read on for a few summary bits of information she pulled together that give us insight into both the recovery process and the addictive process.

Recovery Capital

Recovery Capital describes a set of resources necessary to sustain recovery (Best and Laudet). Chances of sustained sobriety increase as one’s recovery capital increases. The growth of personal recovery capital has ripple effects for families, others in recovery, and the community.

  • Physical capital is defined as assets, like money or housing, that may increase recovery potential – for example, being able to live away from friends who engage in substance misuse or affording residential treatment.
  • Social capital is the resources from personal relationships, such as family or support groups.
  • Human capital is skills, good physical health, positive outlook, etc.
  • Cultural capital includes “values, beliefs, and attitudes” that move a person away from the social conformity of drug culture and toward societal behaviors.
Protective Factors for Recovery

Self-efficacy: The belief that someone can perform the behaviors needed to achieve a specific goal. It’s a measure of how confident someone is in their ability to control their motivation, behavior, and social environment.

  • Steady and stable post-treatment employment and an employer who supports one’s recovery.
  • Living in an environment like a recovery residence and having peer support.
  • Maintaining a good and stable relationship with family and friends who are not in recovery (Alemi et al, 2009).

For more information please review Hattie’s supplementary report: Predictors of Substance Misuse Recovery and Relapse: A Literature Review.