Upper Valley Sees Health Concerns in Broad Terms

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Over the past decade, public health and health care professionals have recognized that health care services only account for a small portion (10 to 20%) of a person’s health status. The rest of one’s health status can be attributed to social and economic factors, the physical environment, and health behaviors. These drivers of health are known as the Social Determinants of Health.

Improving community health is at the core of the mission of the Public Health Council of the Upper Valley. Most of our partners share this goal, but contribute in different ways to reaching that goal. Some partners are health care providers, some provide treatment for substance use disorders or mental illnesses, others support people in our communities who struggle with various social determinants of health.

Every three years, the Public Health Council works with area hospitals to conduct a routine community health needs assessment. These assessments form the basis for updating priorities and give us insight into what concerns community members. Over the course of 2021, the Public Health Council supported data collection efforts led by Dartmouth-Hitchcock, Alice Peck Day Memorial Hospital, VNHVNA, and Mount Ascutney Hospital and Health Center. Each health care organization uses the results to create Community Health Improvement Plans for their organizations. The Public Health Council will work with many partners across the region to generate a Community Health Improvement plan that reflects to great work ongoing in our region, leverage our strengths, and challenge our partners to find and fill gaps together.

Community Health Needs Assessments Available Online

To review the most recent Community Health Needs Assessments and related documents by hospital service area or organization:

The Upper Valley Community Health Needs Assessment generated for the Dartmouth-Hitchcock Alice Peck Day primary hospital service areas covers 19 municipalities in Vermont and New Hampshire, with a total resident population of 69,612 people.  Data came from over 1,600 survey responses from community residents; a direct email survey of key stakeholders and community leaders; a set of community discussion groups; and a review of available demographics and health status indicators.  The New Hampshire Community Health Institute conducted the survey, data analysis, and report generation. Throughout the process, they were careful to focus on vulnerable and disproportionately served populations in the region.

Taking It Back to the Community

Beginning in February 2022, the Public Health Council worked with partners at Dartmouth-Hitchcock, Alice Peck Day Memorial Hospital, Visiting Nurse and Hospice for VT to share the results with members of our communities.  We co-hosted two virtual Community Health Improvement Summits open to all community residents. Our health care partners reviewed the priorities emerging from the recent results. Participants shared their thoughts about what the results tell us, what opportunities we have to address them, and what strategies we might help.

The top six priorities emerging from the results are:

  1. Availability of Mental Health Services
  2. Cost of Health Care Services (Including Dental Care)
  3. Access to Affordable and Nutritious Food
  4. Substance Misuse Prevention and Treatment
  5. Child Wellbeing
  6. Social Determinants of Health (Especially Housing)

The input we received from the two summits, attended by over 125 people, can be found in a report dated April 13, 2022: FY22 CHNA Summit Theme Report.

Recordings of the virtual Summits are available online:

Recording Link: UV Community Health Improvement Summit #1
Date: Feb 23, 2022 08:42 AM Eastern Time (US and Canada)

Recording Link: UV Community Health Improvement Summit #2
Date: Mar 2, 2022 05:14 PM Eastern Time (US and Canada)

Shaping a Plan for Our Communities

For the remainder of 2022, the Public Health Council and partners will work together to create a Community Health Improvement Plan. The Plan will address the priorities by laying out what success would look like and how we can achieve it.

For more information about the community health improvement planning process or ways you can participate, please contact Alice Ely at the Public Health Council.

2021 Community Flu Vaccines Available

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Each fall, partner organizations across the Upper Valley come together to provide seasonal flu vaccine to our community members. This year is no exception.

While the COVID-19 pandemic continues to impact our communities, protecting people from seasonal flu illness is more important than ever. We want to keep people who are medically vulnerable out of health care settings as much as possible. It can also be hard to tell the difference between flu symptoms and COVID-19 symptoms, so the less flu in our community the better.

There are numerous options for vaccination. Please use the information below to find the right vaccine option for you and your family.

This list DOES NOT include school-based seasonal flu vaccine clinics offered in many of our New Hampshire schools. This is because these clinics are reserved only for students of those schools. If your child has the opportunity to get a vaccine in one of these school-based clinics, we encourage you to sign them up.

Public Health Council & Dartmouth Hitchcock Hosts Series of Community Flu Clinics

Starting on Saturday, October 2, the Public Health Council, Dartmouth-Hitchcock, Geisel School of Medicine and other partners will host free seasonal flu vaccine clinics in communities around our region. Clinic details are below:

Saturday, October 2
10 am to 1 pm
Plainfield Elementary School, 92 Bonner Road, Meriden, NH
Walk-In, No Reservation Required, Free, See other guidance below.

Friday, October 8
3 to 6 pm
La Salette Shrine, Rte 4a, Enfield, NH
Drive Thru, No Reservation Required, Free, See other guidance below.

Saturday, October 9
10 am to 1 pm
Orford Congregational Church, 617 NH Rte 10, Orford, NH
Walk-In, No Reservation Required, Free, See other guidance below.

Wednesday, October 13
3 to 6 pm
Oxbow High School, 36 Oxbow Drive, Bradford, VT
Drive Thru, No Reservation Required, Free, See other guidance below.

Friday, October 29
4 to 7 pm
Mascoma Community Health Center, 18 Roberts Road, Canaan, NH
Walk-In, No Reservation Required, Free, See other guidance below.

PHC Vaccination Clinic Guidance
  • Offering regular dose vaccine and enhanced vaccine for people 65+. We will NOT be offering COVID-19 vaccines at these clinics.
  • Please practice social distancing for both drive thru and walk-in clinics.
  • Everyone will be required to wear a mask. A mask will be provided for you if you do not have one.
  • Please do not come if you are experiencing symptoms of COVID-19.
  • Please do not arrive more than 15 minutes prior to the start of the clinic.

Other Flu Vaccine Options in the Upper Valley

Dartmouth-Hitchcock

Dartmouth-Hitchcock will also be offering numerous flu vaccine clinic options at various locations at the Medical Center this year. Please go to their Lebanon Flu Clinic Schedule webpage for details. Many of these clinics are drive thru and a few are walk-in. Reservations are required. If you are a DHMC patient and use myD-H.org to make an appointment. If you do not use myD-H, you may call the Flu Hotline at 603-653-3731.

When you schedule your appointment, please have your insurance card ready. If you carry health care insurance, we will bill your carrier at no cost to you. For individuals who do not have any health insurance, we will be providing flu vaccines free of charge. Please contact the Flu Hotline for more information.

Visiting Nurse and Hospice for VT and NH

Tuesday, October 19
9 am to 2 pm
Thompson Senior Center, 99 Senior Lane, Woodstock
Walk-in clinics open to people age 18 and older. Limited number of enhanced doses available.

Lake Sunapee Region VNA & Hospice

For people ages 19 and older. Appointments required by calling 603-748-1731, Monday through Friday, 9 a.m. to 4 p.m. Bring Medicaid, Medicare and Medicare Replacement Plan insurance cards. Without insurance, it costs $40 for the regular dose and $80 for the enhanced dose, which is recommended for people 65 and older. If able, print out and bring flu vaccine consent form found at LakeSunapeeVNA.org.

A schedule of LSRVNA Clinics is available  at their Flu Clinic webpage.

Valley News

We are grateful to the Valley News for helping spread the word about seasonal flu vaccine clinics. Many of the clinics listed above and more are listed by date and location in an article published on September 16th: 2021 Upper Valley Flu Shot Clinics.

In addition, many of these clinics will be posted to the Valley News Calendar, available online and in the print edition.

We wish all our Upper Valley neighbors a healthy and safe fall and winter!

Geisel School of Medicine Student Arvind Suresh Receives Prestigious Public Health Service Award

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This article was written by Susan Green and originally published in the Geisel School of Medicine News on May 27, 2021. The PHC appreciates the opportunity to share this news about Arvind Suresh, who was a key architect of our Fall 2020 Community Flu Vaccine Clinics. The original posting can be found here. — Alice Ely

Arvind Suresh, Geisel ’23

Given annually to medical students in recognition of their commitment to addressing public health issues in their community, the competitive U.S. Public Health Service Excellence in Public Health Award rewards visionary medical students who are advancing initiatives to improve public health. This is the seventh year in a row a Geisel student has received this award.

Second-year medical student Arvind Suresh ’23 has been recognized for his leadership in organizing and managing student-run mobile community influenza vaccination clinics—marshalling fellow medical student volunteers who contributed more than 600 hours of service in administering influenza vaccines throughout the New Hampshire and Vermont Upper Valley region last Fall. And for his commitment to addressing food insecurity in rural Vermont communities.

Leading the Geisel Vaccinator Corps

Citing Suresh’s work, Commander Andrew Geller, MD, co-chair of the U.S. Public Health Service Excellence in Public Health Awards Program, wrote it is a “testament to the education provided by the Geisel School of Medicine at Dartmouth and to the high caliber of your students. We hope that this will encourage your faculty and students to continue their strong work in public health.”
Partnering with the Upper Valley Public Health Council and Dartmouth-Hitchcock, Suresh, along with Isabelle Tersio ’23, Sean Halloran ’23, and Sean Liu ’23, led a team of Geisel student vaccinators in bringing vaccines to rural locations where community members would otherwise need to travel farther distances to access medical care.

Geisel Vaccinator Corps at Bradford, VT, October 2020

“We have recruited and trained more than 170 medical student volunteers as part of the Geisel Vaccinator Corps with the help of our faculty advisor Dr. Annika Brown,” he says. “Since January 2021, we have also been able to work closely with Dartmouth-Hitchcock to staff weekly COVID-19 vaccine clinics for health care workers, teachers, and Upper Valley community members as part of New Hampshire’s vaccine rollout.”

They also staffed clinics at the Upper Valley Haven, an organization that provides services to individuals facing housing instability or homelessness, for both community members and Haven staff.

During the COVID-19 vaccine clinics, the Vaccinator Corps additionally served as public health educators by helping answer questions about the vaccine and clarifying myths vs. facts—in doing so they played a critical role in promoting vaccine safety.

Care and Vaccines Through Project Salud

Suresh has recently collaborated with Stephen Genereaux MED ’87 and Little Rivers Healthcare in Vermont to bring COVID-19 vaccines to migrant dairy farmworkers farms in the Upper Valley. “It has been so gratifying to be able to advocate for these essential workers—and as part of my ongoing work with Project Salud, a student-run mobile clinic that partners with Genereaux to provide medical screening and care to migrant workers—to be able to develop programs that center the voices of farmworkers and support the physical and mental health needs of this underserved population,” he adds.

Tackling Food Insecurity

Last Spring, he and Arhem Barkatullah ’23, both Schweitzer Fellows, turned their attention to addressing food insecurity in Orange County, Vermont, one of the most food insecure regions in that state where many communities are more than 30 minutes away from the nearest grocery store.
Little Rivers Healthcare was already evaluating patients for food insecurity as part of their social determinants of health screening. Suresh and Barkatullah initially planned to pair nutrition counseling with free groceries that patients would pick up at one of the Little Rivers clinics. But because of the COVID-19 pandemic, they adopted a food delivery service and offered nutrition counseling via telehealth. “We created recipe and nutrition cards to help patients make the best use of produce items they may not be familiar with and included them in the food deliveries,” Suresh explains.

The duo is now developing “bite-sized, digestible” podcasts and infographics that patients can access to learn more about nutrition topics specific to community needs. The long-term goal is to build sustainable solutions for food insecurity via “food pharmacies” at Little Rivers where patients can pick up fresh food specific to their health needs, as well as a gardening program on dairy farms to support migrant farmworkers who wish to grow culturally specific foods.
“One of the most meaningful aspects of leading these projects has been the opportunity to collaborate with so many students, healthcare providers, and community leaders in promoting population health,” Suresh says.

“As a future physician, I strongly believe that we have a responsibility to serve as advocates in our community and address the inequities and social determinants that lead to poor health outcomes—as the COVID-19 pandemic has widened many of the existing health disparities across our country and claimed the lives of so many, it is even more important that we do everything we can as medical students to support our community,” he adds.

Extending Physicians Roles Beyond the Doors of the Clinic

In a year that has completely transformed public health and healthcare, community service has allowed Suresh to see the integral role that physicians can play in advancing social justice, a role, he believes, that extends far beyond the doors of the clinic or hospital.

“My experiences have reinforced how closely tied patient health is to that of the entire community and will strengthen my ability to meet the needs of my future patients,” he says. “I am grateful to be part of such a dedicated community at Geisel. These service projects would not have been possible without the continued support of faculty and classmates.”

Community-Centric Research on Aging Adults

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Community-Centric Research on Aging Adults and Access to Healthcare in the Upper Valley of New Hampshire

We are three Dartmouth students in a spring 2021 class about rural sociology, and we have been conducting research by assessing both data and primary source interviews with community members over the past two months. We are taking a social impact practicum (SIP) class which means that while we study a topic in class, we are simultaneously given the opportunity to work with a local organization or group to gain some firsthand experience in the field. This also allows us to gain a broader perspective on the greater Upper Valley community, its strengths challenges, and idiosyncrasies. The three of us have been privileged to work with the Public Health Council of the Upper Valley (PHC) researching access to healthcare and other resources for the local aging community. We would like to thank the PHC, the Center for Aging Resources at DHMC and all the people who participated in our focus groups and individual interviews for being open, honest, and helpful to us throughout this project. — Hannah Lang, Kate Miller & Katherine Ogden

Town-Specific Findings:

The Upper Valley of New Hampshire consists of 12 towns nestled into the Connecticut river valley. Of the 12 towns in the area, Lebanon has the largest population of people over the age of 65 and has the most centralized senior living establishments. Focus group participants generally spoke very highly of the access to healthcare and other resources in Lebanon. Grafton and Canaan have higher rates of poverty in their elder populations, making these towns potentially ripe for specific affordable or free resources and interventions. Hanover and Lyme on the other hand have wealthier populations but these towns still struggle with social isolation, fall risk and ability to accomplish upkeep tasks around the home. Dorchester has the highest rate of annual ER visits per 1000 people over age 65. While this statistic could be slightly skewed by low population it is still indicative of significant need in the area.

We developed a Data Brief to summarize our findings, which you can download from this post.

Strength of Senior Centers

This map shows Upper Valley towns in New Hampshire. The light purple area indicates areas within a 20 minute drive of the senior center, the dark purple area indicates areas within a 5 minute drive. The Advance Transit bus route is also included on the map. Most areas have a senior center within a relatively short distance, though they may be inaccessible to seniors who are no longer able to drive and do not have a reliable source of transportation. For a live map, see: https://arcg.is/1iCanX

In terms of both culture and community the Upper Valley has some very notable strengths. In our focus groups we found many people feel good about reaching out to neighbors, friends, and family members for help with tasks around the home. We also learned that the Upper Valley has a very strong network of senior centers. Lebanon, specifically, has a senior center that many of the focus group participants both loved and, in many cases, relied on. Senior centers are particularly impactful for providing social spaces for this population as well as medical, nutrition and transportation recourses.

Community Nursing Resources

Many towns in the area also have access to community nurses and community health centers. These are very important resources for people to use while aging in place. Community nurses are able to help their clients without being beholden to insurance regulations because they are funded through either grants, charity or town finances.

Recommendations

One area for intervention in the Upper Valley is providing senior centers in more rural towns or providing access to existing centers in neighboring areas. These centers are hubs of social connection while acting as a safety net to help head off health issues before they become emergencies.

Similarly, many of the towns have access to community nurses but some do not have this recourse. In discussion with a community nurse in Lebanon, it also became apparent that she and her colleagues are both overworked and not always experts in the care they are providing. One place where this problem could be combatted would be access to more mental/cognitive health recourses so that this burden does not fall on community nurses who are untrained in the area. More access to social workers, mental health workers and care coordinators would be very effective for helping to streamline care for individuals who prefer to age in place.

When discussing interventions and increasing accessibility, everything generally comes down to increased funding. One way to create access to more funding for aging resources is just to increase cultural awareness and understanding of the aging population. With more state and federal level funding, it would be easier to make sure that more introverted or isolated seniors do not fall through the cracks. At present the communities are already taxed so it becomes difficult to do the work to extend and advertise existing resources to those who are not actively seeking them out.

Many focus group participants brought up the fact that while they are aware of resources available to them, their less computer savvy or more socially isolated peers could find simply knowing what resources exist to be difficult. Increasing awareness of challenges facing the aging population is an efficient way to help gain funding while also helping to advertise what resources are already organized and functioning.

*One thing to note is that our focus groups were recruited through the Center for Aging Resources. This means those who participated are already engaged within their communities and are outgoing enough to choose to participate in a discussion without any incentive.

Editors Note:

This report focuses on New Hampshire towns in the PHC region because the primary data resource is available only for New Hampshire towns. Comparable data was not readily available for our Vermont towns. Given our experience working in the Upper Valley, we believe the findings that describe the disparities, strengths and resources for older adults are generalizable to many of our Vermont towns as well.

Expanded Special Needs Information Program

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Hanover Police Department and Special Needs Support Center Announce Expansion of SNIP

The Public Health Council works with our partners to ensure all people in the Upper Valley community have the supports they need along their life span to reach optimal mental wellness, including prevention and education, early detection and intervention, and all stigma-free. This includes promoting ways to keep our most vulnerable neighbors safe in times of crisis. This Special Needs Information Program is one example of our local law enforcement agencies stepping up to help. We are pleased to share information about this program.

The Hanover Police Department and the Special Needs Support Center (SNSC) announce the expansion of the Special Needs Information Program (SNIP), a program to help emergency responders identify and respond to vulnerable residents with special needs.

This is a voluntary program in which special needs community members of any age, or their family members, submit information such as triggers, special accommodations, emergency contacts and a photograph. The information is entered into a database in which the Police Officers and Dispatch Team have access.  This is an expansion of the pilot project launched by SNSC and Lebanon Police Department two years ago and recently launched in Hartford, VT.

A New Safety Tool for Our Community

“Estimates show that as many as 80% of people who become involved with law enforcement are individuals affected by autism, Down syndrome, dementia or another form of developmental or mental impairment” said Laura Perez, SNSC Executive Director. “The benefits of the program to our most vulnerable citizens and to law enforcement make it an invaluable safety tool for our community. The tool is free to residents and provides local law enforcement with essential information prior to an emergency.”

“Our implementation of the Special Needs Information Program (SNIP) into the Hanover Police Department will allow individuals, family members, or caregivers to provide information about individuals with special needs into a database that can provide first responders with important information during a response on how best to prepare for an individual’s needs.” said Charlie Dennis, Chief of Police of the Hanover Police Department. “The addition of SNIP into our department will also open the program up to all twenty-six entities we dispatch for through our Hanover Regional Communications Center. SNIP will be a great asset in helping us better serve our community.”

Many New Hampshire and Vermont Towns Covered

This partnership between SNSC and Hanover Police Department expands the program to residents of the New Hampshire towns of Hanover, Etna, Canaan, Cornish, Enfield, Lyme, Orford, Plainfield, Piermont, Meriden, Grafton, Grantham, Springfield, Dorchester, and Orange as well as the Vermont towns of Norwich, Thetford, Fairlee, Bradford, Strafford, Vershire, W. Fairlee, Corinth, Orange, and Topsham.

To register for the Hanover Special Needs Information Program:

  • Complete the form by visiting https://www.hanovernh.org/hanover-police-department or www.snsc-uv.org;
  • Call the Hanover Police Department at 603-643-2222 and request an officer be dispatched to your residence to assist you in completing the form; or
  • Call the Special Needs Support Center at 603-448-6311 and a team member will help you complete the form over the phone or in the office.