Taking on Childhood Lead Poisoning

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Beginning in 2018, New Hampshire state law has required doctors to test all one and two-year old children for lead poisoning. New Hampshire has been acutely vulnerable to lead poisoning in the past by virtue of the fact that 62% of New Hampshire housing stock was built before the ban on lead paint began in 1978[1]. This along with a high prevalence of unsafe renovation practices resulted in over 800 New Hampshire children tested positive for elevated blood lead levels (EBLL) in 2018. Lebanon and Enfield proved to be the two towns with the greatest prevalence of EBLL within the Upper Valley region. (Between 2014 and 2018, Lebanon reported 19 children and Enfield 9, with all other regions reporting 1-4 children, a value indicating insufficient reports of EBLL, according to Lead Exposure Brief Upper Valley 2018).

No Cure. No Treatment.

It only takes a pinch of lead dust or chips to cause irreversible harm to a young child’s developing brain. EBLL has been linked to lower IQ levels, increasing impulsivity and aggression, and difficulties with attention and executive functioning. It is also linked to poor visual, spatial, speech, and motor skills. One in every 5 Attention Deficit Disorder case is attributed to lead exposure. Children from birth to age six are vulnerable because they have not developed a blood-brain barrier yet and lead travels easily from the blood stream into the brain.

The impact of childhood lead poisoning extends beyond an individual’s health. Subsequent to the Flint Water Crisis, Michigan saw a 56% increase in special education budgets. This burden on taxpayers is compounded by the way our current lead-abatement system operates—by placing the burden of cost and remediation on landlords and property managers.

Gathering for Local Action

In an effort to create a regionally based, early intervention system, the Public Health Council collaborated with the NH Healthy Homes and Lead Poisoning Prevention Program to create conversation about lead poisoning in the region. We believe that if the many players involved with lead poisoning and abatement collaborated more effectively, we would be able to reduce the frequency of lead poisoning and simultaneously reduce costs in our region through various educational and training opportunities.

On September 27th, 2019, the Public Health Council hosted an educational presentation facilitated by Ms. Gail Gettens from the Healthy Homes and Lead Poisoning Prevention Program. Ms. Gettens presented an overview of the negative impacts of lead on cognitive and behavioral health as well as the current New Hampshire laws and protocols for screening and BLL testing. After the educational session, the Public Health Council’s Executive Director, Alice Ely, facilitated a stakeholder-planning meeting with the hopes of using our region’s assets to create actionable plans. We hope the plans from this meeting, together with the current traction established through the requirement of lead screening for 1 and 2 year old children, has the potential to create positive change in the Upper Valley.

There was a diverse array of stakeholders in attendance at this September meeting. Industry affiliations included building trades, child-care givers, city government officials, community leaders, legislators, health care providers, housing personnel, landlords and property managers, regional planning commission members, and school district/special education members.

Planning Local Initiatives

Based on the success of this gathering and the quality of the plan that emerged, the Public Health Council was awarded a grant through the New Hampshire Healthy Homes and Lead Prevention Program. Funding will be available in February 2020 to support a two-pronged approach to improving the Upper Valley’s lead prevention plan.

First, we will expand training and certification opportunities for local homeowners, contractors, landlords, property managers and town building inspectors. We will host at least two training sessions using the Environmental Protection Agency’s (EPA) Renovate, Repair and Paint (RRP) lead safe work practices. This approach was determined as a necessary step due to the majority of New Hampshire’s housing stock having lead-based paint. Many believe there are too few RRP contractors in the Upper Valley region, which decreases the likelihood that lead-safe work practices will be used on renovation projects. The Public Health Council aims to host RRP training sessions of eight hours each between March and September 2020, with the hopes of reaching 45 homeowners, contractors, landlords, property managers or town building inspectors.

Secondly, the Public Health Council plans to collaborate with the Mascoma Valley Regional School District (MVRSD) through its Superintendent, School Board members, Special Education Director, other school personnel, and parents to change school policy. MVRSD has over 200 students with disabilities (nearly 20% of their student body) but do not have a clear understanding of how many of these children have been affected by lead poisoning.

The lack of awareness on the severity and impact of lead poisoning has prompted the Superintendent of MVRSD to partner with the Public Health Council to host an educational session for parents and school personnel and lead poisoning, as well as change school policy to require documentation of blood lead level tests for school registration. The Mascoma Community Health Center will also work with us to increase blood lead level screening in the region. We expect to host the educational event in March of 2020, and see a new school policy adopted by December 2020.

As other strategy opportunities emerge, the Public Health Council will look for partners and resources to implement them. For example, with the help of a Dartmouth College Eichler Fellow, we expect to create a webpage and a webpage template with important information about lead-safe practices that towns and other organizations in our region can use to educate their constituents.

— Submitted by Claire Thomas, Dartmouth College ’82 Upper Valley Community Impact Fellow

[1] 2018 Lead exposure Data Brief for Upper Valley Region, NH Division of Public Health Services.

PHC’s Inaugural Legislative Breakfast Helps Organization Reach New Heights

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Public Health Council Executive Director, Alice Ely, delivers opening remarks as local legislators and service providers await subject matter discussion.

The Public Health Council of the Upper Valley continuously looks to expand upon its three guiding principles: collaboration, education, and advocacy. Our organization’s inaugural legislative breakfast held on September 16th at Dartmouth Hitchcock Medical Center, catalyzed reflection and growth in all three of these areas. We are grateful for sponsorships from Mascoma Bank and the Derek J. Cooper Memorial Fund, which helped cover event costs.

In terms of collaboration, the Public Health Council views communication and bi-state cooperation as paramount to addressing public health concerns in the Upper Valley. Through the relationship building that occurs at an event like this, the Public Health Council hopes to encourage collaboration among New Hampshire and Vermont legislators, as well as with the Public Health Council and our many partners. With regard to education, the Public Health Council sees immense value in facilitating educated policy creation. By allowing for discussion between local service providers and legislators, the Public Health Council aims to inform legislators about the most pressing public health concerns in our region. And lastly, this event helped the Public Health Council expand its capacity for advocacy and public policy work, through the relationship building with local legislators, and the extensive follow up work we have done since the event.

Planning for this event took place in many forms and began nearly a year in advance. We conducted focus groups with numerous partners and stakeholders, which helped us develop a format for the event, an invitee list, and desirable outcomes.

Event Overview

The event lasted two hours and consisted of round table discussions focused on one of six Public Health Council priority areas: Availability of Primary Care Services, Health Care for Seniors, Gender Based Violence, Access to Mental Health Care Services, Substance Misuse and Addiction, and Child Abuse and Neglect. Prior to the event, we asked each legislator to give us their top three table choices, from which we assigned them to two for the breakfast. A subject matter expert as well as a table facilitator led each of the six discussions; they each had extensive experience working on the specific topic in the Upper Valley region. The subject matter experts informed each discussion from their experience working within the specific subject area, and the public policy difficulties they see in their day-to-day work. The discussions lasted about thirty minutes, and volunteer recorders captured the conversation point.

Attendee List

Legislators:

  • Richard Abel:  NH Representative, District 13
  • Susan Almy: NH Representative, District 13
  • Tim Briglin: VT Representative, Windsor-Orange-2
  • Alison Clarkson: VT State Senator, Windsor District
  • Michael Cryans: Executive Councilor, NH District 1
  • Carl Demrow: VT Representative, Orange-1
  • Ned Gordon: NH Representative, District 9
  • Jim Harrison: VT Representative, Rutland-Windsor-1
  • Martha Hennessey: NH State Senator, District 5
  • Timothy H. Josephson: NH Representative, District 11
  • Charlie Kimbell: VT Representative, Windsor-5
  • Jim Masland: VT Representative, Windsor-Orange-2
  • Mary Jane Mulligan: NH Representative, District 12
  • Alice Nitka: VT State Senator, Windsor District
  • Brian M. Sullivan: NH Representative, District 1
  • Linda Tanner: NH Representative, District 9

Subject Matter Experts and Facilitators:

  • Erin Barnett: Dartmouth Trauma Interventions Research Center
  • Nancy DuMont: Bayada Health Care
  • Laurie Harding: Upper Valley Community Nursing Project
  • Sara Kobylenski: Consultant to the Couch Family Foundation
  • Kata Lamphere: Health Care and Rehabilitation Services
  • Angie LeDuc: Community Health Improvement, Dartmouth Hitchcock Population Health
  • Dana Michalovic: Good Neighbor Health Clinic, Red Logan Dental Clinic
  • Alison Morgan: Service Link, Grafton County Senior Citizens Council
  • Kate Rohdenburg: WISE of the Upper Valley
  • Susan Seidler: Stepping Stone, and Next Step Peer Support and Respite Centers
  • Melanie Sheehan: Community Health Mount Ascutney Hospital
  • Heather Wilcoxon: Health Care and Rehabilitation Services

Next Steps

In the coming months, the Public Health Council plans to take the actionable points which came from this breakfast to further build our relationship with local legislators and foster collaboration between service providers and legislators to inform positive changes to public policy in the future. The bullets below provide brief information on what we are currently pursuing:

  • A series of advocacy trainings for Public Health Council Partners and community members;
  • Policy Briefs timed in accordance with legislative sessions;
  • Using our website to connect our partners and legislators with facts, best practices, and public health advocacy groups in NH and VT, such as the NH and VT Public Health Associations;
  • Legislative Breakfasts hosted every two years;
  • A relationship with Dartmouth College’s Policy Research Shop, with cost/benefit analyses provided to legislators when questions arise on certain policy changes; and
  • There is some potential for the creation of a bi-state council between VT and NH legislators which the Public Health Council acting as a convener or partner. This idea needs further exploration.

For more details of the conversations at the event, view the PHC Legislative Breakfast Table Discussion Notes attached here.

— Submitted by Claire Thomas, Dartmouth College ’82 Upper Valley Community Impact Fellow

Vermonters must be 21 to purchase and possess tobacco products starting Sept. 1

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Law aims to protect youth from harms of e-cigarettes and reduce smoking rates

BURLINGTON, Vt – Starting September 1, [2019] Vermonters must be at least 21 years old to purchase and possess tobacco products or paraphernalia. The new law also includes tobacco-substitute products, such as e-cigarettes. Health officials say the increase in buying age will help protect youth from nicotine addiction and potentially toxic chemicals.
Commonly known as Tobacco 21, the new law is expected to reduce smoking rates over time and ultimately save lives. An estimated 95% of adults start smoking by age 21, so restricting access to these products will help prevent young Vermonters from ever taking it up.

“We’ve made great strides against tobacco use, but the popularity of e-cigarettes and vaping continues to skyrocket among our youth,” said Health Commissioner Mark Levine, MD. “We are also seeing evidence of increasing rates of health problems associated with vaping.”

According the Vermont Youth Risk Behavior Survey (YRBS) there was a significant increase in the percent of students who have ever tried e-cigarettes, from 30% in 2015 to 34% in 2017. Among high school students in Vermont, 12% said they used electronic vapor products in the past 30 days.

What’s in a “pod”?

A single 5% “pod” of liquid nicotine used in e-cigarettes can contain as much nicotine as an entire pack of cigarettes. Teens and young adults are uniquely vulnerable to the effects of nicotine, and more likely to get addicted. Exposure to nicotine in adolescence can impact attention, learning, mood and impulse control. The aerosol that users breathe from e-cigarettes can contain nicotine and other toxic chemicals, including formaldehyde and arsenic.

Dr. Levine said that while e-cigarettes are less harmful to adults than combustible cigarettes, they are never safe for teens and young adults, making this new law all the more necessary. “These cyber-cigarettes, with their thousands of flavors, represent a 21st Century version of big tobacco’s decades-long push to market and promote their products to youth,” said Dr. Levine. “Society always races to keep up with technology. This law helps to close the gap in favor of protecting public health.”

With the enactment of Act 27, Vermont joins 17 states, the District of Columbia, Guam and more than 480 municipalities with a Tobacco 21 law.

Two related laws went into effect in July that prohibit the online sales of e-cigarettes and liquid nicotine, and subjects e-cigarettes and liquid nicotine to the same 92% tax already assessed on tobacco-related products. These laws, in combination with Tobacco 21, help strengthen statewide tobacco prevention efforts to discourage teens and young adults from using these products.

Want to Learn More?

Health officials urge anyone looking for help to quit smoking or the use of any kind of tobacco product to visit 802quits.org.

Read the Vermont Tobacco Prevention Laws fact sheet and find more information about tobacco, e-cigarettes, at healthvermont.gov/wellness/tobacco.

Schools can also find resources specific to their communities by using our new Electronic Vapor Product Education Toolkit.

Press Release from the Vermont Department of Health, August 29, 2019

Gaining Confianza: Cross-Cultural Lessons on Community Progress

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Deb Kitzmiller with a community member in El Salvador in 1999.

Note: Trust is at the heart of the Public Health Council’s work. Are we representing our community partners fairly? Are we truly listening to them? Are we promoting work that addresses issues of concern to our community in a way that is meaningful and respectful? Every once in a while someone manages to describe the importance of trust in a way that makes it very real. This piece is one of these descriptions and we are lucky enough to have permission to share it. I hope you enjoy it. — Alice Ely

Article Written By Deb Kitzmiller, Brattleboro District’s Maternal and Child Health Coordinator for the Vermont Department of Health. Reposted with permission of Building Bright Futures, Williston, VT.

Cross-Cultural Lessons on Community Progress

Twenty years ago, in the Peace Corps in El Salvador, I was taught a life lesson that proved so valuable that I’m still reflecting on it within my work today. In 1999, Brattleboro based SIT/ World Learning taught me that in El Salvador the most important ingredient to a successful community development project is called confianza (in Spanish.)  The word means trust- the kind that you get by being in a close relationship.

Salvadorans frequently see foreigners who swoop in and try to “fix” their problems in ways that are unsustainable.  For that reason, they could be resistant to ideas brought in by foreigners, and confianza could be hard-won.  Because Peace Corps volunteers actually live in the communities that they work with, there is plenty of time to build relationships, and therefore, the confianza required for working well together. We were actually told during training to spend at least three months doing no work at all except for getting to know people.  This step of building confianza through relationship was that important– a critical step before proceeding together on project work. This concept has recently been popularized by Steven M.R. Covey who writes, “Change happens at the speed of trust.”

“Change happens at the speed of trust”

What surprised me most about this lesson is how much it applied to my work in public health, in my very own community, even now.  What I had previously thought was a truth specific to working within this Central American country is actually true here too.  It’s not about interacting with foreign cultures at all; it is about sustainability, which is universal.  In El Salvador the locals became used to foreigners “dropping in” and telling them how to change their lives for the better, and in many cases these projects did not succeed.  Similarly, in our own community we sometimes try to push through initiatives that weren’t formed with local input, and they have been the source of tension and lack of progress rather than achieving desired results.  In addition, many of the young families that we work with have been let down by the systems and structures that people in positions like mine have helped set up.  For that reason, I understand confianza as one of the most important parts of my job.

Taking the time to slow down and enjoy getting to know the people that I work with in my community is not just an added bonus to my job, it’s often what makes things work. For example, recently Brattleboro OB/GYN put together a postpartum planning packet with the help of the community.  It wasn’t enough that we recognized that the postpartum experience is hard, and that our culture over-emphasizes birth planning as opposed to preparing for what happens after the birth. It also wasn’t enough that UVM’s Sandy Wood’s team had already put together a postpartum planning packet that inspired us.

It was our conversations with local individuals that had recently had babies telling us about their postpartum lives, helping us realize that the time for this action is ripe right now.  It was the ease within which we were able to chat back and forth with Sandy Wood and the trust she had in our team to model our own version after UVM’s materials.  It was also the easy relationship between our Perinatal Wellness Initiative (PWI)’s team members and Meghan Arthur, the nurse-midwife which allowed for the chatting back and forth, tweaking and personalizing the end product to be right for our community.  Without the comfort and ease of frequent communications on all levels, a project like this one will become tedious have too many barriers to succeed. Our community created a beautiful product that will help our birthing families be better prepared for the postpartum period, and better able to access the resources they will need to do so.  This lays one of the first steppingstones for our families to become strong and resilient.

Sometimes it feels like progress is slow, and it is hard to measure our successes.  It is easy to get discouraged by this type of work for that reason. I would encourage anyone in this headspace to take a step back and stop worrying about progress for a bit.  Slow down, get to know people, and develop confianza with your community.   You never know, you might just be planting seeds for the future.

A Workshop Explores Racism

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Jim Wuelfing, left, and Art Woodard lead a Racism of the Well-Intended workshop at Hypertherm in Lebanon, New Hampshire.

On May 20, 2019, The Public Health Council of the Upper Valley and the Hypertherm HOPE Foundation presented a free full-day public workshop, Racism of the Well-intended: Examining Privilege and Power.

“Racism of the Well-intended.” It’s a somewhat unusual title for a workshop, which is why presenters Art Woodard and Jim Wuelfing asked 100 participants in Hypertherm’s conference room to spend 15 minutes thinking about how to define the term. Many came up with a definition for racism similar to the presenters’: “any attitude, action or institutional structure which lessens or denies the power to be or do of a person or group because of their race.”

Participants seemed to struggle, though, with the term “well-intended” in this context. As the workshop progressed, we explored the meanings behind these words. We discussed microaggressions: verbal, nonverbal, or environmental communications that contain a hidden insult to the target group to which it is directed. We explored the concept of white privilege in an exercise that feminist and anti-racism activist Peggy McIntosh calls, “Unpacking the Invisible Knapsack.”

A Training Born of Friendship

Art and Jim, who have been friends for decades, offer Racism of the Unintended workshops to organizations throughout the United States. They hope the presentations serve as a model for changing relationships between people.

As part of their work, the two men conduct field studies together in which Jim, who is white, is attuned to the injustices Art, who is black, faces in daily life. In the same convenience store, Jim is not asked to show his driver’s license when he makes a credit card purchase, while Art carries a license with him at all times, as well as two other forms of ID.  Jim has witnessed Art get harassed by clerks in stores and followed by police in his car. I found it heartbreaking to hear about this inequality, but I would be naïve if I didn’t think it existed: I read about it every day in the news. And just because I don’t have the opportunity to interact with many people of color in our mostly white Upper Valley community, doesn’t mean that the scourge of racism doesn’t affect me, or that it doesn’t affect my community: Since we live in the United States, we live in a racist society.

Several people in the training wondered how best to explore the topic of racism in an area that isn’t racially diverse. Indeed, most of the participants at the workshop were white, and when we broke into smaller discussion groups throughout the day, I discussed heavy topics with others who, like me, were white. I felt I couldn’t fully explore some of the issues at hand because I couldn’t hear the perspective of someone who had experienced them first-hand. I also felt left off the hook for something I often fear when I’m in a diverse gathering: that I may hurt or offend somebody when we try to have an honest conversation.

We All Have Different Identities

The most powerful exercise of the day was when Art and Jim asked all participants to stand around the conference room in a circle. They told us they would name different identities, and if we claimed the identity they called, we were to walk to the center of room. Once there, we were to notice what we were feeling, notice who else was in the center of the room with us, and notice who was standing on the outside of our marginalized group. If we identified with one of the groups called and chose not to walk to the center, we were to take note of that, too, and consider why we kept our status hidden.

Jim began to call out marginalized identities: “If you are a woman, walk to the center of the room…”. He continued to read about 20 more identities. “If you have ever been treated for a mental illness, walk to the center of the room”; “if you were raised by a single parent…”; “if you or someone in your family identifies as LGBTQ+, walk to the center.”

I noticed I felt scared, at first, to publicly acknowledge my marginalized status in some of these categories—especially since we live in a small community. Many people in the room knew me personally but didn’t necessarily know these details about my life. Once I was in the center of the room with others in my group, though, I felt a sense of belonging within the minority.

It became easier, I felt stronger, to walk up each time to claim my marginalized status. While I was there, I noticed the people standing on the outside, and I felt somewhat exposed. I felt the others were lucky, in a sense, not to experience my particular hardship. But later, when I observed them walk to the room’s center under a category under which I didn’t fall, I was reminded of the feelings of my own marginalized status, and I felt connected to these people, even though I now stood on the outside.

The starkest examples were when Jim called for groups including African Americans, and Asian Americans, and only two or three participants stood alone in the center, surrounded by almost 100 people. I thought of how vulnerable those in the center looked: just a couple of people—surrounded by so many others. I also considered, since these were topics of race, these individuals could not choose to hide their identity: it is something that can be seen by all.

I was reminded of this image later that week when I read a column in the Valley News by Deb Beaupre about how a hateful object made her feel unsafe as an African American woman in our community. I recalled the sense of connection I felt that day in the training as participants walked back and forth, together in our very differences, united in our humanity. It was a feeling of compassion I will strive to carry with me.

Elizabeth Kelsey is a writer who specializes in mental health topics.
 www.elizabethkelsey.com