Board of Health: November 12, 2024

Transcript captured from MHTV’s Vimeo auto-captioning. No speaker labels; proper names and dollar figures occasionally misheard. Click any timecode to jump to that moment in the source video.

0:01 Try now. Good evening. Good evening, Dr. Coyle. Good evening. Good evening. I’m Helene Haslett. We have our names. Can you see the names here? Should we introduce ourselves? Yes. Introduce Yourself. I can’t see the names, but, so, We’ll, I’m Helene Hayslett. I’m currently the, uh, chairperson of the, uh, the Board of Health. And we’ve got two gentlemen I either said they’ll introduce themselves. Uh, Tom McMahon. Tom Massaro. Hi, Tom Tomara. And you, and you know, each other, you’ve, you’ve, you’ve talked, I’ve spoken with, with Dr. Massaro. Yes. Great. And Caitlyn, I’m Andrew Petty. Nice to meet you. Hi, nice to meet you too. Um, our administrative assistant, hail, introduce himself. And I’m Martin Flanagan. Hello. Nice to meet you. Hello. Nice to meet you. Uh, so, uh, uh, Dr. Azar would, would like to introduce you and, uh, then we can Well,

0:47 Um, I’ve learned since we’ve talked that, um, this is actually you, at least the third time that you’ve thought about doing a health assessment in Marblehead. That’s true. And we are committed to make the third time a charm. Okay. Um, as I understand it, you were brought in by the Council on Aging in the 2019 timeframe. Uh, Yes. And it got, um, uh, like many things got turned away by Covid, and then immediately after Covid, the subgroup of this board, the Marblehead Mental Health Task Force Yeah. Invited you to modify your approach a little bit and to make a health assessment on mental health alone.

1:35 But what the board, I think, tried to build on that is to go the other way rather than just limit one type of health. We wanna talk about health as broadly as possible, and we wanna get for as much as possible for the whole of our population in Marblehead. So with that background, we’ve, I think Col individually and collectively talked to a number of people, and I think we’re really prepared to make the third time the charm. So if you could, for the record, give us a little background of what you do, how you do it, and how we can define Marvel head in a unique health way.

2:23 Yes. Thank you for that. And, um, I did put a few slides together for this evening just to kind of walk us through how I’m thinking about things, but I think it will be helpful

2:33 to hear from you this evening and, and just kind of ongoing about, you know, sort of the board’s goal for the project in terms of how you intend to use the information collected. And, and, and also this idea of sort of defining health and, um, you know, because obviously it’s a very broad topic and we can, it, you can quickly imagine that it could get, um, sort of hard to manage. Anyway, I’m just, I wanna kind of hear again from you all about sort of the, the focus and sort of how you’re thinking about health and what would be most useful, um, to you all as we go forward. But with that, I can, um, share my screen, although it looks like maybe I need permission to do that.

3:38 You should be able to have video. Great. The ability To share. Yeah. Um,

3:54 there you go.

3:57 Great. We can see your screen now too. Great. Great. Okay. Um, so yeah, so I just put together some, a little bit of background about who, who we are at UMass, um, and sort of how, how I’m thinking about the project at, at its current state. So I’m the director of a small research center within, um, the University of Massachusetts. Um, Boston, we actually housed in the Gerontology Institute, and that is inside of, it’s a research center, um, inside the Manning College of Nursing and Health Sciences. And we have been a center since 2012. And since then we have, uh, worked with about 75 cities

4:43 and towns across the state of Massachusetts, helping them engage their residents in needs assessment processes for a variety of, um, reasons and topics. Uh, we often work with older adults and we often work with councils on aging, um, depending on the community. But we have done work, um, outside of that with respect to, um, a broader adult population that often takes the form of sort of this, um, age friendly community model, which you may or may not have have heard of, that’s developed by the WHO, which is really a community improvement model that’s intended to, it’s rooted in population aging, but it’s under the premise that creating change

5:29 for older adults, ac you know, creating communities that are inclusive of older adults is actually creating communities that are inclusive for all people. Um, we pride ourselves in taking sort of a collaborative participatory process in all of our work. And so this is not, um, something where, you know, we go off and, and do the work and come back with, um, the results. I mean, we do a lot of the work, but we, uh, really like to, um, do all of the work in partnership with the community, understanding that you, you all are the experts in your local, um, culture, and we have sort of the methodological and, um, some of the content area expertise to bring to, to the project. But it’s really, and I’ll, I’ll, I’ll talk a little bit about how we work more specifically, but, um, that is a piece of it. And that we, our mission is really to, in,

6:17 to conduct applied research that informs communities, uh, particularly as the populations become older demographically, but on broader topics that impact, um, people who are seeking to stay in their communities as they get older. So, and I will just sort of, for, for background, just sort of say that it, the center is, um, is staffed by myself, um, one full-time research, uh, uh, staff member. We have a series of part-time, um, research professionals who help us work in the communities. And then we also employ doctoral and, and undergraduate students, um, who have opportunities to participate in these projects as part of their, um, academic experience. And I also imagine that for this particular project,

7:04 I’d like to, um, get some collaborators from, um, community health, um, and sort of public health. Um, here at UMass we have the mm-Hmm. Um, Collins Center for Public Management. They have a sort of core area around, um, community health, public health, and kind of bring somebody else in, um, on our side as we, as you, as you can tell. And as you may know, I mean, I’m a gerontologist by training our back. Our, a lot of our work is rooted in population aging. And while it is true that everyone ages, um, I thought it would be helpful to have to bring someone into the team, um, who has some community health, um, expertise as well. And so working that out, um, on our end in the meantime. But the way I understand the purpose of the proposed project, the needs assessment is to,

7:52 you know, to conduct this community health needs assessment that’s meant to identify, understand, and prioritize health needs, such that all Marblehead residents can achieve wellness. Results of the proposed projects are, are intended to inform the strategic planning of the Marblehead Board of Health regarding the programming services and partnerships. Um, and I’d love to, to talk a little bit more about the purpose of the project, um, if we have a chance to this evening. Um, but I’ll just kind of get through the rest of, of the slides before we do that. So when I’m thinking about health and in the comm in the community context, I’m thinking about the social determinants of health. I’m thinking about, um, in terms of what would the survey and the sort of needs assessment, what would,

8:38 what would be we be asking about what would, what would the questions be about? We would be trying to identify priority issues related to health. So sort of what are the main, um, health needs of the community. Um, and that might include identifying barriers to accessing supports and resources. And it also might be, um, sort of, I, I imagine it culminating in sort of the generation of ideas for prevention and promotion. So it’s this idea that it’s not a help, this isn’t a surveillance study. Like we’re not asking necessarily about, um, you know, chronic disease diagnoses and, and things like that. The way I’m seeing it is really that this is an assessment of health embedded in the community in terms of what are the priorities, and again, we’re, we’re talking about asking individuals sort of what are their priorities for health and wellness?

9:24 What are their barriers to health and wellness as they are currently? And then, um, trying to sort of take into the context things like the neighborhood and built environment. So do they have access to transportation, um, and, and, and sidewalks for example. Um, and also things like economic stability. So the questions are going to be about from the perspective of the resident, what are the priority issues related to health and wellness? What are the barriers experienced? But also wanting to capture some information that can be helpful to us as we think about the social determinants of health as sort of, especially for our community board of health, as sort of the levers by which we can make change. And so, um, that’s sort of how I’m thinking about approaching the project, and I would love to sort of hear from you about

10:11 how, what you think of that. Um, the proponent, the sort of the things that were proposed in the document that I shared. Um, previously, I include, uh, several sort of, um, methods of in, of information gathering. One is a document review, and, and I sort of, I’ll say that this is also kind of an existing data review. I think we have a lot of, especially in Massachusetts, we have access to a lot of public health data that is, that already exists. And so where we are able, we’d like to draw from that, um, so that we can use the survey most efficiently in terms of asking questions that we don’t already, um, have the answers to in other places. Um, but also in terms of documenting any, you know, recent plans, um, that the town has engaged in around some

10:58 of the things that touch on the social determinants. You know, being able to point to, um, other, other things that are going on in the community that might relate to the topics. Um, in this study, uh, a demographic profile of the community, we almost always do that. And that’s from the American Community Survey, um, estimates that tells us just more about the population of Marblehead in general. Um, and we’re talking about all ages in that demographic profile. Um, and then it does include three focus groups. And I know I talked with, um, Andrew about this a little bit. You know, I know that there is some future plans or future goals of doing some additional work on, you know, children and families and, and sort of, um, risk behaviors and things like that.

11:45 And so I thought the focus groups in particular, the way I see the focus groups are really an opportunity to hear from you hear particular voices of the community and kind of get a, a detailed understanding of their lived experience and, and what is challenging to them. And so I thought this would be an opportunity maybe to sort of hone in on some of those voices that we may not pick up, be able to pick up in the survey that could also lay the foundation for, um, that future work that you all have in mind. It’s also an opportunity to bring stakeholders together to understand collectively what the issues are related to health, and also to generate some buy-in so that the people who participate in this project, um, have, you know, a real understanding of the information and, and how it can be used for their own benefit.

12:31 Recognizing that health, um, of the population is something that’s important to a lot of different departments and divisions and, and, and committees, et cetera. So at least one of the focus groups being reserved for that. And we can also talk about, you know, sort of the steering committee of this project and, and who else beyond the board of health might be important to bring, um, into the conversation. And when. And then the survey of residents, which is sort of the main event. Um, we did propose to survey residents of all ages, you know, 18 and older. And that is in part because, um, at u at the University of Massachusetts, Boston, we have to get all of our, um, research approved by an institutional review board that, um, we’re basically, you know, we’re treating, we are, um, all

13:17 of our research practices are with being done, uh, responsibly. And they do identify children under age 18 as to be a vulnerable population. And so if we were to engage, um, in a survey of younger people under 18, we’d have to go through some additional, um, approvals at the university level. But the idea is that we are, would be mailing a postcard to everyone 18 plus, uh, which based on the most recent American community survey, uh, data that I saw was about 16,000 residents. Um, we would expect about a 10 per 10% response to, um, to that survey. And, um, so that would put us around, you know, 1600 responses. I will say that, um, in addition to the postcard mailing, I also encourage people, so that would drive them online.

14:06 So the postcard mailing would drive them to a web-based survey. We would also make the survey available, um, in print and could be made of, you know, we could put it into the, in the senior center in the libraries, in the community centers, in the, you know, town hall, meaning we could, we can handle a certain number of paper surveys coming back to us. And so that’s something that we can work out in terms of detail. Um, we also, on the postcard, we’ll have information about the ability for people to do the survey over the phone so they can call us at UMass and do the survey over the phone if they prefer, um, or if they don’t have access to the internet. Um, so that is the survey component piece. And so all of this information be, would be brought together, sort of triangulated on, and we would be putting forth recomme recommendations

14:52 to the board about sort of, these are the high, these are the priority areas of health, this is what health look like, the health needs look like in your community. And, um, you know, make some broad suggestions about where to go next with respect to, um, uh, addressing those needs. And I think that’s something we can also talk about, um, as we move forward. I wanted to just for the purposes of this evening’s conversation, just to highlight sort of, um, the role of the board of health in all of this, sort of what, what do we need from you to be successful, um, in this work? And, um, as I mentioned, you know, we sort of take this participatory process pretty seriously. And so I mean, you would be involved in, um, the creation of the survey. We have something that we always start with, um, in terms

15:38 of a draft survey, but there’d be, uh, an opportunity for us to work together on crafting those questions. And also, um, identifying the question or helping to develop the questions that would be asked in focus groups. Um, a big part of what, what you’ll help us do is sort of shape the framing of the project to make sure that it’s gonna align with the things that you wanna accomplish. Um, and you would also, um, provide initial feedback on recommendations. And so, as I said in the last slide, you know, we offer these sort of broad, you know, um, here’s the need that emerged, and here are some ways to address that need in a c in a community. Um, but I think obviously you wanna think about the purview of your board and who else is involved and who’s the audience of the report. And so I think we can talk about that. And then obviously there’d have be an opportunity for you

16:25 to sort of, um, provide some initial feedback on those recommendations. The other role, um, for you all would be to promote the survey when the time comes. Um, you know, we can print the survey, we can do it over the phone, we can manage the online piece. We can provide language to you about, you know, what the survey is about, what it’s for. Um, and we can even provide things like social media postings and, um, text for a, you know, an email blast and those kinds of things. But it’ll be sort of up to the town to make sure that all of that outreach gets, gets done so that we can get the best response rate possible. Um, and so thinking about getting the word out in various capacities is something that we would put, um, to you all. And one thing that I, um, have been thinking about is

17:13 that we know from our work that the younger,

17:19 the younger cohorts of, uh, residents are often the ones that we have the lowest response from. And so thinking about how do we, you know, both, so that’s an outreach problem, you know, in terms of how are we getting the message out to people, um, in those age brackets. But I was also thinking about like, is there an opportunity to provide some incentives and what would that look like? And I think we can talk about that as, as we move forward, but that’s something else that, um, we would wanna, you know, work together on in terms of deciding what that incentive is and how to get it out, um, to people. Um, and then also we’d be looking to you for support with recruitment of the focus group participants. Again, we collectively as a group would decide on the sort of type of people we want. So do we, do we want to focus on, you know, a group of, um,

18:08 you know, mothers for example. Like we wanna have a focus, if we decide collectively that we wanna a focus group of mothers of children under age 18, then, um, you know, we, again, I could provide language for recruitment, but we would be looking to the town to help us actually get the word out about that and get people into, into the focus group to have those conversations. And so that’s just to kind of get you thinking about what, you know, what your role will be, um, in this process, um, as we move forward. This is a slightly amended timeline to the one that was in the most recent, um, proposal that I put together. I moved it up just ever so slightly. We do have a pretty full spring semester. Um, and so we can talk about, there’s maybe a little bit of,

18:53 um, a wiggle room here, but sort of starting the project, um, in late spring, uh, with getting, you know, getting, and, and actually before I move into the timeline, one thing that I do wanna put in your brains as we talk also is that, you know, I understand that this is a, a, a project of the board of health. Um, but I know that, and, and to Tom’s you know, sort of introduction, there are others in in town who have a lot of interest, um, in, in this data and in this project. And so I think thinking about, you know, if there’s a working group that could be formed in terms of representatives from multiple, um, either boards and committees or organizations in town that could sort of serve as a steering committee, I’m very open to that. Um, and I would put that to the Board

19:38 of health as something to decide. Um, and there’s also opportunity for people to be involved just a little bit, you know, depending on what their interests are. Um, but anyway, so to think about who, who, who is the working group, who are the point people of this project, um, on, in terms of the, on the town side, so that you can ensure sort of maximum utilization of the data, uh, once it’s complete, um, in terms of people who know and understand what it is and what it’s, um, how it was collected, and then can use it for their, um, their purposes. So that’s something else to sort of decide and think about as sort of who, who, who should be in that group and, and how should we be thinking about working together. Um, and so the timeline is that, you know, late spring, sort of getting that group together, um, as sort of having like a kickoff meeting sort of coming together

20:25 and saying, okay, this is our, um, this is the project, this, these are all the specific activities that we’re doing. And when we’re planning to do them, make sure that everybody understands that we’re all, you know, working from the same playbook, so to speak. Um, at that time we’d get the IRB approval, and we would also be identifying the existing data that I mentioned earlier in terms of what kind of health data do we have at the municipal level, or ability to manipulate at the municipal level, um, on Marblehead. And then in the summer months we would be, um, inviting and planning for some focus groups and also developing the survey content, um, and getting ready for a September, uh, 2025 mailing and survey being distributed and collected, um, in September of 25.

21:12 Getting all that data back to us pulling together the report, you know, that includes sort of previewing the report with you all and, and wrapping everything up, um, probably before March or around March of 2026. So, um, that’s something that we can, um, talk about as well. And I guess at this point, I will pause, ask if people have any questions or reactions and maybe have some discussion of some of the questions that I’ve raised, if that’s okay. When you get a say you get a 10% reaction, I, I mean, I assume younger people probably weren’t. How now, what would you say is, say over 65, what percentage, what portion of that 10%? Oh,

21:59 That would be over 55 That I’d say 65 that, that you get a response from of that 10%, what percentage of that? Um, I probably about 25 to 30%. Okay. Some, you know, what’s interesting about it is that the distribution of the, um, sample, the survey responses, the age distribution is usually like relatively even, it’s that it’s underrepresented of the broader population. Okay. So it’s that we might have like 25 or 30%, um, older adults. But, um, yeah, it, it definitely skews, I would say around 40 is when we start to see like meaning.

22:44 Um, I was just looking at some 18 plus data in another community earlier today and, um, I saw the response rates really jump like the 40 at age 40 meaning, Okay, so pretty much Everybody under age 40, I had to lump into one group because I had such, so, so few cases that the comparisons were like 18 to 39 and then 40, 50, 60, 70 and 80, like those, I had enough cases to let those age groups stand alone, but I had to collapse it. Um, under age 40. Part of that is because college students don’t live in town anymore, you know? Yeah. There’s not a lot of people, um, in terms of, and they might, so anyway, so there’s a lot of challenges with that, but that’s what I would,

23:30 Alright, so 18 to 39 is young, so I’m officially old. Okay. Well, no, I mean, it’s young. I, it’s, it’s in terms of the, of the, the response rates on the survey, yeah, I would, I would, unless, and unless we’re, unless, and I think the, um, as I mentioned, I mean a lot of that has to do with outreach problems. Mm-Hmm. And just sort of getting the message into the right places and for the right people and to motivate, you know, motivate people. I think having people understand what is the data being used for. And so I think that that is, that underrepresentation of young people is something that we can be, we can at least try, um, to over sample by, you know, ramping up outreach for. And also that’s another, another place where

24:15 the focus groups, you know, I mentioned, you know, maybe focusing on, um, in, you know, children and families. I think the focus groups, that’s another place where we can really, if we know that survey response is gonna be lower from those age groups, you know, using those focus groups to try to get in there and have conversations with people about what’s on their minds. I also think that sec, I don’t know about existing data from the schools and things like that. If, if there are ways that we can sort of quantify any of the health behaviors of students, um, through other data sources.

24:45 So we do have some YRBS data, um, that is very recent. Um, but I think when we’re talking about strategic planning, I think we’re also looking for other broad wellness categories. So I think we get a lot of, you know, sub substance abuse, isolation, mental health questions in the lower age grade. But you know, obviously we’re looking for that for 18 to 40, is the other population that we wanna try to make sure we hit that I guess is gonna be hard to hit. Um, No, absolutely. And by the way, 10% is, uh, we were, we were in Swamp Scott the other day. Swamp Scott got 33%. And I understand that Swamp, Scott and Marblehead are very competitive.

25:32 So if they did 33, we want, we set up a goal for at least 35 to give you more statistical, more significance, Which I would, which I would really love and appreciate. I will say though, that the big difference is that in Swampscott we mailed the survey to residents age 60 and older.

25:56 If the population was smaller, the new, the denominator was only 1600 1600 mailings, right? Yeah. Yes. We, yeah. So we, so in that case, so what I, what I’m proposing here is that we sent everybody a postcard, drive them online, or they can pick up a paper copy of the survey or they can call us over the phone and swamp. Scott, we did a similar thing where we invited everybody 18 plus to participate in the survey, but we actually mailed copies of the physical survey to older residents. And so we got a much higher response rate. But that issue of skewing the data to being older, it was, you know, we, because we mailed it to 60 plus, we got a much higher response rate from people 60 plus. So why, why wouldn’t you suggest to mailing to our 60 and older we’re about the same size population?

26:41 Yeah. Well, I think that, I mean, in part, because I think really trying to lean into the all ages, um, and not wanting to have a a a, a sample that is so over is so skewed to, to the older adult population that it sort of loses, um, you know, some meaning of representation. And also, um, from a budget standpoint, the postage, the mailing printing and all of that wasn’t included in this calculation. Oh. In the one for us. I’m sorry The postage was included in their calculation, but not for us. No. The post for this particular proposal, I, I cal it was the mailing of, of, um, of postcards to everyone age 18 and older. So that 16, so 16,000 postcards would be included in this mailing.

27:28 I did not include any mailing of, um, the hard copy surveys.

27:35 But we hope we can do some of that digitally. Yeah. We can get, we can get people to, to be aware of, uh, the fact that the survey’s online. Um, that’s, I I think those things we can, we can see how we how it goes, but, um, I, I’m sure you know, but each hospital has to do with three year health status, uh, profile. And our closest hospital is the Salem Hospital in, in the, um, mass General system. And in that profile, marble Head has the second highest percentage of over 60 individuals.

28:22 I think that’s the cutoff. And we have the third highest under 18. Interesting. So I think that we will be able to get the families that have the under 18 that’ll, if we, if we design a marketing approach to re when we, when we talked to Heidi Weir, one of the things that they learned very quickly was that it shouldn’t have been sponsored by the Center for the Aging because it infu influences any, everyone, and her comment is just so perfect. If you fix the sidewalk for people with walkers, the tricycles will benefit from the sidewalks as well

29:11 as the baby carriages. And that’s what we wanna do in, in Marblehead because we have those two, those two dominant populations. Yeah. Yeah. I completely agree with you, Tom, and I think, um, that’s in that is very much how I’m thinking about this work. And, uh, we certainly know that ageism is alive and well. So we wanna avoid any re any, any reference of, of aging or gerontology so that we can, uh, avoid that. What, what do you know a about, uh, the Mariner that just came into town about two years ago, a year and a half ago? Um, That’s the newspaper? No, the, the Mariners, the, the new, um, residence for,

29:59 uh, senior living. Oh. And I didn’t know whether they did a study with you or does anybody else? They did a, yeah, Actually I, it’s on my list that I’m gonna go talk to them. You want Yeah, because you Is that, is that like an, is that independent living? Independent and assisted and memory care. Okay. So it’s, the mailing is, it’s even Years out. It’s a year, Maybe a year. Yeah, yeah, yeah. It’s, it’s new one. I it, so yeah. It’s Okay. I’m not familiar with them, but I will say just on that topic, that the mailing to residents 18 and older, will it be, um, we use the most recent town census list for that, or we obtain it through the town clerk and so anybody who is, um, a resident of

30:46 a nursing home or another sort of institution would be removed from that list. Meaning we don’t mail mail things to people who are in, so if it’s independent living and they’re, they’re, that’s where they live, then that’s different. Um, but in terms of nursing homes and things like that, we wouldn’t include them. The reason I ask, I, I was, I’m curious ‘cause I don’t know much about them ‘cause whether they did a study or not before they, before they broke ground, you don’t know. I Don’t know. I mean, so one of our benefits is that we do the trash and recycling Mm-Hmm. Um, and curbside collection. So we have the second largest email list Mm. Um, next to the schools. Interesting. Um, so we can do a huge push through that email list as well. Yes. You, you asked

31:35 at first about why is the Board of Health interested? Yeah. Um, and you know, we’re three different people. But let me, let me at least give my comments. Uh, ‘cause I’ve thought a lot about it. Um, I think one of the results of the pandemic is that public health is going through enormous introspection. How did we not do as much as we could of what could we do better? And I think that there are several trends that are, that are going on in public health. And one of them clearly is that the strategic input into public health policy has got to be moved

32:22 to the local environment. I think the United States learned quite clearly that one central agency, no matter how well respected from a research perspective it might be, it doesn’t co cover a complex society and e even a complex state. So there’s clear, clear indication that we want to be moving toward, um,

32:52 local boards like ours to develop, um, a a, a strategic input into policy and strategy. Okay. Well that, so one, two, clearly certainly in Massachusetts with the Steward disaster, uh, but around the country, um, the delivery systems are struggling in most countries. Uh, uh, United States is different for a bunch of reasons, but in most countries there’s a greater partnership between public health and the healthcare delivery system. And I think that if you look at the Commonwealth Fund, they did a big, published, the publishers Aware of Public Health going in the next decade.

33:37 One of the things that we need to do as a, as a group public health groups, is to work more closely with the delivery system. And we’ve talked on this board a number of different examples, you know, um, the obesity drugs out there that are gonna bankrupt most systems, but those sorts of things. But we will try very hard to, to develop a better partnership with our, our provider community, the delivery systems that are, that are near us. Massachusetts is absolutely the, the premier healthcare delivery system in my own, I’m new to Massachusetts. Part of the reason I think Massachusetts’ delivery system is

34:24 so great, it hasn’t needed public health support Mm-Hmm. In the past. But I think, I think over time, public health will allow the delivery system to function a little more efficiently if we do what I think the third part of public health is, historically public health has been in, uh, control prevention of disease. I think over time, without question, public health more and more is going to be moved toward health promotion. We wanna make the, the communities healthier. Uh, he healthier and it it living healthier longer.

35:10 And that, I think is the key reason why we need what you can, this assessment you can do for us. Because if we are gonna try to improve the health of the community, we need to know the baseline. We need to know what, what’s the T zero? So t plus five years, is it healthier because the board has made some policies and some, some plans to, to move forward?

35:37 Well said. Yeah. Well, Yeah, well said. Yeah, go ahead. I was gonna say that it was very well said and I, I actually really appreciate all of those points. And, and I think it just, for me, I often, my frustration sometimes is that these reports don’t always get used to the maximum capacity that they could be used. I think that you guys have a real opportunity, the fact that it’s sitting, potentially sitting at a board of health to, to have data that you could then take and be and, and form partnerships with the Council on Aging partnerships with housing authority, partnerships with other sort of groups in town, um, who all inherently care about health. Um, and so it it’s sort of also about strengthening your local, um, partnerships.

36:25 So with your calendar that you showed us or our calendar, um, starting in June of 25, um, the first thing we would do would, would be create a survey. Is that what, what? And so how, How about the first thing to develop an advisory board to help? You’d Have to do that before Then. I think so. I think that we should, Yes. Once she’s there, once she’s on board in June 25, we should be ready to roll. Oh, no, I think we should, I hopefully at the end the board will agree that we should move forward. And the first thing we swan’s got apparently when they just made a call, is anyone interested in this? They got 60 people volunteering to be on their advisory board and they crazy enough to keep all 60.

37:12 Well, I don’t, and I, I don’t, I don’t, I don’t think we would have any less. We’ve, we’ve put our, on the mental health task force, we got about 25 people. Yeah. So I’m, and and we had a very short window. It was three weeks, I think to, to get the people together. No, I, I think I, I, to that point, I will also say that I think you guys can think about whether you wanna put out an open call or whether you want to invite strategic partners to be on the, the advisory. And I think there’s room for both. You know, maybe it’s that at this sort of initial phase of sort of the study steering committee, maybe it’s about inviting strategic partners to be part of the needs assessment process, that then once the report comes out, you know, you’re sort of saying, okay, now we need folks to participate more broadly in helping get things done.

38:00 Um, and either, either way, I, I think either way is, is right. But I guess I would just say that in terms of the, um, you know, things like the survey review, I will ask that that’s only done with like a subcommittee of the go. Meaning trying to, trying to, trying to design a survey with a room full of 25 people is like maybe my worst nightmare. So I, I guess I’m just putting a plug in for, um, if you do go big and broad with your steering committee, that’s great, but we would just wanna think about sort of having a subgroup of them participate in particularly in that survey design process. Um, but yes, to Helene’s Point, the bigger advisory board with maybe a smaller executive council, something like that, that would do the academic stuff with working with you. Yeah. Yeah. Salem has a Salem for all ages is another, um,

38:49 have you se have you been in contact with them at all? I don’t know. No, I haven’t yet, but it, but they’re so much bigger than we are. It’s a little bit different, isn’t it? It Is, it is a bit different. They do have that sort of executive level. They have two levels of, um, membership. But, um, but just another sort of model. But I think to helene’s Helene’s point earlier, yes. In June when I, when we, when we’re ready to have that kickoff meeting, I would love, you know, you guys, part of being ready to go will be to have, you know, the people who you want to be at the table to be, you know, have them engaged and ready to, to get going because We don’t wanna waste once you have the time, we don’t wanna waste that time. Right. And we want, and I’m always one that says, let’s go, let’s go,

39:34 let’s get it, you know, get, keep our, our, uh, things rolling. So, um, that, that’s helpful. And like once you begin, how, how many times a month would you be speaking with, with, are there are various groups or what, what can we see out of this project? Yeah, from, from your, your office. Yeah, it’s a good question. So we can, we can do it really however you want. We can set up any, um, sort of cadence of check-ins of sort of meeting check-ins. I will say that typically there’s sort of that beginning meeting, the kickoff meeting where we get everybody on the same page. Um, then I would have, you know, and again, it could be a subgroup of people or the whole group, we’d have another, um, point

40:21 of contact in that during, that’s probably that first summer there’d be at least three meetings. One would be sort of the kickoff meeting. One would be about focus groups. So deciding, you know, who do we want to engage in those groups and how do we invite them? That kind of thing. And then a third one would be the survey review meeting where I would provide, uh, a draft of the survey about a week ahead of time. And then we would all sit down and literally go question by question. I would explain, this is why we’re asking this question, this is what we hope to do on the back end of it, of, of with it, um, sort of analytically. And then you’ll all, uh, the people in the room would have the opportunity to ask questions, to change the questions, to add questions, remove questions, et cetera. So that would be sort of three, at least three meetings in that first, um, sort of quarter of the project

41:08 once the survey goes out. Um, there’s a little bit of a lull in terms of, you know, we would be in contact and communication about survey outreach in term and, and, and we would be providing you updates with survey counts and things like that. But there wouldn’t be any, I mean, unless we wanted to have a meeting, we could certainly have one. Um, but communication would probably ha happen via email or by phone during that period. And then there’d be, uh, a fourth meeting to review sort of initial results of the survey and sort of, um, recommendations and then sort of a final, uh, presentation of results, which we can do either publicly or just to the board.

41:48 And, um, you’re, you’re hoping to get 1600 pushing us back. Yes. Okay. So we have to be responsible for some of that too. Oh yeah. People, yeah. Oh yeah. We gotta provide people. Yes, yes. And I mean, the opportunities can Yeah, the committee that not just the three of us. I mean the it be Yes. Roger, yeah.

42:13 That, that’s, that gives me a lot of information.

42:18 And what, what do you, you you must have a, um, you probably answer that in, in one of our meetings, but a, uh, some, uh, what’s the word? Um, some premise of what you think we, we will find. Mm. So, um, that we could verify. Will you be able to give that to us some of the things that we may, may be looking for and Well, that’s, yes. I mean, I, that’s a another good question because I think a lot of it has to do with how we’re gonna, how we’re setting out to frame the definition of health, right? And the things that we care to know about,

43:05 meaning we’re gonna learn about what we ask about. So if we ask about mental and behavioral health, we’re gonna learn about it and that kind of thing. And so I think, um, I can say from other work and from the in, in terms of what we’re seeing on the community level, you know, financial security is a big deal to people in terms of its ability to pay for things like prescriptions and, and healthcare. Um, mental health and stress and substance misuse are another one that we’re seeing. Um, we, we, again, we’re, we see it because we ask about it, but caregiving is a big deal for families in terms of trying to manage, providing care for kids and, um, aging parents. And that sometimes, you know, we also hear about sort of dementia related needs there.

43:53 Um, and then a lot of positive stuff on wellness. People are really, um, we, we usually see high rates of, um, sort of people wanting more things like exercise classes and wellness access to wellness resources and sort of, sort of a real desire from people to engage in this sort of health promotion that you’re talking about. And so I think, um, you know, one thing we can think about is if we want, you know, if we wanna hone in on that even more specifically so that you can help think about, you know, what could be offered that would align with people’s, you know, what they’re motivated to, to participate in. But, um, I think that’s something that I, I’m gonna look

44:38 to you guys for as well, just in terms of what are the health areas. I mean, I can think of, for example, if we think about physical health within physical health, what are the kinds of things you wanna know about? Do you wanna know rates of chronic disease or are you really wanting to know like, how frequently do people exercise? Like, ‘cause I think about it as sort of a behavioral, we’re asking the individual, like that’s our sort of unit of analysis. And so thinking about what can we ask them that we can’t get from surveillance data, you know? So I’m just curious what your thinking is As a group, we have to decide what we really, what what our, what we want our findings to be. That true. Yeah. And we as a group, we’d have to, uh, sit down and just set

45:24 and bang it out. Different people have different interests and then they, we’ll have to come to our agreement. I would say that that’s something else that maybe could be done between now and June, just in terms of your own internal thinking about, okay, within, if we take for example, the social determinants of health or some other frame, like within health, what are, you know, physical health taking that, like what are the kinds of things that you want to have information about? And is it the level of sort of di disease diagnosis, or is it more about, um, sort of perception of need? Is it about service? What kind of health promotion activities people would, you know, there’s just so many sort of layers to it,

46:09 I guess, thinking about, um, and, and same thing with mental health. You wanna know rates of, um, you know, rates of Access. The doctors are, you see, you know, are you able to get the, you know, that you’re looking for access? That’s always a big deterrent for mental health. Yes. Um, I think for the, well, you know, for wellness and physical health, um, it’s really gonna be, you know, some perception of your body figures, you know, are, you know, looking at body weights, you know, what, where are people? Are we getting enough exercise? You know, are we on social media too much? Um, are we eating well? You know, do we have access to good food? All those kind of things as well.

46:55 Yeah. I mean, I, Yeah, we’re definitely gonna have to hone it down and make sure, I mean, obviously that’s where it’s hard to, uh, how, how many survey questions generally are there. Yeah, good. Also a good question. So typically about 40. Okay. 40 to 45, which sounds like a lot, but, But it’s not, But it’s, it goes quickly from a design standpoint, but also, um, anyway, it’s about 40 to 45. They’ll be in different areas too though. Yes. And, and how many surveys have you completed in the last couple years? We do about six a year. Okay. So obviously we can take a look at all those surveys. Yeah, they’re not all, um, that’s all right. Yeah, I can send you the one I’m thinking of

47:42 that we’ve done most recently is more about human services. Okay. Uh, for the town of Natick, which is also a bigger place, but that is maybe one that would be, and that’s very recent.

47:57 The swamps got completed, isn’t it? It is, yeah. That was done a, it’s been a while now actually, that it’s been done Oh two. Oh. So I mean, would that be helpful to see what they, what their concerns were, But as Tom kind of said, this is our, like our big piece for our strategic planning. Yeah. I think, you know, if we’re planning big, we would be completing this, you know, obviously we’d love to say once every three years, but that’s probably not practical. Um, probably once every five years. And that would be driving where the board of health is gonna focus their attention on the different issues. Yes. Yeah. And I mean, with that in mind, to the extent that you want to be able to understand how things change

48:42 Yep. Then that is something also that I would keep in mind as we put the survey together, because we’re gonna wanna ask questions in such a way that we would be able to, that it would make sense that we could look at change over time. Okay. Um, the thing, the other thing that I am

49:08 not, I won’t say I’m struggling with yet, but I’m thinking about is this idea of, so on the online survey, it’s very easy for us to have someone come into the survey, they tell us how old they are, we can send them down, you know, different paths as far as different que different sets of questions for different groups of people. Um, and I don’t know if we’ll need to do that. It might be, it’s possible. I mean, it was possible for, in other communities where we can ask the same questions for all age groups, it just limits. Um, so I guess it’s just one of those things we’ll have to kind of keep, if there’s like a particular issue for a particular age group that you’re really interested in knowing about. For example, if you feel like long-term care access

49:53 to long-term care services are really, is like a big deal that you wanna know about, it’s gonna be hard for me to ask an 18-year-old that question. Um, versus if you are really wanting to know about an issue facing, um, young people, you know, just kind of figuring out how to craft a survey that’s gonna be universal, um, is something else that we’ll just have to balance. And it’s really easy for us to do that online, but once we start printing surveys, it becomes a lot more complicated. And so we’ll just have to, um, You can’t choose door B. Yeah. Yeah. Which I, I don’t know that we would have to yet. Yeah, it’s mostly like if you guys are doing some self-reflection and saying like, oh, I really wanna know about classroom stress, for example.

50:38 Um, there’s, you know, we can get away with asking everybody about, you know, potentially academic stress, um, you know, by putting a, not an na option. But anyway, it’s just one of those things where, um, we’ll have to just be cognizant of the fact that we’re trying to design a survey for an 18 plus population. And sometimes those, those challenges come up, um, and we can deal with them. But, um, was that, as you’re thinking about what you wanna know about,

51:06 Was the 18 plus determination between you and Tom before we met, or where did that, how did that arrive? Well, I think it was my assumption that you all are serving everybody in terms of a board of health. I can only survey people 18 plus. So I think I just sort of, We hope, we hope we’ll get a partnership with the schools. Yes. That’ll, that’ll take a lot of effort. But, but a, as Andrew mentioned, we do have the, the, the risk survey out there already out, out there. And the schools have just introduced social emotional learning as part of their curriculum. And I think that this whole issue of social determinants of health will fit right into that.

51:52 So my hope, I mean, this, this is relatively new, even though you’ve been here twice, this is the first time the board has Yes. Has had a, a, a, a conversation about it in detail. My hope is that the three of us could agree today that we want to do this, and that we then invite you back for maybe a February meeting that we’ll, working at developing partners, we’ll have to figure out where we’re getting the money. We’ll have to do a bunch of other things like that. And we, amongst ourselves and with our, our partners, I mean, clearly the, the, the Center for Aging wants to be involved. Clearly the counseling center wants to be involved.

52:38 The, the, the, we, we hope that we, we’ll get the schools involved one way or the other. Those, uh, the recreation and parks, the, I think that we’ll be able to do that sort of thing. And then a, after the, the, the beginning of the year, we, we come back with you and then we, we have a more developed profile. The one thing I do think that I need to know for sure, because I, this is New England and people are very private, how can we guarantee security and, uh, auto independence of, of the data that that, um, privacy is gonna be absolutely protected?

53:26 Yes. Yes. Well, this must be a, they must be anonymous. It’s a completely anonymous survey. So the, um, Yeah, but there’s ways you, you have to de-identify as much as you possibly can. Yeah. So the only identifiable information we would have is there. So if they do it on, if it’s all on done online, that that would be their IP address. And, um, but I guess all of that to say is that we use, um, a Qualtrics system that’s, uh, licensed through the university in terms of how the data comes into us. We, once the survey closes, we download it and we keep it in a sort of password protected place. Only people at the university have access to it.

54:12 And I guess part of that is, um, yeah, and I mean, it’s, the only way we would have any identifying information is if someone wrote it down in their comments. Um, and we do review every single one of those, and we would, you know, remove anything that was identifiable.

54:33 And the data that we, you know, the, in terms of mailing information, all of that is public, uh, public record.

54:40 So Does anybody else have any questions or you have anything else you wanna share this time since you’ve been invited back for February? And I was gonna say that From our, our visitors or partners, Because, uh, it’s eight 30, that’s just what I’m looking for. Does that 10% response, how does that change if you did 30 questions versus 20 questions versus 40 questions?

55:03 Um, we don’t, we haven’t done anything other than 40 questions, so I can’t, I don’t know exactly, but I can tell you that the trade off to 40 questions is that it’s an increased risk of missing data, meaning that it’s more likely. Yeah. No, I know that. I’m just thinking short attention spans. Oh yeah. Not getting more. Well, people we’ll skip around. Yeah. So yeah, I don’t think it would change the response rate. It’s gonna change the quality of the data. Right. So I Don’t Yeah. Yeah. Okay. Like that. Um, we just did one 18 plus that was predominantly online, and we got a really pretty good response rate, but there was a lot of missing data. Okay. We have An audience question, Tom. Yeah, No, uh, basically I, um, have listened to all of this. Um, but the, the practical aspect, how long does it take

55:52 to complete, to complete a survey? If I were to start it, how long would it take? Because I think that, you know, we get a, as you well know, we get asked for surveys all the time. Yeah. You know, whether you go to your doctor’s office or something else. Some of them are short and some of them are very involved and you don’t, you just opt out. So that’s why I’m, yeah. So it’s a question I have. Yeah. So the survey that we typically work from takes people no less than 15 minutes to complete. And, And what types, I’m so no longer than right. Excuse, I, I’m just wanting to follow up. But back to the logistics of it. Are these Yes, no. Or are these fill in the blank types of responses? They are multiple choice. Some are, yes.

56:38 No, some are multiple choice. We do have, I would say at least four open-ended questions. Okay. That are, and, and I will also say that it, everything is optional. Right, right, right. So, and that’s even true on the online. I will just, we can’t, we can’t require answers to questions. Um, meaning that, you know, online sometimes you can put something in place that will make you, you have to complete the question before it lets you move on. We can’t do that because that would be unethical.

57:12 Anyone else in the audience? We’ve got a couple of dots in the audience here. So like, Andrew, anything else?

57:26 Someone’s raising their hand. No, no. We’ve got an audience on Zoom. There’s no one raising their hand.

57:33 Well, thank you very much. Uh, next step for us to determine if we’re gonna go ahead. Second, no short physical therapy as a question. In order to get that date of June, when would you like to hear? Just ask my, and I’m sure, I’m sure you’re gonna say as soon as possible, but Yeah. Well, no, I, I think, um, I will update the proposal that I had previously shared just to, to reflect any of these sort of new dates and things like that and share that back with you. And I’m, I will hold this, you know, sort of hold you on my calendar as being some to start in June, and you can tell me when you’ll know. I don’t know what the process is if you have to get it approved by 10, you know, I don’t know.

58:20 It depends on what your internal process is in terms of We just have to raise the funds. That’s the, yeah, I think that that’s the, that’s the deal. Okay. Um, and how quickly we do it might be something that I thought maybe you might drive, but as long as you’re holding the date, that’s good. Um, anything else? Not right now. Thank you very much. Thank you. One thing you really would like her to think about, are we, are we winter to come back or, Well, hopefully we can be ready to deliver our thoughts or to her so that we can then start the conversation. Sure. I don’t think we wanna just say, see you in June, right? Uh, once we, once we’ve got the money in the bank

59:07 and we’ve got a team looking at how to proceed, um, I think we wanna be able to bounce our, our thoughts. Gee, have you ever tried this? How about, uh,

59:22 Yeah, you, that’s fine. I’m flexible to come to, you know, to zoom into another meeting in the winter or whatever. And then as we get closer to June, I, but I will say that, you know, in terms of homework assignments, it is about, you know, figuring out who your working group and your partners are gonna be and doing some additional reflection on when we think about the different domains of health, what are the things you want really you wanna know about That would be informative to, um, your board, because we only have 40 questions. So, And reaching out, you want all, all walks of life of citizens, not just professionals and not all lay people, or you, you want a, a good mix? Yep. For the, for the working group? Yes. No, for the Survey. For the Survey. You’re trying to, we’re trying to survey the, the community as a whole.

1:00:08 No, no. I mean, the working group too. The, the group that we have. Are you interested, you think we should look for people that aren’t trained in maybe in, in areas of, I would stick with, um, I would stick with like boards, committees and, and organizational like sort of stakeholder level, because the, you guys are all residents also. Um, but I think at least for this initial phase, I mean, and you can decide how you wanna structure the, the group if you would like to have some kind of executive level group that sort of does the steering of the project. And then you have a broader group that’s involved in keeping in touch with what’s going on and helping to roll out, um, you know, push out the survey

1:00:54 and be involved in the, in the, the what’s next piece of that. But I think ultimately, if this is your strategic plan, you would, I think I would recommend sort of the stakeholder level partners at this Time. Okay. All right. So thank you very much and Thank you. Nice to meet you all. Thank You. Thank you. Thank you for working with us. All right. So we have lots to think about.

1:01:20 Well, I think that, um, we should put this on the agenda for next meeting. Have of course discussion with table, because in, after hearing all this, I’m sure there’s a lot of thoughts running through our minds.

1:01:37 You say bring her in next time. No, not bring her in, but we need to have the talk to get you Debt. I’m gonna, hopefully all three of us will be out trying to sell. I’m gonna speak to the afternoon rotary on December 5th. I’ll bet I get a lot of it. I, you know, I have 30 minutes if I talk for 10 and hear people how they might respond. And if we can get invited to a bunch of different meetings like that, we’ll get the ideas that we bring back here. And Structurally, well, how much does, does this survey cost? 40 to $45,000. Okay.

1:02:21 The, the little bit of increase has to do with the, the group sessions that she’s talking about, which actually was the least positive in Swan Scott. So I think we have to really think, I think they’re absolutely critical, but we have to make sure we don’t just say, let’s bring together a group. Yeah. We need, we need. But So when, when she originally talked, yeah, she, she generally surveys people 18 and up, but we wanted to do full, you know, all ages. Um, so the way you capture the younger groups is through the families, the focus groups and stuff like that. That’s how you capture those younger people.

1:02:59 All right. So, um, Do we need a motion to say that the board endorses the idea of moving toward this? How do we I think you Wanna memorialize it. I think you do wanna create a motion to say 1, 1, 1 thing is, so she doesn’t think that we’ve already engaged her. No. We don’t have a contract with her. Yes. So, of course not. Yeah. But she’s holding the date for us. Yes. Well, I would like to hear a motion of, uh, it of someone at this table to see if we should go forward with, um, with, with Dr. Coyle in her best practices brain. Yeah. I think this would be for the, you know, the public health assessment for the community of Marble Head Earth. Yes. And it, and we would work, the board would be out there developing

1:03:47 the process in the next couple of months. And it would be a, a regular item on our agenda. Not only will we have to work on the funding, we will have to get a group together as we do that. But yeah, you’re maybe, you know, They need to create a steering Committee. It’s like, but it’s like a, uh, feasibility study. As you raise money, you raise interest. And we would be able, I mean, that’s my fundraising hat that, you know, we could, um, get the interest. We come to talk to Rotary and they, alright, so they’re gonna give us $5,000 or whatever they’re gonna give us. And that would be nice, wouldn’t it? And um, maybe there’ll be a couple people that walk come up to you afterwards and say, gee, I’m really interested in this program. I’ve got a mother-in-Law. That’s whatever.

1:04:33 And you know, or a kid that’s this. And, and I think that that’s how you’re gonna get people. So as we fundraise, we need to people raise. Oh, no question. But, but I think that’s where you and Tommy can make a difference. I can’t help. I’m your technocrat. You guys know the community. I don’t. So you, you have to, I, I can read all the literature, I’ll share the literature with you. I’ll talk to you about Those things. If you’ve been where you, if you’ve been where you’ve been, you know how to fundraise too. Um, but that’s academic. Academic grants. Yeah. That’s a little different. Having people trust you Right. Is very different than you. The two of you, the three of four of, you

1:05:19 know, a whole lot more Running, uh, for office the last, uh, half a dozen months. I think that, well Actually I do think that’s a good secondary benefit of this, that the community will know that the Board of Health is interested in health promotion and the transfer station. And so people might run for take their pool papers in the spring to run for the Board of Health because they’re interested in health promotion. That’s interesting. Yes. Okay. So, um, a motion, uh, I’m looking for motion and a second, I, I move the, we, we, we work to meet the calendar for a health assessment that’s proposed by Dr. Coyle. And I’ll second UMass Boston. I’ll second it.

1:06:06 And, uh, all us in favor, it’s unanimous. That means that we have some work to do. We can’t just make this vote and it’s gonna go away. Hey, look, I, my wife is happy to keep me out off the streets.

1:06:23 That’s, I think all our spouses are. Um, okay. So, um, we, we are going to go to the calendar. I think that’s where we are right now. We’ve covered all the, can we help? Yeah, I’d like to move the we because of this, but also because of things that Paul have that we move to, to go to a twice monthly meeting. And if the chair and the director would be willing to, to inquire of the stakeholders and the members, what would be a good, uh, meeting schedule for 2025? Would, would you think that the extra meeting would be maybe just to discuss this, uh, project?

1:07:10 Or would it be a whole other, a regular agenda? I think we’ve got a, a couple of projects that We, yeah. So the meeting could be project oriented as opposed to a regular Agenda. Yes. I, I, my own view, my, my history, I and board big boards that I’ve been on, there was always we would call an agenda committee. Right. And that, that meeting would talk about making sure that the public meeting, both of them have to be public, right. But making sure the bigger meeting was organized, was structured and detailed so that no guests to the smaller meeting, no, uh, extra conversation. Just down to the projects that we’ve gone on. We have a wellness fair coming up. We, we have all these things doing.

1:07:55 Let’s talk about each of the things that we’re doing. We’re gonna be doing some construction hopefully. So, so if the, so Generally like, you know, we spread meetings out, you know, this meeting’s the second Tuesday of the month. The second meeting would be the fourth Tuesday of the month. So on the first Tuesday of the month, you would be a meeting like this where we cover all the topics. The second meeting of the month would be really diving into the big projects. Yeah. Okay. So yeah. ‘cause I, I was suggesting, because I met with Andrew today about the timing. ‘cause I, you mentioned the, um, the first, uh, Tuesday of the month and then the set. But in my mind, we can’t have it that close because we would never be able to post the agenda. ‘cause they’re too close together and people wouldn’t see. But,

1:08:41 But I think, you know, with this, you know, obviously, you know, we’ll continue with, you know, I’ll, I’ll send out two weeks beforehand a big, big meeting, making sure all the board members have everything on that this meeting that they wanna talk about during this meeting. We can set the agenda for the two weeks out. I also was thinking, uh, uh, in, in my own mind that this, these two meetings, so they would be, one would be more of a full agenda. The other would be project oriented. That, so that’s helpful. But I, I, I was wondering if, um, if, uh, I, I know that February the second, the, the fourth, uh, Tuesday of the month is school vacation. And I don’t know that we want it There. There’s always gonna have to be some And either Missing of meetings or, right.

1:09:27 I was trying to think whether we should do it every other month. That’s all. You wanna do it every month. That’s what I’m propo proposing. This Is starting in 2025, right? Yeah. But, but, but, but if we do it in, have two meetings in January, skip February, then two meetings in March, then spring break is in April. So I didn’t know. So those are what, but maybe we can go monthly. Let’s plan the one for January and if it goes well, we’ll do the next one in February. If we need to skip a month and see that I’m picturing it, that we only need it every other month. That’s what I’m saying. As opposed to every month. If you wanna just play it by ear for the few first few months, we can do that. Or if you wanna make a definite for two meetings a month, We’re, we’re board. What do we, what do we think? I think try January to see how much we can get done. Okay.

1:10:14 And then go for it. Okay. But meanwhile, save the second and the fourth Tuesdays of the month, except for March. We’ve already changed the March meeting to March 4th. And the, then the last piece is that it, it does have a budget implication. Um, we, we do have enough money to cover the cost for our admin for doing these meetings. So we’re all set with that. We do have any, We do have enough Focus today. You weren’t, I I had to check and I was able, I did find some time this afternoon to check in on the numbers. See, he has to be people that are sitting at a table working, have to be the ones that are salaried. Have to be salaried. It costs money to make money. I, I, I’m fully aware. We just have to, but it really all,

1:11:00 what it it’s really doing is raising the level of our participation. We just have to be, we’re gonna be raising funds, we’re gonna be be good stewards of the funds we have and we’re gonna go forward. Like you, you indicated that we have 8,000 of IRA money in the mental health task force, right? That’s correct. Okay, well that’s a good down payment to start with. And we can go, but We’ve gotta speak to your group just to let go of it. Yep. Yeah. So Now you’ve got two people to solicit Rotary and the mental health. I better find two people. Oh yeah. We’re, we’re, you and I are good. Now. We’re gonna be competitive, not just swamps Good And Marvel Fine. That’s exact. If I can raise half of what

1:11:46 you can raise with all your friends and Tom has a whole different set of people. Thanks. Hey, we’re gonna, we’ll get the, we’ll get the transfer station in, then the whole construction group in town will be so happy with the board of health. They’ll be willing to pay for this. Alright. I’m, I’m good with it. But I’m always very conscious on my calendar that the second Tuesday of every month, I never make any plans. Uh, the fourth Tuesday of February, I do have plans. Okay. So I made sure I checked my whole, I have plans too. So that’s, yeah, That be good. Go. But we’re gonna go through January 1st. You being issued, right? Uh, I said we’re gonna go through January’s trial on first. So February may not be issue. Fourth, We get something done.

1:12:31 We might get more efficient if we don’t have gas for, uh, uh, uh, month, we can keep, do more work. Yeah. Um, okay. So, uh, that was a good discussion. Um, so now you’re, you’re good. The whole agenda seems I’m a troublemaker. I know. Well, the only thing that I, These academics, you know, that’s the problem. Yeah. You sit around and read things and then talk along.

1:13:02 Well, the, the, the difference that we have, I think in the document that you distributed, you used the term that the Board of Health and the Department of Health are two distinct agencies. And I don’t think we’re distinct. I think the Board of Health is the, the agency that’s established by state government. We are the three people that were elected by the people of Marblehead. We have responsibility for the health activities of the town. We work with the department and air group in doing that. But they are not separate. I, I don’t wanna say they’re subsidiary,

1:13:47 but the, the, the, the, the Department of Public Welfare is not a distinct agency from water and sewer. And that’s the same way I see this. And, and if we agree that, and, and then we, we, we define how we, how we what the responsibilities that the department has and what the responsibilities now that the board has. Obviously we work together collaboratively. But I think indirectly you’ve already agreed that the board will probably have the responsibility to raise the money for this as you probably can’t raise money. Correct. You can’t go out.

1:14:33 I did not solicit that. So, so what that, that’s what I think is the right way to do things. But I think we’re separate but distinct. I, I mean, I, I think I, I think you’re separate because you’re the board and on the department in that. But, but we’re creating the whole piece. What If we, what, what if we, instead of taking, using the word distinct, why don’t we say that we’re, we’re separate but connected entities? Because I, I think, I feel that I need something to connect the two of us. We’re not his boss. He’s not our boss. Well, he needs a boss. Not necessarily. We owe we owe the town to have, uh, an accountable process. My view is the three of us are accountable to the town.

1:15:19 And we, I we hire or we ask public, there’s not public predictions or public human resources department. Right? Yeah. We ask human resources to hire someone to run the Department of Health. The Board of Health hired him all by themselves, But it did it without any legal basis. Right. There is no words in the bylaws. If even that thing you sent to the charter committee is, is it says you either have a Board of Health or a Department of Health. Yeah. But that some people are connected. They did say that. Of course, you’re connected because you’re, you are working in the health space. But if they’re totally separate, I almost think that

1:16:05 we need to have our own budget, the Board of Health.

1:16:11 We’re gonna work on the his budget. So you technically, the the money doesn’t come to us. It comes to you. Well, it comes to the department. Yeah. But obviously you, it’s one and the same. So obviously obvious when we go through the budget process, um, I have to ask for money and, and budgets. So that way, so like, you know, I, I’m gonna, sorry, I’m gonna use this example Tom, but the wellness fair Mm-Hmm. There’s no budget associated to that project. So technically you can’t move forward and do that project ‘cause you don’t have any money because it requires money. Mm-Hmm. But obviously we, we can make some slight shifts to allow that to happen or make some allowances. But when you’re budgeting Yeah. You have to budget for next year. So if the board wants to do a project for next year,

1:16:56 they need to budget this year, get it approved, and then it’s in the budget. See, but I don’t see how the town can allocate money to a department that isn’t defined. So it is, it’s, it’s budgeted to the health department and the waste department, the two departments. But there’s nothing in the bylaws or in state the general funds of the state that defines an existence of the Department of Health. But it’s defined through a county, through accounting, through accounting. So you make, you’re making motions at town meeting to say, this money is going to this department and that department. If you spend that money any other way,

1:17:41 you’re locating funds. So you’re saying it it, the fact that it’s that we work through this, it gives it in existence. Yes. Because I’m asking, I’m thinking that it needs a more legal structure. That’s the, i I certainly agree that you, we are collaborative and partnering And we have the same budget. Yeah. Your legal structure is that you have, you’re required through the state of Massachusetts to fulfill all these requirements, all the different laws, all these different things. Obviously some of those things require money. You go to town meeting, you ask for those appropriations, those appropriations are made to the two departments, and they can be spent based on those appropriations. And yes, the board has to make sure that that stuff is done

1:18:28 and it’s appropriated properly. It seems to me, if you read the general laws of the state of Massachusetts, the money either comes to the Board of Health, or if the board of health goes to the, to the town and gets the town to create a, a Department of Health and the board fades away, then the money goes to the, to the department. So at Some point, the, the town did create the departments because they hired me. They hired all the employees to create the departments. I, I think in a way we’re overthinking this and that the, the money doesn’t necessarily belong to me or the departments or the board. It’s one in the whole piece. But there’s good, it it, we’re moving toward a world that the, the, the trusting world that exists.

1:19:15 We don’t wanna move back to trust each other. But the, for me, the best way to have a trusting environment is to have an infrastructure that we know free creates, sorry. That’s free for politics. Well, as free as unpolitical as you can be. Yeah. Because the, what you’re talking about is subjective and interpretive. And it’s because we’ve always done it that way. This is marblehead. We lock arms, walk off into the sunset because we believe in certain things. But I believe that, that we, it, I, look, I don’t wanna waste any more of the, the board’s time they’ve tolerated me, but I just think that saying that we are not distinct,

1:20:02 we are collaborative partners. I Think that’s a great word. Yeah. No, I think, I think that’s a great word. Yeah. I think that’s the happy, like I see a hundred percent what Tom’s saying is that like, when you read it, it’s very vague. Like as in the board of health is out, you know, inspecting places, but no, we’re not. And so like defining that while keeping them together, just finding the right wording. Yeah. It’s all three. This says collaborative, I think is Good. And also I, if we’ve got rid of the word distinct and say it’s connected entities, I think that that yeah. Just collaborative entities, you know, I think that’s the phrase word when you said it. So I, I’m liking the connected entities that was written here, but whichever. Why don’t we, I think it, I think collaborative is a, is a great word to use.

1:20:47 Why don’t we, we, we are collaborating to work together. But I think the word connected makes it more

1:20:56 means with connected instead of collaborative. I mean, I think that’s where the, the, you know, the collaborative partner goes there. I think, you know, I think I like the word partners because we are truly working together to, you know, to better the community. Um, so I think, you know, we are definitely the board of health and the health department of two co our collaborative partners. Okay. And attract You with that word to Yeah, I fine with, I just, the analogy I use is you have the school board and you have the high school. They are not the state. They are integrated together. And, and we’re even closer than That. I think that, but you have to compare the school board with the superintendent’s office, with the business office, with their, what they do.

1:21:43 Um, the superintendent who, Okay, yeah, That’s fine. To get to get the school I went the school of the, uh, the, uh, the communities, uh, who? The school board and the superintendent in his office. Okay. The, the people that they manage our whole community are the people that, So you said, do you think the superintendent and the board are distinct? Separate but distinct. Oh, you do? Yeah. Alright. Yeah. I think collaborative partners is agree, Um, with the, Okay, why don’t we try to work and Work on that. But let’s, we need to get some sentence above this. Everything down below. Oh, I just pulled from what you have. Well, I have one other thing that I, the board

1:22:29 of health shall oversee. Did you have that word? Did I have oversee in here? Yeah, that’s the word. It is it Its in my, in the one that original document. Yeah. Is it oversee? I’m not sure it Isn’t. No, I think that I was saying the Board of Health’s responsibilities are, I thought oversee was a little strong. See, I’m going the other way now. Well, that’s, it’s so great that we can talk to each other.

1:22:56 That’s how he goes. But you can’t, we had two documents and I went over each one of them as a, you know, word for word. So, um, and I also see that there is, So you wanna say the board of health is responsible for the department. The board of health’s responsibilities are number one, the Marblehead department of health, which is, I don’t Know, or works with the department to ensure that blah, blah, blah. Yeah. Why don’t we look at both of the areas And, and So, so one of the things that you said tonight that I think we really need to kind of focus on is health promotion and making sure that somewhere in this document and living a health healthier longer.

1:23:44 I, I think, and the, But I, I think, I think that is the big piece that we need to move to. I think Keith, claimant, you do have it. Um, The, the new definition of, of public health is what society does to, to make people healthier. Yeah. Mm-Hmm. And we phrase that because the transfer station certainly makes my garage healthier. Right. And therefore me healthier. That’s correct. Yeah. Yep. Okay. So that, and then I went to page, uh, number two. Page two, I, I numbered your your things differently. I, I didn’t think that a should be that we, um,

1:24:29 look for grant opportunities. That’s not the number one thing. So can I make a suggestion? I, I would suggest that you write this whole thing up, bring it back to another meeting and rediscuss it rather than going line. There’s Only, there’s only three things that I, I Yeah, I, I would, I think that’s better use of time. Mm-Hmm. And We can figure out how toti, I, I think the way I read the open meeting law, this is an agenda item. We can discuss an agenda item. Yes, We can. But with, You gotta deliberate here. You gotta talk about it here. If that’s true, you Could both send out drafts Though. It’s true. Yeah. You can both send outs. I have it. Right. So if I just thought I wanted to, and then there was a one other thing. All right. So, and in it also, and you can look at is I don’t see that it’s a,

1:25:16 a five member board or anything like that in the body. All, all I wanted in that was to, to eliminate the word distinct and to All this work to eliminate the word distinct. Well, I wanted you to know that I was taking everything else you had written and just incorporating it in a different way. The only, the only disagreement I had is that, that we are distinct. But I also think somewhere in there we have to be accountable. We have to be accountable to the people who voted us in. But if we’re gonna relate to Andrew, uh, Andrew has to be accountable to the state or to the town in some way. Right. So we, we both are. So you are obviously accountable through master law for public health.

1:26:01 And I’m also accountable be, you know, because of my position and stuff like that. Yes. What I’m gonna do is I’m gonna give the corrected copy to Andrew and he can pass it out to everybody. Yeah, that’s fine. I mean, my corrected copy. Yep. But I, my correct, it’s not the correct, and by the way, this is a collaborative effort and it was not my, it’s not my document, but it was one that I liked. I just wanted you, I didn’t want to, I, I don’t wanna take credit for it because I, we Won’t accuse you of pal plagiarism like we did the president of Harvard.

1:26:34 Well, for the salary that I’m getting.

1:26:39 So, um, anyhow, that’s, Look, we’ve, we’ve made, uh, I think we’ve made the point. I think that we, we will be able to do something that will fit into the way the charter, the charter committee is working if the charter ever gets fast. Okay. So you think you they’re slowing down too.

1:26:58 Sorry, You’re slowing down also. Oh, no. I think it, even the people who on the committee, I’ve got this thing, My observation anyway, Passed all People who were on the committee. Oh, perfect. I just wanna Make sure you guys saw it. Thank, Thank you. Welcome. Um, this is it.

1:27:23 Um, okay, so no, I saw the form on, I have no issues with it. I just have to get some of the people that I’ve talked to to fill it out. Yeah. So I think, you know, the idea obviously is, you know, we wanna make sure that everybody’s involved in this. Yeah. Um, so this is the silent form that we will send out to everybody and, you know, send out to the community. Um, so Who, how are you getting the list to, to sell? So, I, again, I’ll use the listserv and I will send this out to everybody that has put their emails into our board of health. And so I can hit all those people. I can send ‘em out to all the people that get permits through us as well. Sure. Um, but so like, some of the pieces that I’m gonna miss is obviously, like, I don’t have the doctor’s offices. I don’t have all the fitness places. So that’s where I, I have, I have all the fitness places.

1:28:09 Okay. So that’s where we need to kind of like hit some social media. Yeah. Little bit. I’m, I’m all over social media with this. I don’t know how many people have read my things on social media. Okay. I’ve taken some classes on these things written, written up. Perfect. Positive reviews on of them. I’m doing it weekly to kind of build up to, it have about eight to 10 raffle prizes already. Some of them are hitting like seven, 800 bucks. Yeah. And part of the, the signup form is, you know, if you have a raffle Yeah. Willing to, so people we can know right away. Um, and then, so obviously, you know, I’m gonna say we technically have limited space. Um, so if we can over in abundance, um, the idea is to send this out, uh, hopefully next week, send this out to everybody and get everybody back by our meeting in December.

1:28:55 Um, and I can say, Hey, I have too many, how do you want to cut, you know, cut the piece of pie? Or do we need to use the whole thing? I Think that if, if we’re getting these fitness people and, and Thomas said that obesity is a problem and heart rate and all those, I think we should try and seek out some of those people. And I can give you some names on that. Yeah. I think, again, I, you know, don’t give me the names. Yeah, no, go, Go Get them. Go get them like this, That you’re sending out the list. Yeah. I’m, He, he’s just asking It out. I’m just blasting it out through an email. But Andrew’s plate is fault. Yeah. And it’s, uh, like I’m going directly to these places, talking directly to all of them. I’m taking, so yeah, If you have people that goofs that you want there, make sure they have the information. I can make sure that, you know, we’ll finalize the, the signup sheet and get that to you. Obama is planning

1:29:41 To Yep. Some mental health people. Yep. Involved. I, the counseling center said that they were interested in the table. So again, we’ll send this out to the whole community. We’ll see what gets back. And if we have to make cuts, the board will have to decide how we’re gonna do this. Yeah. Hopefully we can just fill up the whole, um, CUNY center. Yeah. That’s not gonna be, did you say there was a a, a fee? No, we’ve talked about the fee. We’re not gonna have a fee for the event. Well, who’s gonna, who’s gonna pay for it? So Right now, the only cost that we’re gonna have to cover is the building and the custodial. So we’re gonna have to find the, the money for that. So we’ll have to really squeeze the budget to do that. How much does someone, I think the, to, I think we’re looking it’s 200. So 200, I think another 200. So I think it’s about a total of 400. Okay.

1:30:27 Okay. The fee for the custodial is 200 and Yeah, the rental room is the, is two. ‘cause I’ve just done it myself. This is In the room where the, we have, we voted right. I, I don’t go there to vote, so I don’t know. Yeah. So the, the main room is gonna be the, the, I call the gym. Gym, yeah. Um, but we can have overflow like, into, to other areas or into the main entrance hall. Um, it would be good to have some tables there. Um, and, and obviously like once we have all the applications and stuff like that, we’ll start to kind of formulate how, where we’re gonna place all the tables. Take a lot of table. That room can take a lot of tables. Do people know that it’s a holiday weekend? That it’s not Luther King weekend?

1:31:10 I did not. Yeah. Oh, I didn’t take, Because I, I, I was just looking at the c I’m, I’m, I’m not sure be available for that.

1:31:21 I, I don’t think it will be a problem. I think, you know, it’s the middle of January. I get back early on that week. Oh, okay. So, um, yeah, so I, I don’t know. Maybe it’ll be helpful. People will be, be around. Um, yeah. Um, And the only other thing for the substance abuse program, Tom and I talked, um, I’m gonna get some dates for March. Yeah. Uh, back to him. And that will give his, um, some flexibility and we’ll nail down a date in March. I’m regularly meeting with Mark Labon on it. We have a structure for it. So the date will just be key structures, basically. Uh, a table with resources outside opening statements. Probably Mark doing that, um, with, uh, stages of addiction,

1:32:10 making a clear distinction between use and abuse, because that’s a big part of the, that’s a big piece. Um, stigma that comes with it, you know, so, um, speakers shooting for between 15 to 20 minutes each. I have reached out to some students to not necessarily participate if they don’t want to, but be present and have the opportunity if they want to because, um, whether they just wanna get up and give feedback, make corrections. ‘cause you know, I’m out of touch with them. So if they, so they’ll get that opportunity if they want. We Have a student on the mental Health. Yeah. I was gonna, yeah, she’s good. If, if you wanna ask her, like, and let, this is what I’ve been telling the ones I’ve been talking to.

1:32:56 It’s basically like if you come, uh, basically at, at some point, or the speaker, whoever’s moderating, um, would basically say, is there any students that’d like to come up? No one being called by name. No one written down on a schedule just to remove all the, But this, this would be a great thing to put on your application to college. Yeah, I Agree. And that’s what Students are Looking for these days. So Yeah. The, you know, however many, you know, if you could ask her, I know there’s one that’s on the, um, goes to the school committee stuff too, so maybe I’ll ask. There’s A, there’s a student school committee. Yeah. See if they’re interested. Um, I did shoot for athletes, um, just because, but, um, and, uh, yeah. So maybe that’ll, you know, I think that’d be good if, if we at least had one

1:33:42 or two giving feedback about what is actually happening without throwing anyone under the bus or anything like that. I, I Have, uh, two representatives at the, at the task force against discrimination come every week and tell me what’s happening in the schools. Yeah. Let’s see if, see if they wanna come invite ‘em, then that’s, I mean, like I said, if they’re just sitting there and they’re just open mic, well, But they, these kids are not ones that are, are going to give you any information about use because No, They don’t have to. I mean, they don’t have it. Yeah. These, these are kids that are pretty clean. No, but they, they’re in the school, they know, like, I didn’t use anything in school. I still knew. You know, so it was, um, you know, uh, and then they’d be talking about after the potential student feedback, then there’d be talking like Marco Obama mostly about, um,

1:34:27 resources available, you know, um, learn to cope, things like that. And then possibly, uh, I know Tom mentioned it, so we’ll leave that, uh, about for, um, the possibility of q and a for speakers if they’re interested. Yep. You know, some might just want to talk and not Yep. It just depends on one that gets too, And yeah. So that’s the basic structure so far, and we’ll just be working it out a little more. Sounds good. So you’ll stay away from the first and fourth Tuesdays the second and fourth Tuesday. Yeah. Well just get the, we got plenty of time to figure out. We, hopefully we can Yeah. Put them out and decide at the next meeting what the date Be. Yeah. And I’m hoping to get the, uh, response about the substance substance abuse program. The play that I’ve had on hold.

1:35:14 I, I was, um, asked to reach out to the principal of the high school. Gina, who is the counselor of the high school, said she couldn’t make the decision without the principal knowing about it. I asked the principal and she didn’t answer the first time. I asked you the second time, and she said, what dates did I want this week? And I gave her the dates and she said, well, now you’ve gotta go to the superintendent’s office. She wasn’t that, it wasn’t, um, she wasn’t able to giving the, I had to now go to the superintendent’s office. So yesterday was a holiday. Today they had all these meetings and press conference in this room to, uh, I’m Not worried about dates. Yeah. Yeah. It’s pretty far. Yeah. We’ll definitely come up with a date and we definitely should have A date for the next thing. But what

1:35:59 I’m just saying is that I’m trying my best and, and I’m getting the run around. Yeah, no, I mean, Andrew had dates for November, but it just repped up too quick before everything was scheduled. So March is, um, you know, far enough away where if you reach out and you get a handful of dates Okay. If we could Yeah. Look at them. But at next meeting, is that enough time you think you’re responsible? Yeah. Yeah. So then, All right. So you want any bills that you wanna start? Yeah. Um, okay.

1:36:28 Uh, exterminators 1590 Agri Source that covers the grinding and compost removal, 18,240, uh, at t Mobility, internet access, uh, 80 bucks. Uh, Bailey’s test strips, that’s for food service. Inspection equipment, that’s 113 Black Earth Compost for residential food composting 4,406 Spot, 88 Bob’s Tire. That’s for tire disposal. 6 19 50, uh, Boston Green Fuel Code that’s, uh, recycles our waste oil. 4 46 25. Uh, we had some, uh, license permits and uniforms for Chris Mon that came out to one 60 East Coast, compacted as compacted repair. 615 bucks. GL Lab for Beach Testing. Lab Services, 600.

1:37:15 Um, LERs for uniforms. Uh, 2 29 91. Haley Ward, Inc. That’s engineering firm for the transfer station. $7,500 Home Depot for disposal supplies, 180 9 94. Uh, the Counseling Center for Psychological Counseling. 3,894. Spot 45 Marblehead Light Department for electricity. Uh, 7 41 56. Marblehead News Group for advertising and promotional. 4 25, uh, 425 me, Lerman and Costa for legal. Uh, 252 Printer Pro Solutions for Office Supplies. 58 50 Project Dog is the company and, um, website used for posting the transfer station projects to solicit bids.

1:38:01 1095, uh, quadrant. Health doctor’s name, word on that. Quadrant Health. Uh, so, uh, physicals and stuff like that. Okay. Okay. 90, uh, recolor, which is the called Latex Paint for Hazardous waste date. Um, 1,790 Spot two five Republic Services for Trash Disposal, 86,000 893 0 7 RMG Enterprises, LLC, that’s the company that recycles TVs, um, laptops and stuff. $938 19 cents, TD and I. That’s, um, r and m hauling Equipment, 1 28. Trident Environmental Household, hazardous Waste Stay, 7,000 7 91 72.

1:38:46 Um, Uline Inc. They do barrels for school. Kitchens $203 29 cents UTECH Inc. Mattresses Recycling Company, 5,094 Verizon for internet access. 1 69 61 Waste Management for trash Disposal. 120,630 Spot 16 WB Mason for office supplies. 1 52 18. William Scottsman, Inc. Uh, and that’s for the rented trailer. 6 47 16 Winter Street Architects, other professional and technical, $12,930.

1:39:27 Okay. Thank you very much. Um, the Director’s Report. Uh, so currently we have the project for the transfer station out to bid. Um, that went in the central registry on Project Dog October 25th. Um, we had a site visit. Um, we all also sent out about 20, 20 to 25 letters to contractors, uh, through the DAM certification list for the north, for the Northeast area. Um, the filed sub bids for the trades will be received on the 13th of November. Uh, that’s all through Project Dog. Um, general Bids will receive the 27th of November at 1:00 PM and again, it all goes through Project Dog. Once all those go in, we’ll take a look at them. And then we expect, we’re hoping to award the projects, um,

1:40:14 at our meeting in December, so December 11th. So you don’t see any, you don’t, you can’t tell up until now, you just see it, Right? No. So the biggest pieces though, so we had a site visit, uh, last week where general contractors filed submitters allowed to come onto the project and ask questions. The biggest pieces that came out of that were the concerns about working during winter conditions. Mm-Hmm. So we have two big pieces for winter conditions. So that’s doing the concrete work for the lower air, for the tractor trailers where the trash trailer sits, sits on a concrete pad. We have wing walls on both sides of that trailer. Um, and then up top, uh, where the concrete for the scale house foundation and the pit, uh, for the, the scale. Um, so winter conditions would be, if it’s cold,

1:41:01 you’re gonna have to heat those con that concrete to make sure it could cure properly. The other big piece for winter conditions is you’re repainting all the, the structure for the compactor building. So you’re gonna have to bring temperatures up. Essentially what the contractor said was that you’d have to scaffold and tent the whole thing and heat it. Um, they were very concerned about that. And the estimated costs just for dealing with winter conditions was about a million dollars. Some of them they’re saying. So we definitely got concerned about that. So we made sure. So in the bid documents, we said that start time we’d like to, to start right away, but to be scheduled with, um, the department. We put out an addendum to say work could begin, um, as late as mid-March to try to avoid winter conditions

1:41:50 and try to avoid those increased costs. Mm-Hmm. The other big piece was the timeframe. We had said 65 days, or as discussed, were agreed to by the owner being the town. They also had concerns about that. So we added additional time. And so we’re gonna stretch out the project. It could, you know, we’re gonna give them up to 120 days. It’s all, again, can still be negotiated. Um, but we didn’t wanna add cost to us. Obviously we are wanna make sure that that compactor gets back up and running, but we have a temporary scale house that can be working while the main scale house is being built. So we need to do some, make sure that we’re not kind of pinching ourselves in the corner, um, and adding some un undue costs for us.

1:42:36 Um, so that would be the biggest piece. So to get away from winter conditions, they suggested mid-March. So we’ve added some information or an addendum in there to say you could begin mid-March and that you’d have, uh, approx, you know, you could have 120 days to finish the project. Okay. That’s good. Those were the big pieces. Um, we’ve had some additional questions that have come out. The architects answer those, um, you know, smaller things, but everything, you know, any question that comes in through Project Dog has to be answered. Do you think, uh, that the, the, uh, project will be com completed by town meeting? No, I do not. No. So it’s 120 working days. So if you started mid-March, technically they, that’s up, you know, into August. But again, you know, you,

1:43:21 it could be some final fixtures that they’re dealing with. When we say done, they’re off the site and all that stuff. So again, we’re wanna make sure that the project is complete under budget or in budget, um, you know, allowing us to do our, all our different work, but making sure that we have the budget to move Forward. So if they’re starting in mid-March, then concrete really isn’t much of a concern because it wouldn’t be on day one. It’s correct. Yeah. Yeah. Okay. That makes more sense. And, and that was, you know, their suggestions mid-March, so we wanted to listen to them and say, you Know. Yeah, no, that’s the smart one. Yeah. Sounds like you’re doing this really well, George. No, we’re trying to, he’s trying to, he’s very experienced trying to think about all these different issues. Um, but yeah, it’s, it’s never easy. And there’s always things that come up and, um, you need to kind of pivot and talk to them about it

1:44:08 and ask them questions and try to figure it all out. Mm-Hmm. Um, with that, um, I need to talk about fees. So one of the things that we are switching over to is that, you know, we are looking at the LPR cameras. We are looking at to move to new software. Um, and we’re also gonna be completing the feasibility study for, um, the construction demolition mat, um, material, um, removal on the site. So we’re, we’re currently working with Haley Ward, um, for them to develop a feasibility proposal for that work. Um, so the idea is that we create an area where we can do construction, demolition, recycling on, on the property. Um, and so that would be, uh, you know, could be a large tented area in the yard waste area where we’re able to essentially back a tractor

1:44:55 trailer back into it. We can load it with an excavator that will be a self-sufficient. But when we do this feasibility study, you’re looking at every piece of the operation. So we’re looking at the cost to build a structure. We’re looking at, and this could be a clear span. Um, you know, I don’t know if you guys are familiar with a clear span structures where it’s almost like they’re used a lot for salt sheds in Massachusetts. Lighter weight material, not necessarily steel structure. It’s got a steel frame, but lighter material on top of it. It generally reduces cost of construction. Um, you can back trailers into it. You can operate full. So they have these at in Wellesley when you went there. Um, so looking at the cost of those structures, you would have higher concrete wing walls on them

1:45:42 so you can push up against it, making sure that you’re not damaging the structure. Again, you can back a tractor trailer up into it. You can park an excavator in the, in the middle, have it elevated. Contractors could dump material on the floor. You could do some sorting. So that engineers gonna be looking at the cost of that building, the cost of the equipment, the cost to process all material, the potential, um, revenues that we could have from that, the number of employees that you’re gonna need to employ to do all this work. So all those different things would go into the feasibility study. Are there different scales? Like when we say, you know, I know it’s called a sorting floor, but not, not, not necessarily be doing the actual sorting as far as Yeah. You know, so like, so would, there’d be one where it’s like, okay, it’s just wood, plaster, you know, metal

1:46:30 and it all goes into one bin, or there’s another option where they, we separate them into three now. So obviously you’re trying to look at what stream of materials coming in. Mm-Hmm. And so generally we look at it as like general, um, building construction material. Yeah. So it’s all mixed together. Like Yeah, it could be wood, plaster, some metal, and that can all be in one truck. Okay. You wouldn’t have to separate it out. Yeah. It would just be brought in, dumped on the floor. Um, and so the, the excavator itself would just kind of crush it up to, to reduce the volume of it. Yep. And then take all that material and dump it into the Yeah. Um, into the tractor trailer. And then that material gets brought to the processing Plan. And then you’re thinking possibly doing two as being like, well, two areas where one’s construction demo,

1:47:15 the other one’s, whatever the acronym is for solar waste. Like a, BC asphalt brick. Yeah, yeah, yeah. Uh, no, we’d actually be looking to do ‘em in the same building. Same spot. Yeah, Well in the same pile. Uh, so not necessarily in the same pile, but yeah, That’s what I mean, like two. Yeah. So like, you know, if, if this was the building, you might be able to do, um, regular building comp, like material over here and the a, b, C over here. Yeah. Or you do it by times a day. There’s a bunch of different ways that you could do that. Yeah. Okay. Um, but yeah, with the general building Special truck for the A, B, C stuff, right. I mean, So generally the A, B, C comes in and like track like, um, dump trucks and stuff like that. So more heavy, heavier duty, um, mason trucks, stuff like that that you might see. Yeah. Yeah. That’s what we saw in Wesland. Yeah.

1:48:03 I’m almost understanding this. Yeah, exactly. Like fifth feeding And I finally, um, so yeah, you’re really looking at, you know, what, what type of material we understand it’s generally builders and stuff like that, that’s gonna be bringing that material in. It can be generally like household goods and stuff like that, but yeah, if there’s metal to be picked out, it can pick the metal out and you’d have a dumpster there that you’re just dropping it into, um, pretty easy. Save the town money in any way from doing our road work. Like what do they do with that Material? So we have a lower yard where we store all that material currently, and it gets ground a couple times a year and then we reuse that material as I usually trench backfill. Okay. Okay. So something is being done with that. Yeah. Okay. Generally have too much of that material to, to reuse again. Yeah. Yeah. Um,

1:48:49 and then as far as the software, um, so yeah, we’re looking to look, move over to a software company called Town Hall 24 7. Um, this will allow people to go online, purchase their stickers online. Um, they would be able to prepay for items. Um, and so one of the things that we need to do is that for in, um, calendar year 25, we need to go cashless at the transfer station. So we will no longer be taking cash. It’ll be check and credit card only. I mean, how much cash do you get right now? I have ton. Do you really? Yeah. Wow. Yeah. Um, so it is a little bit of an issue for, you know, I think that’ll, it’s a risk pains for a month or so, you know, but I

1:49:35 Don’t think it’s really gonna be that big of a deal. No, that’s what Change for Us. I think it’s gonna be annoying for the people that come the first time with only Cash. Yeah. I’m not really worried about it. Yeah. Yeah. So, but the big piece is that we need to switch over and we’re gonna be, for the most part, probably taking majority of credit cards. Yeah. And so we need to capture that fee. Yeah. So we need to do fee adjustments. So I, you know, at our next meeting December, the board needs to meet and talk about fees. So here are all the current fees for the two departments. Do you have comparatives? I I do not have comparatives with me tonight, but I will bring those for, yeah. What’s the rationale on going cash cashless.

1:50:23 I mean, I know that a lot of people, when I buy theater tickets or anything like that, it’s cashless, It, it’s a much easier system, uh, for accounting, cash control. Cash control really comes down to cash control and liability.

1:50:39 Liability. Yep. So, um, is that when you’re gonna st stop the, uh, the checking with, with the computers? Or are you gonna do that right away? So I’m trying a meeting with the software company on next Tuesday, uh, actually next Monday, um, to see how quickly we can implement the software. Currently we can take credit card, we take checks. So that’s, that’s an easy piece for us to switch over. I need the board to authorize the fee changes to, to deal with the, the credit card fees and stuff like that. Um, so just looking at this, the board of health at the top, we don’t need to adjust any of those fees. Those are retail, food service license, all that stuff.

1:51:24 All those fees are acceptable. We receive all these fees essentially through checks. The transfer station fees are the ones that we generally see the most. That’s where we all the cash comes in. Um, so Yeah, the most, I think for the transfer station one, just the, the next closest place as a comparable, Correct. Yeah. Yep. Um, so most of that’s gonna be, you know, we’re gonna be looking at the cost of residential stickers, the additional sticker, uh, the landscaping permit, um, you know, the amount of material that landscapers bringing is quite a bit and there’s obviously an increase in cost of that. Um, and then the current rate for the scale. So we currently charge 14 cents a pound.

1:52:10 I would recommend that you go up to 15 cents a pound minor, things like that. Um, but we’ll be discussing all of this at our next meeting in December. So I just wanna make sure you have all the prices and as soon as we are finished with the price comparison, we’ll send that out to you before the next meeting. Oh, good. Questions about that.

1:52:36 Um, Food service, um, what About your regulations? You going to do anything about that? Uh, regulations, um, um, so we, the, the coalition, so the North Shore Share Public Health Services Coalition, um, has been working on updating the body art regulations. I have. So body art is actually very popular in this area. And with Salem and Peabody and Beverly being one of the, Salem being one of the premier cities in the country now for doing body art. Um, which means that we always need to stay up to date with our body art regulations. The reason we do, we all try to improve the same regulation

1:53:24 and the coalition so that we have, obviously we’re all operating under the same regulations and we don’t have companies sliding into outlying towns where they can kind of skirt Some of these regulations, um, obviously embody art establishments. They do both tattooing and piercing. It’s very, uh, you get a lot of piercing done in, um, body art establishments tattooing because they tend to be, um,

1:53:56 safer than some of the other mall establishments and stuff like that. Um, but with that comes some regulations and stuff like that. I have a draft copy that has been approved by the coalition that now essentially goes out to each board so they can take a look at it. And if there’s slight little things that they can change, wanna change, we can discuss. But, so I’m gonna hand out the copy. You guys can take a look at ‘em. Um, over the next month, two. And then the board, when they have essentially gone through it, they feel comfortable or they don’t have any additional questions, we can set up a date to pass these regulations. So are you saying that we have to have uniform regulations throughout the coalition? We don’t have to. So you’re gonna have slight

1:54:42 discrepancies from town to town, but the majority of the stuff should really be the same. When you’re talking about requirements for education and stuff like that, you’ll be surprised all the different items. There’s actually a copy in there. There should be, What pops up in my mind is when we initially talked about this, maybe six or seven years ago, we, we put fees on. So Fees are set, set by the board themselves, not, not by the coalition. That’s what, Because we made higher fees to try. Correct. So we did the same thing on the cake. We had extremely high fees to try to manage it. Ke keep out. Yeah. Um, body art establishments, that is not necessarily the way to do it when you’re dealing with body art. It’s an expensive, expensive practice.

1:55:29 Um, and these places are willing to pay it, pay it, no problem. But also explained that here I wanna body out is like people putting, uh, um, permanent lipstick on a permanent, Yeah. So part of this, these regulations is trying to capture all the new, um, med spa items. Um, permanent lipstick, permanent eyebrows, some of the newer stuff that’s come in that aren’t necessarily captured under the current regulations. Um, a lot of this stuff is regarding education and experience and stuff like that. Are you gonna do that? Are you gonna get permanent eyebrows? I kinda like the ones, So, yeah. So, you know, the

1:56:14 idea is for the board to take a look at these, read ‘em over, um, when the board is comfortable or the board doesn’t have any additional questions, um, we can set a date and move forward with these. Um, the other ones are tobacco control. Um, so the copy here, I have two different sets of copies for you. Um, the first one is the current regulations that we have currently, and then in the back of this are what’s proposed by the state of Massachusetts, um, to try to capture some of the industry standards that are changing, uh, lots around, um, flavored tobacco and stuff like that. But again, but there’s A new product that we were told. There’s a tons of new products all the time. So one of the big things that the tobacco industries trying to get around right now is menthol by selling cigarettes

1:57:01 that don’t say they’re menthol, but they are menthol. And so there’s a whole bunch of stuff that everyone’s trying to do. Originally, the menthol was supposed to be a big plug for people to buy. I Think a lot of people really enjoy the menthol, but yes,

1:57:24 There’s two things we’re supposed to pick from there. No, there’s on the first, so it’s just one. You just take one packet Yep. And then The packet. And there’s two pieces in that packet. Nope, you’re fine. Tom. Just take that one, one On top. They’re, and they’re both in here together. They’re Both in there. Together. You’ll see the differences. The second one is marked draft. The top one is the current regulations that we have in place today,

1:57:50 Chalk. And we’re gonna be curious to know, there’s several of different kinds of tobacco products. There’s, they try to come up with new tobacco products every day.

1:58:02 That’s, that’s their business. Yeah. Um, I just wanted to talk about food service a little bit. Um, so there’s several different food service permits that we issue. Um, so there’s a regular restaurant food service permit. Um, then there’s something, you know, then we call a retail food service permit. So a retail can be a convenience store, it can be a grocery store, prepackaged items, you know, mixed items. Um, and then we also have something that’s called the residential kitchen permit, or, um, some people call it the cottage industry permit. Um, but we call it the residential kitchen. Um, I just wanna make sure everybody’s aware. The residential kitchen is a very limited food permit that we offer. Um, it is baked goods only, um, non-hazardous.

1:58:52 You can do some jams and jellies, but the idea is that I wanna become a baker. I have some recipes that I want try out. I don’t know if I’m gonna be successful. So I’m gonna do a small amounts in my home to see if I think it’s profitable. You can only sell directly to the consumer. So the consumer has to come to your house. You can deliver personally. So you have to take your items and I can bring it to Tom sells and say, Tom, you wanted to buy these. Here they are. I’ll take your payment. Um, and we also, there’s no wholesale allowed. Um, so you can’t operate a residential kitchen in Marblehead and sell wholesale to any other establishment. Um, but again, residential kitchens are designed for

1:59:37 non potentially hazardous food. Really just trying to see if this product, if I wanna move it to the next stage, what’s the Hazardous food Creams or custards? Anything that’s time temperature sensitive. Okay. Um, but yeah, so you know, we are going, do we have any of those now? We do have some residential kitchens. Yes. Um, the, the, some of the issues with residential kitchens, so I ha obviously our department has to complete inspections, um, of all these establishments every year. Um, I never give notice to any establishment that I have to, however, I have to give notice to the residential kitchen to say, Hey, I need to set up an appointment to come inspect your facility. Obviously, again, with you’re in somebody’s residence, um,

2:00:25 they’re supposed to keep their products separate from their regular, you know, general products that they have in their kitchen. So you’re supposed to have a dry good pantry and stuff like that. Over here. It’s, this is the items I’m using, but it doesn’t mean your cat can’t walk across stuff or your kids are in there. Um, obviously only family members are allowed to make the products with the individual, but is the least, um, you know, restrictive of any of the permits. Um, but we do offer that. Um, they’re not my favorites, to tell you the truth. Um, but that is something that we, we do allow. Um, but we are, we do have a policy that it’s no wholesale. Um, and, and we are, you know, you can sell at the farmer’s market. You can sell direct consumers and you can deliver directly, but you have to be the person what me, what’s

2:01:12 Delivered Directly mean. But so you purchased it already and I’m bringing it to your house to deliver it Only Not to, not to a place of Business. No, not to a place. You cannot do wholesale. That’s wholesale. Oh, what if they sell it for the same price? Cannot do that. That’s not wholesale. Nope. Because I had a guy that called Me that I understand he could not do that. He, He called you. Oh, you called him or whatever. Yep. So he, he, you know, he can off, he has a commercial business, so he can get his wholesale permit to do that, but out of his commercial business, he needs a wholesale license to sell and other establishments. And There’s an additional price to have a wholesale license. Yeah. He just needs to get a permit from the state. But it’s very little, I think the wholesale permit

2:01:58 for the state’s, like $25, maybe it’s 300, but he’s required to have the, everybody has to have all the required permits. And the only required permit that people are doing in their home is the inspection with you. Yeah. Obviously you have to pay the fee, the $175 for the residential permit. We obviously have to conduct an inspection before they begin. You have to tell me what you’re making, how you’re gonna store it all go through all that stuff. You have to have a service Safe Manager’s license. We explain what you’re allowed to do. Um, one of the newer things is, uh, people are buying bulk candy and separated and out a little bit, but again, it’s direct to consumer, so the consumer can come to your house to pick it up. You know, you could deliver it directly to you.

2:02:43 Um, and you can sell it at the farmer’s market if that’s it. Okay. Any questions about that? But yes, so this is the time of year that we send out all the reminders for, um, permitting. Um, so I think we’re sending out 110 applications. Um, and we’ll be going through those in the next month. Um, getting those all signed by you and then send, so, you know, sending them out, um, for the operations to begin in January 1st. Okay. So was that, Uh, the last two things that I have to talk about is air quality. Um, so obviously over the last couple weeks we’ve had some air quality events. Um, so we do have several air quality meters in town here, and then we have ‘em

2:03:29 through the state of Massachusetts. Um, they are called Purple Air. Um, so you can go onto purple air.com, um, and you can dive into the real time map. Um, these devices are updated every 10 minutes. Um, and so these are particle, uh, meters. Um, so there’s two different types of air pollution. There’s particle pollution and then ozone pollution. Um, for the last events that we’ve had here, those are due to the wildfires or the brush fires, really in Massachusetts. Um, and so yes, those are putting up particles into the air. Um, and our particle meters are able to read those. Um, so we’ve been working with the schools to give them guidelines. Um, so a couple different things. Um, these are the air particle guidelines.

2:04:16 Um, so it will tell us when you go onto the website, they will post the number for the meter, and it will, it will be the color that it’s in. So the two correspond. Um, and so you can go down through, I will send, I actually, I sent this all out to everybody. You’ve had copies of this, um, so you understand how to read it. It, there’s also one for,

2:04:47 uh, the schools themselves. So they have a guidance made up just for schools, um, and, you know, outdoor recess and all that stuff. So we provided this document for the schools. We provided the air readings and making sure that they understand what the current readings are. If they’re trying to decide, oh, we’re gonna be able to have sporting events later in this afternoon. Do we need to cancel stuff? We will provide some predictions for them. Um, we use different, um, weather sites between, uh, radar Storm and Vent Sky is another really good one. Um, and that gives us direct access to, generally we’re looking at, uh, weather patterns as far as wind and stuff like that. Um, Is this only being used now when we’ve had this, uh, air quality, quality or So? No. So the air quality meters are up obviously, you know,

2:05:33 24 hours a day. They’ve been up for the last four years. Um, but this is the only period of time we’ve really, um, had to use ‘em to tell you the truth. Obviously, they’re giving us all the time. They’re going all the time. Yep. So you can go onto the website right now. They’ll tell you the current readings. Um, you can, and they update every 10 minutes. My gosh. Well, yeah. Yeah. What is it located? Um, so we have one of the transfer station. We have one of the Franklin Firehouse. Oh, locally? Yeah. Mm-Hmm. Yep. Okay. Um, and we’re trying to add more. It, it’s a great science experiment, so Oh, it’s terrific. Um, you know, we really want to get one established at the high school. Um, no, I’ve got a places like that. I’ve got a kid that’s really being affected, right.

2:06:19 With, because Yeah, They have asthma. Yeah. Correct. And so, um, depending on the levels, it will start to say, you know, you know, at 100 to 150 sensitive groups, so make outdoor activities shorter and less intense. They, you know, they go right into all the different guidelines That, so the nurses taking care of these kids in the schools? No, It’s not really for, you know, obviously the, the schools are putting out guidance. They’re making sure that their, their nurses are aware of this. But it also gives guidance to parents and stuff like that. But The kids that have problems in school, that they must be going to the nurse. Yep. Yep. Must be.

2:06:58 And that’s really about it. Any other questions? No. Any other questions? All right. So, uh, before we, uh, adjourn, uh, we’ll go to the audience, but I just want to remind everybody, our next meeting is December 10th and show I was coming, you said the 12th today, but I think it’s the 11th. So we both Oh, it is the 10th. Oh, pH did write twice today.

2:07:28 12th, 10th. Yep. Thank you. That’s not so important. What was it? Take what You get in this world. So, um, okay. So, um, December 10th and show about from the, uh, Massachusetts of Boards of Health is coming to talk to us. Um, she’s traveling, uh, from South Shore, well west someplace. And she’s very knowledgeable. She’s an attorney and she’s going to help us with some of, uh, questions we, we may have about the, that big thick document. So write your questions down. Okay. All right. And she, well, she’s gonna have a presentation, but she’s here. And I think it’s a very good fine to have her come. And she’s making a big, I think she’s making a huge effort

2:08:15 to do this, because I asked her when the next, uh, training was, and she said it wasn’t until May. And I said, well, we’ve got one person here that’s a, been here a year, one person that’s been here three or four months. When I spoke to her and she said, well, she’s willing to come. We didn’t wanna wait till May. So they kind thank You. And it was, um, the meetings were in May or someplace far away any anyhow. So she’s doing us a big faith. So, and I am at a conference the rest of this week, uh, out in Springfield. Okay. And if anyone, uh, wants to talk about fluoride, I, uh, have plenty of information Again for the, um, Marblehead water that is set by the

2:09:02 MWRA. If there’s any, any question. It, I, it’s absolutely one of the most historic events, health events that have happened in the last 50 years. But there is some reason to think whether we wanna renew it. Hmm. Not yet. I understand it, at least in the pediatric, what I’ve been reading is that because of the ubiquitousness of toothpaste, people are getting the fluoride that wasn’t available before, but That they’re not using, they’re not all, they’re not all using fluoride, not fluoride, toothpaste. ‘cause it’s more expensive. They’re not brushing their teeth, the teeth properly, or they’re not brushing at all.

2:09:47 And, um, yeah, it’s, I all, all I Doctor, yes. Recommend. Can I recommend, uh, Washington Post today? I get my Anna when, read her, read her, uh, she’s a pediatrician or read what she wrote about fluoride, because it was a very, very interesting, she cites a whole number of different studies along the way. So today’s Washington Post. Mm-Hmm. And her name Lena. L-E-N-L-E-L-E-N-A. When? Oh, she’s the former Baltimore public health person. Yes. Oh, she’s the one that was on tv. She’s on Exactly. I mean, she’s, she’s really good, but she’s like, just, she says, just read

2:10:34 through all the studies that she has. She has a whole bunch of them there. Well, I’m he, Elaine Hazel. I have three studies. Right. I mean, I like the rest of you. It’s not such an, you know, there’s a little balance here that you need to read through. And again, we do not control it. We don’t control. No, we don’t. It’s up to the MWA. Yeah. We don’t control it. They have reduced it from one pack per million to seven tenths pack. Right, right. But the, the problem has been in pregnant women that there may be associations with, uh, less, uh, I’m, I’m just so tired now. Less mental development in the children And I, mental development. My, I have a family member that’s pregnant right now, and I, because I read that article I sent her there

2:11:21 with the article and the obstetricians said, don’t worry about it. I know, but obstetricians are not, you know, epidemiologists that they, they have whole different training. I’m Sorry, but they’re not promoting that. But anyhow, but I just needed to Yeah. State it. Just Saying, just saying that I, I I was exactly with you and trust me, until I started reading that and looking through some of the things. Well, if you remember what rampant caries looked like in the fifties, I grew up without any, any variation. I have so many friends. Yes. I could show pictures. I have a mouthful of amalgam. I know. Yeah, we Know, we know, we Do know. It says, I just wanna read this one parent, the one sentence, the addition of low levels

2:12:08 of fluoride to drinking water. This is from the CDC, the addition of low levels of fluoride to drinking water has long been considered one of the greatest public health achievements of the last century. No question. So antibiotics, Paul, I’m saying is we have a world now that wants to question science and science. Science should not draw hard lives when there are other new information that should be interpreted. And we may read the letter. I’ll certainly won’t it. Well, They can do. Yeah. I’m gonna read it to you. ‘cause I, I thought she was wonderful when she just disappeared. And, um, and No, she’s, she’s on c nnn or one of the stations regularly. Uh, well, whatever. I haven’t seen her in long time.

2:12:54 Well, Andrew or or Helen will either you ask, uh, uh, Caitlyn that we can have slides or we have them. No, I’ll ask for the slides. I can do it. Yeah, you can do it too. We can, you’re gonna be our communicator firm. Yep. I’ll Ask Kai for the Slides. Technology and things with our and substance. But you man manage the business side. Right. So the Long meeting, um, Retired retirement.

2:13:23 Second. Good meeting. We got along. We were civil, we’re making promise excuse.