►
From YouTube: Board of Health Meeting October 10
A
A
A
D
E
E
We
recently
sent
several
questions
to
Lexi
Nolan
and
the
board
in
regard
to
the
covid
vaccines,
and
we
request
an
answer
to
these
questions.
I
will
read
some
of
the
questions
now.
The
focus
groups
referred
to
in
the
questions
are
the
recent
groups
that
the
County
held
to
try
to
overcome
the
vaccine.
Hesitancy
of
parents
in
regard
to
the
covid-19
vaccines.
E
I
won't
have
time
to
read
all
the
questions.
I
also
I
guess
would
like
to
know
before
I
get
into
that
when
the
Board
of
Health
will
be
holding
their
meetings
so
that
the
public
can
actually
come
and
see
you
in
person.
So
the
first
question
is
want
and
we
feel
all
this
information
is
public
information
and
should
and
be
shared
with
the
public.
None
of
it
is
about
any
person
or
Personnel
issue
or
parents,
personal
information.
It's
all
public
information.
E
E
D
E
G
Thank
you,
I
appreciate
it.
Thanks
for
the
opportunity
to
speak
again,
I
just
wanted
to
follow
up
and
I
think.
As
long
as
your
group
continues
to
promote
these
vaccines,
then
you
deserve
an
opposing
Viewpoint,
just
highlighting
kind
of
the
obvious
things
that
are
coming
to
light
now.
As
you
see
other
countries
that
are
given
the
acts
to
the
vaccine
program
for
everyone
and
I
think
this
is
born
out
of
your
group's
judgment
in
pushing
forward
your
vaccine
program
requiring
that
for
every
business
around
town.
G
You
made
lives
very,
very
hard
for
the
last
two
years
and
unnecessarily
so
so
that
was
very
unfortunate.
Do
not
try
and
do
that
again.
That
was
a
mess
up.
You
should
have
publicly
acknowledged
that
you
made
missteps
with
locking
everyone
down
and
all
the
abject
failures
along
that
line,
but
just
kind
of
undo
harm
to
kids
as
well.
I'll
mention
Australia
has
essentially
ended
its
covid
vaccination
program
for
healthy
adults
under
the
age
of
50
and
effectively
ban
the
shots
for
people
under
30.
G
G
I
not
once
listened
to
any
of
your
health
guidance
throughout
and
I
feel
healthier
and
happier
because
of
that
so
Australia
Denmark
Norway,
all
countries
that
are
coming
to
their
senses
Banning
these
shots,
if
not
advocating
for
not
advocating
for
their
usage
with
certainly
younger
age
groups,
kids
or
I'll,
say
anyone
under
the
age
of
18
under
the
age
of
50,
very
low
risk.
All
in
all.
So
your
group,
it's
very
unfortunate,
but
you
you
prove.
You
proved
yourselves
to
be
very
one-sided
with
your
guidance.
G
We
get
every
your
money's
dumping
in
from
Pharma,
but
it
was.
It
was
just.
It
was
just
unfortunate
to
watch
unfold,
let
alone
your
predatory
practices
with
businesses
around
town,
where
you
tried
finding
doing
whatever
you
tried
doing
on
that
end.
But
I
spoke
with
enough
business
owners
to
get
an
idea
of
that
Norway's
Guidance,
just
to
be
clear,
said
no
one
under
65
should
receive
additional
shots
in.
G
Of
severe
disease,
yet
you
guys
keep
pushing
boosters
on
the
general
public,
let
alone
kids
who,
through
your
own
admission,
are
hardly
at
any
hardly
at
any
risk
of
an
adverse
outcome
from
covid
I.
Call
that
total
nonsense
so
I'm
here
to,
namely
call
you
out
on
all
these
things,
you've
done
a
terrible,
terrible
job
of
recognizing
where
you
went
wrong
through
this
pandemic.
I.
Think,
if
you
review
a
lot
of
your
discussions
with
experts
and
folks
you're.
H
D
H
D
B
F
A
J
K
Okay,
good,
so,
as
Lexi
acknowledged,
we
had
initially
a
planned
to
have
our
budget
work
session
in
August
and
shared
some
details
about
the
status
asked
for
a
little
bit
of
a
postponement
which
we
appreciate
you
guys
providing
to
us.
So
we
are
now
rescheduled
for
November
2nd.
We
wanted
to
give
you
a
little
bit
of
insight
about
the
work
that
has
occurred
since
that
time,
so
we've
had
the
ability
to
clean
up
and
complete
finalization
of
the
internal
Grant
budget
planning
templates.
K
We
have
updated
many
personnel
Financial
aspects,
including
all
positions,
position,
numbers
parsing
out,
funding
strands,
our
FTE
count,
the
location,
actual
vacancies
and
hourly
rates.
We've
had
the
ability
to
review
and
re-link
many
of
our
indirect
rates
that
impact
our
overall
budget,
as
well
as
application
of
those
indirect
rates
and
we've
been
able
to
ensure
formulas
account
for
all
aspects
and
tie
into
our
reserves
and
overall
fund
balance.
K
K
We
have
also
filled
in
the
updates
on
the
compensation
components
that
the
county
recently
made.
This
includes
the
two
thousand
four
hundred
dollar
bonus
for
the
year
for
salary,
a
five
percent
increase
in
salary
for
both
hourly
and
salary
positions,
a
two
percent
discretionary
increase
for
salary
for
those
past
their
nine
month
introductory
period,
all
of
these
starting
January
of
2023..
So
we
had
to
apply
all
of
those
into
our
budget
preparations
for
2023
as
well.
K
So
then
we
want
to
acknowledge
what
we're
still
working
on
and
working
to
wrap
up
so
we're
working.
We
are
continuing
to
ensure
that
those
changes
in
relation
to
the
compensation
components
I
just
identified
with
you-
are
going
into
those
internal
grants
that
we
had
previously
completed.
We
will
be
doing
individual
line
item
review
with
programs.
We
are
completing
a
compilation
of
necessary
program.
Exception
requests,
as
well
as
breaking
out
an
understanding
of
our
discretionary
fund
and
application
of
those
so
for
the
upcoming
budget
session.
K
I
wanted
to
share
a
little
bit
with
you
about
what
you
have
seen
in
the
past
and
then
ask
if
there's
anything
that
you
would
like
to
see
more
or
less
of
so
in
the
past.
What
we
typically
show
you
is
a
very
large
Excel
spreadsheet,
listing
all
the
orgs
funding
categories
and
funding
amounts.
We
also
provide
you
with
a
budget
session
book
and
PowerPoint
that
is
a
little
over
10
pages
or
slides.
This
includes
a
high
level.
K
We
also
provide
you
a
percentile
breakdown
of
the
funding
sources,
a
percentile
breakdown
of
the
expense
categories,
a
comparison
of
FTE
changes
by
program
over
the
last
four
years.
A
review
of
the
unassigned
fund,
balance
figure
and
percentage
comparison,
a
fund
balance
detailed
list
and
a
glossary
with
acronyms.
K
So
that
is
the
compilation
of
what
we
typically
provide
you
and
review
during
the
budget
session,
based
on
that
I'm
happy
to
go
over
any
of
those,
because
that's
quite
the
list,
but
wanted
to
get
any
thoughts
from
you
all
about
what
you
would
like
to
see.
Any
of
those
that
you
would
like
to
keep
any
of
those
that
you're
not
super
interested
in.
How
can
we
make
this
a
beneficial
budget
work
session?
For
you
all.
B
So
Catherine
I
can't
remember
from
last
year,
but
what
would
be
helpful
is
a
more
high
level
budget
change
for
each
department,
so
comparing
say
the
last
Grover
year
changes
for
the
last
two
or
three
years
in
those
Department
budgets.
That
would
be
helpful,
I
think
before
we
were
maybe
provided
it
line
by
line,
but
if
maybe,
if
we
could
get
it,
you
know
more
of
a
top
level
department
by
Department
comparison
and
then
also
if
we
could
have
a
quick,
a
couple
bullet
points
of
Trends.
What
are
the
trends
of
the
changes?
K
C
K
K
Yeah,
so
revenues
and
expenses
are
going
to
be
a
big
component
of
that,
but
specifically
for
our
entity
as
well
as
most
governmental
entities,
there
are
Reserve
balance
is
going
to
help
identify
also
the
health
of
our
agency
and
as
long
as
we're
able
to
stay
within
a
certain
amount
that
helps
us
in
case
of
emergencies
or
if
we
have
other
things
that
arise.
That
helps
us
identify
and
we
do
go
over
that
in
a
couple
of
different
ways.
K
We
also
break
out
in
that
fund
what
we've
set
aside
money
for
so,
for
example,
in
the
past
Jeff
Zach
had
asked
you
all
for
an
increase
in
the
emergency
amount.
It
had
been
250
000
and
now
it's
500
000
and
that
sits
within
our
fund
reserves.
So
we
do
hold
a
line
item
for
that
to
again
ensure
the
health
of
our
overall
budget
and
our
ability
to
respond.
B
I
Thanks
Catherine
I
I
would
just
add
that
it's
always
helpful
to
have
for
you
to
pull
out
sort
of
hear
arts
and
bullets
of
things
that
we
should
pay
attention
to.
That
are.
You
know
noteworthy
from
the
budget
report
like
a
Highlights,
Highlights
page
and
and
then
the
other
thing
I
have
found
really
helpful
in
the
past
and
I.
Don't
know
if
the
County's
budget
office
produces.
You
know
a
one-pager
or
a
short
set
of
slides
that
talks
about
the
overall
Financial
outlook
for
the
county,
because.
I
From
the
county,
it
would
be
helpful
to
know
you
know:
has
the
County's
budget
increased
year
over
year?
Are
they
anticipating
that
willing?
You
know
continue
so
anything
like
that.
That
gives
us
a
sense
of
because
I,
you
know
again,
I
think
we've
talked
about
our
budget,
you
know
somewhere
around
40,
give
or
take
comes
from
the
general
fund
and
so
understanding
how
the
general
fund
may
or
may
not
be
impacted
year
over
year,
just
if
they
have
something
like
that.
That
would
be
helpful.
K
Yes,
Morgan,
they
do
have
something
like
that
and
originally
back
in
August
we
had
planned
for
them
to
come
along,
so
they
could
do
that
presentation.
I
know,
Jordan
has
reached
out
to
Ramon
or
Aaron
to
see
if
they
would
be
able
to
make
this
one,
if
not
I'm,
happy
to
touch
on
it.
Just
giving
the
caveat
that
I
am
not
the
subject
matter,
expertise
in
the
County's
components,
so
I'm
happy
to
go
over
it,
but
I
may
need
to
reach
back
out.
If
you
have
specific
questions,
yeah.
I
A
Yeah
I
think
the
one
thing
about
the
county
level
presentation
it
was
usually
they
would.
There
would
always
be
these
kind
of
nuances,
with
tax
assessment
years
or
property
taxes
and
and
some
years
made
it
go
up
and
some
years
say
meaning
go
down,
but
it
was
definitely
enlightening
to
see
that.
So,
even
if
it
was
just,
you
know,
sharing
that
presentation
during
the
budget
study
session
and
just
pointing
out
a
couple
of
those
things
not
walking
through
the
presentation
unless
Aaron
or
Ramona
are
available.
I
think
would
be
helpful.
F
J
A
Foreign
no
I
mean
I
I.
Think
it's
probably
you
you
haven't.
Somebody
has
interest
in
that
information.
It's
it's.
Why
you
kind
of
put
it
together
right,
so
you
know
we
realized
that
with
Staffing
shortages
and
and
the
the
changeover
that
you're
you're
behind
you
know,
you
were
kind
of
August
was
probably
not
realistic,
so
I
just
want
to
encourage
you
to
do
whatever
is
makes
the
team's
life
easier.
A
A
J
Let's
go
to
the
next
slide,
so
just
a
few
a
few
you
know,
small
topics
talk
a
little
bit
about
kind
of
the
historical,
chronic
and
increasing
research
challenges
that
we're
seeing
some
recent
snapshots
and
projections
that
give
us
kind
of
a
moment
in
time
and
a
look
forward.
What
some
of
the
workforce,
drivers
and
stressors
are
that
we're
seeing
some
of
the
insights
that
come
out
of
this
research
and
then
a
little
bit
about
some
current
efforts
towards
building
towards
a
solution.
J
So
you
know
this
obviously
bcph's
recovery
plan
post
pandemic
is
nicely
tied
into
some
of
these
conversations.
We
are
going
into
a
strategic
planning
year
and
it
just
seems
like
the
right
moment
to
take
a
breath.
Take
a
pause
think
carefully
about
you
know.
What
have
we
learned
in
this
emergency
response
that
the
pandemic
that
can
tell
us
about
what
our
future
Workforce
needs
are
going
to
be?
J
At
the
same
time,
there
is
kind
of
this
ongoing
National
conversation.
That's
getting
picked
up
again
around
what
the
workforce,
the
public
health
Workforce
of
the
future
needs
to
look
like,
and
so
those
conversations
are
happening
at
National
levels,
they're
having
a
state
level,
even
as
we
talked
about
them
inside
bcph,
so
I
will
go
ahead
and
turn
it
over
to
Bob.
For
the
first,
a
few
sections
yeah.
L
Thanks
so
to
begin
with,
I
think
it's.
It
comes
as
no
surprise.
This
is
not
a
new
challenge,
and
so
the
public
health
Workforce
was
was
changing
and
there
were
challenges
even
prior
to
the
pandemic,
and
so
looking
over
the
last
40
years
you
can
see
there
were
in
the
U.S
on
average
220
public
health
workers
per
100
000
population,
a
decrease
to
158
into
147.
By
the
time
we
reach
2020.,
just
looking
at
sort
of
one
area
of
funding
preparedness
dollars.
L
And
so
The,
Beaumont
and
phnci
looked
into
this
and
published
a
research
brief
just
about
a
year
ago
now
and
estimated
what
the
current
Staffing
is
and
what
the
gaps
are
and
the
needs,
and
they
published
this
in
a
report
and
broke
it
down
by
population
served,
and
so
you
can
see
circled
highlighted.
There
was
the
the
where
Boulder
County
would
fall
and
you
can
see
there's
a
gap
so
that
really
that
nationally,
the
public
health
Workforce
needs
to
increase
by
about
80
percent.
L
L
So
an
additional
challenge
has
been
the
inadequate
and
unpredictable
funding.
Pre-Covered
Colorado
Public
Health
funding
was
half
a
percent
of
the
state
budget
and
the
local
per
capita
contribution
about
a
dollar
fifty
per
person,
and
it's
left
local
public
health
agencies
in
the
place
to
search
for
and
compete
against
one
each
other
one
another.
L
B
I
L
You
know
so
what
we've
experienced
time
and
again
with
public
health
is
the
temporary
emergency
funding
fire
hose.
That
is
transient,
reactive
and
inflexible,
and
so
you
can
see
over
time
it
was
West
Nile
Virus
in
2001
it
was
H1N1
in
2009
Ebola
in
2016
covid
up
through
this
year,
and
then
funding
for
Marshall
fires,
funding
for
for
monkey
pox
and
a
lesson
that
we
may
be
relearned
but
haven't
figured
out
how
to
overcome
is
that
inflexibility?
J
Right
so
so,
we've
talked
a
little
bit
about
kind
of
the
national
context,
a
little
bit
about
projections
when
we
get
down
to
the
question
of
what's
like
what
what
what's
driving
folks
out
of
Public
Health,
you
know.
Sometimes
there
are
push
factors
that
are
pushing
people
out
of
this
space.
Sometimes
there
are
pull
factors
that
are
pulling
people
into
new
spaces.
C
C
J
J
There
have
been
leadership,
transitions
which
create
Staffing
transitions
and
we
do
have
a
need
for
competitive
salaries,
I
think
I
that
probably
shouldn't
be
under
bcph
specific,
but
we
do
know
that
the
cost
of
living,
of
course
in
Boulder
County,
is
particularly
high
and
impacted
when
we
have
inflation
at
the
levels
that
we
do
now
and
the
dearth
of
affordable
housing
that
we
have
in
this
case
down.
So
just
a
little
bit.
Maybe
you
have
extra
need
in
that
space.
J
So
it's
just
the
pathogenic
diseases
related
to
climate
change,
not
a
whole
host
of
other
impacts
of
climate
change,
but
the
reason
that
I
wanted
to
share
that
was
just
to
really
underscore
the
scale
of
what
climate
change
is
setting
up
for
us.
In
terms
of
challenges,
looking
forward
and
I
would
say
that
the
last
piece
is
that,
as
we
get,
you
know
more
sophisticated
in
public
health,
about
what
community
change
processes
look
like
and
what
best
practices
are
and
where
we
see
real
shifts.
J
Those
emphases
on
Equity
policy
and
Community
engagement
do
not
come
without
their
own
resource
needs.
Those
are
additional
resource
needs,
and
you
know
we
feel
very
fortunate
that
we
were
are
in
a
place
where
we
get
to
be
intentional
about.
How
are
we
going
to
incorporate
those
best
practices
into
our
work,
as
we
also
recognize
that
we're
going
to
have
to
work
to
figure
out
how
that
fits
into
our
Workforce.
J
Next
slide
so
kind
of
taking
it
back
to
the
beginning
of
the
conversation
about
retention,
we
should
definitely
be
investing
in
retention,
but
we
also
should
expect
that
there
are
going
to
be
challenges
for
a
while.
We
will
continue
to
see
turnover
in
public
health
for
a
while
extra
pay
bonuses
recognition.
Those
are
all
helpful,
but
they're
not
going
to
solve
the
problem.
The
retention
problem,
some
burnout
recovery
takes
time
and
we've
invested
in
in
that
to
some
degree,
but
it
also
may
not
be
enough
to
be
able
to
hold
everyone.
J
Sometimes
folks
really
need
things.
You
can
change
for
themselves
and
that's
understandable,
recognizing
that
our
pre-pandemic
Workforce
structures
are
insufficient
to
meet
our
current
and
future
needs,
and
our
sustaining
staff
stress
we.
It
is
incumbent
upon
us
to
take
a
look
at
how
our
Workforce
is
structured
and
how
we're
going
to
be
proactive
in
planning
for
those
needs
and
not
just
reactive.
J
J
J
We
were
all
really
grateful
and
surprised
that
we
were
able
to
to
be
able
to
work
with
the
state
that
quickly
in
that
space
and
I
know
that
they
worked
hard
on
that,
and
it
is
something
that
rapid-fending
response
is
something
that
they
have
in
their
minds.
Recognizing
that
the
emergency
response
capabilities
are
hugely
impacted
by
that
ability
to
Pivot
quickly.
J
So
local
responses
may
somewhat
improve
the
retention
challenges,
but
the
local
response,
in
it
alone
can't
overcome
all
of
these
issues.
This
question
about
workforce
planning
is
part
of
this
larger
conversation
about
public
health
transformation
and
what
does
the
new
Public
Health?
What
does
a
modernized
public
health
department?
Look
like
so
just
to
take
a
few
minutes
to
talk
about
kind
of
the
framework
for
that
and
what
some
of
those
conversations
are.
J
So
this
is
from
a
calco
document,
so
it's
Colorado
specific.
It's
about
poor,
core,
Public,
Health,
Services
and
I.
Think
what's
interesting.
To
note
here
is
just
kind
of
this
list
of
the
foundational
capabilities
and
the
foundational
Services
of
a
local
public
health
agency.
So
that's
kind
of
what
we
are
expected
to
be
able
to
deliver
structurally
as
an
agency
next
slide
and
at
the
national
level
there
is
no
dearth
of
proposals
and
thinking
about
what
this
modernized
public
health
system
ought
to
look
like.
J
We
have
documents
from
the
bipartisan
policy
center
from
the
national
network
of
Public
Health
institutes
from
trust
for
America's
health.
What's
interesting
is
that
there's
an
enormous
amount
of
agreement
in
terms
of
that
a
significant
investment
is
needed
in
public
health
Workforce
there
is
unanimity
there.
Sometimes
the
proposals
are
a
little
bit
different
from
each
other.
F
J
Community
engagement
as
a
pathway
to
supporting
equity
and
what
is
public,
Health's
role
in
informing
policy,
and
what
we
see
is
that
the
traditional
governance
and
legal
structures
aren't
always
in
sync
with
what
those
goals
and
what's
required
to
advance
work
in
those
spaces
is
and
so
really
taking
a
close
look
at.
How
do
we
reconcile
that?
How
do
we
find
you
know?
J
How
do
we
thread
the
needle
to
to
really
be
able
to
advance
Public
Health
interests
in
a
broad
sense,
incorporating
the
recognition
of
you
will
need
to
focus
on
this
proportionately
impacted
populations?
What
does
it
mean
to
do
in
community
engagement,
Etc
that
Community
engagement
and
trust
that
investing
in
relationship
building
and
then,
of
course,
cross-sector
Partnerships
are
two
of
the
final
themes
in
that
space.
J
Okay,
at
the
state
level,
the
Colorado
Public
Health
Improvement
plan
really
is
focused
on
at
this
point.
It's
focused
on
investing
in
public
health,
with
funding
levels
that
are
appropriate,
flexible
and
sustainable,
improving
Workforce,
Recruitment
and
Retention,
and
increasing
the
performance
and
longitudinal
tracking
of
the
Public
Health
Service
delivery
system.
Those
are
the
three
core
Focus
areas
of
the
state
level.
Public
Health
Improvement
plan
going
forward
Who.
F
J
J
So
part
of
the
trick,
of
course,
of
emergency
response
is
that
when
there's
not
an
emergency,
what
are
people
doing
with
their
time
and
when
there
isn't
an
emergency?
How
do
you
deploy
them
without
completely
disrupting
their
normal
responsibilities,
so
that
space
I
think
is
a
space
that
a
lot
of
Public
Health
agencies
are
talking
about
much
more
intentionally
right
now,
and
so
we
expect
to
be
learning
about
what
some
of
the
other
models
are
and
what
makes
sense
for
our
own
agency.
C
Let's
see
on
that
note,
are
there
discussions
going
on
about
having
more
of
like
a
volunteer
Workforce
or
something
like
that,
where
you
Flex
that
Flex
down
sort
of
I'm,
like
thinking
of
the
military
analogy
right
where
they
have
people
in
reserves,
it
can
come
out
of
their
civilian
life
to
potentially
help
support
a
crisis?
Is
that
something
that
you
do
currently
is
being
discussed?
We
absolutely.
J
Deploy
the
Medical
Reserve
core,
we
use
them
to
great
effect
during
the
pandemic.
Right
I
think
I
I
think
that
building
on
that
and
understanding
you
know
what
do
we
need
to
be
able
to
rely
on
that
Workforce
and
what
is
the
gap
that
they
can
effectively
fill,
and
we
can
count
on
is
a
really
important
part.
C
Right
and,
of
course,
the
training
component
and
all
the
things
you
have
to
invest,
no
matter
what
to
write,
that's
really
helpful
and
then
the
other
question
I
have
is.
Is
you
guys
I
as
part
of
this
Workforce
study?
Are
you
looking
at?
It
sounds
like
the
priorities
are
very
broad
right
for
public
health.
Like
you
said
that
you
know
these
are
the
things.
Are
we
digging
deeper
to
say
programmatically
if
we
really
have
to
think
about
flexing
to
potentially
a
more
limited
Workforce?
J
I
will
just
also
refer
back
to
the
some
of
the
other
aspects
of
the
scope
of
work
that
you
see
in
front
of
you,
the
Gap.
There
will
be
a
gap
assessment
to
inform
areas
for
growth
or
decrease,
as
well
as
possible
areas
to
increase
cross
training,
to
highlight
position,
areas
where
positions
may
be
shifted
to
minimize
drastic
overhaul
of
positions
or
changes
and
identify
essential
positions
to
emergency
responses
that
are
sometimes
difficult,
so
I
think
that's
part
of
getting
at
what
you're
talking
about
you
know,
public
health
staff
get
notoriously
anxious.
J
Anybody
would
right,
but
what
we're
really
looking
for
is
you
know
the
long
term
we're
talking
about
a
10-year
time.
Horizon,
it's
not
talking
about
trying
to
immediately.
You
know,
write
up
a
new
org
chart,
it's
really
about
what
is
our
North
Star
as
we
go
forward
and
as
we
move
through
these
processes.
B
Similar
question,
then,
is
looking
the
slide
that
you
showed
first
showing
decreases
in
dollars
and
staff
that
was
over
two
decades.
So
is
there
any
chance
that
some
of
that
was
through
the
creation
of
other
departments
Outsourcing
to
Private
Industry
as
a
standard
like
did
the
department
shrink
because
there
were
other
players
there?
It's.
B
J
It's
less
efficient.
You
don't
prevent
all
of
the
other
harms
that
come
along
with
the
primary
harm,
and
so
you
know
even
just
having
that
conversation
about
the
value
of
prevention
in
particularly
primary
prevention
and
the
return
on
investment
that
it
provides.
It
hasn't
historically
won
the
day
right.
It's
historically
lost,
Public
Health
has
not
historically
had
an
enormous
amount
of
political
power,
but
it
does
feel
like
there
is
an
opportunity
right
now
to
really
shine
a
light
on
what
happens
when
you
don't
invest.
I
mean
Public.
J
So
I
think
that
those
conversations
have
to
keep
happening
and
I
think
that
it's
really
incumbent
upon
Public
Health
leaders
to
have
those
conversations
to
have
them
publicly
to
have
them,
often
to
say
we.
You
know,
let's
look
at
the
data
about
what
the
return
of
an
investment,
for
instance
in
family
connects.
J
We
know
that
investing
in
those
little
kids
right
at
that
moment
is
going
to
be
huge,
and
so
there
may
even
be
an
opportunity
to
shift
where
the
funding
flows
are
and
to
recapture
some
of
those
savings
for
reinvestment
in
public
health,
which
I
would
love
to.
You
know,
hear
some
innovative
ideas
about
what
the
funding
flows
look
like
that
start
to
experiment
with
some
of
those.
I
J
A
year
year
and
a
half
ago,
the
state
decided
to
increase
per
capita
funding
to
local
public
health
agencies
for
three
years
and
the
first
year
they
used
arpa
funds
to
do
it,
which
made
it
very
difficult
to
spend,
because
there
were
all
kinds
of
handcuffs
on
that
restrictions
about
what
you
could
spend
it
on,
and
so
we
have
basically
a
little
less
than
two
years
left
with
those
extra
per
capita
funds.
If
the
state
legislature
doesn't
do
anything,
then
it
will
become
permanent,
but
they
could
easily
do
something
they
could
easily
decide.
J
We
don't
want
to
make
this
permanent
before
that,
so
I
think
we're
kind
of
all
all
in
lpha
is
kind
of
holding
our
breath
a
little
bit
and
making
sure
that
we
are
not
programming
the
funding
for
something
that
is
a
long-term
need
that
we
won't
be
able
to
to
manage
and
really
thinking
about.
How
do
we?
J
J
I
J
About
programs
looking
at
program,
Effectiveness
I
think
we
do
want
to
make
sure
that
we
are
really
maximizing
achievement
of
our
community
goals
within
programs.
What
that
will
look
like
we
don't
know
yet,
and
we
also
know
that
career
advancement
is
emerging
as
a
critical
issue
for
a
whole
host
of
reasons.
It's
not
just
the
retention,
it's
not
just
recruitment.
It's
also
about
morale.
It's
about
mental
health.
J
The
final
piece
of
the
workforce
study
has
to
do
with
compensation
and
to
pay
Equity
analysis
just
to
make
sure
that
our
salaries
were
are
in
alignment
with
where
they
should
be
next
slide.
So
I
do
not
expect
you
to
read
this
whole
slide.
You
will,
you
know,
get
the
slides
afterwards
as
per
usual,
but
what
I
really
wanted
to
show?
You
was
that
this
is
an
example
of
four
areas
supporting
and
retaining
the
workforce.
J
What
does
this
future
landscape
tell
us
about
a
a
different
way
of
thinking
about
this
issue
and
things
that
we
would
want
to
incorporate
the
final
column
on
the
page
is
just
a
reminder
that
we
have
already
started
working
in
some
of
these
areas
and
it's
nicely
aligned
with
that
kind
of
vision
about
the
future
Public
Health
Workforce,
and
there
is
that
kind
of
just
right
at
the
end
that
cross
cutting
issue
of
cross-training
staff
and
creating
cohorts
for
strategic
priorities,
active
mentoring
and
coaching.
It
ties
into
career
advancement.
It
ties
into
emergency
response.
J
I
Incoming
Public
Health,
Trends,
Workforce
Trends
and,
for
instance,
to
the
pandemic,
inspire
people
to
join
the
public
health
Workforce,
maybe
at
the
beginning,
maybe
less
so
as
it
were
on.
But
you
know
when
I
was
in
public
health
school.
Like
almost
20
years
ago,
we
were
out
there
talking
to
high
school
kids,
explaining
what
public
health
was
now.
It
feels
like
there's
a
lot
more
understanding
about
public
health,
so
I'm
just
wondering
if
we
know
anything
about
National
Trends
in
terms
of
young
people
going
out.
L
I've
not
I,
haven't
seen
data
I've
only
heard
anecdotes
and
some
of
the
anecdotes
suggest
that
there
are
people
that
are
seeking
out
Cruise
in
public
health
and
even
some
of
the
some
of
our
rural
counties
at
the
recent
calfo
Retreat
were
commenting
that
they
are
getting
more
applicants
for
positions
than
they
had
in
the
past.
So
those
are
those
are
certainly
positive
and
encouraging
signs,
and
so
I
think
there
is
an
opportunity
that
pipeline
I
think
is
going
to
take
time.
L
Confident
is
going
to
take
time
to
catch
up,
probably
to
the
turnover
we're
likely
to
see
in
the
next
year
or
two
but
yeah
I
think
there
is
a
opportunity,
because
there
is
an
awareness
that
didn't
exist
three
years
ago
and
so
capitalizing
on
that
and
harnessing
that
and
that,
and
that
means
having
those
positions.
You
know,
building
the
infrastructure
and
having
the
funding
to
have
positions
to
be
able
to
bring
on
new,
talented
people
while
promoting
people
in
you
know
who
are
who
have
been
working
in
it.
L
So
it
you
know
the
timing.
While
it's
going
to
be
challenging,
I
think
for
the
next
several
years.
I
think
if,
if
done
well,
we
could
be
in
a
in
a
much
better
place
in
the
future.
All
of
It
ultimately
hinges
on.
Is
there
support
for
funding
these
activities
or
not
because
if
you
know
if
that
trend
of
the
40
Years
of
of
Public
Health
Workforce
to
population
continued,
if
we
said
all
right,
the
funding
from
these
acute
emerging
emergency
events
goes
away
and
we
go
back
to
where
how
we
were
before
the
pandemic.
L
J
It's
bridging
opportunities.
In
the
meantime,
Americorps
has
created
public
health
and
alongside
their
teaching
cohort,
which
is
great
we're
seeing
a
lot
of
folks
come
in
through
there
I
think
I
think
when
I
asked
Amanda
about
this
I
think
we
had
hired
something
like
20,
volunteers
and
interns,
so
not
short
term,
but
at
least
like
nine
months
to
a
year
over
the
last
couple
of
months,
and
we
have
another
I
think
15
in
process.
So
that's
great.
J
C
That's
what
I
was
going
to
ask
you
I
know
you
know:
I
went
to
the
school
public
health
at
University
of
Michigan
and
I,
get
requests
every
year
for
internships
right,
which
are
sometimes
can
be
free
right,
and
so
people
really
want
a
solid
experience
in
their
summer
and
I
know.
That's
like
you
said,
a
lot
of
support,
but
but
it
is
pipeline
building
and
then
and
then
engaging
with
these
schools
to
really
help
recruit
people
right
out
of
school,
but
it's
I.
F
C
F
C
B
With
the
attrition
question,
is
that
mostly
retirement,
and
then,
where
are
the
people
that
aren't
retiring?
Where
do
they
go
I'm
just
curious?
Is
this
a
situation
where
we're
growing
Consulting
style
culture
where
people
are
leaving
going
to
companies
where
they
can
serve
multiple
Public
Health
departments
and
make
more
money?
Where
do
they
tend
to
go.
J
I
think
it's
a
mix,
I
think
we
would
need
to
look
specifically
at
our
departures
at
bcph,
but
I
mean
I,
know
folks,
who
are
found
a
better
match
for
the
work
that
they're
interested
in
in
other
public
health
departments.
I
know
folks
who
have
moved
between
public
health
and
another
County
Department,
some
folks
have
retired
it's
it's
a
mix
to
get
you
anything
specific
in
terms
of
waiting.
I
would
have
to
take
a
closer
one.
Yeah
yeah.
H
You
know,
because
we've
had
a
lot
of
attrition
in
sib
right,
the
Strategic
initiatives
and
I
think
most
of
those
people
found
other
positions
right
that
were
maybe
less
stressful
paid
them
more
and
we
lost
some
really
good
staff
because
they
just
couldn't
afford
to
live
here
anymore
and
they
could
work
with
other
lpha
someplace
else
where
the
cost
of
lien
was
half
of
what
it
is
here,
for
example,
and
I,
think
that's
a
huge
elephant
in
this
room.
Frankly,
right
it
is
really
hard.
H
We've
had
we've
been
recruiting
staff,
we
have
several
positions,
I've
been
recruiting
like
two
three
four
times
as
we
can't
get
people
and
to
take
on
those
positions.
Because
of
the
you
know
they
you
know
for
us
to
live
here,
is
going
to
cost
this
amount
of
money,
or
you
know
the
salary
we
offer.
Is
that
and
they're
like
I'm?
Sorry,
you
should
stop
working
for
us
or
whatever,
and
we
do
get
a
lot
of
people.
H
We
do
get
a
lot
of
people
that
are
just
coming
out
of
the
University
at
Public,
Health,
Schools,
and
things
like
that.
But
I
think
you
know
that's
something
that
I
feel
we're.
Gonna
have
to
live
with
and
try
to
figure
out
how
to
get
around
that
creatively,
but
I
I
think
that's
part
of
our
planning
process.
H
When
we
look
at
you
know,
we
look
at
the
next
year
in
2023
of
looking
at
this
Workforce
discussion
and
looking
at
our
broader
strategic
plan,
because
2023,
as
you
mentioned
a
couple
meetings
ago,
is
really
focused
on
planning
and
how
do
we
Implement
priorities?
What
does
that
look
like
and
so
connecting
that
as
Lexi
said,
with
the
staff
being,
the
workforce,
study
I
think
would
be
really
critical
and
then
that
all
feeds
back
into
our
budget,
which
we
were
talking
about
earlier.
So
all
these
pieces
get
interconnected
along
the
way
I.
I
F
J
C
A
For
the
Payette,
what
are
the
analysis?
Is
that
mostly
within
the
department
itself,
where
you
look
at
like
classifications,
you
look
at
experience.
You
look
at
education,
you
kind
of
come
up
with
some
composite
score
and
you
say
here's
the
spread
of
because
I
you
know
I
could
think
of
like
certainly
before
the
pandemic,
but
even
since
the
pandemic,
you're
bringing
in
people
who
may
be
less
experienced
in
their
career
at
higher
salaries,
because
that's
what
the
Market's
requiring,
but
yet
somebody
who's
been
here,
15
or
20
years,
with
their
normal
kind
of
Merit
growth.
A
You
know
that's
gotten
eroded
over
time,
and
so
that
span
isn't
as
big,
which
you
know
I
mean
I,
guess
there
could
be
positives
and
negatives
to
that,
but
I'm
just
curious
like
for
that
pay,
Equity
analysis,
I
mean
I,
know,
there's
the
compensation
side
right,
which
may
look
at
a
whole
bunch
of
other
macro
factors
and
and
the
state,
but
is
that
limited
or
is
that
pay
Equity
analysis
throughout
these
the
county?
So.
J
We
we
see
several
spaces
where
we
would
like
more
clarity
in
on
on
this
particular
issue.
One
is
internal
because
we
do
still
see
differences
across
divisions,
in
particular,
or
particular
roles
that
feel
like
they
may
not
be
quite
aligned.
We
also
know
that
I
will
I
do
have
to
do
some
kudos
to
the
county,
who
implemented
a
Pay
Band
structure
in
the
last
year,
where
similar
classifications
were
grouped
across
County
departments
and
they
were
within
the
same
pay
band
and
what
that
did
was
it
created
a
structure
and
a
uniformity
of
understanding?
J
What
we're
trying
to
compare
to
each
other,
and
so
there
may
be
slight
tweaks.
You
know.
Actually,
this
classification
has
much
bigger
responsibilities
than
the
group
that
it's
in
with
maybe
a
little
shift
there.
Those
kinds
of
things,
but
mostly
what
we
want
to
make
sure
is
that
you
know
our
folks
who
work
in
policy
are
in
the
same,
pave
bandic
as
the
County's
folks
who
work
or
whatever
the
example
is
right.
J
The
third
piece
really
is
more
about
that
compensation
and
involves
kind
of
a
market
analysis,
and
the
good
news
is
that
at
the
same
time,
we're
doing
this
analysis.
Calpho
is
running
a
a
a
compensation
analysis.
So
they're
going
to
be
collecting
a
lot
of
the
data
for
us
that
we'll
be
able
to
use-
and
you
know-
try
to
try
to
just
get
a
little
bit
closer
to
uniformity.
J
But
you're
exactly
right,
Greg.
That
is
something
that
we've
seen
is
that
you
know
the
desperation
of
the
hiring
the
labor
market
right
now
is
is
changing
the
way
that
offers
come
through
and
it
creates
its
own
Ripple
effects
of
inequity
within
the
agency,
yeah
and
I
think
I
think
everybody's
saying
that
right
now
not
unique.
A
Yeah
I
mean
the
only
the
only
other
thing
I
wanted
to
say
is
just
that.
You
know
when
and
going
back
to
what
Catherine
was
saying
and
so
I
think
this
would
probably
be
a
better
discussion
for
the
budget
study
session,
but
in
terms
of
wherever
pay,
Equity
or
wherever
compensation
levels
end
up
is
not
treating
differently.
I
mean
I,
know
it's
really
hard
right.
A
J
I
would
like
to
say
no,
we
have
a
stronger
commitment
Equity
within
our
staffing
than
that.
What
the
solutions
are,
in
particular
situations
may
vary,
but
it
is
absolutely
something
that
is
on
the
radar.
We
do
not
feel
like
it's
appropriate
to,
for
instance,
give
raises
to
compensate
for
an
increased
cost
of
living
to
some
of
our
staff
and
not
give
it
to
others.
J
You
know
there
are
interesting
philosophical
questions
too,
about
whether
you
award
increases
based
on
percent
of
salary
or
a
flat
rate,
which
is
a
much
more
Progressive.
Way
of
you
know,
kind
of
reducing
inequities
vertically
and
structurally
within
the
agency,
and
those
are
conversations
we
haven't
had
yet.
F
C
I
really
appreciate
you
guys,
staying
focused
on
this
topic,
I
think
it's
as
I
think
about
what
I'm
worrying
the
most
about.
This
is
probably
it
fundamentally
because
we're
not
doing
the
work,
we're
helping
to
support
the
working
things
to
do,
and
you
need
staff
to
do
it
and
you
need
experts
to
to
support
that
work
so
anyway,
I
really
appreciate
it.
Thank
you
for
keeping
this
for
absolutely.
A
J
To
have
a
particular
program
Spotlight
every
month,
just
to
provide
that
opportunity
to
do
a
deeper
dive,
really
learn.
You
know
who
our
folks
are
a
little
bit
of
the
nitty-gritty
without
giving
you
too
much
of
the
weeds
vector
control
is
in
Joe
malinowski's,
environmental,
health,
Division
and
I.
Believe
Elaine
Draeger
is
with
us
this
evening
as
the
coordinator
of
vector
control.
Among
many
other
roles.
M
Thank
you
thanks
for
having
me
so
Lane
Draeger
for
those
any
board
members
I
haven't
met
and
those
that
I
do
good
to
see
you
again
twice
in
the
same
week.
That's
awesome.
I
I
coordinate
several
programs,
but
I'm
going
to
talk
about
two
programs.
The
first
one
we're
going
to
talk
about
actually
is
our
mosquito
control
district.
So
this
is
maybe
a
little
bit
of
a
unique
program
in
public
health.
It
kind
of
it
won't
go
through
all
the
history,
but
origins
of
mosquito
control.
M
So
the
mosquito
control
district
has
played
a
pretty
critical
Disease
Control
role
for
some
time,
and
so
the
the
structure
and
funding
for
the
mosquito
control
district
is
through
a
property
tax
assessment.
So
every
four
years
we
do
a
calculation.
We
create
a
budget
looking
at
our
staffing
costs,
the
bulk
of
the
money
going
to
the
contractor.
M
We
hire
to
do
the
work,
and
so
that's
that's
really
where
the
funding
comes
for
that
program,
so
we
build
out
that
budget
and
then
create
a
tax
assessment,
and
so
again
something
with
you
should
definitely
look
at
as
we
look
at
from
this
last
topic
that
you
just
talked
about
is
creating
those
fundable,
sustainable
funding
sources
for
specific
issues.
Even
though
we
would
like
to
see
sustainable
funding
for
all
public
health,
but
I
don't
know
if
I
can
move,
slides
or
or
you.
M
Move
it
yeah
please
next
slide.
This
is
just
a
quick
picture
of
where
our
District
boundary
is
for
the
mosquito
control
district,
so
that
light
blue
color.
All
the
municipalities,
at
least
in
the
in
the
Plains
area
of
the
county,
have
their
own
individual
mosquito
control
programs
that
we
work
very
closely
with
them
outside
of
the
city
of
Boulder.
We
have
the
same
contractor,
so
that
also
makes
it
pretty
easy
for
our
coordination
efforts
next
slide,
please.
M
M
So
larval
control
is
the
main
focus
of
what
we
do,
so
we
have
historic
mapping
of
where
our
mosquitoes
are
breeding
within
the
county,
and
then
the
contractor
employs
a
field
technicians
that
go
out
and
do
that
larval
control
assessment
and
then
we're
appropriate
to
treatment.
So
this
is
definitely
also
the
most
environmentally
friendly
way
to
control
mosquitoes,
in
addition
to
the
most
effective
way.
M
We
do
adult
surveillance,
so
this
is
looking
both
at
populations.
In
addition
to
that,
we
do
our
West
Nile
Virus
Sentinel
surveillance.
So
we
have
a
series
of
traps,
as
do
the
municipalities,
and
we
all
share
that
data
and
it
helps
inform
any
additional
control
measures.
We
might
take
excellent,
please
so
for
what's
now
virus
surveillance.
This
has
changed
over
the
years
as
Joe
can
recall
two
when
we've
been
honestly
back
to
the
previous
conversation,
so
West
Nile
Virus
had
a
lot
of
funding
when
it
was
hitting
the
United
States.
M
We
had
a
lot
of
ability
to
do
surveillance
across
the
county.
That
money
is
not
completely
dried
up,
but
mostly
dried
ups
and
we,
as
in
the
state,
created
the
idea
of
Sentinel
surveillance
zones.
So
we
have
three
zones
that
are
hitting
the
majority
of
our
population
areas
where
we're
doing
testing
of
our
our
adult
surveillance
traps
to
to
detect
West
Nile
and
then
calculating
infection
rates
and
Vector
index
which
give
us
relative
risks
within
our
community
for
us
to
potentially
take
additional
control
measures
and
make
additional
recommendations
next
slide.
M
Please
and
adult
control,
so
obviously
people
seeing
fogging.
That's
the
most
controversial,
that's
done
largely
based
on
our
her
surveillance
date.
We
aren't
just
doing
prescribed.
We
always
spray
this
neighborhood
every
you
know,
day
of
a
week.
It's
really
looking
at
what
are
the
populations
telling
us
and
certainly
for
Disease
Control
we're
looking
specifically
at
speciating
those
mosquitoes
that
we
catch
and
really
looking
for
a
higher
risk
for
Less
Nile
virus
and
that
those
are
than
the
drivers.
But
again
the
origin
of
this
District
was
for
nuisance
control.
M
So
that's
still
a
component
that
we've
done
surveys
every
so
many
years,
just
to
assess
the
continued
desire
of
the
unincorporated
County
to
have
a
program
that
still
addresses
nuisance
control.
That
being
said,
we
have
really
focused
on
finding
a
balance
of
when
we
do
that,
so
that
we
are
conscientious
of
using
pesticides,
even
though
the
pesticides
we
use
are
fairly
benign
in
the
environment
next
slide.
M
M
So
you
know
significant
numbers,
and
this
is
just
total
mosquitoes,
so
this
is
driving
both
our
nuisance
control
and
then
the
next
one
is
going
to
just
focus
on
our
qlex
species,
and
so
we
have
two
specific
species
that
we
look
at,
but
these
are
the
ones
that
drive
more
of
the
human
disease.
So
here's
our
five-year
average.
You
can
see
again
this
last
year
minus
you
know
a
few
months
we
were
significantly
beyond
our
average
and
then
the
when
we
look
really
across
a
10-year
again.
M
You
can
just
see
how
much
that
dropped
over
3,
000
kind
of
from
those
peaks
of
the
of
the
different
shading,
so
significant
risk
that
we've
seen
with
qlex
and
this
year.
You
know
the
human
disease
is
definitely
bearing
that
out,
so
we
are
certainly
not
out
of
finding
what
our
final
total
of
human
cases
will
be.
M
But
if
you
go
to
the
next
slide
and
actually
I
may
have
may
have
lumped
some
of
our
human
disease
into
our
overall
Vector
numbers,
so
I'm
going
to
just
do
a
quick
pause
if
there's
any
kind
of
mosquito
before
I
jump
into
some
of
the
other
Vector
related
stuff
that
we
do,
which
is
under
our
Public
Health
review.
But
any
questions
on
that
again.
This
is
kind
of
a
unique
District
program
that
the
health
department
has
historically
been
the
financial
agent
for,
and
then
we
have
staff
working
in
it.
B
M
No,
we
we
really
are
conscientious,
so
not
to
get
too
technical
with
you,
but
the
the
mosquitoes
that
are
of
concern
for
some
diseases
that
we
don't
deal
with.
We
do
not
have
so
when
we
think
of
80s
apple,
pictas
and
so
mosquitoes
that
that
drive
things
like
Dengue
and
some
of
these
other
diseases
that
are
more
tropical
diseases.
We
do
not
have
those,
so
that
is
still
something
on
our
radar.
As
we
talk
about
climate
change
and
changes
in
our
climate,
if
we
become
more
humid,
that
is
something
that
is
a
potential.
M
There
are
other
diseases
that
we
don't
have
in
our
country
that
mosquitoes
we
do
have
in
Boulder,
County
and
in
Colorado
could
carry
so
that's
another
concern
similar
to
West
Nile
Virus,
which
didn't
exist
in
the
U.S
until
99
and
then
within
four
years.
It
was
in
Colorado.
So
again
it
it
wouldn't
take
a
lot
if
you
introduced
another
disease
into
our
country,
for
it
to
just
be
rampant
and
then
very
present,
so
our
main
nuisance
species,
the
80s
vaccine,
is
a
is
a
disease-carrying
mosquito
in
other
parts
of
the
world.
M
So
so
again,
not
gloom
and
doom,
but
it
is
something
that
we're
very
concerned
about
again
how
Vector
diseases
move
around
the
world.
That's
probably
one
of
the
greatest
risks
for
climate
changes,
Vector
diseases,
first
of
all
that
are
present
and
then
potential
for
emerging
other
Vector
diseases.
So
we
do
not.
We
do
not
have
mosquitoes
for
Dengue
and
some
of
those
other
diseases,
malaria
and
things
like
that.
C
M
I
think
we
are
at
currently
around
35
human
cases,
whereas
we
were
I,
think
18
or
19
last
year,
so
still
smaller
numbers
overall
of
you
know
overall
burden
of
disease,
but
we
also
know
that,
for
the
most
part,
the
disease
that
we
are
tracking
currently
compared
to
what
we
tracked
when
West
now
first
arrived
in,
our
state
is
the
most
neuro-invasive
cases.
So
those
milder
fever
cases
we
aren't
even
really
getting
reported
anymore.
M
Just
the
level
of
of
work
it
takes
to
identify
a
case
is
something
that
most
most
Healthcare
Providers
are
not
doing,
because
they
there's
no
treatment.
They
can
give,
even
even
for
neuro
invasive
cases,
so
to
do
more
invasive
testing
for
a
disease
that
they
can't
do
anything
to
cure.
It
just
doesn't
doesn't
happen.
It's
similar
to
several
of
my
programs
like
foodborne
illness.
You
know
it's
like
you're.
M
C
B
M
M
We
were
fortunate,
even
in
the
2013
flood,
that
it
could
have
been
worse,
then
that
the
flood
occurred
in
September,
but
it
still
was,
there
was
impact
there.
We
we
actually
stopped
surveillance,
because
the
state
was
no
longer
testing.
We,
we
pushed
them
to
test
for
another
week,
but
we
just
stopped
testing
in
the
middle
of
September
and
we
were
not
out
of
the
woods
for
risk,
so
so
the
the
seasonality
has
definitely
shifted.
We
plan
now
to
to
go
well
into
September,
even
potentially
through
the
end
of
September.
M
If
necessary,
we
haven't
had
to
go
that
far
yet,
but
yes,
the
the
seasonality
is
definitely
shifting
already
with
with
warmer
climates.
So
those
are
not
future
things
they're
current
things,
and
so
that
that
is
a
big
concern
is
if
we
start
to
see
our
season
go
longer
and
longer,
we
will
certainly
see
more
human
disease.
M
We
will
not
eradicate.
What's
now,
that's
not
the
even
the
goal
of
the
district
program
is
to
eradicate
mosquitoes,
it's
really
to
manage
them
to
to
a
controllable
for
certainly
for
nuisance,
and
then,
when
we're
looking
at
human
risk,
you
know
do
our
best
to
manage
that.
But
eradication
of
mosquitoes
is
not
not
even
possible
really.
I
M
No
I
would
say
most
do
we're
all
fairly
similar
City
Boulders
is
pretty
unique
there.
They
do
have
some
larval
control
still
and
and
there's
a
little
bit
different
protocol
that
they
use
for
when
they
decide
to
initiate
that,
but
they
they
do
not
do
any
adult
control.
They
are
doing
some
additional
West
Nile
Virus
surveillance,
though
so.
Their
focus,
then,
is
just
educational
approach
as
there's
risk,
but
yeah
that
has
been
I.
M
Think
the
bigger
challenge
with
their
program
is
that
the
significant
amount
of
land
that
they
own,
the
open
space
land
that
the
city
owns
it
is
often
flood
irrigated
and
creates
a
lot
of
habitat
and
oftentimes
adjacent
to
it's
gun.
Barrels
are
the
best
example
of
where,
where
we
have
County
residents,
so
our
only
recourse
then
is
to
do
adult
spring,
because
we
have
no
ability
to
do
any
larval
control
on
City,
open
space
or
city
land
of
any
kind.
A
M
It
just
happened:
yeah
I
can't
speak
to
that
I
know.
Their
open
space
board
is
very
supportive
of
the
direction
that
the
city
has
gone,
but
yeah
they're,
at
least
for
the
mosquito
side,
they're
very
anti-using
anything,
including
even
larval
control.
So
it's
it's
still
something
that
they're
making
specific
decisions
when
and
where
they
want
to
do
that.
Based
on
you
know
their
assessments
of
their
different
habitats
of
when
they
feel
it's
too
sensitive
to
do
anything
to.
A
M
You
that's
very
good
here
and
Marshall
is
the
is
the
engine
behind
all
this?
He
does
the
work
with
our
contractor.
For
those
of
you
who
haven't
met
him.
He
is
prior
to
hiring
him.
He
worked
for
the
mosquito
control
contractor
that
we
employed,
so
he
has
intimate
knowledge
and
he
really
managed
the
Boulder
County
program,
so
he
walked
in
the
door
with
all
the
knowledge
he
needed
to
help
really
administer
it,
and
now
he
does
all
sorts
of
other
programs.
M
Besides
mosquito
control,
all
right,
we'll
jump
into
a
vector
and
I'll
kind
of
Breeze
through
this
go
ahead
and
Advance
the
next
Slide.
The
major
diseases
that
we
kind
of
look
at
under
our
vector
control
program
are
our
plug
into
a
Remia
and
they're
very
sporadic
on.
When
we
see
those
pop
up,
we
already
talked
a
fair
bit
about
lost
Nile
Virus
rabies
is
our
biggest
disease
of
investigation
and
hantavirus.
M
M
Next
slide,
please
here's
just
some
of
some
of
the
common
ones
that
we
see
that
carry
plague,
but
it's
mostly
rodents
and
lagomorphs
or
rabbits
X
slide,
please
tularemia
another,
and
so
these
are
again
fairly
rare
human
diseases,
more
things
that
are
impacting
wildlife
and
then
spill
over
into
our
pets.
Tularim
is
a
tick
based
disease.
Occasionally,
deer
flies
more
of
a
risk
for
ticks,
I.
M
Again,
when
we
see
this,
we
don't
see
this
a
lot,
but
when
we
looked
back
really
over
the
last
30
40
years
in
Colorado
there's
there
are
Cycles
where
we
see
significant
tularemia
kind
of
presence.
You
know,
and
that
happened
several
years
ago,
where
we
were
seeing
it
even
just
sort
of
environmental
exposure.
There
was
no
clear
exposure
to
ticks,
and
so
the
concern
is
that
it
becomes
so
prevalent
environment
that
even
sort
of
Mowing
and
things
like
that
can
can
potentially
cause
a
risk.
M
We
had
an
infant
who
had
had
no
exposure
that
got
to
uremia
and
since
it's
such
a
rare
disease,
it's
often
not
diagnosed.
So
that's
again,
one
of
the
risks
with
with
it
next
slide,
please
West
Nile
again.
This
is
this:
is
a
bird
disease
that
really
spills
over
into
humans.
So
that's
that's
just
the
the
reality
of
it
and
we
do
have
plenty
of
birds
that
that
are
part
of
that
cycle.
Next
slide.
M
Rabies
is
our
most
significant
Vector
disease,
where
we
spend
the
bulk
of
our
our
resources,
as
does
our
communicable
disease.
So
this
is
really
from
a
bite
or
saliva
transmission.
So
in
some
cases
a
scratch
is
still
considered
a
risk.
Next
slide,
please
these
are
our
main
priority
areas.
You
know
we're
looking
at
that
on
the
eh
side,
the
pet
component.
M
We
then
work
very
hand
in
hand
with
our
communal
disease
team
to
look
at
them.
The
human
exposure
but
bats
and
skunks
are
our
primary
Reservoir
concerns
raccoons
and
some
of
the
other
throughout
the
state.
There's
been
mountain,
lions
there's
been
all
sorts
of
different
things,
mule,
deer
and
deer,
and
so
so
we've
seen
it
definitely
still
spill
into,
but
rabies
and
skunks
are
our
two
primary
concerns.
M
Next
slide,
please
hard
to
virus
very
rare
here:
it's
not
all
nice,
it's
specifically
the
deer,
mice
and,
and
then
there
are
some
other
rats
that
are
involved.
This
one
is
often
more
in
rural
areas,
cabins
and
things
that
are
not
used
all
the
time,
and
so
they
get
an
infestation
and
people
come
in
and
clean.
L
M
Aerosolize
the
virus
and
then
inhale
it
and
it
has
fairly
High
fatality
rates.
So
it's
it's,
it's
definitely
it's.
When
it's
present
again,
we've
only
seen
a
handful
of
cases
during
my
tenure.
So
it's
not
something
we
see
too
much
here
next
slide,
there's
their
species
that
are
more
prominently
of
concern.
Next
slide,
all
right.
Let's
get
into
some
numbers
for
you,
so
we've
had
109
rabies
samples
submitted.
M
M
M
We
have
not
seen
any
anywhere
near
that
kind
of
numbers
in
the
last
few
years,
so
last
year
was
a
quiet
year,
so
we
only
had
80,
I,
think
or
so
overall
investigations
91
in
2020,
which
was
definitely
a
tougher
year
to
compare,
because
we
really
didn't
have
a
lot
of
Staff,
but
we
certainly
were
not
getting
a
lot
of
reports
of
any
things.
I
think
people
were
just
not
not
reporting
that
much
of
anything
outside
of
covid
and
then
in
2019.
We
had
114
investigations,
so
a
huge
jump.
M
This
year,
it's
been
incredibly
active
year
for
us
and
then
each
one
of
the
investigations
may
or
may
not
involve
our
communicable
disease.
Folks,
too,
I
don't
have
a
good
breakdown
for
how
many
human
investigations
they
have
but
I
know
we've
had
big
numbers.
Let
me
can
you
pull
that
up
for
you,
the
number
of
human
pep
I
know
we
have
that.
I
M
Possibly
that
that's
one
way,
we
often
get
it
more.
So
our
biggest
partner
in
this
program
is
our
Animal
Control,
so
they
are
the
ones
who
are
going
to
often
respond.
So
someone
sees
a
weird
acting
animal
or
one
that
has
gotten
a
fight
with
their
pet.
Often
Animal.
Control
is
the
first
point
of
contact,
so
then
they
are
the
ones
who
are
working
with
us.
They're
bringing
specimens
in
and
a
decapitation
occurs.
M
You
typically
buy
them
or
by
our
contract
vets
and
then
we're
sending
that
specimen
in
for
testing
bats.
We
send
the
whole
bat
in
but
again
not
every
not
everything
will
initiate
a
specimen.
If
there's
really
no
risk.
Someone
sees
a
weird
acting
animal,
no
person
or
a
pet
has
interacted
with
it.
There's
no
reason
for
us
to
send
that
in
for
testing,
potentially
Animal
Control
might
euthanize
it
if
there's
a
risk
within
the
community,
but
there's
no
reason
to
test
even
finding
a
bat.
M
You
know
in
your
garage,
that's
death,
educated,
you
know
again,
there's
there's
no
risk
of
exposure
there.
So
there's
no
reason
to
test
so
and
then
in
some
cases,
there's
multiple
tests
for
one
investigation
where
any
they
found
three
bats
and
they
don't
know
which
one
was
in
the
the
room
when
people
were
sleeping
or
something
like
that.
So
sometimes
we
have
multiple
samples
for
one
investigation,
but
let
me
get
that
so.
For
human
we
had
30
30,
fam,
30
individuals
and
families
were
post-exposure
rabies.
M
F
M
M
We
had
five
cats
where
they
had
to
do
120
day
quarantine,
and
then
we
had
a
a
situation.
We
had
to
do
a
180
day,
quarantine
for
five
cats
and
that
we
often
see
cats
are
not
vaccinated
compared
to
dogs,
but
there
is
a
requirement
within
the
county
as
well
as
the
municipalities,
for
actually
it
includes
ferrets
too,
as
pets.
M
M
Usually
we
see
if
it's
a
wetter
spring
that
has
a
potential
to
be
more
problematic
plague
into
the
roomie
which
this
year
kind
of
was
so,
but
we
did
not
have
that
and
we're
thankful
for
it
so
and
then
nothing
for
Honda
virus
this
year
we
rarely
see
much,
and
this
is
more
on
the
communicable
disease
side.
They
do
see
some
other
tick
diseases
like
relapsing
fever
and
things,
but
those
are
still
pretty
rare,
Rocky
Mountain
Spine,
if
you're
not
really
a
disease.
We
we
deal
with
so
much
here
next
slide.
Please.
M
M
I
thought
I
saw
an
even
higher
number
more
recently,
but
that
was
as
of
our
last
zoonotic
report
two
weeks
ago,
but
Boulder
County,
Larimer,
County,
Weld
County
on
the
Front
Range
are
the
main
human
centers
and
then
on
the
Western
Slope
Mesa,
Montrose,
Delta
counties,
and
if
you
were
to
map
the
the
state
flood
irrigation
you're,
going
to
see
a
direct
overlap
of
where
the
primary
flood
Irrigation
in
Colorado
is
and
the
primary
West
navaras
human
diseases.
So
that
is
our
our
huge
driver
and
I.
M
M
Also,
our
populated
areas,
so
that's
also
what
you
would
expect
and
where
more
surveillance
is
being
done.
But
still
at
this
point
it's
really
neuro
invasive
cases.
So
it
is
people
who
are
pretty
sick,
that's
being
identified
rather
than
just
people
who
are
are
feeling
ill
during
the
summer
and
getting
tested
next
slide.
M
M
Guess
the
last
thing
before
before
that
is
just
this
is
definitely
a
challenging
program.
I
actually
was
exchanging
earlier
with
Catherine
about
she's,
like
kind
of
where's
the
funding
for
this
program,
and
there
really
is
no
funding
for
this
program.
We
have
some
staff
funding.
We
have
some
County
funding
for
most
of
the
staff
in
this
and
there's
no
other
funding.
So
we
really
run
in
deficit
to
do
you
know
the
vet
decapitation
contracts.
M
We
run
the
couriers
to
get
samples
down
to
the
state
lab,
there's
no
funding
source
to
really
pay
for
any
of
that
stuff.
So
it
all
comes
out
of
just
General
money
or
Surplus
within
our
division
to
cover
it
so
and
it's
a
very
Bare
Bones
Staffing.
So
we
have
Carol
McInnis
is
our
primary
she's,
a
0.6
FTE
to
work
across
all
the
vector
diseases
and
then
Marshall
lips
is
back
up
at
0.1
FTE
and
then
on
the
communicable
disease
side.
M
M
So
so
this
definitely
is
a
challenging
program
and
we're
just
so
fortunate
that
we
have
an
amazing
partnership
with
our
with
our
our
Animal
Control
staff,
because
if
that
workload
came
back
to
Public
Health
in
any
way,
there's
no
way
we
could
could
handle
all
of
that.
And
then
we
have
great
veterinary
assistants,
and
so
we
have
some
contracts
that
we
pay
them
for.
M
For
some
of
that
service,
we
do
a
lot
of
Education
early
in
the
year
we
have
a
annual
Zoo
kickoff,
where
we
invite
the
animal
control,
the
State
Health
Department
folks,
we
have
Colorado
Parks
and
Wildlife
Federal
folks,
even
that
come
in,
and
we
kind
of
have
speakers
and
share
information
and
just
get
everyone
ready
for
what's
going
on.
If
there's
been
any
policy
changes
and
again,
I
think
that's
been
one
of
the
reasons
we've
been
successful.
M
Certainly
vaccination
is
has
addressed
a
lot
of
the
risk
for
pets,
but
you
know
we
we
want
to
stay
rabies
free
on
our
inner
human
population.
It's
it's
not
often
to
see
a
human
case,
but
if
someone
gets
rabies
they
it's
fatal.
There's
really
only
been
a
few
historic
cases
where
someone
survived
rabies
without
getting
post
exposure
prophylaxis
any.
A
F
J
F
F
M
Again,
I
don't
think
our
story
is
unique
in
public
health.
I
think
our
story
is
a
common
story
in
public
health,
but
yes,
you're
right
the
the
expenses
that
we've
seen
for
someone
that
has
to
get
post-exposure.
Prophylaxis
is
incredibly
expensive,
the
first
doses
of
the
immunoglobulin-
or
are
you
always
administered
at
the
ER?
M
So
that's
an
incredible
expense
on
top
of
just
the
shots
themselves
and
then
it's
a
series
of
shots,
so
so
there's
a
it
can
get
into
the
thousands
of
dollars
very
quickly
and
we've
had
folks
that
do
not
have
health
care
and
do
not
have
ability,
and
so
then
that
becomes
a
burden
sort
of
on
the
Health
Care
system.
Because
you
know
these
people
have
to
get
treatment.
They're
it'll
be
fatal.
M
If
they're,
if
they
don't
so
so
yeah,
it
is
it's
a
huge
Challenge
and
then
people
who
you
know
don't
vaccinate
their
pets.
You
know
that
puts
a
challenge
where
pets
you
know:
we've
had
situations
with
pets
have
to
be
euthanized
because
people,
you
know
it's
it's
a
it's
that
question
of.
Is
it
Humane
to
put
a
pet
in
you
know,
strict
quarantine
for
180
days.
You
know
to
really
make
sure
that
they
aren't
going
to
develop
rabies.
M
C
At
these
things,
the
budget
trade-off
decisions
that
we'll
be
talking
about
with
you
guys
in
terms
of,
if
there's
a
finite
pad
of
resources.
Where
do
we
need
to
be
prioritizing
those
resource?
I
mean
vector.
Control
feels
pretty
incredible
from
a
public
health
perspective,
so
yeah
I,
don't
know
like
I,
don't
know
if
the
context
for
some
of
these
discussions
are
not,
but
it
just
it
very
much
worries
me
that
this
is
an
issue
that
is
clearly
under
under
resourced
and
is
so
clearly
a
public
health
need
from
the
community.
C
J
There
are
a
lot
of
things
that
we
will
not
be
able
to
address
by
the
time
we
come
back
for
Budget
study
session
next
month,
but
we
are
planning
to
be
very
intentional
about
looking
across
the
agency
and
how
the
funding
flows
work,
even
as
we
look
at
strategic
planning
as
we
look
at
the
workforce,
study
results
and
things
like
that.
So
yes,.
B
M
So
vector
control
is
just
to
be
clear,
is
is
different
than
the
mosquito
control
they're,
all
programs
under
me,
but
that's
why
I
try
to
call
mosquito
out
separately
because
it
is,
it
is
a
function
that
we
do
for
the
Commissioners
they're,
the
overseer
of
the
district
for
vector
control
rabies.
Again
we
have
fantastic
relationship
with
animal
control
in
the
city
of
Boulder.
They
are
incredibly
active.
They're,
you
know,
participate
in
our
kickoffs,
knowledgeable
folks.
They
make
sure
that
their
new
folks
are
well
trained
and
definitely
send
those
to
our
annual
kickoff.
M
We
see
a
lot
of
specimens
come
in
for
the
city
Builder,
so
we
have
great
relationship
with
them
and
they
they're
they're
very
active.
Interestingly,
they
have
some
programs,
they
do
prairie
dog
relocation
in
some
instances,
so
they
they
do
actually
apply
pesticides
for
potential
plague,
risks
in
those
situations
and
definitely
more
dangerous
chemicals
than
what
we
use
for
adult
mosquito
control,
but
it's
radically
different
applications
and
for
different
purposes,
but
so
they
are
very
conscious
of
playing
they're
they're
monitoring,
their
prairie
dog
populations,
and
so
we
also
work
closely
with
them.
M
There
is
no
there's
no
law
or
ordinance
or
regulation.
We
have
a
district
that
is
formed,
so
that's
a
again
a
tax
assessment
district
and
then
we
provide
those
Services
through
a
contractor
for
unincorporated
Boulder
County
each
municipality.
That
says
it
also
created
a
program
they're
just
their
program.
Focus
for
the
city
of
Boulder
is
is
different
than
ours
and
they're
they're
looking
at
different
larval
habitats,
and
then
they
have
kind
of
a
different
criteria
for
when
they
will
do
larval
control.
H
A
H
A
A
F
H
A
J
J
B
J
Right,
so
this
is
a
really
exciting
space
that
we're
getting
into
because
I
believe
it's
the
first
time
that
we've
really
been
very
intentional
about
having
Public
Health,
actively
participating
in
Partnership
to
develop
a
county-wide
strategic
plan
on
mental
and
Behavioral
Health.
It
isn't
just
related
to
County
government,
but
also
does
include
those
Community
Partners.
I
I
J
J
A
But
if
it's
not,
if
it's
really
more
about
being
more
in
tune
with
development
and
helping
with
implementation
of
strategic
planning
for
the
new
director
coming
on
board,
you
know,
maybe
we
should
give
it
a
try
at
least
to
see.
Okay,
is
this
frequency
too
much
or
too
little?
Well,
it
won't
be
too
little.
Will
you
read
too
much
or
just
right.
C
Yeah
I,
my
view
is:
we
should
plan
it
see
how
it
goes
yeah
if
the
agendas
feel
like
we,
you
know
I,
don't
think
we're
just
meeting
just
to
meet
together.
Educated
like
that's
not
you
know
so
I
think,
particularly
knowing
that
there's
going
to
be
a
leadership
transition
again,
like
I,
think
I
just
think
we
need
to
kind
of
be
in
more
communication
versus
not
at
this
stage
but
and
I
think
we're
doing
it.
C
F
E
B
O
O
F
N
Is
interesting,
though,
with
the
with
the
formula
shortage,
it
really
did
shine
a
light
on
the
supplier
chain
related
to
all
of
this.
So
there's
definitely
some
work
being
done
at
the
should
we
have
more
competition.
Should
we
have
more
entries
and
stuff
like
that,
so
there's
there's
work
being
done.
I
think
approximately
50
of
all
babies
in
the
U.S
are
definitely
eligible
for
WIC,
if
not
on
it,
on
Wix.
So
it's
it's
a
big
deal
and
something
we
should
maybe
come
at
a
future
meeting
with
a
deeper
dive
for
you.
I
And
again,
this
doesn't
have
to
be
answered
tonight,
but
I
am
really
interested
to
learn
as
universal
Pre-K
gets
rolled
out.
How
I
saw
in
the
director's
report
there's
a
reference
to
working
with
preschool
providers
around
completing
you
know
past
the
two
and
a
half
hours
of
coverage,
how
that's
going
to
work
for
folks,
so
that
kind
of.
C
The
emergency
management
section,
which
sounds
like
they're
and
I,
think
we've
talked
about
this
before,
but
the
rebuild
and
the
refocus
post
pandemic
Are
there
specific
areas
of
Emergency
Response,
where
we
feel
like
we're
we're
behind
than
others
like
other,
more
significant
gaps
in
certain
areas.
Or
is
it
pretty
much
across
the
board?
There's
a
rebuild
going
on.
J
I
think
it's
pretty
much
across
the
board.
I
think
what
Chris
is
really
focused
on
right
now
is
making
sure
that
we
have
a
response
or
structure
an
incident
command
structure
that
staff
are
prepared
to
fulfill
those
rules
that
we
have
the
spots
identified,
that
we
have
sufficient
staff
in
those
spaces.
I
think
he
has
in
mind
to
do
a
little
scenario
planning
this
fall,
but
we've
had
so
much
turnover
in
the
agency
that
there's
also
some
kind
of
onboarding
catch-up.
F
J
F
F
J
I
J
A
I
saw
Joe
I
think
did
I
see
that
Grace
is
leaving
yeah,
especially
going
back
to
finish
her
Masters.
Yes,
Grace
was
Grace
Hood
I
as
the
climate
change
I,
don't
forget
the
title,
but
she's
been
really
active
in
the
metro,
Denver
partnership
for
health
and
there's
a
climate
change
committee.
So
since
she
started
she
was
really
active
and
kind
of
helping
to
kind
of
chair
that
group
and
so
yeah
on
behalf
of
that
group,
we're
sorry
to
lose
her,
but
we're
starting
totally
understand
yeah.