DATE: January 24, 2019

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DATE: January 24, 2019 TO: FROM: SUBJECT: Southern Nevada District Board of Health Members Joseph Iser, MD, DrPH, MSc, Chief Health Officer Chief Health Officer Report Influenza Update The reports data collected from local acute care hospitals and other health care providers. On Jan. 3, the Health District reported the season s first flu-related deaths. One of the deaths occurred in a child in the 0-4 age group. The two adult patients who died were in the 50-64 age group. Through week 1 of the influenza season (Jan. 5), influenza activity remained elevated at the local and national level. In the state of Nevada, the geographic spread of influenza was widespread, but influenza-like illness (ILI) was low. As of week 1, there were 149 influenza-associated hospitalizations reported in Clark County. The proportion of emergency room visits for ILI and urgent care clinic visits was 5.7 percent. Approximately 47 percent of area ER and urgent care clinic visits for ILI were children under the age of 18. The Health District will continue to update the public on the flu season and encourage people to get vaccinated. Vaccination is recommended for everyone but is especially important for those most at risk for complications from the flu. At-risk groups include pregnant women, people with underlying medical conditions, and people who care for infants younger than 6 months and their family members, as they are too young to receive the vaccine and vulnerable to the virus. Health District influenza surveillance updates are available at http://www.southernnevadahealthdistrict.org/stats-reports/influenza-surveillance.php. Nevada Ranks 39 th in Protecting Kids from Tobacco On Dec. 14, the Campaign for Tobacco-Free Kids released its annual report assessing how states use their share of tobacco settlement funds to address public health problems caused by tobacco use. Nevada was ranked 39 th nationwide in funding programs that prevent kids from using tobacco and help smokers quit. The report found that Nevada spent $1 million in 2018 on tobacco prevention and cessation programs, which is 3.2 percent of the $30 million recommended by the Centers for Disease Control and Prevention (CDC). Other key findings include: Nevada will collect $230.5 million in revenue this year from the 1998 tobacco settlement and tobacco taxes but will spend only 0.4 percent of the money on tobacco prevention programs.

Tobacco companies spend $64.2 million each year on marketing their deadly and addictive products in Nevada more than 67 times what the state spends on tobacco prevention. Nationwide, tobacco companies spend $9.5 billion a year on marketing more than $1 million every hour. The report, Broken Promises to Our Children: A State-by-State Look at the 1998 Tobacco Settlement 20 Years Later, was released by the Campaign for Tobacco-Free Kids, American Cancer Society Action Network, American Heart Association, American Lung Association, the Robert Wood Johnson Foundation, Americans for Non-Smokers Rights, and Truth Initiative. The full report is available on the Campaign for Tobacco-Free Kids website at https://www.tobaccofreekids.org/what-we-do/us/statereport/. Public Health Accreditation Site Visit The Health District completed its Public Health Accreditation site visit on Jan. 9-10. During the visit, the team met with representatives from the Board of Health and community partners, was provided an overview of our organization, verified the accuracy of the submitted documentation, asked questions about our processes, and toured our main facility. The site visit team s next step will be to develop its report for submission to the Public Health Accreditation Board. Once the accrediting board receives the report, it can take up to three months to determine an agency s accreditation status. Website The Health District completed a soft launch of its newly designed SNHD.info website on Friday, Jan. 11. The new, dynamic website features updated templates and a more user-friendly experience regardless of the device or browser used to access the site. The redesign was completed in-house, and updates and improvements to the new site are ongoing. Community Meetings Week of December 31 Participated in Nevada Public Health Institute meeting Met with Dr. Joe Hardy, Touro University, regarding Health District clinics and future collaborations Participated in Health Officers Association of California Board meeting Participated in Nevada Health Authority Conference call Met with Dr. Joanne Leovy, Nevada Health Centers, regarding climate change and health Participated in NACCHO Board call regarding Big Cities Health Coalition transitions Met with Shawn Gerstenberger, UNLV, regarding matters related to the Health District and future collaborative efforts Met with Nicki Aaker, Director, Carson City Health and Human Services, regarding matters related to the Health District Provided media interviews as requested

Week of December 17 Participated in NACCHO Nominations Committee and NACCHO Finance Committee meetings Met with Ben Schmauss, Government Relations Director and other key Nevada legislative players to discuss public health legislative priorities Participated in County Health Rankings call Participated in Clark County Medical Society Board of Trustees meeting Met with Cody Phinney, Nevada Department of Health and Human Services regarding Medicaid billing and how it can better serve the Health District Participated in the Nevada State Medical Association Public Health Commission meeting Met with Ben Schmauss, Government Relations Director of the American Heart Association and others to discuss the upcoming legislative session and what other local health authorities are proposing Participated in NACCHO s Global Health Task Force meeting Week of December 10 Provided follow up interview with KXNT regarding National Influenza Vaccination Week news release distributed by the Health District Met with Councilman Scott Black, City of North Las Vegas, regarding issues related to the Health District Participated in Nevada Public Health Workforce Development Survey Planning meeting Participated in Big Cities Health Coalition (BCHC) 2018 Monthly call Hosted HIV/AIDS Call-to-Action Partner Event and News Conference Week of December 3 Participated in Big Cities Health Coalition(BCHC)/National Association City and County Health Organizations (NACCHO) Catch Up meeting Presented Mobile Dental Clinic Update to Nye County Commissioners Participated in the Nevada Public Health Initiative (NPHI) meeting Met with Dr. John Fildes, UMC Trauma Center Director, regarding issues related to the Health District Participated in the Medical Advisory Board meeting Met with Megan Messerly, reporter from the Nevada Independent, regarding an interview for a Sandoval retrospective article Met with Ben Schmauss, Government Relations Director, regarding issues related to the Health District Participated in the Health Officers Association of California Board meeting Participated in the Nevada Health Authority Conference call Participated in the State of Nevada Board of Health meeting Met with Dr. Kevin Sherin, Health Officer, Florida Department of Health in Orange County, regarding future presentation to NACCHO Mass Casualty Response Week of November 26 Participated in Small Grant call Participated in Bloomberg American Health Initiative in Washington, DC, November 28-30 as a collaborating organization representing Robert Fyda, Environmental Health Presented at World AIDS Day event organized by The Wellness Center

Week of Week of November 19 Participated in the NACCHO Finance Committee monthly meeting Attended the Continuing Medical Education (CME) Task Force meeting Met with Dennis Worsham, Prevention Division Director, Seattle & King County, regarding information relevant to future projects in Clark County Met with Pam Beal, Chief Operating Officer, FirstMed, regarding possible future collaborative projects Participated in Clark County Medical Society Board of Trustees meeting Week of November 12 Participated in the Nevada Public Health Association Advocacy meeting Week of November 5 Participated in the Nevada Public Health Institute meeting Met with Richard Whitley, Julie Kotchevar and Cody Phinney, DHHS, to discuss Primary Care and other possible collaborations Participated in the Big Cities Health Coalition (BCHC) 2018 Monthly call Participated in the Meadows AHEC Board meeting

2018 Academic Affairs Annual Report Laura Valentino Academic Affairs Coordinator An Academic Health Department 1

Guiding Principles SNHD is an Academic Health Department, and purposefully seeks to strengthen the relationship between academia and public health practice. SNHD seeks to provide the highest quality, mutually beneficial clinical and non-clinical internships, rotations, and student experiences for the future public health workforce. SNHD preceptors will have preceptor development training. SNHD staff are supported in professional development including, but not limited to, undergraduate and graduate education, professional trainings, and professional certification. 2018 Successes at a Glance September 2018: SNHD became the first Academic Health Department (District) in Nevada. It is one of only five in the Western United States. Academic Health Department (AHD) AHD is designed to strengthen the linkage between academia and public health and facilitate greater collaboration in public health practice, research, service, workforce development, and accreditation support. AHD model is based on best practices and facilitated through the Public Health Foundation s Council on Linkages Between Academia and Public Health Practice. AHD agreement between SNHD and the five UNLV health professions schools (Allied Health Sciences, Community Health Sciences, Dental Medicine, Medicine, and Nursing is finalized in September 2018. AHD Joint Advisory Committee (JAC), the steering committee for the JAC, meets in September 2018. The steering committee is comprised of deans or senior leadership from each AHD member school or program and four representatives of SNHD. Touro University Nevada and UNLV College of Liberal Arts, Graduate College, and Honors College join AHD in December 2018. An Academic Health Department 2

Academic Affairs Procedures, Policy and Systems Created Student Learning Application for SNHD website. Wrote Academic Affairs policy. Wrote student evaluation surveys for clinical and non-clinical students. Wrote and published quarterly Intern Success newsletter and biannual Academic Affairs newsletter. Other Student Experiences Coordinated CSN summer biology public health boot camp tour (20 students). Data Tables/Charts CURRENT AFFILIATION AGREEMENTS NEVADA STATE COLLEGE-NURSING ROSEMAN UNIVERSITY-NURSING AND PHARMACY TOURO UNIVERSITY-PHYSICIAN ASSISTANT AND MEDICAL STUDENTS UNLV-LAW UNLV-NURSING UNLV-NUTRITION UNLV-PUBLIC HEALTH UNLV-SCHOOL OF MEDICINE MASTER AFFILIATION AGREEMENT WALDEN-NURSING INFORMATICS A.T. STILL UNIVERSITY-DENTAL PUBLIC HEALTH UNLV-EDUCATION UNLV-SOCIAL WORK ACADEMIC HEALTH DEPARMENT MOU *** Items in bold are new in 2018. *** PENDING AFFILIATION AGREEMENTS ARIZONA STATE UNIVERSITY- BEHAVIORAL HEALTH CAPELLA UNIVERSITY-NON-CLINICAL NURSING NEVADA STATE COLLEGE-BIOLOGY SUNRISE HEALTH-INTERNAL MEDICINE RESIDENTS UNLV-LEE BUSINESS SCHOOL UNR-UNIVERSITY-WIDE VALLEY HEALTH-FAMILY MEDICINE RESIDENTS WALDEN UNIVERSITY-HUMAN SERVICES ACADEMIC HEALTH DEPARTMENT MOU-NEVADA STATE COLLEGE, ROSEMAN An Academic Health Department 3

Year Total Number of Interns 2016 72 2017 142 2018 125 Total Number of Interns, Residents, and 125 Fellows Total Hours of Applied Public Health 6,250 Practice Average Hours Per Intern 52 Institution Number of Participants Percentage of Participants A.T. Still University 1 0.008% Nevada State College 5 0.04% Roseman University of 5 0.04% Health Sciences Touro University Nevada 50 40% University of Nevada Las 63 50.4% Vegas Walden University 1 0.008% Student Type Number of Participants Percentage of Participants Law 2 0.016% Medical Student 1 0.008% Nursing 36 29% Nutrition 2 0.016% Physician Assistant 49 39% Public Health 8 7% Internal Medicine Resident 21 17% Pulmonary/Critical Care Fellow 6.05% An Academic Health Department 4

Touro PA evaluation Scale: 1 (disagree) to 5 (strongly agree). n=33 (67% response rate) Question The Sexual Health clinic exposure was a beneficial learning experience. The Community Health Exposure was a beneficial learning experience The TB clinic exposure was a beneficial learning experience The Immunization clinic exposure was a beneficial learning experience The Environmental Health exposure was a beneficial learning experience The Family Planning clinic exposure was a beneficial learning experience Overall, the Southern Nevada Health District rotation was a valuable learning experience 4.15 4.1 4.19 3.13 3 3.7 3.6 Average Score An Academic Health Department 5