Town of Plymouth Board of Health and Department of Public Health Strategic Plan Table of Contents Plymouth Public Health at a Glance ...4 Public Health 1.0 Yearly Activity and Future
Initial Understanding of Our Public Health Priorities of Interest
A Note About the Vote Point Value Strength (Weight) Assignment Methodology
In this voting system, a first-place vote is worth 4 points, a second-place vote is worth 3 points, a third-place vote is worth 2 points, and a fourth-place vote is worth 1 point A total of 98 votes were cast across 7 participants, including 4 Board members.
During the Board of Health and Public Health staff brainstorming session, the facilitator collected votes from members and three staff, tallying how often each priority of interest was indicated and assigning a predefined vote point value to reflect its weight This method was used to reveal the vote strength attached to each priority, making higher point totals indicate stronger emphasis The vote point strength was calculated to score every item of interest discussed during the session.
Public Health Priorities of Interest
Opioids ‐ Engaging more with education 25
Extreme weather ‐ ability to aid residents 10
Communication (OML)*communication to public/Government 5
Identifying places to dispose of meds 4
Assessing our Public Health Priorities
Assessing Our Public Health Priorities
1 What are we doing well?
2 What can we do better?
Communication (OML)*communication to public/Government 5
Identifying places to dispose of meds 4
3 What new initiatives should we focus on?
Opioids ‐ Engaging more with education 25
4 In the coming years, major health issues in the community?
Extreme weather ‐ ability to aid residents 10
Condensed Priorities of Interest for the Board and Department to Focus On
Condensed Priorities of Interest for Board and Department to Focus On
Total Vote Indication Point Value
Opioid Community Engagement Education and Drug Disposal 26 Climate Change/Infections Disease/Extreme Weather/Preparedness 24
Community Health: Disease Outbreaks and Homelessness 14
Public Health 3.0 (Public Health and Healthcare Collaborating) 12 Plymouth 400 Public Health Disease Prevention and Preparedness 9
Communication (OML)*communication to public/Government 4
2017 Department of Public Health Assessment
Assessment and Evaluation of the
Overview of Local Public Health in Massachusetts 3 Core Functions and Essential Public Health Services 5
This report assesses a representative set of environmental health, community health, and emergency preparedness programs that the Town of Plymouth’s Health Division (PHD) currently implements or should implement While not exhaustive, the review focuses on the administrative and inspection functions central to the PHD’s mission, drawing on Massachusetts statutes and regulations, local municipal regulations, and the national core functions and essential services municipal health departments are expected to address when serving local businesses, visitors, and residents The Findings and Recommendations section presents guidance on program development, new program creation, and minimum staffing levels to strengthen the PHD’s operations.
Plymouth, Massachusetts, is a community of about 60,000 residents that swells with a seasonal influx of tourists, significantly increasing public health burdens As the largest municipality in Massachusetts by square mileage, Plymouth blends urban and rural attributes, presenting unique challenges to ensure its public health infrastructure meets community needs Protecting public health here involves tasks as diverse as collecting bathing beach water samples on the eastern side, inspecting food service establishments on the western side, and conducting tick-borne disease education, all of which require skilled staff, extended travel times, extensive training, and access to external resource support to assure proper public health protection.
According to the 2016 Plymouth Community Health Needs Assessment conducted by Beth Israel
Deaconess Medical Center Plymouth serves an aging population facing significant health challenges, including rising substance abuse and persistent risks of chronic diseases such as cancer, heart disease, and diabetes, along with obesity and sedentary lifestyles as key risk factors Addressing these issues requires targeted prevention, early detection, and comprehensive community health programs led by the medical center.
The Town of Plymouth faces diverse environmental health and health promotion needs, demanding a local health department that can respond effectively Residents deserve a department committed to excellence in delivering comprehensive environmental health services and proactive health promotion programs to meet these challenges.
An Overview of Local Public Health Department Responsibilities in Massachusetts
Massachusetts municipalities oversee a wide range of environmental and community health programs, along with infectious disease surveillance In many communities, including Plymouth, they enforce statutory food establishment inspections and related public health activities to safeguard residents.
Local boards of health (LBOH) and local health departments (LHD) oversee the implementation of federal, state, and regional grant-based and non-grant-based health programs, including substance abuse initiatives, hoarding interventions, fitness and nutrition promotion, infectious disease prevention, Community Health Assessments (CHA), Community Health Improvement Planning (CHIP), and strategic planning Regional health programs include mosquito control, emergency preparedness and response, and tobacco control The effectiveness of these regulatory and non-regulatory programs depends on municipalities maintaining adequate staffing levels and ensuring that LHD staff are properly trained and credentialed to carry out the core functions of public health.
In addition to mandated inspections and complaint driven inspections, municipalities are charged with annual permit fee collection, collection of non-criminal disposition fees and surcharge fees
Administrative staff must be proficient in a variety of computer software and have a working knowledge of regulatory requirements in order to properly interface with town staff, partners and applicants
Local and state sanitary code programs require staff to be trained in the plan review component of environmental health programs Local health department staff review proposed food establishment plans to ensure compliance with equipment and structural requirements and educational provisions such as ServSafe person-in-charge training and allergen awareness training Similar plan review requirements apply to septic systems (Title 5), swimming pools, and body art establishments, and locally mandated reviews may include animal-control oversight of chicken and pigeon coops and horse stables In addition to community health and emergency preparedness, staff carry out numerous inspection duties and must participate in state and local trainings to stay current with evolving practice standards.
Local health departments (LHDs) issue administrative order letters to secure compliance with state and local regulations When a permitted establishment is found to violate codes, an administrative hearing can lead to the suspension or revocation of its operating permit Associated processes include administrative hearings at the department and board of health levels and the drafting and processing of variance petitions to be considered by the board of health Common variance petitions involve onsite wastewater (Title 5) variances and housing code variances For example, it is not uncommon for a property owner to petition the Local Board of Health (LBOH) for a modification or withdrawal of a housing code order letter.
Core Functions and Essential Public Health Services
A 1988 Institute of Medicine report established the core functions of public health as assessment, policy development, and assurance Those concepts were expanded further by the Core Public Health
Functions Steering Committee that developed the framework for the Essential Services in 1994 (per:
Based on CDC guidance from 2014, the core public health functions and the essential services define the public health activities every community should undertake and establish a framework for evaluating the performance of local health departments, including the PHD They also guide efforts toward national public health accreditation by providing metrics and benchmarks to measure effectiveness and drive continuous improvement.
1 Monitor and evaluate health status to identify community health problems
2 Diagnose and investigate health problems and health hazards in the community
3 Inform, educate, and empower people about health issues
4 Mobilize community partnerships to identify and solve health problems
5 Develop policies and plans that support individual and community health efforts
6 Enforce laws and regulations that protect and ensure public health and safety
7 Link people to needed personal health services and assure the provision of health care when otherwise unavailable
8 Assure a competent public and personal health care workforce
9 Evaluate effectiveness, accessibility, and quality of personal and population-based health services
Researching new insights and innovative solutions to health problems must be paired with adequate staffing of trained professionals Health Commissioners, Health Directors/Agents, Chief Community Health Officers, and Public Health Nurses frequently assist in delivering essential services 1–5, 6, 7, and 9, while Health Commissioners, Health Directors/Agents, Chief Environmental Health Officers, Animal Control Officers, and Health Agents/Inspectors oversee essential services 1, 3, 5, 6, 8, and 10 When staffing levels are insufficient, local health departments across communities often cross-train staff to perform core duties beyond their primary roles.
The National Association of City and County Health Officials (NACCHO) provides an operational definition of a functional local health department that expands beyond the essential public health functions to explicitly include health disparities and the response to public health emergencies This expanded framework highlights equity and emergency readiness as central considerations and shapes how local health departments structure their services, governance, and partnerships The framework for a functional health department is often referred to in the context of public health practice and capacity building.
“standards” takes into account that LHDs derive their authority and responsibility from state statues and the local bylaws and regulations that govern them These standards serve as a guide to assist the LHD in the delivery of fundamental public health services while taking into account unique characteristics such as governance and population size (per: NACCHO Operational Definition of a Functional Local Health
Moving Toward Excellence in Public Health through Accreditation
This report provides a clear roadmap for the Town of Plymouth, the Plymouth Board of Health, and the Plymouth Health Department (PHD) to achieve excellence in delivering public health services to residents, visitors, and businesses National public health accreditation serves as the benchmark for local health excellence, guiding the standards, priorities, and actions needed to reach that level.
By 2011, over 200 state and local health departments nationwide had earned accreditation from the Public Health Accreditation Board (PHAB) Accreditation evaluates health department performance against a set of nationally recognized, practice-focused, evidence-based standards Early prerequisites include conducting regular health status assessments, developing community health improvement plans, and establishing a department strategic plan that is linked to health assessment and improvement efforts.
The Public Health Department (PHD) has an opportunity in the coming years to become a national leader in delivering public health services by expanding public health infrastructure to provide essential services It will lay the groundwork for accreditation by collaborating with community stakeholders in health assessment and improvement planning, developing a municipal public health strategic plan, and pursuing public health accreditation.
State Sanitary Code and Local Regulatory Programs