i am Board of Health Vice Chair
Cannon Daniels, and today I
have the pleasure of serving as
the chair for board. Chair
Mosqueda. I
m calling this
meeting to order on JUNE 18th,
2026. Chair Mosqueda
unfortunately could not attend
today and I will surely MISS
The charisma and the precision
that comes with her leadership.
Are you warning this meeting
today MAY be a little rough
around the edges, as this is
only my second tier, second
time chairing our monthly
meetings. So I ask for your
grace, and we
ll work hard to
ensure that our time together
today is spent as effectively
and efficiently as possible
with especially with so many
things vying for our attention
on a per second basis. I really
want to thank everyone for
setting aside these next couple
of hours to learn about and
discuss various public health
items that are set on our
agenda today. It
s good to see
you all at our meeting today.
The board will hear a chair
s
report from me and a director
s
report from Doctor Sandra
Valenciano, health officer and
acting director of Public
Health Seattle in King County.
You can also find a written
report from doctor v in the
meeting Materials packet,
beginning on page nine. Today
we
ll hear three briefings.
First, we
ll hear from board
administrator Joy Carpenter,
Joy Carpine-Cazzanti Canty.
Thank you. To about board
membership and this summer
s
recruitment efforts for 2027.
Second, we
ll hear from board
member Tripoli and Public
Health about innovations and
sexual health. This briefing
was deferred at the MAY
meeting. So I want to ensure
adequate time is given. And
lastly, we
ll hear from me and
the Washington State Department
of Health about findings and
recommendations from the
Washington
s Maternal Mortality
Review Panel. At the end of the
meeting. Board members will
have the opportunity to share
any updates. Additionally, our
our JULY meeting will be held
on the usual third Thursday,
JULY 16th, 2026, beginning at 1
P.M.. Clerk hey, would you
please call the roll?
Thank you. Chair. Daniels.
Board member Dunn. Board
member.
Lewis.
Here. Board member. Mosqueda.
Board member. Von Reichbauer.
Here. Board member. Foster.
Board member. Juarez. Board
member. Rinke. Board member.
Soca. Board member. Falcone.
I
m here.
Board member. Garcia.
Present.
Board member. Schroth. Board
member. Blas.
Present.
Board member. Core.
Here.
Board member. Paquette. Here.
Board member. De Castro. Board
member two. Board member.
Gadgil. Present. Board member.
Hartfield. Board member.
Mohammad.
Here.
Board member. Green. Board
member. Polly.
Present.
Board member. Lu.
Yes.
Board member. Milligan. Board
member. Elkins. Board member.
Thomas. Board member. Williams.
Board member. De Los Angeles.
Board member. Bowen. Board
member. Lucero. Here. Thank
you. Board member. Gilli and
chair. Daniels.
Thank you. Clerk.
You have a quorum.
We always welcome alternates to
join board meetings. Are there
any alternates who are serving
in place of regular members
today?
Board member Green is present.
Thank you. Partner.
Board member. Foster.
Just identifying. I missed roll
call, but I
m present. Thank
you so much, chair Daniels.
Thank you.
Okay. I think that
s all I see.
Okay. All right. Thank you
everyone. We will now move to
the approval of our MAY 21st,
2026 minutes. Board member
Falcon, can you move to approve
the MAY 21st, 2026 minutes?
Yes. Thank you. Vice chair
Daniels, I move that we approve
the MAY 2026 meeting minutes.
Thank you. All those in favor,
please signify by saying I.
I, I.
I.
All opposed name any
abstentions? The ayes have it.
The MAY minutes are approved.
Thank you. Okay, now we will
move on to public comments.
Clerk. Do we have anyone in
chambers or on the line wishing
to provide public comment?
We have one.
Okay. Um, the Board of Health,
we welcome public comment as an
important part of the public
process. And we truly want to
hear your thoughts regarding
public health matters in King
County. With that being said,
each commenter will have two
minutes and I will be a bit
stingy with that time as we do
have a full agenda. Um, in
addition, please keep in mind
that all comments must be
germane to the agenda items or
items within the board
s
purview. Speakers should not
make introductory statements,
derogatory remarks, profanity,
or personal attacks not germane
to an agenda item, nor
statements related to a
political campaign or
statements for or against a
candidate or ballot measure.
Clerk. We have.
One in chamber.
We do.
Have one in chambers signed up.
And that is Alex Zimmerman.
Okay. Alex, you have the four.
We
ll take this down. Yeah.
I
m candidate for election 15
times, and I
m talking about
agenda number eight for my
understanding about sexual
problem. That is, we have it
s
a little bit confused me
because we have a syphilis
epidemic. Who are you guys?
21st century. You can count on
PRESIDENT. Be very
intellectual. How many
percentage people educate? With
college degree? 77% plus minus.
If you have a syphilis
epidemic. Doctor months ago
told me it was the biggest
blood test I took. Everybody
needs this epidemic. I know
last time syphilis epidemic
came in 15th century in Europe.
Who are you? You. I told you
so. King country number one for
city in America. County in
America. Right now you Wilt
County. You know what I mean?
Syphilis in 21st century for
2.5 million people. Because you
are Baggett a killer. All
money. What is you give, you
give to people what is not
deserve this like not legal
immigrants who bring a thousand
syphilis inside America. In
King County you are a bandit.
You are a killer. And I talk
about this many times, but very
interesting because professor,
from you, you double present
this of 20 year ago. And I know
the PRESIDENT Of you double
make a $1 million salary. I
think why he make $1 million in
salary in Alex Zimmerman have
only $2,000 Social Security,
whereas a problem when you stop
an Arctic like a veiled stupid
idiot. Viva Trump, viva new
American revolutions, up slap
and happy cow. You need stop
and steal us money driving
these millions and millions of
dollars to stranger. What is
being.
That was the last person on the
list. Chair Daniels.
Thank you Claire. That
concludes public comment. We
will move on to the chair
s
report. Uh, first chair
Mosqueda wanted to express her
appreciation to all the board
members for considering and
signing the sign on letter to
the state Department of Health
regarding improving access to
massage licensure, reducing
barriers that are preventing
many prospective and current
massage workers, particularly
immigrant, low income and
non-English speaking Asian
women, from from accessing
Washington
s Massage Licensure
system. Chair. And in
partnership with the board
members assigned on stand ready
to work with the Department of
Health team to collectively
address and reduce hurdles to
licensure. Thanks to board
members Foster, Lewis, Mercedes
rink, Scruff, Muhammad, Green,
Melanie Lucero, Lou Hartville,
myself and chair Mosqueda for
signing on to The letter. We
sent a letter on JUNE 12th,
2026 and we
ll let the board
know what the response is. I
also want to say
congratulations to Doctor
Sandra Valenciano. Her
appointment as Director of
Public Health was confirmed
this month by both the Seattle
City Council and the
Metropolitan King County
Council, and her title is
officially official. So,
doctor, v, just unpacked those
last few boxes, settle in
because we want to keep you in
your step with us now.
Congratulations.
Doctor v.
All right. This brings us to
item number seven, the
director
s report. A written
director
s report is in the
meeting material shared by the
clerk last week, beginning on
page nine. And it does include
an update on the Community
Health Improvement Plan or
Chip. Board members Lew
Muhammad and I serve on the
Chip steering committee. So
please take a look at that
written report. Okay. Doctor,
ve, you have the floor.
Thank you. Chair Daniels. And
thank you for the kind words.
Um, that was actually the first
item on my list of updates. Uh,
yes. After four confirmation
hearings or, uh, because I had
to do two with the King County
Council and two with City of
Seattle. Um, happy to inform
everyone that I was officially
confirmed last week, Tuesday by
both councils. And on Friday,
um, was happy to participate in
a swearing in ceremony at the
city of Seattle, along with
other directors. Um, we can
share the link to that,
actually, because I took oath
of office and I had to make
remarks. So happy to share that
with the board. Um, and happy
to be here in, in this dual
role now officially as director
and health officer. Um, thank
you all for your support.
Really appreciate it. Uh, the
other item I wanted to just
quickly highlight is, you know,
fifa World Cup has officially
kicked off in the city of
Seattle. Um, and we had our
first game here on Monday. We
have a game tomorrow. Um, and,
uh, happy to report that so far
it has been knock on wood. Uh,
blue skies in Seattle. Uh, of
course, you all probably saw
and felt the heat. Um, that
happened over the weekend and
earlier part of this week. We
did see a slight increase in
heat related calls for ems and
a slight uptick in heat related
illness. Um, an emergency
department visits. However,
that
s not surprising, right?
Given the changes in the
weather and did not have a
major impact on our health care
system. Uh, aside from that, no
other broader trends requiring
any additional public health
action have been identified at
this time. Um, our team is
activated. We have our Mac
Health Medical Area Command
activated since last week.
Actually. And our team is
continuing to do surveillance
throughout throughout all of
the matches in Seattle. Um, and
I will also add that, you know,
various members of our team are
on a number of different calls
related to fifa. We have, of
course, our internal Mac calls.
We have our emergency
preparedness team that are
sitting in on the King County
emergency operations, as well
as the City of Seattle
emergency operations. Um, I am
on calls with cdc, with local
health officials from all of
the host cities. Uh, so that
s
actually really great because
it
s an opportunity for us to
learn about anything that could
happen. You know, from a public
health standpoint and any of
the other host cities, um, as
well as calls with the
Department of Health and the
Big Cities Health Coalition.
So, needless to say, a whole
number of coordination calls
with a variety of different
partners that are all
monitoring everything related
to fifa World Cup and public
health. Um, at our last board
meeting, I provided an update
about, uh, the hantavirus, uh,
outbreak associated with the
cruise ship. And, um, informed
the board about, you know, our
King County residents that we
had identified as being high
risk exposures. And we did have
an additional low risk
exposure. Just wanted to share
and report that, um, our
residents followed public
health guidance throughout
their entire monitoring period.
And, uh, some have completed
their monitoring period without
any symptoms. Um, and a couple
will be completing theirs, uh,
shortly. The there is one
resident who chose to remain at
the Nebraska facility during
the entire monitoring period.
Um, but happy to report that
also without any symptoms. Um,
and then, of course, right
after hantavirus, I
m sure you
all have seen about the ongoing
outbreak of Ebola. Um, wanted
to share a little bit about
that. So on MAY 5th, uh, the
World Health Organization
alerted, uh, about an outbreak
of Ebola virus occurring in the
eastern providences of the
Democratic Republic of Congo.
And there are different kinds
of Ebola viruses. And the the
one that has been identified is
Buju Ebola virus. Um, so far as
of JUNE 16th. And these are
numbers from the cdc
s, um,
situational update report.
There have been a total of 875
confirmed cases in drc and 202
deaths in Uganda as of JUNE
18th. There have been a total
of 19 confirmed cases and two
deaths. Um, there, as you can
imagine, this is a situation
of, uh, global importance,
especially as we
ve undertaken.
Right? This, um, World Cup and
lots of travel, summertime,
etcetera. Um, the cdc is
actively monitoring their
emergency operations center is
has been stood up and the they
have implemented strict
protocols, including routing
individuals who are returning
from any travel to drc, Uganda
and South Sudan in the last 21
days to specific airports where
upon arrival they are screened
and then state and local health
departments are receiving
information about any travelers
that will then be returning to
their states. Like other Ebola
outbreaks in the past. Public
health is working closely with
the state Department of Health
and the cdc, and will be
conducting symptom monitoring
on any travelers returning from
these affected countries. Uh,
currently, travelers that have
returned have all been
identified to be very low or
low risk. Uh, the risk to the
United States and here in King
County remains low. We do not
expect a bullet to be a local
health threat during the World
Cup. And we are, of course,
continuing to monitor the
situation as it continues to
evolve. Um, and then just to
note also on those numbers, of
course, that, you know, numbers
are actively changing rapidly.
Um, and, uh, another important
piece of information is that no
cases of Ebola have been
identified in the United
States. Uh, and then lastly,
wanted to share about, uh,
measles. Um, so I think
everyone has seen and I
ve
reported in previous board
meetings about measles
outbreaks and where we stand in
the United States. So as of
JUNE 5th, we have had a 45
cases of measles. Measles in
Washington state, uh, with
three cases here in King
County. Uh, cases in Washington
have occurred typically in, uh,
people who have been
unvaccinated or not fully
vaccinated and have either
traveled domestically where
active outbreaks of measles
have been occurring, or
internationally and have been
exposed. Um, we
ve also had
introduction from travelers who
traveled into Washington or
traveled through Washington
with measles and then, um,
have, you know, exposed other
individuals. Our team is
actively working on measles
surveillance at all times, uh,
working with the state
Department of Health and cdc.
And I think really important,
since, of course, we are now in
summer travel period to make
sure that, uh, community
members know that it is really
important to make sure that
they are immune and have had
two doses of measles vaccine.
Um, before traveling outside of
the United States or even
traveling domestically in the
United States, where there
might be an active outbreak of
measles. Um, and typically,
children receive their first
dose of the measles vaccine
between 12 to 15 months of age.
Uh, but I want to make sure
that parents know that children
that are 6 to 11 months old and
who MAY be traveling
internationally or to an area
with an active outbreak, can
get a dose prior to their
travels, even though their
child is not a year old yet. I
think that
s really important.
Um, and so happy to conclude my
updates at this time.
Thank you. Doctor v board
members, are there any
questions or comments.
For Doctor e.
Or members of.
The Sarah who have the floor?
Hey doctor v. Congratulations.
Uh, really happy to have you in
this role. Um. My question.
It
s more of a recommendation.
Actually, I
m wondering if King
County has considered putting
forward all of the sites that
actually provide vaccinations
as, like a form of, you know,
outreach to community with
these reminders. Um, and I
m
particularly thinking because
we, you know, it
s very
important that we contradict
kind of the administration
s
position, the federal
administration
s position on
vaccines. Um, and, you know,
speaking as a leader of one of
the federally qualified health
centers, and I know this is a
massive effort on our part. And
so we could use some assistance
from King County in getting
that information out and having
a broader reach. So that would
be my request.
Yes, absolutely. Um, our team,
uh, we do have about 22
community navigators who are
actively working in community
and with community and are
sharing information regarding
measles. Um, of course, at our
public health clinics and
through our community access
and outreach teams as well. Um,
and but always happy to
collaborate in any way, shape
or form to provide accurate
information to the community.
Um, actually, just yesterday I
did a measles interview in
Spanish, uh, as well. Uh, that
was live Facebook live for
community, kind of answering
questions from community about
misinformation related to
measles vaccination. Um, you
know, misinformation about
measles and autism and just
concerns that people have. Uh,
so we did do that. And I have a
one coming up in a couple of
weeks as well that I
ll be
doing in Spanish for another
outlet. Um, but our team is
actively doing these two with
other smaller community media.
Um, any, you know, uh,
recommendations or suggestions?
Our team is happy to, to work
on this.
Thank you, Doctor Bee.
Uh, board member Lucero, is is
your hand up for additional
follow up?
It
s just a follow up. Yes.
Go ahead.
Please. You know, I was
speaking, um, as the co-chair
who, um, led the Breaking the
Cycle initiative from, um,
executive Zahilay. And one of
the commitments within that,
um, committee is to make sure
that we have meaningful
community. Um, partnerships.
And so I
d like to see much
more than just, you know,
information. But really, um,
advertising and marketing and
communicating the community
based organizations that are
ready to assist with this and
have capacity to be able to
support the need. Um, so that
s
I want to be very clear about
my ask. Thank you.
And I will follow up with we
have a within Public health,
our Office of Equity and
Community Partnerships because
we work with a number of
community based partners. Um,
through a number of efforts,
like Chair Daniels mentioned,
our community health
improvement plan work that
includes a number of community
partners who are constantly
working with um, as well as our
here tag group, which is our
health equity and Anti-Racism
community advisory group. Um,
so we do constantly communicate
with and coordinate and
collaborate with all of those
partners. But I will follow up
with them just to make sure
that, you know, there is that
communication as you
re
mentioning and that, you know,
collaboration. And if there
s
anything that
s missing that
we
re addressing that.
Thank you.
Board member Lucero.
Um, doctor v, any additional
questions or comments from the
board? Okay. Hearing none.
Seeing none. Um, and thank you
so much, board member. Lucero.
It, um, it sounds like you
re
saying, hey, we don
t want just
information dispense. We want
to have in-depth conversations
and connections regarding this,
not just information. So, um,
so it looks like a work is
already been, um, a been, uh,
been done to ensure that that
is possible. And, um, we will
we will continue to make sure
that our community is served.
All right. Okay. All right.
Thank you. Doctor v, next. This
brings us to our. It brings us
to item eight on the agenda
with an update on board
membership and recruitment for
2027. Uh, welcome, board
administrator Joy Joy
Carpine-Cazzanti. I think I got
there, Rick, to join us.
Yes. Thank you. Um, yes, you
got it right. I
m Joy
Carpine-Cazzanti your board of
health administrator from
public health. Uh, and today,
I
ll give you an update on
recruitment for board
membership in 2027. The board
has three members and one
alternate whose terms will
conclude at the end of this
year. Board member Butch de
Castro, who represents public
health facilities and
providers. Board member Lisa
Chu, who also represents public
health facilities and
providers. Board member
Christopher Archiopoli, who
represents community
stakeholders. And lastly,
alternate Francoise Milinganyo,
who also represents community
stakeholders. Board Member Chu
accepted the invitation to be
reappointed and would begin her
third term in JANUARY. Board
member Archie Poli, an
alternate Telangana, have
accepted the invitation to be
reappointed and would also
begin their second terms in
JANUARY. Board member Butch de
Castro um, who
s not with us
today, but he has served on the
board for many years and he has
indicated that he will finish
his current term but not
continue next year. Uh,
alternate Karen Hartfield, who
is his alternate um, has
accepted the invitation to be
appointed to fill. Board member
de Castro
s position. So
therefore, we need to fill her
position. So that
s what we
will be advertising for this
summer, for the recruitment and
appointment process, the state
Board of Health Code outlines
requirements including posting
vacancy announcements in public
places, including the newspaper
of record making, available
vacancy announcements in any
language upon request. Um,
posting vacancy announcements
in all geographic regions
represented by the King County
Board of Health. Working with
local community organizations
to distribute vacancy notices
and complying with applicable
provisions of the Americans
with Disabilities Act. State
requirements place
responsibility for recruitment,
selection, and recommendation
with the Board of Health and
the official appointment with
the King County Council. So we
hope to have board
recommendations in the form of
resolutions approved by the
board this OCTOBER to allow
time for final action by the
King County Council before the
end of the year. So the
recruitment announcement is
available now on the Board of
Health
s web page. Um, if you
look for the Join the Board of
Health link, and I
ll send this
out after the the meeting as
well. And over the next month,
we will announce the
opportunity on Public Health
s
blog and social media channels
and in paid ads in newspapers
across the county. We
ll also
share it with public health in
Public Health
s newsletters,
with community partners, and we
will ask them and you to spread
the word. So today, I would
kindly request that our current
board members and alternates
share the announcements with
your networks as well. And um,
as I mentioned, I
ll send an
email in the next week with
that information to share. Once
we receive applications, I will
share them with all the board
members for your review. And
while we don
t expect a super
intensive process this year,
given that we are recruiting
for only one seat, we will need
1 to 3 board members or
alternates to volunteer to
review applications and serve
on the interview panel. This
summer. Um, I will thank in
advance. Uh, board members are
Chipotle and alternate
Hartfield, who have volunteered
to serve on that committee. Um,
and the commitment for serving
in the committee would require
time for 2 to 3 meetings
outside of the board meetings,
first to review applications,
probably in late JULY, and then
to interview candidates in
AUGUST or SEPTEMBER and discuss
the results in order to make a
recommendation to the full
board at the SEPTEMBER meeting.
So if one or more members or
alternates are willing to
participate on the interview
panel, um, if you
d like to
raise your hands now or let me
know via email, I will sign you
up. Thank you. That
s it for
me. Unless you have questions.
And I see board member
Muhammad.
Board member Muhammad, are you
volunteering to for the
recruitment committee?
Uh, yeah, if I have time. Yes,
maybe. Yeah.
Okay. Thank you. Yeah. I will
follow up with you.
Any any additional board
members? Board member
alternates who would like to
serve? Well, we know that every
that that board members, you
have 20 million things on your
schedule. So, um, take a look
at that and see what your
availability is for the summer
and reach out to Joi if you
have availability. That will be
awesome.
Thank you. And if you are an
elected member, you could also
send a staff member in your
stead. Thank you.
Thank you Joey. Okay. All
right. This brings us to item
number nine on the agenda, an
update on innovations in sexual
health in King County,
including progress and
innovation in hiv and sti
control. This item was deferred
at our main meeting. So thank
you so much, presenters, for
returning today. We thank
Doctor Cannon for his
flexibility. We
ll hear from
board member Archie Epperly and
Doctor Chase cannon from Public
Health. Just a quick reminder.
We have about 30 minutes for
this agenda item, including
discussion. And welcome Doctor
Cannon and board member Archer
Poli. Please kick us off.
Thank you, Vice Chair Daniels.
And thank you, fellow board
members. Uh, I
m Christopher
Archiopoli I
m a community
stakeholder on the Board of
Health. I also identify as a
person in long term recovery
from substance use disorder.
And a person living with hiv
since 2008, and a member of the
queer community. I
ll make sure
that Doctor Cannon has the
majority of our time to talk
about what public health is
doing. My portion has less to
do with innovations. Before
handing things over, I
ll
address what is happening with
community based initiatives, as
well as how sexual health
marketing reaches those most
impacted. Next slide. So a lot
has changed since the height of
the Aids crisis and post-Covid,
but there
s still a robust
community of people looking to
engage with each other and with
research. I facilitate a weekly
support group, a support group
for people living with iv on
Mondays from 6 to 7 P.M. At
Pier Seattle. I
m co-chair of
the University of Washington
Positive Research Community
Advisory Board, focused on
connecting, communicating to
people most impacted about
research efforts being made
towards ending the hiv
epidemic. As vice chair of the
King County Health Care for the
Homeless Governance Council,
I
m always focused on
highlighting the disparities
marginalized communities
experience regarding public
health issues. I also sit on
the communication subcommittee
community for Advancing
Clinical Therapeutics globally,
an international organization
focused on hiv and sti
research. One of my favorite
local organizations is Bailey
Bush House in Seattle
s Madison
Valley neighborhood. They
ve
operated since 1992, providing
hospice care as well as shelter
services to people living with
hiv who are unhoused or on
stably housed. They provide
meals, make connection to
housing services, as well as
ensuring individuals have
access to lifesaving, saving
medications and basic medical
care. I provide haircuts to the
residents once a month and have
been doing qualitative
interviews for a research study
aimed at determining how to how
to best communicate with this
population. In my
conversations, I
ve heard
growing concerns about the
stability of this vital
community resource. As weekend
nursing services have been cut
and quality of care has
decreased since Common Spirit
took over management of the
facility, many shelters will
not serve people living with
hiv. And Bailey Boucher House
is a unique resource that saved
countless lives over 34 years.
This is not an exhaustive,
exhaustive list of what
s
happening in the community, but
there aren
t as many
opportunities to be as engaged
as there were at the height of
the crisis. As hiv research and
treatment have advanced, many
have taken for granted that we
have not solved this challenge.
Next slide. So shifting to a
kind of what what marketing
looks like. I wanted to state
first, I stand in awe of the
talents of physicians and
scientists who devoted their
careers to improving the health
and saving the lives of people
in my community, including
myself. I would not be alive
without the advances in
research that we
ve seen over
the last 30, 40 years. As
someone with a background in
marketing, I often view
challenges through that lens.
These images are examples of
the kind of marketing targeted
at our community. It is often
so generic and sanitized that
it can seem patronizing. I know
from conversations within my
social and professional circles
that this type of marketing
does not give people the
information they need to make
healthcare decisions. Next
slide. So where are people
getting their information? A
quarter of Americans are
getting their information from
influencers. The majority of
influencers are not healthcare
professionals. Leo Herrera and
Bobby Box are two influencers
creating quality content, but
there are many more spreading
myths or disinformation. This
challenge is a broader problem
than just the topic at hand in
this briefing. I think a lot
about the American Revolution,
when the British famously
objected to the guerrilla
tactics of the colonial rebels.
Rather than adjust their
tactics, they dug their heels
in, expecting conformity to
establish norms. We all know
how that battle ended.
Sanitizing our message leads to
death by community committee.
What offends? What offends? No
one reaches no one. If we
aren
t willing to communicate
with people the way that they
receive messages, public trust
will continue to migrate to
online influencers rather than
healthcare professionals. The
information is out there. It
s
our choice if we want to be the
source of that information. So
with that, I want to hand
everything over to Chase
cannon. He
s an assistant
professor in the Department of
Medicine at the University of
Washington, medical director of
the Public Health Seattle and
King County Sexual Health
Clinic, and medical officer on
the Public Health Seattle and
King County Prevention Division.
Thank you very much. Board
member Archer Pulley I will
pull out my slides here.
Hopefully everyone can see
that. Okay. Um, so good
afternoon everyone. Um, thank
you for the opportunity to
present, uh, about this
important topic. Uh, so in the
next few minutes, I
m just
going to review some of the
highlights of the innovation
and the progress that we
ve
made in the control for hiv and
STIs. Uh, here in King County.
So this is a brief overview of
what I
ll discuss. The state of
hiv in Seattle, King County.
Uh, the progress on what
s
called e or ending the hiv
epidemic. And the four pillars
that comprise that. And then
we
ll end with some trends on
STIs, including for syphilis
and something called Doxy Pep,
which I will discuss. So I
wanted to first start by
discussing the status of hiv in
King County. We
ve made really
extraordinary progress, I
d
say, over the past 20 years. So
in the population overall, new
hiv diagnoses have fallen by
65% among men who have sex with
men who historically are a
priority population that is
disproportionately impacted by
hiv. New diagnoses have
dramatically decreased by 75%
since 2010. And the reason that
this is important is because,
you know, we
ve only had about
100 new diagnoses of hiv in
this group in 2025, and that
represents the lowest number
that we have seen since the hiv
epidemic began in King County
in the 1980s. So extraordinary
progress in much of that in
recent years has occurred due
to the success of something
called e, or ending the hiv
epidemic. Um, this is an
initiative that was announced
in 2019 that aims to
substantially reduce hiv
infections in the United States
by focusing resources in 57
jurisdictions that have the
greatest need. So King County
was selected as one of those
jurisdictions, and in 2025, we
received our sixth year of
funding. And there are four
pillars of e that you can see
listed here. Diagnose, treat,
prevent and respond. In the
next few slides, I will just
give a high level summary of
public health
s activities and
successes within each of these
pillars. But for those of you
who are interested in more
detail, I welcome you to access
the county and State hiv
epidemiology report that is
linked here on the slide. So
for the first pillar,
diagnosing hiv, um, overall,
23% of all the new diagnoses in
2025 that we saw in King County
were made as a direct result of
public health. Seattle King
County funding. And that
includes activities ranging
from our staff, you know,
conducting testing at school or
the South County Correctional
Facility to promotion of
testing and low barrier
clinics. We closely followed
diagnosis rates for several key
populations that are
disproportionately impacted by
hiv, or who have been involved
in historic outbreaks. So for
women, we saw slight increase
in diagnoses in 2024. Although
this seems to have declined
more recently. Women still made
up 21% of all new diagnoses in
2025. We continue to see
disproportionately high rates
of hiv being diagnosed among
black residents, and they
comprised 36% of all new
diagnoses, despite only making
up 11% of the population in the
county. And we see similar
trends in men who have sex with
men or msm, where both black
and Latino men are
disproportionately impacted
compared to their makeup in the
population. For people
experiencing unstable housing
or houseless, uh, we have
observed decrease in new
diagnoses since the 2018
outbreak that people MAY
remember, um, but still over
20% of heterosexual people who
are diagnosed with hiv are
unstable, housed. And then on
the right side, you can see a
figure here that outlines the
fact that new diagnoses are not
equally distributed
geographically. So most of the
new diagnoses that we see,
actually over a third of them
were in people residing in
South King County. The second
pillar is treatment. So since
2020, we
ve had a real focus on
building up differentiated care
models. And so that is the
strategy of tailoring our
system of services to what we
offer for people with hiv to
really meet their needs. So
increasing access to low
barrier care has been a
priority. And over the past
year, 10% of all people living
with hiv in the county received
hiv primary care and low
barrier clinics. In addition to
expanding those brick and
mortar low barrier services.
Beyond the clinics that you see
listed there in the table at
the bottom left, um each
supported a new, uh, hiv mobile
Outreach team, or Mott uh,
which aims to reach people with
hiv who are virally suppressed
and who are not engaged in care
and face complex barriers to
care, such as behavioral health
disorders, housing instability,
and justice system involvement.
And out of those who were
referred to the Mott who were
still in county and agreed to
engage with the team, 69% of
people connected to care, 63%
started or restarted hiv
treatment, and then 46% reached
viral suppression. So part of
the success of reaching these
levels of viral suppression,
which is our end goal for
people with hiv, especially
those with the highest needs,
um, is a direct result of the
efforts to expand access to
newer injectable hiv
medications, both in low
barrier clinics and also
through the mobile team. So
moving to pillar number three,
which is prevention. We
ve
worked to increase access to
Prep or hiv pre-exposure
prophylaxis through new low
barrier sites at community
health centers, community based
organizations and public
health. Seattle King County
s
sexual and reproductive health
clinics that are serving
communities in South County.
Um, we
ve also made headway
with promoting Prep through our
e health care collaborative
that brings together leaders
and stakeholders within several
major health systems in the
community that provide care to
over half of all adults in the
county. And then our community
education team has condom cubes
that are set up around the
county, including in some
access spots for the World Cup.
And they distributed nearly 1.3
million external condoms in
2025. But then I
d say the
major innovation in prevention
is the recent advent of
injectable Prep. I mean, you
saw a couple of advertisements
for those that Boardmember
showed, um, including an option
that can be given every two or
even every six months. And, you
know, these are exciting. And
there does seem to be a lot of
demand for the community for
these agents, but they are very
expensive medications. And
currently we
re navigating
financial challenges that are
associated with the Washington
State Department of Health
s
Prep assistance program. And so
we, as public health, have
issued guidance specifically on
how to prioritize this
resource. Um, and currently at
the sexual health clinic, uh,
we are limiting access to
populations who have the
greatest need, but the lowest
uptake of Prep. So those
include black and Latino men
who have sex with men,
transgender two, spirit and
other gender diverse people,
people who use drugs, and then
others who have not found
success using standard oral
prep medications. And then the
fourth and final pillar is
respond. This has focused
primarily on boosting our
capacity to respond to hiv
outbreaks. So one of our public
health epidemiologists
conducted focus groups with
community members to learn what
people know about cluster
detection and response, and to
explain how it can benefit the
public
s health. Staff capacity
has expanded to conduct
outreach to people within
clusters and get them tested
for hiv in either link to care
or to prep for prevention. And
over the last several years,
you can see that a significant
proportion of new diagnoses
with available genetic
information were found to be
linked to clusters like this.
So when public health can
identify, um, these clusters
and using systems that we have
at hand, we can also sort of
put in place activities and
work to intervene to prevent
new hiv transmission events. So
transitioning away from hiv.
Next, I wanted to talk a bit
about syphilis. Um, so this is
a type of bacterial sexually
transmitted infection that I
think people feel is antiquated
and maybe isn
t around anymore,
but it very much is still
present and circulating in the
United States. Um, for many
years, we were seeing
consistent increases in
syphilis cases. But the
epidemic in King County has
recently evolved in two main
ways. So first, since 2023,
we
ve seen a decline in
syphilis cases among all
populations except for
congenital syphilis. So
congenital syphilis is when
syphilis occurs during
pregnancy, which can have
really devastating effects on
babies, including to their
bones, internal organs, and can
even cause stillbirth. So
congenital syphilis is a major
health public health issue that
is completely preventable. So
we
ve put a lot of effort
toward awareness testing and
treatment. And thankfully, we
MAY be seeing a little bit of a
light at the end of the tunnel.
Um, congenital syphilis cases
seem to have kind of peaked in
2024. Um, and maybe coming
down, but we
re waiting for
finalization of those 2025
numbers. Uh, the second way
that we
ve seen the epidemic
evolve is that we
re seeing
increasing proportions of
people who are diagnosed with
syphilis, who are living
homeless and and or using
substances. And like the trends
that we
re seeing with hiv, I
think almost 70% of new cases
among people and that our
public health staff interview
with syphilis are residents of
South County. And then the most
important recent innovation
within the field of sexual
health is Doxy Pep, which
stands for doxycycline
post-exposure prophylaxis. This
is the strategy of taking 200mg
of a common antibiotic,
doxycycline, after sex, to
prevent STIs. So multiple
studies, including a major one
that was conducted here in
Seattle, were done in msm and
transgender women and showed
that doxy Pep can reduce the
risk of getting committee on
syphilis by more than 80%. So
Doxy Pep is something that an
individual can do for
themselves that allows them to
take control of their own
sexual health, and based on the
strong evidence from these
clinical studies, cdc released
guidelines that you see they
re
endorsing doxy Pep use in 2024.
And here in Seattle, because we
were involved in some of the
initial studies, we were early
adopters of Doxy Pep, uh, back
in 2023, even before cdc
released their guidelines to
endorse it, we released our own
for public health, Seattle,
King County, and we started to
see increasing numbers of
people who used it after that.
Um, given that we sort of know
that it works very well for
syphilis, we wanted to study
what impact, if any, it had on
syphilis locally. And so these
are the data that you
re seeing
here in the graphs. We used,
uh, county surveillance
information. And we found that
since the rollout began in
2023, Doxy Pep has really had a
dramatic impact on syphilis
diagnoses overall. Um, so
specifically on the left side,
you see that, uh, diagnoses
went down over 50% in cisgender
men and almost 50% in cisgender
women. Um, but because numbers
were so small, we did not see
this type of change in
transgender and nonbinary folks
and other gender diverse
people. But I think overall,
this is an exciting, uh,
finding. And it
s it
s nice to
see that we finally basically
have a low cost and easy to
implement intervention that
seems to to really be changing
the tides for syphilis in King
County. So to summarize, we
ve
seen tremendous progress in
reducing hiv diagnoses in King
County, but we still see groups
who are disproportionately
impacted, um, including all of
the people that you see listed
there. We have many ongoing
activities to address the hiv
epidemic. Overall, syphilis
rates are decreasing, but cases
remain high in pregnancy and in
babies. And Doxy prep, sort of.
Our newest intervention
prevents chlamydia and syphilis
and has contributed to
declining syphilis cases at the
population level in King County.
So in there and again, thanks
for the time. And we
ll take
questions. Let me stop sharing.
Thank you. Board member Archer,
Polly and Doctor Cannon. Looks
like we do have some hands up.
I think. I
m not sure who had
their hand up first, but board
member foster.
Thank you so much. Vice Chair
Daniels. Um, and thank you so
much to our presenters for that
fantastic information. Doctor
Cannon and board member Archie.
Polly, I really appreciate it
and I apologize, I did not
write down the slide number for
my question, but, um, it was
during your presentation of the
decline in hiv rates, and you
highlighted the ongoing
disproportionate outcomes for
black folks. And I was curious
if, um, we
re seeing that
disproportionate, um, number
change or if that
s been
consistent in the decline. So,
um, can you speak to that a
little bit?
Uh, yes. Sure. So, uh, the
proportion of new diagnoses
that we
re seeing in King
County for black people has
sort of increased over time.
Um, but it doesn
t exactly sort
of, uh, it
s not the way that
it looks, I will say. So it
ranged from around 30 to 35%
for the past couple of years,
after it had been stable for
about two decades, around 10 to
20%. But I think the main
reason that we
re seeing what
looks to be like an increase is
that, uh, the hiv diagnosis
rate has risen over time,
primarily in people who are
black, who are born outside of
the United States. So that
s
partly why public health,
Seattle, King County, we sort
of look at new hiv diagnoses,
uh, by country of birth. So
when we separate those out, um,
we see that actually the
numbers have remained fairly
stable among people who were
born in the United States who
are black. But it is increasing
among people who were born
outside the United States. And
I think, you know, there
s a
lot of reasons for that. But I
think people who immigrate to
the us MAY not be aware of
their status. And so a new
diagnoses when they move here
doesn
t necessarily mean that
they got hiv here. And it MAY
not represent local
transmission that
s happening
in our area.
Thank you so much for that. And
then, um, just to make sure
I
ve got this right. So it
would be uh, based on that, it
would be, would it be accurate
to say that the
disproportionality for us born
black residents has remained
fairly consistent over time?
And then we
re seeing an
increase in that overall number
because it does not represent a
disaggregation of the data
based on, um, nationality or
country of birth.
That
s correct.
Okay. Thank you so much. I
appreciate that.
Thank you. Vice Chair foster.
Uh, I think board member
Google, did you have your hand
up next?
Um, I.
Was willing to go last. If
board member Hartfield wants to
go and ask her question first.
Okay. Thank you. Baughman,
board member. Hartfield. You
have the floor? Sure. Um,
thanks for that. Really
informative presentation. Um, I
have questions about about
funding. Um, doctor v mentioned
the Medicaid changes that are
going to be coming into place.
And then in your slides, you
mentioned the, um, doe, um,
prep dep issue. And I wonder
what kinds of, um, contingency
plans are, how these two, um,
difficult things that are going
to happen are going to impact
the patients that we have who
are on Prep and whether or not
there
s something that you all
are hoping that the Board of
Health can, can do, so that the
funding is prioritized toward,
um, the the highest impact
interventions, which sounds
like Prep and oxy prep at the
Oxy prep at this point.
Yeah. Thank you. That
s a big
concern for our program. Um,
and it
s something that we just
discussed actually this week in
our policy planning meeting.
Um, so I think I
d say we
re
actively monitoring the
situation, but it is, uh,
there
s a lot that
s uncertain.
And it
s it
s tough to know
this early, uh, yet how, uh,
this will impact everything.
What the potential scale of it
all will be. Um, so, yes, it is
possible that we come back to
the Board of health, the county,
and sort of petition for
additional financial support.
But I would say in anticipation
of all of the cuts, we
ve done
a few things. So, um,
implementing some strategies to
kind of economize the care and
sort of making things more
efficient, uh, what we
re
doing. So we want to sustain
specifically capacity for
priority services like
screening and treatment of hiv
and syphilis, um, uh,
especially for people who are
uninsured and really rely on
our clinics for health care. So
a few things that we
ve done,
decreasing the frequency of
visits for Prep monitoring so
we can expand capacity for the
number of people we can see.
And then also removing the
recommendation for frequent
Gonorrhea and chlamydia testing
specifically for msm, because
that is actually the major
proportion of all the total
expenditures that the state is
spending on this Prep drug
assistance program. So we
re
trying to decrease those costs.
Um, and then, you know, like
you said, we also anticipate
people might lose coverage for
their insurance. And so we
re
training more staff to be
certified to be health
insurance navigators. Um, and
working with our Ryan White
program, also to make sure that
we have adequate case
management for people with hiv
and seeing if we can kind of
shift funds around to
contribute to people
s premiums
if they can
t afford them. So a
few things that we
re kind of
considering. But yeah, it
s
it
s going to be an issue and
we
ll see.
Yeah.
And one other one other thing
to add to that is, um, I was
really excited to see the
continued success of the mobile
outreach team. That really
looks amazing. Actually, the
28% viral suppression in that
population. Um, that funding is
federal, which is also shaky,
which hasn
t really been
mentioned. Is there a chance
that that could be funded
through, say, another source
like Ryan White or another, uh,
because that that it looks it
looks like what you want to do
is prioritize the funding for
the highest impact
interventions.
Yeah. That
s correct. I mean, I
think at this moment, uh, it
looks like, you know, funding
is either sort of level or
hopefully will stay that way
for e. Um, and so you
re right,
I think we
re trying to
prioritize the things that we
think have the highest impact.
And so we hope to be able to
preserve that. Um, and Max
clinic, I think those are sort
of two of our big, uh, programs
that we think are having the
greatest impact. So, yeah, we
will see.
Thank you. Board member
Hartville. Um, and thank you.
Cannon on, uh, doctor cannon on
that, uh, candid discussion
regarding H.R. One and its
impact. Um, on, um, Medicaid
population. So, um, it is
something that, um, uh, that is
of public health concern, um,
in King County. So thank you so
much. Okay. So next we will
have doctor. We will have board
member, board member.
Hartfield, your hand is still
up. Where you working? Okay.
Board member. Gojo, thank you
for your patience. Please. You
have the floor.
Hi. Thank you. Board member and
chair Daniels and board member.
Archer and doctor Cannon. Um,
I, uh, I work in South King
County. Uh, and my primary
populations, um, that my
programs serve are our youth
and people who are unhoused.
And I
d like to know what, um,
what those efforts are that are
being directed to decrease the
number of people who are
pregnant with syphilis and
people who are, on, uh, excuse
me. And congenital syphilis
cases.
Uh, yeah. Thank you for that
question. Is absolutely an
important, um, public health
crisis that we
re in. Uh,
because this is completely
preventable. So I think public
health is doing several things,
uh, trying to, of course,
increase awareness about
syphilis. There
s still a lot
of people who don
t know what
it is, um, you know, young
people and others, uh, doing
testing in multiple locations.
You know, we
ve done testing
and sort of libraries and data
centers in South County. Um,
and, and, uh, score, which is
one of the, the jails, um, and
have had good success with
that, actually. And we can
initiate people treating in
jail before they
re released
that way when they
re out,
they
re already sort of treated
and not having to worry about
transmission. Um, and then
specifically for people with
pregnancy, I think that
s a
sort of challenging population,
because increasingly we
re
seeing more that they are
unhoused and or, uh, you know,
having substance use, uh, sort
of mixed into the picture. So,
um, you know, we have a team
that focuses specifically on
this, this population. Um, and
we
re able to kind of support
them to get treated, uh, you
know, using a number of
different strategies, uh, you
know, incentives and sort of
finding them a place to stay
while they
re being treated so
that we can locate them. Um, so
it
s the sort of multi-pronged
approach, and I
m happy to give
you additional information if
you would like, uh, can maybe
send it to you after the
meeting.
I
d appreciate that. That would
be great. Um, and, um, part of
the thing that I
m thinking
about is that some of the
testing and data centers and
libraries, um, has been, has
been diminishing, um, because
the, the organizations that
actually engaged people at
those locations have pulled
back from them. Um, and I
m
also I was really hoping to see
data from the clinics in South
County at the Federal Data
Center and the Kent Engagement
Center, and those numbers were
not included in your report.
And also, just to add to the
concern, as far as the health
of the population goes, though,
that funding was, um,
eliminated from the University
of Washington at least, and,
um, so could you just speak to
that whole that whole, um,
issue of providing low barrier
access to hiv diagnosis and
treatment in South King County?
Yes. Yeah. That is, uh, I
totally agree with you. And I
think this is a priority for
our program to support services
in South County. So we
re
working with a few community
health centers and
organizations to try to, uh,
boost their capacity for doing
more sort of low barrier care.
Um, as you alluded to, in the
wake of sort of loss of a
couple of centers that we had
there, um, specifically about
the engaged clinics. I can
follow up with you again after
the meeting to give you some of
the sort of details about that.
Um, but yeah, I think we are
actively focusing on boosting
our capacity there. Um, I think
that
s sort of the next big
priority for our program. Uh,
we I do agree it
s a it
s a
major issue that we are facing.
And just one one final
question. Why why is it not
currently a priority of the
program?
Uh, which.
The, um, uh, additional access
to testing and treatment in
South King County?
Oh, it is it is a priority. Uh,
maybe. I don
t know if I
misspoke, but, uh, yes, that is
a major priority for us to to
increase capacity for that in
South County. Yeah.
I look forward to connecting
with you after the meeting. And
thank you again for your
presentation.
Thank you so much. Board member
Archer Lee, doctor Cannon and I
don
t see any other I don
t see
any additional questions or
comments. Okay. All right. This
brings us to item number ten on
the agenda. And update on
findings and recommendations
from the from Washington
s
Maternal Mortality Review Panel
report. And this was an item
that I suggested on the agenda.
And while chair mosquito who
can be here today. Um, uh, she
did express support for
continuing this conversation
and the slides for this agenda
item will begin on page 31, I
believe, for the meeting
packet, our presenters will be
using a slightly shorter, um,
deck to keep us on schedule.
Today we are joined by Deborah
Gardner and Anne McCue.
Maternal Mortality Review
coordinators for the Washington
State Department of Health. Um,
I will kick us off and then I
will turn it over to Deborah
and Anne and, um, so before we
begin, I really want to ask
this board to, to to do
something with me. I really
want us to to pause for a
second. Um, what we
re about to
hear isn
t easy. Um, and we
re
going to, we
re going to talk
about rates and numbers and
recommendations, but I
ve spent
more than two decades as a
nurse in women
s health. And I
can tell you behind every
number in this report is a
person, a birthing person,
someone who cared. Hope,
someone who wanted to build a
life, raise a child and
contribute to this community.
We all serve the they were not
strangers. Each one was
someone
s child, someone
s
partner, someone
s best friend.
Each one was our neighbor. Each
one was a Washingtonian, and
each one was ours. So before we
move on into the data, I
m
asking us to hold that truth in
this room. Please let it
matter, because the way we
honor their lives is simple. We
listen closely, and then we
act. Always say helping others
heals us. Let
s let that guide
us in how we listen. Today, Deb
and you have the floor. Please
take it away.
Thank you so much, Chair
Daniels. I really appreciate,
uh, taking that moment in our
review of maternal deaths. We
always have an acknowledgement
that
s similar at the beginning
of our review meetings. So I
m
going to talk today and my
colleague, my epidemiologist
colleague Annie McCue, is also
available especially for
answering any questions. I
m
going to go through our slides.
I
m going to give you some
background about the Maternal
Mortality Review panel, and
then talk about findings and
then recommendations from the
new Maternal Mortality Review
Panel report. So some overview
and background, uh, Washington
state has a maternal mortality
review panel that was
established by the legislature
in 2016. And then in 2019, the
law was amended to make the
panel permanent and add some
details to it. It directs the
mmp to conduct comprehensive
reviews of every death of a
Washington resident that
happened in pregnancy through
one year after the end of
pregnancy, and then to present
a legislative report of every
three years. It also enables
Doe to do things like access
the kind of records they need
to set the panel up to review
these cases. Uh, as I said, the
mmp is housed at the Department
of Health in our state, the
Washington State Department of
Health. We are by far the
largest committee or panel of
this kind in the country. We
had 80 members or so in the
last term and just about 100
right now, about 35 to 50 at
each review meeting. And an
incredible breadth of clinical
and non-clinical expertise and
backgrounds, including a strong
priority focus on American
Indian and Alaska Native
communities. And I mentioned
that breadth. This is a word
cloud that is just a glimpse
into some of the expertise
areas, everything from
indigenous lactation counseling
to maternal fetal medicine to
substance use disorder, to
lived experience and more.
We
re very lucky in Washington,
so our process at the state
level, Doe identifies and
confirms deaths. Doe requests,
medical and other records, and
then writes a de-identified
summary for the panel to use.
The panel meets to review
deaths in a process that I
ll
talk about in a moment and make
recommendations for prevention.
And then every three years, as
we prepare for these reports,
and the mmr and Doe work to
consolidate, narrow down,
prioritize those
recommendations for the report,
compile them with data and have
what we are presenting today. I
want to go over just a couple
of definitions that will give
context to the data. I
m going
to talk about. We talk about
pregnancy associated deaths.
And that
s just literally a
term about timing. That is any
death from any cause
whatsoever, pregnancy related
or not, that happened to take
place during pregnancy through
one year. After some of those
pregnancy associated deaths are
pregnancy related, they were
caused or worsened by
pregnancy. And this is, you
know, the kind of things that
could immediately come to mind,
like a pregnancy complication
or chain of events that
pregnancy initiated. But it can
even be an unrelated condition
that was aggravated by some
aspect of pregnancy, birth,
postpartum. And some of the
docs are not pregnancy related.
Cause a no connection to
pregnancy, and occasionally
there
s a death that the panel
determines they don
t have
enough information to determine
whether it was related. So they
conduct very respectful reviews
of each potentially pregnancy
related death. Using that case
narrative, I described, they
determine whether the death was
pregnancy related using the
definition we just reviewed,
and they look at the deaths
from preventable to was it
preventable, not just from a
clinical perspective, but also
from an equity or social
determinants of health
perspective? Ask questions like
whether racism, discrimination,
and bias played a role and what
factors contributed to those
preventable deaths. And then
they make recommendations, both
interventions at the time of or
systems changes upstream that
could prevent deaths like that.
And those become the basis for
the recommendations in the
report. So I mentioned the
report. I think my colleague
Annie can put the link to the
report in the chat. You all MAY
have it available as well.
There
s a qr code for it here.
We submitted this report in
DECEMBER 2025. It was the
fourth of these reports in
Washington. It includes our
newest data, which are from
2021 and 2022, and then some
cumulative findings for like
some demographics and things
like that going back through
2014 to 2022. There
s
recommendations for the
legislature and for other
audiences, and there
s also
some new components like
storytelling, people
s
experience in Washington of
pregnancy, birth and
postpartum, and success stories
from a from the previous
report
s recommendations. This
is also the second of our
reports with an addendum from
the American Indian Health
Commission with findings and
recommendations from American
Indian and Alaska Native
communities and health leaders.
So I mentioned storytelling in
the report. I
m not going to
read these to you, but I just
wanted to highlight them on the
screen to show the weight of
this, um, to, uh, to show the
weight of this and to
understand, to help the reader
understand how these issues
really do affect people
s
lives. Even people who maybe
had a challenging time but
didn
t pass away. Um, I also
think there MAY not be a chat,
but I think you have the link
to the report in another
format. So let
s talk about the
data and findings briefly here.
So a couple of things to
consider when we
re talking
about this. So maternal
mortality is thankfully a rare
event though every death is one
to many. But the fact that it
s
a rare event means that it
s
difficult with those small
numbers to discern things like
true change or really compare
demographic differences on a
year to year basis. We do it
anyway. It
s just there
s
challenges around it and we can
still make meaningful
recommendations and
interventions from what we do
know. Um, we also often get
asked about Washington compared
to the us, we can
t actually do
a really good comparison
because the us rates leave out
some things like accidental
deaths, including overdose,
which is one of our major
causes or major cause of death
or injury. Deaths like homicide
and suicide. We also don
t have
county level data because of
extremely small or nonexistent
numbers for each county. The
state law has very strict
requirements around
confidentiality, which limits
us, but counties can still find
relevant information and
recommendation based on their
needs, their demographics, what
they know is going on, and
extrapolate from the report to
apply in their regions. So the
pregnancy related maternal
mortality rate actually
increased in these two years,
2021 through 2022. And this is
the first increase to date in
these Washington mmr reports.
Um, that rate was 30.5 per
100,000 live births. And it
s
statistically significantly
higher than the state
s rate in
the period of the last report,
2017 through 2020, which was 19
per 100,000. Causes of these
pregnancy related deaths,
behavioral health related
deaths accounted for nearly
half, 45% of all of the
pregnancy related deaths in
these two years. Most of these
were accidental overdose
deaths, and most of those
involved fentanyl. Other
leading causes of death
included Covid 19, primarily in
2021 and cardiovascular
conditions. 82% of these
pregnancy related deaths were
found to be preventable. There
was at least some chance of the
death being averted if a factor
that contributed to it had been
different. This is very similar
to in the previous report that
found 80%, and this is a
striking number. This is very
high. It
s also a motivation to
act because it means we
understand what
s going on. Um,
we know what
s going on. We can
take action. It also reflects
the panel
s continuing
understanding of preventive
ability, which has grown over
the years of its work.
Disparities by race and
ethnicity are really important
to pay attention to in this
report. One that stands out is
that non-Hispanic American
Indian and Alaska Native people
experienced much higher
maternal mortality rates than
any other racial or ethnic
group. For example, their rate
was 7.3 times higher than
non-Hispanic white people,
which is not the baseline. The
baseline is no preventable
pregnancy related deaths. Um,
and again, that
s a reason why
we
ve got that addendum from
the American Indian Health
Commission in the report. And
also black communities,
multiracial communities, and
Native Hawaiian or Pacific
Islander communities also
experience disproportionately
high rates looking by, um,
urban rural residency insurance
status and age are also really
critical. So even though there
are more pregnancy related
deaths among people living in
urban areas, the maternal
mortality rate was highest
among people in rural areas,
which really underscores the
importance of having access to
quality rural maternity health
services, including emergency,
prenatal emergency support.
People who are covered by
Medicaid as primary insurance,
which of course is a stand in
for a lot of socioeconomic and
related factors, had the
highest frequency and the
highest rate of pregnancy
related deaths. Um, which
underscores the importance of
access to care and support for
people with Medicaid and
pregnancy and postpartum. And
then the maternal, the
pregnancy related mortality
rate was most, uh, excuse me,
pregnancy related mortality was
most common among people ages
30 to 34, but the highest rate
was among people age 40 and
older. Which reminds us that
risk increases with age,
especially for those over 40.
The panel did identify
discrimination bias,
interpersonal racism, or
structural racism in 76% of
preventable pregnancy related
deaths in these two years. That
includes bias about substance
use disorder, reminding us that
communities most burdened by
these and perinatal health
inequities have the expertise,
cultural knowledge to lead
solutions to reduce maternal
mortality and must be centered
as leaders in implementation of
many of the report
recommendations, the timing of
pregnancy related deaths. Now,
a lot of people, when they hear
maternal mortality, they think
death and childbirth, or they
hear pregnancy related death,
death during pregnancy. But
actually most of the deaths are
postpartum in this period. Um,
if you look, most of them even
incurred later postpartum 43
days to one year, nearly half
of those deaths, deaths
occurred, followed by those
between pregnancy. Excuse me,
two days after, uh, pregnancy
in 42 days. Um, one day after
pregnancy. Anyway, that period.
Excuse me? After pregnancy. Um,
but that does that number
skewed towards later postpartum
is even more pronounced when
you look at the unintentional
overdose deaths, 82% of those
occurred in later postpartum.
Really? Again, underscoring the
importance of care support and
health insurance coverage
through one year postpartum. So
let
s talk about
recommendations in the report.
They
re all organized under
three priority recommendations.
And I
ll go through those in a
moment. And the legislative
ones come first. They
re in
their own section. And then
there
s a separate section for
recommendations for all the
other audiences. We did want
the legislative ones to stand
out, but don
t MISS, you know,
one section or the other. These
are the three recommendation
areas, basically focusing on
improving health care quality
and access, strengthening
community support services, and
providing equitable, culturally
responsive care. So the first
one in detail, to ensure
Washingtonians have access to
high quality health care,
including mental health care,
substance use disorder
treatment, and preventive care
throughout pregnancy, birth,
and postpartum. By
strengthening and funding care
coordination, improving
communication and protocols,
and ensuring providers actually
have the skills and training
and professional support they
need to provide high quality
care. I
m going to show you a
couple example recommendations
under each, but again that by
no means are they all the
recommendations in the report.
There
s like over 90
recommendations when you add
them all up. But here are a
couple examples in this
category. So one for the
legislature to protect and
increase funding for family
friendly, judgment free
substance use disorder and
opioid use disorder, and
treatment and support for
pregnant and postpartum
patients, including in rural
areas with limited access to
community services. There
s a
recommendation for state and
local agencies, health care
systems, facilities providers,
and community organizations to
follow best practices in a
health communication to counter
health misinformation and
disinformation about vaccines
or other topics relevant to
health and pregnancy and
postpartum. Another ones for
similar audiences to raise
awareness about urgent maternal
warning signs, perinatal mood
and anxiety disorders, and
substance use disorder. Opioid
use disorder in pregnancy
through public health messaging
strategies and patient
education. Um, there
s also I
wanted to highlight this
recommendation because it calls
out a King County program. So
this is a recommendation for
all different levels of
agencies and organizations to
follow strategies for medical
outreach and workforce
development to increase access
to prenatal, postpartum, and
primary care for unhoused
people. And then one of the
examples we actually
highlighted public health.
Seattle, King County Street
Medicine Program. So the second
of these three priority areas
about strengthening community
support services, this is
investing in developing and
expanding comprehensive
community support services that
are that address essential
needs in pregnancy and
postpartum. So things like home
visiting, social work, doula
support and wraparound support
for mental health and substance
use disorder. A couple examples
from this. So there are a few
for the legislator that I
wanted to highlight about
universal access to those
wraparound services through at
least a year postpartum,
including home visiting, doulas
and peer support. Also
protecting both existing and
funding new programs that meet
people
s needs in pregnancy and
postpartum. Things like
transit, housing, income and
child care to be universally
available. There
s one for
funders and state and local
agencies to increase funding
and capacity for community
based organizations to support
people in pregnancy and
postpartum. And then there
s
one for Doe and local health
departments to invest in
building healthy and safe
communities. There
s a lot of
examples of what that looks
like. So the third priority
recommendation is making sure
all of that care and support is
equitable and culturally
responsive throughout pregnancy
and postpartum, and also trauma
informed, grounded and trauma
informed practices and actively
addressing racial injustice. So
a couple examples under this
one health care system, state
agencies and academic
institutions to work together
to build and sustain a diverse
maternal health workforce that
reflects the communities it
serves, when for state and
local agencies, along with
organizations to deliver
ongoing, culturally relevant
messaging about how to safely
access perinatal care,
including for immigrant and
refugee communities. Language
specific messages about health
insurance access, privacy
protections, and opportunities
to receive perinatal care and
support regardless of insurance
or immigration status. There
s
one for both state and local
agencies and jurisdictions to
work together with and fund
tribal and indigenous led
provider training programs that
emphasize culturally relevant
health care and communication,
and another one for Doe and
health care systems to fund
tribal led, indigenous led, and
community led efforts to access
to expand access to prenatal
and birthing care in American
Indian and Alaska Native
communities, including in rural
areas. I want to acknowledge
that there is a lot of context
at every level, um, local,
state, national, global that
currently and potentially in
emerging contexts can make
these recommendations both more
challenging to implement and
arguably even more important.
So looking at Medicaid access
changes I mentioned, Medicaid
covers 45% of births in
Washington. I think when you
look at rural areas, we
re
talking 70%. So see some
intersectionality there in our
disparities and inequities. And
there are rural maternity care
shortages tying into all of
that. There
s challenges and
access fears around perinatal
and reproductive care, access,
challenges to mental health
care access. There
s a lot of
budget limitations at every
level and challenges in the
current funding landscape.
There
s misinformation and
disinformation out there.
There
s threats to immigrant,
Bipoc and lgbtq plus
communities, including people
who are perceived as parts of
those communities. And there
s
just a lot of uncertainty about
all sorts of aspects of health,
environment and society in the
future. And this is one reason
the report includes
recommendations about both
protecting what already exists
and taking new steps, and why
some recommendations require
funding or legislative support,
and some don
t. So implementing
recommendations and
highlighting success stories to
know that we can do something
about this, um, recommendation
implementation happens on a lot
of different levels. I like to
think of it as centralized and
decentralized. So centralized.
We
re talking about anything
that
s statewide. So
legislative change or other
statewide efforts. Um,
Washington State Department of
Health led work, the work of
the Washington State Perinatal
Collaborative. And if you
re
not familiar with the
Washington State Perinatal
Collaborative, I highly
recommend looking it up, maybe
getting involved in that. Um,
they do a lot of amazing work,
and they
re kind of a hub of
implementation, but that
s just
one piece of it. Anything that
any person or entity or group
does towards these
recommendations is part of
implementation. And that
s
where I see it as
decentralized. So any local or
regional efforts led by any
organization, institution,
coalition, board, individual
health department and so forth,
from the practice level to the
regional level. Um, this could
include regional perinatal
collaboratives, regional county
boards of health, or many other
examples. Literally, we
ve had
like a doula practice change
something based on a
recommendation. So I want you
to think next about how can
this report connect to your
priorities? Which
recommendations are most
relevant in King County? How do
the report
s findings and
recommendations align with your
work and priorities? How can
they be useful in your work?
What kind of collaboration
might go on from, you know,
efforts that already exist or
new efforts that somebody would
like to create and just what
your next steps might be? I
m
putting my contact information
here as long as as well as my
epidemiologist, epidemiologist,
colleague Andy McCue. And thank
you so much for your time.
Happy to take questions. If
there
s time.
Thank you so much, Deb. And
Annie. Um, amazing report.
Looks like we have one hand,
um, board member Gadgil, you
have the floor.
Thank you again, chair Daniels.
And thank you for this really
informative presentation. And
it
s, um, it
s. Yeah, it
s very
sad to hear. And at the same
time, um, I hate to ask this
question, but I, I think we
need to have it for all all
data these days. Um, actual
numbers are, are are missing
more and more. It feels like
from from presentations about,
um, anything uh, and so it
s,
it
s hard to especially
advocate for resources when we
don
t know what the numbers are
of things. And so this this
applies across the board. I
m
not singling you out for that.
And in fact, my purpose for
raising my hand was, um, I
checked in with nurses that are
on my team this morning about,
um, how can we get people into
prenatal care? Because I know
that that is a huge issue. And
then I think it also relates to
the high number of deaths due
to opioid overdose. After, um,
the postpartum period. And so
what they told me is, among
other things, people who are,
um, using substances, for
example, and our pregnancy are
very worried about, um, the
impact of being reported to cps.
And they know that health care
providers are mandatory
reporters. So my suggestion is,
how could King County Board of
Health work to address policy
that could, um, that could
mitigate that barrier to people
choosing to access care of fear
of very negative consequences
to themselves? Thank you.
Thank you. Um, if I can speak
briefly to both of those and
thank you for that feedback.
Um, the report has a lot more
specific numbers than I went
through. This is a very short
version of our presentation
that typically can go up to 45
minutes or more. So we did cut
the data section down to the
short slides version. But
that
s helpful feedback to
know. And please do look at the
report for actual numbers. I
also just wanted to mention
that I know there
s at least
one I believe, maybe even
multiple recommendations in the
report that align with what
you
re talking about. Uh, 1.22
if you look for that is about
strengthening support for
programs for pregnant and
postpartum people experiencing
substance use disorder who MAY
not otherwise take care if they
fear intervention by cps. So
I
m so glad that
s coming up.
And thank you for saying all
that. See, um.
Thank you, thank you.
Boardmember board member
Hartfield, you have before.
Uh, yeah. Thank you for that.
Um, thorough and really
sobering presentation. Um, one
of my questions was the same
one that board member Gadgil
raised about, um, knowing what
the actual end is behind these
numbers. Um, my second question
was, are you also collecting
data on, um, housing status?
Um, whether do you know the
percentage that are unhoused?
And can you speak to that? I
know we
ve got one at least one
piece of data in the report
related to that.
Yeah. No problem. Um, as far as
like the first part with the
whether this is the true end,
we do a linkage with, um, the
death certificate. Birth
certificate. And we use things
like the pregnancy checkbox.
But, um, if someone is being if
someone has a traditional death
certificate, um, that comes
through the vital statistics
team, then we are getting
catching that person. Um, and
then as far as housing, um,
that can come through in kind
of abstracted records. Uh, but
we are working to develop a
flag that would identify if
someone is actually like
putting down a church address
or does not have an actual
address. So that
s something
that will be, um, adding into
the next report.
If I recall correctly, wasn
t
it nearly a third of the
pregnancy related deaths were
among people who faced housing
instability or were unhoused?
Um, I don
t know what off the
top of my head, but we do
identify a fair amount.
Okay.
And my final question was just
about, um, King County and sort
of our role on the Board of
Health that while it
s, you
know, obviously, really, really
important for confidentiality
reasons to, you know, limit the
local information. Um, does
King County, though, have
access to information to, to
these data? I guess for our
county, because it
s really
hard to think about
implementing recommendations
without knowing how your local
area is actually impacted.
Um, and do you want to speak to
that or do you want me to?
Sure I can, I can speak to it
and then you can add, um,
because this is such a small
number, like for one year, we
have about 20 around give or
take 20 pregnancy related
deaths. Um, just as the count,
we don
t even provide the
county to the panel members as
they
re reviewing the case
because it it can be that
identifiable. I will say that
you can see from our data that
a lot of deaths are happening
in urban areas. And I think
that a lot of the
recommendations would apply to
King County. Um, and you can
kind of like Deb
s mentioned in
the in the presentation based
on what you
re seeing from, uh,
general populations, you can
kind of make that, uh, pathway
to our report and pull out
what, what is really going to
apply to King County. But I
would say that a lot of them, a
lot of the recommendations
probably do apply.
I agree with all that. I mean,
King County has such diversity
on so many levels, including
urban and rural areas. Um, I
would say it
s all relevant.
Thank you.
Thank you. Boardman. Heartfelt
board member Lucero, you have a
floor.
Um, I just want to say thank
you for this report. I think
that, um, in contrast to the
federal system, you are
highlighting the reason for,
um, work around Dei. Um,
because being able to identify
these key populations and, you
know, specific interventions to
be able to address, um, you
know, the high impact is really
key. Um, I also want to point
out that, you know, when it
comes to substance use
disorder, we need to look at
the full continuum of care. So
from prevention, early
intervention all the way
through treatment, aftercare is
really lacking, particularly
for pregnant and parenting
people. Um, so, you know, just
to highlight here that the
number of treatment centers
opening on JULY 11th, um, with
the 15 beds dedicated to
serving pregnant and parenting
people opening in JANUARY. And
I
ll have to tell you, that
s
just not even going to scratch
the surface. And so I think
that that
s really key. Um,
also wanted to point out the,
you know, impact of work
requirements for Medicaid, um,
eligibility, uh, and how we
might be able to work as a
community to be to get through
that paperwork. Because really,
that
s what it is. It
s
paperwork burden. Um, and then
finally to highlight, um,
stigma and bias within hospital
systems, uh, because I know one
of the reasons that we have
such prominent information
related to American Indians,
Alaska Natives is because of a
particular incident that
really, uh, you know, showcased
the the bias within health care
delivery systems or just health
care systems, period. So again,
I just want to thank you for
this report. Um, and I look
forward to working with all of
you in interventions that are,
um, going to have impact.
Thank you. And likewise, and
yes, everything you say very
much is aligned with
recommendations in the report.
And yeah, I
m glad we
re all
thinking about the same
challenging things.
Thank you. Board member.
Lucero. Board member. Garcia.
Thank you for the presentation.
Uh, as sobering as it is, it
s
better that we are aware of
these issues. Um, and so thank
you very much for bringing this
up. Um, and, um, presenting,
uh, one of the things I, you
know, was looking into as you
were going through here is some
of the recommendations on
postpartum, um, and what kind
of resources has our public
health, uh, and King County
Public Health pointed towards
that aspect of things that
we
re very fortunate in the
city of Baron that we have, uh,
one doula who is a black woman
led doula service BlackBerry.
I
ve learned a lot about this
particular challenge through
their advocacy, but in a lot of
us, I
m also a board member
represented via our sca Small
Cities Association, and a lot
of the small cities in South
King County and around the
county. Just budget wise, are
strapped and wanting to, uh,
invest into this. So I just
wanted to have a reality check
on to what kind of funding has
the county allocated towards
this specifically, like doula
postpartum? Since a lot of this
happens after birth? And, um,
how will the current budget
crunch impact that? As I
m
preparing for my own budget in
the city of Bern?
Thank you for highlighting all
of that. And I
m hoping that
the report, especially the
findings about how critical
this is in later postpartum,
can help add some momentum to
any support seeking to address
postpartum issues. So thank you.
I just.
Want to respond to board Member
Garcia about a couple of
things. Um, so in terms of
services that Public Health
Seattle and King County
provides, we provide a number
of maternal and child health
related services to ensure
healthy pregnancies and early
childhood development. Um, so
just not running through
everything, but just a couple
of the programs we have, the
women, infants and Children
program, um, which supports
pregnant postpartum
breastfeeding individuals as
well as children up to age
five. We have a nurse family
partnership that pairs low
income, first time mothers with
a registered nurse for home
visits from early pregnancy
until, I believe, until the
child is two. Uh, there
s also
a family waste program, which
provides pregnancy and
parenting support, peer support
for families that identify as
black, African American, Native
American, Alaska Native and
Pacific Islander, Native
Hawaiian communities. Um, and
then we also have a first steps
maternity support services and
infant case management program.
Um, and this is for individuals
that are on Apple Health. And,
um, it helps to support healthy
pregnancies through care
coordination and family
support. Um, in terms of the
funding, we
d have to get back
to you with specifics. You
know, some of these programs
are federally funded, some of
them receive, um, state
funding. Some of them are
funded through fs dollars. Some
of them are like completely
braided funding, you know, so
it
s a mix. Um, but just to, to
get a, you know, some a
sampling of the wide variety of
services that we provide to
support healthy pregnancies and
to help prevent, um, maternal
mortality in our county.
Thank you very much, director.
That
s really appreciated. I
m
hoping to circle back on how
the funding for it works. It
sounds like there
s a lot of
services there. I
m not sure
how geographically they are
impacting. Uh, speaking of
southern ca city, just making
sure that that we are doing our
part to promote and support
referrals and those programs,
uh, especially, you know, for
us cities that have, uh, South
King County as a regions, I
m
kind of connecting the dots and
previous presentation on sti,
hiv to current presentation.
And how in that particular
geographic impact, South King
County was just bearing the
brunt. And historically, we do
that here. I
m enduring and
just wanted to make sure that
we do as much as possible to
lift up the current programs
that are out there, keep
funding as much as we can, and
also look at to how to improve,
maybe more culturally specific,
like doulas. I heard a lot
about, you know, in-home
nursing. Um, but just, uh,
learning. And I have a lot to
learn, and I
m always open to
that. How to keep this in the
forefront because there
s so
many things. But this is really
sobering. So thank you.
Thank you. Board member Garcia,
any board member Garcia, was
there anything else? Okay,
okay, okay. Um, any additional
questions or comments from the
board members? Uh, I will say
this. Now that we
ve heard
this, um, I really want to name
where I believe it must lead
us. Um, we have just been
handed a data. The stories, the
recommendations. Um, what? We
do not yet have is a vehicle to
carry them forward. So, I
m
asking for one, and we would
not be the first right here in
Washington County. Board of
health have already heard this
call and answered, actually,
last fall, um, Clark County
Board of Health passed a
resolution committing to
closing the gaps in pregnancy
related care for their
residents. They turned a
presentation into a promise.
And I believe King County can
do the same, and that we can
tailor it to the families we
serve. So I
m calling on this
board to form a sort of
maternal and perinatal
workgroup. A group of board
member volunteers willing to
take what we heard today and
shape it into a perinatal
resolution for the board
s
full, um, for the full board
s
consideration. Um, I am not
asking us to decide its
contents right now. The
language and the commitments
belong to the workgroup built
together and with care. When
I
m asking for right now is
simpler. Who is willing to do
this? Work with me? I will also
share that I
ve spoken with
Chair Mosqueda about this, and
I bring it forward with her
support and her permission. So
I will open the floor. If this
is moved you the way that it
moves me daily, I will be
honored to have you at the
table. If you are willing to
serve, please raise your hand
now so we can capture your
name. And if you want to think
about it, um. And would you
reach out to Joey? Um,
Carpenter, Garzanti, our board
administrator, after today
s
meeting? Either way, the table
is open. Okay. And so it looks
like. Okay, I see from my
screen, I see Vice Chair Foster.
Yes, i
d love to. Thank you.
Okay. Thank you, thank you.
Vice chair c, board member.
Heartfelt.
Yeah.
Thank you. Board member. Awful
I c board member.
Gojo. I
m in.
Thank you. Board member. Gojo I
see board member. Garcia.
Minute to win it.
Thank you. Board member.
Garcia. Did I MISS Anyone
else
s hand? Okay. Okay. And,
um. And like I said, if you
want to think on it, reach out
to Joi. Um, after, um, after
today
s meeting. Thank you so
much. Uh, Debs and any, um, for
your report. Um, it has
definitely been eye opening.
Uh, so next, we will move on to
updates. Do any board members
have updates to share? Board
member. Heartfelt. Board
member. Garcia, I. I see your
hands up. Or is it up there?
Okay. Okay. Any updates to
share? Going once, going twice.
Okay. Not seeing anyone. Okay.
All right. Okay. Oh. Board
member. Mustafa, I see you.
Uh, yeah. Thank you. Uh, just
the program of the, uh, health
program. Department of health.
Because of the Trump
administration, it was been
yesterday. It was the last
meeting, and we graduated from
that. The Community Advisory
Council and health equity zone.
So we don
t we don
t have
funding. That
s the program we
started four years ago. We
stopped that. So now I just
want to update you guys for
that.
Thank you. Board member
Mohammed, board member Gojo.
Okay. I
m speaking as a private
citizen right now and not as a
representative of Health Point,
but I do want to, um, I do want
to, uh, uh, appreciate my
organization for stepping into
the East King County area. Um,
a very large, important, uh,
primary care. Uh, delivery
location. Um, is closing, and,
uh, that would leave a huge gap
in an already spread thin
primary care system. Um, in
South King County. And we are
going to be opening a clinic in
that same space to preserve the
primary care there. And, um,
prenatal care, perinatal care
has been identified as a
priority. Um, service at that
location.
Thank you. Board member Gojo.
Okay. Any additional updates?
All right. Um, next. Is there
any other business to come for?
To come before the board? Okay.
Hearing none. Seeing none.
Okay. Quick reminder, our next
Board of Health meeting is