The Clark County Board of Health approved the first draft of a policy to require food service establishments to post health inspection reports Wednesday.

The county attorney will review the draft and send it back to the board for a first and second reading before final approval.

If passed, the policy will go into effect in January 2020.

According to the draft, food service establishments required to post inspection reports include restaurants, grocery stores, gas stations which serve prepared food, schools and care facilities.

Because of a lack of a structured operating time and often a lack of a physical structure, mobile food units, pushcarts, restricted concession food services, temporary food service and similar food service facilities will not be required to post inspection reports but will have to keep inspection reports on hand and make them available for viewing upon request.

According to the draft, food establishments must place the inspection report where it is visible upon entry into the establishment, as determined by the health department.

Establishments in continuing violation of the regulation may receive a fine, according to the draft.

Environmentalist Carlene Whitt said there would be a public meeting before the first reading. The health department will finalize the details following the county attorney’s review of the draft.

Public Health Commissioner Jeff Howard also discussed Kentucky’s public health transformation during the board meeting.

Howard, who became acting commissioner in November 2017 after former Commissioner Hiram Polk resigned, and was later appointed the commissioner in July 2018, said he believes every Kentuckian should have access to high-quality public health no matter where they live.

He told the board he believes a public health transformation requires looking at the public health system as a whole rather than seeing it as local health departments versus Kentucky’s Department of Public Health.

He said he is committed to the shared-governance structure and preserving local autonomy. He said he believes public health problems and solutions are local.

Some of his goals for public health transformation include: relieving fiscal instability of the current system; introducing a focused public health model with clearly defined priorities; creating accountability at all levels; improving leadership capacity; preventing duplication of effort; and supporting data-driven decisions to promote community health outcomes best.

However, the transformation comes with its challenges.

Howard said about 42 local health departments representing four districts are at risk for fiscal default in 2020. The current budgetary analysis shows a $40 million deficit in 2020, and the highest deficits outside of core public health services are clinical services.

Howard said current programmatic services are also not reflective of community public health needs. He said the federal funding structure is a significant driver of this result and the public health system has not adjusted to a post-Affordable Care Act era in regards to public health programs and approaches.

Howard said he is also facing legislative challenges because the current public health law as are disparate and voluminous. He said the state needs to consolidate its public health laws to allow the system to be more functional. Current statutes and regulations do not allow for proper operational restructuring, he said.

“Public health law hasn’t been updated for decades,” Howard said.

While Kentucky has never fared well in America’s Health Rankings, the state dropped three places in the ranking system in 2018, putting Kentucky in 45th place.

Howard said local health departments need to focus on their core services such as WIC, HANDS, harm reduction and substance use disorder programs. Local health departments need to focus on population health, enforcement of regulation, emergency preparedness and response, communicable disease control and administrative and organizational infrastructure.

Beyond that, Howard said health departments could assess their community’s needs to create additional services that are not already offered locally by another entity.

Howard said Clark County needs to seriously reevaluate the pros and cons of its Home Health services because, at the moment, it is not operating as efficiently as it should.

“The challenge of Home Health is figuring out how it can be self-sustained in the future,” he said.

Howard said he plans to roll out a Public Health Advisory Board that will review evidence-based and best practices to develop public health service packages and make them available to every local health department. The advisory board would also discuss local priorities with plans and may request revision, clarification and approve or deny submitted plans.

The five-member board will include the Kentucky Health Departments Association president, the Kentucky Public Health Association president, the Kentucky Association of Local Boards of Health president, a university representative and the commissioner of public health.

Howard said the preparation stages of his public health transformation plans are underway and he plans to begin legislative initiatives and early rollout in 2020. Statewide implementation will continue in 2021 and 2022, he said.

The board also discussed its continuing response to hepatitis A.

Nurse Administrator Jennifer Burchett said the department used $10,000, provided by the state, to respond to the hepatitis A outbreak to purchase vaccine; the department used all of it by the end of the year. The department bought an additional 50 doses in January, and it has already used half. An additional 110 doses were sent to the department, again using half by the end of February.

Burchett said the department has three contracts with local restaurants through corporate offices to pay for employee vaccination and will continue to vaccinate community partners such as Beacon of Hope, the Homeless coalition, detention center inmates and staff and other first responders.

The board also announced a few upcoming events:

— Breastfeeding Booby Traps, a free breastfeeding class, 11 a.m. to noon April 18 at the Clark County Health Department

— Healthy living with Diabetes, 5-7 p.m. May 7, May 14, May 21 and May 28 at the Clark County Health Department.