Objective 1.1.a. Stop the annual increase in the rate of deaths due to falls among residents ages 65 and over by maintaining the rate at 4.1 per 10,000 residents

Objective 1.1.b. Decrease the annual rate of hospitalizations due to falls among residents ages 65 and over by 5% to 173.7 per 10,000 residents.

Intervention 1.1.1 Connect older adults and people with disabilities with evidence-based falls prevention programs such as Tai Chi for Arthritis, Stepping On, and A Matter of Balance.

Intervention 1.1.2 Promote health care provider screening for fall risk among older adults and people with disabilities, and engage health care providers in identifying modifiable risk factors and developing a fall prevention plan of care. A fall prevention plan of care may include but is not limited to physical or occupational therapy, community based programs, medication management, Vitamin D supplements, updated eyeglasses, and changes to footwear.

Intervention 1.1.3 Use a home fall prevention checklist to assess the homes of older adults for fall hazards. Make modifications as necessary.

Intervention 1.1.4 Integrate exercise and fall prevention activities into physical or occupational therapy.

Intervention 1.1.5 Engage pharmacists in medication review for older adults and people with disabilities at higher risk for falls.

Objective 1.2.a. Reduce rate of homicide deaths from 0.35 to 0.32 per 10,000.

Objective 1.2.b. Reduce the rate of assault-related hospitalizations from 3.3 to 3.0 per 10,000.

Objective 1.2.b.i Reduce disparity of assault-related hospitalizations by 10%

Objective 1.2.c. Reduce the rate of ED visits due to assault from 42.3 to 38.1 per 10,000.

Objective 1.2.d. Reduce the rate of hospitalization due to assault by firearm from 0.42 to 0.38 per 10,000

Intervention 1.2.1 Implement multi-sector (e.g., local health departments, criminal justice, hospitals, social services, job training, community based organizations) violence prevention programs such as SNUG, also known as Cure Violence, in high-risk communities, including those where gangs are prevalent. These programs work best when they include wraparound services to support victims, families, and other community members impacted by crime.

Intervention 1.2.2 Increase school based and community programs in conflict resolution, bystander interventions, and healthy relationship building.

Intervention 1.2.3 Reduce access to firearms for children and individuals at high-risk for violence.

Intervention 1.2.4 Reduce neighborhood environmental risks (e.g., abandoned buildings, no lighting, deserted streets).

Intervention 1.2.5 Increase educational, recreational and employment opportunities for potentially at-risk youth through after school and summer work experience programs or youth apprenticeship initiatives.

Objective 1.3.a. Reduce disparities in work-related emergency department (ED) visits.

Objective 1.3.b Reduce disparities in work-related hospitalizations.

Objective 1.3.c Reduce the rate of ED visits for occupational injuries among adolescents 15-19 years of age.

Intervention 1.3.1 Improve safety in workplaces: Develop targeted occupational safety and health training programs for employers and workers in high-risk jobs.

Intervention 1.3.2 Educate teens about their rights and applicable regulations using curricula such as "Talking Safety" or "Passport to Safety", targeting vocational schools and industries hiring large numbers of young workers.

Intervention 1.3.3 Incorporate industry and occupation into electronic health records and other patient-oriented databases.

Objective 1.4.a. Decrease the annual rate of crash-related pedestrian fatalities by 10% to 1.43 per 100,000 people.

Objective 1.4.b. Decrease the annual rate of crash-related bicycle emergency department visits by 10% to 26.09 per 100,000 people.

Intervention 1.4.1 Increase coordinated pedestrian injury prevention activities within the 20 NYS Pedestrian Safety Action Plan (PSAP) focus communities. Engage local partners within PSAP focus communities to conduct pedestrian safety education, engineering, and enforcement activities through provision of resources and technical assistance, training, and promotion of funding opportunities. https://www.ny.gov/programs/pedestrian-safety-action-plan

Intervention 1.4.2 Provide training to increase enforcement of NYS Vehicle and Traffic Law pertaining to pedestrians. The NYSDOH, National Highway Traffic Safety Administration, NYS Governor's Traffic Safety Committee, and NYS Department of Transportation produced training modules that encourage active participation among law enforcement by providing education about specific laws and instruction for targeted enforcement efforts. The role of engineering and public education is also included in the training curriculum.

Intervention 1.4.3 Establish bicycle safety programs including a helmet distribution component. Bicycle helmets when used properly reduce head injuries by up to 88%. Helmet distribution programs should include bicycle safety education and actual fitting of recipients' helmets.

Objective 2.1.a. Reduce the annual number of days the with Air Quality Index (AQI) >100 to 3 or less (reflecting unhealthy daily ozone or PM levels).

Objective 2.1.b. Implement policies that target vulnerable groups to reduce exposure to short-term increases in pollutant levels. (No data are available to measure at this time.)

Intervention 2.1.1 Disseminate time sensitive outreach to regulated facilities serving vulnerable populations when air quality is, or is forecast to be unhealthy. An extensive body of research has found that the very young, the elderly, and people of any age with existing cardiovascular or respiratory disease are at increased risk for health effects from ozone and particulate air pollution.

Intervention 2.1.2 Expand air quality health advisories to respond to episodic smoke events from industrial fires and wildfires. Originally developed to alert the public to pollution episodes based upon weather forecasts and monitoring data, NYSDOH is increasingly working to alert communities of air pollution that results from regional or local episodic events, such as wildfires, industrial fires or infrastructure failures that are not captured by the existing monitoring networks.

Intervention 2.1.3 Implement policies that provide resources and guidance on ways individuals, communities, and governmental entities can work to reduce air pollution and CO2 equivalent emissions. Long term reductions in air pollutants and GHGs will hinge on government, community, and personal commitments. Knowing what to do and having the resources and support to accomplish the change is crucial. NYS energy, pollution control, and environmental protection laws and policies can be leveraged to achieve emission reductions. In addition, policies and programs that encourage and facilitate street and parkland tree planting, especially in urban environments, provides direct air quality improvements and indirectly reduces the urban heat island effect. Improving forest land management in rural areas can also mitigate pollution impacts and enhance carbon sequestration.

Objective 3.1.a. Increase the percentage of the population that live in a certified Climate Smart Community by 15%.

Objective 3.1.b. Increase the percentage of people who commute to work using alternate modes of transportation (e.g., public transportation, carpool, bike/walk) or who telecommute by 5%.

Objective 3.1.c. Ensure the availability and accessibility of cooling centers or other places where people can cool off during extreme heat events. (Underdeveloped; data is not available across the State.)

Objective 3.1.d. Increase the percentage of registered cooling towers in compliance with 10 NYCRR Subpart 4-1, Cooling Towers, to reach 93% compliance.

Objective 3.1.e. Improve control of Legionella in Article 28 facilities by improving the quality of environmental assessments and sampling and management plans prepared by Article 28 facilities. (Underdeveloped; complete dataset is unavailable at this time. May be measured in the future.)

Intervention 3.1.1 Become a certified Climate Smart Community (CSC). CSC is a NYS program that helps local governments take action to reduce greenhouse gas emissions and adapt to a changing climate, which also has co-benefits to public health. All communities in NYS can register to become a Climate Smart Community (CSC) by taking the CSC pledge. Becoming a certified Climate Smart Community goes beyond the CSC pledge by completing and documenting a suite of actions that mitigate and adapt to climate change at the local level. Besides the environmental and public health benefits, certification also facilitates better scores for some state funding programs, including NYSDEC's CSC grants.

Intervention 3.1.2 Identify and promote the availability and use of cooling centers and other resources to prepare for extreme heat events. NYS is experiencing increasing temperatures and extreme heat events. A few hours of air-conditioning during an extreme heat event can prevent or reduce the impact of heat on health. Cooling centers are one component of an overall strategy for preventing heat-related morbidity and mortality, by providing a cool location for people who do not have access to air-conditioning during a heat event. As of Summer 2018, 37 counties reported cooling center information to the NYSDOH (NYC maintains a separate cooling center website). It would be prudent for all counties to prepare for extreme heat events by identifying locations that could be used as cooling centers if needed.

Intervention 3.1.3 Enhance active transportation infrastructure by encouraging utilization and seeking opportunities to expand existing networks. Encourage Utilization Encourage public and private sector businesses to develop or adopt programs to utilize alternative commuting methods, and promote and participate in NYS's annual Green Your Commute Day. For state agencies, promote the use of 511NYRideShare within state government agencies. For the private sector, promote greater use of carpooling. Seeking Funding Opportunities Seek opportunities to enhance active transportation through funding. In 2016, the CSC Grant program was established to provide 50/50 matching grants to cities, towns, villages, and counties (or boroughs of New York City) of the State of New York for eligible climate adaptation and mitigation projects. Funds are available for two broad categories: The first category supports implementation projects related to climate change adaptation and the reduction of greenhouse gases outside the power sector. The second category supports planning projects related to CSC certification actions especially in the areas of climate change adaptation, land use, and municipal fleet management.

Intervention 3.1.4 Engage with cooling tower owners and their stakeholders to increase knowledge of, and compliance with, 10 NYCRR Subpart 4-1, titled Cooling Towers. Cooling towers are a potential source of Legionella, the bacteria that causes legionellosis. If cooling towers are not operated and maintained properly, Legionella can grow inside of them and can be dispersed into the air in tiny water droplets or mist. 10 NYCRR Subpart 4-1 was developed in accordance with industry standards for cooling tower operating procedures, most notably ASHRAE Standard 188-2015 Legionellosis: Risk Management for Building Water Systems

Intervention 3.1.5 Engage Article 28 facility stakeholders to strengthen assessment and management of premise water systems, including using proper techniques, practices, and plan development. Healthcare facilities, such as hospitals and nursing homes, usually serve the populations at highest risk for Legionnaires' disease. CDC recommends that healthcare facilities develop and follow a water management program to minimize the growth and spread of Legionella and other waterborne pathogens in premise water systems.

Objective 3.2.a. Increase health care provider's blood lead testing rates of children ages 0-6.

Objective 3.2.b. Increase the number of homes that are inspected for lead and other health hazards.

Objective 3.2.c Reduce the number of children less than six years of age with a blood lead level of 5 ug/dL and over. (This objective may be measured in the future.)

Objective 3.2.d. Increase the number of homes tested for radon

Objective 3.2.e. Increase the number of homes mitigated for radon as needed

Objective 3.2.f. Increase the number of houses built with radon resistant features. (No data are available to measure this objective statewide.)

Objective 3.2.g. By 2024, 10% of NYS public, private, and charter schools enroll in the NYS Clean, Green, and Healthy Schools Program.

Objective 3.2.h. Reduce children's risk of being exposed to environmental hazards at early care and education (ECE) programs. (Data are not available to measure this objective at this time.)

Intervention

3.2.1 Educate healthcare providers and parents about blood lead testing requirements and importance. Such activities may include:

• Promote point-of-care blood lead testing in healthcare provider offices.

• Create a blood lead testing "Report Card" and disseminate to healthcare providers.

• Educate HCPs to use the New York State Immunization Information System (NYSIIS) blood lead reports, e.g., Test Due List Report and Aggregate Clinical Performance Report

• Develop a media campaign targeting parents to discuss blood lead testing with their child's healthcare provider.

Educate healthcare providers to provide anticipatory guidance concerning lead poisoning prevention to parents and caregivers of children at child health visits

Intervention 3.2.2 Promote the use of and increase referrals from healthcare providers, case management providers, community based agencies, and others to the Local Health Departments with Primary Prevention Programs (15 Programs cover 19 municipalities for home visits) and 19 Healthy Neighborhood Programs.

Intervention 3.2.3 Conduct radon outreach and education programs for the public, applicable building construction contractors, and building officials and code inspectors. Component of outreach may include promotion of the NYSDOH's free and low-cost radon test kits, which includes providing test kits at half price to schools and daycares and free test kits as part of the NYSDOH's Healthy Neighborhoods Program and other State Indoor radon grant-funded programs.

Intervention 3.2.4 Explore local level policy and/or code adoption to require radon resistant construction in high radon areas.

Intervention 3.2.5 Promote healthcare provider screening for radon testing particularly in high-risk radon areas. Increase the number of physicians that ask their patients if they have had their homes tested for radon and refer them to the NYSDOH, as needed. Add radon testing questions to routine electronic medical questionnaires.

Intervention 3.2.6

Implement the NYS Clean, Green, and Healthy Schools Program in schools across NYS.

The New York State Clean, Green, and Healthy Schools Program is a statewide school environmental health program developed through collaborative efforts by the NYSDOH in conjunction with over 40 state and federal agencies, and non-government organizations. The program helps schools improve the health and safety of their school environment, which may result in better health, attendance, productivity, and test scores. The program provides information for all school occupants on best practices, tools, knowledge, and resources in nine environmental health focus areas:

1) Indoor Air Quality (IAQ);

2) Energy and Resource Conservation;

3) Integrated Pest Management (IPM);

4) Mold/Moisture;

5) Chemical and Environmental Hazards;

6) Cleaning and Maintenance;

7) Transportation;

8) Construction/Renovation; and

9) Water Quality.

Intervention 3.2.7 Promote outreach and increase education regarding environmental hazards among individuals leading and supporting the licensing of early care and education (ECE) programs. In partnership with the Agency for Toxic Substances and Disease Registry's (ATSDR's) the NYSDOH is working on a 3-year project called "Choose Safe Places for Early Care and Education (CSPECE)." The overall mission of the CSPECE project is to ensure that early care and education programs are located where chemical hazards have been considered, addressed, and ruled out or mitigated to best protect children's health. The environmental hazards include but are not limited to: former uses of the property that may have residual harmful substances, migration of harmful substances onto the property from other sites, presence of naturally occurring harmful substances (i.e. radon), and access to safe drinking water. This program relies on the collaboration and assistance of stakeholders.

Objective 4.1.a. Increase the number of public water systems that apply for and are awarded infrastructure improvement assistance (e.g., Drinking Water State Revolving Fund (DWSRF), Water Infrastructure Improvement Act (WIIA), and Intermunicipal Water Infrastructure Grant Program (IMG)) to reduce exposure to regulated and emerging contaminants and public health impacts associated with aged infrastructure.

Objective 4.1.b: Promote sustainability by advancing policies and practices that protect NYS drinking water quality and quantity, through source water protection and watershed management planning. (Data may be developed and measured in the future.)

Intervention 4.1.1 Promote funding opportunities (e.g., DWSRF) through webinars and notices to stakeholders engaged in public water and public water infrastructure

Intervention 4.1.2

Develop and implement monitoring programs, source water assessments, and drinking water protection strategies. At the state level,

• Identify potential sources of drinking water contamination

• Develop a comprehensive statewide sustainable source water protection program

Objective 4.2.a. Increase access to information on water quality that affects the recreational use of NYS and marine waterbodies. (Underdeveloped; data may be developed and measured in the future)

Objective 4.2.b. Reduce the annual average number of beach closure days due to HABS by 5%.

Intervention 4.2.1 Enhance the public's accessibility to real-time water quality information for recreational waters including beach status (open, closed) and other information. Currently, the NYSDOH Beach Water Quality Information System includes details on bathing beaches in NYS on the Great Lakes and for marine waters. The data displayed are used by the public and other partner agencies. Information on NYS operated bathing beaches are displayed on NYS Parks, Recreation, and Historic Preservation's and other beach specific websites/pages. Centralizing and/or expanding the information available may help improve the usability and access to important information concerning bathing beaches. Promotion of the NYSDOH Beach Water Quality Information System and other relevant sites could be implemented through outreach campaigns, press releases, and links from other web pages to promote public awareness.

Intervention 4.2.2 Adopt and implement best managements practices to reduce nutrient loading through resource conservation, wastewater, and storm water infrastructure improvements (such as green infrastructure). Increasing blooms of toxic cyanobacteria have affected not only NYS waterbodies, but have been found to be increasing around the world. Investigations suggest implementing nutrient loading reduction strategies can have a synergistic reduction effect on cyanobacteria blooms and populations. Sources of increased nutrients and increasingly eutrophic conditions in lakes in the US have been linked to storm water (Siegel, et al., 2011), sewage, atmospheric deposition, groundwater, and agriculture run-off (Anderson, et al. 2002). It is advisable to investigate and adopt best management practices for nutrient loading reduction to assist in the alleviation of harmful cyanobacteria blooms.

Objective 5.1.a. Reduce the potential for exposure to common chemical soil contaminants by supporting improvements to garden environments and promoting healthy gardening practices. (No data are available to measure this objective.)

Objective 5.1.b . Educate the public to make informed fish and game consumption decisions to reduce exposures to contaminants by increasing the number of mapped waterbodies detailing contamination.

Objective 5.1.c Increase public awareness of chemicals and/or contaminants in products. (Underdeveloped; data may be available to measure this objective in the future.)

Intervention 5.1.1 Improve garden environments to reduce the potential for exposure to soil contaminants. For young children, studies suggest that the greatest risk from a garden with soil contamination is direct contact with the soil and soil tracked into the home. For adults, including pregnant women, the greater risk may come from eating produce with adhered soil particles that are not readily removed by washing. Soil can be tested for common contaminants like lead to determine the importance of improving the garden environment to reduce the potential for exposure. Proactive improvements include installing a landscaping fabric barrier over contaminated soil, building raised beds and covering pathways with mulch. These improvements reduce the chances that gardeners and those who eat the garden's produce will be exposed to soil contaminants, without placing the responsibility on gardeners themselves to significantly change their practices. School districts, gardening groups, municipalities and other organizations can adopt practices, policies, or municipal codes that can support these changes by, for example, ensuring an adequate supply of locally available clean soil and amendments, keeping organized records of contaminant testing, and adopting maximum soil contaminant levels above which mitigative changes would be implemented. NYSDOH and its partners provide technical guidance and work to facilitate access to resources for community organizations to build capacity for informed decision-making about the benefits and risks associated with urban gardening.

Intervention 5.1.2 Provide information to gardeners to help them produce healthy vegetables while minimizing exposure to contaminants for themselves and those with whom they share produce. There are a number of healthy gardening practices that can reduce the likelihood of exposure to soil contaminants, such as planting fruiting vegetables instead of leafy or root vegetables, changing shoes before going indoors, washing hands after gardening, and washing and/or peeling vegetables before they are cooked or eaten. NYSDOH helps provide information to gardeners to make healthy choices and adopt healthy practices through evidence-based, culturally appropriate and balanced online content, distribution networks for printed materials (e.g., "Healthy Gardening" brochures), and indirectly, by working with partner organizations to convey these messages. NYSDOH and partners also participate in community outreach events called soilSHOPs, where gardeners who might not be reached through other more traditional means are provided with lead screening results for their backyard soils. NYSDOH's community partners conduct trainings to foster peer education, build demonstration gardens, and engage in dialogue with policymakers to implement health-protective policies. Expanding partnerships will increase the number of gardeners empowered with information to make healthy gardening decisions.

Intervention 5.1.3 Evaluate data on emerging and legacy contaminants in fish and game to develop and/or update health advisories based on the sampling and analyses of target fish and wildlife from waterbodies or areas known or suspected to be impacted by chemical contamination. In NYS, fish and game health advisories are based primarily on information that NYSDEC collects and generates. In recent years, NYSDEC has annually collected approximately 1,500 fish from more than 50 locations/waters and analyzed these fish for various contaminants. NYSDEC also tests some game species (e.g., waterfowl, snapping turtles) that accumulate chemical contaminants. NYSDOH reviews the NYSDEC data for fish and game to determine if an advisory should be issued or revised for fish from specific waters, and game species. The NYSDEC expands their list of contaminants to test for in fish and game as new information on chemicals becomes available (specifically those chemicals that do not break down easily and have known or suspected health risks are of greatest interest). The NYSDOH and NYSDEC continue to work in collaboration to identify susceptible water bodies as new data become available related to emerging contaminants and their use and release.

Intervention 5.1.4 Educate the public, focusing on those populations that consume fish from NYS waterbodies, to adopt healthier fish consumption habits. Utilize a broad range of evidence-based educational tools and distribution methods that are culturally appropriate. Inform the public about fish contamination in NYS water bodies to promote healthy fish consumption. Include advisory information in the NYSDEC Fresh Water Fishing Regulations guide. Provide online access, and utilize social media and distribution networks including entities that sell fishing licenses, environmental and community organizations, recreational facilities, food banks, and bait and tackle shops to distribute written materials. Translate regional materials into languages appropriate to the region, and utilize immigrant and refugee support networks, faith institutions, literacy, and other organizations to facilitate newcomers' access to this information. Fishing is a fun outdoor activity and fish are an important part of a healthy diet. To promote healthy choices for recreational fish consumption, develop public-access county fishing maps that visually illustrate waters where families can eat the fish they catch, and waters where families should not eat fish. The county fishing maps offer local alternatives to contaminated waters for fish consumption without discouraging the practice of fishing nor fish consumption. Develop fishing maps for additional counties and utilize online and distribution networks to distribute.

Intervention 5.1.5

Expand access to chemical ingredient and other relevant product information.

• Promote existing disclosure venues to enhance public awareness.

• Expand chemical ingredient disclosure of products sold in NY through legislation or other.

• Enhance collaborations to investigate contaminants in products, share information, and alert the public.

Objective 5.2.a. By December 31, 2024, incorporate the food safety requirements of the U.S. Food and Drug Administration 2017 Model Food Code into the New York state level Food safety regulations to provide modernized and uniform food safety requirements for operators across state level and local jurisdictions. (This objective may be measured in the future.)

Objective 5.2.b. Identify the contributing factors in 56% of foodborne outbreaks on an annual basis.

Intervention 5.2.1 Adopt Chapters 1-7 of the FDA 2017 Model Food into State Sanitary Code and provide implementation training and resources to Local Health Departments.

Intervention 5.2.2 Provide at minimum one training course to Local Health Department personnel on how to investigate foodborne illness outbreaks to increase the number of trained Local Health Department personnel to carry out foodborne outbreak investigations and to improve the identification of contributing factors in foodborne outbreaks. This intervention focuses on providing targeted resources such as training to Local Health Department staff to improve the completeness and timeliness of outbreak investigations and response. Helping team members improve their skills to investigate outbreaks and to understand each other's roles and responsibilities as a team by building relationships among team members could protect additional people from getting sick. Providing training to Local Health Department staff will improve their ability to identify the root causes of foodborne disease outbreaks. With this information, education could be provided to the public to improve food safety and prevent future illnesses.

Intervention 5.2.3

Improve coordination and response during outbreak investigations to reduce the incidence of disease and duration of the outbreak.

This intervention will focus on updating outbreak investigation procedures for NYS to improve coordination and response during outbreak investigations. The purpose of this procedure is to:

1) provide a standard protocol for enteric outbreak investigation and response;

2) enable stakeholders to work together effectively during outbreak investigations;

3) define roles and responsibilities of the outbreak investigation and control team; and

4) foster effective communication and data sharing among investigation team members.