NACCHO Exchange 11

Preventing recreational water illness and injury (RWII) should be a top priority for local and state health officials. Staggering data, including nearly 3,600 U.S. deaths caused by unintentional drownings in the last decade and almost 5,000 annual emergency room visits related to pool chemicals, illustrate the need for a more stringent and focused approach to national aquatic safety. To better streamline the overwhelming process typically associated with updating or overhauling state-managed recreational water regulations, the Centers for Disease Control and Prevention (CDC) partnered with state and local health agencies and the aquatics industry to create the Model Aquatic Health Code (MAHC). Designed to serve as an extensive resource for state and local health departments, the MAHC provides science- and practice-based guidance on decreasing the risk of recreational water illness, drowning, and pool chemical injury. The First Edition MAHC Code and its annex were initially published in August 2014 and the second editions were recently released.

Many health departments across the country are leading or supporting varying stages of MAHC implementation, based on the needs and available resources in their respective states. This article chronicles the journeys of Colorado and New Mexico to update their aquatic regulations by adopting the MAHC. Told from the perspective of two public health officials, each having played a crucial role in moving their state forward, their accounts provide step-by-step details of the process, tools, and partnerships that were key to their success, and the challenges they met along the way. More importantly, they illustrate the integral role health departments and other government agencies can play in facilitating and expediting MAHC adoption.

Considering MAHC Adoption: Colorado’s First StepsFor years, state and local public health officials in Colorado and their partners in the aquatics industry have expressed a desire to update the laws and regulations for aquatic venues. Originally released in the 1960s, the latest version of these regulations have remained largely unchanged for the last two decades. Challenges to maintaining up-to-date regulations are directly tied to the lack of state resources dedicated to recreational water safety, impeding the ability of the Colorado Department of Public Health and Environment (CDPHE) to provide the necessary oversight and technical support to local health departments, partner agencies, and aquatic facilitates directly engaging community members in recreational water activities.

Responding to the overwhelming consensus and compelling need for updated aquatic regulations, the Colorado Directors of Environmental Health (CDEH), an association of state and local environmental health officials, launched the process in late 2012 by creating a small workgroup charged with drafting revised statutory language. Although the workgroup’s efforts progressed to the State Attorney General’s Office, they were ultimately stalled as the state prioritized more pressing matters (e.g., retail food and child care). The CDEH reinvigorated this project at their July 2015 Quarterly Meeting, opting to seek support at the federal and national levels by inviting representatives from the CDC and the National Swimming Pool Foundation™ (NSPF) to discuss the newly adopted MAHC as a possible solution at CDEH’s October 2015 meeting. To test their assumptions, the CDEH conducted a statewide survey of

Adopting the Model Aquatic Health Code: A Tale of Two States Leading the Way to Aquatic Safety By Jim Rada, Environmental Health Services Division Director, Jefferson County (CO) Public Health; Eugene Knight, Swimming Pool Program Manager, New Mexico Environment Department; and Anastasia Sonneman, Communications Specialist, NACCHO

Why the MAHC Matters

continued on page 12

local environmental health programs in early 2016. The survey gauged the level of local involvement in and resources dedicated to overseeing the regulation of aquatic venues. Key results, displayed on page 12, illustrate the significant gaps in both regulation capacity and consistency for the state’s nearly 2,000 public and semi-public pools.

Using the survey results, the CDEH created a workgroup in collaboration with the NSPF. The workgroup’s goals were to promote broad-based support and industry-wide engagement for MAHC adoption in Colorado. They began by partnering with the NACCHO MAHC Network, an initiative to foster a community among state and local MAHC users, subject matter experts, and others seeking implementation support.

In collaboration with the NACCHO MAHC Network, the workgroup hosted a general interest webinar to spark conversation and identify the level of interest among the key cross-sector stakeholders essential for successful MAHC implementation. The webinar featured presenters from the public health field and the aquatics industry, providing a multi-level perspective of the current state of Colorado’s aquatic regulatory program; exploring the potential value of its revision; and using the MAHC as a tool to make the connection. Beyond raising awareness about these topics, the webinar polled attendees to measure their existing knowledge of the MAHC and interest in supporting future efforts.

Polling data from a diverse attendee pool (55% representing state and local government and 45% from a wide variety of industry groups) demonstrated an equally high level of familiarity with the

NACCHO Exchange12

a large amount of collaboration, public engagement, and effective communication among all stakeholders involved.

First, the Bureau’s Swimming Pool Program team and other interested staff spent several months comparing the MAHC to what had already been developed for the new version of the proposed swimming pool regulations. After completing a line-by-line review of each section, the team was happy to find that most of the updates proposed for the state’s current regulations were already incorporated in the MAHC. Furthermore, they agreed that the language used in the MAHC was actually easier to understand and follow when compared to the state’s current regulations. With the initial review complete and concurrence to move forward with MAHC adoption, the Bureau received formal approval from NMED.

Next, the Bureau prepared a presentation to inform the aquatics industry about the effects new regulations would have on existing pool facilities and any new construction, subsequently launching a public comment period to request feedback on the proposed regulations. The Bureau distributed the presentation and collected comments both through in-person public meetings and digital dissemination via the Swimming Pool Program’s webpage. Public meetings were met with good attendance and digital viewership was also substantial, resulting in a number of public comments.

After incorporating the public comments into the proposed regulations, the updated regulations were presented to the Environmental Improvement Board as the last step to finalizing their adoption as the new State Swimming Pool Regulations. On May 13, the Board held a public hearing at which written and oral evidence was presented on the new regulations and a formal vote was taken, approving them to go into effect on Aug.1.

MAHC and readiness for its implementation. These results were further cemented by a post-webinar survey revealing high potential for broad-based support and engagement and validating continued efforts towards MAHC adoption in Colorado.

Through the remainder of this year, CDEH will focus on encouraging increased cross-sector collaboration; creating a webinar series and other training opportunities to increase general MAHC knowledge; and initiating a formal legislative process to update Colorado’s current aquatic venue laws and regulations. The CDEH hopes to gain support for a 2017 bill updating the statutory framework of the program, which will be followed by a stakeholder review process and, ultimately, adoption of new regulations in the following year.

From Start to Finish: MAHC Adoption in New MexicoNew Mexico’s public swimming pool regulations were first created in 1937, designating the state’s Environmental Health Bureau (Bureau) to provide oversight, implement inspections, and maintain up-to-date statutes. In addition to inspecting more than a thousand aquatic facilities throughout the state, the Bureau also facilitates a formal review process every five years to allow for regulation adjustment based on scientific or industry advancement. However, in the almost 80 years since their enactment, New Mexico’s swimming pool regulations have been updated a total of just nine times.

During the most recent review period, the fact that the regulations were likely out of date combined with an increase in medical visits as a result of RWII led the state to initiate a large-scale update. Fortunately, in 2013, at the same time the process of re-writing regulations began, the MAHC was released for its initial public comment review. As a result, the Bureau decided to use the MAHC as a guiding resource for revising the state’s aquatic regulations, with the ultimate goal of adopting the MAHC in the state of New Mexico. Since 2013, the New Mexico Environment Department (NMED) has worked diligently to successfully integrate the MAHC into New Mexico’s new aquatic venue regulations. The process, nearly complete at press time, required

continued on page 13

continued from page 11

Adopting the Model Aquatic Health Code: A Tale of Two States Leading the Way to Aquatic Safety

NACCHO Exchange 13

Adoption of the MAHC helps NMED to better identify and prevent safety and health violations at pools, hot tubs, spas, and other aquatic venues and enforce closures for repeat offenders. While the current regulations addressed many of these issues, the MAHC provides a science-based explanation, significantly aiding regulatory inspectors in providing justification and consistency when completing inspection reports. The MAHC’s standardized code also brings increased uniformity to regulatory standards, while its annex provides specificity and explanation to regulatory rules.

More importantly, NMED anticipates that MAHC adoption will produce many safety and health benefits for its residents engaging in recreational water activities. Such benefits include fewer outbreaks of recreational water illnesses, such as Legionella and Cryptosporidium; a likelihood of fewer injuries and deaths from drowning in aquatic facilities; and an overall decrease in emergency room visits for swimming-related and pool chemical issues.

To reinforce these benefits, NMED is also upgrading inspection procedures to include a newly designed database with electronic inspection capability. This new design structure will improve tracking and research methods related to aquatic venue violations, allowing health department staff to better identify patterns indicating public health concerns; institute a more proactive protocol for addressing potential gaps in adherence to regulations; and provide additional training to facility and agency staff experiencing continued issues.

Making the MAHC Work for Your Community: Recommendations from the Field Both Colorado and New Mexico illustrate the value of the MAHC as a tool for standardizing aquatic regulations. Of course, each state’s experience will vary in terms of the processes and timelines required to successfully incorporate the MAHC based on levels of regulatory resources, stakeholder engagement, and community needs. However, the following recommendations will make the process smoother and increase the likelihood of success.

First, cross-sector collaboration and multi-level stakeholder engagement must be at the root of all efforts, from start to finish. James Rada further emphasizes, “When addressing policymakers, the likelihood for MAHC adoption is greatly increased with the government and industry speaking as one voice, rather than as adversaries.”

Eugene Knight echoes the sentiment, adding that, “stakeholder involvement was critical in New Mexico moving forward with adopting the MAHC as a major part of our aquatic regulations.”

Second, there are a number of highly valuable resources available such as NACCHO’s MAHC Network that can support health departments in initiating and furthering MAHC adoption. The MAHC Network continues to be pivotal in Colorado’s MAHC implementation. Although the Network had not yet formed when New Mexico was undergoing its revision process, NMED has since become an active member and is eager to help other jurisdictions in any way possible. The CDC Healthy Swimming Website is another useful tool, credited by New Mexico as especially helpful when conducting its comparison of the MAHC to existing state regulations and developing stakeholder presentations.

Finally, states yet to consider the MAHC are at an advantage with the release of its second edition. Current MAHC users have provided feedback and suggestions for improvement, which have all been incorporated into the new version.

To learn more about NACCHO’s MAHC Network, e-mail mahcnet@naccho.org.

First, cross-sector

collaboration

and multi-level

stakeholder

engagement must

be at the root of all

efforts, from start

to finish.

continued from page 12

Adopting the Model Aquatic Health Code: A Tale of Two States Leading the Way to Aquatic Safety