Board of Health Meeting Documents

  1. Call to Order - F. Costante, Chair (4:00 pm)
    1. Land Acknowledgement
      The Caboto Club sits on the traditional territory of the Three Fires Confederacy of First Nations, which includes the Ojibwa, the Odawa, and the Potawatomi.  As we make this land acknowledgement, it is also important that we continue to do the work to address systemic and historic injustices.
    2. New Board Member Introductions (4:02 pm)
    3. Quorum​​
    4. Declaration of Conflict of Interest
  2. Approval of Agenda (4:05 pm)
  3. Approval of Minutes: January 18th, 2024 (4:06 pm)
  4. Consent Agenda (for approval) (4:07 pm)
    1. Information Reports
      1. Communications Report:
        1. January 2024
        2. February 2024
      2. 2023 Vector Borne Disease Report
      3. Healthy Schools – Health Promotion Program Update
      4. Q4 Board of Health Effectiveness Survey Summary
      5. 2023 Privacy Summary Report
      6. 2023 Annual Service Plan: Annual and 4th Quarter Report
      7. Nutrition Month and Nutrition Programming
    2. Correspondence (4:09 pm)
      1. Dr. Kieran Moore -Thank You Letter to WECHU (for information)
      2. Peterborough - Public Health Strengthening (for information)
      3. Peterborough – Intimate Partner Violence and Public Health Action (for information)
  5. Presentations (10:15am) 
    1. Annual Report (K. Blanchette/E. Nadalin) (4:10 pm)
    2. Nutrition Month (K. Bellemore) (4:15 pm)
    3. Measles (M. Aloosh) (4:22 pm)
    4. Solar Eclipse (M. Aloosh) (4:37 pm)
  6. Business Arising
  7. Resolutions/Recommendation Reports
    1. Immunization of School Pupils Act (IPSA) – Re-consideration of Amendment for Required Reporting by Health Care Providers (K. McBeth) (for approval) (4:47 pm)
    2. Food Insecurity Compromises Infant Health (L. Watson) (for approval) (4:52 pm)
    3. Ministry of Children, Community and Social Services Budget (K. Blanchette) (for approval) (4:57 pm)
  8. New Business
    1. CEO Report (K. Blanchette) – verbal (5:02 pm)
    2. JBEC Terms of Reference (K. Blanchette/F. Costante) (5:07 pm)
    3. Audit Committee (K. Blanchette) (5:17 pm)
  9. Committee of the Whole (Closed Session in accordance with Section 239 of the Municipal Act) (5:27 pm)
  10. Next Meeting:  At the Call of the Chair, or May 16, 2024
  11. Adjournment

January 31, 2024

The Honourable Doug Ford
Premier of Ontario
premier@ontario.ca

The Honourable Sylvia Jones
Deputy Minister / Minister of Health
sylvia.jones@ontario.ca

The Honourable Michael Parsa
Minister of Children, Community and Social Services
MinisterMCCSS@ontario.ca


Dear Premier Ford, Ministers Jones and Parsa:

Re: Intimate Partner Violence and Public Health Action

At its January 10, 2024 meeting, the Board of Health for Peterborough Public Health (PPH) considered and endorsed correspondence from the North Bay Parry Sound District Health Unit (NBPSDHU) regarding the need to advance local and provincial action on monitoring, preventing and reducing Intimate Partner Violence (IPV), and adverse events experienced by children with violence or abuse within the family unit.

Intimate Partner Violence (IPV) includes physical, sexual and/or emotional harm toward a current or former intimate partner. Exposure to IPV is associated with negative impacts to social functioning, mental health and physical health. It is well established through research, that children exposed to violence, either directly or through witnessing interparental violence are at risk of intimate partner violence in adolescence and adulthood. IPV is recognized as an adverse childhood experience (ACE), and ACEs are associated with an increased risk of negative social and health impacts.Research indicates that IPV starts early in the lifespan, thus indicating the need for early prevention efforts and interventions targeting adolescents and young adults. As a local public health agency we are engaged in the work of intimate partner violence prevention and addressing health child growth and development in accordance with the Ontario Public Health Standards: Health Growth and Development and Substance Use and Injury Prevention standards.

At the local level, on November 27, 2023, Peterborough became the 74th municipality in the province of Ontario to declare gender-based violence an epidemic. While this is an important step forward, IPV is generally underreported, therefore advocating for a consistent way of collecting data across the province to inform evidenced-based interventions is urgently required to effectively respond to and preventIPV.

I trust you will consider our efforts, along with NBPSDHU and the advocacy of others, who continue to voice their support to invest in surveillance and data -informed strategies that will help monitor trends and reduce intimate partner violence, reduce adverse childhood experiences, and increase resilience and protective factors of children and youth.

Sincerely,

Original signed by

Councillor Joy Lachica Chair, Board of Health

/ag Encl.

cc: 
Hon. Michael Kerzner, Solicitor General of Ontario
Josée Bégin, Assistant Chief Statistician, Statistics Canada Local MPPs
Ontario Boards of Health
Association of Local Public Health Agencies (alPHa)

January 5, 2024

The Honourable Doug Ford
Premier of Ontario
premier@ontario.ca

The Honourable Sylvia Jones
Deputy Minister / Minister of Health
sylvia.jones@ontario.ca

The Honourable Michael Tibollo
Associate Minister of Mental Health and Addictions
michael.tibollo@ontario.ca


Dear Premier Ford and Ministers Jones and Tibollo,

RE: Public Health Strengthening

At its meeting on December 13th meeting, the Board of Health for Peterborough Public Health received a presentation on the importance of investment in health promotion strategies and a diversified skilled workforce to deliver impactful local public health activities.

The Health Promotion Ontario’s White Paper on the Value of Local Health Promotion in Ontario, 2023, stated the value of local health promotion delivered by local public health agencies and how it is an effective strategy in addressing Ontario’s Health Care crisis. It recommends strong and sustained investment in local health promotion by public health units to ensure that health promotion is prioritized on an ongoing basis. The Chief Public Health Officer of Canada’s report: The Chief Public Health Officer of Canada’s Report on the State of Public Health in Canada, 2023 also underscored the importance of health promotion strategies for ensuring resilience and preparedness in the face of pandemics and emergencies.

Public health strategies are only impactful if there is appropriately resourced, skilled and diversified workforce to deliver them. The Ontario Chief Medical Officer of Health’s 2022 report Being Ready: Ensuring Public Health Preparedness for Infectious Outbreaks and Pandemics outlines the importance of funding an adequate and skilled, adaptable and resilient public health workforce that is cross trained in core public health work and has the surge capacity to meet the current and future needs of Ontario.

There are opportunities for system improvements as part of the review of Board of Health roles and responsibilities announced under the government’s Public Health Strengthening initiative. The Board of Health respectfully urges the Provincial Government to ensure local Public Health Units are supported to invest in coordinated action to promote health and reduce the burden of chronic diseases, substance use and injuries and increase health equity. This includes both maintaining the current breadth and scope of health promotion work outlined by the Ontario Public Health Standards and a continued investment of a skilled and diversified public health workforce.

We also respectfully request that the Chief Medical Officer of Health ensure proactive engagement in the sector-driven review of the Ontario Public Health Standards.

Sincerely,

Original signed by

Councillor Kathryn Wilson Chair,
Board of Health

/ag

cc:
Dr. Kieran Moore,Ontario Chief Medical Officer of Health Local MPPs
Ontario Boards of Health
Association of Local Public Health Agencies.

Ministry of Health
Office of Chief Medical Officer of Health, Public Health
Box 12
Toronto, ON M7A 1N3

Ministère de la Santé
Bureau du médecin hygiéniste en chef, santé publique
Boîte à lettres 12

Dr. Ken Blanchette 
Chief Executive Officer
Windsor-Essex County Health Unit

Dr. Mehdi Aloosh
Medical Officer of Health
Windsor-Essex County Health Unit

Kristy McBeth
Director of Public Health Programs
Windsor-Essex County Health Unit

Linda Watson
Director of Public Health Programs
Windsor-Essex County Health Unit

Eric Nadalin
Director of Public Health Programs
Windsor-Essex County Health Unit

Dan Sibley
Director of Human Resources
Windsor-Essex County Health Unit

February 7, 2024


Dear Colleagues,

On behalf of myself and my team with the Office of the Chief Medical Officer of Health, Ministry of Health, I would like to thank you for hosting and meeting with us in early January 2024.

Thank you for sharing your perspectives regarding the voluntary mergers of local public health agencies within your region as well as the financial and capital considerations specific to the Windsor-Essex County Health Unit. It was a pleasure to be in your community, to hear from you and learn more about your local and regional perspectives.

The conversations we had were important and it is through ongoing dialogue and collaboration that we will be able to maximize the opportunities that the Strengthening Public Health strategy presents to make our sector stronger.

We look forward to continuing these important discussions over the coming months.

Sincerely,

Dr. Kieran Michael Moore, MD, CCFP(EM), FCFP, MPH, DTM&H, FRCPC, FCAHS
Chief Medical Officer of Health and Assistant Deputy Minister, Public Health

c. Elizabeth Walker, Executive Lead, Office of the Chief Medical Officer of Health
Brent Feeney, Director, Accountability and Liaison Branch, Office of the Chief Medical Officer of Health
Dr. Wajid Ahmed, Associate Chief Medical Officer of Health, Office of the Chief Medical Officer of Health

14-075

PREPARED BY:

Planning and Strategic Initiatives

DATE:

March 21, 2024

SUBJECT:

2023 Annual Service Plan: Annual and 4th Quarter Report


BACKGROUND/PURPOSE

In 2018, the Ontario Ministry of Health (MOH) introduced a new Annual Service Plan (ASP) that Health Units are required to submit each year. To ensure a single and integrated approach to evaluating progress on this requirement, the Planning and Strategic Initiatives (PSI) department worked with the Information Technology (IT) department to align our planning system with the provincial Ontario Public Health Standards requirements to provide quarterly progress reports on the plan. 

DISCUSSION

2023 Annual Overview

72% of the WECHU’s external public-facing programming was completed as planned in 2023.

Several environmental factors led to adjustments throughout the year and affected completion rates of the plan. These factors included: The Provincial requirement to operate a local COVID-19 vaccination clinic; changes to the co-location partnership with the University of Windsor; and the revised Provincial funding formula that led to significant staffing and resource limitations during the 4th Quarter of 2023.

Q4 Intervention Work Plan Progress

Project Leads have submitted individual progress reports for work plans in their programs for Q4, 2023. 

The 2023 Annual Service Plan – Q4 Recommendation Report indicates:

  • For external client facing programs, there were 124 active plans with 84% being completed.
  • For internal organizational programs, there are 38 active workplans with 63% being completed.

Annual Service Plan Development for 2024

Activities in the Intervention Work Plans (IWP) have begun and detailed reporting on their progress will be submitted to the Ministry of Health in April as directed.

PREPARED BY:

Planning and Strategic Initiatives

DATE:

March 21, 2024

SUBJECT:

2023 Privacy Summary Report


BACKGROUND/PURPOSE

The Windsor-Essex County Health Unit (WECHU) is a “health information custodian (HIC)” in accordance with section 3 of the Personal Health Information Protection Act (PHIPA), and an “institution” in accordance with section 2 of the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA). Under this legislation the WECHU has obligations to ensure the rights of individuals with respect to privacy, access, and correction of records of personal information (PI) and personal health information (PHI), and access to general records that pertain to the WECHU operations and governance.

All institutions under MFIPPA, and HICs under PHIPA, are required to provide statistical reports to the Information and Privacy Commissioner of Ontario (IPC) on an annual basis with respect to:

  • Confirmed privacy breaches under PHIPA (Appendix A)
  • Access and correction requests under PHIPA (Appendix B)
  • Access and correction requests under MFIPPA (Appendix C)

The WECHU submitted statistical reports for each category by the required deadline of March 1st for PHIPA reports and March 31st for MFIPPA. 

DISCUSSION

Privacy breaches

In 2023, the WECHU had 12 confirmed breaches. Privacy breaches in 2023 predominantly included incidents where Personal Information (PI) and/or Personal Health Information (PHI) was disclosed without authority and emailed or faxed to the wrong person and/or organization. 

The WECHU is looking at various ways to prevent breaches of this manner through training and investigating additional electronic information management systems. 

MFIPPA access and correction to information requests

In 2023, the WECHU received 18 formal Freedom of Information requests based on MFIPPA, compared to 22 in 2022. All requests were processed within the reporting year.

Year and number of MFIPPA Requests made through the WECHU
Year Number of MFIPPA Requests
Access Correction
2023 18 0
2022 21 1

PHIPA access and correction to information requests

In 2023, the WECHU received 55 formal Freedom of Information requests based on PHIPA during the reporting year. This was a significant decrease from 2022 due to decreased involvement the WECHU’s support for validating proof of COVID-19 vaccination certification. 

Year and number of PHIPA Requests made through the WECHU
Year Number of PHIPA Requests
Access Correction
2023 55 0
2022 1540 169

CONCLUSION

In summary, all MFIPPA requests and all PHIPA requests were completed within the statutory time limits in 2023. Priorities for the coming year will include continued dedication of resources for the access to information and privacy program, including additional training, and updated workflows to improve request handling processes. These actions will improve records and information management (RIM) within the program and allow the WECHU to respond with increased efficiency to information requests.

PREPARED BY:

Planning and Strategic Initiatives

DATE:

March 21, 2024

SUBJECT:

Q4 Board of Health Effectiveness Survey Summary


BACKGROUND/PURPOSE

The Ontario Public Health Standards (2021), under the Good Governance and Management Practices Domain, states: “the board of health shall have a self-evaluation process of its governance practices…”. 

In addition to a yearly self-evaluation process, the WECHU has developed a quarterly self-assessment survey for Board of Health (BoH) members. The survey provides an opportunity for feedback on BoH operations and is used to inform quality improvement efforts. 

DISCUSSION

Responses in the fourth quarter of 2023 related to BoH operations continued to be positive. In all cases, 100% of the responses were ‘Agree’ or ‘Strongly Agree’ regarding the aspects queried. In terms of overall perceived BoH effectiveness, 70% of the responses were either a 9 or a 10 (on a 10-point scale), where the average score was 9. 

Suggestions for improvement included support for additional BoH education, greater clarity on meeting agendas (including earlier provision of agendas), establishing consistent monthly BoH meetings, establishing a permanent location for BoH meetings, and extending electronic access to BoH materials to additional devices.

PREPARED BY:

Environmental Health

DATE:

March 21, 2024

SUBJECT:

2023 Vector Borne Disease Report


BACKGROUND/PURPOSE

Vector-borne diseases are caused by the transmission of parasites, viruses, and bacteria in humans by vectors. The most common vectors are mosquitoes and ticks and can transfer the pathogen from one host to another. Public health units in Ontario are required under the Health Protection and Promotion Act to conduct vector-borne disease surveillance to monitor trends for emerging diseases including factors that influence their occurrence. In 2023, the Environmental Health Department continued to implement a vector-borne surveillance program to monitor West Nile Virus (WNV), Eastern Equine Encephalitis (EEE), Zika Virus and Lyme disease activity in Windsor and Essex County (WEC). 

DISCUSSION

Active Tick Surveillance is used to assess the local distribution and incidence of black-legged ticks in WEC. It involves the dragging of a white cloth through grassy areas and is performed twice yearly in the spring and the fall. Any black-legged ticks identified are sent to an accredited laboratory for testing for Lyme disease. In 2023, tick dragging was conducted at four sites across WEC in May and October. A total of forty-four black-legged ticks were identified, with twenty ticks carrying the infectious agent that causes Lyme disease. In 2023, there were eight human cases of Lyme disease reported in WEC.

Mosquito Surveillance Program ran for a total of 21 weeks from May 23 to Oct.13, 2023. Once a week, forty-one mosquito traps (26 CDC light traps and 15 BGS 2 traps) were set up across WEC to collect mosquitoes for identification and viral testing.  In 2023, there were 11 WNV positive pools identified and one positive WNV human case was reported. There were no positive pools or human cases for EEE or Zika identified this year.

Mosquito Larviciding involves applying larvicides to catch basins, standing water sites, and lagoons that hold water where mosquitoes may breed. The WECHU and municipalities contracted a service provider to run larval surveillance beginning in May. Three rounds of roadside municipal catch basin larviciding were conducted and a total of 133,024 catch basin treatments were applied WEC. There were a few challenges identified during the larviciding season for catch basins and only one standing water complaint submitted by WEC municipalities. Prior to 2024 season, meetings will be set up with municipalities and vendor of record to look at processes as well as to address concerns from last season.

PREPARED BY:

Healthy Schools Department

DATE:

March 21, 2024

SUBJECT:

Comprehensive School Health – Health Promotion Program


BACKGROUND/PURPOSE

The WECHU Comprehensive School Health Program works to improve the health and well-being of school-aged students, staff, and their families in collaboration with the four schoolboards: Greater Essex County District School Board (GECDSB), Windsor Essex Catholic District School Board (WECDSB), Conseil scolaire catholique Providence (CSC Providence), and Conseil Scolaire Viamonde (Viamonde) as well as local private and faith-based schools. In total, the program supports 132 publicly funded schools, and 31 private or faith-based schools.

The program employs best practices and research and is directed by the School Health Standard and Guidelines of the Ontario Public Health Standards (2018), to provide comprehensive programming to support health and wellness topics as indicated in the Standards. Initiatives are planned using the Foundations for a Healthy School Framework, including curriculum, teaching and learning; school and classroom leadership; student engagement; social and physical environment; and home, school, and community partnerships. An inaugural  Strategic Partnership Agreement has been signed by the WECHU and all four schoolboards for the 2023-2024 school year (presented to the board in January 2024). This Agreement formalizes the collective actions by all parties to collaborate, cooperate and communicate regarding specific programming and planning activities to support the children and youth of WEC, through the creation of healthy school environments. The WECHU’s leadership of the School Board Liaison Committee is one important component of operationalizing this Agreement. 

Program interventions are equity-driven and varying levels of support are provided to schools based on a multi-factor assessment of needs and health priorities identified by schools. There are 70 publicly funded schools which have been identified as highest needs for the 2023-2024 school year. Need was based on combining data sets from the Ministry Education Opportunities Index, EQAO scores, oral health outcomes, immunization rates, and socially disadvantaged community regions. Highest needs schools complete a School Health Assessment survey and work with a dedicated public health nurse to co-develop and implement tailored interventions to meet the needs of the school and students, based on topics identified in the School Health Standard. The top health priorities identified by highest needs schools for 2023-2024 school year include mental health and substance use.

DISCUSSION - Program Highlights

All 163 schools in WEC receive evidence-based program support based on the Foundations for a Healthy School Framework, health topics identified in the School Health Standard, as well as emerging health needs identified by schools and in the larger community. Resources include foundational knowledge and educator tools to support health-related curricula, as well as supportive materials for students and families. Resources are developed and promoted throughout the school year, as well as by request from individual schools. A digital email monthly newsletter of emerging health topics and associated educator resources began in December 2023. All materials developed are readily available from the Healthy Schools section of the WECHU website. Schools, community partners, and caregivers of children and youth are encouraged to sign-up for the newsletter.

Mental Health Literacy Program
(School Health Standard Requirements 1, 2, 3, 4 and PPM 169)

The WECHU is using the Decider Skills Program as one of its mental health literacy approaches. It is a social emotional learning skills-based program that helps students recognize their own thoughts, feelings, and behaviours, enabling them to monitor and better manage their own emotions and mental health. During the 2022-2023 school year, four school nurses piloted the program at four schools, teaching 12 social-emotional learning skills in classrooms over a seven-week period. At the conclusion of the pilot sessions, the majority of students (67.5%) could name and explain and use at least two Decider Skills. 

Based on the evaluation, the program was condensed into five weeks and focused on Grade 4 students at higher needs schools for the 2023-2024 school year. Beginning October 2023, two Decider series of 5 weeks each were completed in 17 priority schools reaching 687 students. Two additional series are planned for this school year, where 16 more higher needs schools will participate. Program evaluation results will be released at the conclusion of the four sessions. 

Substance Use Prevention – Break the Vape Youth PSA Challenge 
(OPHS School Health Requirements 3 and 4)

Break the Vape Challenge is a contest for WEC students in grades 6 to 12. Students are asked to use their voice to create and submit a 30 second Public Service Announcement video to raise awareness to their peers about the dangers of vaping and the sneaky marketing tactics of the tobacco industry. Videos can be submitted in English or French and must include at least one key message about the dangers of vaping and one call to action. The contest was developed with youth, and students will be asked to watch and vote for their favourite video entries to determine the winners. Prizes will be awarded to students for the top voted videos, and to publicly funded schools with the highest participation rates. Entries will be accepted from February 5 to March 8 and voting begins April 16, 2024.

Food and Nutrition – Educator Toolkit for Supportive Food Environments
(OPHS School Health Requirement 4 and PPM 150)

To support a new approach to teaching and talking about food at school, the WECHU has developed a new resource: School Nutrition Toolkit - How to Create a Supportive Food Environment at School. The toolkit provides knowledge, helpful tips, and resources to increase the capacity of educators and school administrators to create supportive food environments at school. The evidence-based strategies promoted in the toolkit are known to help students foster positive relationships with food and their own bodies, which will increase healthy eating behaviours, body image, and self-esteem. 

PREPARED BY:

Chronic Disease and Injury Prevention

DATE:

March 21, 2024

SUBJECT:

Nutrition Month and Nutrition Programming


BACKGROUND/PURPOSE

For the past 40 years, March has been celebrated as Nutrition Month across Canada. Nutrition month is a time to recognize the field of dietetics, to reflect on past practices, and to highlight nutritional needs in the community. Food and nutrition interact and intersect with almost every department within a public health unit. Public health nutrition uses population and health promotion approaches and strategies focused on the assessment, promotion, protection and enhancement of health, and the prevention of nutrition-related diseases. Public health nutrition requires the leadership of Registered Dietitians with expertise in nutrition and related public health sciences, as the field of nutrition constantly evolves and changes. Registered Dietitians ensure that best practices are consistently updated and applied to public health practice.

CURRENT INITIATIVES

Nutrition programing at the WECHU addresses barriers to achieving consistent eating behaviours with a focus on decreasing food insecurity and increasing food literacy in our community. Past and present interventions that support this work are described below. 

Nutrition Month – March 2024

To celebrate Nutrition Month, Dietitians of Canada is shining a spotlight on the dietetic profession to recognize and acknowledge the impact of dietitians nationwide. Locally, the WECHU is focusing on changing the current environment surrounding food and nutrition, through the education and promotion of using a food neutral approach to eating.

  • A newsletter and social media campaign on food neutrality was promoted throughout March. 
  • Food & Nutrition section of the WECHU website updated to reflect food neutral language change.
  • Partnered with the University of Windsor’s student food pantry to provide sessions on food neutrality and how to nourish the body with a limited budget.
  • Food neutrality online training will be released later this year, to continue to support community partners and community members in making this change.

Food Insecurity Initiatives

Food insecurity is a growing Public Health concern, because it is so tightly linked to adverse health outcomes, above and beyond the influence of other social determinants of health. 

  • Monitoring Food Affordability: WECHU continues to release food affordability surveillance data to help inform decision making in our community. 
    • The Real Cost of Eating Report was released in November of 2023.
    • After presenting the findings of the 2023 report at a local Feed Ontario event, the CDIP Nutritionist was interviewed and quoted in 9 media reports. 
    • Briefing note on food insecurity sent to Senator Burey in September of 2023.
    • Data collection for 2024 will occur in May, with report findings to be released in the fall.
  • Food Insecurity Screening: A food insecurity screening tool and associated trainings will be created by the WECHU in 2024.
    • Data on food insecurity in certain demographics is limited. 
    • Screening allows health care providers and community partners the ability to identify and support clients who are experiencing food insecurity, while providing accurate data to ensure supports are being utilized effectively. 

Food Literacy Initiatives

Food literacy impacts how easily a person can implement healthy eating behaviours. Food literacy includes interconnected attributes organized into the categories of food and nutrition knowledge; food skills; self-efficacy and confidence; food decisions; and ecologic (external) factors.

  • You Can Cook Video Series: The You Can Cook video series is a virtual food skill program that teaches basic food skills in five minutes or less. There are 15 videos in the series, with each video building on the previous skills taught as the series progresses. 
    • Since 2022 the series has had over 4,600 views between all videos, and an additional 3,700 views of the series trailer. 
    • Community partners and other Health Units in Ontario are utilizing these videos to help support food skill building with their clients, and they will continue to be promoted throughout 2024. 
  • You’re the Chef train the trainer program: Through key partner interviews, the need for hands on food skill training is high in our community. 
    • The You’re the Chef train the trainer program will be provided to community partners and teachers to facilitate their own, 6-week food-skill program. Training will occur throughout 2024.
  • Food and Mental Health: In addition to food skills training, nutrition and mental health training was highlighted as a community need. 
    • Capacity building for service providers, as well as presentations for priority populations, around building positive relationships with food and body and the intersections between diet culture and food insecurity will be delivered. 
    • This education will also work to reduce the potential harm when providing care, while creating a safe, inclusive space for all.

The registered dietitians at WECHU are committed to continuing to advocate for equitable access to food and adequate incomes, improve physical and social food environments, and enhance the local food system.

March 21st, 2024

ISSUE/PURPOSE

The Windsor-Essex County Health Unit (WECHU) administers the Healthy Babies Healthy Children Program as well as, the Pre-natal and Post-natal Nurse Practitioner Program (Collectively referred to as the Programs).  These Programs are funded entirely by the Ministry of Children, Community and Social Services (MCCSS).  The operating budget for the fiscal year April 1, 2024 to March 31, 2025, requires approval by the Board of Health prior to submission to the MCCSS. 

BACKGROUND

For fiscal 2024/25, these Programs support twenty-two and one quarter (22.25) FTEs comprised of one (1.0) manager FTE, one-quarter (0.25) director FTE, fifteen (15.0) public health nursing FTEs, one (1.0) nurse practitioner FTEs, two (2.0) family home visitor FTEs, one (1.0) social worker FTE, two (2.0) support staff FTEs.

The 2024/25 operating budget is detailed below:
Item April 1, 2024 to March 31, 2025 April 1, 2023 to March 31, 2025 Change
Salaries and benefits 2,630,513 2,778,629 -148,116
Other operating expenditures:      
  Travel 45,000 45,000 -
  Professional Development 11,673 12,770 -1,097
  Program supplies 24,765 42,642 -17,877
  Purchased Services 20,800 15,800 5,000
  Rent 162,090   162,090
Total operating expenditures 264,328 116,212 148,116
Total Budget 2,894,841 2,894,841 0

Significant changes in the operating budget include the following:

  • Net decrease in Salaries and Benefits $148,116 representing decreases of 2 family home visitor, 1 nurse and ½ of support staff. 
  • Reduction in Professional development of $1,097 – The 2024/25 fiscal year reflects a proportionate decrease of professional development in the 2023/24 fiscal year and is predicated by the reduction of FTE’s.
  • Reduction in Program Supplies of $17,877 – The fiscal 2024/25 budget contemplates a reduction in expenditures as a result of discontinuing a software for the upcoming fiscal year ($7,500) and a reduction in IT/phone hardware ($10,386).
  • Increase in Purchased services of $5,000 – The fiscal 2024/25 budget contemplates expenditures being increase due to augmented demands in translation services.
  • Increase Building occupancy of $162,090 – The fiscal 2024/25 budget contemplates expenditures being incurred on Building occupancy.
For the 2024/25 fiscal year, program metrics are forecasted as follows:
Indicators MCCSS Forecasting for April 1st, 2024, thru March 31st, 2025 MCCSS Forecasting for April 1st, 2023, thru March 31st, 2024
#of Families Served (Total of 2 or more visits): HBHC 360 500
#of Individuals Confirmed with Risk (Total): HBHC 380 325
#of Individuals Screened (total-Early Childhood): HBHC 155 180
#of Individuals Screened (Total-Postpartum): HBHC 3600 3600
#of Individuals Screened (Total-Prenatal): HBHC 55 100
# of Individuals who Received an In-depth Assessment: HBHC (nurse going into homes to confirm risk) 550 450

PROPOSED MOTION                          

Whereas, The Windsor-Essex County Health Unit receives grants from the Ministry of Children, Community and Social Services to fund the Healthy Babies Healthy Children and Pre-natal and Post-natal Nurse Practitioner Programs,

Whereas, the total budgeted expenditures for the Programs for the period April 1, 2024 to March 31, 2025 is $2,894,941, and

Now therefore be it resolvedthat the Windsor-Essex County Board of Health approve the operating budget as presented by Administration for the period April 1, 2024, to March 31, 2025.

  1. Call to Order - F. Costante, Chair (10:00am)
    1. Land Acknowledgement
      The Ciociaro Club sits on the traditional territory of the Three Fires Confederacy of First Nations, which includes the Ojibwa, the Odawa, and the Potawatomi.  As we make this land acknowledgement, it is also important that we continue to do the work to address systemic and historic injustices.
    2. Quorum​​
    3. Declaration of Conflict of Interest
  2. Board of Health 2024 Elections (4:02 pm) 
  3. Approval of Agenda (4:14 pm)
  4. Approval of Minutes: November 20, 2023
  5. Consent Agenda (for approval)
    1. Information Reports
      1. Monthly SafePoint Site Operations Update:
        1. November 2023
        2. December 2023
      2. Communications Report:
        1. November 2023
        2. December 2023
      3. Canadian Dental Care Plan           
    2. Correspondence
      1. Dr. Charles Gardner -Voluntary Mergers and Boards of Health
        Leadership – for information
  6. Presentations (10:15am) 
    1. Emergence of Nicotine Pouches (M. Aloosh) (for information) (4:15 pm)
    2. ASP 2024 (K. McBeth, E. Nadalin, L. Watson) (4:30 pm)
  7. Business Arising
  8. Committee of the Whole (Closed Session in accordance with Section 239 of the Municipal Act) (4:50pm)
  9. Resolutions/Recommendation Reports (11:00am)
    1. Emergence of Nicotine Pouches (for approval)  (M. Aloosh)
  10. New Business
    1. CEO Report (K. Blanchette) (for information) - verbal (5:55 pm)
  11. Next Meeting:  At the Call of the Chair, or March 21, 2024
  12. Adjournment

December 1, 2023

Dr. Kieran Moore,
Chief Medical Officer of Health,
Box 12,
Toronto, ON M7A 1N3

Dear Dr. Moore,

Re: Voluntary Mergers and Boards of Health Leadership

On behalf of the Association of Local Public Health Agencies (alPHa) and its Council of Ontario Medical Officers of Health, Boards of Health Section and Affiliate Associations, we are writing to provide advice on the voluntary mergers component of the Strengthening Public Health initiative that is currently underway.

We agree with your statement that, where it makes sense to do so, voluntary mergers  have the potential to address longstanding challenges in the public health system and improve optimization and coordination. We also appreciate the efforts that you have made to share information and discuss the process through meetings with local public health leadership over the past month.

Recognizing the aggressive timelines that have been imposed on this process, we are also cognizant of the fact that engagement opportunities are important for all parties, so it makes sense to use existing channels between your office and the medical leadership (e.g., the Public Health Leadership Table) and meetings with local public health staff via the regional engagement structures to drive the process forward. Our members have, however, identified targeted consultation with boards of health as a gap.

Mergers of this nature are fundamentally a governance issue and must be planned and executed by those with the authority to do so, grounded in the knowledge of the needs of the communities they serve. The final decisions will be made by local boards of health, so it is imperative there is direct and specific ongoing engagement and meaningful dialogue with local boards that includes information, clarity of process, and expectations so that they    are properly equipped with the information they need to make decisions on the future of local public health.

Although there are differences in the structures of Ontario’s local boards of health, it is important to acknowledge they will all be affected by the outcomes of this process. There are boards that are considering it, boards that are well into discussions, and boards that will remain as they are but nonetheless be subject to ripple effects of neighbouring mergers. The implications are too numerous to outline here, but there is a wealth of expertise and experience to draw upon from each group, which will be of tremendous benefit to the others.

We are therefore strongly recommending that you consider the development of a comprehensive strategy for direct engagement and dialogue with boards of health, as a whole and individually, that recognizes their primary authority in following through on new partnerships, taps into existing expertise at the local level, and ensures that all of the complexities and consequences of such an undertaking are fully addressed. alPHa would be pleased to work with you in this regard through our Boards of Health Section.

We look forward to working with you and would like to request an opportunity to meet with you and your staff. To schedule a meeting, please have your staff contact Loretta Ryan, Executive Director, alPHa, at loretta@alphaweb.org or 647-325-9594.

Sincerely,

Dr. Charles Gardner, President

Copy:    Hon. Sylvia Jones, Minister of Health, Deputy Premier
Elizabeth Walker, Executive Lead, Office of the Chief Medical Officer of Health
Colleen Kiel, Director, Public Health Strategic Policy, Planning & Communications Branch
 

PREPARED BY:

Communications Department

DATE:

November 21, 2023

SUBJECT:

October 15, 2023 – November 14, 2023, Communications Update


BACKGROUND/PURPOSE:

Provide regular marketing and communication updates to the Board of Health.

SOURCE October 15 - November 14 September 15 - October 14 DIFFERENCE
News Releases, Media Advisories and Statements, or Notices Issued 1 6 -5
Media Requests Received 8 11 -3
Wechu.org pageviews* 135,260 127,528 7,732
YouTube Channel Subscribers 1,748 1,744 4
Email Subscribers 7,222 7,242 -20
Emails Distributed 7 12 -5
Facebook Fans 19,191 19,176 15
Facebook Posts 64 60 4
Twitter Followers 8,643 8,652 -9
Twitter Posts 71 58 13
Instagram Followers 1,609 1,605 4
Instagram Posts 43 33 10
LinkedIn Followers 1,606 1,641 -35
LinkedIn Posts 15 18 -3
Media Exposure 41 101 -60

Data Notes can be provided upon request

Media Exposure Overview Graph

Media exposure overview chart

Notes: From October 15 – November 14, we experienced one large peak, and a handful of smaller peaks of exposure:

Oct. 16 – We saw a spike in media coverage following a news release confirming the first human case of West Nile Virus in Windsor-Essex County.  

Nov. 8 – 10 – Across these dates, a variety of stories were covered in the media including an event for the public to properly dispose of old medications, radon awareness, and the start of stories around the provincial pause on Consumption and Treatment Service site proposal reviews.

Nov. 13 – On this date, high media coverage was related to the Consumption and Treatment Service site proposal pause, and a news release issued by the WECHU regarding the Immunization of School Pupils Act and the current number of out-dated records locally.


Website Overview Graph

Website overview chart

Notes: During the timeframe of October 15 – November 14, we saw very similar website traffic patterns as the previous month. 


Social Media Overview Graph

Social media overview chart

Lighter blue line represents the current month, darker blue line represents the previous month. 
Note: We saw a drop in Followers on LinkedIn, which occurred on a specific day. This is assumed to have been a clean-out of the platform of spam accounts.


DISCUSSION

The Communications Department worked with the Chronic Disease & Injury Prevention team on a series of boosted social media posts, as well as digital and radio ads for Mental Health Awareness Month, taking place in October. 

While some of the components are still in market, the social media campaign has proved successful. The goal of these posts was to drive traffic to the website, specifically to a page of mental health support resources or a page of mental health education and promotion. In total, the boosted posts have reached 32,641 accounts, and have resulted in 676 link clicks.

BACKGROUND

Overview

  • SafePoint opened on April 26th, 2023, serving clients 7 days per week between the hours of 10:00 a.m. – 
    6:00 p.m. daily.
  • In order to ensure transparency related to SafePoint operations, the Board of Health is provided with regular updates.

Application Status

  • As of January 2024, the WECHU’s pending application to the province to fund SafePoint as a Consumption and Treatment Services (CTS) site remains on-hold. 
  • As no timeline has been provided for the removal of the hold on the WECHU’s application, operations at SafePoint were paused effective January 1st of 2024. 

CURRENT INITIATIVES

Operational Data

SafePoint operated for a period of eight months, recording a total of 1,257 client visits amongst 248 unique clients. Additional details about the services provided at SafePoint during the month of December are presented in Tables 1-4. 

Table 1.   
Brief overview of unique clients at SafePoint over the period of December 1st to December 31st.

Total Unique Clients: 33

Demographic

Number of Unique Clients

Age

Under 25

1

 

25-64

30

 

65+

0

Gender

Man

25

 

Woman

6

  Not list 0

Race

White

28

 

Black, African, or Caribbean

1

  Arabic 1
  Filipino 1

Table 2.   
Brief overview of client visits at SafePoint over the period of December 1st to December 31st.

Total Number of Client Visits: 215

Indicator

Number of Visits

Visit by Time of Day

10:00 – 11:59 a.m.

55

 

12:00 – 2:59 p.m.

88

 

3:00 – 6:00 p.m.

72

Type of Visit

Consumption

83

  Other 132

Consumption Visits Reported

Crystal methamphetamine

40

  Morphine 3
  Fentanyl 23
  Ritalin 10
  Speedball Crystal/Fentanyl 6
  Carfentanyl 1

Consumption Visits by Method of Consumption

Injection

83

  Intranasal 1
  Oral 0
Table 3. 
Brief overview of other services provided at SafePoint over the period of December 1st to December 31st, 2023.

Total Number of Client Visits: 215

Indicator

Number of Times Service Offered

Drug Checking

On-site fentanyl drug checking

3

Basic Care

First aid

7

  Wound/abscess 92
  Foot care 2

Wraparound Services

 

On-site

Referral

 

Addictions treatment

0

4

 

Mental health

12

6

 

Primary care

40

20

  Social services 204 13

Table 4. Brief overview of on-site overdoses reported over the period of December 1st to December 31st, 2023.

Total Number of Overdoses: 2

Indicator 

Number of Overdoses 

Overdoses Treated On-Site 

1

Overdose Treatments Used 

Naloxone and Oxygen/Stimulation

1

Overdoses Resulting in a Death at Safepoint

0

Overdoses Where 9-1-1 Was Called

1

Overdoses That Resulted in a Transport to the Emergency Department for Treatment 

1


Client Experience Narrative

Beyond the number of client visits recorded in the month of December, SafePoint continues to demonstrate that the services being offered are having a positive impact on clients, as highlighted through the following client experience narrative:

Anonymous Client

An individual walking by SafePoint knocked on the entrance door and was brought into the site by staff. The individual informed staff that they felt like they may be “going down” (i.e., experiencing an overdose) and asked for a naloxone kit. After receiving the kit, the individual proceeded to administer naloxone on themselves and staff monitored them afterwards to support their recovery.

NEXT STEPS AND FUTURE INITIATIVES

The WECHU, in collaboration with the SafePoint Advisory Committee, prepared and implemented a mitigation plan for the pause in services to support clients and the community throughout the period of transition. Strategies implemented through the plan were as follows: 

  • Staff at SafePoint met with clients individually over the course of December to create plans for their care while services are paused and to support connections to other community agencies as needed. Clients were also provided with information about alternative harm reduction strategies and supports that they can continue to use during the disruption. 
  • The WECHU connected with multiple community partners towards the end of 2023 to establish connections and increase accessibility to other health and social services in the area that clients can continue to use during the disruption. A list of these services was developed and posted to the SafePoint web page for the community to access: www.wecoss.ca/cts
  • The WECHU developed plans in collaboration with Family Services Windsor-Essex (FSWE) to increase the availability of outreach supports in the areas surrounding SafePoint in the early months of 2024. The Mobile Outreach Support Team (MOST) van will be making nightly stops near SafePoint until the end of March to look out for those seeking the services of SafePoint and to provide harm reduction supplies and referrals to community services. Other relevant outreach strategies are also in development in partnership with FSWE’s Housing Outreach Workers. 
  • Community partners involved in the Windsor-Essex Community Opioid and Substance Strategy were provided with a key messaging document to support conversations with their clients who use SafePoint about the pause in services. Partners were also encouraged to promote the National Overdose Response Service (https://www.nors.ca/) to anyone who might benefit from the services of a virtual safer consumption hotline.
  • Messaging about the pause in operations and the other services available for support was also shared with those subscribed to the SafePoint email subscription list. Moving forward, this list and the SafePoint web page will continue to be maintained by the WECHU to share updates with the community about the site. To subscribe to SafePoint emails, individuals can visit www.wecoss.ca/cts. The SafePoint email inbox (CTSQuestions@wechu.org) will also continue to be monitored by the WECHU to respond to questions and concerns from the community.

While services are paused, ongoing communication will be maintained with the Ministry of Health for updates regarding the status of the WECHU’s CTS application, provincial funding, and a potential 
re-opening under the CTS model. The legal exemption required from Health Canada to operate SafePoint under this model was secured in July of 2023. 

BACKGROUND

Overview

  • SafePoint has been open since April 26th, 2023, serving clients 7 days per week between the hours of 10:00 a.m.  6:00 p.m.
  • In order to ensure transparency related to SafePoint operations, the Board of Health is provided with regular updates.

Application Status

  • As of December 2023, the WECHU’s pending application to the province to fund SafePoint as a Consumption and Treatment Services (CTS) site remains on-hold.
  • As no timeline has been provided for the removal of the hold on the WECHU’s application, operations at SafePoint will be paused effective January 1st of 2024.

CURRENT INITIATIVES

Operational Data

It has been seven months since SafePoint opened on April 26th and there has been a total of 1042 client visits and 217 unique clients to date, with 3 overdoses reported and treated on-site. Additional details about the services provided at SafePoint during the month of November are presented in Tables 1-4. 

Table 1.   
Brief overview of unique clients at SafePoint over the period of November 1st to November 30th.

Total Unique Clients: 35

Demographic

Number of Unique Clients

Age

Under 25

5

 

25-64

30

 

65+

0

Gender

Male

21

 

Female

14

  Gender not listed 0

Race

White

29

  Indigenous 2

 

Black, African, or Caribbean

3

  Race not listed 1

Table 2.   
Brief overview of client visits at SafePoint over the period of November 1st to November 30th.

Total Number of Client Visits: 183

Indicator

Number of Visits

Visit by Time of Day

10:00 – 11:59 a.m.

54

 

12:00 – 2:59 p.m.

55

 

3:00 – 6:00 p.m.

74

Type of Visit

Consumption

93

  Other 90

Consumption Visits Reported

Crystal methamphetamine

30

  Morphine 3
  Dilaudid 3
  Fentanyl 32
  Ritalin 18
  Speedball Crystal/Fentanyl 7

Consumption Visits by Method of Consumption

Injection

92

  Intranasal 2
  Oral 0
Table 3. 
Brief overview of other services provided at SafePoint over the period of November 1st to November 30th, 2023.

Total Number of Client Visits: 183

Indicator

Number of Times Service Offered

Drug Checking

On-site fentanyl drug checking

3

Basic Care

First aid

17

  Wound/abscess 40
  Foot care 2

Wraparound Services

 

On-site

Referral

 

Addictions treatment

0

3

 

Mental health

0

6

 

Primary care

33

17

  Social services 163 7

Table 4. Brief overview of on-site overdoses reported over the period of November 1st to November 30th, 2023.

Total Number of Overdoses: 3

Indicator 

Number of Overdoses 

Overdoses Treated On-Site 

3

Overdose Treatments Used 

Naloxone Only

0

Oxygen Stimulation Only 2
Naloxone and Oxygen/Stimulation 1

Overdoses Resulting in a Death at Safepoint

0

Overdoses Where 9-1-1 Was Called

1

Overdoses That Resulted in a Transport to the Emergency Department for Treatment 

0


Client Experience Narrative

Beyond the number of client visits recorded in the month of November, SafePoint continues to demonstrate that the services being offered are having a positive impact on clients, as highlighted through the following client experience narrative:

Anonymous Client

A client was dropped off at SafePoint by their friends for wound care services. The client did not want to use other health services because of percieved poor treatment in the past. The friend did not return to pick up the client, so staff arranged for a taxi to bring the client back to a local shelter.

NEXT STEPS AND FUTURE INITIATIVES

  • The WECHU is collaborating with its community partners to prepare for the service disruption, aiming to minimize impacts on clients as effectively as possible.
  • SafePoint services will continue to be available daily from 10:00 a.m. – 6:00 p.m., up until December 31st  at 6:00 p.m. During this period, SafePoint staff will be meeting with clients to create plans for their care while services are paused and to support connections to other community agencies as needed.
  • The SafePoint Advisory Committee has also prepared a mitigation plan for the pause in services, which identifies several strategies that will be implemented to support clients during this period of transition. The mitigation plans will be shared with the community to ensure that clients, partners, and other affected stakeholders are aware of the strategies and supports in place.
  • While services are paused, the WECHU will continue to communicate updates about SafePoint to the community as new information becomes available. To stay informed, community members can subscribe to receive email updates at www.wecoss.ca/cts. The SafePoint website will remain up-to- date with current information and the online feedback form and SafePoint email (CTSQuestions@wechu.org) will continue to be monitored by the WECHU to address questions and concerns from the community.

PREPARED BY:

Communications Department

DATE:

November 21, 2023

SUBJECT:

November 15, 2023 – December 14, 2023, Communications Update


BACKGROUND/PURPOSE:

Provide regular marketing and communication updates to the Board of Health.

SOURCE November 15 - December 14 October 15 - November 14 DIFFERENCE
News Releases, Media Advisories and Statements, or Notices Issued 3 1 2
Media Requests Received 22 8 14
Wechu.org pageviews* 111,975 135,260 -23,285
YouTube Channel Subscribers 1,752 1,748 4
Email Subscribers 7,202 7,222 -20
Emails Distributed 3 7 -4
Facebook Fans 19,196 19,191 5
Facebook Posts 61 64 -3
Twitter Followers 8,647 8,643 -4
Twitter Posts 61 71 -10
Instagram Followers 1,621 1,609 12
Instagram Posts 38 43 -5
LinkedIn Followers 1,625 1,606 19
LinkedIn Posts 3 15 -12
Media Exposure 77 41 36

Data Notes can be provided upon request

Media Exposure Overview Graph

Media exposure overview chart

Notes: From November 15 – December 14, we experienced three main peaks of exposure:

Nov. 20 – We saw a spike in media coverage following the Board of Health meeting in which the announcement of the pause in services offered at SafePoint was made.

Dec. 1 – Media coverage on this date was focused on the media statement released regarding the changes to staff at the Windsor-Essex County Health Unit following the approved budget for 2024.  

Dec. 12 – On this date, high media coverage was related to the news release issued around Essex Fire and Rescue Services joining the Ontario Naloxone Program.


Website Overview Graph

Website overview graph

Notes: During the timeframe of November 15 – December 14, we saw very similar website traffic patterns as the previous month, with no notable spikes in traffic. 


Social Media Overview Graph

Social media overview graph

Lighter blue line represents the current month, darker blue line represents the previous month. Notes: Overall, our social media followers stay consistent, with gradual increases across the monthly timespan. 


DISCUSSION

Notable project - Nov - Dec 2023

The Communications Department completed a Social Media Audit for 2023 to serve as a benchmark for future years. The audit collected various metrics from organic social media posts on our four platforms (i.e., Facebook, X, Instagram, and LinkedIn). Metrics were collected quarterly, providing a succinct overview of followers, posts released, and various forms of engagement with our audience. 

The audit will allow the department to monitor changes on our platforms which can inform how we utilize each platform moving forward. For example, the 2023 audit revealed a steady growth in our followers on Facebook over the year, supporting our approach to prioritize this platform as our main social media outreach channel. 

As social media platforms evolve, so will the audit template. This information will guide our communication tactics to take full advantage of these channels to maximize public messaging. 

PREPARED BY: Oral Health Department

DATE: January 18th, 2024

SUBJECT: Canadian Dental Care Plan (CDCP)


BACKGROUND/PURPOSE

In early 2022, the federal government announced plans to enhance access to dental care for Canadian families with annual household incomes of less than $90,000 through the Canadian Dental Care Plan (CDCP).   One of the main objectives of the CDCP is to help bridge the gap in accessing dental care for priority populations across Canada. By providing financial support to Canadian residents who don’t have access to private dental insurance, the CDCP allows at-risk individuals including children, persons with disabilities and seniors to access affordable dental care.

DISCUSSION

On December 11th, 2023, the federal government announced the launch of the second stage of the phased model, outlining the application and implementation process for Seniors 65 and older. 

Service Canada will begin to accept applications in the phases outlined below.
Age Group Application Opens
Seniors aged 87+ December 2023
Seniors aged 77-86 January 2024
Seniors aged 72-76 February 2024
Seniors aged 70-71 March 2024
Seniors aged 65-69 May 2024

The third phase of the model is anticipated to launch in June 2024, with applications opening at that time for persons with a valid disability tax credit certificate and children under 18. Ultimately, this program will be accessible to all Canadians who meet the below eligibility criteria:

  • Have no access to private dental insurance. 
  • Have an annual adjusted family net income of under $90,000.
  • Be a Canadian Resident.
  • Filed their income tax return in the previous year.

Those covered under the CDCP may start seeing Oral Health providers for care as early as May 2024 in local dental offices who enroll as participating treatment providers. Depending on the adjusted family net income of the applicant, some CDCP members making over $70,000/year will be required to make a co-payment for their care.

While clients with private dental insurance will not have access to the CDCP, those on previously established provincial, territorial, or federal social programs are still eligible. This includes the Ontario Seniors Dental Care Program (for eligible seniors 65 years and older) and Healthy Smiles Ontario Program (for eligible children and youth under the age of 18) which are operated by the Windsor-Essex County Health Unit (WECHU) locally. To address the potential overlap in services, the Ontario Association for Public Health Dentistry (OAPHD) has advocated for the following considerations from the federal government to avoid overlaps in services and care:

  1. Streamline the coordination of all public dental programs to ensure simple and accessible processes for both patients and providers.
  2. Build the capacity of the health and social system to improve oral health access and health equity.
  3. Safeguard and sustain the capacity of oral health care through a mixed model system.
  4. Promote wider participation by ensuring oral health professionals receive fair and equitable payments for oral health services across public programs.
  5. Include a strong communication strategy and knowledge plan to enhance public and provider understanding and navigation of federal and provincial programs.
  6. Foster relationships across levels, sectors, and communities to strengthen collaborative health care that includes oral health.
  7. Continue to invest in Public Health to provide upstream health and oral services to all Ontarians.
  8. Administer an effective oral health data framework and evaluation plan that measures and reports on process, quality of care, and outcomes.

The federal government has expressed that they are in dialogue with provincial and territorial ministries regarding their coordination of the CDCP. Additional information is expected to be released in January 2024. 

Steps toward Limiting Nicotine Addiction in Youth;
Local, Provincial, and Federal Restrictions on Nicotine Pouches

Date: Thursday, January 18th, 2024


ISSUE/PURPOSE

The recent availability of Nicotine Pouches under the brand name “Zonnic” has triggered widespread concern from health organizations across Canada, including the Canadian Cancer Society, Heart and Stroke, and the Canadian Lung Association, who have issued calls for immediate federal action to regulate their sale to youth (von Stackelberg, 2023). Health Canada has approved the products under their Natural Health Products designation as a Nicotine Replacement Therapy (NRT) which can be used to quit smoking. Each package contains either 10 or 24 pouches with each pouch contains up to 4mg of nicotine, the equivalent of up to 2 cigarettes (Marsh, 2023). 

Nicotine is highly addictive and has permanent adverse effects on the developing brains of youth and concerns regarding the nicotine pouches are rooted in their marketing and distribution approach being attractive to young people. An approach which includes attractive colours and targeted promotions, fruity flavouring which includes sweeteners, and a lack of regulations which makes it legal for children and youth to purchase these products. The similarities in purpose, advertising, and the range of flavors offered by nicotine pouches relative to the already popular vaping products poses a significant risk of sparking a trend comparable to rapid uptake of vaping amongst youth. 

BACKGROUND

Nicotine pouches were approved for sale in Canada on July 18, 2023 as a Natural Health Product. The nicotine pouches are currently outside the scope of the federal Tobacco and Vaping Products Act (TVPA) and the provincial Smoke-free Ontario Act (SFOA) 2017 which regulate tobacco and vaping products by restricting their advertisement, display, and public use. As a result, the nicotine pouches are currently being sold at convenience stores and gas stations, placed alongside items such as candy and chips. The pouches are sold in vibrant packaging and various sweet and fruity flavours which are attractive to younger populations. 

The recent growth in popularity of vaping products serves as an example of the importance of moving quickly to mitigate the risk of these new products (University of Waterloo & Brock University, 2023). Although research on the health effects of using nicotine pouches is still emerging, the effects of using oral NRTs include mouth ulcers, mouth and throat soreness, and coughing (M. Jackson et al., 2023). For youth and young adults who develop a dependence on nicotine, lasting negative impacts on the cognitive abilities, growth, and development can also occur (Stein et al., 1998; Ren & Lotfipour, 2019). Most concerningly, given the highly addictive nature of nicotine, dependence can lead to further use of vaping product, tobacco products, or other drugs (Leslie, 2020). 

The Windsor-Essex County Health Unit (WECHU) has consistently engaged businesses, school administrators, students, parents, and municipalities to inform these groups about the health consequences of tobacco and vaping and has worked closely with them to develop policies, and enforce provincial regulations pertaining to smoking and vaping in public areas. The WECHU is committed to working closely with these same partners to better understand the best ways to keep residents, in particular young people, safe from these products however, until such time that a regulatory framework is established at the federal and provincial levels it is possible that the uptake of these products in Windsor and Essex County will escalate in a similar manner to vaping products. 

PROPOSED MOTION

Whereas, Health Canada has approved Nicotine Pouches for sale under a Natural Health Product designation which does not provide restrictions on advertising or sale to minors; and

Whereas, there is no evidence to demonstrate the efficacy of Nicotine pouches as a smoking cessation aid; and

Whereas, the emergence of nicotine pouch products produced by Imperial Tobacco Canada, under the brand name “Zonnic” has occurred rapidly without the same regulations applied to other nicotine products; and

Whereas, the marketing and accessibility of Zonnic Pouches raises concerns regarding its appeal to youth populations; and

Whereas, the Nicotine Pouches fall outside existing provincial regulations on tobacco and vaping products; and

Whereas, there are significant concerns regarding the risks to youth and young adults who do not smoke and parallels between nicotine pouch use and vaping.

Now therefore be it resolved that the Windsor-Essex County Board of Health strongly encourages the federal government to take immediate action to close the regulatory gap that permits the sale of nicotine pouches to people under the age of 18; and

FURTHER THAT, the Windsor-Essex County Board of Health strongly encourages the province of Ontario to take immediate action to embed restrictions on the sale, display, and promotion of nicotine pouches under the provincial Smoke-free Ontario Act, 2017; and 

FURTHER THAT, the Windsor-Essex County Health Unit works closely with local municipalities to review tobacco/vape-free public place bylaws to include additional nicotine products; and

FURTHER THAT, the Windsor-Essex County Health Unit works closely with local schools and boards to update policies to ensure products like nicotine pouches, and other emerging products that are tobacco or nicotine related are prohibited on school property.


References

Government of Canada, & Health Canada. (2004, July 26). Natural Health Products Ingredients Database. Webprod.hc-Sc.gc.ca. https://webprod.hc-sc.gc.ca/nhpid-bdipsn/ingredReq.do?id=1518&lang=eng

Health Canada. (2023, October 17). Product information. Health-Products.canada.ca. https://health-products.canada.ca/lnhpd-bdpsnh/info?licence=80125630

Leslie, F. M. (2020). Unique, long-term effects of nicotine on adolescent brain. Pharmacology Biochemistry and Behavior, 197(173010), 173010. https://doi.org/10.1016/j.pbb.2020.173010

M. Jackson, J., Weke, A., & Holliday, R. (2023). Nicotine pouches: a review for the dental team. British Dental Journal, 235(8), 643–646. https://doi.org/10.1038/s41415-023-6383-7

Marina von Stackelberg. (2023, November 15). National health groups call on Ottawa to prevent sales of nicotine pouches to children. CBC. https://www.cbc.ca/news/politics/restrictions-nicotine-pouches-1.7028297

Marsh, S. (2023, June 23). How much nicotine is in a cigarette compared to a vape? The Guardian. https://www.theguardian.com/society/2023/jun/23/how-much-nicotine-is-in…

OSDUHS. (2021). The Ontario Student Drug Use and Mental Health Survey (OSDUHS). CAMH. https://www.camh.ca/-/media/files/pdf---osduhs/2021-osduhs-report-pdf.p…

Ren, M., & Lotfipour, S. (2019). Nicotine Gateway Effects on Adolescent Substance Use. The Western Journal of Emergency Medicine, 20(5), 696–709. https://doi.org/10.5811/westjem.2019.7.41661

Stein, E. A., Pankiewicz, J., Harsch, H. H., Cho, J. K., Fuller, S. A., Hoffmann, R. G., Hawkins, M., Rao, S. M., Bandettini, P. A., & Bloom, A. S. (1998). Nicotine-induced limbic cortical activation in the human brain: a functional MRI study. The American Journal of Psychiatry, 155(8), 1009–1015. https://doi.org/10.1176/ajp.155.8.1009

University of Waterloo, & Brock University. (2023). COMPASS: Windsor-Essex County Health Unit.

WECHU. (n.d.). Smoking and Vaping | The Windsor-Essex County Health Unit. Www.wechu.org. Retrieved December 13, 2023, from https://www.wechu.org/school-health/substance-use/smoking-and-vaping#:~…