January 2024 Board of Health Meeting

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
 

BACKGROUND

Overview

• SafePoint opened on April 26^th, 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 1^st 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. 

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. 

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:

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

BACKGROUND/PURPOSE:

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

Data Notes can be provided upon request

Media Exposure Overview Graph

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

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

Social Media Overview Graph

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.

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.

Data Notes can be provided upon request

Media Exposure Overview Graph

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

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

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

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 18^th, 2024

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 11^th, 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. 

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. 

Board Members Present:

Dr. Mark Awuku, Joe Bachetti, Fabio Costante, Fred Francis, Michael Horrobin,
Dr. Sardar Khan, Judy Lund, Hilda MacDonald, Robert Maich, Angelo Marignani,  Michael Prue, Rob Shepley

Board Member Regrets:

Renaldo Agostino

Administration Present:

Dr. Mehdi Aloosh, Dr. Ken Blanchette, Kristy McBeth, Eric Nadalin, Dan Sibley, Linda Watson, Konrad Farrugia (recorder)

WECHU Guests:

William Willis (Willis Law)

RECORDING SECRETARY: K. Farrugia

SUBMITTED BY: K. Blanchette

APPROVED BY: WECHU Board of Health

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

Date: Thursday, January 18^th, 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#:~…