November 2023 Board of Health Meeting

October 27, 2023

VIA ELECTRONIC MAIL

Honourable Chrystia Freeland
Deputy Prime Minister and Ministry of Finance

Honourable Jenna Sudds
Ministry of Families, Children and Social Development

Honourable Lawrence MacAulay
Ministry of Agriculture and Agri-Food

Honourable Jean-Yves Duclos
Ministry of Public Services and Procurement

Dear Federal Ministers Freeland, Sudds, MacAulay, and Duclos:

Re: Support for a Funded Healthy School Food Program in Budget 2024 (Federal)

At its meeting on October 19, 2023, the Board of Health for Public Health Sudbury & Districts carried the following resolution #61-23:

WHEREAS a universal publicly funded student nutrition program can positively impact students’ nourishment, health and well-being, behaviours and attitudes, school connectedness, and academic success; and

WHEREAS the current provincial student nutrition program strives to offer a breakfast, snack, and/or lunch to students each school day, but not all schools have adequate financial and human resources to offer them; and

WHEREAS the annual monitoring of food affordability in Sudbury and districts demonstrates that some families may struggle to purchase food, and a universal fully-funded student nutrition program can help to ensure no child is left out of the program due to their family’s ability to pay; and

WHEREAS the Board of Health for Public Health Sudbury & Districts passed motion 02-20 supporting a universal publicly funded healthy school food program; and

WHEREAS although the Ontario government recently announced an additional $5 million this year in the provincial Student Nutrition Program and the First Nations Student Nutrition Program, more support is needed to ensure a fully-funded universal student nutrition program; and

WHEREAS the federal government announced its commitment to work toward the creation of a National School Food Policy to help Canadian communities access healthy food in the Food Policy for Canada; and

WHEREAS the Ontario Public Health Standards requires boards of health to support and participate with other partners in advancing school food policy and programming using population health assessment and surveillance, policy development; and

THEREFORE BE IT RESOLVED THAT the Board of Health for Public Health Sudbury & Districts support the recommendations submitted by the Coalition for Healthy School Food to the Government of Canada as part of advance consultations for Budget 2024:

Allocate $1 billion over five years and collaborate with provinces, territories, and Indigenous partners to provide them with an initial $200 million as soon as possible to fund existing school food programs; and

Create a separate School Food Infrastructure Fund grants program of, at minimum, $50 million; and

Negotiate independent School Food Policy agreements with First Nation, Inuit and Métis leadership to ensure long-term and sustainable funding for Indigenous school nutritious meal programs; and

THAT the Board calls on the Federal Minister of Families, Children and Social Development for investment in healthy school food in Budget 2024, as presented in the House of Commons’ online e-4586 (Food and drink); and

FURTHER THAT The Board share this motion with relevant stakeholders, including Ontario Boards of Health and the Association of Local Public Health Agencies (alPHa).

Currently, Canada is the only G7 country without a national school food program in place. In Ontario, the current student nutrition program faces inconsistent year-to-year funding, posing barriers to stability and sustainability and impacting full implementation of the program, such that all students can benefit from proper nourishment. The patchwork of funding sources compromises the quantity and quality of food served, and the availability of adequate infrastructure and human resources to offer a student nutrition program where all children are able to benefit from.

In the Food Policy for Canada, the Government of Canada announced the intention to “engage with provinces, territories, and key stakeholder groups to work toward the creation of the National School Food Program”i. Despite this intention, there was no financial commitment made to establish a National School Food Program in the 2023 federal budget.

The Board of Health is pleased to join many leaders from across Canada in supporting a publicly funded universal school food program model that can positively impact student’s nourishment, health and wellbeing, behaviours and attitudes, school connectedness, and academic success. The proposed universal program model with leadership by Canada, and Ontario’s Ministries would enable all students to have the equal opportunity to eat healthy meals at school everyday, and that no child is left out due to their family’s ability to pay.

Thank you for your attention on this important issue. Given the impact of nutrition related children’s health and wellbeing, we trust you will advance this work quickly and so that no child is left out.

Sincerely,

Penny Sutcliffe, MD, MHSc, FRCPC
Medical Officer of Health and Chief Executive Officer

cc: Honourable Michael Parsa, Minister of Children, Community and Social Services
Honourable Stephen Lecce, Minister of Education
Honourable Sylvia Jones, Deputy Premier of Ontario, Minister of Health
Jamie West, Local Member of Provincial Parliament, Sudbury
France Gélinas, Local Member of Provincial Parliament, Nickel Belt
Michael Mantha, Local Member of Provincial Parliament, Algoma-Manitoulin-Kapuskasing
Viviane Lapointe, Local Member of Parliament, Sudbury
Marc Serré, Local Member of Parliament, Nickel Belt
Carol Hughes, Local Member of Parliament, Algoma-Manitoulin-Kapuskasing
Bruce Bourget, Director of Education, Rainbow District School Board
Danny Viotto, Director of Education, Huron Superior Catholic District School Board
Joanne Bénard, Director of Education, Sudbury Catholic District School Board
Lesleigh Dye, Director of Education, District School Board Ontario North East
Lucia Reece, Director of Education, Algoma District School Board
Paul Henry, Directeur de l’éducation, Conseil scolaire catholique Nouvelon
Sébastien Fontaine, Directeur de l’éducation, Conseil scolaire public du Grand Nord de l’Ontario
Sylvie Petroski, Directrice de l’éducation, Conseil scolaire catholique de district des Grandes Rivières
Debbie Field, Coalition for Healthy School Food
Carol Dodge, Executive Director, Better Beginnings Better Futures
Ontario Boards of Health

November 9, 2023

Fabio Costante, Board of Health Chair
Dr. Kenneth Blanchette, Chief Executive Officer
Windsor-Essex County Health Unit
1005 Ouellette Avenue
Windsor, ON
N9A 4J8

Re: Investing in a Sustainable Federal School Food Policy

Dear Chair Costante and Dr. Blanchette,

At the October 19, 2023 meeting, under Correspondence item d), the Middlesex-London Board of Health moved to endorse the following item:

Date: September 21, 2023
Topic: Investing in a Sustainable Federal School Food Policy
From: Fabio Costante, Board of Health Chair and Dr. Kenneth Blanchette, Chief Executive Officer, Windsor-Essex County Health Unit
To: Honourable Federal Ministers Freeland, Sudds, MacAulay and Duclos

The Middlesex-London Board of Health received a report in April 2023 titled “Monitoring Food Affordability and Implications for Public Policy and Action”. This report noted that local food affordability monitoring is a requirement of the Ontario Public Health Standards. It also provided an update on the Middlesex-London Health Unit’s 2022 Nutritious Food Basket survey results, which demonstrate that incomes, particularly when dependent on social assistance, are not adequate for many Middlesex-London residents to afford basic needs, and that food insecurity has a pervasive impact on health; and there is a need for income-based solutions.

A federal school food policy would support students in the Middlesex-London region, while also supporting families of those students navigating financial strain and inflation while purchasing food at the grocery store. It is noted that the correspondence from Windsor-Essex County Health Unit highlights that public health and many school communities do not have resources to support food programs at schools. The Middlesex-London Health Unit supports our colleagues from Windsor-Essex in advocating for a federal school food program that includes the following aspects:

• Serve tasty, nourishing, culturally appropriate foods;
• Ensure that ALL students in a school can access the program in a non-stigmatizing manner;
• Be a cost-shared model, including federal support;
• Be flexible and locally adapted to the context of the school and region, including commitment to Indigenous control overprograms for Indigenous students;
• Support Canadian farmers and local food producers;
• Provide conflict of interest safeguards that prevent programs from marketing to children; and
  Promote food literacy.

The Middlesex-London Board of Health supports the Windsor-Essex County Health Unit in advocating to the federal government for a federal school food policy for a universal, cost-shared school food program in schools. To view more resources, please visit the Middlesex-London Health Unit’s website page regarding Food Access in Schools.

Sincerely,

Matthew Newton-Reid
Board Chair
Middlesex-London Health Unit

Dr. Alexander Summers MD, MPH, CCFP, FRCPC
Medical Officer of Health
Middlesex-London Health Unit

Emily Williams BScN, RN, MBA, CHE
CEO, Secretary and Treasurer
Middlesex-London Health Unit

CC: Honourable Chrystia Freeland, Deputy Prime Minister
Honourable Mark Holland, Minister of Health
Honourable Jenna Sudds, Minister of Families, Children and Social Development
Honourable Lawrence MacAulay, Minister of Agriculture and Agri-Food
Honourable Jean-Yves Duclos, Minister of Public Services and Procurement
Board Member Skylar Franke

October 27, 2023

VIA ELECTRONIC MAIL

The Honourable Doug Ford
Premier of Ontario

The Honourable Sylvia Jones
Minister of Health

The Honourable Michael Tibollo
Associate Minister of Mental Health and Addictions

Dear Premier Ford and Provincial Ministers Jones and Tibollo:

Re: Public Health Strengthening and Chronic Disease Prevention

On behalf of the Board of Health for Public Health Sudbury & Districts, please accept this correspondence highlighting our commitment to health promotion and chronic disease prevention.

At its meeting on October 19, 2023, the Board of Health carried the following resolution #60-23:

WHEREAS the Board of Health for Public Health Sudbury & Districts is committed to ensuring it addresses the public health needs and health equity in its catchment area, as aligned with board of health requirements under the Health Protection and Promotion Act and Ontario Public Health Standards; and

WHEREAS Health Promotion Ontario’s White Paper on the Value of Local Health Promotion in Ontario recommends strong and sustained investment in local health promotion by public health units to ensure that health promotion is prioritized on an ongoing basis; and

WHEREAS the Board recognizes that there are opportunities for system improvements as part of the review of board roles and responsibilities announced under the government’s Public Health Strengthening initiative, including an assessment of its role in chronic disease prevention though health promotion interventions; and

WHEREAS chronic diseases are mostly preventable, are the cause of 75% of deaths in Ontario, and incur $10.5 billion in direct health care costs in the province; and

WHEREAS as the scope and intensity of infectious disease risks increase in the context of finite resources, there is a risk of under-resourcing public health actions that work on longer horizon chronic disease prevention;

THEREFORE BE IT RESOLVED THAT in the context of the Public Health Strengthening roles and responsibilities deliberations, the Board of Health for Public Health Sudbury & Districts urges all health system actors to remain committed to maintaining appropriate investments in health promotion and chronic disease prevention, while ensuring health risks associated with its health protection work are managed;

AND FURTHER THAT the Board request that the Chief Medical Officer of Health ensure proactive local engagement in the sector-driven review of the Ontario Public Health Standards.

Chronic diseases account for a substantial burden on the health of Ontarians and the health care system. They are the leading cause of death in Ontario, and they disproportionately impact populations who are socioeconomically disadvantaged, intensifying inequities. Chronic diseases are expensive to treat but they are largely preventable. Health promotion and chronic disease prevention work is critical to reducing the health and economic burden of chronic diseases.

The Board of Health respectfully urges the Provincial Government to ensure all health system actors, including local Public Health, are supported to invest in coordinated action to promote health and reduce the burden of chronic diseases, affecting so many Ontarians.

Sincerely,

Penny Sutcliffe, MD, MHSc, FRCPC
Medical Officer of Health and Chief Executive Officer

cc: Dr. Kieran Moore, Chief Medical Officer of Health, Ministry of Health
Heather Schramm, Acting Director, Health Promotion and Prevention Policy and Programs Branch, Ministry of Health
Susan Stewart, Chair, Health Promotion Ontario Executive Committee
Michael Sherar, President and Chief Executive Officer, Public Health Ontario
Matthew Anderson, President and Chief Executive Officer, Ontario Health
Brian Ktytor, Chief Regional Officer, Ontario Health North East & North West
France Gélinas, Member of Provincial Parliament, Nickel Belt
Jamie West, Member of Provincial Parliament, Sudbury
Michael Mantha, Member of Provincial Parliament, Algoma-Manitoulin-Kapuskasing
All Ontario Boards of Health

October 11, 2023

The Honourable Sylvia Jones
Minister of Health
College Park 5th Flr, 
777 Bay St Toronto, ON M7A 2J3

Minister Jones,

I am writing to you about the urgent need for approval of the SafePoint Consumption and Treatment Services (CTS) site in Windsor. I previously wrote to you on March 1, 2023 regarding SafePoint and the dire need to fund this project quickly. The site has been operational under federal exemptions since April 26, 2023 and has already provided hundreds of services in my community through the prevention of overdoses and diversion from area emergency departments. The Windsor-Essex County Health Unit (WECHU) wrote to you on October 3, 2023 highlighting the urgent need to provide timelines for approval of their application. Until now, provincial funding has not been made available and timelines for approval have not been provided. Funding for this site has solely been provided through the WECHU which is unacceptable and further delays will impact my community.

I want to highlight the importance of SafePoint and the impact it has had in my community thus far. The WECHU’s recent letter stated, “since opening its doors on April 26, 2023, as a temporary Urgent Public Health Needs Site, “SafePoint” has had hundreds of visits from people in need of care. Dozens of referrals to addiction treatment, mental health supports, and social services have occurred in addition to primary care, wound care, and foot care on-site. The site has experienced no safety concerns, or issues requiring emergency response and has developed strong working relationships with the residents, law enforcement, and the business community in the surrounding area. In addition, the CTS site received municipal support in the spring of 2022 to proceed with the application that was later validated under the new municipal council. This work has been coordinated in large part by staff at the Windsor-Essex County Health Unit (WECHU), which led the application process and solely funds the operations of SafePoint. The site is operated by our regional experts in mental health and addiction, Hotel Dieu Grace Healthcare.” The WECHU have followed the necessary steps, ensured the application was completed correctly and that all information required was submitted. This has been confirmed multiple times by your Ministry.

As you are likely aware, Ontario has an opioid and overdose epidemic. The number of overdoses in my community and across the province are extremely high and very alarming. The funding needed to open and operate the SafePoint Consumption and Treatment Services site is vital and lifesaving.

I understand that safe consumption and treatment services sites across the province are under a critical incident review due to an ongoing investigation related to an incident nearby a CTS site in the Toronto area. I think everyone can agree that a security review following such a serious incidence is important.

The concern that I share with my community, WECHU and Windsor council members is related to the fact that SafePoint has met all requirements, including safety requirements, set out by provincial, federal and municipal governments and yet many months have passed without you or your government providing WECHU with any certainty regarding provincial funding. I will note that all CTS requirements laid out were met and WECHU began waiting for funding direction prior to the incident at the Toronto area CTS.

Further delays with funding and application status are unnecessary. Healthcare in Ontario is under severe pressure. People requiring mental health and addiction services face long waitlists and barriers to accessing care. Delays in accessing care can have deadly consequences. Providing ongoing, stable funding for SafePoint to continue operating with no delay is just one way to combat pressures on our healthcare system. Data shows that lives are being saved and SafePoint has been successful in connecting patients to critical wrap around supports and services such as housing, social services and other health care.

The WECHU has requested a response before October 13th as they prepare to set their 2024 budget, as are Windsor are Essex County councils. I ask that you respond in a timely manner to ensure SafePoint, the WECHU and Hotel Dieu Grace Healthcare can continue to provide the support and services that are both effective and necessary.

I look forward to your response.

Sincerely,

Lisa Gretzky, MPP Windsor West
Critic of Mental Health and Addictions

CC: Windsor-Essex Health Unit
The City of Windsor – Office of the City Clerk

PREPARED BY:
Planning and Strategic Initiatives

DATE:
November 20, 2023

The Ontario Public Standards requires the Board of Health to have a risk management framework in place that identifies, assesses, and addresses risks. The WECHU risk registry currently tracks 26 risks across 13 categories. Risk categories cover a diverse array of topics such as finances, security, service delivery, equity, and privacy, for example.

Health Units are also expected to submit a list of corporate risks and mitigation strategies to the Ministry of Health during Q3 Standards Activity Reporting.

DISCUSSION

The 2023 WECHU risk registry was reviewed and updated by risk owners in the organization. The risk registry review identified 13 risks scoring “high” before consideration of mitigation strategies and 7 remaining “high” after mitigation measures. 

The Ministry requires reporting of up to 10 highly ranked risks. The WECHU’s submission includes the following 7 high risk types for 2023: 

• Knowledge/Information-Information
• People/Human Resources-Work Disruption
• People/Human Resources-Succession Planning
• People/Human Resources-Staff Engagement
• Privacy-Privacy Requirements
• Security-Work
• Technology-System Outages

Additionally, as part of the 2023 operational planning process, the risk registry was migrated into the WECHU’s information management system. This project builds upon the risk management system the WECHU already has in place and will modernize it by improving automation and collaboration.

BACKGROUND

The WECHU is a publicly funded organization; as such, the WECHU has a responsibility to spend funds prudently with the objective of providing public health programs and services as required by the Health Protection and Promotion Act (HPPA) and the Ontario Public Health Standards: Requirements for Programs, Services, and Accountability (OPHS).

The WECHU receives funding in the following manner:

• The Province of Ontario, more specifically the Ministry of Health, annually grants the WECHU funding to a maximum of 75% of admissible expenditures for its Mandatory Program. In addition, the WECHU receives required contributions for the Corporation of the City of Windsor, the Corporation of the County of Essex, and the Corporation of the Township of Pelee (hereinafter collectively referred to as the Obligated Municipalities) at a minimum of 25% of admissible expenditures.
• The Ministry of Health annually provides grants for certain related health protection and promotion programs at a rate of 100% of admissible expenditures. More specifically this includes the Ontario Seniors Dental Care Program (OSDCP) and the Associate Medical Officer of Health (AMoH)/Medical Officer of Health (MoH) Compensation Initiative.
• The Ministry of Health annually provides grants for certain one-time program initiatives funded at a rate of 100% of admissible expenditures. Historically, this has included: Support for COVID-19 general and vaccination programs; Replacement of Vaccine Fridges; Small capital requests; etc. 
• The Ministry of Children, Community and Social Services (MCCSS) provides annual grants to fund the Healthy Babies Healthy Children Program Initiative and the Nurse Practitioner Program Initiative at a rate of 100% of admissible expenditures. The operating budgets for programs funded by MCCSS will be reported to the Board of Health in a separate report in March of 2024 as the fiscal year for this program runs April through March annually.

Mandatory Program

The 2024 Budget contemplates the Programs and Services as outlined in the draft 2024 Annual Service Plan which will be included in the January 2024 Board of Health Meeting Package.

For the period January 1, 2024, to December 31, 2024, the proposed budgeted total net expenditures are $24,957,466. Details of the financial statement captions that comprise the budgeted total net expenditures are follows:

It is important to note that the 2023 WECHU Budget included $5,592,071 in additional Provincial Ministry of Health funding for Covid-19 Response programming. It was just recently confirmed by the Province that PHU’s should not plan to receive that funding for the 2024 year.

In the latter portion of August, the Ministry of Health announced the current 2023 operational year funding approval along with the following 2 years allotment.  The new budgetary allotment for 2024 announced by the province incorporates the base funding for 2023 with the addition of one-time mitigation funding with a 1 % increase.  Recognising quickly that the new provincial funding allotment does not support the current inflationary pressure of operations and union contracts (CUPE and ONA), the leadership at the WECHU performed a detailed program prioritization analysis to make decisions in an effort to further reduce expenses in the organization. These decisions, although based on evidence and evaluation, have significant programming and services consequences that reduce the WECHU’s ability to meet certain aspects of the provincial OPHS. Although the COVID-19 Extraordinary Expense funding will no longer be provided by the Province, there continues to be pressures on the WECHU and other Ontario health units with regards to high rates of COVID-19 outbreaks in high risk congregate living settings, in addition to ongoing vaccine administration and distribution requirements, in particular to reach those most at risk in our community. These ongoing COVID-19 response activities require an increased staffing footprint to meet the needs of our community.  In addition to the increased expectations of the COVID-19 response activities, other key factors in our community such as increases to local population levels, particularly in priority populations and an influx of asylum seekers, vaccine preventable disease clusters and outbreaks, increased rates of food insecurity, opioid overdoses, youth vaping and cannabis rates, and increasing rates of sexually transmitted and blood born diseases such as syphilis (including neurosyphilis cases for the first time in a decade). The following decreasing trends also pose a higher demand on WECHU resources, decreasing COVID-19 vaccination rates, poor rates of mental health in school aged children and youth, decreasing breastfeeding rates, and folic acid consumption during pregnancy. As these and other factors that affect the collective level of health of our community continue to worsen, in particular post pandemic, the WECHU continues to focus on our strategic priority of partnerships wherever possible in order reduce negative impact of shortfalls in programming and service in our community.

From a monetary perspective, please note that the proposed budget changes include: 

• A total salaries and employee benefits decrease in 2024 of 14.5% from 2023, with a valuation of $24,145,494 to $20,583,385 (with respect to the 2023 overall budget with COVID-19 funding incorporated). 
• Of the 2024 combined salary and benefits total, $15,900,326 (2023 - $18,883,923) relate to salaries and $4,683,059 (2023 - $5,261,571) relate to employee benefits. In comparing both the 2023 and 2024 mandatory budget, an increase of $1,369,529 (7.1%) toward salaries and benefits is demonstrated. 
• Total other operating expenditures decreased $452,441 over 2023 (covid funding included) from $5,369,326 to 4,916,885 in 2024. In comparison of only mandatory budgets, the 2024 budget increases to $207,992 (4.4%) mostly resulting from an increase in the legal ($275,000) and rent ($100,225) line items.

2023 Mandatory Program Funding

As it relates to the 2023 Mandatory Program Budget, Administration has confirmed with the ministry the following:

The grant from the Ministry of Health is consistent with the base funding increase granted in 2023 of 
$16,303,000, plus the Mitigation funding of $1,260,800 and an increase of 1 % in 2024. The resulting total in the Ministry of Health funding is $17,739,438 which calculates to a percentage of 71.1%.

• A proposed increase of $92,061 (1.29%) in the contributions from the Obligated Municipalities, resulting in a Municipal funding contribution percentage of 28.9% as compared to 30.4% in 2023. Total municipal contributions for 2024 would total $7,218,028.  Increases broken down by municipality are as follows: City of Windsor increase of $50,000 The County of Essex increased by $42,011 The Township of Pelee increased by $50.

The following table details the contributions from obligated municipalities for the 2024 and 2023 fiscal years. Contributions are calculated based upon their proportionate share of the population in our catchment area. For 2024 and 2023, population figures are calculated using 2021 census data. 

Ontario Seniors Dental Care Program (OSDCP)

The OSDCP is fully funded by the Ministry of Health. The OSDCP provides free, routine dental services for low-income seniors who are sixty-five (65) years or age or older to reduce unnecessary trips to the hospital, prevent chronic disease and increase their quality of life. More specifically, the coverage includes:

• Check-ups (including scaling, fluoride, and polishing)
• Repairing broken teeth and cavities
• X-rays
• Removing teeth or abnormal tissue
• Treating infection and pain
• Treating gum conditions and diseases
• Dental prosthetics

For the period January 1, 2024, to December 31, 2024, the proposed budgeted total net expenditures for the OSDCP are $3,115,427. Details of the financial statement captions that comprise the budgeted total net expenditures are follows:

For 2024, the total OSDCP has increased from $3,072,752 in 2023 to $3,115,427 in 2024. Significant changes in the financial captions from the 2023 budget include:

• Under Salaries and employee benefits, A decrease in FTEs supporting the OSDCP of 1.5 from 2023, which is due to change in proportion between Health Smiles (under the mandatory program budget) and OSDCP resulting from the limited number operatories within the current clinics. Resulting decrease of $178,895 in this line item.
• Under Other Operating Expenses: Building occupancy: The 2023 OSDCP Budget contemplates building occupancy costs (i.e., rent, property taxes, insurance, utilities, telephone, etc.) for the Windsor and Leamington Offices.
• Under Program supplies and other: Information Technology: In 2023, the OSDCP implemented a new dental records management system. Only licensing of $6,000 will remain under this line item. Resulting decrease of $91,925 under this line item.
• Under Purchased Services: Professional Services: $530,000 will be attributed to the significant wait list of approximately 8 months to receive care. In an effort to reduce the wait times for the senior clients of our community, care is outsourced to external dental professionals that agree to work within the program guidelines. Resulting increase of $230,000 for this line item.

Risk Assessment

• Changes to the Ontario Public Health Standards (OPHS) or other relevant legislation. WECHU’s 2024 Budget does not contemplate changes in direction from the Province of Ontario or any governing legislation that could have implications for programs and services (i.e., changing in funding model; expansion of mandatory program requirements, etc.). Within the 2024 fiscal year, the ministry has indicated that a full review of the program standards will be conducted, with a target implementation of January 1, 2025.  The results of this process could see changes in required programming and services standards across all PHUs in Ontario, resulting in additional staffing fluctuations (augments or reductions). The budget and FTE reductions proposed to the board at this time is reflective of what evidence and evaluation we have available to date. 
• Inflation. The 2024 Budget factors in the on-going impact of inflation on the purchase of goods and services. Administration will continue to mitigate this risk by ensuring procurement processes and procedures are appropriate and are in accordance with WECHU’s Procurement Policy. Furthermore, Administration will actively monitor budgets to actual financial results and implement mitigation strategies (i.e., prioritization) when required.

Motion

Whereas the Windsor-Essex County Health Unit receives grants annually from the Ministry of Health to a maximum of seventy (75%) percent of admissible expenditures associated with the Mandatory Program. In addition, WECHU receives required contributions from the Obligated Municipalities at a minimum of thirty (25%) percent of admissible expenditures, and

Whereas the Ministry of Health annually provides grants for certain related health protection and promotion programs at a rate of one hundred (100) percent of admissible expenditures.

Now therefore be it resolved that the Windsor-Essex County Board of Health approve the 2024 Mandatory Program Budget, requiring $17,739,438 (71.1%) in base funding from the Ministry of Health and $7,218,028 (28.9%) in contributions from the Obligated Municipalities, the Corporation of the City of Windsor, the Corporation of the County of Essex, and the Corporation of the Township of Pelee, be approved.

Further that the Windsor-Essex County Board of Health approve the 2024 Mandatory Program Budget with total expenditures of $24,957,466 and offset revenue of $539,404, and

Further that the Windsor-Essex County Board of Health approve the 2024 Ontario Seniors Dental Care Program, funded at a rate of one hundred (100) percent with total budgeted expenditures of $3,115,425.

PREPARED BY:

Communications Department

DATE:

November 20, 2023

SUBJECT:

September 15, 2023 – October 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

Sept. 22 – On this date, two stories received wide media coverage – the continuation of a boil water advisory for Wheatly residents, and a three-part series on the effect of opioids and overdoses in Windsor-Essex.

Oct. 6 – The largest spike in media coverage was due to the announcement of the updated Moderna COVID-19 vaccine availability, and the pause on Consumption and Treatment Service (CTS) site application reviews in the province. The coverage of CTS site reviews continued for the remainder of the timeframe.

Website Overview Graph

Notes: During the timeframe of September 15 – October 14, we saw similar website traffic patterns as the previous month. We did have a peak in web traffic on October 10, which was when vaccine appointments were first available for the new COVID-19 vaccine (for individuals in high-risk groups).  

Social Media Overview Graph

Lighter blue line represents the current month, darker blue line represents the previous month.

Note: Overall, we saw small increases in our follows on all platforms over the month.

DISCUSSION

The Communications Department worked with the Healthy Schools department on their Healthy Sleep campaign. The goal of the campaign was to drive people to a webpage for information on the importance of sleep for overall health, and ways to improve sleep quality. The campaign utilized four communication components including, a digital display at the Devonshire mall, a printed ad inside Transit Windsor buses, social media ads, and boosted social media posts. 

All components directed people to the Healthy Sleep webpage, either linked from social media, or utilizing QR codes on the ads. For the duration of the campaign, the webpage had a total of 598 views. The Facebook ad reached 16,225 users, and the three boosted posts had a total reach of 11,993. 

PREPARED BY:

Communications Department

DATE:

November 20, 2023

SUBJECT:

August 15, 2023 – September 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: Between August 15 – September 14, we experienced one large peak, and one smaller peak in exposure:

August 24 – On this date, a variety of news stories were released including beach water results, a boil water advisory for Kingsville, and a mental health / suicide awareness event to promote the awareness month of September.

August 30 – 31 – Across these dates, beach water results were shared, the WECHU conducted an interview on sexually transmitted infections, and stories around SafePoint funding approval.

Website Overview Graph

Notes: During the timeframe of August 14 – September 15, we saw similar website traffic patterns as the previous month. We did have a peak in web traffic on August 24, which corresponds with two big news stories – the boil water advisory as well as the weekly beach water testing results. 

Social Media Overview Graph

Lighter blue line represents the current month, darker blue line represents the previous month.

Note: Overall, we saw small increases in our follows on all platforms over the month.

DISCUSSION

The Communications Department worked closely with the Environmental Health Department on the Fight the Bite campaign which raises awareness on the prevention of vector borne illness, specifically West Nile Virus. The campaign was multi-faceted including, commercials on two local radio stations (Blackburn and AM800), digital billboards, and interior bus posters. A variety of online mediums were also used including organic social media posts, paid advertisments on Meta (Facebook and Instagram), and Google Response Display Ads.

The Google Response Display Ads ran for approximately 8 weeks, and had a total of 15,014 impressions (the number of times the ad was on a screen), which yielded 875 link clicks to the Fight the Bite webpage. Paid advertisements on Meta had a total reach of 13,452 (number of people who saw the ad at least once), which yielded 175 link clicks to the Fight the Bite webpage.
 

BACKGROUND

Overview

• SafePoint officially opened on Wednesday, 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 will be provided with regular updates.

Application Status

• In July of 2023, Health Canada authorized the WECHU’s exemption request to operate SafePoint as a Consumption and Treatment Services (CTS) site. 
• The approval from Health Canada was shared with the Ontario Ministry of Health to complete the provincial application to operate a fully funded CTS site. 
• The Ministry of Health application for CTS funding continues to remain under review. An announcement was made that a review of the safety components of all operating sites is underway and that until such time that this is completed, all pending applications for funding will be placed on hold.

CURRENT INITIATIVES

Operational Data

It has been six months since SafePoint opened on April 26^th and there has been a total of 859 client visits and 182 unique clients to date, with no overdoses reported on-site to date. Additional details about the services provided at SafePoint during the month of October are presented in Tables 1-3.

Client Experience Narrative

Beyond the number of client visits recorded in the month of October, 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

Staff from SafePoint, Canadian Mental Health Association’s Safe Beds Program, Hôtel Dieu Grace Healthcare’s Withdrawal Management Service, Family Services Windsor-Essex, Windsor Regional Hospital, and the Toldo Neurobehavioural Institute (TNI) all coordinated to ensure a client’s successful access to the TNI for stabilization and substance use support.

BACKGROUND

Overview

• SafePoint officially opened on Wednesday, 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 will be provided with regular updates.

Application Status

• In July of 2023, Health Canada authorized the WECHU’s exemption request to operate SafePoint as a Consumption and Treatment Services (CTS) site. 
• The approval from Health Canada was shared with the Ontario Ministry of Health to complete the provincial application to operate a fully funded CTS site. 
• The Ministry of Health application for CTS funding continues to remain under review. An announcement was made that a review of the safety components of all operating sites is underway and that until such time that this is completed, all pending applications for funding will be placed on hold.

CURRENT INITIATIVES

Operational Data

It has been five months since SafePoint opened on April 26^th and there have been a total of 601 client visits and 149 unique clients to date, with no overdoses reported on-site to date. Additional details about the services provided at SafePoint during the month of September are presented in Tables 1-3.

Client Experience Narrative

Beyond the number of client visits recorded in the month of September, 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

The Mobile Medical Support (MMS) Team visited SafePoint to complete dental screenings to identify clients who may need oral health services. Through this outreach, the Dental Hygienist identified that a client required dental services but those services were not covered. The Dental Hygienist worked with the client to complete an application for funding to cover the cost of the procedure and the client was later able to have their tooth extracted.

FUTURE PLANS

SafePoint is preparing to launch a business engagement strategy, which will involve regular outreach with area businesses to address any questions or concerns about the site. SafePoint will also be partnering with the Downtown Windsor Business Improvement Association (DWBIA) to share information and resources with their membership about the supports available to businesses as SafePoint operates.
 

PREPARED BY:     
Chronic Disease and Injury Prevention Department

DATE:     
November 20, 2023

When an individual or family struggles to put food on the table, it is a sign of overall deprivation from insufficient or unstable incomes. In these cases, food is often sacrificed to pay for other costs of living. Household food insecurity refers to the inadequate or insecure access to food due to financial constraints which have severe negative impacts on physical health, mental health, the healthcare system, and overall social well-being¹. These impacts can be seen through children living in food insecure households who are more likely to experience mental health issues like hyperactivity, inattention, greater risks of disordered eating, depression, and suicidal ideation in adolescence and early adulthood².

Locally, Windsor and Essex County (WEC) had a 18.8% household food insecurity rate between 2019-2021, with a 19.8% rate in 2021 alone3. Further, 12.9% of children 1 to 17 years old in WEC live in food-insecure households³. Since 1998, the Ontario Public Health Standards have mandated local health units to monitor food affordability through population health assessments and surveillance using the Ontario Nutritious Food Basket (ONFB) tool. The ONFB⁴ is one of many food costing tools that measures the cost of basic eating that represents current nutrition recommendations and average food purchasing patterns. The ONFB tool accounts for the current market availability of many products and the ability to find the price of foods through online grocery platforms. 

CURRENT INITIATIVES

Between May 23 and June 1, 2023, the WECHU used the new ONFB hybrid costing tool to collect data directly from stores and indirectly through online retailers. Using these final numbers, a variety of income and family scenarios for the local community were calculated.

The 2023 cost of the Ontario Nutritious Food Basket, for a family of four in Windsor-Essex is $262.68 per week ($1,137.39 per month). This is an 8.7% increase in food cost from 2022. A sample of three income scenarios from the 2023 Real Cost of Eating in Windsor-Essex report is presented in Table 1 below. Of note, these figures represent the cost of 61 different nutritious food items which would make up a typical grocery list. A 5% buffer was also added to the final basket amount which accounted for miscellaneous items not included in the calculation such as spices, hygiene products, and other household needs. Not included in these calculations are other essential needs including transportation, phone, internet, heat, hydro, medication, childcare, school supplies, clothes, shoes, eye and dental care, home maintenance, and household cleaners.

Below, Table 1 compares monthly income to the cost of rent and the 2023 ONFB calculation. Of note, a single male living on Ontario Works (a social assistance benefit program) could spend close to their entire income on the rent for a bachelor apartment, leaving a shortage of $337.37 for all other expenses and an expecting mother on Ontario Disability Support Program, would have only $2.05 left for all other expenses.

Further, the Windsor-Essex ONFB data has been used as an essential component in the calculation of the Ontario Living Wage rates. A living wage is the minimum amount a person must earn to afford to live and participate in a specific community. A living wage is not the same as the minimum wage, which is the lowest rate an employer can legally pay for work performed. The 2023 Living Wage rate for the southwest region is $18.65 which is $2.10/per hour more than the current provincial minimum wage. Table 2 highlights the local living wage rates compared to the minimum wage rates from 2018 to 2023. 

Income inequality has been recognized as one of the most significant social determinants contributing to poor population health outcomes and is the main driver of food insecurity. When basic needs are not met, this can be a significant barrier for individuals to survive, let alone thrive, or make meaningful contributions to society. The additional income scenarios and case studies included in the 2023 Real Cost of Eating report further demonstrate the difficulties community members face. This report will be disseminatedto local social planners, anti-poverty advocates, Registered Dietitians, and other community partners who will benefit from using this data within their program planning and advocacy efforts. To view the full report, visit www.wechu.org/healthy-eating/nutritious-food-basket.

¹Ontario Dietitians in Public Health, Food Insecurity Workgroup. Position Statement on Responses to Food Insecurity. https://www.odph.ca/upload/membership/document/2021-04/ps-eng-corrected-07april21_3.pdf. Published December 2020.

²Tarasuk V, Li T, Fafard St-Germain AA. (2022) Household food insecurity in Canada, 2021. Toronto: Research to identify policy options to reduce food insecurity (PROOF). Retrieved from https://proof.utoronto.ca/  September 2, 2022.

³Ontario Agency for Health Protection and Promotion (Public Health Ontario). Food insecurity among children using the Canadian Health Survey of Children and Youth. 2nd ed. Toronto, ON: King’s Printer for Ontario; 2023

⁴Ministry of Health Promotion. Nutritious Food Basket Guidance Document. https://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/docs/mhp/NutritiousFoodBasket.pdf May 2010.

PREPARED BY: 
Environmental Health

DATE: 
November 20, 2023

The Environmental Health Department delivers various seasonal programs that are mandated under the Ontario Public Health Standards.  These programs include monitoring beach water quality and heat events, as well as surveillance of West Nile Virus (WNV), Eastern Equine Encephalitis (EEE), Zika Virus, and Lyme disease activity in Windsor and Essex County (WEC). This report provides a summary of these 2023 seasonal programs.

DISCUSSION

Beach Monitoring: The 2023 beach monitoring season ran for a total of 13 weeks, with weekly water sampling conducted from June 12, 2023 to September 5, 2023. There were 20 water quality warnings issued (201-999 E. coli/100ml), and 3 beach closures (≥1000 E. coli/100ml). This season had significantly less water quality issues when compared with 2022, which had 41 warnings and 13 closures. The permanent closure of Mettawas Beach partially accounts for this difference.

Harmonized Heat Warning Information System: Starting in May of each year, the WECHU monitors the Environment Canada and Climate Change’s forecast for heat events and issues heat warnings or extended heat warnings in accordance with the Ontario Harmonized Heat Warning and Information System (HHWIS). In 2023, there were no heat warnings (two consecutive days are forecasted to have a daytime high temperature greater than or equal to 31°C and a nighttime temperature greater than or equal to 21°C or a humidex greater than 42°C ) and three extended heat warnings (three or more than three consecutive days are forecasted to have a daytime high temperature greater than or equal to 31°C and a nighttime temperature greater than or equal to 21°C or a humidex greater than 42°C) issued. This summer had significantly less number of days under heat warning (11 days) as compared to 22 days in 2022. 

Mosquito Surveillance program: The Mosquito Surveillance Program ran for a total of 21 weeks from May 23 to Oct.13, 2023. Once a week, 41 mosquito traps (26 CDC light traps and 15 BGS 2 traps) were set up across WEC to collect mosquitoes for identification and viral testing.  

Number of Mosquitoes caught – 73,028 
Number of pools tested -1159 
Number of WNV positive pools - 11 
Number of WNV human cases - 1 
Number of Aedes albopictus caught -84

There were no positive pools or human cases for EEE or Zika identified this year.

Active Tick Surveillance: Active 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 whereby ticks attach themselves to the fabric and can be easily spotted and identified. Any black-legged ticks identified are sent to an accredited laboratory for testing for Lyme disease. Tick dragging is performed twice yearly in the spring and the fall.

In 2023, tick dragging was conducted at 4 sites across WEC (Ojibway Prairie Nature Reserve, Ruscome Shores Conservation Area, Cipher Systems Green Way – Essex and Hilman Marsh Conservation Area) In May and October. 41 blacklegged ticks were found through tick dragging and have been sent to lab for testing. As of September 30^th, 2023, there were six human cases of Lyme disease reported in WEC.

PREPARED BY:
Planning and Strategic Initiatives

DATE:
November 20, 2023

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 third quarter of 2023 related to BoH operations continued to be positive. In most cases, 80% or more of the responses were Agree or Strongly agree regarding the aspects queried. The one exception was related to the item ‘All material notices of wrongdoing or irregularities were responded to in a timely manner’, where 70% of the responses were Agree or Strongly Agree (20% of responses to this item were ‘Don’t Know/Unsure’). 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 8.9. 

Suggestions for improvement included future quality improvement efforts related to BoH operations and increased engagement with members of the community in public health efforts. Other recommendations included collaboration with all levels of the government and flexible approaches/use of technology to allow the BoH to respond promptly and effectively to new challenges.

PREPARED BY:

Planning and Strategic Initiatives Department

DATE:

November 20, 2023

SUBJECT:

Annual Service Plan Q3 2023 Reporting

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. 

CURRENT INITIATIVES

Q3 Intervention Work Plan Progress

Project Leads have submitted individual progress reports for work plans in their programs for Q3, 2023. 

The 2023 Annual Service Plan - Q3 Status Report indicates:

• For external client facing programs, there are 139 workplans in progress, 4 were completed, and 77% are on target.
• For internal organizational programs, there are 36 workplans in progress and 67% are on target.

Annual Service Plan Development for 2024

Planning for 2024 began in July, 2023. Programs have been selected to be active in the WEHCU’s 2024 service plan and their descriptions updated. The Intervention Work Plans (IWP) that support these programs have been prepared and are currently being reviewed for final approval and budgeting.

2023 Operational Plan Reporting 
Q2 STATUS REPORT

Reporting Structure

This report provides a status summary for Intervention Work Plans (IWP) in the 2023 Annual Service Plan that were in active and in progress during Q3 (July 1 through September 30). 

The project lead for each active IWP was asked to provide a progress report on their work. The status updates consisted of the following categories:

• On Target (the intervention is progressing at the planned pace)
• Variance (the intervention is behind the planned pace)
• Complete (the intervention has been completed)
• Deferred (current work on the intervention has been stopped – with potential to continue next year)
• Cancelled (the intervention will no longer occur)

If the intervention was identified as ‘Variance’, ‘Deferred’, or ‘Cancelled’, a reason was provided. In these cases, the most relevant reason was selected from the following list:

• Adjusted Program Priorities (program priority alterations resulted in changes to the IWP)
• Human Resource Issue (staffing circumstances resulted in changes to the IWP)
• Partnership Limitations (external partner(s) did not to meet their obligations)
• Public Health Emergency (a significant emergency resulted in changes to the IWP)
• Internal Resource Limitation (financial, material, or internal support limitations resulted in changes to the IWP)
• External Resource Limitation (External financial, material, or internal support limitations occurred with partnerships, collaborations, funding, or regulations)

It is important to note that reporting reflects a snapshot summary of progress made on interventions based on the predetermined milestones for the intervention for this quarter. This does not necessarily represent the amount or scope of work captured under each program.

Part 1: External Community Facing Programs

Overall Quarterly Status Summary 

There were 139 active external interventions evaluated for progress in Q3 2023, and 99 of the interventions were reported to be on target. 4 workplans were completed this Quarter. Of all active interventions, 77% are currently on target.

Figure 1 displays the percentage of interventions that were reported on target, indicated a variance, deferred, cancelled, or were completed.

PREPARED BY:
Planning and Strategic Initiatives

DATE:
November 20, 2023

The WECHU’s 2022-2025 Refreshed Strategic Plan provides strategic direction to the organization. The plan defines the organizational vision, goals, and objectives to engage staff and support local public health outcomes within the community - with a specific focus on priority populations.

The Good Governance and Management Practices Domain of the Ontario Public Health Standards (2021) requires the Board of Health to provide governance direction and remain informed about the activities for organizational effectiveness through evaluation of the organization and strategic planning.

DISCUSSION

The 2023 Q3 Strategic Plan Progress Report provides the objectives under each strategic priority with corresponding updates to measure our advancement towards achieving the goal.

Progress has continued on a majority of the strategic objectives. The program impact review has been completed, and members of the Equity, Diversity, and Inclusivity (ED&I) Committee have been selected and the first meeting has been scheduled.

The number of partnerships and collaborations to address needs for emerging public health issues continued to grow this quarter. 

Board Members Present:

Fabio Costante, Renaldo Agostino, Mark Awuku, Joe Bachetti, Fred Francis,
Michael Horrobin, Judy Lund, Hilda MacDonald, Angelo Marignani, Robert Maich, Michael Prue, Rob Shepley

Board Member Regrets:

N/A

Administration Present:

Dr. Ken Blanchette, Dr. Mehdi Aloosh, Dan Sibley, Kristy McBeth, Eric Nadalin, Linda Watson, Lee Anne Damphouse

WECHU Guests:

William Willis, Willis Law

RECORDING SECRETARY: L. Damphouse

SUBMITTED BY: K. Blanchette

APPROVED BY: WECHU BOH – January 18, 2024

1. For the period covered by this CEO Quarterly Compliance Report:
   
   1. The undersigned has personal knowledge of the matters herein reported or has made due inquiry with respect to the same.
   2. Except as reported in any previous CEO Quarterly Compliance Report, the undersigned reports as follows:
      
      1. that the Health Unit has been in material compliance with all laws, regulations, orders, judgments or decrees applicable to it. Without limiting the generality of the foregoing the Health Unit is current in respect of all tax and related withholding and remittances required by law;
      2. the Health Unit has been in material compliance with its By-laws;
      3. the Health Unit has been in material compliance with all other Board resolutions;
      4. the Health Unit has been in material compliance with all contracts and commitments to which the Health Unit is a party including without limitation all funding and accountability agreements;
      5. the Health Unit is current with respect to the payment of all remuneration (including salary and benefits) to its employees;
      6. there are no material variances between what is contemplated by the Operational Plan and what in fact transpired or appears likely to transpire;
      7. more specifically, no material changes are required in respect of financial resource allocation plans to address shifts in need and capacity;
      8. no material adverse change has occurred in the operations of the Health Unit or its assets and liabilities taken as a whole;
      9. there have been no material breaches of the Ethics Code of Conduct by anyone who is subject to it;
      10. there have been no claims made pursuant to any insurance policies maintained by the Health Unit, except as noted below, and
      11. nothing has come to the attention of the undersigned which would materially adversely change any previous CEO Quarterly Compliance Report, except as detailed below:             

                  Items (vii), (viii) and (xi) have been revised due to the COVID -19 pandemic as follows:

• The Organizational Emergency Response that was reported on the previous CEO Compliance Report concluded on April 30, 2023.
• The WECHU continues to have operational plans and finances that are dedicated to the current public health demands related to the ongoing COVID-19 pandemic.  This includes:
  • Augmented staff to facilitate our response to the pandemic associated with case and contact management, outbreaks, and vaccinations.
  • Increased expenses related to case and contact management, outbreaks, and vaccination to address Ministry requirements.

Date:  November 20, 2023                 

Dr. Kenneth Blanchette    
Chief Executive Officer

BACKGROUND

An enterprise risk management framework and corresponding risk registry are important foundational elements in managing risk from an organizational governance perspective. The Ontario Public Health Standards (OPHS) specifies that “the board of health shall have a formal risk management framework in place that identifies, assesses, and addresses risks”. The Ministry of Health (MOH) requires yearly reporting on the highest residual risks to the organization and the related operations. Residual risks are defined as the assessed risk level after consideration of associated mitigation strategies.

The Windsor-Essex County Health Unit (WECHU) maintains a corporate risk registry; this risk registry monitors 22 risks across 12 risk categories. Based on the categorization and reporting requirements by the MOH, 10 of these risks were identified as being high residual risks.

The high residual risks to be reported to the MOH for 2024 are related to: Financial, People/Human Resources, Privacy, Security, and Technology. Each identified high risk includes documentation of current and future mitigation approaches in the registry.

PROPOSED MOTION

Whereas, the Ontario Public Health Standards requires the identification, assessment, and mitigation of enterprise risks; and

Whereas, the Ministry of Health requires yearly reporting on the highest residual risks to the organization; and

Whereas, the Windsor-Essex County Health Unit identifies and establishes risk mitigation approaches;

Now therefore be it resolvedthat the Windsor-Essex County Board of Health accepts the risk assessment outlined in the 2024 WECHU Risk Registry and the proposed mitigation approaches;

FURTHER THAT, risk mitigation approaches will be adopted and monitored by the organization and reported to the Board of Health on a yearly interval.