October 2022 Board of Health Meeting

Meeting held via video: https://youtu.be/VE-wNwRmCM4

PREPARED BY:

Healthy Schools Department – Immunization

DATE:

October 20, 2022

SUBJECT:

Immunization of School Pupils Act (ISPA) Enforcement in Secondary Schools and Grade 7 In-School Immunizations

BACKGROUND/PURPOSE

In Ontario, the Immunization of School Pupils Act (ISPA) R.S.O. 1990, requires children and adolescents attending primary or secondary school to be immunized against mumps, rubella, diphtheria, tetanus, meningococcal, varicella and polio, or have a valid Medical, Conscience or Religious Belief exemption on file at the Health Unit. As outlined in the Ontario Public Health Standards (OPHS), health units in Ontario are required to have a complete immunization record, or a valid exemption on file, for every student attending school in their area.

DISCUSSION

ISPA Enforcement in Secondary Schools

Beginning in the spring, the WECHU reviewed immunization records for students attending secondary school in Windsor and Essex County, as mandated by the ISPA. In June 2022, 13,254 secondary school students had incomplete immunization records and were either overdue for one or more vaccines or had not submitted their updated records to the WECHU. These students received an immunization notice in June, informing them of their missing vaccines along with information on how and where to receive any missing vaccinations and/or how to update their records. A suspension order was then mailed in early August to any secondary student who had not yet submitted the required immunization information to the WECHU.

Throughout the summer, the WECHU hosted catch-up immunization clinics in all municipalities in Windsor and Essex County, to ensure that these students had the opportunity to complete their vaccine series prior to the 2022/2023 school year and to avoid suspension. The WECHU also worked with local health care providers to provide them with the necessary vaccines and ensure their patients’ records were updated.

In addition to the secondary school student immunization record review, an immunization record review was also conducted for children in kindergarten to grade 3 in early 2022. 8,687 immunization notices were sent to parents informing them of the student’s missing vaccines and encouraging them to get their child vaccinated. The enforcement process (i.e., issuing suspension notices and suspension) for elementary students will begin in 2023.

Prior to enforcing the ISPA through the suspension process, the WECHU worked with local school boards to host onsite immunization clinics in local secondary schools, in addition to the clinics in each municipality and WECHU offices. As part of the strategy to promote these clinics, the WECHU developed a detailed communications plan that included news releases, social media posts, paid Facebook and SnapChat ads, a 211 email blast, and radio ads. From June 1st to August 31st, 54 organic Facebook, Twitter, Instagram messages were posted ranging from general messaging about the benefits of vaccination, to where to find an immunization clinic and how to update a student’s immunization clinics.

In August, 7,554 secondary students still had incomplete immunization records and were mailed suspension orders. As of the suspension deadline on Monday, September 12th, there were 1,519 secondary students who had not provided updated records to the WECHU. These students were suspended on September 14th, 2022. The WECHU has continued to provide walk in clinics and updated records with information received by health care providers and online submissions through ICON.

In order for a student to return to school after being suspended, the student or parent/guardian must provide the WECHU with an updated immunization record. Clinics for students who were suspended have been operational at both WECHU locations with evening and weekend appointment availability to ensure every student has the opportunity to receive their vaccine. Additionally, WECHU nurses have been contacting every student on the suspension list and reviewing their immunization records with them to ensure they are complete. Once the student’s immunization record is up-to-date with the WECHU, the school principal is informed that the student can return to school. This process involves sending a daily up-dated suspension list to every secondary school in Windsor and Essex County. As of October 3rd, 49 students are still suspended for incomplete immunization records.

Grade 7 School Immunization Clinics

Due to the ongoing COVID-19 pandemic and the disruption of regular public health and education services, the WECHU was unable to fully implement in-school immunization programs over the last two years, in particular to students in grades 7 for Hepatitis B, Human Papillomavirus (HPV), and Meningococcal Disease. These vaccines were made available to local health care providers to administer free of charge to eligible patients. However, some families have not been able to visit their health care providers to update their child’s vaccinations due to the pandemic or other external factors.

School-based immunization clinics for Grade 7 students will return to the normal pre-pandemic schedule in the 2022-2023 school year. In-school clinics are being offered starting October 20th to all local schools. As of September 28th, there are 4,455 students eligible for the HPV vaccine, 3,941 students eligible for the Hep-B vaccine, and 4,308 students eligible for the Men-C-ACYW-135 vaccine. Given the student’s previous vaccination history, they may be eligible for one or more of these vaccines. These clinics will be offered this fall and a second round of clinics will be scheduled next spring. These publicly-funded vaccines are free of charge, to eligible Grade 7 students. Parents of Grade 7 students will receive a letter informing them of the date for their school’s clinic. Parents will complete an online consent for the vaccines they want their child to receive and will be informed that the meningococcal vaccine is a required vaccine under the ISPA.

PREPARED BY:

Chronic Disease and Injury Prevention

DATE:

October 20, 2022

SUBJECT:

Nutritious Food Basket & Food Insecurity

BACKGROUND

Household food insecurity refers to the inadequate or insecure access to food due to financial constraints. When an individual or family struggles to put food on the table, it is a sign of overall deprivation due to inadequate or unstable incomes. In these cases, food is often sacrificed to pay for other costs of living. Food insecurity has severe negative impacts on physical health, mental health, the healthcare system, and overall social well-being¹. For children, living in a food insecure household is associated with childhood mental health issues, like hyperactivity, inattention, and greater risks of disordered eating, depression and suicidal ideation in adolescence and early adulthood².

Household food insecurity status is determined through a survey of eighteen questions, ranging from experiences of anxiety that food will run out before there is money to buy more, to modifying the amount of food consumed, to experiencing hunger, and in the extreme, going a whole day without eating2. In 2021, it was reported that 48% of food insecure households in Ontario have a household member who earns their main source of income through wages, salaries or self-employment. However, the jobs are often precarious and low-paying (minimum wage), requiring a person to have more than one job to make ends meet. The results of this survey highlights that food insecurity extends beyond people who receive social assistance. Income solutions preserve dignity, address the root case of the problem, and ensure the basic right to food2.

Since 1998, the Ontario Public Health Standards have mandated local health units to monitor food affordability through population health assessments and surveillance using the Nutritious Food Basket (NFB) tool. Food costing tools, such as the NFB³, measure the cost of basic healthy eating that represents current nutrition recommendations and average food purchasing patterns. The 2019 NFB cost was $211.20. However, The NFB tool was recently modified to capture Health Canada’s 2019 update of the National Nutritious Food Basket, the current market availability of many products, and the ability to find the price of foods through online grocery platforms - reflecting modern consumer purchasing behaviour. Due to this update, any NFB basket completed before 2020 cannot be compared to the 2022 NFB value.

CURRENT INITATIVES

Between May 16 and June 24, 2022, the WECHU and 27 other Public Health Units participated in a pilot to test the new NFB costing tool using a hybrid model of in-store and online data collection. Using the updated NFB costing tool, the average cost of the lowest price available for 61 different food items was calculated. Once the average basket price was determined for different age groups and genders based on the scenario, a 5% buffer was added to the final basket amount. This accounted for miscellaneous items not included in the calculation such as spices, hygiene products, and other household needs. Using these final numbers, a variety of income and family scenarios for our local community were calculated.

The 2022 cost of healthy eating for a family of four in our area is $241.66 per week. A sample of three income scenarios from the 2022 Real Cost of Eating Well in Windsor-Essex report can be seen in below (Table 1). This table compares monthly income received to the cost of rent and the 2022 NFB.  As noted, a single male living on Ontario Works (a social assistance benefit program) could spend close to his entire income on the rent for a bachelor apartment, leaving a shortage of $291.61 after other expenses. This highlights how the inability to purchase food is less about food prices being too high and more about people with low incomes not having enough income to cover the costs of basic living, including purchasing nutritious food.

The NFB data has been used as an essential local component in the calculation of the Windsor-Essex County Living Wage. This data can also be used as an advocacy tool toward ends which enhance priority groups’ ability to purchase healthy food by:

• Setting a minimum wage rate that more closely aligns with costs of living in Ontario
• Lowering the income tax rate for the lowest-income households
• Developing a poverty reduction strategy that includes targets for reduction of food insecurity as well as policy interventions that improve the financial circumstances of very low-income households.
• Commiting to ongoing analysis of disaggregated race-based food-insecurity data, including Indigenous Peoples and Black communities in Ontario 

The 2022 Real Cost of Eating Well in Windsor-Essex report will be disseminated to 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.

PREPARED BY:

Planning and Strategic Initiatives Department

DATE:

October 20, 2022

SUBJECT:

Renewal Plan Q3 Reporting

BACKGROUND/PURPOSE

At the May 2022 Board of Health meeting, a Renewal and Transformation plan was presented to the Windsor-Essex County Health Unit (WECHU) Board of Health, detailing the short-term priorities and planning expectations for the WECHU for 2022. This plan includes 5 priority renewal efforts in response to the stabilization of the COVID-19 Pandemic response requirements. Those 5 priorities are: Health Assessment and Surveillance, Addressing Backlog of Services, Mental Health and Substance Use, Healthy Growth and Development, and Capacity Building. Beyond these priorities, the plan outlines sustained COVID-19 response efforts as required, based on local needs and Ministry of Health requirements.

DISCUSSION

Since the release of the Renewal and Transformation Plan, departments have developed operational plans aligning with key areas. The progress made on these plans to date includes work spanning from May 2022 until the end of Q3 (September 30th). Overall, 39% of project objectives are complete, 46% of project objectives are in progress, and 15% or project objectives had no progress. Additional reporting on the progress related to the Renewal and Transformation plan will occur in January 2023 and outline the progress made in Q4 of 2022.

PREPARED BY:

Communications Department

DATE:

October 20, 2022

Data Notes can be provided upon request.

Data Notes can be provided upon request

Media Exposure Overview Graph

Website Overview Graph

DISCUSSION

A notable project that the Communication’s department worked on during this reporting timeframe was the promotion of student immunization catch-up clinics.

In keeping with the Immunization of School Pupils Act, a four-phase marketing campaign launched in the spring and wrapped up in the fall.

From September 6 - 12, a series of three Facebook posts were boosted to inform families to report vaccines to the WECHU leading up to the suspension reporting deadline of Monday, September 12 before 6 p.m.

In total, the three posts had a reach of 16,115 people, and generated 95 unique link clicks to immune.wechu.org (the online immunization reporting portal).

Board Members Present:

Gary McNamara, Joe Bachetti, Tracey Bailey, Rino Bortolin, Aldo DiCarlo, Gary Kaschak, Judy Lund, Robert Maich

Board Member Regrets:

Fabio Costante, Ed Sleiman

PREPARED BY:

Planning and Strategic Initiatives Department

PERIOD:  

JULY 1, 2022 TO SEPTEMBER 30, 2022

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 were two unplanned termination. The first was a non-union employee who chose not to follow WECHU’s updated immunization policy and resigned. The employee has since filed a constructive dismissal claim based on the policy. The second was a non-union staff person with continued performance concerns.
      11. there have been no claims made pursuant to any insurance policies maintained by the Health unit, except as noted below, and,
      12. 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 (vi), (vii), and (viii) have been revised due to the COVID -19 pandemic as follows:
      The WECHU continues through the Organizational Emergency Response. As such, operations are shifted, including redeployments to meet the needs of the organization. Operational plans and finances are shifted in accordance with current public health demands including the ongoing COVID-19 pandemic.

      Item (x). In the period between July 2022 and September 30, 2022 there was an unplanned termination of one non-union position.

Date:   September 23, 2022

Nicole Dupuis,
Chief Executive Officer

I certify that there are no additions to the above compliance report between the period end September 23rd, 2022 and September 30th, 2022.

Date: September 30, 2022

Eleanor Groh
Interim Chief Executive Officer

October 20, 2022

ISSUE/PURPOSE

The Healthy Smiles Ontario (HSO) program is a publically-funded dental care program for children and youth 17 years old and under which provides free preventive, routine, and emergency dental services to those who can not otherwise afford it. The Healthy Smiles Ontario Schedule of Dental Services and Fees for Dentist Providers (HSO Fee Guide) is an administrative tool distributed to dentists, so that they can provide services to clients in the HSO program and bill for these services.

Although limited English language skills have been identified as a key barrier to preventive dental health care utilization (Mehra, Costanian, Khanna, et al, 2019), language interpretation and translation services are not included in the HSO Fee Guide. Almost a quarter (22%) of Windsor and Essex County’s population is comprised of immigrants or refugees (‘newcomers”) (Statistics Canada, 2016), with 14% of residents most often speaking a language outside of English at home (Statistics Canada, 2021). 

The impact of language as a barrier to accessing dental care may be reduced by having access to language interpretation and translation services (Reza, Amin, Srgo et al., 2016). As community dentists are not required to accept HSO as a form of payment, this can already be a significant barrier to accessing services. In Windsor and Essex County, patients have been turned away due to an inability to access translation services. This is understandable, as a patient or guardian needs to be able to provide consent and understand what is involved in treatment. Changes to the funding for HSO, by covering the costs associated with remote interpretation services (i.e., interpretation services that are accessible from a phone, mobile device, or computer) would remove one more of the existing barriers to service.

BACKGROUND

Oral health is important to overall health and well-being for children and youth. Poor dental health can lead to negative health and social outcomes for young people, and is important to many aspects of a child’s development (Rowan-Legg, 2013). One significant oral health concern in children is early childhood caries (ECC) which is decay involving the primary teeth in children younger than 6 years of age. Ethnicity and newcomer status are considered risk factors for ECC with evidence demonstrating that children of recent immigrants and refugees have higher rates of caries and lower rates of preventative dental visits, compared to Canadian-born children (Reza, Amin, Srgo et al., 2016). Newcomer families may lack knowledge about publicly funded dental programs, lack dental health insurance, and have poor oral hygiene, which together can increase the risk and prevalence of oral health issues (Salami, Olukotun, Vastani, et al. 2022). Newcomers may also frequently face other social, cultural, economic, and language barriers to preventive dental health care utilization (Mehra, Costanian, Khanna, et al, 2019). Specifically, limited English skills have been associated with less use of dental care services, as well as challenges with communication with healthcare providers. Language issues may also interact with other known barriers to dental care for newcomers, such as household income and parental education (Reza, Amin, Srgo et al., 2016).

The impact of language, as a barrier to dental health care may be reduced by having access to language interpretation and translation services (Reza, Amin, Srgo et al., 2016). It has been suggested that both dental visits and other oral health promotion efforts for newcomer families would be more impactful if public health organizations and private dental offices, could have access to interpreting services (Amin, Elyasi, Schroth, et al., 2014).  Given the important role that parents and caregivers can play in a child’s oral health, any efforts to improve the oral health literacy of newcomer families, could be considered an important support for those seeking access to services through the HSO program. .

Expansion of public dental programs such as Healthy Smiles Ontario to priority populations has been identified as a key goal of the Windsor-Essex County Health Unit (WECHU). Given the growing urgent need and increase in dental decay among vulnerable children in Windsor-Essex (WECHU, 2018) and recognizing the existing barriers to access to care, the WECHU recommends that fees associated with language interpretation and translation services be included in publicly funded dental programs, such as the Healthy Smiles Ontario program.

PROPOSED MOTION

Whereas, oral health is important to overall health and well-being.  Access to preventive and treatment-based dental care is recognized as a basic human right for children and youth; and

Whereas, in Ontario, while many groups of children continue to have elevated rates of early childhood caries, specific groups of children are disproportionately affected, including those that are newcomers; and

Whereas, the publically funded Healthy Smiles Ontario dental program is intended to reduce overall inequity in access to preventative and affordable dental care for all young people under the age of 18, who do not have access to dental insurance or any other government programs; and

Whereas, the Windsor Essex County Health Unit recognizes the diversity of its residents, in that newcomers make up almost a quarter of the population in its jurisdiction and the important role that the HSO program plays in helping vulnerable children access preventative and emergency dental care; and

Whereas, numerous studies and research reports have indicated the urgent need to transform the current oral care health system, including providing equitable access to newcomers by addressing language obstacles;

Now therefore be it resolved that the Windsor-Essex County Board of Health recommends the province of Ontario include billing options for translation and interpretation services in the  Healthy Smiles Ontario Fee Guide; and

FURTHER THAT, while there is a variety of modalities of interpretation, it is remote interpretation services, accessible 24/7 from a phone, mobile device, or computer, that should be considered as a useful and affordable option; and

FURTHER THAT this resolution be shared with the Ontario Minister of Health, the Chief Medical Officer of Health, the Association of Public Health Agencies, Ontario Boards of Health, the Essex County Dental Society, the Ontario Association of Public Health Dentistry, the Ontario Dental Association and local municipalities and stakeholders.

References

Amin, M., Elyasi, M., Schroth, R., Azarpazhooh, A., Compton, S., Keenan, L., et al. (2014). Improving the oral health of young children of newcomer families: a forum for community members, researchers, and policy-makers. Journal of the Canadian Dental Association. Retrieved from https://jcda.ca/article/e64

Mehra, V.M., Costanian, C., Khanna, S. & Tamin, H. (2019) .Dental care use by immigrant Canadians in Ontario: a cross-sectional analysis of the 2014 Canadian Community Health Survey (CCHS). BMC Oral Health 19, 78. Retrieved from https://doi.org/10.1186/s12903-019-0773-x

Reza, M., Amin, M. S., Sgro, A., Abdelaziz, A., Ito, D., Main, P., & Azarpazhooh, A. (2016). Oral health status of immigrant and refugee children in North America: A scoping review. Journal of the Canadian Dental Association, 82(g3), 1488-2159. Retrieved from https://jcda.ca/g3

Rowan-Legg, A. (2013, January 11). Oral health care for children - a call for action. Paediatric Child Health, 37-43.

Salami, B., Olukotun, M., Vastani, M., Amodu, O., Tetreault, B., Obegu, P. O., Plaquin, J., & Sanni, O. (2022). Immigrant child health in Canada: a scoping review. BMJ global health, 7(4), e008189. Retrieved from https://doi.org/10.1136/bmjgh-2021-008189

Statistics Canada. (2017). Focus on Geography Series, 2016 Census. Retrieved from https://www12.statcan.gc.ca/census-recensement/2016/as-sa/fogs-spg/Facts-cma-eng.cfm?LANG=Eng&GK=CMA&GC=559&TOPIC=7

Statistics Canada. (2021). Census Profile, 2021 Census of Population. Retrieved from https://www12.statcan.gc.ca/census-recensement/2021/dp-pd/prof/details/page.cfm?Lang=E&SearchText=Essex&DGUIDlist=2021A00033537‍‌&GENDERlist=1,2,3&STATISTIClist=1&HEADERlist=0

Windsor Essex County Health Unit. (2018). Oral Health Report 2018 Update. Retrieved from https://www.wechu.org/resources/oral-health-report-2018

October 20, 2022

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 26 risks across 12 risk categories. Based on the categorization and reporting requirements by the MOH, 7 of these risks were identified as being high residual risks. The high residual risks to be reported to the MOH for 2022 are related to: People/Human Resources, Knowledge/Information, Technology, Security, and Privacy. Each identified high risk includes documentation of current and future mitigation approaches.

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 resolved that the Windsor-Essex County Board of Health accepts the risk assessment outlined in the 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

November, 2022

ISSUE

Nicole Dupuis has officially left her role as Chief Executive Officer of the Windsor-Essex County Health Unit effective September 23, 2022. Eleanor Groh continues to be the interim Chief Executive Officer.

Upon Nicole Dupuis’s departure, and after a thorough recruitment process, Ken Blanchette will transition to the position of Chief Executive Officer, effective November 28, 2022. In this role, Ken Blanchette will have a direct reporting line to the Board of Health and have the ability to bind the Board of Health.

PROPOSED MOTION

Whereas, Ken Blanchette was the successful candidate of the Chief Executive Officer recruitment process for the Windsor-Essex County Health Unit,

Now therefore be it resolved that the Windsor-Essex County Board of Health approve the CEO Transition to Ken Blanchette, with a direct reporting line to, and ability to bind, the Windsor-Essex County Board of Health, to take place effective November 28, 2022 as presented by Administration.