Board of Health Meeting Documents

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PREPARED BY:

Environmental Health

DATE:

May 18, 2023

SUBJECT:

Small Drinking Water Systems

BACKGROUND/PURPOSE

The Environmental Health (EH) Department conducts inspections of small drinking water systems (SDWSs) in Windsor and Essex County (WEC), as a part of the Windsor-Essex County Health Unit’s Safe Water Program. This mandatory program contributes to the prevention and reduction of illnesses related to drinking water and operates under the requirements outlined in the Safe Drinking Water and Fluoride Monitoring Protocol, 2019, the Small Drinking Water Systems Risk Assessment Guideline, 2018, and Ontario Regulation 319/08.

Public Health Inspectors (PHIs) assess the risk level of SDWSs and issue site-specific directives to owners and operators, which include requirements for sampling and testing frequency, treatment, equipment, record maintenance, and signage posting. Assessments are required to be completed every two to four years, at minimum. In addition, PHIs monitor SDWSs to ensure that the requirements outlined in the directives and Ontario Regulation 319/08: Small Drinking Water Systems are being met. They also investigate all adverse water quality incidents in a timely manner and ensure that appropriate corrective actions are taken to protect the public from unsafe water.

In WEC, there are currently 36 SDWSs, 34 of which are located on Pelee Island.

SDWS Summary

DISCUSSION

There are 18 SDWS assessments and re-assessments due for 2023. Assessments on Pelee Island will take place between April and November, as permissible by the available ferry services.

The Environmental Health Department has also been experiencing challenges in maintaining an accurate inventory of SDWSs due to business closures and changes in business ownership. In collaboration with the Pelee Island municipality, work is being done to increase education and awareness regarding the requirements for SDWSs registration with the WECHU, as per Ontario Regulation 319/08.

All routine and complaint-based inspection reports of SDWSs and drinking water advisories are made available on the health unit’s Disclosure Website. Assessments are posted within two weeks of a completed inspection and remain posted for four to eight years.

PREPARED BY:

Environmental Health

DATE:

May 18, 2023

SUBJECT:

Zoonotic and Vector-borne Disease Surveillance Program

BACKGROUND/PURPOSE

The Environmental Health Department delivers a zoonotic and vector-borne surveillance program to monitor Rabies, West Nile Virus (WNV), Eastern Equine Encephalitis (EEE), Zika Virus and Lyme disease activity in Windsor and Essex County (WEC). The program is required under the Health Protection and Promotion Act and provides the community with an early warning system for disease transmission through ticks and mosquitoes as well as to prevent human cases of rabies by animal rabies surveillance. This program is made up of the following components: mosquito larval surveillance and larviciding; adult mosquito trapping; human case surveillance for Rabies, WNV and Lyme disease; animal bite investigation; public education; and active tick surveillance. The tasks of mosquito larval surveillance and control, along with mosquito identification and viral testing, are performed by contracted agencies on behalf of the WECHU.

DISCUSSION

Animal Bite Investigations

Rabies is a viral disease that affects the central nervous system of warm-blooded animals, including humans. Once symptoms appear, rabies is almost always fatal.  In Canada, bats, foxes, skunks, and raccoons are the most common transmitters of the disease.

All potential rabies exposure cases are required to be reported to WECHU and are initiated within 24 hours of notification. Investigation includes an assessment of rabies risk in the animal species, the behaviour of the animal implicated, confinement of animals, and ensuring individuals requiring treatment have access to rabies post exposure prophylaxis.

In 2022, a total of 858 rabies cases were investigated and followed up by the Public Health Inspectors. Almost 94% of these exposures were from canine and feline species.

Active Tick Surveillance

Lyme disease is a vector-borne disease caused by the bacterium Borrelia burgdorferi. It is transmitted to humans through the bite of infected black-legged ticks. The WECHU's role is to measure and evaluate the risk of this tick-borne disease in our area.

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 of Lyme disease. Tick dragging is performed twice yearly in the spring and the fall.

In 2022, tick dragging was conducted at 4 sites across WEC (Ojibway Prairie Nature Reserve, Chrysler Greenway, Gesstwood Camp and Education Centre, and  Ruscome Shores Conservation Area) in spring and fall. One Lone star tick and 21 blacklegged ticks were found through tick dragging. This year tick dragging will be conducted during the months of May and September.

Mosquito Surveillance

Adult mosquito surveillance is an important component of the vector-borne disease program and involves the deployment of black-light CDC traps and BG-Sentinel 2 (BGS-2) traps at various locations throughout WEC.

The CDC traps are equipped with light and dry ice that attracts and traps the mosquitoes. These traps capture mosquitoes for testing to determine the presence of WNV and EEE in our region. BG-Sentinel 2 (BGS-2) traps are species-specific traps set up to catch invasive species of mosquitoes (Aedes albopictus and Aedes aegypti) that were identified during routine WNV surveillance in WEC in 2016. These traps use a scent lure and dry ice to attract daytime mosquitoes. The trapped mosquitoes are sent to an accredited laboratory for identification and testing to determine if any of the mosquitoes carry the WNV, EEE or Zika virus.

In 2022, 90,000 mosquitoes were caught, and 12 pools tested positive for West Nile virus. For 2023, the trap deployment will start on May 23rd, and run until mid-October. Once a week, 41 mosquito traps (26 CDC light traps and 15 BGS 2 traps) will be set up across WEC to collect mosquitoes for identification and viral testing. The weekly mosquito surveillance data will be made available on the WECHU's Mosquito Surveillance Dashboard.

Human Case Surveillance

The human case surveillance program identifies human cases of WNV and Lyme disease in WEC to determine the source of the disease. Physicians and hospitals must report all probable and confirmed cases to the WECHU.

The health unit investigates all suspected, probable and confirmed WNV and Lyme disease cases among WEC residents based on case definitions developed by the Ministry of Health (MOH). Standardized medical information, including demographics, symptoms, risk factors (such as travel history or having received blood products) and test results, are entered into the MOH's Integrated Public Health Information System (iPHIS). Through case interviews and GIS mapping, the health unit identifies clusters and geographic areas that may need targeted intervention.

Fight the Bite! Campaign

Fight the Bite! Public awareness campaign will launch in July 2023. It will focus on the prevention of mosquito breeding sites, information on tick removal, signs and symptoms of WNV and Lyme disease, and personal protection.

PREPARED BY:

Communications Department

DATE:

May 18, 2023

SUBJECT:

March 15, 2023 – April 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

Website Overview Graph

Social Media Overview Graph

DISCUSSION

The Communications Department supported the Chronic Disease and Injury Prevention department’s Nutrition team throughout the month of March for Nutrition Month. This is a national campaign, and the 2023 theme was Unlock the Potential of Food with a focus on finding a local dietitian.

Campaign components included a news release to kick off the month as well as a sponsored social media posts directing users to a series of videos with tips to develop their food skills. The You Can Cook videos were developed by a WECHU Public Health Nutritionist and filmed/edited by a local production company. The videos can be found on YouTube and were originally launched in 2021 with the goal of aligning promotions and driving follower traffic during Nutrition Month in subsequent years.

PREPARED BY:

Chronic Disease and Injury Prevention (CDIP)

DATE:

May 18, 2023

SUBJECT:

First Responder Resilience Curriculum Project

BACKGROUND/PURPOSE

In 2016, the Workplace Safety & Insurance Act, Post-Traumatic Stress Disorder (1997) was amended by Bill 163, Supporting Ontario’s First Responders Act, Post-Traumatic Stress Disorder (2016), requiring employers of first responders' (FR) to develop and implement post-traumatic stress disorder prevention plans.

The Ministry of Labour then issued a call for proposals for the Occupational Health, Safety, and Prevention Innovation Program (OHSPIP) in 2017-2018. In response, the Windsor-Essex County Health Unit (WECHU) worked closely with local first responder organizations to submit a successful proposal outlining six project commitments. One key commitment involved working with St. Clair College to investigate the feasibility of developing a mental health educational module to support the resilience of first responders during their post-secondary training.

The first phase of the project was completed in December 2020 and involved a needs assessment to identify core mental health and resilience topics to embed within the existing college-based curriculum. Key informant interviews were conducted with 29 representatives from policing or law enforcement, fire and rescue, paramedic, and emergency healthcare. More than 30 post-secondary representatives and mental health providers were also consulted. The analysis highlighted the need to develop educational materials across four themes, which were: a) Resilience & Coping, b) Mental Health Literacy, c) Help Seeking and Intervention, and d) Role Preparation.

CURRENT INITIATIVES

In the Fall of 2021, The WECHU transitioned into the module content development and implementation phase of the project. A total of twenty lessons were developed for the four modules, which included the creation of powerpoint slide decks, case studies, lesson plans, various multimedia and interactive components, and activities. Throughout this project phase, key stakeholders were consulted regularly in the development and review of material. The four modules and the associated 20 lesson topics are presented in Table 1.

As of March 31st 2022, all module content has been shared with post-secondary stakeholders engaged in the project, including instructors and program administrators from St. Clair College and the University of Windsor. Selected content has been piloted in two post-secondary courses at St. Clair College and positive feedback was received from both instructors and students. The module content is currently at various states of review and implementation in local post-secondary first responder programs. The specific programs as well as the number of students typically enrolled are highlighted in Table 2.

FUTURE PLANS

The WECHU has completed its commitment as part of the Occupational Health, Safety, and Prevention Innovation Program (OHSPIP) project work. Some of the programs listed above have expressed intent for a formal incorporation of module content into their curriculum for upcoming curriculum review cycles. Additionally, there are more than 1,500 individuals are currently employed as municipal or provincial law enforcement officers, paramedics, and firefighters across Windsor-Essex County, and there has been expressed interest from local organizations to expand implementation to in-service voluntary firefighters. The WECHU will continue to remain informed about the implementation status for post-secondary instutitions and first responder organizations, impact of the modules on curriclum design, outcomes of assessment and evaluation initiatives, and impacts on students and working first responder professionals.

References

1. Ministry of Advanced Education and Skills Development College Enrolment Statistical Reporting system. (2022). College enrolment [Dataset]. Government of Ontario. https://data.ontario.ca/dataset/college-enrolment
2. University of Windsor (n.d.) Headcount | Office of Institutional Analysis. Retrieved March 17, 2023, from https://www.uwindsor.ca/institutional-analysis/307/headcount.

^[a] From available data for 2021/2022 and 2022/2023 academic years from referenced data sources.

PREPARED BY:

Chronic Disease and Injury Prevention (CDIP)

DATE:

May 18, 2023

SUBJECT:

SafePoint Site Launch

BACKGROUND/PURPOSE

On April 14th of 2023, the Windsor-Essex County Health Unit (WECHU) received approval from Health Canada to operate the SafePoint Urgent Public Health Need Site at 101 Wyandotte Street East. In preparation for the launch, community agencies, elected officials, neighbourhood businesses, peer groups, potential clients, media, and other stakeholders were invited to private tours of the facility to learn more about the services offered. In total, 17 private tours and 2 public tours were facilitated during the period of April 3rd to April 21st.

A media event was held on-site at SafePoint on April 19th, where the local media was briefed on the upcoming launch of SafePoint, the new partnership with the operational lead agency, Hôtel-Dieu Grace Healthcare (HDGH), and offered a tour of the site. From April 17th to May 1st, there were 32 news stories related to SafePoint. This media engagement was also leveraged as an opportunity to promote open houses later that week which provided members of the public, area businesses, and other stakeholders an opportunity to visit the site. The public open houses were offered on Thursday, April 20th and Friday, April 21st, with an estimated 400 community members touring the site over the course of the two-day period.

Through these tours hosted in April, participants were given the opportunity to share their feedback and express concerns with the staff. Any concerns that were expressed related to access, site design, safety, client services, and community outreach, were documented and presented to the SafePoint Advisory Committee as part of their ongoing dialogue to iteratively improve operations. The general response from residents, community agencies, and business owners who had the opportunity to visit SafePoint for a tour was positive and supportive.

CURRENT INITIATIVES

SafePoint officially opened to serve clients 7 days per week starting on Wednesday, April 26th during the operating hours of 10:00 a.m. – 6:00 p.m. The initial objectives of SafePoint during the first months of operations include:

• Developing relationships with service providers of potential clients as a source of referrals;
• Refining processes, policies, and procedures;
• Building trust with people use substances or could access SafePoint services;
• Establishing positive relationships with neighbourhood businesses;
• Providing ongoing opportunities for the public to participate in open houses outside of operating hours.

Current as of May 10, there have been 24 client visits in the first 14 days of operation, which aligns with expectations for the first few months of operation relative to the population density of the area where the site is located. The current client volume provides an opportunity for staff to build connections with clients and continue to streamline processes to provide the best quality care.

Early indications from the HDGH team operating SafePoint demonstrate that the service is already having a positive impact on clients that access SafePoint services, as highlighted through the following narratives:

Anonymous Client #1

Client had recently been released from incarceration, which indicates an increased susceptibility to overdose. Client was able to consume their substance under the supervision of Registered Practical Nurses and experienced no adverse events. Client expressed interest in social services and was provided with support in completing their application to the Ontario Disability Support Program (ODSP).

Anonymous Client #2

Client visited SafePoint to consume a substance. The client was able to receive assistance in creating an email account and filling out a housing application so that they would have a more stable place to live. The client is now considering treatment options once their housing needs are met.

FUTURE PLANS

Other sites that were consulted throughout this process have indicated that the main source of referrals for clients came through word of mouth. As the number of clients accessing the service grows and trust is built through positive experiences, it is anticipated that client volumes will increase over the next few months. Establishing pathways for community agencies to refer their clients to SafePoint, availability of on-site wrap-around services, and connections to social services will also serve to further incentivize client visits to SafePoint.

Surrounding businesses will continue to be engaged by SafePoint staff and advisory committee to mitigate any security concerns that may emerge. Proactive efforts have already been taken to develop relationships with neighbourhood businesses to work collaboratively to mitigate the use of their facilities for drug consumption and improperly discarded needles, as well as navigating people who use substances to access SafePoint where appropriate. These collective efforts will ensure clients receive the services they need and can access other services to promote their well-being, while ensuring that SafePoint is successfully integrated into the surrounding community. A comprehensive evaluation of SafePoint is underway to measure its impact on the surrounding community and efficacy in achieving its goals for people who use its services.

PREPARED BY:

Environmental Health

DATE:

May 18, 2023

SUBJECT:

Recreational Water Inspections and Beach Monitoring

BACKGROUND/PURPOSE

The Environmental Health Department conducts inspections of recreational water facilities in Windsor and Essex County (WEC), as a part of the Windsor-Essex County Health Unit’s Safe Water Program. This mandatory program contributes to the prevention and reduction of water-borne illnesses, and operates under the requirements outlined in the Recreational Water Protocol, 2019 and the Operational Approaches for Recreational Water Guideline, 2018. Recreational water facilities that are routinely inspected within this program include public pools, splash pads, water slides, and spas. Seasonal beach monitoring is also conducted, which includes surveillance of water and weather conditions, and potential pollutants, as well as weekly water sampling to test for Escherichia coli (E. coli), a bacteria that can cause severe stomach cramps, diarrhea, fever, and vomiting.

* This is a decrease from 9 beaches sampled in 2022

Recreational Water Facilities Summary

2022 Beach Monitoring Summary

The 2022 beach monitoring season was a total of 16 weeks long, with weekly water testing beginning on May 24, 2022, and ending on September 6, 2022. Public Health Inspectors completed a total of 156 on-site beach assessments. There were 41 water quality warnings issued (201-999 E. coli/100 ml), and 13 beach closures (≥1000 E. coli/100 mL).

DISCUSSION

Recreational Water Facility Activities

As a part of pandemic recovery, in 2023, recreational water inspections have resumed routine frequency as required in the Recreational Water Protocol, 2019. Indoor pools and spas are inspected at least four times per year, and outside pools and spas will be inspected at least two times within the operating season. Splash pads and waterslides will be inspected a minimum once per year.

All routine and complaint-based inspection reports of recreational water facilities are made available on the health unit’s Disclosure Website. Reports are posted within two weeks of a completed inspection and remain posted for two years. A campaign to increase the public’s knowledge and use of the disclosure website was launched on March 27, 2023, and is set to run for a total of 9 weeks. The campaign includes bus ads, billboards, social media ads, and radio ads.

Beach Assessments and Testing

Public Health Inspectors will conduct pre-season beach assessments mid-May, with weekly surveillance and water sampling beginning May 23, 2023. Mettawas Beach is no longer designated as a public beach and will not be included in beach monitoring this season. Beach water sampling will take place every Monday (or Tuesday if Monday is a holiday) and results will be made available on the health unit’s Beach Water Testing webpage by Tuesday or Wednesday of the same week. Results will also posted to the Beach Hotline (ext. 1490). If a beach is closed due to high E. coli levels, the beach will be resampled on Wednesday of the same week, with results made available by end of day Friday.

Meeting held via video: https://youtube.com/live/wDjoehFSFnA

March 15, 2023

Honourable Jean-Yves Duclos
Minister of Health, Canada
House of Commons
Ottawa, ON K1A 0A6
jean-yves.duclos@parl.gc.ca

Dear Honourable Minister Duclos:

Re: Support for ‘BILL S-254 An Act to amend the Food and Drugs Act (warning label on alcoholic beverages)’

On March 15, 2023, the Board of Health for the Simcoe Muskoka District Health Unit (SMDHU) received information on the 2023 Canada’s Guidance on Alcohol & Health and passed a motion to endorse Bill S-254 – An Act to Amend the Food and Drug Act (Warning Label on Alcoholic Beverages), calling on the federal government of Canada to implement health warning labels on alcohol. 

According to the Canadian Community Health Survey (CCHS) in 2019/20, 20% of adults in Simcoe Muskoka ages 19 years and older reported drinking at a high-risk level (7+ drinks) in the past week. This was significantly higher than the comparable provincial average of 15%. SMDHU’s Board of Health is committed to our mandate under the Ontario Public Health Standards to influence the development and implementation of healthy policies and programs related to alcohol and other drugs to reduce harms associated with substance use.

As such, we ask for your support of Bill S-254 and the implementation of federally mandated labels on all alcohol containers sold in Canada, to better inform Canadians about the health risks of alcohol. This is especially important given that the majority of Canadians are unaware that alcohol is classified by the World Health Organization (WHO) as a Class 1 carcinogen and is a cause of 7 different types of cancer, including breast and colon.

Bill S-254 aligns with the recent call in Canada’s Guidance on Alcohol and Health for mandatory labelling of all alcoholic beverages with the number of standard drinks in a container, risk levels from Canada’s Guidance on Alcohol and Health, and health warnings. This recommendation by the Canadian Centre on Substance Use and Addiction is based on their 2022 systematic review of enhanced alcohol container labels, and is supported by other scientific experts in the field, including Evidence-based Recommendations for Labelling Alcohol Products in Canada developed by Canadian Alcohol Policy Evaluation (CAPE) Project researchers. A recent study in Yukon has contributed to the growing evidence base regarding the impact of warning labels; briefly introduced labels on alcohol products in government-owned liquor stores saw sales of labelled alcohol products decrease by 6.6%, while sales of unlabeled alcohol products increased by 6.9%¹. The extensive evidence regarding warning labels applied to tobacco products is also informative, having been shown to lead to increased health knowledge and decreased tobacco use (WHO, 2022).

In Canada, similar to tobacco and cannabis products, it is time for the Government of Canada to require warning labels on alcohol. According to a 2020 report on Canadian Substance Use Costs and Harms, alcohol is a drug that cost Canada $16.6 billion and was responsible for more than 18,000 deaths in 2017 alone.

The Senate plays a key role in introducing legislation to serve the best interests of Canadians and we urge you to join Senator Brazeau in supporting Bill S-254.

Sincerely,

ORIGINAL Signed By:

Ann-Marie Kungl, Board of Health Chair
Simcoe Muskoka District Health Unit

AMK:CG:LS:sh

cc:
Members of Parliament for Simcoe and Muskoka
Ontario Boards of Health
Dr. Kieran Moore, Chief Medical Officer of Ontario
Senator Patrick Brazeau
Loretta Ryan, Executive Director, Association of Local Public Health Agencies, alPHa
Dr. Theresa Tam, Chief Public Health Officer of Canada

¹ Weerasinghe, A., Schoueri-Mychasiw, N., Vallance, K., Stockwell, T., Hammond, D., McGavock, J., Greenfield, T.K., Paradis, C., Hobins, E. Improving Knowledge that Alcohol Can Cause Cancer is Associated with Consumer Support for Alcohol Policies: Findings from a Real-World Alcohol Labelling Study. Int. J. Environ. Res. Public Health 2020, 17, 398. Retrieved from: https://doi.org/10.3390/ijerph17020398

PREPARED BY:

Planning and Strategic Initiatives Department

DATE:

April 20 2023

SUBJECT:

2023 Strategic Plan Q1 Report

BACKGROUND/PURPOSE

The WECHU’s 2022-2025 Refreshed Strategic Plan provides strategic direction to the organization for ongoing COVID-19 response, support recovery from unintended population health consequences of the pandemic and help understand how best to engage and support our community as the COVID-19 pandemic begins to subside. It also has 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 to the administration and remain informed about the activities for organizational effectiveness through “evaluation of the organization and strategic planning.”

DISCUSSION

The Planning and Strategic Initiatives Department (PSI) is currently developing the 2023 Q1 Strategic Plan Report in consultation with the Leadership Team. This report will contain a list of current objectives for each priority and provide specific metrics to measure the progress for each of the 12 objectives in the Strategic Plan.

Each quarter, PSI will coordinate with the data custodians for each program and applicable departments to update the progress of the goals and objectives using a colour-coded system.

The first report will be delivered at the end of Q2.

PREPARED BY:

Planning and Strategic Initiatives Department

DATE:

April 20 2023

SUBJECT:

Annual Service Plan Q1 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. In order to ensure a single, integrated approach to planning, the Planning and Strategic Initiatives (PSI) department worked with the Information Technology (IT) department to align our planning system with the provincial requirements. 

With the support of PSI, staff members develop and enter their annual work plans which are then reviewed and approved by the leadership team and integrated in the WECHU’s Annual Service Plan for the Ministry.

DISCUSSION

Annual Service Plan (ASP) Submission

WECHU’s 2023 Annual Service Plan was submitted to the MOH on April 3rd, 2023. The plan provides details about planned expenditures and program plans for 2023.

Planning for 2024

The PSI and IT departments have begun to incorporate changes from the 2023 ASP template and reporting requirements, as well as the feedback received from managers and staff, into the planning approach for 2024.  It is anticipated that the next planning cycle will be launched in mid-summer.

PREPARED BY:

Communications Department

DATE:

April 20 2023

SUBJECT:

February 15, 2023 – March 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

Website Overview Graph

Social Media Overview Graph

DISCUSSION

The Communications Department supported Environmental Health with their Stay Warm campaign from December 2022 until the end of February 2023. The campaign provides information and tips to safely enjoy the winter months.

Campaign components included radio ads, digital media ads (i.e., Google ads), social media ads and organic posts, and WECHU-owned media (i.e., website banner, on-hold messaging).

The Google Display / Search ad yielded 92,289 impressions (i.e., the number of times the ads were on screen), and 622 link clicks. The social media ad ran on Facebook and yielded a reach of 32,610 (i.e., the number of people who saw the ad at least once), and 158,695 impressions. From Facebook, there were a total of 119 post reactions including 5 comments and 21 shares. It also received 722 unique link clicks, which took users to the Stay Warm webpage.

PREPARED BY:

Oral Health Department

DATE:

April 20 2023

SUBJECT:

WECHU Oral Health Services and Oral Health Month

BACKGROUND/PURPOSE

The Ontario Public Health Standards provide direction to Ontario public health units to operate two publicly funded oral health programs under the Oral Health Protocol (2001). The Healthy Smiles Ontario (HSO) Program is offered for children aged 0-17, from low-income households, and the Ontario Seniors Dental Care Program (OSDCP) is available for low-income seniors 65 years and older. Additionally, the Oral Health Protocol mandates Ontario public health units on to implement school based preventative oral health screenings and population-level surveillance of oral health indicators. 

The month of April is Oral Health Month, an ideal time to promote the importance of good personal oral hygiene practices and the role that dental professionals play in maintaining and improving our community’s oral health.

DISCUSSION

WECHU Healthy Smiles Ontario (HSO) Dental Clinics

From January-December 2022, there were 1,232 children screened at one of the WECHU’s two dental clinics operating in Windsor and Leamington that ultimately enrolled into the publicly funded Healthy Smiles Ontario program. Children identified with an emergency dental condition such as infection or carious lesion that requires immediate clinical treatment, are provided access to emergency coverage for treatment either onsite or for free through a community dental office. Children can also receive preventative treatment such as topical fluoride, pit and fissure sealants, scaling, and some interim stabilization therapies through the WECHU clinics.

Ontario Seniors Dental Care Program (OSDCP)

The Ontario Seniors Dental Care Program was put in place in 2019 at both the Windsor and Leamington clinic sites. Given the high demand for this free program, partnership agreements with community dental offices were created in 2022 to manage wait times. Through internal clinics and partnership, the WECHU oral health department supported 3,851 clinic visits across all clients enrolled in the OSDCP. This includes 283 “new patient” exams, for an average of 1.1 new patients added to our client roster every working day. New dentures have also been provided to 162 clients at the WECHU over the course of the year.

School Dental Screening, Assessment and Surveillance

With a full staff complement returning from redeployment, the Oral Health Department implemented an ambitious plan to resume school oral health screenings over the last three months of the 2021-2022 academic school year. By prioritizing high and medium risk schools, the most vulnerable students in our region were provided oral health screening and referral in the school setting. Between April and June 2022, 5,573 students from 35 schools were screened. Within this group, 984 students (17.7%) had an urgent dental care need and were referred for treatment and 2,369 children were referred for non-urgent treatment.

In September, dental teams returned to the schools and during the first half of the 2022-2023 academic year, screened 5,081 students from 34 schools. Following the Oral Health Protocol, all JK/SK and Grade 2 students are screened. In addition, schools that are identified as medium risk also receive screenings for all Grade 7 students while schools identified as high risk receive screenings for both Grade 4 and Grade 7 students. In the 2022/2023 school year, the WECHU endeavored to screen all grades at high-risk schools to ensure that children who were not screened due to the pandemic were captured. Out of the 5,081 students screened there were 834 students (16.4%) that had an urgent dental care need and 2,441 children that were referred for preventive treatment.

Baby Oral Health Program (BOHP)

The Canadian Dental Association and the Canadian Pediatric Society suggest that a child have a dental visit before their first birthday. The BOHP is designed to support parents of children 0 to 4 years of age by inviting them to bring their children for an oral health screening by a public health dental hygienist, which also includes education for caregivers and children on oral hygiene habits. Caregivers are also encouraged to visit a dentist or make a follow-up appointment at the health unit if they do not have a dental home. Children who present with urgent needs are either enrolled into the Healthy Smiles Ontario program or referred externally for dental treatment.

Key References

Ontario. Ministry of Health. (2021). Oral health protocol, 2021. Retrieved from https://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/docs/protocols_guidelines/Oral%20Health%20Protocol_2021.pdf

PREPARED BY:

Healthy Schools Department - Immunization

DATE:

April 20, 2023

SUBJECT:

Immunization of School Pupils Act (ISPA) Compliance Update for Windsor and Essex County

BACKGROUND/PURPOSE

The Immunization of School Pupils Act (ISPA) R.S.O. 1990, requires all Ontario students to be immunized against nine diseases. Public health units are required under the ISPA to routinely review student immunization records for students in their catchment area to ensure compliance. Students may be exempt from immunizations due to medical or non-medical reasons. These students, although not up to date on their immunizations, will have satisfied the ISPA requirements.

The WECHU assesses compliance with the ISPA and takes a progressive and collaborative enforcement approach. Parent(s)/guardian(s) of students not in compliance with the ISPA are notified in advance and provided information on actions to avoid a school suspension. A suspension order is issued only if proof of immunization or an exemption is not provided to the WECHU by the date specified. Students with incomplete immunization records or without a valid exemption by the deadline are suspended from school until the required immunization information is reported to the WECHU.

DISCUSSION

ISPA Enforcement in Secondary Schools

Immunization records for secondary students in Windsor and Essex County, were reviewed in June 2022:

• 13,254 students received immunization notices.
• 7,554 students were mailed suspension orders.
• 1,519 students were suspended.

Prior to enforcing the ISPA through the suspension process, the WECHU hosted onsite immunization clinics in local secondary schools, regional municipalities, and WECHU offices. Clinic promotion was largely done on social media channels and by engaging youth-serving agencies (e.g., school boards and New Canadians’ Centre of Excellence Inc.).

Implementation of ISPA in Elementary Schools

For the 2022/2023 school year, student compliance with the ISPA was assessed and enforced for elementary students starting in December 2022 (see table below). Most students issued a suspension order on March 20, 2023 have since updated their immunization records with the WECHU and have returned to school.

Prior to enforcing the ISPA through the suspension process, the WECHU engaged in activities to help families avoid suspension:

• Collaborated with health care providers to assess/update student immunization records, arranged for increased vaccine supply, and provided education on provincially-funded immunization schedule.
• Collaborated with school boards and school administrators to offer onsite school immunization record review clinics and communicated updates through school social media channels.
• Provided frequent updates to School Board Liaisons.
• Developed a webpage of resources for school administrators.
• Hosted immunization clinics for students to get missing vaccines and updated records with the WECHU.
• Launched a targeted community communication campaign promoting key messages through diverse channels such as: Arabic radio (CINA 102.3 FM) and other media outlets; 2-1-1, and Facebook.
• Translated resources for schools in French, Arabic, and Spanish.
• Used RIO (a phone-based language service) to service families in their preferred language.
• Provided several options for reporting immunization records (e.g., online, phone, fax, in person at the WECHU) along with information on where to get immunized (i.e., their health care provider or via a WECHU clinic).
• Tailored support to families and school administration provided by public health nurses over the phone and in person.

After the suspension deadline, the WECHU has been engaging in key activities to help get suspended children back to school:

• Daily calls to affected families to help troubleshoot.
• Daily communications with school administrators whose schools have affected families.
• Hosting daily walk-in immunization clinics for students to get missing vaccines and update records.
• Media advisories to keep the public aware of enforcement progress.

Immunization Compliance and Coverage Rate

As of April 5, 2023, 94% of enrolled students are in compliance with the Immunization of School Pupils Act during the school year 2022-23, meaning they are either immunized for the ISPA-designated diseases or have a recorded exemption. This percentage includes students from all grades except Grade 9 as the WECHU is currently running the compliance process for this grade.

The WECHU also plans to publish an interactive dashboard in April on local temporal trends of immunization coverage rates among 7- and 17-year-olds up until school year 2021-22 and will also compare these rates to provincial rates and national goals for coverage. The WECHU will provide a second update in August 2023 by adding data on 12- year-olds and include coverage rates for the 2022-23 school year.

Board Members Present:

Renaldo Agostino, Joe Bachetti, Fabio Costante, Fred Francis, Judy Lund, Hilda MacDonald, Angelo Marignani, Michael Prue

Board Member Regrets:

Robert Maich, Rob Shepley

ISSUE/PURPOSE

The Board of Health is required to approval the one-time business cases included in the 2022 Annual Service Plan and Budget Submission (ASP) as submitted on April 3, 2023.

BACKGROUND

On April 3, 2023, the ASP was submitted to the Ministry of Health (MOH).  The ASP included budget information approved by the Board of Health on January 18, 2023.  More specifically:

• 2023 Mandatory Program Budget;
• 2023 Ontario Seniors Dental Care Budget;
• 2023 One-time Business Cases in support of COVID-19, more specifically the COVID-19 general program and the COVID-19 vaccination program.

In addition, the ASP included requests for one-time business cases funded at a rate of 100% by the MOH.  More specifically:

A description of the business cases are as follows:

Vaccine Program Replacement & Contingency Plan Storage Requirements:  This business case is to fund the replacement of two (2) double-door vaccine fridges nearing end of useful life, and the acquisition of one (1) double-door vaccine fridge to be located at a third-party location to support contingency plan storage requirements.

Public Health Inspector Practicum Program:  This business case supports the salaries of four (4) public health inspector practicum students.  Public health inspector practicum students support the general operations of the Environmental Health department while gaining the well-rounded experience required to complete their certification. 

Ontario Seniors Dental Care Program – Furniture and Equipment fit-out:  This business case supports the fit out of operatories, client reception areas and other furniture requirements for the Windsor Office Redevelopment Project.  More specifically, this business case includes:

Information Technology, Furniture and Equipment Replacement:  This business case supports the replacement of the information technology infrastructure for the Windsor Office Redevelopment Project and additional furniture and equipment requirements to fit out other spaces.  A particular emphasis was placed on the replacement of the information technology infrastructure as it will be end-of-life in 2024.  This business case also includes third party consulting costs to support design and procurement requirements, capacity which does not exist within the WECHU Administration. More specifically, this business case includes:

New Windsor Office Location – Leasehold improvements: This business case supports certain of the leasehold improvements to be completed from April 2023 to March of 2024.  This business case includes third-party consulting costs to support overall project management, capacity which does not exist within the WECHU Administration. More specifically, this business case includes:

PROPOSED MOTION

Whereas, the Board of Health for the Windsor-Essex County Health Unit has approved the 2023 Budget which included budget information for Mandatory programs funded by the MOH and the Obligated Municipalities on a cost shared basis, the Ontario Seniors Dental Care Program funded at a rate of 100% by the MOH, as well as preliminary information on one-time business cases funded at a rate of 100% by the MOH relating to COVID-19 (general and vaccination), and

Whereas, the WECHU submitted its Annual Service Plan and Budget Submission to the MOH on April 3, 2023, inclusive of the aforementioned budget approvals as well as additional requests for one-time 100% funded business cases from the MOH, and

Now therefore be it resolved that the Windsor-Essex County Board of Health approve the following additional one-time business cases to be funded at a rate of 100% by the MOH:

ISSUE/PURPOSE

The Windsor-Essex County Health Unit (WECHU) administers the Healthy Babies Healthy Children Program and the Pre-natal and Post-natal Nurse Practitioner Program (collectively referred to as the Programs).  These Programs are funded entirely by the Ministry of Children, Community and Social Services (MCCSS).  The operating budget for the fiscal year April 1, 2023 to March 31, 2024, requires approval by the Board of Health prior to submission to the MCCSS.

BACKGROUND

For fiscal 2023/24, these Programs support twenty-five and three quarters (25.75) FTEs comprised of one (1.0) manager FTE, one-quarter (0.25) director FTE, sixteen (16.0) public health nursing FTEs, one (1.0) nurse practitioner FTEs, four (4) family home visitor FTEs, one (1.0) social worker FTE, two and one-half (2.5) support staff FTEs.

Significant changes in the operating budget include the following:

• Net increase in Salaries and Benefits $10,580 representing salary increases as required by applicable employment agreements, net of uncompensated absences.
• Reduction in Mileage of $5,000 – The 2023/24 fiscal year reflects the average of mileage costs in the 2022/23 fiscal year.
• Reduction in Program Supplies of $5,750 – The fiscal 2023/24 budget contemplates expenditures being incurred on account of supplies to support programs ($15,792), information technology equipment replacement ($10,836), phone operating costs ($3,600), information technology licensing ($12,864).

PROPOSED MOTION

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

Whereas, the total budgeted expenditures for the Programs for the period April 1, 2023 to March 31, 2024 is $2,894,941, and

Now therefore be it resolved that the Windsor-Essex County Board of Health approve the operating budget as presented by Administration for the period April 1, 2023, to March 31, 2024

Meeting held via video: https://youtube.com/live/m9IJV3aMESs

Board of Health
Windsor-Essex County Health Unit
c/o Lee Anne Damphouse
ldamphouse@wechu.org

December 20, 2022

Dear Members of the WECHU Board of Health,

I am writing to you as a Windsor resident and a parent of two children. I know I am not alone in wanting to be confident that up to date peer-reviewed science is used to inform local public health policy.

Almost a year has passed since Windsor reintroduced fluoride to the municipal water supply. The page relating to fluoride on the WECHU website¹ states that the optimal concentration of fluoride in drinking water to support good dental health is 0.7 mg/L and that Health Canada considers 1.5 ml/L to be the maximum acceptable concentration. It refers the reader to Health Canada for further information. Health Canada states:²

Since the 1940’s, researchers have been testing the safety and benefits of fluoride. Apart from dental fluorosis and skeletal fluorosis, there are no other health effects related to fluoride.

During pregnancy and breastfeeding: Fluoride is not harmful to a fetus or through breastfeeding.

When it comes to bottle-fed babies, the following advice appears lower down on the page:

If you live in an area with naturally occurring high levels of fluoride (higher than the guideline of 1.5 mg/L- the maximum acceptable concentration), we suggest you mix the formula with drinking water with a lower fluoride concentration level. (emphasis added)

I am concerned about the stated maximum acceptable threshold of 1.5 ml/L in this advice from WECHU and Health Canada.

The underlying reason for my concern is that the authors of the January 2020 study Fluoride exposure from infant formula and child IQ in a Canadian birth cohort³ found statistically significant reductions in IQ in formula fed infants, even when using “optimally fluoridated water” at a concentration of 0.7 mg/L:

Using optimally fluoridated water (0.7 mg/L) to reconstitute infant formula may diminish the development of intellectual abilities in young children, particularly for non-verbal abilities. The findings also suggest that both prenatal and postnatal fluoride exposure affect the development of non-verbal intelligence to a greater extent than verbal intelligence.

This level is less than half the concentration below which Health Canada deems fluoride to be safe.

In its strategic plan, the WECHU Board has committed that it will “make decisions based on quality evidence and apply best practice program planning and policy development frameworks.”⁴

For this reason, I am writing to ask that WECHU:

• add a link on the fluoride page of its website to inform pregnant women and families who choose to formula-feed their babies about the findings from this now 3-year old peer-reviewed study;
• start advising pregnant women and new parents to use non-fluoridated water to protect the developing brains of their babies.

These common-sense measures will enable parents to be better informed regarding the current science relating to municipal water fluoridation, enabling them to protect the health of their children during the most vulnerable phase of their lives.

I look forward to the Board’s response to my concerns.

Yours sincerely,
Philippa von Ziegenweidt
 

• ¹Fluoride | The Windsor-Essex County Health Unit - (wechu.org)
• ²Fluoride and Oral Health - Canada.ca
• ³Fluoride exposure from infant formula and child IQ in a Canadian birth cohort - ScienceDirect
• ⁴Evidence-Based Public Health Practice | The Windsor-Essex County Health Unit - (wechu.org)