Board of Health Meeting Documents

PREPARED BY:

Environmental Health

DATE:

June 15, 2023

SUBJECT:

Food Handler Training

BACKGROUND/PURPOSE

The Ontario Food Premises Regulation 493/17 requires all operators of food premises to ensure that there is at least one food handler or supervisor onsite who has completed food handler training during every hour in which the premises is operating. Food handler training and certification must be obtained from an Ontario public health unit or another provider that is recognized by the Ontario Ministry of Health, and in accordance with the requirements outlined in the Food Safety Protocol, 2019  and the Operational Approaches for Food Safety Guideline, 2019.

The number of infractions in which a certified food handler was not onsite, in the most two years, during a public health inspection in Windsor and Essex County (WEC) is summarized in the table below.

The Environmental Health (EH) department offers a free online Food Handler course, in English, French, Spanish, Chinese and Arabic languages. There is also a Food Handler manual providing course material to help individuals prepare for the exam. The manual is available to in English and French that individuals can purchased for $10 and can be picked up at one of the Windsor-Essex County Health Unit offices.

In-person certification exams are made available throughout WEC, in multiple languages, for a $10 fee. Individuals must register online to book their exam. A certification card is issued when a grade of 70 percent or higher is achieved and is valid for five years. This year WECHU has offered 28 exam sessions to date. An emerging challenge that the WECHU has identified are individuals registering to attend for examination, fulfilling one of the open spots, and not attending (average actual attendance is 72% of the available space). Based on this recent trend, we have adjusted exam registration capacity to ensure the classes are full at all times. We are also exploring opportunities to utilize larger spaces to accommodate more individuals at a time, that can be efficiently proctored with an efficient writer to proctor ratio.

DISCUSSION

In the fall, Public Health Inspectors (PHIs) will begin issuing fines to food premises operators who are non-compliant with the O. Reg. 493/17 requirement to have at least one certified food handler onsite during every hour in which the premise is operating. In accordance with  (items 248 and 249) of the Provincial Offenses Act, charges will be issued for the total amount of $385 ($305 set fine, plus $75 victim fine surcharge and $5 fee) Schedule 41 Ontario Provincial Penalties  O. Reg. 161/00: VICTIM FINE SURCHARGES under Provincial Offences Act, R.S.O. 1990, c. P.33. In the months leading to this deadline, operators will be provided with education and appropriate notice of this upcoming enforcement action. The EH department will continue increase the number of exam dates available throughout WEC locations to satisfy any additional demand that arises. 

PREPARED BY:

Infectious Disease Prevention (IDP)

DATE:

June 15, 2023

SUBJECT:

Sexual Health Campaigns in IDP

BACKGROUND/PURPOSE

Syphilis is a sexually transmitted and blood-borne infection (STBBI) of public health significance. Although syphilis is largely preventable, data for these infections in Windsor and Essex County (WEC) is showing cause for concern. Syphilis cases are steadily increasing. Over the past 5 years, the WEC crude incidence rate of syphilis (infectious, latent, and other) increased from 13.52 cases/100,000 population in 2018 to 17.37 cases/100,000 population in 2022. This is an increase of 28.55%. In comparison to provincial rates, the crude incidence rate of syphilis (infectious, latent, and other) in Ontario increased from 20.02 cases/100,000 population in 2018 to 35.51 cases/100,000 population in 2022, which is an increase of 77.37%. Congenital syphilis, the transmission of syphilis to a baby during pregnancy or childbirth, has also become increasingly more prevalent in Canada in recent years. (Public Health Agency of Canada, 2021). Locally, three congenital syphilis cases have been reported in WEC.

Most syphilis cases have been found in men, although women are also at risk. Of the 396 cases of syphilis that occurred in WEC from 2018-2022:

• 80.30% were male, 19.19% were female, and 0.51% were transgender;
• Age ranged from 18 to 75 years, with a median age of 39 years; and
• 4.55% of syphilis cases were co-infected with HIV based on iPHIS risk factors.

Risk factors for syphilis include: unprotected sexual activity (especially in men who have sex with men), sexual contact with an identified case of syphilis, sexual contact with an individual from a jurisdiction with an elevated prevalence of syphilis, previously tested positive for syphilis, HIV, or other sexually transmitted bloodborne infections, born to an individual who tested positive for syphilis during pregnancy, and being classified as a member of a vulnerable population engaging in unprotected sex (vaginal, anal, and oral), men having sex with men, and having sex with anonymous and/or multiple partners (Public Health Agency of Canada, 2021). This increasing trend of engaging in anonymous sex with partners found on the internet has created challenges in being able to notify contacts of exposure.

CURRENT INITIATIVES

Public health campaigns play a strategic role in society by raising awareness of important health issues and encouraging groups and individuals to seek information and services. With increased prevalence of syphilis and other sexually transmitted infections, like MPox (previously known as Monkeypox), IDP is developing a sexual health strategy that include various initiatives and platforms to address the issue.

The strategy aims to reach the broader community with an emphasis on reducing stigma, prevention, increasing public knowledge about syphilis, encourage individuals to get tested and know that it can be treated with antibiotics. Recognizing that June is Pride Month, IDP will be kicking off a MPox advertisement (ad) in the Summer Issue for Windsor Life Magazine (see Appendix A). Social media posts on WECHU’s Facebook and Instagram platforms will also push out critical messages about virus transmission, symptoms, testing, and vaccine availability that align with Public Health Ontario’s initiatives, alongside the Gay Mens Sexual Health Alliance. These efforts directly contribute to getting community members vaccinated and helping people access reliable and trustworthy information. The MPox ad will also be published in the 2023 Come OUT & Play Guide to support our local Windsor-Essex Pride Fest, which IDP will partake in as a vendor in August 2023. MPox vaccines, along with sexual health education, will be available at the event.

Moreover, IDP has collaborated with the Healthy Schools department and Merck to organize a Healthcare Provider Breakfast event that will be held on June 15, 2023. Dr. Mehdi Aloosh and Dr. Shanker Nesathurai will be shedding light on the increasing syphilis numbers in WEC. Kim Kirkpatrick, a Nurse Practitioner from Sexual Health Windsor, will also be presenting about the recent syphilis trends and resources available in the community in relation to syphilis. One of the objectives of the event is to emphasize the importance of testing and treating syphilis in the community. Aligning with the Healthcare Provider Breakfast event, a syphilis ad is also underway that focuses on removing the stigma from sexual health and promoting STI testing in the community. The syphilis ad will be included in the July/August issue of the Biz X Magazine, and social media posts will parallel this initiative. The campaigns are carefully crafted to address the demographic changes in WEC in relation to sexual health.

References

Public Health Agency of Canada. (2021, 11). Infectious syphilis and congenital syphilis in Canada, 2020. 2021. Retrieved from https://www.canada.ca/en/public-health/services/publications/diseases-c…

Appendix A
MPox Advertisement

PREPARED BY:

Chronic Disease & Injury Prevention

DATE:

June 15, 2023

SUBJECT:

May 2023 – Monthly SafePoint Site Operations Update

BACKGROUND/PURPOSE

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.
• As part of the Resolution passed at the City of Windsor Council meeting on February 3rd, 2023, the Board of Health committed to providing updates, at regular intervals, about the ongoing operations at SafePoint to the City of Windsor.

Application Status

• Currently, as of May 31st, the respective applications to Health Canada and the Ministry of Health for the Consumption and Treatment Services (CTS) site remain under review.

CURRENT INITIATIVES

Operational Data

Since SafePoint opened on April 26th, there have been 74 client visits amongst 32 unique clients, with no overdoses reported on-site to date. Additional details about the clients served and services provided at SafePoint during the month of May are presented in Tables 1-3.

Client Experience Narrative

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

Anonymous Client #1

A client initially visited SafePoint for the first time in May for issues related to substance use, which impacted the relationship with their family. They returned to visit the site a few times per week to express their gratitude for the support they received from the SafePoint staff. The client recently informed staff that they had not used substances for more than a week due to the care they received at SafePoint. They have since been able to reconnect with their child.

FUTURE PLANS

• Since opening at the end of April, public open house tours continue to be offered every Friday from 8:30 a.m. – 9:30 a.m. as part of the commitment to community engagement.
• In this time, there have been 4 facilitated tours, with a total of 21 visitors. This included some people from the general public as well as community agencies who have brought their clients to visit the facility and provide feedback.
• The WECHU and HDGH staff are continuing efforts to raise awareness about the services being offered at SafePoint as well as engaging with service providers to reach potential clients. SafePoint staff attended the SouthWest Detention Center’s Health Fair on June 1 to provide information to justice-involved individuals about the programs and services being available at SafePoint.

PREPARED BY:

Healthy Schools Department

DATE:

June 15, 2023

SUBJECT:

Update on Healthy Eating/Food Literacy Activities in WEC Schools

BACKGROUND/PURPOSE

Directed by the Ontario Public Health Standard’s School Health Guideline (2018), the mandate of the WECHU Healthy Schools team is to improve the health and well-being of school-aged children and their families across Windsor and Essex County. The WECHU works with schools to support the implementation of the Health and Physical Education Curriculum and the adoption of programs, practices, and policies that enable students to practice making healthy choices. To ensure that programming meets the needs of school communities and builds on identified strengths, the WECHU consults and collaborates with students, parents, teachers, principals, school administrators, and school boards.

There are 168 local schools supported by the Healthy Schools team. Using a health equity approach to target the most vulnerable children and families, our program uses a two-pronged approach to service delivery: targeted and universal. In our targeted program, schools identified as higher needs are assigned a nurse who they can connect with directly. In our universal program, lower-needs schools can contact the Healthy Schools Program by phone or email for support. All schools are provided with WECHU-developed resources throughout the school year, which are also accessible from our WECHU School Health webpage.

Schools that identify healthy eating or food access as a priority during our annual school needs assessment, work School Health staff to create a targeted School Health Action Plan for support. The Action Plans are developed using the principles of Ontario’s Foundations for a Healthy School. Food literacy was introduced into Ontario’s Science and Technology Curriculum in 2022. As a result, our programs are being reviewed and developed in support of the new curriculum elements.

CURRENT INITATIVES

Supporting the Ontario Student Nutrition Program in Windsor and Essex County Schools

The Ontario Student Nutrition Program- Southwest Region (OSNP-SW) is a meal and snack program designed to ensure children have access to healthy food and beverages throughout the school day. The program is housed within the Victoria Order of Nurses (CON) Windsor-Essex site. These programs are run locally by students, parents, and volunteers, and are funded through multiple sources including provincial funding, grants, and local community groups, organizations, and fundraising. In the 2022/23 school year, 93 schools in Windsor-Essex enrolled in the OSNP, reaching approximately 29,000 students. The WECHU supports the OSNP locally by advocating for and supporting new schools to enter the program.

“You’re the Chef” Food Skills Program Training

You’re the Chef (YTC) is a food skills program that educators or volunteers can provide to students after being trained by a WECHU Registered Dietitian. Two sessions of You’re the Chef (YTC) Training were offered in March 2023 following requests from three schools. Interested schools who are identified as higher need, but lack sufficient funds to run this program, are granted start-up funds from the WECHU after training to purchase food or supplies. Trained schools can borrow YTC kits from the WECHU that contain kitchen equipment, and all certified instructors are given access to the YTC online portal for continued support.

Food Neutral Toolkit

The WECHU is in the process of creating a Food Neutral Toolkit for administrators and educators to understand the food neutrality approach and to implement it in their schools and classrooms. This new approach will create a supportive, positive eating and learning environment. The toolkit will be piloted in selected higher needs schools this fall, and then revised and released to all schools in March 2024 for Nutrition Month.

2023 Workplan and Meeting Schedule

2024 Workplan and Meeting Schedule

No scheduled board meeting

ISSUE/PURPOSE

To ensure that should matters arise during months where the Windsor-Essex County Board of Health do not have a regularly scheduled meeting, that any required decision making can occur and to ensure that there are no interruptions in operations, projects or services.

PROPOSED MOTION

Whereas, Article 16, Execution of Documents, By-Law #1, Governance, articulates the delegation of responsibility to bind the Windsor-Essex County Health Unit (WECHU) for a particular agreement; and

Whereas, it is expedient for the Board of Health (BOH) to pass a resolution incorporating specific delegations of authority as permitted by Article 16;

1. The Board may at any time and from time to time direct the manner in which and the person or persons who may sign on behalf of the Board for a particular agreement.  More specifically:
   
   1. Agreements relating to the sale, acquisition, or lease of real property shall be signed by one of the Chair, Vice-Chair or Treasurer and the CEO or designate.
   2. Agreements relating to borrowing (By-law No. 2, Section 8:  Borrowing) shall be signed by one of the Chair, Vice-Chair or Treasurer and the CEO or designate.
   3. Agreements relating to the data sharing shall be signed by the MOH and the CEO or designate.
   4. All other agreements that are operational in nature shall be signed by the CEO or designate.

Now therefore be it resolved that the Windsor-Essex County Board of Health (BOH) delegate authority to the Joint Board Executive Committee (JBEC), which consists of the BOH Chair, the Vice-Chair and the Treasurer to act on behalf of the BOH and bind the Windsor-Essex County Health Unit (WECHU) on matters until such time as the BOH convenes at its next regularly scheduled meeting. If any such matters require discussion/approval by the BOH, an emergency ad-hoc meeting will be scheduled.

ISSUE/PURPOSE

Approval of the annual audited financial statements.  This includes:

• The annual audited financial statements for the Windsor-Essex County Health Unit for the year-ended December 31, 2022 (Appendix A)
• The annual audited financial statements for the Windsor-Essex County Health Unit Ministry of Children, Community and Social Services Program Initiatives for the year-ended March 31, 2023 (Appendix B)

(Hereinafter referred to collectively as “the annual financial statements”).

BACKGROUND

Paragraph 59(2) of the Health Protection and Promotion Act R.S.O. 1990 states that “A board of health shall cause to be prepared statements of its financial affairs in each year including but not limited to, (a) an annual statement of income and expenses; (b) an annual statement of assets and liabilities; (c) an annual estimate of expenses for the year.”

The annual financial statements are audited by KPMG LLP, independent external auditors appointed by the Corporation of the City of Windsor.  On June 8, 2023, the Audit Committee of the Windsor-Essex County Board of Health (Audit Committee) convened to review the annual financial statements and audit findings report with Administration and KPMG LLP.  The Audit Committee has recommended the financial statements for approval to the Board of Health (Board). KPMG LLP is prepared to issue, pending approval by the Board, an unmodified audit opinion on the annual financial statements. 

Windsor-Essex County Health Unit (WECHU)

The enclosed is a summary analytical review addressing material changes in the annual audited financial statement captions year-over-year.

Statement of Financial Position

• Cash and short-term investments decreased 7,926,699.  Refer to the Statement of Cash Flows for details.
• Accounts receivable increased $2,546,835 primarily due to the following:  a) Increase in amounts receivable from the Province of Ontario of $2,188,711 over 2021.  This increase relates to an augment in funding approvals on account of COVID-19 General ($1,627,499) and COVID-19 Vaccination ($480,800) based upon Q2 2022 financial reporting.  b)  Increase in other receivables of $308,864.  The increase related to an amount receivable from the County of Essex of $264,704 for 2022 contributions, and $14,840 for interest receivable from the WECHU’s financial institution on account of our average outstanding cash balances for December 2022.
• Due to Province of Ontario decreased $2,676,659.  This balance is comprised of:

Of noteworthy mention is the following:

• In the period January to March of 2023, $882,238 was clawed back by the Ministry of Health (MOH) on account of the 2022 settlement.  The remaining, will be clawed back upon completion of the settlement review.
• A proportion of the 2021 Settlement was clawed back in advance of the MOH’s final review being completed.  The total amount of the claw back was $2,409,783.
• Completion of the 2019 and 2020 settlement reviews resulting in a claw back of settlements of $508,636 and $1,398,669 respectively. 
• Due to Municipalities decreased $1,798,243.  This balance is comprised of:

** The 2022 Budget contemplated a two (2) percent increase in the funding from the MOH.  The actual 2022 funding approval from the MOH was only one (1) percent.

The following amounts were paid to the Obligated Municipalities in 2022:

• The 2021 Settlement relating to the 2021 Cost-Sharing Mitigation Funding of $1,260,800;
• The 2020 Settlement of $337,007;
• The 2019 Settlement of $1,286,730.
• Trade accounts payable decreased $215,336.  Changes in this financial caption varies on an annual basis due to the timing of vendor invoicing.  The 2021 balance included an amount outstanding to OMERS on account of December 2021 contributions of $273,201.  
• Accrued payroll and deductions decreased $228,521.  On December 31, 2021, $107,577 was outstanding to employees represented by the Ontario Nurses Association on account of retroactive compensation increases for the collective bargaining agreement that expired April 1, 2021.  In addition, liabilities were recognized on account of certain labour related matters that arose in 2021 but were settled in 2022 of $191,497. 
• Deferred revenue decreased $441,844.  Fluctuations in deferred revenue year-over-year typically relate to the nature and timing of grant funding.  The decrease is primarily attributed to School-Focused Nurses funding.  At December 31, 2021, deferred revenue attributed to this grant funding amounted to $439,134 compared to $14,078 at December 31, 2022. 
• Tangible capital assets increased $3,160,779.  The net increase is attributed to:  i) Tangible capital asset additions of $3,442,533; ii) Amortization expense of $281,754.  Of the tangible capital assets acquired in the year, $3,431,595 were funded by the Ministry of Health using Mandatory Program funding (70%), and $10,938 were funded using Ontario Seniors Dental Care Program funding (100%). Refer to note 9 for additional details.
• Prepaid expenses decreased $76,253.  The decrease in this financial caption is primarily attributed to the timing of the payment of licenses for the WECHU’s document management licenses (M-files).  For the year-ended December 31, 2021, M-files licences for 2022, amounting to $99,616 were prepaid in advance of year-end.  M-files licenses for 2023, amounting to $99,616 were paid after the December 31, 2022, year-end.

Statement of Operations and Accumulated Deficit:

• Increase in Revenue from the Province of Ontario of $530,021.  The increase is attributed to the following:
  • Increase in approved base funding for Mandatory Health Programs Funding in the amount of $116,432 or one (1) percent for the period April 1, 2022 to December 31, 2022.
  • Increase in approved base funding for Ontario Seniors Dental Care Program (OSDCP) in the amount of $530,025 for the period April 1, 2022 to December 31, 2022.  Actual revenue earned for 2022 amounted to $1,936,350 based upon total admissible expenses, representing a $261,650 increase from 2021.   
  • Increase in One-time funding of $151,939. This is attributed to:  a) COVID-19 Vaccination Program funding in the amount of $4,051,134; b) COVID-19 General Program funding in the amount of $895,410; c) School-Focused Nurses Initiative funding in the amount of $1,857,824; d) Temporary Retention Incentive for Nurses funding in the amount of $603,013;  e) Mitigation funding in the amount of $1,260,800; f)  Public Health Inspector Practicum Funding in the amount of $40,000.
• Increase in Other Revenue of $595,945.  The increase is attributed to the following:
  • Increase in Interest income in the amount to $75,910 as interest rates were higher than 2021.
  • Increase in Miscellaneous in the amount of $119,702.  This increase is primarily attributed to the recovery of building occupancy costs from the OSDCP in the amount of $120,630.
  • Increase on Other grants in the amount of $299,678.  This increase is primarily attributed to the timeframe surrounding the IPAC Hub funding.  IPAC Hub funding commenced in October of 2021 and continued for the entirety of 2022.
  • Increase in Vaccine reimbursement in the amount of $93,606 (ISPA).  Total number of vaccinations given in 2022 were 15,329 as compared to 5,013 in 2021.

The Ministry of Health funds the WECHU to a maximum of 70% of admissible expenditures.  Admissible expenditures for the purposes of the Ministry of Health Settlement Process is defined below:

• Decrease in Expenses of $3,328,290.  Notable decreases include:
  • Decrease in Salaries and Benefits in the amount of $2,774,735.  Notable decreases from 2022 include:
    • Decrease in FTEs year-over-year.  On January 1, 2022, total FTEs amounted to 299.  On December 31, 2022, total FTEs amounted to 283.
    • Total payments on account of overtime, and retroactive payments for the 2021 fiscal year amounted to $1,314,435.  Overtime and retroactive payments for the 2022 fiscal year amounted to $329,346.
  • Increase in Legal, Audit and Consulting in the amount of $516,416. Notable increases from the prior year include:
    • Increase in legal of $221,521 over 2021 including the following:  i)In 2022, $24,118 was expended on legal advice for the review of the Consolidated Bi-Laws of the Board of Health for the WECHU and other legal matters involving the WECHU’s responsibilities under the Health Protection and Promotion Act (HPPA).  ii) In 2022, $10,461 was expended on legal advise pertaining to the recruitment of a Medical Officer of Health (relating to immigration and licensing).  iii) In 2022, increase in legal fees paid on account of general corporate matters and certain labour related matters in the amount of $173,665. 
    • Increase in consulting of $210,452 over 2021 including the following:  i) Increase in amounts paid to the Acting Medical Officer of Health on account of professional services rendered over 2021 of $198,407 (2022 – 12 months; 2021 – 4 months).  ii)  In 2022, the WECHU contracted an Acting Chief Executive Officer (CEO) while recruitment was underway for a permanent CEO.  The total amount paid on account of those professional services was $12,044 (approximately 6 weeks).
  • Decrease in Purchased Services in the amount of $1,244,910. Notable decreases from prior year include:
    • $192,677 was expended in 2021 for augmented vaccination support for the COVID-19 Vaccination clinics. 
    • $330,350 was expended in 2021 for augmented temporary support staff for call centre activities relating to COVID-19.
    • $686,498 was expended in 2021 for augmented case and contract management support.

Windsor-Essex County Health Unit Ministry of Children, Community and Social Services Program Initiatives

The annual audited financial statements for the Windsor-Essex County Health Unit Ministry of Children, Community and Social Services Program Initiatives include financial information for the Nurse Practitioner Program and the Healthy Babies Healthy Children Program for the period April 1, 2022 to March 31, 2023.

The enclosed summary analytical review addresses material changes in financial statement captions year-over-year.

Statement of Financial Position:

• Due from the Windsor-Essex County Health Unit:  Refer to the statement of cash flow for details on the decrease of $304,599 from March 31, 2022.
• Due to Ministry of Children, Community and Social Services:  The amount outstanding is as follows:
  • Settlement for the year-ended March 31, 2023, in the amount of $266,688;
  • Settlement for the year-ended March 31, 2022, in the amount of $734,310.  This settlement will be clawed back in fiscal 2023/2024.

Statement of Operations and Accumulated Deficit:

• Salaries and benefits increased $476,268 from the comparative period, April 1, 2021 to March 31, 2022.  In the comparative period, substantial nursing resources were deployed to support COVID-19 pandemic-related activities.  This continued until July of 2022, when these staff were returned to the Healthy Babies Healthy Children Program.  
• Mileage increased $19,190 compared to the fiscal year ended March 31, 2022.   This increase is consistent with the return of nursing resources to the Healthy Babies Healthy Children Program in July of 2022. 
• Program supplies decreased $30,961 compared to the fiscal year-ended March 31, 2022.  In the comparative period, the WECHU implemented an electronic information management system to support this Program of $35,361.  The cost was inclusive of implementation and licensing fees. 

A summary of the settlement with the Ministry of Children, Community and Social Services is as follows:

PROPOSED MOTION

Whereas, at the June 8, 2023, meeting, the Audit Committee of the Windsor-Essex County Board of Health reviewed the annual audited financial statements and recommended them to the Board for approval,

Now therefore be it resolved that the Windsor-Essex County Board of Health approve:

The annual audited financial statements of the Windsor-Essex County Health Unit for the year-ended December 31, 2022; and

The annual audited financial statements for the Windsor-Essex County Health Unit Ministry of Children, Community and Social Services Program Initiatives for the year-ended March 31, 2023.

Please contact us if you require this in an alternate format.

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:

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:

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.

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:

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:

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.

Board Members Present:

Renaldo Agostino, Joe Bachetti, Fabio Costante, Judy Lund, Robert Maich, Angelo Marignani, Michael Prue, Rob Shepley

Board Member Regrets:

Fred Francis, Hilda MacDonald

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:

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.