Board of Health Meeting Documents

Prepared By:

Neil Mackenzie, Manager, Chronic Disease and Injury Prevention

Date:

December 19, 2019

Subject:

Windsor and Essex County Living Wage Program

BACKGROUND

Income inequality has been recognized as one of the most significant social determinants contributing to poorer population health outcomes. As such, many communities across Ontario, nationally, and internationally have implemented living wage programs aimed to raise awareness, encourage adoption, and advance healthy public policy. In 2017, the Windsor-Essex County Health Unit (WECHU) agreed to take over the administration of the Windsor and Essex County Living Wage program from Pathway to Potential; Windsor and Essex County’s Social Investment Plan. The program re-launched in March 2018, and as of November 2019, there are 27 Certified Living Wage Employers.

CURRENT INITIATIVES

The 2020 Living Wage calculated for Windsor and Essex County is $15.52/hour for full and part time employees that do not receive health benefits from their employer. This represents a .37 cent per hour (2.4%) increase over the 2019 Living Wage. The 2020 Living Wage for full and part time employees who receive health benefits from their employer remains at $14.00/hour (current provincial minimum wage).

Purpose: To raise awareness about the minimum salary required to increase the likelihood of having a basic standard of living in Windsor and Essex County, and to advance policies, partnerships, and practices that promote health and well-being for our community.

Key Program Deliverables

Each year the living wage calculation is updated and shared with the community. See the attached Calculating a Living Wage for Windsor and Essex County 2020 report (Appendix A). The report is intended to provide an overview of the Living Wage, how it’s calculated, and assumptions that are made in the calculations. It is anticipated that the report will help raise awareness about the importance of paying at least a Living wage to all employees, in order to increase the likelihood that they can meet the basic cost of living in Windsor and Essex County.

The Living Wage Certification Program includes:

• Promotion and recruitment activities;
• An online intake and enrollment process;
• Verification that applicants meet program eligibility criteria;
• Support for employer implementation;
• An employer Living Wage Certification package;
• Program evaluation and reporting activities to support quality improvement; and,
• Recognition at the annual Gord Smith Healthy Workplace and Bike Friendly Awards.

KEY CALCULATION CHANGES FOR 2020

In order to better support local communities in the Living Wage Calculation process, the Ontario Living Wage Network (OLWN) reviewed and updated the living wage calculation methodology in 2018.  This change allows local communities to spend less time calculating the living wage and helps standardize calculations throughout the province.

CONSULTATION

Members of the CAC serve in a consultative capacity, providing recommendations and advice to the WECHU Living Wage program administration team.  The most recent CAC meeting was held on October 24, 2019. At that meeting, the WECHU team delivered a presentation outlining the 2020 Living Wage calculation and relevant changes. They also shared the 2019 Living Wage evaluation report. The plan for promoting and recruiting Living Wage employers for 2020 was discussed.  Group feedback and discussion resulted in valuable input and advice that will be incorporated into the 2020 Living Wage Program.

Note: not all members of the CAC attended the meetings referred to above.

Community Advisory Committee Membership

• Judy Lund (Working Toward Wellness Committee)
• Michelle Suchiu (Executive Director, Workforce WindsorEssex)
• Stephen Lynn (Coordinator of Social Planning, City of Windsor)
• Jelena Payne (The Community Development and Health Commissioner, City of Windsor)
• Luciano Carlone (Director of Finance and Corporate Services, Canadian Mental Health Association - Windsor-Essex County Branch)
• Lorraine Goddard (CEO, United Way/Centraide Windsor-Essex County)
• Robert Ross (Windsor-Essex Food Policy Council)
• Greg Schlosser (Director, Human Resources, County of Essex)

The following individuals contributed to this report: Nicole Dupuis, Marc Frey, Neil MacKenzie, Ramsey D’Souza, Saamir Pasha, and Cathy Bennett.

APPENDICES

• Appendix A – Calculating a Living Wage for Windsor and Essex County 2020 - Report coming soon

APPROVED BY:

Theresa Marentette, CEO

Prepared By:

Lorie Gregg, Director of Corporate Services

Date:

December 19, 2019

Subject:

Q3 Financial Results

BACKGROUND

The Leadership Team of the Windsor-Essex County Health Unit (“the WECHU”) monitors financial results on an on-going basis for the following programs:

• Mandatory programs funded to a maximum of 75% (“Cost-Shared”) by the Ministry of Health and 25% by  the Corporation of the City of Windsor, the Corporation of the County of Essex and the Corporation of the Township of Pelee (hereinafter referred to as the “Obligated Municipalities”);
• Related programs funded 100% by the Ministry of Health;
• Related programs funded 100% by the Ministry of Children, Community and Social Services (“MCCSS”).
• One-time business cases funded 100% by the Ministry of Health.

The third quarter financial report to the Board includes a budget to actual comparison and narrative for material variances for all programs listed above, as well as forecasted financial results for the year-ending December 31, 2019.

COST-SHARED PROGRAM FINANCIAL RESULTS

The following is the financial information for the Cost-Shared programs including Vector-Borne Diseases and Small Drinking Water Systems for the period January 1, 2019 to September 30, 2019 with forecasted financial results for the year-ending December 31, 2019.

For the period January 1, 2019 to September 30, 2019, cash flows relating to the 2019 program year are as follows:

At September 30, 2019, the variance from budget to actual total expenditures amounted to $2,033,408. Specific variances are as follows:

• Salaries and Employee benefits:  Expenditures in these financial captions relate to salaries and benefits paid to the WECHU staff in service of the Mandatory Cost-Shared Program.  The combined variance from budget of $1,847,854 is attributed to: 
  • Labour disruption involving the WECHU staff represented by the Ontario Nurses Association (“ONA”) for the period March 8th, 2019 to May 8th, 2019 (approximate savings of $996,000);
  • Given the uncertainty that arose with the April 11th, 2019, Ontario Provincial Budget, certain positions, predominantly non-union, remained unfilled (approximate savings of $450,000 );
  • Gapping resulting from vacancies (i.e. extended recruitment processes; voluntary departures; unpaid leaves; back-filling positions for unpaid leaves); 
  • Gapping due to under utilization of certain other compensation related provisions (i.e. overtime, benefits, etc.) (approximate savings of $110,441).
• Travel and meetings, Mileage, Professional Development:  The combined variance associated with these financial captions was $117,151.  The aforementioned labour disruption had an impact on these financial captions, causing the WECHU to reprioritize certain less essential activities for those more critical to client service delivery, both during and subsequent to the labour disruption.   Adding to this was the release of the Ontario Provincial Budget, and the austerity measures that the WECHU put in place to ensure that financial resources would only be directed to mandatory travel, meetings and professional development (similar to those put in place by the Province of Ontario).
• Program supplies:   Expenditures in this financial caption support the activities of the departments, those that directly support Public Health Programs as well as those “support” departments such as Information Technology and Communications.  At September 30, 2019, the variance compared to budget amounted to $78,210 and can be attributed to:  i) The aforementioned labour disruption; ii) Timing of program activities. 
• Professional fees:  Expenditures in this financial caption include legal, audit and consulting fees paid to third parties.  The budget variance in Professional fees relates to an increase in legal costs to support the WECHU with collective bargaining (ONA only) and during the labour disruption (approximate impact $114,090). 
• Office equipment rental:  Expenditures in this financial caption include the WECHU’s contractual lease payments on account of multi-function copiers and a large format printer used to support client service delivery.  While the monthly contractual lease payments are consistent (approximately 44% of the 2019 annual budget or $62,480) the overage costs (the term used to describe utilization) vary depending upon the print volume. 
• Utilities and Telephone:  Expenditures in these financial statement captions include utilities for the Windsor and Leamington offices as well as all telecommunication (mobile, broadband, etc.).  The variance at September 30, 2019 of $43,544 is due to lower than anticipated usage coupled with certain cost-saving measures undertaken by the WECHU.
• Security:  Expenditures in this financial caption include security costs contracted on an as needed basis for after-hours events at our Windsor office location.  The WECHU incurred additional security costs of $46,984 for the period March 8, 2019 to May 8th, 2019, on account of the labour disruption.

In addition to the budget to actual analysis above, the WECHU has provided forecasted financial results for the year-ending December 31, 2019.  These forecasted financial results consider actual year-to-date results at November 30, 2019, as well as estimates of expenditures for the remaining 31-day period.  Total forecasted expenditures for the year-ending December 31, 2019 are anticipated to be $1,424,558 underspent when compared to budget.  Material variances between forecast to budgeted financial results are detailed below:

• Salaries and Employee benefits: For the year-ended December 31, 2019, Salaries and Employee benefits are forecasted to be $1,592,568 underspent.  This is attributed to:
  • The aforementioned labour disruption (approximate savings of $996,000);
  • Austerity measures taken by the WECHU resulting from the release of the 2019 Ontario Provincial Budget (approximate savings of $617,526);
  • Gapping resulting from vacancies (i.e. extended recruitment processes; voluntary departures; unpaid leaves; back-filling positions for unpaid leaves); 
  • Finalization of negotiations with the WECHU employees represented by the Canadian Union of Public Sector Employees (“CUPE”) resulting in a one-time bonus to said staff.  The Board of Health approved a one-time bonus to the non-union group of the same amount (approximate impact of $126,000).
• Program supplies:  For the year-ended December 31, 2019, Program supplies are forecasted to be overspent by $223,576.  This is primarily attributed to:
  • Costs associated with translation of the WECHU’s food handler courses into multiple languages (approximate impact of $17,000).
  • Implementation costs associated with the Ceridian Dayforce Project (approximate impact of $26,000).
  • Acquisition of two vaccine fridges to replace existing vaccine fridges nearing “end of life” (approximate impact of $21,042).
  • Acquisition of nicotine replacement therapy/tobacco cessation supports (approximate impact of $50,000).
  • Acquisition of information technology hardware (i.e. computers, servers, etc.) to replace existing equipment before “end of life” due to hardware defects (approximate impact of $30,000) and accelerating replacement to reduce budgetary pressures in 2020 (approximate impact of $20,000).
• Professional fees:  For the year-ended December 31, 2019, Professional fees are forecasted to be overspent by $116,612.  The forecasted variance in Professional fees is attributed to the labour disruption. 
• Security:  For the year-ended December 31, 2019, Security is forecasted to be overspent $35,896.  The forecasted variance in Security is attributed to the labour disruption.

HEALTHY BABIES HEALTHY CHILDREN PROGRAM FINANCIAL RESULTS

The Healthy Babies/Healthy Children Program is funded through the Ministry of Children, Community and Social Services.  This Program supports 27.0 FTEs comprised of managers (2), nurses (17), family home visitors (4), social worker (1), and support staff (3).  The objective of the Program is to ensure a healthy future for children and their families. 

For the period January 1, 2019 to September 30, 2019, the HBHC program underspent compared to budget in the amount of $384,202.  Factors contributing this include:  i) Labour disruption involving the WECHU staff represented by the ONA for the period March 8th, 2019 to May 8th, 2019.  This resulted in a variance in Salaries and benefits of approximately $280,000 and Mileage of $6,000 and likely attributed to under utilization of Professional development of $6,580 and Program supplies of $15,692;  ii)  Lower than anticipated Purchased services (i.e. translation) because of our use of an Arabic speaking nurse to address the needs of our community.

As reported at the November 4th, 2019, Budget meeting, the MCCSS modified the funding year for this Program from the calendar year to an April to March timeframe, aligning the funding year to the Province of Ontario’s fiscal year.  It is the WECHU’s understanding that reporting for this Program will be for the 15-months ending, March 31, 2020.  Administration will report forecasted financial results in February of 2020 for this program.

NURSE PRACTITIONER PROGRAMS

The Nurse Practitioner Program is funded through the Ministry of Children, Community and Social Services.  This Program supports 1 FTE (nurse practitioner).  The objectives of the Program are to promote healthy pregnancy, birth and infancy for children, improve parenting and family supports, strengthen early childhood development, learning and care.

At September 30, 2019, this Program is underspent by $24,569 due to the labour disruption involving the WECHU staff represented by the ONA for the period March 8th, 2019 to May 8th, 2019.

As reported at the November 4th, 2019, Budget meeting, the MCCSS modified the funding year for this Program from the calendar year to an April to March timeframe, aligning the funding year to the Province of Ontario’s fiscal year.  It is the WECHU’s understanding that reporting for this Program will be for the 15-months ending, March 31, 2020.  Administration will report forecasted financial results in February of 2020 for this program.

FINANCIAL INFORMATION FOR RELATED PROGRAMS FUNDED 100% BY THE MINISTRY OF HEALTH

The Healthy Smiles Ontario (“HSO”) program is funded through the Ministry of Health.  This program supports 14.25 FTEs comprised of a manager (0.75), dental assistants (5.5), dental hygienists (5.5), a health promotion specialist (0.5), and support staff (2).  This program provides preventative, routine, and emergency and essential dental treatment for children and youth, from low-income families, who are 17 years of age and under.

For the period January 1, 2019 to September 30, 2019, the HSO budget is underspent $44,426.  The most notable variances are as follows:

• A variance of $39,104 related to Salaries and benefits.  This is due to the reallocation of FTE resources to other program initiatives such as the Ontario Seniors Dental Program (approximate savings of $21,645) as well as gapping resulting from timing of recruitment (approximate savings of $7,500).
• A variance of $32,809 related to Program supplies.  The timing of the acquisition of Program supplies varies annually. 
• A variance of $30,725 related to Purchased Services, which includes professional services provided by dentists as well as translation.  As reported in at Q1 of 2019, there were fewer available dentists’ hours in the months of February and March.  Subsequent to March 31, 2019, additional dentists’ hours are available. 

Forecasted financial results for the year-ending December 31, 2019, indicate that the HSO program budget will be fully expended with amounts from Salaries and benefits being redirected to fund operating expenditures (more specifically Program supplies).

Base funding for the Smoke-Free Ontario Strategy Initiative must be used in the planning and implementation of comprehensive tobacco control activities across prevention, cessation, prosecution, and protection and enforcement at the local and regional levels.  Boards of Health must comply and adhere to the Smoke-Free Ontario Strategy: Public Health Unit Tobacco Control Program Guidelines and the Directives:  Enforcement of the Smoke-Free Ontario Act. 

At September 30, 2019, this program is underspent by $17,757.   In May of 2019, the Ministry of Health approved certain one-time funding up to March 31, 2019 for cannabis related activities.  The total one-time funding approval amounted to $96,700, of which, $37,656 was expended in fiscal 2018, and $44,158 was expended in Q1 of 2019, thus taking pressure off the calendar 2019 budget for this program initiative.  

Forecasted financial results for the year-ending December 31, 2019, indicate that this program budget will be overspent $38,150.  This overage relates to an additional FTE resource (Tobacco Enforcement Officer) added for fiscal 2019 only, to assist with increased work load with the legalization of cannabis in October of 2018.  The overage for this program will be funded from the Cost-Shared Mandatory Program Budget.

A description of other related programs is included below:

Nursing Initiative: The Amending Agreement for 2019 received August 20, 2019, aggregates the following program initiatives under “Nursing Initiatives”.  These include:  the Chief Nursing Officer Initiative; the Infection Prevention and Control Nursing Initiative; and the Social Determinants of Health Nursing Initiative.  Base funding for these initiatives support the salaries and benefits of 4 nursing FTE’s or greater, with certain specific qualifications.  At September 30, 2019, the aggregate underspent budget amounted to $63,442, which resulted from the labour disruption involving the WECHU staff represented by the ONA for the period of March 8th, 2019 to May 8th, 2019.  At December 31, 2019, this program initiative is forecasted to be underspent by $45,153.  The 2019 budget for this initiative included salary and benefit overages ($45,153) associated with three of the four assigned FTEs, which, subsequent to the labour disruption, are forecasted to be negated.

Enhanced Food Safety – Haines Initiative:  This initiative was established to support implementing the Food Safety Program Standard under the Ontario Public Health Standards (“OPHS”).  At September 30, 2019, there is a minor negative variance of $1,919 due to timing of purchases.  This program initiative is not forecasted to be overspent at December 31, 2019.   

Enhanced Safe Water:  This initiative was established to increase the Board of Health’s capacity to meet the requirements of the Safe Water Program Standard under the OPHS.  At September 30, 2019, there is no negative variance to report on.   This program initiative is not forecasted to be overspent at December 31, 2019.

Harm Reduction Program Enhancement:  Base funding for this initiative supports the Board of Health in the activities associated with its Local Opioid Strategy.  More specifically it supports 2.5 FTEs dedicated to working on activities associated with:  i) Our local opioid response; ii) Naloxone Distribution and Training;  iii)  Opioid Overdose Early Warning and Surveillance.   At September 30, 2019, the budget for this program initiative is underspent by $17,122, which resulted from the labour disruption involving employees represented by the ONA (approximately $15,000) for the period March 8th, 2019 to May 8th, 2019.  At December 31, 2019, this program initiative is forecasted to be underspent $21,240.  In addition to the labour disruption noted above, gapping associated with certain other positions resulted.  Recruitment is currently underway but is not anticipated to be concluded before year-end.

Infectious Disease Control Initiative:  This initiative was established to support the hiring of infectious diseases control positions (4.5 FTEs) and supporting these staff to monitor and control infectious diseases.  They serve to enhance the Board of Health’s ability to handle and coordinate increased activities related to outbreak management.  At September 30, 2019, the budget for this program initiative is underspent by $22,964, which resulted from the labour disruption involving employees represented by the ONA for the period March 8th, 2019 to May 8th, 2019.  The 2019 budget for this initiative included salary and benefit overages ($4,817) associated with the 4.5 FTEs allocated to this program, which, subsequent to the labour disruption, are forecasted to be negated.

Needle Exchange Program Initiative:  This initiative was established to support the purchase of needles and syringes, and their associated disposal costs, for the Board of Health’s Needle Exchange Program.  At September 30, 2019, there are no negative variances to report on. This program initiative is not forecasted to be overspent at December 31, 2019.

FINANCIAL INFORMATION FOR RELATED PROGRAMS FUNDED 100% BY THE MINISTRY OF HEALTH

Mandatory Programs - Enhanced Mosquito Surveillance: 

This one-time funding supports an enhanced surveillance program.  Eligible costs include salaries for students, supplies and additional equipment, identification and testing expenses, promotional costs and mileage.  At September 30, 2019, there are no negative variances to report on. 

New Purpose-Built Vaccine Refrigerators: 

This one-time funding supports the acquisition of one new twenty-five (25) cubic foot purpose-built refrigerator used to store publicly funded vaccines.  At September 30, 2019, the new purpose-built vaccine refrigerator has been acquired.  No additional costs are anticipated.

Public Health Inspector Practicum Program: 

This one-time funding supports the hiring of approved Public Health Inspector Practicum positions.  Eligible costs include student salaries, wages and benefits, transportation expenses associated with practicum positions, equipment and educational expenses.  This funding relates to practicum placements for the four-month period, which commenced May of 2019 and concluded in August of 2019.  At September 30, 2019, the funding has been expended.

APPROVED BY

Theresa Marentette, CEO

Prepared By:

Communications Department

Date:

December 3, 2019

Subject:

November Media Relations Recap Report

November Media Coverage

Media Coverage

News Release, Media Advisories and Media Statements

Stories Reported by the Media

AM 800

Blackburn News

CBC News

Note: Digital stories were not available for nine of CBC’s requests.

CTV Windsor News

Note: Digital stories were not available for two of CTV’s requests.

St. Clair College/Mediaplex

Note: Digital stories were not available for five of St. Clair College’s requests.

University of Windsor News​​​​​​​

Windsor Star

Note: Digital stories were not available for three of Windsor Star’s requests.

Windsorite.ca

Note: Digital stories were not available for the Lakeshore News request (1), or Radio-Canada’s requests (2),

The following individuals contributed to this report: Jennifer Jershy, Marc Tortola, and Michael Janisse.

Prepared By:

Darcie Renaud, Performance Improvement & Accountability Coordinator (PIAC), Planning & Strategic Initiatives Department

Date:

December 19, 2019

Subject:

2019 Operational Plan Reporting Q3 Status 

BACKGROUND

In 2018, the Ministry of Health, introduced a new Annual Service Plan (ASP) that Health Units are required to submit each year. An electronic planning and reporting system was created to support the development of the ASP and to monitor operational plan progress throughout the year. In this system, work plans are developed for all public health interventions. These interventions directly address the programs provided by the WECHU. The WECHU’s ASP provides details about planned expenditures and program plans for 2019, including 268 initially planned interventions tied to 61 programs. The Ministry of Health requires program activity and financial reports in Q2 and Q4 of the implementation year, and an annual summary report. In addition, status updates are provided for interventions quarterly. 

CURRENT INITIATIVES

The appended report reflects the quarterly Board of Health summary report for Q3 of 2019. This report includes overall status information for the 223 interventions that were in progress in Q3 of 2019. A majority of the interventions were either on target or completed, though some interventions were cancelled or deferred until the following year. Proposed changes to public health operations and the 2019 labour disruption continued to influence the progress of some interventions, though to a lesser degree than in Q2. The most common reason given for deferral, cancellation, or variance was human resource issues (35%), followed by adjusted program priorities (27%), and the 2019 labour disruption (18%). Further detail is provided about the status of programs based on the related interventions that were planned for in Q3 of 2019.

CONSULTATION

The following individuals contributed to this report:

• Marc Frey, Manager, Planning & Strategic Initiatives

APPROVED BY:

Theresa Marentette, CEO

WECHU Strategic Plan Progress - At a Glance

Communication and Awareness

Organizational Development

Partnerships

Evidence-based Public Health Practice

Communication and Awareness

Partnerships

Organizational Development

Evidence-Based Public Health Practice

Prepared By:

Darcie Renaud, Performance Improvement & Accountability Coordinator (PIAC), Planning & Strategic Initiatives Department

Date:

December 19, 2019

Subject:

Q3 Strategic Plan Report

BACKGROUND

The 2017-2021 WECHU Strategic Plan sets out our plan to enhance our delivery of quality public health programs and services to all residents in Windsor and Essex County. The current strategic plan details our organization’s vision, mission, values, and our four strategic priorities. Each quarter, the Board of Health (BoH) receives a report on the status of progress made towards the Strategic Priorities in that quarter.

CURRENT INITIATIVES

The 2019 Q3 Strategic Plan Progress Report provides the objectives under each strategic priority with corresponding updates to measure our advancement towards achieving the goal. Progress has continued on many of the strategic objectives, however, uncertainty around the proposed merger of public health units by the Ontario government has resulted in the delay and/or deferral of a number of plans related to the WECHU’s strategic objectives.

CONSULTATION

The following individuals contributed to this report:

• Marc Frey, Manager, Planning & Strategic Initiatives 
• Michael Janisse, Manager, Communications
• Ramsay D’Souza, Manager, Evaluation & Epidemiology

APPROVED BY:

Theresa Marentette, CEO

Reporting Structure

This report provides a status summary for all of the 2019 Annual Service Plan program interventions that were in progress in Q3 (July 1st to September 30th).

All active interventions received a status update using the following categories:

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

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

• 2019 Labour Disruption (the labour disruption resulted in changes to the intervention)
• Adjusted Program Priorities (program priority alterations resulted in changes to the intervention)
• Human Resource Issue (staffing circumstances resulted in changes to the intervention)
• Partnership Limitations (external partner(s) did not to meet their obligations)
• Public Health Emergency (a significant public health emergency resulted in changes to the intervention)
• Resource Limitation (financial, material, or internal support limitations resulted in changes to the intervention)

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

Overall Quarterly Status Summary

There were 223 interventions in progress in Q3 2019. Figure 1 displays the percentage of interventions that were on target, reported a variance, were deferred, were cancelled, or were completed. A majority of interventions (64%) were either completed or on target. This is a slight increase from Q2, when 63% of plans were reported as completed or on target. 

Of the 223 interventions in progress, 36% (79) were deferred, cancelled, or reported a variance. Figure 2 provides a summary of the reasons for variances, deferrals, or cancellations as a percentage of the total number of variances, deferrals, and cancellations. 

Proposed changes to public health operations and the 2019 labour disruption continued to influence the progress of some interventions, though to a lesser degree than in Q2. The most common reason given for deferral, cancellation, or variance was human resource issues (35%), followed by adjusted program priorities (27%), and the 2019 labour disruption (18%). Combined, the labour disruption, program priority adjustments, and human resource issues accounted for 80% of the variances, deferrals, or cancellations of interventions. 

In some cases, managers and staff provided comments to further explain the reason for deferral, cancellation, or variance. Examples of human resources issues that affected the status of work plans included expected and unexpected leaves of absence and general staff turnover. When adjusted program priorities were cited, examples provided included the service delivery model change in the Healthy Schools department, changing priorities of partners and partnerships, and a need to focus more staff time than expected on other interventions. 

Program Quarterly Status Summary

All interventions are directly tied to programs and program objectives; Figure 3 displays a summary of the status updates for each WECHU program based on the number of interventions that were on target, varied from target, were completed, were deferred, or were cancelled. 

Prepared By:

Phil Wong, Environmental Health Manager

Date:

December 19, 2019

Subject:

Lead in Drinking Water

BACKGROUND

According to Health Canada, lead in drinking water should be kept as low as reasonably achievable. The most significant contribution of lead in drinking water is generally from lead service lines that supply drinking water to your home. The best approach to eliminate lead exposure is to remove and replace the full lead service line. Lead service lines have not been used for many years but older homes and buildings (pre-1948) may still have lead pipes and service lines. Lead solder and brass fittings/fixtures are also common sources of lead exposure. This report will highlight some of the key regulations and provide some clarification on how lead exceedances are handled in the province of Ontario.

Standards vs. Guidelines and Duty to Report

The Canadian guideline for lead in drinking water was lowered in June 2019 to 5ppb (0.005mg/L) or as low as reasonably achievable. In Ontario, the Drinking Water Quality Standards Reg. 169/03 and the Safe Drinking Water Act, 2002, have the maximum acceptable concentration (MAC) for lead in drinking water as 10ppb (0.010mg/L). All municipal drinking water systems and designated facilities are legally required to meet the 10ppb MAC. Under the Act, all drinking water system operators have a duty to report microbiological, chemical and radiological exceedances to their local public health unit and the Ministry of Environment, Conservation and Parks (MECP). The WECHU’s role is to give direction, in the event of an exceedance, on corrective action to eliminate/reduce any health effects.

Municipal Systems

The Drinking Water Systems Reg. 170/03 outlines the sampling protocol and testing requirements for municipal drinking water systems. The MECP regulates these systems and calls for the implementation of an extended lead testing-program. Targeted testing and sampling is conducted by municipal drinking water operators in each municipality, and any lead service lines are replaced when identified. Homeowners on municipal systems are encouraged to contact their local providers for options on lead sampling and other services. Homeowners are notified by the municipal drinking water operator and the health unit if lead is identified through operator sampling. 

Schools and Child Care Centres

Schools and child care centres are required to sample their water for lead as per Ontario Regulation 243/07: Schools, Private Schools and Child Care Centres. This regulation, recently amended in 2017, increased lead sampling requirements in these facilities. There is a requirement for annual sampling and testing of lead in drinking water to ensure lead levels are below the provincial Ontario Drinking Water Quality Standards Reg. 169/03. It also requires flushing of plumbing in schools to help reduce lead levels in drinking water. Flushing has been shown to reduce lead levels in water and is a recognized lead reduction strategy. Schools and child care centres have replaced service lines, decommissioned fountains, installed NSF POU filters and have bottle filling stations when lead exceedances have been identified. The regulation is enforced by the MECP as schools and child care centres are designated facilities, and the health unit takes a lead role to provide guidance on health related issues.

Private Water Supplies

Homeowners using private water supplies within Ontario can send water samples for lead testing to an accredited private laboratory from the MECP list. There is a cost associated with lead testing at a private laboratory. Private homeowners can submit water samples to the Public Health Ontario Laboratory for bacteriological testing (E. coli and total coliforms) and this service is free for all private drinking water systems.

CURRENT INITIATIVES

Under the Ontario Public Health Standard’s Safe Drinking Water and Fluoride Monitoring Protocol, the health unit is mandated to provide 24/7 on-call support and response to all adverse drinking water events. Where water intended for human consumption may not be safe to consume, the health unit is required under the Health Protection Promotion Act to respond. The health unit initiates a response within 24 hours of receiving notification of any adverse event in the region. Boil Water and Drinking Water advisories, as well as legal orders to drinking water system operators, are issued regularly to prevent exposures to any microbiological, chemical or radiological exceedances. The health unit continues to work with municipal drinking water system operators, school boards and private well owners to provide awareness and education on safe drinking water.  

For more information on safe drinking water please visit the sites below:

• Lead in Drinking Water
• Lead in Schools and Child Care
• Private Well Water
• Enforcement
• Windsor Utilities Commission

APPROVED BY

Theresa Marentette

Board Members Present:

Gary McNamara, Joe Bachetti, Rino Bortolin, Fabio Costante, Gary Kaschak, Judy Lund, John Scott, Ed Sleiman, Larry Snively  ​​​​​​

Board Member Regrets:

Tracey Bailey, Dr. Debbie Kane

Administration Present:

Theresa Marentette, Dr. Wajid Ahmed, Lorie Gregg, Nicole Dupuis, Kristy McBeth, Dan Sibley, Lee Anne Damphouse 

Staff Present:

Kim Casier, Eric Nadalin, Neil MacKenzie, Jen Jershey, Nicole Trajkovski, Denise Barbour, Barb Deter, Nancy Dumouchelle, Heather Gartner, Denise Hryniuk, Dawnice Kavanaugh

QUORUM:  Confirmed

RECORDING SECRETARY:

SUBMITTED BY:

APPROVED BY:

ISSUE

Healthy Smiles Ontario (HSO) is a publically funded dental care program for children and youth 17 years old and under from low-income households. The Ministry of Health introduced HSO in 2010 as a 100% provincially funded mandatory program for local health units, providing $1,529,700 in funding for children in Windsor-Essex (2019). HSO covers regular visits to a licensed dental provider within the community or through public health units.

In April 2019, the provincial government introduced its 2019 Budget Protecting What Matters Most (Minister of Finance, 2019). Following the release of the provincial budget, the Ministry of Health introduced changes to the funding models for health units effective January 2020. The changes in funding for local health units include a change from a 25% municipal share, 75% provincial cost-shared budget for mandatory programs to 30% and 70% respectively. In addition, the Ministry notified health units that formerly 100% provincially funded mandatory programs such as HSO would now share these costs with municipalities at the rate of 30%, a download of approximately $458,910.00 to local municipalities.

BACKGROUND

Oral health is vital to our general health and overall well-being at every stage of life. Most oral health conditions are largely preventable and share common risk factors with other chronic diseases, as well as the social determinants of health, such as income, employment and education, whereby those in the lowest income categories have the poorest oral health outcomes. Approximately 26% of children (0-5 yrs) and 22.6% of children and youth (0-17yrs) in Windsor-Essex County live in low-income households, compared to 19.8% and 18.4% in Ontario (Windsor-Essex County Health Unit, 2019). Tooth decay is one of the most prevalent and preventable chronic disease, particularly among children. In Windsor-Essex from 2011 to 2016, the number of children screened in school with decay and/or urgent dental needs increased by 51%.  Tooth decay is also the leading cause of day surgeries for children ages one to five. The rate of day surgeries in Windsor-Essex in 2016 was 300.6/100K compared to 104.0/100K for Ontario, representing a significant cost and burden to the healthcare system (WECHU Oral Health Report, 2018). For children, untreated oral health issues can lead to trouble eating and sleeping, affect healthy growth and development, speech and contribute to school absenteeism.

In 2016, the MOHLTC integrated six publicly funding dental programs into one 100% funded program, providing a simplified enrolment process and making it easier for eligible children to get the care they need. The HSO program was part of Ontario’s Poverty Reduction Strategy commitment to build community capacity to deliver oral health prevention and treatment services to children and youth from low-income families in Ontario. Windsor-Essex Health Unit operates two dental clinics, one in Windsor and one clinic in Leamington. The WECHU provides preventative and restorative services with a team of registered dental hygienists, general dentists and a pediatric dentist. There is about a six-month wait list for services in our current clinics. The number of preventative oral health services provided through the WECHU dental clinics has increased year over year from 1,931 in 2011 to 7,973 in 2017 (WECHU Oral Health Report, 2018).

Community dentists are not required to take patients under the Healthy Smiles Ontario program which can create barriers to accessing services. Changes to the funding model for HSO will not affect the services provided by local dentists and is only applied to local health units. Mixed model funding for public health units and private fee-for-service dental providers, poses a risk to the delivery of the HSO program in Ontario. Based on the data and analysis in the 2018 Oral Health report, the Windsor-Essex County Health Unit proposed recommendations to improve the oral health status in Windsor-Essex including: Improve access to oral health services within Windsor-Essex and advocate for improved funding for oral health services and expansion of public dental programs such as Healthy Smiles Ontario to priority populations. Given the growing urgent need and increase in dental decay among vulnerable children in Windsor-Essex and recognizing the existing barriers to access to care, the WECHU recommends that HSO retain its current funding and structure as 100% funded, merging it with the Ontario Seniors Dental Care Program to be a comprehensive dental care program for vulnerable children and seniors in Ontario.

PROPOSED MOTION

Whereas the WECHU operates a dental clinic in Leamington and Windsor for HSO eligible children with wait times for services exceeding 6 months, and

Whereas one in four children under five years (26.0%), one in five children under 17 years (22.6%), and one in ten seniors (11.4%) in Windsor and Essex County live in poverty, and

Whereas inadequate access and cost remain barriers to dental care for Windsor and Essex County residents, 23.7% report that they lack dental insurance that covered all or part of the cost of seeing a dental professional, and

Whereas indicators show an overall trend of declining oral health status among children in Windsor and Essex County compared to Ontario, and

Whereas the rate of oral health day surgeries for children in Windsor and Essex County (300.6/100K) far exceeds that of Ontario (100.4/100K), and

Whereas there is an increased difficulty in obtaining operating room time for dental procedures in Windsor-Essex with wait times exceeding 1 year for children in need of treatment, and

Whereas there is a chronic underfunding of the Healthy Smiles Ontario program creating barriers to accessing services among local dentists, and

Now therefore be it resolved that the Windsor-Essex County Board of Health recognizes the critical importance of oral health for vulnerable children and youth, and

FURTHER THAT, urges the Ministry of Health to reconsider its decision to download 30% of the funding of the Healthy Smiles Ontario Program to local municipalities, and

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

Flu shots will be offered to board members prior to the meeting at 3:30 p.m.

Prepared By:

Nicole Dupuis, Director of Health Promotion

Date:

November 21, 2019

Subject:

Mental Health Promotion Framework for Windsor-Essex County: Introduction and Next Steps

Background

In 2018, the revised Ontario Public Health Standards included mental health promotion as a new requirement for public health units in Ontario (Ministry of Health and Long-Term Care, 2018). In preparation for this work, the Windsor-Essex County Health Unit (WECHU) and Canadian Mental Health Association Windsor-Essex (CMHA) joined under a strategic partnership agreement for the prevention of mental illness and promotion of positive mental health through shared resources and leadership.

CMHA and WECHU have collaborated on a number of projects since the inception of their strategic partnership, including but not limited to the development of the suicide prevention coalition, suicide prevention awareness month, curriculum supports for First Responders, and gambling awareness and prevention. As a first step in partnership toward Mental Health Promotion, the CMHA and the WECHU identified the need to develop a Mental Health Promotion framework for Windsor-Essex. 

Current Initiatives

Early in 2019, the WECHU and CMHA began work on a local report for positive mental health. The shared vision of the report was to outline:

• A mental health promotion framework for community adoption;
• A shared community understanding and meaning of mental health promotion;
• Current services and programs for mental health promotion in Windsor-Essex; and
• Areas for future work and collaboration.

Over a six-month period, key stakeholders across Windsor-Essex were engaged in an environmental scan via focus group and online survey. The purpose of the scan was to understand current services related to mental health promotion in Windsor-Essex as well as to understand opportunities for future planning.

The results of the mental health promotion scan have been combined with the mental health promotion framework for the first report on Mental Health Promotion for Windsor-Essex. 

References

Ministry of Health and Long-Term Care. (2018). Ontario Public Health Standards: Requirements for Programs, Services and Accountability. Toronto: Ministry of Health and Long-Term Care.

Consultation

The following individuals consulted in the development of this report:

• Claudia den Boer, Executive Director, Canadian Mental Health Association Windsor-Essex
• Kim Willis, Director, Canadian Mental Health Association Windsor-Essex
• Neil Mackenzie, Manager, Chronic Disease & Injury Prevention, Windsor-Essex County Health Unit
• Alex Erikson, Mental Health Specialist, Windsor-Essex County Health Unit
• Mindy Hartleib, PhD candidate, University of Windsor
• Kelly Farrugia, Manager, Healthy Schools, Windsor-Essex County Health Unit
• Felicia Lawal, Manager, Healthy Families, Windsor-Essex County Health Unit

Approved By:

Theresa Marentette, CEO

Prepared By:

S. Manzerolle

Date:

November 21, 2019

Subject:

School Based Immunization Clinics 2019/2020 School Year

Background

Ontario’s school-based immunization program for students delivered by the WECHU includes immunization of eligible Grade 7 students against three diseases: Hepatitis B (HBV), Human Papilloma Virus (HPV), and Meningococcal Disease (Men-C- A,C,Y,W-135 vaccine). Hepatitis B vaccine protects against a virus that can permanently damage one’s liver and is a leading cause of liver cancer. Meningococcal vaccine (specifically Menactra) protects against a bacteria which causes inflammation of the lining of the brain and spinal cord and/or an infection of the blood. HPV vaccine protects against many types of cancers including cervical and other genital cancers, as well as genital warts.

Participation in the school-based vaccination program is voluntary, however students must have proof of immunization against Meningococcal disease (specifically with the Menactra vaccine) in accordance with the Immunization of School Pupils Act (ISPA) in order to attend school.

According to the Public Health Ontario Immunization Coverage Report for School Pupils in Ontario, for the 2017-18 school years, Ontario falls short in the uptake of these vaccines in meeting the national goal. In comparison to the province, however, the WECHU surpassed the Ontario average among 12 year olds for immunization with HBV, HPV, and Menactra vaccines. For the 2017-2018 school year (grade 7 students), the immunization coverage rates for the school based vaccines are as follows:  HBV - 71.9%, HPV - 60.9%, and Menactra - 82.9%

Current Initiatives

The WECHU implements the school-based immunization program across 130 elementary schools in Windsor and Essex County.  This includes students from four school boards as well as private and agency schools. The WECHU offers immunization in schools in two rounds: Fall (Sept-Dec) and Spring (April-June). Typically the first dose in a series of HPV and HBV vaccines are given during the first round, with the second dose, along with the single dose of Menactra, offered during the second round.

Due to the labour disruption at the WECHU in the spring, both the first and second round of the school-based immunization program for the 2019/2020 school year is currently in progress, targeting both the Grade 7 and Grade 8 cohorts.  The WECHU also provides catch-up and in-house immunization clinics outside of the school setting for eligible students for the HPV, HBV and Menactra vaccines; upcoming catch-up clinics will take place in November and December.

The WECHU is currently entering the final year of a five-year plan to improve immunization coverage rates and compliance with the ISPA.  The five-year plan has included an expanding number of student cohorts who are identified and targeted for record review annually.  Parents of students with out of date records receive a series of communications requesting updated immunization information. Families are provided with a deadline, before which they are required to update their immunization record, otherwise they face suspension from school for up to twenty days. The next school suspension, which will include all elementary school students (JK-8) will occur in March 2020.  The initial notices to families will be distributed during the week of November 11, 2019.

Approved By:

Theresa Marentette

Prepared By:

S. Manzerolle, Manager, Healthy Schools Department

Date:

November 21, 2019

Subject:

Influenza Season 2019/2020

Background

The WECHU plays a key role in the implementation of the Ministry of Health’s Universal Influenza Immunization Program (UIIP) which offers influenza vaccine free of charge each year to all individuals six months of age and older who live, work, or attend school in Ontario.

Under the UIIP, the provincial supply of influenza vaccine doses is received from the Ontario Government Pharmacy (OGP) in predetermined increments dependent on vaccine availability and timing from each of the vaccine manufacturers. The WECHU receives influenza vaccine shipments from OGP and is responsible for the distribution to health care providers in the community.  Allocation to providers is based on total community allocation, number of clients to be served, past usage by the provider, available fridge space, and the proportion of high-risk clients of the provider. The initial supply of influenza vaccine is prioritized for the immunization of high-risk individuals (i.e. long-term care homes and hospitals). Immunization of the general population commences once the provincial supply is replenished. 

In preparation for, and over the course of the influenza season, the WECHU maintains ongoing communication with all providers and pharmacies and relays information about the timelines for vaccine availability. Tailored information packages including vaccine product information, ordering information, and promotional materials are also compiled and distributed to providers by the WECHU each influenza season.

Current Initiatives

Currently the Health Unit has received about 90% of our total influenza vaccine allocation for the 2019/2020 season.  The first large shipment was received at the beginning of October and was distributed to high-risk groups at long term care facilities, retirement homes, and hospitals. In particular, these facilities received 100% of the doses they required for their residents/patients.  Health Care Providers (HCPs) received small quantities for their high-risk patients with the first shipment of vaccine.

A second large shipment was received to the Health Unit mid-October and is being used to fill HCP orders in the community. In addition, there are approximately 100 pharmacies in Windsor and Essex County that were approved to provide influenza vaccine to individuals 5 years of age and older.

The WECHU will provide one public influenza clinic at the University of Windsor on November 18, 2019. The clinic provides influenza vaccine free of charge, and an Ontario Health Card is not required; the clinic is open to the public, however targets international students and their families.

In November, 2019 the WECHU will implement a public influenza or ‘flu’ campaign, which will support Immunize Canada’s key messages encouraging individuals and families to get the flu shot.  The campaign also includes materials aimed at groups such as health care workers, pregnant women, young children, and those 65 years and older.

Approved By:

Theresa Marentette, CEO

Prepared By:

Communications Department

Date:

November 1, 2019

Subject:

October Media Relations Recap Report

October Media Coverage

[[chart-nid:5495,chart-view-mode:full]]

Media Coverage

News Release, Media Advisories and Media Statements

Stories Reported by the Media

AM 800

Blackburn News

CBC News

Note: Digital stories were not available for two of CBC’s requests.

CBC Radio-Canada

Note: Digital stories were not available for two of CBC Radio-Canada’s requests.

CTV Windsor News

The London Free Press

Windsor Star

Note: Digital stories (2) were not available for MediaPlex/St. Clair College.

The following individuals contributed to this report: Jennifer Jershy, Marc Tortola, and Michael Janisse.

Board Members Present:

Gary McNamara, Joe Bachetti, Tracey Bailey, Rino Bortolin, Fabio Costante (4:11 pm), Dr. Deborah Kane (4:17 pm), Judy Lund (via phone), John Scott, Ed Sleiman, Larry Snively ​​​​​​

Board Member Regrets:

Gary Kaschak

Administration Present:

Theresa Marentette, Dr. Wajid Ahmed, Lorie Gregg, Nicole Dupuis, Kristy McBeth, Dan Sibley, Lee Anne Damphouse

Staff Present:

Alexis Erickson, Mike Janisse, Stacey Manzerolle, Neil MacKenzie, Jen Jershey, Nicole Trajkovski, Phil Wong, Adrina Zhong (WECHU medical student)

Guests:

Claudia Den Boer, CMHA

QUORUM:  Confirmed

RECORDING SECRETARY:

SUBMITTED BY:

APPROVED BY:

ISSUE

Climate change means a long-term shift in weather conditions, such as temperature, rain/snowfall, extreme weather events, and rising sea levels. Climate change is expected to result in warmer temperatures, longer and hotter summers, more frequent and/or more severe weather events such as hurricanes/tornadoes, thunderstorms, wildfires, floods, and droughts. The impacts of climate change have the potential to influence health outcomes, and can impact health through temperature-related illnesses, poor air quality, water and foodborne diseases, exposure to ultraviolet rays, as well as increased risk of vector-borne diseases. (Government of Canada, 2019)

As a part of the modernization of the Ontario Public Health Standards in 2018, updates were made to the Health Hazard Response Protocol, 2019 and Healthy Environments and Climate Change Guideline, 2019 that require public health units, in collaboration with municipalities and local organizations, to address local impacts of climate change. This includes reducing exposure to environmental health hazards in the community, increasing public awareness of health hazards, and developing policies that address climate change. The Windsor-Essex County Health Unit (WECHU), in collaboration with municipalities and local partners, is currently working to identify and implement local mitigation and adaptation strategies in order to reduce the negative effects on public health related to climate change.   

BACKGROUND

As noted in the recent Community Needs Assessment 2019 Update, Windsor and Essex County (WEC) has experienced the impacts of climate change in recent years such as record levels of precipitation and severe storms, which have led to widespread flooding events and emergencies. In recent years, there have been periods of extended heat and annual algal blooms that greatly affect our local communities.  Between 1941 and 2012, the annual average temperature for the City of Windsor increased by almost 1°C based on data received from the Environment Canada weather station at Windsor Airport (City of Windsor, 2012). WEC experienced a consistent increase in annual precipitation with a 1 to 3% increase per decade from 1970 – 2000. Heavy rainfall events lasting for approximately 30 minutes increased by 5% per decade during 1971-2000 in Windsor (City of Windsor, 2012). Daily rainfall extremes have especially increased during the months of May, June, and July by 7% per decade during the baseline period. 

The favourable climatic conditions for vector borne diseases is present in Southwest Ontario, especially WEC, and are expected to expand over a wider geographical area by the 2050s and 2080s (Gough et al., 2016). The WECHU’s mosquito and tick surveillance programs have identified the presence and establishment of the lone star tick, and invasive mosquito species like the Aedes albopictus and possibly Aedes aegypti. The lone star tick is a vector for multiple pathogens and its bite can trigger an allergy to red meat. Aedes albopictus and Aedes aegypti mosquitoes transmit viruses not normally seen in Canada, such as Zika, Dengue fever, and Chikungunya.

In support of the development of a comprehensive local approach to address climate change, the WECHU is collaborating with Essex Region Conservation Authority (ERCA) and local municipalities to undertake development of a regional climate change strategy.  The strategy will include establishment of sector-based implementation teams (e.g., Land Use and Watershed planning, Human Health and Well- being, Water Resources, Nature and Ecosystems, Energy, and Agriculture) and each team will develop a ‘roadmap’ for their issue area. The WECHU will lead the Human Health and Well-being implementation team and will provide local evidence and understanding of the linkages between climate change and health within the WEC, identify promising evidence based interventions, and recognize local system gaps and strategies to address them.  

PROPOSED MOTION

Whereas, WEC is experiencing the environmental effects of climate change with examples such as extreme flooding in 2016 and 2017, heat waves, large algal blooms in our lakes, established population of the mosquito Aedes albopictus (a vector for Zika, Dengue fever, and Chikungunya) and food insecurity; and

Whereas, climate change impacts the health of individuals through temperature-related illnesses and mortality, extreme weather events, poor air quality, water and foodborne diseases, exposure to ultraviolet rays, increased risk of infectious diseases, as well as impacts local agri-business ; and

Whereas, climate change affects vulnerable populations disproportionately such as children, older adults, people with chronic illness, low income and homeless people, newcomers, migrant workers, and people living and working in rural and remote areas; and

Whereas, the WECHU is committed to ongoing collaborations with local organizations and municipalities in WEC on a regional climate change strategy in an effort to protect the safety, prosperity and livability of our region.

Now therefore be it resolved the Windsor-Essex County Board of Health encourages  municipalities to systematically incorporate climate change mitigation and adaptation strategies into new and existing policies and programs such as land use and building applications, and active transportation master plans in order to manage health risks associated with climate change; and

FURTHER THAT, the Windsor-Essex County Board of Health will adopt and implement climate change initiatives and programs that  support  municipalities and local organizations, both public and private, to take climate action and raise the public’s awareness about the health impacts of climate change in order to drive individual behaviour change in support of climate change action.

References:

• City of Windsor. (2012). Climate Change Adaptation Plan. Retrieved from https://www.citywindsor.ca/residents/environment/Environmental-Master-Plan/Documents/Windsor%20Climate%20Change%20Adaptation%20Plan.pdf
• Gough, W., Anderson, V., Herod, K. (2016). Ontario climate change and health modelling study: report. Ontario: Queen's Printer for Ontario.
• Government of Canada. (2019). Causes of Climate Change. Retrieved from https://www.canada.ca/en/environment-climate-change/services/climate-change/causes.html
• Kovats, R. S., Bouma, M. J., Hajat, S., Worrall, E. & Haines, A. (2003).  El Niño and health. Lancet. 362, 1481–1489.

View the 2020 Budget document.