Board of Health Meeting Documents

Prepared By:

Communications Department

Date:

August 7, 2019

Subject:

July Media Relations Recap Report

July Media Coverage

Media Coverage

News Release, Media Advisories and Media Statements

Stories Reported by the Media

AM 800

Note: Digital stories were not available for two of AM 800’s requests.

Blackburn News

Cape Breton Post

CBC News

(also includes Radio-Canada)

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

CTV Windsor News

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

The Woodstock Sentinel

Windsor Star

Yahoo News

Note: Digital stories were not available for the Toronto Star and WDET (Detroit).

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

Prepared By:

Communications Department

Date:

September 6, 2019

Subject:

August Media Relations Recap Report

August 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 two of CBC’s requests.

CTV Windsor News

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

Global News

Windsor Star

Windsorite.ca

Note: Digital stories were not available for Farmer’s Forum, Toronto Star and WDET (Detroit).

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

Prepared By:

Alicia Chan, Public Health Nutritionist, Chronic Disease and Injury Prevention

Date:

September 19, 2019

Subject:

Background

Food and Health in Windsor and Essex County

The total economic burden of unhealthy eating is estimated to be $5.6 billion in Ontario, including $1.8 billion for inadequate vegetable and fruit consumption (which is used a population indicator for healthy eating). According to the Windsor-Essex Community Needs Assessment Update 2019 (Windsor-Essex County Health Unit, 2019), only one quarter (26.8%) of the population consume vegetables and fruit five or more times a day with the greatest impact on individuals that are single, male, living in a household with low income and/or education. Healthy eating behaviours play a critical role in promoting health and in preventing, managing, and treating various chronic diseases, including cardiovascular disease, diabetes, and some cancers.

Food insecurity, financial constraints leading to a compromise in diet quality or quantity,  is an ongoing issue in Windsor and Essex County, where, according to data from the Canadian Community Health Survey (2013-2014), 10.8% of households experience moderate or severe food insecurity, and 9.7% of children experience moderate or severe food insecurity (Windsor-Essex County Health Unit, 2019).

Food insecurity negatively influences the physical, mental, and social health of families and individuals, increasing risk of diabetes, hypertension, dyslipidemia, cardiovascular disease, poor sleep, iron deficiency, depression, and other mental health outcomes (PROOF Food Insecurity Policy Research, 2016a). Mothers experiencing food insecurity are also more likely to discontinue exclusive breastfeeding sooner than mothers with food security.

In the absence of adequate income to purchase food, many residents have engaged in alternate avenues of food access, including food charity (e.g., food banks) and other community food programs. For example, the Windsor Essex Food Bank Association (WEFBA) reported that there were over 123,000 visits to WEFBA food banks in 2018, which represented a 5% increase from 2017.

Over the past few years, the WECHU has become more involved in working with various community members to address food and nutrition issues at the systems level, leading to the formation of a food policy council (FPC) and the undertaking of a community food assessment (CFA). The formation of the FPC not only helps to address nutrition and healthy eating issues in a more coordinated and comprehensive fashion, but also creates more opportunities to engage in other health issues, such as climate change, food waste, improving rural health, and improving the health of agricultural workers.

Previous Food Systems Work in Windsor and Essex County

While food insecurity and challenges with the food systems have existed for decades, discussions about change were stimulated by the Hungry for Change Report, released in 2009. The Food Matters Windsor-Essex County (FMWEC) collaborative was established after a successful Ontario Trillium Foundation grant application in 2010, fostering key partnerships and laying the foundation for food systems work in the region including work on the Good Food Charter in 2014. In 2015, community funders convened as the Food Security Strategy Steering Committee to initiate the development of a food security strategy for the next ten years. The establishment of the FPC emerged as a key recommendation.

Windsor-Essex Food Policy Council

Food Policy Councils bridge governments, businesses, and citizens to facilitate partnerships and collaborative actions to identify and address issues that affect the food system. Examples of health topics that either influence or are influenced by the food system include community food security, equitable access to food, food affordability, food literacy, urban and school gardening, the effects of climate change on the agricultural economy, and migrant worker health. Such issues stand to benefit greatly from coordinated, integrated, and meaningful improvements to the food system, which in turn will contribute to improving healthy eating behaviours, stimulating the local economy, and making the food system more environmentally and socially just.

In early 2017, the Windsor-Essex County Health Unit (WECHU) invited a wide range of stakeholders representing community organizations, non-profit organizations, and City and County officials to form a steering committee. The goal of the steering committee was to develop the foundation required to establish the Windsor-Essex Food Policy Council (WEFPC). This included determining its structure, membership, and key logistics and processes. Following a round of community engagement sessions, recruitment for the WEFPC occurred in late 2017, and its first meeting was held in January 2018. A competitive application-based process was undertaken to recruit the best mix of the most qualified individuals to become members of the WECFPC. Currently, the WEFPC is comprised of stakeholders representing a wide range of food system sectors and interests, including farmers, small business operators, non-profit organizations, educators, City and County officials and appointees, and concerned citizens. WECHU provides resource and administrative support for the WEFPC.

Current Initiatives

Community Food Assessment Report

A Community Food Assessment (CFA) was undertaken in 2018, with the aim to provide an understanding of the current and desired state of Windsor and Essex County’s local food system. A comprehensive exercise was undertaken to gather all available data on the food system, identify gaps in knowledge, explore community insights about the food system, and engage key stakeholders in dialogue. Creative Momentum Consulting, with the support of public health nutritionists and dietitians from the WECHU, conducted the research and created the report. Data was gathered through a county-wide online survey, community conversations, and key stakeholder engagement sessions. The Community Food Assessment also received financial support through the Windsor-Essex Community Foundation. The CFA report was shared with members of the WEFPC to help inform priority-setting exercises, which occurred in May and June 2019. The final report was released to the public in September 2019.

WEFPC Action and Evaluation Planning

In 2018 and early 2019, the WEFPC developed and ratified its vision, mission, and value statements, as well as its Terms of Reference. The members also set major priorities areas for action moving forward. The determination of priorities was a multi-step process, which included determining the selection criteria for priorities, reviewing the draft CFA report, identifying recommendations, categorizing recommendations into major topic areas, and determining the five key areas to address. In the end, the WECFPC selected the following five priority areas:

1. Food insecurity and equitable food access
2. School food literacy and education
3. Supporting local small businesses
4. Food waste and waste management
5. Celebration of food

Five subcommittees were formed to address each of the priorities above, and action plans have been under development over the summer months. The WECHU’s Program Evaluation Specialist was previously invited to provide a workshop on planning and evaluation to prepare the WEFPC for this step. The WEFPC will next meet in late September to operationalize these proposed plans in order to move forward. A sixth subcommittee was established to manage communications for the WEFPC, including providing support to the WECHU for the dissemination of the CFA report. 

Glossary

Food system: An interconnected network of individuals, processes, practices, and structures that contribute to all aspects of food, including food production, processing, distribution, access, consumption, education, and waste management.

Household food insecurity: the uncertainty or inability to acquire sufficient food because of financial constraints (PROOF Food Insecurity and Policy Research, 2019b). Three levels of severity exist:

• Marginal food insecurity: worrying about running out of money for food and limiting food selection due to cost
• Moderate food insecurity: compromising diet quality or quantity due to a lack of money
• Severe food insecurity: reducing food intake, missing meals, going for days without food due to cost

References

• PROOF Food Insecurity and Policy Research. (2016a). The Impact of Food Insecurity on Health. Retrieved from https://proof.utoronto.ca/wp-content/uploads/2016/06/health-impact-factsheet.pdf
• PROOF Food Insecurity and Policy Research. (2016b). Monitoring Food Insecurity in Canada. Retrieved from https://proof.utoronto.ca/wp-content/uploads/2016/06/monitoring-factsheet.pdf
• Windsor-Essex County Health Unit. (2019). Community Needs Assessment 2019 Update. Windsor, Ontario.

Consultation

The following individuals contributed to this report:

Alicia Chan, MPH RD, Public Health Nutritionist, Chronic Disease and Injury Prevention

Mariel Munoz, MPH RD, Public Health Nutritionist, Healthy Schools

Approved by:

Theresa Marentette

Board Members Present:

Gary McNamara (via phone), Joe Bachetti, Rino Bortolin, Fabio Costante, Judy Lund, Ed Sleiman 

Board Member Regrets:

John Scott, Tracey Bailey, Dr. Deborah Kane, Larry Snively, Gary Kaschak

Administration Present:

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

WECHU Manager Present:

Fernando Bayuga, WECHU Manager, Information Technology and Facilities 

QUORUM:  Confirmed

RECORDING SECRETARY:

SUBMITTED BY:

APPROVED BY:

Issue

The Consolidated Board By-laws for the Windsor-Essex County Health Unit (“the WECHU”) as well as the WECHU Procurement Policy, require a non-competitive procurement in excess of $2,499 be approved by the Board. 

Background

In April 2019, the Province of Ontario announced the implementation of an Ontario Seniors Dental Care Program (“the Program”) for those Ontario residents 65 years of age and older, that meet certain income thresholds and do not have other dental insurance.  The Program is intended to be delivered by public health units, community health centers or aboriginal heath care centers in Ontario.  After local consultation and, taking into consideration the current capacity of the WECHU’s dental clinics in Windsor and Leamington, it was determined that the WECHU would be best-suited deliver this Program. 

The WECHU’s Windsor Oral Health Department has three (3) dental operatories. Only one (1) is equip with an x-ray machine, which restricts the capacity of the remaining two (2) operatories.  The conversion of an existing room (staff washroom) to an imaging room would increase the capacity of the two remaining operatories.

Based upon the WECHU’s procurement policy and given the estimated procurement value, the WECHU sought three (3) quotations.  Only one (1) of the three (3) proponents responded. The following are the details of the quotation:

Proponent:  Lester Construction
Total budget:  $16,950.00 plus HST

Based upon communications from the Ministry of Health and Long-Term Care, the WECHU understands that the Program could commence as early as October 1, 2019.  To address anticipated Program demands, the WECHU would recommend awarding this procurement to Lester Construction at a total budget of $16,950.00 plus HST.

Proposed Motion

Whereas, the WECHU requested three quotations for the aforementioned procurement, in accordance with the WECHU’s own procurement policy and,

Whereas, only one (1) of three (3) proponents responded and it is the WECHU’s understanding that the Program could commence October 1, 2019,

Now therefore be it resolved that the Windsor-Essex County Board of Health be permitted to contract with Lester Construction to convert an existing room in the WECHU’s Windsor Oral Health Department to an imaging room, at a total budget of $16,500.00 plus HST.

Issue

The Consolidated Board By-laws for the Windsor-Essex County Health Unit (“the WECHU”) as well as the WECHU Procurement Policy, require a non-competitive procurement in excess of $2,499 be approved by the Board

Background

The WECHU utilizes the Ceridian Payflex (“Payflex”) application to process payroll.  The Payflex application does not interface with the WECHU’s Sage 300 Financial System or the InfoHR system (the current system utilized to track employee entitlements and usage as well as limited other human resource information).  The InfoHR system is also dated and limited in its uses.  The majority of human resource processes are manual and documentation is primarily paper-based.  In terms of the managing of staff time, the Program Managers are limited in their abilities to leverage the InfoHR system and have constructed separate excel-based tracking forms requiring frequent manual updating.

The Payflex application is being retired in December 2020, and as a result, the WECHU must implement an alternative solution.  As Ceridian has been WECHU’s payroll service provider for over 25 years, conversion to an alternative application using a Ceridian solution would allow for a more effective implementation.  As such, the WECHU has not embarked upon a competitive procurement process.

The first of two alternatives to Payflex is Ceridian Powerpay (“Powerpay”).  Powerpay is a cloud-based application, similar to Payflex in so far as its ability to process payroll, but also includes limited employee self-serve capabilities (i.e. digital pay stubs).  This application typically serves organizations with 100 to 150 employees but can be expanded to fit our requirements with basic use of the application.  The second alternative to Payflex is Ceridian Dayforce (“Dayforce”).  Dayforce is a cloud-based application, but represents a more wholesome software solution with payroll, human resource and time management capabilities. 

A more wholesome and integrated solution such as Dayforce will allow for increased capacity in the areas of Payroll and Human Resources, as well as with the Management Group.  In addition, this application will enhance the employee experience with a more comprehensive self-serve system that will follow them through their employee life cycle.

The implementation and annual fees associated with the Dayforce application are as follows:

Currently, the WECHU is paying the following annual fees for Payflex and the InfoHR system.

Note:  Costing above includes the non-refundable portion of HST.

Proposed Motion

Whereas, the payroll application the WECHU is currently utilizing is being retired effective December of 2020

Whereas, Ceridian has been the WECHU’s service provider for over twenty-five (25) years and has alternative systems solution to address the WECHU’s requirements, not only from a payroll perspective, but also in relation to human resources and time management,

Now therefore be it resolved that the Windsor-Essex County Board of Health be permitted contract the services of Ceridian to implement the Dayforce solution in advance of the retirement of the existing Payflex application.

Issue

In December 2016, the Windsor-Essex Community Opioid Strategy (WECOSS) Leadership Committee brought together community leaders and key stakeholders across sectors to collectively address rising rates of opioid use in Windsor and Essex County. In line with the recommendations of the WECOSS Action Plan, partners have more recently discussed supervised injection sites (SIS) and their potential to reduce overdose-related morbidity and mortality, public injection, discarding of needles in public spaces, and the transmission of blood-borne infections. In addition, SIS offer access to treatment and withdrawal management services. In Ontario, SIS services are eligible for provincial funding through an application by community organizations to the Ministry of Health to operate a Consumption and Treatment Services (CTS) site. Under the CTS model, funded sites provide wrap-around services that connect clients who use drugs to primary care, treatment, and other health and social services; these sites must include the following;

• supervised consumption and overdose prevention services,
• onsite or defined pathways to addictions treatment services,
• onsite or defined pathways to wrap-around services, and
• harm reduction services.

On April 1, 2019 the Windsor-Essex County Board of Health passed a resolution in support of ongoing public health-led assessment to determine the need for and feasibility of CTS in the City of Windsor. Further to this, the Board of Health endorsed the recommendation that the Windsor-Essex County Health Unit (WECHU) take a lead role in facilitating the completion of an application pending the results of the assessment. Data collection for the WECHU-led community consultations consisted of four phases and was completed on April 26th, 2019.  In total 2648 responses to the different components of the data collection yielded a large sample from which to draw a number of conclusions around community readiness which would inform the completion of the CTS application.

In order to receive provincial funding for CTS, applicants must demonstrate their ability to meet federal requirements as well as additional requirements under Ontario’s CTS program. In particular applicants must first demonstrate that they are seeking an exemption to federal regulations (i.e., Controlled Drugs and Substances Act) and demonstrate that they have been diligent in considering the following areas which constitute mandatory sections of the application:

• Local conditions: Includes opioid-related mortality/morbidity, needle distribution data, naloxone distribution data.
• Capacity to provide treatment and consumption services: Preference given to those organizations that currently offer or have the capacity to offer in partnership, onsite access to services.
• Proximity: Location relative to similar services and to vulnerable areas (e.g., schools, child care centres, parks, post-secondary institutions).
• Community support and ongoing community engagement: Consultation conducted with residents, healthcare organizations, local businesses, community groups, and other stakeholders.
• Accessibility: Sites must be compliant with the Accessibility for Ontarians with Disabilities Act, as well as culturally, demographically, and gender appropriate, and strategically located.

Background

Substance use continues to impact communities across Windsor and Essex County (WEC) and in particular the City of Windsor. Of the 36 opioid-related deaths in WEC in 2017, 31 took place in the City of Windsor and approximately half took place in the home. Among these deaths, less than half showed any signs that effort had been made to resuscitate. The rate of Hepatitis C cases, a blood-borne infection for which injectable drug use is a significant risk factor, has increased from 37 cases per 100,000 people in 2014 to 47 cases per 100,000 people in 2018 with the majority of cases coming from the City of Windsor. Among these cases, 63% of those responding to risk factors related to their diagnosis reported injectable drug use.

Data collected through WECHU’s four-phase SIS Community Consultations which involved a community consultation survey, focus groups, key informant interviews, and interviews with people who inject drugs were analyzed and compiled in the Supervised Injection Services Community Consultations Report. The report shows community support for a Supervised Injection Site (SIS) with 61% of online survey respondents indicating that they felt an SIS would be helpful in WEC relative to 33% who did not. Those in support referenced the potential for an SIS to save lives, decrease harm for those who inject drugs, increase community safety, and decrease stigma. Those in opposition to SIS reference the potential to decrease property values in the area, increase crime in the area, normalize drug use and condone illicit drug use. Among focus group participants there was an acknowledgement that WEC is facing a drug crisis and an openness among most participants to the idea of an SIS. Key informant interview responses mirrored these results adding that there was a lack of consensus among key stakeholder groups about the benefits of an SIS and highlighting the importance of key community leaders to work together should an SIS be created. In speaking with people who inject drugs (PWID), 80% of respondents indicated that they were aware of these types of sites and responded either maybe or yes to using a site if one existed in Windsor. Among the 99 respondents, 67% indicated that they were currently injecting drugs in public or semi-public spaces. Survey participants also shared preferred characteristics of an SIS, including access to sterile needles and harm reduction equipment, supervised injection, drug testing, access to health services and counselling, and referrals to treatment.

Given the available local data and the findings outlined in the Supervised Injection Services Community Consultations Report, access to a consumption and treatment site in the City of Windsor would reduce unintentional deaths associated with drug use and decrease the risk for blood-borne infections among those who inject drugs. In addition, such a site has the potential to reduce the amount of improperly discarded needles in public settings. Through an in-depth assessment of the CTS Application as well as Health Canada’s Exemption for Medical Purposes under the Controlled Drugs and Substances Act for Activities at a Supervised Consumption Site Application, WECHU is working on the initial requirements for a CTS in Windsor. Sections of both the provincial and federal applications related to site location however, were outside of the scope of the initial assessment and must be explored further prior to any submission.

Proposed Motion

Whereas the Government of Ontario announced its funding commitment and endorsement of Consumption and Treatment Services in October 2018, and

Whereas Windsor and Essex County is experiencing significant public health concerns related to the use of opioids and other substance use, including illnesses, deaths, blood borne infections, and public discarding of used needles, and

Whereas Consumption and Treatment Services have the potential to address such public health issues, in addition to reducing health care costs, and

Whereas the Windsor-Essex County Health Unit’s (WECHU) lead role in the Windsor-Essex Community Opioid Strategy and understanding of harm-reduction services in the community, creates an opportunity for the WECHU to lead the successful completion of a comprehensive and collaborative application for Consumption and Treatment Services in our community, and

Whereas the results of the WECHU-led Supervised Injection Services Community Consultations Report demonstrate support and openness among the general public, key stakeholders, and people who inject drugs for an SIS in WEC, and

Whereas the final submission of a CTS application as well as the application for an exemption to the federal Controlled Drugs and Substances Act requires community consultation and the selection of a proposed location in which to operate.

Now therefore be it resolved that the Windsor-Essex County Board of Health supports the submission of a Consumption and Treatment Services Application for the City of Windsor to the Ministry of Health, including the submission of an Exemption for Medical Purposes under the Controlled Drugs and Substances Act for Activities at a Supervised Consumption Site Application required by Health Canada, and

FURTHER THAT an additional comprehensive community consultation be conducted by the Windsor-Essex County Health Unit to determine a suitable and accessible location for a CTS in the City of Windsor.

The following are the Financial Statements of Windsor-Essex County Health Unit
Year ended December 31, 2018

The following are the financial Statements of Windsor-Essex County Health Unit Healthy Babies/Healthy Children Program
Year ended December 31, 2018

The following are the financial Statements of Windsor-Essex County Health Unit Nurse Practitioner Program
Year ended December 31, 2018

Prepared By:

Communications Department

Date:

June 5, 2019

Subject:

May Media Relations Recap Report

May Media Coverage

Media Coverage

News Release, Media Advisories and Media Statements

Stories Reported by the Media

AM 800

Note: Digital stories were not available for two of AM 800’s requests.

Blackburn News

Note: Digital stories were not available for one of Blackburn News’ requests.

Calgary Herald

CBC News

(also includes Radio-Canada)

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

Chatham This Week

CTV Windsor News

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

Global News

Kelowna Daily Courier

Kitchener Today

London Free Press

National Post

Ottawa Citizen

OurWindsor.ca

Penticton Herald

Regina Leader-Post

Saskatoon Star Phoenix

Vancouver Sun

Windsor Star

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

Windsorite.ca

Winnipeg Free Press

Prepared By:

Eric Nadalin, Manager, Chronic Disease and Injury Prevention Department
Theresa Sarkis, Youth Engagement Specialist

Date:

June 2019

Subject:

Background:

E-cigarettes are battery-operated devices that mimic the tobacco smoking experience. These products work by vapourizing a fluid which is then inhaled into the user’s lungs in the same manner as a traditional tobacco cigarette. While the substances consumed within an e-cigarette can vary, they generally consist of a combination of propylene glycol, vegetable glycerine, flavouring agents, and in many cases nicotine, the highly addictive chemical found in tobacco. Recent increases in the popularity of these products among youth and young adults have led the United States Food and Drug Administration to declare e-cigarette use an epidemic among young people (U.S. National Academies of Sciences, Engineering and Medicine, 2018), and in Canada student use of vaping products increased by 30% each year between 2015 and 2017 (University of Waterloo, 2017).

There are two pieces of legislation which regulate the promotion and sale of vaping products in Ontario. The federal Tobacco and Vaping Products Act (TVPA) aims to address the rising popularity of vaping products among young people by placing restrictions on how they can be advertised. At the provincial level, the Smoke-free Ontario Act 2017 (SFOA) further regulates these products by restricting their sale to minors, regulating how they can be displayed in storefronts, and restricting their use in certain public spaces. The SFOA is enforced locally by the Tobacco Enforcement Officers (TEOs) at the Windsor-Essex County Health Unit (WECHU) who inspect spaces proactively, ensure the region’s 223 e-cigarette vendors are operating in compliance, and conduct youth access test shopping inspections to discourage the sale of these products to minors. In spite of these protective measures there remains a lack of adequate safe-guards against the promotion of e-cigarette products in places where they may be observed by young people and other vulnerable populations. Promotions are commonly seen at point-of-sale in many convenience and grocery stores, as well as in locations like gas pumps or parking lots associated with the places in which these products are sold. In addition, efforts to prevent the use of these products are being countered by innovative technologies which include more discrete product designs and increased efficiency of nicotine delivery systems. These newer generation vaping products produced by companies such as JUUL©, VYPE©, STLTH©, or SMOK© deliver higher concentrations of nicotine per puff than older versions of e-cigarettes and, in many cases, even tobacco cigarettes (American Cancer Society, 2019).

Although there is little research on the long-term health impacts of e-cigarette use and second-hand exposure, preliminary research has shown an association between use of these products and increased risk for the uptake and intensity of tobacco smoking (Ontario Agency for Health Protection and Promotion (Public Health Ontario), 2018).

Current Initiatives

Prevention and Education

School Vaping Prevention Toolkit: In order to assist teachers and school administrators in providing students with credible and reliable information about the use of e-cigarettes and the associated health impacts, a toolkit has been created which will be provided to the WECHU Public Health Nurses on the Healthy Schools team. The toolkit includes:

• A guide for parents and teachers on “How to Talk to Teenagers about E-cigarettes”
• Fact sheets  (for parents, teachers, and teenagers)
• Vaping prevention posters and postcards  
• Training presentation for teachers about e-cigarettes and the health effects of vaping and vapour products

Elements of this toolkit have already been utilized in schools, but the full packages will be distributed to all secondary schools, and any other requesting schools, beginning September 2019.

Provincial Vaping Working Group: A representative from WECHU has joined a number of provincial partners to lead a project which will result in consistent messaging across the province for public heath units to utilize in their communication materials. This communication campaign will focus on the potential harms of vaping and is also set to be implemented beginning September 2019.

Cessation

Internal WECHU Education Program: Staff will be educated through an e-module on the types of products available in the marketplace and how to speak with their clients about their use.

School-based Diversion Program: Based on school interest, WECHU’s Youth Engagement Specialist will offer an after-school youth diversion program to students caught vaping on school properties.  This option may be utilized in lieu of ticketing students, with a goal of educating them on the health, legal, and financial implications vaping can have.

Protection & Enforcement

Secondary School Proactive Enforcement Inspections with Police Services: Starting in March of this year, WECHU TEOs conducted joint enforcement inspections at each local high school with officers from the Ontario Provincial Police, LaSalle Police Service, and Windsor Police Service. This “blitz” of secondary schools across the region has yielded 15 charges with fines ranging from $100.00 to $250.00 for the first offense. For many of these students, a Part 3 charge was issued requiring them to meet the WECHU’s lead Prosecutor and appear in court before a Justice of the Peace, in order to determine the amount of their fine.

School and School Board Presentations: Presentations to students about the e-cigarettes and the effects of vaping and vapour products are available to requesting schools for classroom or assembly presentations. Any school which has registered a complaint with WECHU have been offered the opportunity for such a presentation.  In addition, WECHU TEOs, Health Promotion Specialists, and other staff members have provided presentations to school board representatives of the dangers of these products and WECHU’s role in enforcing the regulations which surround them.

Under 25 Electronic Cigarette Vendor Education Program: In addition to the mandated Youth Access Test Shopping inspections conduced by hired youth who are under the age of 19, the Under 25 Vendor Education Program has been implemented by WECHU since 2015. This program expands on the existing inspections which aim to reduce the sale of tobacco and e-cigarettes to minors by educating vendors on their additional legal requirement to request identification from any one who appears to be under the age of 25. For the first time, this program grew in its scope to implement this program with e-cigarette vendors in addition to tobacco vendors.

Smoke/Vape-free Spaces Mass Media Campaign: Given the passing of the SFOA in October of 2018, and the spring and summer seasons bringing additional opportunities to enjoy several outdoor public places which are for the first time vape-free in addition to being smoke-free, a communication campaign including social media, live radio segments, radio ads, public transit ads and other forms of media will be implemented to educate the public about the new regulations. 

Approved by:

Theresa Marentette

References

• American Cancer Society. (2019). What do we know about e-cigarettes? Retrieved from American Cancer Society: https://www.cancer.org/cancer/cancer-causes/tobacco-and-cancer/health-ri...
• Ontario Agency for Health Protection and Promotion (Public Health Ontario). (2018). Current evidence on e-cigarettes: a summary of potential impacts. Toronto, ON: Queen's Printer ofr Ontario.
• U.S. National Academies of Sciences, Engineering and Medicine. (2018). Public Health Consequences of E-cigarettes.
• University of Waterloo. (2017). Canadian student tobacco, alcohol and drugs survey. Retrieved from Canadian Student Tobacco Alcohol Drugs Survey: https://uwaterloo.ca/canadian-student-tobacco-alcohol-drugs-survey/

Prepared By:

Kim Casier, Oral Health Manager, Oral Health Department

Date:

June 2019

Subject:

Background:

Each year, in Ontario approximately 3% to 5% of children (4000 to 7000) experience vision loss and left untreated can lead to poor performance in school. Effective September 2018, new requirements for the provision of vision screening for children in senior kindergarten (SK) were introduced in the Ontario Public Health Standards (OPHS).  Vision screening under the Child Visual Health and Vision Screening Protocol, 2018 includes a short sequence of three tests that can detect risk factors for certain vision disorders. The screening does not diagnose vision disorders nor is it a replacement for a comprehensive eye examination conducted by an optometrist.

The vision screening tools that are currently utilized are the HOTV visual acuity chart with crowding bars; the Randot Preschool Stereotest; and an autorefractor.

1. The HOTV visual acuity chart with crowding bars is a chart that tests visual acuity, otherwise known as the sharpness of one’s eyesight/clarity of vision. Visual acuity is expressed as a fraction, such as 20/20. In addition to visual acuity, this screening test is also designed to identify children at risk for the following vision disorders: amblyopia and refractive errors (e.g., myopia, anisometropia and astigmatism).
2. The Randot Preschool Stereotest (Randot) is a vision test designed to detect reduced stereopsis/stereoacuity at near distances. Stereoacuity is the ability to visually recognize depth based on differences in the images presented to the two eyes.
3. An autorefractor is a lightweight, portable, handheld screening device. It automatically screens for, and can identify the presence and size of some refractive errors, including near and farsightedness (myopia/hyperopia), astigmatism (asymmetrical focus), and anisometropia (unequal power between eyes).

Current Initiatives

In the fall of 2018, oral health staff received Ministry-specified training and completed their first school in November. In January 2019, dental staff began coordinating with all Windsor-Essex elementary schools to provide pre-screening notification for vision screening to occur simultaneously with dental screening.

Parents/guardians of children who are screened and identified in need of visual health services and/or treatment are provided with a post-screening notification and referral to an optometrist for further follow up. All other children receive a notification encouraging parents/guardians to book an appointment with an optometrist. Parent notification forms have been translated into Arabic and are also available in French and English.

To date 1400 senior kindergarten students attending 49 Windsor-Essex elementary schools have received vision screening. Of those screened, 34.29% (480) were referred to an optometrist for further follow up.

The vision screening has been conducted in conjunction with St. Clair College and second year nursing students from the Registered Practical Nurse (RPN) program. Nursing faculty viewed this opportunity as a “beneficial learning experience that would help to fulfil our mandate and provide the student with a rewarding community placement with children.” The RPN students received vision training/orientation at the College prior to the school assignment. A total of 136 RPN students (17 groups of 8 students) helped to complete 17 schools from January – April 2019.  In addition, three BScN nursing students from the University of Windsor assisted with the vision screening.

Vision screening information has also been sent to Windsor–Essex community optometrists to increase awareness of the new vision-screening program. As well, a vision-screening pamphlet has been created for the community as well as program information has been posted on the WECHU website.

Next Steps

The 2018/2019 school year provided the WECHU oral health staff the opportunity to implement vision screening in a variety of school settings both with and without the assistance of nursing students. Currently an evaluation is being conducted to assess the best structure for full implementation of vision screening in all elementary schools starting fall of 2019. As well the WECHU has partnered with Sick Kids and McMaster to measure parental awareness and perceptions of vision screening.

Approved by:

Theresa Marentette

Prepared By:

Stacy Manzerolle, Manager, Healthy Schools

Date:

June 2019

Subject:

Background:

On May 7, 2019 Public Health Ontario (PHO) released the Immunization Coverage Report for School Pupils in Ontario.  This report outlines the latest estimates for immunization coverage and Immunization of School Pupils Act (ISPA) exemptions at the Health Unit level.  The report includes comparisons to provincial and national goals.

Immunization coverage refers to the proportion of a population that is appropriately immunized against a vaccine-preventable disease (VPD) at a point in time. Immunization coverage varies by vaccine, age, and health unit.  Establishing a high immunization coverage rate in the community is essential for the effective prevention and control of VPDs.  Measuring immunization coverage rates allows public health organizations to monitor trends in vaccine uptake over time and identify areas in the province at risk of VPD outbreaks.

In PHO’s report, immunization records for approximately 500,000 students were assessed for a number of vaccines at ages 7, 12 and 17 years. For most vaccines, provincial-level coverage estimates do not meet Canada’s national coverage goals. However, some health units have local coverage estimates that surpass the national goal.

The attached report is a brief summary of the key findings relevant to Windsor and Essex County (WEC) with provincial and national comparisons for the 2017/2018 school year.

Current Initiatives

Key Findings for Windsor-Essex County: Provincial Comparison
ISPA Designated Diseases:
Immunization coverage rates in 7 year olds in WEC for ISPA-designated diseases including measles, mumps, pertussis, polio, rubella, tetanus, diphtheria, meningococcal diseases, and varicella were similar to or higher than Ontario.

Non-ISPA Designated Diseases:
Coverage rates in 7 year olds in WEC for all except one non-ISPA designated disease were similar to or higher than Ontario. Non-ISPA designated diseases that were assessed include: pneumococcal disease, haemophilus influenza type b, human papilloma virus, and hepatitis B.  Coverage for Haemophilus influenza type b was 2.4% lower in WEC than Ontario (80.0% in WEC and 82.4% in Ontario).

Key Findings for Windsor-Essex County: National Comparison
Coverage estimates in 7-year olds met the national goal of 95% for two diseases (meningococcal disease and rubella). For the 12-year-old cohort, the coverage estimates for diseases covered by the school-based immunization program did not meet the national goal of 90%. Coverage estimates in 17-year olds met the national goal of 95% for measles and mumps, as well as the national goal of 90% for rubella and tetanus.

Exemptions for at least one ISPA antigen
The proportion of students with medical and non-medical exemptions was relatively low.  Only 0.3% of 7-year olds and 0.2% of 17-year olds had a medical exemption for at least one ISPA antigen.  These proportions were similar to that of Ontario.

The proportion of students with a non-medical exemption was slightly higher. 3.4% of 7-year olds and 2.6% of 17-year olds had a non-medical exemption for at least one ISPA antigen. The proportion of 7-year olds with a non-medical exemption was slightly higher than Ontario (0.6% higher).

CONSULTATION:

The following individuals contributed to this report:

Stacy Manzerolle, Manager, Healthy Schools Department

Mathew Roy, Epidemiologist, Epidemiology & Evaluation Department

APPROVED BY:

Theresa Marentette

Board Members Present:

Tracey Bailey, Rino Bortolin, Dr. Deborah Kane, Judy Lund, Ed Sleiman, Larry Snively, John Scott, Joe Bachetti (4:10 pm)

Board Member Regrets:

Gary McNamara, Fabio Costante, Gary Kaschak

Administration Present:

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

WECHU Manager Present:

Eric Nadalin, WECHU Manager, Chronic Disease and Injury Prevention (CDIP) 
Ashley Kirby, Health Promotion Specialist, CDIP

QUORUM:  Confirmed

RECORDING SECRETARY:

SUBMITTED BY:

APPROVED BY:

Introduction

Public Health Ontario has released the latest estimates for immunization coverage and ISPA-antigen exemptions at the Health Unit level. The following is a brief summary of the key findings relevant to Windsor and Essex County (WEC).

Key Findings for WEC (2017/18 School Year)

Comparison to the province (see Figures 1 and 2)

1. Immunization coverage rates for children in WEC for ISPA-designated diseases were similar to or higher than Ontario
   1. ISPA designated diseases: measles; mumps; pertussis; polio; rubella; tetanus; diphtheria; meningococcal diseases; and varicella
2. Coverage rates for all except one non-ISPA designated disease were similar to or higher than Ontario
   1. Non-ISPA designated diseases that were assessed include: pneumococcal disease, haemophilus influenza type b; human papilloma virus; hepatitis B
   2. Coverage for Haemophilus influenza type b was 2.4% lower in WEC than Ontario (80.0% in WEC and 82.4% in Ontario).

Comparison to the national goal

3. Coverage estimates in 7-year olds only met the national goal of 95% for two diseases (meningococcal disease and rubella). There is no national goal for varicella.
4. Coverage estimates in 12-year olds for diseases covered by the school-based immunization program did not meet the national goal of 90%.
5. Coverage estimates in 17-year olds met the national goal for measles, mumps, rubella and tetanus. The national goal for measles, mumps, rubella and polio is 95%. The national goal for diphtheria, tetanus and pertussis is 90%

Change from the 2013/14 school year

7-year olds (see Figure 3)

6. Coverage in 7-year olds for ISPA-designated diseases has improved from 2013/14. The percentage point difference varies by disease and ranges from:
   1. less than a 1.0% increase in coverage for measles, mumps and rubella;
   2. 10.1% to 13.2% increase for pertussis polio, tetanus, diphtheria, and meningococcal disease; and
   3. 53.6% increase for varicella
7. Coverage in 7-year olds for non-ISPA designated diseases has declined:
   1. 4.9% decrease in coverage for pneumococcal disease. Coverage has decreased year-to-year for three of the last four school years.
   2. 5.0% decrease in coverage for haemophilus influenza type b

12-year olds (see Figure 4)

8. Coverage in 12-year olds for meningococcal disease has increased by 3.1%
9. Coverage in 12-year olds for non-ISPA designated diseases have varied:
   1. 2.1% decrease for hepatitis B
   2. 1.0% decrease for HPV
   3. The lower coverage estimates for these diseases may be due to their non-ISPA designation. The health unit does not actively collect immunization records for these diseases.

17-year olds (see Figure 4)

10. Coverage in 17-year olds for ISPA-designated diseases has varied:
    1. 1.3% and 2.1% increase for measles and mumps, respectively
    2. 0.3% and 0.5% decrease for polio and rubella, respectively
    3. 36.2% to 37.3% increase for diphtheria, pertussis, and tetanus

Exemptions for at least one ISPA antigen (see Figure 5)

11. The proportion of students with medical and non-medical exemptions was relatively low.  Only 0.3% of 7-year olds and 0.2% of 17-year olds had a medical exemption for at least one ISPA antigen.  These proportions were similar to that of Ontario.
12. The proportion of students with a non-medical exemption was slightly higher. 3.4% of 7-year olds and 2.6% of 17-year olds had a non-medical exemption for at least one ISPA antigen. The proportion of 7-year olds with a non-medical exemption was slightly higher than Ontario (0.6% higher).

Figure 1. Immunization coverage estimates for 7-year olds: WEC and Ontario (2017/18 school year)

Figure 2. Immunization coverage estimates for 12 and 17-year olds: WEC and Ontario (2017/18 school year)

Figure 3. Immunization coverage estimates for 7-year olds: WEC (2013/14 to 2017/18 school years)

Figure 4. Immunization coverage estimates for 12 and 17-year olds: WEC (2013/14 to 2017/18 school years)

Figure 5. Exemption for at least one ISPA antigen: WEC and Ontario (2017/18 school year))

Issue

The recent legalization of cannabis and passing of the new Smoke-free Ontario Act 2017 necessitates the updating of previous Smoke-Free Outdoor Spaces Resolutions passed by the Windsor-Essex County Board of Health to reflect changing legislation, emerging smoking products, and the new landscape of smoking behaviour across the country and locally in Windsor and Essex County.

The Windsor-Essex County Board of Health previously supported two resolutions related to creating additional smoke-free outdoor spaces: the first, Banning Smoking at Outdoor Sport and Recreation Areas in Windsor-Essex County in January of 2011, endorsed prohibiting smoking at outdoor sport and recreation areas, and the second, Smoke-Free Outdoor Spaces (Appendix A) in November 2014 which encouraged further smoke-free policy development in outdoor spaces in alignment with new regulations. Since the passing of these resolutions, the Windsor-Essex County Health Unit has supported eight local municipalities including the City of Windsor in the development, approval, and implementation of Smoke-free bylaws in addition to supporting workplaces and the Essex-Region Conservation Authority in passing policies which restrict smoking in outdoor public spaces.

These actions extend regulations beyond those which are offered under the previous Smoke-free Ontario Act (2006) and the recently passed Smoke-free Ontario Act 2017 providing better protections for residents against the harms associated with second-hand tobacco smoke. These resolutions however did not explicitly outline recommendations for municipalities and policy makers on prohibiting products like electronic cigarettes in public spaces and were passed in advance of the legalization of cannabis on October 17, 2018.

Preliminary research on cannabis consumption after legalization shows increases in the first quarter of 2019 with 18.0% of Canadians aged 15 years and older reporting that they used cannabis in the last three months compared to 14.0% in the same time period in 2018, in addition 6.0% of those surveyed indicated they use cannabis “daily” or “almost daily” (Statistics Canada, 2019).

Although the smoking behaviours and habits differ between the two products, the prevalence of cannabis users is comparable to the national smoking rate when considering that 16.2% of Canadians 12 years of age and older report being daily or occasional smokers (Canadian Community Health Survey, 2017). Similar to other legal but harmful products like tobacco and alcohol, cannabis consumption can have serious negative health implications for users, including impacts on both physical and mental health.

Cannabis smoke contains similar toxins to those found in tobacco smoke which are associated with cancer, heart, and respiratory disease (Smoking and Health Action Foundation (SHAF), 2018) in addition to psychoactive components which can lead to mental illness or other mental health issues with early or heavy use. Both the physical and psychological effects of cannabis use are concerning not only for the one consuming cannabis, but also those who are exposed to environmental smoke or vapour from cannabis consumption over the long or even short-term. As a result, exposure to cannabis smoke should be limited, especially for children who face an increased risk for dependence and long-term mental health or learning issues.

Regarding vaping and the use of e-cigarettes, results of the Ontario Student Drug Use and Health Survey indicate that in 2017, 21.6% of students in Grades 7-12 reported use of a vaping product in their lifetime (Boak et al, 2017). In fact, youth (15 to 19 years) and young adults (20 to 24 years) have the highest rates of vaping uptake among the total population Canada-wide (Health Canada, 2018) and between 2015 and 2017 youth use of vaping products increased by 30% per year in Canada (University of Waterloo, 2017). While the health effects of vaping and second-hand vapour exposure are not well-understood given the recent introduction of these products to the consumer marketplace, linkages have already been made between use of these e-cigarettes and increased risk for tobacco smoking uptake, as well as increased frequency and intensity of subsequent tobacco smoking (Ontario Agency for Health Protection and Promotion (Public Health Ontario), 2018).

Experts within the field of tobacco control have also warned about the potential for increases in exposure. In addition, the normalization of smoking behaviour associated with products like e-cigarettes or cannabis in public settings, has the potential to undermine decades of tobacco control efforts which have been effective in dramatically reducing tobacco smoking rates across the country.

Background

The federal government introduced Bill C-45, including the Cannabis Act, in April of 2017 with the goal of legalizing access to non-medical (i.e., recreational) cannabis in Canada. This Act set a foundation of regulations on which provincial/territorial governments could develop more specific controls for how cannabis is grown, distributed, and sold in their provinces and territories.  In May 2018, the federal Tobacco and Vaping Products Act (TVPA) was passed which allowed for nicotine in vaping products and placed restrictions on the ways in which these products could be promoted through advertisements. The provincial Smoke-free Ontario Act 2017 (SFOA 2017) builds upon these federal regulations to apply restrictions to where cannabis and vaping products can be consumed as well as how vaping products can be displayed in stores. The SFOA 2017 further prohibits the sale or supply of vaping products to anyone under the age of 19 and is enforced at the local level by WECHU Tobacco Enforcement Officers. These provincial regulations came into force on the same day that cannabis was legalized federally, October 17, 2018.

Under the SFOA 2017, the smoking of medical or non-medical cannabis and use of vaping products is prohibited in all areas where individuals cannot smoke tobacco, most notably in indoor workplaces and public places. The Act also prohibits the use of these products in certain outdoor spaces, including on and within 20m of playgrounds, sport fields, adjacent spectator areas, and recreational facility property, on and within 20m of school property, and on an within 9m of bar and restaurant patios. Any additional spaces, such as parks without playgrounds, beaches, trails, marinas are not covered under the provincial Act. As a result, if municipalities do wish to prohibit the use of cannabis or vaping products their only means to do so, would be through municipal bylaw development. Since the passing of the Smoke-Free resolutions in 2011 and 2014, eight municipalities in Windsor-Essex have passed smoke-free outdoor space by-laws. The Essex Region Conservation Authority has also passed a smoke-free outdoor space policy for conservation areas, which was updated in November of 2018 to include cannabis use and new language around the use of vaping products. In addition to more extensive areas of coverage, such as parks, beaches, trails, and municipal property, there has been an increase in the types of tobacco and smoking related products prohibited within these types of policies. Examples of prohibited items now include smokeless tobacco (e.g., chew) and other lighted or heated smoking equipment such as hookah.

Provincially, municipalities have updated municipal by-laws to expand on prohibited outdoor spaces and products. Recently, there have been some instances in which municipalities and organizations throughout Ontario moved towards more extensive protections including some municipalities which have passed bylaws prohibiting the use of cannabis in all public places, examples of these types of regulations include those which have recently passed in the City of Markham, Richmond Hill, and City of Brantford (Appendix B).

The legalization of cannabis and vaping products in Canada may increase access, normalization and exposure to smoking behaviour, rates of use, and exposure to second-hand smoke. Further research is needed to understand the health effects of long-term exposure to second hand smoke/vapour. Given the potential harms of health effects of cannabis and vapour use and exposure, it is recommended to align cannabis and vaping policies with tobacco policies. Due to the importance of this issue it is recommended that the Board of Health expand on its smoke-free outdoor spaces resolution encouraging municipalities to adopt more restrictive smoke-free outdoor space bylaws explicitly including cannabis and vapour products and consider the expansion of prohibitions of public cannabis smoking in additional spaces.

Proposed Motion

Whereas, the legalization of cannabis came into effect October 17, 2018 and the addition of vapour products and cannabis to the Smoke-Free Ontario Act, 2017, and

Whereas, outdoor sport and recreation areas, parks, beaches, trails, and playgrounds are intended to promote the health and well-being for all Windsor-Essex County residents, and

Whereas, entrances/exits of municipal buildings, and transit shelters/stops, are other areas of exposure to second-hand smoke, cannabis and vaping, and

Whereas, second-hand smoke has proven to be harmful in particular for vulnerable populations such as youth, and

Whereas, youth are increasingly susceptible to the influence of social normalization, and

Whereas, youth uptake of vaping and exposure to cannabis consumption is increasing.

Now therefore be it resolved that the Windsor-Essex County Board of Health encourages municipalities to prohibit the smoking or vaping of any substance on all municipally owned outdoor sport and recreation properties, as well as parks, beaches, trails, playgrounds, at minimum, 9m from entrances/exits of municipal buildings, transit shelters, and transit stops.

Further, that the Windsor-Essex County Board of Health encourages all Windsor-Essex municipalities to update and adopt smoking by-laws to explicitly prohibit the use of cannabis in public spaces including streets and sidewalks.