Board of Health Meeting Documents

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

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

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))

Prepared By:

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

Date:

May 2019

Subject:

Background

In 2018, the Ministry of Health and Long Term Care (MOHLTC) introduced a new Annual Service Plan (ASP) that Health Units are required to submit each year. In order to ensure a single, integrated approach to planning, the Planning and Strategic Initiatives (PSI) department worked with the Information Technology (IT) department to align our planning system with the MOHLTC requirements. With the support of PSI, staff members develop and enter their work plans which are then reviewed and approved by the leadership team and integrated in the WECHU’s Annual Service Plan for the Ministry.

Following the planning cycle each year, PSI undertakes an assessment of the process in order to understand the challenges and successes, and to look for ways to further improve for the next cycle. The PSI team then compiles and summarizes the feedback, and incorporates suggested changes and improvements into the next planning cycle.

Current Initiatives

Annual Service Plan (ASP) Submission

WECHU’s 2019 Annual Service Plan was submitted to the MOHLTC on April 1, 2019. The plan provides details about planned expenditures and program plans for 2019 including more than 198 interventions under 54 different programs to be delivered.

Reporting Structure

The MOHLTC provided reporting structures for Q4 of the 2018 ASP in early February.  The Financial reports were submitted on February 20 and program activity reports will be submitted on April 26.

Planning for 2020

The PSI and IT departments have begun to incorporate changes from the 2019 ASP template and reporting requirements, as well as the feedback received from managers and staff, into the planning approach for 2020.  It is anticipated that the next planning cycle will be launched in early summer.

Consultation

The following individuals contributed to this report:

• Kristy McBeth, Director, Knowledge Management
• Marc Frey, Manager, Planning & Strategic Initiatives

Approved by:

 Theresa Marentette

Prepared By:

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

Date:

May 2019

Subject:

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) will receive a report on the status of progress made towards the Strategic Priorities in that quarter.

Current Initiatives

The 2019 Q1 Strategic Plan Progress Report provides the objectives under each strategic priority with corresponding Q1 updates to measure our advancement towards achieving the goal. Progress has continued on most of the strategic objectives, and the WECHU remains on-track to achieve all objectives by 2021.

In Q1, the PSI and Communication departments also began work to re-launch communication efforts internally about the strategic plan, to ensure those in the organization continue to understand and integrate the strategic plan into their work.

Consultation

The following individuals contributed to this report:

• Kristy McBeth, Director, Health Protection
• Marc Frey, Manager, Planning & Strategic Initiatives
• Michael Janisse, Manager, Communications
• Ramsay D’Souza, Manager, Evaluation & Epidemiology
• Jessica Kipping-Labute, Policy Advisor, Planning & Strategic Initiatives

Approved by:

 Theresa Marentette

Prepared By:

Lorie Gregg, Director of Corporate Services

Date:

May 1, 2019

Subject:

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 70% (prior to April 1, 2019, 75%) (“Cost-Shared”) by the Ministry of Health and Long-Term Care (“MOHLTC”) and 30% (prior to April 1, 2019, 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 such as Vector-Borne Diseases and Small Drinking Water Systems, funded on a cost-shared basis to a maximum of 70% (prior to April 1, 2019, 75%) by the MOHLTC and 30% (prior to April 1, 2019, 25%) certain surrounding municipalities within the geographic boundaries of Windsor and Essex County;
• Related programs funded 75% (prior to April 1, 2019, 100%) by the MOHLTC and 30% (prior to April 1, 2019, nil%) by the Obligated Municipalities;
• Related programs funded 100% by the Ministry of Children, Community and Social Services (“MCSS”).  As at the date of this report, there have been no changes to the funding model.
• One-time business cases.  As at the date of this report, the MOHLTC has not communicated what changes, if any, will occur with the funding of these initiatives.

The first quarter financial report to the Board includes a budget to actual comparison and narrative for material variances for all programs listed above.

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 first quarter of 2019.

For the period January 1, 2019 to March 31, 2019, cash flows relating to the 2019 program year are as follows:

Material variances by financial caption compared to budget include the following:

• Association and Membership Fees:  Expenditures in this financial caption relate to memberships in an association or other group by virtue of professional requirements or to support initiatives associated with Public Health.  The majority of Association and Membership Fees are paid in the first half of the fiscal year.  The WECHU anticipates that this financial statement caption will remain within its overall budget for fiscal 2019.
• Program Supplies:   Expenditures in this financial caption support the functions of departments, those that directly support Public Health Programs as well as those that support departments such as Information Technology and Communications.  The variance in the Program Supplies caption relates to the timing of purchases and is nominal.  The WECHU anticipates that this financial caption will remain within its overall budget for fiscal 2019.
• 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 current collective bargaining with the employees represented by the Ontario Nurses Association (“ONA”).
• Bank charges:  Expenditures in this financial caption include processing fees associated with payroll.  The variance in this financial caption is due to additional costs incurred for processing of year-end payroll reporting (i.e. T4 slips).
• Building Maintenance:  Expenditures in this financial caption include costs to maintain Windsor, Essex and Leamington locations.  More specifically, these costs relate to building and equipment maintenance, grounds keeping and housekeeping supplies.  The variance here relates primarily to grounds keeping costs.  These costs are incurred in five (5) of twelve (12) months of the fiscal year (January to March, November and December). Greater than one-half of the year’s grounds budget was expended in Q1 of 2019 ($7,440 of the total $12,300).
• Taxes:  Expenditures in this financial caption include property taxes for the Windsor and Leamington offices.  Windsor property taxes are paid on an installment basis, six (6) times per year while Leamington taxes are paid monthly.  The year-to-date variance/overspend results from three (3) of the six installments for the Windsor office having been paid in Q1 and three (3) of the twelve installments having been paid for the Leamington office.
• Insurance:  Expenditures in this financial caption include costs associated with general liability insurance, property insurance, director and office insurance coverage as well as cyber coverage.   Insurance premiums are paid at the beginning of the year.  The WECHU that the budget for this financial statement caption will remain slightly underspent for fiscal 2019.
• 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 for the period March 8, 2019 to March 31, 2019, due to the labour disruption.  These additional security costs will be reflected in the Q2 financial results.
• Offset revenue:  Revenues included in the financial caption relate to interest, proceeds on sale of tangible capital assets, parking revenue, vaccine recoveries, sales of contraceptives as well as course fees relating to the food handler course and examination.  At March 31, 2019, offset revenue is under budget by $15,121, in part due to the timing (i.e. vaccine recoveries are higher in the latter part of the year) as well as a loss in parking revenue of $4,000 due 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 first quarter of 2019, the HBHC program is $152,761 underspent.  Factors contributing to the total amount underspent at March 31, 2019 include:  1.  Labour disruption involving employees represented by the ONA which commenced March 8th, 2019;  2.  Lower than anticipated purchased services costs (i.e. translation) because of our use of an Arabic speaking nurse to address the needs of our community.

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.

The budget variance of $9,387 due to the labour disruption involving employees represented by the ONA, which commenced March 8th, 2019.

Financial Information for Related Programs Funded 100% by the MOHLTC

The Healthy Smiles Ontario Program is funded through the Ministry of Health and Long-Term Care.  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 or under

At March 31, 2019, the HSO budget is underspent $21,303.  Primarily, this variance relates to Purchased Services, which includes professional services provided by dentists as well as translation.  In 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 and it is anticipated that the Purchased Services budget will trend to be on budget for the remainder of the fiscal year.

Enclosed above is the financial information associated with the WECHU’s requirements to:

• Comply and adhere to the Electronic Cigarettes Act:  Public Health Unit Guidelines and Directives: Enforcement of the Electronic Cigarettes Act;
• 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 March 31, 2019, total expenditures are under budget $708.  Salaries and benefits remain overspent for Q1 due to the addition of one contract Tobacco Enforcement Office to December of 2019, to assist with the increasing demand for enforcement activities due to the legalization of cannabis. 

A description of other related programs is included below:

Chief Nursing Officer Initiative:  Under the Organizational Requirements of the Ontario Public Health Standards, the Chief Nursing Officer role serves to enhance health outcomes of the community at individual, group and population levels:  i) Through contributions to organizational strategic planning and decision making; ii) By facilitating recruitment and retention of qualified, competent public health nursing staff; iii) By enabling quality public health nursing practice.  This funding envelope supports 1 FTE meeting certain qualifications as required by the Ontario Public Health Standards.  At March 31, 2019, there are no negative variances to report on.

Enhanced Food Safety – Haines Initiative:  This initiative was established to enhance the Board of Health’s capacity to deliver the Food Safety Program as a result of the Provincial Government’s response to Justice Haines’ recommendations in his report “Farm to Fork:  A Strategy for Meat Safety in Ontario”.  At March 31, 2019, there are no negative variances to report on. 

Enhanced Safe Water:  This initiative was established to enhanced the Board of Health’s capacity to meet the requirements of the Safe Water Program Standard under the Ontario Public Health Standards.  At March 31, 2019, there are no negative variances to report on.

Harm Reduction Program Enhancement:  Base funding for this initiative supports the Board of Health’s 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 March 31, 2019, the budget for this program initiative is underspent by $8,041 due to the labour disruption involving employees represented by the ONA, which commenced March 8th, 2019 as well as other staff vacancies.

Infection Prevention Control Nurses Initiative:  This initiative was established to support one additional infection prevention and control nursing FTE having certain qualifications.  At March 31, 2019, the budget for this program initiative is underspent by $19,925 due to an unpaid absence as well as the labour disruption involving employees represented by the ONA, which commenced March 8th, 2019.

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 March 31, 2019, the budget for this program initiative is underspent by $3,970 due to the labour disruption involving employees represented by the ONA, which commenced March 8th, 2019.

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 March 31, 2019, there are no negative variances to report on.

Social Determinants of Health Nurses Initiative:  This initiative was established to support 2 public health nursing FTEs with specific knowledge and expertise in social determinants of health and health inequities issues, and to provide enhanced supports internally and externally to the Board of Health to address the needs of priority populations impacted most negatively by the social determinants of health.  At March 31, 2019, the budget for this program initiative is underspent by $15,495 due to the labour disruption involving employees represented by the ONA, which commenced March 8th, 2019.

Financial Information for Related Programs Funded 100% by the MOHLTC

Mandatory Programs - Potassium Iodide Distribution Program:  One-time funding to improve nuclear emergency preparedness and increase knowledge amongst residents living within the primary and secondary zone of the Fermi 2 nuclear generating station.  Eligible costs include potassium iodide pill packs, staff salaries, project materials, printing and postage associated with the distribution of KI packs and on-going communication campaigns.  At March 31, 2019, $134,901 of the total approval of $167,000 was expended. While the WECHU had anticipated that this funding would be expended at March 31, 2019, staff time associated with this project was reallocated to other priorities.

Mandatory Programs - Public Disclosure System:  One-time funding must be used to update software and inspection forms to meet the new disclosure requirements under the Ontario Public Health Standards.   Eligible costs include software update, disclosure and migration.  At March 31, 2019, $10,300 of the funding approval was expended.  Activities related to the implementation of this disclosure system were concluded in February of 2019 and no additional costs are anticipated. 

Capital:  This one-time funding must be used to assist with costs to complete the capital planning requirements for a Stage 2 – Business Case Submission. Utilization of these funds is dependent upon the status of the work being completed internally and by third party consultants based upon the direction from the WECHU’s Board.  At March 31, 2019, $80,057 of the funding approval was expended.  On October 31, 2018, the WECHU submitted a request to extend the deadline to expend funding either to, December 31, 2019, or March 31, 2020.  As at the date of this report, the WECH has not received approval for the funding extension.  Activities related to this initiative are presently on-hold awaiting further direction from the Board and the MOHLTC.

Needle Exchange Program Initiative:  This one-time funding supports extraordinary costs associated with delivering the Needle Exchange Program.  Eligible costs include purchase of needles/syringes and associated disposal costs.  At March 31, 2019, this funding was fully expended.

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 2018 and concluded in August of 2018.  At March 31, 2019, this funding was fully expended.

Vector-Borne Diseases Program - 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 March 31, 2019, this funding was fully expended.

Approved by:

 Theresa Marentette

Prepared By:

Amandeep Hans, Health Promotion Specialist, Environmental Health Department

Date:

May 2019

Subject:

Background

The Environmental Health Department conducts annual monitoring and testing of tick and mosquito populations in Windsor and Essex County (WEC) as part of the WECHU’s Zoonotic and Vector-borne Diseases Program.

Mosquito Surveillance and Testing

Adult mosquito surveillance is an important component of the Zoonotic and Vector-borne Diseases Program. Surveillance runs from May to early October every year and may extend depending on the weather and temperatures. Species-specific traps are deployed in various locations throughout WEC to capture mosquitoes for testing and identification to determine the presence of West Nile and Zika Virus in our communities. In 2018, the Environmental Health Department collected samples from almost 1000 mosquito traps, identifying and testing over 80,000 mosquitoes by the end of the season. Invasive mosquito species Aedes aegypti (Yellow Fever Mosquito) and Aedes albopictus (Asian Tiger Mosquito) are also monitored each year through our Enhanced Mosquito Surveillance Program. These species are known carriers of diseases such as Zika, Malaria, Dengue, and Chikungunya. There were over 1000 invasive mosquitoes identified and tested in 2018, which is a 200% increase from the previous year. Due to the increased numbers of Asian Tiger Mosquitoes noted during trapping, the Public Health Agency of Canada (PHAC) has determined the City of Windsor and Essex County to be endemic for these mosquitoes.

Mosquito Control

The mosquito control program involves applying larvicide to catch basins and standing water sites such as ditches and lagoons that hold water. All municipalities in WEC have standing water by-laws in place. Last year over 133,000 treatments of larvicide were applied to roadside catch basins and standing water sites. Targeted treatment was also conducted for identified “hot spots” during the summer season. A “hot spot” would be a location where,

• Invasive mosquito species have been identified,
• Positive samples for West Nile Virus found or,
• Clusters of human cases of West Nile Virus have been confirmed.

Human Cases

The WECHU follows up on all human cases of West Nile Virus. Cases are investigated to assess if additional mosquito control activities are required. If a cluster of cases is identified, the Environmental Health Department will increase mosquito control and surveillance activities. To date there have been no human cases of Zika Virus identified in WEC.

Ticks and Lyme Disease

The WECHU’s role is to measure and evaluate the risk of tick-borne disease in our area through both passive and active tick surveillance activities. Our surveillance data in the last 3 years indicates an increase in black-legged ticks (Ixodes scapularis) in WEC. The black-legged tick is the main vector for Borrelia burgdorferi, the bacteria that causes Lyme disease.

Passive surveillance involves residents submitting ticks to the health unit for identification and subsequent testing if the ticks are identified as blacklegged. Last year, 339 ticks were submitted to the WECHU, 31 were identified as blacklegged ticks and two of these ticks tested positive for Borrelia burgdorferi.

Active surveillance involves active field surveillance from Environmental Health staff. Active surveillance is usually conducted in the spring and fall seasons in parks and on trails that are frequented by the community.  Black- legged ticks that are identified in both the spring and fall would indicate that the area is potentially endemic. There were 12 blacklegged ticks identified when active surveillance was conducted at the Ojibway Prairie Nature Reserve and Chrysler Greenway in 2018

Tick Control

There is no formalized tick control program for our local parks and trails. Ticks are transported around by birds, deer and other wildlife and are not very mobile. Education is provided to the general public on tick removal and signs and symptoms for Lyme Disease.

Human Cases

In 2018, there were nine cases of Lyme disease in WEC.  All laboratory confirmed cases are interviewed to determine where they may have encountered black-legged ticks. Any local parks or trails that are noted during the investigation would prompt active surveillance.

Current Initiatives

In addition to continued surveillance and monitoring efforts, the WECHU will be launching a Fight the Bite public awareness campaign in June 2019. The awareness campaign will focus on prevention of mosquito breeding sites as well as personal protection. Targeted promotion and messaging will be used to reach priority populations and inform the public of hot spots identified through previous monitoring efforts.

Consultation

The following individuals were contributed to this report:

• Kristy McBeth, Director, Health Protection
• Phil Wong, Manager, Environmental Health Department
• Saamir Pasha, Epidemiologist, Epidemiology and Evaluation Department

• Approved by:

 Theresa Marentette

Prepared By:

Kim Casier, Oral Health Manager, Oral Health Department

Date:

May 16, 2019

Subject:

Background:

Dental decay (cavities) in children is an important public health issue. The current Oral Health Protocol (2018) provides direction on the delivery of oral health services, which includes oral screening, assessment and surveillance, and services offered through the Healthy Smiles Ontario Program (HSO) Program.

As per the protocol, all children in JK, SK and Grade 2 are screened by registered public health dental hygienists during the school year. The screening protocol requires the collection of the total number of primary and permanent teeth with decay (d+D).

Dental benefits for children and youth fall under provincial/territorial jurisdiction. Children in low-income families (whether on social assistance or not) are typically granted some level of support for accessing dental services. On January 1, 2016, Ontario’s six publicly funded dental programs for children were combined into the new Healthy Smiles Ontario (HSO) program. HSO is a government-funded dental program that provides free preventive, routine, and emergency dental services for children and youth 17 years old and under from low-income households. The services covered by this program may include exams and routine checkups, preventive services, extractions, fillings, and x-rays. This program does not cover cosmetic dentistry and braces.

Current Initiatives

Oral Screening, Assessment and Surveillance

During the 2017/2018 school year, 15,117 elementary children received a dental screening across 115 Windsor-Essex elementary schools (publically and privately funded). Screening is conducted by five teams, each team consisting of a registered dental hygienist and a certified dental assistant. Based on the screening results of the Grade 2 students at each school, the school is categorized into three levels of intensity: Low, Medium or High. Higher intensity levels require additional grades to be screened. The need for and the urgency of care is recorded and parents are advised of the required follow-up. As well indicators of previous dental caries (missing and filled) are recorded.  Of the 115 schools that participated, 27 (23.48%) were classified as high intensity schools, 17 (14.78%) were classified as medium intensity schools and 71 (61.74%) were classified as low intensity schools.

Approximately 91% of eligible students were screened in the 2017/18 school year. Reasons a student is not screened include: absence, exclusion by parent, or refusal to be seen on their own.

Other significant 2017/18 dental screening statistics include:

• 1,984 (13.1%) children/youth had an urgent dental care issue/need; eligible for Healthy Smiles Ontario Program’s Emergency and Essential Services Stream (HSO-EESS).
• 6,157 children/youth were clinically eligible for Healthy Smiles Ontario Program’s Preventive Services Only Stream (HSO-PSO).
• 74% of JK students surveyed were found to be visually caries free.
• 62% of SK students surveyed were found to be visually caries free.
• 45% of Grade 2 students surveyed were found to be visually caries free.

WECHU Healthy Smiles Ontario Dental Clinics

Windsor Essex County Health Unit dental clinics are very busy. Our team of dental hygienists and dental assistants provide dental screenings, topical fluoride treatments, dental sealants, scaling (cleaning) and oral hygiene instruction. In 2018:

• 2,308 children/youth received a dental screening at one of our HSO dental clinics (Windsor and Leamington). 
• 1,212 children/youth had an urgent dental care issue/need; or were eligible for HSO-EESS.
• 798 children/youth were enrolled in the HSO-PSO (preventive services only) program.
• 1,730 children/youth received PSO (preventive services only) clinical services in our WECHU dental clinics.
• 734 children/youth received 1634 dental procedures completed by our clinic dentists

There are currently four dentists contracted to work in our HSO dental clinics. Dr. Azza Al-Ryahi works Mondays in our Leamington clinic and Tuesdays in our Windsor clinic. Dr. Robert Trajkovski works in the Windsor clinic on Friday and Dr. Thomas Oper, pediatric dentist, recently joined our clinics in October 2018. Dr. Oper works with us on Wednesday and Thursday mornings.  We currently have an Arabic speaking dental hygienist and dentist working in our HSO clinics.

Baby Oral Health Program (BOHP)

The Canadian Dental Association recommends a dental assessment for infants within six months of their first tooth appearing and no later than one year of age. Our Windsor-Essex County Health Unit also supports the establishment of a dental home by one year of age. The rationale of this program focuses on early professional intervention to provide a dental screening, risk assessment and anticipatory guidance for parents, so that early childhood cavities can be prevented.  In 2018, 265 children received a BOHP screening at one our HSO dental clinics.

Consultation:

The following individuals were contributed to this report:
Mathew Roy, Epidemiologist

Approved by:

Theresa Marentette

Prepared By:

Stacy Manzerolle, Manager Healthy Schools 
Lora Piccinin, Manager Infectious Disease Prevention

Date:

May 2019

Subject:

Background:

Measles is a serious and highly contagious virus that spreads easily when an infected person coughs or sneezes, spreading droplets that contain the virus into the air. The virus can live on surfaces (e.g., door knobs, shopping carts, utensils, etc.) and can remain active in the air for up to 2 hours even after the person has left the air space. If people breathe in contaminated air or touch infected surfaces, they can become infected. Symptoms can include a rash, fever and cough. Measles can spread to others 4 days before or after the appearance of the rash. In some instances, measles can cause long-term complications in the lungs, ears and/or the brain and can lead to death in vulnerable individuals.

In Canada, measles is relatively rare due to high immunization rates across the country. Children in Ontario are scheduled to receive two doses of measles containing vaccine before the age of seven. Endemic measles has been eliminated in Canada; however, travel related cases continue to occur. Immunization is the best way to protect against becoming infected with measles. Those who have received two doses of measles-containing vaccine as a child, or who have been previously infected with measles, are generally protected from the virus. The measles vaccine is free for anyone who lives, works, or attends school in Ontario.

Current Initiatives

There have been no confirmed cases of measles since 1998 in Windsor and Essex County. In 2017, 8 cases of measles were reported in Ontario. In recent months some areas of Canada and the U.S. have reported an increase in the number of confirmed measles cases.

• As of March 30th, 2019, 33 cases of measles have been reported in Canada (Quebec, British Columbia, Northwest Territories, Ontario and Alberta)
• In Ontario, cases have been reported in Toronto, Ottawa and Kingston
• In the US, outbreaks have been declared in the state of Michigan, New York and Washington

Due to the growing number of measles cases within North America and growing awareness and concern, the WECHU has investigated a number of suspect measles reports within the community. Historically 1-2 cases are investigated per year; however, since January 2019, the Health Unit has investigated seven possible cases of measles, all determined to be negative.

To assist health care providers and community partners, the WECHU has developed and disseminated clinical information updates and supporting documents to guide diagnostic testing, reporting, and management of suspected measles cases. Further information is available on our website.

The WECHU continues to work closely with local health care providers to monitor the situation and address the potential spread of measles and other reportable infectious diseases. The Health Unit will continue to keep the community informed about measles related activity within the region to ensure the ongoing protection of the health and wellbeing of our residents.

Approved by:

Theresa Marentette

Prepared By:

Communications Department

Date:

May 8, 2019

Subject:

April Media Relations Recap Report

April Media Coverage

April 2019 Media Relations Recap - Story Source

Media Coverage

News Release and Media Advisories

Stories Reported by the Media

AM 800

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

Blackburn News

CBC News

(also includes CBC Radio and Radio-Canada)

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

CTV News

London Free Press

Toronto Star

Vice Magazine

Windsor Star

Windsorite.ca

Yahoo News

Note: The digital story was not available for St. Clair College. The interview with TV Cogeco does not take place until May.

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

Board Members Present:

Tracey Bailey, Rino Bortolin, Fabio Costante, Dr. Deborah Kane, Judy Lund, Gary McNamara, Ed Sleiman, Larry Snively

Board Member Regrets:

Gary Kaschak, John Scott, Joe Bachetti

Administration Present:

Dr. Wajid Ahmed, Nicole Dupuis (4:25 pm), Lorie Gregg, Theresa Marentette, Kristy McBeth, Dan Sibley, Lee Anne Damphouse

WECHU Manager Present:

Eric Nadalin

QUORUM:  Confirmed

RECORDING SECRETARY:

SUBMITTED BY:

APPROVED BY:

Issue

In January 2014, the Board of the Windsor-Essex County Health Unit resolved to endorse the following actions and policies to reduce the exposure of second-hand smoke in multi-unit housing: 

1. Encourage all landlords and property owners of multi-unit housing to voluntarily adopt no-smoking policies in their rental units or properties;
2. All future private sector rental properties and buildings developed in Ontario should be smoke-free from the onset;
3. Encourage public/social housing providers to voluntarily adopt no-smoking policies in their units and/or properties;
4. All future public/social housing developments in Ontario should be smoke-free from the onset.
5. Encourage the Ontario Ministry of Housing to develop government policy and programs to facilitate the provision of smoke-free housing.

Background

In January 2014, the Board of the Windsor-Essex County Health Unit resolved to endorse several actions and policies to reduce the exposure of second-hand tobacco smoke in multi-unit housing. This included action from existing and future private landlords, existing and future public/social housing providers to adopt smoke-free policies in their rental units or properties, as well as encouraging the Ontario Ministry of Housing to develop government policy and programs to facilitate the provision of smoke-free housing. Since that time, emerging tobacco and non-tobacco products have evolved and/or become available legally such as e-cigarettes and cannabis. It is important that smoke-free policies adapt to include such products for the health and safety of all residents of multi-unit housing, and also to protect the investment of landlords and property owners.

In December 2015, the Government of Canada announced its commitment to legalize, regulate, and restrict access to non-medical cannabis in Canada, with the intent to keep cannabis out of the hands of children and the profits out of the hands of criminals. In response, the Windsor-Essex County Health Unit Board of Health passed a resolution on January 14, 2016 supporting a public health approach to cannabis legalization, including strong health-centered and age-restricted regulations to reduce the health and social harms associated with cannabis use. In addition, the resolution mandated the Windsor-Essex County Health Unit support the development of healthy public policies and enforcement of future regulations to ensure minimal negative effects on public health and safety. The federal government introduced Bill C-45, the Cannabis Act, in April of 2017. This legislation would legalize access to non-medical (i.e., recreational) cannabis in Canada and provide 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. This Act came into effect on October 17, 2018.

Prior to its legalization, cannabis was the most commonly used illegal substance in Canada (CCSA, 2017). Approximately 15% of Ontario residents report cannabis use within 12 months (CCSA, 2016). In Windsor-Essex County, approximately 28, 900 residents used cannabis in the last year and among those who consume cannabis, rates are highest among youth and young adults (WECHU, 2016). Cannabis smoke contains similar toxins to those found in tobacco smoke associated with cancer, heart and respiratory disease (SHAF, 2016). Due to the added psychoactive properties of cannabinoids such as THC (tetrahydrocannabinol), cannabis also increases the risk of injury or harms associated with impaired driving, falls, and other preventable incidents. Cannabis can also cause short or long term damage to cognitive functioning (i.e., memory, focus, ability to think and learn), depression, anxiety, psychosis, and addiction. These harms increase when cannabis use begins prior to the age of 25, and with frequent or heavy use (CCSA, 2016; Parachute Vision Zero Network, 2018). Lastly, maternal cannabis use is linked to low birth weight, pregnancy complications, and may affect children’s cognitive functioning, behaviour, mental health and future substance use (Best Start, 2017).

Exposure to cannabis smoke should be limited, especially for children and those with respiratory or cardiovascular illness. Smoking or vaping of cannabis should be restricted to outdoors (Health Canada, 2018). Research on the effects of second-hand cannabis smoke exposure is limited; however, studies have shown that exposure to second-hand cannabis smoke leads to cannabinoid metabolites in bodily fluids, and can cause exposed individuals to experience psychoactive effects (Holitzki, Dowsett, Spackman, Noseworthy & Clement, 2017). 

Electronic cigarettes may or may not resemble traditional tobacco cigarettes. They consist of a battery, a heating element, and a cartridge that holds “e-liquid” or “e-juice,” a solution usually made of propylene glycol, glycerin, flavouring agents, and in many cases, nicotine. When a user “puffs” on the device, the solution is heated and the resulting vapour is inhaled into the lungs and exhaled in the same manner as a tobacco cigarette. E-cigarette devices can also be used to ingest cannabis-infused oils (PHO, 2018).

Bill S-5, which received Royal Assent in May 2018, established a new legislative framework for regulating vaping products in Canada. Under this framework, e-cigarettes and other vaping products are classified into two main categories: recreational or therapeutic. ‘Recreational’ e-cigarettes (with and without nicotine) do not make any health claims and are regulated under the federal Tobacco and Vaping Products Act for the manufacture, sale, labelling and promotion of vaping products. ‘Therapeutic’ e-cigarettes may be used to treat nicotine dependence, are allowed to make health claims, and are regulated under the more stringent Food and Drugs Act. On September 27th, 2018 the Government of Ontario introduced Bill 36 that makes amendments to the e-cigarette provisions under the Smoke-Free Ontario Act, 2017 and came in to force on October 17th, 2018, replacing  the Smoke-Free Ontario Act, 2006 and the Electronic Cigarettes Act, 201 (PHO, 2018).

The safety of e-cigarette use and second-hand vapour in the short and long term is still unknown as the health effects have not been thoroughly studied. While Health Canada has approved propylene glycol and glycerin as food additives, it is possible that they may be dangerous when vaporized and inhaled. The particles in e-cigarette vapour, including flavouring compounds, are particularly hazardous because they reach deep into lung tissue when used as intended. Some studies have shown e-cigarette vapour can also include heavy metals and other cancer-causing compounds such as formaldehyde (Czoli, Reid, Rynard & Hammond, 2015). Exposure to e-liquids, including accidental ingestion, eye contact, or skin exposure can also lead to adverse health effects. As of May 2018, nicotine can be legally present in vaping products in Canada. The addictive properties of nicotine could result in dependence on e-cigarettes.  Children and youth are especially susceptible to the negative effects of nicotine including addiction, and negative effects on brain development, memory and concentration (PHO, 2018).

In 2015, 3.2% of Canadians aged 15 or older used e-cigarettes in the past month.  In all age groups, the prevalence of past month e-cigarette use increased from 2013 to 2015. Prevalence in Canada is highest among youth (15-19 years) and young adults (20-24 years), where 6.3% reported the use of e-cigarettes in the past month. In Ontario, youth and young adults report the highest past year use of e-cigarettes of all age groups. The CAMH Monitor estimates that in 2016, 20% of Ontario young adults (18-24 years) used e-cigarettes in the past year. The Ontario Student Drug Use and Health Survey (OSDUHS) estimates that in 2017, 18% of Ontario youth (grades 7-12) used e-cigarettes in the past year (PHO, 2018).

Under the Smoke-Free Ontario Act, 2017, smoking or vaping is prohibited in indoor common areas of condominiums, apartment buildings and college and university residences. Examples of common areas include elevators, stairwells, hallways, parking garages, laundry facilities, lobbies, exercise areas and party or entertainment rooms. This means that unless you have signed an agreement or lease or are in a condominium with bylaws that say otherwise, you are allowed to smoke or vape in your private home. In the Act “Smoking” means smoking (inhaling and exhaling) or holding lighted tobacco or cannabis (medical or recreational), and “vaping” means inhaling or exhaling vapour from an electronic cigarette (e-cigarette) or holding an activated e-cigarette, whether or not the vapour contains nicotine (Government of Ontario, 2018).

The legalization of cannabis and vape products in Canada may increase access, normalization, rates of smoking and/or vaping, exposure to second-hand smoke, and exposure to smoking behaviour. While more research is needed to understand the health effects of long-term exposure to second and third-hand smoke, it is recommended to align tobacco and marijuana smoking policies to be most effective (Holitzki, Dowsett, Spackman, Noseworthy & Clement, 2017). Given the potential harms of cannabis and e-cigarette use behaviour and smoke or vape exposure, it is vital that the Board of Health expand on its resolution for smoke-free multi-unit dwellings to encourage housing providers to adopt smoke-free housing policies which explicitly include these products.

Proposed Motion

Whereas, the federal government has passed the Cannabis Act, 2017 to legalize non-medical cannabis, coming into effect on October 17th, 2018, and

Whereas, cannabis smoke contains many of the same carcinogens, toxins, and irritants found in tobacco smoke with the added psychoactive properties of cannabinoids like THC, and

Whereas, Ontarians spend most of their time at home, and it is in this environment where exposure continues to be reported, and

Whereas, indoor air studies show that, depending on the age and construction of a building, up to 65% of the air in a private residence can come from elsewhere in the building  and no one should be unwillingly exposed or forced to move due to unwanted second-hand smoke exposure,

Now therefore be it resolved that the Windsor-Essex County Board of Health endorse the following actions and policies to reduce the exposure of second-hand smoke in multi-unit housing:

1. Encourage all landlords and property owners of multi-unit housing to voluntarily adopt no-smoking policies in their rental units or properties and explicitly include cannabis smoke and vaping of any substance in the definition of smoking;
2. All future private sector rental properties and buildings developed in Ontario should be vape and smoke-free from the onset;
3. Encourage public/social housing providers to voluntarily adopt no-smoking and/or vaping policies in their units and/or properties;
4. All future public/social housing developments in Ontario should be smoke and vape-free from the onset.
5. Encourage the Ontario Ministry of Housing to develop government policy and programs to facilitate the provision of smoke-free housing.

AND FURTHER that this resolution be shared with the Honorable Prime Minister of Canada, local Members of Parliament, the Premier of Ontario, local Members of Provincial Parliament, Minister of Health and Long-term Care, Federal Minister of Health, the Attorney General, Chief Medical Officer of Health, Association of Local Public Health Agencies, Ontario Boards of Health, Ontario Public Health Association, the Centre for Addiction and Mental Health, and local community partners.

References

• Best Start. (2017). Risks of cannabis on fertility, pregnancy, breastfeeding and parenting. Retrieved from https://www.beststart.org/resources/alc_reduction/RisksOfCannabis_A30-E.pdf
• Canadian Centre on Substance Use and Addiction [CCSA]. (2017). Cannabis: Canadian drug summary. Retrieved from https://www.cpha.ca/sites/default/files/uploads/resources/cannabis/ccsa-...
• Canadian Centre on Substance Abuse [CCSA]. (2016). Clearing the smoke on cannabis: Highlights. Retrieved from https://www.ccsa.ca/sites/default/files/2019-04/CCSA-Cannabis-Use-Respir...
• Czoli, C. D., Reid, J. L., Rynard, V. L. & Hammond, D. (2015). Tobacco use in Canada: Patterns and trends, 2015 Edition, Special
• supplement: E-cigarettes in Canada. Waterloo, ON: Propel Centre for Population Health Impact, University of Waterloo.
• Government of Ontario. (2018). Where you can’t smoke or vape in Ontario. Retrieved from https://www.ontario.ca/page/where-you-cant-smoke-or-vape-ontario
• Health Canada. (2018). Thinking about using cannabis before or during pregnancy? Retrieved from https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/health-effects/before-during-pregnancy.html
•  Holitzki, H., Dowsett, L., Spackman, E., Noseworthy, T. & Clement, F. (2017). Health effects of exposure to second- and third-hand marijuana smoke: A systematic review. Canadian Medical Association Journal Open, 5(4): E814-E822. doi: 10.9778/cmajo.20170112
• Parachute Vision Zero Network. (2018). Cannabis and drug impaired driving: What’s happening in Canada right now? Retrieved from https://parachute.ca/wp-content/uploads/2019/06/Vision-Zero-Case-Study-4.pdf
• Public Health Ontario. (2018). Current evidence on e-cigarettes: A summary of potential impacts. Retrieved from https://parachute.ca/wp-content/uploads/2019/06/Vision-Zero-Case-Study-4.pdf
• Smoking and Health Action Foundation [SHAF]. (2016). Secondhand marijuana smoke: Health effects of exposure. Retrieved from https://nsra-adnf.ca/wp-content/uploads/2016/11/health_effects_of_exposure_to_secondhand_mj_smoke_2016-final2.pdf
• Windsor-Essex County Health Unit. (2016). Community needs assessment report. Windsor, Ontario.

Prepared By:

Cathy Bennett, Public Heath Emergency Preparedness Coordinator

Date:

April 1, 2019

Subject:

Background:

The Windsor-Essex County Health Unit (WECHU), in collaboration with the Community Emergency Management Coordinators, has been working to ensure that all residents within the primary and secondary zone of the Enrico Fermi 2 Nuclear Generating Station are prepared in case of a nuclear emergency.  According to the Canadian Nuclear Safety Commission (CNSC), all nuclear installations must ensure that KI pills are pre-distributed and that pre-distribution includes a public education plan. Since the Enrico Fermi 2 Nuclear Generating Station is not regulated by the CNSC, the responsibility for KI distribution falls on the WECHU, the Municipalities of Windsor and Essex County, and the Ministry of Health and Long Term Care.

The Potassium Iodide (KI) Distribution Plan includes three phases.

Phase one of the plan focused on increasing the basic knowledge of nuclear emergency preparedness in the primary zone residents of Windsor and Essex County (WEC), as well as the distribution of KI Pills to all residential households in the primary zone and on Boblo Island.  Phase one was launched on April 26, 2018 with a media release event, news release, social media campaign, and advertising in the Amherstburg River Town Times. All residential property owners identified as living in the primary zone of Amherstburg and on Boblo Island (approximately 388) received a letter, inviting them to attend information and pick-up session at the Libro Centre in Amherstburg either on May 7th and 8th, 2018. These events were co-hosted by staff from WECHU, and staff from the Amherstburg Fire Department. One hundred and forty-seven KI Pill Kits were distributed at these two sessions. Following consultation with the Amherstburg Fire Department, two additional KI pick-up sessions were scheduled on Saturday, July 21st at Amherst Point, and on Saturday, August 11th at the Boblo Island Ferry Terminal. The Public Health Emergency Preparedness Coordinator and staff from the Amherstburg Fire Department distributed 27 KI Pill Kits at each of these sessions.  Approximately 52% of the identified primary zone residents received their KI Pill Kits at the end of phase one of the KI Distribution Plan.

Phase two of the KI Distribution Plan focuses on the distribution of KI Pills to residents of the secondary zone of WEC who wish to have them in their households. Based on experiences from other jurisdictions, it was anticipated that approximately 10% of the secondary zone households would request KI Pills. The communication campaign began with a media advisory on October 11th, 2018 and a press conference on October 15th, 2018. The campaign included 4 weeks of radio advertising and billboards in the Windsor area, print advertisements in the Windsor Star and Amherstburg River Town Times, Windsor Star on-line, and web information and registration on the WECHU website. The KI Distribution Plan for the secondary zone promoted the completion of an on-line KI Pill request form and the selection of a pick-up date and location by WEC residents.  In consultation with the Community Emergency Management Coordinators (CEMC) of Windsor and Essex County, 23 individual KI Pill Kit pick-up events were scheduled from November 3rd to December 5th at multiple locations across Windsor and Essex County. Venues included recreation centres, fire stations, arenas, municipal offices, civic centers, and the WECHU Windsor office site.  The Public Health Emergency Preparedness Coordinator attended all sessions with the assistance of WECHU clerical staff, the CEMCs and Fire Department staff from multiple municipalities. At the completion of the pick-up sessions, 2748 KI Pill Kits were distributed through this strategy.  Approximately 62% of those who registered for pick-up sessions actually attended their scheduled session; however approximately 500 KI Pill Kits were distributed to “walk-in” residents who had not pre-registered.  Since October, secondary zone residents have also had the option of registering for future KI Pill Kit mail-out if they were unable to attend a KI pick-up session.  Additionally, secondary zone residents have been able to receive registration assistance by submitting emails and/or by calling the KI Hotline to speak with the Emergency Preparedness Coordinator or clerical staff.  

Additionally, three KI pill kit pick-up sessions were held for the WECHU staff at the Windsor, Essex and Leamington Office locations in February.

Phase two also aims to stock KI Pills (stock bottles) in the schools within the Town of Amherstburg and work with the schoolboards (Public, Catholic, and French) to create policies around KI administration to students in the event of an emergency.

Phase three of the KI Pill Distribution Plan will be focused on the sustainability of the KI Program, including the replacement of pills prior to the expiration date, and the promotion of basic knowledge of nuclear emergency preparedness for WEC residents.

Current Initiatives

Current plans include the preparation for mail out of the KI Pill Kit packages to approximately 3600 WEC residents who have submitted their on-line requests. This group includes those who were unable to attend the pick-up sessions in November and December and/or submitted their request for a future mail out option. Since the KI Pills are sensitive to temperature and must be stored between 15 to 30 degrees Celsius, this mail out is scheduled for the spring of 2019.

A second round of communication campaign began in February/March 2019 that focussed on the target population of younger families with children. Communication strategies included social media, digital, and targeted print advertisements promoting the submission of on-line requests for the KI Pill Kits for mail out.

The list of the current numbers of first responders for emergency services in Windsor and Essex County has been updated to determine the volume of KI Pill Stock bottles required in the event of a nuclear incident. This list includes: fire department staff in 8 municipalities, police services, Ontario Provincial Police in Essex County, Emergency Medical Services for Windsor and Essex County, and the Canadian Coast Guard. Estimates of the required amount of KI Pills to stockpile for evacuation centers has also been determined based on an estimate of 10% of the population of Amherstburg.

There is continued consultation and communication with the CEMC group as the KI Pill Distribution Plan continues in 2019. There is opportunity for further collaboration with municipalities in the distribution of KI Pills at municipal centers.

Windsor and Essex County school board representatives will be contacted by the Public Health Emergency Preparedness Coordinator to request individual meetings to discuss the process of providing stockpiles of Potassium Iodide Pills for four Amherstburg schools:  Amherstburg Public, Stella Marais, Ste. Jean Baptiste, and General Amherst High School. An initial presentation regarding the proposed plan for the distribution of Potassium Iodide (KI) Pills in the Amherstburg school setting was completed at the August 23, 2018 WECHU/School Board Liaison Meeting.

WECHU has committed to provide the Chatham-Kent Public Health Unit with sufficient KI Pills to support distribution to 10% of the Chatham-Kent households identified as being within the secondary zone.

Consultation:

The following individuals contributed to this report:

Dr. Wajid Ahmed, Medical Officer of Health

Approved by:

 Theresa Marentette

Prepared By:

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

Date:

April 1, 2019

Subject:

Background:

The 2017-2021 WECHU Strategic Plan identifies key roles, priorities, and directions for the organization. It sets out what we plan to do, how we plan to do it, and how we will measure our progress. The Strategic Plan outlines opportunities to enhance our delivery of quality public health programs and services to all residents in Windsor and Essex County. The current strategic plan is based on four strategic priorities: Communication and Awareness; Partnerships; Organizational Development; and Evidence-Based Public Health Practice.

As outlined in the 2017-2021 Strategic Plan under “Implementation and Monitoring”, the plan is to be reviewed and its progress measured and reported to the BoH annually. The annual review process consists of a meeting with the Strategic Planning Committee (SPC), during which the plan elements are discussed, reviewed and altered where necessary. After the SPC review, a strategic plan report is prepared and presented to the BoH for consideration. This year-end report is in addition to quarterly tracking and reporting implemented by the Planning and Strategic Initiative department in early 2018.

Current Initiatives

The 2018 Strategic Plan Year-End Report provides the objectives under each strategic priority and summarizes the progress our organization made during the second year (2018) of implementation and provides evidence of our commitment to quality, excellence, and accountability. It includes previous years’ measures (where established), 2018 measures/results, and next steps. The report also identifies changes made under Objectives 1.3, 3.4 and 4.4 as a result of discussions at the annual SPC review meeting.

The colour-coded state for all of the objectives either remained consistent or moved forward. In some cases, the goal for the measure of an objective was reached (e.g., under Objective 1.2) yet the work necessary to fully achieve the objective was not complete. In these cases, the colour-coded state of the objective remained yellow (progress being made but objective not met). Overall, progress has continued on all of the strategic objectives.

In Q1 of 2019, the PSI department will work with the Communication department to re-launch communication efforts internally about the strategic plan to ensure ongoing understanding of WECHU’s strategic objectives and allow departments to better understand their role in meeting them. These efforts will include a web update, the development of a new strategic plan e-learning module for staff and the BoH, and plans for mid-point activities to highlight WECHU’s progress on the 5-year plan.

Consultation:

The following individuals contributed to this report:

• Kristy McBeth, Director, Health Protection
• Marc Frey, Manager, Planning & Strategic Initiatives
• Michael Janisse, Manager, Communications
• Ramsay D’Souza, Manager, Evaluation & Epidemiology
• Jennifer Johnston, Health Promotion Specialist, Planning & Strategic Initiatives
• Jessica Kipping-Labute, Policy Advisor, Planning & Strategic Initiatives
• Dave Jansen, Performance Improvement and Accountability Coordinator, Planning & Strategic Initiatives

Approved by:

 Theresa Marentette

Prepared By:

Communications Department

Date:

March 6, 2019

Subject:

February Media Relations Recap Report

February Media Coverage

Story Source

Media Coverage

News Release and Media Advisories

Stories Reported by the Media

AM 800

Blackburn News

CBC News

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

Chatham Daily News

CTV News

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

Windsor Star

Windsorite.ca

Note: Digital stories were not available for National Post and The MediaPlex (St. Clair College).

The following individuals contributed to this report:

Jennifer Jershy, Marc Tortola, and Michael Janisse