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June 21, 2018

Prepared By:

Phil Wong, Manager, Environmental Health Department

Date:

June 11, 2018

Subject:

Changes in Public Disclosure Requirements

Background

Health Protection and Promotion Act – Regulatory Changes

The Health Protection and Promotion Act (HPPA) specifies the organization and delivery of public health services in the province of Ontario. The HPPA requires local boards of health such as the Windsor- Essex County Health Unit (WECHU) to oversee or ensure the provision of public health programs and services within their local municipalities.

On October 25th, 2017, proposed amendments to a number of regulations under the HPPA were posted on the Ontario Regulatory Registry. The changes were to modernize and update regulatory requirements to better reflect current evidence and practices for public health programs and services. The changes have addressed inconsistencies, removed redundancies and provide clarity for delivery of the public health services. Some of the changes came into effect on January 1st, 2018 with the remaining changes to come into effect on July 1st, 2018. There were over 110 amendments to the safe food and safe water regulations alone, with over 70% of the changes in the HPPA having direct impact on environmental health program delivery. Any changes to regulations during the modernization process subsequently effects corresponding environmental health protocols, guidance documents and other acts such as the Provincial Offences Act.

Below is a list of new or amended regulations that are enforced by Public Health Inspectors (PHIs) at the WECHU.

  • Personal Service Settings - Ontario Regulation 136/18
  • Food Premises - Ontario Regulation 493/17
  • Public Pools - Ontario Regulation 494/17
  • Public Spas Revocation - Ontario Regulation. 495/17
  • Transitional Small Drinking Water (repeal) - Ontario Regulation 499/17
  • Camps in Unorganized Territory - Ontario Regulation 502/17
  • Recreational Camps - Ontario Regulation 503/17
  • Communicable Disease General - Ontario Regulation 557/90
  • Rabies Immunization – Ontario Regulation 567/90
  • Control of West Nile Virus – Ontario Regulation 199/03

Ontario Public Health Standards - Standard Changes

On January 1st, 2018, the new Ontario Public Health Standards: Requirements for Programs, Services, and Accountability 2018 (OPHS) came into effect.  The OPHS outlines mandatory health programs and services which WECHU must comply with. Local boards of health such as the WECHU are accountable for implementing the standards including any protocols, guidelines and reference documents associated with it. Collectively, there has been a release of over 100 amendments to these documents with many still projected to be released on or after July 1st, 2018. 

Quality and Transparency

The standards require local boards of health to promote a culture of quality and transparency, as well as accountability to community members, clients and other stakeholders. In order to demonstrate transparency, the WEHCU is required to publicly disclose results of all inspections or information in accordance with the following protocols:

  • Food Safety Protocol, 2018 (or as current);
  • Health Hazard Response Protocol, 2018 (or as current);
  • Infection Prevention and Control Complaint Protocol, 2018 (or as current);
  • Infection Prevention and Control Disclosure Protocol, 2018 (or as current);
  • Infection Prevention and Control Protocol, 2018 (or as current);
  • Recreational Water Protocol, 2018 (or as current);
  • Safe Drinking Water and Fluoride Monitoring Protocol, 2018 (or as current);
  • Tanning Beds Protocol, 2018 (or as current);
  • Tobacco Protocol, 2018 (or as current)/ Electronic Cigarettes Protocol, 2018 (or as current);

Summary of Changes

  • Online disclosure is mandatory for all inspections, complaints, convictions and closures
  • On site physical disclosure according to PHI request for all of the following:
    • Personal Service Settings i.e., barber shops, nail salons and tattoo parlors
    • Food premises i.e., restaurants, take out and fast food
    • Recreational water facilities i.e., pools, spas and splash pads
    • Recreational camps

Current Initiatives

In response to these requirements, an upgrade is being made to the Environmental Health Department’s inspection software to facilitate the availability of inspection results on our website.  The Environmental Health Department utilizes inspection software for all inspections, time tracking and investigations. WECHU was one of the first health units in Ontario to use inspection software, migrating from pen and paper to electronic documentation in the early 2000s. This disclosure will go live by the end of 2018.

Owners and operators of premises affected by these changes have been informed in writing in advance of the regulation coming into effect. Letters were mailed out to all municipalities for food premises, personal service settings owners/operators, and owners/operators of public pools and contained a summary of changes and action required in order to comply with the regulation. The Environmental Health Department and the Communications Department at the WECHU are working on a communication plan to launch the new on site physical disclosure requirement, projected to be launched by the end of 2018.

Additionally, the Environmental Health Department will be updating all web content, inspection forms, fact sheets and offering online and onsite operator/owner training courses that reflect the changes to the regulations. All of these updates will be completed by July 1st, 2018.

Data Sources:

 

Consultation:

The following individuals contributed to this report:

  • Karen Lukic, Health Promotion Specialist, Environmental Health Department

  • Mike Tudor, Manager, Environmental Health Department

  • Theresa Marentette, Acting CEO and Director, Health Protection Division

Approved by:

Theresa Marentette, Acting CEO


View Document page

Prepared By:

Amandeep Hans, Health Promotion Specialist, Environmental Health Department

Date:

June 11, 2018

Subject:

Ticks and Lyme Disease Surveillance

Background

Ticks are a relative to the spider and are a crawling, non-flying insect. They vary in size and colour. Ticks are very small (1 to 5 mm) when unfed and female ticks get larger and change colour when fed. Ticks are usually found in wooded areas or areas with long grass, where they attach themselves to humans and animals passing by.

Ticks can spread many diseases including Lyme Disease, Rocky Mountain Spotted Fever, Powassan Virus Disease, and Tularemia. Blacklegged ticks (Ixodes scapularis, formerly called deer ticks) spread the bacteria that cause Lyme disease. The bacteria (Borrelia burgdorferi) are most likely to be transmitted after the tick has been attached to you for more than 24 hours.

The most common symptom of Lyme disease is an expanding bulls-eye skin rash. The rash can begin at the site of the tick bite between three and 30 days after exposure and usually grows in size for several days. Many people never get or see a rash. If the disease is left untreated, other symptoms may develop in the weeks following exposure, including rash, fever, chills, headache, fatigue, muscle and joint aches, problems with your heartbeat, breathing, balance and short-term memory. In rare cases Lyme disease may result in death.

Southwestern Ontario is an established area for Lyme disease. Closer to home, Point Pelee National Park has been identified as an endemic area for blacklegged deer ticks as well as the north shore of Lake Erie, particularly in areas around Long Point, Turkey Point, Rondeau Park and the St. Lawrence Islands National Park. Ticks can be active anytime the temperature is above freezing but the greatest risk of exposure to a tick is during the spring, summer and early fall months.

During the spring and early summer months, ticks can be very small (called nymphs) and once attached can often go unnoticed. This results in a higher chance of being infected with Lyme disease.

Anyone can get Lyme disease, but people who spend more time outdoors are at higher risk. These include: hikers, campers, hunters, people who live or work in an area near woods or overgrown bush, or people who have outdoor jobs. For Lyme disease, there are no vaccines to prevent the illness. Early detection is important to help reduce the risk of developing long-term health effects. Residents can reduce the risk of Lyme disease by using personal protection measures.

To prevent tick bites: 

  • Avoid walking in tall grass and stay on the centre of paths.
  • Cover up. Wear long- sleeved shirts and pants. Tuck your pants into your socks and wear closed toed shoes.
  • Use insect repellant containing DEET or Icaridin on exposed skin and clothing (read and follow directions for use on children). 
  • Do a full body check on yourself and your children after being outdoors. 
  • Shower within 2 hours of being outdoors.
  • Carefully remove any ticks with a tick key or a pair of tweezers.

Current Initiatives

The Windsor Essex County Health Unit’s (WECHU) role is to measure and evaluate the risk of tick-borne disease in our area.  To measure the local distribution and incidence of ticks and Lyme disease cases in Windsor and Essex County (WEC), WECHU uses three surveillance techniques:

Active surveillance involves dragging a white cloth through grassy areas. The ticks attach themselves to the cloth and can be easily spotted. Ticks collected on the cloth are sent to the lab for testing. Tick dragging is performed twice yearly to identify areas in WEC that have populations of blacklegged ticks. Areas for dragging are selected based on known tick habitats as well as areas deemed suitable for potential tick habitats.

Passive surveillance involves residents of Windsor and Essex County submitting ticks to the health unit for identification and subsequent testing if the tick is identified as a blacklegged tick. Passive surveillance is mainly for collection of data and should not be used for diagnostic purposes.

  • In 2017, 386 ticks were submitted through passive surveillance
    • Dermacentor variabills (329 ticks, 84.5%),
    • Ixodes scapularis (32 ticks, 8.2%),
    • Two tested positive for B. burgdorferi. (Lyme Disease)
    • Amblyomma americanum (7 ticks, 1.8%).

Human case surveillance is another important method to determine the level of risk in the community. Lyme disease is a disease of public health significance in Ontario. WECHU investigates reported cases of Lyme disease in the region, although the number of cases fluctuates from year to year.  In 2017, there were 7 cases of Lyme disease in WEC residents.

Table: Ticks and Lyme Disease Surveillance Summary, 2012 to 2017, Windsor-Essex County
Year Blacklegged ticks submitted (%) Other tick species submitted (%) Total ticks submitted that were identified Blacklegged ticks testing positive for B. burgdorferi(%) No. of Lyme Disease cases
2012 1 (2.3%) 43 (97.7%) 44 None 0
2013 4 (4.3%) 90 (95.7%) 94 2 ticks (50%) 3
2014 4 (9.5%) 38 (90.5%) 42 None 5
2015 11 (9.1%) 110 (90.9%) 121 4 ticks (36.3%) 6
2016 7 (4.2%) 160 (95.8%) 167 1 tick (14.3%) 2
2017 32 (8.3%) 354 (91.7%) 386 2 tick (6.25%) 7

Public education awareness campaign in 2017 included key messages that focused on different types of ticks, preventing tick bites, tick removal, tick submission and the cause and symptoms of Lyme disease. These messages were communicated through the WECHU website, social media, presentations and print materials (fact sheets). All surveillance related activities will continue in 2018. Tick dragging was done on May 17, 2018 at 2 sites: Ojibway Nature Centre and Chrysler Greenway. Twelve dog ticks and four black-legged ticks (males) were collected during the tick–dragging session. The black-legged ticks have been sent to the lab for further testing.

References

Consultation:

The following individuals contributed to this report:

  • Theresa Marentette, Acting CEO and Director, Health Protection Division

  • Phil Wong, Manager, Environmental Health Department

  • Mike Tudor, Manager, Environmental Health Department

  • Saamir Pasha, Epidemiologist, Epidemiology and Evaluation Department

Approved by:

Theresa Marentette, Acting CEO


View Document page

Prepared By:

Ashley Kirby, Health Promotion Specialist, Eric Nadalin, Manager, Chronic Disease and Injury Prevention 

Date:

May 25, 2018

Subject:

Smoke-Free Ontario Act 2017 – New Regulations

Background

The Smoke-Free Ontario Act (SFOA) came into effect in May of 2006 imposing regulatory changes which led to significant reductions in smoking and tobacco use across Ontario. These changes led to over 180,000 less smokers across the province, including nearly 13,000 fewer in Windsor-Essex County alone (Canadian Community Health Survey, 2014). In the Spring of 2017, the Minister of Health and Long-Term Care and the government of Ontario committed to the modernization of the Smoke-Free Ontario Act updating the smoking and vaping laws in Ontario to address emerging smoking products which continue to come to market and to continue to make progress toward achieving the lowest smoking rates in the province. Effective July 1, 2018 the Smoke-Free Ontario Act 2017 (SFOA 2017) regulations will repeal the existing SFOA and Electronic Cigarettes Act, 2015 (ECA). The SFOA 2017 will regulate the sale, supply, use, display, and promotion of tobacco and vapour products (e-cigarettes), and the smoking and vaping of medical cannabis. 

Places of Use

The SFOA, 2017 will prohibit the smoking of tobacco, the vaping of any substance, and the smoking of medical cannabis in all enclosed public spaces and workplaces, as well as additional prohibited places, such as children’s playgrounds and sporting fields, which were prohibited under the former SFOA. The SFOA 2017, will further protect Ontarians from second hand smoke and vapour by prohibiting the smoking of tobacco, the use of e-cigarettes, and the smoking and vaping of medical cannabis in additional places that were not previously prohibited under the SFOA. A summary of these prohibitions and a comparison to the previous version and municipal bylaws can be found in Table 1 below.

Table 1: Summary of Regulation Changes Related to Places of Use
Topic/Regulation Current:
Smoke-Free Ontario Act/
Electronic Cigarettes Act
As of July 1st:
Smoke-Free Ontario Act 2017
Impact on Municipal Bylaws
Prohibited Products
  • Smoke or hold lighted tobacco.
  • Smoke or hold lighted tobacco.
  • Smoking or vaping of medical cannabis.
  • Use of an electronic cigarette.

Inclusion of smoking or vaping of medical cannabis and use of an electronic cigarette

Smoke-free Bylaws Impacted:

Municipality of Leamington
Bylaw: 311-13

Smoking/Vaping Prohibition on School Grounds
  • A school as defined in The Education Act.
  • A school as defined in The Education Act.
  • Public areas within 20m of any point on the perimeter of a school.
  • Inclusion of Smoking or vaping of medical cannabis and use of an electronic cigarette.

School property not referenced in any local municipal Bylaws.

Smoke-free Bylaws Impacted:

None.

Smoking/Vaping Prohibition on Children’s Playgrounds and Play Areas
  • Children’s playgrounds
  • Public areas within 20m of any point of the perimeter of a children’s playground.
  • No change for prohibited spaces.
  • Inclusion of Smoking or vaping of medical cannabis and use of an electronic cigarette.

These regulations will continue to supersede outdoor smoking Bylaws in municipalities which provide exemptions for parking lots or designated smoking areas within 20m from the perimeter of playgrounds and play areas.

Smoke-Free Bylaws Impacted:

Town of Amherstburg
Bylaw: 2016-113

Town of Essex
Bylaw: 1228

Town of Tecumseh
Bylaw: 2014-60

City of Windsor
Bylaw: 113-2006

Town of LaSalle
Bylaw: 7775

Smoking/Vaping Prohibition for Sporting Areas
  • Sporting areas
  • Spectator areas
  • Public areas within 20m of any point on the perimeter of a sporting area or spectator area.
  • No change for prohibited spaces.
  • Inclusion of smoking or vaping of medical cannabis and use of an electronic cigarette.

These regulations will continue to supersede outdoor smoking Bylaws in municipalities which provide exemptions for parking lots or designated smoking areas within 20m from the perimeter of sporting areas or spectator areas.

Smoke-Free Bylaws Impacted:

Town of Amherstburg
Bylaw: 2016-113

Town of Essex
Bylaw: 1228

Town of Tecumseh
Bylaw: 2014-60

City of Windsor
Bylaw: 113-2006

Town of LaSalle
Bylaw: 7775

Smoking/Vaping Prohibition on Recreation Centre Property
  • No provincial regulations, but most municipal recreation centers are covered in Smoke-Free Bylaws.
  • The outdoor grounds of a community recreation facility and public areas within 20m of any point on the perimeter of the grounds.
  • Inclusion of smoking or vaping of medical cannabis and use of an electronic cigarette.

These regulations will supersede outdoor smoking Bylaws in municipalities which provide exemptions for parking lots or designated smoking areas on recreation centre property or within 20m of any point on the perimeter of the property.

Smoke-Free Bylaws Impacted:

Town of Amherstburg
Bylaw: 2016-113

Town of Essex
Bylaw: 1228

Town of Tecumseh
Bylaw: 2014-60

City of Windsor
Bylaw: 113-2006

Town of LaSalle
Bylaw: 7775

Smoking/Vaping Prohibitions of Restaurant and Bar Patios
  • Restaurant and bar patios
  • Restaurant and bar patios
  • Public areas within 9m of any point on the perimeter of a restaurant or bar patio.
  • Inclusion of smoking or vaping of medical cannabis and use of an electronic cigarette.

These regulations will supersede outdoor smoking Bylaws in municipalities which provide exemptions for designated smoking areas within 9m of any point on the perimeter of a bar or restaurant patio, such as those which are in operation as part of a fair or festival.

Smoke-free Bylaws Impacted:

Town of Amherstburg
Bylaw: 2016-113

Town of Essex
Bylaw: 1228

Town of Tecumseh
Bylaw: 2014-60

City of Windsor
Bylaw: 113-2006

Town of LaSalle
Bylaw: 7775

Display and Promotion

The SFOA, 2017 will also prohibit the display and promotion of tobacco products, branded tobacco product accessories, and vapour products and any other prescribed product or substance at places where they are sold or offered for sale. While these regulations were in place for tobacco products under the previous legislation, the regulations related to electronic cigarettes and other prescribed products and substances are new and specific to SFOA 2017.

The regulation will include exemptions for Tobacconists and Specialty Vape Shops to display these products if specific conditions are met. These exemptions require business owners to register annually with the Board of Health and abide by the conditions outlined below: 

  • Tobacconists: permitted to display and promote vapour products, if a minimum of 85% of the store's revenues or inventory is dedicated to speciality tobacco products. These requirements have expanded from 50% under the previous Act.
    • The other 15% of store's revenue/inventory can be dedicated to items associated or branded with the name of the tobacconist or a brand of tobacco.
  • Speciality vape stores: permitted to display and promote vapour products, if a minimum of 85% of the store's revenues or inventory is dedicated to vapour products.
    • Are not permitted to sell tobacco products, the other 15% of store's revenue/ inventory can be dedicated to items associated or branded with the name of the vape store or a brand of vape product.

Current Initiatives

Prior to the implementation of the SFOA 2017, our Health Unit will be reaching out to effected stakeholders in the following ways:

  • Meeting with municipalities to educate them on the impact that the Act will have on recreation facilities, sporting areas, parks and playgrounds. As well as how these new regulations will interact with existing smoke-free outdoor space bylaws.
  • Written and in person support to vendors who currently sell e-cigarettes, tobacconists, and speciality vape shops to aid them in complying with SFOA 2017.
  • Written and in person contact with restaurant and bar owners as well as fair and festival organizers to notify them of the restrictions around smoking within 9 metres of patios.
  • Written notification, along with in person meetings with our school board liaison committee and principals to provide education and enforcement expertise regarding the smoke-free space within 20 metres of their school property.
  • Contact owners of medical cannabis vape lounges to inform them that as of July 1st, their current operations will not be compliant with SFOA 2017.
  • Shared work plan being developed among southwest regional health units to create public education materials and a consistent enforcement approach across eight health unit regions.

Consultation:

The following individuals contributed to this report:

  • Southwest Tobacco Control Area Network Steering Committee
  • Southwest Tobacco Control Area Network Enforcement Subcommittee
  • Middlesex-London Health Unit

References:

  • Canadian Community Health Survey. (2014). Tobacco Informatics Monitoring System. Retrieved May 29, 2018

Approved by:

Theresa Marentette, Acting CEO


View Document page

Board Members Present:

Dr. Ken Blanchette, Joe Bachetti, Paul Borrelli, Mark Carrick, Dr. Deborah Kane, Judy Lund, Richard Meloche, Hilary Payne, Gord Queen, Ed Sleiman, Michelle Watters

Board Member Regrets:

Gary McNamara, Bill Marra, Dr. Carlin Miller, John Scott 

Administration Present:

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

Administration Regrets: 

Nicole Dupuis.

  1. Call to Order

    The meeting was called to order at 4:00 p.m.

  2. Agenda Approval

    It was moved

    That the agenda be approved

    CARRIED

  3. Announcement of Conflicts of Interest – None.
  4. Approval of Minutes
    1. Regular Board Meeting: May 17, 2018.

      It was moved

      That the minutes be approved.

      CARRIED

  5. Presentations
    1. Smoke-Free Ontario Act, Changes/Highlights (E. Nadalin)

      E. Nadalin, Manager Chronic Disease and Injury Prevention, provided an overview of the current legislation. The MOHLTC had committed to modernizing the Smoke-Free Ontario Act (SFOA) in the spring of 2017, and these changes will take effect July 1, 2018. The SFOA regulates the sale, supply, use, display and promotion of tobacco and vaping products, as well as smoking and vaping of cannabis. (Non-medical cannabis will fall under the Cannabis Act). Modernization of the SFOA includes smoking prohibitions within School Grounds, Playgrounds and Play Areas, and Sporting and Spectator Areas.

      Restrictions apply for E-cigarettes under the Electronic Cigarettes Act (ECA), and products for sale will not be openly displayed. The ECA also prohibits the sale and supply of e-cigarettes to persons who are less than 19 years old.

      WECHU’s role is to ensure pubic compliance with regulations of tobacco and E-cigarette sales through enforcement by WECHU’s Tobacco Enforcement Officers, to support municipalities and businesses to make sure they are aware of the legislation and are compliant, and to provide community education and outreach.

    2. Association of Local Public Health Agencies (alPHa) BOH Conference Update (P. Borrelli)

      Board of Health member, P. Borelli, attended the alPHa Conference on June 10-12, 2018 in Toronto, and brought forward various points of interest. Due to the municipal elections taking place this fall, the next alPHa Conference is scheduled for February 2019.

      It was moved

      That the presentations be received for information.

      CARRIED

  6. Consent Agenda:
    1. Information Reports

      The following information reports were presented to the Board.

      1. Q1 Reports Submitted to Ministry
      2. Changes in Public Health Disclosure Requirements
      3. Ticks and Lyme Disease Surveillance
      4. Baby Friendly Initiative – Journey to Designation
      5. Smoke-Free Ontario Act, 2017 – New Regulations
      6. Health Equity Strategy
      7. May 2018 Media Relations Recap

        It was moved

        That the information reports be received.

        CARRIED

    2. Recommendation Reports
      1. Recommendation/Resolution Report – 2017 Annual Financial Statements – May 25, 2018

        ISSUE:

        Approval of the annual audited financial statements for the year-ended December 31, 2017 including:

        •Windsor-Essex County Health Unit (Appendix A)
        •Windsor-Essex County Health Unit Nurse Practitioner Program (Appendix B)
        •Windsor-Essex County Health Unit Healthy Babies Healthy Children Program (Appendix C) (hereinafter referred to collectively as “the annual financial statements”).

        BACKGROUND

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

        The annual financial statements audited by KPMG LLP, independent external auditors appointed by the Corporation of the City of Windsor. On May 25th, 2018, the Audit Committee of the Windsor-Essex County Health Unit convened to review the annual financial statements and audit findings report with Administration and KPMG LLP. The Audit Committee has recommended the financial statements for approval to the Board. KPMG LLP is prepared to issue, pending approval by the Board, an unmodified audit opinion on the annual financial statements.

        Windsor-Essex County Health Unit

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

        Statement of Financial Position:

        • Accounts receivable increased $423,766 over 2016. This increase is primarily attributed to: i) A net increase in amounts receivable from the Province of Ontario due to timing of 2017 approvals of $217,448; ii) Increase in other receivables in the amount of $201,799 as current year’s balance included amounts outstanding from third parties for wellness services rendered. For additional details, refer to note 3 to the annual financial statements of the Windsor-Essex County Health Unit.

        • Due to Province of Ontario increased $157,338. This increase is attributed to the following: i) Increase in the balance outstanding relating to the 2016 settlement. In the prior year an amount remained receivable from the Ministry of Health and Long-Term Care. This receivable balance was offset against the total amount payable to the Ministry of Health and Long-Term Care. The Ministry subsequently cash flowed this in Q1 of 2017; ii) The 2017 settlement amount of $67,898. This amount relates to 100% Related Program funding and 100% funded One-time business case funding that remain unspent at the settlement date. Currently the 2016 settlement is under review. Once the review is concluded, the Ministry of Health and Long-Term Care will issue a settlement letter and claw back funding during the remainder of 2018. The 2017 settlement is due to the Ministry of Health and Long-Term Care May 31, 2017. The timing of the review of that settlement is unknown. For additional details refer to note 4 to the annual financial statements of the Windsor-Essex County Health Unit.

        • Due to Municipalities increased $561,872. This net increase is attributed to the following: i) Repayment of amounts outstanding to 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”) in the amount of $144,349; ii) 2017 settlement to the Obligated Municipalities in the amount of $706,221. For additional details, refer to note 5 to the annual financial statements of the Windsor-Essex County Health Unit.

        • Tangible capital assets decreased $274,418. This net decrease is attributed to: i) Tangible capital asset additions of $197,409; ii) Amortization expense in the amount of $471,827. Of the tangible capital assets acquired in the year, $106,400 were funded by the Ministry of Health and Long-Term Care using 100% Related Program funding or 100% funded One-time business cases. Refer to note 9 for additional details.

        Statement of Operations and Accumulated Deficit:

        • Increase in Revenue from the Province of Ontario, Mandatory Programs, in the amount of $298,562. This increase is attributed to the year-over-year increase in the general program expenses. As you recall, the Ministry of Health and Long-Term Care funds the WECHU to a maximum of 75% of admissible expenditures. Admissible expenditures for the purposes of the Ministry of Health and Long-term Care Settlement Process is defined below:
         

        Total General Program expenses at December 31, 2017 $18,518,025
        Less: Non-admissible expenses
        Amortization (471,827)
        Change in Employee Future Benefits Liability (24,296)
        Other Accounting Adjustments (25,825)
        Plus: Tangible capital asset additions – Mandatory Program 91,009
        $ 18,087,086
        Less: Offset revenue (189,851)
        Total admissible expenditures $ 17,897,235
        Ministry portion (75%) $ 13,422,926
        Ministry approval $ 13,316,100
        Ministry funded expenditures $ 13,316,100

        • Increase in General Program Expenses in the amount of $739,870 is attributed to:
         •Net increase in permanent FTEs of 2 staff funded by the Cost-Shared Program;
         •Annual increases (cost of living and grid increases) as follows: i) ONA 2% annual; ii) CUPE 1.5% annual; iii) Non-union 2%;
         •Other employee obligations.

        Windsor-Essex County Health Unit Nurse Practitioner Program

        The Nurse Practitioner Program is funded by the Ministry of Children and Youth Services. The funding supports the salaries and benefits of the nurse practitioner whose role is to assist with promoting healthy pregnancy, birth and infancy for children, improve parenting and family supports, strengthen early childhood development, learning and care.

        Windsor-Essex County Health Unit Healthy Babies Healthy Children Program

        The Healthy Babies/Healthy Children Program is funded through the Ministry of Children and Youth 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.

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

        Statement of Financial Position:

        •Due from the Windsor-Essex County Health Unit: Refer to the statement of cash flow for the decrease of $111,757 from December 31, 2016.

        •Accounts payable: The decline in accounts payable in the amount of $50,487. At December 31, 2015 $40,800 was payable to a third party provider for scanning services of client files.

        •Due to Ministry of Children and Youth Services in the amount of $64,399. The net decrease was as a result of the following: 1. 2015 and 2015 settlements being reclaimed in 2017 amounting to $32,721. 2. Settlement for 2017 in the amount of $27,793; 3. Reduction of other amounts owing from pre-2000 settlements of $59,471.

        Statement of Operations and Accumulated Deficit:

        •Program Supplies: The decrease in program supplies in the amount of $41,913. As indicated above under the Accounts Payable caption a scanning project was undertaken in 2016 to archive client files with significant retention periods. The project was substantially concluded in 2016.

        •Purchased Services: The increase in purchased services in the amount of $15,323 resulting from an increase in translation services from 2016.

        PROPOSED MOTION

        Whereas, at its May 25th, 2018, meeting of the Audit Committee reviewed the 2017 annual financial statements and recommended them to the Board for the Board’s approval,

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

        •Windsor-Essex County Health Unit 2017 audited annual financial statements

        •Windsor-Essex County Health Unit 2017 Nurse Practitioner Program financial statements

        •Windsor-Essex County Health Unit 2017 Healthy Babies/Healthy Children Program financial statements

        It was moved

        That the resolution be supported.

        CARRIED

  7. Business Arising
    1. Board of Health Retreat – February 21, 2019 (T. Marentette)

      Due to scheduling conflicts, the Board of Health Retreat originally planned for February 10, 2017 has been postponed and rescheduled to take place during the February 21, 2019 regular Board meeting. Board of Health members are highly encouraged to attend.

    2. WECHU Letter in Support of Fluoride (W. Ahmed)

      The Board of Health requested that Dr. Ahmed write a letter to the leaders of various political parties to update their mandates in support of community water fluoridation, as opposed to placing the issue with municipalities. A letter via email was sent to the incoming Premier, and the Association of Local Public Health Agencies (alPHa) provided a letter of support to WECHU’s email.

    3. Oral Health Report to Essex County Council (W. Ahmed)

      The WECHU attended and presented the Oral Health Report to Essex County Council on June 6. Although the report was well received, the underlying discussion was that fluoridation is something that the province should address. The WECHU will present the Oral Health Report to Windsor City Council on December 17. Board of Health member, J. Lund, asked if there were any long term comparisons that would help bear weight to this issue. WECHU has comparables, but they are not long term. WECHU’s goal is to make this an oral health issue, and not specifically a fluoride issue. The majority of areas across Ontario do have community water fluoridation. Board of Health member, G. Queen, noted that the County of Essex does not own or run their water treatment plants, and WECHU may need to promote this issue to the municipalities, and not to Essex County Council.

      It was moved

      That the information presented be received.

      CARRIED

  8. Board Correspondence – Circulated
  9. New Business
    1. Board of Health Education Sessions (T. Marentette)

      T. Marentette noted the upcoming Board of Health Education Sessions taking place in Windsor on July 19 (Health Equity overview) and August 16 (Program overview and changes). Board members are encouraged to attend.

  10. Other Board of Health Resolutions/Letters – Circulated
    1. Dedicated funding for Local Public Health Agencies from Cannabis Sales Taxation Revenue – Hastings Prince Edward Public Health – For Support
    2. Mandatory Food Literacy Curricula in Ontario Schools – Kingston, Frontenac and Lennox & Addington Public Health – For Support

      It was moved

      That the Board support agenda items 10.1 and 10.2

      CARRIED

    3. Canada Tobacco Strategy – alPHa – For Information

      It was moved

      That the Board receive the report for information

      CARRIED

  11. Committee of the Whole (CLOSED SESSION, in accordance with Section 239 of the Municipal Act)

    It was moved

    That the Board move into Committee of the Whole at 4:36 p.m.

    CARRIED

    It was moved

    That the Board move out of Committee of the While at 4:52 p.m.

    CARRIED

  12. Next Meeting: At the Call of the Chair, or September 20, 2018 in Windsor, Ontario
  13. Adjournment

    The meeting adjourned at 5:17 pm.

RECORDING SECRETARY:

SUBMITTED BY:

APPROVED BY:


View Document page

May 17, 2018

Introduction of New Managers:
Kelly Farrugia, Manager, Healthy Schools
Amy Wolters, Manager, Accounting & Financial Reporting

  1. Call to Order
  2. Agenda Approval
  3. Announcement of Conflict of Interest
  4. Approval of Minutes
    1. Regular Board Meeting:  April 19, 2018
  5. Presentation
    1. 1st Quarter Financial Results (L. Gregg)
  6. Consent Agenda
    1. Information Reports
      1. 1st Quarter Financial Results (L. Gregg)
      2. 1st Quarter Update – Strategic Plan (K. McBeth)
    2. Recommendation Report
      1. Provincial Election Priorities (N. Dupuis)
    3. Media Coverage Summary Report (Handout)
  7. Business Arising
    1. Oral Health Presentation (Dr. Ahmed)
    2. KI Distribution Update (Dr. Ahmed)
  8. Board Correspondence - Circulated
  9. New Business
    1. Budget Update - (T. Marentette/L. Gregg) (Handout)
    2. alPHa AGM/Conference-June 10-12, 2018 (T. Marentette)
  10. Other Board of Health Resolutions/Letters - Circulated
  11. Committee of the Whole (Closed Session in accordance with Section 239 of the Municipal Act)
  12. Next Meeting: At the Call of the Chair, or June 21, 2018, Essex
  13. Adjournment

View Document page

2018 Q1 WECHU Strategic Plan Progress - At a Glance

Communication and Awareness

Objective

2017

2018
Q1

1.1. 60% of survey respondents are aware of the programs and services offered by the WECHU by 2021.

Progressing Progressing

1.2 60% of survey respondents have seen or heard about the WECHU by 2021.

Progressing Progressing

1.3 60% of survey respondents are satisfied with internal communication efforts in the WECHU by 2021.

Work Needed Progressing

Organizational Development

Objective

2017

2018
Q1

3.1. A minimum of 2 organization-wide quality improvement activities will occur annually through to 2021.

Objective Met Objective Met

3.2. 100% of the WECHU staff are trained in change management strategies by 2021.

Progressing Progressing

3.3. 100% of corporate risks identified as high have mitigation strategies developed and implemented by 2021

Progressing Progressing

3.4. 80% of the WECHU staff have a positive view of organizational culture by 2021.

Work Needed Progressing

Partnerships

Objective

2017

2018
Q1

2.1. 100% of program/service driven departments implement a formal feedback process with at least one external partnership by 2021.

Progressing Work Needed

2.2. At least 20% of activities in the operational plan identify formal internal partnerships by 2021.

Work Needed Progressing

Evidence-based Public Health Practice

Objective

2017

2018
Q1

4.1. 100% of departments collect corporate level client satisfaction data by 2021.

Progressing Progressing

4.2. 100% of the Ontario Public Health Standards (OPHS) 2018 program areas have at least one activity focused on healthy public policy development by 2021.

Progressing Progressing

4.3. 100% of the OPHS population health assessment requirements (7), the research, knowledge exchange, and communication requirements (3) and the related protocols are being addressed by 2021.

Progressing Objective Met

4.4. 100% of our programs and service departments have adopted a health equity approach to an activity by 2021.

Progressing Progressing

Communication and Awareness

OBJECTIVE

GOAL

Q1 UPDATE

1.1 Strengthen the community’s awareness of our programs and services by developing and implementing a corporate communications strategy.

60% of survey respondents are aware of the programs and services offered by the WECHU by 2021.

Corporate marketing and communications plan still to be developed. Policies and procedures are being updated and developed to address organizational branding across media channels.

1.2 Increase the WECHU’s visibility by developing and implementing a community engagement approach.

60% of survey respondents have seen or heard about the WECHU by 2021.

Community engagement plan still to be developed. Enhanced focus on organizational branding has been implemented.

1.3 Improve communication within the WECHU by developing and implementing an internal communication strategy.

60% of survey respondents are satisfied with internal communication efforts in the WECHU by 2021.

Employee engagement strategy implementation begins at the start of Q2. Measurements associated with internal communication will be generated as a result of these activities. Activities include: team meeting discussion question on intranet, new web-based all staff meeting, engagement survey with section on internal communication measures.

Partnerships

OBJECTIVE

GOAL

Q1 UPDATE

2.1 Increase the effectiveness of partnerships through formal feedback mechanisms.

100% of program/service driven departments implement a formal feedback process with at least one external partnership by 2021.

Development of the partnership tool is still in progress. The tool is in the final stages of development and is currently being revised.

2.2 Increase the number of internal partnerships.

At least 20% of activities in the operational plan identify formal internal partnerships by 2021.

19% of work plans included in the 2018 Operational Plan referenced objective 2.2. The PSI department is working to refine the way in which internal partnerships are identified for the 2019 planning cycle.

Organizational Development

OBJECTIVE

GOAL

Q1 UPDATE

3.1 Improve performance by striving towards operational excellence and a focus on continuous quality improvement.

 

A minimum of 2 organization-wide quality improvement activities will occur annually through to

2021.

Four corporate level quality improvement activities have been identified for 2018 and are underway, including: maintaining the risk registry and mitigation plans, continuing to improve our planning approach for 2019, developing corporate quality improvement plans, and creating standard procedure for the meeting AODA requirements.

3.2 Increase our readiness to adapt to internal and external factors through effective change management practices.

100% of the WECHU staff are trained in change management strategies by 2021.

Exploring options related to ongoing change management training.

3.3 Enhance our understanding and monitoring efforts of identified corporate risks to embrace opportunities, create flexibility, and preserve organizational assets.

 

100% of corporate risks identified as high have mitigation strategies developed and implemented by 2021

Working with leads from LT, the risk registry has been significantly updated through the PSI department. All high risks, and many moderate risks, have identified “actions required” to be implemented moving forward. The risk registry will soon include Key Risk Indicators (KRI’s), each with a reporting schedule. An information report was provided to the Board of Health in April 2018 to apprise them of these updates.

3.4 Improve organizational culture through people development and employee engagement strategies.

80% of the WECHU staff have a positive view of organizational culture by 2021.

Employee engagement strategy implementation begins in Q2.

Evidence-Based Public Health Practice

OBJECTIVE

GOAL

Q1 UPDATE

4.1 Establish organizational supports for client-centered service strategies.

 

100% of departments collect corporate level client satisfaction data by 2021.

Data collection and analysis of internal client experience survey has continued, with quarterly reporting now for the IT and Facilities Departments. The research protocol for the external facing department client experience survey has been renewed until 2021 through the University of Windsor’s Research Ethics Board. Client experience in other departments is yet to be planned out.

4.2 Develop and implement a framework to support healthy public policy.

 

100% of the Ontario Public Health Standards (OPHS) 2018 program areas have at least one activity focused on healthy public policy development by 2021.

The Public Policy Toolkit and Guidance Document is complete. It will be launched in Q2 with training provided for staff and management. There were two activities focused on healthy public policy completed in Q1 under the Chronic Disease Prevention and Healthy Environments Standard. There are activities focused on healthy public policy in progress under the Chronic Diseases Prevention and Well-being Standard, Substance Use and Injury Prevention Standard, and Healthy Environments Standard.

4.3 Enhance local data collection efforts and analysis to support knowledge exchange both internally and externally.

100% of the OPHS population health assessment requirements (7), the research, knowledge exchange, and communication requirements (3) and the related protocols are being addressed by 2021.

100% of the population health assessment requirements (7), the research, knowledge, exchange, and communication requirements (3) are being addressed by at least one work plan identified in the 2018 planning process. Moving forward, the SPC may consider incorporating the achievement of ASP objectives and indicators related to these requirements into the goal for this objective.

4.4 Develop and implement protocols that ensure all programs and services are using a health equity approach.

100% of our programs and service departments have adopted a health equity approach to an activity by 2021.

A corporate health equity strategy was developed and presented to LT. Once implemented, progress towards achieving the goal of the health equity strategy will demonstrate evidence of programs and services using health equity approaches. In addition, the 3 health equity-focused planning tools will be evaluated and a summary report prepared by the end of Q2.


View Document page

Prepared By:

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

Date:

April 10, 2018

Subject:

Strategic Plan Quarterly Report

Background

The 2017-2021 WECHU Strategic Plan allows our organization to identify key roles, priorities and directions and sets out what we plan to accomplish, how we plan to do it, and how our progress will be measured. The plan is based on four strategic priorities: Communication and Awareness, Partnerships, Organizational Development, and Evidence-Based Public Health Practice.

The plan was reviewed by the Strategic Planning Committee (SPC) at the beginning of 2018and a report provided to the WECHU Board of Health (BoH) which summarized the progress our organization made during the first year of implementation.

Current Initiatives

The Planning and Strategic Initiatives department has begun the implementation of a corporate tracking system to monitor Strategic Plan performance and to provide quarterly and annual updates to the BoH. In the first quarter of 2017, progress was made on a number of objectives. The 2018 Q1 Strategic Plan Progress Report provides updates on each objective with corresponding next steps (see appendix A).

Consultation:

The following individuals contributed to this report:

  • Kristy McBeth, Director, Knowledge Management
  • Marc Frey, Manager, Planning & Strategic Initiatives
  • Ramsey D’Souza, Manager, Epidemiology & Evaluation
  • Michael Janisse, Manager, Communications
  • 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


View Document page

Prepared By:

Communications Department

Date:

May 16, 2018

Subject:

April Media Relations Recap Report

April Media Coverage

Total Media Coverage

25

Interview Requests

19

Mentions (In the news without direct interviews)

6

April 2018 Media Relations Recap - Media Coverage

Story Source

April 2018 Media Relations Recap - Story Source

Media Coverage

Outlet

Number of Stories

AM 800

5
CBC 5

CTV

5

Windsor Star

4

Blackburn

2
St. Clair College Media Plex News

1

Watertoday.ca

1

Windsorite.ca

1

Yahoo News

1

News Release and Media Advisories

Date Type Headline Response
March 13, 2018 News Release Windsor Express, Windsor Lancers, and 2 Stories Reported St. Clair Saints Battle It Out at Sliced

2018!
2 Stories Reported
March 14, 2018 Media Advisory Windsor-Essex County Health Unit Board of Health Meeting 3 Stories Reported
March 16, 2018 News Release Windsor-Essex County Health Unit Re-Launches Living Wage Program 5 Stories Reported
March 20, 2018 News Release Grade 11 & 12 Students with Incomplete Immunization Records Suspended Today 7 Stories Reported

Links to Stories

AM 800

Publish Date

Title

April 4, 2018

Lyme Carrying Deer Ticks Found At Ojibway Prairie Complex

April 6, 2018

Health Unit Asking Parents To Brush Up On The Facts

April 20, 2018

Health Unit Want To Reintroduce Fluoride Into The Drinking Water

April 29, 2018

Radon Study Results Worrying Health Unit

April 29, 2018

Health Unit Launches Campaign For Rabies Month

Blackburn News

Publish Date

Title

April 23, 2018

Health Unit Urging Reintroducing Fluoride

April 26, 2018

Amherstburg To Begin Ki Pill Distribution

CBC News

Publish Date

Title

April 20, 2018

Windsor Health Unit Wants Fluoride Put Back Into The Water

April 25, 2018

To Drink Or Not To Drink? Fluoride Debate Set To Hit Council, Again

April 26, 2018

Potassium Iodide Pills To Be Distributed To Amherstburg Residents In Fermi Nuclear Plant's 'Primary Zone'

CTV News

Publish Date

Title

April 8, 2018

'Deliverbae' Delivers

April 25, 2018

Amherstburg Residents Near Nuclear Plant To Get Anti-Radiation Pills

April 29, 2018

Health Unit Launches Campaign For Rabies Month

May 4, 2018

Essex County Dentists Want Fluoride Back In Drinking Water

Watertoday.ca

Publish Date

Title

April 25, 2018

How Health Units Across the Province Are Coping

Windsor Star

Publish Date

Title

April 4, 2018

Deer Ticks That Can Carry Lyme Disease Found At Ojibway

April 4, 2018

Use Of Vapes On The Rise By High School Students

April 19, 2018

Province Narrows Down Potential Sites For Cannabis Retail Store In Windsor

April 20, 2018

Health Unit's Oral Healthcare Plan Calls For Return Of Fluoridation

Windsorite.ca

Publish Date

Title

April 26, 2018

Potassium Iodide (Ki) Pill Distribution To Start In Amherstburg

Yahoo News

Publish Date

Title

April 20, 2018

Windsor Health Unit Wants Fluoride Put Back Into The Water

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


View Document page

Board Members Present:

Joe Bachetti, Mark Carrick, Dr. Deborah Kane, Judy Lund, Bill Marra, Gary McNamara, Richard Meloche, Dr. Carlin Miller, Hilary Payne, John Scott, Ed Sleiman, Michelle Watters

Board Member Regrets:

Gord Queen, Dr. Ken Blanchette

Administration Present:

Dr. Wajid Ahmed, Nicole Dupuis, Lorie Gregg, Theresa Marentette, Kristy McBeth, Dan Sibley, Konrad Farrugia (Recorder)

Administration Regrets:

None.

Introductions: 

L. Gregg introduced the Amy Wolters as the new Manager of Finance.
N. Dupuis introduced Kelly Farrugia as the new Co-Manager of Healthy Schools

  1. Call to Order
    The meeting was called to order at 4:03 p.m.
  2. Agenda Approval
    It was moved
    That the agenda be approved
    CARRIED
  3. Announcement of Conflicts of Interest – None.
  4. Approval of Minutes
    1. Regular Board Meeting: March 15, 2018.
      It was moved
      That the minutes be approved.
      CARRIED
  5. Presentations
    1. 1st Quarter Financial Results

      L. Gregg presented 1st quarter financial results to the Board of Health. The cost-shared financial results were reviewed in order to present a more wholesome view of WECHU’s programs. Specifically, L. Gregg provided explanations for variances related to Association and Membership Fees, Program Supplies, Publications, Taxes, and Insurance IT Licensing Fees, and Property Taxes.

      An overview of the 1st quarter financial results was also presented for the Healthy Babies
      Healthy Children Program and the Nurse Practitioner Program. It was noted that in the 2018 budget submission to the Ministry of Children and Youth Services included a one time grant request to cover forecasted overage in salaries and benefits or the Pre/Postnatal Nurse Practitioner Program.

      The budgeted amount for the Healthy Smiles Ontario program was discussed. An enhancement of $120,900 was received. There are items in the base funding that have not yet been operationalized.

  6. Consent Agenda
    1. Information Reports
      1. 1st Quarter Financial Results
      2. 1st Quarter Update – Strategic Plan
    2. Recommendation Reports
      1. Provincial Election Priorities

        Whereas, tobacco use remains the number one preventable cause of death in Ontario; and

        Whereas, oral diseases, including dental caries and periodontal disease, are among the most prevalent and preventable chronic diseases; and

        Whereas, Ontario’s universal health care system does not include dental care for adults and nearly 1 in 3 Windsor-Essex County residents report having no form of dental insurance coverage; and

        Whereas, rates of opioid use and opioid-related harms continue to increase in Windsor-Essex County and across the province; and

        Whereas, cannabis legalization presents a number of public health concerns and a comprehensive education, harm reduction, and regulatory framework would help to reduce risks associated with youth; and

        Whereas, 1 in 5 Canadians struggle with mental health issues and illness every year and the
        difference in funding between mental and physical health has led to a dearth of services available to those struggling with mental health issues and illness; and

        Now therefore be it resolved that the Windsor-Essex County Board of Health supports the Association of Local Public Health Agency’s five areas of provincial election priorities; and

        FURTHER THAT, the Windsor-Essex County Board of Health supports a provincial focus on the Tobacco Endgame, tobacco usage rate of less than 5% in Ontario by 2035, and a shift from tobacco “control” to a future that is free from commercial tobacco; and

        FURTHER THAT, the Windsor-Essex County Board of Health encourages the Ontario government to fund a, comprehensive, multifaceted action plan for the Ontario Opioid Strategy, including education, harm reduction and treatment. The action plan should include targets, deliverables, timelines and an evaluation component and be supported by Public Health Units and key community stakeholders; and

        FURTHER THAT, the Windsor-Essex County Board of Health encourages the provincial government to adopt and fund a comprehensive public health approach to cannabis legalization, regulation, restriction of access, education and harm reduction in Ontario. This approach should align the regulatory restrictions on cannabis with those on tobacco, as provided in the Smoke-Free Ontario Act; and

        FURTHER THAT, the Windsor-Essex County Board of Health supports CAMH’s request for the provincial government to address ongoing financial support inequities and “Erase the Difference” between physical and mental health funding in the Ontario.

        It was moved
        That the resolution be supported.
        CARRIED

    3. Media Coverage Summary Report
      It was moved
      That the consent agenda be received.
      CARRIED
  7. Business Arising
    1. Oral Health Presentation

      Dr. Ahmed updated the Board of Health on the City of Windsor council meeting that members of the Health Unit attended on May 7th. The Health Unit was on the agenda to present the Oral Health report. However, a City of Windsor councilor made a motion to have the Health Unit return to City of Windsor council after the provincial election takes place. The Health Unit is scheduled to bring forward the Oral Health report to Essex County council on June 6th.

      It was asked what the provincial government is doing to mandate fluoride throughout the
      province. N. Dupuis stated that the Board of Health submitted a letter to the province requesting that the province enact fluoride province-wide.

      G. McNamara, board chair, recommended that a letter in support of fluoride be issued to the current provincial political candidates. A letter to alPHa (Association of Local Public Health Agencies) should also be considered.

    2. KI Distribution Update

      Distribution of the KI pills in the Town of Amherstburg has started. Approximately 146 KI packages have been collected by Amherstburg residents. There are still a significant number of residents who have not yet picked up their KI package. Fire fighters in Amherstburg have now started going door-to-door to distribute KI packages. Once distribution in the primary zone has been completed distribution in the secondary zone will commence. Funding for the KI initiative has been secured until March 2019. G. McNamara thanked Dr. Ahmed and the now retired Deputy Fire Chief of Amherstburg Lee Tome for bringing this initiative forward.

  8. Board Correspondence – Circulated
  9. New Business
    1. Budget Update

      T. Marentette mentioned that the budget for 2018 was received from the Ministry of Health and Long-Term Care. T. Marentette notified all Board of Health members via email in advance of the board meeting. An increase of approximately $400k was received to the base funding for the cost-shared programs and $120k increase for Healthy Smiles Ontario. Five of ten one-time funding requests were approved. The one-time requests included the following:

      • Public Disclosure System
      • Potassium Iodide Distribution Program
      • Needle Exchange Program
      • Public Health Inspector Practicum Program
      • Vector-Borne Diseases Program: Enhanced Mosquito Surveillance

      Also, the Health Unit’s application for the Capital Project was pending approval. The funding for the Capital Project has now been received.

      T. Marentette mentioned that the budget submission is now tied to the Annual Service Plans. T. Marentette stated that the Health Unit did a great job articulating its needs to the Ministry of Health and Long-Term Care. The Health Unit remains underfunded yet continues to deliver great services.

    2. alPHa AGM/Conference – June 10-12, 2018

      T. Marentette mentioned that the alpha Annual General Meeting & Conference will be taking place in Toronto on July 10th-12th this year. An email went out to board members earlier. Any board member interested in attending should contact WECHU Administration. Currently, one board member has expressed interest and will be attending.

  10. Other Board of Health Resolutions/Letters – Circulated
  11. Committee of the Whole (CLOSED SESSION, in accordance with Section 239 of the Municipal Act)
    It was moved
    That the Board move into Committee of the Whole at 5:02 p.m.
    CARRIED
    It was moved
    That the Board move out of Committee of the While at 5:02 p.m.
    CARRIED
  12. Next Meeting: At the Call of the Chair, or May 17th in Windsor, Ontario
  13. Adjournment
    The meeting adjourned at 5:03 pm.

RECORDING SECRETARY:

SUBMITTED BY:

APPROVED BY:


View Document page

Issue

The upcoming provincial election presents the opportunity to promote the endorsement of healthy public policies to key stakeholders vying for seats in Ontario’s Legislative Assembly. The Association of Local Public Health Agencies (alPHa) has released a set of provincial election priorities, spanning across numerous public health topic areas, to call on candidates in the 2018 provincial election to commit their support for a healthier Ontario through a strong local public health system.  These priorities were previously shared with provincial party leaders in December of 2017. The promotion of these priorities is an important step in continuing to advance the profile of public health issues.  Topical public health issues which would benefit from increased regulation, funding, or renewed attention include, tobacco, oral health, opioids, cannabis, and mental health.

In addition, The Centre for Addiction and Mental Health (CAMH) has called upon the three main political parties to “Erase the Difference” in funding between physical health and mental health/addictions. This proposal, in recognition that mental health and addiction agencies currently receive only 6.5% of Ontario’s health budget, is supported by the disproportionately high rates of mental health issues or mental illness as well as the relative burden of these conditions.

Background

The Association of Local Public Health Agencies have outlined five key areas of election policy priorities that focus on improving Ontarians’ health:

  • Tobacco Endgame in Ontario
  • Oral Health for Adults in Ontario
  • Universal Pharmacare Program
  • Public Health Approach to Cannabis in Ontario
  • Opioid Strategy Action Plan for Ontario

Tobacco

Tobacco remains the leading cause of preventable death and illness in Ontario with approximately 36 deaths per day as a result of tobacco use or related conditions. As one of the primary causes of lung disease, heart disease, lung cancer and many other illnesses there is growing support in Canada and globally for a tobacco endgame, with the adoption of endgame targets in Ireland, Scotland, Finland, and New Zealand. A Steering Committee for Canada’s Tobacco Endgame was convened in 2015 and identified an endgame goal of less than 5% tobacco use by 2035.

Oral Health

According to the World Health Organization (WHO), oral health is essential to general health and quality of life. In spite of this, many low income, and middle income Canadians suffer from pain, discomfort, disability, and loss of opportunity because of poor oral health. With under one-third of Ontario workers without employer dental benefits, and 13.9% of the Ontario population living on a low income, there exist significant and impactful financial barriers which prevent many marginalized and low-income adults from accessing preventive and acute dental care. Many acute dental complications which result in emergency department visits are avoidable with timely preventive care such as cleanings and fluoride treatments as well as fillings and extractions. In order to address the underlying causes of the disproportionate number of low-income adults and seniors without access to preventative dental treatments, we recommend that the Ontario government commit to a provincially funded oral health program for low-income adults and seniors in Ontario before 2025.

Opioids

Ontario has one of the highest prescription rates in Canada for opioids, a class of drugs that includes pain relievers such as fentanyl, morphine and OxyContin.  While these drugs can be an effective part of pain management for some medically supervised patients, opioids can be harmful and result in addiction and overdoses. Over the past 13 years, the province of Ontario has experience increasing opioid overdose fatalities and opioids have risen to become the third leading cause of accidental death in the province. In June 2016, Ontario made naloxone, a medicine designed to quickly reverse the effects of opioid overdose, available without a prescription at pharmacies across the province. In October of the same year, Ontario announced its Opioid Strategy to prevent opioid addiction and overdose. Recognizing that lives can be saved through a coordinated prevention, treatment, harm reduction, and enforcement response, many health regions, including Windsor-Essex County, have adopted this four pillar approach in their communities.

Cannabis

Cannabis use carries health risks, including problems with brain functioning (e.g., drug-impaired driving), respiratory problems, and dependence. Canadian youth are among the top users of cannabis in the developed world. In April 2017, the federal government introduced Bill C-45, An Act respecting cannabis and to amend the Controlled Substances Act, the Criminal Act and other Acts. The Act seeks to legalize and regulate recreational cannabis in order to keep cannabis out of the hands of Canadian youth and to prevent organized crime from profiting from the illegal cannabis market.  As provinces and territories will be responsible for licensing and overseeing the distribution and sale of cannabis, there exists the opportunity to develop stringent regulations on promotions, advertising, and marketing, particularly to children and youth These policies have proven effective in tobacco control and should be applied to cannabis legalization. In addition, the government should develop a comprehensive framework to address and prevent cannabis-impaired driving. Indeed, the government should fund a public health approach to cannabis legalization including public education on: risk factors; safer consumption; and a strategy to address impaired driving; would help to mitigate concerns associated with the anticipated increased use as a result of legalization.

Mental Health (Erase the Difference)

Similar to physical health, mental health and illness can take many forms including anxiety disorders, depression/bipolar disorder, eating disorder, obsessive compulsive disorder, phobias/panic disorders, post-traumatic stress disorder, schizophrenia, and suicide. Mental health issues and mental illness affect one in five Ontarians every year however only 6.5% of Ontario’s health budget is allocated to the treatment of these conditions. Inadequate service systems and social alienation are a reality for those affected with poor mental health. A recognition of the importance and prevalence of mental illness and mental health issues warrants a reallocation of resources to help address the treatment “bottle neck”, which acts as a barrier to so many looking for help.

PROPOSED MOTION                       

Whereas, tobacco use remains the number one preventable cause of death in Ontario; and

Whereas, oral diseases, including dental caries and periodontal disease, are among the most prevalent and preventable chronic diseases; and

Whereas, Ontario’s universal health care system does not include dental care for adults and nearly 1 in 3 Windsor-Essex County residents report having no form of dental insurance coverage; and

Whereas, rates of opioid use and opioid-related harms continue to increase in Windsor-Essex County and across the province; and

Whereas, cannabis legalization presents a number of public health concerns and a comprehensive education, harm reduction, and regulatory framework would help to reduce risks associated with youth; and

Whereas, 1 in 5 Canadians struggle with mental health issues and illness every year and the difference in funding between mental and physical health has led to a dearth of services available to those struggling with mental health issues and illness; and

Now therefore be it resolved that the Windsor-Essex County Board of Health supports the Association of Local Public Health Agency’s five areas of provincial election priorities; and

FURTHER THAT, the Windsor-Essex County Board of Health supports a provincial focus on the Tobacco Endgame, tobacco usage rate of less than 5% in Ontario by 2035, and a shift from tobacco “control” to a future that is free from commercial tobacco; and

FURTHER THAT, the Windsor-Essex County Board of Health encourages the Ontario government to fund a, comprehensive, multifaceted action plan for the Ontario Opioid Strategy, including education, harm reduction and treatment.  The action plan should include targets, deliverables, timelines and an evaluation component and be supported by Public Health Units and key community stakeholders; and

FURTHER THAT, the Windsor-Essex County Board of Health encourages the provincial government to adopt and fund a comprehensive public health approach to cannabis legalization, regulation, restriction of access, education and harm reduction in Ontario. This approach should align the regulatory restrictions on cannabis with those on tobacco, as provided in the Smoke-Free Ontario Act; and

FURTHER THAT, the Windsor-Essex County Board of Health supports CAMH’s request for the provincial government to address ongoing financial support inequities and “Erase the Difference” between physical and mental health funding in the Ontario.

Approved by:

Theresa Marentette


View Document page

Issue

Approval of the annual audited financial statements for the year-ended December 31 2017 including:

  • Windsor-Essex County Health Unit (Appendix A)
  • Windsor-Essex County Health Unit Nurse Practitioner Program (Appendix B)
  • Windsor-Essex County Health Unit Healthy Babies Healthy Children Program (Appendix C)

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

Background

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

The annual financial statements audited by KPMG LLP, independent external auditors appointed by the Corporation of the City of Windsor.  On May 25th, 2018, the Audit Committee of the Windsor-Essex County Health Unit convened to review the annual financial statements and audit findings report with Administration and KPMG LLP.  The Audit Committee has recommended the financial statements for approval to the Board. KPMG LLP is prepared to issue, pending approval by the Board, an unmodified audit opinion on the annual financial statements. 

Windsor-Essex County Health Unit

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

Statement of Financial Position:

  • Accounts receivable increased $423,766 over 2016.  This increase is primarily attributed to:  i) A net increase in amounts receivable from the Province of Ontario due to timing of 2017 approvals of $217,448; ii) Increase in other receivables in the amount of $201,799 as current year’s balance included amounts outstanding from third parties for wellness services rendered.  For additional details, refer to note 3 to the annual financial statements of the Windsor-Essex County Health Unit.
  • Due to Province of Ontario increased $157,338.  This increase is attributed to the following: i) Increase in the balance outstanding relating to the 2016 settlement. In the prior year an amount remained receivable from the Ministry of Health and Long-Term Care.  This receivable balance was offset against the total amount payable to the Ministry of Health and Long-Term Care.  The Ministry subsequently cash flowed this in Q1 of 2017; ii) The 2017 settlement amount of $67,898.  This amount relates to 100% Related Program funding and 100% funded One-time business case funding that remain unspent at the settlement date. Currently the 2016 settlement is under review.  Once the review is concluded, the Ministry of Health and Long-Term Care will issue a settlement letter and claw back funding during the remainder of 2018.  The 2017 settlement is due to the Ministry of Health and Long-Term Care May 31, 2017.  The timing of the review of that settlement is unknown.   For additional details refer to note 4 to the annual financial statements of the Windsor-Essex County Health Unit.
  • Due to Municipalities increased $561,872. This net increase is attributed to the following:  i) Repayment of amounts outstanding to 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”) in the amount of $144,349; ii) 2017 settlement to the Obligated Municipalities in the amount of $706,221.  For additional details, refer to note 5 to the annual financial statements of the Windsor-Essex County Health Unit.
  • Tangible capital assets decreased $274,418.  This net decrease is attributed to:  i) Tangible capital asset additions of $197,409; ii) Amortization expense in the amount of $471,827.  Of the tangible capital assets acquired in the year, $106,400 were funded by the Ministry of Health and Long-Term Care using 100% Related Program funding or 100% funded One-time business cases. Refer to note 9 for additional details.

Statement of Operations and Accumulated Deficit:

  • Increase in Revenue from the Province of Ontario, Mandatory Programs, in the amount of $298,562. This increase is attributed to the year-over-year increase in the general program expenses.  As you recall, the Ministry of Health and Long-Term Care funds the WECHU to a maximum of 75% of admissible expenditures.  Admissible expenditures for the purposes of the Ministry of Health and Long-term Care Settlement Process is defined below:
Description Amount
Total General Program expenses at December 31, 2017 $18,518,025
Less:  Non-admissible expenses (471,827)
Less: Change in Employee Future Benefits Liability (24,296)
Less: Other Accounting Adjustments (25,825)
Plus: Tangible capital asset additions – Mandatory Program 91,009
  18,087,086
Less:  Offset revenue (189,851)
Total admissible expenditures $17,897,235
Ministry portion (75%) $13,422,926
Ministry approval $13,316,100
Ministry funded expenditures $13,316,100
  • Increase in General Program Expenses in the amount of $739,870 is attributed to:
    • Net increase in permanent FTEs of 2 staff funded by the Cost-Shared Program;
    • Annual increases (cost of living and grid increases) as follows:  i) ONA 2% annual; ii) CUPE 1.5% annual; iii) Non-union 2%;
    • Other employee obligations.

Windsor-Essex County Health Unit Nurse Practitioner Program

The Nurse Practitioner Program is funded by the Ministry of Children and Youth Services.  The funding supports the salaries and benefits of the nurse practitioner whose role is to assist with promoting healthy pregnancy, birth and infancy for children, improve parenting and family supports, strengthen early childhood development, learning and care. 

Windsor-Essex County Health Unit Healthy Babies Healthy Children Program

The Healthy Babies/Healthy Children Program is funded through the Ministry of Children and Youth 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. 

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

Statement of Financial Position:

  • Due from the Windsor-Essex County Health Unit:  Refer to the statement of cash flow for the decrease of $111,757 from December 31, 2016.
  • Accounts payable:  The decline in accounts payable in the amount of $50,487.  At December 31, 2015 $40,800 was payable to a third party provider for scanning services of client files.
  • Due to Ministry of Children and Youth Services in the amount of $64,399.  The net decrease was as a result of the following:  1.  2015 and 2015 settlements being reclaimed in 2017 amounting to $32,721. 2.  Settlement for 2017 in the amount of $27,793; 3.  Reduction of other amounts owing from pre-2000 settlements of $59,471.

Statement of Operations and Accumulated Deficit:

  • Program Supplies:  The decrease in program supplies in the amount of $41,913.  As indicated above under the Accounts Payable caption a scanning project was undertaken in 2016 to archive client files with significant retention periods.  The project was substantially concluded in 2016.
  • Purchased Services:  The increase in purchased services in the amount of $15,323 resulting from an increase in translation services from 2016. 

Proposed Motion

Whereas, at its May 25th, 2018, meeting of the Audit Committee reviewed the 2017 annual financial statements and recommended them to the Board for the Board’s approval,

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

  • Windsor-Essex County Health Unit 2017 audited annual financial statements
  • Windsor-Essex County Health Unit 2017 Nurse Practitioner Program financial statements
  • Windsor-Essex County Health Unit 2017 Healthy Babies/Healthy Children Program financial statements

View Document page

April 19, 2018

  1. Call to Order
  2. Agenda Approval
  3. Announcement of Conflict of Interest
  4. Approval of Minutes
    1. Regular Board Meeting:  March 15, 2018
  5. Presentation –  Radon Study (P. Wong)
    Oral Health (Dr. Ahmed)
  6. Consent Agenda
    1. Information Reports
      1. Radon (T. Marentette)
      2. Risk Management (L. Gregg/K. McBeth)
      3. Quarterly Planning Update (K. McBeth)
      4. Seasonal Housing (T. Marentette)
    2. Recommendation Reports
      1. Reserves (T. Marentette/L. Gregg)
      2. Oral Health (N. Dupuis)
    3. Media Coverage Summary Report
  7. Business Arising
  8. Board Correspondence - Circulated
  9. New Business
    1. Board of Health alPHa Fitness Challenge (K. McBeth)
  10. Other Board of Health Resolutions/Letters - Circulated
  11. Committee of the Whole (Closed Session in accordance with Section 239 of the Municipal Act)
  12. Next Meeting: At the Call of the Chair, or May 17, 2018, Windsor
  13. Adjournment

View Document page

Prepared By:

Communications Department

Date:

April 4, 2018

Subject:

March Media Relations Recap Report

March Media Coverage

Total Media Coverage

40

Interview Requests

31

Mentions (In the news without direct interviews)

9

March Media Relations Recap - Media Coverage

Breakdown of Top Stories

Topic

Requests for Interviews

Mentions in the News (no interviews)

CHC Smoke-Free Housing Policy

2

1

Dental Health Coverage/NDP

1

0

Dental Health Survey

1

0

ER Trips For Kids With Severe Allergies

1

0

Flu Update

2

1

Health Needs/Town Of Amherstburg

1

0

Living Wage

3

2

Measles

2

0

Online Nutrition Challenge

1

0

Opioids

3

1

Sliced

1

1

Student Immunizations and Suspensions

11

2

Ticks

1

1

Vaping and Student Health

1

0

March Media Relations Recap - Story Source

Media Coverage

Outlet

Number of Stories

CBC

10

AM 800

7

CTV

7

Windsor Star

6

Blackburn

4

Windsorite.ca

3

Advocator.ca

1

Windsor Business Magazine

1

Yahoo News

1

News Release and Media Advisories

Date Type Headline Response
March 13, 2018 News Release Windsor Express, Windsor Lancers, and 2 Stories Reported St. Clair Saints Battle It Out at Sliced

2018!
2 Stories Reported
March 14, 2018 Media Advisory Windsor-Essex County Health Unit Board of Health Meeting 3 Stories Reported
March 16, 2018 News Release Windsor-Essex County Health Unit Re-Launches Living Wage Program 5 Stories Reported
March 20, 2018 News Release Grade 11 & 12 Students with Incomplete Immunization Records Suspended Today 7 Stories Reported

Links to Stories

AM 800

Publish Date

Story Link

March 7, 2018

Sad But Not Surprised: Local Reaction To Latest Stats On Opioid-Related Deaths

March 16, 2018

Living Wage In Windsor-Essex Is $14.81/Hour According To Local Health Unit

March 19, 2018

Health Unit Put Focus On Nutrition With Sliced Competition

March 20, 2018

388 High School Students Suspended In Windsor-Essex

March 27, 2018

Suspensions Down Due To Incomplete Immunization Records

Advocator.ca

Publish Date

Story Link

March 31, 2018

Deer Ticks Found at Ojibway Prairie Complex. Do They Carry Lyme Disease?

Blackburn News

Publish Date

Story Link

March 13, 2018

Over 800 Students Face Suspension Next Week

March 20, 2018

Nearly 400 Students Suspended

March 23, 2018

Flu Season Not Over Yet in Windsor-Essex

CBC News

Publish Date

Story Link

March 12, 2018

Flu has already caused 18 deaths and 31 outbreaks, and the season is not over yet

March 15, 2018

Windsor Essex Community Housing Corporation implements smoke-free policy

March 16, 2018

Health officials say $14.81/hr is what it costs to live comfortably in Windsor-Essex

March 16, 2018

Immunization deadline for grade 11 and students is Monday

March 16, 2018

Detroit measles exposure prompts health unit to remind people to be vaccinated

March 20, 2018

Almost 400 students suspended over incomplete immunization records

March 29, 2018

Ticks that can transmit Lyme disease found at Ojibway Prairie Complex

CTV News

Publish Date

Story Link

March 8, 2018

Opioid-related deaths up across province in 2017, including Windsor-Essex

March 13, 2018

Health Unit reminds residents of online immunization reporting tool

March 16, 2018

Health unit says living wage in Windsor-Essex is $14.81/hour

March 19, 2018

Suspensions expected as immunization deadline looms for high school students

Windsor Star

Publish Date

Story Link

March 2, 2018

Social housing starts forbidding smoking in units, with little protest

March 6, 2018

Guidelines released to combat opioid epidemic call on doctors, hospitals to join fight

March 15, 2018

Travellers at Detroit airport might have been exposed to the measles

March 15, 2018

Health unit calculates 2018 local living wage at $14.81 an hour

Windsorite.ca

Publish Date

Story Link

March 16, 2018

Health Unit Re-Launches Living Wage Program

March 17, 2018

Photos: Annual Sliced Competition Cooks Up A Storm At Devonshire Mall

March 20, 2018

Students With Incomplete Immunization Records Suspended Today

Yahoo News

Publish Date

Story Link

March 15, 2018

Windsor Essex Community Housing Corporation implements smoke-free policy

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


View Document page

Prepared By:

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

Date:

March 27, 2018

Subject:

Quarterly Planning Report

Background

In 2017, the WECHU introduced a new electronic planning system using project management principles to help us more closely align our planning strategies with operational activities. This system was developed with key public health program and service requirements in mind, and focused on embedding evidence-based approaches, health equity, privacy, ethics, and our strategic priorities into departmental work plans. Shortly after development, training, and implementation of the WECHU’s new planning system, the Ministry of Health and Long Term Care (MOHLTC) officially released the modernized Ontario Public Health Standards (OPHS) 2018.

With the introduction of the modernized standards, the MOHLTC included the requirement to complete an Annual Service Plan (ASP) in conjunction with the 2018 budget submission.  The ASP describes the programs and services that the WECHU plans to deliver based on provincial public health requirements, local needs, and budgets at the program level, and includes self-generated objectives and measures for monitoring program performance.

Following the completion of the 2018 planning cycle and the submission of the first ASP, the Planning and Strategic Initiatives (PSI) Department undertook an assessment of both processes and templates in order understand the challenges and successes of each process and to look for ways to better align our planning approach with the MOHLTC requirements.  Planning staff and managers took part in a multi-step feedback process, and the ASP was reviewed by the PSI department to compare its content to 2018 work plans previously completed by departments. This information will be used to inform the development of a new reporting structure for 2018 and beyond.

Current Initiatives

2018 Reporting Structure

The primary goals of the WECHU’s reporting structure (including both operational and strategic reporting) is to ensure ongoing quality improvement through monitoring and to provide organizational insight to the Leadership Team and the WECHU BoH to facilitate evidence driven decision making. A coordinated and consistent planning and reporting structure also provides timely identification of emerging issues and program/service gaps, and supports the values, priorities, and objectives of the WECHU’s strategic plan.

Over the next quarter, an updated reporting structure, reflective of new public health requirements, will be developed to monitor the objectives and indicators identified in the WECHU’s ASP, and to support the implementation of operational work plans as required.

Operational Planning/ASP Alignment

Based on the ASP and work plan comparison as well as feedback from the 2017 cycle, PSI staff will work with managers and departments to align the 2018 organizational planning outcomes with the MOHLTC requirements in order to maximize efficiency and ensure consistency across the organization.

Consultation

The following individuals contributed to this report:

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

Approved by:

Theresa Marentette                       


View Document page

Prepared By:

Phil Wong, Manager, Environmental Health Department

Mike Tudor, Manager, Environmental Health Department

Date:

April 19, 2018

Subject:

Seasonal Housing and Tenant Complaint Processes

Background

The Environmental Health Department’s (EHD) role can be divided into two distinct activities when discussing housing in the City of Windsor and Essex County. These activities include the inspection and assessment of boarding and lodging homes, which include the seasonal housing accommodation, and the investigation of tenant complaints. Both activities require high levels of collaboration with local municipalities, as well as provincial and federal agencies. All activities conducted by the EHD in relation to housing is mandated by Part III of the Health Protection and Promotion Act (HPPA) and the Ontario Public Health Standards: Requirements for Programs, Services and Accountability 2018 (OPHS) and its related protocols and guidelines.

Windsor and Essex County (WEC) leads the province of Ontario when it comes to agricultural activities, with a large number of greenhouses producing crops such as tomatoes and cucumbers. The greenhouse farm operations allow for high yields year round which is unique to this region.  Many of the seasonal agricultural workforce are offshore workers from Mexico and Caribbean countries. This large number of offshore workers adds to the vibrant multicultural communities in towns such as Leamington and Kingsville. It is essential from a public health perspective that seasonal workers are provided with a good standard of living and access to public health programs.

Currently, there are approximately 650 seasonal accommodations throughout WEC that are inspected annually. In 2017 Public Health Inspectors (PHIs) conducted close to 900 inspections, including re-inspections for the approval of these accommodations used to house foreign workers, as well as the investigation of health hazard complaints in these premises. Due to the steady growth of the agricultural sector in the last three years the number of staff hours dedicated to  seasonal housing accommodation inspections has almost doubled. The EHD works with Services Canada and the Foreign Agricultural Resource Management Services (FARMS) to approve all seasonal accommodations for occupancy. PHIs also work with local fire, building, and by-law enforcement to address issues that are associated with seasonal worker accommodations. The inspection and complaint process requires a great deal of coordination as multiple government agencies are involved with the entire process including the Mexican and Jamaican Consulates.

All complaints of potential health hazards are followed up by the EHD. All complaint investigations are required to be initiated within 24 hours and are addressed according to the Health Hazard Protocol 2018 and Health Protection and Promotion Act. The PHI investigating the complaint will collaborate with the local municipal departments that would have the primary role to deal with the identified hazard. This may include joint inspections with local building, fire, by-law enforcement, or public works departments. In 2017 PHIs followed up on over 1000 complaints in WEC of which 170 were related to residential settings. These complaints include but were not limited to mould, sewage, heating, pest, indoor air quality, hoarding, lack of potable water, etc.

Current Initiatives

The Health Hazard Response Protocol 2018 provides direction on the investigation, assessment, and management of mitigation strategies to prevent or reduce the burden of illness from potential, suspected, and/or identified health hazards. The protocol identifies facilities as a place with “public access and/or that serve priority or vulnerable populations in situations where they may present an elevated risk of exposure to health hazards to the public or priority populations. These facilities may include, but are not limited to ice arenas, seasonal farm workers’ housing, schools, childcare centres and other childcare facilities, shelters, and other facilities that may serve priority populations.

The EHD currently provides education, conducts inspections, surveillance, and monitoring, and has a 24/7 on call system in place to respond to all notifications of potential health hazards in the community. A response to all calls received will be initiated within 24 hours of the notification. It is a requirement under the OPHS that the EHD continues to work and collaborate with local municipalities and other community partners to develop effective strategies to reduce the exposures to health hazards.

Approved by:

Theresa Marentette                       


View Document page

Prepared By:

Karen Lukic, Health Promotion Specialist, Environmental Health Department

Date:

April 19, 2018

Subject:

Radon: Know Your Level Project

Background

Radon is a gas that is produced when naturally occurring uranium, found in soil and rock, decays. It can’t be seen, smelled or tasted and is in nearly every home across Canada. When radon gets into buildings and homes, it can accumulate to levels high enough to cause an increase in lung cancer risk. According to Health Canada (2014), long- term exposure to radon is the second leading cause of lung cancer after smoking and the primary cause for non-smokers. Health Canada has set the Canadian guideline for radon levels in the home at 200 Bq/m3. It is recommended that if homes test at 200 Bq/m3 or higher, they should be remediated to reduce levels to as low as physically possible.

Unfortunately, many homeowners are not aware of radon or the level of radon exposure within their homes. A local telephone based survey conducted by the Windsor- Essex County Health Unit (WECHU) found the majority of respondents (62.3%) had no plans to have their dwelling tested with 17.0% of them believing radon testing is not important and there is no risk. In addition, 7.5% did not know how to test their home (RRFSS, 2017). In a cross- Canada study released by Health Canada in 2012, 13.8% of homes tested in Windsor- Essex County (WEC) had radon levels at or above 200 Bq/m3 (Health Canada, 2012). These numbers were comparable to the internal 2015/2016 and 2016/2017 radon studies completed by the WECHU which found 12.2% and 14.6% of homes respectively had levels above 200 Bq/m3 (WECHU, 2016 and 2017). In comparison, based on the Health Canada study in 2012, the proportion of homes in Lambton and Chatham-Kent counties with levels above 200 Bq/m3 were 8.5% and 18.4% respectively.

Public awareness initiatives such as the Radon: Know Your Level Project are put in place to address potential environmental exposures of health hazards to the general public such as radon gas. The WECHU’s Environmental Health Department (EHD) coordinates the monitoring, and surveillance of environmental exposures of public health significance and provides the public with education and mitigation options. These activities are required in the Health Hazard Response Protocol, 2018 and Healthy Environments and Climate Change Guideline, 2018.

The "Radon: Know Your Level" Project

The Radon: Know Your Level Project is a 3-year research study led by the EHD which began in 2015. The goals of the project are to increase awareness of radon and its association with lung cancer; provide the public with radon reduction resources on how to test and reduce the amount of radon in their homes and; determine areas in WEC with higher average indoor radon concentrations and home characteristics associated with higher risk.

During each year of this study, approximately 1000 local homeowners received a free radon testing kit for their homes. Promotion and test kit distribution was strategically implemented during the month of November which is Lung Cancer Awareness month and Radon promotion month in Canada. The kits were distributed equally across the WEC communities and to date, almost 3000 homes in Windsor-Essex have been tested for radon. This project was divided into two phases for each of the study years.

Phase 1

Promotion and Education

Begins in October with a press release announcing the launch of the study and application process, social media posts (Facebook and Twitter) that provide information about radon and promotion of the study, development of WECHU website articles, and posters are distributed throughout the community to notify the public. The WECHU utilizes different avenues to educate homeowners, targeting members of the community through online, in-person and telephone. 

Kit Distribution

The general public was invited to apply to be part of the study by completing a survey that determines eligibility and collects information about the applicant and their home. Phase 1 ends with the distribution of the radon kits to eligible applicants and the beginning of the approximate 3-month testing phase.

Phase 2

Kit Retrieval

This phase begins in March and involves the collection of test kits from study participants. Collected kits are shipped to an accredited laboratory for testing. Results are received within 6-8 weeks of the lab receiving the kits and relayed to the homeowner.

Data Analysis

All data is collected, processed and analyzed by the WECHU team to look for trends to report to the public. All data collected is used to inform future program planning. The data supports the development of strategies that further raises public awareness and reduces environmental health risks in our community.

Highlights of the 2016/2017 Study Report

  • 14.6% of homes in WEC had radon levels above 200 Bq/m³ (compared to 12.2% in the 2015/2016 study).
  • Essex County had a significantly greater proportion of homes with levels above the Canadian guideline (22%)  compared to the City of Windsor (8%).
  • The average indoor radon level for WEC from the 2016/2017 study results was 106 Bq/m³.
  • Amherstburg, Kingsville, Leamington, and LaSalle had average concentrations 20 to 33 Bq/m3 higher than the WEC average.
  • Newer builds (2011 or after) had the highest average indoor radon concentrations.
  • Homes with two levels (i.e., basement and main floor) had 21% higher average radon levels compared to one-level houses with a crawl space partially or completely under the house.

Current Initiatives

The final year of the Radon: Know Your Level project (2017/2018 Study) is nearing completion. Phase 2 was recently completed in March of 2018.  A total of 832 kits were received from the 947 that were distributed for a response rate of 88%.  A report with results from the 2017/2018 study and a final report summarizing all 3 years of the study will be completed in 4th quarter 2018.

Consultation:

The following individuals contributed to this report:

  • Theresa Marentette, Acting CEO and Director, Health Protection Division
  • Phil Wong, Manager, Environmental Health Department
  • Mike Tudor, Manager, Environmental Health Department
  • Saamir Pasha, Epidemiologist, Epidemiology and Evaluation Department

Data Sources:

Approved by:

Theresa Marentette


View Document page

Prepared By:

Dave Jansen, Performance Improvement & Accountability Coordinator (PIAC), Planning & Strategic Initiatives Department

Date:

March 19, 2018

Subject:

Risk Management

Background

In September 2017, a Risk Management Framework was presented to the Windsor-Essex County Board of Health along with a draft risk registry. In this framework, the Planning and Strategic Initiatives (PSI) Department was tasked to maintain the corporate risk registry and construct a plan for corporate risk reporting.

Current Initiatives

To begin the transition of risk management to PSI, the WECHU’s risk management framework was compared to the Association of Local Public Health Agencies’ (alPHa) three-phase implementation approach. This comparison highlighted the progress made to date and the actions necessary to develop risk preparedness. The alPHa documentation suggests that their approach should take approximately three years, with one year assigned to each phase. To summarize this comparison, the WECHU has completed most of the first phase actions, with some updates currently underway. The WECHU is now pursuing a number of items in the second phase, including the creation of a risk management review cycle, complete with key risk indicators, reporting mechanisms, and reporting timelines.       

The second phase of the implementation approach includes a structured and comprehensive risk registry. As such, the draft risk registry approved in September 2017 has been updated to allow for a more robust assessment of risk. Based on resources provided through alPHa, and using the Ontario Public Service Risk Framework, the risk registry was updated as follows:

Risk Identification

Many risks and their consequences were reshaped to better express the uncertainties each risk category brings. With these updates, the corporate risk registry was reduced to 29 risks.


Inherent Risk Assessment

This section still assesses the gross risk, or risk before controls. Each risk’s likelihood and impact are assessed on a scale of one to three, and the inherent risk score is a product of the two.


Controls

This section indicates the efforts we currently have in place to prevent, detect, or correct the risk.


Residual Risk Assessment

This new section measures exposure, that being the level of risk after evaluating the effectiveness of controls. If the control was preventative, the likelihood was reduced. If the controls are detective or corrective, the impact was reduced. The residual risk score is then the product of the two.

If that new score exceeds our risk tolerance or risk appetite, further mitigation actions were identified.


Risk Ownership

Each risk now identifies three separate ownership roles. First is the accountable person, who may approve or veto decisions regarding each risk. Second is the risk owner, who is responsible for the management of that risk. Third is the control owner, who ensures that the control strategies are appropriate and effective.


Risk Monitoring

This section will help monitor the status of risks and action plans, and measure the effectiveness of controls. Key Risk Indicators (KRI’s) will be developed in the near future along with specific timelines for each. Updates to the registry will be made using this data.


The following table provides two separate examples pulled from the updated risk registry.

Section

Subsection

Example A

Example B

Risk Identification

Risk ID

SDO1

F1

Risk

Program Planning. WECHU may be at risk of programs and services not being planned to address the needs of our community or public health requirements.

Funding. WECHU may be at risk that funding uncertainties will hamper the financial planning, monitoring, and decision making processes.

Consequences

  • Inability to meet the requirements of the Ontario Public Health Standards (2018).
  • Staff time and resources gathered through data collection and knowledge exchange wasted or not being used effectively.
  • Increased health disparity/inequity in Windsor-Essex.
  • Inability to satisfy the WECHU's objectives (Strategic and Operational).
  • Inability to meet the requirements of the OPHS.
  • Cost reduction measures (i.e. headcount reductions; prioritization of expenditures) and resulting impact on staff morale.
  • If late approval or approval in excess of budget, lost opportunities if the WECHU is unable to act on plans.
  • Organization’s reputation is at risk.

Inherent Risk Assessment

Likelihood (L)

2

3

Impact (I)

3

3

Score (L x I)

6

9

Controls

Control Type

Preventative & Corrective

Detective

Control Strategy

  • Annual Service Plan submitted to MOHLTC
  • WECHU Operational and Departmental Plans. 
  • Departmental and corporate planning support from Planning and Strategic Initiatives Department (PSI).
  • Monthly variance analysis comparing budget to actual financial results reviewed by Leadership Team (LT) and Board of Health (BoH).
  • Responsible budget process that balances finite resources with program/departmental priorities.
  • Identification of priorities (i.e. contract positions, operating expenditures) to be strategic with budget/planning reallocation when positive budget variances are realized.
  • Forecasting of expenditures on a quarterly basis (internal).

Residual Risk Assessment

Likelihood (L)

1

3

Impact (I)

2

2

Score (L x I)

2

6

Action Required

  • Continually review and update planning processes and procedures to meet changing public health requirements and organizational needs.
  • Expanded variance analysis to provide budget to actual, budget to forecast, and year-over-year variance analysis.
  • Evaluation of budget (process and quality).

 

Ownership

Accountable

CEO

CEO

 

Risk Owner

Director,

Knowledge Management

 

Director,

Corporate Services

Control Owner

Director,

Knowledge Management

Manager,

Accounting & Financial Reporting

Risk Monitoring

KRI’s

TBD

TBD

Reporting Period

TBD

TBD

The WECHU expects to begin the third phase of the risk management implementation approach by the end of the 2018, which will involve rolling out risk management to all operational levels.

Consultation:

The following individuals contributed to this report:

  • Lorie Gregg, Director, Corporate Services
  • Kristy McBeth, Director, Knowledge Management
  • Marc Frey, Manager, Planning & Strategic Initiatives

Approved by:

Theresa Marentette


View Document page

Board Members Present:

Joe Bachetti, Dr. Ken Blanchette, Paul Borrelli, Mark Carrick, Judy Lund, Bill Marra, Gary McNamara, Richard Meloche, Dr. Carlin Miller, Hilary Payne, Gord Queen, Ed Sleiman

Board Member Regrets:

Dr. Deborah Kane, John Scott, Michelle Watters

Administration Present:

Dr. Wajid Ahmed, Nicole Dupuis, Lorie Gregg, Theresa Marentette, Kristy McBeth, Dan Sibley, Konrad Farrugia (Recorder)

Administration Regrets: 

None.

  1. Call to Order
    The meeting was called to order at 4:05 p.m.
  2. Agenda Approval
    It was moved
    That the agenda be approved - CARRIED
  3. Announcement of Conflicts of Interest - None
  4. Approval of Minutes
    1. Regular Board Meeting: March 15, 2018.
      It was moved
      That the minutes be approved - CARRIED
  5. Presentations
    1. Radon Study

      P. Wong provided background information on radon in the Windsor-Essex County region. A three-year study on radon in Windsor-Essex has concluded. The study began in 2015. Approximately 3,000 long-term radon test kits were distributed in Windsor-Essex during this period. The 2017/2018 radon study data will soon be received and analyzed by the Windsor-Essex County Health Unit.

    2. Oral Health

      Dr. Ahmed discussed the need for good oral health in our community. Oral health data representing children in JK, SK, and Grade 2 was presented. Promoting the need for increased oral health screening in the community needs to continue. Overall oral health in Windsor-Essex ranks poorly when compared to the rest of the province. Improving access to oral health services in the community for both children and senior residents is essential.

  6. Consent Agenda:
    1. Information Reports
      1. Information Report – Radon
      2. Information Report - Risk Management
      3. Information Report - Quarterly Planning Update
      4. Information Report - Seasonal Housing
        It was moved
        That the Media Coverage Summary Report be received - CARRIED
    2. Recommendation Reports
      1. Reserves

        At the last board meeting the Board of Health asked Administration to find out if other health units in the province had reserve funds. L. Gregg drafted a report and provided a few recommendations. The proposed motion seeks to request from the province that they consider revisiting the timelines for approval of grants to public health units. Should the province comply with this request a policy would be created outlining the reporting structure of reserve funds.

        It was moved
        That the resolution be supported. - CARRIED

        Whereas the Windsor-Essex County Health Unit is funded through grants from the Province of Ontario and required contributions from the Obligated Municipalities, and

        Whereas the Province of Ontario does not permit for unspent grants to be carried forward to the next fiscal year irrespective of the timing of approvals, and

        Whereas the Windsor-Essex County Health Unit presently does not have reserves and reserve funds that could be drawn upon to address the challenges associated with late funding approvals from the Province of Ontario as well as emergent public health needs, and

        Now therefore be it resolved that the Windsor-Essex County Board of Health direct Administration to send an appeal to the Province of Ontario requesting that they consider revisiting the timelines for approval of grants to public health units as approvals in recent years have hindered public health units to implement public health initiatives with approved funds. In addition, the appeal should request for the Province of Ontario to revisit its position on contribution of unspent grant funding into a reserve, recognizing that the Province of Ontario would need to provide appropriate policy and reporting structure over such reserve funds.

        FURTHER THAT the Board direct Administration to write a report, including a proposed policy and reporting framework, and present their request for the establishment of Reserves and Reserve Funds to the Administrations of the Obligated Municipalities for feedback and support, and

        FURTHER THAT the Board direct Administration to present a report to the Councils of the Obligated Municipalities for the establishment of Reserves and Reserve Funds for their consideration and approval.

      2. Oral Health

        The Board of Health discussed amending Administration’s recommended board motion as presented in the Oral Health Recommendation Report.

        Whereas Oral health is an essential part of overall health, and

        Whereas the Ontario Public Health Standards require the assessment, surveillance and reporting of Oral Health data to community partners including municipalities, and

        Whereas municipalities are in the position to create healthy public policies and bylaws that impact resident’s health and overall wellbeing, and

        Whereas the Oral health of residents in Windsor-Essex is much worse than Ontario and comparable communities and continues to worsen, and

        Now therefore be it resolved that the Windsor-Essex County Board of Health receive the Oral Health Report (2018) and supports the accompanying recommendations for:

        - Windsor-Essex municipalities to continue to or introduce community water fluoridation as a key prevention strategy for dental caries.
        - Ongoing support for oral health education and awareness in the community.
        - Improved access to oral health services within Windsor-Essex.
        - Advocacy efforts for improved funding and expansion for public dental programs such as Healthy Smiles Ontario.

        FURTHER THAT the Windsor-Essex County Board of Health share the Oral Health Report (2018) and this resolution with municipal and community partners, stakeholders, the general public and identified target groups, and

        FURTHER THAT the Windsor-Essex County Board of Health request through delegation to present the Oral Health report, its findings and recommendations at the whole of City of Windsor Council and the County of Essex Council in May/June of 2018, and

        FURTHER THAT the Oral Health Report (2018) and this resolution be shared with all other health units in the province of Ontario, the Minister of Health and Long Term Care, the Ontario Dental Association and local members of parliament.]

        After much discussion,

        It was moved

        That the City of Windsor reintroduce fluoridation in the water system; and further that the County municipalities reintroduce fluoridation in the water system.

        CARRIED

    3. Media Coverage Summary Report
      It was moved
      That the report be received - CARRIED
  7. Business Arising
  8. Board Correspondence – Circulated
  9. New Business
    1. Board of Health alPHa Fitness Challenge

      K. McBeth mentioned that this year alPHa (Association of Local Public Health Agencies) has included boards of health in the alPHa Fitness Challenge. The recommendation by Administration is to complete the challenge on the day of the next board meeting in May. Thirty minutes of physical activity is required in advance or after the meeting. However, if board members cannot participate on the day of the meeting they may complete thirty minutes of physical activity on any day in May prior to the board meeting. Board members are required to let the Health Unit know that they have completed the challenge.

  10. Other Board of Health Resolutions/Letters - Circulated
  11. Committee of the Whole (CLOSED SESSION, in accordance with Section 239 of the Municipal Act)
    It was moved
    That the Board move into Committee of the Whole at 5:43 p.m. - CARRIED
    It was moved
    That the Board move out of Committee of the While at 6:00 p.m. - CARRIED
  12. Next Meeting: At the Call of the Chair, or May 17th in Windsor, Ontario
  13. Adjournment
    The meeting adjourned at 6:13 pm.

RECORDING SECRETARY:

SUBMITTED BY:

APPROVED BY:


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Issue

Oral health is a key part of overall well-being and can directly impact a person’s quality of life. The Canadian Dental Association outlines oral health as a state that is linked to a person’s physical and emotional well-being (Canadian Dental Association, 2010). Good oral health means being free of mouth and facial pain, cavities, periodontal disease, and any other negative issues that impact our mouths (World Health Organization). Two of the most common oral health diseases are tooth decay (cavities) and periodontal disease (gum disease). In Canada, 57% of children, 59% of adolescents and 96% of adults have been affected by tooth decay.

Oral health has a direct as well as an indirect impact on a person’s overall health and quality of life. At a community level, complications from poor dental health may also have serious consequences for our healthcare system including unnecessary oral health related trips to our hospital emergency departments further adding to the existing long waits in the emergency rooms. In Ontario, over 60,000 emergency department visits were related to tooth pain. The Ontario medical system spends at least 38 million dollars per year treating oral health problems in emergency departments and physician’s offices. Prevention is critical to good health. Tooth decay and gum diseases are almost always preventable, with preventive oral health services/strategies that should be available to all individuals in our community. In Ontario, the majority of oral health care services are not publicly funded, which means that Ontarians are responsible for the costs of their own dental care. Ontario provides public dental coverage to children of low income families, but there are very few options for adults with low income, including seniors (Wellesley Institute, 2015).

Windsor-Essex County’s Oral Health 2016 report highlighted the oral health profile of our community and also made recommendations to improve the oral health status and access to oral health care in our community. Despite all these efforts, the oral health status of our community continues to remain a public health concern.

Background

Oral health and general health should not be thought of separately; oral health is one important component of overall health (Seto et al.2014). In recent years an increasing amount of research has shown an important link between oral health and overall health. Oral health issues have been linked to respiratory infections, cardiovascular disease, diabetes, as well as a potential link between maternal periodontal disease and babies with low birth weights.

Many of the same social and economic determinants of health (e.g., income, employment, education, access to health services, social support networks) also impact the oral health of people and communities. The World Health Organization states that oral health is an important determinant of the quality of life.

Oral Health Services in Windsor and Essex County:

There a many programs that operate in Windsor-Essex County with the aim of improving oral health, primarily among children. These include programs and services offered in collaboration between public health, school boards, primary care and others. The Windsor-Essex County Health Unit (WECHU) provides clinics in both Leamington and Windsor serving children and youth from 0-17 under the Healthy Smiles Ontario program (HSO). 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. Over the past several years WECHU has seen an increase in the number of individuals requiring treatment as well as an increase in the wait times associated with services. As a result, the WECHU has increased their staffing and clinics with additional funding from the Ministry of Health and Long Term Care in order to address some of the increasing need. The WECHU has also worked closely over the past few years with the dental community and its community partners to increase oral health education including the introduction and implementation of the baby oral health program and fluoride varnish pilot.

Unlike those for children, there are very few publically funded programs available to adults, including seniors, in Ontario. Ontario Works and the Ontario Disability Support Program offer services to some adults, but are limited to very basic dental services (which are at the discretion of the municipality that funds these programs). In Windsor-Essex County there are two options available for adults and seniors who do not have insurance or the resources to pay for dental services (cleanings only). St. Clair College offers full mouth scaling by dental hygiene students. A second program offering dental services (cleanings only) is Street Health, a program of the Windsor Essex Community Health Centre.  Operation Smile is an event that is hosted by the Essex County Dental Society, in partnership with the St. Clair College dental clinic. The yearly one-day event is designed to promote oral health in the community and offers basic restorative and surgical services to people that might not otherwise have access to such services.

Oral Health Assessment and Surveillance Reporting in Windsor-Essex:   

The Windsor-Essex County Health Unit (WECHU) provides programs and services under the guidance and direction of the Health Promotion and Protection Act (HPPA) and the Ontario Public Health Standards (OPHS). The OPHS include a requirement for the assessment, surveillance and reporting of oral health data including information collected through school based screening conducted in accordance with the Oral Health Protocol. The information collected through school screening includes the number of decayed, missing and filled teeth (DMFT) for each child in JK, SK and grade 2 and is recorded in the Oral Health Information Support System (OHISS). The WECHU began reporting DMFT in OHISS in the school year 2011/2012 and has continued to screen and report since that time.

In keeping with population assessment and surveillance requirements identified in the OPHS and associated protocols, in 2015 the WECHU devised a plan to report oral health data to community stakeholders, the general public, and target populations for the purpose of knowledge exchange, informing healthy public policy and health service planning. This plan included the development of the first Oral Health Report released in 2016 with the intent to update every five years. The 2016 Oral Health Report provided a comprehensive view of the oral health status of residents in Windsor-Essex using the most current data available and accessible by the health unit for the past five years. In the beginning of 2016, Ontario made changes to all provincially funded oral health programs combining them into a newly launched Healthy Smiles Ontario (HSO). Due to the changes in how eligibility is assessed and services are provided under HSO it was determined that reporting data up to 2016 was a natural starting point for the Oral Health survey ensuring the five-year cycle from 2016 to 2021 would represent five years under the new HSO system.

Requests for Oral Health Assessment and Surveillance Data and Response:

In 2013 the City of Windsor council made a decision to discontinue the fluoridation of the water supply. This decision affected the communities of LaSalle, Tecumseh and the City of   Windsor. Specifically, the council decision was as follows:

That City Council PASS a by-law DIRECTING the Windsor Utilities Commission to CEASE the fluoridation of the City of Windsor water supply while ensuring continued regulatory compliance, and that the savings from this action BE DIRECTED to oral and health nutrition education in Windsor and Essex County, for a period of 5 years, to be spent at the discretion of the Community Development and Health Commissioner.

At that time the WECHU had agreed to look at its oral health data and that of the community for a period of five years beginning in 2013 and bring back a report on the oral health of the community in 2018. Since this time, the WECHU has continued to collect and analyze its oral health data and has consulted with experts in oral health research to best determine what is able to be reported given the data available and the time frame of collection. The Oral Health Report (2018, update) provides 6 years of school screening data and allows the WECHU to look at overall oral status of the community, compare with Ontario averages and determine the trends for oral health outcomes across Windsor-Essex.

Based on the findings detailed in the Oral Health report (2018 update) the WECHU recommends:

  • Windsor-Essex municipalities continue to or introduce community water fluoridation as a key prevention strategy for dental caries
  • Continued support for oral health education and awareness in the community
  • Improve access to oral health services within Windsor-Essex
  • Advocate for improved funding and expansion for public dental programs such as Healthy Smiles Ontario

Amended Motion

Whereas Oral health is an essential part of overall health, and

Whereas the Ontario Public Health Standards require the assessment, surveillance and reporting of Oral Health data to community partners including municipalities, and

Whereas municipalities are in the position to create healthy public policies and bylaws that impact resident’s health and overall wellbeing, and

Whereas the Oral health of residents in Windsor-Essex is much worse than Ontario and comparable communities and continues to worsen, and

Now therefore be it resolved that the Windsor-Essex County Board of Health receive the Oral Health Report (2018) and supports the accompanying recommendations for:

  • The City of Windsor to reintroduce fluoridation in the water system.
  • The County municipalities to reintroduce fluoridation in the water system.
  • Ongoing support for oral health education and awareness in the community.
  • Improved access to oral health services within Windsor-Essex.
  • Advocacy efforts for improved funding and expansion for public dental programs such as Healthy Smiles Ontario.

FURTHER THAT the Windsor-Essex County Board of Health share the Oral Health Report (2018) and this resolution with municipal and community partners, stakeholders, the general public and identified target groups, and

FURTHER THAT the Windsor-Essex County Board of Health request through delegation to present the Oral Health report, its findings and recommendations at the whole of City of Windsor Council and the County of Essex Council in May/June of 2018, and

FURTHER THAT the Oral Health Report (2018) and this resolution be shared with all other health units in the province of Ontario, the Minister of Health and Long Term Care, the Ontario Dental Association and local members of parliament.


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Issue

Constrained financial resources coupled with late funding approvals from the Ministry of Health and Long-Term Care limits the ability of the Windsor-Essex County Health Unit to address public health needs within the Community of Windsor and Essex County.

Background

The Windsor-Essex County Health Unit (“WECHU”) is a publicly funded organization.  As such the WECHU has a responsibility to spend funds prudently and with the objective of providing public health programs and services as required under the Health Protection and Promotion Act, R.S.O. 1990 (“HPPA”) and the Ontario Public Health Standards:  Requirements for Programs, Services, and Accountability (“OPHS”). 

The WECHU is funded through grants from the Province of Ontario, more specifically the Ministries of Health and Long-Term Care (“MOHLTC”) and the Children and Youth Services (“MCYS”) (collectively referred to as “Ministries”).  As well it is funded through required contributions from the Corporation of the City of Windsor (“City”), the Corporation of the County of Essex (“County”) and the Corporation of the Township of Pelee (“Pelee”) (collectively referred to as “the Obligated Municipalities”). 

Programs funded by the Ministries through grants can be categorized as follows:

  • Public Health and Health Promotion Mandatory Programs funded to a maximum of 75% by the MOHLTC;
  • Public Health Mandatory Programs funded at a rate of 100% by the MOHLTC;
  • Health Promotion Programs funded at a rate of 100% by the Ministries
  • Public Health and Health Promotion one-time funding business cases funded by the MOHLTC;
  • Health Capital one-time funding business cases (historically funded at a rate of 100% but depends on the nature of the request) funded by the MOHLTC.

The budget for the Public Health and Health Promotion Mandatory Programs funded to a maximum of 75%, commonly referred to as the Cost Shared Program, is presented to the Board of Health for the Windsor-Essex County Health Unit in the November to January timeframe annually.  That budget forms the basis of the Annual Service Plan and Budget Submission to the MOHLTC. Approval of the Annual Service Plan and Budget Submission by the MOHLTC has historically been in the 4th quarter of the WECHU’s fiscal year (January 1 to December 31).  For example, the Cost Shared Program budget for the 2017 fiscal year was approved in December of 2016.  MOHLTC funding approvals were received mid-November 2017.

The delay in the approval process creates a number of challenges for the WECHU:

  1. Overspending – The delay in the approval process puts the WECHU at risk of overspending.  This circumstance can arise if the budget submission assumes an increase in MOHLTC funding that is subject to approval historically at a later date.  In this circumstance, the Obligated Municipalities would be required to fund a deficit that may arise from operationalizing the approved Cost Shared Budget.  This obligation is set out in the HPPA, in the following provision:
    Payment by obligated municipalities
    72 (6) Where additional expenses incurred
    If, after a notice is given by a board of health under subsection (5) in a respect of a year, additional expenses referred to in subsection (1) that were not anticipated at the time the notice was given are incurred during the year, the board of health may give another written notice to each obligated municipality in the health unit, specifying the additional amount for which the obligated municipality is responsible under this section and the time at which the addition amount must be paid.
  2. Underspending – This is the inability of WECHU to spend funding received from the Ministries and Obligated Municipalities. The following scenarios help articulate this challenge:
    1. Mandatory Programs – Human Resource Information System (“HRIS”):  The 2017 budget submission included a one-time business case to support WECHU acquiring and implementing a HRIS.  As approval of this business case was not received until mid-November of 2017, WECHU Administration was not able to embark upon the necessary activities to acquire and successfully implement the HRIS by March 31, 2018.  This funding will be returned to the MOHLTC.  A one-time business case for an HRIS was submitted to the MOHLTC with the 2018 Annual Service Plan and budget submission.
    2. Assumed increase in funding from the MOHLTC:   In recent history, the WECHU has integrated an assumed percentage increase in base funding from the MOHLTC.  Recognizing that the Obligated Municipalities bear financial risk in the event that the budgeted augment in funding is not approved, the WECHU proceeds cautiously during the fiscal year monitoring budget variances and identifying other operating efficiencies to ensure the budget is not overspent.  Administration recognizes and does its best to balance what is required of the WECHU under the HPPA with the fact that we operate using finite financial resources funded by the Community of Windsor-Essex County that we serve. 
  3. Re-prioritization of resources to address emerging public health needs – In 2017 in response to increasing opioid-related deaths in Windsor and Essex County as well as the Province of Ontario, WECHU reassigned already constrained resources to help support the development of a local opioid strategy.  In early 2017, the WECHU made certain decisions to defer activities associated with other public health needs to address this emergent issue.   The MOHLTC announced additional funding to support this initiative in June of 2017.

The above represent a few examples of the challenges faced by the WECHU associated with late funding approvals from the MOHLTC.  Like the other 36 public health units within Ontario we have expressed our concerns to the MOHLTC regarding late funding approvals.  We have made appeals to the MOHLTC for certain one-time 100% funded business cases to be extended to allow us the opportunity to establish these initiatives and expend funding.  In two instances in recent years we have been successful.  But this success likely represents a lost opportunity in future periods to redirect those funding asks and efforts to other public health needs.

Reserves and reserve funds

Reserve and reserve funds have historically been used by public sector entities to ensure that adequate financial resources exist to fund specific initiatives and/or circumstances that arise that were unforeseen in the current year’s budget.   Contributions to and utilization of reserves and reserve funds typically follow a prescribed methodology in accordance with an Organization’s Corporate By-Laws or approved policy. The Province of Ontario does not permit Public Health Units to contribute unspent grant funding into a reserve fund.  The following section within the 2014 Accountability Agreement dated January 1st, 2014, address this matter:

15.5 Carry Over of Grant Not Permitted.  The Board of Health is not permitted to carry over the Grant from one calendar year to the next, unless pre-authorized in writing by the Province.

Therefore, reserves or reserve funds held by a public health unit would need to be established through contributions from Obligated Municipalities or other funding sources.

The WECHU currently has the following reserve funds.  These reserve funds were not established using contributions from the Obligated Municipalities.  They have specified purposes for which funding can be utilized.

Employee future benefits fund:  This reserve fund was established as a result of the demutualization of Mutual Life to help defray the future employee benefit costs incurred by the WECHU.  At December 31, 2016, the balance of this reserve fund was $180,929.

Septic fund:  The Septic reserve fund was established from the Ministry of Environment for septic inspection services and have been retained in a reserve fund to help defray costs associated with septic inspection services.  At December 31, 2016, the balance of this reserve fund was $43,365.

The WECHU did an informal survey of 36 other public health units in Ontario to understand whether they do/do not have reserve funds and if so, are those reserve funds supported by policy.

The enclosed table summarizes the results from the respondents

Public Health Unit

Does your PHU have reserves?

Do you have Policy?

Types of Reserves?

Algoma Public Health

Yes

Yes

Working Capital Reserve, Land Control Reserve, Human Resources Management Reserve, Public Health Initiatives and Response Reserve, Corporate Contingencies Reserve, Facility and Equipment Repair and Maintenance Reserve

Chatham-Kent Public Health Unit

Administered by Municipality

-

-

Elgin-St. Thomas Public Health

Yes

Yes

Reserve funds are to be used for items such as employee pay equity adjustments, vacation and sick leave entitlements, capital repairs and replacements, unforeseen program and or corporate expenses, or any other items as deemed necessary by the Board of Health.

Grey Bruce Health Unit

Yes

No details provided.

No details provided.

Haliburton, Kwartha, Pine Ridge District Health Unit

Yes

Yes

Use at the discretion of the Board of Health and to be maintained at no less than 75% of one month’s operating expenses.

Halton Region Public Health

Administered by Municipality

-

-

Hastings Prince Edward Public Health

Yes

Yes

Operating Fund Reserve, Capital Fund Reserve

KFL&A Public Health

Yes

Yes

Board of Health Reserve Fund; Capital Fund Reserve; Excess recoveries for private sewage system programs

Lambton Public Health

Administered by Municipality

-

 

-

Middlesex-London Health Unit

Yes

Yes

Funding Stabilization Reserve, Dental Treatment Reserve Fund, Sick Leave Reserve Fund, Environmental Reserve - Septic Tank Inspections,  Technology & Infrastructure Reserve Fund, Employment Costs Reserve Fund

Niagara Region Public Health

Administered by Municipality

-

-

North Bay Parry Sound District Health Unit

Administered by Municipality

-

Examples of how reserves can be used:  i)  to address one-time short-term expenditures, planned or unplanned; ii) to match provincial dollars (25/75) or be used 100% toward the cost of the expenditure.

Ottawa Public Health

Yes

Yes

Technology Reserve

Perth District Health Unit

 

Yes

No details provided.

No details provided.

Peterborough Public Health

Yes

Practices in place but no specific policy.

Capital, Program, Contingency, Septic Program, Other

Public Health Sudbury & Districts

Yes

Yes

Working Capital, HR Management, Public Health Initiatives& Response, Corporate Contingencies, and Facility Equipment Repairs and Maintenance

Simcoe Muskoka District Health Unit

Yes

Yes

Sick Leave Reserve Fund, Contingency Reserve Fund, Capital Reserve Fund

Thunder Bay District Health Unit

Yes

Yes

Sick Leave Plan Allowance Reserve, Capital Expenditures Reserve, Land Development Reserve, Program Contingency Reserve, Benefit Cost Stabilization Reserve, SFH Training Reserve

Toronto Public Health

Administered by Municipality

-

-

Wellington-Dufferin Guelph Public Health Unit

Yes

Yes

Facilities Reserve, Contingency Reserve, Technology Reserve, Orangeville Facilities Reserve, Guelph Facilities Reserve, Fluoride Varnish Program Reserve, Poverty Elimination Task Force Reserve

Public Health Units that responded indicated that they either held reserves directly or that reserves were administered by their respective municipalities.  Furthermore, respondents indicated that reserves were supported by policy and or guidelines as established by corporate bylaws.  Certain of these Organizations have shared those policies with the WECHU and will serve as good resources to support our own policy development if directed by the Board to do so.

With a proper policy and reporting structure, the reserve fund mechanism funded through contributions from the Obligated Municipalities could provide the necessary resources to address the challenges identified above.  More specifically:

  • Reserve funds could assist in mitigating financial risk in future periods to the Obligated Municipalities in instances where the WECHU has overspent.
  • Reserve funds could serve to provide cash flow for implementation of 100% funded business cases in advance of MOHLTC approvals thus ensuring that funding approvals will be spent irrespective of the timing of those approvals.  Cash flows would then be returned to the reserve fund for future uses.
  • Reserve funds could serve to provide cash flow for emergent public health needs rather than re-prioritizing or deferring other public health activities.

Proposed Motion

Whereas the Windsor-Essex County Health Unit is funded through grants from the Province of Ontario and required contributions from the Obligated Municipalities, and

Whereas the Province of Ontario does not permit for unspent grants to be carried forward to the next fiscal year irrespective of the timing of approvals, and

Whereas the Windsor-Essex County Health Unit presently does not have reserves and reserve funds that could be drawn upon to address the challenges associated with late funding approvals from the Province of Ontario as well as emergent public health needs, and

Now therefore be it resolved that the Windsor-Essex County Board of Health direct Administration to send an appeal to the Province of Ontario requesting that they consider revisiting the timelines for approval of grants to public health units as approvals in recent years have hindered public health units to implement public health initiatives with approved funds.  In addition, the appeal should request for the Province of Ontario to revisit its position on contribution of unspent grant funding into a reserve, recognizing that the Province of Ontario would need to provide appropriate policy and reporting structure over such reserve funds.

FURTHER THAT the Board direct Administration to write a report, including a proposed policy and reporting framework, and present their request for the establishment of Reserves and Reserve Funds to the Administrations of the Obligated Municipalities for feedback and support, and

FURTHER THAT the Board direct Administration to present a report to the Councils of the Obligated Municipalities for the establishment of Reserves and Reserve Funds for their consideration and approval.


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