Board of Health Meeting Documents

Reporting Structure

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

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

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

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

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

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

Overall Quarterly Status Summary

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

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

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

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

Program Quarterly Status Summary

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

Prepared By:

Phil Wong, Environmental Health Manager

Date:

December 19, 2019

Subject:

Lead in Drinking Water

BACKGROUND

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

Standards vs. Guidelines and Duty to Report

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

Municipal Systems

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

Schools and Child Care Centres

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

Private Water Supplies

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

CURRENT INITIATIVES

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

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

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

APPROVED BY

Theresa Marentette

Prepared By:

Neil Mackenzie, Manager, Chronic Disease and Injury Prevention

Date:

December 19, 2019

Subject:

2019 Nutritious Food Basket and the Real Cost of Eating Well in Windsor-Essex

BACKGROUND

Nutritious Food Basket – Description

As part of the Population Health Assessment and Surveillance Protocol, 2018, under the modernized Ontario Public Health Standards (OPHS), boards of health are required to monitor food affordability at a local level. The Ministry of Health and Long Term Care provides guidance for determining the Nutritious Food Basket in its guidance document: Monitoring Food Affordability Reference Document, 2018 (MOHLTC, 2018).

Each year, the WECHU releases its calculation for the Nutritious Food Basket. Food costing tools, such as the Nutritious Food Basket (MOHLTC, 2008), measure the cost of basic healthy eating representing current nutrition recommendations and average food purchasing patterns. It allows for improved understanding of the real cost of eating a basic nutritious diet for a reference family and those of different ages, gender, and physiological status (i.e., pregnant, breast feeding) within Windsor-Essex County. 

Over a two-week period in May 2019, the WECHU’s Registered Dietitians (RD) surveyed nine different grocery stores within the city and county. Stores are selected following the NFB protocol, ensuring representation of all types of grocery stores (i.e., high-end, discount, community based). Using the NFB costing tool, the average cost of the lowest price available for 67 different food items is calculated. Once the average price is determined, different income and family scenarios for our local community are calculated.

Nutritious Food Basket – 2019 Reality

The cost of healthy eating for a family of four in Windsor and Essex County was calculated to be $211.20 per week. This represents an increase of $17.16/week (8.8 %) over the previous year’s calculation. The 2019 Nutritious Food Basket cost ($211.20/week) is 12.3% higher than the cost in 2014 ($188.04/week). Over that same period, rental costs in WEC have increased by 18.9%, and Ontario Works benefits have only increased by 7.8%.  Households who are reliant on social assistance as their main source of income are at a greater risk for food insecurity than households who receive income from employment (PROOF Food Insecurity Policy Research, 2017).

Note: The NFB does not include items such as spices, sauces, condiments, processed and ready-to-eat foods, baby food and formula, personal hygiene, and cleaning products.

The increase in the cost of the Nutritious Food Basket for 2019 has a real impact, in that healthy eating will continue to be unattainable by many in our community. For example, a family of four* receiving Ontario Works has an average monthly household income of $2,623. When rent is accounted for, the family would be left with only $1,533 to cover the cost of food ($914.50) and all other remaining expenses, including utilities, transportation costs, medical expenses, clothing, etc. The reality is much worse for a single adult male receiving Ontario Works. After accounting for rent, the individual is left with only $225 to cover all remaining expenses, including food. This amount is less than the cost of the Nutritious Food Basket for an adult male ($306.93/month). Indeed, the individual would be left with no money at all for other basic expenses. With less money for food, the quality and quantity of foods purchased are compromised, causing individuals to turn to other options such as food banks or missing meals to make ends meet. 

CURRENT INITIATIVES

The NFB data is intended to raise awareness about the cost of basic healthy eating in our community.  This data can be used to assist policy and decision makers to advocate for improved social assistance rates, living wage uptake, more affordable housing availability, accessible and affordable child care, affordable and flexible utility costs, and other supports to ensure everyone has enough money available to meet their family’s basic nutrition needs.

The NFB has been used as an essential local component in the calculation of the Windsor-Essex County Living Wage for 2020.

A plan is in place to disseminate the 2019 NFB results and the Real Cost of Eating Well in Windsor-Essex to a variety of partners, organizations, and municipal councils who can use the information to support the most vulnerable individuals in our community. The information provided will help inform an urgent discussion on short and longer-term measures required to support individuals and families in having sufficient funds for a basic healthy diet. 

CONSULTATION:

The following individuals were contributed to this report:

• Heather Nadon, Public Health Dietitian
• Noura Jabbour, Public Health Dietitian
• Neil Makenzie, Manager, Chronic Disease and Injury Prevention

APPENDICES

• Appendix A - The Real Cost of Eating Well in Windsor-Essex, 2019 Report

APPROVED BY

Theresa Marentette

Board Members Present:

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

Board Member Regrets:

Tracey Bailey, Dr. Debbie Kane

Administration Present:

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

Staff Present:

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

QUORUM:  Confirmed

RECORDING SECRETARY:

SUBMITTED BY:

APPROVED BY:

ISSUE

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

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

BACKGROUND

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

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

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

PROPOSED MOTION

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

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

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

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

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

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

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

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

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

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

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

Prepared By:

Nicole Dupuis, Director of Health Promotion

Date:

November 21, 2019

Subject:

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

Background

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

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

Current Initiatives

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

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

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

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

References

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

Consultation

The following individuals consulted in the development of this report:

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

Approved By:

Theresa Marentette, CEO

Prepared By:

S. Manzerolle

Date:

November 21, 2019

Subject:

School Based Immunization Clinics 2019/2020 School Year

Background

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

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

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

Current Initiatives

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

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

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

Approved By:

Theresa Marentette

Prepared By:

S. Manzerolle, Manager, Healthy Schools Department

Date:

November 21, 2019

Subject:

Influenza Season 2019/2020

Background

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

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

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

Current Initiatives

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

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

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

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

Approved By:

Theresa Marentette, CEO

Prepared By:

Communications Department

Date:

November 1, 2019

Subject:

October Media Relations Recap Report

October Media Coverage

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Media Coverage

News Release, Media Advisories and Media Statements

Stories Reported by the Media

AM 800

Blackburn News

CBC News

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

CBC Radio-Canada

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

CTV Windsor News

The London Free Press

Windsor Star

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

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

Board Members Present:

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

Board Member Regrets:

Gary Kaschak

Administration Present:

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

Staff Present:

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

Guests:

Claudia Den Boer, CMHA

QUORUM:  Confirmed

RECORDING SECRETARY:

SUBMITTED BY:

APPROVED BY:

ISSUE

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

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

BACKGROUND

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

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

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

PROPOSED MOTION

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

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

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

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

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

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

References:

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

View the 2020 Budget document. 

Prepared By:

Theresa Marentette

Date:

September 2019

Subject:

ProsperUs Board Information Report

Background

“ProsperUs is a collective of non-profit, government, health care, education, labour, business, and inspired residents with a shared vision of a prosperous Windsor-Essex County where every young person has the opportunity and support they need to thrive.”¹ The unique aspect of ProsperUs is the value of collective impact, a term that captures the importance of organizations coming together to share experiences and expertise for the common goal of supporting youth in our community and making a positive impact in their lives.

The United Way, under the leadership of CEO Lorraine Goddard, is the backbone organization supporting these efforts led by Co-Chairs Janice Kaffer (HDGH) and Noah Tepperman (2018) and Jim Inglis (2019). Financial and in-kind support has occurred across organizations with the lead agencies of the United Way and Hotel Dieu Grace Healthcare dedicating funds and human resources to this initiative. An Investor Table strategy is currently in development.

The vision of ProsperUs is embedded in the work of the Windsor-Essex County Health Unit (WECHU). The Ontario Public Health Standards (2018) support working with priority populations and community partners to offer population-based activities that promote the health of the population and reduce health inequities.² Collective impact initiatives such as ProsperUs’ Cradle to Career, are an effective way to approach large-scale social changes that fundamentally align with public health strategies.

Furthermore, the goal of WECHU’s school based programs and services is to achieve optimal health of school-aged children and youth through partnerships and collaboration with school communities and school boards. By bringing these, and other key strategic community partners together, we create opportunities for meaningful and effective engagement that will move us closer to realizing this goal.

Early work of ProsperUs formalized the Leadership Council, the Data and Evaluation Table, and the Marketing and Communications Working Table. A media launch one year ago introduced the community to the vision of ProsperUs “Every young person in Windsor-Essex County has the opportunity and support to succeed- from cradle to career.”  Other sub committees would follow with the establishment of a Planning Committee in early 2019.

By late Fall (2018), data sharing agreements were established with organizations followed by a community engagement strategy led by Overlap Associates. The goal was to engage community members, including families and youth to gain insights into their perceptions about opportunities for youth in Windsor and Essex County. This strategy included an online survey, key informant interviews and ethnographic research. Street Teams were created from partnering agencies to engage people in the community and conduct brief interviews. Results of community engagement activities were presented to the Leadership Council in December of 2018.

Current Initiatives

The work of ProsperUs moved forward in 2019 with interactive Data Walks implemented in neighbourhoods across Windsor and Essex County to share existing data and engage participants in meaningful discussion about what they had learned and what was missing. In the coming months, further support was provided by the Data and Evaluation Table to examine key indicators and identify priority neighbourhoods.

In July, a media event highlighted the release of the Coming Together- Building a Hopeful Future for Children and Youth in Windsor-Essex County Executive Summary Report which identified Downtown Windsor, West Windsor and the Town of Leamington as priority areas for the initial Cradle to Career focus.

The next phase of the project is the recruitment of staff and community representatives to begin the work of the Community Action Network. It will be these groups, across the three identified neighbourhoods that will delve deeply into the issues and barriers that children and youth are facing in our community and propose innovative solutions to overcome these barriers.

There is much work to be done. The Chairs of the Leadership Council and members of the partnering agencies continue to celebrate milestones in the work that has been accomplished so far. The Windsor-Essex County Health Unit is proud to be part of this initiative and continues to provide human resources and expertise to the Cradle to Career initiative. Specifically, I would like to acknowledge Ramsey D’Souza, our manager of Epidemiology and Evaluation, who is a valued member of the Data and Evaluation Table. Jen Johnston, our Social Determinants of Health nurse participated as a member of the one of the Street Teams. In addition, our Health Unit has put forward names of several members of our Healthy Schools department to participate as co-chair, facilitators and content experts for the Community Action Network working tables.

1. ProsperUs Communications, July 2018.
2. Ministry of Health and Long Term Care, Ontario Public Health Standards, 2018.

Prepared By:

Communications Department

Date:

October 2, 2019

Subject:

September 2019 Media Relations Recap Report

September Media Coverage

Media Coverage

News Release, Media Advisories and Media Statements

Stories Reported by the Media

AM 800

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

Blackburn News

CBC News

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

CTV Windsor News

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

London Free Press

Windsor Star

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

Windsorite.ca

Yahoo News

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

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

WECHU Strategic Plan Progress - At a Glance

Communication and Awareness

Organizational Development

Partnerships

Evidence-based Public Health Practice

Communication and Awareness

Partnerships

Organizational Development

Evidence-Based Public Health Practice

Board Members Present:

Gary McNamara, John Scott, Tracey Bailey, Deborah Kane (4:15 pm), Judy Lund, Joe Bachetti (4:10pm), Larry Snively, Rino Bortolin, Fabio Costante, Gary Kaschak, Ed Sleiman

Board Member Regrets:

N/A

Administration Present:

Theresa Marentette, Dr. Wajid Ahmed, Lorie Gregg, Nicole Dupuis, Kristy McBeth, Dan Sibley, Elspeth Troy

QUORUM:  Confirmed

RECORDING SECRETARY:

SUBMITTED BY:

APPROVED BY:

ISSUE

Recent increases in the popularity of electronic cigarette (vaping) products among youth and young adults has led the United States Food and Drug Administration to declare their use an epidemic among young people (U.S. National Academies of Sciences, Engineering and Medicine, 2018). E-cigarettes heat liquid (e- juice) producing an aerosol that e-cigarettes users inhale. The liquid in e-cigarettes or vapes as they are more commonly referred to can include nicotine, cannabinoid (CBD) oils, tetrahydrocannabinol (THC) or other substances. In Canada student use of vaping products increased by 30% each year between 2015 and 2017 (University of Waterloo, 2017), and a recent study by Hammond et al. (2019) noted vaping rates among 16 to 19 year olds in Canada increased 74% between 2017 and 2018. These nationwide trends are reflected in Ontario where 21.6% of students in Grades 7-12 reported use of a vaping product in their lifetime (Boak et al, 2017).

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

There is currently little research on the long-term health impacts of e-cigarette use and second-hand exposure, although, preliminary research has shown a positive association between use of vaping products and the risk for the uptake and intensity of tobacco smoking (Ontario Agency for Health Protection and Promotion (Public Health Ontario), 2018). This is complemented by the finding by Hammond et al. (2019) that after several decades of decline, tobacco smoking rates among Canadian adolescents have recently increased. Outside of the risk for nicotine addiction and susceptibility for tobacco uptake, the long term health effects of vaping products are unknown. The potential for more acute implications of chronic use have recently been realized with the approximately 1,080 cases of severe respiratory illness and 18 deaths associated with the use of vaping products in the United States (Centers for Disease Control and Prevention, 2019). In September of 2019, Health Canada issued a warning to Canadians that use vaping products to monitor themselves for symptoms of pulmonary illness, which has resulted in Ontario’s health minister ordering all public hospitals to report vaping-related cases of severe pulmonary illness to the Ministry of Health.

BACKGROUND

The Windsor-Essex County Health Unit has been working with municipalities, business, and school administrators to ensure these groups are prepared and educated around the harms of vaping and the existing regulations around vaping in public spaces. Since February of 2019 WECHU Tobacco Enforcement Officers have engaged in enhanced proactive inspections to ensure compliance with both municipal Bylaws and the provincial SFOA 2017. Since the passing of the SFOA 2017 in October of 2018 these efforts have resulted in 25 charges issued to high school students for vaping on or within 20 metres from school property, several verbal and written warnings to both high school and elementary students, 11 charges issued to vaping product vendors for selling vapour products to a person who is under the age of 19 years old, and multiple charges being issued to vaping product retailers for improper display or promotion of their merchandise.

Additional efforts were further described in an information report provided to the Board of Health on June 20, 2019 in which existing and planned activities to address vaping among young people were detailed, including:

• Distribution of School Vaping Prevention Toolkit to school administrators
• Participation in a provincial vaping working group
• WECHU staff education and policy development for clients using vaping products
• Secondary school proactive enforcement inspections in partnership with local Police Services
• School and school board presentations for students, teachers, and administrators
• Policy support offered to school boards
• Under 25 Electronic Cigarette Vendor Education program
• Smoke/Vape-free Spaces media campaign

The Windsor-Essex County Board of Health has passed a series of resolutions beginning in 2014 encouraging action at the provincial and local level to curb the potential for harms of vaping particularly among young people and people who do not smoke. The WECHU has since been instrumental in developing and passing local regulations to further protect residents from exposure to smoking and vaping products in public spaces. Since 2014, eight municipal bylaws have been passed which build upon and surpass the existing provincial regulations for smoke/vape-free indoor and outdoor spaces. Support was also provided to the Essex Regional Conservation Authority in their development, passing, and subsequent revisions to include more public spaces in which smoking and vaping were not permitted. A summary of the Board of Health Resolutions which have supported this and future work related to vaping is provided below:

In their consultation process, Health Canada and the Ontario Ministry of Health (formerly, the Ministry of Health and Long-term Care) provide public health units, other health organizations, stakeholders, and the general public with the opportunity to provide feedback into new regulations related to public health matters. The WECHU has responded with feedback at every opportunity provided by these levels of government in their consultations related to vaping. A summary of the feedback provided can be referenced below:

PROPOSED MOTION

Whereas, the WECHU Board of Health has passed three previous resolutions related to vaping to encourage further regulation at the federal, provincial, and local levels of government;

Whereas, the WECHU has submitted feedback independently and through regional collaborations for the increase in regulations related to vaping products;

Whereas, there is evidence that vaping products have short-term negative health effects and contain harmful chemicals like nicotine;

Whereas, the restrictions on the promotion and display of tobacco products and the removal of tobacco flavouring from the retail marketplace has contributed to the reduction of tobacco smoking among young people;

Whereas, Individuals who do not smoke should not start vaping, especially youth, young adults, pregnant women, and those planning on becoming pregnant;

Whereas, vaping rates among young people have increased 74% between 2017 and 2018;

Whereas, Vaping products have the potential to re-normalize smoking and lead to tobacco use among youth;

Now therefore be it resolved that the Windsor-Essex County Board of Health supports the ban on the promotion of vaping products in the retail setting and online, and

FURTHER THAT, the provincial government further restricts the sale of flavoured vaping products to include only tobacco flavours targeting current smokers who are looking to quit, and

FURTHER THAT, all regulations related to protecting youth and young people from the harms of tobacco smoke be applied to vaping products.

References

• American Cancer Society. (2019). What do we know about e-cigarettes? Retrieved from American Cancer Society
• Boak, A. Hamilton, H. A., Adalf, E. M., & Mann, R. E. (2017). Drug use among Ontario students, 1977-2017: Detailed findings from the Ontario Student Drug Use and Health Survey (OSDUHS) (CAMH Research Document Series No. 46). Toronto, ON: Centre for Addiction and Mental Health.
• Centers for Disease Control and Prevention. (2019, 10 08). Smoking and Tobacco Use. Retrieved from Centers for Disease Control and Prevention
• Hammond, D., Reid J. L., Rynard, V. L., Fong G.T., Cummings K. M., McNeill A., et al. (2019).Prevalence of vaping and smoking among adolescents in Canada, England, and the United States: repeat national cross sectional surveys.
• BMJ; 365 :2219. Retrieved from https://doi.org/10.1136/bmj.l2219
• Margolis, K. A., Donaldson, E. A., Portnoy, D. B., Robinson, J., Ne, L. J., & Jamal, A. (2018). E-cigarette openness, curiosity, harm perceptions and advertising exposure among U.S. middle and high school students. Preventive Medicine 112(September 2017), 119–125
• National Academies of Sciences, Engineering, and Medicine. (2018). Public health consequences of e- cigarettes.Washington, DC: The National Academies Press. Retrieved from https://doi.org/10.17226/24952
• Ontario Agency for Health Protection and Promotion (Public Health Ontario). (2018). Current evidence on e- cigarettes: a summary of potential impacts. Toronto, ON: Queen's Printer ofr Ontario.
• Smoke-Free Ontario Scientific Advisory Committee, Ontario Agency for Health Protection and Promotion (Public Health Ontario). Evidence to guide action: Comprehensive tobacco control in Ontario (2016). Toronto, ON: Queen's Printer for Ontario; 2017.
• The Ontario Tobacco Research Unit. (2019). Promotion of Flavoured Vaping Products that appeal to Youth. Available here.
• University of Waterloo. (2017). Canadian student tobacco, alcohol and drugs survey. Retrieved from Canadian Student Tobacco Alcohol Drugs Survey
• U.S. National Academies of Sciences, Engineering and Medicine. (2018). Public Health Consequences of E-cigarettes.