Alternate Formats and Communication Supports are Available on Request. Contact Susan Cronin at 519-524-8394 Ext. 3257
County of Huron BOARD OF HEALTH AGENDA Thursday, March 7, 2019 at 9:00 AM In Seminar Room 2 of the Health and Library Complex, Clinton
1. Chair David Jewitt to call the Board of Health meeting to order:
2. Agenda and Reports: RECOMMENDED MOTION: THAT: The Board of Health Agenda for March 7, 2019 be accepted and all reports included in the Agenda be received as presented.
3. Declaration of Pecuniary Interest and the General Nature Thereof:
4. Minutes of Previous Session: RECOMMENDED MOTION: THAT: The minutes of the Board of Health meeting of February 7, 2019 be adopted as circulated.
5. Board Member Issues:
6. Administrative Issues:
Update from the Transition Committee
7. Information Session:
8. Program Reports:
8.1 The Role of Public Health in Reducing Hallway Medicine: (presented by Dr. Maarten Bokhout) RECOMMENDED MOTION: THAT: The Board of Health accepts the report of Dr. Maarten Bokhout, Acting Medical Officer of Health, dated March 7, 2019, titled The Role of Public Health in Reducing Hallway Medicine, as presented for information.
8.2 Population Health Assessment: (presented by Dr. Erica Clark) RECOMMENDED MOTION: THAT: The Board of Health accepts the report of Dr. Erica Clark, Epidemiologist, dated March 7, 2019, County of Huron BOARD OF HEALTH AGENDA Thursday, March 7, 2019 ~ Page 2 ~
titled Population Health Assessment, as presented for information.
8.3 Program Planning and Evidence-Informed Decision Making: (presented by Kristin Beaton, Andrew Esser-Haines, and Angela Willert) RECOMMENDED MOTION: THAT: The Board of Health accepts the report of Kristin Beaton, Program Evaluator, Andrew Esser- Haines, Program Evaluator, and Angela Willert, Public Health Supervisor, dated March 7, 2019, titled Program Planning and Evidence-Informed Decision Making, as presented for information.
8.4 Health Equity Overview: (presented by Donna Parsons, Pam Hanington, and Gloria Workman) RECOMMENDED MOTION: THAT: The Board of Health accepts the report of Donna Parsons, Health Equity Coordinator, Pam Hanington, Community Developer, and Gloria Workman, Community Developer, dated March 7, 2019, titled Health Equity Overview, as presented for information.
8.5 Financial Statements: (presented by Jean-Guy Albert) RECOMMENDED MOTION: THAT: The Board of Health accepts the report Jean-Guy Albert, Public Health Manager, dated March 7, 2019, titled Financial Statements, as presented for information; AND FURTHER THAT: The Board of Health supports the decision of County Council to reduce the number of financial reports being provided by eliminating the Financial Statements section of the Board of Health Agenda.
9. Acting Medical Officer of Health Update and Administration Update:
9.1 Acting Medical Officer of Health Update: (presented by Dr. Maarten Bokhout) RECOMMENDED MOTION: THAT: The Board of Health accepts the report of Dr. Maarten Bokhout, Acting Medical Officer of Health dated March 7, 2019, titled Acting Medical Officer of Health Update, as presented for information.
9.2 Administration Update: (presented by Dr. Maarten Bokhout) RECOMMENDED MOTION: THAT: The Board of Health accepts the report of the Huron County Health Unit Management Team, dated March 7, 2019, titled Administration Update, as presented for information.
County of Huron BOARD OF HEALTH AGENDA Thursday, March 7, 2019 ~ Page 3 ~
10. Correspondence: 10.1 Grey Bruce Health Unit letter to The Honourable Christine Elliott, Minister of Health and Long-Term Care and Deputy Premier Re: Sustainable Infrastructure and Financial Support for Local Drug Strategies – dated January 18, 2019.
10.2 Grey Bruce Health Unit letter to The Honourable Christine Elliott, Minister of Health and Long-Term Care and Deputy Premier Re: Strengthening Smoke-Free Ontario Act (2017) to address the promotion of vaping – dated January 18, 2019.
10.3 Grey Bruce Health Unit letter to Renu Kulendran, Executive Director Legalization of Cannabis Secretariat Ministry of the Attorney General Re: Regulatory Framework for Cannabis Storefronts in Ontario – dated January 18, 2019.
10.4 Grey Bruce Health Unit letter to The Honourable Caroline Mulroney, Ministry of the Attorney General Re: Provincial Legislation for Cannabis and the amended Smoke-Free Ontario Act, 2017 – dated January 22, 2019.
10.5 Grey Bruce Health Unit letter to The Honourable Doug Ford, Premier of Ontario Re: Support for Provincial Oral Health Program for Low Income Adults and Seniors – dated January 22, 2019.
10.6 Grey Bruce Health Unit letter to The Honourable Caroline Mulroney, Attorney General and Minister of Francophone Affairs Ministry of the Attorney General Re: Cannabis Retail Locations – dated January 22, 2019.
10.7 Southwestern Public Health Unit letter to Renu Kulendran, Executive Director Legalization of Cannabis Secretariat, Ministry of the Attorney General Re: Regulatory Framework for Cannabis Storefronts in Ontario – dated January 10, 2019.
10.8 Durham Region letter to The Honourable Doug Ford, Premier of Ontario Re: Motion on Cannabis Use in Public Places – dated January 31, 2019.
10.9 Simcoe Muskoka Health Unit letter to The Honourable Doug Ford, Premier of Ontario Re: Support of a Provincial Oral Health Program for Seniors – dated February 6, 2019.
10.10 Haliburton, Kawartha, Pine Ridge District Health Unit letter to The Honourable Doug Ford, Premier of Ontario Re: Support for Provincial Oral Health Program for Low-Income Adults and Seniors – dated February 14, 2019.
County of Huron BOARD OF HEALTH AGENDA Thursday, March 7, 2019 ~ Page 4 ~
10.11 alPHa letter to All Ontario Senators Re: Bill S-228, Child Health Protection Act – dated February 15, 2019.
RECOMMENDED MOTION: THAT: The Board of Health accepts correspondence not specifically dealt with, for information.
11. Financial Statements: December 2018 Financial Statements will be available when Year-end is finalized.
12. Closed to the Public Session: RECOMMENDED MOTION: THAT: The Board of Health do now go into a Closed to the Public Session at under Section 239 of the Municipal Act, 2001 as amended; to discuss an item/items that relates to:
AND FURTHER THAT: remain in attendance.
RECOMMENDED MOTION: THAT: The Board of Health rise from the Closed to the Public Session at .
Reporting Out
13. Next Meeting: The next meeting of the Board of Health will be on Thursday, April 4, 2019 at 9:00 AM in Seminar Room 2 at the Health & Library Complex, south of Clinton.
14. Adjournment: RECOMMENDED MOTION: THAT: The Board of Health meeting adjourn at .
HURON COUNTY BOARD OF HEALTH
Clinton, Ontario February 7, 2019
The Board of Health met in Seminar Room 2 at the Health and Library Complex south of Clinton on the 7th day of February. Members of the Board present: Warden J. Ginn, J. Fergusson, D. Jewitt, B. MacLellan, M. Murdock, R. Rognvaldson. Members of the Board Absent: R. Watt. Staff present: County Clerk Susan Cronin, Acting Medical Officer of Health Maarten Bokhout, Public Health Managers Jean-Guy Albert, Barbara Leavitt and Christina Taylor.
1. Chair Dave Jewitt called the Board of Health meeting to order at 9:00 AM:
2. Agenda and Reports:
MOTION: Moved by: Warden Ginn and Seconded by: Member Rognvaldson THAT: The Board of Health agenda for February 7, 2019 be accepted and all reports included in the agenda be received as presented. CARRIED
3. Declaration of Pecuniary Interest and the General Nature Thereof:
There were no declarations stated.
4. Minutes of Previous Session:
MOTION: Moved by: Member Murdock and Seconded by: Member Fergusson THAT: The minutes of the Board of Health meeting of January 3, 2019 and January 22, 2019 be adopted as circulated. CARRIED
5. Board Member Issues: None.
6. Administrative Issues:
Barbara Leavitt updated members on the Transition Meeting held on February 6, 2019. This will be a standing item on the agenda.
7. Information Session: Senior Management continued the orientation provided by the Health Unit on programs/responsibilities to members of the Board.
8. Program Reports:
8.1 2018 Operational Plan Year End Status Report: (presentation by Christina Taylor)
MOTION: Moved by: Warden Ginn and Seconded by: Member Rognvaldson THAT: The Board of Health accepts the report of the Huron County Health Unit Management Team, dated February 7, 2019, titled 2018 Operational Plan Year End Status Report, as Board of Health Thursday February 7, 2019 Page 2 of 3 presented for information. CARRIED
8.2 Non-Compliant with Vision Screening Protocol: (presentation by Tanya Sangster)
MOTION: Moved by: Member MacLellan and Seconded by: Member Murdock THAT: The Board of Health accepts the report of Tanya Sangster, Public Health Manager, dated February 7, 2019, titled Non-Compliant with Vision Screening Protocol, as presented for information; AND FURTHER THAT: The Board of Health acknowledges that while there has been much work to date, a full implementation of the Vision Protocol will not take place in the 2018-2019 school year. CARRIED
9. Acting Medical Officer of Health Update and Administration Update:
9.1 Acting Medical Officer of Health Update: (presentation by Dr. Maarten Bokhout)
MOTION: Moved by: Warden Ginn and Seconded by: Member Rognvaldson THAT: The Board of Health accepts the report of Dr. Maarten Bokhout, Acting Medical Officer of Health dated February 7, 2019, titled Acting Medical Officer of Health Update, as presented for information. CARRIED
9.2 Administration Update: (presentation by Dr. Maarten Bokhout)
MOTION: Moved by: Member Fergusson and Seconded by: Member Murdock THAT: The Board of Health accepts the report of the Huron County Health Unit Management Team, dated February 7, 2019, titled Administration Update, as presented for information. CARRIED
10. Correspondence:
MOTION: Moved by: Warden Ginn and Seconded by: Member Murdock THAT: The Board of Health accepts correspondence not specifically dealt with, for information. CARRIED
11. Financial Statements:
December 2018 Financial Statements will be available when Year-end is finalized.
12. Closed to the Public Session: None.
13. Next Meeting:
Board of Health Thursday February 7, 2019 Page 3 of 3
The next meeting of the Board of Health will be on Thursday, March 7, 2019 at 9:00 AM in Seminar Room 2 at the Health & Library Complex, south of Clinton.
14. Adjournment:
MOTION: Moved by: Warden Ginn and Seconded by: Member Fergusson THAT: The Board of Health meeting adjourn at 10:30 AM. CARRIED
Chair Jewitt
CORPORATION OF THE COUNTY OF HURON Health Unit
TO: Chair and Members of the Board of Health FROM: Dr. Bokhout and the Management Team DATE: March 7, 2019 SUBJECT: The role of public health in reducing hallway medicine
RECOMMENDATION
That the board accept this report for information.
BACKGROUND
In recent months there has been much media coverage of the provincial government’s plans to end “hallway medicine”. This has generated much concern in the public health field that resources may be priorized for primary care and the value of public health may not be acknowledged.
The Association of Local Public Health Agencies (alpha) drafted the attached summary paper of the value of public health.
FINANCIAL IMPACTS
There are no financial impacts to this report.
Original Signed By Original Signed By ______Dr. Maarten Bokhout Tanya Sangster Acting Medical Officer of Health Public Health Manager
Original Signed By Original Signed By ______Barb Leavitt Christina Taylor Public Health Manager Public Health Manager
Original Signed By ______Jean-Guy Albert Public Health Manager
Page 1 of 1 2 Carlton Street, Suite 1306 Toronto, Ontario M5B 1J3 Tel: (416) 595-0006 Fax: (416) 595-0030 E-mail: [email protected]
Improving and Maintaining the Health of the People The Contribution of Public Health to Reducing Hallway Medicine As the Government of Ontario considers one of its most high-profile election commitments – the elimination of “Hallway Medicine” in Ontario – this paper has been developed to explain the work of the public health sector and to highlight the important role that the sector can play in meeting that challenge. One of the answers to keeping people out of hospital hallways is to reduce the demand for hospital and primary care services. Building healthy communities through an efficient, proactive and locally managed public health system, mandated to lead on preventative measures to protect and promote the health of Ontarians, can go a long way to reducing that demand. Ontario’s public health system delivers value for money, ensuring Ontarians remain healthy, and are able to contribute fully to a prosperous Ontario. Studies have shown tremendous return on investment. For example, every $1 spent on: • mental health and addictions saves $7 in health costs and $30 dollars in lost productivity and social costs; • immunizing children with the measles-mumps-rubella vaccine saves $16 in health care costs; and • early childhood development and health care saves up to $9 in future spending on health, social and justice services. A systematic review of international public health investments published in 2017 concludes that cuts to public health budgets in high income countries represent a false economy and are likely to generate billions of dollars of additional costs to health services and the wider economy. At the same time, the public health system supports an effective health care system by reducing the demand for hospital services through: • advising and convening diverse stakeholders (e.g. schools, police, healthcare) to improve mental health and addictions treatments in community settings; • ensuring people are treated for sexually transmitted infections and tuberculosis and preventing infections and related hospital visits; • safeguarding the community from harms caused by impure drinking water and environmental hazards; • reducing the impact of outbreaks, such as influenza in Long Term Care Homes and hospitals; and • providing a point of access to supports and information for people with greater needs, whether rural, newcomers or others isolated in urban environments. In short, public health actions now can result in fewer emergency room and doctor’s office visits today and in the future. The geographic breadth of Ontario means that the needs of residents differ from region to region. Public health and community-based programs and services require localised input and delivery, leveraging existing partnerships with schools, municipalities, business networks, health care providers and social services organizations, resulting in the ability to quickly and efficiently respond to the needs
www.alphaweb.org Providing Leadership in Public Health Management of the people: • In 2016, the Middlesex-London Health Unit identified an outbreak of HIV in London. Provincially, HIV rates largely driven by men who have sex with men, had been declining for a decade. In London, rates were spiking, and driven by IV drug use. The Health Unit put boots on the ground, assembled an outreach team to find people on the street, and connected them with HIV testing and treatment. Today, the outbreak is over. • As the opioid crisis became critical in 2017, Ottawa Public Health supported people most at risk, informed schools and parents, made naloxone available across the city, and created a new real-time surveillance system. Today, the public health unit is using the surveillance data to inform and organize a Mental Health and Substance Use Summit, with The Royal Hospital. A broad range of stakeholders is identifying actions to increase prevention and create a more integrated approach to improve mental health assessment and access to treatment. • Recently, the North Bay Parry Sound Health Unit identified a need for enhanced dental services for low-income adults, based on data about high rates of emergency room visits for dental problems. The health unit solved the problem by starting a now well-used dental clinic for people who meet the financial and program criteria. • Last year, Toronto Public Health completed implementation of a wireless strategy that allows personal services setting inspectors and nurses inspecting vaccine fridges in doctors’ offices to complete their visits using tablets that upload results in real time rather than recording the inspection on paper and entering it on the website later. This means that results of inspections, information on the BodySafe website that people use each day to shop for a nail salon or other personal service, is the most current information. • Local public health units are increasingly using technology to serve people, improving convenience and cost-effectiveness, such as through interactive web-based prenatal education and chats with nurses on Facebook and by using on-line video to observe people taking tuberculosis medication instead of in-person observation. Such innovations begin locally and have spread across the province. These local solutions show that, when combined with stable, designated funding, the public health system has the capacity to relieve pressure on doctors and hospitals. Furthermore, accountability is firmly established by provincial legislation and policy ensuring that the money spent on public health is spent effectively and with purpose. Together we serve the people of Ontario to ensure: • that healthy people can support a strong economy, providing a direct economic impact; • coordination of responses to community health concerns such as mental health and addictions, in partnership with community level organizations; • reduction of pressures on doctors and hospitals by concentrating on the health of the community, starting at birth; and, • a significant, cost-effective contribution to the elimination of hallway medicine. In conclusion, public health works as a system that is greater than the sum of its parts - leveraging the skills and experience of nutritionists, nurses, health promoters, inspectors, epidemiologists, doctors, dentists and dental hygienists, board members and administrators, and more – to together support and protect the health of the people of Ontario. Public health delivers promotion, protection and prevention services on behalf of, and in partnership with, the Ontario Government.
www.alphaweb.org Providing Leadership in Public Health Management
CORPORATION OF THE COUNTY OF HURON Health Unit
TO: Chair and Members of the Board of Health FROM: Dr. Erica Clark, Epidemiologist DATE: March 7, 2019 SUBJECT: Population Health Assessment
RECOMMENDATION
That the Board of Health accept this report of March 7, 2019 as presented for information.
BACKGROUND
Boards of Health undertake population health assessment work to determine the health of a population similar to the way a health practitioner assesses individual health. When you go to see your health care practitioner, he or she may conduct a series of tests to monitor your health. Those tests may include taking your blood pressure and temperature and asking about any health complaints. At the population level we look at other measurements such as the percentage of people reporting their health is good or excellent and the rate of hospitalizations due to injuries to monitor the health of a population.
Boards of Health are required to undertake population health assessment work as outlined in the Ontario Public Health Standards and Population Health Assessment and Surveillance Protocol, 2018. Population health assessment is the measurement, monitoring, analysis, and interpretation of population health data to ensure that public health’s responses to current and evolving conditions are effective, and to improve population health with programs and services that are informed by the population’s health status, including social determinants of health and health inequities. This population health assessment work is part of the evidence we use to inform decision making.
The model in Figure 1 outlines the types of evidence that inform our decision making process
Page 1 of 3
Figure 1: Evidence informed decision making model1 Population health assessment focuses on community health issues and local context (yellow bubble) and, to a lesser extent, research (purple bubble) and community and political preferences and actions (green bubble). When we are doing population health assessment, we need to keep in mind several lens including,
Healthy rural lens
Ethical practice
Privacy
Health and well-being approach
Health equity There are a number of questions we ask when doing population health assessment. Some examples include,
What are the most common causes of injuries in Huron County?
Do Huron County residents experience more injuries than other rural areas or the rest of Ontario?
Are there groups of people in Huron County who are more likely to experience injuries?
1 National Collaborating Centre for Methods and Tools. (revised 2012). A Model for Evidence- Informed Decision-Making in Public Health. [fact sheet]. Retrieved from https://www.nccmt.ca/uploads/media/media/0001/01/0285efc9fa08b3b0fab06b7c940c2f6767 087cfc.pdf. on 13 February 2019. Page 2 of 3 The information we use to answer these questions comes from a number of different sources including,
Databases
Research other people have done
Primary data collection (surveys, interviews, or focus groups we have done) We have access to, or own, 29 databases including,
Canadian Community Health Survey (Ontario Share File)
Huron County beach water sampling
Hospital discharge abstract database (DAD)
iPHIS (contains investigation records for diseases of public health significance)
Hedgehog (contains Huron County Health Unit inspection records)
BORN (contains prenatal, birth, and postnatal information on Huron County babies)
Ontario Cancer Registry After gathering information from the databases, other research, and primary data collection, the population health assessment information is used to create reports, presentations, infographics, and other products to be used in evidence informed decision making.
FINANCIAL IMPACTS
None.
Original Signed By Original Signed By ______Erica Clark Barb Leavitt Epidemiologist Public Health Manager
Original Signed By ______Tanya Sangster Public Health Manager
Page 3 of 3 Population health assessment is looking at information that tells us how well communities are doing.
That information can then be used to plan programs and services to improve the health of communities. This is similar to what a health care practitioner does for an individual except we are interested in populations rather than individuals
Health care practitioner uses information Huron County Health Unit uses information to look to look at health of individual at health of communities Blood pressure Percentage reported overall good or excellent health Temperature Rate of hospitalizations due to injuries Asking about health complaints Percentage low birth weight babies Evidence informed decision making model
Source: National Collaborating Centre for Methods and Tools. (revised 2012). A Model for Evidence-Informed Decision-Making in Public Health. [fact sheet]. Retrieved from https://www.nccmt.ca/uploads/media/media/0001/01/0285efc9fa08b3b0fab06b7c940c2f6767087cfc.pdf. on 13 February 2019. Things to keep in mind/..
• Healthy rural lens • Ethical practice • Privacy • Health and well-being approach • Health equity Examples of questions we ask/..
• What are the most common causes of injuries in Huron County? • Do Huron County residents experience more injuries than other rural areas or the rest of Ontario? • Are there groups of people in Huron County who are more likely to experience injuries? The information we use to answer these questions comes from a number of sources/.. Research other Primary data Databases people have done collection • Canadian • Systematic • Surveys Community reviews • Interviews Health Survey • Reports from • Focus groups • Hedgehog other health • BORN units CORPORATION OF THE COUNTY OF HURON Health Unit
TO: Chair and Members of the Board of Health FROM: Kristin Beaton, Program Evaluator, Andrew Esser-Haines, Program Evaluator, Angela Willert, Public Health Supervisor DATE: March 7, 2019 SUBJECT: Program Planning and Evidence-Informed Decision Making
RECOMMENDATION This report is to provide the Board of Health with information regarding how evidence-informed decision making and program planning are integrated into programs and services at the Huron County Health Unit.
This report is to be received for information purposes.
BACKGROUND The Ontario Public Health Standards, 2018 (OPHS) outlines that programs and services should use current and emerging evidence to support effective public health practice. Effective public practice, as listed as a requirement under the Foundational Standards, articulates that “Evidence-informed practice is responsive to the needs and emerging issues of the health unit’s population and uses the best available evidence to address them” (Ontario Public Health Standards, 2018, p. 17). In addition, it speaks to transparency and the application of skills in evidence-informed decision-making, research, knowledge exchange, program planning and evaluation, and communication, with a continued focus on quality and transparency as a requirement for boards of health.
In order to achieve the requirements as listed under Effective Public Health Practice, as well as address our health unit’s strategic plan and core values, we have developed and implemented a program planning policy and process. The iterative program planning process is ongoing in order to develop and modify programs throughout their lifespan.
PROGRAM PLANNING FRAMEWORK AT HCHU The Program Planning Framework and the tools associated with it, as outlined below, were created to provide a common process for local program planning in accordance with the OPHS.
Page 1 of 4
The process leads staff through assessing the situation, planning, implementing, and planning to evaluate local public health programs and interventions.
A program or intervention, when being initiated, facing significant change, or identified by management, will go through the program planning process. This process may include:
Gathering evidence of community needs and literature to support current activities Undertaking a situational assessment (use available documentation tools) Commencing a formal monitoring and/or evaluation process
For programs and interventions not facing significant change, it is expected that the practice and principles of the framework are followed to ensure programs and interventions are rooted in evidence. Based on the discretion of management, some programs may enter the program planning process at different phases of the program planning cycle.
Not all programs will go through the formal Program Planning Process. Protocol-driven programs are informed by evidence at the Ministry level and may not go through a full program planning process. Management and health unit staff on the Foundational Services Team provide direction as to whether the program planning process is appropriate, or if quality improvement methods may be applied to improve adherence to the standards and protocol. Staff resources are allocated to support staff through the program planning process. Through ongoing support and oversight of the program planning process, the health unit ensures that
Page 2 of 4 resources are allocated based on evidence, duplication is minimized, and overall program and service impact is maximized. The process is rooted in evidence-informed decision making.
EVIDENCE-INFORMED DECISION MAKING The health unit uses tools developed by the National Collaborating Centre for Method and Tools. These tools ensure that evidence-informed decision making involves integrating best available evidence into the decision-making process. The process takes into account the following factors:
Research Community health issues and local context Community and political preferences and actions, Public health resources
Combined, the sources of evidence influence decision-making. Depending on the situation, different factors may be weighted differently in order to make a final decision. For example, while there may be a wealth of local context (e.g., rates of youth binge drinking) highlighting youth binge drinking as an area to focus on, the limited research evidence (population-based rural approaches) that points to a solution for our small rural community is further complicated by the mixed and inconsistent community and political forces and existing public health resources. In order to weigh the sources of evidence, health unit staff continually use their public health expertise and overall critical analysis skills. In this example, we would look to leverage existing community momentum while prioritizing where to invest in new programming based on research evidence that is most closely aligned with our community’s needs and assets.
Page 3 of 4 FINANCIAL IMPACTS This report outlines the deployment of resources approved as part of the 2019 budget.
Original Signed By Original Signed By ______Barb Leavitt Tanya Sangster Public Health Manager Public Health Manager
Original Signed By Original Signed By ______Angela Willert Kristin Beaton Public Health Supervisor Program Evaluator
Original Signed By ______Andrew Esser-Haines Program Evaluator
Page 4 of 4 Program Planning and Evidence-Informed Decision Making Board of Health | March 7, 2019
Kristin Beaton, Program Evaluator Andrew Esser-Haines, Program Evaluator Angela Willert, Public Health Supervisor Overview • Foundational Standard: Effective Public Health Practice • Supports to Program Planning Process • Evidence-Informed Decision Making • Health Unit Program Planning Process • Case Study (Youth Alcohol) • Impact on Resources, Planning and Decision Making • Reflections Foundational Standard: Effective Public Health Practice The board of health shall… Demonstrates the use of a systematic process to plan public health programs and services to address the needs of the community by integrating the best available research and evaluation evidence with contextual factors such as local population health issues, priority populations, community assets and needs, political climate, public engagement, and available resources” (OPHS, p. 24) Support to Program Planning Process
Internal External • Program Planning Policy • NCCMT’s EIDM online • Program Planning modules Framework • PHO Virtual Library • Situational assessment template • Program Planning Guidance Document • Management decision making tool Evidence Informed Decision Making Based on multiple sources of Evidence HCHU Program Planning Framework Step 1 “!ssess” Situational Assessment Considerations • Various evidence sources • Staff support • Adaptable • Collapse/expand • Template: – One place – Prompts – Links – Report Completed Situational Assessments • Cancer Prevention and Early Detection • Healthy Weights • Positive Parenting • Prenatal Classes • Substance Misuse Prevention • Injury Prevention • Adventurous Play • Opioids • Sleep Step 1 “!ssess” Case Study Recommendations Management 1. Review & Approval 2. 3. 4. Recommendations 5. 1. 6. 2. 7. 3. 4. 5. 6. Annual Workplan 7. Step 2 “Plan” Program Planning Process • Completed assessment • Staff support • Guidance document outputs: – Logic model – Program plan • Workplan • Evaluation and monitoring plans “Plan” Logic Model
Program goal Reduce burden of alcohol use in Huron County
Reduce harms associated with youth alcohol use Long term outcomes Reduce youth high risk behaviours
Medium term outcome Increase youth mental wellbeing
Short term Increase social and interpersonal relationship skills outcome
Intervention Challenges, beliefs, changes program “Plan” Operations Plan Impact on Resources, Planning and Decision Making
• Effective use of resources & maximized impact • Evidence-based decisions • Maintain focus • Capacity building of staff • Accountability & Transparency • Prioritizing Reflections
Lessons Learned Limitations • Scope • Comparing program to • Program planning support program • Adaptable tools for • Resource intensive situational assessment and • Protocols management • Involve the right supports at Provincial Leadership the right time • Regional Knowledge • Co-leads Transfer & Exchange Day • Watch for program lead bias • TOPHC • Ownership • NCCMT CORPORATION OF THE COUNTY OF HURON Health Unit
TO: Chair and Members of the Board of Health FROM: Donna Parsons (Health Equity Coordinator), Pam Hanington (Community Developer), Gloria Workman (Community Developer) DATE: March 7, 2019 SUBJECT: Health Equity Overview
RECOMMENDATION
That the board of health accept this report of March 7, 2019 as presented for information.
BACKGROUND
Health equity means that all people can reach their full health potential and are not disadvantaged from attaining it because of their race, ethnicity, religion, gender, age, social class, socioeconomic status or her socially determined circumstance. There is a difference between equality, where everyone is given equal support, and equity where people are given supports based on need.
Social Determinants of Health (SDOH) Health is influenced by a broad range of factors, including social determinants that affect the conditions in which individuals and communities live, learn, work, and play. Health equity is linked to the following key SDOH:
• Access to health services • Housing • Culture, race, and ethnicity • Income and income distribution • Disability • Indigenous status • Early childhood development • Personal health practices and • Education, literacy, and skills resiliency • Employment, job security, and working • Physical environments conditions • Sexual orientation and attraction • Food insecurity • Social inclusion/exclusion • Gender identity and expression • Social support networks
In our public health work, we need to pay attention to all the social conditions that influence health. Social determinants frequently intersect and can have compounding effects. By developing policies that strive to reduce inequalities in these conditions, we can help to generate healthier lives and communities.
Health Equity at the Huron County Health Unit Health equity as a foundational service at the Huron County Health Unit is guided by the Public Health Foundational Standard and the Health Equity Guidelines (2018) set out by the Ministry of Health and Long-Term Care. This Guideline provides the framework in which we inform our strategies. It is based on four public health roles including:
Page 1 of 4 1. Assess and Report 2. Modify and Orient Interventions 3. Partner with Other Sectors 4. Participate in Policy Development
Health equity is considered at all levels within HCHU, including: organization, team, programs and services and individual with a focus on safe, inclusive, diverse and equitable practice. While all staff are expected to use a health equity lens in their daily work, we currently have staff whose main role is to support Health Equity as a Foundational Standard: Donna Parsons is a Public Health Nurse who is our Health Equity Coordinator. Her focus is coordinating the Health Equity work across the Health Unit and developing Equity Strategic Planning. She is also responsible for building internal capacity, which includes development of tools and resources to support identifying priority populations, and completing Health Equity Impact Assessments. Pam Hanington is a Community Developer whose focus is working at a systems level in the areas of poverty, food security, homelessness, and transportation. Gloria Workman is a Community Developer whose focus is a United Way funded project supporting several communities across Huron County to identify and address issues Laura Miller is a Public Health Nurse who works in the Amish and Mennonite communities.
Our Health Equity vision for the HCHU is: Health Equity, as a vital component to achieve true population health, is integrated into all public health programs and services. Our commitment to Health Equity is demonstrated without bias or judgment but with empathy and informed decision- making. Building relationships across communities and public sectors as advocates of Health Equity will contribute to positive change in population health throughout Huron County.
Building Internal Capacity Health equity is identified as a core value on our health unit strategic plan. We recognize that it is vital that we build internal capacity and integrate health equity as a foundation across all programs and services in order to support people in Huron County to reach their full health potential. Equity- focused internal capacity building initiatives are delivered regularly, such as training at All staff meetings and team meetings. In addition, we have a Safe, Inclusive, Diverse and Equitable (SIDE) internal Community of Practice, which has representation from all teams and is an opportunity for all staff to discuss health equity as it relates to their programs and services.
Priority populations Priority populations generally refer to some individuals and groups who are at greater risk of negative health outcomes due to their social and/or economic position within society. Our health unit is in the process of gathering information to identify what our key priority populations are. For example, they may include people who live with low incomes, or members of the LGBTQ+ community.
Page 2 of 4 As well, the health unit dedicates one public health nurse to work specifically with the Amish and Mennonite communities with a focus on building relationships to ensure those communities can access all public health services. The Amish and Mennonite communities have many strengths. They have close personal connectedness, strong natural physical activity behaviors, and excellent food skills. With ongoing assessments of these communities, the need to support in the areas of road/personal safety, optimal growth and development and informed decision making regarding immunizations remain from a public health perspective. The Amish and Mennonite communities continue to demonstrate their willingness to partner with the health unit.
Population health approach Population health is the state of health of the population as measured by health status indicators and as influenced by social, economic and physical environments, personal health practices, individual capacity and coping skills, human biology, early childhood development, and health services - the determinants of health. Key elements of a population health approach include: increasing upstream investments, addressing the social determinants of health, applying multiple strategies, and collaborating across sectors and levels. Population-based strategies focus on root causes and aim to prevent health inequities through upstream activities such as advocacy and social action.
The HCHU applies a population health approach to health equity through our systems-level work, which includes inter-sectorial action and diverse partnerships, and by taking a community development approach to support communities in solutions.
Poverty to Prosperity (P2P) The HCHU provides backbone support to Poverty to Prosperity, a collaborative and action-based group that brings people together from across sectors to improve the lives of individuals who live in poverty. P2P envisions an end to poverty in Huron County and a healthy, equitable, just and inclusive community where every person has a sense of belonging.
Areas that have emerged for action are income security, food security, affordable housing, health and transportation. The main objectives are to: improve access to services and supports through cross-sectorial collaboration, build support for people living in poverty by fostering commitment among stakeholders, utilize local data, information and evidence for decision-making educate and raise awareness of poverty issues and, advocate for policy changes that will reduce poverty in Huron County.
P2P is comprised of services, supports, organizations, citizens, faith groups and networks that focus on building capacity in Huron County to decrease poverty and its impact. P2P undertakes participatory action research, education and awareness activities and community development initiatives. In particular, P2P is committed to integrating the expertise of people with lived experience into service coordination and improvement.
Destination: Prosperity is P2P’s three-year community development strategy, funded by Perth Huron United Way and supported by P2P and the Health Unit, designed to enhance existing services,
Page 3 of 4 better meet community needs and to foster community participation through working with women as heads of households and potential community leaders in three of Huron County's most socially isolated and underserviced communities. The choice to work with women was made because of women’s higher poverty rates. The other goal of the project is to invite health and social service providers to make changes in the way they deliver services at the local level. There are three communities that have been involved in the project; Huron Park, Dungannon and Area and Brussels and Area. Each community was selected according to a list of criteria, such as geographic isolation, lack of services, and lack of transportation. Each of these communities has chosen a different model for their communitydriven efforts based on their strengths, capacity and aspirations for themselves, their families and their community. Three new community groups have formed with assistance of the project. Women from Huron Park have created New Outlook and five community organizations in Dungannon have come together to form the Dungannon Community Alliance. An integrated model including community members, service providers, faith groups, service organizations and municipal representatives have formed the Brussels Community Alliance. Communities have initiated projects to ensure that everyone has enough to eat, can learn cooking skills, and have raised awareness around poverty issues in their local communities. They have held community social, consultation and educational events in collaboration with municipal governments and health and social service providers.
FINANCIAL IMPACTS
There are no financial impacts of this report.
Original Signed By Original Signed By ______Donna Parsons Gloria Workman Health Equity Coordinator Community Developer
Original Signed By Original Signed By ______Pam Hanington Barb Leavitt Community Developer Public Health Manager
Original Signed By ______Tanya Sangster Public Health Manager
Page 4 of 4 Board of Health Orientation to Health Equity March 7, 2019
Donna Parsons - PHN, Health Equity Coordinator Pam Hannington - Community Developer Gloria Workman – Community Developer What is Health Equity?
Health equity means that all people can reach their full health potential and are not disadvantaged from attaining it because of their race, ethnicity, religion, gender, age, social class, socioeconomic status or her socially determined circumstance. Our Health Equity Cultural Vision: Health Equity, as a vital component to achieve true population health is integrated into all public health programs and services. Our commitment to Health Equity is demonstrated without bias or judgment but with empathy and informed decision-making. Building relationships across communities and public sectors as advocates of Health Equity will contribute to positive change in population health throughout Huron County. (“What is your health equity cultural vision for 2019” small group work – HE Champions) Equality Versus Equity Social Determinants of Health
Health is influenced by a broad range of factors, including social determinants that affect the conditions in which individuals and communities live, learn, work, and play. Health equity is linked to the following key social determinants of health:
• Access to health services • Housing • Culture, race, and ethnicity • Income and income distribution • Disability • Indigenous status • Early childhood development • Personal health practices and • Education, literacy, and skills resiliency • Employment, job security, and • Physical environments working conditions • Sexual orientation and attraction • Food insecurity • Social inclusion/exclusion • Gender identity and expression • Social support networks
Our Foundational work is based on the Health Equity Guidelines set out by the MOHLTC: The Ups and Downs of the Social Determinants of Health Game
Objective is to create real world understanding of the Social Determinants of Health CORPORATION OF THE COUNTY OF HURON Health Unit
TO: Chair and Members of the Board of Health FROM: Jean-Guy Albert, Public Health Manager DATE: March 7, 2019 SUBJECT: Financial Statements
RECOMMENDATION
That the Board of Health accepts this report of March 7, 2019 as presented for information, and That Board of Health supports the decision of County Council to reduce the number of financial reports being provided by eliminating the Financial Statements section of the Board of Health Agenda.
BACKGROUND
During its September 19, 2018 Committee of the Whole Day 2 meeting, members approved a staff recommendation to reduce the number of financial reports being provided to County Council.
One of the responsibilities assigned to the Board of Health is to provide financial oversight to the Health Unit. To assist in the fulfillment of this fiduciary responsibility, a finance committee of the Board of Health was created, with its terms of reference approved by the members during the August 4, 2016 meeting.
The terms of reference define the purpose, the membership, the terms of office, and the duties of the finance committee. One of the duties of the committee members is to review and recommend to the Board, the Health Unit’s annual capital and operating budget. Another duty is to review all quarterly financial statements for approval by the Board.
If the recommendations in this report are approved and the financial statements section is removed from the agenda, Board of Health Members, through the Finance Committee and during Board of Health meetings, will continue to be informed of the Health Unit’s financial matters through the review of the annual budget and of the quarterly financial statements.
Page 1 of 2 FINANCIAL IMPACTS
Funding associated with the implementation of the recommendations of this report is through the 2019 Huron County Health Unit’s operational budget.
Original Signed By Original Signed By ______Jean-Guy Albert Tanya Sangster Public Health Manager Public Health Manager
Original Signed By Original Signed By ______Christina Taylor Barb Leavitt Public Health Manager Public Health Manager
Page 2 of 2
CORPORATION OF THE COUNTY OF HURON Health Unit
TO: Chair and Members of the Board of Health FROM: Dr. Maarten Bokhout, Acting Medical Officer of Health DATE: March 7, 2019 SUBJECT: Acting Medical Officer of Health Update
RECOMMENDATION
This report to be received for information purposes.
BACKGROUND
Climate change is an increasingly important public health issue and will affect all of us in many different ways in the years to come. While various projections suggest only a relatively modest average temperature increase for this part of the world, the likelihood of extreme weather conditions will increase. We have experienced severe cold weather conditions in the past month; now we are dealing with freezing rain, which brings its own problems. April showers are less likely; summers have been wetter than usual. Weather changes bring with it a different mix of illnesses, UV exposure and injuries. Our health messages will reflect these new realities.
A disturbing feature of this new reality is that it is largely a result of human activity. We travel more; we take for granted technology, scientific advances and improved illness/injury management, inconceivable a few years ago, to ease our struggle for survival. We expect to live longer and healthier and, as professionals, we continue to work to bring these improved living conditions to all who live in Huron County. This has been accomplished, in part, through the vastly increased consumption of fossil fuels, which have, as an unintended side effect, contributed to the gradual accumulation of greenhouse gases in the atmosphere, with potential catastrophic consequences for the millions of people who live near the sea, and more unpredictable weather for many others - including us.
A number of studies suggest that the adverse effects of our human-induced climactic changes can no longer be reversed. However, these findings are not universally accepted, and it therefore continues to be important to advocate for, and do our part, to reduce our dependence on, and consumption of, fossil fuels. Driving more fuel efficient cars, lowering home temperatures during the cold season, and allowing a couple of extra degrees of warmth during the summertime (and dressing accordingly!), are simple steps to take, and will help in this quest. Making dietary choices which are more reflective of what is locally available; using manufactured goods which can be fully recycled, as opposed to being discarded to landfill as garbage will, along with the other examples, constitute a new way of thinking about our relationship with the world in which we live, reduce the production of greenhouse gases,
Page 1 of 2
and, perhaps will result in environmental changes which are more health promoting than they are now, or threaten to be.
Transition Team Update
Please see attached February 6, 2019 Huron County Health Unit & Perth District Health Unit Transition Team meeting minutes.
Original Signed By ______Dr. Maarten Bokhout Acting Medical Officer of Health Huron County Health Unit
Page 2 of 2
Huron County Health Unit (HCHU) & Perth District Health Unit (PDHU) Transition Team Meeting February 6, 2019 @ 2pm Minutes
Present: Miriam Klassen, Julie Pauli, Donna Taylor, Kathy Vassilakos, Melissa Rintoul (Recorder), Jim Ginn (tc), Dave Jewitt (tc), Tanya Sangster (tc), Bob Wilhelm, Barb Leavitt, Dr Maarten Bokhout
Regrets: Tony Yu, Roger Watt
1. Welcome and introductions Members were introduced
2. Approval of Agenda Agenda approved as presented
3. Business Arising
Membership/Quorum- see updated TOR Tanya Sangster and Kathy Vassilakos will be co-chairs
Schedule for 2019 Meetings will be held the first Wednesday of the month in afternoon at 2 pm, alternating sites. Next meeting will be Wednesday, March 8, 2019 at 2 pm at HCHU.
Huron County facilities update Julie, Miriam and Tanya met with Huron County and confirmed that both sides are interested in exploring a lease arrangement; meeting planned to review details.
Legal update Julie provided update RFP process is complete Legal representation expected to be secured shortly
HR update Julie provided update, policies and procedures in progress Non-union org chart in progress
IT update Julie provided update regarding RFP process, interviews complete Successful consultant to be contracted shortly
Communications Working Group update Barb provided update on RFP process to date The portal is up and running and will continue to be added to for information sharing as the process evolves
Program Working Groups update LB is helping to finalize process to align programs LB will be meeting with the Huron Perth Public Health Management Team to launch February 22
4. Amalgamation Expenses and Time Tracking Julie presented expense report Discussion regarding detail of time tracking Direction given to staff to track the direct hours spent on amalgamation (Jan 1-Mar 31, 2019), and apply those hours against the Amalgamation Contingency Fund Julie will track time allocated by the Transition Team/Municipal Staff
5. New Business
6. Key Messages Transition Team Met today The team received updates on Legal, Facilities, HR, IT and PW groups The TT will meet on the first Wednesday of the Month Updated membership of TT is; Miriam Klassen, Julie Pauli, Donna Taylor, Kathy Vassilakos, Melissa Rintoul (Recorder), Jim Ginn (tc), Dave Jewitt (tc), Tanya Sangster (tc), Bob Wilhelm, Barb Leavitt, Dr Maarten Bokhout, Roger Watt
7. Next meeting date Wednesday, March 6, 2019 at 2 pm at HCHU
Meeting adjourned at 2:50 pm
CORPORATION OF THE COUNTY OF HURON Health Unit
TO: Chair and Members of the Board of Health FROM: Huron County Health Unit Management Team DATE: March 7, 2019 SUBJECT: Administration Update
RECOMMENDATION
This report to be received for information purposes.
Annual Service Plan (ASP) Extension
The Ministry of Health and Long-Term care has issues an extension of the March 1, 2019 deadline of the ASP to April 1, 2019; management staff have the ASP well underway. Board of Health members will see the narrative piece of the ASP before submission.
Public Health Ontario Visit
Peter Donnelly president of Public Health Ontario is set to visit the Health Unit on May 7th, 2019.
Original Signed By Original Signed By ______Tanya Sangster Christina Taylor Public Health Manager Public Health Manager
Original Signed By Original Signed By ______Jean-Guy Albert Barb Leavitt Public Health Manager Public Health Manager
Page 1 of 1 O PUBLIC HEALTH GifIltr,Irrfrlrtm|rlnllr January 18,2019
The Honourable Christine Elliott Minister of Health and Long-Term care and Deputy premier Hepburn Block, 1Oth Floor 80 Grosvenor St. Toronto, ON M7A 1Eg ch risti ne. ell iott@pc. ola. orq
Dear Minister Elliott:
Re: Sustainable lnfrastructure and Financial Supports for Local Drug Strategies
on November 23, 2018 ata regular meeting of the Board for the Grey Bruce Health unit, the Board considered the attached correspondence from peterborough public Health regarding opioid-related overdoses and ensuring that local drug strategies are integrated into future planning for provincial mental health and addiction programs. The following motion was passed:
GBHU BOH Motion 201A-111
Moved by: Mitch Twolan Seconded by: paul Eagleson
"THAT' the Board of Health support the correspondence from peterborough Health Unit regarding sustainable infrastructure and financial supports for local drug strategies.,,
Carried
Sincerely,
/ <-:*-.--
Dr. lan Arra, Medical Officer of Health (Acting) Grey Bruce Health Unit
Encl.
Cc: Local Mp's and Mpp's alPHa All Ontario Health Units ' Working fogefher for o heolthier fufure for oll. loi i;il ii;;;ii;;i;i;;;; i.,"J, o'"i.jiiij N;( ift ;;;ffili;;;;rh;;;6;;;;:;; ;; 519-376-9420 l-800-263-3456 Fqx 519-376-0605 Jackson Square, 185 King Street, Peterborough, ON K9J 2R8 P: 705-743-1000 or 1-877-743-0101 F: 705-743-2897 peterboroughpublichealth.ca
Serving the residents of Curve Lake and Hiawatha First Nations, and the County and City of Peterborough
Serving the residents of Curve Lake and Hiawatha First Nations, and the County and City of Peterborough o PUBLIC HEALTH GMilrtrrlrfifirmln January 18,2019
The Honourable Christine Elliott Minister of Health and Long-Term Care and Deputy premier Hepburn Block, 1Oth Floor 80 Grosvenor St. Toronto, ON M7A 1E9 christine. ell iott@pc. ola.orq
Dear Minister Elliott:
Re Strengthening the Smoke-Free Ontario Act (2017) to address the promotion of vaping
On November 23, 2018 at a regular meeting of the Board for the Grey Bruce Health Unit, the Board considered the attached correspondence from Peterborough public Health urging the Ontario government to strengthen the Smoke-Free Ontario (2017)Act and prohibit through regulation, the promotion of vaping products. The following motion was passed:
GBHU BOH Motion 2018-112
Moved by: Laurie Laporte Seconded by: Sue Paterson
"THAT, the Board of Health support the correspondence from Peterborough Health Unit urging the province to strengthen the Smoke-Free Ontario Act2017 and prohibit the promotion of vaping products."
Carried
Sincerely,
).--- Dr. lan Arra, Medical Officer of Health (Acting) Grey Bruce Health Unit
Encl
Cc: Local MP's and MPP's alPHa All Ontario Health Units Working fogether for o heolthier fufure for oll.
I0l l Tth Street Eost, Owen Sound, Ontorio N4K 0A5 www.publicheolthgreybruce.on,co
519-376-9420 l-800-263-3456 Fox 519-376-0605 BOH - CORRESPONDENCE - 5
Jackson Square, 185 King Street, Peterborough, ON K9J 2R8 P: 705-743-1000 or 1-877-743-0101 F: 705-743-2897 peterboroughpublichealth.ca
Serving the residents of Curve Lake and Hiawatha First Nations, and the County and City of Peterborough
1 Health Canada (2018). Canada’s Tobacco Strategy. Retrieved from https://www.canada.ca/content/dam/hc- sc/documents/services/publications/healthy-living/canada-tobacco-strategy/overview-canada-tobacco- strategy-eng.pdf
2 Statistics Canada (2018). Canadian Tobacco, Alcohol and Drugs Survey (CTADS): Summary of results for 2017. Retrieved from https://www.canada.ca/en/health-canada/services/canadian-tobacco-alcohol-drugs- survey/2017-summary.html
Serving the residents of Curve Lake and Hiawatha First Nations, and the County and City of Peterborough o PUBLIC HEALTH @!HIiT!ED January 18,2019
Renu Kulendran, Executive Director Legalization of Cannabis Secretariat Ministry of the Attorney General McMurtry-Scott Building 720 Bay Street, 11th Floor Toronto ON M7A 2Sg renu. kulendran@ontario. ca
Dear Ms. Kulendran:
Re: Regulatory Framework for Cannabis Storefronts in Ontario
On November 23, 2018 at a regular meeting of the Board for the Grey Bruce Health Unit, the Board considered the attached correspondence from Peterborough Public Health regarding regulations pertaining to cannabis storefront operating parameters, siting requirements and public notice processes. The following motion was passed:
GBHU BOH Motion 2018-113
Moved by: David Shearman Seconded by: Mitch Twolan
"THAT, the Board of Health support the correspondence from Peterborough Health Unit in regards to regulation of cannabis storefront retail sales."
Carried
Sincerely,
<----z--'-t--
Dr. lan Arra, Medical Officer of Health (Acting) Grey Bruce Health Unit
Encl
Cc: Local MP's and MPP's alPHa All Ontario Health Units
Working fogelher for o heolthier fufure for oll. i0i'i;il'i;;;;;;;o;;; iij,i j, ij'"i.iiil, N;k'iils' il;;;;ril;;rh;;;6;;;; ;; ;; 519-376-9420 l-800-263-3456 Fox 519-376-0605 BOH - CORRESPONDENCE - 6
Jackson Square, 185 King Street, Peterborough, ON K9J 2R8 P: 705-743-1000 or 1-877-743-0101 F: 705-743-2897 peterboroughpublichealth.ca
Serving the residents of Curve Lake and Hiawatha First Nations, and the County and City of Peterborough
Serving the residents of Curve Lake and Hiawatha First Nations, and the County and City of Peterborough
BOH Correspondence - 1
Jackson Square, 185 King Street, Peterborough, ON K9J 2R8 P: 705-743-1000 or 1-877-743-0101 F: 705-743-2897 peterboroughpublichealth.ca
Serving the residents of Curve Lake and Hiawatha First Nations, and the County and City of Peterborough Serving the residents of Curve Lake and Hiawatha First Nations, and the County and City of Peterborough
BOH - CORRESPONDENCE - 5
December 7, 2018
VIA ELECTRONIC MAIL
The Honourable Doug Ford Premier of Ontario Legislative Building Queen’s Park Toronto, ON M7A 1A1
Dear Premier Ford:
Re: Support for Provinical Oral Health Program for Low Income Adults and Seniors
I am very pleased to write to you on behalf of the Board of Health for Public Health Sudbury & Districts to share our sincere appreciation for the provincial government’s support of a provincial oral health program for low-income seniors. This is a welcome addition to oral health programs already available for children and youth in low-income families through Healthy Smiles Ontario.
The Board of Health for Public Health Sudbury & Districts has a keen interest in oral health. In reviewing our 2018 data on oral health, we identified that to further support oral health for all Ontarians, programs are needed for low-income adults, in addition to those in place or planned for children, youth and seniors.
At its meeting on November 22, 2018, the Board of Health carried the following resolution #42-18: Letter Re: Support for Provinical Oral Health Program for Low Income Adults and Seniors December 7, 2018 Page 2
WHEREAS as compared with other provinces, Ontario has the lowest rate of public funding for dental care, as a percentage of all dental care expenditures and the lowest per capita public sector spending on dental services, resulting in precarious access to dental preventive and treatment services, especially for low-income Ontarians; and
WHEREAS the Ontario Progressive Conservative party pledged to implement a comprehensive dental care program that provides low income seniors with quality care by increasing the funding for dental services in Public Health Units, Community Health Centres, and Aboriginal Health Access Centres and by investing in a new dental services in underserviced areas including increasing the capacity in public health units and investing in mobile dental buses;
THEREFORE BE IT RESOLVED THAT the Board of Health for Public Health Sudbury & Districts fully support the Premier’s plan to invest in oral health programs for low income seniors and further encourage the government to expand access to include low income adults; and
FURTHER that this motion be shared with area municipalities and relevant dental and health sector partners, all Ontario Boards of Health, Chief Medical Officer of Health, Association of Municipalities of Ontario (AMO), and local MPPs.
Thank you for your attention to this matter and I look forward hearing more about the role public health can take in support of a new oral health program for low income adults and seniors that is cost effective and accessible.
Sincerely,
Penny Sutcliffe, MD, MHSc, FRCPC Medical Officer of Health and Chief Executive Officer cc: Honorable Christine Elliott, Minister of Health and Long-Term Care Dr. David Williams, Chief Medical Officer of Health, Minister of Health and Long-Term Care Mr. Jamie West, MPP, Sudbury Ms. France Gelinas, MPP, Nickel Belt Mr. Michael Mantha, MPP, Algoma-Manitoulin All Ontario Boards of Health Constituent Municipalities within Public Health Sudbury & Districts Ms. Loretta Ryan, Executive Director, Association of Local Public Health Agencies Association of Municipalities of Ontario Dr. David Diamond, President, Sudbury & District Dental Society Dr. Tyler McNicholl, vice-president, Sudbury & District Dental Society Ms. Jacquie Maund, Alliance for Healthier Communities
St. Thomas Site Woodstock Site Administrative Office 410 Buller Street 1230 Talbot Street Woodstock, ON St. Thomas, ON N4S 4N2 N5P 1G9
January 10, 2019
Renu Kulendran, Executive Director Email: [email protected] Legalization of Cannabis Secretariat Ministry of the Attorney General McMurty-Scott Building 720 Bay Street, 11th Floor Toronto, ON M7A 2S9
Dear Ms. Kulendran,
Re: Regulatory Framework for Cannabis Storefronts in Ontario
The Board of Health for Southwestern Public Health, at its meeting on January 9, 2019 considered correspondence from Peterborough Public Health (November 8, 2018) regarding the regulatory framework for cannabis storefronts in Ontario. On behalf of the Board of Health for Southwestern Public Health, we are writing to you to inform you that the Board supports the comments written by Peterborough Public Health, as outlined below. Southwestern Public Health continues to receive questions from municipalities and residents concerning the cannabis retail environment. The regulation of the cannabis retail environment is an important component of a public health approach to cannabis legalization to reduce negative impacts of cannabis use. Lessons from alcohol and tobacco retail show that increased availability results in increased consumption, which can lead to significant health and social costs.1 Operating Parameters
Limit retail hours: • Research shows that longer retail hours significantly increase consumption and related harms.1 Cannabis consumption and harms can be reduced by limiting early morning and late-night hours.2 Establish minimum training requirements for staff: • According to the Alcohol and Gaming Commission of Ontario (AGCO), training will be required for holders of a retail store authorization, holders or a cannabis retail manager licence, and employees of a cannabis retail store. The Centre for Addiction and Mental Health (CAMH) suggested the Liquor Control Board of Ontario’s Challenges and Refusal program could provide a good model for this training.
Siting Requirements
Set minimum distances from youth-serving facilities and vulnerable populations: • Retail outlet proximity to youth-serving facilities and vulnerable populations can normalize and increase substance use.3 Setting minimum distances prevents the role
www.swpublichealth.ca modeling of cannabis use and reduces youth access through minimum distance requirements from facilities such as schools, child care centres, libraries, and community centres. In Kelowna there are recommendations for retail cannabis stores to be 150m from elementary schools and 500m from middle and secondary schools. Regulate cannabis retail densities: • A high retail density can contribute to increased consumption and related harms.1 Outlet density can be reduced through minimum distance requirements between cannabis retail outlets and limits on the overall number of outlets. The City of Calgary has enacted a 300m separation distance between cannabis stores. Prohibit co-location of cannabis, alcohol, and tobacco retail: • Evidence suggests the co-use of cannabis and other substances increases the risk of harm, such as impaired driving.4 Prohibiting the co-locations of cannabis, alcohol, and tobacco can discourage the co-use of these substances. CAMH reports that this precautionary measure has been taken in all U.S. states that have legalized cannabis.
Public Notice Processes
Strengthen municipal influence over store locations and density: • The Cannabis Licence Act, 2018, limits the authority of municipalities to pass zoning or licensing by-laws relating to cannabis retail. Municipalities play an important role in the health and safety of communities and strengthening the voice of municipalities within the written comment period with AGCO, would enable municipalities to uphold this role. Clarify ‘public interest’ for written submission: • As the Cannabis Licence Act, 2018, sets out, municipalities and residents are granted a 15-day period to make written submissions to the AGCO regarding whether a store authorization is in public interest. It is unclear how municipalities are to make an informed determination around public interest within the 15-day period. Municipal by laws can help clarify the written submission parameters for municipal respondents.
Sincerely,
Cynthia St. John Dr. Joyce Lock Chief Executive Director Medical Officer of Health
c. The Hon. Doug Ford, Premier of Ontario The Hon. Christine Elliot, Minister of Health and Long-Term Care Municipal Councils in Oxford County, County of Elgin, and the City of St. Thomas Ernie Hardeman, MPP, Oxford Jeff Yurek, MPP, Elgin-Middlesex-London Loretta Ryan, Executive Director, Association of Local Public Health Agencies Ontario Boards of Health
1 Babor, T, Caetano R, Cassell S, Edwards G, Giesbrecht N, Graham K, Rossow I. (2010). Alcohol no ordinary commodity: Research and public policy (Second ed.). New York, USA: Oxford University Press. Ottawa, ON. 2 Popova S, Giesbrecht N, Bekmuradov D, Patra J. (2009). Hours and days of sale and density of alcohol outlets: impacts on alcohol consumption and damage: a systematic review. Alcohol Oct;44(5):500-16. 3 U.S. Department of Health and Human Services (HHS), Office of the Surgeon General (2016). Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Available from: https://addiction.surgeongeneral.gov/surgeon-generals- report.pdf 4 Government of Canada (2016). A framework for the legalization and regulation of cannabis in Canada: The final report of the task force on cannabis legalization and regulation. Available from: http://www.healthycanadians.gc.ca/task-force-marijuana-groupe- etude/framework-cadre/alt/framework-cadre-eng.pdf 2 / 2
February 6, 2019
The Honourable Doug Ford Premier of Ontario Legislative Building Queens’s Park Toronto, ON M7A 1A1
Dear Premier Ford:
Re: Support of a Provincial Oral Health Program for Seniors
The Board of Health for the Simcoe Muskoka District Health Unit (Board) is encouraged by the new provincial government’s support for a provincial oral health program for low-income seniors. The financial, health and social impacts of poor oral health in seniors has been a long standing area of concern for our Board.
In 2016, our Board sent a letter to the Minister of Health calling on the Provincial Government to expand access to publically funded dental care for all low income adults, including low income seniors and all institutionalized seniors. The letter cited how access to prevention and dental treatment would reduce oral health inequities in Ontario that profoundly impact some of the most vulnerable people in our local jurisdiction and the Province as a whole.
As an indication of this need, in 2017 there were 4,069 visits to emergency departments within hospitals in Simcoe and Muskoka for oral health reasons. This figure remains highly troubling. It shows that a large number of our residents lack access to preventive and restorative oral health care, and therefore, need to resort to emergency departments for their dental needs. Unfortunately, these visits further burden an already overwhelmed hospital system and ultimately fail to address the underlying oral health problems causing pain and infection.
The Ontario Progressive Conservative Party has pledged to implement a publically funded dental care program for low income seniors. As well, they have committed to increase dental services through Public Health Units, Community Health Centres, and Aboriginal Health Access Centres and to increase funding to provide investment for service delivery in underserviced areas. Our Board sees firsthand the positive impact that our Healthy Smiles Dental Clinics have on the clients and communities we serve. In 2018, we completed approximately 4,300 appointments for eligible clients in our clinics and over 900 preventive appointments for Healthy Smiles Ontario children in schools. We support increasing clinical capacity, including in Public Health Units, in order to address the severe need among low income seniors. We await further news concerning public health’s role in reducing barriers to oral health, increasing service delivery for low income seniors and improving health system efficiency.
Sincerely,
ORIGINAL Signed By:
Anita Dubeau Chair, Board of Health
AD:HM:cm
Cc. Honorable Christine Elliot, Minister of Health and Long-Term Care Dr. David Williams, Chief Medical Officer of Health Members of Provincial Parliament for Simcoe and Muskoka Ontario Boards of Health Ms. Loretta Ryan, Association of Local Public Health Agencies Ms. Jacquie Maund and Ms. Anna Rusak, Ontario Oral Health Alliance Mayors and Councils in Simcoe Muskoka Central Local Health Integration Network North Simcoe Muskoka Local Health Integration Network
The Honourable Doug Ford Premier of Ontario Legislative Building, Queen's Park Toronto, ON M7A 1A1 (Sent via email to: [email protected] )
February 14, 2019
Dear Premier Ford
Re: Support for Provincial Oral Health Program for Low-Income Adults and Seniors
I am writing to you on behalf of the Board of Health for the Haliburton, Kawartha, Pine Ridge District Health Unit (Health Unit) to express our support for the Government of Ontario’s commitment to build a provincial dental program for low- income seniors by increasing the funding for dental services in Public Health Units (PHUs), Community Health Centres (CHCs), and Aboriginal Health Access Centres and by investing in new dental services in underserviced areas including increasing the capacity in PHUs and investing in mobile dental buses. The Health Unit’s Oral Health staff take pride in being able to assist parents of children and youth 17 and under in our communities to access the Healthy Smiles Ontario program to look after their children’s oral health needs and look forward to being able to help local seniors access dental care.
In our Health Unit area, we are fortunate to have two CHCs, one in Northumberland County and one in the City of Kawartha Lakes that offer low-cost dental programs, and there is a volunteer dental clinic in Haliburton County, run by dental professionals who provide treatment at no cost to residents with serious dental care needs. Our local social service agencies are able to offer some limited discretionary dental assistance to recipients of Ontario Works. Northumberland County Community & Social Services also has a Community Outreach program that may be able to provide minimal funding to some low-income adults and seniors to assist with health issues like dental care.
Despite the existence of these programs, our Health Unit’s Oral Health staff regularly hear from adults and seniors who fail to qualify for these programs because discretionary funding has run out, they are not financially or clinically eligible for the program and/or they simply cannot afford to pay the reduced rate offered. This leaves many residents no choice but to visit their local Emergency Room (ER). Hospital data from the Ministry of Health and Long-Term Care tell us that in 2015, 1,208 adults living in our Health Unit area visited the ER for dental-related issues. At an estimated $513 per dental- related ER visit, this cost the system $619,700, for patients to access a painkiller or an antibiotic but no dental treatment. We also know from these data that over 75% of those visiting the ER are adults between the ages of 20 and 64. We therefore ask that while developing the proposed dental program for low-income seniors, that your government consider how this program could eventually expand into a dental care program that also serves low- income adults.
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Premier Ford February 14, 2019 Page 2
We look forward to receiving more information about how Ontario public health units can facilitate and support the implementation of a new public dental program for low-income seniors, with the potential for this program to also serve low-income adults in the future.
Thank you again for your commitment to improving the oral health and overall health of Ontarians.
Sincerely
BOARD OF HEALTH FOR THE HALIBURTON, KAWARTHA, PINE RIDGE DISTRICT HEALTH UNIT
Cammie Jaquays Chair, Board of Health
AR/ALN:ed
cc (via email) : Honourable Christine Elliott, Minister of Health and Long-Term Care Dr. David Williams, Chief Medical Officer of Health, Minister of Health and Long-Term Care Mr. David Piccini, MPP, Northumberland Peterborough South Ms. Laurie Scott, MPP, Haliburton Kawartha Brock Municipalities within the Haliburton, Kawartha, Pine Ridge District Health Unit area All Ontario Boards of Health Ms. Loretta Ryan, Executive Director, Association of Local Public Health Agencies Ms. Pegeen Walsh, Executive Director, Ontario Public Health Association Association of Municipalities of Ontario
2 Carlton Street, Suite 1306 Toronto, Ontario M5B 1J3 Tel: (416) 595-0006 Fax: (416) 595-0030 E-mail: [email protected]
ALL ONTARIO SENATORS February 15, 2019 alPHa’s members are The Senate of Canada the public health units Ottawa, Ontario, Canada K1A 0A4 in Ontario. VIA E-MA IL alPHa Sections: Honourable Ontario Senators, Boards of Health Section Re: Bill S-228, Child Health Protection Act
Council of Ontario On behalf of the Association of Local Public Health Agencies (alPHa) and its member Medical Officers of Health (COMOH) Medical Officers of Health, Boards of Health and Affiliate organizations, I am writing today to express our full support for Bill S-228, which, if passed into law, would prohibit
certain food and beverage marketing directed at children. Affiliate Organizations: alPHa has long advocated for a regulatory approach to limiting marketing to children,
Association of Ontario having recognized that industry’s voluntary and self-regulating regime is extraordinarily
Public Health Business weak and, in many cases, demonstrably dishonest. Administrators
In 2008, alPHa passed Resolution A08-13, which calls for a ban on commercial advertising Association of Public Health of food and beverages to children under the age of 13. The following year, alPHa passed
Epidemiologists a similar Resolution (A09-1) which extends this call to banning commercial marketing of in Ontario any kind to children. The first is based on the extensive evidence that marketing food and
beverages to children has a significant negative impact on their food and beverage Association of Supervisors of Public choices, as foods and beverages marketed to children are predominantly unhealthy and
Health Inspectors of unhealthy food and beverage choices are contributing to obesity and its associated Ontario chronic diseases. The second is based on the evidence that direct marketing to children is
Health Promotion by definition manipulative. I am pleased to attach both for your reference. Ontario
Indeed, we were very pleased to see that one of the key recommendations of the 2016 Ontario Association of Canadian Senate Report, Obesity in Canada: Whole-of-Society Approach for a Public Health Dentistry Healthier Canada was for the federal government to “immediately conduct a thorough
Ontario Association of assessment of the prohibition on advertising food to children in Quebec; and design and
Public Health Nursing implement a prohibition on the advertising of foods and beverages to children based on Leaders that assessment”.
Ontario Dietitians in Public Health We were of course also delighted with the subsequent introduction of Bill S-228, which
provides a ready-made legislative model for what such intervention could look like across Canada , and that it has reached the stage where it is on the verge of being passed into law.
The time is right to implement an enforceable legislative framework that protects child
health by protecting them from predatory marketing practices. The pioneering Quebec
system has been in place for over 35 years and the evidence for restricting marketing to
kids to protect their health has never been more clear. Moreover, public opinion polls have shown that more than 80% of Canadians approve of government intervention to limit advertising of unhealthy food and beverages to children. www.alphaweb.org Providing Leadership in Public Health Management Unhealthy eating patterns are a major risk factor for a number of chronic conditions, including heart disease, cancer, and diabetes. These constitute a measurable burden on our health care system and considerable societal and economic costs. We know that such patterns are established early in life and that creating environments that support healthy eating must be a top public health priority. This must include placing stronger limits on the aggressive marketing of unhealthy food and beverages to our children.
We believe that passing Bill S-228 is a necessary and important step in improving the health of future generations of Canadians and we urge you to vote in its favour.
Sincerely,
Dr. Robert Kyle, President
Copy: Rt. Hon Justin Trudeau, Prime Minister of Canada Hon. Ginette Petitpas Taylor, Minister of Health Dr. Theresa Tam, Chief Public Health Officer of Canada Dr. David Williams, Chief Medical Officer of Health (Ontario) Encl.
About alPHa: The Association of Local Public Health Agencies (alPHa) is a non-profit organization that provides leadership to Ontario’s boards of health and public health units. The Association works with governments and other health organizations, to advocate for a strong and effective local public health system in the province, as well as public health policies, programs and services that benefit all Ontarians.
alPHa RESOLUTION A09-1
TITLE: Ban on Advertising to Children Under 13 Years of Age
SPONSOR: alPHa Board of Directors
WHEREAS the Association of Local Public Health Agencies has resolved to call upon the Governments of Ontario and Canada to ban all commercial advertising of food and beverages targeted to children under 13 years of age; and
WHEREAS this position was adopted based on evidence presented about the harms of marketing to children in general
THEREFORE BE IT RESOLVED THAT the Association of Local Public Health Agencies also support the broader goal of the Ontario Public Health Association and other organizations that are advocating for a ban on all commercial advertising targeted to children under 13 years of age.
ACTION FROM CONFERENCE:
Moved: V. Sterling (Toronto) Seconded: J. Butt (Leeds-Grenville Lanark)
Resolution CARRIED AS AMENDED
3
ALPHA RESOLUTION A08-13
TITLE: Ban on Commercial Advertising of Food and Beverages to Children Under 13 Years of Age
SPONSOR: Toronto Board of Health
WHEREAS children today are exposed to a greater intensity and frequency of marketing than any previous generation; and
WHEREAS there is strong evidence that younger children lack the cognitive abilities to understand marketing messages; and
WHEREAS there is strong evidence that food advertising has a direct influence on what children choose to eat and indirectly exerts pressure on parents to choose those things; and
WHEREAS the dominant focus of commercial advertising to children is for products that undermine parents’ and public health professionals’ efforts to promote healthy diets and physical activity; and
WHEREAS recent industry initiatives promising to change advertising to children have proven to be ineffective; and
WHEREAS the Quebec ban on commercial advertising to children provides a wealth of experience in implementing a national framework; and
WHEREAS the Supreme Court of Canada ruled in 1989 that the Quebec ad ban is a reasonable limit on the right to free speech and that “...advertising directed at young children is per se manipulative”; and
WHEREAS almost 90% of television watched by Canadian children is on Canadian-based stations which would be subject to Canadian laws; and
WHEREAS the Toronto Board of Health, the Centre for Science in the Public Interest and the Elementary Teachers’ Federation of Ontario have called for a ban on all commercial advertising targeted to children;
NOW THEREFORE BE IT RESOLVED THAT the Association of Local Public Health Agencies call for a ban on all commercial advertising of food and beverages targeted to children under 13 years of age by the Government of Ontario and the Government of Canada;
AND FURTHER THAT the Association of Local Public Health Agencies partner with the Ontario Public Health Association, Toronto Public Health and other interested stakeholders to develop and implement an effective province-wide advocacy plan.
ACTION FROM CONFERENCE:
Moved: R. Pellizzari (Peterborough) Seconded: V. Sterling (Toronto)
Resolution CARRIED AS AMENDED