THUNDER BAY DISTRICT HEALTH UNIT BOARD OF HEALTH MEETING AGENDA

2020-11 November 18, 2020 1:00 PM Microsoft Teams Meeting Pages

1. CALL TO ORDER Chair: Mr. James McPherson

2. ATTENDANCE AND ANNOUNCEMENTS

3. DECLARATIONS OF CONFLICT OF INTEREST

4. AGENDA APPROVAL

RES 1: THAT the Agenda for the Regular Board of Health Meeting to be held on November 18, 2020, be approved.

5. INFORMATION SESSION 1

6. MINUTES OF THE PREVIOUS MEETINGS

6.1. Thunder Bay District Board of Health 7 The Minutes of the Thunder Bay District Board of Health (Regular and Closed Session) Meeting held on October 21, 2020, for approval.

RES 2: THAT the Minutes of the Thunder Bay District Board of Health (Regular and Closed Session) Meeting held on October 21, 2020, be approved 7. MATTERS ARISING FROM THE MINUTES

8. BOARD OF HEALTH (CLOSED SESSION) MEETING

RES 3a: THAT the Board of Health move into Closed Session to receive information relative to labour relations or employee negotiations.

9. DECISIONS OF THE BOARD

9.1. 2021 Mandatory Program Budgets 16 Report No. 37-2020 (Finance) relative to providing the Board of Health with the proposed 2021 Mandatory Program (Cost-Shared) Budgets.

RES 4: THAT with respect to Report No. 37 – 2020 (Finance), we recommend that the: 1. 2021 Mandatory Core Program Budget (Cost-Shared) be approved at $15,724,603 including 40 net full time equivalent (FTE) positions, for submission to the Ministry of Health; 1. Municipal Levy be set at $3,213,543; 1. 100% Indigenous Communities: Indigenous Partnerships budget be approved at $99,500, with 1.0 FTE and submitted to the Ministry of Health; 1. 100% Indigenous Communities: Street Outreach budget be approved at $110,000, with 1.0 FTE and submitted to the Ministry of Health; 1. 100% Indigenous Communities: Public Health budget be approved at $400,000, with 1.0 FTE and submitted to the Ministry of Health;

1. 100% Ontario Seniors Dental Care Program budget be approved at $612,400, with 2.9 FTEs and submitted to the Ministry of Health; 1. 100% Northern Fruit and Vegetable Program budget be approved at $661,600, with 3.5 FTEs and submitted to the Ministry of Health; 1. Land Development Program budget be approved at $193,488 including 2.0 FTE positions; 1. 100% Public Health Inspector Practicum budget be approved at $10,000, and be submitted to the Ministry of Health; 1. Director of Corporate Services and Manager of Finance be authorized to complete any administrative requirements of the respective budget submission processes, as required; and 1. Director of Corporate Services and Manager of Finance be authorized to arrange appropriate financing for the funding of the Health Unit operations, if

9.2. Employee Benefit Plan Renewal 105 Report No. 38-2020 (Finance) relative to providing the Board of Health with recommendations for the renewal of the Employee Benefit Plan.

RES 5: THAT with respect to Report No. 38 – 2020 (Finance / Human Resources), we recommend the renewal of the Employee Group Benefit Plan with Green Shield Canada and Sun Life Financial through the Association of Local Public Health Agencies (alPHa) Employee Group Benefit Consortium Plan as presented for the policy term of December 1, 2020 to November 30, 2021; AND THAT the Director of Corporate Services and the Manager of Finance be authorized to complete any administrative requirements of the renewal.

9.3. Income Solutions to Address Food Insecurity 110 Report No. 41-2020 (Healthy Living) relative to providing the Board of Health with recommendations for food insecurity and poverty reduction advocacy.

RES 6: THAT with respect to Report No. 41-2020 (Healthy Living), we recommend examining income solutions to reduce food insecurity in Canada; AND THAT a letter be sent to the federal government on behalf of the Board of Health in support of this recommendation.

10. COMMUNICATIONS FOR INFORMATION

10.1. Ontario Senior's Dental Program 115 Report No. 32-2020 (Oral Health) relative to providing the Board of Health with an update on the Ontario Senior's Dental Program, for information.

10.2. Third Quarter Interim Financial Statements 117 Report No. 40-2020 (Finance) relative to providing the Board of Health with the interim financial report for the quarter ended September 30,2020, for information.

10.3. COVID-19 Financial Implications 125 A memorandum from Mr. L. Dyll, Director of Corporate Services, dated November 18, 2020, relative to providing the additional information on the financial implications of the COVID-19 pandemic, for information.

10.4. COVID-19 (Coronavirus) Update Dr. J. DeMille, Medical Officer of Health and Chief Executive Officer, will provide an update to the Board of Health on the status of the coronavirus pandemic in the Thunder Bay District Health Unit, for information.

10.5. Public Health System Evaluation - COVID Response Dr. J. DeMille, Medical Officer of Health and Chief Executive Officer, will provide an overview of the report from the Council of Ontario Medical Officers of Health relative to public health system evaluation and lessons learned from the first peak of the COVID-19 pandemic, for information.

11. NEXT MEETING The next regularly scheduled meeting will be held on December 16, 2020. at 1:00 p.m.

12. ADJOURNMENT

RES 7: THAT the Board of Health meeting held on November 18, 2020, be adjourned at ______p.m.

13. RESOLUTION CORRESPONDENCE 127 Letter from Grey Bruce Health Unit, dated October 29, 2020, addressed to Minister Hajdu and Minister Elliott, relative to endorsing the call from the Municipal Drug Strategy Coordinators Network of Ontario regarding safer supply initiatives. Letter from Grey Bruce Health Unit, dated October 30, 2020, address to Minister Hajdu, Minister Fullerton and Ontario’s Long-Term Care COVID-19 Commission, relative to supporting correspondence from Simcoe Muskoka District Health Unit regarding the need to reform and redesign the Long-Term Care system in Canada. 11/17/2020

Addressing the Root Cause of Household Food Insecurity

Presented to: Thunder Bay District Health Unit - Board of Health Presented by: Ivan Ho, Public Health Nutritionist

Outline

1. Household Food Insecurity (HFI) 2. HFI Statistics 3. Impacts of COVID-19 on HFI 4. Income Solutions to HFI 5. Call to Action 6. Questions

1 1 11/17/2020

Household Food Insecurity (HFI)

“Inadequate or insecure access to food primarily due to financial constraints” - PROOF Food Insecurity Policy Research

Marginal Moderate Severe Proportion or percentage (%) of Worry about Compromise in Miss meals, households that running out of food quality and/or reduce food intake, and/or limited food quantity of food and at the most experience food selection extreme go day(s) insecurity without food

Household Food Insecurity (HFI)

Consequences of HFI

- ↑Poor diets - ↑Chronic disease rates - ↑Premature death - ↓Productivity and learning (esp. youth) - ↓Mental health - ↑Healthcare costs

2 2 11/17/2020

HFI Statistics

● 1 in 3.5 28.2% Indigenous households ● 1 in 7.8 12.7% Canada households ● 1 in 7.5 Ontario 13.3% households ● 1 in 6.9 Thunder Bay 14.3% households

(CCHS 2017-2018 - Based on PROOF method)

HFI Statistics

Household Food Insecurity in the District of Thunder Bay 14.6 14.4 14.4 14.3 Percent (%) 14.2 Household 14.0 Food 13.8 Insecurity 13.6 13.5 13.4 13.4 13.2 13.0 12.8 2009/2010 2011/2012 2013/2014 2017/2018

Data Source: Statistics Canada, Canadian Community (CCHS) 2009-2010, 2011-2012, 2013-2014 2017-2018

3 3 11/17/2020

Impacts of COVID-19 on HFI

Loss of work Loss of income Increase in HFI

Precarious work At a moment’s notice, HFI in Canada is hours loss of work leads to significantly higher decreased income during COVID-19 Reduced work hours which direct affects (14.6%) compared to Extensive job loss food affordability the 2017/2018 CCHS results (10.5%)* Uncertain food supply and increase in food prices

Income Solutions to HFI

Current solutions are not effective, not sustainable, and are not equitable

● Charitable food programs (i.e. Food Banks) ● Social supports /assistance (i.e. Ontario Works)

4 4 11/17/2020

Income Solutions to HFI

Research has shown that HFI can be reduced through public policies that improve the financial circumstances of low-income households

↓ Poverty and ↑ Adequate Income

Call to Action

- BOH - Letter of Support - Continued monitoring of Food Affordability (Nutritious Food Basket Survey Annually or Biennially) - Support efforts to reduce racialized poverty

5 5 11/17/2020

Questions?

6 6

BOARD OF HEALTH MEETING

MINUTES OF THE MEETING: OCTOBER 21, 2020

TIME OF MEETING: 1:00 P.M.

PLACE OF MEETING: VIDEOCONFERENCE

CHAIR: MR. JAMES MCPHERSON

BOARD MEMBERS PRESENT: ADMINISTRATION PRESENT:

Ms. Alana Bishop Dr. J. DeMille, Medical Officer of Health and Chief Mr. Norm Gale Executive Officer Ms. Deborah Harris Shallow Mr. L. Dyll, Director – Corporate Services Mr. Dave Hamilton Ms. T. Rabachuk, Director – Health Protection Ms. Maria Harding Ms. L. Roberts, Director – Health Promotion Mr. John MacEachern Ms. D. Gowanlock, Manager – Infectious Diseases Mr. James McPherson Ms. A. Jennings, Manager – Human Resources Ms. Karen O’Gorman Ms. K. Battigelli, Senior Public Health Nurse Ms. Kristin Oliver Ms. N. Kent, Administrative Assistant – Corporate Mr. Don Smith Services Mr. Greg Vallance Ms. S. Stevens, Executive Assistant and Secretary to Ms. Michelle Warywoda the Board of Health

REGRETS: Mr. Jim Vezina

1. CALL TO ORDER The Chair called the meeting to order at 1:00 p.m.

2. ATTENDANCE AND ANNOUNCEMENTS The Chair presented regrets from Mr. Vezina. Board members were reminded that the meeting is being live-streamed on the Health Unit website.

7 Board of Health Meeting October 21, 2020

3. DECLARATIONS OF CONFLICT OF INTEREST There were no declarations of conflict of interest.

4. AGENDA APPROVAL Resolution No. 72-2020

Moved By: A. Bishop Seconded By: M. Harding THAT the Agenda for the Regular Board of Health Meeting to be held on October 21, 2020, be approved. CARRIED

5. INFORMATION SESSION 5.1 Case and Contact Management Ms. K. Battigelli, Senior Public Health Nurse, provided a presentation to the Board of Health on the Case and Contact Management of Infectious Diseases, specifically relative to COVID-19, for information.

6. MINUTES OF THE PREVIOUS MEETINGS 6.1 Thunder Bay District Board of Health The Minutes of the Thunder Bay District Board of Health (Regular and Closed Session) Meeting held on September 16, 2020, to be approved. Resolution No.: 73-2020 Moved By: D. Smith Seconded By: J. MacEachern THAT the Minutes of the Thunder Bay District Board of Health (Regular and Closed Session) Meeting held on September 16, 2020, be approved CARRIED

7. MATTERS ARISING FROM THE MINUTES There were not matters arising from the previous minutes. 2 8 Board of Health Meeting October 21, 2020

8. BOARD OF HEALTH (CLOSED SESSION) MEETING Resolution No.: 74a-2020 Moved By: M. Warywoda Seconded By: J. MacEachern THAT the Board of Health move into Closed Session to receive information relative to labour relations or employee negotiations. CARRIED

At 1:25 p.m., the Board of Health moved into a Closed Session. The following individuals left the meeting: Ms. D. Gowanlock, Manager – Infectious Disease Program Ms. K. Battigelli, Senior Public Health Nurse Ms. N. Kent, Administrative Assistant – Corporate Services Ms. S. Stevens, Executive Assistant

At 1:50 p.m., the following individuals also left the meeting:

Dr. J. DeMille, MOH/CEO Mr. L. Dyll, Director – Corporate Services Ms. T. Rabachuk, Director – Health Protection Ms. L. Roberts, Director – Health Promotion Ms. A. Jennings, Manager – Human Resources

At 2:20 p.m., the Board of Health moved out of Closed Session to resume regular business. The following individual returned to the meeting:

Dr. J. DeMille, MOH/CEO Mr. L. Dyll, Director – Corporate Services Ms. T. Rabachuk, Director – Health Protection Ms. N. Kent, Administrative Assistant – Corporate Services Ms. S. Stevens, Executive Assistant

Mr. D. Hrychuk, Manager of Finance, also joined the meeting.

3 9 Board of Health Meeting October 21, 2020

9. DECISIONS OF THE BOARD 9.1 Reserve & Reserve Fund Strategy Report Number 35-2020 (Finance) relative to providing the Board of Health with the annual review and recommendations regarding the Reserves and Reserve Fund Strategy was presented and discussed. Resolution No.: 75-2020 Moved By: K. Oliver Seconded By: M. Warywoda THAT with respect to Report No. 35-2020 (Finance), we recommend:

 the Reserve Fund strategies and transfers be approved as presented;

 any year-end municipal surplus at December 31, 2020 be applied to replenish the $10,000 withdrawal from the Program Contingency Reserve Fund for the contribution to the Thunder Bay Drug Strategy Community Partnership;

 the parameters for the Stabilization Reserve fund be approved for the purpose of stabilizing future Municipal levy increases;

 $279,513 be transferred to the newly created Stabilization Reserve fund as a result of mitigation funding received from the Ministry of Health after the budget approval process;

 any further remaining municipal surplus be transferred into the Capital Expenditure Reserve Fund, to replenish any amounts withdrawn for the Roof and Building Envelope Repairs;

 any year-end surplus or deficit from the Land Development Program be transferred into or withdrawn from the Land Development Reserve Fund, respectively;

 the Director of Corporate Services and Manager of Finance be authorized to complete any related administrative requirements for the Reserve and Reserve Fund. CARRIED

4 10 Board of Health Meeting October 21, 2020

9. DECISIONS OF THE BOARD (Continued) 9.2 Bargaining Parameters - ONA

At the Board of Health Closed Session meeting held earlier in the day, a presentation containing recommendations relative to the above noted was provided.

At that time, the Board of Health was advised that a relating resolution would be presented in the Open Session for consideration.

Resolution No.: 74c-2020

Moved By: D. Harris Shallow Seconded By: D. Smith

THAT with respect to labour negotiations with the Ontario Nurses Association (ONA) we recommend that Administration proceed as directed. CARRIED

9.3 Bargaining Parameters – CUPE

At the Board of Health Closed Session meeting held earlier in the day, a presentation containing recommendations relative to the above noted was provided.

At that time, the Board of Health was advised that a relating resolution would be presented in the Open Session for consideration.

Resolution No.: 74d-2020

Moved By: D. Harris Shallow Seconded By: A. Bishop THAT with respect to labour negotiations with the Canadian Union of Public Employees (CUPE) we recommend that Administration proceed as directed. CARRIED

5 11 Board of Health Meeting October 21, 2020

10. COMMUNICATIONS FOR INFORMATION 10.1 COVID-19 Update Dr. J. DeMille provided an update to the Board of Health on the status of COVID- 19 in the Thunder Bay District Health Unit.

11. NEXT MEETING The next regularly scheduled meeting will be held on Wednesday, November 18, 2020, at 1:00 p.m.

12. ADJOURNMENT Resolution No.: 76-2020 Moved By: K. Oliver Seconded By: A. Bishop THAT the Board of Health meeting held on October 21, 2020,be adjourned at 2:47 p.m. CARRIED

6 12 THUNDER BAY DISTRICT HEALTH UNIT

MINUTES OF MEETING: BOARD OF HEALTH (IN CAMERA)

DATE October 21, 2020

TIME: Immediately Following Approval of Resolution

PLACE: Videoconference

CHAIR: Mr. James McPherson

BOARD MEMBERS PRESENT: ADMINISTRATION PRESENT:

Ms. Alana Bishop Dr. Janet DeMille, Medical Officer of Health and Chief Mr. Norm Gale Executive Officer Mr. Dave Hamilton Mr. Lance Dyll, Director of Corporate Services Ms. Deborah Harris Shallow Ms. Tanelle Rabachuk, Director of Health Protection Ms. Maria Harding Ms. Lynda Roberts, Director of Health Promotion Mr. John MacEachern Ms. Alyson Jennings, Manager of Human Resources Mr. James McPherson Ms. Karen O’Gorman Ms. Kristen Oliver Mr. Don Smith Mr. Greg Vallance Ms. Michelle Warywoda

REGRETS: Mr. Jim Vezina

CALL TO ORDER

The Chair called the meeting to order at 1:25 p.m.

1. DECLARATIONS OF CONFLICT OF INTEREST

There were no declarations of conflict of interest.

13 Thunder Bay District Health Unit October 21, 2020 Board of Health (Closed Session) Minutes Page 2 of 3

2. NEW BUSINESS

2.1 Bargaining Parameters – Ontario Nurses Association

Mr. L. Dyll, Director of Corporate Services, provided a power point presentation to the Board of Health with information relative to the above noted.

The Board of Health was advised that a relating resolution would be brought back to the open session for consideration.

2.2 Bargaining Parameters – Canadian Union of Public Employees

Mr. L. Dyll, Director of Corporate Services, provided a power point presentation to the Board of Health with information relative to the above noted.

The Board of Health was advised that a relating resolution would be brought back to the open session for consideration.

At 1:50 p.m., the following individuals left the Closed Session meeting:

Dr. Janet DeMille, Medical Officer of Health and Chief Executive Officer Mr. Lance Dyll, Director of Corporate Services Ms. Tanelle Rabachuk, Director of Health Protection Ms. Lynda Roberts, Director of Health Promotion Ms. Alyson Jennings, Manager of Human Resources

2.3 MOH/CEO Performance Review

Mr. J. McPherson, Board of Health Chair, and Mr. D. Smith, Board of Health Vice Chair discussed the performance review of the Medical Officer of Health and Chief Executive Officer with the Board of Health, in accordance with Board of Health policy BH-02-16.

Resolution No.: 74b-2020

MOVED BY: D. Smith SECONDED BY: A. Bishop

THAT the Board of Health move out of Closed Session to resume regular business.

CARRIED

14 Thunder Bay District Health Unit October 21, 2020 Board of Health (Closed Session) Minutes Page 3 of 3

3. ADJOURNMENT

The meeting adjourned at 2:20 p.m.

15 Issue Report PAGE 1 OF 14

PROGRAM/ Finance DIVISION Corporate Services REPORT NO. 37 - 2020

MEETING DATE November 18, 2020 MEETING TYPE Regular

SUBJECT 2021 Mandatory Budgets

RECOMMENDATION THAT with respect to Report No. 37 – 2020 (Finance), we recommend that the:

1. 2021 Mandatory Core Program Budget (Cost-Shared) be approved at $15,724,603 including 138.40 net full time equivalent (FTE) positions, for submission to the Ministry of Health;

2. Municipal Levy be set at $3,213,543;

3. 100% Indigenous Communities: Indigenous Partnerships budget be approved at $99,500, with 1.0 FTE and submitted to the Ministry of Health;

4. 100% Indigenous Communities: Street Outreach budget be approved at $110,000, with 1.0 FTE and submitted to the Ministry of Health;

5. 100% Indigenous Communities: Public Health budget be approved at $400,000, with 1.0 FTE and submitted to the Ministry of Health;

6. 100% Ontario Seniors Dental Care Program budget be approved at $612,400, with 2.9 FTEs and submitted to the Ministry of Health;

7. 100% Northern Fruit and Vegetable Program budget be approved at $661,600, with 3.5 FTEs and submitted to the Ministry of Health;

8. Land Development Program budget be approved at $193,488 including 2.0 FTE positions;

9. 100% Public Health Inspector Practicum budget be approved at $10,000, and be submitted to the Ministry of Health;

10. Director of Corporate Services and Manager of Finance be authorized to complete any administrative requirements of the respective budget submission processes, as required; and

11. Director of Corporate Services and Manager of Finance be authorized to arrange appropriate financing for the funding of the Health Unit operations, if required.

16 REPORT NO. 37 – 2020 (Finance) PAGE 2 OF 14

REPORT SUMMARY To provide the Board of Health with the proposed 2021 Mandatory Core Program Budgets.

BACKGROUND The Thunder Bay District Health Unit (TBDHU) provides programs and services in compliance with the Ontario Public Health Standards Requirements for Programs, Services, and Accountability (OPHS; the Standards). The Standards outline the expectations on Boards of Health, who are responsible for the assessment, planning, delivery, management, and evaluation of a variety of public health programs and services that address public health needs, as well as the contexts in which these needs occur. This includes assessment and surveillance, health promotion and policy development, disease and injury prevention, and health protection. Through the delivery of these programs and services, Boards of Health collectively contribute to the physical, mental, and emotional health and well- being of all Ontarians. The Standards also include requirements for Boards of Health related to transparency and accountability as well as effective governance and management practices. The Standards apply to all Boards of Health in Ontario and are published by the Ministry of Health under the authority of the Health Protection and Promotion Act.

The budget process is the annual planning process where resources are allocated to meet the public health standards. The Budget Committee, comprised of the Medical Officer of Health and Chief Executive Officer, Associate Medical Officer of Health (currently vacant), and Division Directors, conduct administrative reviews of proposed budgets to ensure consistency with the overall organization’s strategy and to make recommendations to the Board of Health for the allocation of resources for the next fiscal year.

In accordance with the Budget Process Policy, FP-05-03, the Board of Health must approve all budget estimates for all health unit programs.

COMMENTS On April 11, 2019 the Ontario Government tabled its 2019 Budget which, under the banner of Modernizing Ontario’s Public Health Units, proposed plans to significantly restructure Ontario’s public health system, including the creation 10 regional public health entities with regional boards under a common governance model, and adjustments to the provincial-municipal cost sharing. In August 2019, the Government confirmed that changes related to the cost sharing model were implemented effective January 1, 2020. With a few exceptions, all previous funding moved to a cost sharing arrangement of 30% Municipal and 70% provincial.

Since the release of the 2019 Ontario budget, the Board of Health has been kept informed of the changes and the implications for TBDHU as the details emerged on the implementation of the government direction. 17 REPORT NO. 37 – 2020 (Finance) PAGE 3 OF 14

In August 2020, Administration received notice of the 2020 Provincial Grant Allocation, which confirmed the implementation of the cost-sharing changes.

Expenses related to COVID-19 are expected to be substantial for 2021. This budget has been prepared with the assumption that 100% One-Time funding will be used to offset these increased expenditures. On March 25th, 2020, the Province announced it is investing up to $100 million in additional funding to the Public Health Sector to support extraordinary costs incurred. Health Units are expected to track COVID-19 related expenses separately and must be able to account for all amounts. Administration is closely monitoring the situation, tracking all staff time and expenditures related to COVID-19 separately.

Given the potential for funding challenges over the long term as well as the unknowns with Provincial funding due to Public Health Modernization, Administration will continue to take a disciplined approach to program planning, including investigating innovative opportunities to provide service, implementing process improvements to assist in maintaining quality services, and utilizing optimal allocation of available resources to address priorities. Administration has demonstrated this approach over a number of years, allowing for a stable workforce, lower than average provincial growth rate, and the lowest per capita funding of all northern health units.

Mandatory Core Program Budget

The Consolidated 2021 Mandatory Core Program Budget Recommendation Summary is provided in Attachment 1.

Highlights of the significant items within the 2021 consolidated Mandatory Core Program Budget are as follows:

Revenues

The Mandatory Core Program Budget is financed by the following significant funding sources. Revenues included in the recommended 2021 budget total $15,724,603 and include:

i) Provincial Funding – Mandatory Core Program Budget

Funding for mandatory core programs was last confirmed by the Province at $9,537,800 in 2020. This represents a total decrease in base funding from the Ministry as compared to the 2020 mandatory core programming budget of $397,372. The decrease is related to 100% Indigenous Communities: Public Health funding which was previously included in the mandatory core programming on a cost-shared basis and is now 100% funded from the Province.

To support an effective transition and to mitigate impact to municipalities in 2021, the Province has stated that transitional funding to Health Units is available in 2021 (amount was also received in 2020). For TBDHU the one- time transitional funding from the Province is budgeted in the amount of $1,323,900. No direction has been provided for future years. 18

REPORT NO. 37 – 2020 (Finance) PAGE 4 OF 14

ii) Municipal Levy

Administration is not recommending a base increase to the Municipal levy and that levy amounts remain the same as 2020.

Attachment 2 provides the respective municipal contributions by obligated municipality.

iii) Generated Revenues

Generated revenues, totaling $700,460 ($757,241 in 2020), include clinic fees, course and consulting fees, interest income, miscellaneous recoveries, and allocated administration received from 100% Funded and Other Programs. Generated revenues have decreased mainly due to decreased allocated administrative revenue.

iv) Provincial funding - Unorganized Territory Grant (100%)

The Unorganized Territory Grant is provided entirely by the province to support mandated programs in areas without municipal organization. The last increase to this funding was in 2016 for total funding of $948,900. No increase is expected in 2021.

Expenditures

Expenditures total $15,724,603, and reflect an overall decrease of 1.10% from the 2020 Board approved level of $15,899,243. Consistent with previous years, the most significant expenditure category relates to Salaries & Benefits. In the 2020 budget, this accounts for approximately 83% (82% in 2020) of the mandatory program budget, which funds a total of 138.40 Full-Time Equivalents (FTEs) a decrease of 2.00 FTE’s as compared to 2020. (Attachment 3 provides the Cost-Shared Budget FTE Summary). Other non- compensation expenses decreased by 0.4% from the 2020 approved levels.

i) Salaries and Benefits

The total salaries and benefits are projected to be approximately $13,075,105 in 2020, a decrease of $32,478 or 0.25%. Total FTEs decreased by 2.00 from 140.40 to 138.40, these changes are identified and explained in Attachment 3.

ii) Other Operating Expenses

Operating Expenses have decreased by 5.09%. The majority of expense categories have seen reductions with the largest decreases being in purchased

program service of $67,900, materials and supplies of $18,889 and allocated administrative expenses of $124,526. This is offset by an increase in purchased and allocated admin of $76,590 and equipment expense of $21,450.

Attachment 4 provides an overview of each Program (by Division) funded by the Cost-Shared Budget. It also contains detail on the 100% Funding Initiatives 19 REPORT NO. 37 – 2020 (Finance) PAGE 5 OF 14

and the Related 100% and Other Program budgets. Included for each program is a summary, financial information (budget) and human resources (FTEs), key goals and directions, and any significant budget implications or changes for 2021.

100% Funded Programs

The following funding sources are anticipated to remain 100% funded by the Ministry of Health:

100% Indigenous Communities: Indigenous Partnerships

The 100% Indigenous Communities: Indigenous Partnerships funding was included in base funding in 2020 for the development and implementation of an Indigenous organization strategy to build relationships and enhance engagement with Indigenous communities and organizations. The TBDHU has allocated one (1.0) FTE Health Promotion Planner to this budget.

The Ministry has not changed any requirements for this program, therefore, the 2021 budget is recommended at $99,500, with no change from the 2020 approved funding amount.

The 2021 100% Indigenous Communities: Indigenous Partnerships is recommended by Administration as presented.

100% Indigenous Communities: Street Outreach

The 100% Indigenous Communities: Street Outreach funding was included in base funding in 2020 to be used for salaries, wages, benefits, and other program expenses for a Public Health Nurse to enhance the Board of Health’s ability to more comprehensively manage infectious disease threats and other issues with Indigenous Communities in Thunder Bay. This will be accomplished through improved relationship building, surveillance, testing services, case and contact management, and harm reduction services.

The Ministry has not changed any requirements for this program, therefore, the 2021 budget is recommended at $110,000 with no change from the 2020 approved funding amount.

The 2021 100% Indigenous Communities: Street Outreach is recommended by Administration as presented.

100% Indigenous Communities: Public Health

The 100% Indigenous Communities: Public Health funding was included in

base funding in 2020 to be used for the implementation of the Sioux Lookout First Nations Health Authority’s (SLFNHA) Approaches to Community Well- Being public health model for First Nations communities in the Sioux Lookout region. SLFNHA is currently working in partnership with the Province, Health 20 REPORT NO. 37 – 2020 (Finance) PAGE 6 OF 14

Canada, Northwestern Board of Health, and Thunder Bay District Board of Health on this project. The base funding must be used for salaries, wages and benefits (including 1.0 FTE AMOH position), accommodation costs, transportation and communication costs, and supplies and equipment to assist with the implementation of SLFNHA’s integrated public health model, and to support vulnerable populations including First Nations in the Thunder Bay area.

The Ministry has not changed any requirements for this program, therefore, the 2021 budget is recommended at $400,000, with no change from the 2020 approved funding amount.

The 2021 100% Indigenous Communities: Public Health is recommended by Administration as presented.

100% Ontario Seniors Dental Care Program

In 2019, the Government confirmed the implementation of the Ontario Seniors Dental Care Program. The Ontario Seniors Dental Care Program (OSDCP) provides comprehensive dental care to eligible low-income seniors to help reduce unnecessary trips to the hospital, prevent chronic disease and increase quality of life for seniors. The TBDHU has allocated two point nine (2.9) FTEs to this budget.

The Ministry has not changed any requirements for this program, therefore the 2021 budget is recommended at $612,400, with no change from the 2020 approved funding model.

The 2021 100% Ontario Seniors Dental Care Program is recommended by Administration as presented.

100% Northern Fruit and Vegetable Program

In 2019, the Government moved previous one-time Northern Fruits and Vegetable funding to TBDHU base funding. The program objective for the Northern Fruit and Vegetable Program is to ensure a coordinated approach to increasing consumption and awareness of fresh fruits and vegetables in combination with healthy eating and physical activity education to school-aged children and their families, on and off reserve, in Northern Ontario. This funding also supports working with First Nations communities exploring solutions to issues such as, food security, how to coordinate, consolidate and receive affordable healthy food; food safety and food literacy, and the development of local food initiatives.

The Ministry has not changed any requirements of this program, therefore the 2021 budget is recommended at $661,600, with no change from the 2020 approved funding model.

The 2021 100% Northern Fruits and Vegetable Program is recommended by Administration as presented.

21 REPORT NO. 37 – 2020 (Finance) PAGE 7 OF 14

Other Programs

Land Development Program

The Land Development program is budgeted at $193,488 Revenues and Expenditures, an increase of $2,647 over 2020 budget levels. Staffing remains consistent at 2.0 FTEs.

The 2021 Land Development Program is recommended by Administration as presented.

100% Public Health Inspector Practicum

The Public Health Inspector Practicum Program budget 100% funded by the Ministry of Health. This funding must be used to hire the approved Public Health Inspector Practicum position.

The Board of Health must comply with the requirements of the Canadian Institute of Public Health Inspectors Board of Certification for field training for a 12-week period; and, ensure the availability of a qualified supervisor/mentor to oversee the practicum student’s term.

The 2021 100% Public Health Inspector Practicum Program is recommended by Administration as presented.

One-Time Requests

There are no one-time requests being recommended at this time for 2021. Additional requests may be brought to the Board of Health for approval in February prior to the submission of the Annual Service Plan and Budget Submission to the Ministry of Health.

FINANCIAL IMPLICATIONS

Overall, revenues from all sources included within the recommended Mandatory Programs Cost-Shared Budget total $15,724,603. This represents an overall decrease of 1.10% from the 2020 Board approved levels. These total revenues are provided to fund existing mandatory core programming. Revenues are balanced with expenditures for each of the 100% and Other Funded Programs at levels required to deliver existing programming and include:

 100% Indigenous Communities: Indigenous Partnerships at $99,500  100% Indigenous Communities: Street Outreach at $110,000  100% Indigenous Communities: Public Health at $400,000  100% Ontario Seniors Dental Care Program at $612,400  100% Northern Fruit and Vegetable at $661,600

22 REPORT NO. 37 – 2020 (Finance) PAGE 8 OF 14

 Land Development – Revenue and Expenditures at $193,488  100% Public Health Inspector Practicum budget at $10,000

STAFFING IMPLICATIONS Attachment 3 provides a full summary of the FTEs within the Cost-Shared Budget, including the impact of the above noted program adjustments.

Attachment 5 provides the summary of the FTEs for the 100% and Other Funded Programs, including Land Development, 100% Public Health Inspector Practicum budget, 100% Indigenous Communities: Indigenous Partnerships, 100% Indigenous Communities: Street Outreach, 100% Indigenous Communities: Public Health, 100% Ontario Seniors Dental Care Program and 100% Northern Fruit and Vegetable Program.

CONCLUSION The 2020 Mandatory Program Budget (Cost-Shared), totaling $15,724,603 with 138.40 FTE’s, represents a package that balances fiscal capacity with health protection and promotion programming, and sets the Municipal Levy at $3,213,543.

It is recommended that the 2021 Mandatory Program Budget be approved by the Board of Health as presented and submitted to the Province in accordance with its prescribed process;

And that the 2021 Land Development Program budget be approved at $193,488 for Revenues and Expenditures;

And that the balanced budgets listed below be approved by the Board of Health as presented and submitted to the Ministry of Health in accordance with its prescribed processes:

 100% Indigenous Communities: Indigenous Partnerships at $99,500  100% Indigenous Communities: Street Outreach at $110,000  100% Indigenous Communities: Public Health at $400,000  100% Ontario Seniors Dental Care Program at $612,400  100% Northern Fruit and Vegetable at $661,600  100% Public Health Inspector Practicum budget at $10,000

23 REPORT NO. 37 – 2020 (Finance) PAGE 9 OF 14

LIST OF ATTACHMENTS

Attachment 1 Consolidated 2021 Mandatory Core Programs Budget Summary Attachment 2 Municipal Levy Distribution Attachment 3 Summary of Full Time Equivalent Changes (Mandatory Core Programs) Attachment 4 2020 Mandatory Core Programs (Cost-Shared) Divisional Summary, 100% Funding Initiatives, and 100% and Other Attachment 5 ProgramsSummary of Full-Time Equivalent Changes for 100% Funded Programs

PREPARED BY: Dan Hrychuk, CPA, CA Manager, Finance Lance Dyll, CPA, CA Director, Corporate Services THIS REPORT RESPECTFULLY SUBMITTED BY: DATE: L. Dyll, CPA, CA, Director, Corporate Services November 18, 2020

______Medical Officer of Health and Chief Executive Officer 24

REPORT NO. 37 – 2020 (Finance) PAGE 10 OF 14

Attachment 1

Consolidated 2021 Mandatory Core Program Budget Summary

THUNDER BAY DISTRICT HEALTH UNIT CONSOLIDATED 2021 COST SHARED BUDGET SUMMARY

2020 2021 Board Total Approved Budget Increase/(Decrease) Budget Request (2021 vs 2020) $ $ $ %

(1) (2) (3) (4)

REVENUES

Provincial - Mandate 9,935,172 9,537,800 (397,372) -4.00%

Provincial - Transitional Funding 1,044,387 1,323,900 279,513 26.76%

Municipal Contributions 3,213,543 3,213,543 - 0.00%

Provincial - Unincorporated Area 948,900 948,900 - 0.00%

Generated 757,241 700,460 (56,781) -7.50%

Total Revenues 15,899,243 15,724,603 (174,640) -1.10%

EXPENDITURES

Salaries & Benefits 13,107,583 13,075,105 (32,478) -0.25%

Travel 241,271 237,871 (3,400) -1.41%

Staff Training & Recognition 178,180 171,050 (7,130) -4.00%

Board of Health 42,600 42,600 - 0.00%

Purchased Program Service 182,900 115,000 (67,900) -37.12%

Purchased & Allocated Admin 717,484 794,074 76,590 10.67%

Building Occupancy 395,810 391,690 (4,120) -1.04% Equipment Expense 224,150 245,600 21,450 9.57%

Materials & Supplies 466,095 447,206 (18,889) -4.05%

Office Expenses & Printing 111,308 107,587 (3,721) -3.34%

Communications 107,336 96,820 (10,516) -9.80%

Allocated Administration 124,526 - (124,526) -100.00%

Total Expenditures 15,899,243 15,724,603 (174,640) -1.10%

Favourable/(Unfavourable) - - -

25 REPORT NO. 37 – 2020 (Finance) PAGE 11 OF 14

Attachment 2

Municipal Levy Distribution

CONSOLIDATED 2021 MANDATORY CORE PROGRAMS BUDGET MUNICIPAL LEVY DISTRIBUTION

Method of Apportionment: Population

2020 2021 2021 vs 2020 Municipality $ %

Conmee 17,820 17,820 0 0.00% Dorion 6,561 6,561 0 0.00% Greenstone 96,174 96,174 0 0.00% Gillies 11,689 11,689 0 0.00% Manitouwadge 50,365 50,365 0 0.00% Marathon 75,518 75,518 0 0.00% Neebing 51,940 51,940 0 0.00% Nipigon 36,957 36,957 0 0.00% O'Connor 16,244 16,244 0 0.00% Oliver Paipoonge 144,362 144,362 0 0.00% Red Rock 21,888 21,888 0 0.00% Schreiber 27,818 27,818 0 0.00% Shuniah 66,179 66,179 0 0.00% Terrace Bay 37,387 37,387 0 0.00% Thunder Bay 2,552,643 2,552,643 0 0.00% Total Cost 3,213,543 3,213,543 0 0.00% 28.65 28.65 - 0.00% Per Capita

26

REPORT NO. 37 – 2020 (Finance) PAGE 12 OF 14

Attachment 3

Summary of Full-Time Equivalent Changes (Mandatory Core Programs)

Full Time Equivalents (FTE) Enhancements Reductions Balance

2020 Cost Shared Budget FTEs (Base) 140.40

Additions Health Protection Vaccine Preventable Disease / Sexual Health - Manager 1.00 1.00 Total Additions 1.00

Reductions Health Promotion Chronic Disease Prevention - Nutritionist -1.00 -1.00 Health Protection Street Nursing - PHN -1.00

-1.00 Medical Officer of Health Indigenous Communities: Public Health - AMOH -1.00

-1.00 Total Reductions -3.00

2021 Total Cost Shared Budget FTEs 138.40

27 REPORT NO. 37 – 2020 (Finance) PAGE 13 OF 14

Attachment 4

2021 Mandatory Core (Cost-Shared) Divisional Summary, 100% Funding Initiatives, and 100% and Other Programs

Under Separate Cover

28 REPORT NO. 37 – 2020 (Finance) PAGE 14 OF 14

Attachment 5

Summary of Full-Time Equivalent Changes for 100% Funded Programs

Full Time Equivalents (FTE) Enhancements Reductions Balance

2020 Total 100% Funded Program FTEs 9.40

Additions Health Protection Indigenous Communities: Street Outreach PHN 1.00 1.00 MOH Office Indigenous Communities: Public Health MOH (Note 1) 1.00 1.00 Total Additions 2.00

2021 Total 100% Funded Program FTEs 11.40

Note 1: For 2020 purposes the AMOH was included in the Mandatory Core Programming (Cost-shared) portion of the budget therefore the FTE is a transfer to 100% funding.

29 37 – 2020 (Finance)

2021 Mandatory Core Programs Divisional Summary, 100% Funding Initiatives and 100% Other Programs

Attachment 4

301 Thunder Bay District Health Unit 2021 Expenditure Budget Summary

Page Cost Shared Budgets by Division 2020 2021 Change % Change Number

Health Promotion Financial Resources $4,768,550 $4,711,101 -$57,449 -1.2% 3 - 29 Human Resources in FTE 46.70 46.10 (0.60) -1.3%

Health Protection Financial Resources $5,925,976 $5,967,638 $41,662 0.7% 30 - 49 Human Resources in FTE 57.90 57.50 -0.40 -0.7%

Medical Officer of Health Financial Resources $1,274,636 $903,248 -$371,388 -29.1% 50 - 53 Human Resources in FTE 6.00 5.00 -1.00 -16.7%

Corporate Services Financial Resources $2,177,887 $2,229,035 $51,148 2.3% 54 - 59 Human Resources in FTE 22.00 22.00 0.00 0.0%

Corporate Financial Resources $1,072,125 $1,190,896 $118,771 11.1% 60 - 64 Human Resources in FTE 0.00 0.00 0.00 n/a

Branch Offices Financial Resources $680,069 $722,685 $42,616 6.3% 65 - 66 Human Resources in FTE 7.80 7.80 0.00 0.0%

Total Financial Resources $15,899,243 $15,724,603 -$174,640 -1.1% Human Resources in FTE 140.40 138.40 (2.00) -1.4%

Page 100% and Other Funded Programs 2020 2021 Change % Change Number

100% Funding Initiatives Financial Resources $10,000 $10,000 $0 0.0% 67 Human Resources in FTE 0.00 0.00 0.00 n/a

100% Funded and Others Financial Resources $1,564,341 $2,076,988 $512,647 32.8% 67 Human Resources in FTE 9.40 11.40 2.00 21.3%

312 Health Promotion Division 2021 Division Expenditure Budget Summary

Program Area 2020 2021 Change % Change Page

Divisional Administration Financial Resources $533,760 $685,010 $151,250 28.3% 4 Human Resources in FTE 4.00 5.00 1.00 25.0%

Chronic Disease Prevention Financial Resources $376,167 $313,829 -$62,338 -16.6% 6 Nuitrition Human Resources in FTE 3.90 3.24 -0.66 -16.9%

Chronic Disease Prevention Financial Resources $270,012 $283,801 $13,789 5.1% 9 Physical Activity Human Resources in FTE 2.80 2.80 0.00 0.0%

Chronic Disease Prevention Financial Resources $222,187 $234,505 $12,318 5.5% 10 Workplace Human Resources in FTE 2.30 2.30 0.00 0.0%

Chronic Disease Prevention Financial Resources $110,276 $122,121 $11,845 10.7% 11 Tobacco Human Resources in FTE 1.00 1.00 0.00 0.0%

Chronic Disease Prevention Financial Resources $545,009 $529,332 -$15,677 -2.9% 12 Healthy Schools Human Resources in FTE 5.34 5.00 -0.34 -6.4%

Financial Resources $241,232 $250,381 $9,149 3.8% 14 Substance Misuse Human Resources in FTE 2.50 2.50 0.00 0.0%

Financial Resources $101,575 $100,298 -$1,277 -1.3% 15 Youth Mental Health Human Resources in FTE 1.00 1.00 0.00 0.0%

Financial Resources $114,024 $116,025 $2,001 1.8% 16 Falls Prevention Human Resources in FTE 1.00 1.00 0.00 0.0%

Financial Resources $85,593 $90,488 $4,895 5.7% 17 Road Safety Human Resources in FTE 1.00 1.00 0.00 0.0%

Financial Resources $490,127 $486,411 -$3,716 -0.8% 18 Healthy Growth and Development Human Resources in FTE 5.00 5.00 0.00 0.0%

Financial Resources $107,771 $114,343 $6,572 6.1% 19 Child Health Breastfeeding Human Resources in FTE 1.20 1.20 0.00 0.0%

Financial Resources $727,200 $662,873 -$64,327 -8.8% 20-25 Smoke Free Ontario Human Resources in FTE 6.65 6.65 0.00 0.0%

Children's Clinical Programs - Financial Resources $226,119 $230,151 $4,032 1.8% 26 Oral Health Human Resources in FTE 2.60 2.60 0.00 0.0%

Financial Resources $141,898 $144,512 $2,614 1.8% 27 Vision Human Resources in FTE 1.74 1.74 0.00 0.0%

Financial Resources 475,600 347,021 -$128,579 -27.0% 28 Healthy Smiles Ontario Human Resources in FTE 4.67 4.07 -0.60 -12.8%

Total Financial Resources $4,768,550 $4,711,101 -$57,449 -1.2% Total Base Positions (FTEs) 46.70 46.10 (0.60) -1.3%

323 Health Promotion Division Budget Year 2021 Promotion Admin Program Budget Summary

2020 2021 Change % Change

Budget 533,760$ 685,010$ 151,250$ 28.3%

FTEs 4.00 5.00 1.00 25.0%

Program Overview Health Promotion Administration supports the divisional management team in supporting programs and service delivery. The division continues to focus on building and maintaining collaborations internally between programs, with external stakeholders, optimizing research and external funding opportunities, quality and continuous improvement, and prioritizing projects and work plans in accordance with the 2018 Ontario Public Health Standards and the 2017-2020 Strategic Plan.

Key Strategic Goals of the Program and Direction for 2021 Strategic Goals:

• To continue to expand upon and increase cross-collaboration between programs within the division and with Health Protection Division on topics such as mental health, alcohol, cannabis, vaping, prenatal mood disorders, trauma, etc. • To continue to expand our collaboration and level of engagement with Indigenous partners and organizations.

Direction for 2021:

Transition to resumption of regular programming within the context of COVID-19.

Budgetary Changes/Implications Increase due to reallocation of 1.0 FTE manager position from Health Protection Admin.

334 Thunder Bay District Health Unit Reduction/Expansion

Division: Health Protection Expansion/ Expansion Program: Health Protection Admin Reduction:

Expenditure Rank Description/ Expense name Expenses Code Cost Justification Oral Health, Children's Visual Health and District Office's programs will move from Salary & $ Health Protection to the Health Promotion Division. Manager of these programs will Benefits 121,790.00 report to the Director of Health Promotion.

5

Total Cost $ 121,790.00

Staff Resource Impact Staff Impact Group FTE Manager CUPE Non- 1.00 ONAUnion Total FTE Enhancement 1.00 (Reduction)

34 Health Promotion Division Budget Year 2021 CDP - Nutrition Program Budget Summary

2020 2021 Change % Change

Budget 376,167$ $ 313,829 $ (62,338) -16.6%

FTEs 3.90 3.24 (0.66) -16.9%

Program Overview To reduce the burden of chronic diseases of public health importance and improve well-being through food and nutrition. To achieve optimal preconception, pregnancy, newborn, child, youth, parental and family health related to food and nutrition.

A comprehensive approach is applied which targets all population levels, addresses different settings and implement multiple strategies at various levels of intervention including increased public awareness. Priority populations and social determinants are considered in planning, as well as the principles of need, capacity, impact, partnerships and collaboration.

Key Strategic Goals of the Program & Direction for 2021 • Increase food literacy in Thunder Bay & District. • Increase the availability and accessibility of healthy foods in municipal and recreational settings, in and around schools and child care centres, worksites, restaurants and corner stores. • Increase public awareness and provide evidence informed advice in the area of food & nutrition, healthy weights and health inequities that contribute to chronic disease. • Increase the capacity of community partners to coordinate and develop programs and services related to food and nutrition. • Increase access to health services in priority neighborhoods. • Promote primary prevention in primary care settings. • Improve policies in a variety of settings that promote improved food and nutrition.

Budgetary Changes/Implications Decrease in budget is as a result of changes in staffing. Addition of .34 dietitian from Chronic Disease Prevention - Healthy Schools. This position change occurred to consolidate the nutrition staff under one manager to better organize nutrition services. Decrease of 1.00 FTE funded through the 100% Northern Fruits and Vegetables Enhancement program.

356 Thunder Bay District Health Unit Reduction/Expansion

Division: Health Promotion Expansion/ Expansion Program: Nutrition Reduction:

Expenditure Rank Description/Justification Expense name Expenses Code Cost Part of a long term plan to have all nutrition staff members managed by one manager in Salary & $ order to make collaboration on projects more productive. Benefits 28,922.00 7

Total Cost $ 28,922.00

Staff Impact Staff Resource Impact Group FTE Dietitian CUPE Non- 0.34 ONAUnion Total FTE Enhancement 0.34 (Reduction)

36 Thunder Bay District Health Unit Reduction/Expansion

Division: Health Promotion Expansion/Reduction: Reduction Program: Nutrition

Expenditures Rank Description/Justification Expense name Expense Code Cost Salary and benefits for Nutritionist has moved from the Healthy Living Nutrition program Salary & Benefits $ 105,112.00 (01011) to the NFVP Enhancement project. 8

Total Cost$ 105,112.00

Staff Impact Staff Resource Impact Group FTE Nutritionist CUPE Non-Union -1.00 ONA Total FTE Enhancement (Reduction) -1.00

37 Health Promotion Division Budget Year 2021 CDP - Physical Activity Program Budget Summary

2020 2021 Change % Change

Budget 270,012$ $ 283,801 13,789$ 5.1%

FTEs 2.80 2.80 0.00 n/a

Program Overview The goal of the Physical Activity team is to prevent chronic disease through increased physical activity, decreased sedentary behaviour and healthy sleep through: • creating supportive environments that increase active school travel and active commuting for adults; • raising education, awareness and capacity building to increase knowledge of negative impacts of sedentary behaviours, healthy sleep, physical literacy and physical activity; • conduct research to support healthy built environments.

A comprehensive approach is applied which targets all population levels, addresses different settings and implement multiple strategies at various levels of intervention including increased public awareness. Priority populations and social determinants are considered in planning, as well as the principles of need, capacity, impact, partnerships and collaboration.

Key Strategic Goals of the Program & Direction for 2021 Strategic Goals • Increase engagement in physical activity through environments supportive of active school travel. • Support ongoing healthy neighbourhoods initiatives for children and youth through collective impact. • Increase levels of active commuting for adults in Thunder Bay. • Increase knowledge of importance of physical literacy and negative impacts of sedentary behaviours. • Increase knowledge of importance of healthy sleep. • Increase awareness and capacity of early years providers to incorporate physical literacy into early years programming. Direction for 2021 • Conduct research to support healthy built environments. • Develop and maintain partnerships with community stakeholders to enhance and sustain efforts to increase community participation in physical activity. • Increase support for implementation of Daily Physical Activity and active school travel in schools to increase levels of physical activity. • Influence healthy public policy which supports and encourages physical activity in Thunder Bay.

Budgetary Changes/Implications Budgetary increases relates to change in staffing compliment as compared to 2020 with more senior staff in the program.

389 Health Promotion Division Budget Year 2021 CDP - Workplace Program Budget Summary

2020 2021 Change % Change

Budget 222,187$ $ 234,505 12,318$ 5.5%

FTEs 2.30 2.30 0.00 n/a

Program Overview Public health interventions related to the Worksite Health Program are implemented in accordance with several guidelines including: the Chronic Disease Prevention Guideline; the Health Equity Guideline; Mental Health Promotion Guideline and Substance Use Prevention and Harm Reduction Guideline. The program promotes healthy lifestyle behaviours and encourages work environments that support physical and mental health through a comprehensive workplace toolkit with resources to support worksites.

Key Strategic Goals of the Program & Direction for 2021 Strategic Goals: • To increase awareness among worksite wellness champions in Thunder Bay and District of the benefits of adopting the Comprehensive Workplace Health Promotion model and the support that TBDHU can provide. • Continue to work with the Worksite Mental Health Steering Committee to provide opportunities to share education related to this topic. • Continue to support worksites with COVID-19 health and safety measures.

Direction for 2021: • Continue to provide presentations and onsite support for workplace policies Continue to provide COVID advice to businesses.

Budgetary Changes/Implications Budgetary increases relates to change in staffing compliment as compared to 2020 with more senior staff in the program.

3910 Health Promotion Division Budget Year 2021 CDP - Tobacco Program Budget Summary

2020 2021 Change % Change

Budget 110,276$ $ 122,121 11,845$ 10.7%

FTEs 1.00 1.00 0.00 n/a

Program Overview The goal of the Tobacco Use Cessation Program is to reduce the burden of preventable chronic diseases by ensuring the provision of tobacco use cessation programs and services for priority populations. Cessation services are offered one-on-one through the Take Control Clinic at the Health Unit as well as through workshops and education events offered in the community. Services are universal but also target and reach local priority populations with high rates of smoking such as employees in the trades, youth, young adults, Indigenous people and individuals dealing with mental health and addictions. Cessation is a key component of comprehensive tobacco control. Forming partnerships and building capacity to provide cessation services or referrals across health unit programs, community groups, organizations and worksites helps to create an environment where support is available whenever smokers want to quit.

Key Strategic Goals of the Program & Direction for 2021 Strategic Goals: • Provide leadership in tobacco cessation through internal/external collaboration, capacity building and mobilization. • Improve the effectiveness and efficiencies of the cessation programs and services. • Increase internal/external capacity for provision of tobacco use cessation for priority populations. • Promote local, regional and provincial cessation initiatives that assist people to quit tobacco use. • Increase equitable access to cessation services and effective treatment.

Direction for 2021: • Increase internal capacity to support cessation across programs. • Increase external capacity for provision of tobacco use cessation programs and services for priority populations by: supporting the Northwest Tobacco Cessation Community of Practice; training health/social service providers in brief intervention cessation counselling and referral to cessation supports and working with trades employers/educators. • Increase effectiveness of the cessation clinic through the provision of NRT (Nicotine Replacement Therapy) and enhanced evaluation. • Continue to promote cessation services to priority populations including evidence informed approaches to support youth to quit vaping.

Budgetary Changes/Implications Increase in budget as a result of Nicotine Replacement Therapy costs for Cessation Clients previously provided to the Health Unit at no charge.

4011 Health Promotion Division Budget Year 2021 CDP - Schools Health Program Budget Summary

2020 2021 Change % Change

Budget 545,009$ 529,332$ $ (15,677) -2.9%

FTEs 5.34 5.00 (0.34) -6.4%

Program Overview

The goal of the School Health program aims to involve the whole school community including students, parents, teachers, school boards and community partners to build healthier school environments.

Key Strategic Goals of the Program & Direction for 2021 Strategic Goals • Use a comprehensive school health approach address health related topics through curriculum, teaching & learning; a healthy social & physical environment; student engagement; school & classroom leadership and school & community partnerships. Health related topics are aligned with current curriculum expectations for students: healthy eating, physical activity, personal safety & injury prevention, substance misuse prevention, healthy growth & development and mental health.

Direction for 2021 • Implementation of health-related curricula as outlined in the Healthy Schools Program Resource Guide in schools based on need in the areas of Healthy Growth and Development, Personal Safety and Injury Prevention, Alcohol and Substance Prevention, Mental Health, Healthy Eating and Physical Activity.

• Initiate and expand the Youth Mental Health Addiction Champions Projects in select elementary and secondary schools.

• Support the deliverables of the Youth Violence Prevention Project in elementary and secondary schools across Thunder Bay & District.

• Coordinated health monitoring and planning to support school boards to collect child and youth health & well-being information via the local implementation of the Healthy Living Module (Children Count Pilot Study).

• Facilitate the identification and management of COVID-19 cases among students or staff by providing and/or facilitating rapid-response support to schools and boards through public health and preventative measures, including case and contact management.

• Education, training, facilitating access, interpreting and communicating COVID-19-related information to students, parents, teachers, and school administrators.

Budgetary Changes/Implications

Reduction of budget as a result of .34 FTE dietitian salary moved to the Chronic Disease Prevention - Nutrition program.

4112 Thunder Bay District Health Unit Reduction/Expansion

Division: Health Promotion Expansion/Reduction: Reduction Program: School Health

Expenditures Rank Description/Justification Expense name Expense Code Cost Part of a long term plan to have all nutrition staff members managed by one manager in order Salary & Benefits $ 28,922.00 to make collaboration on projects more productive. 13

Total Cost $ 28,922.00

Staff Impact Staff Resource Impact Group FTE Dietitian CUPE Non-Union -0.34 ONA Total FTE Enhancement (Reduction) -0.34

42 Health Promotion Division Budget Year 2021 Substance Misuse Program Budget Summary

2020 2021 Change % Change

Budget 241,232$ $ 250,381 9,149$ 3.8%

FTEs 2.50 2.50 0.00 n/a

Program Overview In accordance with Ontario’s Public Health Standards Substance Use, staff develop programs and services that address varying substance use patterns in order to reduce the burdens associated with substance use including: preventing or delaying use; preventing problematic substance use; reducing harms associated with substance use; re-orienting health services to meet population needs; and/or contributing to the planning of and referral to treatment and other services to meet population needs. Programs and services should focus on those topics that address identified gaps and address inequities among priority populations. Public health interventions are informed by local needs and take into consideration risk and protective factors; consultation with local stakeholders; assessment of existing programs and services; and evidence of effective interventions.

Key Strategic Goals of the Program & Direction for 2021 Strategic Goals • With community stakeholders on Thunder Bay Drug Strategy (TBDS), lead and support evidence-based community approaches to reducing substance-related risk and harm. • Increase awareness and uptake of health-promoting policy options among municipal decision-makers to address substance-related risk and harm with a focus on alcohol and cannabis by sharing evidence and providing input. Plus, promote healthy public policy at the provincial and national level through working groups and consultations related to drug policy.

Direction for 2020 • Provide public health evidence to Thunder Bay Drug Strategy (TBDS) and lead the revision and implementation of the prevention pillar/Drug Awareness Committee work plan. • Encourage substance-related policies and practices that promote safe and supportive environments in different settings, municipalities i.e. drinking environments and workplaces in Thunder Bay District (TBD). • Increase awareness and provide education and skill-building among key audiences in TBD (priority populations) to increase mental wellness and reduce problematic substance use with a focus on alcohol, using evidence and best practices (harm reduction, life course approach, strengths-based, etc.). • Create communication strategies to increase awareness of cannabis in TBD. • Participate in the implementation and evaluation of a universal evidence-based prevention program: Fourth R program in district schools. • Reduce stigma, promote recovery from addiction and contribute to improved access to needed services and supports for people at risk of or living with substance use disorders in TBD i.e. 2021 Recovery Day event(s)

Budgetary Changes/Implications There are no significant budgetary changes or implications as compared to the 2020 budget.

4314 Health Promotion Division Budget Year 2021 Mental Health Program Budget Summary

2020 2021 Change % Change

Budget 101,575$ $ 100,298 $ (1,277) -1.3%

FTEs 1.00 1.00 0.00 n/a

Program Overview Mental health promotion is the process of enhancing the capacity of individuals and communities to increase control over their lives and improve their mental health. By working to increase self-esteem, coping skills, social connectedness and well-being, mental health promotion empowers people and communities to interact with their environments in ways that enhance emotional and spiritual strength. This approach fosters individual and community resilience and promotes socially supportive environments. Informed by situational assessments and a proportionate universalism approach and in accordance with the OPHS, TBDHU shall complete and begin to implement a Mental Health Promotion (MHP) Framework plan that: • embeds mental health promotion strategies and approaches across public health programs and services; • supports opportunities to offer mental health promotion programs and services across the life course; and • supports opportunities to implement whole-population and community-based interventions.

Key Strategic Goals of the Program & Direction for 2021 The mental health promotion framework development for the Health Unit began in July of 2019 and aspects of its development and implementing its recommendations are continuing into 2021. Phase 1 included an internal scan of current mental health promotion activities across programs (the ‘current state’), as well as the identification of priority opportunities to consider moving ahead. Internal staff engagement sessions also included education about the role of public health in mental health promotion. Phase 1 also included the development of a mental health/illness profile report of Thunder Bay and the District that captures the relevant data we have available (and identifies gaps where information-gathering resources may need to be directed). Phase 2 builds off of this information to share the public health role with stakeholders and gather information from the community mental health stakeholders and people with lived experience to ensure that the direction of mental health promotion and illness prevention at the Health Unit is responsive to need. Into the future, the goals of this program are to integrate mental health promotion alongside other programming and services to ensure mental health be a core underpinning of much of the TBDHU's work moving forward.

Goals for 2021: • Resilient communities where everyone can thrive. • Decrease in the prevalence of mental illness and mental health challenges. • Increase in self-reported rates of positive mental health and wellness. • Decrease in stigma around mental illness and mental health challenges. • Increase in trauma-awareness and trauma-informed care, practice and systems.

Budgetary Changes/Implications There are no significant budgetary changes or implications as compared to the 2020 budget.

4415 Health Promotion Division Budget Year 2021 Falls Prevention Program Budget Summary

2020 2021 Change % Change

Budget 114,024$ $ 116,025 2,001$ 1.8%

FTEs 1.00 1.00 0.00 n/a

Program Overview As per the Injury Prevention and Substance Use Standard, program staff use a comprehensive health promotion approach in collaboration with community partners, to strengthen community action, build healthy public policy, raise awareness and create safe and supportive environments to prevent falls in older adults. Concussion prevention and promotion of appropriate return to learning and sport in school‐aged children and youth is achieved in collaboration with community partners using awareness raising and training and support for peer to peer student education.

Key Strategic Goals of the Program & Direction for 2021 Strategic Goals • Increase capacity of community organizations to decrease falls and concussions in high risk populations in Thunder Bay District.

Directions for 2020

• Continue the planning and stakeholder engagement process to develop a 3 year work plan aimed at decreasing falls in high risk populations of Thunder Bay and District. • Collaborating with internal and external partners, raise awareness of benefits of exercise programs and approaches to increase safety of winter walking that contribute to falls prevention for older adults. • Increase collaboration with Indigenous organizations to promote falls prevention in community dwelling older adults. • Increase awareness of falls prevention and dealing with concussion with key demographics. • Collaborate with provincial and national partners to build on initiatives that increase focus on falls prevention and dealing with concussions.

Budgetary Changes/Implications No significant budgetary changes or implications as compared to the 2020 budget.

4516 Health Promotion Division Budget Year 2021 Road Safety Program Budget Summary

2020 2021 Change % Change

Budget 85,593$ 90,488$ 4,895$ 5.7%

FTEs 1.00 1.00 0.00 n/a

Program Overview The On & Off Road Safety program functions under the Substance Use and Injury Prevention Standard of the Ontario Public Health Standards (OPHS). The program involves collaboration with external and internal community partners to examine trends, evidence/literature, design, and support implementation of initiatives to address priority health risks such as: • distracted driving; • alcohol and drug-impaired driving; • fatigued driving; • safely sharing the road with vulnerable road users; and • all-terrain vehicle safety (ATVs, Snowmobiles, and boating vessels).

These priority health risks (and others) are tailored to the context of isolated and rural communities as well as priority populations including young and high risk drivers. A comprehensive health promotion approach, to influence the development and implementation of healthy policies and programs, raise awareness and create and enhance safe and supportive environments that reduce preventable injury related to road and off-road safety.

Key Strategic Goals of the Program & Direction for 2021 Strategic Goals • To provide comprehensive, evidence-based approaches in consultation and collaboration with local stakeholders in order to reduce the frequency, severity, and impact of preventable on and off road injury.

Direction for 2021 • Continue to collect, analyze and share relevant data to monitor trends over time, emerging trends, priorities, and health inequities related to on and off road injuries and substance use to inform program plans. • Build prevention awareness through campaigns and education related to cannabis and alcohol-impaired driving in on and off-road safety vehicles (all terrain vehicles and snowmobiles), as well as distracted driving. • Continue to address key issues such as drug-impaired driving, sharing the road with vulnerable road users, such as pedestrians and cyclists, in partnership with related collaborative and supports (Thunder Bay Drug Strategy, Snowmobile, ATV, Vessel Education Committee (SAVE), Community Traffic Awareness Committee, Safe Communities, Regional Highway Safety Committee, Ontario Public Health Cannabis Collaborative, Thunder Bay Drug Strategy Alcohol Working Group, Northern Ontario Injury Prevention Practitioners Network, Public Health Ontario).

Budgetary Changes/Implications Budget increase of 5.7% increase due to step/inflationary wage increases as compared to the 2020 budget.

4617 Health Promotion Division Budget Year 2021 Healthy Growth and Development Program Budget Summary

2020 2021 Change % Change

Budget 490,127$ 486,411$ $ (3,716) -0.8%

FTEs 5.00 5.00 0.00 n/a

Program Overview The goal of the Healthy Growth & Development program is to achieve optimal preconception, pregnancy, newborn, child, youth, parental and family health.

Key Strategic Goals of the Program & Direction for 2021 Strategic Goals • Implement best practice programming and interventions to increase education, skill building and awareness of healthy growth and development influencers: reproductive and preconception health, parenting, mental health and healthy environments.

Direction for 2021 • Parenting Programs: Adapt and provide best practice parenting programs (virtually or in person), education, resources and support to families that address attachment, healthy growth & development, and positive parenting practices.

• Pre-natal Education: Implement and promote InJoy (new on line parenting program customized for TBDHU). Using community pre-natal program survey feedback, tailor and customize in person classes to reflect local needs.

• Maternal Substance Use - Provide health promotion education and support related to healthy growth and development to parents and caregivers living with and overcoming substance use. Working with community and provincial partners, provide assessment & surveillance support and services to collect, monitor and report local data and trends related to the Healthy Growth & Development as it relates to maternal substance use.

• Preconception Health - Increase awareness of the reproductive health benefits and the supplement rates of preconception folic acid in our community through implementation of the Multivitamin Supplementation Pilot.

• Mental Health Promotion: Increase community and service provider awareness of perinatal mood disorders and local resources available to help women who are having mental health challenges. Promote and support the mental health and well being of individuals across the lifespan in particular of pregnant and parenting families throughout the prenatal, pregnancy and perinatal timeframe in addition to supporting and promoting mental health within their infants and children throughout the early years. Increase education, resources and capacity building opportunities for staff and community members to support, respond and refer individuals at risk for violence.

Budgetary Changes/Implications No significant budgetary changes or implications as compared to the 2020 budget.

4718 Health Promotion Division Budget Year 2021 Child Health - Breastfeeding Program Budget Summary

2020 2021 Change % Change

Budget 107,771$ $ 114,343 6,572$ 6.1%

FTEs 1.20 1.20 0.00 n/a

Program Overview The Child Health Breastfeeding program delivers components of the Healthy Growth and Development Standard in the Ontario Public Health Standards (OPHS). Initiatives include:

• Breastfeeding services provided to clients by Public Health Nurses through breastfeeding clinics, drop-in services, telephone consultation and home visits. • Health promotion to support increasing breastfeeding exclusivity to six (6) months and sustainability to two (2) years and beyond (Health Canada recommendation). • Collection of data related to breastfeeding surveillance in the Thunder Bay District through Baby Friendly Initiative (BFI) On-line. • Supports professional skill development (Thunder Bay District Health Unit (TBDHU) staff, student placements, and external providers).

Key Strategic Goals of the Program & Direction for 2021

Goals for 2021: • Support for continuous improvement of breastfeeding rates (initiation and exclusivity) as per Health Canada recommendation through programming that aligns with the BFI Ten Steps and World Health Organization (WHO) code requirements that are of relevance to Public Health. • Improve access to breastfeeding clinical support services through the provision of clinical and home-based breastfeeding services. • Improve infant feeding evidence-based practice in the communities we serve by providing updates to broader health and social services staff and by partnering in professional breastfeeding education initiatives.

Direction for 2021: • Continued infant feeding surveillance to identify infant feeding trends across all demographic groups through BFI On-line. • Share infant feeding surveillance results to inform breastfeeding support planning in the Thunder Bay District. • To enhance access to breastfeeding supports across the community through the provision of office, and home visiting clinical services. • Continued collaboration with community partners to enhance breastfeeding supports through on-going education to professional and non-professional care providers, including those employed by the TBDHU (Family Health, Branch Offices and HBHC Programs).

Budgetary Changes/Implications Budget increase as a result of a staff changes within the program.

4819 Health Promotion Division Budget Year 2021 Smoke Free Ontario - Enforcement Program Budget Summary

2020 2021 Change % Change

Budget $ 181,900 $ 166,945 $ (14,955) -8.2%

FTEs 2.20 2.20 0.00 n/a

Program Overview The Tobacco Protection and Enforcement Program reduces the burden of tobacco related preventable chronic diseases by decreasing youth access to tobacco and vapour products and reducing exposure to second-hand smoke/vapour for all. Tobacco Enforcement Officers carry out the Health Protection requirement in the OPHS under Substance Use and Injury Prevention Standard to enforce and support compliance with the Smoke-Free Ontario Act (SFOA, 2017) in accordance with provincial protocols. This includes mandatory inspections of tobacco vendors related to youth access and display and promotion; mandatory annual inspection of secondary schools as well as complaint-based inspections for schools, bars, restaurants, hospitals, sports fields, provincial government buildings, workplaces and public places. Support for policy development is provided to reduce exposure to second-hand smoke in multi-unit housing and at outdoor events, on post- secondary campuses. Community capacity for compliance and moving beyond the SFOA in tobacco control is increased through awareness raising, education, training, policy development and collaboration internally and with external partners, regionally through NWTCAN, and provincially.

Key Strategic Goals of the Program & Direction for 2021 Strategic Goals:

• To decrease youth access to tobacco and reduce exposure to second hand smoke for all. • To support the provincial goal of making Ontario the province with the lowest smoking rate.

Direction for 2021:

• To improve tobacco protection and enforcement services by addressing local needs related to high risk vendors, trades worksites and exposure to second hand smoke (i.e. vehicles, living spaces, workplaces and outdoor public spaces including college and university campuses). • Increase vendor compliance rates with SFO through enhanced vendor education. • To collaborate with all district hospitals and provincial buildings to support them in achieving smoke-free grounds. • To continue to decrease exposure to second hand smoke in “Multi-Unit Housing” through education of the public and landlords and supporting housing providers with policy development. • To work towards making all district outdoor events (municipal, fairs, music) smoke and vapour-free.

Budgetary Changes/Implications Decrease due to removal of allocated admin corresponding with SFO's move to cost-shared funding.

4920 Health Promotion Division Budget Year 2021 Smoke Free Ontario - E Cigarettes Program Budget Summary

2020 2021 Change % Change

Budget $ 18,600 17,129$ $ (1,471) -7.9%

FTEs 0.25 0.25 0.00 n/a

Program Overview The E-Cigarettes Program reduces the burden of tobacco related preventable chronic diseases by decreasing youth access to vapour products and reducing exposure to second-hand vapour for all. Tobacco Enforcement Officers carry out the Health Protection requirement in the OPHS under Substance Use and Injury Prevention Standard to enforce and support compliance with the Smoke-Free Ontario Act (SFOA, 2017) in accordance with provincial protocols. This includes mandatory inspections of E-cigarette vendors related to youth access and display and promotion, registration of specialty vape shops; mandatory annual inspection of secondary schools as well as complaint-based inspections for schools, bars, restaurants, hospitals, sports fields, provincial government buildings, workplaces and public places. Support for policy development is provided to reduce exposure to vapour in multi-unit housing and at outdoor events, on post-secondary campuses. Community capacity for compliance and moving beyond the SFOA in tobacco control is increased through awareness raising, education, training, policy development and collaboration internally and with external partners, regionally through NWTCAN, and provincially.

Key Strategic Goals of the Program & Direction for 2021 Strategic Goals:

• To decrease youth access to vapour products and reduce exposure to second hand vapour for all. • To support the provincial goal of making Ontario the province with the lowest smoking rate.

Direction for 2021:

• To improve compliance with school related vaping and cannabis smoking through education to school staff and education tailored to students who are vaping. • To improve vapour protection and enforcement services by addressing local needs related to high risk vendors, trades worksites and exposure to second hand vapour (i.e. vehicles, living spaces, workplaces and outdoor public spaces including college and university campuses). • Increase vendor compliance rates with SFO through enhanced vendor education. • To collaborate with all district hospitals and provincial buildings to support them in achieving vapour-free grounds. • To decrease exposure to second hand vapour in “Multi-Unit Housing” through education of the public and landlords and supporting housing providers with policy development. • To work towards making all district outdoor events (municipal, fairs, music) vapour-free.

Budgetary Changes/Implications Decrease due to removal of allocated admin corresponding with SFO's move to cost-shared funding.

5021 Health Promotion Division Budget Year 2021 Smoke Free Ontario - Youth Engagement Program Budget Summary

2020 2021 Change % Change

Budget $ 80,000 72,388$ $ (7,612) -9.5%

FTEs 0.85 0.85 0.00 n/a

Program Overview The Youth Engagement and Prevention Program collaborates locally, regionally (through NWTCAN) and provincially to reduce tobacco and vaping initiation and use among youth and young adults by engaging youth, and community partners in integrating prevention and/or quitting promotion into their practices. This is achieved by: increasing the knowledge and ability of community partners and youth/young adults to integrate tobacco reduction programming into their practices through provision of training and by supporting Tobacco Reduction in Youth Partnerships with schools (including post- secondary), Indigenous and community groups with a youth focus; supporting tobacco prevention and quitting promotion at high schools and in post-secondary settings; promoting local, provincial/federal tobacco/vaping prevention and quitting promotion campaigns through education and social media.

Key Strategic Goals of the Program & Direction for 2021 Strategic Goals

• Increase the knowledge and ability of community partners and youth/young adults to integrate tobacco and vaping reduction programming into their practices

Direction for 2020

• Provide tobacco and vaping reduction training and support Tobacco Reduction in Youth Partnerships with schools (including post-secondary), Indigenous and community groups with a youth focus. • Support tobacco/vaping prevention and quitting promotion at high schools with virtual Youth Education Program based on school interest and capacity. • Promote local, provincial/federal tobacco and vaping prevention and quitting promotion campaigns through education and social media. • Strengthen relationships with college and university stakeholders to enhance smoke-free policies and increase quitting promotion. • Support smoke-free housing promotion to reduce exposure to 2nd hand smoke among youth and young adults.

Budgetary Changes/Implications Decrease due to removal of allocated admin corresponding with SFO's move to cost-shared funding.

5122 Health Promotion Division Budget Year 2021 Smoke Free Ontario - Tobacco Control and Coordination Program Budget Summary

2020 2021 Change % Change

Budget $ 100,000 92,792$ $ (7,208) -7.2%

FTEs 0.85 0.85 0.00 n/a

Program Overview The Tobacco, Vapour and Smoke Program aims to reduce the burden of tobacco related preventable chronic disease and the higher than provincial average smoking rate in the TBDHU catchment area using a comprehensive approach to tobacco, vapour and smoke control. Tobacco Control Coordination manages and supports this comprehensive approach to tobacco control, including addressing cannabis, e-cigarettes, heat-not-burn devices and other emerging products in order to reduce the burden of tobacco related preventable chronic diseases in accordance with the Substance Use and Injury Prevention Standard of the OPHS, this SFOA 2017 and the Ministry Tobacco, Vapour and Smoke Protocols.

Key Strategic Goals of the Program & Direction for 2021 Strategic Goals:

• To oversee the effective delivery of the protection requirements in the OPHS to support and enforce compliance with the Smoke-Free Ontario Act (SFOA, 2017) in accordance with provincial protocols as well as to further reduce exposure to environmental tobacco and cannabis smoke through policy development. • To manage effective implementation of initiatives to prevent the initiation of tobacco among youth and young adults. • To direct the building of community capacity and provision of supports to reduce tobacco use in priority populations (youth, young adults, pregnant women, Indigenous people, people employed in the trades, people living on a limited income, people with mental health challenges). • To support shifts in programming based on an assessment of local needs and changes in regulations associated with vapour products and the smoking and vaping of cannabis.

Directions for 2021:

• Oversee the evaluation and assessment of the impact of the new Youth Education Program • Direct evaluation and planning related to cessation services provided through the health unit

Budgetary Changes/Implications Decrease due to removal of allocated admin corresponding with SFO's move to cost-shared funding.

5223 Health Promotion Division Budget Year 2021 TCAN Program Budget Summary

2020 2021 Change % Change

Budget $ 285,800 $ 258,189 $ (27,611) -9.7%

FTEs 2.50 2.50 0.00 n/a

Program Overview

The Northwest Tobacco Control Area Network (TCAN) plans and coordinates collaborative initiatives across Northwestern Ontario, including the catchment area of Thunder Bay District Health Unit and Northwestern Health Unit. Regional, multi- region, and province-wide tobacco control initiatives are coordinated by the TCANs to increase efficiencies and collaboration, and minimize cost and duplication across health units.

The TCAN will to coordinate Thunder Bay District Health Unit and Northwestern activities with the goal of decreasing: • The smoking rate in Northwestern Ontario. • The rate of exposure to second-hand smoke. • The initiation and escalation of smoking among young people.

Key Strategic Goals of the Program & Direction for 2021 Strategic Goals:

The Northwest Tobacco Control Area Network (TCAN) will decrease the smoking rate in Northwestern Ontario and decrease the rate of exposure to second-hand smoke by: • Engaging and training health care providers in Brief Contact Intervention training and systemization. • Supporting commercial tobacco users in making quit attempts, with a focus on priority populations. • Educating the public and increasing awareness and compliance of the Smoke Free Ontario Act. • Increasing the number of smoke/vape-free multi-unit housing complexes. • Increasing the number of smoke/vape-free outdoor spaces and events.

Direction for 2021:

Key activities include: • Build on the nwquit.com online platform/social media campaign • Specialized cessation training for health and wellness providers who work with priority groups, such as mental illness and substance use disorders. • Promote partner cessation campaigns. • Engage with and support property owners, landlords, and tenants to adopt or strengthen policies to prohibit smoking and vaping in public places and multi-unit housing. • Promote SFOA regulations through targeted social media. • Support communities and organizations in adopt or strengthen smoke/vape-free policies.

In addition to the work undertaken by TCAN Prevention these measures help to create a environment supportive of preventing the initiation of smoking and vaping among young people.

Budgetary Changes/Implications Decrease due to removal of allocated admin corresponding with SFO's move to cost-shared funding.

5324 Division Budget Year 2021 TCAN Prevention Program Budget Summary

2020 2021 Change % Change

Budget $54,700 49,230$ $ (5,470) -10.0%

FTEs 0.00 0.00 0.00 n/a

Program Overview Tobacco Control Area Network (TCAN) plans and coordinates collaborative initiatives across Northwestern Ontario, including the catchment area of Thunder Bay District Health Unit and Northwestern Health Unit. Regional, multi-region, and province-wide tobacco control initiatives are coordinated by the TCANs to increase efficiencies and collaboration, and minimize cost and duplication across health units.

TCAN Prevention will reduce youth smoking and vaping rates in Northwestern Ontario by preventing the initiation and increased use of commercial tobacco and vapour products.

Key Strategic Goals of the Program & Direction for 2021 Strategic Goals:

To reduce youth smoking and vaping rates in Northwestern Ontario and prevent the initiation and increased use of commercial tobacco and vapour products in Northwestern Ontario: • Increase the # of partners across Northwestern Ontario who address commercial tobacco use with youth. • Reduce smoking prevalence among youth and young adults. • Reduce initiation of use of e-cigarettes and other non-combustible tobacco alternatives among youth in the NW region.

Direction for 2021:

Key activities include: • Planning and delivery of training for community partners who work with youth, to support them in addressing commercial tobacco or vaping among youth. • Coordination of the NW TCAN Tobacco Reduction in Youth Partnerships (TRYPs) program with a focus on community partners (including groups, schools, organizations and communities) who work with priority populations. • Administration of the Northwest Health Partnerships online community. • Coordination and implementation of young adult focused tobacco reduction campaigns. • Coordination, development and promotion of youth and young adult focused nwquit.com content. • Coordination and support of vaping prevention education. • Implementation of youth tobacco reduction programs in high schools or other appropriate venues to support youth who want to quit smoking or vaping.

Budgetary Changes/Implications Decrease due to removal of allocated admin corresponding with SFO's move to cost-shared funding.

5425 Health Protection Division Budget Year 2021 Oral Health Program Budget Summary

2020 2021 Change % Change

Budget 226,119$ $ 230,151 4,032$ 1.8%

FTEs 2.60 2.60 0.00 0.0%

Program Overview The activities of the Oral Health program are informed by the Ontario Public Health Standards, specifically the Oral Health Protocol, 2018 and the Population Health Assessment and Surveillance Protocol, 2018. The team provides screening and surveillance in all elementary schools in our catchment area to determine the risk intensity of the school population. The screenings also inform program planning related to the oral health status of the children in our catchment area. A universal/targeted fluoride varnish program is provided to children from birth to four years of age at the Health Unit clinic and at strategic community child care sites. This program is also offered at selected publicly funded schools identified as medium to high-risk through screening and surveillance activities beginning with children in JK through to grade 2. Children with urgent oral health needs are referred for service to community dental providers and children with identified non-urgent oral health care needs are provided information on access to community dental providers. All students are advised of preventive services available through Healthy Smiles Ontario that includes the Health Unit's Children's Oral Health program. The program also provides universal and targeted oral health education and promotion.

Key Strategic Goals of the Program & Direction for 2021 Strategic Goals for 2021:

• To maintain the early intervention universal/risk based community fluoride varnish program to children up to grade 2 in elementary schools identified as high risk through oral health screening activities. • To continue to promote early oral health care and the benefits of fluoride within the catchment area through a variety of strategic advertising modes. • To meet Ministry Oral Health indicator of schools screened in 2020/21 school year. • To refer eligible children requiring oral health care to the Healthy Smiles Ontario program. • To promote use of Early Years and School Aged oral health education toolkits by service providers. • To encourage adolescents to engage in Healthy Smiles Ontario and in healthy oral health behaviours through GetMouthy Campaign tools.

Direction for 2021:

• The Oral Health team will provide screening and surveillance to all eligible schools in Thunder Bay and District. • Health promotion and education activities will include ages 12 to 17 years, and their families. • The team will continue collaborative partnerships with strategic daycares and community sites to provide universal/risk based fluoride varnish (FLV) program for children from birth to four years of age as well as our school-based program to targeted elementary schools based on high-risk indicators from oral health screening and surveillance results.

Budgetary Changes/Implications No significant changes or implications as compared to the 2020 budget.

5526 Health Protection Division Budget Year 2021 Children's Visual Health Program Program Budget Summary

2020 2021 Change % Change

Budget 141,898$ $ 144,512 2,614$ 1.8%

FTEs 1.74 1.74 0.00 0.0%

Program Overview In accordance with the Child Visual Health and Vision Screening Protocol, 2018, the Children's Visual Health Program offers vision screening services to all senior kindergarten (SK) children in schools in the District of Thunder Bay. This involves the use of three separate screening tools. They are the HOTV visual acuity chart with crowding bars that tests visual acuity; the Randot Preschool Stereotest designed to detect reduced stereopsis/stereo acuity at near distances; and use of an Autorefractor can identify the presence and size of some refractive errors including near and farsightedness (myopia/hyperopia), astigmatism (asymmetrical focus) and anisometropia (unequal power between the eyes). The program also involves working with community partners to ensure children have access to the necessary supports required before and following screening, including schools, optometrist services for exams and providers and funders of glasses. Visual health navigation is also required to "support awareness of, access to, and utilization of visual health services". This includes education and promotion to improve awareness about visual health, the importance of early identification of vision disorders. General promotion and targeted outreach to priority populations and/or communities is required. The program will promote awareness of school-based vision screening and available services and will assist families with access to appointments and treatment as needed. Data collection and analysis is also performed as per Ministry direction.

Key Strategic Goals of the Program & Direction for 2021 Strategic Goals:

• Provide vision screening to SK children in all publicly funded schools in Thunder Bay and District. • Assist families with access to ophthalmology care as identified through screening. • Promote evidence-based messaging around pediatric eye health. • Comply with Ministry reporting requirements. • Implement effective and efficient programming and administrative practices.

Direction for 2021:

• Complete Situational Assessment with Health Protection Program Planner. • Engage with community stakeholders to provide program and visual health education. • Provide vision screening to all SK students between September 2020 and June 2021 including follow up data entry and reporting activities. • Identify and prepare promotional material as resources allow regarding evidence-based visual health messaging and engage with relevant community stakeholders. • Complete program procedures, training manual and annual work plan. • Create and implement evaluation strategy of first full year of program activities to inform program needs.

Budgetary Changes/Implications No significant changes or implications as compared to the 2020 budget.

5627 Health Protection Division Budget Year 2021 Healthy Smiles Ontario Program Budget Summary

2020 2021 Change % Change

Budget $ 475,600 $ 347,021 $ (128,579) -27.0%

FTEs 4.67 4.07 (0.60) n/a

Program Overview The Healthy Smiles Ontario (HSO) program is informed by Ontario Public Health Standard School Health Requirement #5 and #6 and in particular the Oral Health Protocol, 2018. Services are provided to eligible families within the Thunder Bay District Health Unit catchment area. Following screening and surveillance activities required by the Oral Health Protocol, the team identifies children in need of preventive, emergency and essential and/or treatment services.

The program provides preventive services to eligible children and ensures access to emergency and essential oral health services and treatment services within the dental community. All children who are screened receive notification of non- urgent and urgent oral health findings. Case management is provided to ensure children receive follow up care.

Families requiring assistance receive help in accessing providers and/or the HSO program, if deemed eligible. The team provides oral health navigation services to support awareness, access and utilization of the HSO program for eligible families. This includes oral health promotion, program promotion, client enrolment assistance and case management. As well, they deliver oral health and program promotion activities that are general and targeted to priority populations. The program uses research, knowledge and evaluation to inform program planning and delivery.

Strategic Goals:

• Increase community awareness of the HSO Program to maximize enrolment of eligible children and youth. • Engage with community health and social service providers working with families of children from birth to 17. • Provide access to preventive clinic services for HSO eligible clients. • Provide follow up screening at school to children identified with urgent oral health care needs and whose case remains open (suggesting services not complete) with the intent to maximize intervention and minimize child welfare referrals. • Identify and register children eligible for HSO. • Provide access to preventive fluoride varnish services for low income clients. • Evaluate collaborative outreach activities. • Share results of program activities with stakeholders. • Assist eligible families to register for the HSO program and to establish a dental home. • Ensure timely mandatory Ministry reporting requirements for HSO program.

Direction for 2021:

• Establish collaboration with three additional community service providers for use of Oral Health Guide for children birth to 5 years of age with emphasis on HSO eligibility. .Collaborate with Healthy Kids initiatives in targeted neighbourhood service delivery. • Offer and provide school based fluoride varnish program to existing participating publicly funded schools identified through screening and surveillance risk outcome and targeting HSO eligibility. • Evaluate partnership with the District of Thunder Bay Social Services Administration Board (DSSAB) around use of children's oral health resources and HSO referral process to ensure effectiveness and efficiencies. • Engage in health promotion and education activities intended to create oral health awareness and eligibility for HSO program for youth 12 to 17 years through GetMouthy! campaign materials. • Maintain preventive hygiene clinic appointment access consistent with 2019 year (2020 year incomplete due to COVID service suspension).

Budgetary Changes/Implications Decrease in budget due to removal of allocated admin because of HSO's move to cost-shared funding as well as 0.60 FTE (Manager) being moved to the Health Promotion Administrative budget.

5728 Thunder Bay District Health Unit Reduction/Expansion

Division: Health Promotion Expansion/Reduction: Reduction Program: Healthy Smiles Ontario

Expenditures Rank Description/Justification Expense name Expense Code Cost Healthy Smiles Ontario Manager moved from Health Protection to Health Promotion. Salary Salary & Benefits -$ 85,942.00 and benefits to be included in Health Protection Administration budget. 29

Total Cost-$ 85,942.00

Staff Impact Staff Resource Impact Group FTE Manager CUPE Non-Union -0.60 ONA Total FTE Enhancement (Reduction) -0.60

58 Health Protection Division 2021 Division Expenditure Budget Summary

Program Area 2020 2021 Change % Change Page

Divisional Administration Financial Resources $870,435 $954,283 $83,848 9.6% 31 Human Resources in FTE 7.20 7.80 0.60 8.3%

Emergency Preparedness Financial Resources $57,225 $57,225 $0 0.0% 34 Human Resources in FTE 0.00 0.00 0.00 0.0%

Health Hazard Financial Resources $211,448 $214,538 $3,090 1.5% 35 Human Resources in FTE 2.00 2.00 0.00 0.0%

Food Safety Financial Resources $712,853 $718,741 $5,888 0.8% 36 Human Resources in FTE 7.00 7.00 0.00 0.0%

Safe Water & Small Drinking Water Financial Resources $220,600 $224,444 $3,844 1.7% 37 Systems Human Resources in FTE 2.00 2.00 0.00 0.0%

Sexual Health Clinics & Street Nursing Financial Resources $907,416 $820,918 -$86,498 -9.5% 38 Human Resources in FTE 8.70 7.70 -1.00 -11.5%

Sexual Health - Harm Reduction Financial Resources $219,391 $227,219 $7,828 3.6% 40 Human Resources in FTE 2.10 2.10 0.00 0.0%

Rabies Financial Resources $20,360 $20,669 $309 1.5% 41 Human Resources in FTE 0.20 0.20 0.00 0.0%

Tuberculosis Control & ID Cost Shared Financial Resources $883,798 $859,497 -$24,301 -2.7% 42 Human Resources in FTE 8.50 8.50 0.00 0.0%

Vaccine Preventable Disease (VPD), Financial Resources $915,623 $914,386 -$1,237 -0.1% 43 Consolidated Human Resources in FTE 12.50 12.50 0.00 0.0%

Universal Influenza Financial Resources $4,000 $4,000 $0 0.0% 44 Human Resources in FTE 0.00 0.00 0.00 0.0%

Vector Borne Disease Financial Resources $115,267 $117,825 $2,558 2.2% 45 Human Resources in FTE 1.10 1.10 0.00 0.0%

Unincorporated Area (NOPHS) Financial Resources $20,860 $20,860 $0 0.0% 46 Human Resources in FTE 0.00 0.00 0.00 0.0%

Harm Reduction Enhancement Financial Resources 250,000 253,362 $3,362 1.3% 47 Human Resources in FTE 2.40 2.40 0.00 0.0%

Needle Exchange Initiative Financial Resources 124,600 124,600 $0 0.0% 48 Human Resources in FTE 0.00 0.00 0.00 0.0%

Nursing Initiatives Financial Resources 392,100 435,071 $42,971 11.0% 49 Human Resources in FTE 4.20 4.20 0.00 0.0%

Total Financial Resources $5,925,976 $5,967,638 $41,662 0.70% Total Base Positions (FTEs) 57.90 57.50 -0.40 -0.69%

5930 Health Protection Division Budget Year 2021 Health Protection Admin Program Budget Summary

2020 2021 Change % Change

Budget 870,435$ $ 954,283 83,848$ 9.6%

FTEs 7.20 7.80 0.60 8.3%

Program Overview Health Protection Administration supports the divisional management team to advance programming and deliver initiatives according to the Ontario Public Health Standards.

Key Strategic Goals of the Program & Direction for 2021 Strategic Goals:

• Provision of evidence-based planning and programming in accordance with the Ontario Public Health Standards, Protocols and Guidelines. • Continued implementation of enterprise risk management within the Thunder Bay District Health Unit. • Identify and implement quality improvement initiatives. • Development of program performance measures.

Direction for 2021:

• Oversight of the Ontario Public Health Standards at the divisional and program level.

Budgetary Changes/Implications Increase in wages and benefits due to the addition of 1.0 FTE manager for VPD and Sexual Health to support the COVID 19 response partially offset by a reallocation of 0.4 FTE manager to Health Promotion Admin.

6031 Thunder Bay District Health Unit Reduction/Expansion

Division: Health Protection Expansion/Reduction: Expansion Program: Health Protection Admin

Expenditures Rank Description/Justification Expense name Expense Code Cost Addition of 1 FTE manager for SH & VPD. This addtion is to address management capacity Salary & Benefits $ 121,790.00 issues due to Covid 19 and also an increase in other infectious diseases in our community. 32

Total Cost$ 121,790.00

Staff Impact Staff Resource Impact Group FTE Manager CUPE Non-Union 1.00 ONA Total FTE Enhancement (Reduction) 1.00

61 Thunder Bay District Health Unit Reduction/Expansion

Division: Health Protection Expansion/Reduction: Reduction Program: Health Protection Admin

Expenditures Rank Description/Justification Expense name Expense Code Cost Reduction of Manager of Oral Health, Vision and Branch offices who will now report to the the Salary & Benefits -$ 57,294.88 Director of Health Promotion 33

Total Cost-$ 57,294.88

Staff Impact Staff Resource Impact Group FTE Manager CUPE Non-Union 0.40 ONA Total FTE Enhancement (Reduction) 0.40

62 Health Protection Division Budget Year 2021 Emergency Preparedness Program Budget Summary

2020 2021 Change % Change

Budget 57,225$ 57,225$ -$ 0.0%

FTEs 0.00 0.00 0.00 n/a

Program Overview The purpose of the Public Health Emergency Preparedness Program is to implement measures that will prepare the Thunder Bay District Health Unit (TBDHU) to respond to emergencies, defined as “a situation or an impending situation that constitutes a danger of major proportions that could result in serious harm to persons or substantial damage to property and that is caused by the forces of nature, a disease or other health risk, an accident or an act whether intentional or otherwise."

Key Strategic Goals of the Program & Direction for 2021 Strategic Goals:

• Ensure ability of TBDHU to respond to emergencies and assess public health risks on a 24/7 basis. • Ensure continuity of operations for critical services during business disruptions.

Direction for 2021:

• Maintain robust on-call system, including appropriate services and equipment. • Maintain participation with District community emergency response exercises and other training activities. • Maintain connectivity with emergency preparedness partners such as Emergency Management Ontario, local community emergency management coordinators, Thunder Bay International Airport, Cross Border Emergencies Working group.

Budgetary Changes/Implications No significant budgetary changes or implications as compared to the 2020 budget.

6334 Health Protection Division Budget Year 2021 Health Hazard Program Budget Summary

2020 2021 Change % Change

Budget 211,448$ 214,538$ $ 3,090 1.5%

FTEs 2.00 2.00 0.00 n/a

Program Overview The purpose of the Health Hazard program is to prevent and reduce adverse health outcomes from health hazards in the environment by the delivery of comprehensive, local health hazard prevention and management programs including investigation and control of health hazards in the natural and built environment.

The Health Hazard program conducts itself in accordance with best practices for addressing health hazards in the environment in order to prevent or reduce the burden of illness from such hazards. A key aspect of the Health Hazard Program is local collaboration and sharing of information and expertise, recognizing that the Thunder Bay District Health Unit (TBDHU) is not always the lead agency in responding to health hazards in the environment.

Key Strategic Goals of the Program & Direction for 2021 Strategic Goals:

• Eliminate or control health hazards in the natural and built environment through effective response and partnerships.

Direction for 2021:

• Respond to all reports of potential health hazards. • Provide playground safety inspection services. • Develop system for public disclosure of recreational camp inspections. • Identify and promote innovative strategies to control and prevent bed bug infestations.

Budgetary Changes/Implications No significant budgetary changes or implications as compared to the 2020 budget.

6435 Health Protection Division Budget Year 2021 Food Safety Program Budget Summary

2020 2021 Change % Change

Budget 712,853$ $ 718,741 5,888$ 0.8%

FTEs 7.00 7.00 0.00 0.0%

Program Overview The purpose of the Food Safety Program is to prevent and reduce food-borne illness by delivering local, comprehensive food safety management programs, that include, but are not limited to:

• Surveillance and inspection of food premises; • Epidemiological analyses of surveillance data; • Food handler training; and • Timely response to reports of food-borne illnesses or outbreaks; unsafe food-handling practices, food recalls, adulteration and consumer complaints; and food-related issues arising from floods, fires, power outages or other situations that may affect food safety.

Regulations under the Health Protection and Promotion Act (HPPA) that are relevant to this protocol include: • O. Reg. 562 (Food Premises); • O. Reg. 568 (Recreational Camps); and • O. Reg. 554 (Camps in Unorganized Territories).

The Enhanced Food Safety 100% funding augments a Board of Health's capacity to deliver the Food Safety Program. Base funding for this initiative is used to help implement the Food Safety Program Standard under the OPHS.

Key Strategic Goals of the Program & Direction for 2021 Strategic Goals:

• Prevent or reduce the burden of foodborne illness in the population using a variety of methods, including education, enforcement, and advocating for healthy public policy. • Detect and control instances and outbreaks of foodborne illness in a timely and effective manner. • To Inform the public and food premise operators about safe food-handling practices and food safety issues, through health promotion messaging, disclosure of inspection results, and food handler training and certification.

Direction for 2021:

• Attain compliance with Accountability Agreement Performance Indicator - 100% of high-risk food premises inspected once every four months while in operation. • Attain compliance with Accountability Agreement Performance Indicator - 100% of medium-risk food premises inspected once every six months while in operation. • Continue work on three-year strategy for Public Disclosure of Inspection Results; Launch online disclosure portal.

Budgetary Changes/Implications No significant budgetary changes or implications as compared to the 2020 budget.

6536 Health Protection Division Budget Year 2021 Safe Water Program Budget Summary

2020 2021 Change % Change

Budget 220,600$ $ 224,444 3,844$ 1.7%

FTEs 2.00 2.00 0.00 n/a

Program Overview The Safe Water Program is comprised of two sub-programs: the Drinking Water Program and the Recreational Water Program.

• The Drinking Water Program consists of a surveillance and inspection system for drinking water systems, response to adverse drinking water events, reports of water-borne illness or outbreaks and informing the public about unsafe drinking water conditions.

• The Recreational Water Program consists of a surveillance and inspection system for publicly accessible recreational water facilities, including pools, spas and beaches. In addition to regular inspections, the Program responds to reports of water-borne illness and injury related to recreational water use, education and training of operators of recreational water facilities, testing of beach water and informing the public about potentially unsafe recreational water conditions.

The Enhanced Safe Water Initiative - 100% funding: Base funding requested for this initiative must be used for the sole purpose of increasing the board of health's capacity to meet the requirements of the Safe Water Program Standard under the OPHS.

Key Strategic Goals of the Program & Direction for 2021 Strategic Goals:

• Prevent and reduce water-borne illness related to drinking water. • Prevent and reduce water-borne illness and injury related to recreational water use.

Direction for 2021:

• Maintain compliance with Accountability Agreement Performance Indicator - 100% of pools and public spas by class inspected while in operation. • Provide education and training to pool operators regarding safe pool operation and compliance with regulatory framework. • Develop system for public disclosure of inspection results for public pools and spas • Ensure SDWS operator compliance with Directives issued under Regulation 319, with a particular focus on ensuring that drinking water sampling and testing requirements are being met.

Budgetary Changes/Implications No significant budgetary changes or implications as compared to the 2020 budget.

6637 Health Protection Division Budget Year 2021 Sexual Health Clinics/Street Nursing Program Budget Summary

2020 2021 Change % Change

Budget 907,416$ $ 820,918 $ (86,498) -9.5%

FTEs 8.70 7.70 (1.00) -11.5%

Program Overview The Sexual Health (SH) program, specifically the Sexual Health, Sexually Transmitted Infections (STIs) and Blood- borne Infections (BBIs) (including HIV), is required under the Ontario Public Health Standards to prevent or reduce the burden of STIs and BBIs and to promote healthy sexuality. The Board of Health outcomes include:

• timely detection of cases of STIs and BBIs and risk factors and trends; • use of epidemiological data to develop policy, programs and services; • increase public awareness of factors related to healthy sexuality and prevention of STIs and BBIs; • to work with community partners to promote healthy sexuality and to prevent STIs and BBIs; • to work with priority populations to promote health sexuality, to prevent STIs and BBIs, and to ensure access to contraception; and • to appropriately manage cases and contacts of STIs and BBIs, and ensure health care providers have the capacity to manage cases and contacts of STIs and BBIs.

The Street Nursing program consists of a mobile unit operating in the City of Thunder Bay and is staffed by three Public Health Nurses and a Nurse Practitioner. The goal is to provide culturally safe, trauma-informed services to vulnerable, street involved populations in the City of Thunder Bay who are suffering from or are at risk for infectious diseases and blood-borne illnesses such as tuberculosis, invasive group A streptococcal, hepatitis C and HIV. Services provided on the mobile include BBI/STI testing, harm reduction, tuberculosis screening, immunization, wound care, and referrals to other services such as substance use disorder treatment, withdrawal management, emergency services and mental health services.

Key Strategic Goals of the Program & Direction for 2021 To reduce the health inequities experienced by people who are under-housed or using injection drugs in the City of Thunder Bay through the provision of mobile public health services, with a focus on relationship building, harm reduction and health promotion.

Strategic Goals:

• Increase priority population access to clinical services, including anonymous HIV testing. • Increase priority population access to low- or no-cost contraception. • Enhance management of cases of STIs and BBIs to increase secondary prevention, decrease re-infections, and improved data quality for program and policy development. • Ongoing review of clinical services, sexual health resources and supplies available to the community. • Ongoing compliance with Ministry of Health and Long-Term Care Accountability Agreement Performance Indicators. • Align the program to fit community needs specific to public health role; and • Completion of a developmental evaluation.

Direction for 2021:

The Sexual Health program will continue to focus on four main areas over the next year:

• STBBI Surveillance; • Sexual Health Promotion; • Clinical Services; and • Case and contact management. • Continue engagement with high-risk populations and service providers that work with similar populations to both increase awareness and increase connectivity of programming for wrap around care services.

Clinical service delivery will concentrate on client-centered care and efficiencies. This will be achieved by expanding existing clinical roles, addressing barriers and process improvement.

Budgetary Changes/Implications Decrease due to 1.0 FTE PHN funded through Indigenous Communities: Street Outreach program.

6738 Thunder Bay District Health Unit Reduction/Expansion

Division: Health Protection Expansion/Reduction: Reduction Program: Street Nursing

Expenditures Rank Description/Justification Expense name Expense Code Cost Position shifted to Indigenous Street Outreach program due to shift in funding. Salary & Benefits 05100 -$ 102,057.00 39

Total Cost-$ 102,057.00

Staff Impact Staff Resource Impact Group FTE CUPE Non-Union ONA -1.00 Total FTE Enhancement (Reduction) -1.00

68 Health Protection Division Budget Year 2021 Harm Reduction Program Budget Summary

2020 2021 Change % Change

Budget 219,391$ $ 227,219 7,828$ 3.6%

FTEs 2.10 2.10 0.00 n/a

Program Overview The Harm Reduction program ("Superior Points") is required under the Ontario Public Health Standards, specifically the Sexual Health, Sexually Transmitted Infections (STIs) and Blood-borne Infections (BBIs) (including HIV) standards, to prevent or reduce the burden of BBIs. The Board of Health outcomes include:

• timely detection of BBI risk factors and trends; • use of epidemiological data to develop policy, programs and services; • increase public awareness of factors related to prevention of BBIs; • to work with community partners to prevent BBIs; • to work with priority populations to prevent BBIs; and • to work with priority populations to ensure access to harm reduction services.

The Health Unit is required to ensure access to harm reduction services, including clean and sterile drug-using equipment, naloxone, condoms, counselling, skills-building and appropriate referrals.

Key Strategic Goals of the Program & Direction for 2021 Strategic Goals:

• Perform targeted outreach and promotion of harm reduction services to priority populations. • Increase priority population access to harm reduction services. • Increase access to overdose prevention training, and availability of naloxone. • Increase access to public biohazard bins, thereby reducing publicly discarded used equipment.

Direction for 2021:

• Sustain existing and increase community partnerships. • Work with district communities to develop harm reduction strategy in their communities. • Deliver a Harm Reduction conference targeted at partner community members.

Budgetary Changes/Implications No significant budgetary changes or implications as compared to the 2020 budget.

6940 Health Protection Division Budget Year 2021 Rabies Control Program Budget Summary

2020 2021 Change % Change

Budget 20,360$ 20,669$ $ 309 1.5%

FTEs 0.20 0.20 0.00 n/a

Program Overview The Rabies Prevention and Control Program's goal is to prevent the occurrence of rabies in humans. The Board of Health outcomes are to provide timely and effective detection and identification of positive reports of rabies in animal species and other emerging risks and trends associated with rabies in humans; influencing the development of healthy public policy supported by local epidemiology; increase awareness and prevention of rabies; reporting of all suspected rabies exposures in the health unit district; management of suspected rabies exposures; preparation of the public, community partners and health care providers for rabies threats.

Key Strategic Goals of the Program & Direction for 2021 Strategic Goals:

• Prevent the occurrence of rabies in humans through identification and risk assessment of animal bites, as well as public health management of suspected rabies exposures, including ensuring 24/7 availability of rabies vaccine and consultation services for physicians encountering suspected rabies exposures.

Direction for 2021:

• Maintain 100% compliance with accountability indicator 3.2, which is percentage of suspected rabies exposures reported with investigation initiated within one business day of public health unit notification.

• Provide effective communication with community stakeholders regarding notification and follow up with all animal bites.

Budgetary Changes/Implications No significant budgetary changes or implications as compared to the 2020 budget.

7041 Health Protection Division Budget Year 2021 Infectious Disease Program Budget Summary

2020 2021 Change % Change

Budget 883,798$ $ 859,497 $ (24,301) -2.7%

FTEs 8.50 8.50 0.00 n/a

Program Overview The goal of the Infectious Disease cost-shared program, IPC nurse and Tuberculosis programs is to prevent or reduce the burden of infectious diseases of public health significance within the TBDHU area.

Key Strategic Goals of the Program & Direction for 2021

Strategic Goals:

ID Cost Shared • Increase available online learning resources; and • Increase capacity within long-term care facilities related to outbreak identification and management.

Tuberculosis • Reinforce the role of the program to provide expertise and resources to the community regarding TB; and • Increase screening to high-risk populations through Street Nursing team.

Direction for 2021:

ID Cost Shared • Increase capacity within TBDHU for IPAC related issues; and • Development of public disclosure system for licensed childcare settings.

Tuberculosis • Continue with case and contact investigation related to 2018 TB outbreak; • Increase capacity and understanding of TB screening processes for social service agencies and other community healthcare providers; and • Continue with TB skin testing education for students of local nursing programs to ensure that new healthcare providers have knowledge of proper technique for administering and reading TB skin tests.

IPCN • Work towards increasing capacity for IPAC follow-up by studying for certification exam with completion in 2021.

Budgetary Changes/Implications Budget decrease is due to staffing changes with new staff at lower grid steps on the pay scale.

7142 Division Budget Year 2021 VPD - Schools & Community Program Budget Summary

2020 2021 Change % Change

Budget 915,623$ 914,386$ $ (1,237) -0.1%

FTEs 12.50 12.50 0.00 0.0%

Program Overview The Vaccine Preventable Disease (VPD) program works toward the societal goal of reducing or eliminating the burden of vaccine preventable diseases. The Board of Health outcomes in this program area are:

• Timely and effective detection and identification of children susceptible to VPD, their associated risk factor and emerging trends; • Timely and effective detection and identification of priority populations facing barriers to immunization; • Development of healthy public policy to eliminate the burden of vaccine preventable disease; • Public awareness of the importance of immunizations across the lifespan; • Timely and effective monitoring oaf and reporting on adverse events following immunization (AEFI); • Adherence to proper vaccine management, including storage and handling practices by vaccine providers; • Achievement of targets for provincially funded immunizations; • Effective response to VPD outbreaks; • Public awareness of travel health services; and • Children having up-to-date immunizations according to the Ministry's publicly funded immunization schedule and in accordance with the Immunization of School Pupils Act.

Key Strategic Goals of the Program & Direction for 2021 Strategic Goals:

• Increase understanding of local situation regarding knowledge, attitudes and beliefs regarding vaccines and vaccine hesitancy. • Improve over all communication with health care providers related to all components of immunization program including vaccine distribution, handling, and reporting. • Improve VPD monitoring and reporting at the local level. • Decrease vaccine wastage. • Continue to implement efforts to reduce school suspensions related to the informant of the Immunization of School Pupils Act (ISPA).

Goals for 2021:

• Complete a situational assessment regarding vaccine knowledge and vaccine hesitancy. • Conduct a situation assessment to determine knowledge gaps, desired areas of support and preferred method of information delivery for health care providers. • Establish a process to regularly monitor and respond to local VPD rates in collaboration across the Health Protection Division. • Conduct internal analysis of trends in cold chain incidents and fridge inspection results to inform an internal vaccine management strategy. • Continue to communicate with parents and guardians regarding the ISPA enforcement process. • Continue to provide individualized parent/guardian notification, including summer letters to update immunization records, followed by suspension notification process. • Continue to provide prioritized immunization services when required for children involved in the ISPA process.

Budgetary Changes/Implications No significant budgetary changes or implications as compared to the 2020 budget.

7243 Health Protection Division Budget Year 2021 VPD - Influenza Program Budget Summary

2020 2021 Change % Change

Budget 4,000$ 4,000$ -$ 0.0%

FTEs 0.00 0.00 0.00 n/a

Program Overview The program goal is to promote and provide the Universal Influenza Immunization Program (UIIP) in Thunder Bay and district. The role of the Thunder Bay District Health Unit (TBDHU) is multi-fold including managing vaccine inventory, distributing vaccine to health care providers, promotion and education on vaccine storage and handling requirements and vaccine fridge inspections, and promotion and education on different flu vaccines that are available. The Ministry of Health has been expanding this program in recent years, including the addition of pharmacies as an example and, therefore, the role of the TBDHU has seen significant changes.

Key Strategic Goals of the Program & Direction for 2021 Strategic Goals:

• Ensure the availability of safe and effective influenza vaccine to our providers. • Continue with promotion of influenza vaccine for all residents. • Ensure provision of vaccine storage and handling education and accompanying vaccine fridge inspections to new providers entering the UIIP.

Direction for 2021:

• Implement expectations of Ministry of Health regarding vaccine inventory management and vaccine distribution. • Discontinue community clinics as more residents turn to more accessible sites such as pharmacies for their vaccine. TBDHU staff will target vulnerable families and those with children under five years of age with appointment-based on-site clinics as well as with outreach clinics to interested Early Years sites. • Use of the Panorama Enhanced Analytic Reporting (PEAR) tool for more accurate flu vaccine wastage calculations. • Increase promotion to healthcare providers regarding new influenza vaccines that are available for use. • Provide expertise and support for Influenza vaccination during pandemic.

Budgetary Changes/Implications No significant budgetary changes or implications as compared to the 2020 budget.

7344 Division Budget Year 2021 Vector Borne Disease Program Budget Summary

2020 2021 Change % Change

Budget 115,267$ 117,825$ 2,558$ 2.2%

FTEs 1.10 1.10 0.00 n/a

Program Overview The Vector-Borne Disease program implements an integrated vector-borne disease management strategy based on local risk assessment and other scientific evidence with respect to effective and efficient prevention and control measures.

Key Strategic Goals of the Program & Direction for 2021 Strategic Goals:

• Prevent or reduce the number of cases of vector-borne disease including West Nile Virus and Lyme Disease.

Direction for 2021:

• Conduct surveillance of key aspects of the life cycle of West Nile Virus and Lyme disease, including their vectors, reservoirs and human hosts. • Conduct active surveillance for black-legged ticks, which are the vector for Lyme disease. • Conduct public education on personal protective measures.

Budgetary Changes/Implications No significant budgetary changes or implications as compared to the 2020 budget.

7445 Division Budget Year 2021 Unincorporated Program Budget Summary

2020 2021 Change % Change

Budget 20,860$ 20,860$ -$ 0.0%

FTEs 0.00 0.00 0.00 n/a

Program Overview The purpose of the Unincorporated Territories budget is to provide public health services in areas without municipal governance.

Environmental Health provides key public health services in Unorganized Territories, including Food Safety and Safe Water inspections; and Health Hazard Investigations of food premises outside of organized municipalities, including tourist camps and industrial operations, such as mines, logging camps, tree planting camps, exploration camps, etc. Many of these operations are located in rough terrain or in remote fly-in areas.

Key Strategic Goals of the Program & Direction for 2021 Strategic Goals:

• Ensure that remote areas of the district are protected from public health threats by delivering key environmental health programming, including Food Safety, Safe Water, and Health Hazard Investigations.

Direction for 2021:

• Fulfill the inspection requirements of the Food Safety and Safe Water Public Health Standards in the Unorganized Territories. The leasing of a four-wheel drive vehicle and allocating money to fly-in travel costs ensure that we are able to access the rough terrain and remote fly-in areas where the relevant premises are located.

Budgetary Changes/Implications No significant budgetary changes or implications as compared to the 2020 budget.

7546 Health Protection Division Budget Year 2021 Harm Reduction Enhancement Program Budget Summary

2020 2021 Change % Change

Budget 250,000$ $ 253,362 3,362$ 1.3%

FTEs 2.40 2.40 0.00 n/a

Program Overview

The Harm Reduction Enhancement program focuses on a local opioid response, naloxone distribution and training; and opioid overdose early warning and surveillance.

Key Strategic Goals of the Program & Direction for 2021

Strategic Goals:

• Engage and support district communities to develop local harm reduction programs. • Perform targeted outreach and promotion of harm reduction services to priority populations. • Increase priority population access to harm reduction services. • Increase access to overdose prevention training, and availability of naloxone. • Increase access to public biohazard bins, thereby reducing publicly discarded used equipment.

Direction 2021:

• Implementation of FAST overdose reporting program. • Addressing increase in overdoses in Thunder Bay and District in partnership with the Opioid Taskforce.

Budgetary Changes/Implications No significant budgetary changes or implications as compared to the 2020 budget.

7647 Division Budget Year 2021 Needle Exchange Initiative Program Budget Summary

2020 2021 Change % Change

Budget 124,600$ $ 124,600 -$ 0.0%

FTEs 0.00 0.00 0.00 n/a

Program Overview The Needle Exchange program Initiative provides base funding that must be used for the purchase of needles and syringes, and their associated disposal costs, for the Needle Exchange program.

Key Strategic Goals of the Program & Direction for 2021 Strategic Goals:

• Increase priority population access to harm reduction services. • Increase access to public biohazard bins, thereby reducing publicly discarded used equipment.

Direction for 2021:

• Sustain existing and increasing community partnerships. • Work with district communities to develop harm reduction strategy in their communities.

Budgetary Changes/Implications No significant budgetary changes or implications as compared to the 2020 budget.

7748 Division Budget Year 2021 Chief Nursing Officer/Social Determinants of Health/Infection Prevention & Control Nurse Program Budget Summary

2020 2021 Change % Change

Budget 392,100$ $ 435,071 42,971$ 11.0%

FTEs 4.20 4.20 0.00 n/a

Program Overview Chief Nursing Officer The Professional Practice Lead position supports the Chief Nursing Officer as the lead for nursing practice and professional issues to support a consistent high standard of nursing practice in all programs across the Thunder Bay District. These roles focus on nursing leadership initiatives, supporting organizational effectiveness and quality improvement.

Social Determinants of Health This initiative supports two public health nurses (PHNs) with specific knowledge and expertise in social determinants of health and health inequities issues, to provide enhanced supports internally and externally to address the needs of priority populations impacted most negatively by the social determinants of health. At the TBDHU, the positions are currently divided between the Sexual Health program (1.0 FTE), the Family Health program (.5 FTE) and the Foundational Standard team (.5 FTE). Funding is limited to public health nursing salaries and benefits only and cannot be used to support operating or training costs.

Infection Prevention and Control Nurse This initiative supports one or greater than one FTE infection and control nursing services at the Board of Health.

Key Strategic Goals of the Program & Direction for 2021 Chief Nursing Officer

Nursing Leadership:

• Develop nursing leadership throughout the organization. • Support quality student learning in public health and community health nursing through development of a strong preceptorship program.

Organizational Effectiveness:

• Support organizational effectiveness through development of professional practice policy and procedure. • Foster an environment supportive of best practices according to the College of Nurses of Ontario Professional Practice Standards.

Quality Improvement:

• Support quality improvement and adoption of best practice evidence into practice. • Continue with Best Practice Spotlight Organization commitments ensuring deliverables are met.

Social Determinants of Health

Increase organizational capacity to incorporate the social determinants of health into programming. Develop strategic partnerships with key community partners with respect to addressing health inequities. Direction includes advancing health equity issues in accordance with the Ontario Public Health Standards and the TBDHU Strategic Plan (2017-2020).

Infection Prevention and Control Nurse • To ensure the prevention and control of the spread of infection through best practices.

Budgetary Changes/Implications This funding is now included within the mandatory core program funding and no longer 100% funded therefore budget is no longer maximized and the entire salary and benefit amounts for nurses in this program have been included in the budget.

7849 Medical Officer of Health Division 2021 Division Expenditure Budget Summary

Program Area 2020 2021 Change % Change Page

Medical Officer of Health Office Financial Resources $626,451 $645,673 $19,222 3.1% 51 Human Resources in FTE 2.60 2.60 0.00 0.0%

Foundational Standards Financial Resources $248,185 $257,575 $9,390 3.8% 52 Human Resources in FTE 2.40 2.40 0.00 0.0%

Indigenous Communities: Public Health Financial Resources $400,000 $0 -$400,000 -100.0% 53 Human Resources in FTE 1.00 0.00 -1.00 -100.0%

Total Financial Resources $1,274,636 $903,248 -$371,388 -29.1% Total Base Positions (FTEs) 6.00 5.00 -1.00 -16.7%

7950 Medical Officer of Health Division Budget Year 2021 MOH/CEO Office Program Budget Summary

2020 2021 Change % Change

Budget 626,451$ $ 645,673 19,222$ 3.1%

FTEs 2.60 2.60 0.00 n/a

Program Overview The Medical Officer of Health and Chief Executive Officer (MOH/CEO) with the support of the Associate Medical Officer of Health (AMOH) and Senior Management provides organizational leadership and oversight to the public health programs and services and reports to the Board of Health on organizational direction, programs, services and issues of public health concern. The MOH/CEO has key responsibilities under the HPPA as well as in numerous other acts and regulations. The Executive Assistant provides administrative support to the MOH/CEO, AMOH, and the Board of Health. The MOH/CEO Office budget covers the MOH/CEO, AMOH and EA.

Key Strategic Goals of the Program & Direction for 2021 The MOH/CEO Office works to improve and protect the health of all people in the Thunder Bay District Health Unit area, including assessing and mitigating health risks, recommending and implementing public policies, and utilizing knowledge and sharing information with community partners. By establishing and building relationships with high- level leadership in the community and in the government, the MOH/CEO Office is able to promote the goals of the organization through meaningful engagement. Internally, the MOH/CEO Office provides leadership and strategic direction and oversight to the delivery of all public health programs and services under the HPPA.

Strategic Goals: To guide the organization through the remainder of the COVID-19 pandemic and through the process of public health modernization; including consulations in the TBDHU area and advocacy at the provincial level.

To continue implementation of the 2017-2020 TBDHU Strategic plan and maintain compliance with the Standards for Public Health Programs and Services.

To build and maintain relationships with the community partners, regional partners and provincially to advance the work of the TBDHU and to more effectively address public health issues in the Thunder Bay District area and more broadly.

Direction for 2021: Provide organizational oversight and leadership in all aspects of managing the COVID-19 pandemic, in the ongoing public health modernization process, and in addressing public health issues in the Thunder Bay District area.

Budgetary Changes/Implications No significant budgetary changes or implications as compared to the 2020 budget.

8051 Medical Officer of Health Division Budget Year 2021 Foundational Standards Program Budget Summary

2020 2021 Change % Change

Budget 248,185$ $ 257,575 9,390$ 3.8%

FTEs 2.40 2.40 0.00 n/a

Program Overview The Foundational Standards Team (FST) supports the application of the three of the four Foundational Standards of the OPHS across the organization. The Foundational Standards articulate requirements that underlie and support all Program Standards and include: Population Health Assessment; Health Equity; Effective Public Health Practice (Program Planning, Evaluation and Evidence-Informed Decision-Making, Research, Knowledge Exchange and Communication and Quality and Transparency). Key areas of focus are epidemiology, program evaluation and library support. In particular, this team helps provide the data, information and evidence that supports programs in understanding the need in the population around a public health issue, and in aligning activities to maximize impact. The FST also includes a Social Determinants of Health (SDOH) nurse and the Professional Practice Lead. Activities and most of the costs for these positions are included in other budgets.

Key Strategic Goals of the Program & Direction for 2021 The Foundational Standards Team focuses on an organizational approach that supports improvement of evidence- informed program planning; capacity building through direct support, training, and research; and incorporation of a health equity approach to planning and delivery of programs.

Strategic Goals: To enhance capacity across the organization in fulfilling the requirements of the Foundational Standards of the OPHS. To build capacity across the organization for epidemiology, program evaluation and library and research methods through assessing needs, delivering training and sharing resources. To work with programs to deliver evidence-informed programs and services.

Direction for 2021:

Continued epidemiology support to the organization in managing the COVID-19 pandemic; research on evidence and best practices related to COVID-19; continued development of relevant procedures, guidance, tools and other resources to support the planning and evaluation activities consistent with the Foundational Standards; continued development of an organizational Ethics framework.

Participate in operationalizing elements of the 2017 - 2020 TBDHU Strategic Plan that are related to the Foundational Standards.

Budgetary Changes/Implications No significant budgetary changes or implications as compared to the 2020 budget.

8152 Medical Officer of Health Division Budget Year 2021 Indigenous First Nations Program Budget Summary

2020 2021 Change % Change

Budget 400,000$ $ - $ (400,000) -100.0%

FTEs 1.00 0.00 (1.00) -100.0%

Program Overview The goal of the Indigenous Communities program is to support public health issues in the First Nation communities in the TBDHU catchment area and to support the implementation of the Sioux Lookout First Nations Health Authority (SLFNHA) Approaches to Community Wellbeing model for First Nations communities.

The Indigenous Communities program also supports infectious disease initiatives in the under-housed, marginalized population in Thunder Bay which is disproportionately Indigenous.

Key Strategic Goals of the Program & Direction for 2021 SLFNHA: Support the continued implementation of the Approaches to Community Wellbeing model through secondment of the Associate Medical Officer of Health. Continued collaboration with SLFNHA and NWHU for the delivery of public health programs and services by implementation of protocols and agreements.

Thunder Bay: Continue Infectious disease surveillance and support Indigenous engagement on public health modernization.

Budgetary Changes/Implications This budget is now included with 100% funding. See 100% funding.

8253 Corporate Services Division 2021 Division Expenditure Budget Summary

Program Area 2020 2021 Change % Change Page

Director of Corporate Services Financial Resources $239,748 $250,481 $10,733 4.5% 55 Human Resources in FTE 2.00 2.00 0.00 0.0%

Finance Financial Resources $494,434 $515,243 $20,809 4.2% 56 Human Resources in FTE 5.00 5.00 0.00 0.0%

Human Resources Financial Resources $402,279 $408,679 $6,400 1.6% 57 Human Resources in FTE 4.00 4.00 0.00 0.0%

Information Systems Financial Resources $630,562 $635,583 $5,021 0.8% 58 Human Resources in FTE 6.00 6.00 0.00 0.0%

Communications Financial Resources $410,864 $419,049 $8,185 2.0% 59 Human Resources in FTE 5.00 5.00 0.00 0.0%

Total Financial Resources $2,177,887 $2,229,035 $51,148 2.3% Total Base Positions (FTEs) 22.00 22.00 0.00 0.0%

8354 Corporate Services Division Budget Year 2021 Director Corporate Services Program Budget Summary

2020 2021 Change % Change

Budget 239,748$ 250,481$ 10,733$ 4.5%

FTEs 2.00 2.00 0.00 n/a

Program Overview Working together with the senior management team, carries out the Board of Health's strategic plans and policies, and directs the Corporate Services Division (Human Resources, Finance, Communications, Information Systems and Property) in providing administrative leadership to the organization.

Key Strategic Goals of the Program & Direction for 2021 TBDHU's 2017-2020 Strategic Plan focuses on the guiding principles of excellence, commitment and inclusion. Stemming from these principles are the priority areas of Communities & People First, Indigenous People, Mental Wellness and Organizational Effectiveness. Our goal is to align the direction of the 2021 Administrative programs with these priority areas;

Communities & People First Serve the public health needs of the Thunder Bay District's diverse communities and people.

Indigenous People Work with Indigenous people and organizations to improve health outcomes and reduce inequities.

Mental Wellness Promote and support mental health and well-being in our community.

Organizational Effectiveness Improve how we work and learn together.

Budgetary Changes/Implications There are no significant budget changes or implications as compared to the 2020 budget.

8455 Corporate Services Division Budget Year 2021 Finance Program Budget Summary

2020 2021 Change % Change

Budget 494,434$ $ 515,243 20,809$ 4.2%

FTEs 5.00 5.00 0.00 n/a

Program Overview Finance provides a wide range of financial services to support Health Unit programming while upholding financial data integrity and safeguarding assets of the organization through ethical, efficient and cost-effective processes; including the system of internal controls, the budget process, financial reporting, payroll and procurement.

Key Strategic Goals of the Program & Direction for 2021 Strategic Goals:

• Develop excellence in our systems, people, infrastructure, tools and technology. • Create a culture of empowerment. • Enhance System to support client service standards.

Direction for 2021:

• Provide support and direction as needed and/or requested in order to assist the organization with future amalgamation plans.

• Develop Finance team expertise to enhance knowledge and innovation thereby improving customer service and support to the organization as well as improve the use and effectiveness of our systems.

• Review Finance policies, procedures, processes and systems in collaboration with internal clients (programs) to enhance their program/service delivery. Provide staff with the necessary skills, tools, technology, and direction to make use of the existing software programs to provide better services and programs to our clients.

• Continue to improve financial support services to internal clients (Programs) through updated technology solutions in the areas of budgets, variance reporting, payroll and purchasing.

Budgetary Changes/Implications There are no significant budget changes or implications as compared to the 2020 budget.

8556 Corporate Services Division Budget Year 2021 Human Resources Program Budget Summary

2020 2021 Change % Change

Budget 402,279$ $ 408,679 6,400$ 1.6%

FTEs 4.00 4.00 0.00 n/a

Program Overview Human Resources (HR) provides support and services to management and staff of the Health Unit in the following areas: recruitment, hiring and orientation; policies and procedures; facilitating effective labour relations and adherence with employment legislation; coordination of corporate training sessions; ensuring the organization is in compliance with health and safety legislation; student and volunteer coordination; salary and benefit administration; as well as providing ongoing guidance in the areas of employee discipline, disability management, privacy requests/breaches, and performance management.

Key Strategic Goals of the Program & Direction for 2021 One of the goals of the Corporate Services Division is to align the direction of the 2021 Human Resources program with these priority areas.

Strategic Goals for 2021: Organizational Effectiveness • Provide relevant management training to all managers and high performers identified as future leaders. • Take measures to ensure roles and responsibilities are well defined, understood and met, including up-to-date job descriptions and defined level of authority and responsibility. • Complete a review and update procedures and processes to ensure consistent and efficient processes are in place across the organization. Mental Wellness • Implement the National Standard for Psychological Health and Safety in the Workplace internally within the Thunder Bay District Health Unit, and promote implementation of the standard to external organizations, • Support mental wellness promotion activities within our organization via the Wellness Committee.

Direction for 2021: Organizational Effectiveness • Provide managers with leadership essentials training. • Complete both ONA and CUPE negotiations (CAs expire Dec. 31, 2020). • Review and update 50% of the Human Resources policies and procedures. Mental Wellness • Continue the implementation of the National Standard for Psychological Health and Safety in the Workplace with a focus on one of the following two psychosocial factors: clear leadership and expectations or organizational culture. • Continue to support mental wellness promotion activities including but not limited to: stress and resiliency workshop(s), nutritional wellness session(s) and Yoga/Tai Chi within our organization via the Wellness Committee.

Budgetary Changes/Implications There are no significant budget changes or implications as compared to the 2020 budget.

8657 Corporate Services Division Budget Year 2021 Information Systems Program Budget Summary

2020 2021 Change % Change

Budget 630,562$ 635,583$ 5,021$ 0.8%

FTEs 6.00 6.00 0.00 n/a

Program Overview Information Systems provides service and support for staff at the main office as well as the four branch offices. Information Systems' guiding statement is: “To support and advance Health Unit programming while ensuring that the stability and security of all systems are not compromised in order to protect the system and employees from internal and external threats in a cost effective manner.

Key Strategic Goals of the Program & Direction for 2021 Strategic Goals • Develop excellence in our systems, people, infrastructure, tools and technology. • Create a culture of empowerment. • Enhance System to support client service standards.

Direction for 2021 • Provide support and direction as needed and/or requested in order to assist the organization with future pandemic response and amalgamation plans.

• Develop Information Systems team expertise to enhance knowledge and innovation thereby improving customer service and support to the organization as well as improve the use and effectiveness of our systems and technology to help shape the future and growth of the organization.

• Review Information Systems policies, procedures, processes and systems in collaboration with internal clients (programs) to enhance their program/service delivery. Provide staff with the necessary skills, tools, technology, and direction to make use of the existing technology and infrastructure to provide better services and programs to our clients.

• Provide leadership and be a resource for enhancements/upgrades to the facility including Seniors Dental Renovations, HVAC and structural improvements. Work with TBDHU leadership, contractors, consultants, and vendors to ensure that the core values of our renovation project are considered when making necessary enhancements/upgrades to the facility.

• Ensure the stability and effectiveness of the organizations technology infrastructure is considered in all future upgrades and enhancements and ensure that the organizations data and systems are secure from outside threats and vulnerabilities.

• Continue to implement and upgrade technology to provide staff with access to systems and tools to help efficiently and effectively deliver service to clients and also provide a flexible infrastructure necessary to allow growth and the addition of staff and resources as a result of amalgamation.

• Research/integrate O365 into the current technology infrastructure and ensure privacy and security requirements are maintained.

Budgetary Changes/Implications There are no significant budget changes or implications as compared to the 2020 budget.

8758 Corporate Services Division Budget Year 2021 Communications Program Budget Summary

2020 2021 Change % Change

Budget 410,864$ $ 419,049 8,185$ 2.0%

FTEs 5.00 5.00 0.00 n/a

Program Overview Provides direction, services, resources, and leadership to support effective communication/practices and customer service programming. Core functions include the provision of support/services for: customer service (main reception), media relations, graphic design, health communication productions, social media engagement, website, internal relations, risk communications and stakeholder relations. Upholds corporate priorities and supports programs in meeting the Ontario Public Health Standards and the Ontario Public Health Organizational Standards requirements.

Key Strategic Goals of the Program & Direction for 2021 Strategic Goals and Direction: • Individuals who access our services or who seek information through other means (e.g. phone and website) are well-served. • For client-serving programs, consider the accessibility of their services and make adjustments to better serve clients. • Optimize client reception and flow to support effective and efficient client service. • Purposeful reporting and sharing of information to the public, partners and other key stakeholders is done to inform and foster action on public health issues. • Incorporate objectives and action related to this in program plans. • Complete a review and update to ensure consistent and efficient processes are in place across the organization.

Budgetary Changes/Implications There are no significant budget changes or implications as compared to the 2020 budget.

8859 Corporate Division 2021 Division Expenditure Budget Summary

Program Area 2020 2021 Change % Change Page

Board of Health Financial Resources $53,850 $53,850 $0 0.0% 61 Human Resources in FTE 0.00 0.00 0.00 0.0%

Corporate Overhead Financial Resources $199,675 $212,286 $12,611 6.3% 62 Human Resources in FTE 0.00 0.00 0.00 0.0%

HR Overhead Financial Resources $162,300 $162,300 $0 0.0% 63 Human Resources in FTE 0.00 0.00 0.00 0.0%

Information Systems Overhead Financial Resources $656,300 $762,460 $106,160 16.2% 64 Human Resources in FTE 0.00 0.00 0.00 0.0%

Total Financial Resources $1,072,125 $1,190,896 $118,771 11.1% Total Base Positions (FTEs) 0.00 0.00 0.00 n/a

8960 Corporate Division Budget Year 2021 Board of Health Program Budget Summary

2020 2021 Change % Change

Budget 53,850$ 53,850$ -$ 0.0%

FTEs 0.00 0.00 0.00 n/a

Program Overview The Board of Health is convened in accordance with the Health Protection and Promotion Act (HPPA) and regulations, and constitutes a local board of the obligated municipalities in accordance with the Municipal Act.

Key Strategic Goals of the Program & Direction for 2021 Strategic Goals

The Board of Health has the responsibility for the delivery of local public health programs and services, including effective and efficient governance and management practices. Specifically, the Board of Health is accountable for: 1) Implementing the Ontario Health Standards (OPHS); 2) Complying with the Ontario Public Health Accountability Framework; 3) Providing the Annual Service Plan and Budget.

Budgetary Changes/Implications There are no significant budget changes or implications as compared to the 2020 budget.

9061 Corporate Division Budget Year 2021 Corporate Overhead Program Budget Summary

2020 2021 Change % Change

Budget 199,675$ $ 212,286 12,611$ 6.3%

FTEs 0.00 0.00 0.00 n/a

Program Overview Expenses that are designed to provide resources that impact the entire organization as a whole, and are not program specific, are included within the Corporate Overhead Budget. Amounts are included for legal, audit, payroll and general insurance costs.

Key Strategic Goals of the Program & Direction for 2021 Strategic Goals:

To maintain the physical capacity and fundamental infrastructure to support the organization in the most cost- effective and efficient manner.

Budgetary Changes/Implications Increase as compared to the 2020 budget is a result of an increase to the cost of insurance.

9162 Corporate Division Budget Year 2021 Human Resources Overhead Program Budget Summary

2020 2021 Change % Change

Budget 162,300$ 162,300$ -$ 0.0%

FTEs 0.00 0.00 0.00 n/a

Program Overview Expenses that are designed to provide resources that impact the entire organization as a whole, and are not program specific, are included within the Human Resources Overhead Budget. Amounts are included for legal, training and recognition and recruitment and retention.

Key Strategic Goals of the Program & Direction for 2021 Strategic Goals:

To provide resources that impact the entire organization as a whole to support the organization in the most cost- effective and efficient manner.

Budgetary Changes/Implications There are no significant budget changes or implications as compared to the 2020 budget.

9263 Corporate Division Budget Year 2021 Information Systems Overhead Program Budget Summary

2020 2021 Change % Change

Budget 656,300$ $ 762,460 106,160$ 16.2%

FTEs 0.00 0.00 0.00 n/a

Program Overview Expenses that are designed to provide resources that impact the entire organization as a whole, and are not program specific, are included within the Information Systems Overhead Budget. Amounts are included for software licence fees, building occupancy and Equipment Expense.

Key Strategic Goals of the Program & Direction for 2021 Strategic Goals:

To provide resources that impact the entire organization as a whole to support the organization in the most cost- effective and efficient manner.

Budgetary Changes/Implications Budget increase due to increased software licensing fees as well as leasing costs for computers and photcopier equipment. In 2020 these amounts were significantly under budgeted for.

9364 Branch Offices Summary 2021

Branch Office 2020 2021 Change % Change

Red Rock Financial Resources $165,381 $177,938 $12,557 7.6% Human Resources in FTE 1.90 1.90 0.00 0.0%

Geraldton Financial Resources $186,643 $187,125 $482 0.3% Human Resources in FTE 2.00 2.00 0.00 0.0%

Terrace Bay Financial Resources $103,403 $114,965 $11,562 11.2% Human Resources in FTE 1.25 1.25 0.00 0.0%

Marathon Financial Resources $172,406 $175,464 $3,058 1.8% Human Resources in FTE 1.90 1.90 0.00 0.0%

Manitouwadge Financial Resources $52,236 $67,193 $14,957 28.6% Human Resources in FTE 0.75 0.75 0.00 0.0%

Total Financial Resources $680,069 $722,685 $42,616 6.3% Total Base Positions (FTEs) 7.80 7.80 0.00 0.0%

Branch Office Divisional Allocations 2020 2021 Change % Change

Health Promotion Financial Resources $535,303 $579,298 $43,995 8.2% Human Resources in FTE 6.80 6.80 0.00 0.0%

Health Protection Financial Resources $100,056 $102,057 $2,001 2.0% Human Resources in FTE 1.00 1.00 0.00 0.0%

Corporate Financial Resources $44,710 $41,330 -$3,380 -7.6% Human Resources in FTE 0.00 0.00 0.00 n/a

Total Financial Resources $680,069 $722,685 $42,616 6.3% Total Base Positions (FTEs) 7.80 7.80 0.00 0.0%

9465 Thunder Bay Dist. Health Unit Branch Offices Hlth Protection Division Program Budget Sheet for 2021 Program Code : CDP - Marathon CDP - Red Rock CDP - Geraldton Inj Prev - Red Rock Repr Hlth - Manitouw Child Hlth-Terrace Bay VPD - Geraldton 01010 - 003 01020 - 001 01020 - 004 01210 - 001 02100 - 005 02200 - 002 03710 - 004 2020 2021 2020 2021 2020 2021 2020 2021 2020 2021 2020 2021 2020 2021 Budget Budget Budget Budget Budget Budget Budget Budget Budget Budget Budget Budget Budget Budget

Salary & Wages 122,570 127,975 17,627 21,027 55,524 52,832 98,618 106,821 - 53,474 75,389 84,707 81,346 82,973 Total Salary & Wages 122,570 127,975 17,627 21,027 55,524 52,832 98,618 106,821 - 53,474 75,389 84,707 81,346 82,973

Benefits 28,191 29,434 4,054 4,836 11,254 12,151 22,682 24,569 - 12,299 17,339 19,483 18,709 19,084 28,191 29,434 4,054 4,836 11,254 12,151 22,682 24,569 - 12,299 17,339 19,483 18,709 19,084

Expenses

Travel 07000 Mileage 1,900 1,850 2,400 2,400 1,470 1,600 1,200 1,600 - 1,500 1,500 - - 07004 Fuel - - - 1,000 1,000 - - - - 07005 Lease ------07010 Meals 150 150 150 200 150 200 300 250 - 150 200 - - 07015 Accomodations 120 200 150 250 430 400 250 450 - 300 400 - - 07020 Travel Out of District ------07200 Teleconference ------2,170 2,200 2,700 2,850 2,050 2,200 2,750 3,300 - - 1,950 2,100 - -

Staff Training & Recognition 08000 Transportation 1,155 1,155 1,600 750 1,095 1,095 150 150 400 400 300 300 - - 08005 Meals 200 200 450 350 250 250 100 100 100 100 100 100 - - 08010 Registration & Materials - 800 300 ------08015 Accomodations 480 540 1,120 675 600 675 240 270 240 270 240 270 - -

66 08020 Volunteer Recognition ------08200 Teleconference ------1,835 1,895 3,970 2,075 1,945 2,020 490 520 740 770 640 670 - -

Purchased Allocated Administration 10002 Facility Rental 200 300 - - 100 200 100 300 100 200 100 300 - - 10072 Program Service Advertising ------10125 Memberships ------10135 Subscriptions ------10160 Other ------10161 Graphics Charges - 180 180 ------200 300 180 180 100 200 100 300 100 200 100 300 - -

Materials & Supplies 18500 Educational Handouts ------18510 Films & Videos ------18525 Publications ------20025 Other - - - - - 100 - 100 - 100 - 140 - - 21005 General Program Supplies 690 50 - - 850 700 1,500 600 500 300 1,100 610 - - 21010 Catering Modelling & Incentives 650 610 - - 695 495 100 100 - - 155 155 - - 21011 Catering Meetings - 600 - - - - 200 200 ------1,340 1,260 - - 1,545 1,295 1,800 1,000 500 400 1,255 905 - -

Office Expense, Printing & Postage 22000 External Photocopying & Printing ------22010 Photocopy ------22011 Printing 200 150 200 200 150 200 200 300 - - 200 200 - - 22015 Computer Supplies ------22016 Ergonomic Supplies ------22020 General Office Supplies 200 200 - - 200 150 200 150 - - 200 200 - - 22021 Courier and Delivery 50 50 - - 50 50 50 50 50 50 50 50 - - 22022 Postage Metre & Stamps 250 250 - - 200 200 100 100 - - 200 200 - - 700 650 200 200 600 600 550 600 50 50 650 650 - -

Total Expense 157,006 163,714 28,731 31,168 73,018 71,298 126,990 137,110 1,390 67,193 97,323 108,815 100,055 102,057

95 100% Funded and Other Programs Summary 2021

100% Funding Initiatives 2020 2021 Change % Change Page

Public Health Inspector Practicum Financial Resources $10,000 $10,000 $0 0.0% 68 Human Resources in FTE 0.00 0.00 0.00 0.0%

Total Financial Resources $10,000 $10,000 $0 0.0% Total Base Positions (FTEs) 0.00 0.00 0.00 0.0%

100% Funded and Other Programs 2020 2021 Change % Change Page

Indigenous Communities: Indigenous Partnerships Financial Resources $99,500 $99,500 $0 0.0% 69 Human Resources in FTE 1.00 1.00 0.00 0.0%

Indigenous Communities: Street Outreach Financial Resources $0 $110,000 $110,000 100% 70 Human Resources in FTE 0.00 1.00 1.00 100.0%

Indigenous Communities: Public Health Financial Resources $0 $400,000 $0 0.0% 71 Human Resources in FTE 0.00 1.00 0.00 0.0%

Ontario Seniors Dental Care Program Financial Resources $612,400 $612,400 $0 0.0% 72 Human Resources in FTE 2.90 2.90 0.00 100.0%

Northern Fruit and Vegetable Program Financial Resources $661,600 $661,600 $0 0.0% 73-74 Human Resources in FTE 3.50 3.50 0.00 100.0%

Land Development Financial Resources $190,841 $193,488 $2,647 1.4% 75 Human Resources in FTE 2.00 2.00 0.00 0.0%

Total Financial Resources $1,564,341 $2,076,988 $512,647 32.8% Total Base Positions (FTEs) 9.40 11.40 2.00 21.3%

9667 Division Budget Year 2021 PHI Practicum Program Budget Summary

2019 2020 Change % Change

Budget $ 10,000 10,000$ $ - 0.0%

FTEs 0.00 0.00 0.00 n/a

Program Overview The Public Health Inspector Practicum Program budget is 100% funded by the MOHLTC. One-time funding must be used to hire the approved Public Health Inspector Practicum position.

Key Strategic Goals of the Program & Direction for 2020 The Board of Health must comply with the requirements of the Canadian Institute of Public Health Inspectors Board of Certification for field training for a 12-week period; and, ensure the availability of a qualified supervisor/mentor to oversee the practicum student’s term.

Budgetary Changes/Implications No signficiant budgetary changes or implications as compared to the 2020 budget.

9768 Division Budget Year 2021 Indigenous Communities: Indigenous Partnerships Program Budget Summary

2020 2021 Change % Change

Budget $ 99,500 99,500$ $ - 100.0%

FTEs 1.00 1.00 0.00 n/a

Program Overview This is a position that has been created to support the planning and advancement of an organizational Indigenous Engagement Strategy in accordance with the Ontario Public Health Standards and the Thunder Bay District Health Unit Strategic Plan 2017-2020.

Key Strategic Goals of the Program & Direction for 2021 Program Goals: The Health Promotion Planner - Indigenous Engagement will: • conduct planning activities, including the completion of an environmental scan; • support the development of an organizational strategic approach to enhancing Indigenous engagement; and • identify opportunities to support mutually beneficial working relationships with Indigenous peoples and organizations.

Strategic Direction • The advancement of a strategic approach to Indigenous Engagement for TBDHU

Budgetary Changes/Implications There are no significant budgetary changes or implications as compared to the 2020 budget.

9869 Division Budget Year 2021 Indigenous Communities: Street Outreach Program Budget Summary

2020 2021 Change % Change

Budget $ - $ 110,000 $ 110,000 100%

FTEs 0.00 1.00 1.00 100.0%

Program Overview This program supports staffing for the Street Outreach Nursing Program. The Street Nursing program consists of a mobile unit operating in the City of Thunder Bay and is staffed by three Public Health Nurses and a Nurse Practitioner. The goal is to provide culturally safe, trauma-informed services to vulnerable, street involved populations in the City of Thunder Bay who are suffering from or are at risk for infectious diseases and blood-borne illnesses such as tuberculosis, invasive group A streptococcal, hepatitis C and HIV. Services provided on the mobile unit include BBI/STI testing, harm reduction, tuberculosis screening, immunization, wound care and referrals to other services such as substance use disorder treatment, withdrawal management, emergency services and mental health services.

Key Strategic Goals of the Program & Direction for 2021 To reduce the health inequities experienced by people who are under-housed or using injection drugs in the City of Thunder Bay through the provision of mobile public health services, with a focus on relationship building, harm reduction and health promotion.

Strategic Goals:

• Align the program to fit community needs specific to public health role; and • Completion of a developmental evaluation.

Direction for 2021:

• Continue engagement with high-risk populations and service providers that work with similar populations to both increase awareness and increase connectivity of programming for wrap around care services.

Budgetary Changes/Implications This is new funding received and included in base 100% funding in 2020 and 2021 that was applied for in the Annual Service Plan and Budget Submission in 2020.

9970 Medical Officer of Health Division Budget Year 2021 Indigenous First Nations Program Budget Summary

2020 2021 Change % Change

Budget -$ $ 400,000 400,000$ 100.0%

FTEs 0.00 1.00 1.00 100.0%

Program Overview The goal of the Indigenous Communities program is to support public health issues in the First Nation communities in the TBDHU catchment area and to support the implementation of the Sioux Lookout First Nations Health Authority (SLFNHA) Approaches to Community Wellbeing model for First Nations communities.

The Indigenous Communities program also supports infectious disease initiatives in the under-housed, marginalized population in Thunder Bay which is disproportionately Indigenous.

Key Strategic Goals of the Program & Direction for 2021 SLFNHA: Support the continued implementation of the Approaches to Community Wellbeing model through secondment of the Associate Medical Officer of Health. Continued collaboration with SLFNHA and NWHU for the delivery of public health programs and services by implementation of protocols and agreements.

Thunder Bay: Continue Infectious disease surveillance and support Indigenous engagement on public health modernization.

Budgetary Changes/Implications In the previous year this budget was included in the mandatory core programming (cost-shared) budget.

10071 Division Budget Year 2021 Senior Dental Program Budget Summary

2020 2021 Change % Change

Budget $ 612,400 $ 612,400 $ - 0.0%

FTEs 2.90 2.90 0.00 n/a

Program Overview The Ontario Seniors Dental Care program (OSDCP) was announced by the Ministry of Health in the Spring of 2019 and began in the late fall of 2019. Services fall within the Oral Health Protocol. Eligibility criteria for access to the program includes residents of Ontario aged 65 years and older who meet an income threshold of $19,300 or less for a single senior or a combined income of $32,300 or less for a couple. Those with access to other forms of dental benefits are ineligible. Public health is required to facilitate services through publicly funded clinics and/or external service level agreements. The eligible services schedule is under development by the Ministry but will be similar to existing publicly funded service schedules. Activities required of public health include service delivery, oral health navigation, data collection and analysis and reporting. Promotion activities related to program access and health education are also required. Public health will also be required to facilitate and oversee all services and service level agreements with external providers.

Key Strategic Goals of the Program & Direction for 2021

Strategic Goals for 2021:

- Facilitate access to the OSDCP for eligible seniors - Provide access to basket of eligible services for seniors registered in the program - Collect and report data and service information as per Ministry requirements - Promote the OSDCP using various promotions strategies - Provide education opportunities to the public regarding seniors oral health - Work with community partners for service provision and health promotion

Direction for 2021:

-Procure the services of dental providers to serve Seniors registered with the Ontario Seniors Dental Care Program -Work with architect and dental consultant on dental clinic build -Create and implement guidelines, policies and procedures to ensure effective program management -Support staff through knowledge exchange and required tools to meet ministry program requirements including client registration, client navigation, data collection, claims submission, Ministry reporting and eligible service provision - Promote the program to increase awareness and registration for eligible seniors

Budgetary Changes/Implications There are no significant budgetary changes or implications as compared to the 2020 budget.

10172 Division Budget Year 2021 NFVP - Program Delivery Program Budget Summary

2020 2021 Change % Change

Budget $ 218,400 $ 218,400 $ - 0.0%

FTEs 1.50 1.50 0.00 n/a

Program Overview The school based Northern Fruit and Vegetable Program (NFVP) has been operating in three Northeastern Ontario Health Units since 2006. In May 2016, the expansion of the program throughout all elementary schools in Northern Ontario was announced as part of the Ontario First Nations Health Action Plan. The program was initiated in Thunder Bay and District in August 2017 with a school level roll out that began in May 2018. The NFVP expansion to Thunder Bay & District impacts approximately 15,860 elementary school aged children in 87 schools, within 7 School Boards and schools within 17 First Nations communities.

Funding is provided to public health units to administer the program at the local level. The Ontario Food Growers' Association is responsible for the co-ordination of all direct food delivery to the schools. The University of Windsor conducts the program evaluation across the province.

The goal of the NFVP is to increase consumption and awareness of fresh fruits and vegetables in combination with healthy eating and physical activity education to elementary and intermediate school aged children. The 20 week program that runs from January-June in schools, provides twice weekly, no cost, fresh fruits and vegetables in combination with a variety of health promotion programming to address healthy eating behaviors and active living. Additional activities include the development of educational materials and resources, coordination of food handler training, train-the-trainer skills based programming, evaluation and reporting.

Key Strategic Goals of the Program & Direction for 2021 Program Goals; • Ensure successful implementation of the school based NVFP through communication with provincial and local partners. • Build & foster relationships with First Nation community educators to better support programming needs at the school level.

Strategic Direction: • Increase consumption of fresh fruits and vegetables among elementary students in Thunder Bay and the District. • Increase healthy eating and active living programming (cooking with kids, cooking together, bright bites) among elementary schools in Thunder Bay and the District.

Budgetary Changes/Implications There are no significant budgetary changes or implications as compared to the 2020 budget.

10273 Division Budget Year 2021 NFVP Enhancement - Food Security Program Budget Summary

2020 2021 Change % Change

Budget $ 443,200 $ 443,200 $ - 0.0%

FTEs 2.00 2.00 0.00 n/a

Program Overview The Northern Fruit and Vegetable Program (NFVP) Expansion Program is part of a provincial investment in Indigenous health through the First Nations Health Action Plan. Along with Northwestern Health Unit, all First Nations communities within the jurisdiction of the TBDHU are serviced within this Program. The TBDHU has worked with fourteen road accessible communities including: Animbiigoo Zaagi igan Anishinaabek (AZA); Aroland First Nation; Biinjitiwaabik Zaaging Anishinaabek (BZA); Bingwi Neyaashi Anishinaabek (BNA); Biitigong Nishnaabeg (Pic River); Fort William First Nation; Ginoogaming First Nation; Kiashke Zaaging Anishinaabek (KZA); Long Lake #58 First Nation; Namaygoosisagagun First Nation; Pawgwasheeng (Pays Plat First Nation); Netmizaaggamig Nishnaabeg (Pic Mobert), Red Rock Indian Band, Whitesand First Nation. This project is community-led identifying issues pertaining to community food security, distribution, food literacy/ food skills. This work supports the objectives of the NFVP increasing access, consumption and awareness of fruits and vegetables to Indigenous northern and remote communities.

Key Strategic Goals of the Program & Direction for 2021 Strategic Direction: • Continue to support communities with food sovereignty visions through enhanced collaborative community planning. • Increase resources for in-community project support and implementation including awareness raising, skill building, knowledge sharing and planning.

Goals: • Offer annual regional gatherings for purpose of information sharing and planning. • Provide opportunities for intercommunity knowledge exchange. • Further develop model for sustainability with anticipated ongoing base funding.

Budgetary Changes/Implications There are no significant budgetary changes or implications as compared to the 2020 budget.

10374 Division Budget Year 2021 Land Development Program Budget Summary

2020 2021 Change % Change

Budget $ 190,841 $ 193,488 $ 2,647 1.4%

FTEs 2.00 2.00 0.00 n/a

Program Overview The Land Development program approves new construction of on-site wastewater systems in accordance with Part 8 of the Ontario Building code. Other functions of the program include approvals for lot severances, sub-division approvals and assessing failed systems to prevent contamination of surface and/or groundwater. The Land Development Program is a fee for service program and not stipulated by the Ontario Public Health Standards but mandated by the Ontario Building Code Act.

Key Strategic Goals of the Program & Direction for 2021 Strategic Goals:

• Prevent or reduce the burden of illness that may result from exposure to wastewater by ensuring that septic systems operate effectively. • Ensure the financial viability of the Land Development Program.

Direction for 2021:

• 100% compliance with the Ontario Building Code Act timelines for lot severance approvals. • 100% compliance with the Ontario Building Code Act timelines for final field inspections. • Lakehead Source Protection Plan implementation in Rosslyn Village: implement re-inspection regime for existing septic systems in the Rosslyn Village Area of Concern. • Continue implementation of succession plan for Land Development program. • Monitor the financial viability of the Land Development Program.

Budgetary Changes/Implications No significant budgetary changes or implications as compared to the 2020 budget.

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Issue Report PAGE 1 OF 5

PROGRAM/ Finance & Human Resources DIVISION Corporate Services REPORT NO. 38 - 2020

MEETING DATE November 18, 2020 MEETING TYPE Regular

SUBJECT Employee Group Benefit Plan Program

RECOMMENDATION

THAT with respect to Report No. 38 – 2020 (Finance / Human Resources), we recommend the renewal of the Employee Group Benefit Plan with Green Shield Canada and Sun Life Financial through the Association of Local Public Health Agencies (alPHa) Employee Group Benefit Consortium Plan as presented for the policy term of December 1, 2020 to November 30, 2021;

AND THAT the Director of Corporate Services and the Manager of Finance be authorized to complete any administrative requirements of the renewal.

REPORT SUMMARY

To recommend the renewal terms for the provision of the Employee Group Benefit Plan Program.

BACKGROUND

The Thunder Bay District Health Unit (TBDHU) offers various benefits for its employee groups as a component of its overall compensation program and in order to meet contractual obligations as negotiated with the bargaining units. These benefits include Basic Life, Long Term Disability, Extended Health, Dental and Travel Insurance.

To assist with the administration of these benefit plans, the TBDHU participates as a member of the alPHa Employee Group Benefit Consortium Plan, utilizing group benefit consultants, Mosey & Mosey. There are currently ten (10) Ontario Health Units that participate in this Consortium.

In addition to assisting with the administration of the benefit plans, Mosey & Mosey leverage the Consortium for the purpose of reducing the cost through obtaining competitive rates based on volume discounts.

Annually, Mosey & Mosey analyze prior usage statistics, demographics, market conditions and trends against proposed renewal rates from insurers, and negotiates or markets the insurance on behalf of the Health Units in the consortium.

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REPORT NO. 38 – 2020 (Finance / Human Resources) PAGE 2 OF 5

The Extended Health and Dental benefits are underwritten on an Administrative Services Only (ASO) arrangement. Basic Life, Long Term Disability and Travel Insurance are provided on a traditional pooled basis.

Under the ASO funding method the employer is self-insuring and assumes financial and legal liability for all plan costs. The insurance company accepts no risk and fulfills the role of administrator. To mitigate the risk, the Board maintains a Reserve Fund designed to protect against potential liabilities and significant fluctuations impacting any current budgets and provides for a staff wellness program designed to reduce future paid claims. In addition, catastrophic stop- loss insurance is in place to protect against any paid claim to an individual in excess of $15,000 up to $1,000,000.

The ASO plan results are analyzed annually. If the monthly deposits paid under the plan are insufficient to pay the amount of the claims paid plus the associated administrative costs and taxes, the resulting deficit is normally payable by the plan sponsor to the plan administrator. Conversely, if the monthly deposits paid under the plan are in excess of the amount required to pay the amount of the claims paid under the plan plus the associated administrative costs and taxes, the resulting surplus is normally paid by the plan administrator to the plan sponsor.

Should the period end in a surplus position, funds can either be left on deposit or refunded. It is to the benefit of the TBDHU to maintain a positive balance or surplus with the insurer as this favorably impacts the renewal rates. As well, if the current period ends in a deficit, it would be offset against deposits held. If there are not sufficient funds on deposit to eliminate the deficit, the TBDHU is required to pay the deficit.

COMMENTS

The Extended Health Care and Dental benefits are currently underwritten by Green Shield Canada. For 2019/2020, Extended Health Care and Dental claims paid, plus the associated administrative costs and taxes, were less than the annual deposits. As a result, the closing surplus deposit balance is in a surplus position of November 30, 2020. This balance will remain on account and is intended to be used to fund the subsequent year’s plan expenses.

During the policy period, the net claims were $189,681 (prior period - $339,177). Note that these net claims were only for an eight (8) month basis due to renewal terms being revised in the current year. TBDHU has also experienced a decrease in Health and Dental expenses, which is attributed to closures associated with COVID- 19 this year, which is not a trend we expect to continue.

The Out of Country travel coverage is provided through Green Shield Canada on a fully-pooled basis. Under this arrangement, the premium and claims are combined by Green Shield Canada and the rates are determined based on the overall claim experience of this pool.

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REPORT NO. 38 – 2020 (Finance / Human Resources) PAGE 3 OF 5

As the Health, Dental and Travel benefits renewed eight (8) months ago (April 1, 2020) and there is a surplus on account, Green Shield agreed to maintain existing rates and expenses to line up with Sun Life’s renewal date effective December 1, 2020.

The stop-loss protection charge, effective December 1, 2020, will be 15.1% of net health claims plus expenses. This is competitive when compared to the overall marketplace for ASO funded health benefits as all insurers have experienced a significantly increased risk for the stop-loss coverage. During the policy period, there was one (1) claim that exceeded the $15,000 limit. The overage of $3,825 was not included in the total net claims amount, thereby not impacting premium experience and future rate calculations.

Sun Life provides the Basic Life and Long-Term Disability (LTD) coverage. These rates were previously marketed in conjunction with the 2018 annual renewal and as part of Mosey and Mosey’s ongoing services, expiring November 1, 2020. As a result of Mosey and Mosey marketing the plan, the new rates in effect December 1, 2020 for Basic Life have increased by 15% and for Long-Term Disability by 12%. This results in monthly premium increases of $378 for basic life and $1,273 for long-term disability. The total annual change in premium amounts to $19,812.

The increase in this area is a result of the overall performance of the insurance company’s pool and changes in the demographics for the alPHa Consortium (weighted age distribution, female/male ratio and occupation). The rates are calculated and determined based on the previous five (5) years of claim information. It is also noted that there has been a significant increase in LTD claims over the past several years with the primary driver being mental health related claims.

Total administrative expenses for extended health care and dental will remain unchanged as compared to last year at 10.6%. This includes Green Shield Canada’s rate of 7.75% (no change from prior year) and Mosey and Mosey’s commission of 2.85% (no change from prior year).

Mosey and Mosey has proposed that this agreement be in effect for the period of December 1, 2020 to November 30, 2021, at which time all Employee Group Benefits will be renewed together (Basic Life and Long-Term Disability, Optional Life, Extended Health Care, Dental).

Summary

Effective December 1, 2020, there will be a 0% increase in premium rates for the Extended Health Care, Dental and Travel rates combined. The total estimated cost for these benefits will be $420,900.

Effective December 1, 2020 there will be an overall increase of 12.6% to Basic Life and Long-Term Disability. The total estimated cost for these benefits will be $177,624.

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REPORT NO. 38 – 2020 (Finance / Human Resources) PAGE 4 OF 5

The estimated total increase in all premiums for the Employee Group Benefit Plan over the prior renewal period is $21,394 (including taxes). This represents a 3.42% overall increase from the previous coverage year. Total estimated premiums for the renewal period are $646,404 including taxes.

FINANCIAL IMPLICATIONS

The costs associated with the Employee Group Benefit Plan are provided annually within the Mandatory Core and Related Program Budgets. A designated Reserve Fund provides protection for any liability beyond the capacity of any operating budget.

Attachment 1 – Employee Benefit Premium Summary compares the premium changes from the current coverage period to the previous year.

STAFFING IMPLICATIONS

There are no staffing implications related to the renewal of the Employee Group Benefit Plan.

CONCLUSION

It is concluded that the Health Unit should maintain its Basic Life and Long-Term Disability benefit program with Sun Life Financial and maintain its Extended Health Care, Dental and Travel benefit program with Green Shield Canada, and be renewed effective December 1, 2020 to November 30, 2021.

And that the TBDHU participate as a member of the alPHa Employee Group Benefit Consortium Plan to assist with the administration of these benefit plans.

LIST OF ATTACHMENTS

Attachment #1 – Employee Benefit Premium Summary

PREPARED BY: Dan Hrychuk, CPA, CA, Manager, Finance Alyson Jennings, Manager, Human Resources

THIS REPORT RESPECTFULLY SUBMITTED BY: DATE: November 18, 2020

Medical Officer of Health and Chief Executive Officer

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REPORT NO. 38 – 2020 (Finance / Human Resources) PAGE 5 OF 5

ATTACHMENT 1

EMPLOYEE BENEFIT PREMIUM SUMMARY

Current Estimated Estimated Employee Benefit Premiums Premiums Increase (Decrease) Premium Summary

Benefit: $ $ $ % Basic Life 30,372 34,908 4,536 14.93 LTD 127,440 142,716 15,276 11.99 Sun Life Financial 157,812 177,624 19,812 12.55 Total Extended Health Care 276,240 276,240 - 0.00 Travel 8,928 8,928 - 0.00 Dental 135,732 135,732 - 0.00 Green Shield Canada 420,900 420,900 - 0.00 Total PST 46,297 47,882 1,585 3.42 Total Annual 625,009 646,406 21,397 3.42 Premiums

109 Issue Report PAGE 1 OF 5

PROGRAM/ Healthy Living DIVISION Health Promotion REPORT NO. 41-2020

MEETING DATE November 18, 2020 MEETING TYPE Regular

SUBJECT Income Solutions to Address Food Insecurity

RECOMMENDATION THAT with respect to Report No. 41-2020 (Healthy Living), we recommend examining income solutions to reduce food insecurity in Canada;

AND THAT a letter be sent to the federal government on behalf of the Board of Health in support of this recommendation.

REPORT SUMMARY To provide the Board of Health with information relative to income solutions to reduce poverty and food insecurity.

BACKGROUND According to data prior to COVID-19, 1 in 8 Canadian households, or 12.7%, faced food insecurity, which is inadequate and insecure access to food due to financial constraints. This is the equivalent to 4.4 million Canadians, of which 1.2 million represent children. This is the highest national estimate to date. In Ontario, the household food insecurity rate is at 13.3%, higher than the national estimate. Locally, in Thunder Bay, our latest reports from 2019 estimate that 1 in 7 households, or 14.3%, are facing food insecurity, which is higher than the provincial and national average.

Abundant research has shown that higher food insecurity rates are associated with increased risk for poor and inadequate diets that are directly linked to higher chronic disease rates. In addition, food insecurity further exacerbates health inequities that are already faced by populations that are at risk. For example, children living in food insecurity experience reduced learning and productivity at school, along with higher rates of mental health conditions like anxiety and depression. Pregnant mothers may experience higher rates of complications such as giving birth to a baby with a low birth weight. In addition, more recent research shows that racialized poverty exists particularly in Canadian households that identified as Indigenous or black, with more than 1 in 4 households facing food insecurity for both demographics.

With the onset of COVID-19, household food insecurity rates have risen even higher. The latest research from Statistics Canada shows 14.6% of Canadian households are experiencing food insecurity rates, a marked increase from their 110

REPORT NO. 41-2020 (Healthy Living) PAGE 2 OF 5

2017-2018 data, reporting a rate of 10.5% pre-COVID-19. The higher numbers were anticipated due to many individuals facing precarious employment, reduced hours, or losing their jobs altogether, coupled with the less predictable food supply and fluctuation in food prices. As short-term temporary solutions, many have relied on emergency and charitable food programs and services, such as food banks. However, being temporary solutions, the effectiveness and outcomes of such programs and services are also temporary and short-lived. Moreover, the sudden increase in demand has led to the capacity of these services and programs to be quickly oversaturated. For example, for every one person that uses a food bank, there are four people that are food insecure and do not use a food bank. This shows the magnitude of the issue, and that relying on short-term emergency measures will not address the main root cause of food insecurity – inadequate income.

During COVID-19, the Canadian government took a commendable step to allocate $200 million for emergency and charitable food-based programs. These funds provided a means for temporary access to food (e.g. via food banks) and likely alleviated some of the immediate difficulties faced. However, anticipating that COVID-19 will have a prolonged presence, this fund is unlikely to sustain continuing needs, and does not address the other consequences of inadequate income such as rent, or other basic expenses for daily living.

The Canadian government also enacted the Canada Emergency Response Benefit (CERB), Canada Emergency Student Benefit (CESB), and the Canada Emergency Wage Subsidy (CEWS). These support programs have played an integral part in temporarily supporting individuals and households with lost income. However, it is important to note that 65% of those experiencing household food insecurity before COVID-19 reported employment as their primary source of income. This means that being employed does not preclude one from being food insecure. This is a function of precarious or low-paying jobs, and multi-person households with a single income earner. For example, while the $2000 / month CERB may be adequate for a single person sharing rent with others, it is likely inadequate for a family of four with a single-income earner. Moreover, 15% of those that experience household food insecurity receive social assistance, and are more at risk to the negative impacts of food insecurity, yet they are unlikely to qualify for any of the COVID-19 benefits or subsidies.

COMMENTS

While the hope is that the financial and economic drain of COVID-19 will be short- lived for many, the reality is that the situation is uncertain and may take much longer. Many will be unable to make up for lost income, and some households may face permanent hardship from the financial strain. The existence of deep- rooted and persistent poverty has led to certain households becoming poor and facing food insecurity at a moment’s notice, and exacerbation for those that have already been struggling.

111 REPORT NO. 41-2020 (Healthy Living) PAGE 3 OF 5

The provincial expert body on food insecurity, PROOF – Food Insecurity Policy Research, recommends and supports the use of income solutions as a means of providing an effective long-term response to the problem of persistent poverty and household food insecurity, but also alleviate the shorter term economic fallouts caused by the COVID-19 pandemic. A letter of support (Attachment 1) from the Thunder Bay District Health Unit – Board of Health will further support this cause and add to the collective voice of numerous community and public health agencies that endorse reducing food insecurity and poverty, and improving health equity.

FINANCIAL IMPLICATIONS

There are no current financial implications with this report.

STAFFING IMPLICATIONS

There are no staffing implications with this report.

CONCLUSION

Household food insecurity has been a persistent issue in Canada and contributes to the on-going health inequities faced within our region. Because household food insecurity and its consequences are deeply rooted in poverty, it will require strategies and solutions that provide adequate financial income, particularly to at- risk populations. The impacts of COVID-19 have further exacerbated household food insecurity rates due to precarious jobs, reduced hours, and job loss coupled with less predictable food supply and fluctuating food prices. It is crucial at this point to support efforts to reduce poverty through income solutions as a means of providing an effective long-term response to household food insecurity.

LIST OF ATTACHMENTS

Attachment 1 – Draft Letter of Support addressed to the Prime Minister’s Office, and respective leaders of the Federal Political Parties of Canada

PREPARED BY: Silva Sawula, Manager – Healthy Living THIS REPORT RESPECTFULLY SUBMITTED BY: DATE: Lynda Roberts, Director – Health Promotion November 6, 2020 ______Medical Officer of Health and Chief Executive Officer

112 REPORT NO. 41-2020 (Healthy Living) PAGE 4 OF 5

ATTACHMENT 1

DRAFT LETTER OF SUPPORT FOR INCOME SOLUTIONS TO REDUCE HOUSEHOLD FOOD INSECURITY (PAGE 1 OF 2)

To Whom It May Concern:

The Thunder Bay District Health Unit (TBDHU) – Board of Health would like to express support for efforts to provide income solutions to reduce Household Food Insecurity (HFI) to Federal leaders, dated [date].

Prior to COVID-19, many Canadians were already experiencing HFI, which is the inadequate and insecure access to food due to financial constraints. Statistics Canada estimated that in 2017/2018, 10.5% or 1 in 10 households experienced HFIi. In Thunder Bay, this value is 14.3% or 1 in 7 householdsii. Abundant research has shown that higher HFI rates are associated with increased risk for poor and inadequate diets that are directly linked to higher chronic disease rates, poorer health outcomes and increased health inequitiesiii. Since COVID-19, this pre-existing issue has become more apparent and worrisome with Statistics Canada reporting an increase to 14.6%, or 1 in 7 households, experiencing food insecurity1. Applying that similar increase locally to the District of Thunder Bay would mean an HFI rate of 18.4% or 1 in 5 household. This increase was anticipated due to many individuals facing precarious employment, reduced hours of work, or loss of job altogether, coupled with the less predictable food supply and fluctuating food prices.

As short-term temporary solutions, many have relied on emergency and charitable food programs and services, such as food banks. The commitment of the Federal government to allocate $200 million for these programs has undoubtedly bolstered the initial access to food for many experiencing HFI. In addition, the enactment of Canadian Emergency Response Benefit (CERB), amongst others, has demonstrated that income solutions can be effective. The issue however, is that both of these solutions are intended for emergency and temporary coverage, which may not provide longer coverage with the anticipated prolonged existence of COVID-19. It also does not address the root cause of food insecurity, which is inadequate income, and may not fully provide relief for other needs for daily living (such as rent and household expenses) experienced by those in poverty. This has set the precedent for the call to action in this letter of support, which is the consideration for adequate income solutions that provide long-term income support, has a permanence structure and is not only available during emergencies or pandemics, and is equitable in that it provides support to the most at-risk and in need.

113 REPORT NO. 41-2020 (Healthy Living) PAGE 5 OF 5

ATTACHMENT 1

DRAFT LETTER OF SUPPORT FOR INCOME SOLUTIONS TO REDUCE HOUSEHOLD FOOD INSECURITY (PAGE 1 OF 2)

An adequate and secure level of household income is strongly linked to lower food insecurity rates, and income solutions have been recommended as the primary strategy to address this issue. The TBDHU will continue to support the government in their priority actions to reduce poverty and improve household food insecurity, and we appreciate your time, commitment and consideration for this crucial endeavor.

Sincerely,

Board of Health Thunder Bay District Health Unit

References:

i Statistics Canada. (2020). Food Insecurity during the COVID-19 pandemic, May 2020. Retrieved from: https://www150.statcan.gc.ca/n1/pub/45-28-0001/2020001/article/00039-eng.htm ii CCHS. (2017). Hungry for Change – 2019. Retrieved from: https://www.tbdhu.com/resource/cost-of- eating-well-district-of-thunder-bay iii PROOF – Food Insecurity Policy Research. (2020). Household Food Insecurity in Canada (2017-2018). Retrieved from: https://proof.utoronto.ca/wp-content/uploads/2020/03/Household-Food-Insecurity-in- Canada-2017-2018-Full-Reportpdf.pdf

114 Issue Report PAGE 1 OF 2

PROGRAM/ Ontario Seniors Dental Care Program DIVISION Health Promotion Division REPORT NO. 32 - 2020

MEETING DATE November 18, 2020 MEETING TYPE Regular

SUBJECT Ontario Seniors Dental Care Program Update

RECOMMENDATION FOR INFORMATION ONLY

REPORT SUMMARY To provide the Board of Health with updated program information on the Ontario Seniors Dental Care Program.

BACKGROUND On April 11, 2019 the Government of Ontario released its 2019 budget. It included a commitment to introduce a new publicly funded dental care program for low-income Ontario seniors with an annual investment of $90M. The Ontario Seniors Dental Care Program (OSDCP) will help reduce unnecessary trips to the hospital, prevent chronic disease and increase quality of life for seniors. The program launched in early December 2019. At that time, eligible seniors began enrolling in the program with the assistance of public health units. A final Ontario Public Health Standards (OPHS) Oral Health Protocol has not yet been released. Schedules of services for Dental and Non-Dental providers have been released. Since the last Board report of November 20, 2019, the Thunder Bay District Health Unit (TBDHU) participated in meetings with Ministry representatives regarding a capital application for a public health dental clinic build and contracted with FORM Architects to produce clinic drawings. In August 2020, TBDHU was advised by the Ministry that the capital application was successful and tenders for a contractor and dental equipment have been posted.

COMMENTS In order to provide services, the TBDHU secured formal agreements with ten private general dental providers to offer OSDCP service in office. Agreements were also signed with one clinic offering dental hygiene services only and one denturist office. TBDHU is hoping to enter into agreements with local dental specialists and will be having discussions in this regard in the near future. All 115 REPORT NO. 32 - 2020 (Ontario Seniors Dental Care Program) PAGE 2 OF 2

Northern Public Health Units have been accepted with the Northern Health Travel Grant program for eligible seniors required to travel for services under the OSDCP. At this time TBDHU has 120 seniors registered for the OSDCP. Of those registered, 9 are on a wait list for service initiation due to service disruption caused by COVID-19, while 111 have been referred to contracted dental providers. With the lifting of COVID-19 restrictions, OSDCP services have resumed with contracted general dental providers at this time. TBDHU will monitor impacts on clients and service providers with regard to service capacity which could be affected by the new clinical and infection control standards required due to COVID-19. All service contracts expire on December 31, 2020 and all providers will be given an option to renew for the 2021 budget year. TBDHU continues to seek collaborations with local dental specialists.

FINANCIAL IMPLICATIONS The OSDCP is 100% funded and there are no financial implications at the current time. However, given the increased costs associated with new infection control standards for dental providers, it is possible that the amount of service may be impacted due to provider increased costs and TBDHU requirement to manage within the prescribed 100% budget.

STAFFING IMPLICATIONS There are no staffing implications at this time.

CONCLUSION TBDHU is moving forward with a dental clinic renovation project and will continue to connect with local service providers to seek service options for eligible seniors in the interim.

LIST OF ATTACHMENTS There are no attachments with this report.

PREPARED BY: Carolyn Tait, Manager - Oral Health, Children’s Visual Health, District Offices THIS REPORT RESPECTFULLY SUBMITTED BY: DATE: Lynda Roberts, Director – Health Promotion November 3, 2020 ______Medical Officer of Health and Chief Executive116 Officer

Issue Report PAGE 1 OF 8

PROGRAM/ Finance DIVISION Corporate Services REPORT NO. 40 - 2020

MEETING DATE November 18, 2020 MEETING TYPE Regular

SUBJECT Interim Financial Reports as of September 30, 2020

RECOMMENDATION FOR INFORMATION ONLY.

REPORT SUMMARY To provide the Interim Financial Reports for the quarter ended September 30, 2020.

BACKGROUND The Mandatory Core Program Budget, including Cost-shared and Provincial 100% funds, for the period January 1 to December 31, 2020, was approved by the Board of Health at its November 20, 2019 meeting (Budget Report No. 59- 2019) with some funding requests also approved by the Board in February, 2020. The budget was submitted to the Ministry of Health (the Ministry) on March 2, 2020, through the Annual Service Plan and Budget Submission (ASPBS) process. On August 21, 2020, the Thunder Bay District Health Unit (TBDHU) received notification that the budget submitted to the Ministry of Health was approved at the amounts requested, with additional base funding provided for a few specific programs. This information was presented to the Board of Health at its September 16, 2020 meeting (Report #30-2020).

Administration completes regular reviews of the status of the financial position of the Mandatory Core Programs and Provincial 100% and Other Funded Programs relative to the budgets approved by the Board of Health. These reviews are presented to the Board of Health on a quarterly basis in accordance with S. 39(2) of the Board Amalgamated By-Law and S. 3.1.4 of the Budget Process Policy FP- 05-03.

COMMENTS Subsequent to the approval of the respective budgets by the Board of Health, Administration monitors funding, revenues, and expenditures. Based on identified quarterly variance analysis reporting objectives, Program Managers review their year-to-date actual results, and project program year-end financial position based

117 REPORT NO. 40 – 2020 Finance PAGE 2 OF 8

on actual and projected programming activities. Action plans are developed to deal with any significant negative projected year-end financial results. For Mandatory Core Programs, the year-end is December 31; for 100% and Other Funded Programs, the year-end may be December 31 or March 31.

The objective of the third quarter variance analysis is to identify significant items that may/will impact the year-end financial position of the Health Unit so that appropriate corrective action, if required, can be implemented.

FINANCIAL IMPLICATIONS

Overall Summary

This report is prepared based on the Board of Health 2020 budget as approved on November 20, 2019 (Budget Report No. 59-2019). Financial and operating results are based on the information currently available (including the matters noted below), which includes the TBDHU Annual Service Plan and Budget Submission (ASPBS). Actual results will vary from estimates and the variances may be significant as more information becomes available.

On April 11, 2019, the Ontario Government tabled its 2019 Budget which, under the banner of Modernizing Ontario’s Public Health Units, proposed plans to significantly restructure Ontario’s public health system including the creation of 10 regional public health entities with regional boards under a common governance model and adjustments to the provincial-municipal cost sharing. In August, the Government confirmed that changes related to the cost-sharing model will be implemented effective January 1, 2020. With a few exceptions, all previous funding moved to a cost sharing arrangement of 30% Municipal and 70% provincial. In the TBDHU 2019 budget, the ratio was 25% Municipal and 75% for provincial for the Mandatory Core Programs, and 100% Provincial in many other programs.

Since the release of the Ontario budget, the Board of Health has been kept informed of the changes and the implications for TBDHU as the details emerged on the implementation of the government direction. In August 2020, Administration received notice of the Provincial Grant Allocation for 2020, which confirmed the implementation of the cost-sharing changes.

Expenses related to COVID-19 are expected to be substantial for 2020. Mandatory Core Programs funding and 100% One-Time funding, if available, will be used to offset these increased expenditures. On March 25, 2020, the Province announced it is investing up to $100 million in additional funding to the Public Health Sector to support extraordinary costs incurred. Health Units are expected to track COVID-19 related expenses separately and must be able to account for all amounts. Administration is closely monitoring the situation, tracking all staff time

118 REPORT NO. 40 – 2020 Finance PAGE 3 OF 8

and expenditures related to COVID-19 separately and has submitted initial reports to the Ministry as required.

Mandatory Core Programs

Attachment #1 provides the summary of the financial position for the Mandatory Core Programs. Actual year-to-date financial results to September 30, 2020, show an unfavourable net operating variance of $185,953. The following is a brief description of the variances of the major revenue and expense categories:

Revenues

At September 30, 2020, there is a favourable variance related to higher than budgeted generated revenues in the amount of $31,524.

Expenditures

Total unfavourable variance related to expenditures is $217,477. Notable favourable variances include Salaries and benefits $139,859 relating to various vacancies throughout the year, the majority of which are temporary, Travel $70,516, Staff Training & Recognition $109,244, and Purchased Program Services $41,267. These favourable variances are mostly due to COVID-19 response efforts and a shift in priority of the staff across the Organization.

Notable unfavorable variances include Purchased & Allocated Admin $42,786 resulting from software licenses purchases, Building Occupancy $388,197 resulting from higher than budgeted snow removal costs, other unexpected building repairs, roof and building envelope repairs and Equipment Expense $199,151 as a result of purchases of computer equipment.

Mandatory Core Programs Summary

At September 30, an unfavourable variance of $185,953 is reported based on a total budget of $15,499,243. The majority of the deficit is due to higher than budgeted software and hardware purchases, additional cleaning and facility related expenses, roof and building envelope repairs. This is offset by decreased travel, staff recognition and training, most of which has not occurred due to the response to COVID-19. The Mandatory Core Programs variance is expected to be nil at year-end as a result of applications for extraordinary COVID costs to be funded by the Province.

Provincial and Other 100% Funded Programs

Attachment #2 provides the financial results of the Provincial and Other 100% Funded Programs.

119 REPORT NO. 40 – 2020 Finance PAGE 4 OF 8

The Ontario Seniors Dental Care 100% funded program has a favourable variance due to the delay in implementing the program and the shutdown of the program due to COVID-19. It is expected there will be a small favourable variance at year-end. Administration continues to work on the implementation phases related to this funding. Any surplus must be returned to The Ministry of Health at the end of the year.

The Indigenous Communities 100% funded program has a favourable variance due to a vacancy of the AMOH. Any favourable variance will be returned to the Province at year-end.

The Indigenous Communities 100% funded program has a favourable variance due to the timing of funding received. This variance is expected to be nil at year- end and amounts will be spent on the new Street Outreach Mobile Unit as approved on September 16, 2020 (Report 34-2020).

The Northern Fruits and Vegetable Delivery 100% funded program has a favourable variance due to travel not occurring as a result of COVID-19 and the evaluation component of the program not occurring this year.

The Northern Fruits and Vegetable Enhancement 100% funded program has a favourable variance due to vacancies in the Nutritionist and Coordinator positions of the program.

The School Health Nurses funded program has a favourable variance due to the timing of the announced funding and the time required to hire nurses for the positions. There is expected to be a small favourable variance at year-end and it will be returned to the Province.

The Youth Violence Prevention 100% funded program has a favourable variance due to COVID-19. Aspects of the program have been delayed due to the closure of schools. The variance is expected to be nil at year-end.

The Healthy Babies Healthy Children 100% funded program has a favourable variance due to current program vacancies. The variance is expected to be nil at year-end.

Land Development Program

Attachment #3 provides the financial results for the Land Development Program, including a favourable variance of approximately $6,150 at September 30, 2020. Any unfavourable variance at year-end will be transferred into the Land Development Reserve fund.

120 REPORT NO. 40 – 2020 Finance PAGE 5 OF 8

STAFFING IMPLICATIONS There are no staffing implications associated with the report, as of September 30, 2020.

CONCLUSION At September 30, 2020, it is concluded that:

• Mandatory Core Programs currently show a unfavourable variance; • Any extraordinary costs as a result of COVID-19 will be submitted to the Ministry of Health for reimbursement; • Some significant favourable variances exist within the 100% funded programs; • A small favourable variance exists within the Land Development Program; • Interim Financial Reports will be provided to the Board of Health quarterly.

LIST OF ATTACHMENTS Attachment 1 – Financial Position – Mandatory Core Programs Attachment 2 – Financial Position – 100% Funded Programs Attachment 3 – Financial Position – Land Development Program

PREPARED BY: Dan Hrychuk, CPA, CA, Manager of Finance THIS REPORT RESPECTFULLY SUBMITTED BY: DATE: Lance Dyll, CPA, CA, Director of Corporate Services November 18, 2020 ______Medical Officer of Health and Chief Executive Officer

121 REPORT NO. 40 – 2020 Finance PAGE 6 OF 8

Attachment 1

Financial Position – Mandatory Core Programs

122 REPORT NO. 40 – 2020 Finance PAGE 7 OF 8

Attachment 2

Financial Position – 100% Funded Programs

THUNDER BAY DISTRICT HEALTH UNIT Financial Position as at September 30, 2020

PROVINCIAL PROGRAMS SUMMARY - 100% FUNDED

As at Septembr 30, 2020 Variance Annual Favourable/ Year End Budget Actual Budget (Unfavourable) Senior Dental Dec 31st 612,400 171,758 459,300 287,542 Indigenous Partnerships Dec 31st 99,500 68,147 74,625 6,478 Indigenous Communities Dec 31st 400,000 164,542 300,000 135,458 Indigenous Street Outreach Dec 31st 110,000 - 82,500 82,500 NFVP Delivery Dec 31st 218,400 107,888 163,800 55,912 NFVP Enhancement Dec 31st 443,200 135,743 285,229 149,486 School Health Nurses 100% July 31st 800,000 52,236 133,333 81,098 HUB Library Mar 31st 126,217 65,771 63,109 (2,663) Youth Violence Prevention Mar 31st 164,726 42,734 82,363 39,629 HIV Mar 31st 60,271 28,358 30,136 1,778 Nurse Practitioner Mar 31st 165,453 78,009 82,727 4,718 Healthy Babies - Healthy Children Mar 31st 1,296,335 614,399 648,168 33,769 FNHIB Mar 31st 140,100 70,086 70,050 (36) Total Other 4,636,602 1,599,670 2,475,338 875,669

123 REPORT NO. 40 – 2020 Finance PAGE 8 OF 8

Attachment 3

Financial Position – Land Development Program

THUNDER BAY DISTRICT HEALTH UNIT LAND DEVELOPMENT Financial Position as at September 30, 2020

Annual As at September 30, 2020 Budget Actual Budget Variance $ $

REVENUES

Certificates of Approval 158,000 118,475 122,450 (3,975) Subdivisions 970 200 752 (552) Severances 17,000 7,879 13,175 (5,296) File Searches 4,360 1,294 3,379 (2,085) Lot Inspections 8,700 1,075 6,743 (5,668) Other Services 1,811 471 1,404 (933) Total Revenues 190,841 129,394 147,902 (18,508)

EXPENDITURES

Salaries & Benefits 144,579 101,703 112,049 (10,346) Travel 15,742 2,703 12,200 (9,497) Staff Training & Recognition 3,850 2,198 2,984 (786) Purchased Allocated Admin 7,900 4,663 6,123 (1,459) Equipment Expense 1,500 1,125 1,163 (38) Materials & Supplies 600 - 465 (465) Office Expense 2,970 666 2,302 (1,635) Communications 1,500 1,035 1,163 (127) Capital - - - - Allocated Administration 12,200 9,150 9,455 (305) Total Expenditures 190,841 123,244 147,902 (24,658)

Favourable/(Unfavourable) - 6,150 - 6,150

124

TO: Board of Health

FROM: Lance Dyll, CPA, CA, Director of Corporate Services

DATE: November 18, 2020

RE: Extraordinary Expenses Associated with COVID-19

Expenses related to the COVID-19 pandemic are expected to be substantial for the 2020 fiscal year. Mandatory Core Programs funding and 100% One-Time funding, if available, will be used to offset these increased expenditures.

On March 25th, 2020, the Province announced it is investing up to $100 million in additional funding for the Public Health Sector to support extraordinary costs incurred. Health Units are expected to track COVID-19 related expenses separately and must be able to account for all amounts. Administration is closely monitoring the situation, tracking all staff time and expenditures related to COVID-19 separately and has submitted initial reports to the Ministry as required.

As of September 30, 2020, expenses related to COVID-19 total approximately $704,391 (see Attachment 1). The majority of the expenses relate to salaries and benefits, which total $404,620. Other major expenditures to date included consulting fees, telecommunication expenses for meetings, computer leases and purchases (including both hardware and software) for work from home arrangements, additional janitorial requirements, and medical supplies including face shields, hand sanitizer, masks and goggles.

The costs reported in Attachment 1 only include extraordinary expenses. These are amounts that are outside of, or over and above, the approved Mandatory Core and 100% Provincial Budgets. A significant number of staff have been deployed to the COVID-19 response, however the cost reported here are only those that are over and above the budgeted expenses as approved by the Board of Health.

Also included in Attachment 1 are projections of spending to December 31, 2020. Total projected costs at this time to December 31, 2020 are $1,080,070. The majority of the expenses relate to salaries and benefits in the amount of $685,858. Other major expense categories include Purchased Allocated Admin of $128,119, Building Occupancy of $70,577, Equipment of $117,941 (the majority of which has already been spent on computer leases) and materials and supplies of $54,885 which includes the purchase of additional personal protective equipment.

It should be noted that the amounts reported are subject to change based on the needs identified as the Health Unit continues to respond to the pandemic. 125 Extraordinary Expenses Associated with COVID-19 Page 2 of 2 November 18, 2020

Attachment 1

COVID-19 Expenses and Projections

Expenses as at Projected expenses to September 30, 2020 December 31, 2020 Category $ $ Salaries 404,620 685,858 Travel 6,399 13,899 Purchased Allocated Administration 75,769 128,119 Building Occupancy 51,077 70,577 Equipment Expense 114,441 117,941 Materials & Supplies 43,885 54,885 Office Expense, Printing & Postage 8,190 8,790 Total Expense 704,391 1,080,070

126

October 29, 2020

The Honourable Patty Hajdu Federal Minister of Health House of Commons Ottawa ON K1A 0A6 Via e-mail [email protected]

The Honourable Christine Elliott Provioncial Minister of Health 5th Floor 777 Bay Street Toronto ON M7A 2J3 Via e-mail [email protected]

Dear Ministers Hajdu and Elliott:

Re: Municipal Drug Strategy Coordinators Network of Ontario, Safe Supply

On September 25, 2020 at a regular meeting of the Board of Health for the Grey Bruce Health Unit, the Board considered the attached letters from the Municipal Drug Strategy Coordinators Network of Ontario regarding safer supply initiatives. The following motion was passed:

GBHU BOH Motion 2020-65

Moved by: Anne Eadie Seconded by: Brian O’Leary

“THAT, the Board of Health endorse the Municipal Drug Strategy Coordinators Network of Ontario call on the provincial government to fund implementation of safer supply initiatives in a coordinated approach with the federal government; and support the implementation of safer supply initiatives by adding the required formulations to the Ontario Drug Benefit Formulary to enable injectable safer supply initiatives to operate.” Carried

Sincerely,

Mitch Twolan Chair, Board of Health Grey Bruce Health Unit

Encl.

Cc: Municipal Drug Strategy Coordinators Network of Ontario, Adrienne Crowder, Alex Ruff, MP Bruce-Grey-Owen Sound, Terry Dowdall, MP Simcoe-Grey , Ben Lobb, MP Huron-Bruce Association of Local Public Health Agencies, Ontario Health Units

Working together for a healthier future for all.. 101 17th Street East, Owen Sound, Ontario N4K 0A5 www.publichealthgreybruce.on.ca

519-376-9420 1-800-263-3456127 Fax 519-376-0605

Municipal Drug Strategy Coordinators Network of Ontario c/o Adrienne Crowder Manager, Wellington Guelph Drug Strategy 176 Wyndham St. N. Guelph ON, N1H 898

August 21, 2020

Honourable Patty Hajdu Minister of Health Government of Canada House of Commons Ottawa ON, K1A 0A6

Dear Honourable Minister of Health Hajdu,

We would like to commend your government for addressing the drug poisoning crisis by funding and facilitating access to safer supply initiatives, and other health interventions. As you know, safer supply initiatives provide pharmaceutical-grade drugs, such as hydromorphone or diacetylmorphine, to people who use substances within a health care context. However, additional safer supply initiatives are needed in Ontario and across Canada. Therefore, on behalf of the Municipal Drug Strategy Coordinators Network of Ontario (MDSCNO), we urge the Government of Canada to immediately increase funding to safer supply initiatives to save lives, and improve the health, safety and well- being of people who use drugs in our province.

Safer supply initiatives significantly improve individual health by transitioning people from the toxic, unregulated market to pharmaceutical-grade substances within a health care context. Substance use is addressed as a health issue rather than a criminal justice issue. Safer supply initiatives can also offer participants case management and other supports to address a spectrum of health and social concerns. These health initiatives have demonstrated exceptionally high client retention rates and significant reductions in overdose fatalities while simultaneously creating a pathway to health care services for their clients.1 Beyond the health sector, safer supply initiatives provide significant benefits, including improved community safety and well-being, and reduced

1 Canadian Centre on Substance Use and Addiction. "Exploring Expanded Response Options to Opioid Harms: Case Studies from Four Canadian Clinics", June 2020. Available at: https://www.ccsa.ca/sites/default/files/2020- 06/CCSA-Expanded-Response-Options-Opioid-Harms-Case-Studies-2020-en.pdf.

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128 enforcement- and criminal justice-related costs.2 For these reasons, they have strong support in many Ontario communities.

In 2019, Ontario recorded the highest number of opioid-related overdose deaths in Canada, with 1,535 people dying from opioid-related poisoning, surpassing the province of British Columbia for the first time.3,4 Since the year 2000, when 111 opioid-related fatalities were recorded, the number of preventable deaths has increased every year, resulting in declining life expectancy in Ontario.5 While several factors contribute to the drug poisoning crisis, exposure to toxic drugs from an unregulated market is the primary driver of deaths in Ontario and the rest of Canada.

The drug poisoning crisis has been intensified by the COVID-19 pandemic, resulting in two concurrent public health crises. Services have temporarily closed or reduced their hours and capacity. In addition, the unregulated drug market has become increasingly toxic. Stress, isolation, and other pandemic-related factors have increased the risks associated with substance use. Preliminary data from the Office of the Chief Coroner for Ontario shows a 35% increase in suspected drug-related deaths in Ontario in March, April and May 2020 compared to the monthly average in 2019, with approximately 60 suspected-drug related deaths occurring each week.6 It is now more evident than ever that urgent action is needed to address the opioid poisoning crisis that is co-occurring with the COVID-19 pandemic.

In late 2019 and early 2020, most community proposals submitted to the Substance Use and Addictions Program (SUAP) for safer supply initiatives were denied simply because of inadequate funding. The MDSCNO calls on the federal government to urgently increase SUAP funding available for existing proposals, and to issue a second call for new SUAP safer supply proposals to support a full spectrum of safer supply initiatives across Canada.

The MDSCNO’s members are among Ontario’s leading experts in drug policy and program development. We represent comprehensive drug strategies in many municipalities throughout Ontario who share a collective interest in making our province safer and healthier for present and future generations.

2 Ontario Agency for Health Protection and Promotion (Public Health Ontario), Leece P, Tenenbaum M. Evidence Brief: Effectiveness of supervised injectable opioid agonist treatment (siOAT) for opioid use disorder. Toronto, ON; 2017. 3 Public Health Ontario. Personal Communication, May 2020. 4 Preliminary data from the Office of the Chief Coroner for Ontario shows that there were 1,535 probable and confirmed opioid overdose deaths in Ontario in 2019. This number may increase as coroner’s complete investigations. 5 Statistics Canada. (2020). The Daily: Life Tables. Retrieved from https://www150.statcan.gc.ca/n1/daily- quotidien/200128/dq200128a-eng.htm 6 Office of the Chief Coroner for Ontario. Personal Communication, August 2020

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129 Sincerely,

Adrienne Crowder Susan Shepherd Manager, Guelph Wellington Drug Strategy Manager, Toronto Drug Strategy Secretariat On behalf of the Municipal Drug Strategy On behalf of the Municipal Drug Strategy Coordinators Network of Ontario Coordinators Network of Ontario

CC: Prime Minister Trudeau Alliance for Healthier Communities Association of Municipalities of Ontario Canadian Alliance to End Homelessness Canadian Drug Policy Coalition Canadian Mental Health Association Canadian Nurses Association Canadian Public Health Association Chiefs of Ontario College of Nurses of Ontario College of Physicians and Surgeons of Ontario Council of Medical Officers of Health Federation of Canadian Municipalities Ontario Association of Chiefs of Police Ontario College of Pharmacists Ontario Pharmacists Association Ontario Public Health Association Public Health Ontario

About the Municipal Drug Strategy Coordinators Network of Ontario Our 65+ members work in diverse health settings across the province, including public health units, community health centres and not-for-profit organizations. Members coordinate multi-sectoral initiatives that aim to prevent and/or reduce the harms of substance use through regionally tailored strategies incorporating prevention, harm reduction, treatment and enforcement-justice initiatives. Learn more at: www.drugstrategy.ca.

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130 Municipal Drug Strategy Coordinators Network of Ontario c/o Adrienne Crowder Manager, Wellington Guelph Drug Strategy 176 Wyndham St. N. Guelph ON, N1H 898

August 21, 2020

Honourable Christine Elliott Minister of Health Government of Ontario 777 Bay Street, 5th Floor Toronto, ON M7A 2J3

Dear Minister Elliott,

On behalf of the Municipal Drug Strategy Coordinators Network of Ontario (MDSCNO), we urge the Province of Ontario to immediately fund and scale up implementation of safer supply initiatives to save lives, and improve the health, safety and well-being of people who use drugs in our province.

Safer supply initiatives significantly improve individual health by transitioning people from the toxic, unregulated market to pharmaceutical-grade substances within a health care context. Substance use is addressed as a health issue rather than a criminal justice issue. Safer supply initiatives can also offer participants case management and other supports to address a spectrum of health and social concerns. These health initiatives have demonstrated exceptionally high client retention rates, and significant reductions in overdose fatalities while simultaneously creating a pathway to health care services for their clients.1

In 2019, Ontario recorded the highest number of opioid-related overdose deaths in Canada, with 1,535 people dying from opioid-related poisoning, surpassing the province of British Columbia for the first time.2,3 Since the year 2000, when 111 opioid-related fatalities were recorded, the number of preventable deaths has increased every year,

1 Canadian Centre on Substance Use and Addiction. "Exploring Expanded Response Options to Opioid Harms: Case Studies from Four Canadian Clinics", June 2020. Available at: https://www.ccsa.ca/sites/default/files/2020- 06/CCSA-Expanded-Response-Options-Opioid-Harms-Case-Studies-2020-en.pdf. 2 Public Health Ontario. Personal Communication, May 2020. 3 Preliminary data from the Office of the Chief Coroner for Ontario shows that there were 1,535 probable and confirmed opioid overdose deaths in Ontario in 2019. This number may increase as coroner’s complete investigations. 1

131 resulting in declining life expectancy in Ontario.4 While several factors are contributing to the opioid poisoning crisis, exposure to increasingly toxic drugs from an unregulated market is the primary driver of deaths in Ontario and the rest of Canada.

The drug poisoning crisis has been intensified by the COVID-19 pandemic, resulting in two concurrent public health crises. Services have temporarily closed or reduced their hours and capacity. In addition, the unregulated drug market has become increasingly toxic. Stress, isolation, and other pandemic-related factors have increased the risks associated with substance use. Preliminary data from the Office of the Chief Coroner for Ontario shows a 35% increase in suspected drug-related deaths in Ontario in March, April and May 2020 compared to the monthly average in 2019, with approximately 60 suspected-drug related deaths occurring each week.5 It is now more evident than ever that urgent action is needed to address the opioid poisoning crisis that is co-occurring with the COVID-19 pandemic.

The patient- and system-level benefits of safer supply initiatives directly support the government’s commitment to end hallway health care, reduce wait times, and improve patient interactions within the health care system. Beyond the health sector, safer supply initiatives provide significant benefits, including improved community safety and well-being, and reduced enforcement- and criminal justice-related costs.6 For these reasons, they have strong support in many Ontario communities. Therefore, the MDSCNO calls on the provincial government to:  fund implementation of safer supply initiatives in a coordinated approach with the federal government; and  support the implementation of safer supply initiatives by adding the required formulations, such as hydromorphone (i.e., 50 milligrams/millilitres and 100 milligrams/millilitres hydromorphone) and diacetylmorphine, to the Ontario Drug Benefit Formulary to enable injectable safer supply initiatives to operate.

The MDSCNO’s members are among Ontario’s leading experts in drug policy and program development. We represent comprehensive drug strategies in many municipalities throughout Ontario who share a collective interest in making our province safer and healthier for present and future generations.

4 Statistics Canada. (2020). The Daily: Life Tables. Retrieved from https://www150.statcan.gc.ca/n1/daily- quotidien/200128/dq200128a-eng.htm 5 Office of the Chief Coroner for Ontario. Personal Communication, August 2020 6 Ontario Agency for Health Protection and Promotion (Public Health Ontario), Leece P, Tenenbaum M. Evidence Brief: Effectiveness of supervised injectable opioid agonist treatment (siOAT) for opioid use disorder. Toronto, ON; 2017. 2

132 Sincerely,

Adrienne Crowder Susan Shepherd Manager, Guelph Wellington Drug Strategy Manager, Toronto Drug Strategy Secretariat On behalf of the Municipal Drug Strategy On behalf of the Municipal Drug Strategy Coordinators Network of Ontario Coordinators Network of Ontario

CC: Premier Doug Ford Michael A. Tibollo, Associate Minister of Mental Health and Addictions Alliance for Healthier Communities Association of Municipalities of Ontario Canadian Alliance to End Homelessness Canadian Drug Policy Coalition Canadian Mental Health Association Canadian Nurses Association Canadian Public Health Association Chiefs of Ontario College of Nurses of Ontario College of Physicians and Surgeons of Ontario Council of Medical Officers of Health Federation of Canadian Municipalities Ontario Association of Chiefs of Police Ontario College of Pharmacists Ontario Pharmacists Association Ontario Public Health Association Public Health Ontario

About the Municipal Drug Strategy Coordinators Network of Ontario Our 65+ members work in diverse health settings across the province, including public health units, community health centres and not-for-profit organizations. Members coordinate multi-sectoral initiatives that aim to prevent and/or reduce the harms of substance use through regionally tailored strategies incorporating prevention, harm reduction, treatment and enforcement-justice initiatives. Learn more at: www.drugstrategy.ca.

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October 30, 2020

The Honourable Patty Hajdu Federal Minister of Health House of Commons Ottawa ON K1A 0A6 Via e-mail [email protected]

The Honourable Marilee Fullerton Minister of Long-Term Care 400 University Ave., 6th Floor Toronto ON M7A 1T7 Via email: [email protected]

Ontario’s Long-Term Care COVID-19 Commission 700 Bay Street, 24th Floor Toronto ON M5G 1Z6 Via email: [email protected]

Dear Ministers:

Re: COVID-19 and Long-Term Care Reform

On September 25, 2020 at a regular meeting of the Board of Health for the Grey Bruce Health Unit, the Board considered the attached letter from Simcoe Muskoka District Health Unit regarding the Long-Term Care system in Canada and the need for reform and redesign. The following motion was passed:

GBHU BOH Motion 2020-66

Moved by: Brian O’Leary Seconded by: Sue Paterson

“THAT, the Board of Health support the recommendations from the Royal Society of Canada Working Group on Long-Term Care regarding critical issues that must be addressed moving forward with Long- Term Care reform and redesign.”

Carried

Sincerely,

Mitch Twolan Chair, Board of Health for the Grey Bruce Health Unit

Encl.

Cc: Local MP’s and MPP’s, RSC Working Group on LTC, Ontario Health Units, alPHa

Working together for a healthier future for all.. 101 17th Street East, Owen Sound, Ontario N4K 0A5 www.publichealthgreybruce.on.ca

519-376-9420 1-800-263-3456134 Fax 519-376-0605

September 18, 2020

The Honourable Patty Hajdu Minister of Health House of Commons Ottawa, Ontario, K1A 0A6 Email: [email protected]

The Honourable Marilee Fullerton Minister of Long-Term Care Ministry of Health and Long-Term Care 400 University Ave., 6th Floor Toronto, ON M7A 1T7 Email: [email protected]

Ontario’s Long-Term Care COVID-19 Commission 700 Bay Street, 24th Floor Toronto, ON M5G 1Z6 Email: [email protected]

Dear Ministers:

RE: COVID-19 and Long-Term Care Reform

COVID-19 has shone a glaring light on what many knew to be a crisis with the Long-Term Care (LTC) system in Canada in need of reform and redesign, with 81% of COVID-19 related deaths in Canada occurring in LTC Homes (LTCHs) which is far higher than other comparable countries.i Urgent reform and redesign of Canada’s LTC system is critical in order to address infection prevention and control (IPAC) issues (including COVID-19) and to improve all standards, quality of care and quality of life. Those who require services within a LTCH setting deserve those assurances.

A report released following deployment of the Canadian Armed Forces (CAF) to five LTCHs in Quebec and Ontario struggling in their response to COVID-19 indicates highly concerning living conditions and serious lapses in standards and quality of medical and personal care. The list of deficiencies identified by the CAF as requiring immediate attention is lengthy and includes inadequate infection and control practices, inadequate supplies and lack of training, knowledge, oversight and accountability of LTCH staff and management. ii

The Royal Society of Canada (RSC) Working Group on LTC has since released a policy briefing highlighting the pre-pandemic issues with LTCHs that contributed to the heightened crisis in the face of COVID-19, a global pandemic. Namely, addressing the changing demographics and complexities of older adults entering homes, the inadequate workforce and staffing mix to meet their needs, and the inadequate physical environments to accommodate the complex needs of residents, are critical issues that must be addressed moving forward with LTC reform and redesign.

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The Working Group policy briefing outlines nine steps requiring strong federal/provincial/territorial and municipal leadership to address necessary improvements in IPAC and provision of quality care for LTC residents with increasingly complex needs:

1. Implement best practice national standards for the necessary staffing and staffing mix to deliver quality care in LTCHs and attach federal funding to the standards; 2. Implement national standards for training and resources for infectious disease control and for outbreak management; 3. Provide appropriate pay and benefits including sick leave for the large unregulated segment of the LTC workforce (i.e. care aides and personal support workers); 4. Provide full time employment and benefits for regulated and unregulated nursing staff and assess impact of “one workplace” policies implemented during COVID-19; 5. Establish minimum education standards for unregulated direct care staff, ongoing education for both regulated and unregulated direct care staff, and proper training and orientation for all external agency staff assigned to a LTCH; 6. Support educational reforms for specialization in LTC for all providers of direct care (i.e. care aides, health and social service providers, managers and directors); 7. Provide mental health supports for LTCH staff; 8. Implement reporting requirements and data collection needed to effectively manage and ensure resident quality of care and quality of life, resident and family experiences and quality of work life for staff; and 9. Take an evidence based approach to mandatory accreditation as well as to regulation and inspection of Long-Term Care Facilities (LTCFs). iii

The Simcoe Muskoka District Health Unit’s (SMDHU) Board of Health at its September 16, 2020 meeting endorsed these recommendations and is writing to advocate for their adoption through your collective efforts to create necessary system reform and redesign for Ontarians living in LTCHs.

As of September 8, 2020, of the 21 outbreaks within institutional, workplace and congregate settings in Simcoe Muskoka, LTCHs and Retirement Homes accounted for 76% (16) of the outbreaks. As of August 25, 2020, there have been 24 resident deaths attributed to these LTC and Retirement outbreaks and an additional 2 Simcoe Muskoka resident deaths in facilities outside of the region for a total of 26. The median age of all cases who have recovered is 46 years compared to the median age of 85 years among all deceased cases. iv

SMDHU’s mandate under the Ontario Public Health Standards (OPHS, 2018) v regarding LTC and Retirement Homes is substantial. As a vulnerable population, SMDHU supports these facilities with food safety, and infectious and communicable disease prevention and control (including outbreak management). There are currently 29 LTC and 53 Retirement Homes within SMDHU. Since March 1, 2020, the Infectious Disease team has supported over 1700 IPAC consults or COVID-19 questions for LTC and Retirement Homes.

In addition to the mandate in LTCF’s, SMDHU is required to develop and implement a program of public health interventions using a comprehensive health promotion approach that addresses risk and protective factors to reduce the burden of preventable injuries and

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substance use in the health unit population. iv SMDHU supports community dwelling seniors and promotes healthy aging at home for those that are able, and for as long as they are able. The SMDHU supports these seniors through;

• active participation on the Ontario Fall Prevention Collaborative, the Simcoe County and other community based Age-Friendly Community Coalitions, The Muskoka Seniors Planning Table, Age-Friendly and the Central LHIN Fall Strategy; • best practice healthy aging policy advocacy; and • a wide variety of community awareness and engagement strategies to promote healthy aging key messages.

SMDHU remains committed to supporting local LTC and Retirement Homes to improve IPAC practices and to advocate for improvement to standards and quality of care and quality of life for residents, their families and staff, and implore municipal, provincial and federal leaders to make the necessary investments to create safe supportive care to ensure the health and safety for residents of LTCHs.

Sincerely,

ORIGINAL Signed By:

Anita Dubeau, Chair Simcoe Muskoka District Health Unit Board of Health

AD:JC:cm cc: Ontario Boards of Health Matthew Anderson, President and CEO, Ontario Health Loretta Ryan, Executive Director, Association of Local Public Health Agencies Mayor and Council of Simcoe and Muskoka Members of Provincial Parliament for Simcoe and Muskoka

References: i Canadian Institute for Health Information. “New analysis paints international picture of COVID-19’s long-term care impacts”: CIHI; June 25, 2020. Available from: https://www.cihi.ca/en/new-analysis- paints-international-picture-of-covid-19s-long-term-care-impacts ii Headquarters 4th Canadian Division Joint Task Force (Central). (2020). OP LASER - JTFC Observations in Long Term Care Facilities in Ontario iii Estabrooks CA, Straus S, Flood, CM, Keefe J, Armstrong P, Donner G, Boscart V, Ducharme F, Silvius J, Wolfson M. Restoring trust: COVID-19 and the future of long-term care. Royal Society of Canada. 2020 retrieved on Aug. 28 at https://rsc- src.ca/sites/default/files/LTC%20PB%20%2B%20ES_EN.pdf iv Retrieved on Aug. 25, 2020 https://www.simcoemuskokahealthstats.org/topics/infectious-diseases/a- h/covid-19 v Ministry of Health and Long-Term Care. (2018).OPHS

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