Board of Health Meeting MEETING AGENDA Friday, May 28, 2021 – 10:00 a.m. Electronic Participation – Zoom Grey Bruce Health Unit Boardroom 101 17th Street East, Owen Sound
1.0 Call to Order/Roll Call
2.0 Amendments to Agenda
3.0 Approval of Agenda
4.0 Disclosure of Pecuniary Interest
5.0 Grey Bruce Board of Health Appointment
6.0 Elections – BOH Vice Chair
7.0 Recognition 7.1 Retirement Acknowledgements
8.0 Adoption of Minutes 8.1 Friday April 23, 2021 8.2 Wednesday April 28, 2021 – BOH Special Meeting 8.3 Friday, May 7 – BOH Executive Meeting 8.4 Monday, May 10 – BOH Executive Meeting 8.5 Wednesday, May 12 – BOH Special Meeting
9.0 Delegations 9.1 Letter to Board of Directors, John Tamming, Cathy Moore Coburn, Ryan Greig, Melissa Kanmacher (15 mins) 9.2 Petition and Request for Organizational Review, Micheline Mann (15 mins)
10.0 Correspondence and News Releases 10.1 Correspondence Page 1 of 3
10.1.1 Councillors Taming, Moore Coburn, Kanmacher, and Greig, Letter regarding MOH Compensation and 20 questions 10.1.2 (A) Mayor Alar Soever, Town of The Blue Mountains, Letter of Support for Dr. Ian Arra and the Grey Bruce Health Unit (B) The Town of The Blue Mountains Supports Township of Southgate Resolution of Support – Grey Bruce Public Health Unit’s MOH 10.1.3 David Smith, Letter of Support for Dr. Arra 10.1.4 (A) Elizabeth Murray, Letter requests Board respond to delegation (B) Elizabeth Murray, Subsequent letter again requests the Board respond to delegation 10.1.5 Township of Southgate, Resolution of Support – Grey Bruce Public Health Unit’s MOH 10.1.6 Bruce Grey Child and Family Services, Open Letter of Support – Grey Bruce Health Unit BOH and MOH 10.1.7 Donna Beatty and Tom Senese, Letter re: MOH Compensation 10.1.8 Municipality of Grey Highlands, Resolution of Support for Grey Bruce Health Unit 10.1.9 County of Lambton Letter to Prime Minister Re: Basic Income Security 10.1.10 Township of Hanover Council, Endorsement of Township of Southgate’s Resolution of Support for Grey Bruce Health Unit’s MOH 10.1.11 Grey County Council, Resolution to Support Letter to Thank and Support Dr. Arra and Grey Bruce Health Unit 10.1.12 alPHa Letter Re. Public Health Measures 10.1.13 Peterborough Board of Health Thanks Premier Ford for Stay-at-Home Order Extension 10.1.14 Lee Fawcett, Letter of thanks to Grey Bruce Health Unit BOH and MOH 10.1.15 Grey Bruce Health Unit BOH Response to Delegation Questions 10.2 News Releases 10.2.1 Grey Bruce COVID-19 Critical Threshold Overcome 10.2.2 Owen Sound COVID-19 Immunization Clinic Relocating to Julie McArthur Regional Recreation Centre 10.2.3 Grey Bruce Health Unit’s COVID-19 Helpline Re-Activated 10.2.4 Download Grey Bruce COVID-19 Vaccine App Now 10.2.5 Grey Bruce Marinas and Boat Launches 10.2.6 Grey Bruce Wait 16 Weeks for Second Dose 10.2.7 Local Vaccine Booking if First Dose Only May 4, 2021 10.2.8 COVID-19 Vaccines for Homebound 10.2.9 COVID-19 Vaccine for Immunocompromised Patients 10.2.10 Vaccines for Homebound Residents in Bruce County 10.2.11COVID-19 Cases Associated with Two Owen Sound Restaurants 10.2.12 COVID-19 Safe Playground 10.2.13 Public Assistance Request Dog Scratch – Eugenia
10.2.14 Provincial Stay-At-Home Order Remains in Place over Victoria Day Weekend 10.2.15 COVID-19 and Campgrounds 10.2.16 Updated – Provincial Stay-At-Home Order Remains in Place over Victoria Day Weekend 10.2.17Grey Bruce Update - Marinas and Boat Launches
11.0 Medical Officer of Health Update 11.1 MOH Update 11.2 Public Health Modernization Update (STANDING ITEM) 11.3 Opioid Situation Grey Bruce (STANDING ITEM)
12.0 Corporate Services 12.1 Financial Report – March 2021
13.0 Other 13.1 Resolutions for Consideration at the alPHa Annual General Meeting
14.0 In-Camera 14.1 Advice Subject to Solicitor-Client Privilege (1 Item)
15.0 Adjournment
Next Meeting: Friday, June 25, 2021 at 10:00 a.m. Grey Bruce Health Unit, Owen Sound
Board of Health Minutes
Date: Friday, April 23, 2021 Location: Electronic via Zoom Time: 10:01 AM – 12:20 PM Members Present: Sue Paterson (Chair), Selwyn Hicks, Brian Milne, Brian O’Leary, Helen- Claire Tingling, Alan Barfoot, Nick Saunders (Chippewas of Nawash Unceded First Nation, Non-Voting) Regrets: Chris Peabody, Mitch Twolan Also Present: Dr. Ian Arra, Dr. Zayed, Matt McMurdie, Drew Ferguson, Kristy Hansford, Connie Rossitter Special Guests: Neena Gupta, Gowling Law Recording Secretary: Erin Meneray
1.0 Call to Order/Roll Call The roll was called by the recording secretary. Quorum was declared and Chair Paterson called the meeting to order at 10:01 AM
2.0 Disclosure of Pecuniary Interest There were no disclosures of pecuniary interest declared at this time.
3.0 Amendments to Agenda Communication/clarification on two Items: Reopening Golf Courses and Boat Launches These items will be addressed under the MOH Report
Two additional Correspondence Items: 7.1.4 Municipality of Grey Highlands, Support for the Grey Bruce Health Unit 7.1.5 Town of Hanover, Endorsement of Resolution, Support for Grey Bruce Health Unit MOH
4.0 Approval of Agenda Moved by: Alan Barfoot Seconded by: Helen-Claire Tingling “THAT, the agenda for April 23, 2021 be approved as amended.” Carried
5.0 Recognition 5.1 Board of Health Member and Former Kincardine Mayor, Anne Eadie Chair Paterson shared a message from former Board Member and former Kincardine Mayor, Anne Eadie. Ms. Eadie was recognized for her time on the Board of Health.
5.2 Staff Retirement Recognition
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On behalf of the Board, Chair Paterson congratulated Krista Jones on her retirement. Ms. Jones was recognized for 23 years as a Parent Support Worker in the Healthy Babies Healthy Children program.
6.0 Adoption of Minutes 6.1 Friday March 26, 2021 Moved by: Brian Milne Seconded by: Selwyn Hicks “THAT, the minutes of the Board of Health Meeting held on Friday, March 26, 2021 be approved as circulated.” Carried
6.2 Thursday April 8, 2021 BOH Executive Committee Meeting One amendment was noted; the location of the meeting should state electronic via zoom. Moved by: Brian O’Leary Seconded by: Helen-Claire Tingling “THAT, the minutes of the Board of Health Executive Committee Meeting held on Thursday April 8, 2021 be approved as amended.” Carried
6.3 Friday April 16, 2021 BOH Special Meeting Two amendments were noted; the location of the meeting should state electronic via zoom and the title of the minutes Board of Health Special Meeting. Moved by: Brian Milne Seconded by: Alan Barfoot “THAT, the minutes of the Board of Health Special Meeting held on Friday, April 16, 2021 be approved as amended.” Carried
7.0 Correspondence and News Releases 7.1 Correspondence 7.1.1 Mayor Town of Blue Mountains Open Letter of Support 7.1.2 Response from Opioid Response Team, Government of Canada Re. Board od Health Correspondence on the Opioid Crisis 7.1.3 City of North Bay Resolution Re. Redistribution and Prioritization of unused vaccine allocations 7.1.4 The Municipality of Grey Highlands – Support for the Grey Bruce Health Unit 7.1.5 Town of Hanover – Endorsement of Resolution of the Township of Southgate supporting the Grey Bruce Health Unit 7.2 News Releases 7.2.1 Third Wave is Possible 7.2.2 Public Assistance Request Cat Bite 7.2.3 Fourth Death Related to COVID-19 7.2.4 Imminent Surge is Possible – One Last Push 7.2.5 COVID-19 Associated with Harvest Canadian Reformed School 7.2.6 COVID-19 Associated with Edge Hill Country School 7.2.7 COVID-19 Associated with Kincardine District Secondary School 7.2.8 COVID-19 Associated with St. Anthony’s School 7.2.9 COVID-19 Vaccine Booking Moving to 70+ Completely Booked
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7.2.10 COVID-19 Associated with St. Anthony’s School Update 7.2.11 COVID-19 Associated with Ripley Huron Community School 7.2.12 COVID-19 Associated with Georgian Bay Community School 7.2.13 Grey Bruce Moves to Provincial Shutdown 7.2.14 COVID-19 Associated with Beaver Valley Community School 7.2.15 Grey Bruce Priority Population Booking System Now Live and Vaccine for 60+ 7.2.16 Vaccine Progress – End of Phase One – April 8, 2021 7.2.17 Grey Bruce Sets Record for Largest Ever COVID-19 Vaccine Clinic 7.2.18 COVID-19 Associated with Notre Dame Catholic School 7.2.19 Suspect Outbreak Beaver Valley Community School 7.2.20 COVID-19 Associated with Immaculate Conception School 7.2.21 COVID-19 Associated with St. Mary’s High School Owen Sound 7.2.22 COVID-10 Associated with Hanover Heights Community School 7.2.23 Outbreak at Notre Dame Catholic School 7.2.24 Suspect Outbreak at Queen of Hearts Nursery School Owen Sound 7.2.25 Vaccine Rollout Week of April 12, 2021 7.2.26 COVID-19 Associated with Georgian Bay Community School 7.2.27 Confirmed Outbreak at Queen of Hearts Nursery School 7.2.28 COVID-19 Critical Threshold April 14, 2021 7.2.29 Grey Bruce COVID-19 Critical Threshold Stay at Home 7.2.30 Grey Bruce COVID-19 Critical Threshold Health Unit Resources Redeployed 7.2.31 COVID-19 Community Outbreak Declared in Eastern Grey County 7.2.32 Suspect Outbreak Hanover Heights Community School 7.2.33 COVID-19 From Challenge to Opportunity – Grey Bruce Strong 7.2.34 MOH Issues Class Order 7.2.35 All Grey Bruce Scheduled Vaccine Clinics Continue to Operate 7.2.36 COVID-19 Suspect Outbreak at Jardin des Découvertes
Moved by: Brian O’Leary Seconded by: Brian Milne “THAT, the Board of Health receives the correspondence and Media Releases for April 23, 2021 as presented.” Carried
8.0 Medical Officer of Health Update 8.1 MOH Update Situation Report: Dr. Arra provided an overview of the Situation Report and COVID-19 Vaccine Dashboard (testing and case counts for April 22, 2021). He described measures that were implemented over the two weeks from having identified over 70 new cases across Grey Bruce in less than 36 hours and declaring a “Critical Threshold” one week ago to the present case count of 14 new cases. Dr. Arra explained that the surge in cases were linked to variants of concern (VOC) and primarily related to two events; an outbreak in a childcare setting and parties/gatherings among high-school aged youth which spread out into the community through close contacts of affected individuals.
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By declaring a critical threshold and implementing temporary changes to operations, the Health Unit was able to maintain control over the pandemic locally.
Large-scale vaccine clinics were deferred and dedicated mobile teams made up of Health Unit staff, EMS and volunteers were deployed. Vaccines were directed to residents in shelters and congregate settings where the risk of transmission would be higher with the current surge.
Three hospitalization transfers were received from other health unit areas; Dr. Arra noted this is something that we will likely see more of going forward due to lagging indicators.
Vaccine Dashboard: 52,755 total doses of vaccine administered in Grey Bruce 150,000 people eligible based on age Equivalent to a little over one-third of the population vaccinated as of April 21, 2021 which is consistent with the provincial average.
The Vaccine Dashboard is updated daily and can be accessed on the Health Unit website.
A question was raised about herd immunity given the current pace. Dr. Arra noted that the current goal would be to reach herd immunity by August; however, it is difficult to predict. There are a number of external factors such as supply issues and delays, which slow the process.
Unfortunately, there is no way to reassure the community that events and gatherings will be able to happen.
Golf Courses: Golfing is considered safe from a risk of transmission point of view; however, it is not considered an essential activity. One of the three main objectives of a stay at home order is to reduce/restrict mobility inter-provincially. Although it is safe, going golfing would entail travel to and from the golf course and stops along the way. The provincial direction is that this is a restricted activity and the local MOH does not have the authority to override a provincial direction. Locally the MOH can restrict further but not loosen the restrictions.
Boat Launches: The Provincial direction would restrict travel to the boat launch or public facility; however, property owners can use their own docks/facilities for personal use. The provincial direction is not concerned with the type of activity – only concerned with the travel and use of the public facility.
There is some confusion in the public as some municipalities are interpreting and applying the direction differently and it is not consistent across Grey Bruce.
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Communication clarifying provincial direction regarding Marinas and Boat Launches will be sent.
Case and Contact Management: Some Board members are being approached/questioned by members of the public on the information/direction they have received from Public Health regarding identification as a high-risk contact. There is some confusion around what determines whether someone should self-isolate or self-monitor.
Dr. Arra noted that case and contact management is a speciality that takes years to understand and cannot really be summarized in one or two lines. Risk assessment will be individualized based on the scenario or specific case and should not be generalized.
It is important to note that all contact tracing and determination of individual and community risk is made by Public Health. This is true of all cases, whether in schools, workplaces or the community. A health care provider or school official cannot make this decision.
If someone is contacted by Public Health, they will be provided with appropriate direction based on their specific situation.
Visitors from Out of Area: With the May long-weekend coming up and kick-off to summer, a question was raised about whether or not Grey Bruce should be enhancing provincial orders or restricting visitors to the area.
Dr. Arra noted that Grey Bruce saw thousands of visitors to the area last summer and there is no indication that those visits generated cases (whether from visitor to a local or from visitor to visitor). To the best of our knowledge, visitors and seasonal residents followed protocols to the best of their ability.
The goal of the Provincial Stay at Home order is to minimize mobility inter- provincially. Will Grey Bruce see zero visitors – not likely – however, sightseeing and hiking are not considered high-risk activities. The risk is when people are coming to the area to visit family or friends.
8.2 Public Health Modernization Update (STANDING ITEM) No update at this point.
8.3 Opioid Situation Grey Bruce (STANDING ITEM) Not much change since last meeting, last reported figure was up to 18 deaths in 2020, final count would be reported in May or June. Core program activities remain functioning.
Moved by: Alan Barfoot Seconded by: Selwyn Hicks
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“THAT, the Board of Health receives the Medical Officer of Health update for April 23, 2021 as presented.” Carried
9.0 In-Camera 9.1 Advice Subject to Solicitor-Client Privilege Moved by: Brian O’Leary Seconded by: Brian Milne “THAT, the Board of Health go into closed session at 11:01 AM to discuss one item pertaining to advice subject to solicitor-client privilege.” Carried
The Board returned to open session at 12:05 PM. Chair Paterson declared that only the items stated on the agenda to go into closed session were discussed. In-camera minutes from the BOH Executive Committee Meeting April 8, 2021 and the BOH Special Meeting April 16, 2021 were adopted and direction was given to staff on one item.
10.0 Corporate Services 10.1 Financial Report – February 2021 The financial report shows a deficit of approximately $154,000. Matt noted that this number is not unexpected given the pandemic response and additional human resources required. There are a number of items accounting for additional expenses such as IT software, support and supplies.
COVID regular hours report is included in the package; hours continue to build as the Health Unit expands for case and contact management and ramps up vaccine response.
Two Ontario Seniors Dental capital projects were approved as part of the Health Unit’s 2020 budget. Clinics are in Markdale and Owen Sound. Monthly statements will now be provided to report the progress of these projects.
Moved by: Alan Barfoot Seconded by: Helen-Claire Tingling “THAT, the Board of Health receives the February 2021 Financials as presented.” Carried
10.2 2021 Budget Summary The 2021 budget shows an increase of roughly 4.9M (32%) year over year – this is completely related to COVID-19 response. Costs are largely human (salaries and benefits). COVID-19 related costs will continue to be covered by the Ministry.
Moved by: Alan Barfoot Seconded by: Selwyn Hicks “THAT, the 2021 budget be approved as presented.” Carried
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10.3 Procurement Policy Update Moved by: Brian Milne Seconded by: Brian O’Leary “THAT, the updated Procurement Policy, IV-205 (ADMIN-FIN) be approved as presented.” Carried
10.4 alPHa Summary: Budget 2021 Received for information.
11.0 Other
12.0 Adjournment By motion of Alan Barfoot, the Board of Health meeting adjourned at 12:20 PM.
Next Meeting: Friday, May 28, 2021, 2021 10:00 AM Electronic Participation
X X Sue Paterson Dr. Ian Arra Chairperson Medical Officer of Health
X Erin Meneray Recording Secretary
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Board of Health Special Meeting Minutes ______
Date: Wednesday April 28, 2021 Location: Electronic via Zoom Time: 10:01 AM to 11:54 AM Members Present: Sue Paterson, Alan Barfoot, Brian Milne, Chris Peabody, Helen- Claire Tingling, Mitch Twolan, Brian O’Leary, Selwyn Hicks, Chris Peabody Regrets: Also Present: Dr. Ian Arra, Matthew McMurdie, Drew Ferguson, Torey Barfoot Guests: John Mascarin and David Reiter, Aird & Berlis LLP Secretary: Connie Rossitter
1.0 Call to Order The roll was called by the recording secretary. Quorum was declared and Chair Paterson called the meeting to order at 10:01 AM.
It was noted that the sole purpose of this meeting is the receiving of advice from legal on three issues.
2.0 Amendments to Agenda None
3.0 Approval of Agenda Moved by: Brian Milne Seconded by: Helen-Claire Tingling “THAT, the Agenda be approved as circulated.” Carried
4.0 In-Camera Moved by: Brian O’Leary Seconded by: Alan Barfoot “THAT, the Board of Health Executive Committee does now go into closed session at 10:04 AM to discuss three items relating to advice subject to solicitor-client privilege, and further THAT, all Health Unit Staff shall remain present.” Carried
The Board of Health Meeting returned to open session at 11:53 PM with Chair Paterson presiding. Chair Paterson confirmed that only the items stated in the resolution to move into closed session were discussed and direction subject to solicitor-client privilege was received.
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5.0 Adjournment By motion of Selwyn Hicks, the Board of Health Executive Committee meeting adjourned at 11:54 AM
Next Meeting: To be determined
X X Sue Paterson Connie Rossitter Chairperson Recording Secretary
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Board of Health Executive Committee Minutes ______
Date: Friday May 7, 2021 Location: Virtual via zoom Time: 1:01 PM to 2:01 PM Members Present: Sue Paterson, Chris Peabody, Helen-Claire Tingling Regrets: Also Present: Dr. Ian Arra, Matthew McMurdie, Drew Ferguson Guests: John Mascarin, David Reiter, Aird & Berlis LLP Pam, Jeff Costen Secretary: Erin Meneray
1.0 Call to Order The meeting was called to order at 1:01 PM The sole purpose of the meeting is the receiving of advice from legal.
2.0 Amendments to Agenda
3.0 Approval of Agenda Moved by: Helen-Claire Tingling Seconded by: Chris Peabody “THAT, the Agenda be approved as circulated.” Carried
4.0 In-Camera Moved by: Chris Peabody Seconded by: Helen-Claire Tingling “THAT, the Board of Health Executive Committee does now go into closed session at 1:03 PM to discuss advice subject to solicitor-client privilege” Carried
The Executive Committee returned to open session at 2:01 PM with Chair Paterson presiding. Chair Paterson confirmed that only the items stated in the resolution to move into closed session were discussed.
5.0 Adjournment By motion of Chris Peabody, the Board of Health Executive Committee meeting adjourned at 2:01 PM
Next Meeting: To be determined
X X Sue Paterson Erin Meneray Chairperson Recording Secretary
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Board of Health Executive Committee Minutes ______
Date: Monday May 10, 2021 Location: Electronic via zoom Time: 12:41 PM to 1:41 PM Members Present: Sue Paterson, Chris Peabody, Helen-Claire Tingling Regrets: Also Present: Dr. Ian Arra, Matthew McMurdie, Drew Ferguson Guests: Neena Gupta, Gowling Law, Jeff Costen, Navigator Ltd. Secretary: Erin Meneray
1.0 Call to Order The meeting was called to order at 12:41 PM The sole purpose of the meeting is the receive advice from the Board Lawyer.
2.0 Amendments to Agenda
3.0 Approval of Agenda Moved by: Helen-Claire Tingling Seconded by: Chris Peabody “THAT, the Agenda be approved as circulated.” Carried
4.0 In-Camera Moved by: Helen-Claire Tingling Seconded by: Chris Peabody “THAT the Board of Health Executive Committee does now go into closed session at 12:42 PM to discuss advice subject to solicitor-client privilege” Carried
The Executive Committee returned to open session at 1:40 PM with Chair Paterson presiding. Chair Paterson confirmed that only the items stated in the resolution to move into closed session were discussed.
5.0 Adjournment By motion of Chris Peabody, the Board of Health Executive Committee meeting adjourned at 1:41 PM
Next Meeting: To be determined
X X Sue Paterson Erin Meneray Chairperson Recording Secretary
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Board of Health Special Meeting Minutes ______
Date: Wednesday May 12, 2021 Location: Electronic via Zoom Time: 10:03 AM to 11:54 AM Members Present: Sue Paterson, Alan Barfoot, Brian Milne, Chris Peabody, Helen- Claire Tingling, Mitch Twolan, Brian O’Leary, Selwyn Hicks, Janice Jackson Regrets: Brian Milne Also Present: Dr. Ian Arra, Matthew McMurdie, Drew Ferguson Guests: David Reiter, Aird & Berlis Wendy Wagner, Gowling WLP, Jeff Costen, Navigator Ltd. Secretary: Erin Meneray
1.0 Call to Order The roll was called by the recording secretary. Quorum was declared and Chair Paterson called the meeting to order at 10:03 AM.
It was noted that the sole purpose of this meeting is the receiving of advice from legal on three issues.
2.0 Amendments to Agenda None
3.0 Approval of Agenda Moved by: Selwyn Hicks Seconded by: Alan Barfoot “THAT, the Agenda be approved as circulated.” Carried
4.0 In-Camera Moved by: Mitch Twolan Seconded by: Helen-Claire Tingling “THAT, the Board of Health does now go into closed session at 10:04 AM to discuss one item relating to advice subject to solicitor-client privilege, and further THAT, all Health Unit Staff shall remain present.” Carried
The Board of Health Meeting returned to open session at 11:46 AM with Chair Paterson presiding. Chair Paterson confirmed that only the items stated in the resolution to move
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into closed session were discussed, and direction subject to solicitor-client privilege was received.
5.0 Adjournment By motion of Selwyn Hicks, the Board of Health Executive Committee meeting adjourned at 11:47 AM
Next Meeting: To be determined
X X Sue Paterson Erin Meneray Chairperson Recording Secretary
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Correspondence Package
Friday May 28, 2021
Board of Health Correspondence – May 28, 2021
Item Correspondence Information / Previous Actions Recommended Action 1 John A. Tamming, Letter regarding MOH Compensation and 20 questions Receive Cathy Moore Coburn, Melissa For information Kanmacher, Ryan Greig 2 (A) Alar Soever Mayor, Town of The Blue Mountains, Alar Soever writes letter on his own behalf, in support of Dr. Arra. Receive
For information 2 (B) Town of The Blue Mayor, Town of The Blue Mountains, Alar Soever, writes letter on behalf of Council with resolution in support Receive Mountains of Dr Arra and Grey Bruce Health Unit. For information 3 David Smith Former Grey Bruce municipal CAO writes letter of support for Dr. Arra. Receive For information 4 (A) Elizabeth Murray Letter requests Board respond to delegation and protect the jobs of frontline health care workers (sic). Worth Receive noting healthcare workers are part of the health care system and not under authority of public health. For information 4 (B) Elizabeth Murray Subsequent letter again requests the Board respond to delegation and protect the jobs of frontline health care Receive workers (sic). Worth noting healthcare workers are part of the health care system and not under authority of public health. For information 5 Township of Township of Southgate council provides resolution in support for Medical Officer of Health, Dr Arra. Receive Southgate Council For information
6 Bruce Grey Child and Open letter supports Board of Health and Dr. Arra during pandemic. Receive Family Services For information
7 Donna Beatty, Tom Letter regarding MOH compensation Receive Senese For information
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Board of Health Correspondence – May 28, 2021
8 Council Municipality Grey Highlands Council provides their own resolution in support for Medical Officer of Health, Dr Arra. Receive of Grey Highlands For information 9 Lambton County Lambton County Council confirms support for basic income and income solutions are an effective long-term Receive Council response to income security, poverty, food insecurity, to improve overall community health and well-being. Dec 18, Oct. 23, Sept. 25, Aug. 28, July 24, 2020, BOH receives same or similar motions from Thunder Bay, Chatham-Kent; Renfrew Peterborough and Sudbury and District Health Units. June 26, 2020, BOH endorse motion from Simcoe Muskoka District Health Unit, Timiskaming Health Unit, and Board of Health for the Haliburton, Kawartha, Pine Ridge District Health Unit. April 25, 2019, BOH endorse the component of Bill 60 that would establish a Social Assistance Research Commission to study and recommend social assistance rates and policy changes to the Minister of Children, Community and Social Services as an initiative to address health inequities, including food insecurity. Jan. 26, 2018, the Board received OPHA / alPHa letter commenting on the “Income Security: A Roadmap for Change” report. Jan. 27, 2016, the Board supported Basic Income Guarantee and Hugh Segal discussion paper ”Finding a Better Way: A Basic Income Pilot Project for Ontario”. 10 Council Town of Town of Hanover Council correspondence supports the resolution of the Township of Southgate in support of Receive Hanover Dr Arra. For information
11 Grey County Council Resolution supports letter, under the Warden’s signature, on behalf of Grey County Council in support of and Receive thanking Dr. Arra and his Team. For information
12 alPHa alPHa shares letter to Premier Ford advocating for a further extension of the current province-wide Receive restrictions, including the stay-at-home order, beyond their planned expiry on May 20. For information 13 Peterborough Board Peterborough Board of Health congratulates Premier Ford for the subsequent decision to extend the stay-at- Receive of Health home order. For information 14 Lee Fawcett Letter of thanks to the Board of Health and Dr. Arra from recently retired team member Receive
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Board of Health Correspondence – May 28, 2021
For information 15 Grey Bruce Health Board of Health Response to Delegation Questions Unit Board of Health For information
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BOH - CORRESPONDENCE - 1 1
March 29, 2021
Via Email
GREY BRUCE HEALTH UNIT (GBHU) BOARD OF DIRECTORS
Dear Sirs/Mesdames:
Re: Recent Developments at the Grey Bruce Public Health Unit (GBPHU)
We write as elected members of separate local municipal councils. We write on our own behalf and not on behalf of our councils. With others, we are very concerned about recent developments at the Health Unit. We speak both of what the Board paid its chief executive last year and of the very high rate of management turnover since his appointment.
Thank You
We thank you all, and particularly the front-line staff, for all their diligence and hard work since COVID-19 first entered our region. Nothing in this letter detracts from that. Indeed, we write with their morale in mind as we express our concerns. It is critical to have a strong, vibrant, trusted public health unit as we move forward to defeat the pandemic in our region.
Our Requests
1. We ask that Dr. Arra return the excess money he was paid and that it either be returned to the province or bonussed out to front line workers employed by the Board to fight the pandemic.
2. We also ask that the Board bring in an Ontario Public Health consultant (HR and otherwise) to advise the Board and Dr. Arra on improving the management of the Health Unit.
3. We also ask the Board and Dr. Arra be transparent with the public and answer the questions regarding process which we put to the Board at the end of this letter.
Dr. Ian Arra’s 2020 Compensation: What it Represents
With all of Ontario, we recently learned that in 2020 Dr. Ian Arra, our Medical Officer of Health (MOH), was paid $631,510. This represents:
A 60% increase over his base annual pay of $385,000 in 2019
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The highest pay received by any of the 36 Medical Officers of Health in Ontario
$220,000 more than the next highest paid MOH (Middlesex)
$290,000 more than what Toronto paid its MOH, who works for a population of 3.4 million (Grey-Bruce has 160,000 residents)
Almost $200,000 more than what Ontario pays Dr. David Williams, the Chief MOH for the entire province
Reactions and Explanations to Date
This compensation has received national media attention. We have each heard (loudly) from ordinary residents across Grey and Bruce, front line health care workers and those familiar with the internal affairs of the Health Unit.
Remarkably, some councillors and Board members have said that there is nothing to see here, that we should move on and rally together lest public confidence in the Health Unit be shaken. We respectfully disagree.
That is precisely the wrong course of action and is, frankly, not an option for elected representatives. Through the twin counties, our municipalities are partners with the province when it comes to public health. It is our obligation to seek answers to questions which we or members of the public may have.
It is unfortunate that, with possible health unit mergers still very much on the table, Dr. Arra’s actions and those of the Board have drawn negative publicity. But that is hardly the fault of those who now ask for answers.
The explanations received to date from the chair of your Board, Ms Sue Paterson, have not been satisfactory. Let us review them:
We are told that in 2020 Dr. Arra was working the job of two people, since he did not have an Associate Medical Officer of Health (AMOH). We note:
i) This is simply not accurate. We understand that Dr. Arra was out of the country during part of the late winter of 2020, after which he presumably quarantined for several weeks. During that absence, the Board relied on his acting AMOH, Dr. Linni Li. Dr. Li remained with the Health Unit until mid- 2020, when she joined those others who had left (see below). Other physician consultants were hired at that point, again, sharing the load.
ii) Even if Dr. Arra was bereft of an associate for part of the year, such should not trigger a doubling of his income. We note in this regard that the public health unit 3
of Hastings-Prince Edward, with an identical population to ours and with no AMOH at all, paid its MOH $282,000 last year, less than half of what was paid Dr. Arra.
iii) Finally, as detailed below, working 24/7 for a year is not a metric of managerial competence and, indeed, when coupled with the loss of key staff, may suggest the very opposite. Communications, testing, contact tracing and vaccinations can and should be the purview of senior managers, not the CEO.
Ms Paterson also rather glibly asks how one can “put a price on lives”. That is not a serious argument. Why stop then at a doubling of his salary? Why not move to seven figures? Surely Board oversight of his remuneration does not go out the window because COVID can take lives. Are lesser paid MOHs not saving as many lives?
We are told by Ms Paterson that Dr. Arra acted in a “visionary” manner for his use of hockey arenas as vaccination sites and because he obtained four deep freezers. We choose not to comment.
We were also told that these monies were a special injection of overtime funds made available by the province specifically to help out health units with overtime. We question whether the Board in fact was compelled to pay out such monies to Dr. Arra. We ask why such funds were not either declined (salaried persons do not usually receive overtime) or distributed more widely among staff. Other Medical Officers of Health reported their actual numbers of overtime hours. As of the date of this letter, to our knowledge, our Board has not released this same data. Our citizens pay local taxes that go towards our local Health Unit, and they also pay provincial taxes. Either way, this payment is coming out of their pockets. Per the cliché, there is only one taxpayer.
Managerial Turnover at the Health Unit
The ultimate strength of any health unit is the quality and experience of its people. On first glance, something seems seriously “off” at our Health Unit.
Staff turnover at any organization is natural. As well, there had been an effort to prune the size of the Health Unit for budgetary reasons.
But since Dr. Arra’s appointment, such turnover has been substantial and unprecedented. Dr. Arra joined as acting MOH in October, 2018 and, once he passed some exams, assumed the full title in January, 2019. In a little more than two years under his management, many non- unionized positions have been vacated. The positions that have seen turnover include senior management and others:
Acting Associate Medical Officer of Health/Physician Consultant
4
Part-time Physician Consultant
Human Resources Managers (two)
Senior Epidemiologist
Contract Epidemiologist (contract not renewed)
Director of Operations and Program Development
3 Public Health Managers
There has been turnover at less senior levels as well, including health data analyst. Doubtless, some left on good terms. Others, not so much.
But for a relatively small public health unit, this loss of management and other staff raises the issue of organizational dysfunction. It certainly erodes the institutional memory essential to navigate these pandemic waters.
The loss of senior and experienced staff is of particular concern given that Dr. Arra is new in this vocation and only recently completed his certifications. He has never before managed a health unit.
Questions for the GBHU Board
As a first step to restoring public trust, we respectfully request that the Board respond to the questions below. We anticipate that the Board will rely on privacy concerns to argue that it cannot respond to some of these queries.
But nothing prevents Dr. Arra from voluntarily agreeing to release this information. His actions have triggered all of this and we trust he will do just that. This is public money being spent. Further, the integrity and morale of the health unit deserves that gesture from him. In addition to written answers, we ask for copies of relevant documents which ground those replies, including Board minutes, contracts and correspondence.
1. Will you ask Dr. Arra to voluntarily disclose all aspects of his compensation?
2. What was Dr. Arra’s contractual annual base rate before the pandemic?
3. What “normal” hours were assumed for that annual base compensation?
4. What “overtime” hours were worked in addition to those assumed base hours?
5
5. Please provide a breakdown of all such hours, on a weekly basis.
6. What was he paid per overtime hour?
7. Did Dr. Arra vacation outside the country last year? If so, for what period of time did he both travel and quarantine at home?
8. Were other managers paid overtime or denied same?
9. Did the Board in fact have prior knowledge of and approve all of his compensation for 2020 including overtime pay?
10. Did the Board as a whole have an ongoing idea of how much Dr. Arra was billing for his overtime or were Board members as surprised as the public when the Sunshine List was published?
11. Was any such approval of any aspect of his compensation made retroactively?
12. Did the Board seek and obtain legal advice on whether the overtime payments to Dr. Arra were absolutely compulsory? Could the Board have said no?
13. Did the Board consider either declining available overtime funds from the province or sharing it more equitably among staff at the unit? If this was not possible, please explain why.
14. Were any constraints of any kind placed on Dr. Arra’s overtime billings?
15. Did the Board consider whether, in addition to his dedication, the claimed overtime may have also reflect:
i) his inexperience;
ii) a refusal or inability to delegate; or
iii) the loss of middle and upper management under his tenure?
16. If the Board did not entertain these possibilities and intervene to reduce his claimed overtime, why not?
17. Did the Board know that Dr. Arra’s compensation was going to outstrip by far every one of his Ontario peers in 2020, including very experienced MOHs?
18. Did the Board consider the impact of such compensation and its inevitable disclosure on staff morale?
6
19. Does the loss of management staff reflect a level of dysfunction within the organization?
20. We urge you to examine whether women in particular are having difficulty fitting within the Health Unit, given that most of the remaining senior management is male.
We ask for fulsome answers to these questions from the Board, while reserving the right to request an investigation down the road. Under the circumstances, we see no reason why answers cannot be provided within 30 days.
Concluding Comments
It brings us no pleasure to write this letter. One of us (Councillor Moore Coburn) worked with pride for a quarter of a century with the Health Unit. Another (Councillor Tamming) toured the health unit many months ago with Dr. Arra, and was so impressed with both his deep understanding of epidemiology and the systems he had put in place that he publicly praised him in writing.
Thank you for your kind attention to this matter. We assume you want what we do – a healthy organization that is transparent with the public it serves.
We look forward to your response.
Sincerely,
“John A. Tamming” John A. Tamming Councillor, City of Owen Sound
“Cathy Moore Coburn” Cathy Moore Coburn Councillor, Municipality of Georgian Bluffs
7
“Melissa Kanmacher” Melissa Kanmacher Councillor, Municipality of Arran-Elderslie
“Ryan Greig” Ryan Greig Councillor, Municipality of Arran-Elderslie
BOH - CORRESPONDENCE - 2 (A)
March 31, 2021 Open Letter to:
John A. Tamming Councillor, City of Owen Sound
Cathy Moore Coburn Councillor, Municipality of Georgian Bluffs
Melissa Kanmacher Councillor, Municipality of Arran-Elderslie
Ryan Greig Councillor, Municipality of Arran-Elderslie
Re: Your Letter to the Grey Bruce Board of Health
I have just read the letter the four of you wrote as elected members of separate local municipal councils. on your own behalf and not on behalf of your councils and I feel compelled to respond on my own behalf to this unwarranted attack on our Medical Officer of Health, Dr. Arra.
Over the last year I have had occasion to work and correspond with Dr. Arra on a number of COVID related issues. He has worked tirelessly over the past year to put in place and enforce protocols that have kept Grey Bruce safe. The results of this hard work are evident in our relatively low case counts and the fact we have had only four deaths.
Particularly impressive is the fact we have had no major outbreaks in our Long Term Care Homes and Seniors Residences. Unlike most of the rest of Ontario, the few cases we have had have been quickly contained and isolated through rigorous application of best practice health protocols. In contrast, in most of the rest of Ontario there have been large outbreaks in long term care facilities and many deaths.
In addition, through the contact tracing efforts of our Health Unit, cases relating to outbreaks in the community, including one involving our staff, have been quickly isolated and contained.
In addition, he and his team have:
• been proactive in working with Chapman’s to procure deep freezers so we were set-up to store and deliver the Pfizer vaccine; • developed the Hockey hub model to transform arenas into mass vaccination sites; • worked with the province on an endless number of other issues;
I am advised that Dr. Arra’s salary is set by the Ministry of Health and includes a provision for overtime. Although I don’t know the exact details of the hours he works, on multiple occasions re has called me or responded to my e-mails late at night, a few times after midnight. Just last night I received a response to an enquiry of mine on behalf of our seniors at 2:12 am.
As head of a relatively small health unit, he does not have the support that Medical Officers of Health of larger health units have. We are fortunate to have someone as dedicated and hard working as Dr. Arra. Our low case counts and deaths demonstrate that his hard work and leadership has paid off. We should not be asking why he is being paid so much, but why other Medical Officers of Health haven’t worked equally as hard, earned the same amount of overtime, and achieved the same results.
In summary, I am shocked that you would object to paying someone for hard work and the resulting success, particularly when it is measured in the saving of lives. I believe he has outperformed most, if not all of the other Medical Officers of Health, and deserves to be compensated accordingly, so I don’t begrudge him his 2020 salary. He has earned it.
PS. When it comes to hard work, I wonder why only 48 of 444 municipalities in Ontario applied for the application-based Second Phase of COVID Recovery Funding, including only 3 of the 17 municipalities in Grey Bruce. One can assume that the municipalities who didn’t apply either didn’t take any initiatives to support their citizens in the fight against COVID, or they simply didn’t bother to apply for funding.
Rather than spend time criticizing the hard, successful work of Dr. Arra and his team, I suggest that you start to do your part in the fight against COVID and turn your energies to setting your own houses in order.
Alar Soever, Mayor of The Town of the Blue Mountains On my own behalf
Phase 2 2020 Application Based Municipality County Funding Saugeen Shores, Town of Bruce Huron-Kinloss, Township of Bruce Arran-Elderslie, Municipality of Bruce South Bruce, Municipality of Bruce South Bruce Peninsula, Town of Bruce Northern Bruce Peninsula, Municipality of Bruce Kincardine, Municipality of Bruce Brockton, Municipality of Bruce Bruce, County of Bruce Southgate, Township of Grey The Blue Mountains, Town of Grey $385,000.00 Georgian Bluffs, Township of Grey Hanover, Town of Grey $985,000.00 West Grey, Municipality of Grey Meaford, Municipality of Grey Owen Sound, City of Grey $157,000.00 Grey Highlands, Municipality of Grey Chatsworth, Township of Grey Grey, County of Grey cc: Grey Bruce Board of Health Grey County Council The Blue Mountains Council
BOH - CORRESPONDENCE - 2 (B)
Town of The Blue Mountains 32 Mill Street, Box 310 THORNBURY, ON N0H 2P0 https://www.thebluemountains.ca
OFFICE OF: Mayor Alar Soever Email: [email protected] Phone: 519-599-3131 Ext 400
Sent via E-mail May 19, 2021 Dr. Ian Arra Medical Officer of Health and Chief Executive Officer Grey Bruce Public Health Unit 1010 17th Street East Owen Sound, ON N4K 0A5
Dear Dr. Ian Arra:
Re: Letter of Thanks and Support
At its meeting on May 3rd, 2021 the Council of the Town of The Blue Mountains unanimously passed the following resolution:
THAT Council of the Town of The Blue Mountains receives Agenda Item D.5 Municipality of Grey Highlands, D.6 Township of Southgate and D.7 County of Grey regarding support for Grey Bruce Health Unit; AND THAT Council of the Town of The Blue Mountains supports the efforts of Dr. Ian Arra and the Grey Bruce Health Unit, and requests Mayor Soever to write a letter of support to Dr. Arra on behalf of Council and the residents of The Blue Mountains.
I am honoured and pleased to provide the following on behalf of our Council and residents:
Since before the beginning of the pandemic, the Grey Bruce Health Unit under the leadership of Dr. Ian Arra, has been proactive and taken actions which have been highly effective in minimizing the impact of COVID-19 in our community.
The Health Unit staff’s efforts have been, and continue to be exceptional, and they have made sacrifices in terms of their personal lives to assist us all in defeating COVID-19. It gives me great pleasure to write this letter to recognize their efforts, and thank not only them, but also their families, for their efforts and sacrifices in helping us defeat COVID-19.
As a relatively small health unit population wise, but one which is geographically large, and which is a popular tourist destination that hosts visitors from many other parts of Ontario, our Health Unit has to deal with many challenges without the benefit of the staffing levels that Medical Officers of Health of larger health units enjoy. We are fortunate to have people as dedicated and hard working as Dr. Arra and his team. Our low case counts and deaths demonstrate that their hard work and leadership has paid off.
Page 1 of 2
Over the last year I have had occasion to work with and correspond with Dr. Arra and his team on a number of COVID related issues. They have worked tirelessly over the past year to put in place and enforce protocols that have kept Grey Bruce safe. The results of this hard work are evident in our relatively low case counts and the fact we have had only five deaths.
Particularly impressive is the fact we have had no major outbreaks in our Long Term Care Homes and Seniors Residences. Unlike most of the rest of Ontario, the few cases we have had, have been quickly contained and isolated through rigorous application of best practice health protocols. In contrast, in most of the rest of Ontario there have been large outbreaks in long term care facilities and many deaths. In addition, through the contact tracing efforts of our Health Unit, cases relating to outbreaks in the community, including one involving our staff, have been quickly isolated and contained. More recently, the Health Unit contact traced over 600 people in a few days, and quickly and effectively contained a spike in cases associated with several social gatherings.
In addition, Dr. Arra and his team have: • worked tirelessly with our businesses and municipal staff to develop and implement best practices to prevent the spread of COVID-19; • been proactive in working with Chapman’s to procure deep freezers so we were set-up to store and deliver the Pfizer vaccine; • developed the Hockey hub model to transform arenas into mass vaccination sites; • worked with the province on an endless number of other issues;
All of these achievements and this record of success required a tremendous amount of hard work and dedication on the part of Dr. Arra and his team. I recall multiple occasions when Dr. Arra has called me or responded to my e-mails late at night; a few times the e-mails came after midnight. His staff work just as hard, and I can recall interacting with them as well late at night. We cannot thank you all enough. Once again, please know that you have our support, and thank you for all you continue to do to keep us safe.
Sincerely yours,
Mayor Alar Soever Town of The Blue Mountains cc. Grey Bruce Board of Health (via email) Grey County Council (via email) Council, Town of The Blue Mountains (via email) CAO Shawn Everitt, Town of The Blue Mountains (via email) Tim Hendry, Manager of Communications and Economic Development, The Blue Mountains (via email) Drew Ferguson, Public and Media Relations Coordinator, Grey Bruce Public Health Unit (via email) Grey Bruce Municipalities (via email) Hon. Jim Wilson, MPP Simcoe-Grey (via email) Hon. Bill Walker, MPP Bruce-Grey (via email) Hon. Christine Elliott, Minister of Health (via email)
Department File - C2048
Page 2 of 2
BOH - CORRESPONDENCE - 3.0
Dr. Arra, Ian (MOH)
From: [email protected] Sent: April 2, 2021 8:25 AM To: [email protected]; [email protected]; [email protected] Cc: Dr. Arra, Ian (MOH) Subject: Dr. Arra Compensation
Categories: Green category
[EXTERNAL]: This email originated from outside of the organization. Do not click links or open attachments unless you recognize the sender and know the content is safe. Good Day,
I have followed with interest some of the theatrics related to Dr. Arra’s 2020 compensation.
Board members don’t need a reminder that we deep into a global pandemic and Grey Bruce has always been in the most favourable position compared to other health units in Ontario. This is in large part due directly to Dr Arra and his extraordinary leadership during the most profound health crisis of our lifetimes. His leadership has been clear, thoughtful, unwavering and has saved lives and economic ruin for many. The debate should stop with that sentence. In fact the debate should never have even started.
In my opinion Dr. Arra has been the most important person in the health unit area for the past year and his compensation barely reflects that.
Having worked closely with Dr. Arra and his team from the very beginning as a former Grey/Bruce municipal CAO I can without hesitation attest to the impact of his decisions, commitment and communications. It was and is exceptional compared to many of his peers. I have seen first hand how other Medical Officers of Health have performed during the pandemic and congratulate him on the success of the most important measures, COVID numbers. The goal at the outset was to flatten the curve and the curve in Grey/Bruce is spectacularly flat. GREEN
I don’t live or work in Grey/Bruce any longer and I will tell you that starting Monday my local community is on our third Medical Officer of Health since the pandemic started.
In summary, board members should focus on the important things and support their Medical Officer of Health with the same commitment he has demonstrated to the community. The real crisis is just starting; lots of infection, citizen apathy and little vaccine.
This email has been sent to board members that have publicly available email addresses. Feel free to share with those that don’t have public email addresses.
David Smith
Cc
Sue Patterson Mitch Twolan Brian Milne Chris Peabody Anne Eadie Selwyn Hicks Brian O’Leary
1 Alan Barfoot NO EMAIL Helen-Claire Tingling NO EMAIL Nick Saunders NO EMAIL Ian Arra
2 BOH - CORRESPONDENCE - 4.0 (A)
Erin Meneray
From: Elizabeth Murray
[EXTERNAL]: This email originated from outside of the organization. Do not click links or open attachments unless you recognize the sender and know the content is safe. Good afternoon, Erin.
Attached is a letter to West Grey Council members in which I ask that they join others and ask for a response to questions in the 29 March Owen Sound Hub.
Thank you for distributing it to the Chair and Board Members of the Grey Bruce Health Unit.
Elizabeth Murray Ayton ON
1 To: Mayor Christine Robinson and West Grey Municipal Council
Cc: Chair Sue Patterson and Board of Grey Bruce Health
Councillor Tamming (City of Owen Sound), Councillor Moore Coburn (Georgian Bluffs), Councillors Kanmacher and Grieg (Aaron Elderslie)
From: Elizabeth Murray Resident, Ayton
Date: Tuesday 06 April 2020
Subject: Compensation and Management at Grey Bruce Health
This letter is a request that West Grey Council support, Councillors Tamming (City of Owen Sound), Moore Coburn (Georgian Bluffs), Kanmacher and Grieg (Aaron Elderslie) in both the essence and specifics of their 29 March letter in The Owen Sound Hub, regarding 2020 compensation to Dr. Arra and management practices at Grey Bruce Health.
For the year 2020 Dr Arra’s compensation was reported at $631,512.00. Dr. Arra was the highest paid public health officer in the Province of Ontario yet the Grey Bruce Health Unit serves one of the smallest populations and the combined Counties has one of the smallest tax bases in the Province.
The four authors of the 29 March letter are asking for transparency from Dr. Arra and Grey Bruce Health Board members in response to serious and important questions. They also seek an independent review to assess management, practices and procedures at Grey Bruce Health over the past couple of years.
As a resident of West Grey, I ask that you publicly join them in asking Dr. Arra and the Grey Bruce Board of Health for fulsome and transparent responses to the Councillors’ questions and for an independent review of Board and Management practices. Our frontline health care providers deserve nothing less nor do the residents of Grey and Bruce Counties.
Thank you for your consideration. BOH - CORRESPONDENCE - 4.0 (B)
Connie Rossitter
From: Elizabeth Murray
Categories: BOH
[EXTERNAL]: This email originated from outside of the organization. Do not click links or open attachments unless you recognize the sender and know the content is safe.
Good afternoon Erin Would you please include a copy of the attached letter in each of the Board Member’s packages. Would you also confirm that the letter will be distributed and placed on the 28 May Board Meeting agenda. Many thanks.
Elizabeth Murray Resident Ayton, West Grey
1 To: Grey Bruce Public Health Unit (GBPHU) Chair Sue Paterson and Board Members
From: Elizabeth Murray Ayton, West Grey Resident
Date: Monday 17 May 2021
Subject: Board and Management Accountability and Transparency
In my 20 April letter to West Grey Council, as you know, I asked that they support Councillors Greig, Moore Coburn, Tamming and Kanmacher In their request for answers to some very important questions regarding Board and Management issues at the GBPHU.
I learned that our local elected officials haven’t such a role with our Public Health Unit and was advised by West Grey Mayor Christine Robinson to send my concerns directly to you.
At your 28 May Board meeting you will receive a delegation from the four Councillors and one from the petition author. They will address a number of the issues that have concerned so many of us for a long period of time.
My concerns, in particular, are for our frontline healthcare providers. Our PSWs, RPNs, RNs, technicians, physicians, paramedics and office staff who have been working for more than a year at great personal risk to themselves and their families and yet they stay on even as the virus mutates and becomes more virulent causing yet a third wave.
These same healthcare providers care for those of us who live in Grey and Bruce Counties. They look after our friends and families. They themselves are our neighbours, friends and in many cases family members. Please understand why, therefore, we cannot remain silent when we learn of unfair Human Resources and Management practices at our Public Health Unit.
More than 1400 people have signed the petition and many have written individual letters. The letters from individuals and comments by those who signed the petition have received many likes. The numbers in support of the original letter are now in the thousands, yet there has been no acknowledgement of our concerns from you.
Please, in response to the two delegations at your 28 May Board Meeting, agree to engage a management consulting firm to complete an independent audit of Board and Management responsibilities and practices and to publish recommendations to improve the working conditions for our healthcare providers. They deserve nothing less, nor do the residents of Grey and Bruce Counties. BOH - CORRESPONDENCE - 5
Township of Southgate Phone: 519-923-2110 Administration Office Toll Free: 1-888-560-6607 185667 Grey County Road 9, RR 1 Fax: 519-923-9262 Dundalk, ON N0C 1B0 Web: www.southgate.ca
April 8, 2021
Grey Bruce Public Health Unit 101 17th Street East Owen Sound Ontario N4K 0A5
To whom it may concern:
Re: Resolution of Support - Grey Bruce Public Health Unit's Medical Officer of Health Dr. Ian Arra
Please be advised that at the April 7, 2021 Regular Meeting of Council, the following motion was carried:
No. 2021-191 Moved By Deputy Mayor Milne Seconded By Councillor Frew Whereas the integrity of the Grey Bruce Public Health Unit's Medical Officer of Health Dr. Ian Arra has been questioned by four Grey and Bruce lower tier Councillors; Arran-Elderslie Councillors Ryan Greig and Melissa Kanmacher, Georgian Bluffs Councillor Cathy Moore Coburn and Owen Sound Councillor John Tamming; and Whereas the same Councillors have questioned Dr. Arra's handling of the ongoing COVID-19 pandemic; and Whereas Provincial pandemic indicators show that Grey Bruce residents have done, and continue to do, a tremendous job of adhering to the advice of the Medical Officer of Health Dr. Arra thus keeping the COVID-19 infection and transmission rates low locally, Therefore be it resolved that the Council of the Township of Southgate wishes to indicate that it supports our Medical Officer of Health, Dr. Arra and has full confidence in him and his team at the Grey Bruce Public Health Unit; and That Council directs staff to forward this motion to the Grey Bruce Public Health Unit, Grey and Bruce Counties and all lower-tier Municipalities in Grey and Bruce.
Yay (5): Mayor Woodbury, Deputy Mayor Milne, Councillor Sherson, Councillor Frew, and Councillor Shipston Nay (2): Councillor Dobreen, and Councillor Rice
1 | Page Carried (5 to 2)
If you have any questions, please contact our office at (519) 923-2110.
Sincerely,
Lindsey Green, Clerk Township of Southgate cc: The County of Grey The County of Bruce Township of Huron-Kinloss Municipality of Northern Bruce Peninsula Municipality of South Bruce Town of South-Bruce Peninsula Municipality of Kincardine Municipality of Brockton Municipality of Arran Elderslie Town of Saugeen Shores Town of Hanover Municipality of West Grey Municipality of Grey Highlands Township of Chatsworth Township of Georgian Bluffs City of Owen Sound Municipality of Meaford Town of the Blue Mountains
2 | Page BOH- CORRESPONDENCE - 6
LETTER TO THE EDITOR
Bruce Grey Child and Family Services has been navigating the pandemic and service provision to vulnerable families for a year now and through it all Public Health, led by Medical Officer of Health Dr. Ian Arra, has provided continuous, timely and reliable support when it mattered most. From town hall meetings for essential staff to providing support to foster families to advice about service delivery, Public Health has been there for us. We, along with other social service agencies who maintained face to face contact with people have had access to Public Health expertise starting already in February 2020, well before the declaration of the pandemic. We proudly continue to serve while keeping our staff safe and while also meeting the needs of the community.
We shared this challenge with many others – police, food banks, firefighters, charities and the people who served grocery stores, long term care centers, gas stations and the like. A small army of individuals in our region surmounted their personal fears and worries and have continued to work face to face with the public.
We are a region who has demonstrated high compliance with public health recommendations. This is the end result of getting good advice from a trusted source of advice. Dr. Arra and his team focused on support and communication to our entire community and we were inspired to be compliant with this advice. The result of good communication and high trust is low numbers of infection because we are all doing our best to protect ourselves and each other.
The correspondence from Councillor John Tamming to both the board of health and the city’s representative on the board, which he has made public, serves to undermine public confidence in the health unit at a time when that confidence is most critical. Our concern is his often baseless comments and conclusions will diminish the public’s trust in this invaluable institution and its medical officer of health. It is a dangerous campaign based on innuendo and inference.
Dr. Arra reports to a Board of Directors populated by the region’s most competent municipal politicians and provincial appointees. They are individuals who understand accountability and the unique challenges faced by their organization. Many of these individuals are elected and there is a trickle down accountability for the organization that they govern to the electors. I trust that they are fully proficient to evaluate the performance of their Medical Officer of Health and the functioning of the organization. Dr. Arra’s compensation is their responsibility and their business.
We are grateful to our staff and foster parents for their outstanding service through the pandemic. BGCFS could not have navigated this experience without the continuous wise counsel of Dr. Arra and his team. We encourage all of the citizens of our region to keep listening to and heeding the advice of our immensely talented and committed Medical Officer of Health and his team. Get immunized when it is your turn and follow the guidelines. The end is in sight.
Phyllis Lovell Christine John Chief Executive Officer Board Chair
BOH - CORRESPONDENCE - 7
Erin Meneray
From: Grey Bruce Health Unit Sent: April 14, 2021 1:38 PM To: Erin Meneray; Dr. Arra, Ian (MOH) Subject: FW: Letter to the Board of Health Attachments: let to Sun Times.docx
From: dbeatty dbeatty
[EXTERNAL]: This email originated from outside of the organization. Do not click links or open attachments unless you recognize the sender and know the content is safe.
Hi there. Attached is a letter to the members of the Board of Health. It is a copy of a letter sent to the Owen Sound Sun Times yesterday. I hope the letter will be published soon.
I am Donna Beatty. I live at 1278 4th Ave. W. My telephone number is 519-371-3200. If you have any questions, please just email me or call. Also, please confirm that you have received this letter.
Many thanks.
1
April 13, 2021
To the Sun Times Editor
Not everyone agrees with Grey County Council’s letter of support sent to Dr. Arra, as reported in the Sun Times Edition of April 13th, 2021. As tax payers, we don’t support the letter and we believe there are many other non-supporters in this area.
The MOH & the excellent staff at the Health Unit deserve a huge thank you for their work during this pandemic BUT we do not understand how an individual public figure like MOH, Dr. Arra could earn such an exorbitant take home pay. At the same time, the Board of the Health Unit is facing a lawsuit where Dr. Arra’s leadership style is a key issue. The allegations, available to the public, are not pretty.
Furthermore, we support an agenda of ‘disruption’ (as you report in the article). We appreciate learning different sides of a question that this process can bring. In fact, we thought that, thorough examination from all angles of a concern impacting the existing municipal system, was part of a councillor’s job description.
In closing, we hope there will be a Public Health Consultant appointed who will help guide the future management of the Grey Bruce Health Unit. We also hope that Dr. Arra makes a large donation to one of the many community organization’s serving people living in Grey Bruce, who are facing pandemic hardships.
Donna Beatty and Tom Senese
Owen Sound Residents
Cc
Board of Health, Grey Bruce Health Unit
Mayor Ian Boddy & Councillors
Grey County Council
Erin Meneray
From: Lisa Alguire Sent: April 20, 2021 12:51 PM To: Erin Meneray Subject: FW: Board of Health
FYI – see email below re: letter to BOH. Thanks, Lisa A.
From: Contact Us
Category: Grey Bruce Health Unit
Hi. I sent a copy of a letter that my husband & I recently had published in the Letters section in the Sun Times. The letter was intended for each member of the Board of Health. I have not received any feedback that indicated the letter was received and will be forwarded to the Board. Was the letter received? Thanks for your Feedback.
Submitted by:
Name: Donna Beatty
Street: 1278 4th Ave. W.
City: Owen Sound
Phone: (519) 3713200
Email: [email protected]
1 BOH - CORRESPONDENCE - 8 P a g e | 1
April 22, 2021
RE: Support for Grey Bruce Health Unit
Please be advised that the Council of the Municipality of Grey Highlands, at its meeting held April 21, 2021, passed the following resolution:
2021-285 Moved by Aakash Desai, Seconded by Paul Allen
Whereas Provincial pandemic indicators show that Grey Bruce residents have done, and continue to do, a tremendous job of adhering to the advice of the Grey Bruce Health Unit thus keeping the COVID-19 infection and transmission rates low locally;
Therefore, be it resolved that the Council of the Municipality of Grey Highlands wishes to indicate that it supports our Public Health Unit and has full confidence in the Medical Officer of Health and his team at the Grey Bruce Public Health Unit; and
That Council directs staff to forward this motion to the Grey Bruce Public Health Unit, Grey and Bruce Counties and all lower-tier Municipalities in Grey and Bruce. CARRIED.
As per the above resolution, please accept a copy of this correspondence for your information and consideration.
Sincerely,
Jerri-Lynn Levitt Deputy Clerk Council and Legislative Services Municipality of Grey Highlands
The Municipality of Grey Highlands 206 Toronto Street South, Unit One P.O. Box 409 Markdale, Ontario N0C 1H0 519-986-2811 Toll-Free 1-888-342-4059 Fax 519-986-3643 www.greyhighlands.ca [email protected] BOH - CORRESPONDENCE - 9
Office of the County Warden Telephone: 519-845-0801 789 Broadway Street, Box 3000 Toll-free: 1-866-324-6912 Wyoming, ON N0N 1T0 Fax: 519-845-3160
April 26, 2021
The Right Honourable Justin Trudeau, P.C., MP Prime Minister of Canada Office of the Prime Minister 80 Wellington Street Ottawa, ON K1A 0A2 Sent via email: [email protected]
The Honourable Chrystia Freeland, P.C., M.P. Deputy Prime Minister and Minister of Finance Privy Council Office, Room 1000 80 Sparks Street Ottawa, ON K1A 0A3 Sent via email: [email protected]
Dear Prime Minister Trudeau and Deputy Prime Minister Freeland:
Re: Basic Income for Income Security during COVID-19 Pandemic and Beyond
At its meeting held on February 3rd, 2021, Lambton County Council received correspondence to the federal government from the Thunder Bay District Health Unit dated November 20, 2020 with respect to using a basic income to address food security. This letter is intended to express our support for these efforts to provide income solutions to reduce food insecurity.
Income is one of the strongest predictors of health, and it makes sense that focusing on population health interventions to address socioeconomic factors will impact health outcomes far greater than individual focused interventions.
Prior to COVID-19, 8% of Lambton County residents reported moderate or severe food insecurity: experiencing actual issues with procuring an adequate quality or quantity of food, or worrying about the source of their food. 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 5 households. This increase was anticipated due to many individuals facing precarious employment, reduced hours of work, or loss of job altogether, coupled with increasing food prices.
Food insecurity is associated with significantly higher annual provincial health care costs; one study showed total health care costs were 49% and 121% higher among households experiencing moderate or severe food insecurity, respectively. People without consistent access to enough healthy food struggle to eat a nutritious diet,
www.lambtononline.ca The Right Hon. Justin Trudeau, P.C., M.P. (page 2) April 26, 2021 The Hon. Chrystia Freeland, P.C. M.P. putting them at increased risk of health problems such as chronic and infectious diseases, low birth weight pregnancies, and poor child growth and development. Undernourished children also do not perform as well at school academically, have difficulty concentrating in class, and have poorer psychosocial outcomes than those who are fortunate enough to eat a balanced diet.
Annual analysis of the local cost of a nutritious food basket has continued to illustrate how little money a family of four on a social assistance budget would have left to cover the costs of childcare, transportation, and other basic needs, after paying for shelter and healthy food.
As a result of the COVID-19 pandemic, we can anticipate the exacerbation of existing disparities, creating an even wider gap between those with opportunity and those without. Local concerns around homelessness, poverty, food insecurity, transportation, mental health and addictions, child and partner violence, and the needs of Indigenous people have been amplified.
Lambton County Council agrees that income solutions are an effective long-term response to the issues of income security, poverty, food insecurity, to improve overall community health and well-being.
Sincerely,
Kevin Marriott Chair, County of Lambton Board of Health Warden, County of Lambton cc: The Hon. Doug Ford, Premier of Ontario The Hon. Monte McNaughton, Minister of Labour, MPP, Lambton-Kent-Middlesex The Hon. Bob Bailey, MPP, Sarnia-Lambton Dr. David Williams, Chief Medical Officer of Health The Hon. Lianne Rood, MP, Lambton-Kent-Middlesex The Hon. Marilyn Gladu, MP, Sarnia-Lambton Pegeen Walsh, Executive Director, Ontario Public Health Association Association of Local Public Health Agencies Ontario Boards of Health BOH - CORRESPONDENCE - 10
341 10th St. Hanover ON N4N 1P5 t 519.364.2780 | t 1.888.HANOVER | f 519.364.6456 | hanover.ca
April 21, 2021
Lindsay Green, Clerk Township of Southgate 185667 Grey Road 9, RR#1 Dundalk, ON
Via Email: [email protected]
Re: Endorsement of Resolution - Grey Bruce Public Health Unit’s Medical Officer of Health Dr. Ian Arra
Further to your correspondence dated April 8, 2021 regarding support for Grey Bruce Public Health Unit Medical Officer of Health, Dr, Ian Arra, please be advised that Hanover Council passed the following resolution at their April 19, 2021 meeting:
Moved by DEPUTY MAYOR HICKS | Seconded by COUNCILLOR HOCKING THAT the Council of the Town of Hanover support the resolution of the Township of Southgate and the actions and leadership of the Grey Bruce Public Health Unit Medical Officer of Health Dr. Ian Arra, in response to the Covid-19 pandemic. CARRIED
I trust this is satisfactory, however should you have any questions or concerns, please do not hesitate to contact the undersigned.
Respectfully,
Brian Tocheri CAO/Clerk
BT/vm cc: Grey Bruce Public Health Unit County of Bruce County of Grey Township of Huron-Kinloss Municipality of Northern Bruce Peninsula Municipality of South Bruce Town of South-Bruce Peninsula Municipality of Kincardine
Municipality of Brockton Municipality of Arran Elderslie Town of Saugeen Shores Municipality of West Grey Municipality of Grey Highlands Township of Chatsworth Township of Georgian Bluffs City of Owen Sound Municipality of Meaford Town of the Blue Mountains
Page | 2
BOH - CORRESPONDENCE - 11
Office of the Warden
595 9th Avenue East, Owen Sound Ontario N4K 3E3 519-376-2205 / 1-800-567-GREY / Fax: 519-376-8998 April 27, 2021
Dr. Ian Arra Grey Bruce Health Unit By Email: [email protected]
Dear Dr. Arra:
It is with respect and gratitude that I send you this letter of thanks. At the April 8, 2021 session of Grey County Council, a unanimous vote supported the following resolution:
That a letter of support be drafted under the Warden’s signature on behalf of Grey County Council thanking Dr. Arra and his Team for his continued diligence and support during the COVID-19 pandemic.
Please share this letter with your team. Grey County Council wishes you and your team the very best as you continue to support the health of the residents of Grey and Bruce counties.
Yours truly,
Selwyn Hicks Warden (519) 372-0219 ext. 1225 www.grey.ca
/kn cc. Grey County Council
Grey County: Colour It Your Way BOH - CORRESPONDENCE - 12 480 University Ave., Suite 300 Toronto, Ontario M5G 1V2 Tel: (416) 595-0006 E-mail: [email protected]
Hon. Doug Ford May 7, 2021 Premier of Ontario Legislative Bldg Rm 281, Queen's Park, alPHa’s members are Toronto, ON M7A 1A1 the public health units in Ontario. Dear Premier Ford, alPHa Sections: Re: Public Health Measures – Extension of Current Restrictions
Boards of Health Section On behalf of the Association of Local Public Health Agencies (alPHa) and its Council of Ontario member Medical Officers of Health, Boards of Health and Affiliate organizations, I Medical Officers of am writin g today to strongly recommend a further extension of the current Health (COMOH) province -wide restrictions, including the stay-at-home order, beyond their planned expiry on May 20th. Affiliate Organizations: After an aggressive resurgence that followed the lifting of similar restrictions in Association of Ontario February, we are encouraged by the beginnings of clear downward trends in the Public Health Business reproductive rate, new daily cases, active cases, hospitalizations, and test Administrators positivity rates following the reimposition of restrictions in early April. Most of
Association of these metrics however, most notably patients in ICU, remain far higher than they
Public Health were at the peak of the second wave, and we do not anticipate that this will Epidemiologists in Ontario change before the current orders lapse.
Association of It is crystal clear that public health measures aimed at decreasing mobility and Supervisors of Public Health Inspectors of interpersonal contact are by far the most important tool we have currently to Ontario prevent transmission of COVID-19. Their effectiveness is not up for debate after
Health Promotion three waves of declines and resurgences occurred in lockstep with the Ontario intensification and relaxation of restrictions. Any move to relax restrictions now woul d without a doubt reverse the modest downward trends we have observed Ontario Association of over the past two weeks. Public Health Dentistry
Ontario Association of Ontario is making great progress with its vaccination campaign but until we have Public Health Nursing Leaders achieved a critical mass of people who are fully vaccinated, we must rely on minimizing transmission by limiting interpersonal contact until such a time as the Ontario Dietitians in metrics we have been using to guide our decisions thus far reflect solid Public Health epidemiologic al evidence that transmission and the risks of severe outcomes are low enough, and capacity in acute care and public health has improved enough that restrictions can be lifted. Now is not that time.
Our members, as Ontario’s front-line and pre-eminent public health experts, are more than willing to provide further advice and input to ensure the success of
Ontario’s COVID-19 response and we look forward to an invitation to discuss this
with you further. To schedule a meeting, please have your staff contact Loretta Ryan, Executive Director, alPHa, at [email protected] or 416-595-0006 x 222. www.alphaweb.org Providing Leadership in Public Health Management
Yours Sincerely,
Carmen McGregor, Dr. Paul Roumeliotis, Trudy Sachowski, alPHa President Chair, Council of Ontario Medical Chair, Boards of Health Officers of Health (COMOH) Section
COPY: Hon. Christine Elliott, Minister of Health Dr. David Williams, Chief Medical Officer of Health Alison Blair, Associate Deputy Minister, Pandemic Response and Recovery
The Association of Local Public Health Agencies (alPHa) is a not-for-profit organization that provides leadership to the boards of health and public health units in Ontario. alPHa advises and lends expertise to members on the governance, administration and management of health units. The Association also collaborates with governments and other health organizations, advocating for a strong, effective and efficient public health system in the province. Through policy analysis, discussion, collaboration, and advocacy, alPHa’s members and staff act to promote public health policies that form a strong foundation for the improvement of health promotion and protection, disease prevention and surveillance services in all of Ontario’s communities. BOH - CORRESPONDENCE - 13
Jackson Square, 185 King Street, Peterborough, ON K9J 2R8 P: 705-743-1000 or 1-877-743-0101 F: 705-743-2897 peterboroughpublichealth.ca
May 14, 2021
Honourable Doug Ford Premier of Ontario [email protected]
Dear Premier Ford,
On behalf of the Peterborough board of health, I would like to share our appreciation and support for your decision to extend the current Stay-at-Home Order that was set to expire on May 19 until at least June 2, 2021. Your announcement yesterday has come as good news for our communities in Peterborough, where we have seen a much slower decline in the incidence of daily COVID-19 cases than with previous provincial lock downs.
Although we understand the sacrifices that are required by our local operators and businesses, it is critical that when we do emerge from this period, we are able to sustain any gains made. We continue to make great progress with our vaccination roll-out but we will not have achieved the critical mass of fully immunized individuals by June 2nd and we must rely on a continuation of public health measures to prevent a resurgence.
With this in mind, we would like to propose three priorities for provincial leadership in order to prepare for June 2nd and a successful transition to recovery over the summer months:
First, we request that the province articulate the parameters that need to be achieved in order for the order to be lifted or modified. This includes clearly specifying goals such as daily new cases, transmission rates, test positivity rate, hospitalization and ICU capacity that will indicate when it is safe to ease the current restrictions. Sticking to the health measures will be much easier if we have specific goals to work towards.
Second, we urge that lower-risk outdoor activities be permitted. Communities are exhausted and the science supports the outdoors as a safer setting for physical activities such as play and recreation. Surely we can allow sports, exercise, and similar activities that can be done in small numbers, allow for physical distancing and other public health measures like the wearing of masks where necessary. For many of these spaces, the missing ingredient is the required supervision to ensure appropriate use. This may be a target for enhanced provincial funding to allow municipalities to step in to fill this gap.
Third, we believe that part of the encouragement for people to get vaccinated is the provision of the rationale. In other words, the descriptions of what additional activities can or loosened restrictions fully vaccinated individuals can expect. Now is the time to provide guidelines of what a fully vaccinated person can do with another fully vaccinated person – whether that may be to hug, eat together, share a visit with a parent in long- term care. We encourage the Premier to accept the invitation from alPHa, our provincial association of boards of health, for further input and advice on how best to ensure the success of Ontario’s COVID-19 response as we move into the summer months.
Serving the residents of Curve Lake and Hiawatha First Nations, and the County and City of Peterborough
The battle against COVID 19 and the management of the pandemic has highlighted the value of the partnership between public health and the government in protecting the health of Ontarians. As we move forward together to finish the job and as we consider the ongoing role of Public Health in a post-pandemic environment, we look forward to continuing the close collaboration with the government and other health care partners.
Once again, thank you, Premier, for taking action and communicating it clearly with us in a timely way.
Sincerely,
Original signed by
Mayor Andy Mitchell Chair, Board of Health cc: Hon. Christine Elliott, Minister of Health Dave Smith, MPP Peterborough-Kawartha David Piccini, MPP Northumberland-Peterborough South Laurie Scott, MPP Haliburton-Kawartha Lakes-Brock Curve Lake First Nation Council Hiawatha First Nation Council Peterborough City Council Peterborough County Council Association of Local Public Health Agencies Ontario Boards of Health
Serving the residents of Curve Lake and Hiawatha First Nations, and the County and City of Peterborough BOH - CORRESPONDENCE - 14
From: Lee and Bryan Fawcett
Hello Erin Please convey my heartfelt thanks to the board of health and Dr Arra for the lovely plaque and generous monetary gift acknowledging my years of service at the HU. Wow, very unexpected and gracious. Public health has been monumental through SARS, H1N1 and now COVID. Dr.Arra is doing a great job of leading everyone on this journey. it is History in the making. Take care until we meet again Big Virtual hug going out to you Sincerely Lee
BOH - CORRESPONDENCE - 15
May 27, 2021
Response to Delegation Questions
Dear Ms. Kanmacher, Ms. Moore Coburn, Mr. Greig, and Mr. Tamming
I write in response to two letters received by the Grey Bruce Health Unit Board of Directors in advance of your upcoming delegation. The first letter, “Recent Developments at the Grey Bruce Health Unit (GBHU)”, was sent on March 29th, attributed to all four of you. The second, entitled “Attention: Grey Bruce Health Unit Board of Health” was sent on May 20th, attributed to Ms. Moore Coburn and Ms. Kanmacher. Given the substantial overlap between the two requests, we have responded to all questions presented below. Before responding to your specific questions, we wish to address your underlying concerns about organizational strength and accountability directly.
The GBHU has a high-functioning, resilient team that has worked together on a public health COVID-19 response that has contained both cases and deaths to an extremely limited number relative to other jurisdictions. The region has led the way with a paradigm-changing vaccine distribution process that is being studied and used as a benchmark across the country and the GBHU has nimbly and responsibly taken steps to protect our most vulnerable populations.
Residents of Grey Bruce have a great deal to be proud of in their public health response, and the MOH has played a leading role in that response. Our Board is grateful for the work ethic and skill he has brought during this difficult time. Regarding compensation, the MOH’s salary is developed by the Ministry of Health and negotiated by the Ontario Medical Association. Overtime payments were established by the Board of Health for the Grey Bruce Health Unit, applying the same formula that was used with other unionized or non-unionized employees.
We hope that these responses will be of use to you and your constituents, so that we can work together and collaboratively on the public health response that is essential for Grey Bruce residents, in particular at this challenging time.
A healthier future for all. 101 17th Street East, Owen Sound, Ontario N4K 0A5 www.publichealthgreybruce.on.ca
519-376-9420 1-800-263-3456 Fax 519-376-0605
Re: “Attention: Grey Bruce Health Unit Board of Health”
To ensure a healthy, functioning, and effective public health unit, and in keeping with the principles of public accountability and transparency, we ask that the board immediately implement the following: 1. An audit of the current contract of the MOH, the process for determining and approving his 2020 OT pay, and his baseline salary as to how it falls within the Ministry’s MOH salary chart.
We certainly share the principles of public accountability and transparency and hope that daily correspondence with residents, media, and partners demonstrates this. As for this specific request, we have been clear that the MOH salary is determined by an agreed upon salary grid developed by the Ministry of Health and negotiated by the Ontario Medical Association. This grid can be found in the attached PDF.
Policy Framework_MOH Appointments_June 2020.pdf
Overtime pay was determined by the Board of Directors based on a consistent formula applied equally to all employees, whether unionized or non-unionized. All overtime payments have been covered by the province, which provided emergency funding for the additional staffing needs required for the COVID-19 response.
2. An independent, third-party human resources and management review of the organization, resulting in actions undertaken to improve the functioning of the Health Unit. This review should be made public and follow a process to ensure no retaliatory consequences for current and former staff who contribute to this investigation.
The Health Unit has a strong team of skilled managers. Their excellent underlying work, and the successes they have realized on behalf of all of us, reflect the crisp, tight and fully functioning nature of the organization. As you are aware, throughout 2020, and into 2021, Grey Bruce has been a leader in
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responding to the pandemic, and it has successfully been able to contain both cases and deaths to a relatively small number.
In light of the successes that the Unit has realized and its ability to address its public health functions, the engagement of an external consultant would not appear to be justified. Having said that, as we are constantly evolving as an organization, we certainly welcome and will carefully consider any specific suggestions that are provided to us with respect to improving the management of the Health Unit.
It is worth mentioning, based on recommendations from the MOH and the best practice, the recruitment and interviewing of all senior managers have taken place with active involvement of the Board through a committee. Similarly, all non-voluntary managerial departures took place with active oversight and involvement of the Board.
Re: “Recent Developments at the Grey Bruce Health Unit (GBHU)”
1. You asked that the MOH return the excess money he was paid and that it either be returned to the province or bonussed out to front line workers employed by the Board to fight the pandemic.
The Medical Officer of Health (MOH) did not receive any “excess money”. The MOH’s compensation was determined by an agreed upon salary grid that was developed by the Ministry of Health and negotiated by the Ontario Medical Association. The MOH overtime payments were established by the Board of Health for the GBHU, applying the same fair formula that was used with other unionized or non- unionized employees.
Further, it is important to emphasize clearly that the MOH’s compensation did not impact the pay of frontline workers. The provincial government provided additional funding to cover extraordinary expenses posed by the pandemic and all managers and staff (union/non-union) were (and are) eligible to receive overtime payments based on the applicable individual’s workload. While 2020 was an extraordinary year on many fronts, it is expected and hoped that all hours, including those of the MOH, will normalize as the pandemic becomes more manageable and the Associate Medical Officer of Health (AMOH) process is complete.
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In light of the above, the use of the term “excess money” is neither appropriate nor accurate.
2. You also asked that the Board bring in an Ontario Public Health consultant (HR and otherwise) to advise the Board and the MOH on improving the management of the Health Unit.
The Health Unit has a strong team of skilled managers. Their excellent underlying work, and the successes they have realized on behalf of all of us, reflect the crisp, tight and fully functioning nature of the organization. As you are aware, throughout 2020, and into 2021, Grey Bruce has been a leader in responding to the pandemic, and it has successfully been able to contain both cases and deaths to a relatively small number.
In light of the successes that the Unit has realized and its ability to address its public health functions, the engagement of an external consultant would not appear to be justified. Further, Ontario Public Health (PHO) is a scientific body with a mandate to provide scientific and technical advice and support, but it does not provide HR consultations. Having said that, as we are constantly evolving as an organization, we certainly welcome and will carefully consider any specific suggestions that are provided to us with respect to improving the management of the Health Unit.
3. You also asked the Board and the MOH be transparent with the public and answer the questions regarding process which we put to the Board at the end of this letter.
The Board and the MOH have been and will continue to be transparent.
As one example only, the MOH has engaged with Councillor Tamming extensively throughout the pandemic by phone calls, text, emails, his in-person site visit to the Health Unit and a deputation to Owen Sound Council, all to address various concerns that he has raised.
However, we appreciate that it may assist to have a comprehensive response in one place. We have done that below, and we trust that the below is satisfactory.
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Questions for GBHU Board
1. Will we ask the MOH to voluntarily disclose all aspects of his compensation?
GBHU’s employees are subject to existing disclosure requirements, including the annual province-wide Public Sector Salary Disclosure. Overtime pay submissions are carefully reviewed, and are publicly reported on every month in aggregate.
These processes address transparency, and supplementing them for the case of one individual is neither required nor would it be appropriate. We trust that you will appreciate that the request you have made would not only breach the MOH’s privacy and confidentiality, but could act as a chilling precedent for other public servants.
2. What was the MOH’s contractual annual base rate before the pandemic?
The MOH compensation was determined by an agreed upon salary grid developed by the Ministry of Health and negotiated by the Ontario Medical Association. This grid can be found in the attached PDF. The MOH’s compensation rates have been disclosed in previous versions of the Public Sector Salary Disclosure, which we have included here.
Policy Framework_MOH Appointments_June 2020.pdf
3. What “normal” hours were assumed for that annual base compensation?
The MOH’s base rate is 1,820 hours annually.
4. What “overtime” hours were worked in addition to those assumed base hours?
The MOH worked 1,412 overtime hours in 2020. The total (regular and overtime) for the year was 3,232 hours.
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5. Please provide a breakdown of all such hours, on a weekly basis.
As noted above, all reporting requirements have been met, and the MOH’s total annual compensation was disclosed via the Public Sector Salary Disclosure. Supplementing that reporting for the case of one individual is neither required, nor would it be appropriate.
6. What was he paid per overtime hour?
The overtime rate was established by the Board of Health using the same formula that was used for all other unionized or non-unionized employees. As we have noted, supplementing what has already been transparent reporting to single out one individual is neither required, nor appropriate.
7. Did the MOH vacation outside the country last year? If so, for what period of time did he both travel and quarantine at home?
The MOH did not travel outside of Ontario since the declaration of the pandemic. He was on a pre- pandemic leave from February 27 to March 11, 2020, and throughout that time continued to work remotely and maintain daily contact by phone and email with key individuals within the organization. At all times, as events unfolded, he remained available to all our managers, staff and partners.
8. Were other managers paid overtime or denied same?
All staff, managers, union, non-union (with the exception of the MOH) were, and continue to be, paid overtime according to the same fair formula that had been negotiated by the Health Unit unions. This was done by the MOH in the spring of 2020, when it quickly became evident that the workload of non-union staff would require a fair overtime formula to reflect the increased capacity. In September 2020, the Board unanimously decided to apply the same overtime formula to the MOH’s salary.
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All overtime was addressed by additional funding that had been provided by the provincial government to cover extraordinary expenses posed by the pandemic.
9. Did the Board in fact have prior knowledge of and approve all of his compensation for 2020 including overtime pay?
Yes. The Board unanimously decided to apply the same overtime formula to the MOH salary after a thorough discussion that acknowledged the points noted above, and the following:
. The extraordinary pandemic year coupled with the fact that the Health Unit did not have an Associate MOH with Ministerial approval resulted in a larger than average level of compensation.
. Disclosure would occur, as was appropriate, through the Sunshine List.
10. Did the Board as a whole have an ongoing idea of how much the MOH was billing for his overtime or were Board members as surprised as the public when the Sunshine List was published?
The Board was aware of the MOH’s, and others’, overtime. As is noted above, overtime pay submissions were, and are, carefully reviewed, and are publicly reported in aggregate every month.
11. Was any such approval of any aspect of his compensation made retroactively?
The MOH’s overtime payments for 2020 were established by the Board in September, 2020 and then paid. As is noted above, this was done applying the same formula used with other unionized or non-unionized employees. This decision followed the provincial government’s provision of additional funding to cover extraordinary expenses posed by the pandemic.
12. Did the Board seek and obtain legal advice on whether the overtime payments to the MOH were absolutely compulsory? Could the Board have said no?
This is not a legal issue. In August 2020, the Board directed the Corporate Director to seek advice, both
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internally and externally, on overtime payments for the MOH. This research included organizational history from the Walkerton Emergency, input from the Accountability Officer at the Ministry of Health, and available information from other health units. All three sources clearly indicated that overtime payments were the most fair practice.
13. Did the Board consider either declining available overtime funds from the province or sharing it more equitably among staff at the unit? If this was not possible, please explain why.
The board decided not to exclude the MOH from the overtime compensation that was provided by the province for all staff. All staff, whether unionized or non-unionized received overtime compensation based on the same formula for hours worked.
14. Were any constraints of any kind placed on the MOH’s overtime billings?
The MOH was compensated for the hours he worked from the funds provided by the province for this purpose. As mentioned above, The Board is grateful for the commitment the MOH showed, and the over and beyond sacrifices he made for our communities. His extra hours were submitted, reviewed, and paid according to the same process that was applied to other employees. If at any time, hours were inappropriate or inaccurately logged, they would not have been paid. However, that did not occur.
15. Did the Board consider whether, in addition to his dedication, the claimed overtime may have also reflect:
i) his inexperience; ii) a refusal or inability to delegate; or iii) The loss of middle and upper management under his tenure?
Every staff that claimed overtime was paid for hours worked from the funds provided by the province for this purpose. The excellent work that the Health Unit does every day demands a crisp, tight, and fully- functioning organization. This starts at the top. The Board was, and remains, extremely confident in the MOH’s leadership, and Grey Bruce residents are healthier and safer as a result of the work that the entire Health Unit has done under his leadership this year.
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Prior to being hired, the MOH was fully vetted based on the ministerial approval process, which includes reviews and verification of the physician specialty certification in Public Health and Preventive Medicine (PHPM) with the Royal College of Physicians and Surgeons of Canada (RCPSC), and the physician’s current membership card certifying registration for independent practice with the College of Physicians and Surgeons of Ontario (CPSO).
Additionally, the MOH currently holds two faculty positions in PHPM; one at the PHPM Residency training program, Northern Ontario School of Medicine, and the other at the Master of Public Health program, Western University. He holds a Master’s Degree in Epidemiology and Biostatistics from the Schulich School of Medicine, Western University, has completed a fellowship with the World Health Organization in PHPM, Copenhagen Denmark, and has achieved certification from the American Board of Preventative Medicine (ABPM).
Each of the PHPM-RCPSC and ABPM certifications is the “Gold Standard” in competency of practicing the specialty of Public Health in Canada and the US respectively. Each require mastery in Health Services Administration (Systems-Based Practice) and management of health organizations.
The Ministry of Health places a physician holding either specialty certification at the highest level of experiences on the MOH salary grid (found in the attached PDF). A handful of PHPM specialists in Ontario simultaneously hold both certifications.
Policy Framework_MOH Appointments_June 2020.pdf
We have no reason to second guess the MOH’s qualifications and are tremendously proud of the depth of experience that he brings to Grey Bruce.
The MOH’s ability to delegate may be the source of confusion on this point. While the contributions of physician consultants are certainly valued and appreciated, none of them had the legislative authority to undertake the on-call requirements of the MOH throughout the pandemic. Without anyone else having been approved by the Ministry, and as other MOHs were occupied discharging their duties to their health units, the MOH was left with no choice, but to be available 24/7 throughout this pandemic.
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Finally, the references in your letter to the loss of middle and upper management that occurred during the MOH’s tenure is overstated. Since his appointment in January 2019, eight managers have left, four of them voluntarily. The majority of the departures that were not voluntary resulted from provincial direction to reduce our budget by 10% in 2019. The reduction of managerial positions was deliberate, so that a potentially greater reduction in frontline staff could be avoided. All non-voluntary managerial departures took place with active oversight and involvement of our Board.
16. If the Board did not entertain these possibilities and intervene to reduce his claimed overtime, why not?
The submitted overtime was appropriate, and reduction would not have been warranted.
17. Did the Board know that the MOH’s compensation was going to outstrip by far every one of his Ontario peers in 2020, including very experienced MOHs?
Each situation is unique and it would be irresponsible to speak to the personal or professional circumstances of other MOHs. We can emphasize only that the GBHU’s MOH did not have the option of taking time off, as the Ministry requires an MOH on call 24/7. As such, recognizing the hours worked, the compensation provided to him in 2020 was proportionate and appropriate.
18. Did the Board consider the impact of such compensation and its inevitable disclosure on staff morale?
The Board is alive to staff morale issues at all times, as it is to public health issues. Having said that, it would have been inappropriate to arbitrarily reduce the MOH’s compensation in light of the level of work and responsibility with which he was charged.
19. Does the loss of management staff reflect a level of dysfunction within the organization?
The GBHU is a highly functioning organization. The GBHU has risen to the challenge providing the public with clear guidelines and with emergency response measures that have assisted to mitigate the serious
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threat posed by the pandemic. Throughout 2020, and into 2021, we have been leaders in responding to the pandemic, containing both cases and deaths to a relatively small number. By every metric, the story is one of success The Unit’s success speaks to its strength and health.
And while we have had a number of departures since 2019, the majority of which were voluntary, we did not lose positions. During the pandemic, the organization had approximately 60 new hires, including eight managers. These hires include professionals in nursing, inspectors, human resources, epidemiology, infection control, support staff and more.
While all are dealing with challenges during the pandemic, it is not accurate to say that there is dysfunction in the GBHU.
20. We urge you to examine whether women in particular are having difficulty fitting within the Health Unit, given that most of the remaining senior management is male.
The Board has been actively involved in recruiting and interviewing all senior managers. Based on recommendations by the MOH, recruitment of all senior management positions (directors, physician consultants) is through a committee made up of senior management, the Chair of the Board and at least one Board member. Furthermore, all non-voluntary managerial departures took place with active oversight and involvement of our Board.
There has not been a disproportionate number of women impacted by staffing reductions. Around 90 per cent of the GBHU’s employees and the majority of new employees are female. Therefore, any turnover will be mostly females. Having said that, the MOH has been, and remains, available to answer questions or to listen to feedback from employees on steps that the organization can take to evolve and grow as an inclusive, supportive employer.
Conclusion
We trust that you will find the answers to your questions posed satisfactory. We remain available for continued dialogue. At that same time, we unequivocally stand by the MOH and the dedication,
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leadership and effort that he has demonstrated, as well as the decisions and actions we have taken, both prior to and during this difficult and unprecedented time.
Sincerely,
Sue Paterson
Chair, Board of Directors for the Grey Bruce Health Unit cc: Board of Health for the Grey Bruce Health Unit
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Media Package
May 28, 2021
Board of Health Media Releases Summary – May 28, 2021
Item Date Sent Media Release Title Content of Media Releases
1 April 22, 2021 Grey Bruce COVID- The community responded to Grey Bruce's top doctor's critical threshold alarm 19 Critical Threshold and maintained complete control over the pandemic locally. That community- Overcome wide response to support the Grey Bruce Health Unit at the cusp of a critical threshold in COVID-19 cases was vital in containing any further surge in Grey Bruce.
Acknowledging the severe nature of the situation, the community responding by embracing public health's direction to stay-at-home. Many organizations and businesses went further by voluntarily shutting their doors for the critical 48-hour period.
2 April 23, 2021 Owen Sound COVID- The Grey Bruce Health Unit is relocating the Owen Sound Hockey Hub mass 19 Immunization immunization clinic to the Julie McArthur Regional Recreation Centre, 700 10th Clinic Relocating to St E, Owen Sound. This move is effective Thursday, April 29, 2021. Julie McArthur Regional Recreation Anyone currently booked to the Bayshore Community Centre should attend the Centre Julie McArthur Regional Recreation Centre instead. Times of appointments have not changed. Notification of the location change will go out by phone or email to those with appointments.
The move to the Julie McArthur Regional Recreation Centre will alleviate congestion and subsequent delays experienced at the Bayshore clinic.
3 April 26, 2021 Grey Bruce Health Having successfully contained the recent surge in cases of COVID-19 locally, Unit’s COVID-19 the Grey Bruce Health Unit is re-activating our telephone Helpline, 519-376- Help Line Re- 9420 ext. 3000. To prevent further transmission and support the large case Activated volume staff were re-assign from the Helpline to assist contact tracing and case management during the recent surge.
The Helpline provides general guidance related to COVID-19. It is not a vaccine
1
Board of Health Media Releases Summary – May 28, 2021
Item Date Sent Media Release Title Content of Media Releases
booking system or capable of managing booking system challenges. Most questions to the Helpline are answered on our website. As such, basic vaccine or COVID-19 questions in which the answer is easily available on our website or application will be referred to our website. We will respond to those without capacity to review the website.
4 April 26, 2021 Download Grey The Grey Bruce Health Unit, in partnership with Bruce Power and NPX Innovation, Bruce COVID-19 is pleased to announce the release of the Grey Bruce COVID-19 Vaccine App for Vaccine App Now residents of Grey and Bruce counties.
This application is now available free to download from the Google Play and Apple Stores for all mobile devices and tablets. To download, enter ‘gbvaccineapp’ into the search bar.
5 April 30, 2021 Grey Bruce – During the current Shutdown, marinas are addressed by Ontario Reg. Schedule Marinas and Boat 2. Marinas are permitted to repair or service watercraft, place boats or watercraft Launches in the water to be secured to a dock and carry out other services to support commercial and government operations or services and enable individuals to access their place of residence or other property. A marina may not be used for recreational boating purposes except those mentioned above.
6 April 30, 2021 Grey Bruce – Wait 16 As per the provincial direction based on the Ontario ethical framework, anyone Weeks for Second looking to book an appointment for the second COVID-19 vaccine MUST WAIT Dose 16 WEEKS from their first shot, unless they qualify for a specific exemption. Anyone booking, and showing up at a clinic for there second vaccine, before the 16-week wait will be turned away and not receive the shot.
The provincial direction and the ethical framework for Ontario are based on the National Advisory Committee on Immunization’s (NACI) scientific recommendations extending dose intervals for COVID-19 vaccines to optimize early vaccine rollout and population protection in Canada. 2
Board of Health Media Releases Summary – May 28, 2021
Item Date Sent Media Release Title Content of Media Releases
7 May 4, 2021 Grey Bruce – Local Provincial direction requires a four-month (16-week) interval between the first Vaccine Booking is and second dose of COVID-19 vaccines. As such, the Grey Bruce Health Unit First Dose Only local booking system for other eligible groups will allow for booking FIRST DOSE ONLY, at this time. Individuals who have already received a first dose will be flagged in the system and cancelled as well as turned away from the clinic. There is only one vaccine product on site for each first dose clinic.
8 May 6, 2021 Grey Bruce – An innovative partnership between family health, paramedic services and public COVID-19 Vaccines health is getting COVID-19 vaccine to those unable to leave their home for for Homebound health reasons. Residents Two-person teams comprised of staff from the Grey County Paramedic Services and the Owen Sound Family Health Team travel throughout Grey County to administer vaccine to those unable to attend a clinic due to medical issues.
Those receiving the vaccine must also meet eligibility criteria based on the Ontario ethical framework.
This service is available by calling public health at 1-800-263-3456 ext 3000 or by email at [email protected]. Do not call the family health team for an appointment.
9 May 10, 2021 COVID-19 Vaccine The Grey Bruce Health Unit is providing specially scheduled COVID-19 vaccine for clinics in order to meet the unique vaccination needs of immunocompromised Immunocompromised and pregnant patients. These clinics will primarily offer first dose vaccines to Patients those that qualify, as well as second dose vaccines for the select group that are currently eligible.
Special clinics will be held each Thursday, at designated times. Clinic is located at the Julie McArthur Centre in Owen Sound, but as the vaccine rollout moves
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Board of Health Media Releases Summary – May 28, 2021
Item Date Sent Media Release Title Content of Media Releases
forward, specific clinics may also be held in other locations. These clinics will accommodate between 50 and 100 clients per week.
10 May 12, 2021 COVID-19 Vaccines An innovative partnership between paramedic services and public health is for Homebound getting COVID-19 vaccine to those residents in Bruce County unable to leave Residents in Bruce their home for health reasons. County Teams comprised of staff from the Bruce County Paramedic Services travel throughout the county to administer vaccine to those unable to attend a clinic due to medical issues. Similar services are also available in Grey County from Grey County Paramedic Services.
Those receiving the vaccine must also meet eligibility criteria based on the Ontario ethical framework.
This service is available by calling public health at 1-800-263-3456 ext 3000 or by email at [email protected]. Do not call the Bruce County Paramedic Services for an appointment.
11 May 14, 2021 COVID-19 Cases The Grey Bruce Health Unit is working with two restaurants in Owen Sound to Associated with Two manage cases of COVID-19 in three of the restaurant team members. The Owen Sound restaurants, located at 925 10th Street East and 1595 16th Street East are Restaurants voluntarily closed until full complement of team members can return. These voluntary closures are NOT related to any assessed risk to the general public. The location at 925 10th Street East is deemed a workplace outbreak. There is no outbreak declared at the 1595 16th Street East location, at this time. The Grey Bruce Health Unit has assessed the risk to the general public and there is no risk for patrons of this establishment. Public Health is conducting the investigations and we will update the public with timely information.
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Board of Health Media Releases Summary – May 28, 2021
Item Date Sent Media Release Title Content of Media Releases
12 May 19, 2021 COVID-19 Safe We want to remind everyone of the importance of physical activity for children’s Playground wellbeing. As the weather improves, children are naturally drawn to outdoor activities, including parks and playground equipment. These are wonderful ways to remain active, but we must also ensure their safety, from COVID, the sun, and other potential hazards.
13 May 19, 2021 Public Assistance The Grey Bruce Health Unit is seeking assistance from the public in finding the Request Dog Scratch owner of a dog involved in a scratching incident that occurred in Eugenia near - Eugenia Hoggs Fall on the Bruce Trail. On Thursday, May 13, 2021 at approximately 6:00 pm, a man was scratched by a large black/brown dog. This dog was off- leash on the Bruce Trail near Hoggs falls. The victim was scratched while breaking up fight between his own dog and the other dog described above.
Staff of the Grey Bruce Health Unit need to confirm the dog is not infectious with rabies. By verifying the health of the dog, the victim can avoid receiving the post- exposure rabies treatment. If you have any information related to this incident, please contact the Grey Bruce Health Unit at 519-376-9420 ext 1518.
14 May 19, 2021 Provincial Stay-At- The Stay-at-Home order is in place until June 2, 2021, as the province continues Home Order to deal with the impacts of COVID-19. Remains in Place over Victoria Day Stay-At-Home means you are only allowed to gather indoors or outdoors with Weekend anyone you live with, and limit close contact to only members of your household (the people you live with). If you live alone, you can have close contact with only one other household.
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Board of Health Media Releases Summary – May 28, 2021
Item Date Sent Media Release Title Content of Media Releases
15 May 19, 2021 COVID-19 and There are restrictions in place for both campground operators as well as Campgrounds campers during the current lockdown.
Requirements for Operators
Campground operators must comply with public health advice on physical distancing, cleaning, and screening. Operators shall ensure that a person in an indoor area wears a mask or face covering.
Additionally, seasonal campgrounds/sites must:
be made available only for trailers and recreational vehicles that, o are used by individuals who are in need of housing, or o are permitted to be there by the terms of a full season contract. Only allow use of campsites with electricity, water service and facilities for sewage disposal. Close all recreational facilities in the campground and all other shared facilities in the campground, other than washrooms and showers. Close other areas of the seasonal campground to the general public. These areas must only be opened for the purpose of preparing the seasonal campground for reopening Comply with the province’s Stay-at-Home Order, which prohibits transient camping, such as weekend reservations at seasonal campgrounds.
We encourage operators to remind users that the Stay-At-Home restrictions allow seasonal campers to either visit their site for no more than 24 hours for an essential purpose, or for a minimum of 14 consecutive days.
Requirements for Users (i.e. Seasonal Campers)
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Board of Health Media Releases Summary – May 28, 2021
Item Date Sent Media Release Title Content of Media Releases
The provincial Stay-At-Home Order allows seasonal campers to visit their site for: no more than 24 hours for an essential purpose, or for a minimum of 14 consecutive days.
Trips outside of the home should be limited and only for essential purposes (accessing health care and medication, grocery shopping, child care, exercising alone or with people in your household and in the community where you live, walking pets when required, and supporting vulnerable community members to meet the needs above). Staying home is the best way to protect yourself and others.
16 May 20, 2021 UPDATED – The Stay-at-Home order is in place until June 2, 2021, as the province continues Provincial Stay-At- to deal with the impacts of COVID-19. Home Order Remains in Place Effective May 22, 2021, certain outdoor recreational amenities will reopen with over Victoria Day restrictions in place, such as the need to maintain physical distancing. These Weekend amenities include but are not limited to golf courses and driving ranges, soccer and other sports fields, tennis and basketball courts, and skate parks. No outdoor sports or recreational classes are permitted.
Outdoor limits for social gatherings and organized public events will be expanded to five people, which will allow these amenities to be used for up to five people, including with members of different households. All other public health and workplace safety measures under the province wide emergency brake will remain in effect.
17 May 20, 2021 Grey Bruce – The Province is amending Reg. 82/20 to allow marinas and boat clubs to open UPDATE Marinas for extended services including fueling and launching. and Boat Launches
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Board of Health Media Releases Summary – May 28, 2021
Item Date Sent Media Release Title Content of Media Releases
Recreational boating permitted but only members of a household can gather on a boat. Marinas / Boating Clubs may open with limited services including, repairs or servicing of boats, placing boats in water, and enabling individuals’ access to their residence or property.
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Board Report
Friday, May 28, 2021
Financial Report
Friday, May 28, 2021
MEMORANDUM
Date: May 28, 2021
Report To: Board of Health
Submitted By: Kim Rutherford, Manager of Finance Matthew McMurdie, Director of Corporate Services Subject: March 2021 Financial Statements and Capital Projects ______
March Financials Overview: Update: The financial statements now include the 2021 approved budget by the Board of Health. The Health Unit is still waiting for the budget approval announcement from the Ministry of Health to confirm funding amounts for 2021.
General: The deficit at the end of February 2021 was $867,254. This deficit is a result of increased expenditures relating to COVID-19 with no funding received to cover these costs. The annual budget which included a forecast of 2021 COVID-19 response and vaccine expenditures of $4.7 million was submitted to the Ministry of Health in May 2021. GBHU has been advised that the Ministry expects funding announcements in the summer, at which time cash flow for COVID-19 response and vaccine expenses should commence.
Statement of Operations YTD:
Revenues: Ministry of Health funding will be below budget until the 2021 funding announcement is received and an approved amount for COVID-19 response and vaccine expenses are confirmed.
The Ministry of Children, Community and Social Services as well as Health Canada both fund programs that operate on an off-calendar year. March 31 is the year-end for both of their respective programs. The revenues and expenses in this statement reflect the full year balances for these program (April 2020 – March 31, 2021). April 2021’s statement will present their new fiscal years.
Year-to-date salary and benefit totals are consistent with budgeted expectations and only above budget by $20,114. The budget includes forecasts and estimates relating to the timing of new hires, wage rates for new hires, overtime payments for existing staff. These variables all can result in variances to budget.
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IT Equipment, Software, Support and Supplies – IT purchased additional laptops to support the increased number of staff. The Health Unit also purchased the on-line booking system Verto to provide additional capacity and flexibility for scheduling the vaccine rollout. The finance department’s budgeting software implementation was also completed and the final fees for those services were paid.
Furniture and equipment – the two Belmont Dental Chairs that went to tender and then to Board for approval to purchase have been received and paid for.
Travel reflects the cost of reimbursing staff to travel to the various vaccine hubs setup in Grey and Bruce Counties with some travel occurring to supportGBHU’s continuity of operations.
The majority of the othering operating expense lines are in line with budgeted expectations and under spent as programs focus on responding to COVID-19 and the vaccine rollout.
Capital YTD:
Revenues and expenses are in line with expectations. No major renovations or projects were identified for 2021 in the Capital Reserve Study that was completed in 2019. The current budget includes an amount for unexpected building repairs and maintenance during the year.
Capital Projects:
Two Ontario Seniors Dental capital projects were approved as part of the Health Unit’s 2020 budget. Due to the size and scope of the projects, approval to carryforward this funding to 2021 was granted.
The Markdale clinic renovation started in March with the construction of a new chiropody room. Renovations to the main operatory room, reprocessing room and charting room are scheduled to start in May. An additional RFT was circulated for custom cabinets required in the space.
The Owen Sound clinic renovation is scheduled to start late May/early June. The project will include renovations to three (3) operatories, pan room, reprocessing room and storage/charting room. An additional RFT was circulated for custom cabinets required in the space.
2020 COVID-19 Funding Announcement
On April 1, 2021, the Grey Bruce Health Unit received notice that an additional $756,200 in one- time funding would be provided to support extraordinary costs incurred in 2020 for monitoring, detecting and containing COVID-19 in the province. That brought the total one-time funding for
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COVID-19 extraordinary costs in 2020 to $1,006,200 ($250,000 was approved on December 31, 2020).
This amount of funding was sufficient to cover the deficit originally reported at year-end. The 2020 fiscal year has now been fully funded.
Regulatory Reporting:
2021 Due Date Date filed / paid April CPP, EI and Personal Tax reporting and payment Apr 19 Apr 12 May 5 Apr 26
April EHT reporting and payment May 15 Apr 26 April WSIB reporting and payment May 30 May 13 April OMERS reporting and payment May 15 May 11 Draft 2021 Annual Service Plan Apr 1 Apr 1
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Page 3 of 4
COVID-19 Time Update:
The following graph illustrates the growing hours that have been required to respond to COVID-19 cases in addition to planning and setting up the three large vaccine hubs while maintaining continuity of operations for our programs.
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Grey Bruce Health Unit Statement of Operations - Combined For the Month Ended March 31, 2021
Current Month Fiscal Year to Date Annual Actual Budget Over/(Under) Actual Budget Over/(Under) Budget Revenue: Ministry of Health and Long Term Care 999,926 1,366,361 (366,435) 3,049,959 3,966,854 (916,895) 16,087,799 The Corporation of the County of Grey 139,736 142,415 (2,680) 419,207 413,464 5,744 1,676,825 The Corporation of the County of Bruce 99,006 100,906 (1,899) 297,019 292,951 4,068 1,188,081 Ministry of Children and Youth Services 91,850 91,850 (0) 1,102,211 1,102,211 - 1,102,211 Health Canada - 7,470 (7,470) 87,950 87,950 (0) 87,950 MOH/AMOH Funding 7,829 10,319 (2,490) 23,485 29,959 (6,474) 121,500 Occupancy Revenue from Programs 1,833 1,869 (36) 5,499 5,425 74 22,000 Direct from Clients 536 849 (313) 1,356 2,466 (1,110) 10,000 Interest 382 764 (382) 1,653 2,219 (566) 9,000 Miscellaneous Income 376 - 376 29,757 29,028 729 37,028
Total Revenue 1,341,474 1,722,804 (381,330) 5,018,097 5,932,527 (914,430) 20,342,394
Expenses: Salaries and Benefits Program Staff 796,083 754,704 41,379 2,613,291 2,617,920 (4,629) 8,570,658 Program Management 132,940 124,137 8,803 340,388 349,170 (8,782) 1,283,555 Program Support Staff 96,247 92,824 3,423 272,617 302,896 (30,279) 1,104,650 Administration 284,280 313,224 (28,944) 650,749 630,798 19,951 1,993,960 Benefits 268,077 253,051 15,026 886,896 891,115 (4,219) 3,061,906 Total Salaries and Benefits 1,577,627 1,537,940 39,687 4,763,941 4,791,898 (27,957) 16,014,730
Occupancy Building and Ground Maintenance 5,794 6,001 (206) 22,314 17,270 5,044 70,300 Maintenance Salary & Benefits 33,304 18,460 14,845 76,632 54,465 22,167 219,382 Internal Rent/Mortgage 91,333 93,085 (1,752) 274,000 270,247 3,753 1,096,000 External Rent 2,366 3,497 (1,131) 8,012 11,521 (3,509) 41,219 Utilities 10,524 12,567 (2,043) 30,776 36,500 (5,725) 148,000 Maintenance Supplies 788 2,182 (1,394) 4,722 6,340 (1,617) 25,704 Total Occupancy 144,110 135,791 8,318 416,456 396,342 20,114 1,600,605
Operating Expenses Accommodation - 1,492 (1,492) 9 5,844 (5,835) 17,606 Associations & Memberships 1,579 2,434 (855) 4,614 7,218 (2,604) 28,663 Audit 2,894 2,954 (60) 10,931 10,849 82 34,832 Bank Charges 925 566 359 1,602 1,643 (41) 6,664 Board Expenses 64 218 (154) 64 632 (568) 2,564 Board Honoraria 1,166 1,462 (296) 1,640 4,245 (2,605) 17,215 Dentist Fees 10,555 15,387 (4,833) 29,468 44,672 (15,205) 181,170 IT Equipment, Software, Support and Supplies 119,503 44,797 74,705 199,226 140,063 59,162 527,701 Internal Allocation 1,833 1,853 (20) 12,996 12,959 37 22,000 Furniture and Equipment 45,380 491 44,889 48,646 1,426 47,220 5,784 Legal and Negotiations 13,139 6,879 6,260 17,215 19,973 (2,758) 81,000 Liability Insurance 11,396 11,614 (219) 34,187 33,719 468 136,750 Office Supplies 2,398 863 1,535 4,454 2,507 1,947 10,167 Inventory to be expensed at year-end 44,001 - 44,001 44,001 - 44,001 - Postage and Courier 1,075 1,766 (691) 5,509 5,126 383 20,789 Professional Development 3,539 3,230 309 6,146 14,684 (8,538) 38,164 Program Materials, PPE, Supplies and Printing 35,282 58,609 (23,327) 147,666 209,531 (61,865) 727,734 Public Education 4,487 9,781 (5,294) 12,909 28,398 (15,489) 115,169 Purchased Services\Consulting Fees 9,893 30,724 (20,831) 23,885 89,571 (65,686) 362,616 Telephone 7,092 8,993 (1,901) 24,162 30,658 (6,495) 106,000 Travel 29,897 23,805 6,093 74,062 107,349 (33,288) 281,228 Other Expenses 1,310 275 1,034 1,562 800 763 3,243 Total Operating Expenses 347,407 228,194 119,213 704,954 771,866 (66,913) 2,727,058
Total Expenditures 2,069,144 1,901,925 167,218 5,885,351 5,960,107 (74,756) 20,342,394
Surplus/(Deficit) (727,670) (179,121) (548,548) (867,254) (27,580) (839,675) 0 Grey Bruce Health Unit Capital Income Statement For the Month Ended March 31, 2021
Fiscal Year to Date
Variance Budget Actual Budget Annual Budget Over/(Under) Remaining
Revenue Rental Income - MOE 31,288 30,884 405 125,250 93,962 Interest 1,875 1,792 83 7,500 5,625 Internal Rent 274,000 270,247 3,753 1,096,000 822,000 Total Revenue 307,163 302,922 4,241 1,228,750 921,587
Expenditures Repairs and maintenance - 9,863 (9,863) 40,000 40,000 Mortgage Interest 109,607 109,078 529 428,516 318,909 Mortgage Principle 147,000 147,000 - 601,000 454,000 Total Expenses 256,607 265,941 (9,334) 1,069,516 812,909
Total Surplus (Deficit) 50,556 36,981 13,575 159,234 108,678
Opening Surplus/(Deficit) 1,656,544 Ending Surplus/(Deficit) 1,707,100
Note 1: Mortgage payments are made quarterly with payments on the following dates: February 1, 2021 May 1, 2021 August 1, 2021 November 2021 Capital Projects
Project 1 Grey Bruce Health Unit Ontario Senior's Dental Capital - Owen Sound Clinic Renovations For the Month Ended March 31, 2021
Estimated Cost Total Estimated Project Actuals Total Budget (Over)/Under to Complete Cost
Funding Ministry of Health One Time Funding 100% - 320,000 320,000 320,000 - Total Funding - 320,000 320,000 320,000 -
Expenditures Clinic renovations (leasehold improvements) - 100,100 100,100 320,000 219,900 Total Expenses - 100,100 100,100 320,000 219,900
Project (Over)/Under - 219,900 219,900 - 219,900
Project 2 Grey Bruce Health Unit Ontario Senior's Dental Capital - Markdale Clinic Renovations For the Month Ended March 31, 2021
Estimated Cost Total Estimated Project Actuals Total Budget (Over)/Under to Complete Cost
Funding Ministry of Health One Time Funding 100% - 336,900 336,900 336,900 - Total Funding - 336,900 336,900 336,900 -
Expenditures Clinic renovations (leasehold improvements) 38,698 165,012 203,710 336,900 133,190 Total Expenses 38,698 165,012 203,710 336,900 133,190
Project (Over)/Under (38,698) 171,888 133,190 - 133,190
Other Business
Friday May 28, 2021 To: Chairs and Members of Boards of Health Medical Officers of Health alPHa Board of Directors Presidents of Affiliate Organizations From: Loretta Ryan, Executive Director Subject: alPHa Resolutions for Consideration at the June 8, 2021 Annual General Meeting Date: May 10, 2021
Please find enclosed a package of the resolutions to be considered at the Resolutions Session taking place during the 2021 Annual General Meeting (AGM).
This resolution was received prior to the deadline for advance circulation. It has been reviewed and recommended by the alPHa Executive Committee to go forward for discussion at the Resolutions Session. (As of this writing, late resolutions were not received and are not included in this package. Late resolutions are indicated as such and not typically reviewed by the Executive Committee.)
Sponsors of resolutions should be prepared to have a delegate introduce and move the resolution(s).
IMPORTANT NOTE FOR LATE RESOLUTIONS:
Late resolutions (i.e., those brought to the virtual floor) will be accepted, but please note that any late resolution must come from a Health Unit, the Board of Health Section, the Council of Medical Officers of Health, the Board of Directors or an Affiliate Member Organization of alPHa. These may not come from an individual acting alone.
To have a late resolution considered it must be first submitted in writing to [email protected] by 4:30 pm on Thursday, May 27, 2021. The Chair will quickly review the resolution to determine whether it meets the criteria of a proposed resolution as per the "Procedural Guidelines for alPHa Resolutions".
If the resolution meets these guidelines, it proceeds to the membership to vote on whether there is time to consider it. A successful vote will garner a 2/3 majority support. If this is attained, it will be displayed on the screen and read aloud by its sponsor followed by a discussion and vote. Any late
1 resolution(s) will go through this process.
We value timely and important resolutions and want to ensure that there is a process to consider all resolutions.
IMPORTANT NOTE FOR VOTING DELEGATES:
Members must register to vote at the Resolutions Session. A registration form is attached. Health Units must indicate who they are sending as voting delegates and which delegates will require a proxy vote on or before 4:30 pm on June 1, 2021. Only one proxy vote is allowed per person.
Eligible voting delegates include Medical Officers of Health, Associate Medical Officers of Health, Acting Medical Officers of Health, members of a Board of Health and senior members in any of alPHa's Affiliate Member Organizations. Each delegate will be voting on behalf of their health unit/board of health.
Delegates who are voting will receive special log in instructions for voting purposes shortly before the conference.
Attached is a list describing the number of votes for which each Health Unit qualifies.
If you have any questions on the above, please contact Loretta Ryan, Executive Director, 416-595-0006, x 222.
Enclosures: Resolutions Voting Registration Form Proxy Voting for Resolutions Number of Resolutions Votes Eligible Per Health Unit June 2021 Resolutions for Consideration
2 480 University Avenue Suite 300 Toronto ON M5B 1J3 Tel: (416) 595-0006 Fax: (416) 595-0030 E-mail: [email protected]
Providing leadership in public health management
2021 alPHa Resolutions Session 10:30 AM to 11:30 AM alPHa Annual General Meeting
REGISTRATION FORM FOR VOTING
Health Unit
Contact Person & Title
Phone Number & E-mail _
Name(s) of Voting Delegate(s):
Name and email address Proxy* Is this person (Check this box if the registered to attend person requires a proxy the alPHa Annual voting card. Only one Conference? (Y/N) proxy is allowed per delegate.) 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
Please email this form to [email protected] by 4:30 pm on June 1, 2021 .
* Each voting delegate may carry their own vote plus one proxy vote for an absent delegate. For any health unit, the total number of regular plus proxy votes cannot exceed the total number of voting delegates allotted to that health unit.
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Number of Resolutions Votes Eligible Per Health Unit
HEATLH UNITS VOTING DELEGATES
Toronto* 20
POPULATION OVER 400,000 7 Durham Halton Hamilton Middlesex-London Niagara Ottawa Peel Simcoe-Muskoka Waterloo York
POPULATION OVER 300,000 6 Windsor-Essex
POPULATION OVER 200,000 5 Eastern Ontario Kingston, Frontenac, Lennox and Addington Southwestern Wellington-Dufferin-Guelph
POPULATION UNDER 200,000 4 Algoma Brant Chatham-Kent Grey Bruce Haldimand-Norfolk Haliburton, Kawartha, Pine-Ridge Hastings-Prince Edward Huron Lambton Leeds, Grenville and Lanark North Bay Parry Sound Northwestern Perth Peterborough Porcupine Renfrew Sudbury Thunder Bay Timiskaming
* total number of votes for Toronto endorsed by membership at 1998 Annual Conference
Health Unit population statistics taken from: Statistics Canada. 2011 Census. Census Profile.
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2021 alPHa Resolutions Session 10:30 AM to 11:30 AM alPHa Annual General Meeting
PROXY VOTING FOR RESOLUTIONS - EXAMPLES
If a health unit is entitled to a maximum of 5 votes and they have 5 registered attendees, each of whom are eligible to vote, the health unit will not be entitled to any further votes, proxy or otherwise, beyond their allotted five votes.
Scenario 1: A health unit is entitled to 5 votes and there will be 5 eligible voters attending the Resolutions Session:
Person A gets 1 vote Person B gets 1 vote Person C gets 1 vote Person D gets 1 vote Person E gets 1 vote TOTAL: 5 votes allocated (since 5 is the maximum the HU is entitled to)
Here in this case, nobody is assigned the proxy because there are enough eligible voters attending the Session.
The proxy vote is used only when the maximum number of votes is not met by the number of eligible voters. For example:
Scenario 2: A health unit is entitled to 5 votes and only 3 eligible voters are attending the Resolutions Session:
Person A gets 1 vote + 1 proxy = 2 votes allocated Person B gets 1 vote + 1 proxy = 2 votes allocated Person C gets 1 vote (no proxy) = 1 vote allocated TOTAL = 5 votes allocated (since 5 is the maximum the HU is entitled to use)
You will note that in the above scenario, an eligible voter may carry 1 vote + 1 proxy, provided the maximum number of votes for his/her health unit is not exceeded. Each delegate can only carry a maximum of one proxy.
The health unit must decide (before the conference) which of its conference attendees should be assigned voting privileges (usually some combination of the MOH, Chair of BOH, BOH members, and if none of these are attending, then a senior manager who is allowed to vote on behalf of the board of health). By completing the attached Voting Registration Form in advance, this allows the health unit to determine beforehand who will be voting.
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Resolutions for Consideration 2021
Resolutions Session 2021 Annual General Meeting Monday, June 8, 2021 Online
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Resolution Title Sponsor Page # A21-1 REDUCING THE HARMS, THE AVAILABILITY AND Middlesex-London 1 YOUTH APPEAL OF ELECTRONIC CIGARETTES Board Of Health AND VAPING PRODUCTS THROUGH REGULATION
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DRAFT alPHa RESOLUTION A21-1
TITLE: Reducing the Harms, the Availability and Youth Appeal of Electronic Cigarettes and Vaping Products through Regulation
SPONSOR: Middlesex-London Board of Health
WHEREAS electronic cigarettes (e-cigarettes), also referred to as electronic nicotine delivery systems, vapour products, vapes or vapourizers, were first introduced into the Canadian market in 2004; and
WHEREAS an alPHa resolution in 2014 requested that Health Canada and the Ontario Ministry of Health and Long-Term Care provide for the public health, safety and welfare of all Ontario residents by: ensuring manufacturing consistency of e-cigarettes; conducting research on the long-term health effects of e-cigarettes and exposure to secondhand vapour; and, regulating the promotion, sale and use of e-cigarettes in Ontario; and
WHEREAS there are no long-term studies on the health effects of using e-cigarettes that can conclusively show they do not pose a health risk to the user; and
WHEREAS there is substantial evidence that some chemicals present in e-cigarette aerosols are capable of causing DNA damage and mutagenesis, and that long-term exposure to e- cigarette aerosols could increase the risk of cancer and adverse reproductive outcomes; and
WHEREAS there is inconclusive evidence that e-cigarettes are effective as a cessation tool to help people break their addiction to nicotine; and
WHEREAS in Canada, most people who use e-cigarettes also smoke tobacco cigarettes (dual users), maintaining tobacco use and nicotine addiction over time; and
WHEREAS data shows that the concurrent use of cigarettes and e-cigarettes is even more dangerous than smoking cigarettes alone due to increased exposure to toxicants and nicotine; and
WHEREAS the use of e-cigarettes has grown at an exponential rate, with a 74% increase in youth vaping in Canada from 8.4% in 2017 to 14.6% in 2018; and
WHEREAS e-cigarette prevalence rates among Canadian grade 7 to 12 students have doubled from 10% in 2016-17 to 20% in 2018-19, with prevalence rates of past-30-day use being higher among students in grades 10 to 12 (29%) than those in grades 7 to 9 (11%); and
WHEREAS 56% of Ontario students in grades 7 to 12 who have used an e-cigarette in the past year are vaping nicotine; and
WHEREAS there is substantial evidence that e-cigarette use increases the risk of cigarette smoking initiation among non-smoking youth and young adults; and
8 WHEREAS simulation models in the United States show e-cigarette use represents more population- level health harms than benefits, with an estimated 80 youth and young adults starting to use an e-cigarette product for every cigarette smoker who quits; and
WHEREAS a January 2020 statement from the Council of Chief Medical Officers of Health (CCMOH) outlines regulatory and policy recommendations for the federal, provincial/territorial and municipal governments to address the rapidly emerging public health threat of increased vaping prevalence; and
WHEREAS As of July 1st, 2020, the sale of most flavoured vaping products and all vaping products with nicotine concentrations higher than 20 mg/mL are restricted to specialty vape stores and provincially licensed cannabis retail outlets because they are age-restricted (19 years plus) retail environments; and
WHEREAS In Ontario, the sale of menthol, mint and tobacco-flavoured e-cigarettes are permitted at convenience stores, gas stations, and any other retail environment where children and youth have access; and
WHEREAS additional regulatory measures will serve to further strengthen the goal of tobacco use prevention, cessation and a reduction in use of all nicotine-containing products by regulating vapour products as equivalent to commercial tobacco products;
NOW THEREFORE BE IT RESOLVED that the Association of Local Public Health Agencies (alPHa) write to the federal and provincial Ministers of Health acknowledging the steps already taken by the Governments of Canada and of Ontario to address the epidemic of youth vaping, and urge that they enact the following policy measures based on those recommended by the Council of Chief Medical Officers of Health:
• A ban on all vapour product and e-substance flavours except tobacco; • A cap on the nicotine concentration levels in any vapour product to 20 mg/mL, in alignment with the European Union Tobacco Products Directive; • The application of the same plain and standardized packaging regime that is applied to commercial tobacco products and accessories to vapour products; • The enforcement of strict age-verification measures for online sales, including age-verification at time of purchase and proof of legal age at delivery; • Limit tobacco and vapour product and accessory sales to licensed, age-restricted tobacconists, specialty vape shops and cannabis retail shops respectively; • The enactment of a tax regime on vapour products and the establishment of product set price minimums to discourage use of all tobacco and vaping products; and, • An increase to the legal age for the sale and supply of tobacco and vaping products and accessories to 21 years of age.
AND FURTHER that alPHa advise all Ontario Boards of Health to advocate for and support local municipalities to develop bylaws to regulate the retail sale and the use of tobacco and vapour products;
AND FURTHER, that the Prime Minister of Canada, the Chief Public Health Officer of Canada, the Premier of Ontario and the Chief Medical Officer of Health of Ontario be so advised.
Supplementary information attached (14 pages)
9 Statement of Sponsor Commitment
The Middlesex-London Board of Health share the concerns of Health Canada and the Ontario Ministry of Health regarding the increase in vapour product use by young people in Canada. The Board is encouraged by the commitment to develop regulatory measures to reduce youth access and appeal of vaping products. The popularity of e-cigarettes has been explosive among our youth. It threatens to addict a whole new generation to nicotine products, reversing what has been a downward trend in smoking rates and nicotine addiction among Canadian youth. We are not alone in our concern. Our public health staff are working closely with our school communities, municipalities and public health partners to counter the use and popularity of e-cigarettes to prevent youth, young adults and non- tobacco users from becoming addicted to vaping products. Using a comprehensive approach that includes education and awareness targeted to youth, parents and adult influencers, and the enforcement of the Smoke-Free Ontario Act, 2017, we are committed to helping our youth develop the personal skills that will support their efforts to adopt healthy lifestyle behaviours free of all tobacco industry products. However, despite our concerted efforts to prevent initiation of vapour product use and addiction to nicotine among youth, we are being met with limited success because of the allure and attraction of these products. The ease of accessing vaping products at corner stores and through online sales, the smoother vaping experience provided by the development of nicotine salts, and despite some regulation the continued availability of high nicotine concentrations and flavours, has posed significant challenges in our efforts to halt vapour product uptake.
Under the Smoke-Free Ontario Act, 2017, smoking and the use of vaping products is prohibited on school grounds and within 20 metres of school property. The use of vaping products inside and outdoors on school property has become a substantial problem for elementary and secondary school staff. In the 2018-2019 school year, Tobacco Enforcement Officers (TEOs) with the Middlesex-London Health Unit issued 207 warnings and charges in 2018-2019 by Health Unit Inspectors responsible for enforcing the Smoke-free Ontario Act, 2017. As of February 2020, just prior to the pandemic shut down, 151 warnings and charges for the 2019-2020 school year have been issued. Health Unit Inspectors report that students caught vaping on school property often state that because of their addiction to nicotine, they are unable to wait for class breaks to leave school property to vape, and instead they are choosing to vape inside school washrooms, change rooms, classrooms and on school buses. Public Health Nurses working in our secondary schools have reported that students are sharing with them alarming experiences of adverse reactions to high doses of nicotine, including headaches, nausea, elevated heart rate, general malaise, and, in extreme situations, seizures. Data from the 2019 Ontario Student Drug Use and Health Survey shows that in Middlesex-London, 19%* (11.8-29.1%) of students in grades 7 to 12 reported weekly or daily e-cigarette use (vaping) in the past 12 months (*interpret with caution).
Too much remains unknown about the short- and long-term health effects of vaping to ignore this growing public health issue. Across Canada, as of February 18, 2020, there were 18 cases of 14Tvaping- associated lung illness1 reported to the Public Health Agency of Canada, resulting in the hospitalization of 14 people including a 17-year-old high school student from the London area who spent 47 days in the hospital, part of it on life support (Government of Canada, 2020). In the United States, as of February 18, 2020, there have been a total of 2807 hospitalized 14Te-cigarette or vaping product use-associated lung injury (14TEVALI) cases including 68 deaths (CDC, 2020). At this time, there has yet to be a consistent product, substance, or additive that has been isolated as the cause in these cases. Continued efforts are needed from all levels of government to address the harms, the availability and youth appeal of e- cigarettes and vaping products through regulations like those contained in this resolution.
10 Dr. Christopher Mackie, Medical Officer of Health for the Middlesex-London Health Unit will be able to provide clarification on this resolution at the alPHa Annual General Meeting in June.
Background Summary
Electronic cigarettes (e-cigarettes), also referred to as electronic nicotine delivery systems, vapour products, vapes or vapourizers were first introduced into the Canadian market in 2004 (Heart and Stroke Foundation, 2018). In 2014, alPHa Resolution A14-2, “Regulating the Manufacture, Sale, Promotion, Display, and Use of E-Cigarettes” was carried at the Annual General Meeting. The resolution requested that Health Canada and the Ontario Ministry of Health and Long-Term Care provide for the public health, safety and welfare of all Ontario residents by ensuring manufacturing consistency of e- cigarettes; conducting research on the long-term health effects of e-cigarettes and exposure to secondhand vapour; and regulating the promotion, sale and use of e-cigarettes in Ontario (Association of Local Public Health Agencies, 2014). Since 2014, the e-cigarettes available in the market have rapidly evolved and the growing public health concerns associated with product safety and an exponential increase in youth vaping have prompted the need for stricter regulations and immediate public health intervention. A January 2020 statement was released by the Council of Chief Medical Officers of Health (CCMOH), outlining regulatory and policy recommendations for the federal, provincial/territorial and municipal governments to address the rapidly emerging public health threat of increased prevalence of vaping (Public Health Agency of Canada, 2020).
When vaping products initially entered the market, they closely resembled a traditional cigarette, however, now they have become complex units that come in different shapes and sizes, with features that allow for customization in device configuration. There are newer products on the market, such as JUUL, SMOK, and VYPE, that use nicotine salts in novel, youth-friendly USB designs. These products have a higher nicotine content, and have become immensely popular with youth, due to their small, discrete design and recharging capabilities using computers and phone chargers (American Cancer Society, 2020).
In May 2018, Bill S-5, An Act to Amend the Tobacco Act and Non-Smokers’ Health Act, received Royal Assent and e-cigarettes, with or without nicotine, became legal in Canada. According to Health Canada (2018), this new legislative framework applied a harm reduction approach to vaping product regulations, striking a “balance between protecting youth from nicotine addiction and tobacco use, and allowing adults to legally access vaping products as a less harmful alternative to cigarettes” (Health Canada, 2018). The opening of the legal e-cigarette market in Canada led to increased vapour product availability and promotion, contributing to an exponential increase in vaping prevalence rates (Hammond, et al., 2019). The legalization of vaping products containing nicotine occurred despite firm evidence that they were effective as cessation devices and without conclusive evidence regarding their safety.
Health Effects of Vaping
Emerging data suggests that vapour products may be safer than combustible tobacco products; however, this data is not yet conclusive, and there is consensus among the public health community that vapour products and the aerosol that vaping devices produce are not harmless (U.S. Department of Health and Human Services, 2016).
11 Vaping devices are still relatively new, and more research is needed to fully understand both the short- and long-term health risks associated with vaping. According to Bhatta and Glantz (2019), the use of e- cigarettes appears to be an independent risk factor for the development of respiratory disease, but more longitudinal studies are needed. In the absence of conclusive longitudinal evidence, there is consensus that vapour products expose users to harmful toxins, including cancer-causing chemicals, diacetyl, volatile organic compounds, heavy metals, and ultrafine particles that can be inhaled deeply into the lungs (Centers for Disease Control and Prevention, 2020; U.S. Department of Health and Human Services, 2016; National Academies and Science, Engineering and Medicine (NASEM), 2018). These substances have been linked to increased cardiovascular and non-cancer lung disease (U.S. Department of Health and Human Services, 2016). Additionally, there is substantial evidence that some chemicals present in e-cigarette aerosols are capable of causing DNA damage and mutagenesis, and that long-term exposure to e-cigarette aerosols could increase risk of cancer and adverse reproductive outcomes (NASEM, 2018).
Vaping Products for Cessation Requires Further Review
E-cigarettes are marketed by the vapour product industry as a tool to help people quit smoking. Available evidence indicates that e-cigarettes deliver lower levels of carcinogens than conventional cigarettes, and according to NASEM (2018), there is conclusive evidence that completely substituting e- cigarettes for combustible tobacco cigarettes reduces users’ exposure to numerous toxicants and carcinogens present in combustible tobacco. However, there is no safe level of exposure to commercial tobacco smoke (Inoue-Choi, et al., 2016) and there is inconclusive evidence that e-cigarettes are effective as a cessation tool to help people break their addiction to nicotine (U.S. Department of Health and Human Services, 2020; NASEM, 2018). Vaping products have not been approved by Health Canada as a smoking cessation aid because they are not currently tested, manufactured, and regulated as such in Canada.
Dual use, a term used to describe the concurrent use of e-cigarettes and tobacco cigarettes, is a real concern that can compromise cessation efforts among cigarette smokers (Czoli, et al., 2019). According to a recent Canadian report published by the Propel Centre for Population Health Impact at the University of Waterloo, half (52.7%) of e-cigarette ever users and a majority (64.58%) of past 30-day e- cigarettes users also reported being current smokers, suggesting that the rate of dual use in Canada is high (Reid, et al., 2019). Overall, nearly half (44.6%) of e-cigarette ever users who were also cigarette smokers reported using an e-cigarette when they were unable to smoke, or to smoke fewer cigarettes (Reid, et al., 2019). Dual users often report using e-cigarettes to help them quit or to reduce their smoking (Czoli, et al., 2019; Wang, et al., 2018). However, for cigarette smokers trying to quit smoking using vaping products, the use of e-cigarettes is associated with lower odds of being successful in their quit attempt (Kalkhoran & Glantz, 2016; Glantz & Bareham, 2018). Maintaining tobacco use and nicotine addiction through dual use may also pose additional health risks to the user. Compared to individuals who only use e-cigarettes, there is emerging evidence that dual users have increased risk of breathing difficulties, asthma and chronic obstructive pulmonary disease, which is indicative of adverse health effects on the respiratory system (Wang et al., 2018; Bhatta & Glantz, 2019).
Youth Vaping and Nicotine Addiction
Youth vaping rates are increasing at an alarming rate, with a 74% increase in vaping among Canadian youth observed from 2017 to 2018 (Hammond, et al., 2019). Results from the 2018-19 Canadian Student Tobacco, Alcohol and Drugs Survey (CSTADS) show that e-cigarette prevalence rates among Canadian
12 grade 7 to 12 students have doubled from 10% in 2016-17 to 20% in 2018-19, with prevalence rates of past 30-day use being higher among students in grades 10 to 12 (29%) than those in grades 7 to 9 (11%) (Health Canada, 2019). Of additional concern, the results indicate that students who reported using an e-cigarette (with or without nicotine) in the past 30 days are vaping frequently, with approximately 40% reporting daily or almost daily use (Health Canada, 2019). The 2019 Ontario Student Drug Use and Health Survey (OSDUHS) reinforces the need for intensive public health intervention. Vaping rates have doubled among Ontario students in grades 7 to 12 in the two-year survey period between 2017 and 2019, with 23% reporting e-cigarette use in the past year (184, 200 students) compared to 11% in 2017 (Boak, et al., 2019). About 13%, or 1 in 8 report using an e-cigarette weekly or daily, which is up from 2% in 2015 (Boak, et al., 2019).
According to the manufacturer, a single pod that is used in the JUUL e-cigarette device contains as much nicotine as a pack of cigarettes (Willett, et al., 2018). Nicotine is a highly addictive substance that can have adverse effects on the developing brain (Health Canada, 2019; NASEM, 2018, U.S. Department of Health and Human Services, 2016). Research has shown that exposure to nicotine before the age of 25 can negatively alter the brain and can cause long-lasting negative effects on attention, memory, concentration, and learning, decreased impulse control, increased risk of experiencing mood disorders (such as depression and anxiety), and increased risk of developing nicotine dependence and addiction. (NASEM, 2018; Health Canada, 2019; Goriounova & Mansvelder, 2012). Compared to the adult brain, an adolescent brain finds nicotine more rewarding and will progress faster to nicotine dependence and addiction (Goriounova & Mansvelder, 2012; Health Canada, 2019). Some vapour devices have the capability of delivering higher amounts of nicotine compared to conventional cigarettes, which could put young people at even greater risk of developing nicotine dependence (U.S. Department of Health and Human Services, 2016). The OSDUHS data illustrates that over- exposure to nicotine by young people is a public health concern; 56% of Ontario students in grades 7 to 12 who have used an e-cigarette in the past year (2019) are vaping nicotine, a significant increase from 2015 when only 18.8% of students reported vaping with nicotine (Boak, et al., 2019).
In addition, there is substantial evidence that e-cigarette use increases the risk of ever using combustible tobacco cigarettes among youth and young adults (NASEM, 2018). One study found that young people who use e-cigarettes are four times more likely to smoke tobacco cigarettes; an effect that is especially pronounced in low-risk youth who do not exhibit risky behaviours, sensation-seeking personality traits, or cigarette susceptibility (Berry, et al, 2019). When attempting to weigh the harms against the potential benefits that e-cigarettes may yield through cessation and harm reduction, the current state of evidence is concerning. Simulation models that have been tested in the United States show e-cigarette use represents more population-level health harms than benefits, with an estimated 80 youth and young adults starting to use an e-cigarette product for every cigarette smoker who quits (Soneji, et al., 2018).
Current State of Vapour Product Regulations
On December 21PstP, 2019, Health Canada published the Vaping Products Promotion Regulations (VPPR), in the Canada Gazette, Part I. The proposed regulations intend to address the rapid increase in youth vaping, to raise awareness about the harms of vapour product use, and to mitigate the impact of vaping product promotion on young persons and non-users of tobacco products. On August 7, 2020 the final Vaping Products Promotion Regulations came into force with the exception of the point-of-sale display prohibition, which came into force on September 6, 2020. The regulations prohibit advertising that can be seen or heard by young people; prohibit the display of vaping products that can be seen by
13 youth at point of sale; and, require that all vaping product advertisements convey a health warning (Health Canada, 2019). Health Canada had also proposed online advertising restrictions and the use of social media influencers; however, these restrictions have not been enacted. On December 19th, 2020 Health Canada published the Concentration of Nicotine in Vaping Products Regulations to the Canadian Gazette, Part 1. The proposed regulations intend to protect youth by lowering the concentration of nicotine in a vaping product to 20 mg/mL.
In Ontario on January 1st, 2020, the promotion of vapour products at convenience stores, gas stations and other retail outlets where youth under the age of 19 have access was prohibited by regulation under the Smoke-Free Ontario Act, 2017. On February 28th, 2020, Ontario Minister of Health Christine Elliott announced that Ontario is proposing regulatory changes for Cabinet members’ consideration that, if approved, would place restrictions on where flavoured and high nicotine vapour products are sold, while also expanding vaping prevention initiatives and services to quit vaping. (Ministry of Health, 2020 February 28). Regulations were set to come into force on May 1PstP, 2020; however, due to the COVID- 19 pandemic, the government changed the implementation of Regulation 268/18 to July 1st, 2020. Details of the regulations include: restricting the retail sale of most flavoured vapour products to specialty vape stores and cannabis stores, restricting the retail sale of high nicotine vapour products (more than 20 mg/mL) to specialty vape stores, and requiring specialty vape stores to ensure that vapour product displays and promotions are not visible from outside their stores. Ontario’s proposed approach also included enhanced cessation services through increasing access to services to help people quit vaping through Telehealth and enhancing mental health and addiction services and resources to include vaping and nicotine addiction. However, these initiatives were not introduced. Lastly, Ontario is proposing to work with major online retailers of vapour products to ensure compliance with age restricted sales, as well as establishing a Youth Advisory Committee to provide advice on vaping initiatives in an effort to reduce the prevalence of youth vaping (Ministry of Health, 2020). It is unclear at this time where these initiatives stand.
Health Canada and the Ontario Ministry of Health should be commended for their commitment to work collaboratively with national, provincial and territorial partners to address vaping, but continued pressure and additional regulations are required at the federal, provincial and municipal levels.
Vapour Product and E-Substance Flavours
Flavour is a perception involving many senses, including taste, aroma, and feelings of cooling and burning within the mouth and throat (Small & Green, 2012). The documented evidence within the food consumer science literature demonstrates that flavour impacts the appeal of consumable goods, and that flavour preferences direct food selection (Piqueras-Fiszman & Spence, 2016; Etiévant, et al., 2016). Youth and young adults are particularly influenced by flavours (Mennella, et al., 2005). Due to pervasive marketing tactics and the addition of attractive candy and fruit flavours to vapour products, sales of e- cigarettes are growing rapidly across Canada and around the world, with over 1,000 e-liquid flavours available in the marketplace under the banner of 460 different brands (Euromonitor International, 2015). Given the known and potential short- and long-term health effects of vaping and the lack of longitudinal health data, Health Canada and the Ministry of Health need to strengthen the current approach to regulating flavoured e-substances by enacting a ban on the manufacturing and sale of flavoured e-cigarettes and e-substances, except for tobacco flavouring. Until e-cigarettes are deemed to be effective smoking cessation aids through rigorous scientific study and they are licensed and strictly regulated as approved cessation aids by Health Canada, the manufacturing and sale of flavoured vaping products should be prohibited.
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Restricting the Concentration and/or Delivery of Nicotine
Nicotine is a highly addictive substance that poses significant risk, especially to young people. To reduce youth appeal and to protect the developing youth brain, acceptable nicotine concentration levels for vapour products should be more closely aligned with the approved nicotine concentrations for nicotine replacement therapeutic products (e.g. patches, gum, mist, inhalers, lozenges) already approved and regulated as cessation aids in Canada. Regardless of the type or power of any e-cigarette device, the nicotine concentration level for e-substances purchased in Canada should not exceed 20 mg/mL. This level is in alignment with the European Union Tobacco Products Directive (20 mg/mL), which states that this concentration allows for delivery of nicotine that is comparable to a standard cigarette (Health Canada, 2019). More research is needed to determine how consistent and uniform nicotine dosing could be established in e-cigarette devices; this would create a more unified market that could be better regulated and controlled. Additionally, more research and intensive investigation into the effectiveness of e-cigarettes as smoking cessation aids are required prior to setting government policy that promotes vapour products as tools to help people quit.
Appearance and Product Packaging Design
In November 2019, Canada joined the 13 other countries that have already implemented plain and standardized tobacco product packaging regulations. With strict promotion and advertising rules in effect for tobacco products across Canada, the package became an important marketing tool for tobacco manufacturers. Acting as mini billboards, the tobacco industry used colours, images, logos, slogans and distinctive fonts, finishes, and sizing configurations of packages to make their product appealing and attractive to existing and new tobacco users (Smoke-Free Ontario Scientific Advisory Committee (SFO-SAC, 2010). The design of the package can make its contents appear safe to use, undermining the visibility, credibility and effectiveness of health warnings. According to Moodie, Mackintosh, Hastings and Ford, (2011), studies have determined that the colour, shape and size of a package can influence consumer behaviour and contributes to consumer perceptions of the product. There is substantial documented evidence that confirms that plain packaging reduces the attractiveness of tobacco products, particularly among young people and women, making plain and standardized tobacco product packaging one of the most effective tobacco control policy measures to reduce consumption (SFO-SAC, 2010).
The same principles and body of evidence can be applied to the regulation of vapour products and their packaging. Devices are being manufactured to look like small, discrete everyday objects, so that youth can hide vaping behaviour from teachers and parents. In Ontario, the ability to “stealth vape” in school washrooms and classrooms is undermining efforts that school staff and Public Health Unit staff are taking to promote and enforce the Smoke-Free Ontario Act, 2017 on school property. E-cigarette use on school property is normalizing e-cigarette use among youth; the ability to skirt the law increases the appeal of these products. The devices can be customized and personalized, which complements the lifestyle messaging that youth are receiving from the internet and on social media. The lifestyle messaging often depicts cheerful and stylish smokers taking back “their right to smoke” in public by using e-cigarettes (Heart and Stroke, 2018). The messaging promotes e-cigarettes as a safe alternative to tobacco products, without communicating the potential health concerns related to the inhalation of toxic chemicals, heavy metals, and nicotine found in the vapour (Tozzi & Bachman, 2014). To reduce youth appeal, the same plain and standardized packaging regime that has been applied to commercial tobacco and cannabis products should also be applied to vapour products.
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Restricting and Enforcing Online Retail Access and the Role of Age-Restricted Retail Outlets
Besides the availability of e-cigarette devices at retail outlets such as convenience stores, gas stations, grocery stores, tobacconist shops, and specialty vape stores, e-cigarette devices and e-substances are widely available for sale through websites and social media (Hammond, et al., 2015). While many online e-cigarette vendors use age-verification measures during online purchase, people under the age of 18 years are still able to purchase e-cigarettes and e-substances online. Research conducted by Williams, Derrick, and Ribisl (2015) in North Carolina showed that the overall success rate for youth purchases of e-cigarettes online was 93.7%. False birth dates were entered into the website and no delivery company attempted to verify recipients’ ages at point of delivery, with 95% of e-cigarette deliveries being left at the door (Williams, Derrick & Ribisl, 2015). Anecdotally, many youth and young adults who vape report that they obtain these products online. Online vendors may be both less able and less inclined to take effective measures to limit sales to minors; some online vendors accept a simple declaration of a client’s age. Strict age-verification measures are required for online sales, including age-verification at time of purchase and proof of legal age at delivery. Active enforcement of online sales to assess compliance is also required. Additionally, at the time of delivery, confirmation of age by government-issued identification should be required. The enforcement of age restriction legislation for online retailers can be challenging; however, creative solutions may exist, including the requirement for internet service providers to ban online retailers from continuing to sell products online if they routinely ignore legislated sales to minors restrictions.
Best practice evidence from tobacco control literature provides insight regarding product accessibility and its impact on tobacco use initiation. Greater availability and density of retail outlets increases consumption, normalizes product use, decreases the ability to succeed in quit attempts and undermines health warnings (SFO-SAC, 2010). Similarly, we see alcohol availability as a contributor to alcohol normalization, alcohol use, and resulting alcohol harm (Centre for Addiction and Mental Health, 2019). The accessibility of both tobacco and vapour products is inconsistent with the extensively documented burden of illness from commercial tobacco product use and the emerging evidence regarding the short- and long-term health effects from vaping. The Ontario Ministry of Health’s proposal to limit the sale of flavoured vapour products that contain highly concentrated levels of nicotine to age-restricted specialty vape shops is a positive step forward; however, the need to reform the retail environment for both tobacco and vaping products is a public health imperative. Limiting the sale of tobacco products to licensed, age-restricted tobacco retail outlets (i.e. tobacconists) and limiting the sale of vapour products to licensed, age-restricted specialty vape shops and cannabis retail outlets would reduce the availability and accessibility of these products to youth.
Enactment of a Tax and Vapour Product Pricing Regime
There is unequivocal evidence documented in the tobacco control literature that price increases result in decreased demand and use of cigarettes, and increased intentions to quit smoking (SFO-SAC, 2010). As of January 23, 2020, the provinces of British Columbia, Alberta and Prince Edward Island have proposed or passed legislation to tax vapour products (Jeffords, 2020 January 23). There exists the opportunity to enact a tax regime on vapour products to reduce the consumption of vapour products by youth and young adults, both of whom tend to be more price sensitive than adults (U.S. Department of Health and Human Services, 2000). The revenue from tobacco taxes along with the revenue from the taxation regime applied to vaping products could be used to fund comprehensive tobacco and vapour product control programming, including prevention and cessation efforts, enforcement, and research.
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A complementary measure to increase the retail price of tobacco and vapour products is to mandate a minimum pre-tax set price minimum (Feighery, et al., 2005). Setting minimum price limits can inhibit the manufacturers’ ability to employ discount pricing and the retail sale of low-cost brands to absorb and offset the price increases from taxation (SFO-SAC, 2010). Minimum price polices are effective and widely used to reduce the consumption and associated harms from alcohol (Anderson, Chisholm & Fuhr, 2009). The taxation level and the set price minimums for vapour products should be set independently from tobacco products, with careful consideration being given to ensure that e-cigarettes do not become more expensive than cigarettes.
Increasing the Legal Age to 21 Years of Age
In Canada, under the Tobacco and Vaping Products Act, the sale or supply of tobacco and vaping products is illegal to anyone under the age of 18 years. In Ontario, the sale and supply of tobacco and vaping products is governed by the Smoke-free Ontario Act, 2017; the legal age of sale or supply is 19 years of age.
The importance of delaying the initiation of tobacco product use by young people has been well established in the evidence, including nicotine addiction and the corresponding negative impacts on youth brain development, respiratory symptoms, negative impacts on the growth and development of lung tissue, and the development of atherosclerosis and increased risk of heart disease (U.S. Department of Health and Human Services, 2012). According to simulation modelling conducted by the Institute of Medicine of the National Academy of Sciences (IOM) (2015) in the United States, raising the legal age of sale or purchase of tobacco products to 21 or 25 years of age would have a substantial impact on preventing or delaying the initiation of tobacco use; the simulation predicted a 12% reduction in smoking rates if the legal age was changed to 21 years (IOM, 2015). Increasing the legal age of tobacco product access to 21 years of age has the potential to delay youth initiation, while also reducing the burden of illness from over exposure to nicotine, carcinogens and smoke during adolescence (Pope, Chaiton, & Schwartz, 2015). There exists the opportunity to apply findings from the tobacco control literature to curb youth access to vaping products.
In the United States, tobacco and vaping products are regulated by the U.S. Food and Drug Administration (FDA). On December 20th, 2019, it became illegal to sell any tobacco product, including cigarettes, cigars and e-cigarettes to anyone under the age of 21 years across the United States (FDA, 2019). There appears to be public support in Canada for raising the legal age to 21 years for vaping products; according to an Ipsos poll of 1002 Canadians conducted for Global News between December 3 and December 5, 2019, approximately 8 out of 10 respondents support raising the minimum age for use of these products to 21 years (Yourex-West, 2019 December 23).
The Role of Ontario Boards of Health and Municipal Regulations
Municipalities and local public health agencies have taken a leadership role in advocating for and implementing laws about smoke-free indoor and outdoor spaces to reduce physical exposure to second- hand smoke and tobacco product use. In addition to the extensively documented health harms from exposure to second-hand smoke, Social Cognitive Theory and Social Ecological Theory suggest that the more children and youth are exposed to tobacco product use, the more likely they are to become tobacco product users themselves (SFO-SAC, 2010). Role modelling a tobacco-free culture plays an important role in preventing tobacco use initiation. Smoke-free spaces legislation also plays an
17 important role in promoting and supporting quit attempts by those already addicted to nicotine trying to break their addiction (SFO-SAC, 2010). The same approach to controlling exposure to aerosol and exposure to vapour product use has already been taken by many municipalities across Ontario; however, there exists the opportunity to further strengthen municipal regulations to exceed protections currently provided for under the Smoke-Free Ontario Act, 2017 and allows for specificity in prescribed prohibited spaces to meet community need.
Another opportunity for municipalities to address vaping is to explore issues that pertain to the retail sale of vaping products. Research shows that increased retail availability to substances, such as alcohol and tobacco, results in increased consumption, contributing to significant health care costs and social harms (SFO-SAC, 2016). Vapour product retail outlet density and the proximity of retail outlets to youth- serving facilities are neighbourhood planning and zoning controls that municipalities could explore. Municipalities should also explore the implementation of licensing bylaws, and a move toward a system of designated sales outlets or caps on the number of licenses issued as a way to enact and strengthen retail controls at the local level.
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