May 2024 Board of Health Meeting

April 30, 2024

The Honourable Mark Holland
Minister of Health
House of Commons
Ottawa, ON K1A 0A6
hcminister.ministresc@hc-sc.gc.ca

Dear Minister Holland,

Re: Recommendation for Federal Restrictions on Nicotine Pouches

Peterborough Public Health (PPH) wishes to express our gratitude and support for the “Statement from the Minister of Health on nicotine replacement therapies” and the corresponding public advisory, released on March 20th, 2024. We share your concerns regarding the highly addictive and harmful effects of nicotine, especially as they pertain to children and adolescents.

We know that Health Canada has only authorized nicotine pouches to help adults quit smoking. However, as you now know, this novel product is not being marketed or sold as a typical cessation aid. A regulatory gap exists that has presented an opportunity to market and sell highly addictive and dangerous nicotine pouches in brightly coloured packaging with candy-like flavours with no restrictions. These products have a high potential to appeal to youth, who are particularly susceptible to the adverse effects associated with nicotine use, addiction, and the developing brain.

PPH supports the implementation of federal regulations to target the marketing and sale of nicotine pouches and other nicotine-containing products. Specifically, we ask:

• that the federal government takes swift action to close the regulatory gap that currently permits the sale of nicotine pouches and other nicotine-containing products to individuals under 18 years of age; and,
• that the federal government requests provinces align their applicable legislation with said federal restriction.

Closing this regulatory gap is necessary to safeguard public health and must be urgently addressed. Immediate federal action to restrict the sale of these items would provide the time necessary for the province of Ontario to embed restrictions within the Smoke-Free Ontario Act, while protecting the communities we serve in the meantime.

We echo your sentiment that nicotine pouches pose a significant risk for addiction and long-term health consequences, especially among youth and adolescents. Restricting nicotine pouch sales will reinforce the great strides already made to protect youth from the dangers of tobacco and nicotine use, promoting healthier lifestyles and fostering a future generation free from addiction-related burdens.

Sincerely,

Original signed by

Councillor Joy Lachica,
Chair, Board of Health

cc: Hon. Sylvia Jones, Ontario Deputy Premier & Minister of Health
Local MPs
Local MPPs
Association of Local Public Health Agencies
Ontario Public Health Association
Ontario Boards of Health

March 21, 2024

Philip Lawrence, MP Northumberland-Peterborough South
Jamie Schmale, MP, Haliburton-Kawartha Lakes-Brock
House of Commons Ottawa, ON K1A 0A6

Sent via email to: Philip.Lawrence@parl.gc.ca & Jamie.Schmale@parl.gc.ca

Dear MP Lawrence and MP Schmale

Re: Private Member’s Bill C-322 – National Framework for a School Food Program Act

The Board of Health for the Haliburton, Kawartha, Pine Ridge District Health Unit (HKPRDHU), is writing to you today in strong support of MP Serge Cormier’s Private Member’s Bill C-322, National Framework for a School Food Program Act. Specifically, we are requesting that you work with your caucus colleagues to seek unanimous consent of this Bill in support of children and youth across Canada. As the preamble to the Bill states, “almost one in five children reported to school or to bed hungry sometimes, often or always because there was not enough food at home.” In a country as developed and wealthy as ours, this is simply unacceptable. In fact, Canada is currently the only country in the G7 that does not have a national school food program or national standards.

The Board of Health for the HKPRDHU fully supports the concept of a universal, non-stigmatizing national school food policy and program for all public schools. A growing body of research demonstrates that school food programs can benefit students’ physical and mental health, improve food choices, and lead to student success (e.g. academic performance, student behaviour, and school attendance).¹ In Ontario, these programs help reduce the $5.6 billion/year in costs due to nutrition-related chronic disease injuries. Well-designed and non-stigmatizing School Nutrition Programs (SNPs) also have broad, positive impacts on families, communities, and the economy by reducing household food costs, creating jobs, and strengthening the Agrifood sector.²

Given the widespread need across Ontario and Canada, and the inequities faced by schools in marginalized neighborhoods, there is a strong need for the federal government, in partnership with provincial ministries and school boards/districts, to commit to a National School Food Policy.

A national policy would set a standard both for securing food for schools and ensuring it is delivered consistently, sustainably, and within a context of transformative action to improve students’ health and achievement outcomes and build cultural and economic success.

The policy should be followed up by the rollout of a National School Nutritious Meal Program, and with it the $200 million per year that the Government of Canada committed to in 2021. An investment in Budget 2024 in a national school food program will support both families and school food providers, who have been struggling due to the affordability crisis.

The Board of Health for the HKPRDHU looks forward to continued engagement on this critical issue for children and youth and encourage you to vote to pass Bill C-322 as soon as possible. For more information, please review the Employment and Social Development Canada National School Food Policy Engagements – What We Heard Report.

Please do not hesitate to contact me should you wish to discuss the importance of this legislation.

Yours truly

BOARD OF HEALTH FOR THE HALIBURTON,
KAWARTHA, PINE RIDGE DISTRICT HEALTH UNIT

Original signed by Mr. Marshall

David Marshall
Board of Health Chair
Haliburton, Kawartha, Pine Ridge District Health Unit

DM:kl

cc: Laurie Scott, MPP, Haliburton-Kawartha Lakes-Brock
David Piccini, MPP, Northumberland-Peterborough South
Association of Local Public Health Agencies
Ontario Boards of Health

1. The case for a Canadian national school food program. Hernandez et al., 2018; Nourishing Young Minds. Toronto Public Health, 2012; The impact of Canadian School Food Programs on Children’s Nutrition and Health. Colley et al., 2018; Coalition for Healthy School Food
2. The Burden of Chronic Disease in Ontario. CCO & PHO 2019

April 22, 2024

VIA ELECTRONIC MAIL

The Honourable Doug Ford
Premier of Ontario
Legislative Building
Queen's Park
Toronto ON M7A 1A1

Dear Premier Ford:

Re: Recommendations for Government Regulation of Nicotine Pouches

In July 2023, Health Canada gave approval to Imperial Tobacco Canada to sell Zonnic under the Natural Health Product Regulations as a Nicotine Replacement Therapy (NRT) product. Consequently, Zonnic is sold under the Health Canada approval without adhering to the restrictions of the Federal Tobacco and Vaping Products Act, 1997 and the Smoke-Free Ontario Act, 2017.
Since this time, nicotine pouches have become widely available to youth. These flavoured pouches can be legally purchased by those under 18 years of age in Ontario. The unrestricted sale, display, and promotion of nicotine pouches contribute to accessibility, normalization, and potential health hazards. Nicotine is highly addictive and its use, in any form, is unsafe for children¹ and youth². Exposure to nicotine can have adverse effects on the developing brains of children and youth and increases the likelihood of initiation and long-term use of tobacco².

In March 2024, Public Health Sudbury & Districts released an advisory alert to local health system partners sharing concerns related to nicotine pouches. Additionally, letters were sent to education directors, educators, and parents to increase awareness of the availability and risks of nicotine pouches to children and youth.

At its meeting on April 18, 2024, the Board of Health for Public Health Sudbury & Districts took further action and carried the following resolution #26-24:

WHEREAS Health Canada approved nicotine pouches for sale under the Natural Health Product regulations providing no restrictions on advertising or sale to children and youth; and

WHEREAS the unrestricted sale, display, and promotion of nicotine pouches contribute to their accessibility, the normalization of nicotine use, and potential health hazards; and

WHEREAS nicotine is highly addictive and its use, in any form, is unsafe for children and youth; and

WHEREAS exposure to nicotine can have adverse effects on the developing brains of adolescents and young adults and increases the likelihood of initiation and long-term use of tobacco products; and

WHEREAS the emergence of nicotine pouch products occurred rapidly without requiring adherence to the restrictions of the federal Tobacco and Vaping Products Act, 1997, and the Smoke-Free Ontario Act, 2017; and

THEREFORE BE IT RESOLVED THAT the Board of Health for Public Health Sudbury & Districts strongly encourage Health Canada to take immediate action to close the regulatory gap that permits the sale of nicotine pouches to youth under 18 years of age; and

FURTHER THAT the Board of Health urge Health Canada to strengthen regulations to restrict the sale of new and emerging tobacco and nicotine products, ensuring that nicotine availability to children and youth never occur again; and

FURTHER THAT the Board of Health for Public Health Sudbury & Districts strongly encourage the Government of Ontario to exclusively sell nicotine pouches from behind pharmacy counters, limit their display in retail settings, and restrict their promotion, especially to youth; and

FURTHER THAT the Government of Ontario expand the Smoke-Free Ontario Strategy to create a comprehensive, coherent public health-oriented framework for the regulation of vaping and all nicotine-containing products.

We strongly encourage the Government of Ontario to follow immediately the Government of British Columbia and the Government of Québec to exclusively sell nicotine pouches in pharmacies, specifically behind the counter. This decision reduces product availability, restricts their promotion, and limits their display in retail settings.

Until tighter restrictions of nicotine pouches are implemented, the widely available and accessible product will continue to expose children and youth to nicotine. The Board of Health for Public Health Sudbury & Districts strongly encourages the Government of Ontario to expand the Smoke-Free Ontario Strategy to create a comprehensive, coherent public health-oriented framework for the regulation of vaping and all nicotine-containing products.

We thank you for your speedy attention to this important issue, and we continue to look forward to opportunities to work together to promote and protect the health of Ontarians.

Sincerely,

René Lapierre
Chair, Board of Health

M. Mustafa Hirji, MD, MPH, FRCPC
Acting Medical Officer of Health and Chief Executive Officer

cc: Honourable Mark Holland, Minister of Health of Canada
Honourable Sylvia Jones, Deputy Premier and Minister of Health
Honourable Ya’ara Saks, Canada’s Minister of Mental Health and Addictions and Associate Minister of Health
Honourable Michael Parsa, Minister of Children, Community and Social Services
Yasir Naqvi, Parliamentary Secretary to the Minister of Health, Honorable Mark Holland
Dr. Kieran Moore, Chief Medical Officer of Health of Ontario
France Gélinas, Member of Provincial Parliament, Nickel Belt
Jamie West, Member of Provincial Parliament, Sudbury
Michael Mantha, Member of Provincial Parliament, Algoma-Manitoulin
Viviane Lapointe, Member of Parliament, Sudbury
All Ontario Boards of Health
Association of Local Public Health Agencies

1. U.S. Department of Health and Human Services. (2014). “The Health Consequences of Smoking-50 Years of Progress: A Report of the Surgeon General.” https://www.ncbi.nlm.nih.gov/books/NBK294308/#ch5.s2
2. National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. (2016). “E-cigarette Use Among Youth and Young Adults: A Report of the Surgeon General.” Retrieved on January 30, 2024 from www.cdc.gov/tobacco/sgr/ecigarettes/pdfs/2016_sgr_entire_report_508.pdf.

April 25, 2024

VIA ELECTRONIC MAIL

Hon. Sylvia Jones
Ministry of Health
College Park, 5th Floor
777 Bay Street
Toronto, ON M7A 1Z8

Dear Minister Jones:

RE: The Sale of Nicotine Pouches in Ontario

The Kingston, Frontenac and Lennox & Addington (KFL&A) Board of Health passed the following motion at its meeting of April 24, 2024:

THAT the KFL&A Board of Health endorse the recommendations proposed by the Canadian Cancer Society for immediate action by the Provincial Government of Ontario to restrict the sale of nicotine pouches to behind the counter in Ontario pharmacies, and to urge the Government of Canada to expedite their proposed regulatory response to nicotine pouches announced on March 20, 2024.

Health Canada’s approval of Zonnic as a nicotine replacement therapy in July 2023 has exposed crucial gaps in federal and provincial regulations related to nicotine products. This product appeared in retail outlets such as convenience stores and gas stations across Ontario communities in mid-October 2023. With colourful packaging and flavours including Berry Frost, Chill Mint and Tropic Breeze, this product is being positioned to appeal to youth through lifestyle marketing and in-store promotion near candy and chocolate displays.

Nicotine pouches are not subject to the same federal and provincial sale and promotion restrictions as tobacco and vaping products and are readily accessible to Ontario’s youth. Increased access to nicotine products by youth is concerning because of the harms of nicotine to the developing brain and threatens to increase nicotine dependence amongst youth and adults who do not smoke.

Although the Government of Canada is working towards closing the regulatory gap and is working with provincial and territorial governments on complementary control measures, there are immediate actions that the Government of Ontario can take as robust regulatory frameworks are developed. First, we urge you to require that nicotine pouches be sold in pharmacies from behind the counter only. The provinces of Quebec and British Columbia have already implemented this measure.

By doing so, these provinces have maintained access to this form of nicotine replacement therapy for those who are attempting to quit using nicotine products while protecting youth from a highly addictive substance.

Second, we would also ask that you urge the Government of Canada to move quickly to address the regulatory gaps related to these products to protect the health of Ontarians.

Nicotine is a highly addictive drug and without a robust regulatory framework at both the federal and provincial levels, emerging nicotine products such as nicotine pouches threatens to increase nicotine dependence amongst youth and adults who do not smoke.

Sincerely,

Wess Garrod
KFL&A Board of Health Chair

Copy to: The Honourable Mark Holland, Minister of Health for Canada
The Honourable Michael Tibollo, Associate Minister of Mental Health and Addictions
Dr. Theresa Tam, Chief Public Health Officer of Canada
Dr. Kieran Moore, Chief Medical Officer of Health and Assistant Deputy Minister, Public Health
MPP Ric Bresee, Hastings-Lennox and Addington
MPP Ted Hsu, Kingston and the Islands
MPP John Jordan, Lanark-Frontenac-Kingston
Ontario Boards of Health
Association of Local Public Health Agencies (alPHa)

PREPARED BY:

Chronic Disease and Injury Prevention

DATE:

2024-05-16

SUBJECT:

Windsor Essex Community Opioid and Substance Use Strategy 2023

BACKGROUND/PURPOSE

The Windsor-Essex Community Opioid and Substance Strategy (WECOSS) is a collaboration of over 40 community partners and individuals with lived experience brought together to address the drug poisoning crisis. As the backbone agency, the Windsor-Essex County Health Unit (WECHU) is responsible for coordinating the Strategy, monitoring local data for trends in substance use events, supporting the development, implementation, and evaluation of projects, and building sustainable communication channels to disseminate evidence-based information to the public. Utilizing a four-pillar approach, the WECOSS works to address the harms of substance use at the community level through Prevention and Education, Harm Reduction, Treatment and Recovery, and Enforcement and Justice interventions.

DISCUSSION

Each of the four WECOSS pillars develops and implements at least one project a year, in addition to the ongoing work from previous year’s initiatives. These are captured in the WECOSS Annual Reports. The 2023 WECOSS highlights were as follows: 

Opioid and Substance Use Notification System (OSUNS)

The OSUNS monitors real-time trends in local data to identify spikes in opioid and other substance use-related events across Windsor-Essex County. An evaluation of the OSUNS was conducted which engaged 31 WECOSS members in a survey.

• 90% agree that the alerts increase their awareness of local substance use trends.
• 87% find the information in the alerts relevant to local needs.
• 71% use the alerts within the context of their work.

The recommendations for improvement included:

• More real-time monitoring
• Linking community substance programs to the alerts
• Expanding the knowledge of the public regarding the OSUNS

Enforcement and Justice

• 21 service providers surveyed to identify educational needs regarding substance use.
• Findings will be used to develop tailored workshops for service providers, corrections officers, and post-secondary students.

Treatment and Recovery 

• Online inventory of 187 substance use and mental health programs and services developed.
• Pilot testing and public launch in 2024 planned to assist residents to find and access services that best meet their needs. 

Prevention and Education

• 17+ lbs of unused/expired medication collected at medicine take-back event and brought to the pharmacy for safe disposal.
• Development of a community partner communications toolkit with integration of alcohol and cannabis messaging developed for distribution in 2024. The toolkit includes key messages and a dissemination plan to heighten the profile of the WECOSS strategy and increase recognition of its role in the community.

Harm Reduction

• Through the Needle Syringe Program delivered by Pozitive Pathways Community Services (PPCS) there were:
  • 20,870 client transactions across 4 NSP sites and mobile delivery programs.
  • 533,844 needles distributed.
• Promotion of SafePoint Safer Consumption Site including outreach to clients, community engagement, and mitigation strategy development to address needs of clients following pause in operations.

Substance Supports in Neighbourhoods Accessed Through Police Partnerships (SSNAPP)

In 2023, the Enforcement and Justice Working Group welcomed the Substance Supports in Neighbourhoods Accessed Through Police Partnerships (SSNAPP) initiative, led by the Windsor Police Service, the WECHU, and the City of Windsor. Aligned with the Windsor Essex Regional Community Safety and Well-Being Plan and the WECOSS, this initiative strengthened the ongoing efforts to address substance-related challenges within in our community, with the WECHU playing a crucial role in coordinating activities, offering public health expertise on substance use issues and related trends in our community, and supporting data collection and analysis efforts.

The impact of the SSNAPP initiative in 2023 is demonstrated through the following achievements: 

• Facilitated a Crime Prevention Through Environmental Design (CPTED) Workshop attended by 56 stakeholders representing 30 diverse social, health and business sectors.
  • 73% of survey respondents found the training highly relevant to their roles within the community.
• Supported Trauma Informed Training Sessions conducted by the Downtown Windsor Community Collaborative (DWCC), for both clients and frontline health and social service providers.
  • Included 4 client sessions with a total of 57 participants.
    • 58% of survey respondents discovered a new support.
  • Included 10 service provider sessions with a total of 302 participants.
    • 83% of survey respondents felt more equipped to engage with individuals affected by complex trauma. 
• Supported Community Engagement Events organized by the DWCC in high-priority neighbourhoods. 
  • Included a total of 4 events with approximately 200 community members in attendance per event.
    • 82% of survey respondents gained a deeper understanding of available community resources. 
• Hosted two ‘De-Escalating Potentially Violent Situations’ Workshops in collaboration with the Crisis and Trauma Training Resource Institute, catering to frontline health and social service providers.
  • A total of 122 participants from 35 organizations.
    • 93% of survey respondents expressed satisfaction with the course’s learning objectives.

The attached Annual Report provides greater detail on the work of the WECOSS in 2023 and will be disseminated through the committee and publically through organization’s social media and websites.

Introduction

In February 2024, a competency based self-assessment survey was distributed to the Windsor-Essex County Health Unit (WECHU) Board of Health (BOH) members. This survey was structured around twelve competency areas and was developed based on the Ontario Public Health Standards (OPHS) (2021), the WECHU BOH By-laws, and the Association of Local Public Health Agencies Board of Health Governance Toolkit. The purpose of this approach was to identify the strengths of the BOH, while also identifying opportunities to provide additional training and support. The OPHS (2021), under the Good Governance and Management Practices Domain, states: “the board of health shall have a self-evaluation process of its governance practices and outcomes that is completed at least every other year. Completion includes an analysis of the results, board of health discussion, and implementation of feasible recommendations for improvement, if any”. 

The same survey was implemented in 2017, 2018, 2020, 2022, 2023 and again in 2024, allowing for a comparison of the data across years. Current BOH membership includes 14 members, of which 13 completed the 2024 self-evaluation competency survey.

Results

Competency Scores

There were 2 to 4 questions asked for each of the 12 competency areas. Average scores for each competency range from 0 to 4. The BOH average scores for each statement can be found in Appendix A. The overall BOH average score for each competency, along with the difference from the satisfactory and optimal range, can be found in Table 1.

The satisfactory response range (BOH average scores greater than 2, but below 3) reflects a score indicating that BOH members, on average, have the necessary competencies to successfully complete tasks related to that topic, but might require assistance from an expert at times.

The optimal response range (BOH average scores greater than or equal to 3) represents areas where BOH members on average can function most effectively and are able to perform actions related to these topic areas without expert assistance.

The overall average score for 2024 was 2.29 which was slightly lower than the 2023 average of 2.47.

As shown in Table 1, average scores in 2024 were lower than those in 2023 for all but one competency: Performance Management and Quality Improvement.  

Figures 1 and 2 are visual representations of the BOH average score on each competency compared to the satisfactory (2-2.99) and optimal (3-3.99) range. Three competency scores were below the satisfactory range threshold (Health Equity, Knowledge and Delivery of Public Health Programs/Services, and Legal Acumen). The remaining nine competencies fell into the satisfactory range. No competencies fell into the optimal range. 

Figure 1. Average scores compared to the satisfactory and optimal range

Figure 2. Average scores compared to the satisfactory and optimal range (con’t).

Additional Comments and Suggestions

Lastly, members were asked if they had any feedback or suggestions for future learning topics. Comments included a request to learn about WECHU management systems, the Ontario Public Health Standards (OPHS), the Health Promotion and Protection Act (HPPA), Ministry of Health (MOH) initiatives and their impact on our community, how to assess organizational risk and the legal impacts of such risks, information on allocating budgets, and how politics impact BOH decision processes.  

Overall Recommendations

• Continue to update and offer training sessions and e-learning modules to board members, focusing on those areas with the lowest scores (i.e., Health Equity, Knowledge and Delivery of Public Health Programs and Services, and Legal Acumen).
• Continue to provide quarterly opportunities to Board of Health members to provide feedback and recommendations related to Board of Health operations and decision-making to ensure continuous quality improvement. 
  

Appendices

PREPARED BY: Planning and Strategic Initiatives

DATE: 2024-05-16

BACKGROUND/PURPOSE

In 2018, the Ontario Ministry of Health (MOH) introduced a new Annual Service Plan (ASP) that Health Units are required to submit each year. To ensure a single, integrated approach to planning, the Planning and Strategic Initiatives (PSI) department worked with the Information Technology (IT) department to align our planning system with the provincial requirements. 

With the support of PSI, all internal and external facing departments develop and enter their annual work plans, which are then reviewed and approved by the Leadership Team. These plans are then integrated in the WECHU’s Annual Service Plan for the Ministry.

DISCUSSION

Annual Service Plan (ASP) Submission

WECHU’s 2024 Annual Service Plan was submitted to the MOH in April, 2024. The plan provides details about planned expenditures and local public health programming for 2024. 

Q1 Progress Update

• There are 174 active Intervention Work Plans.
• Of the 126 public facing external plans, 94% are on target.

Of the 48 internal corporate plans, 92% are on target and 4 have been completed.

This report provides a status summary for Intervention Work Plans (IWP) in the 2024 Annual Service Plan that were in active and in progress during Q1 (January 1 through March 31). 

The project lead for each active IWP was asked to provide a progress report on their work. The status updates consisted of the following categories:

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

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

• Adjusted Program Priorities (program priority alterations resulted in changes to the IWP)
• Human Resource Issue (staffing circumstances resulted in changes to the IWP)
• Partnership Limitations (external partner(s) did not to meet their obligations)
• Public Health Emergency (a significant emergency resulted in changes to the IWP)
• Internal Resource Limitation (financial, material, or internal support limitations resulted in changes to the IWP)
• External Resource Limitation (External financial, material, or internal support limitations occurred with partnerships, collaborations, funding, or regulations)

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

Part 1: External Community Facing Programs

Overall Quarterly Status Summary 

There were 126 active external intervention workplans (IWP’s) in progress during Q1 2024. 118 (94%) of the IWP’s were reported to be on target by Project Leads. 7 workplans reported a variance and 1 was deferred.

Figure 1 displays the percentage of interventions that were reported as on target, indicated a variance, or were deferred.

Of the 126 interventions in progress in Q1, 7 (6%) experienced a variance from the target and one was deferred. Figure 2 provides a summary of the reasons for the variances. 

Of the active interventions that were deferred or varied from the target, the most common reason given was availability of internal resources (63%).

Year to Date Progress Summary (External)

Program Quarterly Status Summary

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

Part 2: Internal Corporate Programs

Overall Quarterly Status Summary 

There were 48 internal IWP’s in progress in Q1 2024 with 40 (83%) reporting on target. 4 workplans were completed.

Figure 4 displays the percentage of interventions that were on target, reported a variance, were deferred, were cancelled, or were completed.

Of the 48 internal interventions in progress, 8 (17%) were either cancelled, completed, or varied from the target. 

Figure 5 provides a summary of the reasons for variances and cancellations.

Of the interventions that have a variance, the most common reason given was partnership limitations (50%).

Year to Date Progress Summary (Internal)

Program Quarterly Status Summary

All interventions are directly tied to programs and program objectives. Figure 6 displays a summary of the status updates for each WECHU program based on the number of interventions that were on target, varied from target, were completed, were deferred, or were cancelled during this quarter. 

PREPARED BY: Communications Department 

DATE: April 18, 2024

SUBJECT: March 15, 2023 – April 14, 2024, Communications Update

BACKGROUND/PURPOSE:

Provide regular marketing and communication updates to the Board of Health.

Data Notes can be provided upon request.

Media Exposure Overview Graph

Notes: From March 15 – April 14, we experienced two main peaks of media exposure:

March 21 & 22 – On March 21, the WECHU issued a news release with tips to stay safe when watching the solar eclipse which resulted in 17 total stories between the two days.

April 12 – A story was released focused on Grey Bruce Public Health Unit’s funding. The article mentioned the WECHU for our similar budget reductions.

Website Overview Graph

Notes: From March 15 – April 14, we saw very similar website traffic patterns as the previous month, but with lower levels of traffic overall.

Social Media Overview Graph

Lighter blue line represents the current month, darker blue line represents the previous month.

Discussion - Solar Eclipse Safety

On April 8, 2024, a solar eclipse occurred in the middle of the afternoon. Parts of Windsor-Essex County were identified as falling in the path of totality (where the sun would be completely covered by the moon). Looking directly at the sun is always dangerous for an individual’s vision, and a phenomenon like a solar eclipse increases the likelihood someone may want to look at the sun. In light of this, the Communications Department worked with various departments at the WECHU to compile a comprehensive list of safety tips (i.e., vision safety, driving, food illness, and illness prevention).

To communicate these tips, a webpage was created and linked from our homepage (the page has since been archived). The webpage received a total of 6,283 visits over the four weeks it was published and was the most-viewed page for three weeks in a row. Six social media posts were issued, all of which linked back to the solar eclipse safety webpage. On Facebook, the posts were shared a total of 179 times.

A news release was shared on Thursday March, 21 which resulted in 17 media stories published online or in print linked to the WECHU. The Medical Officer of Health, Dr. Aloosh, also participated in a radio interview with AM800 in advance of the eclipse. 

To ensure consistent messaging across our region, the WECHU connected with communication representatives at the local hospitals, school boards, and municipalities. Many of these groups shared social posts on their own platforms and referenced the webpage content in their own communication pieces. 

PREPARED BY: Communications Department 

DATE: March 20, 2024

SUBJECT: February 15, 2023 – March 14, 2024, Communications Update

BACKGROUND/PURPOSE:

Provide regular marketing and communication updates to the Board of Health.

Data Notes can be provided upon request.

Media Exposure Overview Graph

Notes: From February 15 – March 14, we experienced three main peaks of media exposure:

February 26: We were mentioned in a story about Ontario public health units merging, and local stories around a recreational pool closure following a wild animal event.

March 4 – 6: Over these two days, several stories were published with information around student immunizations, measles, and an update on Consumption and Treatment Site provincial reviews.

March 12: Stories were related to an opioid overdose alert issued by the WECHU.

Website Overview Graph

Notes: From February 15 – March 14, we saw very similar website traffic patterns as the previous month, with no notable changes

Social Media Overview Graph

Lighter blue line represents the current month, darker blue line represents the previous month. Notes: We saw minor fluctuations in followers over the month, notably a larger increase on Instagram.  

Discussion - Break the Vape Challenge

The Communications Department worked closely with the Healthy Schools (promotion) Department on the Break the Vape challenge. This challenge called for Grade 6 – 12 students to create their own public service announcement video to encourage other students to either quit vaping, or not start vaping.

The Communications Department completed a privacy impact assessment on a new web-based platform to allow students to submit their videos. Additionally, a wide variety of communication outreach was done to promote the challenge, including a new webpage, social media posts (organic and boosted) and a news release.

As a result, the webpage was one of our top five visited sites for five weeks, and all the local media outlets covered the story (via on-camera interviews, radio call-in shows, and from the news release). At the close of the video submission timeframe, close to 100 videos were received. After review, the top videos will go online for public voting, which the Communications Department will continue to assist through public outreach and web support

PREPARED BY:

Planning and Strategic Initiatives

DATE:

2024-05-16

SUBJECT:

Strategic Plan Q1 Progress Report

BACKGROUND/PURPOSE

The WECHU’s 2022-2025 Refreshed Strategic Plan provides strategic direction to the organization. The plan defines the organizational vision, goals, and objectives to engage staff and support local public health outcomes within the community - with a specific focus on priority populations.

The Good Governance and Management Practices Domain of the Ontario Public Health Standards (2021) requires the Board of Health to provide governance direction and remain informed about the activities for organizational effectiveness through evaluation of the organization and strategic planning.

DISCUSSION

All current facets of the Strategic Plan are on track to be completed or implemented by the end of 2025. 

Highlights for Q1 2024 include:            

• The Equity, Diversity & Inclusion committee held their first monthly meeting, and members completed training sessions on anti-racism and gender diversity regarding health inclusivity.
• A draft of the Corporate Performance Management and Quality Improvement Plan has been prepared to incorporate continuous quality improvement (CQI) into departmental processes. All departments have developed relevant public health indicators for monitoring and reporting for 2024.
• In addition to the WECHU’s routine communication of public health data, messaging around solar eclipse safety was produced and shared widely with support of community partners.

PREPARED BY:

Planning and Strategic Initiatives

DATE:

2024-05-16

SUBJECT:

Q1 Board of Health Effectiveness Survey Summary

BACKGROUND/PURPOSE

The Ontario Public Health Standards (2021), under the Good Governance and Management Practices Domain, states: “the board of health shall have a self-evaluation process of its governance practices…”. 

In addition to a yearly self-evaluation process, the WECHU has developed a quarterly self-assessment survey for Board of Health (BoH) members. The survey provides an opportunity for feedback on BoH operations and is used to inform quality improvement efforts. 

DISCUSSION

Responses from the first quarter of 2024 related to BoH operations were positive. In all categories, responses were ‘Agree’ or ‘Strongly Agree’ or ‘Don’t Know/Unsure’. In terms of overall perceived BoH effectiveness, responses ranged from 8 to 10 (on a 10-point scale), with an average score of 9. 

Suggestions for improvement included:

• Providing paper copies of agendas at meetings and email notifications when minutes are available. 
• Email notifications when there are impending issues in the media to which BoH members need to be made aware.
• More frequent board meetings.
• Enhanced financial reporting at each meeting.
• Routine updates that provide outcome data demonstrating the effectiveness of WECHU work. 

PREPARED BY:

Planning and Strategic Initiatives

DATE:

2024-05-16

SUBJECT:

2024 Board of Health Assessment Survey

BACKGROUND/PURPOSE

The Ontario Public Health Standards (2021), under the Good Governance and Management Practices Domain, states: “the board of health shall have a self-evaluation process of its governance practices and outcomes that is completed at least every other year. Completion includes an analysis of the results, board of health discussion, and implementation of feasible recommendations for improvement, if any”. 

To meet this requirement, the WECHU developed a competency-based self-evaluation survey for Board of Health (BOH) members. The survey includes 12 competency areas used to identify the strengths of the BOH, as well as opportunities to provide additional training and support for the BOH. 

DISCUSSION

The survey was sent to current BOH members in February 2024. Analysis of the results from the 2024 BOH survey demonstrated that the top strengths of the BOH are:

• Leadership and Governance
• Community Partners and Stakeholder Engagement
• Human Resources

Identified areas of opportunity are:

• Knowledge of Public Health Programs and Services
• Health Equity
• Legal 

Future training opportunities will be provided to the BOH to support their efforts; as well, quarterly feedback opportunities will be provided to support effective BOH operations and decision-making. 

PREPARED BY:

Healthy Schools

DATE:

2024-05-16

SUBJECT:

Break the Vape Challenge

BACKGROUND/PURPOSE

While data tell us that over the past few decades, there has been a decline in the number of young Canadians smoking cigarettes and using tobacco products, the emergence of vapour products has caused a shift in the types of nicotine products youth are using. This increase is putting them at risk of becoming addicted to nicotine. The tobacco industry continues to target younger people with appealing flavours, packaging, and devices and vapour products are the most used nicotine product among youth (Physicians for Smoke-Free Canada, 2021). In Windsor-Essex 23.5% of students in grades 7 to 12 are daily vapers (Ontario Student Drug Use and Health Survey, 2023). The use of nicotine before age 25 can impact learning, memory, attention, and increase the risk for addiction to other substances. During the 2022-2023 school year, the Healthy School department had over 100 interactions with schools around support for vaping education and enforcement. As a result, the WECHU launched the Break the Vape Challenge as part of a wider strategy to bring raise awareness, educate with the intent of decreasing youth vaping.

The purpose of the Break the Vape Challenge was to engage Windsor and Essex County students in grades 6 to 12 with an opportunity to use their voice to learn about and raise awareness of the dangers of vaping.  Providing youth with evidence-based information increases their knowledge to make informed decisions to initiate or quit vaping. Students were asked to create and submit a 30 second Public Service Announcement (PSA) video that included at least one key message about the dangers of vaping and one call to action. The challenge used a full youth engagement approach, starting with the development of the challenge, to the selection of videos for public voting. This approach ensured the components of the challenge and messages resonated with youth, with the goal of having greater youth buy-in and increased awareness of the health effects of vaping and nicotine.  A panel of youth judges voted for their top 5 videos from each category to narrow the entries down for public voting. Prizes were awarded to students for the top voted videos, and to publicly funded schools with the highest participation rates. The winning PSA videos will be promoted to continue to raise awareness around the harms associated with vaping.

DISCUSSION

The submission period for the challenge took place from February 5 to March 8. To promote the challenge our Healthy School nurses conducted 19 lunch and learns at secondary schools focused on providing information about the contest and vaping resources. The challenge received 98 video submissions (57 for the grade 6 to 8 category and 41 for the grade 9 to 12) totaling 238 participating students. A total of 30 youth judges participated in scoring the qualified videos over 3 sessions. Videos were scored using 8 questions focused on the messaging and quality of the videos. The top five scoring videos from each category were then selected for public voting which took place from April 15 to April 26. Over 2,700 votes determined the winners. The winning videos were announced on May 3rd, the following videos and schools won the challenge:

Grade 6 to 8: 

• 1st place: Échappe le vape - Christina K., Alexandra K., Josephine L., and Sophie L.: École élémentaire catholique Saint-Edmond
• 2nd place: Escape the Vape -Joshua F., Sam L., and Chris H.: St. John the Baptist Catholic Elementary School
• 3rd place: Stop the Peer Pressure - Aeden A.B., Aidan C., Jaden L., and Leah B.: St. John the Baptist Catholic Elementary School
• Elementary school- Highest percentage of participating students prize: École élémentaire catholique Saint-Edmond 

Grade 9 to 12: 

• 1st place: Break the Vape for Mental and Physical Health - Julia P. and Kailey Y.: St. Thomas of Villanova Catholic Secondary School
• 2nd place: Anti-Vape PSA - Reihan P., Joshua P., and Cory L.: Catholic Central Highschool
• 3rd place: I was told it was trendy... - Timothy L.: Assumption College Catholic High School 
• Secondary school- Highest percentage of participating students’ prize: E'cole secondaire catholique EJ Lajeunesse 

Moving forward, the Healthy Schools department plans to use the winning videos to further promote awareness around the youth vaping issue and promote resources for those looking to quit. You can find more information about the challenge and view the winning videos on the Break the Vape Challenge web page.

PREPARED BY:

Infectious Disease Prevention

DATE:

2024-05-16

SUBJECT:

Communicable Diseases and Outbreaks

BACKGROUND/PURPOSE

The Windsor-Essex County Health Unit’s (WECHU) Infectious Disease Prevention (IDP) department provides programs and services focused on addressing communicable disease prevention and control. Through case and contact management, the WECHU works to isolate and contain cases of disease from further impacting our community. The WECHU also uses methods of surveillance to identify trends of illness and inform decision making for public health interventions. Although the IDP department responds to all reports of diseases with public health significance, respiratory diseases have a greater potential to lead to outbreaks in congregate living spaces when cases peak during the respiratory season; which is observed primarily from early fall to late winter each year. 

DISCUSSION

COVID-19 

While COVID-19 continues to be a major cause of respiratory illness worldwide, the World Health Organization states that Covid-19 no longer qualifies as a global emergency. Decreasing number of COVID-19 cases and increased levels of immunity, have shifted the way that covid-19 illness is managed. Driven by provincial guidance, WECHU continues to focus its efforts on integrating Covid-19 as part of regular case and contact management activities, with COVID-19 becoming a part of long-term standardized processes for managing cases of respiratory illness. In the 2023-2024 season, cases of COVID-19 locally have decreased from 7,503 to 1,830, a 76% reduction from the previous season. The WECHU continues to receive positive COVID-19 reports for individuals in hospital or congregate living settings, and these facilities are provided guidance on respiratory infection control practices. 

Influenza Cases

As COVID-19 cases are decreasing, the WECHU has observed a rise in confirmed influenza cases this past respiratory season which is consistent with provincial data reports of influenza illness. During the 2022-2023 respiratory season, the reported case count for influenza was 407. However, in the 2023-2024 season, there has been a notable increase, with 686 confirmed cases reported from September 2023 to date.

Measles

Measles, a serious respiratory infection, was rare in Ontario, due in large part to the successful elimination of measles in Canada. However, in line with an increase in measles activity seen globally, Ontario has recorded 14 laboratory-confirmed cases of measles to date in 2024. Thirteen of these cases are linked to international travel and 8 were individuals not previously vaccinated for measles. 

Locally, the WECHU investigated 1 travel-related adult confirmed case of measles in January. No other cases have been confirmed to date in WEC. Case management and contact tracing efforts focused on ensuring the case remained isolated during the infectious period and minimizing the risk of exposure to our community.  

Outbreaks 

The WECHU investigates all reports of suspected and confirmed outbreaks in high risk congregate living settings including long-term care, retirement homes, supportive housing, shelters, and boarding homes. For the 2022-2023 season, the WECHU reported 239 total respiratory outbreaks. Of those, 193 (80%) were due to COVID-19. From Sept 2023 to date, the WECHU has seen a decrease in the number of respiratory outbreaks to 163 where 117 (71%) were due to COVID-19. Other respiratory infections such as Influenza, RSV, Metapneumovirus, Parainfluenza, and others, that were absent during the 2020 to 2021 outbreak season, where COVID-19 infection predominated, have now made a resurgence. 

While the impact of COVID-19 has decreased since the beginning of the 2020 pandemic, the WECHU continues to advise the public of precautionary measures for all respiratory illnesses, including influenza and measles. Promotional activities such as external messaging on social media platforms, or public health alerts have been aimed at the importance of vaccination, respiratory etiquette, hand hygiene, staying home when unwell, and wearing masks when the risk necessitates it. 

Infection Prevention & Control (IPAC) Hub 

WECHU continues in its commitment to support and strengthen infection control practices in our community through the IPAC Hub. Using a collaborative approach, WECHU nurses and Public Health Inspectors conduct supportive visits to congregate living facilities, targeting education to IPAC leads around infection control best practices. In an effort to build capacity and knowledge, facilities are encouraged to engage self-assessment questionnaires to review their internal IPAC practices and measure those practices against established standards. IPAC leads are also encouraged to participate in the Windsor-Essex IPAC Community of Practice (CoP) monthly forums. Recent topics of discussion have included: Outbreak Prevention, Internal Auditing of Hand Hygiene practices, and Waste Management. 

PREPARED BY:

Environmental Health

DATE:

2024-05-16

SUBJECT:

Recreational Water Inspections

BACKGROUND/PURPOSE

The Environmental Health Department conducts inspections of recreational water facilities in Windsor and Essex County (WEC), as a part of the Windsor-Essex County Health Unit’s Safe Water Program. This mandatory program contributes to the prevention and reduction of water-borne illnesses and operates under the requirements outlined in the Recreational Water Protocol, 2019 and the Operational Approaches for Recreational Water Guideline, 2018. Recreational water facilities that are routinely inspected within this program include public pools, splash pads, water slides, and spas. Seasonal beach monitoring is also conducted, which includes surveillance of water and weather conditions, and potential pollutants, as well as weekly water sampling to test for Escherichia coli (E. coli), a bacteria that can cause severe stomach cramps, diarrhea, fever, and vomiting.

Recreational Water Facilities Summary

Beach Monitoring Summary

The 2023 beach monitoring season ran for a total of 13 weeks, with weekly water sampling conducted from June 12, 2023, to September 5, 2023. There were 20 water quality warnings issued (201-999 E. coli/100ml), and 3 beach closures (≥1000 E. coli/100ml). This season had significantly less water quality issues when compared with 2022, which had 41 warnings and 13 closures. The permanent closure of Mettawas Beach partially accounts for this difference.

DISCUSSION

Recreational Water Facility Activities

In 2024, all the recreational water inspections will be conducted as per the requirements outlined in the Recreational Water Protocol, 2019. Indoor pools and spas are inspected at least four times per year, and outside pools and spas will be inspected at least two times within the operating season. Splash pads and waterslides will be inspected a minimum once per year. All routine and complaint-based inspection reports of recreational water facilities are made available on the WECHU’s Disclosure Website. Reports are posted within two weeks of a completed inspection and remain posted for two years. 

Beach Assessments and Testing

Public Health Inspectors will conduct pre-season beach assessments mid-May, with weekly surveillance and water sampling beginning May 21, 2024. Beach water sampling will take place once a week every Wednesday and there will be no resampling done. The results will be made available on the WECHU’s Beach Water Testing webpage by Friday of the same week. Results will also posted to the Beach Hotline at 519-258-2146 ext. 1490.

PREPARED BY:

Infectious Disease Prevention

DATE:

2024-05-16

SUBJECT:

Tuberculosis Campaign in IDP

BACKGROUND/PURPOSE

While tuberculosis (TB) is preventable and curable, 10 million people around the world become sick from TB and 1.5 million people die every year (WHO, 2023). According to Jordan et al. (2023), TB is the leading cause of death by a single infectious agent worldwide. Foreign-born residents bear 80% of the burden of TB disease in Canada, where 1 in 4 foreign-born Canadian residents has TB infection (Jordan et al., 2023). People with active TB may pass the bacteria to others by coughing, speaking, or saliva. Without proper treatment, TB infection can cause sever illness or even death. TB can affect anyone, regardless of age, gender, ethnicity, or race. 

The incidence of active TB has continued to increase provincially, and Windsor-Essex County (WEC) is also seeing a rise. In 2023, WEC had 13 reported cases of active TB – the highest number in 4 years, as well as 294 cases of TB infection. The WECHU’s Infectious Disease Team also supported the transfer of three active TB disease cases to West Park Healthcare Centre in Toronto to further assist with isolation requirements. In addition, the WECHU received 161 TB medical surveillance (TBMS) reports from the Immigration, Refugees and Citizenship Canada (IRCC) in 2023 for individuals who newly arrived in Canada. 

DISCUSSION

World Tuberculosis (TB) Day was observed on March 24 and this year’s theme, “Yes! We can end TB”, provided an opportunity to raise awareness about TB-related problems and solutions and to support worldwide TB control efforts. A package was shared with local community partners containing information about TB and the bacille Calmette-Guerin (BCG) vaccination, as well as a copy of WECHU’s TB Health Care Provider Investigation and Reporting Form and Public Health Ontario’s General Test Requisition Form. Proclamations were also proclaimed by the City of Windsor and the Town of Essex, highlighting World TB Day in 2024. Moreover, an information booth was set up at Devonshire Mall on March 25^th, 2024, from 10:00 am to 8:00 pm, to shed light on World TB Day and raise community awareness.

The WECHU invites local community partners to join quarterly Community of Practice (CoP) meetings focused on infectious diseases, like TB. The aim is to foster technical exchange, collaboration, learning, capacity building, and resource mobilization by providing a forum to enable information sharing and problem-solving relevant to the IDP public health standards.

PREPARED BY:

Oral Health

DATE:

2024-05-16

SUBJECT:

WECHU Oral Health Services and Oral Health Month

BACKGROUND/PURPOSE

The Windsor Essex County Health Unit operates two provincially-funded dental programs under the Oral Health Protocol (2021), a component of the Ontario Public Health Standards. The Healthy Smiles Ontario (HSO) Program is available for children 0-17, from low-income households, and the Ontario Seniors Dental Care Program (OSDCP) is offered to low-income seniors 65 years and older. These programs important contributors to improved access to dental care as they remove financial barriers for vulnerable populations in Windsor-Essex.  Additionally, the Oral Health Protocol mandates the implementation of school based preventive oral heath screenings and population-level surveillance of oral health indicators.

DISCUSSION

WECHU Healthy Smiles Ontario (HSO) Dental Clinics

Our Windsor and Leamington WECHU dental clinics successfully screened and enrolled 1,335 children in the publicly funded Healthy Smiles Ontario program during the 2023 calendar year. We provided emergency coverage for urgent dental conditions, including open carious lesions and infections, and assisted families in connecting with community dentists to address these immediate needs. Additionally, we offered preventive treatments such as topical fluoride applications, scaling, and pit and fissure sealants.

Ontario Seniors Dental Care Program (OSDCP)

The OSDCP was launched in October 2019 to address the barriers that low-income seniors in the Windsor-Essex face when accessing oral health care. The primary goal of the program is to remove clients from dental pain and infection and reduce the number of visits to the ED for dental emergencies. Due to high demands on the program, the WECHU implemented a multitiered approach in 2022, forming partnerships with community dental offices to better meet the needs of the OSDCP clients. By utilizing both internal clinics and community dental offices, in 2023, 4,006 clinic visits were provided for seniors enrolled in OSDCP.  In this time, 570 "new patient" exams were completed, with an average of 2.2 new patients being added daily to the client roster. Furthermore, the WECHU provided new dentures to 164 senior clients over the course of the year.

School Dental Screening, Assessment and Surveillance 

School dental screenings are typically conducted in line with the Oral Health Protocol (2021), which includes the following students:

• Schools deemed LOW risk: all JK/SK and grade 2 students
• School is deemed MEDIUM risk: all JK/SK, grade 2 and grade 7 students 
• School is deemed HIGH risk: all JK/SK, grade 2, grade 4, and grade 7 students

In 2023, the Oral Health Team set a goal of screening all grades in high-risk schools (JK-8). This initiative was to ensure that all students in high-risk schools were captured and given access to publicly-funded dental care in spite of disruptions to normal screening practices throughout the COVID-19 pandemic. From January to June of 2023, a total of 11,068 students from 82 schools underwent screening. Among them 1,466 (13.2%) students were identified with urgent dental care needs and were promptly referred for treatment and while 5,535 children were recommended for preventive care. Overall, in the 2022-2023 school year, 16,149 students were screened, and 2,300 (14.2%) children were identified with an urgent dental need and subsequently enrolled in the HSO program. 

After successfully meeting this goal, the Oral Health Team transitioned back to implementing the Oral Health protocol as outlined above for the 2023/2024 school year. From September to December 2023, a total of 5,245 students from 39 schools were screened, 895 (17.1%) were identified as requiring urgent dental care, and 2,390 children were recommended for preventive treatment. 

CONSULTATION:

The following individuals have contributed to this report: Sarah Hill and Kendra Chappus Sikich, Managers, Oral Health Department

Key References

Ontario. Ministry of Health. (2021). Oral health protocol, 2021. Retrieved from https://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/docs/protocols_guidelines/Oral%20Health%20Protocol_2021.pdf

PREPARED BY:

Environmental Health

DATE:

2024-05-16

SUBJECT:

Emergency Preparedness

BACKGROUND/PURPOSE

Being ready for an emergency starts with being prepared and having a plan. All Windsor and Essex County residents have a role to ensure readiness for emergencies. Emergency Preparedness Week (EP Week) is a national event that educates communities across the province about actions people can take to prepare for emergency situations. This annual event has taken place for over 25 years and is traditionally held during the first full week of May. The event serves as a great reminder for residents to keep an ongoing awareness of the risks specific to our community, make a plan to respond to these risks, prepare a 72-hour emergency kit, and to stay informed in the unlikely event that an emergency occurs. The WECHU provides a number of important resources on our website with important links and guides to help everyone feel prepared.

DISCUSSION

EP Week took place from May 5-11, 2024. Aligning with Ontario’s Provincial Emergency Management Strategy and Action Plan and it’s goal to keep Ontario in a state of constant readiness and preparedness, the theme for 2024 was “Plan for Every Season.” This theme reflected the unique challenges we face in Ontario on a seasonal basis and the opportunities to practice emergency preparedness throughout the year. 

The WECHU, in collaboration with the City of Windsor and the New Canadians Centre for Excellence (NCCE), hosted information sessions on Emergency Preparedness for newcomers in the Windsor and Essex County region. The 40-person session covered essential topics such as preparing 72-hour emergency kits and plans for families, fire safety, heat-related events, and nuclear preparedness. Additionally, the WECHU conducted a social media campaign with content on emergency kit items, extreme heat preparedness, and emergency plans. Internally, the WECHU refreshed its own emergency readiness through testing of our 24/7 notification system, known as RAVE Alert mobile safety, to ensure quick and barrier free communication with our staff during emergencies.

The WECHU participated in a bi-annual OPHEMN (Ontario Public Health Emergency Management Network) meeting, a knowledge-sharing and exchange platform for enhancing public health emergency management programming across the province. Several public health units, including the WECHU, signed up as active observers for a provincially led extreme heat exercise. The exercise facilitated meaningful engagement on the exercise scenario and sharing learnings on initial onset and impacts, sustained response, recovery, and demobilization.

Potassium Iodide (KI) Distribution

The WECHU, initially introduced in 2018, continues to support a Potassium Iodide (KI) pill distribution program to ensure that WEC residents living within the primary and secondary zones of the Fermi 2 Nuclear Energy plant are prepared in the event of a nuclear emergency. These exposure zones are based on the Canadian Nuclear Safety Commission guidelines as the Emergency Planning Zone (EPZ), which extends 10 miles (16 km) in a radius around a plant (Primary Zone). This zone includes sections of the Town of Amherstburg and LaSalle, including the entirety of Boblo Island. The secondary zone is the Contingency Planning Zone (CPZ), which extends about 50 miles (80 km) around a nuclear plant in WEC. KI is a stable iodine salt that is effective in reducing the risk of thyroid cancer in the event of a radioactive iodine release. Newborns, infants, children, adolescents, and pregnant and breastfeeding individuals are at the highest risk of adverse health effects to the thyroid from radioactive iodine. Therefore, these individuals should be the first utilize KI tablets in the unlikely event of a nuclear accident. KI tablets are only to be taken when instructed by the Medical Officer of Health. The current KI tablet stock out in the community is nearing expiry in Spring 2025. The WECHU, in consultation with the Ontario Ministry of Health, has developed a plan to ensure a replacement process for KI pills beginning in June 2024 to ensure ongoing nuclear emergency readiness. The WECHU, in collaboration with municipalities in the primary zone, will be implementing a community level distribution of KI pills, prioritizing primary zone residents, followed by secondary zone residents.

PREPARED BY:

Environmental Health

DATE:

2024-05-16

SUBJECT:

Zoonotic and Vector-borne Disease Surveillance Program

BACKGROUND/PURPOSE

The Environmental Health Department delivers a zoonotic and vector-borne surveillance program to monitor Rabies, West Nile Virus (WNV), Eastern Equine Encephalitis (EEE), Zika Virus and Lyme disease activity in Windsor and Essex County (WEC). The program is required under the Health Protection and Promotion Act and provides the community with an early warning system for disease transmission through ticks and mosquitoes as well as to prevent human cases of rabies by animal rabies surveillance. This program is made up of the following components: mosquito larval surveillance and larviciding; adult mosquito trapping; human case surveillance for Rabies, WNV and Lyme disease; animal bite investigation; public education; and active tick surveillance. The tasks of mosquito larval surveillance and control, along with mosquito identification and viral testing, are performed by contracted agencies on behalf of the WECHU.

DISCUSSION

Animal Bite Investigations

Rabies is a viral disease that affects the central nervous system of warm-blooded animals, including humans. Once symptoms appear, rabies is almost always fatal.  In Canada, bats, foxes, skunks, and raccoons are the most common transmitters of the disease.

All potential rabies exposure cases are required to be reported to WECHU and are initiated within 24 hours of notification. Investigation includes an assessment of rabies risk in the animal species, the behaviour of the animal implicated, confinement of animals, and ensuring individuals requiring treatment have access to rabies post exposure prophylaxis.

In 2023, a total of 1075 rabies cases were investigated and followed up by the Public Health Inspectors. Almost 94% of these exposures were from canine and feline species. 

Active Tick Surveillance

Lyme disease is a vector-borne disease caused by the bacterium Borrelia burgdorferi. It is transmitted to humans through the bite of infected black-legged ticks. The WECHU's role is to measure and evaluate the risk of this tick-borne disease in our area.

Active surveillance is used to assess the local distribution and incidence of black-legged ticks in WEC. It involves the dragging of a white cloth through grassy areas whereby ticks attach themselves to the fabric and can be easily spotted and identified. Any black-legged ticks identified are sent to an accredited laboratory for testing of Lyme disease. Tick dragging will be performed in the fall for 2024.

In 2023, tick dragging was conducted at 4 sites across WEC (Ojibway Prairie Nature Reserve, Ruscom Shores Conservation Area, Cipher Systems Green Way – Essex and Hillman Marsh Conservation Area) in May and October. A total of forty-four black-legged ticks were identified through tick dragging, the majority of these were collected during fall (43 ticks).  The lab results confirmed twenty black legged ticks carrying the infectious agent that causes Lyme disease.   As the majority of the black -legged ticks were collected during fall months as well as based on the recommendations from Public Health Ontario, the tick dragging for this year is scheduled to be conducted in September.

Mosquito Surveillance

Adult mosquito surveillance is an important component of the vector-borne disease program and involves the deployment of black-light CDC traps and BG-Sentinel 2 (BGS-2) traps at various locations throughout WEC.

The CDC traps are equipped with light and dry ice that attracts and traps the mosquitoes. These traps capture mosquitoes for testing to determine the presence of WNV and EEE in our region. BG-Sentinel 2 (BGS-2) traps are species-specific traps set up to catch invasive species of mosquitoes (Aedes albopictus and Aedes aegypti) that were identified during routine WNV surveillance in WEC in 2016. These traps use a scent lure and dry ice to attract daytime mosquitoes. The trapped mosquitoes are sent to an accredited laboratory for identification and testing to determine if any of the mosquitoes carry the WNV, EEE or Zika virus.

In 2023, 73,000 mosquitoes were caught, and 11 pools tested positive for West Nile virus. For 2024, the trap deployment will start on May 21st, and run until mid-October. Once a week, 41 mosquito traps (26 CDC light traps and 15 BGS 2 traps) will be set up across WEC to collect mosquitoes for identification and viral testing. The weekly mosquito surveillance data will be made available on the WECHU's Mosquito Surveillance Dashboard.

Human Case Surveillance

The human case surveillance program identifies human cases of WNV and Lyme disease in WEC to determine the source of the disease. Physicians and hospitals must report all probable and confirmed cases to the WECHU.

The health unit investigates all suspected, probable and confirmed WNV and Lyme disease cases among WEC residents based on case definitions developed by the Ministry of Health (MOH). Standardized medical information, including demographics, symptoms, risk factors (such as travel history or having received blood products) and test results, are entered into the MOH's Integrated Public Health Information System (iPHIS). Through case interviews and GIS mapping, the health unit identifies clusters and geographic areas that may need targeted intervention. 

Public Awareness Campaigns

In 2024, Fight the Bite! campaign and rabies awareness campaign will run through summer months and will utilize various social media platforms, WECHU website and print resources (fact sheets, posters) to get the message on prevention of WNV, Lyme disease and Rabies.

PREPARED BY:

Chronic Disease and Injury Prevention

DATE:

2024-05-16

SUBJECT:

Implementation of the Ontario Naloxone Program 2023

BACKGROUND/PURPOSE

Naloxone is a fast-acting medication that can temporarily reverse the effects of an opioid overdose.  The Windsor-Essex County Health Unit (WECHU) operates the local Ontario Naloxone Program (ONP) which provides naloxone kits to eligible community organizations that work directly with populations at risk of opioid overdose through harm reduction programming, outreach and/or social determinants of health. 

In 2023, there were 26 community partners actively involved with the ONP, 7 of which were newly on-boarded. Through these partners, there were:

• 1,487 naloxone kits distributed
• 171 single nasal sprays distributed
• 1,106 individuals trained to administer naloxone
• 43 overdoses where naloxone was administered (emergency services only)

The WECHU’s ONP team actively recruits new agencies for participation in the ONP, including the two local police services, emergency medical services, fire departments, addictions treatment facilities, outreach programs, and several others. A WECHU public health nurse consults with new partners, provides training, enters into a service agreement with new partners, and manages storage, inventory, delivery, and reporting components of this program.  

In addition to operating the ONP locally, WECHU staff also engaged in several interventions to enhance community access to naloxone, which are highlighted below.

DISCUSSION

Supporting Pharmacy Naloxone Distribution

Through participating pharmacies, the Ontario Naloxone Program for Pharmacies (ONPP) distributes injectable and nasal spray naloxone kits to:

• Individuals at risk of opioid overdose
• Family and friends of a person who uses substances 
• People in a position to care for individuals who uses substances

In 2023, there were 99 eligible pharmacies in the ONPP across Windsor-Essex County that distributed:

• 2,801 injectable naloxone kits
• 23,036 intra-nasal naloxone kits

These pharmacies were engaged in a survey to identify gaps and/or barriers in naloxone distribution practices and to determine strategies to support distribution. 

• 42 pharmacies participated in the survey, 41 of which distributed naloxone. 
• Lack of public awareness about naloxone availability and stigma around naloxone/substance use were the top reported barriers to client access of naloxone kits.
• 80% of pharmacies reported that their naloxone distribution could benefit from support including access to naloxone educational posters and handouts (75%) and client training resources (50%).

The findings will be used in 2024 to create tailored outreach packages to participating pharmacies to support the promotion of naloxone distribution.

Fentanyl Test Strip Pilot

A three-month pilot of fentanyl test strips (FTS) distribution was conducted with three shelter partners and SafePoint. The purpose of the pilot was to examine the usefulness of FTS as a harm reduction strategy. Over the three-month pilot period:

• 292 FTS were distributed to 53 unique clients, 4 of which were returning clients. 
• As a result of receiving the FTS package, 43 total behaviour changes were reported by clients following use of FTS:
  • 18 instances of clients having naloxone available when using substances.
  • 12 instances where clients used substances with someone else present.
  • 5 instances of clients using slower.
  • 4 instances of clients doing a test shot/hit before using substances.
  • 4 instances of clients seeking substance use treatment and/or counselling.

Moving forward, additional ONP partners will be engaged to distribute fentanyl test strips, as well as xylazine and benzodiazepine test strips.

Community Training Event

In November, the Kingsville Community Centre and Town of Kingsville hosted an event to provide education on substance use and addictions to the community. At this event, the ONP team collaborated with Essex-Windsor EMS to provide naloxone and overdose response training, naloxone kits, and fentanyl test strips. In 2024, the ONP team along with the Windsor-Essex Community Opioid and Substance Use Strategy (WECOSS) plan to expand these overdose prevention trainings across four events to be hosted in Windsor. 

Purpose

To identify the BOH strengths and identify opportunities for training and support. 

• BOH is required to conduct a self-assessment.
• Questions related to 12 competencies.
• The 12 competencies and related questions were developed based on the Ontario Public Health Standards, BOH By-laws, and the alPHa BOH Governance Toolkit.

Results

• Current board membership includes 14 members, of which 13 completed the survey.
• There were 2 to 4 questions asked for each competency.
• Average scores were created for each competency.
• A satisfactory and optimal range was determined:
  • Satisfactory range (average score ≥2 and <3):BOH members have the necessary competencies to successfully complete tasks related to that topic but might require assistance from an expert at times.
  • Optimal range (average score ≥3):BOH members on average can perform actions related to these competencies without expert assistance.

Self-Assessment Scale

Areas of Competency

1. Communication and marketing:

Interacting with partners to promote programs/services.

2. Community partners and stakeholders engagement: 

Identifying key partners/stakeholders.

Establishing strong partnerships with other organizations.

Resolving conflicts between partners/stakeholders.

3. Health equity: 

Identifying barriers individuals face when accessing public health services.

Consideration of health inequities in program/services decision making.

4. Human resources: 

Attracting and retaining employees.

Assessing the work-related performance of employees.

Succession planning in an organization.

Addressing challenges in a unionized environment.

5. Financial management: 

Managing a budget within an organization.

Assessing financial information.

Creating innovative approaches to deal with fiscal restraints.

Re-allocating resources within an organization.

6.  Knowledge of delivery of public health programs/services: 

Implementation of the OPHS, developing evidence-based program/services, integrating client/customer needs into programs/services

7. Leadership and governance: 

Service on other boards or committees.

Decision-making that considers the impact on relevant stakeholders.

Leadership-level guidance of organizational operations.

Guiding an organization through change to reach their goals.

8. Legal: 

Managing organizational legal considerations, applying ministry level legal requirements in an org, adhering to ministry required BoH legal obligations

9. Performance mgmt. and quality improvement: 

Supporting an organizational culture of continuous quality improvement.

Making organizational decisions based on the quality of programs/services.

10. Political acumen: 

Understand the formal process for decision making at the municipal level.

Identifying key players in the political decision making process.

Developing healthy public policies (e.g., analyzing, planning, implementing, and evaluating policy).

Advocating for the passing and enforcement of healthy public policies.

11. Risk mgmt: 

identifying organizational risks, documenting the cause and consequence of identified organizational risks

12. Strategic and operational planning: 

Development of organizational strategic plans.

Working towards organizational strategic priorities.

Monitoring progress towards meeting a strategic plan.

Competency Assessment

Top Strengths/Opportunities

Overall Recommendations

• Provide training education sessions and e-learning modules to board members.
  • Beginning with the areas of opportunity (e.g., Health Equity, Knowledge and Delivery of Public Health Programs and Services, Legal).
• Quarterly opportunity to provide feedback in regards to BOH operations and decision-making.

Endorsement of CMOH Annual Report - An All of Society Approach to Substance Use and Harms

5/16/2024

BACKGROUND

In April 2024, Ontario’s Chief Medical Officer of Health (CMOH) Dr. Kieran Moore released his 2023 Annual Report, Balancing Act: An All-of-Society Approach to Addressing Substance Use and Harms. This report is his second as CMOH following the previous year’s Being Ready: Ensuring Public Health Preparedness for Infectious Outbreaks and Pandemics (2022). Highlighting recent trends and emerging or urgent public health matters, CMOH Annual Reports aim to set priorities for action across all levels of government. The 2023 report guides policy decisions and planning related to substance use and harm reduction interventions to reflect the increasing rates of overdose and death caused by substances prior to and throughout the COVID-19 pandemic. While this is the first report to focus solely on substance use, several previous CMOH annual reports have commented on its public health impact through the below 2015-2017 Annual Reports:

• Mapping Wellness: Ontario’s Route to Healthier Communities, 2015
• Improving the Odds: Championing Health Equity in Ontario, 2016
• Connected Communities: Healthier Together, 2017

The 2023 report provides 30 goals to guide action related to four specific substances: tobacco/vaping products, alcohol, cannabis, and opioids. These four substances combined account for thousands of emergency department visits hospitalizations and deaths in Ontario in addition to an economic impact of nearly $15 billion in costs attributable to healthcare, lost productivity, and the criminal justice system. When considering interventions at the local level, the report identifies the below strategies to address substance use across the prioritized four substances:

Tobacco/Vaping Products

1. Raise awareness of the risks of tobacco and vaping products.
2. Prevent/reduce vaping and nicotine use among youth and non-smokers.

• Advocate for expanding areas where smoking/vaping is prohibited (including apartment and condominium board policy), and include water pipes in bans.
  • Manage outlet density and hours of access.

3. Increase access to evidence-based smoking cessation therapies and supports.

Cannabis

1. Increase Awareness of Cannabis Harms.

• Promote Health Canada’s Low Risk Cannabis Guidelines​.
• Educate related to the risks of cannabis use including different forms and concentrations, during pregnancy, impaired driving, and polysubstance use.

2. Reduce risks to young children.

• Increase awareness related to the risk of pediatric poisonings from edibles.

Alcohol

1. Advocate for a comprehensive provincial alcohol strategy.
2. Increase awareness of alcohol-related harms.
3. Advocate for policies which limit access to prevent harm at the local level.
4. Enhance clinical services by promoting best practices, including screening and brief interventions and treatment access for people with alcohol use disorder.

Opioids

1. Advocate for increased access to resources that address determinants of health, including housing and access to  healthcare and social services.
2. Raise awareness of the risks associated with the toxic, unregulated drug supply.

• Inform communities about how to respond effectively (administering naloxone, calling 911).

3. Advocate for harm reduction service access, including naloxone, safer supply, supervised consumption (including for people who smoke drugs), and drug checking services and diversion program options.
4. Increase access to integrated, timely, low barrier, evidence informed treatment for people who use opioids. 
5. Address the impacts of grief and loss through services and support for families and friends of people who have died from toxicity and for support workers.

Since 2016 the WECHU has served as a central coordinating agency in Windsor and Essex County around many of the strategies referenced in the CMOH’s report. Through its leadership of the Windsor-Essex Community Opioid and Substance Strategy, its school and community-based health promotion activities, and its harm reduction programming (e.g., Ontario Naloxone Program implementation and Safer Consumption Site advocacy) several of the above-referenced strategies are currently in action. Planning and ongoing public health efforts will build upon the work already underway to align strategies with those prioritized provincially as indicated in the 2023 CMOH Annual Report. In this regard, ongoing partnerships with municipalities and partners in the addictions sector are necessary to take a comprehensive approach to mitigating and scaling back the escalating harms and impact of substance use in the region.

PROPOSED MOTION

Whereas, the CMOH has prioritized the prevention of harms associated with substance use as one of the biggest threats to what had previously been a steady increase in life expectancy in Ontario; and

Whereas, the CMOH calls on all levels of government to support public health efforts and contribute solutions through a comprehensive all-of-society approach to decreasing the impact of substance use on communities; and

Whereas, the impact of substance use on families, the health sector, and the provincial economy requires all partners to work collaboratively on solutions;

Whereas, the WECHU is a leading agency in the area of substance use prevention and harm reduction through its leadership and coordinating role in Windsor and Essex County;

Now therefore be it resolvedthat the Windsor-Essex County Board of Health endorses the 2023 Chief Medical Officer of Health’s Annual Report, Balancing Act: An All-of-Society Approach to Addressing Substance Use and Harms, to reaffirm its support for investment in public programming to mitigate the impact of substance use on Windsor and Essex County communities, and

FURTHER THAT, the Windsor-Essex County Health Unit shares the 2023 CMOH Annual Report as correspondence with local municipalities to inform healthy public policy development in Windsor and Essex County.

Canadian Substance Use Costs and Harms Scientific Working Group. Ontario Profile: Canadian Substance Use Costs and Harms (2007–2020) [Internet]. Ottawa, ON: Canadian Centre on Substance Use and Addiction; 2023. Available from: https://csuch.ca/substance-use-costs/provincial-territorial-costs/&nbsp;

Moore K. Being Ready: Ensuring Public Health Preparedness for Infectious Outbreaks and Pandemics. 2022 Annual Report of the Chief Medical Officer of Health of Ontario to the Legislative Assembly of Ontario. Toronto, ON: Queen’s Printer for Ontario; 2022. Available from: https://www.ontario.ca/page/chief-medical-officer-health-2022-annual-re… 

Williams D. Mapping wellness: Ontario’s route to healthier communities. 2015 annual report of the Chief Medical Officer of Health of Ontario to the Legislative Assembly of Ontario. Toronto, ON: Queen’s Printer for Ontario; 2017. Available from: https://www.simcoemuskokahealth.org/docs/default-source/hu-library/repo…; 

Williams D. Improving the odds: championing health equity in Ontario. 2016 annual report of the Chief Medical Officer of Health of Ontario to the Legislative Assembly of Ontario. Toronto, ON: Queen’s Printer for Ontario; 2018. Available from: https://www.simcoemuskokahealth.org/docs/default-source/hu-library/repo… 

Williams D. Connected communities: healthier together. 2017 annual report of the Chief Medical Officer of Health of Ontario to the Legislative Assembly of Ontario. Toronto, ON: Queen’s Printer for Ontario; 2019. Available from: https:// files.ontario.ca/moh-2017-annual-report-chief-medical-officer-health-en-2023-03-09.pdf