Board of Health Meeting Documents

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:

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:

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:

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:

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.

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: 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: 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. 

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: 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.