Board of Health Meeting Documents

ISSUE/PURPOSE

The Windsor-Essex County Health Unit (WECHU) administers the Healthy Babies Healthy Children Program and the Pre-natal and Post-natal Nurse Practitioner Program (collectively referred to as the Programs).  These Programs are funded entirely by the Ministry of Children, Community and Social Services (MCCSS).  The operating budget for the fiscal year April 1, 2023 to March 31, 2024, requires approval by the Board of Health prior to submission to the MCCSS.

BACKGROUND

For fiscal 2023/24, these Programs support twenty-five and three quarters (25.75) FTEs comprised of one (1.0) manager FTE, one-quarter (0.25) director FTE, sixteen (16.0) public health nursing FTEs, one (1.0) nurse practitioner FTEs, four (4) family home visitor FTEs, one (1.0) social worker FTE, two and one-half (2.5) support staff FTEs.

Significant changes in the operating budget include the following:

• Net increase in Salaries and Benefits $10,580 representing salary increases as required by applicable employment agreements, net of uncompensated absences.
• Reduction in Mileage of $5,000 – The 2023/24 fiscal year reflects the average of mileage costs in the 2022/23 fiscal year.
• Reduction in Program Supplies of $5,750 – The fiscal 2023/24 budget contemplates expenditures being incurred on account of supplies to support programs ($15,792), information technology equipment replacement ($10,836), phone operating costs ($3,600), information technology licensing ($12,864).

PROPOSED MOTION

Whereas, The Windsor-Essex County Health Unit receives grants from the Ministry of Children, Community and Social Services to fund the Healthy Babies Healthy Children and Pre-natal and Post-natal Nurse Practitioner Programs,

Whereas, the total budgeted expenditures for the Programs for the period April 1, 2023 to March 31, 2024 is $2,894,941, and

Now therefore be it resolved that the Windsor-Essex County Board of Health approve the operating budget as presented by Administration for the period April 1, 2023, to March 31, 2024

ISSUE/PURPOSE

The Board of Health is required to approval the one-time business cases included in the 2022 Annual Service Plan and Budget Submission (ASP) as submitted on April 3, 2023.

BACKGROUND

On April 3, 2023, the ASP was submitted to the Ministry of Health (MOH).  The ASP included budget information approved by the Board of Health on January 18, 2023.  More specifically:

• 2023 Mandatory Program Budget;
• 2023 Ontario Seniors Dental Care Budget;
• 2023 One-time Business Cases in support of COVID-19, more specifically the COVID-19 general program and the COVID-19 vaccination program.

In addition, the ASP included requests for one-time business cases funded at a rate of 100% by the MOH.  More specifically:

A description of the business cases are as follows:

Vaccine Program Replacement & Contingency Plan Storage Requirements:  This business case is to fund the replacement of two (2) double-door vaccine fridges nearing end of useful life, and the acquisition of one (1) double-door vaccine fridge to be located at a third-party location to support contingency plan storage requirements.

Public Health Inspector Practicum Program:  This business case supports the salaries of four (4) public health inspector practicum students.  Public health inspector practicum students support the general operations of the Environmental Health department while gaining the well-rounded experience required to complete their certification. 

Ontario Seniors Dental Care Program – Furniture and Equipment fit-out:  This business case supports the fit out of operatories, client reception areas and other furniture requirements for the Windsor Office Redevelopment Project.  More specifically, this business case includes:

Information Technology, Furniture and Equipment Replacement:  This business case supports the replacement of the information technology infrastructure for the Windsor Office Redevelopment Project and additional furniture and equipment requirements to fit out other spaces.  A particular emphasis was placed on the replacement of the information technology infrastructure as it will be end-of-life in 2024.  This business case also includes third party consulting costs to support design and procurement requirements, capacity which does not exist within the WECHU Administration. More specifically, this business case includes:

New Windsor Office Location – Leasehold improvements: This business case supports certain of the leasehold improvements to be completed from April 2023 to March of 2024.  This business case includes third-party consulting costs to support overall project management, capacity which does not exist within the WECHU Administration. More specifically, this business case includes:

PROPOSED MOTION

Whereas, the Board of Health for the Windsor-Essex County Health Unit has approved the 2023 Budget which included budget information for Mandatory programs funded by the MOH and the Obligated Municipalities on a cost shared basis, the Ontario Seniors Dental Care Program funded at a rate of 100% by the MOH, as well as preliminary information on one-time business cases funded at a rate of 100% by the MOH relating to COVID-19 (general and vaccination), and

Whereas, the WECHU submitted its Annual Service Plan and Budget Submission to the MOH on April 3, 2023, inclusive of the aforementioned budget approvals as well as additional requests for one-time 100% funded business cases from the MOH, and

Now therefore be it resolved that the Windsor-Essex County Board of Health approve the following additional one-time business cases to be funded at a rate of 100% by the MOH:

Meeting held via video: https://youtube.com/live/m9IJV3aMESs

Board of Health
Windsor-Essex County Health Unit
c/o Lee Anne Damphouse
ldamphouse@wechu.org

December 20, 2022

Dear Members of the WECHU Board of Health,

I am writing to you as a Windsor resident and a parent of two children. I know I am not alone in wanting to be confident that up to date peer-reviewed science is used to inform local public health policy.

Almost a year has passed since Windsor reintroduced fluoride to the municipal water supply. The page relating to fluoride on the WECHU website¹ states that the optimal concentration of fluoride in drinking water to support good dental health is 0.7 mg/L and that Health Canada considers 1.5 ml/L to be the maximum acceptable concentration. It refers the reader to Health Canada for further information. Health Canada states:²

Since the 1940’s, researchers have been testing the safety and benefits of fluoride. Apart from dental fluorosis and skeletal fluorosis, there are no other health effects related to fluoride.

During pregnancy and breastfeeding: Fluoride is not harmful to a fetus or through breastfeeding.

When it comes to bottle-fed babies, the following advice appears lower down on the page:

If you live in an area with naturally occurring high levels of fluoride (higher than the guideline of 1.5 mg/L- the maximum acceptable concentration), we suggest you mix the formula with drinking water with a lower fluoride concentration level. (emphasis added)

I am concerned about the stated maximum acceptable threshold of 1.5 ml/L in this advice from WECHU and Health Canada.

The underlying reason for my concern is that the authors of the January 2020 study Fluoride exposure from infant formula and child IQ in a Canadian birth cohort³ found statistically significant reductions in IQ in formula fed infants, even when using “optimally fluoridated water” at a concentration of 0.7 mg/L:

Using optimally fluoridated water (0.7 mg/L) to reconstitute infant formula may diminish the development of intellectual abilities in young children, particularly for non-verbal abilities. The findings also suggest that both prenatal and postnatal fluoride exposure affect the development of non-verbal intelligence to a greater extent than verbal intelligence.

This level is less than half the concentration below which Health Canada deems fluoride to be safe.

In its strategic plan, the WECHU Board has committed that it will “make decisions based on quality evidence and apply best practice program planning and policy development frameworks.”⁴

For this reason, I am writing to ask that WECHU:

• add a link on the fluoride page of its website to inform pregnant women and families who choose to formula-feed their babies about the findings from this now 3-year old peer-reviewed study;
• start advising pregnant women and new parents to use non-fluoridated water to protect the developing brains of their babies.

These common-sense measures will enable parents to be better informed regarding the current science relating to municipal water fluoridation, enabling them to protect the health of their children during the most vulnerable phase of their lives.

I look forward to the Board’s response to my concerns.

Yours sincerely,
Philippa von Ziegenweidt
 

• ¹ Fluoride | The Windsor-Essex County Health Unit - (wechu.org)
• ² Fluoride and Oral Health - Canada.ca
• ³ Fluoride exposure from infant formula and child IQ in a Canadian birth cohort - ScienceDirect
• ⁴ Evidence-Based Public Health Practice | The Windsor-Essex County Health Unit - (wechu.org)

PREPARED BY:

Communications Department

DATE:

March 2023

SUBJECT:

January 15, 2023 – February 14, 2023, 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

Website Overview Graph

Social Media Overview Graph

DISCUSSION

The Communications Department launched Phase One of the Corporate Marketing Campaign on January 31.

This phase, which is focused on the historical aspect of public health, as well as introducing the seven main programs at the WECHU, will run until the end of March.

To date, organic (unpaid) social posts have been issued once per week, a boosted social post has run for seven days, emails have gone to our general subscribers, and our owned communication pieces (e.g., website banner, on-hold phone message) point to the new webpage.

The boosted post which ran from February 3 – 10, 2023 had a reach of 11,749 accounts, and resulted in 92 link clicks (visits to the wechu.org/history webpage). The post was targeted to adults living in Essex, Leamington, and Windsor (geographic tags available through Facebook’s ad centre, Meta), with the goal of boosting website visits.

PREPARED BY:

Planning and Strategic Initiatives Department

DATE:

March 2023

SUBJECT:

2023 Board of Health Competency Self-Evaluation

BACKGROUND

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”. 

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

CURRENT INITIATIVES

The survey was sent to current BOH members in January 2023. Analysis of the results from the 2023 BOH survey demonstrated that the top strengths of the BOH were Leadership and Governance, Political Acumen, and Communication and Marketing. Identified areas of opportunity were Knowledge of Public Health Programs and Services, Health Equity, and Legal Requirements. 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:

Planning and Strategic Initiatives Department

DATE:

March 2023

SUBJECT:

2022 Annual Statistical Reporting 

BACKGROUND

The WECHU is a “health information custodian (HIC)” in accordance with section 3 of the Personal Health Information Protection Act (PHIPA), and an “institution” in accordance with section 2 of the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA). Under this legislation the WECHU has obligations to ensure the rights of individuals with respect to privacy, access, and correction of records of personal information (PI) and personal health information (PHI), and access to general records that pertain to the WECHU operations and governance.

All institutions under MFIPPA, and HICs under PHIPA, are required to provide statistical reports to the Information and Privacy Commissioner of Ontario (IPC) on an annual basis with respect to:

• Confirmed privacy breaches under PHIPA
• Access and correction requests under PHIPA
• Access and correction requests under MFIPPA

The WECHU submitted statistical reports for each category by the required deadline of March 1st for PHIPA reports and March 31st for MFIPPA.

DISCUSSION

Privacy breaches

In 2022, the WECHU had eight confirmed breaches, the same as in 2021. Privacy breaches in 2022 predominantly included incidents where Personal Information (PI) and/or Personal Health Information (PHI) was disclosed without authority and emailed or faxed to the wrong person and/or organization.

The WECHU is looking at various ways to prevent breaches of this manner through training and investigating additional electronic information management systems.

MFIPPA Access and correction to information requests

In 2022, the WECHU received twenty-one formal MFIPPA access requests, compared to thirty-eight in 2021, and one correction request during the reporting year. All requests were completed within the reporting year.

Of the twenty-one access requests completed in 2022, the majority of requests came from an “individual /public” (43%) and “individual by agent” or lawyer (43%). This was followed by “media” (9%), and “government” (5% each).

PHIPA Access and correction to information requests

In 2022, the WECHU received 1540 formal PHIPA access requests and 169 formal correction requests during the reporting year. This was a significant increase from 2021 due to the WECHU’s involvement in supporting the proof of COVID-19 vaccination certificate program, as well as in the implementation of a COVax client access and correction process.

CONCLUSION

In summary, 95% of all MFIPPA requests and 99.9% of all PHIPA requests were completed within the statutory time limits, despite the operational impacts of the pandemic. Priorities for the coming year will include continued dedication of resources for the access to information and privacy program, including additional training, and updated workflows to improve request handling processes. These actions will improve records and information management (RIM) within the program, and allow the WECHU to respond with increased efficiency to information requests.

Introduction

In January 2023, a competency based self-assessment survey was distributed to 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 and again in 2023, allowing for a comparison of the data across years. Current BOH membership includes 10 members, of which 10 completed the 2023 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 are able to function most effectively, and are able to perform actions related to these topic areas without expert assistance.

The overall average for 2023 was 2.47, which was slightly higher than the 2022 average of 2.42.

As shown in Table 1, average scores in 2023 were higher than those in 2022 for all but five competencies (Health Equity, Leadership and Governance, Performance Management and Quality Improvement, Political Acumen, and Strategic and Operational Planning).  

Figures 1 and 2 are visual representations of the BOH average score on each competency compared to the satisfactory and optimal range. Scores for all but two competencies (Health Equity and Knowledge and Delivery of Public Health Programs/Services) fell into the satisfactory range, while no scores 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 further comments or suggestions. The themes of the comments included the request for more information regarding the future of the modernization of Health Units in Ontario, opportunities to make WECHU stand out amongst other Health Units, and more information on WECHU programs and services, namely Consumption and Treatment Services Sites (CTS) and the related regulations. 

Overall Recommendations

• Provide training education sessions and e-learning modules to board members, beginning with those areas with the lowest scores (i.e., Health Equity, Knowledge and Delivery of Public Health Programs and Services).
• Provide quarterly opportunities to Board of Health members to provide feedback and recommendations in regards to Board of Health operations and decision-making to ensure continuous quality improvement.

Appendices

Letters in support and regading provincial funding of CTS operations.

An accessible version of these documents will be posted when available.

Meeting held via video: https://youtube.com/live/gah0EtFWtWk

PREPARED BY:

Communications Department

DATE:

February 16, 2023

SUBJECT:

December 15 , 2022 – January 14, 2023 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

Website Overview Graph

Social Media Overview Graph

DISCUSSION

The Communications Department is working with the Healthy Schools Department to inform parents and guardians of elementary school students that they must update their child’s vaccination records with public health or risk a possible suspension from school. Parents and guardians are required under the Immunization of School Pupils Act to keep their child’s immunization records up to date with public health. It is not the responsibility of health care providers to update public health.

An awareness campaign started in December and is running until Thursday, March 16, 2023, in preparation for the Monday, March 20 suspension date. The two calls to action for parents and guardians are to update records and book an appointment to receive any outstanding immunizations.

A boosted post on Facebook (image above) ran for 7 days and resulted in a reach of 2,764 viewers, and 38 link clicks. In addition to ongoing boosted posts, the Communications Department is working closely with representatives from the four school boards’ communication teams to deliver messages directly to families. Some components include Communication Guides, email and voicemail scripts, FAQs for school administrators, and monthly social media content calendars.

Board Members Present:

Renaldo Agostino, Joe Bachetti, Fabio Costante, Fred Francis, Judy Lund, Hilda MacDonald, Angelo Marignani, Michael Prue, Rob Shepley

Board Member Regrets:

Robert Maich

ISSUE

The Windsor and Essex County (WEC) leads the province of Ontario when it comes to agricultural activities, with a large number of greenhouse-producing crops. The greenhouse farm operations allow for high yields year-round, which is unique to this region. Many seasonal agricultural workers are offshore workers from Mexico and Caribbean countries. From a public health perspective, International Agricultural Workers (IAWs) must be provided with adequate housing conditions in accordance with all applicable guidelines and protocols. As of 2022, there are approximately 1,156 seasonal housing accommodations in our region that the Public Health Inspectors (PHIs) routinely inspect.

WEC has seen an influx of IAWs over the past three years in order to meet the rising demand of crop production. As a result, (Table 1), the WECHU has seen a significant increase in the number of requests for inspection of new seasonal housing accommodations, and in 2023, we anticipate an additional 15% amounting to a total of 1330 (annually). This growth has substantially impacted the human resources required for inspections, re-inspections, administrative management, program processes, and coordination within the Environmental Health (EH) department.

The initial cost recovery fee structure for the program introduced with WECHU’s Board of Health approval in 2020 ($75 per annual licensing inspection). This structure was based on a preliminary assessment of other Ontario health units operating the same program. In the fall of 2022, an updated scan of public health units was completed to understand how similar programs were being maintained given the increases in quantity and cost. It was identified that the majority of other health units were charging fees ranging from $105 - $125 for both licensing and other re-inspections. With this in mind, and in consideration of the ongoing growth in the number of seasonal housing facilities requiring inspections, and the increased demand on administration and resources it is recommended that the WECHU revise the current fee structure.

BACKGROUND

In 2022, 1156 seasonal accommodations were inspected, at least once, in WEC. These inspections are mandated under Part III of the Health Protection and Promotion Act (HPPA) and the Ontario Public Health Standards: Requirements for Programs, Services and Accountability 2018 (OPHS) and its related protocols and guidelines. The Environmental Health (EH) Department also works with Services Canada and the Foreign Agricultural Resource Management Services (FARMS) to approve all seasonal accommodations for occupancy. Our staff also works with local fire, building, and by-law enforcement to address issues that are associated with IAWs accommodations. The inspection and complaint process requires a great deal of coordination, tracking, and documentation as multiple government agencies are involved with the entire process, including the Mexican and Jamaican Consulates.

PROPOSED MOTION

Whereas the WECHU’s work related to seasonal housing is mandated by Part III of the Health Protection and Promotion Act (HPPA) and the Ontario Public Health Standards: Requirements for Programs, Services and Accountability 2018 (OPHS) and its related protocols and guidelines; and

Whereas the funds collected through a fee-for-service program have been utilized to support human resources in the WECHU Leamington office to meet the requirements of the seasonal housing program since 2020; and

Whereas the number of seasonal housing accommodation that requires inspections, documentation, and processing through the WECHU has significantly increased since 2020; and

Whereas the additional funds generated through an increase in the current fee structure would be more reflective of the rising operational costs attributed to this program.

Now therefore be it resolved that the Windsor-Essex County Board of Health supports a fee increase of $25 (increase from $75 to $100) increase for annual licensing inspections in the seasonal housing inspection program; and

FURTHER THAT, the Windsor-Essex County Board of Health supports the utilization of monies generated from the seasonal housing licensing inspection fees be used to support the increasing costs of program implementation within the Environmental Health Department, including supporting the department’s clerical staff complement.

Meeting held via video: https://youtube.com/live/yOsk6Ql-azY

Letters in support of the proposed CTS operations at 101 Wyandotte Street East are being submitted on behalf of the following agencies:

• Brentwood Recovery Home – Elizabeth Dulmage, Executive Director
• Canadian Mental Health Association – Windsor-Essex County Branch – Dr. Sonja Grbevski, Chief Executive Officer
• Conseil Scolaire Catholique Providence – Joseph Picard, Director of Education
• The Downtown Windsor Business Improvement Association – Pat Papadeas – Acting Chair
• Essex-Windsor Emergency Medical Services (EMS) – Chief Bruce Krauter
• Family Services Windsor-Essex – Joyce Zuk, Executive Director
• Legal Assistance of Windsor – Marion Overholt, Executive Director
• Pozitive Pathways Community Services – Michael Brennan, Executive Director
• REACT Windsor-Essex – Robert Cameron, Executive Director
• Windsor Essex Community Health Centre – Rita Taillefer, Executive Director
• Windsor Police Service – Jason Bellaire, Chief of Police
• Windsor Regional Hospital – Jonathan Foster, Vice President of Emergency, Trauma, Mental Health, Cancer Services, & Renal

An accessible version of this document will be posted when available.

An accessible version of this document will be posted when available.

An accessible version of this document will be posted when available.

An FAQ document that provides answers to commonly asked questions about the provincial (CTS) and federal (Supervised Consumption Services) application and program requirements.

An accessible version of this document will be posted when available.

An accessible version of this document will be posted when available.

Results from a community consultation study conducted by the WECHU, in partnership with the Windsor-Essex Community Opioid & Substance Strategy and the CTS Stakeholder Advisory Committee, in 2021 that yielded community support/acceptance and demonstrated a local need for establishing a CTS at 101 Wyandotte Street East in the City of Windsor.

An accessible version of this document will be posted when available.