May 2023 Board of Health Meeting - Minutes

Board of Health Chair, Fabio Costante, called the Regular meeting to order at 4:07 pm, noting that the Board was happy to be meeting in person after a long hiatus due to COVID-19, and introduced our guests Dr. Robert Gordon and Gillian Heisz from the University of Windsor.

Dr. R. Gordon briefly discussed the partnership between the University of Windsor (“University”) and the Windsor-Essex County Health Unit (“WECHU”), funding collaboration, and our common goal to support and improve public health in the Windsor-Essex region.  The University and the WECHU are looking at establishing a Masters of Public Health program locally at the University to support talent development and improve the full student experience as we move forward together.  There will be many opportunities for growth over the next couple of years and the University is looking forward to a 25-year relationship with the WECHU. 

Dr. K. Blanchette echoed Dr. Gordon’s comments.  The University and the WECHU are working closely together and conducting weekly meetings at an Executive level to align Strategies, Visions and Key Needs for the community in terms of public health.  Meetings with key leaders locally and outside of our community have been positive.  We have connected with Dr. Shanthy Johnson, who will fill the role Vice-President of Research and Innovation for the University on July 1, 2023. Dr. Johnson comes to our region from the University of Alberta and this partnership will make a tremendous impact, not just locally, but across the province.  

A. Marignani asked what category or direction that research would take, and if it would be aligned with cancer research or mental health.  Dr. R. Gordon noted that the University is already in partnership with organizations such as St. Clair College, Hotel-Dieu Grace Healthcare, Windsor Regional Hospital and WE-Spark, and the research is broadly defined.  Dr. Johnston will provide a clear alignment with this partnership and will be the key lead on this relationship with the University’s Leadership Team to provide support to the WECHU.  The University has completed their first Strategic Plan in 15 years with a forward-thinking strategy.  The Key Pillar is Partnerships and to assist in being a solution-provider for the betterment of our region. 
4:17 pm - Dr. R. Gordon and G. Heisz left the meeting

1. Quorum - Confirmed
2. Land Acknowledgement
3. Declaration of Conflict of Interest - No conflicts declared. 

Approval of Agenda
Motion: That the agenda be approved.
CARRIED

Approval of Minutes:  April 20, 2023
Motion: That the minutes be approved.
CARRIED

Introduction: Dr. Mehdi Aloosh, Acting Medical Officer of Health (K. Blanchette)
Board Chair, F. Costante, introduced Dr. Mehdi Aloosh as the WECHU’s new Acting Medical Officer of Health.  The Board welcomed Dr. Aloosh and congratulated him on his new role.  Dr. Aloosh thanked the Chair, addressed the group and said that he was happy to serve as the region’s Acting MOH. 

1. Acting Medical Officer of Health Update (Dr. M. Aloosh) (for information)

   Dr. M. Aloosh provided information to the Board on the Human Papillomavirus or more commonly known as HPV, and the benefits of the HPV vaccine.  The vaccine is free to individuals in Grade 7 (age 11-12) at no cost until graduation from high school.  HPV transmits easily through sexual contact. Some individuals are asymptomatic and can pass the virus on to others without being aware they are infected.  Infections and symptoms are preventable and HPV is safe, effective and can protect people for their lifetime. Some common sexually transmitted diseases can affect 3 out of 4 sexually active individuals.

   With other measures, including screening, we can eliminate cervical cancer by 2040 by achieving an HPV vaccination rate over 90% by 2025. To achieve this by 2025 we need to advocate heavily for HPV.  

   The HPV can cause high risk diseases such as cancer and low risk diseases such as genital warts.  The vaccine could help reduce the affects of certain cancers up to 90%.  The best protection against HPV is pre-exposure and safe sex needs to be encouraged. 

   J. Lund asked what the Board and the community can do to support and promote, since this is not a mandatory vaccine. Dr. M. Aloosh said that education and awareness is best.  L. Watson advised that public health nurses go into the schools and letters are sent out to parents/guardians.  There is a lot of education and a strong health promotion program to make parents aware within the school system, but there needs to be more public awareness. There is no “age of consent” for health treatment and children would not require parental permissions to receive the HPV vaccine.  Consent is based on whether the youth is suitable to make decisions on their own. 

   Dr. S. Nesathurai said that the Board can speak publicly on vaccinating young people against the Human Papillomavirus.  We need to advocate and speak broadly about this.  R. Maich asked when the school program began, and at what age do we see a gap around coverage for young adults.  Dr. M Aloosh advised that the program began in the 2007-2008 school year in Ontario.  Optics have not been particularly good in general as the topic relates to sexual activity.  There are non-mandatory vaccines that have higher vaccination rates.  There is a population that is unvaccinated and that is why the HPV vaccine is recommended for women up to age 45 and for men up to 25-26 years.  The vaccine is readily available to students until graduation from secondary school. After graduation, the HPV vaccine can be obtained through Primary Care Providers and pharmacies but at a cost of approximately $200-$300 per dose (x2).

   K. Blanchette advised that there is a Physician Engagement Event taking place on Thursday, June 15, 2023.  Both Drs. Aloosh and Nesathurai will be presenting to Primary Care Providers and will promote increased advocacy around the HPV Vaccine. 

1. Board of Health By-Law #1 - Governance

2. Information Reports

   1. Zoonotic and Vector-Borne Surveillance Program

   2. Recreational Water Inspections and Beach Monitoring

   3. Small Drinking Water System

   4. First Responder Resilience Curriculum Project

   5. SafePoint Site Launch

   6. Communications Report
      Motion:    That the above information be approved.
      CARRIED 

3. Correspondence (for information)

   1. City of Hamilton - 2023 PHS Annual Service Plan & Budget Submission - Support for Sufficient, Stable and Sustained Funding for Local Public Health Agencies - Letter to Hon. Sylvia Jones, Minister of Health
      Motion:    That the information be received.
      CARRIED

1. Environmental Health Update (E. Bennett) (for information)
   Elaine Bennett, WECHU, Manager of Environmental Health, provided information to the Board on various topics related to Environmental Health. 

   Recreational Water Facility Inspections
   Recreational Water Facilities Inspections are outlined in the Recreational Water Protocol, 2019.  Public Health Inspections ensure water chemistry is appropriate to prevent and reduce water-borne illnesses such as ear, eye, and skin infections and gastrointestinal illnesses. Inspections of these facilities are also conducted to ensure appropriate emergency equipment is readily available in good repair, and appropriate signage is posted to prevent and reduce the risk of injury.  Pool operators are required to contact the WECHU’s Environmental Health Department prior to opening the following facilities:

   •    Class A Pools - pools open to the general public where lifeguards are required;
   •    Class B Pools - pools operated on the premises of an apartment buildings, hotels, that contain 6 or more units and are unsupervised;
   •    Class C Pools - wading pools, spray/splash pads, water slide receiving basin

   Beach Monitoring Program
   •    Public Health monitors (8) beaches weekly to collect water samples to test for Escherichia Coli (E. Coli) and surveys water, weather conditions and potential pollutants
   •    E. Coli can cause minor eye, ear, nose, skin or throat infections with various symptoms - the most vulnerable are children, the elderly and those with weakened immune systems
   •    Beach Warnings/Beach Closures are issued if E. Coli levels are go beyond acceptable levels
   •    Results are posted weekly on the WECHU website or is available through our hotline at 519-258-2146, #1490
   •    This program runs from June to September

   Small Drinking Water Systems
   •    Public Health Inspectors (PHIs) assess the risk level of Small Drinking Water Systems and issue site-specific directives to owners and operators, which include requirements for sampling and testing frequency, treatment, equipment, record maintenance, and signage posting
   •    Assessments are required to be completed every two to four years, at a minimum
   •    In addition, PHIs monitor lab results to ensure that the requirements outlined in the directives and Ontario Regulation 319/08: Small Drinking Water Systems are being met
   •    All adverse water quality incidents are inspected in a timely manner and appropriate corrective actions are taken to protect the public from unsafe water
   •    Most Small Drinking Water Systems in our region are located on Pelee Island 

   Vector-Borne Disease Surveillance
   •    Vector-Borne Diseases (VBD) are caused by vectors such as mosquitoes, ticks, and fleas that can spread pathogens (i.e., bacteria and viruses)
   •    Public Health Units across the Province are mandated under the Health Protection and Promotions Act (HPPA) as well as the Ontario Public Health Standards (OPHS) to have a VBD Surveillance program
   •    These VBD programs detect diseases such as Lyme Disease, West Nile Virus (WNV), Zika, and Eastern Equine Encephalitis Virus (EEE)
   •    Ontario started trapping mosquitoes for WNV in 2002, and Windsor-Essex County was one of the first regions in Canada to discover the WNV and have a human case
   •    Adult Mosquito Surveillance starts in May and typically runs until mid-October - this involves the deployment of black-light CDC traps and BG-Sentinel 2 (BGS-2) traps at various locations throughout Windsor-Essex
   •    The results of mosquito identification and viral testing are updated weekly on the Mosquito Surveillance Dashboard on the WECHU website 

   Active Tick Surveillance
   •    Active Tick Surveillance is used to assess the local distribution and incidence of black-legged ticks in Windsor-Essex in bush/wooded areas
   •    There are 4 different sites for tick dragging and they are located in the City, the County and Ojibway
   •    Tick dragging involves the dragging of a white cloth through grassy areas where 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, which can be transmitted to humans
   •    The WECHU provides proper direction on its website, should members of the public find a tick
   •    Public Health Ontario has declared most of Windsor-Essex as endemic for black-legged ticks
   •    In 2017 as well as last year a Lone Star Tick was identified during active tick dragging surveillance
   •    Tick dragging is performed twice a year, in the spring and in the fall 

   R. Agostino noted that in the Southern USA they have added QR Codes to pools and beach areas so water quality can be viewed prior to using. E. Bennett said we have implemented QR Codes last year and provide this information on our website. 

   A. Marignani asked the source of E-Coli at beaches, specifically Sandpoint Beach in Windsor.  E. Bennett said it can come from various sources such as wildlife, wind and rain, and boaters who do not dispose properly.  

   M. Prue asked about the Algae Bloom situation and E. Bennett advised that public health looks at this later in the season.  Algae Blooms are mostly attributed to weather and higher temperatures.  K. Blanchette noted that we are already in conversation with the Great Lakes Institute for Environmental Research as part of our partnership with the University of Windsor.

2. First Responder Resilience Curriculum Project (E. Nadalin) (for information)
   Gordon Thane, WECHU, Manager of Chronic Disease and Injury Prevention, provided a presentation to the Board on First Responder Mental Health Curriculum.

   There is a growing recognition that first responders workplace experiences result in unique mental health needs.  In 2016, the Workplace Safety & Insurance Act, Post-Traumatic Stress Disorder (1997) was amended by Bill 163, Supporting Ontario’s First Responders Act, Post-Traumatic Stress Disorder (2016), requiring employers of first responders to develop and implement post-traumatic stress disorder prevention plans. 

   In 2017-2018 the Ministry of Labour issued a call for proposals for the Occupational Health, Safety, and Prevention Innovation Program.  In response, the local First Responder Mental Health Coalition,  including the Windsor-Essex County Health Unit, submitted a successful proposal outlining six project commitments. 

   One of these commitments involved working with St. Clair College to investigate the feasibility of developing a common mental health module to be included in first responder programs offered by the college.  To ensure that any content developed would meet the needs of first responders, a needs assessment was conducted with local first responders. 

   Some of the most commonly identified topics that first responder would like to see included in the  education piece were resilience and coping, stigma reduction, self-awareness and role preparation, as well as general information about mental health and illness. Similarly, some of the most-commonly discussed threats to first responder mental health were a lack of self-awareness, balancing work and life, and engaging in reactive self-care. 

   Overall, the lesson content for the First Responder Curriculum Project was developed through a comprehensive approach that drew from a range of sources and stakeholders. This approach helped to ensure that the curriculum was grounded in the needs identified by local first responders and was responsive to the unique challenges they face.

   Motion:    That the information be received. 
           CARRIED

1. Consumption and Treatment Services Site Update (K. Blanchette/E. Nadalin) (for information)

   K. Blanchette and E. Nadalin provided an update on the SafePoint site.  The site has been open for three weeks and so far has been very positive.  People are comfortable, we are building and creating trust with clients, and we are establishing good relationships with local businesses.

   There have been a number of private tours and E. Nadalin thanked Board members who toured the site before the official opening.  Over 2 days there were approximately 400 residents, business owners and stakeholders who came through.  There has been a lot of interest and positive feedback and that was in advance of the site opening. 

   At end of day yesterday, we had 43 client visits, 26 consuming on site, and a ratio of 50/50 male and female. We have developed a transportation partnership, and there are security guards are on site.

   There have been community referrals, i.e., mental health and additions treatment, housing, and social services support.  There are RPNs on site to offer wound care, foot care and first aid.  The RPNs will refer to offsite primary care when care needs exceed the scope of staff.  There have been a number of success stories so far, and we are attending at the Southwest Detention Center in June to advise of our services at SafePoint.  

   A Marignani asked which wrap around services should be focused on at a municipal level, and if there was more access to housing would there be a decrease in services offered at SafePoint.  E. Nadalin said most specific services are access to treatment and housing.  The idea is to decrease the burden on hospitals by offering wound care on site, and all of the services being offered are critical. In terms of housing, consuming in an isolated residential setting increases the risk of overdose than using at facilities such as SafePoint.

   K. Blanchette said it is not just the homeless population that requires a site like SafePoint.  There are statistics that show that a significant portion of opioid deaths occur at home.  SafePoint provides a safe place to consume.

   F. Costante said that the launch of SafePoint has been successful and appreciates the ongoing reporting to the Board.  He thanked E. Nadalin and his team for their work over the last 5-6 years to get to this point, and that it was well worth the effort. 

   Motion:     That the information be received.
   CARRIED

1. CEO Report (K. Blanchette) (for information)

    K. Blanchette provided the following CEO updates: 
   •    K. Blanchette and Board Chair F. Costante attended the WE-Spark Event in April and met with young talent involved in various research projects  
   •    K. Blanchette attended the Physicians Award Night
   •    He noted the News Release for the 3 new Canada Research Chairs through the University of Windsor 
   •    The alPHa conference is in June and he will be attending along with Dr. Aloosh and Board member Judy Lund
   •    He asked that Board members continue to complete their Education modules that are part of the Board orientation piece 

2.  2023 Board of Health Meetings - Summer Sessions (K. Blanchette) (for information)
   K. Blanchette said now that we are no longer in Emergency Status we are looking at taking a summer recess for the Board as done in years previous to the pandemic.  We can provide Board Education sessions in July and August and resume regular meetings in September.  Emergency or ad hoc meetings could be called at the Board Chair’s discretion.  With regard to ongoing board meetings, F. Costante said that we will try to provide a virtual option, but in-person attendance is preferred.