Board of Health Meeting Documents

We also respectfully request that the Chief Medical Officer of Health ensure proactive engagement in the sector-driven review of the Ontario Public Health Standards.

Sincerely,

Original signed by

Councillor Kathryn Wilson Chair,
Board of Health

/ag

cc:
Dr. Kieran Moore,Ontario Chief Medical Officer of Health Local MPPs
Ontario Boards of Health
Association of Local Public Health Agencies.

The conversations we had were important and it is through ongoing dialogue and collaboration that we will be able to maximize the opportunities that the Strengthening Public Health strategy presents to make our sector stronger.

We look forward to continuing these important discussions over the coming months.

Sincerely,

Dr. Kieran Michael Moore, MD, CCFP(EM), FCFP, MPH, DTM&H, FRCPC, FCAHS
Chief Medical Officer of Health and Assistant Deputy Minister, Public Health

c. Elizabeth Walker, Executive Lead, Office of the Chief Medical Officer of Health
Brent Feeney, Director, Accountability and Liaison Branch, Office of the Chief Medical Officer of Health
Dr. Wajid Ahmed, Associate Chief Medical Officer of Health, Office of the Chief Medical Officer of Health

14-075

PREPARED BY:

Planning and Strategic Initiatives

DATE:

March 21, 2024

SUBJECT:

2023 Privacy Summary Report

BACKGROUND/PURPOSE

The Windsor-Essex County Health Unit (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 (Appendix A)
• Access and correction requests under PHIPA (Appendix B)
• Access and correction requests under MFIPPA (Appendix C)

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

DISCUSSION

Privacy breaches

In 2023, the WECHU had 12 confirmed breaches. Privacy breaches in 2023 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 2023, the WECHU received 18 formal Freedom of Information requests based on MFIPPA, compared to 22 in 2022. All requests were processed within the reporting year.

PHIPA access and correction to information requests

In 2023, the WECHU received 55 formal Freedom of Information requests based on PHIPA during the reporting year. This was a significant decrease from 2022 due to decreased involvement the WECHU’s support for validating proof of COVID-19 vaccination certification. 

CONCLUSION

In summary, all MFIPPA requests and all PHIPA requests were completed within the statutory time limits in 2023. 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.

In 2023, the WECHU initiated a total of 207 Intervention Workplans (IWP). 

153 of the workplans were external (public facing) endeavors with work spanning across 6 external departments and 47 individual programs. 

54 workplans were internal which supported operations and initiatives within the WECHU.

As illustrated in Figure 1a, 110 of the external workplans were completed (72%), with 32 being deferred, and 11 cancelled.

Figure 1b depicts the internal workplans, of which 34 were completed (63%), 17 deferred, and 3 cancelled.

PREPARED BY: Communications Department 

DATE: January 22, 2024

SUBJECT: December 15, 2023 – January 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 December 15 – January 14, we experienced three main peaks of media exposure:

Dec 20 – A spike in media coverage followed a News Release issued around the emergence of nicotine pouches and their target of a youth population.

Dec 29 & Jan 3 – Media coverage over this timeframe focused on the pause in services at SafePoint which took effect on January 1, 2024.

Website Overview Graph

Notes: From December 15 – January 14, we saw very similar website traffic patterns as the previous month, but with lower traffic overall due to the holidays and fewer messages released to direct to our website.

Social Media Overview Graph

Lighter blue line represents the current month, darker blue line represents the previous month. Notes: We saw some small decreases in followers over the month, likely due to a decrease in posts over the holidays. 

Discussion

The Communications Department worked with the Chronic Disease and Injury Prevention on a series of digital images to raise awareness of safer gambling practices as part of a grant. The work was a partnership between the WECHU, Hotel-Dieu Grace Healthcare (HDGH), and the Lower-Risk Gambling Guidelines (LRGG) organization. The series of four posts were boosted on Facebook and were set as Google Display ads which appear on the webpages of members of the target audience.

The campaign offered tips to practice safer gambling, encouraged people to assess their risk level with a tool through the LRGG, and directed readers to local resources such as HDGH’s Centre for Problem Gambling and Digital Dependency.

The posts and Google ads performed better than expected (e.g., they were anticipated to have low engagement due to being launched over the holiday season where viewership is generally lower). The standout result of the posts was that they drove enough traffic to the webpage that it ended up in the top five visited pages for four straight weeks. Specifically, the four posts yielded a total of 577 link clicks on Facebook over the two-week duration.

PREPARED BY:

Communications Department

DATE:

February 20, 2024

SUBJECT:

January 15, 2024 – February 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

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

January 26: Following our release about a possible measles exposure, 29 media stories were issued. 

January 30 – February 1 & February 5: The announcement of the decision to no longer relocate to the University of Windsor campus resulted in 16 stories. Overlapping this, our news release with an updated number of students with incomplete immunization records received 19 stories. The spike on February 5 was an echo effect of these two stories.

Website Overview Graph

Notes: From January 15 – February 14, we saw very similar website traffic patterns as the previous month, but an increase in traffic overall. This can be attributed to the lower viewership in December over the holidays, as well as a handful of large news stories which were issued in January, driving people to our website (e.g. News Releases around measles exposure, our office relocation, and student immunizations).

Social Media Overview Graph

Lighter blue line represents the current month, darker blue line represents the previous month. Notes: We saw some increases in followers over the month. 

Discussion – Student Immunizations

The Communications Department worked with the Healthy Schools department to communicate to families around the Immunization of School Pupils Act (ISPA) and the importance of keeping immunization records up to date. These communication pieces included a News Release which was issued on January 31, 2024, boosted (paid) social media posts and ads, as well as meetings with the school board communication representatives. 

The News Release had an open rate of 43% from the media audience. This resulted in 19 published news stories to help raise awareness of the various ways parents and guardians can update their child’s record or receive any necessary immunizations. 

Additionally, a webpage was created for school administrators which houses a variety of documents to support the ISPA enforcement process. Documents include a flow chart of next steps for parents, frequently asked questions and answers, and a communication guide with pre-created social media posts, emails, and voice recording scripts for schools to utilize. Through feedback from the communications representatives at the school boards, these documents have proven to be incredibly valuable and helpful for their administrative teams when speaking with parents and guardians. 

PREPARED BY:

Planning and Strategic Initiatives

DATE:

March 21, 2024

SUBJECT:

2023 Annual Service Plan: Annual and 4th Quarter Report

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 and integrated approach to evaluating progress on this requirement, the Planning and Strategic Initiatives (PSI) department worked with the Information Technology (IT) department to align our planning system with the provincial Ontario Public Health Standards requirements to provide quarterly progress reports on the plan. 

DISCUSSION

2023 Annual Overview

72% of the WECHU’s external public-facing programming was completed as planned in 2023.

Several environmental factors led to adjustments throughout the year and affected completion rates of the plan. These factors included: The Provincial requirement to operate a local COVID-19 vaccination clinic; changes to the co-location partnership with the University of Windsor; and the revised Provincial funding formula that led to significant staffing and resource limitations during the 4th Quarter of 2023.

Q4 Intervention Work Plan Progress

Project Leads have submitted individual progress reports for work plans in their programs for Q4, 2023. 

The 2023 Annual Service Plan – Q4 Recommendation Report indicates:

• For external client facing programs, there were 124 active plans with 84% being completed.
• For internal organizational programs, there are 38 active workplans with 63% being completed.

Annual Service Plan Development for 2024

Activities in the Intervention Work Plans (IWP) have begun and detailed reporting on their progress will be submitted to the Ministry of Health in April as directed.

PREPARED BY:

Planning and Strategic Initiatives

DATE:

March 21, 2024

SUBJECT:

Q4 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 in the fourth quarter of 2023 related to BoH operations continued to be positive. In all cases, 100% of the responses were ‘Agree’ or ‘Strongly Agree’ regarding the aspects queried. In terms of overall perceived BoH effectiveness, 70% of the responses were either a 9 or a 10 (on a 10-point scale), where the average score was 9. 

Suggestions for improvement included support for additional BoH education, greater clarity on meeting agendas (including earlier provision of agendas), establishing consistent monthly BoH meetings, establishing a permanent location for BoH meetings, and extending electronic access to BoH materials to additional devices.

PREPARED BY:

Chronic Disease and Injury Prevention

DATE:

March 21, 2024

SUBJECT:

Nutrition Month and Nutrition Programming

BACKGROUND/PURPOSE

For the past 40 years, March has been celebrated as Nutrition Month across Canada. Nutrition month is a time to recognize the field of dietetics, to reflect on past practices, and to highlight nutritional needs in the community. Food and nutrition interact and intersect with almost every department within a public health unit. Public health nutrition uses population and health promotion approaches and strategies focused on the assessment, promotion, protection and enhancement of health, and the prevention of nutrition-related diseases. Public health nutrition requires the leadership of Registered Dietitians with expertise in nutrition and related public health sciences, as the field of nutrition constantly evolves and changes. Registered Dietitians ensure that best practices are consistently updated and applied to public health practice.

CURRENT INITIATIVES

Nutrition programing at the WECHU addresses barriers to achieving consistent eating behaviours with a focus on decreasing food insecurity and increasing food literacy in our community. Past and present interventions that support this work are described below. 

Nutrition Month – March 2024

To celebrate Nutrition Month, Dietitians of Canada is shining a spotlight on the dietetic profession to recognize and acknowledge the impact of dietitians nationwide. Locally, the WECHU is focusing on changing the current environment surrounding food and nutrition, through the education and promotion of using a food neutral approach to eating.

• A newsletter and social media campaign on food neutrality was promoted throughout March. 
• Food & Nutrition section of the WECHU website updated to reflect food neutral language change.
• Partnered with the University of Windsor’s student food pantry to provide sessions on food neutrality and how to nourish the body with a limited budget.
• Food neutrality online training will be released later this year, to continue to support community partners and community members in making this change.

Food Insecurity Initiatives

Food insecurity is a growing Public Health concern, because it is so tightly linked to adverse health outcomes, above and beyond the influence of other social determinants of health. 

• Monitoring Food Affordability: WECHU continues to release food affordability surveillance data to help inform decision making in our community. 
  • The Real Cost of Eating Report was released in November of 2023.
  • After presenting the findings of the 2023 report at a local Feed Ontario event, the CDIP Nutritionist was interviewed and quoted in 9 media reports. 
  • Briefing note on food insecurity sent to Senator Burey in September of 2023.
  • Data collection for 2024 will occur in May, with report findings to be released in the fall.
• Food Insecurity Screening: A food insecurity screening tool and associated trainings will be created by the WECHU in 2024.
  • Data on food insecurity in certain demographics is limited. 
  • Screening allows health care providers and community partners the ability to identify and support clients who are experiencing food insecurity, while providing accurate data to ensure supports are being utilized effectively. 

Food Literacy Initiatives

Food literacy impacts how easily a person can implement healthy eating behaviours. Food literacy includes interconnected attributes organized into the categories of food and nutrition knowledge; food skills; self-efficacy and confidence; food decisions; and ecologic (external) factors.

• You Can Cook Video Series: The You Can Cook video series is a virtual food skill program that teaches basic food skills in five minutes or less. There are 15 videos in the series, with each video building on the previous skills taught as the series progresses. 
  • Since 2022 the series has had over 4,600 views between all videos, and an additional 3,700 views of the series trailer. 
  • Community partners and other Health Units in Ontario are utilizing these videos to help support food skill building with their clients, and they will continue to be promoted throughout 2024. 
• You’re the Chef train the trainer program: Through key partner interviews, the need for hands on food skill training is high in our community. 
  • The You’re the Chef train the trainer program will be provided to community partners and teachers to facilitate their own, 6-week food-skill program. Training will occur throughout 2024.
• Food and Mental Health: In addition to food skills training, nutrition and mental health training was highlighted as a community need. 
  • Capacity building for service providers, as well as presentations for priority populations, around building positive relationships with food and body and the intersections between diet culture and food insecurity will be delivered. 
  • This education will also work to reduce the potential harm when providing care, while creating a safe, inclusive space for all.

The registered dietitians at WECHU are committed to continuing to advocate for equitable access to food and adequate incomes, improve physical and social food environments, and enhance the local food system.

PREPARED BY:

Healthy Schools Department

DATE:

March 21, 2024

SUBJECT:

Comprehensive School Health – Health Promotion Program

BACKGROUND/PURPOSE

The WECHU Comprehensive School Health Program works to improve the health and well-being of school-aged students, staff, and their families in collaboration with the four schoolboards: Greater Essex County District School Board (GECDSB), Windsor Essex Catholic District School Board (WECDSB), Conseil scolaire catholique Providence (CSC Providence), and Conseil Scolaire Viamonde (Viamonde) as well as local private and faith-based schools. In total, the program supports 132 publicly funded schools, and 31 private or faith-based schools.

The program employs best practices and research and is directed by the School Health Standard and Guidelines of the Ontario Public Health Standards (2018), to provide comprehensive programming to support health and wellness topics as indicated in the Standards. Initiatives are planned using the Foundations for a Healthy School Framework, including curriculum, teaching and learning; school and classroom leadership; student engagement; social and physical environment; and home, school, and community partnerships. An inaugural  Strategic Partnership Agreement has been signed by the WECHU and all four schoolboards for the 2023-2024 school year (presented to the board in January 2024). This Agreement formalizes the collective actions by all parties to collaborate, cooperate and communicate regarding specific programming and planning activities to support the children and youth of WEC, through the creation of healthy school environments. The WECHU’s leadership of the School Board Liaison Committee is one important component of operationalizing this Agreement. 

Program interventions are equity-driven and varying levels of support are provided to schools based on a multi-factor assessment of needs and health priorities identified by schools. There are 70 publicly funded schools which have been identified as highest needs for the 2023-2024 school year. Need was based on combining data sets from the Ministry Education Opportunities Index, EQAO scores, oral health outcomes, immunization rates, and socially disadvantaged community regions. Highest needs schools complete a School Health Assessment survey and work with a dedicated public health nurse to co-develop and implement tailored interventions to meet the needs of the school and students, based on topics identified in the School Health Standard. The top health priorities identified by highest needs schools for 2023-2024 school year include mental health and substance use.

DISCUSSION - Program Highlights

All 163 schools in WEC receive evidence-based program support based on the Foundations for a Healthy School Framework, health topics identified in the School Health Standard, as well as emerging health needs identified by schools and in the larger community. Resources include foundational knowledge and educator tools to support health-related curricula, as well as supportive materials for students and families. Resources are developed and promoted throughout the school year, as well as by request from individual schools. A digital email monthly newsletter of emerging health topics and associated educator resources began in December 2023. All materials developed are readily available from the Healthy Schools section of the WECHU website. Schools, community partners, and caregivers of children and youth are encouraged to sign-up for the newsletter.

Mental Health Literacy Program
(School Health Standard Requirements 1, 2, 3, 4 and PPM 169)

The WECHU is using the Decider Skills Program as one of its mental health literacy approaches. It is a social emotional learning skills-based program that helps students recognize their own thoughts, feelings, and behaviours, enabling them to monitor and better manage their own emotions and mental health. During the 2022-2023 school year, four school nurses piloted the program at four schools, teaching 12 social-emotional learning skills in classrooms over a seven-week period. At the conclusion of the pilot sessions, the majority of students (67.5%) could name and explain and use at least two Decider Skills. 

Based on the evaluation, the program was condensed into five weeks and focused on Grade 4 students at higher needs schools for the 2023-2024 school year. Beginning October 2023, two Decider series of 5 weeks each were completed in 17 priority schools reaching 687 students. Two additional series are planned for this school year, where 16 more higher needs schools will participate. Program evaluation results will be released at the conclusion of the four sessions. 

Substance Use Prevention – Break the Vape Youth PSA Challenge 
(OPHS School Health Requirements 3 and 4)

Break the Vape Challenge is a contest for WEC students in grades 6 to 12. Students are asked to use their voice to create and submit a 30 second Public Service Announcement video to raise awareness to their peers about the dangers of vaping and the sneaky marketing tactics of the tobacco industry. Videos can be submitted in English or French and must include at least one key message about the dangers of vaping and one call to action. The contest was developed with youth, and students will be asked to watch and vote for their favourite video entries to determine the winners. Prizes will be awarded to students for the top voted videos, and to publicly funded schools with the highest participation rates. Entries will be accepted from February 5 to March 8 and voting begins April 16, 2024.

Food and Nutrition – Educator Toolkit for Supportive Food Environments
(OPHS School Health Requirement 4 and PPM 150)

To support a new approach to teaching and talking about food at school, the WECHU has developed a new resource: School Nutrition Toolkit - How to Create a Supportive Food Environment at School. The toolkit provides knowledge, helpful tips, and resources to increase the capacity of educators and school administrators to create supportive food environments at school. The evidence-based strategies promoted in the toolkit are known to help students foster positive relationships with food and their own bodies, which will increase healthy eating behaviours, body image, and self-esteem. 

PREPARED BY:

Environmental Health

DATE:

March 21, 2024

SUBJECT:

2023 Vector Borne Disease Report

BACKGROUND/PURPOSE

Vector-borne diseases are caused by the transmission of parasites, viruses, and bacteria in humans by vectors. The most common vectors are mosquitoes and ticks and can transfer the pathogen from one host to another. Public health units in Ontario are required under the Health Protection and Promotion Act to conduct vector-borne disease surveillance to monitor trends for emerging diseases including factors that influence their occurrence. In 2023, the Environmental Health Department continued to implement a vector-borne surveillance program to monitor West Nile Virus (WNV), Eastern Equine Encephalitis (EEE), Zika Virus and Lyme disease activity in Windsor and Essex County (WEC). 

DISCUSSION

Active Tick Surveillance is used to assess the local distribution and incidence of black-legged ticks in WEC. It involves the dragging of a white cloth through grassy areas and is performed twice yearly in the spring and the fall. Any black-legged ticks identified are sent to an accredited laboratory for testing for Lyme disease. In 2023, tick dragging was conducted at four sites across WEC in May and October. A total of forty-four black-legged ticks were identified, with twenty ticks carrying the infectious agent that causes Lyme disease. In 2023, there were eight human cases of Lyme disease reported in WEC.

Mosquito Surveillance Program ran for a total of 21 weeks from May 23 to Oct.13, 2023. Once a week, forty-one mosquito traps (26 CDC light traps and 15 BGS 2 traps) were set up across WEC to collect mosquitoes for identification and viral testing.  In 2023, there were 11 WNV positive pools identified and one positive WNV human case was reported. There were no positive pools or human cases for EEE or Zika identified this year.

Mosquito Larviciding involves applying larvicides to catch basins, standing water sites, and lagoons that hold water where mosquitoes may breed. The WECHU and municipalities contracted a service provider to run larval surveillance beginning in May. Three rounds of roadside municipal catch basin larviciding were conducted and a total of 133,024 catch basin treatments were applied WEC. There were a few challenges identified during the larviciding season for catch basins and only one standing water complaint submitted by WEC municipalities. Prior to 2024 season, meetings will be set up with municipalities and vendor of record to look at processes as well as to address concerns from last season.

1. Establishment.  By these terms of reference, the “Joint Board Extension Committee” is established as a standing committee of the Board pursuant to Article 7 of By-law #1 - Governance.
2. Name.  The name of the committee shall be the “Joint Board Extension Committee.”
3. Mandate.  The Joint Board Extension Committee shall act on behalf of the Board on those matters that are necessary to act when it is not reasonably practicable for the Board to meet in a timely manner.  Further the role of the Joint Board Extension Committee shall be to exercise any other authority delegated to it from time to time by the Board.
4. Composition.  Members of the  Joint Board Extension Committee will be as follows:
   
   1. Officers.  Three Officers of the Board of Health as follows:  Chair, Vice-Chair and Treasurer.  The Chair of the Board of Health shall be the Chair of the Joint Board Extension Committee, and the Vice Chair of the Board of Health shall be the Vice-Chair of the Joint Board Extension Committee.
   2. Leadership Team.  Members of the Leadership Team (as defined in Section 1.1 of By-law #1 – Governance) as selected from time to time by the CEO.
5. Frequency of Meetings. The Joint Board Extension Committee shall meet as often as is required in order to fulfil its mandate as determined by the Chair in consultation with the CEO, and otherwise whenever meetings are called in accordance with Section 6 of these Terms of Reference.
6. Calling of Meetings. Meetings of the Joint Board Extension Committee may be called by the Chair or any three Members of the Joint Board Extension Committee, providing at least one of those three members is an Officer identified in Section 4(a).
7. Place of Meetings.  Joint Board Extension Committee meetings shall be held at the Health Units offices or another location within Essex County as determined by the Chair in consultation with the CEO.   All, or any one or more, of the Members of the Joint Board Extension Committee can attend and participate electronically in a meeting of the Joint Board Extension Committee if permitted to do so by the Chair and in such case by such electronic means as is determined by the Chair from time to time. A Member of the Joint Board Extension Committee participating electronically in accordance with this Section 7 shall be counted in determining whether or not a quorum of Members is present at any point in time.
8. Notice.  Notice of meetings of the Joint Board Extension Committee shall be subject to and in accordance with the following:
   
   1. Responsibility.  The Chair shall give or cause to be given the required notice.
   2. Amount.  At least twenty-four (24) hours’ notice (exclusive of the day on which the notice is delivered or sent but inclusive of the day for which notice is given) shall be given.
   3. Content.  Include the date, time and place, as well as a description of the nature of the business to be transacted.
   4. To Whom Given.  Given to each member of the Joint Board Extension Committee.
9. Transaction of Business.  Transaction of business of the Joint Board Extension Committee shall be subject to and in accordance with the following:
   
   1. Chair.  The chair of the Joint Board Extension Committee shall be the Chair and in the absence or inability of the Chair, the Vice-Chair.
   2. Quorum.  Quorum shall be a majority of each of the Officer appointees and a majority of the Leadership Team appointees.
   3. Voting.  Questions arising at any Joint Board Extension Committee meeting shall be decided by a majority of votes.  Every Joint Board Extension Committee member that is an Officer shall have two votes and every Leadership Team shall have one vote except the chair of the Joint Board Extension Committee shall have a third and casting vote in the event of a tie.
10. External Advisors.  If, in the opinion of the Joint Board Extension Committee, it is necessary and/or appropriate from time to time to obtain the advice of external advisors in order to discharge its responsibilities, the Joint Board Extension Committee shall seek a resolution of the Board in that regard, and if the Board so resolves, the Health Unit shall engage such advisors at the Health Unit’s expense.
11. Record Keeping.
    
    1. Minutes.  The Secretary shall keep or cause to be kept minutes of all Joint Board Extension Committee meetings which shall include the following:
       
       1. name of the Committee;
       2. date, time and place of meeting;
       3. attendance at the meeting;
       4. declarations of conflict of interest or inability to exercise independent judgment;
       5. succinctly, accurately and clearly the material aspects of the Committee’s deliberations relative to the subject matter;
       6. precise wording of all motions but not the mover or seconder;
       7. whether the motion carried but not the number of votes for and against or which Member voted which way; and
       8. any objections or dissent requested by the maker to be put on record but otherwise shall not attribute specific comments to specific individuals.
    2. Keeping of Records.  All meetings shall be documented, with minutes circulated and preserved.
    3. Reporting and Accountability.  Minutes of Joint Board Extension Committee meetings shall be provided to the Board for information and the Joint Board Extension Committee shall at all times be accountable and subject to direction of the Board.

ISSUE

The impact of household food insecurity on infant health is becoming increasingly apparent. Over the past few years, the Healthy Families department has observed several families struggle to afford adequate infant formula while experiencing breastfeeding challenges. The department’s multidisciplinary team works diligently to help clients optimize breastfeeding and improve access to infant formula, however, a collaborative strategy is urgently needed to address this public health issue at the population level.  

BACKGROUND

Local Prevalence: Food Insecurity, defined as inadequate or insecure access to food due to financial constraints (Li et al., 2023), remains a significant public health issue in Windsor-Essex County (WEC). Household food insecurity in WEC rose from 16.0% in 2019 to 19.8% in 2022 (Public Health Ontario, 2023). While the local prevalence of infant-specific food insecurity has not been formally investigated, it is likely significant considering that 1 in 7 children in Windsor-Essex County is living in poverty (Canada Census, 2021). Declining breastfeeding rates in WEC have created additional vulnerability, as infant formula prices rise and the formula supply chain remains unstable. Rates of exclusive breastfeeding at hospital discharge have steadily declined since 2015 and remain significantly below the Ontario average (45.7% vs 52.8%) (Public Health Ontario, 2023).  

Women in lower income households are also less likely to sustain breastfeeding for the recommended duration. Local infant feeding surveillance revealed that WEC mothers whose annual household income was less than $60,000 were 1.71 times less likely to continue breastfeeding until two months postpartum compared to mothers with higher household income (WECHU, 2019). This paradox was also observed in a larger Canadian study which reported that mothers experiencing food insecurity were significantly less likely to sustain exclusive breastfeeding past four months compared to their food secure peers (Orr et al., 2018).

Potential Impact on Infant Health: When household food insecurity results in unreliable access to breast milk or formula, both infant health and parental mental health are threatened. Undernutrition during infancy can lead to cognitive impairments, growth faltering, and health complications, which may have lifelong repercussions. In a meta-analysis, Corbett and Drewitt (2004) concluded that significant undernutrition during infancy (i.e., failure-to-thrive) is associated with adverse intellectual outcomes significant enough to be of importance at a population-level. Shankar et al. (2017) confirmed the positive correlation between household food insecurity and behavioral, academic, and emotional problems starting in early childhood. Undernutrition during critical periods of development impairs physical maturation and increases risk of acute and chronic morbidity (Martins et al, 2011), causing unnecessary personal suffering and strain on the healthcare system.

In addition to increased risk for malnutrition and its manifestations, infants in food insecure households are more likely to have a parent experiencing mental health concerns. Food insecurity has been consistently associated with parental depression, anxiety, and stress (Cain et al, 2022). In Ontario, maternal food insecurity was correlated with postpartum mood disorders and a greater likelihood of infants being treated in an emergency department (Tarasuk et al, 2020). Further, preliminary evidence suggests that maternal mental health issues negatively impact attachment with infant children (Barnes & Theule, 2019). These associations imply that there may be secondary impacts of food insecurity on infant development related to parental mental health.

Existing Infant Food Security Initiatives:  The Healthy Families department has implemented several initiatives to help low-income clients secure reliable sources of nutrition for their infants. These initiatives include reinstating the in-home lactation consultation program to reduce financial barriers to accessing breastfeeding services. The Healthy Babies, Healthy Children program also provides infant feeding education and helps clients access necessary feeding essentials. Unfortunately, no local organization consistently supplies infant formula or other infant feeding supplies to low-income families. In response, the department will pilot a breast pump loan program and has collaborated with the local social services agency to identify efficiencies in the Special Diet Allowance application process for clients who require formula due to inadequate breastmilk supply. While these initiatives help Health Unit clients access the products they need, an upstream strategy is required to adequately address this public health issue at the population level.

The Healthy Families Department is well-positioned to lead this strategy and monitor the efficacy of the associated work. The department already collaborates with many of the key stakeholders and will be relaunching the Windsor-Essex Infant Feeding Surveillance survey this year, which will include measures of infant food security. Initial work should include the formation of a Windsor-Essex Infant Food Security Working Group, including representation from each birthing centre and midwifery clinic, in addition to related community agencies and primary care providers. Key deliverables should include the implementation of community-wide strategies to screen for infant food insecurity and improve breastfeeding rates and infant formula access. The working group could also facilitate coordinated advocacy efforts to support equitable access to infant feeding products and services, such as the most recent Call to Action from Ontario Dietitians in Public Health and Food Allergy Canada (2023). This Call to Action would ensure equitable access to specialized formulas for children with a medical diagnosis requiring strict avoidance of standard soy and milk proteins. 

PROPOSED MOTION

WHEREAS improving household food security among families with infants is essential to protecting the health and cognitive potential of future generations.

WHEREAS immediate action is required to improve access to proactive breastfeeding education and timely, coordinated lactation support.

WHEREAS immediate action is required to improve access to infant formula and associated education for low-income families when exclusive breastfeeding is not possible. 

WHEREAS effective solutions to infant food insecurity require coordinated, community-wide policies and programs. 

NOW THEREFORE BE IT RESOLVED that the Board of Health at the Windsor-Essex County Health Unit will continue to advocate for more sustainable solutions to household food insecurity and will advocate for equitable access to infant formula and in-person breastfeeding support. 

AND FURTHER that the Board of the Windsor-Essex County Health Unit endorses the Call to Action: ODB Program amendments to support infants and children with a medical diagnosis requiring strict avoidance of standard soy and milk proteins (Ontario Dietitians in Public Health & Food Security Canada, 2023).

AND FURTHER that the Board of the Windsor-Essex County Health Unit supports infant food security by prioritizing the following initiatives:

1. The creation of a comprehensive strategic plan to improve infant food security in Windsor-Essex County, including targeted food insecurity screening initiatives and the creation of an associated referral pathway. 
2. Community mobilization to improve equitable access to infant feeding products, education, and consultation. Work will include the formation and leadership of an Infant Food Security Working Group, which will have representation from birthing centres, midwifery clinics, dietitians, primary healthcare providers, and related community agencies.
3. Surveillance of infant food security in WEC and the coordination of related advocacy efforts. The cost of formula feeding will also be monitored as part of the Health Unit’s annual Cost of Healthy Eating initiative.
4. The development or enhancement of internal policies and procedures to support equitable access to early nutrition. These initiatives will include screening for food insecurity during feeding and growth assessments and prioritizing associated internal and external referrals.

References: 

Barnes J, Theule J. (2019). Maternal depression and infant attachment security: A meta-analysis. Infant Ment Health J. 2019 Nov;40(6):817-834. doi: 10.1002/imhj.21812. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/31415711/ 

Cain KS, Meyer SC, Cummer E, Patel KK, Casacchia NJ, Montez K, Palakshappa D, Brown CL. Association of Food Insecurity with Mental Health Outcomes in Parents and Children. Acad Pediatr. 2022 Sep-Oct;22(7):1105-1114. Retrieved from:
https://pubmed.ncbi.nlm.nih.gov/35577282/

Corbett and Drewitt (2004). To what extent is failure to thrive in infancy associated with poorer cognitive development? A review and meta-analysis. J Child Psychol Psychiatry, 45 (3): 641-54. Retrieved from:   https://pubmed.ncbi.nlm.nih.gov/15055382/ 

Li T, Fafard St-Germain AA, Tarasuk V. (2023). Household food insecurity in Canada, 2022. Toronto: Research to identify policy options to reduce food insecurity (PROOF). Retrieved from https://proof.utoronto.ca/ 

Martins VJ, Toledo Florêncio TM, Grillo LP, do Carmo P Franco M, Martins PA, Clemente AP, Santos CD, de Fatima A Vieira M, Sawaya AL. (2011). Long-lasting effects of undernutrition. Int J Environ Res Public Health. 2011 Jun;8(6):1817-46. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3137999/ 

Ontario Dietitians in Public Health and Food Allergy Canada (2023). Call to Action: ODB Program amendments to support infants and children with a medical diagnosis requiring strict avoidance of standard soy and milk proteins. Retrieved from: www.odph.ca/advocacy

Orr S, Dachner N, Frank L, Tarasuk V. (2018). Relation between household food insecurity and breastfeeding in Canada. CMAJ, 190:E312-9. Retrieved from: https://www.cmaj.ca/content/190/11/E312

Public Health Ontario (2023). Household Food Insecurity Snapshot. Retrieved from: https://www.publichealthontario.ca/en/Data-and-Analysis/Health-Equity/Household-Food-Insecurity 

Risi A, Pickard JA, Bird AL (2021). The implications of parent mental health and wellbeing for parent-child attachment: A systematic review. PLoS One. 16(12):e0260891. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/34914730/

Shanker P, Chung R, Frank D (2017). Association of Food Insecurity with Children’s Behavioral, Emotional, and Academic Outcomes: A Systematic Review. J Dev Behav Pediatr. 38(2):135-150. Retrieved from:  https://pubmed.ncbi.nlm.nih.gov/28134627/ 

Tarasuk V, Gundersen C, Wang X, Roth D, Urquia M (2020). Maternal Food Insecurity is Positively Associated with Postpartum Mental Disorders in Ontario, Canada. The Journal of Nutrition, 150 (11), 3033-3040. Retrieved from: https://doi.org/10.1093/jn/nxaa240

March 21^st, 2024

ISSUE/PURPOSE

The Windsor-Essex County Health Unit (WECHU) administers the Healthy Babies Healthy Children Program as well as, 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, 2024 to March 31, 2025, requires approval by the Board of Health prior to submission to the MCCSS. 

BACKGROUND

For fiscal 2024/25, these Programs support twenty-two and one quarter (22.25) FTEs comprised of one (1.0) manager FTE, one-quarter (0.25) director FTE, fifteen (15.0) public health nursing FTEs, one (1.0) nurse practitioner FTEs, two (2.0) family home visitor FTEs, one (1.0) social worker FTE, two (2.0) support staff FTEs.

Significant changes in the operating budget include the following:

• Net decrease in Salaries and Benefits $148,116 representing decreases of 2 family home visitor, 1 nurse and ½ of support staff. 
• Reduction in Professional development of $1,097 – The 2024/25 fiscal year reflects a proportionate decrease of professional development in the 2023/24 fiscal year and is predicated by the reduction of FTE’s.
• Reduction in Program Supplies of $17,877 – The fiscal 2024/25 budget contemplates a reduction in expenditures as a result of discontinuing a software for the upcoming fiscal year ($7,500) and a reduction in IT/phone hardware ($10,386).
• Increase in Purchased services of $5,000 – The fiscal 2024/25 budget contemplates expenditures being increase due to augmented demands in translation services.
• Increase Building occupancy of $162,090 – The fiscal 2024/25 budget contemplates expenditures being incurred on Building occupancy.

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, 2024 to March 31, 2025 is $2,894,941, and

Now therefore be it resolvedthat the Windsor-Essex County Board of Health approve the operating budget as presented by Administration for the period April 1, 2024, to March 31, 2025.

ISSUE/PURPOSE

The Immunization of School Pupils Act (ISPA) R.S.O. 1990 is a law in Ontario that requires certain vaccines to be given, or for a valid exemption to be obtained, for a child to attend school in Ontario making sure that all school aged children are protected from vaccine preventable diseases. The Windsor-Essex County Health Unit (WECHU) reviews immunization records of students attending school in Windsor and Essex County (WEC) in accordance with the ISPA. Parents/guardians are responsible for reporting child immunizations to the WECHU. Health care providers do not have this responsibility, although often will support patients by sending copies of immunization records to the health unit or providing copies to families who are required to self-report but lack documentation. Interim solutions by health care providers such as faxing immunization records directly to public health or using other internet interfaces to report immunizations, result in increased workload for health care providers and public health units. Although the WECHU, and all local public health units provide multiple ways to make this reporting as easy and accessible for families as possible, it is recognized that more efficiencies may be possible through connected and streamlined reporting processes with health care providers. 

During the January 18, 2024 WECHU Board of Health Meeting, after discussing the complexities of ISPA enforcement and compliance practices locally, it was requested that a report outlining local public health recommendations on this matter be brough forward for board consideration and support. 

BACKGROUND

At the end of June in 2017, the newly elected Ontario government halted the implementation of a new rule, included in the previously endorsed Bill 198 -- Immunization of School Pupils Amendment Act, 2016, that would have required doctors and nurses in Ontario to report all immunizations administered to children directly to public health units. This rule would also have required the development of a province-wide computerized system for tracking children's vaccination records that seamlessly interacted with public health unit systems. It was widely recognized that this change would make it easier for parents/guardians to demonstrate ongoing compliance and reduce unnecessary suspensions due to out-of-date immunization records. The Bill was originally set for implementation on July 1, 2017, but was stopped in response to what has been described as concerns from the Ontario Medical Association and others that felt the Bill lacked proper consultation. 

PROPOSED MOTION                        

Whereas, vaccination is important for the health of each student and the school community and, 

Whereas, Ontario's immunization reporting system involves many redundancies and barriers for families and,

Whereas, a part of the mandate for all public health units in Ontario is to reduce inequities and increase access to opportunities and conditions that are conducive to health for all, including compliance with the ISPA.

Now therefore be it resolved that the Windsor-Essex County Board of Health request that the Ontario Government reconsider the requirement for all health care providers to report administered immunizations directly to public health, and

FURTHER THAT, the Ontario government dedicate resources to develop a seamless system for transferring vaccination records electronically from health care providers into public health databases across the province.

December 1, 2023

Dr. Kieran Moore,
Chief Medical Officer of Health,
Box 12,
Toronto, ON M7A 1N3

Dear Dr. Moore,

Re: Voluntary Mergers and Boards of Health Leadership

On behalf of the Association of Local Public Health Agencies (alPHa) and its Council of Ontario Medical Officers of Health, Boards of Health Section and Affiliate Associations, we are writing to provide advice on the voluntary mergers component of the Strengthening Public Health initiative that is currently underway.

We agree with your statement that, where it makes sense to do so, voluntary mergers  have the potential to address longstanding challenges in the public health system and improve optimization and coordination. We also appreciate the efforts that you have made to share information and discuss the process through meetings with local public health leadership over the past month.

Recognizing the aggressive timelines that have been imposed on this process, we are also cognizant of the fact that engagement opportunities are important for all parties, so it makes sense to use existing channels between your office and the medical leadership (e.g., the Public Health Leadership Table) and meetings with local public health staff via the regional engagement structures to drive the process forward. Our members have, however, identified targeted consultation with boards of health as a gap.

Mergers of this nature are fundamentally a governance issue and must be planned and executed by those with the authority to do so, grounded in the knowledge of the needs of the communities they serve. The final decisions will be made by local boards of health, so it is imperative there is direct and specific ongoing engagement and meaningful dialogue with local boards that includes information, clarity of process, and expectations so that they    are properly equipped with the information they need to make decisions on the future of local public health.

Although there are differences in the structures of Ontario’s local boards of health, it is important to acknowledge they will all be affected by the outcomes of this process. There are boards that are considering it, boards that are well into discussions, and boards that will remain as they are but nonetheless be subject to ripple effects of neighbouring mergers. The implications are too numerous to outline here, but there is a wealth of expertise and experience to draw upon from each group, which will be of tremendous benefit to the others.

We are therefore strongly recommending that you consider the development of a comprehensive strategy for direct engagement and dialogue with boards of health, as a whole and individually, that recognizes their primary authority in following through on new partnerships, taps into existing expertise at the local level, and ensures that all of the complexities and consequences of such an undertaking are fully addressed. alPHa would be pleased to work with you in this regard through our Boards of Health Section.

We look forward to working with you and would like to request an opportunity to meet with you and your staff. To schedule a meeting, please have your staff contact Loretta Ryan, Executive Director, alPHa, at loretta@alphaweb.org or 647-325-9594.

Sincerely,

Dr. Charles Gardner, President

Copy:    Hon. Sylvia Jones, Minister of Health, Deputy Premier
Elizabeth Walker, Executive Lead, Office of the Chief Medical Officer of Health
Colleen Kiel, Director, Public Health Strategic Policy, Planning & Communications Branch
 

BACKGROUND

Overview

• SafePoint opened on April 26^th, 2023, serving clients 7 days per week between the hours of 10:00 a.m. – 
  6:00 p.m. daily.
• In order to ensure transparency related to SafePoint operations, the Board of Health is provided with regular updates.

Application Status

• As of January 2024, the WECHU’s pending application to the province to fund SafePoint as a Consumption and Treatment Services (CTS) site remains on-hold. 
• As no timeline has been provided for the removal of the hold on the WECHU’s application, operations at SafePoint were paused effective January 1^st of 2024. 

CURRENT INITIATIVES

Operational Data

SafePoint operated for a period of eight months, recording a total of 1,257 client visits amongst 248 unique clients. Additional details about the services provided at SafePoint during the month of December are presented in Tables 1-4. 

Client Experience Narrative

Beyond the number of client visits recorded in the month of December, SafePoint continues to demonstrate that the services being offered are having a positive impact on clients, as highlighted through the following client experience narrative:

Anonymous Client

An individual walking by SafePoint knocked on the entrance door and was brought into the site by staff. The individual informed staff that they felt like they may be “going down” (i.e., experiencing an overdose) and asked for a naloxone kit. After receiving the kit, the individual proceeded to administer naloxone on themselves and staff monitored them afterwards to support their recovery.

NEXT STEPS AND FUTURE INITIATIVES

The WECHU, in collaboration with the SafePoint Advisory Committee, prepared and implemented a mitigation plan for the pause in services to support clients and the community throughout the period of transition. Strategies implemented through the plan were as follows: 

• Staff at SafePoint met with clients individually over the course of December to create plans for their care while services are paused and to support connections to other community agencies as needed. Clients were also provided with information about alternative harm reduction strategies and supports that they can continue to use during the disruption. 
• The WECHU connected with multiple community partners towards the end of 2023 to establish connections and increase accessibility to other health and social services in the area that clients can continue to use during the disruption. A list of these services was developed and posted to the SafePoint web page for the community to access: www.wecoss.ca/cts. 
• The WECHU developed plans in collaboration with Family Services Windsor-Essex (FSWE) to increase the availability of outreach supports in the areas surrounding SafePoint in the early months of 2024. The Mobile Outreach Support Team (MOST) van will be making nightly stops near SafePoint until the end of March to look out for those seeking the services of SafePoint and to provide harm reduction supplies and referrals to community services. Other relevant outreach strategies are also in development in partnership with FSWE’s Housing Outreach Workers. 
• Community partners involved in the Windsor-Essex Community Opioid and Substance Strategy were provided with a key messaging document to support conversations with their clients who use SafePoint about the pause in services. Partners were also encouraged to promote the National Overdose Response Service (https://www.nors.ca/) to anyone who might benefit from the services of a virtual safer consumption hotline.
• Messaging about the pause in operations and the other services available for support was also shared with those subscribed to the SafePoint email subscription list. Moving forward, this list and the SafePoint web page will continue to be maintained by the WECHU to share updates with the community about the site. To subscribe to SafePoint emails, individuals can visit www.wecoss.ca/cts. The SafePoint email inbox (CTSQuestions@wechu.org) will also continue to be monitored by the WECHU to respond to questions and concerns from the community.

While services are paused, ongoing communication will be maintained with the Ministry of Health for updates regarding the status of the WECHU’s CTS application, provincial funding, and a potential 
re-opening under the CTS model. The legal exemption required from Health Canada to operate SafePoint under this model was secured in July of 2023.