Minutes - February 15, 2024 - Board of Health Meeting

Members Present: 

Matthew Newton-Reid (Chair)
Michael Steele (Vice-Chair)
Selomon Menghsha
Skylar Franke
Michelle Smibert
Aina DeViet
Peter Cuddy (arrived at 7:43 p.m.)
Michael McGuire
Howard Shears
Emily Williams, Chief Executive Officer (ex-officio) (Secretary and Treasurer)
Dr. Alexander Summers, Medical Officer of Health (ex-officio)

Others Present:

Stephanie Egelton, Executive Assistant to the Board of Health (recorder)
Sarah Maaten, Director, Public Health Foundations
Jennifer Proulx, Director, Family and Community Health and Chief Nursing Officer
Dr. Joanne Kearon, Associate Medical Officer of Health
Mary Lou Albanese, Director, Environmental Health, Infectious Disease and Clinical Services
Cynthia Bos, Associate Director, Human Resources and Labour Relations
Marc Resendes, Acting Manager, Strategy, Planning and Performance
David Jansseune, Associate Director, Finance and Operations/Chief Financial Officer
Ryan Fawcett, Manager, Privacy, Risk and Client Relations
Angela Armstrong, Program Assistant, Communications
Parthiv Panchal, End User Support Analyst, Information Technology
Morgan Lobzun, Communications Coordinator
Emily Van Kesteren, Acting Manager, Communications
Dr. Mark Cachia, Public Health and Preventative Medicine Resident

Chair Matthew Newton-Reid called the meeting to order at 7 p.m.

Dr. Alexander Summers, Medical Officer of Health introduced Jennifer Proulx, Director, Family and Community Health and Chief Nursing Officer to the Board of Health. J. Proulx was the successful candidate to the permanent position and has been in the acting role for approximately 1 year.

Disclosure of Conflict of Interest

Chair Newton-Reid inquired if there were any disclosures of conflicts of interest. None were declared.

Approval of Agenda

It was moved by M. Steele, seconded by S. Franke, that the AGENDA for the February 15, 2024 Board of Health meeting be approved.
Carried

Approval of Minutes

It was moved by S. Franke, seconded by A. DeViet, that the MINUTES of the January 18, 2024 Board of Health meeting be approved.
Carried

New Business

Finance and Facilities Committee Meeting Summary (Verbal Report)

Incoming Committee Chair Michael (Mike) Steele noted that he was re-appointed as the Finance and Facilities Committee Chair for 2024 and provided an overview of reports heard by the Committee for the Board of Health’s consideration.

It was moved by M. Steele, seconded by H. Shears, that the Board of Health:
1) Receive Report No. 01-24FFC re: “2024 Finance and Facilities Committee Terms of Reference” for information;
2) Approve the 2024 Terms of Reference for the Finance and Facilities Committee;
3) Receive Report No. 02-24FFC re: “Wellness Programming Contract Awarded”;
4) Receive Report No. 03-24FFC re: “Employee and Family Assistance Program (EFAP) Services Contract Extension” for information;
5) Receive Report No. 04-24FFC re: “2023 Public Sector Salary Disclosure” for information;
6) Receive Report No. 05-24FFC re: “2023 Vendor and Visa Payments” for information;
7) Receive Report No. 06-24FFC re: “2023 Board of Health Remuneration” for information;
8) Receive Report No. 07-24FFC re: “2023 Reserve, Bank Loan and Annual Surplus” for information;
9) Approve the adjusted 2023 entries for Reserve and Accelerated Bank Loan payment;
a) Approve the transfer of 2023 surplus up to $107,935 to the Technology & Infrastructure Reserve, pending approval from the City of London and County of Middlesex; and
b) Approve the drawdown of this reserve in 2024 to purchase IT related equipment that was paused during 2023 Q4 (drawdown to equal contribution not exceeding $107,935);
10) Direct staff to collaborate with the City of London and County of Middlesex; seek their approval on alternate use of 2023 surplus funds not exceeding $107,935; and
11) Approve the adjustments to the 2024 budget outlined herein in Appendix A.
Carried

2023-25 Provisional Plan Q4 2023 Status Update (Report No. 11-24)

Marc Resendes, Acting Manager, Strategy, Planning and Performance presented the Health Unit’s Provisional Plan Q4 status update.

M. Resendes noted that since the Board of Health approved the extension of the provisional plan to the end of 2025, all internal materials have been amended to reflect the extension. Progress has been made on many initiatives during the first six (6) months of the provisional plan. 11 of the 14 initiatives are underway and all 14 are proceeding as planned. Three (3) of these initiatives will start in 2024.

Board Member Howard Shears sought clarification over the statement “equity deserving groups” and was concerned that all groups are ‘equity deserving’.

Sarah Maaten, Director, Public Health Foundations, noted that in public health, an equity deserving group is one that may need additional resources to reach the same level of positive health outcomes as the rest of the population in a community. These groups are sometimes referred to as ‘priority populations’ as it relates to public health program planning. Within the Health Unit’s organizational plans for Anti Black Racism and Taking Action for Reconciliation, priority populations include individuals identifying as Indigenous, members of the Black, Caribbean, and African community, and other groups that have more likelihood of having poor health outcomes related to the Social Determinants of Health (SDOH).

Dr. Alexander Summers, Medical Officer of Health added that the term equity deserving group is commonly being used in government, replacing the previously used term ‘equity seeking’. The evolution of this change reflects the fact that these groups do not bear all of the responsibility for seeking equity. Dr. Summers noted that this change in language is consistent throughout the public sector.

It was moved by A. DeViet, seconded by M. Smibert, that the Board of Health receive Report No. 11-24 re: “2023-25 Provisional Plan 2023 Q4 Status Update” for information.
Carried

Middlesex-London Health Unit Approach to Climate Change Action (Report No. 12-24)

Dr. Joanne Kearon, Associate Medical Officer of Health provided an overview on the Health Unit’s approach to climate change.

Dr. Kearon noted that public health is acutely interested in the impacts of climate change due to its impact on health. These impacts include extreme weather, extreme temperatures, air quality, water quality, vector-borne disease, food insecurity and mental health, all of which can have negative acute health outcomes for a community. In 2014, the Board of Health heard a vulnerability assessment (prepared by the Health Unit and the Public Health Agency of Canada) of the health impacts of climate change in the Middlesex-London region, which included the following actions:
• Development of a climate change and health action plan;
• Education and outreach related to the impacts of climate change;
• Evaluating adaptations to determine effectiveness of efforts to reduce risks of climate change;
• Continued surveillance and monitoring of climate sensitive diseases;
• Developing a greater understanding of how urban and rural vulnerabilities may differ in the Middlesex-London Region; and
• Development of policies and programs that address multiple risks to help deal with uncertainties of a changing climate and work towards adaptation and mitigation.

Dr. Kearon noted that this year, the Health Unit conducted a review of programs and interventions with the Ontario Public Health Standards on the approach to climate change action. It is noted that while there is an Ontario Public Health Standard associated with climate change, it was important to review for gaps. Multiple teams are involved in climate change work, directly and indirectly, within the following programs:
• Health Hazards
• Healthy Environments and Climate Change
• Active Transportation and Built Environment
• Ultraviolet Radiation and Sun Safety
• Vector-Borne Diseases
• Food Safety
• Drinking Water
• Recreational Water
• Food Systems and Nutrition; and
• Mental Health.

Examples of climate change action work at the Health Unit include:
• Vector-Borne Diseases: Surveillance
o Monitoring of tick population for vector-borne diseases, such as Lyme disease
• Active Transportation and Built Environment: Healthy public policy development
o Provision of input into municipal Official Plan, and other related plans
• Food Systems and Nutrition: Surveillance
o Monitoring food affordability through the Ontario Nutritious Food Basket Program
• Recreational Water: Inspections
o Ensuring safe recreational water through inspections of all public sites

Dr. Kearon added that over the next 1-2 years, the focus will be advancing population health assessment and surveillance of health impacts of climate change and communication of health risks related to climate change and adaptation strategies.

Board Member Skylar Franke inquired if policy/by-law regulation of maintaining heat/cooling in multi-family dwellings (apartments) was in the realm of public health. S. Franke noted that the City of Hamilton passed a by-law recently to regulate landlords to have cooling solutions in their units to prevent overheating of units. Dr. Kearon explained that she has been engaged with the City of London and County of Middlesex to actively review the alerts policies and meeting communication needs. Dr. Kearon added that related to heat alert warnings, the Health Unit have engaged with the City of London on specific issues, including heat/cooling in dwellings, and a potential by-law.

Chair Newton-Reid added that Vice-Chair Michael Steele and himself have attended a workshop hosted by the Association of Local Public Health Agencies, and the Medical Officer of Peel Region presented information on extreme heat alerts, along with how their public health unit is working with the region to address.

It was moved by S. Franke, seconded by M. Smibert, that the Board of Health receive Report No. 12-24 re: “Middlesex-London Health Unit Approach to Climate Change Action” for information.
Carried

2024 Middlesex-London Health Unit Labour Relations Impacts of Budget (Report No. 13-24)

Cynthia Bos, Associate Director, Human Resources and Labour Relations provided an update on labour relations impacts to the 2024 budget.

C. Bos noted that as a result of the budget shortfall for 2024, the Health Unit conducted organizational restructuring. As a result of restructuring due to budget shortfall, several roles were disinvested. To minimize impacts to staff, voluntary retirement incentives were offered, there was a reduction of already vacant positions, and some staff were transferred to temporary roles within the Health Unit.

At the time of this report, within the Canadian Union of Public Employees (CUPE) bargaining unit, only 1 part time employee was laid off. Within the Ontario Nurses Association (ONA) bargaining unit, there was a lot of movement and displacement throughout the organization, but there was only 1 employee who was laid off. There could be potential further deferred layoffs throughout the year within the ONA bargaining unit. Within the non-union employee group, there was an elimination of three manager and one director roles.

C. Bos noted that Human Resources worked collaboratively with staff and union partners for continued transparency, communication and education regarding the labour relations processes.

It was moved by M. McGuire, seconded by A. DeViet, that the Board of Health receive Report No. 13-24 re: “2024 Middlesex-London Health Unit Labour Relations Impacts of Budget” for information.
Carried

Q4 Financial Update, Borrowing Update and Factual Certificate (Report No. 14-24)

David Jansseune, Chief Financial Officer and Associate Director, Finance and Operations, presented the 2023 Q4 Financial Update and Factual Certificate for the quarter ending December 31, 2023. D. Jansseune reminded the Board that this set of financial information is not consolidated, and the MLHU and MLHU2 companies are separate to simplify reporting.

Financial Highlights
Within the Shared Funding Programs, there was no surplus or deficit at year end. There was $31.5 million of funding received in 2023, with no further funding for COVID-19 expected in 2024. COVID-19 expenditures totaled $6.4 million in 2023, with funding expected in early 2024.

• School Focused Nurses Initiative (ended June 2023) had $1.1 million in funding, with $771,000 in expenditures
• Ontario Seniors Dental Program had $3.2 million in funding with $3 million in expenditures
• City of London Funding for Cannabis Legalization has $111,000 in expenditures, with the City approving carryover of funds into 2024
• MLHU2 expenses are as expected for the end of December
• Strathroy Dental Clinic capital funding was spent fully at $1 million

Shared Funding Variances
• Grants, User Fees and Income were $605,000 favourable. This includes the Ministry of Health’s pro-rated 1% funding increase, Infection Prevention and Control Hub funding and recovery for the iHeal/Nurse Family Partnership programs
• Salaries, Overtime and Benefits were $791,000 favourable. This includes approximately 8 vacancies throughout 2023
• General Expenses were $338,000 favourable. This includes interest expenses, program supplies and occupancy costs
• The budgeted gap was $1,539,000, which is a budgeted override of expenses, to generate a balanced budget. The gap will be covered through favourable variance
• Reserves were $195,000 unfavourable due to restrictions in cashflow negatively impacting the ability to transfer as budgeted

Forecast
D. Jansseune noted that a forecast does not apply for Q4, as the actual spending is representing the full year. D. Jansseune note that Shared Funded Programs had forecasted a year-end surplus of $176,000 with the actual surplus being $108,000 before the non-budgeted reserve fund contribution.

Cashflow
In December, the bank balance was $1.4 million positive. The fixed loan was $3,050,000 with $2,675,000 owing and the variable loan was $1,150,000 with $473,000 owing.

D. Jansseune added that the Finance team will be working on the following activities to close out the fiscal year:
• Continue with year-end closing with minimal entries to journal entries
• Audit by KPMG in March and April
• Continued reporting of differences in 2023 financials to the Board of Health
• Preparation of financial statements for auditing and presentation to the Board; and
• Preparing the Annual Reconciliation Report.

It was moved by M. Steele, seconded by H. Shears, that the Board of Health receive Report No. 14-24 re: “2023 Q4 Financial Update, Borrowing Update and Factual Certificate” for information.
Carried

Current Public Health Issues (Verbal)

Dr. Summers provided a verbal update on current public health issues within the region.

Respiratory Season Update
The respiratory season status is currently high risk but is showing signs of plateau. There has been a decrease in outbreaks and hospitalizations, with the positivity rate for COVID-19 decreasing.

The COVID-19 rate in Middlesex-London is declining, consistent to Ontario’s rate. This shows potentially the ending of the COVID season. Wastewater positivity rates are high but are not being reflected in outbreaks or hospitalizations.

Influenza A rates have been significant and have yet to see a decline.

Coronavirus (not COVID-19) is also appearing during the respiratory season, which is different than COVID-19 and less severe in symptoms.

Dr. Summers noted that it is important to continue to be diligent about respiratory hygiene such as washing your hands and wearing a mask in crowded spaces. The Health Unit will be looking ahead to next year to ensure that vaccination campaigns are rigorous.

Toxic Drug Supply
There are a few municipalities that are experiencing toxic drug supply overdoses in recent weeks. Drugs are being contaminated with substances that cause respiratory depression (difficulty breathing). Last week, the City of Belleville declared a state of emergency after 23 individuals overdoses in a short period of time.

On February 6, the Regional HIV/AIDS Connection (RHAC) issued a community substance use advisory, based on anecdotal reports and drug testing, of several batches of fentanyl potentially cut with other substances. On February 8, the Office of the Chief Medical Officer of Health issued a memo warning of new and emerging toxic drugs appearing in Ontario illicit drug supplies.

Community Drug and Alcohol Strategy
The work of the Community Drug and Alcohol Strategy (co-chaired by the Health Unit and the London Intercommunity Health Centre) is continuing. Staff continue to work with other community agencies to ensure a coordinated response such as supporting the naloxone distribution program and the needle syringe program.

A new report has been released by the Ontario Drug Policy Research Network called the Safer Opioid Supply: A Rapid Review of the Evidence. This report discusses safer opioid supply programs, which provide prescriptions for opioids and supportive services to individuals at high risk of harms related to substance use, with the goal to provide a safer alternative to the unregulated drug supply.

In summary, the following conclusions were made from the report:
• Lack of fatal opioid toxicity events and lower non-fatal opioid toxicity events among active participants
• Reduced emergency room visits, hospitalizations, and healthcare-related costs among participants
• Reduced opioid withdrawal due to improved access stability
• Participants reported greater personal autonomy, reduced stigma, heightened feelings of safety in their drug use, more income for food, shelter, and basic needs and decreased criminal activities
• Extent of diversion of drugs from program is unknown; and
• Reasons for diversion of drugs included compassionate sharing with others, inadequate doses through the program, financial needs, and inadequate doses for withdrawal prevention.

Barriers to participating and providing safe supply programs include:
• Inconvenient site hours
• Regimented check-in requirements
• Lack of information on eligibility criteria
• Insufficient program capacity
• Mismatch between strength of unregulated drugs vs. prescribed doses
• Lack of training
• Perception of limited evidence re: effectiveness and safety; and
• Need for additional support to mitigate burnout

Measles
Public health is currently seeing travel related cases of measles. Measles is a highly contagious virus and is spread through coughing and sneezing with the virus being able to stay in the environment for up to 2 hours.

Symptoms include
• Fever
• Cough, runny nose
• Red, blotchy rash
• Red watery eyes; and
• White spots in mouth.

Complications include:
• Common: Pneumonia, diarrhea, ear infection
• Severe: Brain infection (encephalitis), death

Measles cases are increasing globally. In December 2023, the World Health Organization (WHO) issued a warning of 30-fold rise in measles in European region in 2023. In 2023, the Health Unit had two confirmed measles cases (February and December) associated with travelers returning to the Middlesex-London region. The Health Unit has an approximate 85% vaccination rate for measles, with a goal of 95% for herd immunity.

MLHU in the News
The Health Unit has been in the news during February regarding the investigation of infection, prevention and control (IPAC) lapses, food insecurity, measles, and varicella (chickenpox) outbreaks.

Vice-Chair Michael Steele requested further comments on Respiratory Syncytial Virus (RSV) and its impacts in the community. Dr. Summers explained that RSV has been circulating in the region for a while. It is common in children and children with certain health conditions (such as being premature) may have poor outcomes. Immunoglobulin is provided to these children in their first year to minimize risks. Throughout the pandemic, there were lots of children who were not exposed to RSV as they normally would be, and there was a subsequent increase to pediatric hospitalization as restrictions lifted. There is now a vaccine for RSV, which has been approved for individuals over age 60 and pregnant individuals, and has been rolled out in long term care settings. Public health is currently waiting for the National Advisory Committee on Immunization (NACI) to provide further information on upcoming vaccination guidelines for RSV.

Vice-Chair Steele inquired when the measles vaccination is given to individuals. Dr. Summers noted that the classic schedule is at 12 months and 4-6 years of age in a 2-dose series. The measles vaccination is given as the MMR (measles, mumps, rubella) vaccination and is 97% effective for life. Children at 6 months old can receive the vaccination, but effectiveness is better at 12 months old. Public health also recommends that if travelling to endemic areas for measles, it may be recommended to vaccinate at both 6 and 12 months.

Board Member Aina DeViet inquired why different geographic areas of Ontario have differing vaccination uptake when they are governed under the same legislation (Immunization of Student Pupils Act). Dr. Summers noted that the Immunization of Student Pupils Act is provincial legislation, enforced in all public health units. Through the pandemic, some health units could not fully enforce due to capacity – Middlesex-London was the first who was able to gain capacity post pandemic to enforce. Currently, the Health Unit is 1-2 years ahead of most health units regarding enforcement. Currently, the estimates are that there is 85% compliance in 2023 for measles vaccination, however the full report from Public Health Ontario is pending.

It was moved by S. Franke, seconded by M. Smibert, that the Board of Health receive the verbal report re: Current Public Health Issues for information.
Carried

Correspondence

It was moved by P. Cuddy, seconded by H. Shears, that the Board of Health receive items a) through c) for information:
a) Middlesex-London Board of Health External Landscape for February
b) City of London re: Municipal Compliance Annual Report
c) Public Health Sudbury & Districts re: Household Food Insecurity
Carried

Other Business

The next meeting of the Middlesex-London Board of Health is Thursday, March 21, 2024 at 7 p.m. in person.

Closed Session

At 8:05 p.m., it was moved by S. Franke, seconded by A. DeViet, that the Board of Health will move into a closed session to consider matters regarding labour relations or employee negotiations, personal matters about an identifiable individual, including municipal or local board employees, and to approve previous confidential Board of Health minutes.
Carried

At 8:14 p.m., it was moved by S. Franke, seconded by M. Smibert, that the Board of Health return to public session from closed session.
Carried

Adjournment

At 8:14 p.m., it was moved by P. Cuddy, seconded by S. Menghsha, that the meeting be adjourned.
Carried

Matthew Newton-Reid
Chair

Emily Williams
Secretary