Minutes - March 16, 2023 - Board of Health Meeting

Members Present: 

Matthew Reid (Chair)
Michael Steele (Vice-Chair)
Selomon Menghsha
Skylar Franke (arrived at 7:10)
Michelle Smibert
Michael McGuire
Aina DeViet
Emily Williams, Chief Executive Officer (ex-officio)
Dr. Alexander Summers, Medical Officer of Health (ex-officio)

Regrets:

Peter Cuddy
Tino Kasi

Others Present:

Stephanie Egelton, Executive Assistant to the Board of Health (recorder)
Sarah Maaten, Acting Director, Office of the Medical Officer of Health
Mary Lou Albanese, Director, Environmental Health and Infectious Disease
Dr. Joanne Kearon, Public Health Medical Resident
Jennifer Proulx, Acting Director, Healthy Start
Linda Stobo, Manager, Substance Use Program Team
Jordan Banninga, Manager, Infectious Disease Control
David Jansseune, Assistant Director, Finance
Dan Flaherty, Manager, Communications
Jason Micallef, Marketing Coordinator, Communications
Parthiv Panchal, End User Support Analyst, Information Technology

Chair Matt Reid called the meeting to order at 7 p.m.

Disclosure of Conflict of Interest

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

Approval of Agenda

It was moved by A. DeViet, seconded by M. Smibert, that the March 16, 2023 Board of Health meeting agenda be approved.
Carried

Approval of Minutes

It was moved by M. Steele, seconded by S. Menghsha, that the MINUTES of the February 16, 2023 Board of Health meeting be approved.
Carried

It was moved by M. Steele, seconded by S. Menghsha, that the MINUTES of the March 9, 2023 Finance and Facilities meeting be received.
Carried

New Business

Performance Appraisal Committee Meeting Summary (Verbal)

Chair of the Performance Appraisal Committee, Michele Smibert provided a verbal update from the March 16, 2023 meeting.

There was no discussion on this report.

It was moved by M. Smibert, seconded by M. Steele, that the Board of Health:
1) Receive Report No. 01-23PA, re: 2023 Medical Officer of Health and Chief Executive Officer Performance Appraisals Procedures for information;
2) Amend the Appendices to Policy G-050 MOH and CEO Performance Appraisals Procedure to conduct a 360 external partner Performance Appraisal process on a bi-annual basis;
3) Amend the Appendices to Policy G-050 MOH and CEO Performance Appraisals Procedure to conduct an internal Performance Appraisal process on an annual basis; and
4) Approve the performance appraisal process, supporting documents, and timelines as amended (Appendix A).
Carried

City of London Funding to Support Cannabis Programming (Report No. 17-23)

Dr. Alexander Summers, Medical Officer of Health (on behalf of Maureen MacCormick, Director, Healthy Living) introduced Linda Stobo, Manager, Substance Use Program Team to discuss City of London funding to support the Health Unit’s work in cannabis programming.

The Health Unit has an excellent relationship with municipal and cannabis enforcement partners through a partnership established prior to legalization in 2018. The goal of this collaboration was to anticipate needs for the community once cannabis was legalized. The provincial government, in anticipation of these needs, have provided municipalities (since 2018) funding through the Cannabis Legalization Initiative Fund (CLIF) to offset costs. Funds were used to increase health promotion capacity related to cannabis and public health enforcement officers. In 2022, the Health Unit’s awareness campaigns have focused on preventing unintentional poisonings and misinformation regarding impacts of cannabis on mental health. For 2023, the focus will be on planning targeted messaging to the young adult population on impaired driving, mental health and brain development. Next week is Poison Prevention Week, which the Health Unit will be providing messaging on preventing cannabis edible overdose. At the end of 2023, the CLIF funding will expire for the Health Unit.

Board Member Aina DeViet inquired why cannabis poisoning rates in Middlesex-London are more than twice as high as compared to the provincial rate. L. Stobo noted that available data predates when cannabis was legalized in 2018, and post legalization data is not available. L. Stobo noted that generally, the increase in serious cannabis poisonings to hospitals in Ontario is with non-legal products obtained online or sold in unauthorized establishments.

Board Member A. DeViet inquired if there are long-term impacts on those who experience a serious cannabis poisoning incident. L. Stobo noted that young children who experience a cannabis poisoning can become seriously ill enough to be admitted to hospital, which at times can cause damage to the memory/impulse control part of the brain. Dr. Summers highlighted that there are acute poisoning effects in children (consuming a cannabis edible disguised as a treat) which may result in sedation, seizures, or other neurological impairment. Dr. Summers noted that there is emerging data on the negative long-term impacts of youth who start using cannabis at an age where the brain still developing, and its impacts on mental illness or increased anxiety. Dr. Summers further noted that the Health Unit will need to continue monitoring data and investigate impacts after CLIF expires at the end of 2023.

It was moved by M. McGuire, seconded by M. Smibert, that the Board of Health receive Report No. 17-23, re: “City of London Funding to Support Cannabis Programming” for information.
Carried

Burden of Health Attributable to Smoking and Alcohol Consumption in Middlesex-London (Report No. 18-23)

Sarah Maaten, Acting Director, Office of the Medical Officer of Health introduced this report, and noted the collaboration on this report between the Substance Use Program and Population Health Assessment and Surveillance teams.

L. Stobo provided an overview of the report. On February 6, 2023, Ontario Health and Public Health Ontario released a report on the burden of health conditions attributable to smoking and alcohol by public health unit in Ontario. This report estimates the prevalence of smoking and alcohol consumption, and highlights burden of disease linked to smoking and alcohol consumption across Ontario. The data includes estimates of the number of deaths, hospitalizations and emergency department visits associated with smoking and alcohol consumption for Ontario and by public health unit.

Highlights of this report included the following:
- Between 2015 and 2017, 18.1% of Middlesex-London population 20 years of age and older reported smoking on a daily or occasional basis.
- Between 2015 and 2017, 36.5% of the Middlesex-London population 19 years of age and older reported that they had more than two drinks per week.
- Attributable harm outcomes related to smoking in the Middlesex-London population 35 years of age and older resulted in 597 deaths, 2,082 hospitalizations and 3,917 emergency department visits. These local outcomes (related to smoking) resulted in 16.3% of all deaths, 7.9% of all hospitalizations and 3.2% of emergency department visits.
- Attributable harm outcomes related to alcohol consumption in the Middlesex-London population 15 years of age and older resulted in 154 deaths, 842 hospitalizations and 6,968 emergency department visits. These local outcomes (related to alcohol consumption) resulted in 4.1% of all deaths, 2.4% of all hospitalizations, and 3.8% of all emergency department visits.
- The data notes that while progress has been made in decreasing the proportion of people who regularly smoke, there remains a substantial population health burden.

L. Stobo provided an overview of current initiatives within the Substance Use Program Team, which include work with the Southwest Tobacco Control Area Network, social marketing campaigns (Dog and Tom), protection and enforcement, and cessation work. The Substance Use Program Team is actively working on a strategy for the alcohol program which includes promotion of new safe consumption of alcohol guidelines on the health unit website, staff engagement (using internal meetings), work with the Polysubstance Public Health Working Group, (RethinkYourDrinking.com) and work with the Ontario Public Health Association’s Alcohol Policy Group.

Board Member A. DeViet inquired if a report on harms attributable to smoking and alcohol consumption in Middlesex-London can be created, showing an urban and rural data split. S. Maaten noted that the Population Health Assessment and Surveillance team could create an urban and rural split of data when there are enough years of data to see.

It was moved by M. Smibert, second by M. Steele, that the Board of Health receive Report No. 18-23, re: “Burden of Health Attributable to Smoking and Alcohol Consumption in Middlesex-London” for information.
Carried

2022 Mpox Outbreak Summary (Report No. 19-23)

Mary Lou Albanese, Director, Environmental Health and Infectious Disease provided a brief overview of Mpox activity provincially.

Highlights included the following:
- Since May 1, 2022, 703 (an additional 12 confirmed since data was released) confirmed cases of Mpox have been reported in Ontario.
- Over 99% of cases identify as male and the most common risk factor has been sexual or intimate contact with a new partner and or having more than one sexual partner.
- Changes in sexual practices among the impacted population, timely case and contact management, and the Mpox vaccine (Imvamune) helped to control the spread of Mpox in Ontario.
- The data shows that the largest amount of confirmed cases was in July 2022.
- As of December 7, 2022, 687 individuals confirmed to have contracted Mpox had the following vaccination status:
o 79.2% had not received Imvamune prior to symptom onset.
o 20.8% had received at least one dose prior to symptom onset.

M. Albanese introduced Jordan Banninga, Manager, Infectious Disease Control to provide a brief overview of the 2022 Mpox Outbreak in Middlesex-London.

Highlights included the following:
- It was noted that Mpox is similar to smallpox and transmissibility between close contacts is high. The experience with the COVID-19 pandemic response assisted in identifying contacts, conducting case and contact management, and working with community partners.
- There were health promotion materials on Mpox created by the Communications and Sexual Health teams, which were distributed to community partners.
- It was noted that the rise of Mpox was occurring around the same time as Pride events, which was an opportunity for engagement on prevention and vaccination with community partners.
- The Health Unit’s Sexual Health clinic saw many initially identified cases locally and advised the Infectious Disease Control team for case and contact management purposes.
- Middlesex-London reported the first confirmed case of Mpox on June 13, 2022 and saw a cluster of confirmed cases between July 7-19, 2022.

J. Banninga noted that the Health Unit’s response to Mpox was a collaborative effort between the Sexual Health, Infectious Disease Control, and Vaccine Preventable Disease teams.

It was moved by A. DeViet, seconded by S. Franke, that the Board of Health receive Report No. 19-23 re: “2022 Mpox Outbreak Summary” for information.
Carried

Current Public Health Issues (Verbal)

Dr. Alexander Summers, Medical Officer of Health provided a verbal update on current public health issues within the region.

Health and Homelessness
- Health and Homelessness work has been shared via media partners and been endorsed by City of London Council.
- There is a proposed development of 24/7 integrated hubs, as part of the continuum of housing and health care. These hubs would be supported by the collective work of several agencies.
- MLHU leadership continues to support conversations around governance.

Immunization of School Pupils Act work
- The third of six suspension date for students not in compliance with the Immunization of School Pupils Act was earlier in March.
- Implementation of the ISPA continues to go well, and will strengthen vaccination coverage in Middlesex-London.

Respiratory Season
- There will be a spring booster campaign for high-risk individuals for whom it has been more than 6 months since their last COVID-19 vaccine.
- High-risk individuals likely include:
o Adults over the age of 65;
o Adults 18-64 with a moderate or severe immunocompromising condition; and
o Residents of long-term care homes and other congregate living settings for seniors or those with complex medical care needs.
- There will not be a spring booster campaign for the general population but there are plans for a fall booster campaign.
- There was an Influenza A spike from October through to December. There are early signs of an increase in Influenza B infections, making this a bimodal season.
- No significant impacts anticipated on healthcare system capacity.

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

Medical Officer of Health Activity Report for February (Report No. 20-23)

Dr. Alexander Summers, Medical Officer of Health, presented the Medical Officer of Health activity report for February.

There was no discussion on this report.

It was moved by S. Franke, seconded by M. McGuire, that the Board of Health receive Report No. 20-23 re: “Medical Officer of Health Activity Report for February” for information.
Carried

Chief Executive Officer Activity Report for February (Report No. 21-23)

Emily Williams, Chief Executive Officer, presented the Chief Executive Officer activity report for February.

There was no discussion on this report.

It was moved by S. Franke, seconded by M. McGuire, that the Board of Health receive Report No. 21-23 re: “Chief Executive Officer Activity Report for February” for information.
Carried

Correspondence

Chair Reid requested that Dr. Summers highlight specific correspondence items to the Board.

Dr. Summers highlighted correspondence g) re: Chief Medical Officer of Health – 2022 Annual Report. This annual report from the Chief Medical Officer of Health (Dr. Kieran Moore) highlights pandemic preparedness and the health system overall. The CMOH intends to report annually to the provincial legislature on the readiness of public health system to respond to a pandemic. Themes include sector/system readiness, community readiness, and societal readiness. This report highlights to the public the importance of sustained investment in public health and emergency preparedness.

In correspondence h) re: Association of Local Public Health Agencies re: in response to the Chief Medical Officer of Health’s 2022 Annual Report, the Association of Local Public Health Agencies (alPHa) provides context on the report.

Dr. Summers noted that the Board has three (3) items for endorsement.

For correspondence i) re: Public Health Sudbury & Districts re: Provincial Funding for Consumption and Treatment Services, Dr. Summers noted that Middlesex-London has permanent and stable funding for the Carepoint consumption and treatment site, but many other communities (such as Sudbury & Districts) do not.

Dr. Summers highlighted that for correspondence j) re: Association of Local Public Health Agencies re: Boards of Health – Order in Council Appointments, it is important to have a full complement on the Board of Health to make governance decisions. Further, Dr. Summers noted that for correspondence k re: Association of Local Public Health Agencies re: Pre-Budget Submission, alPHa highlights the needs of public health for sustained budgeting and addressing inflationary pressures.

It was moved by S. Franke, seconded by A. DeViet, that the Board of Health receive the following items for information:
a. Public Health Sudbury & Districts re: 2022 COVID-19 Response by the Numbers and Recovery Progress Report
b. Public Health Sudbury & Districts re: Community Engagement to Address Food Insecurity
c. Health Canada re: response to August 2, 2022 consultation letter on the Tobacco and Vaping Products Act
d. March 2023 Middlesex-London Board of Health External Landscape
e. Windsor-Essex County Health Unit re: Letter of Support – Physical Literacy for Healthy Active Children
f. North Bay Parry Sound District Health Unit re: Food Insecurity in Ontario
g. Chief Medical Officer of Health – 2022 Annual Report
h. Association of Local Public Health Agencies re: in response to the Chief Medical Officer of Health’s 2022 Annual Report
Carried

It was moved by M. Smibert, seconded by M. Steele, that the Board of Health endorse the following items:
i. Public Health Sudbury & Districts re: Provincial Funding for Consumption and Treatment Services
j. Association of Local Public Health Agencies re: Boards of Health – Order in Council Appointments
k. Association of Local Public Health Agencies re: Pre-Budget Submission
Carried

Finance and Facilities Committee Meeting Summary (Report No. 22-23)

Mike Steele, Chair of the Finance and Facilities Committee provided an update on reports heard at the March 9, 2023 Finance and Facilities Committee meeting.

Emily Williams, Chief Executive Officer provided a presentation of the 2023 budget process that was heard by the Committee:

Funding assumptions

o Flat provincial funding to 2022, with the Health Unit covering all inflationary pressures
o Mitigation funding continuing for 2023
o COVID-19 extraordinary funding will have the same process as 2022
- Inflationary pressures
o Salary and benefits at $597,000
o Corporate expenses at $300,000
- Additional pressures included a plan to bring gapping to 2021 levels ($330,000 pressure) and a plan to budget for an accelerated payment plan on the variable bank loan ($200,000).
- The total target was $1.2 million.

Current State and Changes to Funding

E. Williams explained the current state of funding. Funding from the provincial government remains unknown, with the budget anticipated on March 23, 2023. Currently, most public health units in Ontario are budgeting 1-2% increases - municipalities will bear these costs if provincial funding does not come through.

Budget Overview

Dave Jansseune, Assistant Director, Finance provided a budget overview.

Financial changes to the target include:
- Staffing inflation (initial estimate was $597,000 and revised to $478,470)
- Corporate inflation (initial estimate was $300,000 and revised to $306,184)
- OMERS pension increase for non-full-time staff (initial was unknown and revised to $199,452)
- Decrease to the gapping budget (initial was $300,000 and revised to $54,453)

The total target of savings is now $515,118. Salaries and benefit costs for 2023 is at $25,917,470, compared to $25,767,797 from 2022.

Disinvestments

Disinvestments have been discussed by the Senior Leadership Team in accordance with the public health pyramid and critical business infrastructure frameworks.

Pre-approved disinvestments by the Board of Health at the November 10, 2022 meeting include:
- General Expense reduction
- Cell phone reduction
- Student reductions

100% Funded – COVID-19, Seniors Dental and MLHU 2

COVID-19 funding supports the vaccine and case and contact management programs. For 2023, the total budget from the Ministry of Health is $10,655,019, which is a $17,413,875 decrease from 2022.

The Seniors’ Dental program supports operating costs for the program only. For 2023, the total budget is $3,693,148. The budget request has increased to include staffing increases to support the expansion of the program, including the opening of the Strathroy operatories.

MLHU 2 includes Best Beginnings ($2,483,000), FoodNet ($116,000), Smart Start for Babies ($152,000) and Shared Library Services ($108,000).

There was no discussion on Report No. 05-23FFC – 2022 Vendor and Visa Payments.

It was moved by M. Steele, seconded by A. DeViet, that the Board of Health:
1) Receive Report No. 04-23FFC re: “Proposed Revised 2023 Budget” for information; and
2) Receive Report No. 05-23FFC re: “2022 Vendor and VISA Payments” for information.
Carried

Other Business

The next meeting of the Middlesex-London Board of Health is on Thursday, April 20, 2023 at 7 p.m.

Confidential

At 8:26 p.m., it was moved by S. Franke, seconded by M. McGuire, that the Board of Health will move in-camera to consider matters regarding labour relations or employee negotiations, personal matters about an identifiable individual, including Board employees, advice that is subject to solicitor-client privilege, including communications necessary for that purpose, litigation or potential litigation, including matters before administrative tribunals, affecting the municipality or local board and to approve previous confidential Board of Health minutes.
Carried

At 9:23 p.m., it was moved by M. Steele, seconded by M. McGuire, that the Board of Health return to public session from closed session.
Carried

Adjournment

At 9:23 p.m., it was moved by M. Steele, seconded by M. Smibert, that the meeting be adjourned.
Carried

Matthew Reid
Chair

Emily Williams
Secretary