Minutes - May 18, 2023 - Board of Health Meeting

Members Present: 

Matthew Newton-Reid (Chair)
Selomon Menghsha (arrived at 7:03 p.m.)
Skylar Franke (exited at 7:45 p.m.)
Michelle Smibert
Aina DeViet
Tino Kasi (arrived at 7:10 p.m.)
Michael McGuire
Emily Williams, Chief Executive Officer (ex-officio)
Dr. Alexander Summers, Medical Officer of Health (ex-officio)

Regrets:

Michael Steele
Peter Cuddy

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
Jennifer Proulx, Acting Director, Healthy Start
David Jansseune, Assistant Director, Finance
Linda Stobo, Manager, Substance Use Program Team
Abby Dafoe, Public Health Dietician
Claire Bilik, Public Health Dietician
Donna Kosmack, Manager, Oral Health
Warren Dallin, Manager, Procurement and Operations
Dan Flaherty, Manager, Communications
Alex Tyml, Online Communications Coordinator
Cynthia Bos, Manager, Human Resources

Chair Matthew Newton-Reid called the meeting to order at 7:01 p.m.

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. McGuire, seconded by M. Smibert, that the AGENDA of the May 18, 2023 Board of Health meeting be approved.
Carried

Approval of Minutes

It was moved by A. DeViet, seconded by S. Franke, that the MINUTES of the April 20, 2023 Board of Health meeting be approved.
Carried

It was moved by M. Smibert, seconded by S. Franke, that the MINUTES of the April 20, 2023 Governance Committee meeting be received.
Carried

It was moved by M. Smibert, seconded by S. Franke, that the MINUTES of the May 11, 2023 Finance and Facilities Committee meeting be received.
Carried

New Business

Finance and Facilities Committee Meeting Summary from May 11, 2023 (Report No. 32-23)

Secretary and Treasurer Emily Williams provided an update on reports heard at the May 11, 2023 Finance and Facilities Committee meeting.

E. Williams noted that there were four (4) reports presented to the Committee for the Board’s consideration. It was further noted that the next Finance and Facilities Committee meeting is in August. The June meeting has been cancelled due to challenges with staffing resources with the auditors.

It was moved by M. McGuire, seconded by S. Franke, that the Board of Health:
1) Receive Report No. 06-23FFC re: Vector-Borne Disease Program: Contract Extension;
2) Approve extension of the existing contract for the Vector Borne Disease Program, Part A - Larval Mosquito Surveillance & Control, to Canadian Centre for Mosquito Management (CCMM) Inc. in the amount of $89,460 (before taxes) and $4,008 (before taxes) for supply of mosquito larvicide;
3) Approve extension of the existing contract for the Vector Borne Disease Program, Part B - Mosquito Identification and Viral Testing, to Entomogen Inc. in the amount of $21,025 (before taxes);
4) Receive Report No. 07-23FFC re: “2023 Q1 Financial Update and Factual Certificate” for information;
5) Receive Report No. 08-23FFC re: “Insurance Policies” for information; and
6) Receive Report No. 09-23FFC: “Employee and Family Assistance Program (EFAP) Services Contract Extension” for information.
Carried

2023-24 MLHU Provisional Plan (Report No. 33-23)

Emily Williams, Chief Executive Officer and Dr. Alexander Summers, Medical Officer of Health presented the 2023-24 MLHU Provisional Plan.

E. Williams provided background on the Provisional Plan to date:
• The previous Board of Health approved the Provisional Plan to complete a two-year provisional plan and with current priority areas (November 2022). It was noted that capacity for a fulsome plan in 2022 remained limited.
• The 2021-22 Provisional Plan is being updated with a new 2023-24 Provisional Plan that provides interim strategic direction over the next two years until a full strategic plan can be completed.
• The strategic directions required a refresh, as they focused on COVID-19 recovery. The strategic goals (Client and Community Confidence, Program Excellence, Employee Engagement and Learning, and Organizational Excellence still resonate with strategic work underway at the Health Unit and are being carried over to the 2023-24 Provisional Plan per the Board’s previous direction.
• To date, staff have been informed at the weekly Town Hall on the Provisional Plan process, the Strategy, Planning and Performance Team provided Senior Leadership Team a draft Provisional Plan for review, the Management Leadership Team was consulted, and the Marketing Coordinator created graphics for the draft Provisional Plan.
• As the Health Unit continues to be in COVID-19 recovery, the provisional plan is an opportunity to reflect on core public health work as we re-emerge from pandemic deployments to build a solid foundation for a full strategic plan. This includes:
o Reprioritizing relationships with key partners from equity deserving groups;
o Understanding what we (the Health Unit) does and do it well;
o Supporting our staff well-being and their recovery; and
o Clearly outline how we make effective decisions and follow through with them.

The next steps are:
• Get feedback from the Board on the drafted Provisional Plan;
• Receive approval and endorsement from the Board on the Provisional Plan;
• Communicate the approved Provisional Plan to all staff; and
• Update our website with the updated Provisional Plan.

Dr. Summers introduced the draft 2023-23 MLHU Provisional Plan. Dr. Summers noted that this process is not a fulsome strategic planning process – this will occur in the future during the five-year strategic plan.

Dr. Summers explained the definitions of the Provisional Plan:
• Goal: Where we want to go;
• Direction: The path we are taking to get there;
• Initiative: How we plan to move us forward along that path; and
• Tactics: The specific activities and projects to make progress on the initiatives.

Further, Dr. Summers provided an overview of the goals and directions within the 2023-24 Provisional Plan as referenced in Appendix A of the report:

Client and Community Confidence

Goal: We have strong relationships with our partners and are trusted by our community.

Directions:
• Facilitate meaningful and trusting relationships with prioritized equity-deserving groups, specifically Black and Indigenous communities; and
• Develop and adopt a partner engagement framework.

Program Excellence

Goal: Our public health programs are effective, grounded in evidence and equity.

Direction: Define what we do and do it well.

Employee Engagement and Learning

Goal: Our staff and leaders have the skills and capacity to do their jobs well, and their wellbeing is supported.

Directions:
• Develop and implement strategies to support staff mental health and wellbeing, including addressing systemic factors contributing to burn out; and
• Develop and implement comprehensive training, learning and development, and professional development opportunities for staff and leaders.

Organizational Excellence

Goal: We make effective decisions, and we do what we say we are going to do.

Directions:
• Clarify who makes decisions and how those decisions are made; and
• Develop and initiate an organizational quality management system.

Dr. Summers noted that within the draft Provisional Plan, there is detail on how the organization will be moving along its directional path, which includes tactics and initiatives. It was noted that some of this work overlaps. Further, some work continues with ongoing implementation of the Taking Action for Reconciliation Plan (TAFR) and the Anti-Black Racism Plan (ABRP), in addition to prioritizing equity, diversity and inclusion.

Board Member Tino Kasi inquired if the Health Unit having policies in place with respect to equity and diversity in the workplace specific to leadership positions in the organization, and if related goals have specifically been considered for racialized individuals.

E. Williams noted that the Senior Leadership Team has recently approved organizational targets for improving diversity within workforce. Additionally, the Health Unit conducted a workforce census as a baseline assessment which was compared to the most recent Canadian census to establish targets. It was also noted that under the Client and Community Confidence section of the draft Provisional Plan, the Health Unit has been implementing recommendations (88 in total) from the Employment Systems Review, specifically related to improving Human Resources policies and procedures to support diversity, equity and inclusion. Recruitment tools have also been reviewed with the lens of diversity, equity and inclusion to consider equivalent experience as a proxy for education requirements, and with standardized interview tools with documented scoring to remove bias. E. Williams noted that staff would be pleased to bring a report to a future Board of Health meeting on the Employment Equity Policy and organizational targets.

T. Kasi further inquired if the Health Unit’s leadership is mirroring the diverse population in which they serve (specifically racialized groups) and if this goal could be included in the Provisional Plan.

E. Williams noted that the current leadership complement does not reflect the levels of diversity in the London-Middlesex area, and this is one of the targets included in the Employment Equity Policy. Further, the Provisional Plan can be amended specifically under the “Organizational Excellence” section to include how the Health Unit is prioritizing employment equity.

It was moved by S. Franke, seconded by M. Smibert, that the Board of Health:
1) Receive Report No. 33-23 re: “2023-24 MLHU Provisional Plan” for information; and
2) Provide feedback on the 2023-24 Provisional Plan (Appendix A) as appended to this report.
Carried

Public Consultation on Potential Amendments to Federal Cannabis Regulations (Report No. 34-23)

Dr. Summers introduced Linda Stobo, Manager, Substance Use Program Team to present the report on consultations for amendments to federal cannabis regulations.

L. Stobo noted that on March 25, 2023, Health Canada released a Notice of Intent seeking public input on potential amendments to the Cannabis Regulations under the federal Cannabis Act to reduce regulatory burden while still maintaining the controls in place to address public health and safety risks. Health Canada is considering potential amendments that would reduce duplication within the legal requirements and reduce administrative and regulatory burdens where possible, while continuing to meet public health and safety objectives in the Act.
Health Unit staff from the Southwest Region collaborated on a set of recommendations that align with the public health approach to cannabis legalization, including increased access to a strictly regulated product while removing commercial influence to protect youth, eliminating the illicit market, and increasing public safety. These recommendations are with the Board for consideration as Appendix A.

L. Stobo summarized the recommendations in the draft submission, which correspond to three of the five priority areas that fall within the public health domain for which Health Canada has requested feedback:
• Priority Area 3: Production requirements for cannabis products;
• Priority Area 4: Packaging and labelling requirements for cannabis products; and,
• Priority Area 5: Record keeping and reporting for cannabis license holders.

It was moved by A. DeViet, seconded by S. Franke, that the Board of Health:
1) Receive Report No. 34-23, re: “Public Consultation on Potential Amendments to Federal Cannabis Regulations” for information; and
2) Endorse and submit feedback prepared by Middlesex-London Health Unit staff, attached as Appendix A, to the Health Canada’s Controlled Substances and Cannabis Branch on potential amendments to regulations under the Cannabis Act.
Carried

Support for Health Canada’s Policy Update on Restricting Advertising of Food and Beverages to Children (Report No. 35-23)

Dr. Summers introduced Abby Dafoe and Claire Bilik, Public Health Dieticians to present the report on Health Canada’s Policy Update on Restricting Advertising of Food and Beverages to Children.

C. Bilik provided an overview of the current situation with food and beverage advertising to children. Children and youth are vulnerable and constantly exposed to the advertising of the food and beverage industry. This exposure typically increases as children grow into teens and have more screen time, especially online. The food industry appeals to children and youth using cartoons, celebrities, popular music, slang, and sports to market their products. Children are targeted because they are unable to critically assess advertisement messages, can influence family spending, and provide an opportunity to establish brand loyalty at a young age. Youth are also vulnerable to marketing due to their cognitive and emotional development, peer pressure, high levels of exposure to advertising, and increased independent purchasing power. Exposure to food and beverage advertising influences children and youths’ food preferences, purchase requests and consumption patterns, which negatively impacts their health and wellbeing.

C. Bilik further provided a brief history on the Food and Drugs Act as it relates to this report:
• In 2015, Bill S-228, An Act to amend the Food and Drugs Act (prohibiting food and beverage marketing directed at children), was introduced and passed by the Senate and the House of Commons; however, it was not called to a final vote in 2019.
• In 2016, Health Canada released their Healthy Eating Strategy which included a commitment to restricting food and beverage advertising to children.
• In November 2021, Bill C-252, An Act to amend the Food and Drugs Act (prohibition of food and beverage marketing directed at children) was introduced.
• In April 2023, Bill C-252 was adopted by the Standing Committee on Health and was presented to the House of Commons on April 26, 2023. Health Canada released a policy update, indicating intention to amend the Food and Drug Regulations to “restrict advertising to children under the age of 13 of foods that contribute to excess intakes of sodium, sugars and saturated fat… focusing on television and digital media first”. Health Canada is accepting comments until June 12, 2023, which are proposed in a letter of support.

C. Bilik added that the Canadian Children’s Food and Beverage Advertising Initiative set voluntary standards for the food industry to follow, however, this voluntary approach has not been effective at reducing food and beverage advertising to children.

A. Dafoe provided the recommendations proposed to the Board to be provided to Health Canada in the form of a letter of support:
• Increasing the age to under 18 for restricting commercial advertising; and
• Expanding restrictions to all advertising types such as celebrity and character endorsements as indicated in Bill C-252.

It was moved by A. DeViet, seconded by M. Smibert, that the Board of Health:
1) Receive Report No. 35-23 re: “Support for Health Canada’s policy update on restricting advertising of food and beverages to children”;
2) Submit a letter on behalf of the MLHU Board of Health in support of Health Canada’s recent policy update on restricting the commercial advertising of food and beverages to children along with these additional measures:
• Increasing the age to under 18 for restricting commercial advertising;
• Expanding restrictions to all advertising types such as celebrity and character endorsements as indicated in Bill C-252.
Carried

Chair Newton-Reid noted that before proceeding with the meeting, that the Board must formally approve the provisional plan as amended based on feedback provided by Board Member T. Kasi to include the Health Unit’s commitment to employment equity, under the “Organizational Excellence” section and to direct staff to bring a future report to the Board of Health on implementation of the Employment Equity Policy and employment targets.

It was moved by T. Kasi, seconded by S. Menghsha, that the Board of Health:
1) Direct staff to provide a report to a future Board of Health meeting regarding implementation of the Middlesex-London Health Unit’s Employment Equity Policy and related employment targets; and
2) Approve the 2023-24 Middlesex-London Health Unit Provisional Plan as amended.
Carried

MLHU Strathroy Dental Clinic – May 2023 Update (Report No. 36-23)

E. Williams introduced Warren Dallin, Manager, Procurement and Operations to present the update on the MLHU Strathroy Dental Clinic.

W. Dallin provided a brief update on the Strathroy Dental Clinic build located at the Shops on Sydenham in Strathroy. The build for the dental clinic is proceeding as planned, with the project team working to continue to address matters that arise and working with the selected vendors (CCS Construction and Henry Schein). The dental clinic’s expected construction completion date is May 31, dental equipment installation on June 9, and an expected clinic opening date in late June.

W. Dallin noted that the capital budget for the project (funds given to the Health Unit from the Ministry of Health) is currently $1,050,000, which is currently carrying a surplus.

It was moved by M. McGuire, seconded by M. Smibert, that the Board of Health receive Report No. 36-23, re: “MLHU Strathroy Dental Clinic – May 2023 Update” for information.
Carried

MLHU’s Seniors’ Dental Care Program - Partnerships (Report No. 37-23)

Dr. Summers introduced Donna Kosmack, Manager, Oral Health to provide an update on current partnerships within the Seniors’ Dental Care program at the Health Unit.

D. Kosmack highlighted the work of the Oral Health team and partners with the Ontario Seniors’ Dental program to address large wait times being experienced in the community. The new dental clinic in Strathroy will be operational in June and will assist with the wait times in the County of Middlesex.

D. Kosmack noted that the Ontario Seniors’ Dental Program was launched before the COVID-19 pandemic. The pandemic caused dental services provincially to be paused, and public health dental services to be paused longer due to Oral Health staff being redeployed to support the pandemic response. The program interest and uptake as a result was higher than anticipated and has a lengthy waiting list. The Health Unit works with two (2) partners for community dental services – the Wright Clinic and the Southwest Ontario Aboriginal Health Access Centre (SOAHAC). These partners see clients of the Health Unit and the Health Unit provides funds for these services. The Health Unit has positive relationships with these partners, and Oral Health staff attend these clinics to support Health Unit clients on Mondays and Wednesdays.

D. Kosmack noted further that there have been higher volumes of clients needing emergency dental care than usual. The Health Unit has relationships with a few general dentists who assist when appointments are not available at the dental clinic, which ensures clients can be seen and diverted away from the hospital system.

It was moved by A. DeViet, seconded by T. Kasi, that the Board of Health receive Report No. 37-23, re: MLHU’s Seniors’ Dental Care Program - Partnerships 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.

World Health Organization Announcements
On May 5, 2023, the Director General of the World Health Organization (WHO) declared that the COVID-19 virus no longer constitutes a public health emergency of international concern. This means that COVID-19 is now endemic and will continue to be present in the community as a seasonal respiratory illness with periods of high and low risk. Dr. Summers noted that getting regular COVID-19 vaccination boosters and masking when recommended is the best form of protection.

Further, on May 11, 2023, the Director General also determined that MPox (formerly Monkeypox) no longer constitutes a public health emergency of international concern. Outbreaks in Middlesex-London decreased towards the end of 2022. It is recommended that MPox surveillance efforts are integrated into existing health unit programs to address future outbreaks. Vaccination for MPox continues to be available.

Immunization of School Pupils Act
Work under the Immunization of School Pupils Act continues to be underway at the Health Unit. Through six cohorts, notices were sent out to students and their families regarding receiving necessary vaccinations to be in compliance or having an exemption form on file.
• May 2022 - August 2022: 41,000 information letters were mailed
• September 2022 - May 15, 2023: 35,567 information letters were mailed and over 35,000 immunization records were entered
• Suspension Rounds 1 – 6: 21,549 suspension letters were mailed resulting in 5,750 suspensions
• Suspension Round 7 (May 25 suspension date): 287 suspension letters were mailed, and suspensions are to be determined
• Suspensions outstanding: Round 5 = 40; Round 6 =187

Public education has been provided to students and parents through letters, the Health Unit website, and social media on how to update vaccination records and receive missing vaccinations. The Health Unit held 17 vaccination “catch up” clinics within the community between September 2022 and May 2023. These clinics saw 8,144 students and 16,651 vaccinations were administered.

Health and Homelessness – Whole of Community System Response
Homelessness has doubled in the region and there are substantial impacts to those who are unhoused. The Whole of Community System Response is comprised of leaders from community partners, using a people centric and housing-first model. Hubs around the community will be created with different referral pathways for clients and are intended to provide wraparound supports and assist with the transition to housing. This is an entry point of a continuum of housing supports for clients, one where they choose where they need to be. Agencies from across the health and social services field have come together to build values, principles and commitment to a systems-level approach.

The Strategy and Accountability framework has been finalized, and meetings are being held to work further on implementation. Participating organizations will sign off on commitment letters and a Terms of Reference will be finalized. Discussions in May will be focused on 24/7 hub design, supportive housing units and models of care, and an encampment strategy.

MLHU in the News
Dr. Summers highlighted current news articles involving the Health Unit since the last Board meeting. Topics reported on by local media outlets included:
• Social Assistance Rates and Food Insecurity
• WHO’s declaration ending the COVID-19 public health emergency
• MLHU inspection reports of restaurants on Western University Campus

Chair Newton-Reid inquired on the reason for media interest on food premises at Western. Dr. Summers noted that there were no specific concerns, and the media outlet (Western Gazette) was looking for a greater understanding on the inspection process. Dr. Summers added that during the inspection process of food premises, infractions may be identified and rectified, and the premises would pass inspection. Public Health Inspectors take an educational approach to food premises in the community regarding enforcement when possible.

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

Medical Officer of Health Activity Report for April (Report No. 38-23)

Dr. Summers presented the Medical Officer of Health activity report for April.

It was moved by M. McGuire, seconded by T. Kasi, that the Board of Health receive Report No. 38-23 re: “Medical Officer of Health Activity Report for April” for information.
Carried

Chief Executive Officer Activity Report for April (Report No. 39-23)

E. Williams presented the Chief Executive Officer activity report for April.

It was moved by T. Kasi, seconded A. DeViet, that the Board of Health receive Report No. 39-23 re: “Chief Executive Officer Activity Report for April” for information.
Carried

Correspondence

It was moved by T. Kasi, seconded by M. Smibert, that the Board of Health receive the following items for information:
a) City of Hamilton Public Health Services re: 2023 PHS Annual Service Plan & Budget Submission; Support for Sufficient, Stable and Sustained Funding for Local Public Health Agencies
b) May 2023 Middlesex-London Board of Health External Landscape
c) Public Health Sudbury & Districts re: Support for the 2022 Annual Report of the Chief Medical Officer of Health for Ontario
d) Association of Local Public Health Agencies re: Ontario Public Health Nursing Leaders Recommendations
Carried

Other Business

The next meeting of the Middlesex-London Board of Health is on Thursday, June 15, 2023, at 6 p.m.

Confidential

At 8:08 p.m., it was moved by M. Smibert, 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 8:25 p.m., it was moved by M. Smibert, seconded by M. McGuire, that the Board of Health return to public session from closed session.
Carried

Adjournment

At 8:25 p.m., it was moved by A. DeViet, seconded by S. Menghsha, that the Board of Health adjourn the meeting.
Carried

Matthew Newton-Reid
Chair

Emily Williams
Secretary