Minutes - July 20, 2023 - Board of Health Meeting

Members Present: 

Matthew Newton-Reid (Chair)
Michael Steele (Vice-Chair)
Selomon Menghsha
Skylar Franke
Tino Kasi
Michael McGuire
Emily Williams, Chief Executive Officer (ex-officio)
Dr. Alexander Summers, Medical Officer of Health (ex-officio)

Regrets:

Peter Cuddy
Michelle Smibert
Aina DeViet

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
Cynthia Bos, Manager, Human Resources
Ryan Fawcett, Manager, Privacy, Risk and Client Relations
David Jansseune, Assistant Director, Finance
Lisa Kenny, Comptroller
Janet Roukema, Human Resources Specialist, Diversity and Inclusion
Linda Stobo, Manager, Substance Use Program Team
Dan Flaherty, Manager, Communications
Alex Tyml, Online Communications Coordinator, Communications
Parthiv Panchal, End User Support Analyst, Information Technology
Katie DenBok, Partner, KPMG
Dale Percival, Senior Manager, KPMG

Chair Matthew Newton-Reid called the meeting to order at 7:03 p.m.

Chair Newton-Reid provided a brief update on provincial appointments, and that Board Member Selomon Menghsha’s provincial appointment was received earlier this month with an extended appointment until September 2026.

Emily Williams, Chief Executive Officer introduced Ryan Fawcett, incoming Manager, Privacy, Risk and Client Relations to the Board of Health. R. Fawcett started at the Middlesex-London Health Unit on May 15 and has an extensive background in risk, privacy, and client relations, having held similar manager roles at the South Bruce Grey Health Centre and the St. Thomas Elgin General Hospital. R. Fawcett also holds a Green Belt in Lean Methodology and has had recent experience as a Quality Improvement Specialist at Windsor Regional Hospital.

Disclosure of Conflict of Interest

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

It was noted at 7:24 p.m. that Board Member Michael McGuire declared a conflict of interest to Report No. 42-23, due to a family operated business that may be financially impacted by activities outlined in Report No. 42-23. Board Member McGuire recused himself from discussion and voting on relevant motions associated.

Approval of Agenda

It was moved by M. McGuire, seconded by S. Franke, that the AGENDA of the July 20, 2023 Board of Health meeting be approved.
Carried

Approval of Minutes

It was moved by S. Franke, seconded by T. Kasi, that the MINUTES of the May 18, 2023 Board of Health meeting be approved.
Carried

It was moved by M. Steele, seconded by S. Franke, that the MINUTES of the May 18, 2023 Performance Appraisal Committee meeting be received.
Carried

Correspondence

It was moved by S. Franke, seconded by T. Kasi, that the Board of Health receive items a) through q) for information:
a) Honourable Senator Patrick Brazeau - Letter to New Democratic Party of Canada regarding Bill S-254
b) City of Hamilton Public Health Services - Declarations of Emergency in the Areas of Homelessness, Mental Health, and Opioid Overdoses and Poisoning
c) Public Health Sudbury & Districts - Saving Lives Through Lifejacket and Personal Flotation Device Legislation
d) Peterborough Public Health – 2024 Budget
e) Public Health Sudbury & Districts - Letter of Support for Improved Indoor Air Quality in Public Settings
f) June and July 2023 Middlesex-London Board of Health External Landscape
g) Algoma Public Health - Letter of Support for Bill S-254, an Act to amend the Food and Drug Act (warning labels on alcoholic beverages)
h) Public Health Sudbury & Districts - Letter of Support for Bill S-254, an Act to amend the Food and Drug Act (warning labels on alcoholic beverages)
i) Association of Local Public Health Agencies - Annual Report for 2023
j) Association of Local Public Health Agencies - 2023 Resolutions
k) Simcoe Muskoka District Health Unit - 2024 Simcoe Muskoka District Health Unit Budget
l) Public Health Sudbury & Districts - Public Health Funding
m) Public Health Sudbury & Districts - Bill 103, Smoke-Free Ontario Amendment Act (Vaping is not for Kids), 2023
n) Simcoe Muskoka District Health Unit - 2023-24 Strategic Plan
o) Haliburton, Kawartha, Pine Ridge District Health Unit - 2024 Budget
p) Porcupine Health Unit - Request for Air Quality Monitoring Stations in the Porcupine Health Unit region
q) Association of Ontario Public Health Business Administrators - Call for Sustained Funding
Carried

New Business

Governance Committee Meeting Summary from July 20, 2023 (Verbal)

Emily Williams, Chief Executive Officer (Secretary and Treasurer) provided a verbal update on reports that were heard by the Governance Committee at 6 p.m. There was no discussion on these reports.

It was moved by M. Steele, seconded by S. Franke, that the Board of Health:
1) Receive Report No. 06-23GC re: “Governance Policy Review – Board of Health By-Laws” for information;
2) Receive Report No. 07-23GC re: “MLHU Q1 2023 Risk Register” for information; and
3) Approve the Q1 2023 Risk Register (Appendix A).
Carried

It was moved by M. McGuire, seconded by S. Franke, that the Board of Health amend G-B10 By-law No. 1 Management of Property through a first, second, third and final reading.
Carried

It was moved by M. Steele, seconded by S. Franke, that the Board of Health amend G-B20 By-law No. 2 Banking and Finance through a first, second, third and final reading.
Carried

It was moved by S. Franke, seconded by S. Menghsha, that the Board of Health amend G-B30 By-law No. 3 Proceedings of the Board of Health through a first, second, third and final reading.
Carried

It was moved by S. Franke, seconded by M. McGuire, that the Board of Health amend G-B40 By-law No. 4 Duties of the Auditor through a first, second, third and final reading.
Carried

Government of Canada’s Public Consultation on Single Use Plastic Waste (Report No. 41-23)

Dr. Alexander Summers, Medical Officer of Health noted that there are two (2) critical health aspects involved when discussing single use plastic waste within the local environment: 1) the evident impacts to the environment, specifically how single use plastics impact climate change; and 2) how the single use plastic industry is highly prevalent within the nicotine and vapour product industry. Dr. Summers introduced Linda Stobo, Manager, Substance Use Program Team to further discuss the response, which was sent to the Government of Canada.

L. Stobo explained that on April 18, 2023, the Canadian Government launched a consultation on a regulatory framework for the proposed Recycled Content and Labelling for Plastic Products Regulations. Health Unit staff submitted feedback on May 16, providing comments that pertain to the utilization of plastics within the commercial tobacco and vapour product industries. L. Stobo noted that it was important for the Health Unit to provide feedback, as the prevalence for young adults accessing disposable vapour products in retail locations has increased, and that cigarette filters are considered a plastic product as they are not biodegradable. It was noted that the submission was focused on the tobacco and vapour product industry because it is not currently named in the Government of Canada’s proposed regulations.

Dr. Summers added that public health generally uses the strategies of prevention and cessation to decrease impacts of nicotine and vapour products, however opportunities for public health to play a role in industry in consultations such as the one discussed can assist with further limiting the negative impacts of highly addictive nicotine products.

It was moved by S. Franke, seconded by S. Menghsha, that the Board of Health receive Report No. 41-23 re: “Government of Canada’s Public Consultation on Single Use Plastic Waste” for information.
Carried

Concerns Regarding Modernizing the Alcohol Marketplace and Product Sales (Report No. 42-23)

Dr. Summers highlighted ongoing concerns with shifting changes to the regulatory landscape regarding alcohol in Canada. It was reminded that the Board received a report earlier in the year (Report No. 18-23) on the burdens and harms of alcohol in Middlesex-London, and their impact to the community. Overall, impacts of alcohol are often unaddressed due to the ‘drinking culture’, which normalizes alcohol consumption, in Canada. Public health identifies alcohol as a drug, and it is vital to highlight to regulatory bodies, when provided the opportunity, the negative health impacts to individuals from increased alcohol use.

L. Stobo noted that evidence is clear that when availability to alcohol is increased, health and societal harms will increase due to increased alcohol consumption. Alcohol accounts for a significant number of injuries, illnesses, and deaths each year.

L. Stobo noted that while public health does not have specifics on which aspects the Government of Ontario is considering when changing regulatory access to alcohol, public health has learned through partners such as the Ontario Public Health Association the general ways in which the Ontario government plan to or have expanded the alcohol marketplace. These include:
• Expanding sales of beverage alcohol to more than 270 new retail outlets across Ontario since 2018;
• Permanently allowing licensed restaurants and bars to include alcohol with food as part of a takeout or delivery order;
• Freezing the basic beer tax rates that were set to be indexed to inflation;
• Permanently extending hours of operation for alcohol retail store locations; and
• Campaigning for alcohol to be sold in convenience stores.

L. Stobo added that in front of the Board was a recommendation to endorse a letter from the Ontario Public Health Association to share public health risks associated with alcohol marketplace expansion and evidence-informed policies to mitigate alcohol-related harms with the Ministries of Finance and Health.

Dr. Summers noted that addressing the use of alcohol can assist in decreasing other harms, such as intimate partner violence (prevention of violence against women). Dr. Summers added that the ideal landscape when reviewing a drug strategy is one of legalization, that is highly regulated and de-commercialized.

Board Member M. McGuire declared a conflict of interest to Report No. 42-23, due to a family operated business that may be financially impacted by activities outlined in Report No. 42-23. Board Member McGuire recused himself from discussion and voting on relevant motions associated.

Board Member Tino Kasi inquired if similar initiatives for vaping stigmatization have been considered. Dr. Summers noted that public health has had success with advocacy, education and harm reduction with cigarettes. Leading up to the legalization of cannabis, public health was heavily involved in significant consultation. It was reiterated that with substances such as cannabis, alcohol and tobacco, the goal is to legalize, highly regulate and de-commercialize. Dr. Summers noted that public health has not seen these goals fully manifesting at this time, but mechanisms such as providing opportunities for consultation will assist in moving forward. Public health also strives to de-normalize drug use while de-stigmatizing the individuals that use the drug.

It was moved by S. Franke, seconded by T. Kasi, that the Board of Health:
1) Receive Report No. 42-23, re: “Concerns Regarding Modernizing the Alcohol Marketplace and Product Sales” for information; and,
2) Endorse the Ontario Public Health Association’s (OPHA) letter, attached as Appendix A, to share information about the public health risks associated with alcohol marketplace expansion and evidence-informed policies to mitigate alcohol-related harms with the Ontario Ministries of Finance and Health.
Carried

MLHU Employment Systems Review Update: Employment Equity and Recruitment Policy (Report No. 43-23)

E. Williams introduced Janet Roukema, Human Resources Specialist, Diversity and Inclusion to present information on the Health Unit’s Employment Systems Review, specifically the Employment Equity and Recruitment Policy. J. Roukema reminded the Board of the recommendation within the Employment Systems Review to develop a recruitment policy that improved diversity across employee groups within the organization. The accompanying procedure to this policy was approved by Senior Leadership and required the establishment of employee diversity targets with assistance from the Director, Public Health Foundations.

Targets and benchmarks were established by staff to help monitor progress. Targets are the incremental objectives to help monitor our progress towards the established benchmarks. Benchmarks are based on available census data with the goal being that staff composition meets or exceeds the diverse demographic representation of the clients the Health Unit serves. J. Roukema emphasized that targets are not quotas, and staff continue to seek the most qualified candidate for a job posting.

In the Health Unit, the current breakdown within permanent full-time and part-time employees and associated targets are as followed (based on 216 employees who responded to the Workforce Census):

• North American Indigenous - permanent full-time and part-time employee representation is <2%, target is 3% with a benchmark based on local census data of 5%;
• Racialized - employee representation is 14%, target is 18% with a benchmark of 20%;
• White/European - employee representation is 82%, target is 79% with a benchmark of 75%; and
• 2% of individuals preferred not to answer.

Procedures for the new policy were presented and trialed in the spring. A few variables impacted the procedure for the policy, such as the future size of the organization, budgetary uncertainty, changing demographics in Middlesex-London, and availability of diverse applicant pools. Another key variable is the ability to make the changes needed to ensure the organization is a safe and inclusive workplace that attracts and retains diverse employees. This work is actively occurring with the Health Equity and Indigenous Reconciliation Team, and the Equity, Diversion and Inclusion Advisory Committee.

Teams have been provided with information to explain the rationale and method used to set targets by their respective leader, and this will be reiterated during the month of July to all staff at a Town Hall. Staff will also continue to address recommendations and begin audits on competition files to ensure compliance.

Board Member T. Kasi inquired if there were any targets and benchmarks associated with bringing diversity specifically to leadership within the Health Unit. J. Roukema noted that with the Potential Leaders Program at the Health Unit, leaders are encouraged to approach equity seeking employees who have shown leadership potential and to provide mentorship both within and outside of the program.

It was moved by S. Franke, seconded by T. Kasi, that the Board of Health receive Report No. 43-23 re: “MLHU Employment Systems Review Update: Employment Equity and Recruitment Policy” for information.
Carried

Current Public Health Issues (Verbal)

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

Strathroy Dental Clinic Opening
On June 26, MLHU held its Grand Opening for the new Strathroy Dental Clinic, within the Shops on Sydenham.

Health and Homelessness
Dr. Summers attended the Strategy and Accountability Table meeting on July 12 for the integrated hub work. Work is in progress on an implementation plan for the Hubs, which will be safe, supportive 24/7 places that provide immediate basic needs (clothing, food, rest, water, wound care, hygiene), wrap-around services (e.g. medical stabilization, integrated care planning, justice system support, income support), and intentional steps towards housing. Hubs are proposed to have lead agencies with the support of interdisciplinary, cross-sectional and multi-agency teams working to provide support and services.

COVID-19 Update
COVID-19 infections have increased, which is to be expected heading into respiratory season. Planning for the fall COVID-19 booster campaign is also underway. If it has been at least six months since a last dose or confirmed COVID-19 infection, individuals aged five years and older are eligible for a booster dose; however, they are encouraged to delay their COVID-19 booster dose until fall 2023 to maximize protection against COVID-19 during respiratory season.

Air Quality and Wildfires
Smoke from wildfires in Ontario and Quebec resulted in poor air quality in Middlesex-London throughout June. MLHU issued media releases throughout June regarding Special Air Quality Statements for Middlesex-London, with the following advice:
• Reducing outdoor activities if you have heart or respiratory problems, are an older adult, young child, or pregnant;
• Reducing or rescheduling strenuous outdoor activities if at lower risk for health outcomes;
• Listening to your body and going indoors if you experience shortness of breath, wheezing, severe cough, dizziness or chest pain; if you do not have access to a space with proper ventilation, taking a break from activities or moving to an indoor public space;
• Drinking plenty of water; and
• Contacting your healthcare provider if you experience symptoms that do not improve.

MLHU in the News
Dr. Summers highlighted the MLHU in the news since the last Board meeting:
• Wildfire smoke
• Opening of the Strathroy Dental Clinic
• Change of hours at the COVID-19 Vaccination clinic
• Tick bite safety
• Pandemic to endemic status of COVID-19

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

Medical Officer of Health Activity Report for May and June (Report No. 44-23)

Dr. Summers presented the Medical Officer of Health activity report for May and June. There was no further discussion on this report.

It was moved by M. Steele, seconded by T. Kasi, that the Board of Health receive Report No. 44-23 re: “Medical Officer of Health Activity Report for May and June” for information.
Carried

Chief Executive Officer Activity Report for May and June (Report No. 45-23)

E. Williams presented the Chief Executive Officer activity report for May and June. There was no further discussion on this report.

It was moved by M. McGuire, seconded by S. Franke, that the Board of Health receive Report No. 45-23 re: “Chief Executive Officer Activity Report for May and June” for information.
Carried

2024 Budget Projection (Report No. 46-23)

E. Williams provided a projection for the Health Unit’s 2024 budget. It was noted that the Health Unit is projecting a shortfall for 2024, with the elimination of COVID-19 funding, mitigation funding, changing of the municipal funding formula for public health, inflationary pressures, and continued financial uncertainty as 2023 funding is unknown. E. Williams noted that this was important to advise the Board early on, as many public health units are advocating to the Ministry of Health for stable and sufficient funding, which the MLHU would also request to do so. It was further noted that the financial staff from the County of Middlesex and City of London are aware of the funding pressures and requesting for the mitigation funds will not be a surprise.

Dr. Summers highlighted that during 2023 budgeting process we anticipated 2024 would be a challenging financial year for the health unit. Lack of funding would be limiting the ability to provide services in all aspects of public health standards.

Chair Newton-Reid noted a lot of work being done from the advocacy side. The Board Chair, E. Williams and Dr. Summers are meeting with Members of Provincial Parliament to discuss the importance of funding for local public health and will have delegations with caucus leaders and Ministers at the upcoming Association of Municipalities of Ontario (AMO) conference in August.

Chair Newton-Reid further inquired what the percentage of the base budget funding was for previous years.
E. Williams confirmed base funding last year was increased by 1% and prior to 2018, the Health Unit was receiving regular funding increases above this amount.

Board Member S. Franke requested if the Board would be able to send an advocacy letter to the City of London, County of Middlesex and local Members of Provincial parliament, and supported additional advocacy efforts for public health funding.

S. Franke inquired on further funding sources to the Health Unit aside from the Ministry of Health and municipalities. E. Williams noted that the Health Unit receives funding from Public Health Agency of Canada, Public Health Ontario and the Ministry of Children, Community and Social Services. This amount of funding is approximately $3 million and is separate from the cost-shared $20 million budget for mandatory programs.

It was moved by M. Steele, seconded by M. McGuire, that the Board of Health:
1) Receive Report No. 46-23 re: “2024 Budget Projection” for information;
2) Direct staff to submit relevant business cases via the City of London Multi-year Budgeting Process, including one to reflect the loss of mitigation funding, and one to request an inflation-related increase; and
3) Direct staff to submit information to the County of Middlesex to support the 2024 budgeting process, to reflect the loss of mitigation funding, and to request for an inflation-related increase.
Carried

Furthermore, it was moved by M. McGuire, seconded by M. Steele, that the Board of Health draft a letter of advocacy for stable and sufficient funding for local Public Health and direct it to the Minister of Health, the Premier of Ontario, City of London Council, County of Middlesex Council, and local Members of Provincial Parliament.
Carried

2022 Draft Financial Statements (Report No. 47-23)

David Jansseune, Assistant Director, Finance introduced Katie DenBok, Audit Partner and Dale Percival, Senior Manager of KPMG to discuss the MLHU Draft Financial Statements. D. Jansseune noted that the Board would have the opportunity in closed session to ask questions of the auditors.

K. DenBok provided an overview on the audit conducted on the Health Unit. The financial statements include:
• the statement of financial position as at December 31, 2022;
• the statement of operations and accumulated surplus for the year then ended;
• the statement of change in net debt for the year then ended;
• the statement of cash flows for the year then ended; and
• Notes to the financial statements, including a summary of significant accounting policies.

K. DenBok and D. Percival provided audit highlights for the Board to review. Highlights included:
• The audit being completed, except for the following outstanding procedures:
o Journal entry testing
o Review of lease commitment schedule
o Final review and documentation of audit file
o Receipt of the signed management representation letter (to be signed)
o Completing our discussions with the Board of Directors, and
o Obtaining evidence of the Board of Directors’ approval of the financial statements (to be signed and completed after the meeting)
• No matters to report based on procedures performed to address the presumed fraud risk from management override of controls.
• No unusual transactions.
• No identified control deficiencies that were determined to be significant deficiencies in internal control over financial reporting.
• There was a change in the grouping of elements making up other revenue in the notes to the financial statement. This did not result in a change in the overall other revenue amount. There was also a corrected statement regarding payroll adjustments.
• Materiality of $1,080,000 (2021 -$1,177,000) was determined based on preliminary total expenses, resulting in an audit posting threshold of $54,000 (2021 -$58,850). A threshold of $216,000 has been used for reclassification misstatements in the current year.

It was moved by M. McGuire, seconded by M. Steele, that the Board of Health review and approve the audited Financial Statements for the Middlesex-London Health Unit for the year ending December 31, 2022.
Carried

Other Business

It was moved by S. Menghsha, seconded by S. Franke, that the Board of Health cancel the Thursday, August 17, 2023 Board of Health meeting.
Carried

The next meeting of the Middlesex-London Board of Health is on Thursday, September 21 at 7 p.m.

Confidential

At 8:28 p.m., it was moved by M. McGuire, seconded by M. Steele, 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 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 9:06 p.m., it was moved by M. Steele, seconded by T. Kasi, that the Board of Health return to public session from closed session.
Carried

Adjournment

At 9:06 p.m., it was moved by M. McGuire, seconded by S. Franke, that the meeting be adjourned.
Carried

Matthew Newton-Reid
Chair

Emily Williams
Secretary