Minutes - January 18, 2024 - Board of Health Meeting

Members Present: 

Matthew Newton-Reid (Board Chair Appoint)
Michael Steele (Vice-Chair Appoint) (attended virtually) (exited the meeting at 7:22 p.m.)
Selomon Menghsha
Skylar Franke
Michelle Smibert
Aina DeViet
Peter Cuddy
Michael McGuire (attended virtually)
Howard Shears
Emily Williams, Chief Executive Officer (ex-officio) (Secretary and Treasurer Appoint)
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, Acting 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 (attended virtually)
Janet Roukema, Human Resources Specialist, Diversity and Inclusion
David Jansseune, Chief Financial Officer
Ryan Fawcett, Manager, Privacy, Risk and Client Relations
Alex Tyml, Online Communications Coordinator
Parthiv Panchal, End User Support Analyst, Information Technology
Morgan Lobzun, Communications Coordinator
Emily Van Kesteren, Acting Manager, Communications
Christian Daboud, Manager, Health Equity and Indigenous Reconciliation
Crystal George, Indigenous Wellness Team Coordinator, Biigajiiskaan: Indigenous Pathways to Mental Wellness
Tino Kasi, Former Board of Health Member
Linda Kasi-Weir, Community Member
Alice Cooper, Community Member
Arthur Weir, Community Member

Outgoing Secretary and Treasurer Emily Williams called the meeting to order at 7 p.m.

E. Williams welcomed everyone to the inaugural meeting of the Board of Health. E. Williams introduced and called upon Crystal George, Indigenous Wellness Team Coordinator, Biigajiiskaan, Pathways to Mental Wellness to provide a reflection.

Dr. Alexander Summers, Medical Officer of Health presented a gift to C. George and thanked her on behalf of the Board for her reflection.

Meeting Procedures

Election of 2024 Board of Health Executive and Other Procedures (Report No. 01-24)

Outgoing Secretary and Treasurer Williams introduced election and appointment procedures for the positions of Chair, Vice Chair, Secretary and Treasurer to the 2024 Board of Health.

E. Williams opened the floor to nominations for the position of Chair of the Board of Health for 2024.

It was moved by P. Cuddy, seconded by M. Steele, that Matthew Newton-Reid be nominated for Chair of the Board of Health for 2024.
Carried

Matthew Newton-Reid accepted the nomination.

E. Williams invited further nominations. Hearing none, it was moved by M. Steele, seconded by P. Cuddy, that Matthew Newton-Reid be appointed as Chair of the Board of Health for 2024.
Carried

M. Newton-Reid took over as Board Chair presiding over the meeting.

Chair Newton-Reid opened the floor to nominations for the position of Vice-Chair of the Board of Health for 2024.

It was moved by M. Steele, seconded by S. Franke, that Michael Steele be nominated for Vice-Chair of the Board of Health for 2024.
Carried

Michael Steele accepted the nomination.

Chair Newton-Reid invited further nominations. Hearing none, it was moved by M. McGuire, seconded by S. Menghsha, that Michael Steele be appointed as Vice-Chair of the Board of Health for 2024.
Carried

Chair Newton-Reid opened the floor to nominations for the position of Secretary of the Board of Health for 2024.

It was moved by A. DeViet, seconded by M. Smibert, that Emily Williams be nominated as Secretary of the Board of Health for 2024.
Carried
Emily Williams accepted the nomination.

Chair Newton-Reid invited further nominations. Hearing none, it was moved by A. DeViet, seconded by M. Smibert, that Emily Williams be appointed as Secretary of the Board of Health for 2024.
Carried

Chair Newton-Reid opened the floor to nominations for the position of Treasurer of the Board of Health for 2024.

It was moved by A. DeViet, seconded by M. Smibert, that Emily Williams be nominated as Treasurer of the Board of Health for 2024.
Carried

E. Williams accepted the nomination.

Chair Newton-Reid invited further nominations. Hearing none, it was moved by A. DeViet, seconded by M. Smibert, that Emily Williams be appointed as Treasurer of the Board of Health for 2024.
Carried

Appointment of 2024 Board of Health Committees (Report No. 02-24)

Chair Newton-Reid noted that Governance Policy G-290 requires that the Board must decide at the first meeting of each year as to whether it wishes to establish Standing Committees or have all matters dealt with directly by the Board.

Chair Newton-Reid noted that the Board would appoint the Committees after membership interest was established.

Chair Newton-Reid invited interested members to be on the Finance and Facilities Committee. It was noted that the Chair and Vice-Chair of the Board of Health sit on the Committee automatically.

Selomon Menghsha, Howard Shears and Michael McGuire declared interest to be on the Finance and Facilities Committee.

Chair Newton-Reid invited interested members to be on the Governance Committee. It was noted that the Chair and Vice-Chair of the Board of Health sit on the Committee automatically.

Michelle Smibert and Selomon Menghsha declared interest to be on the Governance Committee. Chair Newton-Reid noted that more members could be added to the Committee if needed throughout the year.

Chair Newton-Reid invited interested members to be on the Performance Appraisal Committee. It was noted that members of the Governance Committee automatically sat on this Committee. No further interest was declared for membership on the Performance Appraisal Committee.

It was moved by A. DeViet, seconded by P. Cuddy, that Matthew Newton-Reid, Michael Steele, Selomon Menghsha, Howard Shears and Michael McGuire be appointed to the Finance & Facilities Committee for 2024.
Carried

It was moved by A. DeViet, seconded by P. Cuddy, that Matthew Newton-Reid, Michael Steele, Michelle Smibert and Selomon Menghsha be appointed to the Governance Committee for 2024.
Carried

It was moved by A. DeViet, seconded by P. Cuddy, that Matthew Newton-Reid, Michael Steele, Michelle Smibert and Selomon Menghsha be appointed to the Performance Appraisal Committee for 2024.
Carried

Chair Newton-Reid highlighted that the draft 2024 Board of Health and Committee Reporting Calendar is a combined calendar for all Board and Committee business and was presented for approval.

It was moved by M. Smibert, seconded by S. Menghsha, that the Board of Health approve the 2024 Board of Health and Committee Reporting Calendar.
Carried

Disclosure of Conflict of Interest

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

Approval of Agenda

Chair Newton-Reid noted that there was an additional report regarding the 2024 Federal Budget Consultation – Submission as Report No. 09-24 for consideration to be added to the agenda.

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

Approval of Minutes

It was moved by P. Cuddy, seconded by H. Shears, that the MINUTES of the December 14, 2023 Board of Health meeting be approved.
Carried

New Business

MLHU Employment Systems Review: Project Status Update (Report No. 03-24)

Cynthia Bos, Associate Director, Human Resources and Labour Relations introduced Janet Roukema, Human Resources Specialist, Diversity and Inclusion to provide a high-level overview and status update of the Middlesex-London Health Unit’s Employment Systems Review.

J. Roukema reviewed the timeline of the Employment Systems Review:

• March 2021: The Employment Systems Review yielded 88 recommendations for the Health Unit
• May 2021: The Board of Health approved the implementation of the review
• November 2021: Work began on the prioritization of the work, and the towards implementation of the work
• October 2023: 93% of recommendations were completed
• December 2023: 97% of recommendations were completed, ahead of the original target for implementation of organizational recommendations of April 2024
• April 2024: Anticipated project close out

Additionally, the Board was provided with updates in March 2022, March 2023 and July 2023 on the progress of the Employment Systems Review.

The 88 recommendations were split into categories: Policy and Document Reviews, Recruitment and Selection Processes and Practices, Office Spaces and Employee Perspectives.

J. Roukema noted that the priorities of the project were the following: accessibility work, accommodation work, equity recommendations and recruitment policies and processes. In addition to successful review of recruitment policies and procedures, other milestones included the relaunch of the Equity, Diversity and Inclusion Advisory Committee, bias-free training for leaders, approval of employment equity targets, LGBTQ2+ training for staff, guidance for gender transition, and mental health training for leaders.

J. Roukema noted that 85 out of 88 (97%) recommendations have been addressed and some will require ongoing monitoring and updating. One recommendation (medical notes) was declined as in certain situations, medical notes are not always necessary. Regarding gender inclusive washrooms, there are currently gender-neutral washrooms on the first floor of CitiPlaza, but the review recommended installing single use gender inclusive bathrooms on the second floor at Citi Plaza. The Health Unit have not done this to date due to budget and structural constraints.

Next steps for the project include: continued auditing, a future workplace census, ongoing communication, checking in with the Equity, Diversity and Inclusion Advisory Committee for taking the pulse of organizational changes, education on gender neutral washrooms, anti-oppression training, and ongoing training for bias-free hiring and managing diversity on teams.

It was moved by P. Cuddy, seconded by S. Franke, that the Board of Health receive Report No. 03-24 re: “MLHU Employment Systems Review: Project Status Update” for information.
Carried

2023-24 Provisional Plan Update – Extension (Report No. 04-24)

Sarah Maaten, Director, Public Health Foundations provided an update on the 2023-24 Middlesex-London Health Unit Provisional Plan, and a request to the Board of Health for an extension of the priorities within the plan.

S. Maaten explained to the Board that the Health Unit is requesting approval from the Board to extend the current Provisional Plan to the end of 2025 (to become the 2023-25 Provisional Plan) and that strategic planning be shifted to 2025 to create a 2026-2030 Strategic Plan for the Health Unit.

The Health Unit has undergone a significant organizational restructure due to budget shortfalls. This has impacted staff and the organizational climate, as well as service delivery changes. The priorities of the 2023-24 Provisional Plan will support these changes and continued work to stabilize the organization through to the end of 2025. In addition, there is uncertainty around changes to the Ontario Public Health Standards, with changes expected in early 2025. Other health units have delayed strategic planning for this reason.

Board Member Howard Shears inquired if the extension to the end of 2025 was long enough for the Health Unit. S. Maaten stated that the extension fits the current needs of the Health Unit but noted that if the mandate of the Ontario Public Health Standards is unclear, then a further extension may be needed.

Dr. Summers added that the Ontario Public Health Standards Review has commenced, and results are anticipated in January 2025. The result of the review will assist in clear understanding of the program standards required by the Health Unit, as well as the status of any voluntary mergers, which will help the agency engage in a robust strategic planning process. Dr. Summers also noted that provincial timelines are subject to change.

It was moved by A. DeViet, seconded by H. Shears, that the Board of Health:
1) Receive Report No. 04-24, re: “2023-24 Provisional Plan Update - Extension” for information; and
2) Approve the extension of the 2023-24 Provisional Plan to the end of 2025.
Carried

Submission to Inform the Second Legislative Review of the Tobacco and Vaping Products Act (Report No. 05-24)

Jennifer Proulx, Acting Director, Family and Community Health and Chief Nursing Officer provided an overview of the second informative submission of the Middlesex-London Health Unit to the federal government on the Tobacco and Vaping Products Act.

J. Proulx provided highlights of the submission, which was provided to Health Canada in November 2023. In 2018, Canada enacted the Tobacco and Vaping Products Act to create a new legal framework to regulate both tobacco and vaping products. In April 2022, the Health Unit submitted feedback in response to Health Canada’s public consultation to fulfill the mandated legislative review of the Tobacco and Vaping Products Act. On September 7, 2023, Health Canada launched a public consultation seeking feedback to inform the second legislative review of the Tobacco and Vaping Products Act, with an emphasis on tobacco-related provisions. The Middlesex-London Health Unit, on behalf of the Southwest Tobacco Control Area Network, submitted feedback to Health Canada on November 10, 2023 providing evidence-informed measures to reduce the health harms associated with commercial tobacco use for consideration.

The submission (which was included as Appendix A in the report) included the following recommendations for Health Canada to consider:
• Implementation of a “smoke-free generation” policy which prohibits the sale of commercial tobacco products to anyone born after 2008 and lowers the level of nicotine in cigarettes to non-addictive levels;
• Implementation of vaping policies to decrease appeal to youth such as increased taxation and bans on all flavors including mint and menthol;
• Increase funding for smoking cessation interventions such as fully funded pharmacological cessation aids like nicotine replacement therapy;
• Address inducements to tobacco use including controls on tobacco and vaping depictions on-screen, closer monitoring of online sales of tobacco and vapor products, and increased tobacco and vapour product manufacturers’ reporting requirements on sales data, research, and product development;
• Engaging with Indigenous populations, supporting a community-centered and community-directed approach to explore the impact of intergenerational trauma intertwined with a culture of accepting commercial tobacco use; and
• Enhancing compliance with and enforcement for commercial tobacco control.

Board Member H. Shears inquired on more details regarding the “smoke free generation”. Dr. Summers noted that the “smoke free generation” is a climbing age of prohibition (for tobacco sales) for those born in 2008 or later. These individuals would not be able to purchase tobacco even at the age of majority.. This would result in more regulation and further restricting of accessibility to tobacco products.

It was moved by S. Franke, seconded by P. Cuddy, that the Board of Health receive Report No. 05-24 re: “Submission to Inform the Second Legislative Review of the Tobacco and Vaping Products Act” for information.
Carried

Board Report and Correspondence Policy (Report No. 06-24)

E. Williams presented the proposed amendments to Policy G-490 Board Reports, including the recommendation to rename the policy ‘Board of Health Reports and Correspondence Policy’.

E. Williams noted that the amendments to the policy ensure modernization, and provide more standardized and strategically relevant information for the Board. The policy was also amended to ensure reliable and relevant information for the Board to fulfil its governance function across all domains. These amendments also include criteria of what items are appropriate to bring to the Board, and updated templates for reports.

It was moved by M. Smibert, seconded by S. Menghsha, that the Board of Health:
1) Receive Report No. 06-23 re: “Board of Health Reports and Correspondence Policy” for information;
2) Approve the name change of G-490 - Board of Health Reports Policy (Appendix B) to G-490 - Board of Health Reports and Correspondence Policy (Appendix A); and
3) Amend G-490 - Board of Health Reports and Correspondence Policy and appendices (Appendix A).
Carried

Current Public Health Issues (Verbal)

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

Dr. Summers’ update included the following:

Respiratory Season Update
The Middlesex-London region remains in a high-risk period for respiratory illnesses. With respect to COVID-19, there is a continued high-rate but it has been stable for the past month and there are some early indications of a decline. COVID-19 is not yet behaving like a typical fall and winter respiratory virus, as it continues to circulate in the summer. With respect to Influenza, Influenza A is the most prevalent now, with limited Influenza B. Vaccine effectiveness for influenza is typically unknown until after the season. Vaccination for flu and COVID are available and the Health Unit continues to encourage the community to get vaccinated but noting that only 16% of individuals over 12 have received a COVID-19 vaccination over the past 6 months.

iGAS
There has been an increase of iGAS (Invasive Group A Streptococcal Disease) in Middlesex-London. Group A Streptococcus (GAS) is caused by bacteria and spread person-to-person through bodily fluids (nose, throat, wound) or respiratory droplets, with typically no symptoms or mild illness. Invasive Group A Streptococcal Disease occurs when bacteria enter the blood or deep tissue and can cause life-threatening illness.

In 2023, 100 iGAS cases were reported to the Health Unit, exceeding annual average of previous 5 years of 65 cases. In 2023, there were 12 fatal cases in Middlesex-London. There have been no pediatric fatalities in the region. The region has higher iGAS rates than the provincial average, and there is no clear reason for the increase in cases. It is noted that underhoused and those who use injection drugs are highly affected, but iGAS can impact all members of the community. When the Health Unit is made aware of a confirmed case, case and contact management is conducted, and close contacts may be presented with chemoprophylaxis to present further spread.

Standing Committee on Finance and Economic Affairs

The Health Unit was selected to appear before the Standing Committee on Finance and Economic Affairs Pre-Budget Consultations in London on January 17. E. Williams and Dr. Summers attended to provide the Committee with information on public health pressures and needs. There was positive feedback from all political party affiliation on the Committee, and many questions were directed at the Health Unit.

MLHU in the News

Dr. Summers highlighted that the Health Unit has been in the news for a confirmed measles case over Christmas, three (3) cold weather alerts and respiratory season.

Chair Newton-Reid requested for Dr. Summers to explain why the Health Unit puts out cold and hot weather alerts. Dr. Summers explained that extreme temperatures have health implications, and this will worsen with advancing climate change. Public health has the responsibility to provide the health impacts of extreme weather events and communicating these events to the public. It was noted that the Health Unit works with municipal partners to provide a robust municipal and local response to support facilities such as cooling and warming centres.

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 November and December 2023 (Report No. 07-24)

Dr. Summers presented the Medical Officer of Health activity report for November and December. There was no discussion on this report.

It was moved by H. Shears, seconded by P. Cuddy, that the Board of Health receive Report No. 07-24 re: “Medical Officer of Health Activity Report for November and December 2023” for information.
Carried

Chief Executive Officer Activity Report for November and December 2023 (Report No. 08-24)

E. Williams presented the Chief Executive Officer activity report for December. There was no discussion on this report.

It was moved by A. DeViet, seconded by S. Franke, that the Board of Health receive Report No. 08-24 re: “Chief Executive Officer Activity Report for November and December 2023” for information.
Carried

2024 Federal Budget Consultation – Submission (Report No. 09-24)

Chair Newton-Reid noted that Report No. 09-24 was added to the agenda earlier.

E. Williams noted that the online portal for the 2024 Federal Budget has been opened and is providing individuals and organizations the opportunity to provide submissions regarding budgetary priorities. The Federal Government has the overall responsibility for immigration and refugee matters, and the region has seen many newcomers to the area. Between 2016 and 2021, the number of recent immigrants or newcomers to Middlesex-London increased by nearly 70%, from 11,595 in 2016 to 19,685 in 2021 (increase of 8,090). The submission would focus on funding associated with newcomers in the community. In addition, the Health Unit has arranged for a meeting with Member of Parliament (London North Centre) Peter Fragiskatos and is waiting on a response for a meeting with Member of Parliament (London West) Arielle Kayabaga.

Dr. Summers explained that the increase in newcomers has seen an increased demand for services within the Vaccine Preventable Disease, Infectious Disease Control, and Healthy Babies Healthy Children teams.

For vaccine, a high proportion of individuals newly arrived in Canada may be susceptible to vaccine preventable diseases because of a lack of effective immunization programs in their country of origin. Immunization of persons new to Canada is often challenging because: immunization records may not exist; records may be difficult to interpret because of language barriers; and immunization schedules and vaccines may differ from those used in Canada.

For infectious disease control, newcomers are required to complete an Immigration Medical Examination (IME). If there are any abnormalities associated with the IME chest x-ray, public health staff on the team will review the examination and conduct a medical history interview and symptom assessment. The increase in newcomers to London has had an impact on the volumes of suspected and active tuberculosis (TB) cases, requiring follow up by public health, with the number of active TB cases more than tripling since 2016, up from 8 per year to 23 by 2021. Each case requires very intensive investigation, requiring approximately 50 hours of staff time. The number of new referrals to the Health Unit has increased by 28% over the same five years, from 76 in 2016 to 273 in 2022.

For healthy babies home visiting, a screening tool is used which considers certain risk factors for less-than-optimal development. The screening tool includes a question on whether infants and families need newcomer support. Infants and families need newcomer support if the mother is new to Canada, less than 5 years living in Canada, who lacks social supports, or is experiencing social isolation. The percent of infants screened with families in need of newcomer support has been significantly higher for Middlesex-London compared to Ontario, with only 70% of newborns being screened.

Overall, the priorities highlighted in the draft submission are:
• The need for additional nursing and program assistant resources for the Vaccine Preventable Disease team;
• The need for additional nursing resources for the Infectious Disease Control team; and
• The need for additional nursing resources for the Healthy Babies Healthy Children home visiting team.

Board Member Skylar Franke inquired on how much financial contribution the federal government provides the Health Unit. E. Williams noted that the exact number could be provided after the meeting, but funding that the Health Unit receives is from Public Health Agency of Canadafor Smart Start for Babies and FoodNet programs.

Board Member Selomon Menghsha inquired why the Health Unit was only screening 70% of infants in hospitals. Dr. Summers explained that this was a resource issue and regrettably, if the Health Unit did screen 100%, then the agency would be challenged to keep up with the increase in volumes that would need services. This challenge was articulated to the provincial government as well.

Chair Newton-Reid requested that the submission should include more contextual numbers such as dollar amounts and full-time equivalent numbers for further impact, and the submission would be amended.

It was moved by S. Franke, seconded by A. DeViet, that the Board of Health:
1) Receive Report No. 09-24 re: “2024 Federal Budget Consultation - Submission” for information; and
2) Approve the attached response (Appendix A) as amended.
Carried

Correspondence

It was moved by S. Franke, seconded by M. Smibert, that the Board of Health receive items a) through e) for information:
a) Middlesex-London Board of Health External Landscape for January
b) Association of Municipalities of Ontario re: Public Health Mergers
c) MPP Peggy Sattler re: MLHU Funding
d) Peterborough Public Health Unit re: Public Health Strengthening
e) Timiskaming Health Unit re: Public Health Strengthening and Chronic Disease Prevention
Carried

It was moved by P. Cuddy, seconded by H. Shears, that the Board of Health endorse item f) Association of Supervisors of Public Health Inspectors re: One-Time Funding Opportunities to Support PHI Practicum Positions.
Carried

Other Business

The next meeting of the Middlesex-London Board of Health is on Thursday, February 15, 2024 at 7 p.m.

Closed Session

At 8:10 p.m., it was moved by A. DeViet, seconded by M. Smibert, 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, litigation or potential litigation, including matters before administrative tribunals, advice that is subject to solicitor-client privilege, including communications necessary for that purpose affecting the municipality or local board and to approve previous confidential Board of Health minutes.
Carried

At 8:46 p.m., it was moved by S. Franke, seconded by S. Menghsha, that the Board of Health return to public session from closed session.
Carried

Adjournment

At 8:46 p.m., it was moved by H. Shears, seconded by S. Franke, that the meeting be adjourned.
Carried

Matthew Newton-Reid
Chair

Emily Williams
Secretary