Minutes - May 16, 2024 - Board of Health Meeting

Members Present: 

Matthew Newton-Reid (Chair)
Michael Steele (Vice-Chair)
Selomon Menghsha
Skylar Franke
Michelle Smibert (attended virtually)
Peter Cuddy
Michael McGuire
Howard Shears
Dr. Alexander Summers, Medical Officer of Health (ex-officio)

Regrets:

Emily Williams, Chief Executive Officer (ex-officio)
Aina DeViet

Others Present:

Stephanie Egelton, Executive Assistant to the Board of Health (recorder)
Dr. Joanne Kearon, Associate Medical Officer of Health
Sarah Maaten, Director, Public Health Foundations
Jennifer Proulx, Director, Family and Community Health and Chief Nursing Officer
Mary Lou Albanese, Director, Environmental Health, Infectious Diseases and Clinical Services
Shaya Dhinsa, Manager, Sexual Health
Darrell Jutzi, Manager, Municipal and Community Health Promotion
Ryan Fawcett, Manager, Privacy, Risk and Client Relations
David Jansseune, Associate Director, Finance and Operations/Chief Financial Officer
Megan Cornwell, Manager, Corporate Communications
Morgan Lobzun, Communications Coordinator
Parthiv Panchal, End User Support Analyst, Information Technology
Scott Courtice, Executive Director, London InterCommunity Health Centre
Angela Armstrong, Program Assistant, Communications
Linda Stobo, Manager, Social Marketing and Health System Partnerships
Donna Kosmack, Manager, Oral Health

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

It was moved by M. Steele, seconded by P. Cuddy, that the Board of Health appoint an Acting Secretary (Alexander Summers) for the duration of the May 16 Board of Health Meeting per the Middlesex-London Board of Health – By-law No. 3 - Proceedings of the Board of Health.
Carried

It was moved by S. Franke, seconded by S. Menghsha, that the Board of Health appoint an Acting Treasurer (Alexander Summers) for the duration of the May 16 Board of Health Meeting per the Middlesex-London Board of Health – By-law No. 3 - Proceedings of the Board of Health.
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

It was moved by M. Steele, seconded by S. Franke, that the AGENDA for the May 16, 2024 Board of Health meeting be approved.
Carried

Approval of Minutes

It was moved by H. Shears, seconded by P. Cuddy, that the MINUTES of the April 18, 2024 Board of Health meeting be approved.
Carried
It was moved by M. Steele, seconded by S. Menghsha, that the MINUTES of the April 18, 2024 Performance Appraisal Committee meeting be received.
Carried

It was moved by M. Steele, seconded by S. Menghsha, that the MINUTES of the April 18, 2024 Governance Committee meeting be received.
Carried

New Business

Finance and Facilities Committee Meeting Summary (Verbal Report)

Committee Chair Michael Steele provided an overview of the report heard by the Finance and Facilities Committee at 6 p.m. for the Board of Health’s consideration.

M. Steele noted that in summary for Q1, the Health Unit is in a slight surplus position, with vacancies contributing to the gap and the expectation that finances will be balanced at the end of the year.

It was moved by M. Steele, seconded by P. Cuddy, that the Board of Health receive Report No. 09-24FFC re: “2024 Q1 Financial Update, Borrowing Update and Factual Certificate” for information.
Carried

Delegation from the London InterCommunity Health Centre (Verbal Delegation)

Dr. Summers introduced Scott Courtice, Executive Director, London InterCommunity Health Centre to present as a delegation to the Board of Health.

Dr. Summers noted that the Board had indicated its desire to know more about local partners with which the Health Unit works. The Board of Health will be presented with more local partners at future Board meetings.

Scott Courtice, Executive Director, London InterCommunity Health Centre provided an overview of the London InterCommunity Health Centre and noted its continued close partnership with the Middlesex-London Health Unit.

S. Courtice noted that the London InterCommunity Health Centre opened in 1989. Community health centers are to support those who are marginalized, newcomers and who face barriers in the traditional health system. There are three (3) locations, with a care team including family doctors, nurse practitioners, nurses, social workers, dietitians, community health workers who work with community developers and health promoters to support the population. S. Courtice added that the client base is approximately 12,000.

S. Courtice briefly reviewed the programs that the London InterCommunity Health Centre offers, which are in the categories of Children, Youth, Families and Community, Diabetes and Chronic Diseases and Primary Health Care. S. Courtice noted that the Health Unit has had a strong partnership with the London InterCommunity Health Centre with some of these programs before COVID-19, especially with the safer supply programs and care for those with HIV.

In addition to regular programming, the London InterCommunity Health Centre supports newcomers, vaccination, infectious disease support, health and homelessness, opioids and harm reduction. S. Courtice noted that as the Community Drug and Alcohol Committee has been re-established (and as co-chair), this is an important time to be doing work related to substances due to the loss of members of the community to the toxic drug supply.

Chair Newton-Reid noted that the London InterCommunity Health Centre has 6.5 doctors on staff and inquired what the current waitlist is seeing a doctor within the organization. S. Courtice noted that for the first time, the LIHC has a full roster of doctors on staff and there is currently no open wait list. The London InterCommunity Health Centre identifies clients with high risk factors to be rostered and noted that the community could use more physicians and nurse practitioners.

Chair Newton-Reid inquired on the funding sources for the London InterCommunity Health Centre. S. Courtice explained that 90% of their funding is from the Province of Ontario and do not receive federal funding due to resources being met through provincial funding.

Chair Newton-Reid thanked S. Courtice and Dr. Summers for their collaborative work and alignment to support the community. Vice-Chair Michael Steele added his gratitude for S. Courtice attending the Board of Health meeting and noting that based on the London InterCommunity Health Centre’s values and mission that the work between them and the Middlesex-London Health Unit are clearly aligned.

Board Member Selomon Menghsha inquired how many employees work at the London InterCommunity Health Centre and what geographical area it serves. S. Courtice stated that there are 150 employees and the LIHC is focused on serving the City of London due to its complex urban health needs.

It was moved by S. Franke, seconded by S. Menghsha, that the Board of Health receive the verbal delegation from the London InterCommunity Health Centre for information.
Carried

Collective Action to Address Substance Use and Harms in Middlesex-London (Report No. 36-24)

Jennifer Proulx, Director, Family and Community Health introduced Sarah Maaten, Director, Public Health Foundations and Darrell Jutzi, Manager, Municipal and Community Health Promotion to present on the Health Unit’s collective action to address substance use and harms in the community.

D. Jutzi explained that the Chief Medical Officer of Health Annual Report titled “Balancing Act: An All-of-Society Approach to Substance Use and Harms” was released on March 28, 2024. The report focused on tobacco/vaping Products, alcohol, cannabis and opioids along with the factors that drive their use. The Chief Medical Officer of Health in the report calls for a balance between long-term upstream strategies to create healthy communities with short-term actions to respond to substance-specific challenges.

S. Maaten provided information on data associated with the burden of substance use within the Middlesex-London community.

For opioid use causing emergency department visits, there are substantial impacts among males, individuals 25-44 years old, and those in urban areas. This rate is significantly higher among Middlesex-London residents compared to Ontario and peer group. For deaths related to opioid use, there are substantial impacts among males, individuals 25-44 and 45-64 years old. Death rates are significantly higher among Middlesex-London residents compared to Ontario and peer group in 2021 and 2022.

For cannabis use causing emergency department visits, there have been increased visits from 2013 to 2019, primarily among those under the age of 25 years old with hospitalizations significantly higher among Middlesex-London residents compared to Ontario and peer group.

For alcohol use causing emergency department visits, the incident rate is significantly lower than Ontario but higher compared to peer group, with the highest rates among males and individuals 15-24 years old and hospitalizations significantly higher among Middlesex-London residents compared to Ontario and peer group.

D. Jutzi noted that the Health Unit is using a number of interventions to address substance use and harms which closely align with the approach highlighted in the Chief Medical Officer of Health Annual Report. These interventions include:

• Surveillance (e.g., collect, analyze, and interpret population-level health substance related data);
• Clinical Services Delivery (e.g., early childhood home visiting programs);
• Community and Partner Mobilization (e.g., Middlesex-London Community Drug and Alcohol Committee);
• Healthy Public Policy Development (e.g., guidance pertaining to municipal alcohol retailor density);
• Communication and Social Marketing (e.g., regional campaigns such as Rethink your Drinking);
• Inspections (e.g., enforcing legal requirements of the Smoke-Free Ontario Act, 2017);
• Investigations (e.g., progressive enforcement activities related to Cannabis);
• Health Resource Inventory Management (e.g., needle exchange program and naloxone kit distribution and tracking).

The Chief Medical Officer of Health report calls for a whole-of-society, health-first approach in a non stigmatizing manner. Early this year, the former Middlesex-London Community Drug and Alcohol Strategy (CDAS) Steering Committee was re-established as the Middlesex-London Community Drug and Alcohol Committee (CDAC). Next steps for this Committee include reviewing and expanding membership, liaise with other tables to support other strategies and develop a framework to raise and prioritize issues to guide work in this area going forward.

The Health Unit will continue to collect and analyze relevant data to monitor trends over time, emerging trends, priorities and health inequities related to substance use and harms. In addition, the Health Unit will
identify recommendations from the report and the previous Community Drug and Alcohol Strategy identify opportunities to enhance existing work or address gaps. The Board of Health will continue to receive updates on this work and through the Community Drug and Alcohol Committee.

Vice-Chair Steele inquired what would trigger an emergency department visit regarding cannabis. S. Maaten noted that this would relate to cannabis poisonings (such as the use of edibles).

Vice-Chair Steele inquired which organizations other than the Health Unit and London InterCommunity Health Centre were involved with the Community Drug and Alcohol Committee. D. Jutzi noted that there is representation from the City of London, London Police and the Canadian Mental Health Association. D. Jutzi added that as the committee is being re-established, there is an opportunity to expand membership. Dr. Summers added that the gap for membership currently is Middlesex County, Indigenous representation and those with living and lived experience.

Board Member Skylar Franke noted that there are 98 actions to combat substance use in the community by the Committee, and inquired if these actions within the strategy will continue or if there will be updates required. Dr. Summers noted that there has been continued significant discussion at Community Drug and Alcohol Committee meetings, and it was determined that at this time, the actions did not need to be changed. The Committee is currently looking at moving forward with reviewing acute issue responses and key strategies to prioritize over years 2 and 3. Dr. Summers concluded that actions may need to be revisited in the future, but at this time, strategic coordination is the goal.

Board Member S. Menghsha inquired on the jump in 2020 for the burden of opioid use and why London differs from peer groups. Dr. Summers noted that broadly speaking, we are in the third wave of the opioid crisis. From 2014 onward, the burden of opioid use was driven by compromised and toxic drug supply. The push to de-prescribe, in conjunction with other variables, resulted in individuals seeking street-available opioids. Dr. Summers added that Southwestern Ontario has had an increase potentially because of its proximity to the 401 and quicker access to the United States borders.

Board Member Howard Shears inquired if Niagara, Windsor and Sarnia are comparable peer groups to Middlesex-London. Dr. Summers explained that peer groups are informed by size and rural and urban mix, and that Hamilton and Waterloo would be comparable peer groups for the region.

Board Member S. Franke inquired on when the Health Unit needs direction on conducting work associated with the Chief Medical Officer of Health Annual Report, as some political figures may not agree with recommendations within the report. Dr. Summers noted that the key next steps for staff is to identify components of the Chief Medical Officer of Health Annual Report and identify how it is actioned in a local context such as what we are identifying, leveraging and mitigating. An example of this is that alcohol retail will be expanded in Province and the report conclusion is that increased availability anticipates increased harms. Dr. Summers added that the Health Unit is exploring tools that public health, partners or local councils can use to minimize the harms associated with this new policy measure.

It was moved by P. Cuddy, seconded by S. Franke, that the Board of Health receive Report No. 36-24 re: “Collective Action to Address Substance Use Harms in Middlesex-London” for information.
Carried

Harm Reduction, Program Enhancement and Needle Syringe Program Activity (Report No. 37-24)

Mary Lou Albanese, Director, Environmental Health, Infectious Diseases and Clinical Services introduced Shaya Dhinsa, Manager, Sexual Health to provide information on the Health Unit’s work with ham reduction and the needle syringe program.

S. Dhinsa noted that the Health Unit reports to the Ministry of Health annually on use of the Harm Reduction Program Enhancement (HRPE) and the Needle Syringe Program (NSP). The reporting notes staffing resources, local opioid or overdose response plans, naloxone distribution, early warning system, surveillance and programs gaps.

S. Dhinsa noted that there were 10,837 naloxone kits distributed in 2023 and 5 new eligible community organizations became part of the program supported by the Health Unit. Staff continue to monitor weekly emergency department opioid overdose reports, and the local and provincial monthly drug alerts, which increase awareness of the toxic drugs circulating in our community. In 2023, one local drug alert was issued. Chippewas of the Thames First Nation Health Centre, Munsee-Delaware Nation Health Services, and Oneida Nation of the Thames Health Services along with the Strathroy Middlesex General Hospital identified the increase in overdoses. Analysis identified that many of the patients were from the identified communities and support was offered at the request and direction of First Nations’ partners. The local drug alert information is also distributed through the Ministry of Health provincial monthly drug alert.

S. Dhinsa explained that the Needle Syringe Program currently has the main core site at Regional HIV/AIDS Connection (RHAC)’s Carepoint, with 11 public access satellite locations, 16 client-only satellite sites, and 1 mobile outreach van. There are 23 needle disposal bins located throughout the City of London. In 2023, there were 37,537 visits to these sites, 1,719,589 needles distributed and 828,215 returned with an estimated 48% return rate.

Board Member Michael McGuire noted that in British Columbia, the approach was to decriminalize some drugs (opioid use) and this decision was recently reversed. M. McGuire inquired if this type of policy change is monitored by the Health Unit, as there are conversations within the community that discuss if programs like the needle syringe program are helping or exacerbating a problem. S. Dhinsa noted that the Health Unit often reviews substance policy from other provinces and programs and noted that some staff from the Health Unit visited British Columbia to review their programming on reducing HIV within the community of people who inject drugs. S. Dhinsa further noted that the programming in British Columbia is more for urban residents and does not necessarily need to be replicated in Middlesex-London, noting that it is important regardless to bring the knowledge back to the area. In regard to harm reduction, the needle syringe program reduces harm but does not eliminate them. The program (Carepoint) can provide safe supplies for those who inject drugs and information on addiction support if requested. Dr. Summers noted that harm reduction is a balancing act between destigmatization of those who inject drugs and minimizing harm, while still de-normalizing substances and ensures the population in aware of the harms. Dr. Summers explained that in British Columbia, the act of decriminalizing opioids was intended to move substance use from a legal issue to a medical issue. What appears to have caused significant concern is the use of these substances in public spaces, and a perceived loss of public order. The Health Unit is reviewing substance use policy and minimizing health harms, and that public health supports a legalized, decommercialized, highly regulated drug supply. M. McGuire thanked S. Dhinsa and Dr. Summers for this information, as the Health Unit is taking a “eyes wide open” approach to harm reduction.

It was moved by M. McGuire, seconded by S. Menghsha, that the Board of Health receive Report No. 37-24 re: “Harm Reduction, Program Enhancement and Needle Syringe Program Activity Report” for information.
Carried

Q1 2024 Risk Register Update (Report No. 38-24)

Ryan Fawcett, Manager, Privacy, Risk and Client Relations presented the Q1 2024 Risk Registry.

R. Fawcett noted that the Health Unit has made progress with mitigating risks for removal from the registry. Ten (10) risks were identified in Q4, and four (4) have been removed due to successful mitigation. One (1) new risk was added to the registry in the People/Human Resources category.

Among the seven (7) risks identified on the registry, four (4) are high risk and three (3) are medium risk.

High risk

Two (2) significant residual risks are within the Financial and People/Human Resources categories. The Financial risk is related to COVID-19 funding and mitigation. The new People/Human Resources risk related to restructuring, as there is a risk of reduced productivity as new teams are forming and learning new work in Q1.

Two (2) moderate residual risks are within Financial and Political categories. The Financial risk is related to budget and funding being stagnant and not sustainable due to contractual obligations and inflation. The Political risk is related to public health modernization and mergers.

Medium risk

One risk (1) carries moderate residual risk related to the Technology category and two (2) carry minor residual risk related to Technology and Legal/Compliance risk categories. These three (3) risks are receiving effective mitigation strategies to minimize organizational risk to an acceptable level.

There were no questions or discussion.

It was moved by H. Shears, seconded by S. Franke, that the Board of Health:
1) Receive Report No. 38-24 re: “MLHU Q1 Risk Register” for information; and
2) Approve the Q1 Risk Register (Appendix A).
Carried

Q1 2024 Provisional Strategic Plan Update (Report No. 39-24)

Sarah Maaten, Director, Public Health Foundations presented the Q1 2024 Provisional Strategic Plan Update.

S. Maaten noted that all fourteen (14) projects are on track to proceed as planned, with three (3) additional projects starting in Q1. The three (3) new projects are to:
• Catalog and track MLHU relationships with key local and regional partners, including the assigned MLHU leads / key liaisons for those relationships;
• Develop and implement an evidence-based framework to effectively engage with partners; and
• Integrate public health foundational principles and practices into staff orientation and ongoing training curriculum.

S. Maarten added that one of the tactics among six within the organizational quality management system initiative has not been initiated yet, as it is for the development of a template for programmatic operational plans within the Management Operating System (MOS) work. S. Maaten noted that this will be presented to the Board of Health at an upcoming meeting.

There were no questions or discussion.

It was moved by P. Cuddy, seconded by S. Franke, that the Board of Health receive Report No. 39-24 re: “2023-25 Provisional Plan 2024 Q1 Status Update” for information.
Carried

Current Public Health Issues (Verbal)

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

COVID-19 Vaccine Spring Campaign & Fall National Advisory Concerning Immunization (NACI) Recommendations

The COVID-19 Vaccine Spring Campaign runs from April to June, for the following individuals including:
• Adults 65 years of age and older
• Adult residents of long-term care homes, retirement homes, and other congregate living settings for seniors
• Individuals 6 months of age and older who are moderately to severely immunocompromised
• Individuals 55 years and older who identify as First nations, Inuit, and Metis and their non-Indigenous household members who are 55 years and older

The campaign is targeted for the highest risk individuals, with the rest of the population not being recommended for their vaccine at this time. There is a lower number of COVID-19 positive cases in the community, but it is still present. Looking ahead to the fall, public health still encouraging those considering getting vaccination for COVID-19 and influenza to reduce the burden of illness.

Chair Newton-Reid sought clarification on the recommendation for individuals ages 5 and up who are not vaccinated. Dr. Summers explained that the recommendation is that those ages 5 and up should receive a primary series of COVID-19 vaccinations (3) and an annual booster.

Ontario Blacklegged Tick Risk Areas

There has been an increase in Lyme disease caused by Blacklegged Ticks in Ontario. The Blacklegged Tick was not as prevalent in Ontario 20 years ago.

Blacklegged Ticks can spread four tick-borne diseases of public health significance:
• Anaplasmosis
• Babesiosis
• Lyme Disease
• Powassan virus infection

The estimated risk areas for blacklegged ticks have been increasing throughout Ontario, year over year, with Kingston previously being the main risk area of the province. Blacklegged Ticks are found in London and Middlesex County. With the increase presence of Blacklegged Ticks, treat the Middlesex-London region as a high-risk area. The Health Unit’s Vector Borne Disease team conducts surveillance, tick dragging and education. Dr. Summers reminded to take precautions such as educating yourself on outdoor safety from ticks and when returning home, checking for ticks on yourself and your pets.

Health & Homelessness Update

The City of London approved the “Highlight Supportive Housing” Plan on April 2, 2024. Highlights of the plan include:
- 600 Highly Supportive Housing units to be developed in next 3 years;
- Highly Supportive Housing will provide 24/7 on-site support and a continuum of care for those using substances;
- Use of a coordinated intake approach to standardized intake practices; and
- Core, consistent functions will be required to ensure quality and consistency across multiple projects to support those in the housing units.

The City (of London) will also be hosting community engagement opportunities on the Whole of Community Response, the homeless crisis and an encampment to housing strategy.

Hospital Costs of Homelessness

A report from the Canadian Institute for Health Information has explored the hospital admission costs of homelessness in the community. The report highlighted the importance of preventing homelessness due to the amount of costs (twice as much) associated with emergency room visits and those experiencing homelessness.

The key findings of the report include:
- Nearly 30,000 people last year homeless when admitted to hospital and/or discharged from hospital;
- Average length of stay for people experiencing homelessness 15.4 days vs national average 8 days;
- Average cost per stay $16,800 vs national average $7,800; and
- Of patients, 93% admitted to hospital after emergency department visit.

Vice-Chair Steele noted that dogs receive Lyme disease vaccination and treatment, and inquired if there was anything similar for humans. Dr. Summers confirmed that there is no vaccination for Lyme disease for humans.

It was moved by P. Cuddy, 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 April (Report No. 40-24)

Dr. Summers presented his activity report for April, noting that he had taken time off during the month and shared appreciation to the Board of Health and colleagues for this time off.

There were no questions or discussion.

It was moved by S. Franke, seconded by H. Shears, that the Board of Health receive Report No. 40-24 re: “Medical Officer of Health Activity Report for April” for information.
Carried

Board of Health Chair Activity Report for March and April (Report No. 41-24)

Chair Newton-Reid presented his activity report for March and April.

There were no questions or discussion.

It was moved by S. Franke, seconded by P. Cuddy, that the Board of Health receive Report No. 41-24 re: “Board of Health Chair Activity Report for March and April” for information.
Carried

Correspondence

Board Member S. Franke requested that correspondence items d) Peterborough Public Health re: Chief Medical Officer of Health Annual Report and e) Peterborough Public Health re: Recommendation for Federal Restrictions on Nicotine Pouches be endorsed. Further, S. Franke requested that related to item d), that the Health Unit and funders (City of London and County of Middlesex) write a similar letter to the Chief Medical Officer of Health with the London and Middlesex context in mind.

It was moved by M. McGuire, seconded by S. Franke, that the Board of Health receive items a), b), c), f) and g) for information:
a) Timiskaming Public Health Unit re: Endorsement of Public Health Sudbury & Districts Letter on Gender-based and Intimate Partner Violence (IPV)
b) Public Health Sudbury & Districts re: Recommendations for Government Regulation of Nicotine Pouches (Provincial)
c) Public Health Sudbury & Districts re: Recommendations for Government Regulation of Nicotine Pouches (Federal)
f) Middlesex-London Board of Health External Landscape for May 2024
g) Summary of Association of Local Public Health Agencies’ Resolutions for 2024
Carried

It was moved by S. Franke, seconded by M. McGuire, that the Board of Health endorse correspondence item e) Peterborough Public Health re: Recommendation for Federal Restrictions on Nicotine Pouches.
Carried

It was moved by S. Franke, seconded by M. McGuire, that the Board of Health:
1) Endorse correspondence item d) Peterborough Public Health re: Chief Medical Officer of Health Annual Report; and
2) Direct staff in coordination with public funders (City of London and County of Middlesex) to write a letter of support grounded in the local Middlesex-London context regarding the Chief Medical Officer of Health Annual Report.
Carried

Other Business

The next meeting of the Middlesex-London Board of Health is Thursday, June 20, 2024 at 7 p.m.

Closed Session

At 8:20 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 litigation or potential litigation, including matters before administrative tribunals, affecting the municipality or local board; advice that is subject to solicitor-client privilege, including communications necessary for that purpose; and to approve previous closed session Board of Health minutes.
Carried

At 8:26 p.m., it was moved by S. Franke, seconded by M. Steele, that the Board of Health return to public session from closed session.
Carried

Adjournment

At 8:27 p.m., it was moved by M. McGuire, seconded by M. Smibert, that the meeting be adjourned.
Carried

Matthew Newton-Reid
Chair

Alexander Summers for Emily Williams
Acting Secretary