Minutes - July 18, 2024 - Board of Health Meeting

Thursday, July 18, 2024, 7 p.m.
Microsoft Teams (Virtual)

Members Present: 

Matthew Newton-Reid (Chair)
Michael Steele (Vice-Chair)
Michelle Smibert
Howard Shears
Aina DeViet
Selomon Menghsha
Skylar Franke (joined 7:28 p.m.)
Dr. Alexander Summers, Medical Officer of Health (ex-officio)
Emily Williams, Chief Executive Officer (ex-officio)

Regrets:

Michael McGuire
Peter Cuddy

Others Present:

Carolynne Gabriel, Executive Assistant to the Medical Officer of Health/Associate Medical Officer of Health (recorder)
Dr. Joanne Kearon, Associate Medical Officer of Health
Mary Lou Albanese, Director, Environmental Health, Infectious Diseases and Clinical Services
Jennifer Proulx, Director, Family and Community Health
Kim Loupos, Registered Dietitian
Heather Thomas, Health Promotion Specialist
Jaelyn Kloepfer, Health Promotion Specialist
Lindsay Croswell, Community Health Nursing Specialist
Andrew Powell, Acting Manager, Infectious Disease Control
Ryan Fawcett, Manager, Privacy, Risk and Client Relations
Cynthia Bos, Associate Director, Human Resources and Labour Relations
Megan Cornwell, Manager, Corporate Communications
Abha Solanki, End User Support Analyst, Information Technology
Angela Armstrong, Program Assistant, Communications

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. Steele, seconded by M. Smibert, that the AGENDA for the July 19, 2024 Board of Health meeting be approved.
Carried

Approval of Minutes

It was moved by A. DeViet, seconded by M. Smibert, that the MINUTES of the June 20, 2024 Board of Health meeting be approved.
Carried

It was moved by H. Shears, seconded by M. Steele, that the MINUTES of the June 20, 2024 Performance Appraisal Committee meeting be received.
Carried

New Business

Public Health Action to Support School Food Programs (Report No. 48-24)

This report was introduced by Jennifer Proulx, Director, Family and Community Health who introduced Kim Loupos, Registered Dietitian.

Highlights of this report included:
• In 2022-2023 the highest number of requests for support from the Thames Valley Education Foundation’s Caring Fund were for hunger and food scarcity.
• During the 2023-2024 school year, the Ontario Student Nutrition Program operated in 89 out of 182 schools in London and Middlesex County, supporting an estimated 23,000 students. Insufficient funding, rising food costs, and increased participation rates have resulted in some schools being waitlisted for funding, to end programming early, to reduce the quality or quantity of food provided, or to terminate the program.
• Ontario school food programs receive 10 cents per student per day from Provincial core annual funding. This is the second lowest per capita funding of all provinces and territories.
• The Coalition for Healthy School Food is a non-partisan network of over 300 non-profit organizations across Canada which advocates for a universal cost-shared healthy school food program. Some of the current endorsers of the Coalition include other public health entities such as the Association of Local Public Health Agencies (alPHa) and several Ontario public health units. Current members of the Coalition include the Middlesex-London Food Policy Council, the Ontario Public Health Association, and the Ontario Dietitians in Public Health.
• April 1, 2024, the Prime Minister announced a $1 billion investment to create a national school food program, followed by the release of the National School Food Policy on June 20, 2024.

Chair Newton-Reid indicated that during his tenure as Chair for the Thames Valley District School Board it was observed that sometimes school food programs are the only source of nutritious food for some students and that school food programs were often supplemented through fundraising. Recognition was also given to the federal government for investing in school food programs when such programs are traditionally the purview of the provincial government.

A. DeViet commented that investing in school food programs is common sense when the repercussions of a poor diet are considered: decreased education attainment, impact to students’ ability to concentrate, and the effects on staying healthy in the long term.

It was moved by A. DeViet, seconded by S. Menghsha, that the Board of Health:
1) Receive Report No. 48-24 re: “Public Health Action to Support School Food Programs”; and
2) Endorse the work and initiatives of The Coalition for Healthy School Food.
Carried

Support for “An Act to Develop a National Framework for a Guaranteed Livable Basic Income” (Report No. 49-24)

This report was introduced by J. Proulx who introduced Heather Thomas, Health Promotion Specialist.

Highlights of this report included:
• There are two bills, S-233 and C-233 before the Senate and House of Commons, respectively, for An Act to develop a national framework for a guaranteed livable basic income.
• If passed, this Act is intended to: ensure all Canadians have access to a livable basic income; facilitate the eradication of poverty while improving income equality, health conditions, and educational outcomes; benefit individuals, families and communities and project those most vulnerable in society; and ensure the respect, dignity and security of all persons in Canada.
• A guaranteed livable basic income has the potential to reduce health inequities. One example is food insecurity. Food insecurity is inadequate or insecure access to food due to financial constraints. It negatively impacts physical, mental, and social health and impacts one in five households in London and Middlesex County, representing nearly 85,000 people.
• Between 2021 to 2022 the percentage of Ontarians living in poverty increased from 7.7% to 10.9%. This is anticipated to increase further due to increased costs for food, fuel, and housing.
• Old Age Security and Guaranteed Income Supplement are successful examples of basic income in Canada.

A. DeViet observed that currently a lot is spent assisting those who cannot afford proper food and shelter, likely in excess of what the guaranteed livable basic income would cost.

A. DeViet referenced the pilot study conducted by the Ontario government, mentioned in Report No. 49-24, which was ended early. Anecdotal evidence from individuals involved in the pilot demonstrated the money was used to improve their conditions. One example was a single parent who used money from the pilot to attend school to improve their career prospects.

It was moved by A. DeViet, seconded by M. Steele, that the Board of Health:
1) Receive Report No. 49-24 re: “Support for ‘An Act to Develop a National Framework for a Guaranteed Livable Basic Income’”; and
2) Direct the Board Chair to send a letter to the Prime Minister of Canada, Deputy Prime Minister and Minister of Finance, Minister of Health, House Leaders, Standing Senate Committee on National Finance, and local Members of Parliament in support of S-233 and C-223 “An Act to develop a national framework for a guaranteed livable basic income”.
Carried

Alcohol Density and Related Harms (Report No. 50-24)

This report was introduced by J. Proulx who introduced Jaelyn Kloepfer, Health Promotion Specialist.

Highlights of this report included:
• The Provincial Government has announced plans for expanding the availability of alcohol, both in additional settings and additional alcohol options within existing settings. There are currently no provincial restrictions on alcohol retail outlet density or restrictions on proximity of outlets to sensitive land use areas.
• These changes are concerning because research shows an increase in alcohol availability is correlated with an increase in the consumption of alcohol. Increased consumption, in turn, is correlated with an increase in alcohol-related harms, examples of which are numerous chronic diseases, fetal alcohol spectrum disorder, injuries, violence, public disturbances, and crime.
• Reports of alcohol-related crimes are especially prevalent in neighbourhoods with high alcohol outlet density.
• Alcohol has the greatest societal burden of all substances when direct and indirect costs are considered.
• Increased normalization, exposure, and access to alcohol is correlated with increased use in youth which is a concern, as alcohol is known to harm developing brains and to increase the risk of injury and risky behaviours.
• Best practice guidelines for off-premises alcohol outlets recommends two outlets or fewer per 10,000 people aged 15 and older. Middlesex-London currently meets this best practice which means an increase in outlets will put the community beyond the best practice threshold.
• Protective regulatory measures to protect public health and safety related to alcohol include density restrictions, restricting hours of sale, pricing and taxation, and restricting advertising and promotion.
• MLHU has developed a Primer for Municipalities that outlines the harms and costs associated with alcohol use and includes potential actions local municipalities can explore to reduce risks.

Chair Newton-Reid noted a news article that referenced Dr. Joanne Kearon, Associate Medical Officer of Health and commented on the harms of alcohol exceeding the tax revenue received from alcohol, $7 billion compared to $5 billion, resulting in a $2 billion deficit to society. This deficit will only increase as access to alcohol increases.

M. Steele observed that with LCBO stores closed due to LCBO workers being on strike, the parking lot of a plaza with an LCBO store was empty when compared to usual, which is an indication of how many people purchase alcohol. When alcohol is readily available elsewhere, the purchase of alcohol may become exponential.

It was moved by M. Steele, seconded by M. Smibert, that the Board of Health:
1) Receive Report No. 50-24 re: “Alcohol Density and Related Harms” for information; and
2) Direct staff to send Report No. 50-24 (including Appendix A) to the City of London, Middlesex County, and lower tier municipalities within the County of Middlesex.
Carried

Nurse-Family Partnership – Annual Report (Report No. 51-24)

This report was introduced by J. Proulx who introduced Lindsay Croswell, Community Health Nursing Specialist.

Highlights of this report included:
• The Nurse-Family Partnership (NFP) is an evidence-based, intensive, two-and-a-half year, home visiting program delivered by public health nurses to those pregnant or parenting for the first time and who are experiencing multiple social and economic disadvantages.
• NFP is an internationally licensed program, currently in eight countries. The Middlesex-London Health Unit is the license holder in Ontario and is required to submit an annual report to the international team including program data indicators and demonstrating program fidelity.
• In 2023, 392 clients participated in the program, with ages ranging from 13 to 32 years of age. 4228 visits were completed.
• At intake: 38% reported an annual income of less than $25,000; 45% reported tobacco or nicotine use; 32% reported alcohol use; 42% reported cannabis use; and 56% reported concerns with their mental health.
• In 2023 the program showed an improved enrollment rate and total number of referrals, a successful transition of the NFP Canada website to a new server, and the incorporation of additional data indicators.
• Areas of focus for the program in 2024 include: expanding the number of Community Advisory Boards, increasing site self-efficacy, reviewing the data from a recently released randomized controlled trial (RCT) from British Columbia, and continuing to improve cross-provincial collaboration.

A. DeViet inquired if the program conducts exit interviews in order to collect data to compare to those taken at intake, for example to track changes in reported alcohol use. L. Croswell advised that there are five different time points during the two-and-a-half years where program outcome information is collected, such as for substance use. The intention in 2024 is to compare the data collected, using the RCT from British Columbia to inform the analysis.

It was moved by M. Steele, seconded by A. DeViet, that the Board of Health receive Report No. 51-24 re: “Nurse-Family Partnership Annual Report” for information.
Carried

Private Well Water Testing (Report No. 52-24)

This item was introduced by J. Kearon who introduced Mary Lou Albanese, Director, Environmental Health, Infectious Disease, and Clinical Services and Andrew Powell, Acting Manager, Infectious Disease Control.

Highlights of this report included:
• The intention of the report is to provide information on MLHU’s private well water testing program within the context of the proposed discontinuation of private well water testing in Ontario as outlined in the Auditor General of Ontario’s Value for Money Audit of Public Health Ontario released in 2023, and in response to the Council resolution from the Township of Lucan-Biddulph provided to the Board of Health on June 20.
• MLHU spends approximately $19,800 annually on the pickup and delivery of private drinking water samples to the Public Health Ontario Laboratory (PHOL) from 17 pick-up locations in London and Middlesex County. Annually MLHU receives an average of approximately 1900 samples. MLHU also supports the program through public health inspectors assisting residents with adverse results and interpreting results and providing education.

Chair Newton-Reid observed that even though the laboratory testing fees are covered by the Provincial government, there remains a cost for MLHU.

H. Shears inquired what the uptake of testing is from private well owners in London-Middlesex. A. Powell advised it is unknown for London-Middlesex. Studies have demonstrated that the percentage of private well owners who follow the recommendation of testing three times per year is very low. Anecdotally, testing one time per year is a higher percentage but still low overall. MLHU uses reporting from Public Health Ontario as data is not available from the couriers picking up the samples as to how many are picked up from which locations.

J. Kearon noted research has demonstrated the percentage of well owners following testing recommendations has been around 0.3% over the course of five years. Within one year, it was found to be 10%. It is estimated that Middlesex-London is in line with the province at 10% of private well owners testing at the recommended three times per year. It was noted that the recommendations for the ideal frequency for testing is not well established. Ontario recommends three times per year, the Public Health Agency of Canada recommends two times per year, and the CDC in the United States recommends testing annually.

A. DeViet inquired what the outcomes are for the 25% of private well test results that fail and if there would be benefit to an education program for increasing testing. A. Powell advised that residents with poor well water test results typically are not symptomatic and likely the failed test results were because the test was not done correctly rather than the actual presence of harmful contamination. M. Albanese advised that if residents are presenting with waterborne illnesses, case and contact management provided by the health unit will identify if there is a private well and will investigate.

A. DeViet commented that residents paying for water utilities and through taxes pay for regular testing of the water. There was a concern for equity between urban and rural residents, especially those on private wells, and a concern for negative health outcomes in those not conducting regular testing. J. Kearon advised that private well water testing is one part of multiple strategies that protect against waterborne illnesses.

It was moved by S. Franke, seconded by M. Smibert, that the Board of Health receive Report No. 52-24 re: “Private Well Water Testing in Middlesex-London” for information.
Carried

Q1 2024 Organizational Performance Reporting (Report No. 53-24)

This item was introduced by Emily Williams, Chief Executive Officer and co-presented by Dr. Alexander Summers, Medical Officer of Health.

Highlights of this report included:
• MLHU is implementing a Management Operating System (MOS), one component of which is Organizational Performance Management. This component was the least developed previously and will assist in determining how the organization is performing and ensure accountability and excellence.
• Organizational Performance Management consists of four parts with different cadences: program assessment, planning and evaluation; quarterly performance review; and quality improvement. In the early implementation of the MOS, effort has been focused on developing the quarterly performance review process.
• The Quarterly Performance Review process consists of managers reporting on their teams and interventions to their directors who summarize at the divisional level for the Medical Officer of Health and CEO, who in turn summarizes at the organizational and public health program levels for the Board of Health.
• The first Quarterly Performance Review report for Q1 involved the Environmental Health, Infectious Diseases, and Clinical Services and Family and Community Health divisions. It integrates information previously reported to the Board of Health in the areas of human resources, finance, and risk as well as assists to fill reporting gaps in public health programs and services.
• Regarding public health programs, as expected, operations across all programs were impacted by the restructuring. Additionally, there was significant scaling up of efforts to support the toxic drug and homelessness crisis, as well as significant increases in reports and cases of infectious diseases.
• Regarding client and community confidence, there was ongoing engagement and relationship building with priority populations, specifically First Nations communities and the Black community.
• Regarding employee engagement and learning, the organizational restructuring resulted in a high amount of disruption to staff. Efforts were made to support teams with team-building and to minimize negative impacts to organizational culture.
• The Quarterly Performance Review process will continue to be refined and optimized. The Q1 process allowed for a full audit of all the work being done across the organization. The process will also assist with streamlining annual reporting to the Board of Health and Ministry.

Chair Newton-Reid recognized that the organization only now, coming out of the COVID-19 pandemic, has the capacity to implement high-level reviews and procedures.

A. DeViet recognized the value of the process for leveraging information to support the continuous improvement of services to residents.

It was moved by M. Steele, seconded by S. Menghsha, that the Board of Health receive Report No. 53-24 re: “Q1 2024 Organizational Performance Reporting” for information.
Carried

Quarterly Risk Register Update – Q2 2024 (Report No. 54-24)

This item was introduced by E. Williams, who introduced Ryan Fawcett, Manager, Privacy, Risk, and Client Relations.

Highlights of this report included:
• The Q1 Risk Register had seven risks. One was removed for Q2, which was the financial risk related to COVID-19 mitigation funding. This was removed as the funding has been rolled into the base budget and mitigation funding accounted for in the 2024 balanced budget.
• Of the six risks remaining in Q2, two have significant residual risk, two have medium, and two are considered minor.
• One significant risk pertains to sustained financial pressures, as the 1% increase in base funding from the Ministry is insufficient to offset contractual obligations and inflation.
• The second significant risk pertains to human resources and the reduction in productivity as a result of restructuring and onboarding of staff to new teams and positions. Mitigation strategies included engaging an external consultant to assist teams and staff with the transition, enhanced onboarding and wellness initiatives. To mitigate decreased resiliency in leaders, Senior Leadership is addressing workload issues through prioritization as well as investing in associate manager positions.

Chair Newton-Reid recognized that some risks are beyond the control of the organization, such as the funding levels, despite the mitigation strategies developed and implemented.

It was moved by M. Smibert, seconded by S. Menghsha, that the Board of Health:
1) Receive Report No. 54-24 re: “Quarterly Risk Register Update – Q2 2024” for information; and
2) Approve the Q2 Risk Register (Appendix A)
Carried

Current Public Health Issues (Verbal)

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

Community Encampment Response Plan
• In the City of London there have been significant efforts to have a coordinated response to homelessness. The MLHU has been supporting this effort through participation in several working groups including the Strategy and Accountability Table and the Encampment Strategy Table.
• London City Council has endorsed the Community Encampment Response Plan which outlines the ways in which those living in encampments will be supported as well as parameters of acceptable locations and behaviours.

London Police Services Press Conference
• The London Police Services held a press conference at which A. Summers participated. Among other announcements, the Chief of Police informed there has been a significant increase in the amount of hydromorphone seized. It is believed the pills are largely diverted from safer supply programs.
• Safer supply is a harm reduction intervention where prescription-grade opioids are provided to manage acute opioid addiction, so individuals are not reliant upon illicit drugs which are more dangerous. When paired with wraparound supports, those receiving the program are less likely to overdose.
• The risk of diversion from safer supply programs is always present but protocols to reduce diversion exist and are implemented by London InterCommunity Health Centre (LIHC), which is the most visible operator of a safer supply program in Middlesex-London. There are other providers of safer supply, and it is unknown what protocols they use and additional supports they provide.
• Harm reduction interventions, like safer supply, are and can be highly contentious. Many perspectives exist on how to manage the toxic drug crisis. Dividing the community into different perspectives has not proved helpful for addressing the significant suffering caused by the crisis. Finding ways to have constructive conversations will be key to responding effectively to the crisis. Facilitating these conversations is part of the reason the Community Drug and Alcohol Committee was resumed and is looking to expand its membership.
• A priority of the Community Drug and Alcohol Committee is to assess how to limit diversion from safer supply programs and to minimize disruption to the community, while ensuring continued support to those suffering from the toxic drug supply. Treatments like suboxone, methadone, or abstinence may not be an option for all people, and until it is an option, harm reduction measures help prevent overdoses and deaths.
Pride
• The MLHU will be marching in the annual London Pride Parade on July 21, 2024. MLHU’s theme is “We Are Healthier When Everyone Belongs.”
• MLHU will also have a booth at the London Pride Festival.

M. Steele inquired about the parameter that minors are not permitted to reside in encampments and what would happen if someone younger than 16 years of age was living in an encampment. A. Summers was unable to speak to the specifics of the process; however, it was noted there are strong, local agencies that support youth living in poverty and experiencing homelessness, like Youth Opportunities Unlimited (YOU), which operates one of the new homeless hubs specific to youth.

M. Steele observed there could be other sources besides safer supply programs that contribute to the diverted hydromorphone. A. Summers advised the details of the police investigation have not been released but they believe the majority of diverted hydromorphone is from safer supply programs. It is unknown if the diverted pills are from one or several providers. As a local public health unit, MLHU does not have line of sight or oversight on rates of prescriptions and more work is needed to understand the prescription practices for hydromorphone in the community. It is known that greater availability can lead to greater use; however, the issue is complex because what is available illicitly is unsafe and providing hydromorphone can help with keeping people alive.

M. Steele observed some political social media sites are saying safer supply is not a good thing. This is concerning for those supportive of a balanced approach to addiction. A. Summers highlighted that evaluations of safer supply programs with wraparound supports continue to show benefits for individuals in the program. The conversation about managing diversion is important, but it was cautioned to not let it overwhelm the more pressing issue of the toxic drug supply paired with homelessness and mental health crises.

Chair Newton-Reid commented that there may be a misperception among the public that safer supply programs provide patients with a large number of pills through one appointment, rather than providing a smaller number of pills and requiring regular visits.

H. Shears inquired how safer supply sites are selected or managed. A. Summers advised that safer supply is a clinical model rather than an assigned clinic. The way safer supply is funded and operates varies widely. The safer supply program at LIHC is a broader primary care model and receives dedicated funding through Health Canada as a pilot program. Any regulated prescriber could theoretically open a safer supply clinic in partnership with a pharmacy, which is partially why the Ministry of Health does not have a complete understanding of the number of prescribers operating safer supply. MLHU does not have oversight and prescriptions are outside of the agency’s scope.

It was moved by H. Shears, seconded by M. Steele, that the Board of Health receive the verbal report re: Current Public Health Issues for information.
Carried

Medical Officer of Health Activity Report for June (Report No. 55-24)

A. Summers presented his activity report for June and advised he will be on leave starting August 2 so his next activity report will not be until the November Board of Health meeting. J. Kearon will be providing coverage.

It was moved by S. Franke, seconded by S. Menghsha, that the Board of Health receive Report No. 55-24 re: “Medical Officer of Health Activity Report for June” for information.
Carried

Chief Executive Officer Activity Report for June (Report No. 56-24)

E. Williams presented her activity report for June.

There were no questions or discussion.

It was moved by S. Franke, seconded by M. Smibert, that the Board of Health receive Report No. 56-24 re: “Chief Executive Officer Activity Report for June” for information.
Carried

Board of Health Chair Activity Report for May and June (Report No. 57-24)

Chair Newton-Reid presented his activity report for May and June.

There were no questions or discussion.

It was moved by S. Franke, seconded by M. Steele, that the Board of Health receive Report No. 57-24 re: “Board of Health Chair Activity Report for May and June” for information.
Carried

Correspondence

It was moved by S. Franke, seconded by M. Smibert, that the Board of Health receive items a) through d) for information:
a) Association of Local Public Health Agencies re: Ontario Public Health Standards Review 2024
b) Peterborough Public Health re: Wastewater Surveillance
c) Middlesex-London Board of Health External Landscape for July 2024
d) Public Health Sudbury and Districts re: Physical Literacy for Communities: A Public Health Approach
Carried

A. Summers informed that E. Michael Perley was a stalwart supporter of tobacco control and instrumental in the creation of smoke-free spaces. He was the executive director of the Ontario Tobacco Research Unit which drove a lot of the policy research which led to the Smoke-Free Ontario Act. He worked closely with local public health agencies including TCANs and others. In light of the ongoing risks of vaping and other ways the tobacco industry is trying to get people to buy their products, his acknowledgement is a reminder of how critical the work is.

It was moved by M. Smibert, seconded by S. Franke, that the Board of Health:
1) Endorse item e) Governor General of Canada’s Order of Canada Appointments for June 2024; and
2) Direct the Board Chair to write a congratulatory letter to E. Michael Perley for their contributions to public health and appointment to the Order of Canada
Carried

Other Business

The next meeting of the Middlesex-London Board of Health is Thursday, September 19, 2024 at 7 p.m.

Adjournment

At 8:30 p.m., it was moved by H. Shears, seconded by A. DeViet, that the meeting be adjourned.
Carried

Matthew Newton-Reid
Chair

Emily Williams
Secretary