Minutes - November 21, 2024 - Board of Health Meeting

Thursday, November 21, 2024, 7:30 p.m.
MLHU Board Room – Citi Plaza
355 Wellington Street, London ON

Members Present: 

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

Regrets:

Michael McGuire
Peter Cuddy
Emily Williams, Chief Executive Officer (ex-officio)

Others Present:

Stephanie Egelton, Executive Assistant to the Board of Health (recorder)
Dr. Joanne Kearon, Associate Medical Officer of Health
Mary Lou Albanese, Director, Environmental Health, Infectious Diseases and Clinical Services
Sarah Maaten, Director, Public Health Foundations
Jennifer Proulx, Director, Family and Community Health
Ryan Fawcett, Associate Director, Operations/Privacy Officer
Alanna Leffley, Epidemiologist, Population Health Assessment and Surveillance
Amanda Harvey, Manager, Strategy, Planning and Performance
Parthiv Panchal, End User Support Analyst, Information Technology
Alex Zhou, Medical Student

Vice-Chair Michael Steele called the meeting to order at 7:31 p.m.

Vice-Chair Steele noted that Emily Williams, Chief Executive Officer was absent for this meeting. This will require the Board of Health to appoint an Acting Secretary and Acting Treasurer for the meeting per the Board’s By-Law No. 3 – Proceedings of the Board of Health.

It was moved by S. Franke, seconded by A. DeViet, that the Board of Health appoint an Acting Secretary (Alexander Summers) for the duration of the November 21 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 M. Smibert, that the Board of Health appoint an Acting Treasurer (Alexander Summers) for the duration of the November 21 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

Vice-Chair Steele inquired if there were any disclosures of conflicts of interest. None were declared.

Approval of Agenda

It was moved by H. Shears, seconded by S. Menghsha, that the AGENDA for the November 21, 2024 Board of Health meeting be approved.
Carried

Approval of Minutes

It was moved by H. Shears, seconded by S. Menghsha, that the MINUTES of the October 17, 2024 Board of Health meeting be approved.
Carried

It was moved by S. Franke, seconded by M. Newton-Reid, that the MINUTES of the October 17, 2024 Governance Committee meeting be received.
Carried

New Business

Opioid Crisis Update 2024 (Report No. 74-24)

Jennifer Proulx, Director, Family and Community Health and Alanna Leffley, Epidemiologist presented information and data on the current status of the opioid crisis in Middlesex-London.

A. Leffley explained that opioid related morbidity and mortality continues to have a significant impact on the Middlesex-London community. Interventions across pillars of upstream prevention, harm reduction, treatment, and enforcement are required to address the opioid crisis within the community. The Health Unit and community partners continue to implement a variety of interventions to address opioid-related harms.

A. Leffley summarized the findings from the Health Unit’s newly revised substance use interactive data dashboard.

Since 2017, the Middlesex-London rates for opioid-related poisoning emergency department visits have remained significantly higher compared to Ontario and peer group (other health unit areas). Since peaking in 2021, local rates have significantly decreased for the second year in a row, by 16%, to 122.8 per 100,000 in 2023. Despite this decrease, there were still more than 650 (nearly 2 per day) opioid-related poisoning emergency departments visits in 2023 for Middlesex-London. Those who attending the emergency room the most were males (2.5 more than females) and those between the ages of 25-44. There was no significant difference between urban and rural emergency department visits. Hospitalizations in Middlesex-London have remained comparable to its peer group.

Middlesex-London opioid-related death rates were significantly higher in 2021 and 2022 but were comparable to Ontario and its peer group in 2023. The local rate of opioid-related poisoning deaths declined for the second year in a row to 19.3 per 100,000 in 2023, which is an 18% decrease. This represents over 100 deaths (about 2 deaths per week) in 2023. Deaths occurred 3 times more in males than females and the highest age group of deaths was in the 25-44 age range. A. Leffley noted that while the rates were decreasing slightly, opioids continue to take the lives of people within the Middlesex-London community. The Health Unit’s Population, Assessment and Surveillance team will continue to monitor data closely for any changes for the Board of Health.

J. Proulx explained that the Health Unit uses several interventions to address the opioid crisis at the local level, including surveillance of substance related data. The Health Unit delivers clinical services, including early childhood home visiting, naloxone distribution and the needle syringe program. The Health Unit also delivers social marketing, education, supports healthy public policy development and supports community and partner mobilization. Further, the Health Unit provides administrative support and leadership to the Community, Drug and Alcohol Committee (CDAC), which reconvened earlier this year. The opioid crisis and toxic drug supply has been identified as a priority area for the Committee. The Committee brings leaders of community agencies and subject matter expert together to identify issues and to ensure collaborative action to address the harms in the community. The Committee is working to further expand membership and identify local actions. For next steps, there is a continued need for upstream prevention, community-based treatment, harm reduction interventions, and enforcement to reduce opioid related harms in the Middlesex-London region. Health Unit staff will continue to work with and learn from community partners to guide and support community action.

Board Member Skylar Franke noted that across the province, some of the safe consumption sites are being closed down. S. Franke inquired that if London’s safe consumption site was closed, would the area see an increase in opioid-related deaths? She also asked if a visit to the emergency room is more expensive than a visit to a safe consumption site. Dr. Summers noted that the community is still in a crisis, however the decrease in rates are being reflected in other parts of North America. The hypothesis is that there may be more services and foundational supports, along with the decreasing toxicity of the drug supply. The shift in policy around harm reduction services (consumption and treatment sites) has a potential to impact some progress as people are less likely to have an overdose who use these sites. The other benefit is that the sites are a place for people to use that is not out in the open, which is a local concern as expressed to the Community Drug and Alcohol Committee. Dr. Summers highlighted that a continuum of support is required to make progress, and some may see as enforcement being antagonistic to this progress – it is not. People who are relying on harm reduction may be ready for treatment or they may not, depending on the stage of their illness. Treatment is essential and it is needed desperately in the community.

S. Franke followed up inquiring if the Community Drug and Alcohol Committee has considered joint advocacy with the City of London and County of Middlesex to the Province of Ontario on the lack of recovery and detox centres in Ontario.

J. Proulx noted that the first step is trying to understand which partners are offering what services, and the Committee is still in its early action planning.

Vice-Chair Steele noted that he previously served as Chair of the Foundation for Addiction Services at Thames Valley and learned extensively about the disease of addiction. Vice-Chair Steele added that it is distressing to hearing about the closure of the consumption and treatment sites and that while treatment centres do important work, an individual cannot be forced to seek treatment if they are not ready for the step of recovery.

It was moved by M. Newton-Reid, seconded by M. Smibert, that the Board of Health receive Report No. 74-24 re: “Opioid Crisis Update 2024” for information.
Carried

2023-25 Provisional Plan 2024 Q3 Status Update (Report No. 75-24)

Sarah Maaten, Director, Public Health Foundations introduced Amanda Harvey, Manager, Strategy, Planning and Performance to present the Q3 2024 status update for the Health Unit’s Provisional Strategic Plan.

A. Harvey noted that within the status document for the Provisional Plan, many of the tactics continue to move forward. The Strategy, Planning and Performance team identified that there were many big projects happening all at the same time, so the Senior Leadership team has conducted reprioritization of some of these projects to stagger implementation in a reasonable manner. A. Harvey concluded that this is a positive win for the Health Unit as it indicates the use of the framework as a learning organization is occurring, which means the Health Unit can learn further and pivot as needed.

There were no questions or discussion.

It was moved by S. Franke, seconded by H. Shears, that the Board of Health receive Report No. 75-24 re: “2023-25 Provisional Plan 2024 Q3 Status Update” for information.
Carried

2024 Budget Amendment (Report No. 76-24)

Dr. Summers presented to the Board the report on a 2024 budget amendment related to funding received from the Ministry of Children, Community and Social Services.

Dr. Summers explained that the Health Unit received notification in July of additional funds from the Ministry (of Children, Community and Social Services) for the Healthy Babies, Healthy Children program. The funding amount was an additional $304,120 and was not in the original approved budget for 2024, which requires an amendment from the Board of Health.

Board Member Howard Shears inquired if the funding provided has to be spent expeditiously in 2024, as the funding was received halfway through 2024. Dr. Summers explained that the funding provided was to support the Healthy Babies, Healthy Children program for six (6) months in 2024, and will be utilized in 2025 to expand the service portfolio. For 2024, the increased funding was used to offset financial pressures for the rest of 2024 due to a portion of the program being paid from the cost shared budget. The funding for the program is otherwise 100% funded by the Ministry of Children, Community and Social Services. Dr. Summers concluded that it is anticipated that this will be the ongoing amount of funding received for the program and that the program has not previously received a funding increase in twelve (12) years.

It was moved by A. DeViet, seconded by M. Smibert, that the Board of Health:
1) Receive Report No. 76-24 re: “2024 Budget - Amendment” for information; and
2) Approve an amendment to the 2024 Middlesex-London Board of Health Budget to include the additional $304,120 in funding from the Ministry of Children, Community and Social Services for the Healthy Babies, Healthy Children program.
Carried

Q3 2024 Organizational Performance Reporting (Report No. 77-24)

Dr. Summers provided the Board of Health with the Health Unit’s Q3 2024 Performance Reporting.

Dr. Summers noted that this is the third report to the Board regarding quarterly performance reporting. Performance reporting describes the work that the organization is doing across several different domains. Organizational performance management allows for the alignment of people, resources and processes to achieve annual objectives. It further allows leadership to identify risks and create timely solutions that ensure accountability and excellence in the organization, while conducting continuous improvement and learning. Dr. Summers reminded the Board of the reporting process: managers report metrics and performance to their directors, directors report to the Medical Officer of Health and Chief Executive Officer and then the Medical Officer of Health and the Chief Executive Officer report to the Board of Health. Performance at the team and division level is organized around the work that is being done (the public health intervention) whereas the Board is provided information summarized by program area.

Highlights of Q3 include:
• The Health Unit continues to see increased demand for services from clients due to lack of access to a family doctor, particularly in immunization;
• Collaboration is underway with municipal partners on policy positions related to topics such as built environment, school food programs, housing and homelessness, and substance use;
• Significant work continued in Q3 with school-aged children under the Immunization of School Pupils Act, R.S.O. 1990, c. I.1; this included follow up with students outstanding from previous rounds to reduce potential suspensions in subsequent quarters;
• Discussions and action on the opioid crisis within Middlesex-London continued through the reconvening of the Community Drug and Alcohol Committee; and
• Continued work to support recommendations from the Health Unit’s Taking Action for Reconciliation Plan and Anti-Black Racism Plan.

There were no questions or discussion.

It was moved by S. Franke, seconded by S. Menghsha, that the Board of Health receive Report No. 77-24 re: “Q3 2024 Organizational Performance Reporting” for information.
Carried

Current Public Health Issues (Verbal Report)

Dr. Summers provided the Board of Health with an update on current public health issues.

Respiratory Season Update

Middlesex-London is in a high-risk season across all respiratory illness except influenza, but rates are starting to increase. There are many outbreaks in long term care homes and institutional healthcare facilities. COVID-19 activity is relatively high, consistent with the activity observed through the summer (July-October).
Influenza has not yet had a significant impact, but there have been some cases of influenza A. Respiratory syncytial virus (RSV) is starting to make an impact slowly in the community. Dr. Summers emphasized the importance of vaccination; influenza and COVID-19 vaccines are available to everyone, and RSV vaccines are available to a select population.

Avian Flu

Avian influenza (bird flu) has been known to cause illness in humans, however the public health community has not seen transmission from human to human. Canada has announced its first domestically acquired case recently in in British Columbia. Public health authorities are still investigating to understand where the teenager may have contracted that virus. Dr. Summers noted that the general risks to the public still remain very low and that the situation is being monitored.

Safer Streets, Stronger Communities Act

The Safer Streets, Stronger Communities Act was introduced in the provincial legislature and if passed, it would affect consumption and treatment facilities and other safer supply initiatives. It prohibits any consumption and treatment site within 200 metres from a school, licensed childcare centre, EarlyON centre or family centre. The legislation would require municipalities and local boards to get provincial approval before making or supporting requests for new or renewal of federal exemption required to operate a consumption and treatment site. At the moment, the consumption and treatment site in the Middlesex and London region is beyond 200 metres and will still be permitted to operate. Dr. Summers noted that the Health Unit is looking into understanding the ongoing risks for when an exemption is requested as historically, the Medical Officer of Health supports the exemption. It is unknown at this time if the Health Unit will legally be able to provide exemption support for a site.

Ontario Public Health Standards Review

The review of the Ontario Public Health standards is underway, and the Ministry of Health has provided an update based off a survey conducted in early 2024 to public health units. There was feedback that some of the work of local public health could be releveled, which means potentially shifted to the province so that there could be centralized approaches. There were requests for further clarity on how public health works with other partners, specifically school boards, Ontario Health teams and Ontario Health. It was also highlighted that public health need access to high quality and relevant data, with opportunities to coordinate business functions. Overall, the standards are asking public health to do critical work, but public health units are struggling due to low resources. The next steps include further engagement within the Ministry of Health to understand the final version of the review. It is anticipated that the current standards will be still in effect in 2025.

MLHU in the News

The Health Unit was in the media discussing a few different topics. These topics included vaccines, the RSV virus, scaling down School Health program due to budgetary constraints and the opioid crisis.

Board Member S. Franke inquired if a 2.5-year-old is eligible to be vaccinated for COVID-19, influenza and RSV. Dr. Summers noted that a 2.5-year-old is eligible for COVID-19 and influenza, but not RSV at this time. RSV vaccines are being provided to pregnant individuals between 32 to 36 weeks of pregnancy over the winter, as they will then have protection against the virus. The RSV vaccine is also available for those over 60 who are higher risk. The vaccine that children under one (1) are receiving for RSV is an immunoglobulin, which are pre-formed antibodies that provide passive immunization.

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

Acting Medical Officer of Health Activity Report for October (Report No. 78-24)

Dr. Joanne Kearon, Associate Medical Officer of Health presented her activity report for October. It is noted that Dr. Summers returned from his parental leave of absence on October 28. Dr. Summers thanked Dr. Kearon for her remarkable leadership during his leave.

There were no questions or discussion.

It was moved by M. Smibert, seconded by M. Newton-Reid, that the Board of Health receive Report No. 78-24 re: “Acting Medical Officer of Health Activity Report for October” for information.
Carried

Chief Executive Officer Activity Report for October (Report No. 79-24)

Vice-Chair Steele noted that as E. Williams was absent, the Board of Health would be required to defer her activity report to the December Board meeting.

It was moved by S. Franke, seconded by S. Menghsha, that the Board of Health defer Report No. 79-24 re: “Chief Executive Officer Activity Report for October” to the December 12, 2024 Board of Health meeting.
Carried

Board of Health Chair and Vice-Chair Activity Report for September and October (Report No. 80-24)

Board Chair Matthew Newton-Reid and Vice-Chair Steele co-presented their activity report for September and October. Board Chair Newton-Reid noted that Vice-Chair Steele supported many tasks as Vice-Chair for October due to work commitments of the Board Chair.

There were no questions or discussion.

It was moved by S. Menghsha, seconded by A. DeViet, that the Board of Health receive Report No. 80-24 re: “Board of Health Chair and Vice-Chair Activity Report for September and October” for information.
Carried

Correspondence

It was moved by S. Franke, seconded by M. Newton-Reid, that the Board of Health receive items a) through e) for information:
a) Public Health Sudbury and Districts re: Support for Ontario to continue to protect the safety of private drinking water
b) Municipality of Central Manitoulin re: Public Health Ontario Proposes Phasing Out Free Water Testing for Private Wells
c) Town of Gore Bay re: Public Health Ontario proposes phasing out free water testing for private wells
d) Peterborough Public Health re: Funding support for Student Nutrition Programs
e) Middlesex-London Board of Health External Landscape for November 2024
Carried

Vice-Chair Steele noted that the Board of Health’s general email inbox received an email from Board Chair Chris Moise (Toronto Public Health) at the end of October which the Board may find interest to discuss:

“I am reaching out as the Chair of the Board of Health in Toronto to open a conversation about the upcoming Provincial changes to the regulation of safe consumption sites. As my colleagues and I grapple with what this will mean in Toronto, we also wanted to hear from you, as chairs of respective boards of health in Ontario, about how you are preparing for these changes in your own communities. Additionally, I wanted to pose the idea of putting out a joint letter advocating for the Province to reconsider the legislation.”

Members of the Board of Health suggested that the Board Chair casually reach out to Board Chair Moise to learn more about his email request.

It was moved by S. Franke, seconded by A. DeViet, that the Board of Health receive item f) for information re: Email Correspondence from Board of Health Chair, Chris Moise (Toronto Public Health).
Carried

Other Business

The next meeting of the Middlesex-London Board of Health is Thursday, December 12, 2024 at 7 p.m.

Closed Session

At 8:18 p.m., it was moved by M. Newton-Reid, seconded by A. DeViet, that the Board of Health will move into a closed session to consider matters regarding personal matters about an identifiable individual, including municipal or local board employees, labour relations or employee negotiations, 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 8:22 p.m., it was moved by H. Shears, seconded by S. Menghsha, that the Board of Health return to public session from closed session.
Carried

Adjournment

At 8:22 p.m., it was moved by S. Franke, seconded by M. Smibert, that the meeting be adjourned.
Carried

Michael Steele
Vice-Chair

Alexander Summers
Acting Secretary