Minutes - December 12, 2024 - Board of Health Meeting

Thursday, December 12, 2024, 7 p.m.
Microsoft Teams

Members Present: 

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

Regrets:

Michael McGuire

Others Present:

Stephanie Egelton, Executive Assistant to the Board of Health (recorder)
Mary Lou Albanese, Director, Environmental Health, Infectious Diseases and Clinical Services
Sarah Maaten, Director, Public Health Foundations
Ryan Fawcett, Associate Director, Operations/Privacy Officer
Cynthia Bos, Associate Director, Human Resources and Labour Relations
Kim Loupos, Public Health Dietitian
Darrell Jutzi, Manager, Municipal and Community Health Promotion
Abha Solanki, End User Support Analyst, Information Technology

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

Dr. Alexander Summers, Medical Officer of Health noted that this Board of Health meeting is the last for Mary Lou Albanese, Director, Environmental Health, Infectious Diseases and Clinical Services before she retires at the end of the year.

Chair Newton-Reid recognized M. Albanese for her dedication to the organization.

Disclosure of Pecuniary Interest

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

Approval of Agenda

Chair Newton-Reid noted that there would be an update regarding the meeting that Vice-Chair Michael Steele had with Toronto Public Health Board Chair, Chris Moise.

It was moved by M. Steele, seconded by P. Cuddy, that the AGENDA for the December 12, 2024 Board of Health meeting be approved as amended.
Carried

Approval of Minutes

It was moved by P. Cuddy, seconded by M. Smibert, that the Board of Health:
1) Approve the MINUTES of the November 21, 2024 Special Board of Health meeting; and
2) Approve the MINUTES of the November 21, 2024 Board of Health meeting.
Carried

It was moved by A. DeViet, seconded by M. Smibert, that the MINUTES of the November 28, 2024 Performance Appraisal Committee meeting be received.
Carried

New Business

2025 Middlesex-London Health Unit Budget (Report No. 81-24)

Emily Williams, Chief Executive Officer presented the draft 2025 Middlesex-London Health Unit Budget to the Board of Health for approval. E. Williams noted that the Board has seen previous reports regarding budgetary and funding matters in 2024.

Context for the 2025 Budget
- The Ontario Ministry of Health is providing a 1% increase to public health base funding in 2025.
- The Board of Health approved an additional 3% increase from municipalities (City of London and County of Middlesex) for 2025 to avoid lay-offs and further reductions in services later in 2024.
- The 2024 financial experience included high demand faced by several teams (vaccine, infectious disease and environmental health) and challenges in meeting gapping targets.
- In 2025, it is noted that there will be negotiations with both unions (Ontario Nurses Association and Canadian Union of Public Employees).

Strategy for the 2025 Budget
E. Williams noted that to build the 2025 budget, staff used the following strategies:
- Utilized the increased funding to address inflationary and current budget pressures such as overtime, on-call and shift premium costs;
- Avoiding lay-offs and reviewing all role vacancies for potential elimination based on service requirements;
- Reassigning staff to address teams with high demands; and
- Reducing the organizational gap to an attainable amount.

Budget Components
E. Williams reminded the Board that the Health Unit’s budget is composed of two (2) companies – MLHU and MLHU2.

MLHU (January to December programs)
The majority of programs are called “Shared Funded Programs” and are cost-shared between the Ministry of Health and municipalities. The “100% Funded Programs” are the Ontario Senior Dental Care Program (funded by the Ministry of Health) and the Cannabis Legalization Implementation Funding (funded by the City of London).

MLHU2 (April to March programs)
There are four (4) programs in MLHU2: Smart Start for Babies (funded by the Public Health Agency of Canada), Best Beginnings – Healthy Babies, Healthy Children (funded by the Ontario Ministry of Children, Community and Social Services, Library Shared Services (funded by Public Health Ontario) and FoodNet Canada (funded by the Public Health Agency of Canada).
Shared Funded Program Highlights
There is a revenue increase of $850,220, which includes an additional 3% from the funding municipalities.

Staffing-related changes include: eliminating 1 Registered Dietitian position (a retirement), eliminating 1 Part-time Marketing Coordinator position (temporary contract role), integrating salary increase assumptions, increasing on-call, over-time and shift premiums, and some recovery for shared funded programs due to the increase in funding for Healthy Babies, Healthy Children (in MLHU2).

There are benefits related changes with savings from the Health Unit’s new benefits provider starting January 1, 2025 (awarded through the Request for Proposal process). There is also an increase in retiree benefits to align with actual budgeted funds.

General expenses have had inflationary increases integrated, such as insurance, translation and software costs.

The gapping budget is also going to be decreased to $441,244.

100% Funded Program Highlights
There is no change to revenue for the 100% funded programs.

Within the Ontario Seniors Dental Care Program, there is an increase in staffing and decrease in general expenses. The goal is to meet increased demand and capacity created by two (2) additional operatories in London (Citi Plaza) and four (4) in Strathroy.

Within the Cannabis Legalization Implementation Fund (CLIF), the funds from the City of London are carried over until fully used. It is expected these funds will end in 2025. The temporary Tobacco Enforcement Officer staff will continue until funding is depleted.

MLHU2 Program Highlights
The Ontario Ministry of Children, Community and Social Services increased funding for Healthy Babies, Healthy Children by $304,000. This resulted in an investment of 1.0 Public Health Nurse, 0.6 Registered Practical Nurse and 0.5 Program Assistant.

For the other programs, increases in staffing expenses mean a decrease in program expenses required to administer programs. E. Williams noted that follow-up with funders is underway to ensure understanding of pressures and request inflationary increases.

There were no questions or discussion.

It was moved by P. Cuddy, seconded by H. Shears, that the Board of Health:
1) Receive Report No. 81-24 re: “2025 Middlesex-London Health Unit Budget” for information; and
2) Approve the 2025 Budget as outlined in Appendix A.
Carried

Monitoring Food Affordability and Implications for Public Policy and Action 2024 (Report No. 82-24)

Sarah Maaten, Director, Public Health Foundations introduced Kim Loupos, Public Health Dietitian to present the 2024 Food Affordability and Implications for Public Policy and Action report.

K. Loupos explained that the current Ontario Public Health Standards require monitoring local food affordability (Population Health Assessment and Surveillance Protocol). This activity is led by the Health Unit’s Municipal and Community Health Promotion Team.

There are 3 main components to this activity:
1) Monitoring local food insecurity rates as reported in the Canadian Income Survey;
2) Monitoring local food costs utilizing the Ontario Nutritious Food Basket survey; and
3) Comparing local food and rental costs to local incomes utilizing tools developed by the Ontario Dietitians in Public Health with support from Public Health Ontario.

The current food insecurity rate in Middlesex-London is the highest rate reported since the Canadian Income Survey started measuring food insecurity in 2019. In 2023, 25% of households in Middlesex-London (1 in 4 households) were food insecure. The 2023 rate represents a statistically significant increase from 2022. In 2022, 17.5% of households (1 in 6 households) were food insecure. Nearly 44,000 more Middlesex-London residents lived in food insecure households in 2023 as compared to 2022. In 2023, over 150,000 Middlesex-London residents lived in food insecure households, as compared to less than 110,000 in 2022.

K. Loupos explained the process of monitoring food affordability locally. To monitor food affordability, local food and rental costs from May 2024 were compared to a variety of household and income scenarios. The scenarios include food and rent only and are not inclusive of other needs, such as utilities, phone, transportation and personal care items. A key indicator for food insecurity is the average monthly cost of a nutritious diet as a proportion of household income. Households with low incomes spend up to 47% of their after-tax income on food, whereas households with adequate incomes only spend approximately 12%.

In 2024, a single person receiving Ontario Works (OW) needed $522 per month just to pay for rent and food, an additional $102 more than in 2023. A single person in the Ontario Disability Support Program (ODSP) also does not have enough funds to pay for rent and food; however, this person is doing slightly better than in 2023. This indicates that indexing ODSP rates to Ontario’s Consumer Price Index, which started in July 2023 is having an impact. OW rate increases are not indexed to inflation.

K. Loupos explained that food insecurity is a key social determinant of health and action is needed across all levels of government. The Health Unit’s food affordability data is shared with government, municipalities, community partners, and the wider community, and used in a variety of ways. The food costs are used by the Ontario Living Wage Network to help calculate the regional living wage. The data is also shared by our partners in community reports, such as London Community Foundation’s 2024 Vital Signs Report. K. Loupos reminded that the Board of Health has previously sent letters to the federal government in support of basic income and to the provincial government in support of increased social assistance rates.

K. Loupos noted that Health Unit staff are exploring the development of a municipal primer about food insecurity as an important local public health issue and actions municipalities can take to address it.

Board Member Skylar Franke inquired on what the municipal primer would look like in addition to the infographic attached with the report. K. Loupos explained that some of the information for the primer would come from the infographic and expanding on what local municipalities can do from an advocacy standpoint with resources. K. Loupos added that Dieticians across Ontario are working towards developing this primer. Dr. Alexander Summers, Medical Officer of Health added that resources such as primers are tools that can be provided to municipalities to promote healthy public policy development. In January, the Board will be hearing how the Municipal and Community Health Promotion team is integrating into the municipal planning process such as the City of London’s Mobility Master Plan and informing healthy public policy.

It was moved by S. Franke, seconded by A. DeViet, that the Board of Health:
1) Receive Report No. 82-24 re: “Monitoring Food Affordability and Implications for Public Policy and Action 2024” for information; and
2) Direct staff to forward Report No. 82-24 re: “Monitoring Food Affordability and Implications for Public Policy and Action 2024” to Ontario boards of health, the City of London, Middlesex County, and appropriate community agencies.
Carried

Middlesex London Food Policy Council Restructuring (Report No. 83-24)

S. Maaten introduced Darrell Jutzi, Manager, Municipal and Community Health Promotion to provide an update on the Health Unit’s involvement with the Middlesex-London Food Policy Council.

D. Jutzi explained that the Middlesex-London Food Policy Council was established in 2016 and the Health Unit has supported this work since its creation. The Council includes members from all areas of the food system, from food production to distribution, government advocacy and food waste. The Council collaborates to address food related challenges and opportunities to promote a safe, healthy, equitable, ecologically responsible and economically viable food system.

The Food Policy Council has evolved since its creation and there was a need to review its structure to ensure that the Council maximizes their skills and capacity to benefit the work of the Council. Prior to the Council's restructuring, the administrative role had been previously held by a Heath Unit Dietitian – administrative duties will now be conducted by the newly hired Community Food Systems Facilitator. The Dietician’s role will shift from primarily administrative duties to focusing on the delivery of public health interventions, including Community and Partner Mobilization and Healthy Public Policy Development. This change will enhance the Council's ability to expand outreach with new and potential partners and coordinate efforts of the Council to respond to community need through collective impact. The Health Unit Dietitian will also have some increased capacity in their work at the Health Unit.

Board Member Michelle Smibert commented that she had been a member of the Middlesex-London Food Policy Council for two (2) years and noted the current Dietitian has been an amazing resource for the Council. M. Smibert thanked the Health Unit for its collaboration with the Food Policy Council.

Dr. Summers noted for the Board of Health’s information that historically, a member of the Board participates in the Middlesex-London Food Policy Council. The Food Policy Council has been asked for clarification by the Health Unit to determine if a senior staff member, Board Member or another employee satisfies the requirement, with a response pending in the Council’s Terms of Reference review.

Chair Newton-Reid requested if Dr. Summers or M. Smibert could inquire if the Middlesex-London Food Policy Council could attend a future Board of Health meeting to provide information on their work or present their Annual Report for more clarity and context.

It was moved by M. Smibert, seconded by S. Menghsha, that the Board of Health receive Report No. 83-24 re: “Middlesex London Food Policy Council Restructuring” for information.
Carried

MLHU Ontario Living Wage Network Certification (Report No. 84-24)

E. Williams introduced Cynthia Bos, Associate Director, Human Resources and Labour Relations to present the Health Unit’s Living Wage Certification report.

C. Bos noted that the Health Unit is a living wage employer and has been certified as such. The living wage for London, Elgin and Oxford has increased to $19.50 per hour. This increase does require an increase in the wages of our Student Test Shoppers and some of our contracted services such as security, to maintain the certification. The increase in wages for the Student Test Shoppers will be effective January 1, 2025 and the increase for contracted services will be effective within six (6) months. The Health Unit’s commitment to being a living wage employer aligns with equity values and compensation practices.

Chair Newton-Reid requested C. Bos to highlight the anticipated cost to the Health Unit to sustain certification for the year. C. Bos stated that the additional cost is $6,941.

Board Member S. Franke noted that she is happy that the Middlesex-London Health Unit is a living wage employer and hopes to see other agencies within the City of London and the City of London itself adopt this certification.

It was moved by S. Franke, seconded by P. Cuddy, that the Board of Health receive Report No. 84-24 re: “MLHU Ontario Living Wage Network Certification” for information.
Carried

Client Relations Process (Report No. 85-24)

E. Williams introduced Ryan Fawcett, Associate Director, Operations/Privacy Officer to present the client relations process to the Board of Health.

R. Fawcett explained that this client relations framework is to ensure that the Health Unit is following the Excellent Care for All Act, which states that all health agencies have a mechanism to receive and respond to client feedback. The process will ensure that client interactions are managed effectively, transparently and consistently. The framework will apply to all leaders, employees and healthcare providers within the agency. Staff will also commit to providing data to the Board of Health at least twice a year. The next steps include enhanced training for teams. Staff will continue to review and refine as more about the process is learned.

There were no questions or discussion.

It was moved by M. Steele, seconded by A. DeViet, that the Board of Health receive Report No. 85-24 re: “Client Relations Process” 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
The Middlesex-London region is seeing significant activity of COVID-19, RSV and emerging activity from influenza. COVID-19 has yet to follow the typical seasonality of respiratory illnesses – it is the highest in the winter but is still present in the spring and summer. COVID-19 remains present in the community and the vaccine is available at pharmacies within Middlesex-London and the Health Unit for younger children. Vaccination uptake in Middlesex-London is significantly lower across Ontario than it was after the pandemic. For those under the age of 30, less than 5% of the population has received a COVID-19 vaccine this fall.

The influenza vaccine program at this time does not have real time data for coverage and will be provided later in the year. Influenza is emerging but is still very low with regards to how much it is transmitting in the community. Dr. Summers encouraged those who have not received a vaccine to receive one for their protection.

Respiratory syncytial virus (RSV) has also been present in the community, as a relatively unexposed cohort of children got exposed to RSV at once, resulting in a number of hospitalizations. This year, we have vaccines available for infants under 1, pregnant persons, and adults over the age of the age of 60.

Legislative Updates: Health Protection and Promotion Act and Office of the Chief Medical Officer of Health
There have been some announced changes to the Health Protection and Promotion Act. The provincial government recently tabled legislative updates that if passed will result in some changes.

The first is the approval of voluntary mergers across the province of certain public health units as of January 1, 2025. The Board of Health has had several discussions regarding mergers of public health units. It was announced that on January 1, there will be a creation of four new health units reducing the totality of public health units in the province from 34 to 29. The changes are as follows:
• Porcupine Health Unit + Timiskaming Health Unit are now Northeastern Health Unit
• Brant County Health Unit + Haldimand-Norfolk Health Unit are now Grand Erie Health Unit
• Haliburton, Kawartha & Pine Ridge District Health Unit + Peterborough County-City Health Unit are now Haliburton, Kawartha, Northumberland & Peterborough Area Health Unit
• Hastings & Prince Edward Counties Health Unit + Kingston, Frontenac and Lennox & Addington Health Unit + Leeds, Grenville and Lanark District Health Unit are now South East Health Unit

It is anticipated that these public health units will take time to transition and will be in transition for a few years. It has been confirmed they will be receiving temporary funds for the transition.

The second change to the legislation relates to regulations as they apply to public pool owners, and residential pool and spa owners. These are refinements to practices that are already happening but now will be reflected in legislation.

The third change is a shift to the legislative authorities of a Medical Officer of Health under Section 22 of the Health Protection and Promotion Act. Section 22 gives Medical Officers of Health the authority to order individuals, businesses, or agencies to do certain actions to reduce infectious disease or communicable disease spread. Within this section, there is a tool called a “class order” which can be applied for many individuals or organizations. A class order was rarely used prior to the pandemic. It was first put into effect during the 2003 SARS outbreak. Through the COVID-19 pandemic, it was used mainly to stop the spread of COVID-19 through different avenues. With the changes to the legislation, the use of a class order will require consultation with the Chief Medical Officer of Health to ensure consistency, however it could be seen as a reduction in the autonomy of a Medical Officer of Health.

MLHU in the News
There is a phenomenon called “walking pneumonia” that has increased across Canada. Walking pneumonia is a catch all syndromic term that refers to a milder presentation of inflammation of the lungs or pneumonia that can be caused by several different viral and bacterial organisms. It can often cause mild symptoms through a bacteria called mycoplasma pneumonia. The Health Unit does not do case and contact management for this illness, but it is tracked at a laboratory level. In Ontario, mycoplasma pneumonia has risen from less than 1% to over 18% and requires a different antibiotic to treat.

It was moved by P. Cuddy, seconded by H. Shears, 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 (Report No. 86-24)

Dr. Summers presented his activity report for November. There were no questions or discussion.

It was moved by M. Smibert, seconded by S. Franke, that the Board of Health receive Report No. 86-24 re: “Medical Officer of Health Activity Report for November” for information.
Carried

Chief Executive Officer Activity Report for October and November (Report No. 87-24)

E. Williams presented her activity report for October and November. There were no questions or discussion.

It was moved by S. Franke, seconded by A. DeViet, that the Board of Health receive Report No. 87-24 re: “Chief Executive Officer Activity Report for October and November” for information.
Carried

Correspondence

It was moved by P. Cuddy, seconded by M. Smibert, that the Board of Health receive items a) through e) for information:
a) Peterborough Public Health re: Support for the Walport Report and Sustained Investment and Reporting on Provincial Emergency Preparedness
b) Middlesex-London Board of Health External Landscape – December 2024
c) Kingston, Frontenac, Lennox and Addington Public Health re: Harm Reduction in Ontario
d) Peterborough Public Health re: Support for a Provincial Immunization Registry
e) Kingston, Frontenac, Lennox and Addington Public Health re: Health Canada Radon Guideline
Carried

It was moved by M. Steele, seconded by S. Franke, that the Board of Health endorse item f) re: Community Drug and Alcohol Committee re: Letter to Ontario Chief Medical Officer of Health
Carried

Vice-Chair Steele provided an update to the Board on the meeting held with Board Chair Chris Moise (Toronto Public Health). It was noted that Board Chair Moise reached out to Board Chairs in Ontario requesting conversations regarding closures of consumption and treatment sites, and the request for support to the Province of Ontario.

Chair Newton-Reid and Vice-Chair Steele provided context to London’s consumption and treatment site and noted that the location on York Street was just outside of the 200 metre distance threshold from a school or daycare centre as outlined within the Safer Streets, Stronger Communities Act. The concern noted by Chair Newton-Reid and Vice-Chair Steele was that sharing public dissent could potentially cause political rifts and retaliation, which could challenge the future of the York Street location.

In Toronto, there are five consumption and treatment sites, four of which fall within the 200 metres requirement, which means that only one will be allowed to continue under the new legislation. Chair Moise wanted to stress that this is not just a Toronto matter, it is an all of Ontario matter. He was encouraging Boards of Health to take action and specifically to write a letter to the Province, so that it was documented that public health are in support of safe consumption sites.

Board Chair Moise was supportive of the Health Unit’s active and continued engagement with Members of Provincial Parliament but noted his desire for Boards of Health to submit written letters to the Province. At this time, the Board Chair and Vice-Chair are not recommending a letter from the Board of Health be written to the Province of Ontario until more information is known, to avoid political challenges and to continue working as partners with Members of Provincial Parliament.

Board Member S. Franke inquired if there have been coordinated responses through the Association of Local Public Health Agencies (alPHa) regarding the closure of consumption and treatment sites in Ontario. Dr. Summers noted that alPHa has not initiated action around this particular topic at this time. There is a working group on opioid use that is actively discussing action. In addition, the Chief Medical Officer of Health Annual Report from last year does speak highly to the utility in need for a comprehensive set of tools to respond to the drug crisis, including harm reduction services like consumption and treatment facilities, needle syringe programs and naloxone distribution. The broader community groups who work with people who suffer from addiction, associated with drugs is struggling from some of the rapid changes to the types of services that are happening. Locally, the Community Drug and Alcohol Committee’s last meeting was focused on conversations with the Chief of London Police and members of its executive team on how to support a therapeutic approach to the legislative changes that are happening. Dr. Summers noted that there is still ongoing uncertainty around how to respond at this time.

Vice-Chair Steele added that he is empathetic for the Toronto situation in that closing their consumption and treatment sites, and then prosecuting those who use drugs in public, is a vicious cycle. Vice-Chair Steele further noted that in the external landscape for this month, there was a news article regarding the Canadian Mental Health Association locally that has applied for a HART hub for London, which may create changes. Vice-Chair Steele showed gratitude that London’s consumption and treatment site on York Street remains open to provide support.

It was moved by P. Cuddy, seconded by M. Smibert, that the Board of Health receive the verbal update re: Meeting with Toronto Public Health Board Chair for information.
Carried

Other Business

The next meeting of the Middlesex-London Board of Health is Thursday, January 23, 2025 at 7 p.m.

Closed Session

At 8:04 p.m., it was moved by P. Cuddy, 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 8:35 p.m., it was moved by H. Shears, seconded by M. Smibert, that the Board of Health return to public session from closed session.
Carried

Adjournment

At 8:35 p.m., it was moved by S. Franke, seconded by A. DeViet, that the meeting be adjourned.
Carried

Matthew Newton-Reid
Chair

Emily Williams
Secretary