Ottawa Board
of Health Meeting
Notes for Chair Keith Egli’s Verbal Report
Monday, April 15, 2019
Good evening everyone, Bonsoir,
March 20 launch
of 2 new have THAT talk videos
On March 20th, I had the
pleasure of joining Dr. Etches and the OPH team to unveil the two new have THAT
talk videos and an activity guide on mental health for newcomers and diverse
populations. The two new videos are called
1) Are You New to Canada?
and
2) Mental Health = Health.
These new resources are an
expansion on the popular mental health awareness and stigma reduction video
series called have THAT talk, which has received more than one million views to
date on YouTube. These videos and guide were developed in collaboration with 13
community partners and based on feedback from the community, evidence and local
population data. These tools recognize people’s experiences and the challenges
of settling into a new country and acknowledge newcomers’ resilience as they
adapt to their new home. The aim is to increase awareness of positive mental
health, the negative impact of stigma within Ottawa’s newcomer and diverse
communities and to highlight the importance of seeking help early. I was
impressed by the knowledge and compassion of the Expert Panelists at the launch
as well as the questions and support shown from our many community partners in
attendance. I would like to thank OPH employees for this great initiative and
the community partners for their collaboration and support.
OPH participation at summer
events
Spring is in the air and we
are heading into a busy summer event season. In preparation, OPH has reached out to all members of
Council and local MPPs to identify opportunities to connect directly with
members of their communities. OPH enjoys and values participating in community
events as these allow employees to connect directly with residents, community
partners and stakeholders to share important public health information. These
events also allow OPH to gather valuable feedback, which helps inform the
development of public health policy, programs & services.
alPHa 2019 fitness challenge – an
invitation for BOH members to participate
Looking ahead, Members may have
noticed that one of the Communication Items included in our Agenda package
relates to the Association of Local Public Health Agencies (alPHa) Fitness
Challenge for Boards of Health. The Challenge calls on all members of the Board
to walk or wheel for 30 minutes in April or May. Though a group activity is
recommended, the challenge can also be completed individually. Board Members
attending the OPH All-Staff Meeting on May 28th have the opportunity
to make it a group activity by taking a 30-minute walk together at the end of
the day. Otherwise, I would encourage Board members to complete their 30-minute
walk or bicycle ride individually and to report this activity to our Board
Secretary, who will report our participation back to alPHa.
CTS funding
Finally, as you know, on
March 29, the Ministry of Health and Long-Term Care announced that Ottawa
Public Health was not one of the 15 approved Consumption and Treatment Services
in Ontario. In response to this announcement, on April 1st,
Mayor Watson and I sent a joint letter to the Minister of Health and Long-Term
Care expressing disappointment with the decision, stressing the need for
continued funding and requesting reconsideration. The letter outlined OPH’s
role in the community with respect to reducing the risks of infectious diseases
and deaths and our work with partner agencies. It also referenced the more than
14 thousand visits to our Supervised Consumption site since its opening, which
helped reduce the burden on the overall health system.
On April 3, 2019, Mayor
Watson, Dr. Etches and I met with the Honourable Ginette Petitpas Taylor,
federal Minister of Health, to discuss options for interim support from the
Government of Canada. This meeting was followed by a joint letter to the
Minister asking for her consideration of a specific request for interim funding
for OPH’s Consumption and Treatment Service.
Board of Health Members
have been kept informed on these recent developments through regular email
communications on March 29, April 1 and April 5.
For over 20 years, OPH has
served and provided leadership in the community of Ottawa by reducing the risk
of infectious diseases and deaths through the direct provision of harm
reduction services as well as through the coordination of such services across
agencies. As such, OPH has been a pioneer in delivering services to prevent the
transmission of HIV, hepatitis C and other associated diseases and in linking
clients to social and health services. The consumption and treatment services
at 179 Clarence Street have been operating daily since September 26, 2017.
Though there are
Consumption and Treatment services nearby that have been approved for
provincial funding for the fiscal year 2019-2020, most notably the Shepherds of
Good Hope/Inner City Health service, they have indicated that they are
currently operating at full capacity. From an ethical perspective, OPH cannot
cease delivery of these services to its current clients without at least
providing for some transitionary period.
Since April 1, 2019, OPH
has been continuing to provide these important, life-saving services through
internal re-allocations at a cost of about $3000 per day. OPH also continues to
be a leader in harm reduction. As public health professionals, and as advocates
for compassion in the communities, OPH continues to work alongside community
partners to ensure as many services as possible continue to be available to
those who need them, when and where they need them.
If colleagues are in
agreement, I would ask that you authorize me, as Chair of the Board, to take any
further actions that may be necessary and appropriate to secure ongoing funding
for Ottawa Public Health’s Consumption and Treatment Services, in collaboration
with the Medical Officer of Health and/or other partners and stakeholders.
Should ongoing funding not be secured, I will seek to secure bridge funding to
allow OPH to transition its clients to other Consumption and Treatment Service
clinics over a reasonable period of time. I will also commit to continuing to
keep Board Members informed of any new developments on this matter.
That concludes my verbal report.
I would welcome a motion on the last
point, as well as any questions or discussion.
Ottawa Board
of Health Meeting
Notes for Dr. Vera Etches Verbal Report
Monday, April 15, 2019
Thank you Chair, and good evening,
bonsoir, kwe everyone.
I would also like to begin by honoring Métis Elder Jo
MacQuarrie, she was truly a remarkable person, we will continue to share her
message and echo her passionate voice to promote reconciliation and address
Indigenous health inequities. May she rest in peace.
In tonight’s verbal report,
I will be focusing on the significant changes to Ontario’s public health system
that were announced as part of the budget.
Before describing the
specific announcements, I want to tell you why I chose to specialize in public
health and preventive medicine and I want to highlight the core functions of
the public health system.
As a medical student and
then family physician, I saw so many people, in clinics and emergency rooms, in
hospital, who were there because they had failed to receive the supports that
would keep them well. I remember an older man who had not accessed care
until his arthritis had made him almost unable to move – he did not know how to
read and had suffered poor health because of it. I remember a mother, who was a
newcomer, whose baby I caught and how isolated she was after the birth of her
baby, unaware of the supports available for healthy growth and development.
These individual interactions are precious and important points of care, and,
they showed me the need to create communities and a health system that prevents
poor health. After 14 years of work alongside the diverse professionals in the
public health system, I am more convinced than ever that people need a strong
public health system to be healthy, safe and well.
(Slide 1) There are five
classic functions of the public health system, as shown on this slide. I think
of population health assessment first because that is like our diagnostic
tool. Epidemiologists use their skills to measure the health of the population
and point us towards what interventions or treatments are necessary.
The next handful of slides
provide examples of how we carry out the other public health functions here in
Ottawa. We work within the community, supporting people from before they are
born through the end of life, with programming and service offerings that are
most often delivered in partnership.
·
OPH assists families prenatally and with newborns so that they
may get a good start in life. Created in partnership with CHEO, Our Parenting
In Ottawa/Être parents à Ottawa website, is a resource for parenting right
through the teen years and on this site people can learn more about connecting
to a nurse on-line, options for telephone or chat support, and our most
intensive support for parents, in-home visiting by public health nurses and
home visitors with different cultural backgrounds, to which people can
self-refer. Screening of new parents, usually
after the birth of a child, also identifies risk factors that trigger
this additional support. The PIO website is a resource for grandparents, also,
to brush up on the latest evidence-based approaches to early childhood
development. For every $1 spent on early childhood development, the health
care system saves up to $9 in future spending on health, social and justice
services.
·
OPH reaches school aged children
through health promotion activities and programs such as vision screening in
school. Many school children are not benefitting from free optometrist eye
exams and 3 to 5% are at risk of permanent vision loss each year in Ottawa.
Therefore, OPH is piloting screening 5 year olds in school and working with
local optometrists to increase access to glasses as needed.
·
OPH provides immunization services to reduce the harms caused by
infectious diseases. In addition to school-based immunizations, OPH has
ventured into giving childhood and catch-up immunizations to populations with
barriers to primary care, such as in shelters for families with unstable
housing and for refugees, in partnership with the Centretown CHC and the YMCA.
Every $1 spent on immunizing children with the measles-mumps-rubella vaccine
saves $16 in health care costs.
We see the need for this work in our City
today, as this month OPH entered into an enhanced response to investigate two cases of measles in individuals who recently
travelled internationally. These measles cases are not connected.
OPH is working closely with local health care providers and hospitals to
contact individuals and families who may have been exposed to the infectious
case.
·
OPH engages youth and emerging
adults, on their ground, through social media and online interactions. Health
communications is a core function and channel for health promotion. We have
more followers on Twitter, 55,000+, than any other local public health organization
in North America. We have some great material for you to re-tweet.
·
OPH Engages in partnerships, such
as with Inner City Health and Community Health Centres, to assist people with
substance use issues to reduce the harms from substance use and find a pathway
to treatment and reduction or cessation of use. As the need to address opioid
overdose continues, we are also focussing on the myths about cannabis and
continuing to shine a light on the substance causing the greatest burden of
illness after tobacco – alcohol. Every $1 spent on mental health and
addictions saves $7 in health costs and $30 dollars in lost productivity and
social costs.
·
Speaking of tobacco, one of OPH’s
roles is to promote and protect health through healthy public policies, and the
City of Ottawa has been a leader around by-laws that create smoke-free spaces.
Every $1 invested in tobacco prevention programs saves up to $20 in future
health care costs. Following Board support to engage the provincial and
federal governments on the related subject of vaping, the Mayor, Chair and I
had a chance to convey our concerns about promotion of vaping products to the
provincial and federal Ministers of Health earlier this month.
Other public policy work that we engage in relates to
advancing reconciliation with Indigenous communities. Municipal policy is a
special focus, such as transportation policy. In fact, the Official Plan that
guides development in the City of Ottawa is currently in consultation and you
have an opportunity to let Councillors know that building walkable, connected
communities is important to you for the health of the population.
·
OPH also partners with the City of
Ottawa as an active participant in city-wide emergency responses such as last
fall’s tornado/power outage and the Westboro bus crash earlier this winter.
That being said, we also work with partners to plan and prepare for emergencies
– before they occur.
·
The LHIN has supported OPH’s work
in partnership with the city Recreation Department to provide our growing
population of seniors with fitness and wellness programs that includes falls
prevention – the number one cause of injury-related emergency room visits and
hospitalizations among older adults.
·
Lastly, OPH promotes mental health
across the lifespan. A resource for workplaces is the video series called
“have THAT talk”, which is on YouTube and comes with facilitators’ guides that
can be used by teams to promote mental health in the workplace. Two new videos
were just released this week to address the topic of mental health for
newcomers and people from diverse backgrounds.
By ensuring that Ottawans get a healthy start, remain healthy, are
able to quickly return to health and well-being at all ages, the public health
system delivers value for money.
In an era where there is a greater focus on providing better, more
timely and patient-centred care, the public health system more than carries its
weight, making significant contributions to reducing the demands placed on
hospitals and primary care providers. Public health actions now result in
fewer emergency room visits today, as well as the prevention of more visits
tomorrow.
Moving now to the
announcements in the budget last Thursday. (Slide 12)
·
In 2019–20:
o
Improve public health program and back‐office
efficiency and sustainability while providing consistent,
high‐quality
services, be responsive to local circumstances
o
Adjust provincial–municipal cost‐sharing
of public health funding (currently about 75
provincial, 25 municipal)
o
Streamline the Ontario Agency for Health
Protection and Promotion (Public Health Ontario) to enable greater
flexibility with respect to non‐critical
standards based on community priorities
·
By 2020-21
o
Establish 10 regional public health
entities and 10 new regional boards of health with one common governance
model
o
Modernize Ontario’s public health laboratory
system by developing a regional strategy to create greater efficiencies
across the system and reduce the number of laboratories
o
Remove back‐office
inefficiencies through digitizing and streamlining processes to ensure public
health agencies focus their efforts on providing better, more efficient front‐line
care
·
By 2021-22:
o
Achieve annual savings of $200M by
modernizing public health units through regionalization and governance changes
to achieve economies of scale, streamlined back‐office
functions and better coordinated action by public health units
§ The
current provincial contribution for cost-shared programs is $750M, which leads
to the figure of 27% of the funding being cut that has been discussed in the
media.
The Ministry of Health and Long-Term
Care has not yet communicated with the public health field about this budget
direction. There is not yet any information available about what this means
specifically for Ottawa Public Health.
Slide 13 – There are many questions
raised by the provincial budget. Answers to these questions will be important
to guide next steps. While the direction to establish 10 regional public
health agencies is clear, the timelines and process used for implementation are
likely areas where we can influence.
Slide 14 - What I do know is that we
will likely have to look at the priorities for how we spend our money, so I
have included a couple of slides that remind us of the current breakdown of our
budget. Much of the school health funding actually goes towards provision of
immunizations in schools.
Slide 15 – Most of our budget is for
salaries, wages and benefits, so any reductions will most likely have
implications for employees.
While the changes are significant and
raise important concerns about maintaining capacity for carrying out core
protection, promotion and prevention work, there are opportunities that could
be realized with a regional approach.
Slide 16 – Previous reviews of the
public health system after SARS led to recommendations that there be fewer
health units in Ontario. Larger health units have greater capacity for
foundational standards like population health assessment, for recruitment and
retention of skilled professionals, and are able to mobilize more quickly for
urgent responses. The province has indicated that savings could come with more
collaboration on back-office practices, like purchasing, and digital
processes. Ottawa Public Health is very interested in initiatives that could
involve electronic records, for instance.
Another key opportunity that is part of
the evolving health system landscape in Ontario is that Ontario Health Teams
are forming. Ontario Health Teams are intended to
focus on the coordination of care for patients and on improving their defined
population’s health. I believe that there is a role for the participation of
public health agencies, who can focus on prevention, protection and health
promotion, informed by patient and community health needs. I see a future
where public health units can work with multiple OHTs, providing:
·
guidance on
understanding the population in a geographic area to ensure that the teams
understand the complex needs of the populations they serve;
·
capacity building and
promoting supports, including environmental supports, that lead to chronic and
infectious disease prevention, healthy living, substance use and injury
prevention;
·
reach into the
extensive networks that public health fosters - links with education,
municipalities and others - that will facilitate community-based awareness and
response to emerging health needs, with a focus on equity; and,
·
the planning and
management expertise to support the prevention and control of communicable
diseases and emergency responses that will not be restricted to the clients of
any single Ontario Health Team.
OPH’s mission
is to work together with our community to improve, promote and protect the
health and well-being of the people of our city. I anticipate that
participation as a member of the Ontario Health Teams that will form in Ottawa
will help to achieve this mission, as well as aid with the objective of
reducing the pressure on health care providers. The capacity to carry out
public health work could be strengthened within Ontario Health Teams.
Slide 17 – What is
important to keep as a guiding principle is that the population’s health needs
vary across the province and so flexibility for local adaptations to service
provision is key. Maintaining a way for municipalities to influence delivery
of public health services is important, not only because elected officials
represent the needs of their populations but also because many of the drivers
of health are outside of the healthcare sector. With a regional lens on public
health programing, efforts need to be made to keep specific needs of Indigenous
communities or Francophones as priorities. As we move forward with
implementation of 10 regional health units, the goal must be timely and quality
public health services that prevent disease and injury for all now and into the
future.
Slide 18 – This is a slide
I use to highlight that not only are local municipalities partners, but so are
local school board, social services, police and many others.
Lastly, the way forward…
Health is not
just about the individual or healthcare, health is also about the communities
in which we live and the social, political and economic policies that shape our
environment. As you can see in this slide, the social and built environments
are much greater contributors to our overall health when compared to our
biology and the health care we receive.
As I described
the role of public health, I think you will be able to recognize that some of
our interventions (like immunization and harm reduction) fall in the overlap
between public health practice and the healthcare system, as depicted on this
slide. The public health sector also values the connections with municipal,
education and other sectors, some of which I have mentioned, to address the
determinants of health. In order to improve the population’s health, capacity
must be maintained to do the unique work of public health – initiatives focused
on prevention, protection and health promotion.
Chair that concludes my
verbal report. I am happy to answer any questions. Merci.