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Government Urged to Take Action to Stop Breast-Milk Substitutes Code Violations

The local health unit is urging the federal government to enact legislation to ensure an international code governing the marketing of baby formula is followed.

At the April 17 Board of Health meeting for the Haliburton, Kawartha, Pine Ridge District Health Unit, Family Health Nurses Cindy Hutchinson and Mary-Lou Mills asked the Board to follow the lead set by neighbouring health units in urging the federal government to take a tougher stand against companies that don’t comply with the International Code of Marketing Breast-Milk Substitutes.

The Code, developed and recommended by the World Health Organization in 1981, was voluntarily adopted by Canada and studies have shown compliance with the Code leads to more women breastfeeding their babies for longer periods of time. The Code recommends that there be no advertising of breast-milk substitutes (formula) to the public, no free samples provided to mothers, and no free samples provided to health care workers.

“Mothers of babies are very vulnerable to the marketing of breast-milk substitute as it erodes their confidence and makes them feel that they should be providing formula to their baby if they want their baby to be healthy,” Hutchinson told the Board.

Although it is recommended babies be exclusively breastfed for the first six months, a study of mothers in the HKPR area found that less than nine percent of mothers were breastfeeding exclusively after five months. As well, follow-up calls to breastfeeding mothers indicate that 63 per cent of babies had received formula supplementation by the time they were two months of age.

“Mothers are telling us they have received both coupons and free samples through a variety of channels and we are also aware that local physicians are providing free ready-to-use beverage supplements for expectant mothers given to them by formula companies,” Hutchinson said. “These marketing strategies are violations of the Code.”

In approving the resolution, the Board of Health will be sending a letter to other boards of health for support, the Prime Minister, federal cabinet members as well as local Members of Parliament and local Members of Provincial Parliament, Health Canada, and a variety of other provincial and national health organizations and agencies.

MOH Updates

Dr. Noseworthy provided the Board with the following updates:

Regulatory Amendment under the Immunization of School Pupils Act (ISPA):

Three new diseases are being added to Regulation 645 under the Immunization of School Pupils Act (ISPA), the legislation that governs what immunizations students must receive in order to attend school. As of July 2014, students will require proof of immunization against meningococcal disease, whooping cough and chickenpox to attend school. (Note: immunization against chickenpox is only a requirement for children born in 2010 or later.) This is in addition to the existing requirements for proof of immunization against tetanus, diphtheria, poliomyelitis, measles, mumps and rubella. Children without proof of adequate immunization or documentation regarding a valid exemption for medical reasons, or reasons of conscience or religious belief may be suspended from school.  The Health Unit is preparing information for health care providers, parents and schools and will be offering a series of catch-up clinics in the summer for students whose immunizations may not be up-to-date with ISPA requirements.  Health care providers will be encouraged to order additional vaccine supplies to meet the increased demand.

Healthy Smiles Ontario:

As of April 1, 2014 the income eligibility requirements for the Healthy Smiles Ontario (HSO) program have changed to reflect the number of dependent children and start with an income threshold of $21,513 for families with one dependent child. Previously, the income eligibility of the HSO program was an adjusted family net income of $20,000 or less. Under the new income threshold, eligibility is expected to be opened to more than 70,000 children and youth in the province. All other eligibility requirements remain the same with clients needing to be 17 years of age or under, residents of Ontario and not having access to any other form of dental coverage.

Food Seizure:

Earlier this month, the Health Unit’s Environmental Health staff were involved in a seizure of improperly transported foods after the Ministry of Transportation and OPP officers pulled over a food delivery truck on the highway. The truck was escorted to the Health Unit’s Port Hope office, where Public Health Inspectors determined that some of the foods were not properly frozen and posed a potential hazard to consumers at the restaurants where these foods were to be delivered. The truck was escorted to a local transfer station where the unsafe products were discarded.

Active Transportation in Haliburton County:

Information was presented on a study conducted to evaluate the work of the Communities in Action Committee (CIA) on changes to active transportation policy, infrastructure and activity in Haliburton County. The CIA was formed in 2004 to promote and plan for active transportation as a strategy for creating a healthy, active community. The evaluation was intended to measure what had changed in Haliburton County with respect to policy, planning decisions, infrastructure, awareness and behaviour around active transportation and to determine the contribution of CIA. The research showed that implementation of active transportation initiatives is achievable in small, rural communities and there are unique opportunities for partnerships.

Public Sector Salary Disclosure (February meeting):

The Health Unit reported nine employees who earned more than $100,000 in 2013, including: Medical Officer of Health, Directors of Administration and Human Resources, Communicable Disease Control, Oral Health, Chronic Disease and Injury Prevention, Family Health/Chief Nursing Officer, Environmental Health, and Managers of Environmental Health and Communicable Disease Control. For purposes of comparison, the Health Unit reported seven employees earning more than $100,000 in 2012.

Privacy Requests (February meeting):

The Health Unit received and responded to three requests under PHIPA in 2013. The Health Unit received and responded to eight requests under MFIPPA in 2013.


Aging Well Communities:

Health Promoters Angela Andrews and Doreen Boville made a presentation on the work being done to make Haliburton and Northumberland counties and the City of Kawartha Lakes “age-friendly” for residents. Working together with residents and various community partners, age-friendly coalitions have been instrumental in helping to implement benches, ramps and handrails in public areas as well as participating in senior’s fairs and hosting information meetings on topics such as rural transportation needs and health issues.

Lyme Disease (March meeting):

During his presentation, Public Health Inspector Bud Ivey told Board of Health members that Lyme disease is the most common tick-related illness in the Northern Hemisphere and that ticks able to carry the disease are spreading into Canada at a rate of 46km/year due to global warming. As a result, people of all ages are being urged to protect themselves from tick bites. While tick bites are more common for people who hike in the woods or in areas with long grasses, Ivey said that ticks can be transferred to other areas by birds or pets, putting all people at risk.  Ivey provided information on the discovery of Lyme disease, the look and size of ticks, and the signs and symptoms of Lyme disease. If bitten by a tick, people should remove the tick within 24 hours to prevent the possible transmission of Lyme disease, place the tick in a container, and then take it to either a health care professional or health unit for further testing. In 2013, there were two laboratory-confirmed human cases of Lyme disease in the area served by the HKPR District Health Unit.

Strategic Plan Update (January meeting):

A presentation on the status of the Health Unit’s new Strategic Plan was provided to the Board. Dr. Noseworthy spoke to the evolution of the current plan, while advances in the three Strategic Priorities were highlighted by the lead in each area. For Social Determinants of Health, Anne-Marie Cyr, Manager of Professional Practice and Accountability, spoke to the work already conducted in this area and plans for the future. For the Strategic Priority Mental Health, Chronic Disease and Injury Prevention Manager, Lorna McCleary spoke about the creation of a logic model and the identification of community partners. For the Communications Strategic Priority, Chandra Tremblay, Manager, Communication Services, discussed communication vehicles used to reach local residents, action plans and the work underway. Plans for consultation with Community Stakeholders were also discussed.

Overdose Prevention Program (January meeting):

Shawn Woods, Manager, Communicable Disease Control, provided the Board with an overview of the local Overdose Prevention Program. Accidental overdoses are the third leading cause of unintentional deaths in Ontario, a figure comparable to traffic fatalities. Mrs. Woods highlighted that overdoses often occur when people use unfamiliar drugs or use drugs in the presence of others who are afraid to call 911 for help. The Provincial Narcotic Strategy, which included harm reduction programs, began in 2010. In March 2012, the Ministry of Health and Long-Term Care (MOHLTC) created an Expert Working Group on Narcotic Addictions. The Working Group made a number of recommendations to the MOHLTC including increasing and sustaining the availability of Naloxone overdose prevention kits and harm reduction information and materials through public health units in Ontario. In May, 2013, the Central East Local Health Integration Network provided funding to local organizations for opiate overdose prevention programs and this initiative has become a regional community partnership that involves organizations from Durham Region, Peterborough, Northumberland County, City of Kawartha Lakes and Haliburton County. The goal of the partnership is to engage additional community partners in moving towards the implementation of an overdose prevention program that strives to reduce opioid overdose deaths through education and the distribution of Naloxone kits.

Oral Health Advocacy in Our Community (December meeting):

Registered Dental Hygienist Sue Hochu spoke to the Board on the importance of oral health care and the inability of many people to afford to see a dentist for regular treatment and care. With an aim of improving access to dental care for area residents, the Health Unit and community partners created the Northumberland Oral Health Coalition in 2005.  In 2007, similar coalitions joined together to form the Ontario Oral Health Alliance to give oral health advocacy a provincial voice. Ms. Hochu highlighted some of the work of both the provincial and local coalition, including a symposium featuring Dr. Arlene King as a speaker, and a provincial post card campaign designed to increase awareness and encourage members of the public to let their MPPs know they want improved access to oral health care for all Ontarians.

Health Concerns Related to Waterpipe Smoking (December meeting):
Michael Perley, Director of the Ontario Campaign for Action on Tobacco joined the meeting by teleconference to participate in a presentation with HKPR Tobacco Control Officer, Lorne Jordan, on the health concerns of waterpipe smoking. Mr. Jordan provided the Board with an overview of the origin of waterpipes and the increasing popularity of waterpipes with young people. A 2006 report from the Canadian Tobacco Use Monitoring Survey reported that seven per cent of Canadian youth in grades 7 to 12 reported trying a waterpipe, and less than three per cent reported usage in the last month. Mr. Jordan explained that people consider waterpipe smoking less risky than cigarette smoking, but it actually produces more exposure to dangerous chemicals than smoking and also puts the waterpipe user at risk for infectious diseases including tuberculosis, hepatitis, herpes, influenza, etc. With waterpipe lounge operators referring to the product as herbal to avoid the Smoke-Free Ontario Act violations, Mr. Jordan told the Board it is difficult to dispute as testing of the herbal product batches must be done in Ottawa and costs $1,200. In tests that have occurred, tobacco has been found in the mixture. While there are currently no waterpipe establishments in the Health Unit’s area, Mr. Jordan said it is just a matter of time before some appear, given the proximity of other establishments and the ease in which people can purchase the waterpipes and products. Both Mr. Jordan and Mr. Perley urged municipalities to be proactive and do some education with their staff granting business licenses so they are aware of these types of establishments.                                                                  

New Business

Operating Statement:

Approved, a motion to accept the draft operating statement for the HKPR District Health Unit. As of March 31, 2014, the Health Unit had expenditures of $4,326,111.

Operational Plan Annual Progress Report (2013):

Received, a report on the activities of the Health Unit’s programs and support services for 2013. The report is based on operational plans developed by each department and highlights accomplishments, variances from the plans, and the Ontario Public Health Standard under which the work is performed.

2014 Budget (February meeting):

Approved, the Health Unit’s proposed 2014 budget request in the amount of $17,007,855 be submitted to the Ministry of Health and Long-Term Care. The proposed budget results in a cost-sharing ratio of 74.43 per cent for the province and 25.57 per cent for obligated municipalities. Seven requests for one-time funding are included with the budget for the following items:

·       -  Accessibility for Ontarians with Disabilities Act/Risk Assessment – modifications to Health Unit facilities and parking lots to improve accessibility and staff safety

·       - Port Hope Space Design and Layout – the hiring of a consultant to review space requirements within the office and provide design and configuration options

·       - Clinical Services Equipment – the purchase of new equipment for sexual health clinics

·       - Vaccine Fridge and Monitoring System – the purchase of a new vaccine fridge for the Brighton office and an improved monitoring system for all vaccine fridges

·       - External/Internal Signage – replace the two outdoor message signs for the Port Hope and Lindsay offices with new logos and a new electronic sign as well as replace all old internal and external signs with signs containing new logo

·       - Clinical Services Improvement – purchasing room dividers to create more privacy for clients participating in vaccination or clinical services offered at Health Unit offices

·       - Smoke-free Ontario Smoking Cessation program – purchasing nicotine replacement therapy to offer to 83 residents for 12 weeks each.

Policies and Procedures:

Approved, a series of policies and procedures on topics such as the collection of personal and personal health information, privacy impact assessments, privacy breach, accountability, privacy training requirements and interdepartmental committees.

Service Recognition (December meeting):

The Board of Health recognized the following employees of HKPR District Health Unit for their long-serving contributions to the organization:

Marjorie Oke – 35 years

Cathy Adams – 30 years

Kris Kadwell – 30 years

Debbie Brisbin – 30 years

Pat Nicol – 15 years

Rachel Moon-Kelly – 15 years

Lesley Tusch – 15 years

Fyffe Murdock – 10 years

Richard Ovcharovich – 10 years

Bruce Barthorpe – 10 years

Zinda Harper – 10 years

Shawn Woods – 10 years

Sue O’Connor – 10 years

Joanne Patton – 10 years

Julie Tukendorf – 5 years

Elizabeth Hulse – 5 years
Ingrid Nachtrieb – 5 years

Kelly Taylor – 5 years

Marianne Rock – 5 years

Sarah Tsang – 5 years

Lynne Franke – 5 years

Joni Delrosario – 5 years

Next Meeting:

The next Board of Health meeting is scheduled for Thursday, May 15 at 10 am in the Health Unit’s Brighton office.

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For media inquiries, contact:

Dr. Lynn Noseworthy, Medical Officer of Health, HKPR District Health Unit, (905) 885-9100 or

Chandra Tremblay, Manager, Communication Services, HKPR District Health Unit (905) 885-9100



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