CMOH Presentation Council of Medical Officers of Health Boards of Health

1. CMOH Presentation Council of Medical Officers of HealthBoards of Health Friday February 26, 2010

2. 2 Overview of Presentation CMOH Office Review Current Issues: H1N1 Lessons Learned Review Raw Milk Wind Turbines Interactive Q&A Period

3. 3 CMOH Office Review A review of the scope and role of the CMOH office is currently underway. The review is occurring in two phases: Phase 1 will look at what the CMOH Office requires to get work done, including strategy, policy development, key processes and customer/client coordination. Phase 2 will examine the governance, leadership relationships, processes and intersections between the CMOH, the Public Health Division, OAHPP and the Ministry of Health Promotion.  Work on Phase 1 was completed at end of January 2010 and implementation has started; Phase 2 is slated for completion by the end of April 2010 and implementation will continue into the summer. Findings and recommendations of this review, along with other inputs, will help to shape the vision for the future of Public Health in Ontario. 

4. 4 New CMOH Team Members Elizabeth Walker – Interim Director of the CMOH Officer Ben Lim – Issues Management Jason Stanley – Special Advisor Laura Seeds – Stakeholder Relations and Information Management

5. Current Issues

6. 6 pH1N1 - Review Process pH1N1 review and lessons learned process is underway Four strategic objectives of the review have been identified: To critically examine and report on key lessons learned: what worked well, what requires improvement. To enable application of lessons learned to future events. To inform key reports from the CMOH to the provincial legislature. To inform potential 3rd party reviews that may take place, such as a review at a later date by the Auditor General of Ontario.

7. 7 pH1N1 - Review Methodology Engagement of the Ontario Internal Audit Division Helps validate methodology and objectivity. Provides baseline of information for on-going process improvements and the 2009 CMOH Report. Review will include all the relevant stakeholders including: Internal to MOHLTC. Internal to Ontario Public Service. Health external stakeholders. Non-health external stakeholders. Public, front-line workers and media.

8. 8 pH1N1 - Review Methodology Methodologies include: Surveys and facilitated discussions with health and non-health stakeholder associations, labour unions and provincial ministries. Focus groups with the general public, targeting the demographics most affected, in addition to front-line workers in the acute care, community health and public health sectors. Interviews with media outlets, including editorial boards and in-province/out-of-province reporters of major dailies. Lessons learned from other debriefs (e.g., COMOH H1N1 Debrief) will also be valuable in informing the review process, final report and subsequent changes to emergency plans.

9. 9 Wind Turbines The position of the CMOH continues to be that given the existing literature, there has not been an association found between adverse health effects and wind turbines. In response to continued public concerns about wind turbines and its potential health effects, and to the need to have a consistent provincial position on the topic, the CMOH committed to review the literature and research to determine whether there had been any changes, whether there were any areas that required further research, and to develop a common view across the province. A working group was struck between the Ministry, the Ontario Agency for Health Protection and Promotion, and COMOH to guide this work. Results of the review and consultation will be summarized in a report to the CMOH expected in the near future.

10. 10 Raw Milk The issue of raw milk sales was the focus of intense media interest in the fall of 2006. Individual cases and outbreaks of illness have been associated with consumption of raw milk and raw milk products. People with compromised immune systems, including the very young and elderly, are at greater risk of serious illness from raw milk. 145 cases of illness associated with exposure to raw milk were reported in Ontario from 2005 to 2009.

11. 11 Raw Milk Advocates for unpasteurized milk take the position that raw milk provides significant health benefits while the pasteurization process destroys the nutritional and therapeutic benefits of milk. The pasteurization of milk is one of the greatest public health achievements in Ontario. From 1929 – 1938 (the year in which it became legally compulsory to pasteurize milk before sale and consumption), there were almost 9000 documents cases of milk-borne illnesses and over 700 deaths. Milk-borne disease outbreaks accounted for 25% of all food and water-borne outbreaks in North America prior to pasteurization and over 10% of all childhood tuberculosis was caused by drinking T.B contaminated milk. Now, pasteurization has made bovine tuberculosis all but unknown to the general public. However, from Campylobacteriosis to Salmonellosis, consumption of unpasteurized milk still causes many instances of illnesses a year in Ontario.

12. 12 Raw Milk - Recent Decision On December 21, 2009, a Justice of the Peace in Newmarket issued a decision dismissing 19 charges that had been brought against a farmer who distributed raw milk through his “cow-share” operation. The charges were laid and prosecuted by the Grey Bruce Health Unit and the Ministry of Natural Resources (acting on behalf of MOHLTC and OMAFRA). Section 18 of the Health Protection and Promotion Act (HPPA) prohibits the sale and distribution of raw milk and raw milk products. The defendant was charged with numerous offences under section 18 of the HPPA.

13. 13 Raw Milk Other charges were laid under section 100 of the HPPA (relating to the defendant’s violation of a 1994 “health hazard” order), and under OMAFRA’s Milk Act, which sets out a licencing scheme for milk processing and distribution. The Ministry of the Attorney General has filed a notice of appeal – numerous substantive and procedural grounds for appeal cited in notice. Decision will now be reviewed by an Ontario Court of Justice judge. Grey Bruce Health Unit has also filed notice of appeal.