Board of Health for

Peterborough Public Health

AGENDA
Board of Health Meeting
Wednesday, February 12, 2020 – 5:30 p.m.
Dr. J. K. Edwards Board Room, 3rd Floor
Jackson Square, 185 King Street, Peterborough

1. Call to Order
Mayor Andy Mitchell, Chair

1.1. Welcome and Opening Statement

We respectfully acknowledge that Peterborough Public Health is located on the
Treaty 20 Michi Saagiig territory and in the traditional territory of the Michi
Saagiig and Chippewa Nations, collectively known as the Williams Treaties First
Nations, which include: Curve Lake, Hiawatha, Alderville, Scugog Island, Rama,
Beausoleil, and Georgina Island First Nations.

Peterborough Public Health respectfully acknowledges that the Williams Treaties

First Nations are the stewards and caretakers of these lands and waters in
perpetuity, and that they continue to maintain this responsibility to ensure their
health and integrity for generations to come. We are all Treaty people.

2. Confirmation of the Agenda

3. Declaration of Pecuniary Interest

4. Consent Items to be Considered Separately

Board Members: Please identify which items you wish to consider separately from section
12 and advise the Chair when requested. For your convenience, circle the item(s) using the
following list: 9.1 9.2 a b c d e f 9.3.1 9.3.2 9.3.3 9.3.4 a b c d 9.3.5

5. Delegations and Presentations

5.1. PRHC - Transforming Healthcare Within a Shifting Provincial Landscape

Presenters:
Dr. Peter McLaughlin, President & Chief Executive Officer
Don Gillespie, Board Chair

 Cover Report
a. Presentation

BOH Agenda - Feb 12 2020

Page 1 of 149
6. Confirmation of the Minutes of the Previous Meeting

 Cover Report
a. January 8, 2020

7. Business Arising From the Minutes

7.1. Oral Update: Consumption and Treatment Site

Dr. Rosana Salvaterra, Medical Officer of Health

 Cover Report

8. Staff Reports

8.1. Staff Report: BWXT Nuclear Energy Canada: Application for Licence Renewal

 Staff Report
a. PPH Written Intervention to the CNSC

8.2. Staff Presentation: Annual Service Plan 2020

Presenter: Donna Churipuy, Director of Public Health Programs

 Cover Report
a. Presentation

9. Consent Items

9.1. Correspondence for Direction – Provincial Immunization Registry

 Cover Report
a. City of Hamilton Letter
b. COMOH Letter

9.2. Correspondence for Information

 Cover Report
a. Health Canada – Vaping Regulations
b. MPP Smith - Provincial Appointments
c. Minister Elliott – E-Cigarettes
d. CAOs – Off-Road Vehicles
e. Ministers Mulroney - Off-Road Vehicles
f. alPHa e-newsletter

9.3. Staff Reports

BOH Agenda - Feb 12 2020

Page 2 of 149
 9.3.1. Staff Report: Summary of Donations, 2019

 Staff Report

9.3.2. Staff Report: Summary of Complaints, 2019

 Staff Report

9.3.3. Staff Report: Summary of Research Activities, 2019

 Staff Report

9.3.4. Report: Q4 2019 Peterborough Public Health Activities

 Cover Report
a. Q4 2019 Overall Compliance Status
b. Q4 2019 Communications and I.T. Report
c. Q4 2019 Social Media Report
d. Q4 2019 Finance Report

9.3.5. Staff Report: Audit Letter of Engagement, 2019

 Staff Report
a. Audit Planning Report

9.4. Committee Reports (nil)

10. New Business

11. In Camera to Discuss Confidential Matters

In accordance with the Municipal Act, 2001,

239(2)(d) Labour relations or employee negotiations
239(2)(k) a position, plan, procedure, criteria or instruction to be applied to any negotiations
carried on or by or on behalf of the municipality or local board.

12. Motions for Open Session

13. Date, Time, and Place of the Next Meeting

Wednesday, March 11, 2020, 5:30 p.m.

Dr. J. K. Edwards Board Room, 3rd Floor, Jackson Square, 185 King Street, Peterborough

BOH Agenda - Feb 12 2020

Page 3 of 149
 14. Adjournment

ACCESSIBILITY INFORMATION: Peterborough Public Health is committed to providing information in a format that meets
your needs. To request this document in an alternate format, please call us at 705-743-1000.

NOTICE: Proposed recommendations as noted within the posted agenda package may not be indicative of the final
decision made by the Board of Health at the meeting. Should a member of the public or media outlet wish to confirm or
clarify any Board position following the meeting, please contact the PPH Communications Manager or refer to the
meeting summary issued shortly thereafter. Final motions are recorded in posted approved Minutes.

BOH Agenda - Feb 12 2020

Page 4 of 149
PETERBOROUGH PUBLIC HEALTH
BOARD OF HEALTH

TITLE: Presentation: PRHC - Transforming Healthcare Within a Shifting

Provincial Landscape
DATE: February 12, 2020

PROPOSED RECOMMENDATIONS

That the Board of Health for Peterborough Public Health receive the following for information:

Presentation: PRHC - Transforming Healthcare Within a Shifting Provincial Landscape

Presenters:
Dr. Peter McLaughlin, President & Chief Executive Officer
Don Gillespie, Board Chair

Note: Mary Ferguson-Paré (Vice Chair) and Lesley Beagrie (Board Member) will also be in
attendance as guests.

ATTACHMENTS

Attachment A – Presentation

BOH Agenda - Feb 12 2020

Page 5 of 149
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PETERBOROUGH PUBLIC HEALTH
BOARD OF HEALTH

TITLE: Meeting Minutes, January 8, 2020

DATE: February 12, 2020
PREPARED BY: Natalie Garnett, Board Secretary
APPROVED BY: Dr. Rosana Salvaterra, Medical Officer of Health

PROPOSED RECOMMENDATIONS

That the Board of Health for Peterborough Public Health approve the minutes of the meeting
held on January 8, 2020.

ATTACHMENTS

Attachment A – Board of Health Minutes, January 8, 2020

BOH Agenda - Feb 12 2020

Page 16 of 149
 Board of Health for
Peterborough Public Health
DRAFT MINUTES
Board of Health Meeting
Wednesday, January 8, 2020 – 5:30 p.m.
Dr. J.K. Edwards Board Room
Jackson Square, 185 King Street

In Attendance:
Board Members: Deputy Mayor Bonnie Clark
Councillor Henry Clarke
Mr. Gregory Connolley
Ms. Kerri Davies
Deputy Mayor Matthew Graham
Councillor Nodin Knott
Mayor Andy Mitchell, Chair
Ms. Catherine Praamsma
Mr. Andy Sharpe
Councillor Don Vassiliadis
Mr. Michael Williams
Councillor Kathryn Wilson
Councillor Kim Zippel

Staff: Dr. Rosana Salvaterra, Medical Officer of Health

Ms. Brittany Cadence, Manager of Communications and IT
Ms. Donna Churipuy, Director of Public Health Programs
Ms. Natalie Garnett, Recorder
Ms. Alida Gorizzan, Executive Assistant
Mr. Larry Stinson, Director of Operations

1. Call to Order

Dr. Rosana Salvaterra, Medical Officer of Health, called the meeting to order at 5:30 p.m.

Recognition of Outgoing Board of Health Chair – Councillor Kathryn Wilson

Dr. Rosana Salvaterra, Medical Officer of Health, thanked Councillor Wilson for her work as the
Board Chair in 2019.

2. Elections and Appointments

BOH Agenda - Feb 12 2020

Page 17 of 149
2.1 Elections

Dr. Rosana Salvaterra, Medical Officer of Health, called for nominations for the Chair of
the Board of Health for 2020.

MOTION:
That Mayor Andy Mitchell be appointed as Chair of the Board of Health.
Moved: Councillor Clarke
Seconded: Ms. Davies
Motion carried. (M-2020-001)

Mayor Mitchell assumed the Chair and called for nominations for the position of Vice
Chair for the Board of Health for 2020.

MOTION:
That Keri Davies be appointed as Vice Chair of the Board of Health.
Moved: Deputy Mayor Clark
Seconded: Councillor Zippel
Motion carried. (M-2020-002)

2.2 Committee Appointments

MOTION:
That the Board of Health for Peterborough Public Health appoint members to its
Committees as follows:
Indigenous Health Advisory Circle - Councillor Nodin Knott, Mr. Michael Williams,
Councillor Kathryn Wilson, Councillor Kim Zippel
Governance Committee - Mr. Andy Sharpe, Mr. Greg Connolley, Councillor Don
Vassiliadis, Deputy Mayor Bonnie Clark
Stewardship Committee - Councillor Henry Clarke, Ms. Kerri Davies, Deputy Mayor
Matthew Graham, Ms. Catherine Praamsma

That the Board of Health for Peterborough Public Health appoint the following
community members to the Indigenous Health Advisory Circle: Ms. Lori Flynn,
Nogojiwanong Friendship Centre, Ms. Kari Lepine, Métis Nation of Ontario Peterborough
and District Wapiti Métis Council
Moved: Mr. Williams
Seconded: Deputy Mayor Clark
Motion carried. (M-2020-003)

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 2.3 Provincial Appointments

MOTION:
That the Board of Health for Peterborough Public support the renewal of provincial
appointments for Catherine Praamsma, Kerri Davies and Greg Connolley.
Moved: Ms. Praamsma
Seconded: Mr. Sharpe
Motion carried. (M-2020-004)

3. Establishment of Date and Time of Regular Meetings

MOTION:
That the regular meetings for the Board of Health for Peterborough Public Health in 2020 be
held on the following dates starting at 5:30 p.m., or at the call of the Chairperson:
Dates:
January 8, February 12, March 11, May 13, September 9, November 11, December 9. Location:
Dr. J. K. Edwards Board Room, Jackson Square, 185 King Street, Peterborough.

Date: April 8 Location: TBD, Township of Havelock-Belmont-Methuen

Date: June 10 Location: Lower Hall, Administration Building, 123 Paudash St., Hiawatha First
Nation.

Date: October 14 Location: Board Room, Curve Lake Health Centre / Oshkiigmong
MnoBmaadziwin Gamiing, 38 Whetung Street East, Curve Lake First Nation.
Moved: Mr. Connolley
Seconded: Ms. Davies
Motion carried. (M-2020-005)

4. Establishment of Honourarium for 2020

MOTION:
That the Board of Health for the Peterborough Public Health approve a 1.7% increase in
honourarium for its members, representing a total amount of $154.16.
Moved: Councillor Clarke
Seconded: Deputy Mayor Graham
Motion carried. (M-2020-006)

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5. Confirmation of the Agenda

MOTION:
That the agenda be adopted as circulated.
Moved: Deputy Mayor Graham
Seconded: Deputy Mayor Clark
Motion carried. (M-2020-007)

6. Declaration of Pecuniary Interest

7. Consent Items to be Considered Separately

MOTION:
That the following items be passed as part of the Consent Agenda: 12.2 a-g, and 12.3.1.
Moved: Ms. Praamsma
Seconded: Councillor Wilson
Motion carried. (M-2020-008)

MOTION (12.2 a-g):

That the Board of Health for Peterborough Public Health receive the following for information:
a. Letter dated December 11, 2019 to Chief Whetung and Council regarding community
alcohol policies.
b. Letter dated December 11, 2019 to Chief Carr and Council regarding community alcohol
policies.
c. Letter dated December 11, 2019 to Health Canada regarding an application for an
exemption for a consumption and treatment service for Peterborough.
d. Letter dated December 11, 2019 to the Ministry of Health regarding an application for a
consumption and treatment service for Peterborough.
e. E-newsletter dated December 13, 2019 from the Association of Local Public Health
Agencies (alPHa).
f. Letter dated December 16, 2019 to local Chief Administration Officers regarding
municipal alcohol polices.
g. Letter dated January 2, 2020 to Minister Elliott regarding a request for weekly data
reports on vaping cases.
Moved: Ms. Praamsma
Seconded: Councillor Wilson
Motion carried. (M-2020-008)

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 MOTION (12.3.1):
That the Board of Health for Peterborough Public Health receive the staff report, Guarding
Minds @ Work Update, for information.
Moved: Ms. Praamsma
Seconded: Councillor Wilson
Motion carried. (M-2020-008)

8. Delegations and Presentations

9. Confirmation of the Minutes of the Previous Meeting

a. December 11, 2019

MOTION:
That the minutes of the Board of Health for the Peterborough Public Health meeting held
on December 11, 2019 be approved as circulated.
Moved: Mr. Sharpe
Seconded: Councillor Clarke
Motion carried. (M-2020-009)

10. Business Arising From the Minutes

11. Staff Reports

12. Consent Items

12.3.2 No Money for Food is Cent$less Report (2019 Limited Income Report)

MOTION:
That the Board of Health for Peterborough receive the report, No Money for Food is
Cent$less (Limited Incomes Report, 2019), for information.
Moved: Ms. Davies
Seconded: Deputy Mayor Clark
Motion carried. (M-2020-010)

13. New Business

13.1 Modernization of Public Health – PPH Response

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 MOTION:
That the Board of Health for Peterborough Public Health approve the following items for
submission: - Discussion Paper - Modernization of Public Health (Survey Response from
PPH) - Position Paper - Submission to Jim Pine, Special Advisor
Moved: Mr. Connolley
Seconded: Deputy Mayor Clark
Motion carried. (M-2020-011)

14. In Camera to Discuss Confidential Matters

15. Motions from In Camera for Open Session

16. Date, Time, and Place of the Next Meeting

The next meeting will be held Wednesday, February 12, 2020 at 185 King Street, Peterborough,
at 5:30 p.m.

17. Adjournment

MOTION:
That the meeting be adjourned.
Moved by: Deputy Mayor Graham
Seconded by: Councillor Knott
Motion carried. (M-2020-012)

The meeting was adjourned at 6:33 p.m.

Chairperson Medical Officer of Health

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PETERBOROUGH PUBLIC HEALTH
BOARD OF HEALTH

TITLE: Oral Report: Consumption and Treatment Site Update

DATE: February 12, 2020
PREPARED BY: Dr. Rosana Salvaterra, Medical Officer of Health

PROPOSED RECOMMENDATIONS

That the Board of Health for Peterborough Public Health receive the oral report, Consumption
and Treatment Site Update, for information:

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PETERBOROUGH PUBLIC HEALTH
BOARD OF HEALTH – STAFF REPORT

TITLE: BWXT Nuclear Energy Canada: Application for Licence Renewal

DATE: February 12, 2020
PREPARED BY: Julie Ingram, Manager of Environmental Health
APPROVED BY: Donna Churipuy, Director of Public Health Programs
Dr. Rosana Salvaterra, Medical Officer of Health

PROPOSED RECOMMENDATIONS

That the Board of Health for Peterborough Public Health receive the staff report, BWXT Nuclear
Energy Canada: Application for Licence Renewal, for information.

FINANCIAL IMPLICATIONS AND IMPACT

There are no financial implications arising from this report.

DECISION HISTORY

The Board of Health has not previously made a decision with regards to this matter.

BACKGROUND

Purpose of the Report

This report has been prepared to provide Board of Health members with an overview of
Peterborough Public Health’s involvement and assessments in relation to BWXT’s licence
renewal application to the Canadian Nuclear Safety Commission.

BWXT Nuclear Energy Canada

In December 2016, BWXT Canada (a subsidiary of BWX Technologies Inc.) acquired GE Hitachi
Nuclear Energy Canada Inc. Currently, BWXT Nuclear Energy Canada (BWXT NEC) operates the
Peterborough facility located on Monaghan Road at the former General Electric Peterborough
complex.

This facility assembles CANDU® (Canada Deuterium Uranium) fuel bundles for CANDU®
reactors, such as those located at the Pickering and Darlington nuclear generating stations. The
facility is licenced by the Canadian Nuclear Safety Commission (CNSC), the federal regulator for
the nuclear sector in Canada. On November 12, 2018, BWXT NEC submitted an application to
the CNSC for the renewal of its operating license for a ten (10) year period. The current licence
applies to both BWXT Peterborough and Toronto facilities, and expires on December 31, 2020.

The application submitted by BWXT NEC is seeking authorization from the CNSC to permit the

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production of natural uranium pellets at the Peterborough facility. Currently, pelleting
operations are only conducted at the Toronto facility. The Peterborough facility is licenced to
produce and test fuel bundles using the uranium dioxide pellets, which have been
manufactured in Toronto. BWXT NEC’s website states: “While there is currently no plan to
change the existing state of operations, including the flexibility to allow BWXT NEC’s
Peterborough facility to conduct pelleting will help to ensure that BWXT NEC has the ability to
adapt as needed to changing business needs over the decade-long licence period.”

The CNSC will host public hearings for the proposed licence renewal application on March 2 and
3, 2020 in Toronto and on March 4, 5 and 6, 2020 in Peterborough.

Peterborough Public Health’s Engagement in the Licence Renewal Application

Peterborough Public Health (PPH) has been involved with the activities surrounding the licence
renewal application for BWXT Peterborough. A summary of these activities is provided below:

 meetings with BWXT Executives;

 meetings and consultation with CNSC staff;
 meetings and discussion with members of CARN – Citizens Against Radioactive
Neighbourhoods;
 meeting with the Kawartha Pine Ridge District School Board;
 consultations with Public Health Ontario;
 consultations with Ministry of the Environment, Conservation and Parks;
 consultations with the City of Peterborough Environmental Protection Division;
 collaboration with Toronto Public Health;
 attendance at various information nights hosted by BWXT and the CNSC;
 review of the evidence surrounding the health-related impacts of the Peterborough
operations;
 comprehensive review of the Commission Member Document (December, 2019);
 development of website content for public education and outreach;
 collaboration with an expert from Trent University; and
 response to public questions and inquires.

These activities have enabled PPH to enhance our understanding of the operations at BWXT
Peterborough and complete risk assessments of the various potential public health hazards
related to operations at BWXT Peterborough. On January 27, 2020, PPH provided a written
submission, otherwise known as an intervention, to the CNSC with a request to present orally
during the public hearings in Peterborough (see Appendix A). Our submission was accepted and
our request to present was granted. Furthermore, it is our understanding that a request will
come from the CNSC for PPH to be present at the public hearings to answer health-related
questions from Commission members, pertaining to the licence renewal.

On February 11, 2020 PPH staff, management and executive will be touring the BWXT Toronto

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facility in order to better-understand pelleting operations and the potential risks in the event
that pelleting operations are relocated to Peterborough.

Summary of Peterborough Public Health’s Written Intervention to the CNSC

A complete copy of PPH’s written submission to the CNSC is provided in Appendix A. In
summary, PPH supported the conditions recommended by CNSC staff in the Commission
Member Document, particularly those outlined in Licence Conditions 15.1: Environmental
Monitoring and 15.2: Commissioning Report. However, PPH is urging commission members to
consider the following additional recommendations:

1. That BWXT implement a comprehensive environmental monitoring program to

provide sufficient data to assess the full extent of uranium and beryllium emissions in
the surrounding area prior to any decision regarding renewal of the licence and the
addition of pelleting at the Peterborough site.
2. That the BWXT Peterborough facility retain the services of an independent, neutral
third party for soil, water, and air testing for Uranium and Beryllium, as appropriate,
and publicly share all reports and test results in their entirety; and
3. That the BWXT Peterborough facility establish a Community Liaison Committee (CLC)
in Peterborough, similar to that which has been established in Toronto.

We are hopeful that these additional recommendations will be considered by the Commission
and believe that these measures will help increase our community’s confidence with sampling
results and ensure that moving forward, our community’s concerns are addressed.

PPH is aware of the many concerns from community members related to the location of the
facility. Given that the Peterborough BWXT facility is located within a residential
neighbourhood and adjacent to an elementary school, the concerns of the community are
understandable. Accordingly, we have stated in our written submission that should the licence
be renewed to allow BWXT to continue operating, it would be essential to ensure that the
surrounding community has the information it requires, in a timely and transparent manner, to
reassure residents that emissions into the environment are not posing a risk to health.

Generally, children can differ from adults in their susceptibility to hazardous chemicals, but
whether there is a difference depends on the chemical itself. The physiology and behaviour of
children may result in increased exposure. For example, if a chemical is found in high
concentrations in the soil, children may be more likely to be exposed due to their tendency for
increased hand-to-mouth contact. When it comes to chemical toxicity, children may be more
vulnerable due to their longer remaining lifetime for the damage from chemicals to become
evident, which is particularly relevant for cancer.

As part of our comprehensive risk assessment, PPH has considered the following potential
hazards associated with current and proposed operations at the BWXT plant:
 Uranium Dioxide (currently present)
 Beryllium (currently present)

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  Liquid Hydrogen (proposed for pelleting)

The BWXT Peterborough and Toronto facilities are licenced and regulated by the Canadian
Nuclear Safety Commission (CNSC) whose role is to regulate the nuclear sector in Canada and
protect health, safety, security and the environment. The CNSC also ensures that Canada
complies with its international obligations on the peaceful use of nuclear materials and
technology. Licences granted by the CNSC outline various requirements for operations including
fire safety and emergency response plans, as well as establish action levels and release limits
for radioactive or hazardous substances into the environment. An action level is set as a type of
early warning system as it indicates when releases may be deviating from the norm. The licence
issued by the CNSC sets facility-specific release limits, which are derived to protect the health
and safety of the public and the environment. At the Peterborough BWXT facility, there are
guidelines and limits for both uranium and beryllium.

Uranium
Uranium is a naturally occurring element that is present at low levels in various chemical forms
in the environment. It is a heavy metal and is found in various rocks and ores, soils, water, air,
plants, and at low concentrations in animal tissue. Uranium is present in drinking water and
food and small amounts are ingested and inhaled by everyone every day. It has been estimated
that the average person ingests 1.3 µg or micrograms (0.033 Bq or becquerel) of uranium per
day, corresponding to an intake of 11.6 Bq per year. It has also been estimated that the average
person inhales 0.6 µg (15 mBq or megabecquerels) annually.1 On average, about 90 µg of
uranium exist in the human body from daily intakes of water, food and air; approximately 66%
is found in the skeleton, 16% in the liver, 8% in the kidneys and 10% in other tissues.2 Radiation,
including UV radiation from the sun, is a known carcinogen, but natural uranium is not. It has
not been classified as a carcinogen by the International Agency for Research on Cancer (IARC).3

Most of the naturally occurring uranium is uranium 238, which is considered to be weakly
radioactive. Its half-life is 4.5 billion years – which means it takes 4.5 billion years for it to lose
half of its radioactive alpha particles, on its way to becoming Thorium 234. Most people are
primarily exposed to uranium through the ingestion of food and water, however exposure can
also be as a result of inhalation or dermal contact. The amount of uranium in air is generally
very small. BWXT uses uranium dioxide, a naturally occurring oxide of uranium.

The biological and health effects of uranium are due to both its chemical and radiological
toxicity. In general, this toxicity, as demonstrated in animal studies done since 1949, is caused
by chemical rather than radiological components, although there is still some uncertainty about
a possible cumulative effect. Exposure to uranium primarily results in damage to the kidneys,
and the severity of health effects is partially dependent upon the level and duration of
exposure.4 Occupational and epidemiologic studies in humans have failed to consistently
demonstrate a higher risk of deaths from respiratory disease or cancers of any kind. Workers
exposed to insoluble uranium compounds did not show renal toxicity.

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Evidence reviews completed up to 2016 do not provide any information on whether or not
children are more susceptible than adults to natural uranium.5 Although we believe that
children would likely show the same health effects as adults, we do not know whether children
are more susceptible than adults to uranium effects.

There are three exposure pathways for uranium: air, soil and water. The Radiation Protection
Regulations established under the Nuclear Safety and Control Act sets a public dose limit for
radiation at 1 mSv or millisievert/year.6 To put this limit into perspective, a typical chest CT scan
provides a 7mSv dose of radiation, the average dose from natural background radiation in
Canada is 1.8mSv per year and a typical cross-Canada flight results in 0.2 mSv.7 The Canadian
regulations comply with the recommendations of the International Commission on Radiological
Protection.

For air, Ontario maintains a list of Ambient Air Quality Criteria (AAQC), which is developed by
the Ministry of Environment, Conservation and Parks. The limit for uranium and uranium
compounds in coarse particulate matter (PM10) is 0.03 µg/m3. The limit for uranium and
uranium compounds in total suspended solids, is 0.06 µg/m3. These limits are annual averages
and are deemed to be health-protective.8 PPH staff is awaiting additional clarification on how
these limits are derived.

Limits for uranium in soil are determined by the Canadian Council for Ministers of the
Environment (CCME) as outlined in the Canadian Soil Quality Guidelines for the Protection of
Environmental and Human Health. The limit for uranium in soil for residential and parkland
areas is 23 mg/kg.9

Finally, the regulatory limit for the discharge of uranium into wastewater is based on the CCME
Water Quality Guidelines for the Protection of Aquatic Life, which sets a limit of 15 µg/L.10
Additionally, the City of Peterborough has a sewer use by-law (number 15-075)11 which allows
the discharge of waste radioactive materials under a licence from the CNSC.

Beryllium
Beryllium is a naturally-occurring element present in a variety of materials including rocks and
soil. Beryllium is an important metal used in a number of industries; it is known for being
lightweight and for its exceptional strength, stability and heat-absorbing capability.12 Beryllium
is used at the BWXT Peterborough facility in the fuel bundle manufacturing process.

Human exposure to beryllium occurs primarily in the workplace and inhalation is the most
common route of exposure with respiratory disease typically being the end result. Based on
sufficient evidence for carcinogenicity in humans and animals, the International Agency for
Research on Cancer (IARC) has classified beryllium in Group 1, carcinogenic to humans.13

While there is little evidence surrounding the effects of beryllium on children, it is likely that
health effects of beryllium exposure on children would be similar to the effects seen in adults.

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According to the Toxicological Profile for Beryllium14, no data were located that examined age-
related differences in the toxicity of beryllium.

Most information regarding adverse health effects in humans after the inhalation of beryllium
come from occupational exposure studies, where significant exposure has occurred. The
respiratory tract is the primary target of beryllium toxicity. Inhalation of beryllium dust or
fumes in an occupational setting can result in chronic beryllium disease, which is scarring of the
lungs that is irreversible and potentially fatal. Lung cancer may also be a result of occupational
beryllium exposure.15 It is important to be mindful that the health-related outcomes described
above are observed only in occupational settings. Beryllium is not likely to cause any respiratory
disease from exposure in the general environment because ambient air levels of beryllium are
very low.

There are regulatory limits for beryllium based on the potential routes of exposure including air,
soil and water. Ontario’s AAQC for beryllium is 0.01 µg/m3 in a twenty-four hour period16,
based on potential health effects. Like uranium, limits for beryllium in soil are determined by
the CCME Canadian Soil Quality Guidelines for the Protection of Environmental and Human
Health. The limit for beryllium in soil for residential and parkland areas is 4 mg/kg.17 Finally,
beryllium discharge to wastewater also falls under the City of Peterborough’s sewer use by-law,
which allows for the annual release limit determined by the CNSC licence for the facility.
Release limits of beryllium into the wastewater stream from the Peterborough facility are based
on the Ontario Provincial Water Quality Objectives, which is 11µg/L.18

For comparison, according to information received from Public Health Ontario, the
occupational exposures that can lead to chronic beryllium disease or lung cancer occurred at
levels 50 to 100 times the Ontario AAQC limit of 0.01µg/m3.19 Acute beryllium disease
(berylliosis) has been documented in the past (1950s) where exposure to high levels of soluble
beryllium compounds in some cases led to progressive upper and lower respiratory tract
symptoms, and in a small number of severe cases, death. The concentrations of exposure in
these cases were approximately 10,000 times greater than the Ontario AAQC.

Liquid Hydrogen
Liquid hydrogen is not currently stored on site at BWXT Peterborough but it is stored on site at
the Toronto facility. In the event that pelleting is relocated to Peterborough, the storage of
liquid hydrogen would likely be required as it is used in the manufacturing of uranium pellets.
Liquid hydrogen is flammable and explosive when combined with air. Liquid hydrogen is also
stored at an extremely low temperature, which poses an additional occupational hazard for
handling.

According to the BWXT 2018 Annual Compliance and Monitoring Report,20 there are fire safety
and evacuation emergency response plans for the Peterborough and Toronto facilities. PPH
staff consulted with City of Peterborough staff, who have indicated that fire services and
emergency management staff meet annually with BWXT to discuss emergency response and
review emergency response plans. City staff advised that in the event pelleting is relocated to

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Peterborough and there is the need to store liquid hydrogen at the facility, protective measures
will be required, developed and implemented.

For the following section of this report, data provided by CNSC and BWXT has been reviewed to
determine whether or not emissions are posing a risk to the health to the general public.
Occupational health concerns fall within the mandate of Ontario’s Ministry of Labour and are
outside the scope of this review.

RESULTS

PPH has reviewed data for current and historical emissions of beryllium and uranium from the
BWXT Peterborough and Toronto facilities. In addition, we have reviewed the findings of
Toronto Public Health in its 2018 report to its board of health.21 Overall, emissions are typically
well below the release limits outlined in the operating licence for the BWXT facilities, which are
set to achieve the environmental and health standards and guidelines previously described in
this report.

Radiation Dose
Uranium exposures have both a radiological and a chemical component. Table 3.6 from the
CNSC report provides data on the annual doses to the public from both the Toronto and the
Peterbrough site. Dosimeters were added in Peterborough in 2016.

BWXT is required to estimate the total radiation dose to members of the public resulting from
its operations. These estimated radiation doses assume that a member of the public occupies
the boundary of the facility continuously for 24 hours per day, 365 days per year. Recall that the
regulatory effective public dose limit is 1mSv per year. At the Peterborough facility, the 2018
estimated radiation dose to a member of the public was 0.00mSv, contributing 0% to the public
dose limit. This has been the case from 2014 to 2018, inclusive. At the Toronto facility, the 2018
estimated radiation dose to a member of the public was 0.0004 mSv, contributing 0.04% to the
public dose limit.

Radiation from the Toronto site, where pelleting currently takes place, has resulted in annual
doses since 2014 that range from 0.41 μSv or microSieverts to 17.49 μSv, well below the limit of
1000 μSv, or 1 mSv. In the event that pelleting operations relocate to Peterborough, we might
expect higher emissions of uranium, and therefore expect a higher estimated radiation dose.
From 2014 to 2018 inclusive, the highest estimated dose in Toronto was 0.0175 mSv, which
contributed approximately 1.8% of the public dose limit.

Table 3.6: Estimated annual public doses from air emissions and environmental
thermoluminescent dosimeter (TLD) for both Toronto and Peterborough facilities respectively
[8-12]22

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 Toronto Peterborough
Gamma Public
Dose Gamma Dose
dose from dose
Period from air Total dose from air Total
TLD/Survey limit
emissions [μSv] from TLD emissions [μSv]
Meters [μSv]
[μSv] [μSv] [μSv]
[μSv]
2014 4.8 0.41 5.2 N/A 0.00 0.00 1000
2015 9.4 0.41 9.8 N/A 0.00 0.00
2016 0.00 0.7 0.7 0.00 0.00 0.00
2017 17 0.49 17.49 0.00 0.00 0.00
2018 0.00 0.41 0.41 0.00 0.00 0.00

In addition to the radiation dose, data on chemical exposures for both uranium and beryllium
will now be discussed.

Uranium
Air emissions of uranium at the Peterborough BWXT facility are from a single point. Emissions
are exhausted through a High Efficiency Particulate Air (HEPA) filter and continuous in-stack
monitoring is performed. In 2018, the highest recorded release of uranium was 0.006µg/m3
(recall that the standard is 0.03 µg/m3), and there was a total discharge of 0.002 grams of
uranium for the year. This is thousands of times lower than the licence release limit of 550
grams. Over the last five years, total annual air emissions of uranium at the Peterborough plant
have ranged from 0.002 to 0.004 grams.

Table 3.1: Uranium air emissions (kg/year) monitoring23

Parameter Uranium - Toronto Uranium - Peterborough

Licence Limit (FLOLs) 0.76 0.55
2011 0.00928 0.000011
2012 0.01267 0.000005
2013 0.00579 0.000013
2014 0.01090 0.000003
2015 0.01080 0.000003
2016 0.01080 0.000004
2017 0.00744 0.000002
2018 0.00628 0.000002

If pelleting operations are relocated to Peterborough, the emission of uranium might be

expected to increase to similar amounts observed at the Toronto facility. A review of the data
from the Toronto facility over the last five years shows that uranium emissions in the air have
ranged from 6.3 to 10.9 grams per year. Although this is many times higher than the current air
emissions of uranium at the Peterborough facility, it is still well below the licence release limits.

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Additional air monitoring is conducted at the boundary of the Toronto facility and over the last
three years, the highest average concentration was 0.001µg/m3, which is thirty times lower
than Ontario’s AAQC limit of 0.03µg/m3.

Boundary monitoring is not currently conducted at the Peterborough facility, but CNSC’s
recommended licence renewal conditions requires that it be implemented prior to pelleting
being relocated to Peterborough. Ambient air samples were collected as part of the CNSC’s
Independent Environmental Monitoring Program (IEMP) in 2014, 2018 and 2019. According to
the CNSC, results were 0.0013µg/m3 (2014), <0.003 µg/m3 (2018) and <0.00009 µg/m3 (2018)24,
all well below the requirements of Ontario Regulation 419/05 Air Pollution – Local Air Quality
Regulation25, which sets the release limit as 0.03µg/m3 on an annual basis.

At the Peterborough facility, uranium may be discharged with the wastewater stream as a
result of routine activities such as washing floors, walls and equipment. Prior to release, all
wastewater that is potentially contaminated with uranium is held for the determination of the
quantity and concentration of uranium. The water is filtered prior to sampling and once the
results of batch samples are verified to be below control levels (6 parts per million (ppm) per
batch and 3ppm annual average) the water is filtered again during discharge to the sanitary
sewer system. From 2016 to 2018, no samples exceeded action levels and in 2018, 0.01 grams
of uranium was discharged with the wastewater stream. From 2014 to 2018 inclusive, annual
releases ranged from 0.01 to 0.14 grams, and the licence release limit is 760 kilograms. A
similar process is followed at the Toronto facility. From 2014 to 2018 inclusive, annual releases
ranged from 0.39 to 0.94 kilograms. This is significantly higher than the releases from the
Peterborough facility, however, the amounts remain well below the licence limit. PPH staff have
consulted with the City of Peterborough Environmental Protection Division to discuss the
release of uranium through wastewater from the BWXT facility and no concerns were identified
by City staff.

Table 3.3: Uranium liquid effluent (kg/year) monitoring results and licence limits for BWXT
Toronto and Peterborough (2011-2018) [4-12]26

Parameter Uranium - Toronto Uranium - Peterborough

Licence Limit (FLOL) 9,000 760
2011 1.05 0.00010
2012 0.90 0.00010
2013 0.83 0.00020
2014 0.72 0.00014
2015 0.39 0.00006
2016 0.65 0.00013
2017 0.94 0.00003
2018 0.94 0.00001

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Air emissions are the primary pathway for potential release from the BWXT facilities into the
natural environment by impingement on the surface of the ground. Available data indicate that
air emissions of uranium from the Peterborough facility are extremely low therefore, soil
sampling is not required or conducted in Peterborough as part of the facility’s licence
conditions. However, soil sampling is conducted in Toronto on an annual basis and samples are
collected at 49 locations in accordance with a documented plan. In 2018, without exception, all
samples fell below the acceptable standard for residential and park land (23mg/kg = 23µg/g)
and ranged from <1.0 to 11.9µg U/g soil. Some soil sampling has been done in Peterborough as
part of CNSC’s IEMP. The results of soil samples collected and tested for uranium
concentrations were all below the regulatory limits as determined by the CCME Soil Quality
guidelines, described in the background section of this report.

Beryllium
As stated in the background, inhalation is the most common route of exposure for beryllium.
There are three stacks that act as air emission points for beryllium at the Peterborough facility.
The CNSC requires BWXT to monitor beryllium concentrations in each stack. This is achieved
with continuous in-stack monitoring which involves drawing a sample of air across a filter
capable of trapping beryllium. The filter is analyzed and the result is related to the air volume
passed through the filter. According to the 2018 Annual Compliance Monitoring Report, the
highest value recorded for beryllium air emissions was 0.001µg/m3, which is ten times less than
the internal control level, which is 0.01µg/m3, the same as Ontario’s AAQC guidelines for
beryllium in a twenty-four hour period.

Beryllium emissions were reviewed back as far as 2013 and all were below the licence action
level.

Air monitoring at the Point of Impingement (the plant/public boundary) for beryllium is not
currently required as part of BWXT’s licence conditions for the Peterborough facility. However,
ambient air samples were collected and tested as part of CNSC’s IEMP in 2014, 2018 and 2019.
According to the CNSC, results were 0.000077µg/m3 (2014), <0.003 µg/m3 (2018) and <0.0003
µg/m3 (2018), all below the requirements of Ontario Regulation 419/05 Air Pollution – Local Air
Quality Regulation, which sets the release limit as 0.01µg/m3 at the point of impingement.27

Beryllium may also be released from BWXT Peterborough with wastewater that is generated
from equipment use and washing. Potentially contaminated water passes through a settling
weir system (a weir tank or frac tank is used to hold water for up to twenty-four hours to allow
solids to settle out), prior to release to the sanitary sewer. There are release limits outlined in
BWXT’s operating licence and internal control levels are set to provide additional protection.
Upon reviewing beryllium releases with wastewater, they are below the established release
limits. The limits are set using the Ontario Provincial Water Quality Objectives, which for
beryllium is 11µg/L.

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Table 3.2: Average Beryllium concentrations in liquid effluent (μg/L) for BWXT Peterborough
(2011-2018) [4-12]28

Parameter Beryllium - Peterborough

BWXT’s Internal Control Level1 4.0
2011 N/A2
2012 N/A2
2013 0.38
2014 1.34
2015 4.5
2016 0.4
2017 1.0
2018 0.6
1
United States Environment Protection Agency maximum contaminant level for drinking water [42]
2
Beryllium liquid effluent monitoring results were not reported until 2013

PPH staff consulted with the City of Peterborough Environmental Protection Division to discuss
the release of beryllium through wastewater from the BWXT facility. No concerns were
identified and City staff indicated that beryllium will start being monitored as part of routine
sampling procedures. Over the last three years, the maximum beryllium concentration
measured in the wastewater from the facility ranged from 2.5 to 5.4 µg/L.

Just prior to this board report, concerns have emerged regarding the concentrations of
beryllium in the soil close to the Peterborough facility. Soil monitoring in Peterborough is not
required as part of BWXT’s operating licence, however, it too is conducted as part of CNSC’s
IEMP. The upper limit has been steadily increasing: 1.1 mg/kg (2014) 1.34mg/kg (2018) and
2.34 mg/kg (2019). Although the results continue to be below the CCME Soil Quality Guidelines
(4.0 mg/kg), the results are approaching the guideline and require further study to determine if
there are fugitive beryllium emissions from the facility. Increasing concentrations in soil, if
validated, are a concern, given the proximity of the facility to the elementary school across
Monaghan Road, which includes a playground for the youngest and potentially the most
vulnerable children. Although data on susceptibility in children is not available, children are
considered to be at risk for increased exposure through ingestion and dermal contact.

As described above, the air effluent monitoring results at the beryllium emission points for the
BWXT Peterborough facility have been reported since 2013 and appear to be below the action
levels in the licence conditions. Therefore, it is not clear whether or not the increase in
beryllium in the soil sampling is attributable to the BWXT Peterborough facility and for this
reason, PPH has recommended to the CNSC that a more comprehensive environmental
monitoring program be completed prior to the decision regarding the renewal of the licence
and/or moving the pelleting process to the Peterborough facility.

BOH Agenda - Feb 12 2020

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Liquid Hydrogen
In an effort to further understand the risks, PPH staff consulted with Public Health Ontario
(PHO) as to the potential health hazards associated with the storage of liquid hydrogen. PHO
suggests that the hazards would occur from the low temperature and/or high pressure under
which the liquid hydrogen is stored, and is likely more of a workplace health and safety
concern. PHO indicated that an engineering assessment may be beneficial to assess the
potential for offsite impacts and ensure that appropriate protective measures are
implemented. PPH will be visiting the BWXT Toronto facility on February 11, 2020 at which time
we intend to ask questions and gather additional information about the storage, use and safety
of the liquid hydrogen at that facility. An oral update will be provided to the Board of Health on
February 12, 2020.

CONCLUSION

Based on our review of the available data associated from the storage and use of uranium
dioxiode at the Peterborough site, we believe that the additional radiation dose to the general
public is neglible. At the Toronto site, levels well below the limits are documented.

For nonradiologic health effects, results of current and historic emissions of uranium and
beryllium from the Peterborough facility suggest that the emissions are below regulatory
requirements and well within facility licence release limits for BWXT. For Peterborough, there is
more limited data upon which to base this assessment, and we have noted a concerning trend
in the levels of beryllium in soil samples located near the facility. It would be prudent to
determine whether or not the increases in beryllium found in the soil are attributable to
fugitive emissions from BWXT Peterborough prior to making a decision about licensing.

Review of the data from the Toronto facility indicates that if pelleting operations are relocated
to Peterborough, uranium emissions will be expected to increase however, they will still fall
within regulatory guidelines and the licence limits for the Peterborough facility. There is no
evidence to support any exceedances, even if pelleting operations come to Peterborough and
the evidence indicates that the health of community and the environment will be protected.

Additional monitoring and sampling, including for soil and ambient air, should be in place prior
to the implementation of pelleting in Peterborough. One of the best ways to ensure that there
are no risks or threats to public health is to ensure the presence of a robust sampling program
and full communication of sampling results in their entirety with the local community. It is for
these reasons PPH is recommending the implementation of a comprehensive monitoring
program to fully assess current uranium and beryllium emissions prior to any decision regarding
the licence renewal and the addition of pelleting.

Additionally, in order to increase public confidence with sampling, we recommend that an

independent, third party be retained and that a Community Liaison Committee be established
in Peterborough.

BOH Agenda - Feb 12 2020

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STRATEGIC DIRECTION

This report applies to the following strategic direction(s):

 Community-Centred Focus
 Determinants of Health and Health Equity

APPENDICES

Appendix A – PPH Written Intervention Submission to the CNSC (January 27, 2020)

REFERENCES

1Depleted Uranium. International Atomic Energy Agency. https://www.iaea.org/topics/spent-

fuel-management/depleted-uranium

2Depleted uranium: sources, exposure and health effects. World Health Organization.
https://www.who.int/ionizing_radiation/pub_meet/en/DU_Eng.pdf

3Toxic Substances Portal – Uranium. Agency for Toxic Substances and Disease Registry.
https://www.atsdr.cdc.gov/toxfaqs/tf.asp?id=439&tid=77

4Depleted uranium: sources, exposure and health effects. World Health Organization.
https://www.who.int/ionizing_radiation/pub_meet/en/DU_Eng.pdf

5Keith s, faroon O, roney N, et al. Toxicological Profile for Uranium. Atlanta (GA): Agency for
Toxic Substances and Disease Registry (US); 2013 February 3, Health Effects. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK158798/

6 Radiation Protection Regulations. Ministry of Justice. https://laws-

lois.justice.gc.ca/eng/regulations/sor-2000-203/page-1.html

7Natural Background Radiation: Fact Sheet. Canadian Nuclear Safety Commission.

https://nuclearsafety.gc.ca/eng/pdfs/Fact_Sheets/Fact-Sheet-Background-Radiation-eng.pdf

8Ontario’s Ambient Air Quality Criteria. Standards Development Branch Ontario Ministry Of The
Environment. https://www.ontario.ca/page/ontarios-ambient-air-quality-criteria-sorted-
contaminant-name

9Canadian Soil Quality Guidelines for the Protection of Environmental and Human Health.
Canadian Council of Ministers of the Environment.
http://esdat.net/Environmental%20Standards/Canada/SOIL/rev_soil_summary_tbl_7.0_e.pdf

10Scientific Criteria Document for the Development of the Canadian Water Quality Guidelines
for the Protection of Aquatic Life. Canadian Council of Ministers of the Environment.

BOH Agenda - Feb 12 2020

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https://www.ccme.ca/files/Resources/supporting_scientific_documents/cwqg_uranium_scd_1.
0.pdf

11By-Law Number 15-075. City of Peterborough.

https://bylaws.peterborough.ca/bylaws/getFNDoc.do?class_id=20&document_id=9409

12Managing Health Effects of Beryllium Exposure. National Research Council.

https://www.ncbi.nlm.nih.gov/books/NBK214770/

13Beryllium, Cadmium, Mercury, and Exposures in the Glass Manufacturing Industry IARC
Monographs on the Evaluation of Carcinogenic Risks to Humans Volume 58. IARC.
http://publications.iarc.fr/76

14Toxicological Profile For Beryllium. U.S. Department Of Health And Human Services Public
Health Service Agency for Toxic Substances and Disease Registry.
https://www.atsdr.cdc.gov/ToxProfiles/tp4.pdf

15Alert: Workplace Beryllium Exposure. Ontario Ministry of Labour, Training and Skills
Development. https://www.labour.gov.on.ca/english/hs/pubs/alerts/a21.php

16Ontario’s Ambient Air Quality Criteria. Ministry of the Environment, Conservation and Parks.
https://www.ontario.ca/page/ontarios-ambient-air-quality-criteria-sorted-contaminant-name

17Canadian Soil Quality Guidelines for the Protection of Environmental and Human Health:
Beryllium. Canadian Council for Ministers of the Environment. http://ceqg-
rcqe.ccme.ca/download/en/354

18Water management: policies, guidelines, provincial water quality objectives. Ministry of the
Environment, Conservation and Parks. https://www.ontario.ca/page/water-management-
policies-guidelines-provincial-water-quality-objectives#section-13

19Ontario’s Ambient Air Quality Criteria - Sorted by Contaminant Name. Ministry of the
Environment, Conservation and Parks. https://www.ontario.ca/page/ontarios-ambient-air-
quality-criteria-sorted-contaminant-name

20Annual Compliance Monitoring Report January 1 to December 31, 2018. BWXT.

https://www.bwxt.com/bwxt-nec/safety/our-compliance-record

21Lachapelle B and Shapiro H. Evironmental Uranium Levels Near 1025 Landsowne Avenue,
Toronto. Toronto Public Health. June 28, 2018. Accessed Feburary 6, 2020 at
https://www.toronto.ca/legdocs/mmis/2018/hl/bgrd/backgroundfile-118124.pdf

22 Ibid.

BOH Agenda - Feb 12 2020

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23A Licence Renewal BWXT Nuclear Energy Canada Inc.: Application to renew licence for the
Toronto and Peterborough Facilities. Canadian Nuclear Safety Commission.
http://www.nuclearsafety.gc.ca/eng/the-commission/hearings/cmd/pdf/CMD18/CMD20-
H2.pdf

24 Ibid.

25O. Reg. 419/05: Air Pollution - Local Air Quality. Government of Ontario.
https://www.ontario.ca/laws/regulation/050419

26A Licence Renewal BWXT Nuclear Energy Canada Inc.: Application to renew licence for the
Toronto and Peterborough Facilities. Canadian Nuclear Safety Commission.
http://www.nuclearsafety.gc.ca/eng/the-commission/hearings/cmd/pdf/CMD18/CMD20-
H2.pdf

27O. Reg. 419/05: Air Pollution - Local Air Quality. Government of Ontario.
https://www.ontario.ca/laws/regulation/050419

28A Licence Renewal BWXT Nuclear Energy Canada Inc.: Application to renew licence for the
Toronto and Peterborough Facilities. Canadian Nuclear Safety Commission.
http://www.nuclearsafety.gc.ca/eng/the-commission/hearings/cmd/pdf/CMD18/CMD20-
H2.pdf

BIBLIOGRAPHY:

A Review of Human Carcinogens. Part D: Radiation. International Agency for Research on

Cancer. https://monographs.iarc.fr/wp-content/uploads/2018/06/mono100D.pdf

Annual Compliance Monitoring Report January 1 to December 31, 2018. BWXT.

https://www.bwxt.com/bwxt-nec/safety/our-compliance-record

Canadian Soil Quality Guidelines for Uranium: Environmental and Human Health. Canadian
Council of Ministers of the Environment
https://www.ccme.ca/files/Resources/supporting_scientific_documents/uranium_ssd_soil_1.2.
pdf

Guidelines for Canadian Drinking Water Quality Guideline Technical Document Uranium. Health
Canada. https://www.canada.ca/en/health-canada/services/publications/healthy-
living/guidelines-canadian-drinking-water-quality-guideline-technical-document-uranium.html

Guidelines for Canadian Drinking Water Quality Summary Table. Health Canada.
https://www.canada.ca/en/health-canada/services/environmental-workplace-health/reports-
publications/water-quality/guidelines-canadian-drinking-water-quality-summary-table.html

BOH Agenda - Feb 12 2020

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Hazards of liquid hydrogen: Position paper. Health and Safety Laboratory, UK.
https://www.hse.gov.uk/research/rrpdf/rr769.pdf

Nuclear Safety and Control Act. Minister of Justice. https://laws-lois.justice.gc.ca/eng/acts/n-

28.3/

Radiation, People And The Environment. International Agency for Atomic Energy.
https://www.iaea.org/sites/default/files/radiation0204.pdf

Radiation Protection Regulations. Minister of Justice. https://laws-

lois.justice.gc.ca/eng/regulations/sor-2000-203/

Sources, Effects And Risks Of Ionizing Radiation. United Nations Scientific Committee on the
Effects of Atomic Radiation.
http://www.unscear.org/docs/publications/2016/UNSCEAR_2016_Report.pdf

Toxicological Profile For Uranium. . U.S. Department Of Health And Human Services Public
Health Service Agency for Toxic Substances and Disease Registry.
https://www.atsdr.cdc.gov/ToxProfiles/tp150.pdf

BOH Agenda - Feb 12 2020

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 APPENDIX A

Jackson Square, 185 King Street, Peterborough, ON K9J 2R8

P: 705-743-1000 or 1-877-743-0101
F: 705-743-2897
peterboroughpublichealth.ca

January 27, 2020

Canadian Nuclear Safety Commission

280 Slater Street, P.O. Box 1046, Station B
Ottawa, ON K1P 5S9

Dear Canadian Nuclear Safety Commission Members,

RE: Application for Renewal of the BWXT Nuclear Energy Canada Inc. Class 1B Fuel Facility Operating
Licence for the facilities in Toronto and Peterborough, Ontario

Please accept this written submission with respect to the above-mentioned licence renewal for BWXT Nuclear
Energy Canada Inc. (BWXT NEC). The comments made in this submission pertain to the Peterborough BWXT
facility, which falls within the geographical jurisdiction served by the Board of Health for the Peterborough
County-City Health Unit (operating name, Peterborough Public Health (PPH)).

According to Ontario’s Health Protection and Promotion Act (HPPA), a medical officer of health shall
investigate complaints regarding potential hazards related to occupational or environmental health in the
health unit.1 In addition, the HPPA requires medical officers of health to stay informed on matters related to
occupational and public health.2 As such, PPH has been engaged with community members, CNSC staff, the
Ministry of Environment, Conservation and Parks, the City of Peterborough, and Public Health Ontario, as well
as directly with BWXT in relation to the license renewal.

When considering whether or not the licence renewal should be approved, PPH urges commission members
to consider the location of the BWXT NEC Peterborough facility. It is located within a residential
neighbourhood and adjacent to an elementary school. The playground for the youngest children in the school
is across the road from the facility. Should the licence be renewed to allow BWXT to continue operating, it
would be essential to ensure that the surrounding community has the information it requires, in a timely and
transparent manner, to reassure residents that environmental emissions are not posing a risk to health. In our
opinion, strengthening the relationship with, and accountability to, the surrounding residential neighbourhood
presents a challenging but worthwhile endeavour for any long term operation of BWXT in Peterborough.

PPH has reviewed the Commission Member Document (CMD) submitted by CNSC staff, dated December 20,
20193 regarding the BWXT Nuclear Energy Canada Inc. Application to renew licence for the Toronto and
Peterborough Facilities. Upon review of this document, PPH believes that the recommendations proposed by
CNSC staff in the CMD will help to ensure that if the uranium dioxide pelleting operations are relocated to
Peterborough, emissions from the Peterborough BWXT facility can be controlled and maintained at levels that
are protective for the community’s health. However, we believe the implementation of recommendations and
licence conditions proposed by CNSC staff, including those outlined in Licence Conditions 15.1: Environmental
Monitoring and 15.2: Commissioning Report4, are critical prior, and not subsequent, to the approval of any
changes in operations at the Peterborough BWXT facility, including the initiation of pelleting operations.

BOH Agenda - Feb 12 2020

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Current data for emissions of uranium in water and air at the Peterborough facility is published in the facility’s
annual compliance reports. Additionally, the Independent Environmental Monitoring Program (IEMP) provides
additional sample results. Although reassuring, these snapshots do not provide PPH with enough data upon
which to base, with confidence, a recommendation regarding the safety of the facility. It appears that the
uranium emissions into air and water are far below the level that would impact human health, but we would
appreciate a much more robust data set to support our assertions. It would be beneficial for this purpose for
the IEMP to expand the number and location of samples collected and include additional air monitoring for
uranium and beryllium.

In addition, we note what appears to be an upward trend of beryllium present in the results of the soil
monitoring conducted as part of the IEMP.5 The samples show an upward trend in the presence of beryllium in
soil testing conducted in 2014, 2018 and 2019. The latest results did not become available until after the CMD
had been posted. The upper limit has been steadily increasing: 1.1 mg/kg (2014) 1.34mg/kg (2018) and 2.34
mg/kg (2019). Although the results continue to be below the CCME Soil Quality Guidelines (4.0 mg/kg), the
results are approaching the guideline and require further study to determine if there are fugitive beryllium
emissions from the facility.

A comprehensive and robust monitoring program is quintessential to prevent exposure and protect public
health. According to the current licence, monitoring for beryllium is not required at or outside of the fence
line. The facility does conduct continuous in-stack monitoring. Given the trends in the soil samples collected as
part of the IEMP, additional environmental monitoring outside of the fence of the facility should be
considered, including air monitoring in areas where soil samples have been collected as part of the IEMP.

As the beryllium results have recently come to light, it would be most prudent to investigate with the
establishment of a more comprehensive environmental monitoring program to be done first, prior to the
decision regarding the renewal of the licence and/or the moving of the pelleting process to the Peterborough
site. It would be our recommendation that this monitoring should be undertaken with the full participation of
representatives of the local community.

Further to the licence conditions outlined by CNSC staff in the CMD, Peterborough Public Health encourages
commission members to consider these additional recommendations:

1. That BWXT implement a comprehensive environmental monitoring program to provide sufficient

data to assess the full extent of uranium and beryllium emissions in the surrounding area prior to
any decision regarding renewal of the licence and the addition of pelleting at the Peterborough site.
2. That the BWXT Peterborough facility retain the services of an independent, neutral third party for
soil, water, and air testing for Uranium and Beryllium, as appropriate, and publicly share all reports
and test results in their entirety; and
3. That the BWXT Peterborough facility establish a Community Liaison Committee (CLC) in
Peterborough, similar to that which has been established in Toronto.

We believe that these additional measures will help to increase the level of confidence that our community
has in sampling results and will help to ensure that, moving forward, community concerns will be heard and
addressed.

Peterborough Public Health plans to attend the public hearings in Peterborough on March 5 and 6, 2020 in
order to address any public health-related questions from commission members.

BOH Agenda - Feb 12 2020

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Thank you in advance for considering this submission.

Sincerely,

Original signed by

Rosana Salvaterra, MD, CCFP, MSC, FRCPC

Medical Officer of Health

1
Health Protection and Promotion Act, R.S.O. 1990, c. H.7, s. 11(1) https://www.ontario.ca/laws/statute/90h07#BK12
(January 14, 2020)
2
Ibid. s. 12(1)
3
Canada. Canadian Nuclear Safety Commission. BWXT Nuclear Energy Canada Inc. Application to renew licence for the Toronto and
Peterborough Facilities.CMD 20-H2. December 20, 2019.
4
Ibid. pp. 223 – 226.
5
Canada. Canadian Nuclear Safety Commission. Environmental Protection Review Report: BWXT Nuclear Energy Canada Inc.Toronto
and Peterborough Facilities – FFOL – 3620.01/2020 Licence Renewal. e-Doc 6018621 (PDF). December 20, 2019.

BOH Agenda - Feb 12 2020

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PETERBOROUGH PUBLIC HEALTH
BOARD OF HEALTH

TITLE: Staff Presentation: Annual Service Plan 2020

DATE: February 12, 2020
PREPARED BY: Donna Churipuy, Director of Public Health Programs and Chief Nursing
Officer
APPROVED BY: Dr. Rosana Salvaterra, Medical Officer of Health

PROPOSED RECOMMENDATIONS

That the Board of Health for Peterborough Public Health:

- receive the staff presentation, Annual Service Plan 2020, for information; and,
- approve the submission of the Annual Service Plan to the Ministry of Health, in
principle.

ATTACHMENTS

Attachment A - Presentation

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 Annual Service Plan: 2020

Dated: February 12, 2020

Presenter: Donna Churipuy

Proposed Recommendation
That the Board of Health for Peterborough
Public Health:
• receive the staff presentation, Annual Service
Plan 2020, for information; and,
• approve the submission of the Annual Service
Plan to the Ministry of Health, in principle.

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 What is the Annual Service Plan?
• Budget expenditures and high level program
plans for Ministry of Health funded standards
• Description of the programs and interventions
that the Board is planning to deliver in
accordance with the OPHS
• Based on local needs and program level
budgets

What are its Components?

• Organized according to the Standards
– Narrative detail and budget financial data is required
for each standard
• Community Assessment
– Community Needs and Priorities
• Process oriented questions – how do we assess community
needs
– Priority Populations
• High level description
– Unique Challenges and Risks

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 The following Programs are included:
• Foundational Standards
– Population Health Assessment
– Health Equity
– Effective Public Health Practice
– Emergency Management
• Chronic Disease Prevention and Well-being
• Food Safety
• Healthy Environments
• Healthy Growth and Development
• Immunization
• Infectious and Communicable Diseases Prevention and Control
• Safe Water
• School Health
• Substance Use and Injury Prevention

Foundational Standards Include

• Population Health Assessment

– Description
• Evaluation and research projects
• Role of BOH in research
• Engagement with health care and other partners
• Health Equity
– Description
• Incorporation of health equity approach in all programs and
services
• Identification of strategies to reduce health inequities
• Role of Social Determinants of Health Public Health Nurses
in this work

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• Effective Public Health Practice
– Description
• Program planning, evaluation and evidence-informed
decision making
• Research, knowledge exchange and communication
• Quality and transparency
• Emergency Management
– Description (planning, communication, recovery,
capacity building, evaluation)
– Objectives
– Key partners

Program Standards must address

• Community needs and priorities
– Key data and information
– Determination of priorities
• Key partners and stakeholders
– Internal and external
• Programs
– Descriptions
– Objectives
– Interventions (descriptions)

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 What else must be included?
• Staff allocation to programs
• MOH and Administration
• Allocation of Expenditures
• Budget Summaries
• One-time Requests
• Board of Health Membership
• Apportionment of BoH costs
• Key Contacts and Certification

Guided by our “Theory of Change”

Intended Impact Statement
By 2025, priority populations residing in
Peterborough County and City, and Hiawatha
and Curve Lake First Nations, will experience an
increase in the number of healthy years lived.

Results Chain
• The proposed results chains spans the levels
within the socio-ecological model to
contribute to the Intended Impact.

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 Strategies
There are four categories of strategies.
Each contributes to the Results Chain.

Health Equity Analysis, Modifying and

Engaging in
Assessing and Policy Development and Orienting Public
Multi-Sectoral
Reporting Advancing Healthy Public Health
Collaboration
Policies Interventions

Community Assessment

• How do we identify needs/priorities?

• Priority populations
• Unique about Peterborough

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 Chronic Disease Prevention
and Well-being
• Community Needs and Priorities
– Cancer and circulatory diseases are the leading
causes of death.
– 3102 low income seniors living in Peterborough
County and City (2016 Census)
– Between 2003 and 2017, there were 12,449 ED
visits due to dental issues among Peterborough
residents with an average of 830 visits per year.

Chronic Disease Prevention

• Programs
– Blue and Green Spaces
– Healthy Eating
– Healthy Kids Community Challenge/Keeping Kids
Healthy
– Ontario Seniors Dental Care Program
– Non-mandatory Oral Health Programs
– Skin Cancer Prevention Program
– Menu Labelling Program

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Chronic Disease Prevention: Programs
Blue and Green Spaces
Families with children living on low income have been
identified as the priority population for interventions.
• The objectives :
• Increase partners and stakeholder knowledge about
importance of health promoting blue and green spaces and
children’s play
• Build capacity for partners and stakeholder to increase access
to blue and green spaces and opportunities for play
• Provide information and perspective for community planners
and providers of healthy play spaces
• Interventions
– Access to blue and green spaces
– Active transportation
– Access to recreation

Chronic Disease Prevention: Programs

Healthy Eating
Priority population includes families and children living on low
income.
• Program Objectives:
– Provide opportunities to increase food literacy
– Provide support to child care facilities to develop and
implement healthy eating policies
– Provide support to child care facilities to incorporate healthy
eating into curriculum
• Interventions
– Food Literacy
– Food Environments
– Access to Healthy foods

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Chronic Disease Prevention: Programs
Healthy Kids Community Challenge/Keeping Kids
Healthy
• Program Objectives:
– Implement activities to improve healthy behaviours
among children related to healthy eating and physical
activity.
– Increase the number of activities that promote
systems change and improved collaboration between
partners
• Interventions
– HKCC Coordination

Chronic Disease Prevention: Programs

Ontario Seniors Dental Care Program
• Objectives:
– To increase and ensure easy access among low income seniors to
preventive, treatment and prosthodontic services by December 31,
2020.
– To ensure that the OSDCP meets the needs of the priority population.
– To increase awareness among community organizations of the impacts
of poor oral health and opportunities for preventive and treatment
services.
• Interventions:
– Oral Health Navigation
– Clinical Services
– Specialty Services
– Dentures

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Chronic Disease Prevention: Programs
Non-Mandatory Oral Health Programs
• Program Objectives:
– Provide access to preventive and early treatment
dental services to eligible adults that may not
otherwise be able to access them.
• Interventions
– Preventive and Treatment Services

Chronic Disease Prevention: Programs

Skin Cancer Prevention
Priority population for this program is adolescents.
• Program Objective: To ensure compliance with the Act and reduce the incidence of
skin cancer.
• Interventions:
– Inventory
– Inspections
– Public Disclosure

Menu Labelling
• Program Objective: To ensure compliance with the Act and increase awareness of
energy content of food
• Interventions:
– Inventory
– Inspection
– Reporting

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 Food Safety
• Community Needs and Priorities
– There are 1152 food premises within the City and
County of Peterborough Fully subsidized food handler
courses for volunteers, home based childcare
providers etc.
– Develop risk assessment policies and standard process
for all Farmers' Markets and Special Events
– Further explore regulations and promotions of
cultural foods and the creation of a local perspective
will be explored
– Cultural safety/humility training/education for PHIs

Food Safety
• Objectives
– Increase access to food handler courses especially among
priority pop’ns
– Prevent the incidence of foodborne illness within the
community.
– Maintain a reliable and current system for public disclosure
Enhance public awareness and use of the disclosure system.
– Collaborate with First Nation partners to provide food safety
inspection services, as requested.
• Programs
– Inspections
– Education
– Enhanced Food Safety

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 Food Safety: Programs
• Inspections
– Emphasis will be placed on the inspection of food
banks and community feeding organizations to protect
priority populations
• Education
– Offer food handler courses only to those who live or
work in PCCHU or CLFN or HFN
– Development and dissemination of educational
resources re Food Safety practices surrounding the
use of Traditional Foods for our Indigenous population

Food Safety: Programs

Enhanced Food Safety
– Dedicated webpage for disclosure of farmers’
markets
– Develop risk assessment tool for special events

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 Healthy Environments
Community Needs and Priorities
• In 2019, PHIs responded to approximately 135 complaints
related to potential Health Hazards within private
residences.
• The following facilities are routinely inspected:
– 8 facilities that house migrant farm workers
– 6 recreational camps
– 10 funeral homes
– 13 arenas
• In 2019, application was submitted by BWXT Nuclear
Energy Canada Inc. to renew and expand their license for
the Peterborough facility through the Canadian Nuclear
Safety Commission

Healthy Environments

• Programs
– Surveillance and Monitoring
– Inspections and Investigations
– Climate Change

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 Healthy Environments: Programs
Surveillance and Monitoring
• Objectives
– Reduce the exposure to health hazards
– Identify risk factors and priority health needs
• Interventions:
– Local Environmental and Public Health Hazards
– Radon Monitoring
– Stakeholder Engagement

Healthy Environments: Programs

Inspections and Investigations
• Objectives:
– To ensure compliance with HPPA and regulations
• Interventions
– Inspections and Re-inspections of Facilities
– Response to complaints
– Disclosure
– 24/7

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 Healthy Environments: Programs
Climate Change
• Objectives:
– Achieve compliance with protocol
– Reduce impact of extreme temperature on human
health
• Interventions
– Heat alerts
– Cold alerts
– Community Health Vulnerability Assessment and
Adaptation Plan
– Communication campaign

Healthy Growth and Development

Community Needs and Priorities
• higher neonatal and overall infant mortality rates a higher rate of
high birth weight (HBW) and large for gestational age (LGA) babies
• higher rate of congenital heart defects
• twice the proportion of mothers smoke tobacco at admission
• higher proportion of mothers who report using alcohol or an illicit
substance during pregnancy.
• higher rates of hospitalization of infants affected by maternal use of
addictive drugs
• breastfeeding rates higher than Ontario’s
• a notable increase in the proportion of children vulnerable in one or
more Early Development Instrument (EDI) domains over the last ten
years;

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Healthy Growth and Development
• Program Interventions
– ACEs
– Infant Feeding
– Access to parenting supports
– Perinatal health
– Basic Needs

Healthy Growth and Development:

Programs
ACEs
Priority populations are lone parents, particularly female-led lone parent
families
Objectives
– Promote awareness and provide health education to support positive
parenting, healthy growth and development and perinatal health
– Increase public awareness and knowledge, skills, environments and
policies to support positive parenting and healthy growth and
development
• Interventions:
- PHO and Healthy Growth and Development Evidence Network
– Determine public health intervention
– Community engagement
– Theory of change

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 Healthy Growth and Development:
Programs
Infant Feeding
• Objectives:
– Foster infant feeding best practices including
breastfeeding
• Interventions
– Maintain principles of BFI
– Coordinate education activities
– Collaboration on breastfeeding promotion
– Surveillance

Healthy Growth and Development:

Programs
Access to parenting supports
Objectives
Improve language and literacy skills and promote learning
– Provision of resources and supports
– Health promotion campaigns and targeted education
– Positive parenting training
– Provision of screening tools and referral information
Perinatal Health
Objectives
Enhance healthy growth and development
• Prenatal education
• Provision of resources
• Networks and collaboratives
• Tobacco cessation

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 Healthy Growth and Development:
Programs
Basic Needs
Objective
Support community coalitions/networks to influence
policy related to SDOH and health inequities.
– Quality child care
– Better employment opportunities
– Work with partnerships to plan and implement
activities that increase access to basic needs
– Participate in key networks to support HG&D and
public health practice

Immunization: Programs
• Percent of day nursery attendees adequately immunized for their
age (Q3 2019- 66%; Q3 2018- 43%)
• Number of immunizations administered at the Routine
Immunization Clinic for individuals without a primary health care
provider (Q3 2019- 1532; Q3-2018- 955)
• Number of cold chain inspections (Q3 2019- 117; Q3 2018- 103)
• Percent of Grade 7 students who have completed immunizations
for HPV– by school year (Q3 2019- 70%; Q3 2018-61%)
• Percent of Grade 7 students who have completed immunizations
for hepatitis B – by school year (Q3 2019- 76%; Q3 2018-68%)
• Percent of Grade 7 students who have completed immunizations
for meningococcus – by school year (Q3 2019- 90%; Q3 2018-83%)

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 Immunization: Programs
• Programs:
– Community-Based Immunization Outreach
– Immunization Monitoring and Surveillance
– Vaccine Administration
– Vaccine Management

Immunization Programs
Community-Based Immunization Outreach
• Objective:
– to increase knowledge and confidence related to
immunizations and increase access to vaccine
administration for priority populations
• Interventions
– Collaboration with HCPs
– Collaboration with DSBs
– Collaboration with shelters

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 Immunization Programs
Immunization Monitoring and Surveillance
• Objectives:
– detection of outbreaks, identification of AEFI trends, a
nimble and organized response to a VPD related
outbreaks and increase vaccine coverage rates for
priority populations.
• Interventions
– Data input
– Data analysis
– AEFI reporting
– VPD Outbreak response

Immunization Programs
Vaccine Administration
• Objective:
– to reduce vaccine preventable diseases and increase
the number of adequately immunized individuals
– to increase the uptake of Grade 7 immunizations
• Interventions
– Routine clinics
– School based Clinics
– Catch up clinics
– Influenza clinics

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 Immunization Programs
Immunization Management
• Objective
– to ensure compliance by each premise and avoid
vaccine wastage
Interventions
– PPH Storage and Distribution
– Education and Inspection

Infectious and Communicable

Diseases Prevention and Control
• Community Needs and Priorities
– Chlamydia- 570 cases (5 year average 512)
– Gonorrhea- 66 cases (5 year average 37.8)
– Syphilis- 15 cases (5 year average 5.4)
– Influenza 208 cases (5 year average 143)
– Campylobacter: 42 cases ( 5 year average 33)
– institutional outbreaks - 40 (5 year average 37)
– Significant dental IPAC investigations – 2
– Build capacity among HCPs to diagnose, stage and
treat syphilis

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• In 2019, 283 ticks involving human contact submitted to PPH for testing.
• By the end of July, 2019, 27 of the 153 ticks submitted (17.6%) were
positive for the Borrelia burgdorferi; of the 27 positive ticks, 8 (29.6%)
were from the County.
• In 2018, within PCCHU, six human cases of Lyme disease; there were 624
cases in Ontario.
• In 2019, a total of 781 WNV carrier mosquitos were identified; all were
negative for WNV.
• In 2019, Peterborough Public Health investigated 498 reported potential
rabies exposures; this was a 48% increase in the number of investigations
from 2018.
• In 2019, of the specimens submitted for testing by Peterborough Public
Health, one brown bat was positive for the rabies virus.
• In 2019, 84 residents of the residents living within the geographical area
served by PPH received PEP for potential rabies exposures.

Infectious and Communicable

Diseases Prevention and Control
• Programs
– Vector Borne Disease
– Rabies Prevention and Control
– Zoonotic Disease Surveillance and Monitoring
– Sexual Health
– Management of Infectious Diseases
– IPAC

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 Infectious and Communicable
Diseases Prevention and Control
Vector Borne Disease
• Objective
– Prevent and reduce the number of human cases
with WNv and Lyme disease.
• Interventions
– Lyme Disease Prevention, Surveillance and
Response
– WNv Prevention, Surveillance and Response
– Public Education and Outreach

Rabies Prevention and Control

• Objectives
• Prevent human cases of rabies

• Interventions
– Surveillance and Monitoring
– Investigation of potential human exposure
– Vaccine management and distribution
– Education and prevention
– 24/7 availability

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Zoonotic Disease Surveillance and Monitoring
• Objective
– Reduce the impact of exposure to zoonotic
disease to human health
• Interventions
– Response to reports of zoonotic cases

Infectious and Communicable Diseases

Prevention and Control: Programs
Sexual Health
• Objective
– to prevent and control sexually transmitted and
blood-borne infections (STBBIs) and promote healthy
sexuality and safer sexual practices for priority
populations, cases and contacts.
• Interventions
– Management of STBBIs
– Clinic services
– Collaboration with HCPs and community partners

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 Infectious and Communicable
Diseases Prevention and Control
Management of Infectious Disease
• Objective:
– to reduce the burden of infectious and
communicable diseases of public health
importance
• Interventions:
– Case management
– Outbreak management
– Collaboration with HCPs and community partners

Infectious and Communicable Diseases

Prevention and Control: Programs
IPAC
• Objective:
– to minimize the risk of contracting blood-borne infections
and other infections through surveillance, inspection,
investigation, education, enforcement and reporting.
• Interventions
– Inspection and education
– Investigation of complaints
– Collaboration with local HCPs and community partners

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 Safe Water
Community Needs and Priorities
• Twenty-two (22) public beaches routinely sampled during
the summer months and 326 sampling occurrences.
• 18 occurrences of beaches being posted as having
conditions unsafe for swimming.
• 95 active recreational water facilities routinely inspected by
Peterborough Public Health – 9 wading pools, 7 splash
pads, 65 swimming pools, and 14 public spas (hot tubs).
• 348 Small Drinking Water Systems registered with PPH - 6
are high risk, 77 are medium risk, and 265 are low risk. 47%
of the systems are seasonal and 53% are year-round.

Safe Water

• Programs
– SDWS
– Municipal and Private Drinking Water
– Recreational Water and Facilities
– Seasonal Beach Monitoring

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 Safe Water: Programs
SDWS
• Objective
– Reduce the number of medium-risk SDWS and increase the
number of low-risk SDWS by the end of 2020 by ensuring
owners and operators have completed the required training as
outlined in Directives
– Ensure access to safe drinking water
• Interventions
– Inspections
– Education and training
– Inventory, surveillance and monitoring
– Response to AWQIs
– Public disclosure

Safe Water: Programs

Municipal and Private Drinking Water
• Objective:
– prevent and reduce the burden of water-borne illness
related to drinking water
• Interventions
– Awareness and education
– 24/7 response
– Public disclosure
– Liaison and collaboration
– Fluoride monitoring

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 Safe Water: Programs
Recreational Water and Facilities
• Objective
– Prevent water borne illness
• Interventions
– Surveillance and monitoring
– Inspections
– Education and training
– 24/7 response
– Public disclosure

Safe Water: Programs

Seasonal Beach Monitoring
• Objective
– Prevent water borne illness
• Interventions
– Surveillance and monitoring
– Sampling of public bathing beaches
– Liaison and collaboration
– 24/7 response
– Public disclosure

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 School Health
• Community Needs and Priorities
– Children and youth spend close to 1300 hours per year in
school; next to family, school exerts the greatest influence on
children and youth.
– Three school boards and numerous private schools operate 60
schools;
– Student population is over 18,000.
– Significant home school population in Peterborough and area.
– There are 38 publicly funded elementary schools and 7 private
schools in Peterborough County and City and Curve Lake First
Nation. For the 2018-19 school year, of the 3891 children
screened for oral health 8.43% required urgent care at the time
of screening.

School Health
• Programs
– Oral Health
• HSO
• Oral health assessment and surveillance
– Vision
• Child visual health and vision screening
– Immunization
• Immunization for children in schools and licensed child care
settings
– Other
• Comprehensive School Health
• Industry denormalization

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 School Health: Programs
HSO
• Objectives:
– To increase easy access to and enrolment in preventive
and early treatment dental services to more than 75
unique children and youth that may not otherwise be able
to gain access
– To increase awareness among community organizations,
for example, EarlyON programs, of the HSO program and
the impact of low income on oral health.
• Interventions
– Preventive
– Emerging and Essential

School Health: Programs

Oral Health Assessment and Surveillance
• Objectives:
– To detect and identify children and youth at risk of poor oral
health outcomes and their associated risk factors by the end of
the school year.
– To assess and identify emerging oral health trends among school
children including high intensity schools and use that data to
plan programs, policy and investments.
– To increase awareness of preventive measures for pre-school
age children and their families.
• Interventions
– Oral health screening
– Oral health surveillance

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 School Health: Programs
Child visual health and vision screening
• Objective:
– To increase awareness and access to vision health
and vision screening services including (OHIP
funded) for school aged children among parents
and guardians
• Interventions
– Vision health supports
– Vision screening

School Health: Programs

Immunization
• Objective
– Ensure children are protected through routine immunization.
– Progress towards the National Vaccination Coverage Goals of
95% coverage by age two and seven, and 90% coverage goals for
all adolescents that are 17 years of age.
– To address barriers, PPH will explore offering other options for
parents/guardians to report immunization status to PPH.
• Interventions
– Collection of demographic and immunization information
– Assessments
– Suspension orders

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 School Health: Programs
Comprehensive School Health
• The objectives for 2020:
– School-aged children and youth obtain and sustain optimal health and developmental
potential.
– Monitor and assess needs and opportunities for action in schools, with school boards or
across regional public health units through the collection or use of local data generated at
school level.
– Determine process to prioritize schools based on health inequities.
– Provide support to schools to develop and implement healthy eating policies
– Provide support to schools for implementing H&PE curriculum
• Interventions
– School Health Liaison
– Healthy Schools
– Curriculum supports
– Substance use prevention
– Active and Safe Routes to School
– School Nutrition Program
– Risk Watch

School Health: Programs

Industry Denormalization:
• The objectives for 2020 include:
– Implement a Theory of Change for industry denormalization
focus of work with adolescents in schools
– adapt the Challenges, Beliefs, and Changes (CBC) program to
include decision making skills critical in an industry dominated
environment across topic areas including substance use
(tobacco, vaping, alcohol, cannabis)
– Train secondary school students who in turn will deliver
programing to Gr 8 students preparing to enter secondary
school
• Interventions
– Informed decision making

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 Substance Use and Injury Prevention
Community Needs and Priorities
• Peterborough region has a higher number of smokers and binge drinkers than the
provincial average (Statistics Canada, 2017)
• Self-reported rate of exceeding low-risk alcohol drinking guideline for injury
prevention age standardized rate for both sexes, 2015/16 is 43.7 % in
Peterborough similar to 42.2 % in Ontario (PHO)
• Self-reported underage drinking rate (crude rate both sexes) 52.7% compared to
30.2 % in Ontario (PHO Snap Shots)
• In the first quarter of 2019 the rate of deaths due to opioid poisoning in
Peterborough is 25 per 100,000 compared to the Ontario rate of 12 per 100,000.
In the same time frame, the rate of ED visits due to opioid poisoning in
Peterborough is 161.1 per 100,000 compared to the Ontario rate of 81.7 per
100,000. (PHO)
• Emergency department visits for injuries due to motor vehicle collisions age
standardized (both sexes), 2017 is 768.8 per 100,000 compared to the province at
607.8 per 100,000 (PHO)
• Emergency department visits for injuries due to falls age standardized (both sexes),
2017 is 4050.9 per 100,000 compared to 3150.4 per 100,000 in Ontario. (PHO)

Substance Use and Injury Prevention

Programs
– Harm Reduction Program Enhancement
– Harm Reduction Community
– Substance Use
– Injury Prevention
– Smoke-Free Ontario

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 Substance Use and Injury Prevention
Harm Reduction Program Enhancement
• Objectives:
– To continue the distribution of naloxone.
– Provide at least 6 overdose prevention training sessions.
– To maintain opioid surveillance and early warning system in
collaboration with community partners.
– Provide opioid harm data to community partners on a quarterly basis.
• Interventions:
– Local response
– Naloxone distribution
– Surveillance and early warning

Substance Use and Injury Prevention

Harm Reduction- Community
• Objectives:
– Provide harm reduction services of needle exchange
and provision of disposal equipment to reduce the
burden of STBBIs.
– To increase public awareness around the safe disposal
of found needles.
• Interventions:
– Needle Exchange
– Community harm reduction/found needles

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 Substance Use and Injury Prevention
Substance Use – General
• Objectives:
– Increase knowledge of the Lower Risk Cannabis Use Guidelines
– Increase community knowledge of low risk drinking guidelines
– Increase the capacity of local municipalities and FN
communities in updating developing/implementing municipal
and FN Community alcohol policies.
– Facilitate the creation of environments that support cannabis
and alcohol wise living in community settings
• Interventions:
– Cannabis Misuse Prevention
– Alcohol Misuse Prevention

Substance Use and Injury Prevention

Injury Prevention
• Objectives:
– Support local initiatives that will create complete streets
– Support local initiatives that will create a transportation
safety plan.
– Support community initiatives that promote transportation
safety
– Support community initiatives that promote the
prevention of concussions
• Interventions
– Road safety
– Concussion Prevention Initiatives

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 Substance Use and Injury Prevention
Smoke-Free Ontario
• Objectives:
– Increase quit attempts particularly among youth and priority
populations
– To reduce exposure to second-hand smoke
– Support landlords and tenants to establish and maintain smoke-
free MUDs
– To support ORCA in the development and implementation of
smoke-free policies
– To support implementation/enforcement of local smoke-free
by-laws and the SFOA
– To collaborate with municipal partners for the cooperative
enforcement of the SFOA in municipally-owned public spaces
and review success of such collaborations on a quarterly basis.

Substance Use and Injury Prevention:

Programs
SFO
• Interventions:
– Tobacco/Cannabis Wise Living (prevention,
cessation, protection)
– Enforcement
– Prosecution

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 2020 Budget Allocation
Expenses

FS CDPW FS HE HGD IMM ICDPC SW SH-OH SH-VIS SH-COMP SH- IMM SIP PHA

2019/2020 Comparison by Standard

Program Standard 2019 2020 Change
Healthy Growth and 863,008 763,994 -126,014
Development
Immunization 390,110 554,621 +164,551
Food Safety 435,517 482,620 +47,103
Safe Water 417,040 421,557 +4,517
Infectious and 1,706,947 1,701,056 -5,891
Communicable
Disease Prevention
and Control

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 2019/2020 Comparison by Standard
Program Standard 2019 2020 Change
School Health – 966,066 968,382 +2,316
Oral Health
School Health – 29,540 31,825 +2,285
Vision Screening
School Health – 187,127 174,502 -12,625
Immunization
School Health – 391,290 364,120 -27,170
Comprehensive

2019/2020 Comparison by Standard

Program Standard 2019 2020 Change
Foundational 916,768 909,164 -7,604
Standards
Chronic Disease 1,629,075 1,643,823 +14,748
Prevention
Healthy Envt. 210,450 357,200 146,750
Substance Use and 1,272,343 1,249,179 -23,164
Injury Prevention
Public Health 1,637,379 1,586,228 -51,151
Administration
Total 11,052,660 11,181,271 +128,611

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PETERBOROUGH PUBLIC HEALTH
BOARD OF HEALTH

TITLE: Correspondence for Direction – Provincial Immunization Registry

DATE: February 12, 2020
PREPARED BY: Patti Fitzgerald, Manager, Infectious Diseases
APPROVED BY: Dr. Rosana Salvaterra, Medical Officer of Health

PROPOSED RECOMMENDATIONS

That the Board of Health for Peterborough Public Health:

 receive correspondence from the City of Hamilton Board of Health, dated October 30,
2019, and correspondence from the Council of Ontario Medical Officers of Health
(COMOH), dated March 19, 2019, for information; and,
 support their positions related to a provincial immunization registry and communicate
this support to the Ontario Minister of Health, with copies to the Ontario Chief Medical
Officer of Health, local MPPs, Opposition Health Critics, COMOH, the Association of
Local Public Health Agencies (alPHa) and Ontario Boards of Health.

BACKGROUND

Correspondence from City of Hamilton Board of Health (Attachment A) was forwarded to all
Ontario Boards of Health on October 30, 2019. PPH supports their recommendation that a
seamless immunization registry would address several of the challenges with the current
system, including:
 eliminating the burden of parents/guardians needing to report vaccines to local public
health agencies;
 reducing the risk of inaccurate information being reported by parents/guardians;
 reducing staff time and resources needed to manually input vaccine records; and
 reduce the number of suspension due to the lack of reporting by parents/guardians.

In a letter to Minister Elliott dated March 14, 2019 (Attachment B), COMOH communicated
their full support to the Ministry of Health for moving forward with Electronic Medical Records
and Digital Health Immunization Repository Integration Project. PPH is in agreement that
seamless reporting of immunizations from health care providers directly to local public health
agencies will not only address the challenges as stated above, but will also assist in the
investigation of outbreaks of vaccine preventable diseases when they occur. Having one
database containing immunization records will allow for a quick identification of those
individuals who are susceptible and vulnerable. In addition, an immunization registry aligns
with the Ministry of Health’s intent to create efficiencies and improve outcomes by introducing
technology solutions into health care.

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ATTACHMENTS

Attachment A: City of Hamilton Board of Health Letter

Attachment B: COMOH Letter

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PETERBOROUGH PUBLIC HEALTH
BOARD OF HEALTH

TITLE: Correspondence for Information

DATE: February 12, 2020
PREPARED BY: Alida Gorizzan, Executive Assistant
APPROVED BY: Dr. Rosana Salvaterra, Medical Officer of Health

PROPOSED RECOMMENDATIONS

That the Board of Health for Peterborough Public Health receive the following for information:

a. Letter dated January 16, 2020 to Health Canada regarding Vaping Products Promotion
Regulations.

b. Letter dated January 20, 2020 to MPP Smith regarding provincial appointments to the Board
of Health.

c. Letter dated January 22, 2020 to Minister Elliott regarding e-cigarette and aerosolized
product prevention and cessation.

d. Letter dated January 24, 2020 to Chief Administrative Officers for the City, County and
Lower-Tier Municipalities regarding off-road vehicles. Similar letters were also sent to
Curve Lake First Nation and Hiawatha First Nation.

e. Letter dated January 29, 2020 to Ministers Mulroney and Elliott regarding off road vehicles.

f. E-newsletter dated February 3, 2019 from the Association of Local Public Health Agencies
(alPHa).

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 Jackson Square, 185 King Street, Peterborough, ON K9J 2R8
P: 705-743-1000 or 1-877-743-0101
F: 705-743-2897
peterboroughpublichealth.ca

January 16, 2020

Tobacco Products Regulatory Office

Tobacco Control Directorate,
Controlled Substances and Cannabis Branch,
Health Canada
150 Tunney’s Pasture Driveway,
Ottawa, ON K1A 0K9
Sent via e-mail: [email protected]

To whom it may concern:

Re: Canada Gazette, Part I, Volume 153, Number 51: Vaping Products Promotion Regulations

Foremost we wish to congratulate Health Canada for exploring the necessary steps to further protect
Canadians, especially young Canadians, from the yet to be fully understood long-term health effects of vaping.

The Vaping Products Promotion Regulations (proposed Regulations) are an overdue but essential step in
mitigating some of the harms that come from youth vaping. That said, Peterborough Public Health (PPH)
would recommend that the proposed Regulations be implemented such that they mirror the regulations
currently in place for conventional tobacco products. Using the evidence that has guided conventional tobacco
control for decades would increase enforcement effectiveness and efficiencies, promote health equity, and
increase vendor compliance, all while further protecting the health of all Canadians.

Part 1 — Advertising and Point of Sale Promotion

We agree with Health Canada that “Simply requiring visitors to ‘check the box’” as described in the proposed
Regulations is not enough to restrict online sales, and welcome more stringent controls to verify that the
person visiting the e-cigarette website is in fact the age they claim to be.

With regards to Point of Sale (POS) advertising, we agree that “Only black characters on a white background
would be permitted and no visual, sound or other effects would be permitted that may draw attention to it” is
a good start. However, we would encourage Health Canada to consider further restrictions on the copy of
these signs, as advertising flavours could be seen as proprietary promotion. For example, this is how two
brands distinguish themselves between similar flavours:

 JUUL “Vanilla” versus VYPE “Infused Vanilla”;

 JUUL “Mango” versus VYPE “Ripe Mango”; and,
 JUUL “Mint” versus VYPE “Crisp Mint”.1,2
Further restrictions are recommended, otherwise e-cigarette brands could be identified through the signage.

BOH Agenda - Feb 12 2020

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Permitting the promotion of vaping products through pamphlets and brochures upon the request of an adult
could increase the chances that youth are involuntarily exposed to these documents; forgotten or misplaced
pamphlets and brochures left at the POS increases the risk to youth. Our recommendation is that all
promotion of vaping products that youth have access to (i.e., convenience stores, gas stations, etc.) be
prohibited the same as conventional cigarettes.

POS advertising has long been a strategy used by the tobacco, and now vaping industries, to target potential
customers. However, there is a disparity between how, where and to whom these products are marketed.
“Certain racial and ethnic communities, low-income communities, and LGBTQ communities are exposed to
more POS advertising, live in places with a higher concentration of retailers that sell tobacco products, and
have a higher prevalence of smoking”3 than their peers that aren’t at risk. Furthermore, the tobacco industry’s
own documents show that this marketing tactic is not a coincidence.4

To ensure health equity and positive health outcomes, all POS advertising where youth have access to needs
to be prohibited.

Part 2 - Required Information in Advertising

Many proponents of vaping argue that nicotine is as “harmless as caffeine”.5 However nicotine is not a
harmless substance,6 and the main purpose for vaping devices is nicotine delivery.7,8,9 Despite this
information, a recent focus group identified concerning trends among the younger participants in the study.
This study found that participants were not concerned about becoming addicted to nicotine, and most had not
observed any health related warnings about these products.10 A recent study of Ottawa, Ontario high school
students found that “48 per cent mistakenly believe that even regular vaping doesn't pose a health a risk”. 11
Furthermore, a 2019 study about health warnings and e-cigarettes noted that “the most promising warnings
include health hazards (other than nicotine addiction) and imagery.” 12 As such, any health warnings that are
included in the proposed regulations must alert people to the fact that using an e-cigarette comes with a
variety of potential harms including, but not limited to, nicotine addiction.13

Restricting the advertising of vaping products at POS and enhancing health warnings of these products is a
critical first step. However, in light of the most recent survey data that shows a doubling of e-cigarette use by
Canadian youth from 2016-17 to 2018-19,14 it is clear that a comprehensive and fulsome approach needs to be
deployed to address this issue.15

Dr. Sandy Buchman, the Canadian Medical Association president, notes that “immediate action is needed to
respond to the crisis in youth vaping. We have enough evidence from decades of work in tobacco control. We
don’t have to reinvent the wheel. What we need is political commitment.”16 To this end we look forward to
working with Minister Hajdu and other local leaders to protect Canadian youth from the vaping industry.

Respectfully,

Original signed by

Rosana Salvaterra, MD, MSc, CCFP, FRCPC

Medical Officer of Health

/ag

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1
https://www.juul.ca/en-CA/shop/pods
2
https://govype.ca/buy-online/vype-epen-3-cartridges
3
https://countertobacco.org/resources-tools/evidence-summaries/health-equity-and-point-of-sale-tobacco-control-
policy/?ct=t(Counter_Tobacco_2019_December)
4
https://tobaccocontrol.bmj.com/content/23/e2/e139
5
https://tobacco.ucsf.edu/nicotine-not-caffeine
6
https://otru.org/wp-content/uploads/2017/02/update_feb2017.pdf
7
https://www.juul.ca/en-CA/our-technology
8
https://govype.ca/faq
9
https://logicvapes.ca/faq/why-do-your-e-liquids-contain-nicotine-salts/
10
https://www.otru.org/wp-content/uploads/2019/03/otru_projectnews_mar2019.pdf
11
https://www.cbc.ca/news/canada/ottawa/youth-vaping-epidemic-ottawa-public-health-1.5178586
12
https://tobaccocontrol.bmj.com/content/early/2019/07/10/tobaccocontrol-2018-054878
13
https://www.nap.edu/resource/24952/012318ecigaretteConclusionsbyEvidence.pdf
14
https://www.canada.ca/en/health-canada/services/canadian-student-tobacco-alcohol-drugs-survey/2018-2019-summary.html
15
http://smoke-free-canada.blogspot.com/2019/12/response-to-health-canadas-proposals-to.html
16
https://www.cma.ca/immediate-action-needed-respond-crisis-youth-vaping-cma-among-health-groups-calling-federal-action

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 Jackson Square, 185 King Street, Peterborough, ON K9J 2R8
P: 705-743-1000 or 1-877-743-0101
F: 705-743-2897
peterboroughpublichealth.ca

January 20, 2020

Mr. Dave Smith, M.P.P. Peterborough-Kawartha

1123 Water Street, Unit 4
Peterborough, ON K9H 3P7
Sent via email: [email protected]

Dear M.P.P. Smith,

As you know, the Board of Health for the Peterborough County-City Health Unit (operating name -
Peterborough Public Health) is an autonomous board, and has a complement of five provincially-appointed
representatives. This year, terms for the following members are set to expire:
 Catherine Praamsma, April 26, 2020
 Michael Williams, April 26, 2020
 Kerri (Keryl) Davies, October 21, 2020
 Gregory Connolley, November 18, 2020

With the exception of Michael Williams, the remaining three members have expressed interest in renewing
their terms. At its meeting on January 8th, the board supported these renewals given the valued contributions
of these members and their dedication to public health in Peterborough City and County.

We hope that the Province will be able to make a timely decision on this matter so that our board of health
will benefit from full and robust membership. We thank you in advance for your consideration of this request,
should you have any questions or concerns, please do not hesitate to contact us.

Sincerely,

Original signed by

Mayor Andy Mitchell

Chair, Board of Health

/ag

cc: Dr. Rosana Salvaterra, Medical Officer of Health

Public Appointments Unit, Ministry of Health

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 Jackson Square, 185 King Street, Peterborough, ON K9J 2R8
P: 705-743-1000 or 1-877-743-0101
F: 705-743-2897
peterboroughpublichealth.ca

January 22, 2020

The Honourable Christine Elliott

Minister of Health
10th Floor, Hepburn Block
80 Grosvenor Street
Toronto ON M7A 2C4
Sent via e-mail: [email protected]

Dear Minister Elliott:

At its meeting on December 11, 2019, the Board of Health for Peterborough Public Health received
correspondence from Public Health Sudbury & Districts (enclosed) regarding e-cigarette and aerosolized
product prevention and cessation.

Foremost, we wish to congratulate the Ministry for the recently announced changes to the Smoke-Free
Ontario Act that, effective January 2020, ban the promotion of e-cigarettes/vapour products in corner stores
and gas stations. The Board of Health for Peterborough Public Health also urges the adoption of an expert-
informed comprehensive tobacco and e-cigarette strategy to address flavoured e-juice, online sales to
minors, treatment program of youth cessation and public education.

The previous Smoke-Free Ontario Strategy, released in May 2018, provided an updated framework for tobacco
control, guiding direction across the province on tobacco prevention, cessation, protection and enforcement.
Considering the increase in use of vapour products and the ongoing prevalence of tobacco use impacting the
lives of Ontarians, it is a critical in this time of public health modernization for the Ministry of Health to
develop a new comprehensive tobacco and e-cigarette strategy.

A greater proportion of the Peterborough population 12 years and older are currently smoking (2013/2014)
compared to both the province and the Peer Group, at 27.0%, 17.3%, and 20.6% respectively.1 These rates
have the potential to increase with 24.1% of Peterborough area students in grades 9 to 12 trying electronic
cigarettes.2 Further to this, Professor David Hammond of the University of Waterloo, found that among
Ontario youth 16-19 years old, vaping increased by a stunning 74% from 2017 to 2018, from 8.4% to 14.6%. 3

The recent rise in youth addiction to vaping products seen in local secondary schools and requests for
prevention supports in elementary schools, speak to the current situation and the need for a coordinated and
comprehensive tobacco and e-cigarette strategy to improve the health of Ontarians and stay on course for
achieving the lowest smoking prevalence rates in Canada.

We look forward to working with the Ministry and local partners to develop and implement a comprehensive
tobacco and e-cigarette strategy that will ultimately protect the health of all Ontarians.

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Respectfully,

Original signed by

Mayor Andy Mitchell

Chair, Board of Health

/ag
Encl.

cc: Hon. Doug Ford, Premier of Ontario

Dr. David Williams, Ontario, Ontario Chief Medical Officer of Health
Local MPPs
Hon. Doug Downey, Attorney General of Ontario
France Gélinas, MPP, Health Critic
Association of Local Public Health Agencies
Ontario Boards of Health

1
Peterborough County-City Health Unit (2016). Tobacco Use in Peterborough: Priorities for Action Peterborough, ON: Beecroft, K.,
Kurc, AR.
2
During the 2014/2015 school year, the Peterborough County City Health Unit (PCCHU) collected data on 1,358 students at six (out
of nine) different secondary schools across Peterborough with support from the Propel Centre for Population Health Impact at the
University of Waterloo. This represents approximately 15% of the population 15 through 19 according to Statistics Canada’s 2011
Census. Source: University of Waterloo. Canadian Student Tobacco, Alcohol, and Drugs Survey. Available:
https://uwaterloo.ca/canadian-student-tobacco-alcohol-drugs-survey/about
3
Hammond, D., Reid, J., Rynard, V., Fong, G., Cummings, K.M., McNeill, A., Hitchman, S., Thrasher, J., Goneiwicz, M., Bansal-Travers,
M., O’Connor, R., Levy, D., Borland, R., White, C. (2019) Prevalence of vaping and smoking among adolescents in Canada, England,
and the United States: repeat national cross sectional surveys. British Medical Journal 365:l2219.

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 Jackson Square, 185 King Street, Peterborough, ON K9J 2R8
P: 705-743-1000 or 1-877-743-0101
F: 705-743-2897
peterboroughpublichealth.ca

January 24, 2020

Chief Administrative Officers

City of Peterborough
County of Peterborough
Lower-Tier Municipalities
Sent via e-mail

Dear Chief Administrative Officer:

Re: Off Road Vehicles

Peterborough Public Health (PPH) is mandated by the Ontario Public Health Standards and the Health
Promotion and Protection Act to deliver public health programs and services that promote and
protect the health of Peterborough City and County residents.1 One of our stated goals is to reduce
the burden of preventable injuries, where road safety is an important factor. Given the Provincial
government’s recent passing of Bill 107, which includes provisions to change legislation to permit Off-
Road Vehicles (ORVs) on municipal roads, we know many local municipal Councils will be considering
new by-laws or changing current by-laws. As a result, we wanted to provide you with a summary of
recent evidence and local ORV-related death and injury statistics for your consideration. For the
purpose of this letter, the term ORV is inclusive of all-terrain vehicles (ATVs), side-by-side ATVs,
utility-terrain vehicles, and off-road motorcycles (i.e. dirt bikes), and does not include snowmobiles.

The popularity of ORVs has greatly increased over the last 30 years and with increased use, ORV-
related injuries and deaths have also risen.2,3 In 2010 there were 435 ORV users seriously injured and
103 ORV-related fatalities in Canada. This compares to 149 seriously injured users in 1995, and 45
fatalities in 1990.2 These statistics are based on police reported data and medical examiner files.

Hospital records are another source of data where Emergency Department (ED) visits, more serious
hospitalizations, and deaths are identified to be caused by an ORV injury. In 2015 to 2016 in Ontario,
there were over 11,000 ORV-related ED visits and over 1,000 ORV-related hospitalizations.4 There
have been between 29 and 52 fatalities each year relating to ORV or snowmobile use from 2005 to
2012.4 Children and youth aged 0-15 made up approximately 20% of ED visits,4 and 17% of the
hospitalizations and deaths related to ORV use.2,4 However, the most affected demographic group
has been males aged 16-25.2,4 Rollovers, falling off the vehicle, and ejection are the most commonly
cited mechanisms for ORV injury.4 The most common cause of death is due to head and neck
injuries.4

Locally, statistics show that from 2003 to 2018 there were 1,862 ED visits among Peterborough (City
and County) residents resulting from an ORV injury, which is an average of 116 visits per year. During
this same time period, there were 172 hospitalizations as a result of ORV injuries, which is an average

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of 11 per year. When assessing death statistics, from 2001 to 2015 there were 20 deaths as a result
of an ORV incident among Peterborough residents. It is concerning that there seems to be an
increasing trend of ORV-related fatalities. From 2011 to 2015 there were 9 deaths, which is elevated
from the previous five-year periods: 6 deaths during 2006 to 2010, and 5 deaths during 2001 to 2005.
Across ED visits, hospitalizations and deaths, males make up a large proportion of these incidents,
and those aged ten to 29 are highly represented in the statistics. See the Appendix for more
information and data sources.

ORV-related incidents are classified according to whether they occur on roadways (“traffic”)* or off-
roadways (“non-traffic”). Research indicates that there are higher rates of fatalities and serious
injuries for ORV riders on roadways compared to off-roadways.5,6,7 Being on roadways increases the
risk of collisions with other motor vehicles.5,8,9 Also, certain design characteristics of these vehicles,
particularly ATVs, make them unsafe on roadways.5,10 In Peterborough, ORV incidents on roadways
contributed to only 7.7% of ORV-related ED visits, but 14.0% of ORV hospitalizations and 40.0% of
ORV-related deaths. These local statistics demonstrate that ORV injuries as a result of traffic
incidents have a much higher fatality rate when compared to non-traffic incidents. Some of the
associated risk factors related to ORVs used in Ontario include alcohol and drug use, riding at night,
lack of helmet use, and excessive speed.4,11 It has been found that the majority of ORV-related ED
visits occur on the weekend (Friday to Sunday), and almost all are related to recreational use of
ORVs.4

With these factors in mind, in consideration of developing or revising an ORV by-law, we recommend
the following:
 Specify the roads that will permit or prohibit ORV use
o Assess the safety conditions for ORVs to travel along all municipal roads.
Consideration of traffic volume and road shoulder characteristics may lead to
decisions to prohibit ORV use on certain municipal roads.
 Specify speed limits
o As per O. Reg. 316/03 (2018), set maximum speed limits of 20 kilometres per hour, if
the roads speed limit is not greater than 50 kilometres per hour, and 50 kilometres per
hour, if the roads speed limit is greater than 50 kilometres per hour.
 Specify restrictions to time of use
o Prohibit night-time riding. Language that references “dusk to dawn” may address
seasonality of night-time. Restricting access to roads during certain months of the
year may also be considered.
 Emphasize provincial regulations relating to minimum age and safety requirements, such as
requirement to wear an approved helmet.

Finally, we encourage your municipality to determine ways that they can educate users about ORV
road-use laws and the risks of riding on the roads.

In summary, ORV-related accidents continue to be a significant cause of injury, with on roadway

accidents resulting in higher proportions of severe injury (hospitalization) and fatalities than off
roadway accidents. We appreciate your consideration of the health implications of ORVs as you
consider developing or revising your current by-law. Please feel free to use the local statistics we
have provided you, which are summarized in the Appendix for ease of reference.

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If you have any questions or would like additional information about our comments, please contact
Deanna Leahy, Health Promoter, at 705-743-1000 ext. 354, [email protected].

Sincerely,

Original signed by

Rosana Salvaterra, MD, MSc, CCFP, FRCPC

Medical Officer of Health

/ag

References

1. Ontario Ministry of Health and Long-term Care. (2018). Ontario Public Health Standard:
Requirements for Programs, Services, and Accountability. Toronto, ON: Author.
2. Vanlaar, W., McAteer, H., Brown, S., Crain, J., McFaull, S., & Hing, M. M. (2015). Injuries related to
off-road vehicles in Canada. Accident Analysis & Prevention, 75, 264-271.
3. Canadian Paediatric Society. (2015). Are we doing enough? A status report on Canadian public
policy and child and youth health. Ottawa (ON): Canadian Pediatric Society. Retrieved from
http://www.cps.ca/uploads/status-report/sr16-en.pdf.
4. Ontario Agency for Health Protection and Promotion (Public Health Ontario), Chu A, Orr S,
Moloughney B, McFaull S, Russell K, Richmond SA. The epidemiology of all-terrain vehicle- and
snowmobile-related injuries in Ontario. Toronto, ON: Queen’s Printer for Ontario; 2019.
5. Denning, G. M., Harland, K. K., Ellis, D. G., & Jennissen, C. A. (2013). More fatal all-terrain vehicle
crashes occur on the roadway than off: increased risk-taking characterises roadway
fatalities. Injury prevention, 19(4), 250-256.
6. Williams, A. F., Oesch, S. L., McCartt, A. T., Teoh, E. R., & Sims, L. B. (2014). On-road all-terrain
vehicle (ATV) fatalities in the United States. Journal of safety research, 50, 117-123.
7. Denning, G. M., & Jennissen, C. A. (2016). All-terrain vehicle fatalities on paved roads, unpaved
roads, and off-road: Evidence for informed roadway safety warnings and legislation. Traffic injury
prevention, 17(4), 406-412.
8. Yanchar NL, Canadian Paediatric Society Injury Prevention Committee. (2012). Position
statement: Preventing injuries from all-terrain vehicles. Retrieved from
http://www.cps.ca/en/documents/position/preventing-injury-from-atvs.
9. Ontario Medical Association. (2009). OMA Position Paper: All-Terrain Vehicles (ATVs) and
children’s safety. Ontario Medical Review, p. 17–21.
10. Fawcett, V. J., Tsang, B., Taheri, A., Belton, K. & Widder, S. L. (2016). A review on all terrain vehicle
safety. Safety, 2, 15.
11. Lord, S., Tator, C. H., & Wells, S. (2010). Examining Ontario deaths due to all-terrain vehicles, and
targets for prevention. The Canadian Journal of Neurological Sciences, 37(03), 343-349.
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Appendix: Off-Road Vehicle (ORV) Injuries in Peterborough City and County

Emergency Department Visits resulting from an ORV Injury

Data source: Ambulatory Emergency External Cause (Chapter 20), MOHLTC, IntelliHEALTH ONTARIO,
extracted Wednesday August 14, 2019.

Between 2003 and 2018 (16 years), there were:

 1,862 Emergency Department (ED) visits among Peterborough residents resulting from an ORV
injury, which is an average of 116 visits per year;
 Males accounted for 78.1% of these ED visits;
 144 (7.7%) of these visits were a result of a traffic accident;*
 The majority of visits occurred among those aged ten through 29 (53.8%). For traffic accidents
specifically, this age group makes up a similar proportion (49.3%) of visits.

Hospitalizations as a result of ORV injury

Data source: Ambulatory Emergency External Cause (Chapter 20), MOHLTC, IntelliHEALTH ONTARIO,
extracted Wednesday August 14, 2019.

Between 2003 and 2018 (16 years), there were:

 172 hospitalizations among Peterborough residents as a result of ORV injuries which is an average
of 11 per year;
 Males accounted for 87.2% of these hospitalizations;
 24 (14.0%) of these hospitalizations were a result of a traffic accident;
 36.7% hospitalizations occurred among those aged ten through 29. There were smaller but
noticeable peaks in admissions of patients aged between 40 and 45 and between 53 and 56 as
well, contributing to another 25% of hospitalizations collectively.

Deaths as a result of ORV injury

Data source: Ambulatory Emergency External Cause (Chapter 20), MOHLTC, IntelliHEALTH ONTARIO,
extracted Wednesday August 14, 2019.

Between 2001 and 2015 (15 years) there were:

 20 deaths as a result of an ORV among Peterborough residents;
o 9 from 2011 to 2015, rate: 6.6 deaths per 100,000 over 5 years, averaging 1.32 per
100,000 each year.
o 6 from 2006 to 2010, rate: 4.5 deaths per 100,000 over 5 years, averaging 0.90 per
100,000 each year.
o 5 from 2001 to 2005, rate: 3.9 deaths per 100,000 over 5 years, averaging 0.77 per
100,000 each year.
 Males accounted for the large majority (over 80%) of deaths;
 Deaths occurred among persons aged 14 through 71 (median: 40, mean: 37); and eight deaths
(40.0%) were a result of a traffic accident.

Definition
*Traffic accident (incident) - is any vehicle accident occurring on the public highway (i.e. originating on,
terminating on, or involving a vehicle partially on the highway).
Retrieved from: http://apps.who.int/classifications/icd10/browse/2016/en#/V80-V89

ICD-10 Codes included: V86, excluding snowmobiles.

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 Jackson Square, 185 King Street, Peterborough, ON K9J 2R8
P: 705-743-1000 or 1-877-743-0101
F: 705-743-2897
peterboroughpublichealth.ca

January 29, 2020

The Honourable Caroline Mulroney

Minister of Transportation
Sent via e-mail: [email protected]

The Honourable Christine Elliott

Minister of Health
Sent via e-mail: [email protected]

Dear Honourable Ministers,

Re: Off Road Vehicles (ORV) and Bills 107 and 132

Peterborough Public Health (PPH) is mandated by the Ontario Public Health Standards and the Health
Promotion and Protection Act to deliver public health programs and services that promote and protect the
health of Peterborough City and County residents.1 One of our stated goals is to reduce the burden of
preventable injuries, where road safety is an important factor. Given the Provincial Government’s recent
passing of Bills 107 and 132, we anticipate changes to Ontario Regulation 316/03 are being drafted and wish
to express several concerns and propose recommendations to consider. For the purpose of this letter, the
term ORV is inclusive of all-terrain vehicles (ATVs), side-by-side ATVs, utility-terrain vehicles, and off-road
motorcycles (i.e., dirt bikes), and does not include snowmobiles.

The popularity of ORVs has greatly increased over the last 30 years and with increased use, ORV-related
injuries and deaths have also risen.2,3 In Canada in 2010 there were 435 ORV users seriously injured and 103
ORV-related fatalities. This compares to 149 seriously injured users in 1995 and 45 fatalities in 1990. 2 These
statistics are based on police reported data and medical examiner files. Hospital records are another source of
data where Emergency Department (ED) visits, hospitalizations, and deaths may be identified to be caused by
an ORV injury. In Ontario in 2015 to 2016, there were over 11,000 ORV-related ED visits and over 1,000 ORV-
related hospitalizations.4 There have been between 29 and 52 fatalities each year relating to ORV or
snowmobile use from 2005 to 2012.4 The most affected demographic group has been males aged 16-25.2,4
Rollovers, falling off the vehicle, and ejection are the most commonly cited mechanisms for ORV injury.4 The
most common cause of death is due to head and neck injuries.4

ORV-related incidents are classified according to whether they occur on roadways (“traffic”) or off-roadways
(“non-traffic”). Research indicates that there are higher rates of fatalities and serious injuries for ORV riders
on roadways compared to off-roadways.5,6,7 Riding on roadways increases the risk of collisions with other
motor vehicles.5,8,9 Also, design characteristics of certain classes of ORVs make them unsafe on roadways.5,10,11
Indeed, across the border in 2007 it was found that 65% of ATV rider deaths occurred on roads. There was
also a greater increase in on-road than off-road deaths between 1998 and 2007, which coincided with more
states increasing legal ATV access to roads in some way.11

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Some of the associated risk factors related to ORVs used in Ontario include alcohol and drug use, riding at
night, lack of helmet use, and excessive speed.4,12 It has been found that the majority of ORV-related ED visits
occur on the weekend (Friday to Sunday), and almost all are related to recreational use of ORVs. 4

With these factors in mind, in revision of O. Reg 316/03, we recommend the following in PART III:
 Equipment requirements:
o Maintain current* contents of section, ensuring content is up-to-date and is applicable to all
classes of ORVs that will be permitted on roads.
 Operation requirements:
o Maintain current* contents of section and requirements. Specifically:
 Requiring the driver to hold a valid driver’s licence, with restrictions on number of
passengers at night for novice young drivers;
 Requiring all riders to wear an approved helmet; and
 Setting maximum speed limits of 20 kilometres per hour, if the roads speed limit is not
greater than 50 kilometres per hour, and 50 kilometres per hour, if the roads speed limit
is greater than 50 kilometres per hour.
o Under “Driver’s licence conditions”, include the condition that the blood alcohol concentration
level of young or novice drivers be zero, as per the Highway Traffic Act (2019).

Finally, we encourage the Ministry of Transportation and the Ministry of Health to establish an effective
communication strategy to educate all road users about forthcoming changes to ORV road-use laws, as well as
to communicate the risks of riding ORVs on roads.

In summary, ORV-related accidents continue to be a significant cause of injury, with on roadway accidents
resulting in higher proportions of severe injury (hospitalization) and fatalities than off roadway accidents. We
appreciate your consideration of the safety implications of on-road ORV use as you revise O. Reg. 316/03.

If you have any questions or would like additional information about our comments, please contact Deanna
Leahy, Health Promoter, at 705-743-1000 ext. 354, [email protected].

Sincerely,

Original signed by

Mayor Andy Mitchell

Chair, Board of Health

cc: The Hon. Doug Ford, Premier of Ontario

Dr. David Williams, Chief Medical Officer of Health
Local MPPs
Opposition Health Critics
The Association of Local Public Health Agencies
Ontario Boards of Health

*“current” refers to O. Reg. 316/03: Operation of off-road vehicles on highways, dated January 1, 2018

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References

1. Ontario Ministry of Health and Long-term Care. (2018). Ontario Public Health Standard: Requirements for
Programs, Services, and Accountability. Toronto, ON: Author.
2. Vanlaar, W., McAteer, H., Brown, S., Crain, J., McFaull, S., & Hing, M. M. (2015). Injuries related to off-road
vehicles in Canada. Accident Analysis & Prevention, 75, 264-271.
3. Canadian Paediatric Society. (2015). Are we doing enough? A status report on Canadian public policy and
child and youth health. Ottawa (ON): Canadian Pediatric Society. Retrieved from
http://www.cps.ca/uploads/status-report/sr16-en.pdf.
4. Ontario Agency for Health Protection and Promotion (Public Health Ontario), Chu A, Orr S, Moloughney B,
McFaull S, Russell K, Richmond SA. The epidemiology of all-terrain vehicle- and snowmobile-related
injuries in Ontario. Toronto, ON: Queen’s Printer for Ontario; 2019.
5. Denning, G. M., Harland, K. K., Ellis, D. G., & Jennissen, C. A. (2013). More fatal all-terrain vehicle crashes
occur on the roadway than off: increased risk-taking characterises roadway fatalities. Injury
prevention, 19(4), 250-256.
6. Williams, A. F., Oesch, S. L., McCartt, A. T., Teoh, E. R., & Sims, L. B. (2014). On-road all-terrain vehicle
(ATV) fatalities in the United States. Journal of safety research, 50, 117-123.
7. Denning, G. M., & Jennissen, C. A. (2016). All-terrain vehicle fatalities on paved roads, unpaved roads, and
off-road: Evidence for informed roadway safety warnings and legislation. Traffic injury prevention, 17(4),
406-412.
8. Yanchar NL, Canadian Paediatric Society Injury Prevention Committee. (2012). Position statement:
Preventing injuries from all-terrain vehicles. Retrieved from
http://www.cps.ca/en/documents/position/preventing-injury-from-atvs.
9. Ontario Medical Association. (2009). OMA Position Paper: All-Terrain Vehicles (ATVs) and children’s safety.
Ontario Medical Review, p. 17–21.
10. Fawcett, V. J., Tsang, B., Taheri, A., Belton, K. & Widder, S. L. (2016). A review on all terrain vehicle safety.
Safety, 2, 15.
11. Consumer Federation of America. (2014). ATVs on roadways: A safety crisis. Retrieved from
https://consumerfed.org/pdfs/ATVs-on-roadways-03-2014.pdf.
12. Lord, S., Tator, C. H., & Wells, S. (2010). Examining Ontario deaths due to all-terrain vehicles, and targets
for prevention. The Canadian Journal of Neurological Sciences, 37(03), 343-349.

Page 3 of 3
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Serving the residents of Curve Lake and Hiawatha First Nations, and the County and City of Peterborough Page 101 of 149
From: [email protected] [mailto:[email protected]]
Sent: Monday, February 03, 2020 12:14 PM
To: Alida Gorizzan <[email protected]>
Subject: alPHa Information Break - February 3, 2020

February 3, 2020

This update is a tool to keep alPHa's members apprised of the latest news in public health
including provincial announcements, legislation, alPHa activities, correspondence and
events.

Update on Public Health Modernization

On January 30, alPHa submitted its response to the Ministry of Health's discussion paper on
public health modernization and shared a copy with all health units afterward. The
submission followed a teleconference held the previous day between the alPHa Board of
Directors and Ministry of Health representatives that included Jim Pine, Special Advisor. Mr.
Pine updated the board on feedback received to date from stakeholders since the release of
the discussion paper. He also noted that while several in-person consultations with
stakeholders have been completed to date, others will be taking place in different regions
over the next month or so. He further indicated that the February 10 cutoff to respond to
the consultation paper is no longer a fixed deadline.
Download alPHa's response on public health modernization
Go to the Ministry of Health's public health consultations website

BOH Agenda - Feb 12 2020

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alPHa invites health units and their boards to share their submissions to the provincial
discussion paper with us by emailing them to Gordon Fleming at [email protected].
These will be uploaded to alPHa's dedicated resource page on public health modernization
(link below), which contains announcements, responses and updates on related matters.
Visit alPHa's Public Health Modernization resource web page

Novel Coronavirus

As part of the collective effort to communicate timely information about novel coronavirus
(2019-nCoV), alPHa is attending daily ministry-led briefings and sending daily situation
reports from the Ministry of Health to update health units on this emerging issue. COMOH
members are monitoring the situation closely and, through the COMOH Chair, are in
frequent contact with provincial officials, including Chief Medical Officer of Health Dr. David
Williams, to ensure the health and well-being of the public. For convenience, alPHa has
provided links to the Ministry's dedicated website and others on its home page and below.
Go to the Ministry of Health's novel coronavirus website
Visit the Ministry's page for health professionals here
Go to Public Health Ontario's novel coronavirus website
Visit the Government of Canada's website on novel coronavirus

Winter 2020 Symposium & Section Meetings

alPHa looks forward to members' participation at the upcoming Winter 2020 Symposium and
Section Meetings on February 20 and 21 at the Central YMCA in downtown Toronto. The
not-to-miss program includes a leadership workshop led by Tim Arnold of Leaders for
Leaders, a consultation session with Ministry of Health representatives on public health
modernization, and an update from the Association of Municipalities of Ontario (AMO). For
more information about this event, please click the link below.
Register here to attend
Visit the Winter 2020 Symposium & Section Meetings page

TOPHC 2020

Members are advised to register for TOPHC 2020 early and and book their preferred
workshop as space is limited. The annual event will take place March 25-27 at the Beanfield
Centre in Toronto. Highlights include keynotes on the impact of racism on communities'
health, and how persuasive technologies (apps, games) can improve health and wellness
behaviours. This year's HOT TOPHC focuses on the causes and characteristics of syndemics
and their effect on health. Early bird promotional pricing ends February 12, so register
soon.
Learn more about TOPHC 2020 here
Register for TOPHC 2020

BOH Agenda - Feb 12 2020

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Public Health News Roundup

Minister Elliott lauds public health's response to coronavirus - 2020/01/31

Ontario confirms third case of novel coronavirus - 2020/01/31

World Health Organization declares novel coronavirus a global public health emergency -
2020/01/30

British Columbia reports first presumed confirmed case of novel coronavirus - 2020/01/28

Ontario briefs leaders from colleges and universities on novel coronavirus and directs public
to trusted information resources - 2020/01/28

Ontario confirms second presumptive case of novel coronavirus - 2020/01/27

Ontario briefs school boards' directors of education on novel coronavirus - 2020/01/26

Toronto reports first presumptive confirmed case of novel coronavirus - 2020/01/25

Ontario confirms first case of new coronavirus - 2020/01/25

Canada announces screening measures for novel coronavirus at major airports - 2020/01/24

US Surgeon General releases first report on smoking cessation in 30 years - 2020/01/23

Ontario Minister of Health designates novel coronavirus as a reportable disease -

2020/01/22

alPHa's New Address

In case you missed the announcement, alPHa relocated its office in December to 480
University Avenue, Suite 300, Toronto ON M5G 1V2. E-mails and phone numbers remain the
same; however, our extensions are now three digits --a '2' has been added to the beginning
of our previous extensions. Please update your records accordingly.

Upcoming Events - Mark your calendars!

Winter 2020 Symposium/Section Meetings - February 20 & 21, 2020, Central YMCA,
20 Grosvenor St., Toronto. Register here before the February 13 deadline. View the draft
program.

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 The Ontario Public Health Convention (TOPHC) 2020 - March 25-27, 2020; Beanfield
Centre, 105 Princes' Blvd., Toronto. Register here. Early bird registration ends February 12,
2020.

June 2020 Annual General Meeting & Conference - June 7-9, 2020, Chestnut
Conference Centre, 89 Chestnut St., Toronto. View the notice and calls.

alPHa is the provincial association for Ontario's public health units. You are receiving this update because you are a
member of a board of health or an employee of a health unit.

This email was sent to [email protected] from the Association of Local Public Health Agencies ([email protected]).
To stop receiving email from us, please UNSUBSCRIBE by visiting:
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2098f20032910254783e047
Please note that if you unsubscribe, you will no longer receive notices, important announcements, and correspondence from
alPHa.

BOH Agenda - Feb 12 2020

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PETERBOROUGH PUBLIC HEALTH
BOARD OF HEALTH – STAFF REPORT

TITLE: Summary of Donations, 2019

DATE: February 12, 2020
PREPARED BY: Dale Bolton, Manager, Finance and Property
APPROVED BY: Larry Stinson, Director, Operations
Dr. Rosana Salvaterra, Medical Officer of Health

PROPOSED RECOMMENDATIONS

That the Board of Health for Peterborough Public Health receive the staff report, Summary of
Donations, 2019, for information.

FINANCIAL IMPLICATIONS AND IMPACT

For the year ending December 31, 2019, Peterborough Public Health (PPH) received a total of
$40,255 in charitable donations for programs.

DECISION HISTORY

Organizational policy requires the Board of Health be advised annually about donations received.

BACKGROUND

Peterborough Public Health received its charitable status in 2010 and is able to issue charitable
receipts.

To provide the Board with information on donations, an analysis was completed for the last two
years comparing the number of external donations, donations by designation and donations by
donor type.

An “external” donation is defined as the donor writing a cheque to PPH and receiving a
charitable receipt.

Internal charitable donations from our employees are received through payroll deduction, which
are receipted through their T4. In 2019, sixty-four employees made charitable donations
through payroll deductions, with donations being directed to the public health programs and/or
the United Way. A total of $12,637 was donated by PPH employees through payroll
contributions to the United Way and PPH programs.

In 2019, Peterborough Public Health received $3,640 after transactions fees through the
donation web site Canada Helps. The funds are reflected below under individual donations.

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 Table 1: Donations Year over Year – Peterborough Public Health Programs
Year 2018 2019
$24,746 $32,117
Total Cheques / Cash Received
(47 donors) (25 donors)

$1,794 $3,640
Total On-Line Canada Helps
(24 donors) (21 donors)

$3,504 $4,498
Total Payroll Deductions
(34 donors) (36 donors)
Total Donations $30,044 $40,255

Table 2: External and Payroll Donations by Designation

Program 2018 2019
Collective Kitchens $4,300 $2,700
Community Kitchen $467 $464
Contraceptive Assistance Fund $310 $176
Dental Treatment Assistance Fund $3,799 $3,521
(DTAF)
Food for Kids (FFK) $20,203 $32,216
Food Security $190 $91
Healthy Babies, Health Children
(HBHC) Equipment and Supply Fund $410 $646
Prenatal Classes for Young Parents $181 $78
Infant Toddler Equipment Fund $0 $155
Gleaning Program $0 $198
Undesignated $184 $10

Table 3: Donations by Donor Type

Donor Type 2018 2019
Business $7,429 $17,290
Church $7,450 $2,000
Individual $3,326 $3,817
Payroll Deduction $3,504 $4,498
Service Clubs/ Foundations $8,335 $12,650

Food for Kids, Dental Treatment Assistance Fund and Collective Kitchens activities rely heavily on
donations. FFK continues to receive some larger donations from a local service club and food

BOH Agenda - Feb 12 2020

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supply businesses to support ongoing school breakfast program activities. Overall, donations for
majority of public health programs were slightly lower in 2019 than the previous year, with the
exception of the significant increase for FFK. The donations provide the much needed support to
offer the programs to our community members in throughout 2019 and in the upcoming year.

RATIONALE

The generous donations from community residents, local businesses, our employees and Board
members demonstrate their willingness to provide financial support to programs that positively
impact the members of the community.

Peterborough Public Health will continue to:

 inform the public we are a charitable organization and welcome donations;
 use www.canadahelps.org as a convenient way to make donations; and
 profile these specific programs/funds on the PPH Website, and in applicable PPH
publications and resources.

STRATEGIC DIRECTION

This report applies to the following strategic directions:

 Determinants of Health and Health Equity
 Capacity and Infrastructure;
by enhancing program resources and improving access to programs, services and resources for
those individuals and families in the community.

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PETERBOROUGH PUBLIC HEALTH
BOARD OF HEALTH – STAFF REPORT

TITLE: Summary of Complaints, 2019

DATE: February 12, 2020
PREPARED BY: Alida Gorizzan, Executive Assistant
APPROVED BY: Dr. Rosana Salvaterra, Medical Officer of Health

PROPOSED RECOMMENDATIONS

That the Board of Health for Peterborough Public Health receive the staff report, Summary of
Complaints, 2019, for information.

FINANCIAL IMPLICATIONS AND IMPACT

There are no financial implications arising from this report.

DECISION HISTORY

The Board of Health’s policy and procedure (2-280, Complaints) requires the Board be advised
annually about complaints received in the prior year.

BACKGROUND

During the 2019 calendar year, the organization received five complaints. In comparison, there
was one in 2018, and four complaints in 2017.

Details regarding the complaints are as follows:

No. Nature of Complaint Comments Status

1 Complaint related to The complainant has lodged a Ongoing.
requirements under the complaint against PPH with
Immunization of School the Human Rights Tribunal of
Pupils Act. Ontario.

2 Complaint regarding the The complainant Resolved.

actions of an inspector. communicated concerns
during an inspection regarding
lack of equipment and vehicle
idling. The complaint was
investigated and addressed
with staff.

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 No. Nature of Complaint Comments Status
3 Complaint regarding the The complainant took issue Resolved.
actions of an inspector. with the conduct of a Public
Health Inspector (PHI). The
complaint was investigated,
and it was determined that
the actions of the PHI were
within the scope of their
duties.

4 Complaint regarding the A complaint was brought Dismissed.

actions of the Medical forward to the Board of
Officer of Health. Health. It was dismissed by
the Board on the grounds that
it was vexatious in nature.
5 Complaint regarding pest A complaint was received Resolved.
and infection control, and requesting that PPH
storm water management investigate concerns
at a local health care communicated by the
facility. complainant. These were
investigated by a PHI and the
results were provided in a
response. The complainant
was not satisfied with our
response.

Peterborough Public Health strives to respond to all complaints in a timely and respectful
manner.

STRATEGIC DIRECTION

This report applies to the following strategic direction: Quality and Performance.

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PETERBOROUGH PUBLIC HEALTH
BOARD OF HEALTH – STAFF REPORT

TITLE: Summary of PPH Research Activities, 2019

DATE: February 12, 2020
PREPARED BY: Jane Hoffmeyer, Manager, Foundational Standards
APPROVED BY: Dr. Rosana Salvaterra, Medical Officer of Health

PROPOSED RECOMMENDATIONS

That the Board of Health for Peterborough Public Health (PPH) receive the staff report,
Summary of Research Activities (2019), for information.

FINANCIAL IMPLICATIONS AND IMPACT

There is no direct financial impact.

DECISION HISTORY

The provision of an annual report to the Board of Health which summarizes research activities
undertaken in the previous calendar year has been in practice since 2016.

BACKGROUND

Annual reporting was initiated to ensure board of health members were knowledgeable about
this aspect of PPH operations.

The positive role of research is recognized within Ontario’s public health standards (see
Attachment B). These standards view research as being fundamental to effective public health
practice and PPH research practices should be included within organizational transparency and
quality improvement processes.

The implementation of OPHS research-related requirements has been assigned to the Manager,
Foundational Standards.

RATIONALE

2018 Ontario Public Health Standards require the board of health to be informed about
organizational activities related to research.

STRATEGIC DIRECTION

This staff report is directly relevant to the following thematic areas of the current PPH Strategic
Plan.

BOH Agenda - Feb 12 2020

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  Capacity and Infrastructure
 Quality and Performance

Attachments:

Attachment A – Summary Table of Peterborough Public Health Research Activities (2019)

Attachment B – OPHS 2018 Research-related Requirements

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Attachment A - Summary Table of Peterborough Public Health Research Activities (2019)

General Overview

In 2019, all Peterborough Public Health (PPH) research initiatives were a continuation of work already underway in 2018. In total,
there were seven research projects as described in the table below.

PPH’s role across the set of research activities varies and entail being a lead organization, collaborator or knowledge user. PPH staff
have also contributed individually as key informants/survey respondents to at least two public health research projects (one listed
below, the other led by another LPHA).

The Locally Driven Collaborative Project research initiative led by Public Health Ontario has funded three of these projects.

Principle Investigator Project Title Summary Status

Organization (s)
Trent University Sexual Health Survey Co-collaboration between Trent University, Phase 2 data collection
Fleming College and Peterborough Public completed in late 2019
Dr. Dr. Terry Health. (including control group).
Humphreys, Ph.D.
The purpose of this study is to examine the Phase 1 report is anticipated
sexual health-related behavioural practices of in Q1 2020. Phase 2 report
the local community. This information is anticipated in Q2 2020.
intended to assist in the design and delivery of
sexual health services and programming for The results from this study,
local residents and students. based on local data, will assist
in determining priorities for
PPH.

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Principle Investigator Project Title Summary Status
Organization (s)
Halliburton Kawartha Measuring Food Year 1: To identify and summarize the In 2019, pilot testing took
and Pine Ridge District Literacy (Locally attributes* of food literacy including food skills, place. PPH was involved in
Health Unit; Driven Collaborative in the literature. Determine which attributes of participant recruitment,
Middlesex London Project) food literacy, including food skills, are priorities revisions of the tool, website
Health Unit for measurement and tool development. content review, and
*Attribute defined: The quality or feature knowledge exchange
regarded as a characteristic or inherent part of planning.
someone or something A PPH Nutritionist represents
PPH as a knowledge user at
Year 2 and 3: (December 2017 to May 2019) monthly meetings, provides
To develop a food literacy measurement tool for feedback as part of an expert
use with youth (age 16-19 years), and young panel, and contributes to
parents and pregnant women (aged 16-25 knowledge exchange
years) at risk for poorer health. activities.

In 2020, knowledge exchange

will take place through
provision of train-the-trainer
workshops, online training on
the tool, exploration of
housing of the tool on an
online platform,
presentations at conferences,
and preparation of a
manuscript.

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Principle Investigator Project Title Summary Status
Organization (s)
Precarious Precarious This study is based on research initially The PPH website now houses:
Employment Research Employment completed by McMaster University within the  An interactive data
Initiative (PERI) Project Research Initiative Poverty and Employment Precarity in Southern dashboard (using
Group (PERI) Ontario (PEPSO) work. PERI replicated the Tableau Public) of the
(previously process used in Toronto and London. research
Group membership referenced in 2016  InfoBriefs
includes: report as “PEPSO The goal is to have local information about  Proceedings from the
Peterborough Public Employment people’s employment and working conditions 2018 conference
Health; Workforce Research Study”) as well as the impact on their health. www.peterboroughpublichea
Development Board; The research will be used by Peterborough lth.ca/PERI.
City of Peterborough Public Health as well as several community
Social Services; partners in identifying future areas of focus for Phase 2 is under
Peterborough and program and service delivery, public awareness consideration to add
District Labour and education and policy development. qualitative data and to repeat
Council; the survey. Plans will be
United Way of completed in early 2020.
Peterborough;
Literacy Ontario
Central South; and Dr.
Fergal O’Hagan, Trent
University.

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Principle Investigator Project Title Summary Status
Organization (s)
Windsor Essex County Children Count Pilot The Children Count Pilot Study (Jan 2018 – Dec Completed. Final reports
Health Unit (lead Study (Locally Driven 2019) aims to develop a novel approach to received.
health unit) Collaborative Project) collect local health data on school-aged children
through the School Climate Survey which is
mandatory by the Ministry of Education. Public
health units in collaboration with English and
French school board partners participating in
this study have developed a new health survey
module with questions about healthy eating,
physical activity and mental health. Pilot site
school boards will collect data from students
(grades 4 to 12) by integrating this new module
into their School Climate Survey.
University of Western Health Equity We aim to evaluate the outcomes and impacts Completed Spring 2019.
Ontario Indicators User of health equity indicators in use by Ontario
Guide Evaluation LPHAs. The project objectives are to: Final report was shared with
Dr. Benita Cohen, Dr. (Locally Driven 1. Identify if and how the health equity LPHAs.
Marlene Janzen LeBer Collaborative Project) indicators’ knowledge products (i.e., Phase 1
and Dr. Anita Kothari Report: Review of the Literature, Phase 2
Report: A Case Study Approach to Pilot Test
Indicators, User Guide, associated
presentations and publications) have helped
LPHAs assess their health equity work.
2. Examine if and how these knowledge
products have been used for health equity
capacity building within Ontario’s local public
health system.

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Principle Investigator Project Title Summary Status
Organization (s)
3. Explore if and how these knowledge products
influenced organizational health equity
decision- making in LPHAs.
University of Waterloo Rural Public Health The purpose of this study is to understand Completed 2019.
Systems Research implementation of evidence-informed chronic Publication pending
Dr. John Garcia Study disease prevention practice in Ontario rural completion of dissertation.
Deanna White (Ph.D. “Factors that public health units. Knowledge and information
candidate) Facilitate and generated from this study may help to make a
Impede the practical contribution to improve the
Implementation of performance of public health in rural areas,
Evidence-Informed through a better understanding of factors that
Chronic Disease facilitate and impede the implementation of
Prevention evidence-informed chronic disease prevention
Programs and programs and policies in rural areas.
Policies in Rural
Ontario Public
Health Units”

St. Michael’s Strengthening the Four year project funded by Canadian Institute Launched in Oct 2018.
Centre for Urban Implementation of of Health Research. Dr. Salvaterra is a co- Peterborough was selected as
Health Solutions “Health in All applicant. a case study site. Local data
Policies” at the local collection began in 2019 and
Dr. Ketan Shankardass level in Ontario and Co-collaborators include Public Health Agency will continue into 2020.
Quebec of Canada and the National Collaborating
Centre for Healthy Public Policy.

The research engages six knowledge user sites

from Ontario (including Peterborough) and
Quebec.

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Principle Investigator Project Title Summary Status
Organization (s)
The three main objectives of the research are:
“(1) Conduct six explanatory case studies of
HiAP implementation in local governments of
Ontario and Quebec to ask: (i) What social
mechanisms explain positive and negative
outcomes of implementation?, and (ii) What
influence did provincial governments have on
implementation?

(2) Directly mobilize knowledge by facilitating a

community of practice, generating local policy
briefs, and hosting interactive KM workshops
and webinars with knowledge users;

(3) Evaluate the impacts of the KM activities on

HiAP implementation.”

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Attachment B – 2018 OPHS Research-related Requirements

Foundational Standards

“5. The board of health shall engage in knowledge exchange activities with public health practitioners across the province, policy-
makers, academic and community partners, health care providers, and the public regarding factors that determine the health of the
population as informed by population health assessment, surveillance, research, and program evaluation.

6. The board of health shall foster relationships with community researchers, academic partners, and other appropriate organizations
to support public health research and knowledge exchange activities, which may include those conducted by the board of health
alone or in partnership or collaboration with other organizations.

7. The board of health shall use a variety of communication modalities, including social media, taking advantage of existing resources
where possible, and complementing national/provincial health communications strategies.” (OPHS, 2018: pg. 25)

Good Governance

14. The board of health shall provide governance direction to the administration and ensure that the board of health remains
informed about the activities of the organization on the following: a) Delivery of programs and services; b) Organizational
effectiveness through evaluation of the organization and strategic planning; c) Stakeholder relations and partnership building;
(OPHS, 2018: pg.67-8)

Reference: Ministry of Health and Long-Term Care. 2018. Ontario Public Health Standards.

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PETERBOROUGH PUBLIC HEALTH
BOARD OF HEALTH – REPORT

TITLE: Q4 2019 Peterborough Public Health Activities

DATE: February 12, 2020
PREPARED BY: Management Staff
APPROVED BY: Donna Churipuy, Director of Public Health Programs
Larry Stinson, Director of Operations
Dr. Rosana Salvaterra, Medical Officer of Health

PROPOSED RECOMMENDATION

That the Board of Health for Peterborough Public Health receive report, Q4 2019 Peterborough
Public Health Activities, for information.

ATTACHMENTS

Attachment A – Q4 2019 Overall Compliance Status

Attachment B – Q4 2019 Communications and I.T. Report
Attachment C – Q4 2019 Social Media Report
Attachment D – Q4 2019 Finance Report

BOH Agenda - Feb 12 2020

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 Quarter 4 2019 Status Report
(September 1, 2019 – December 31, 2019)

Overall Compliance Status

Ontario Public Health Standard Mandated Programs # Requirements

Compliant
Program Standards
Chronic Disease Prevention and Well-Being 4 /4
Food Safety 4 /5
Healthy Environments 7/10
Healthy Growth and Development 3 /3
Immunization 10/10
Infectious and Communicable Diseases Prevention and Control 21/21
Safe Water 8/8
School Health 6/10
Substance Use and Injury Prevention 3 /4
Foundational Standards
Population Health Assessment 7/7
Health Equity *4/4
Effective Public Health Practice 8/9
Emergency Management 1/1
Non-OPHS Mandated Programs Status
Infant and Toddler Development ME
Safe Sewage Disposal ME
ME: Meeting Expectations PME: Partially Meeting Expectations

Link to Ontario Public Health Standards

Food Safety
Julie Ingram, Manager, Environmental Health
Program Compliance
Requirement #4: The majority of the components of the Food Safety Program were met
however not all routine compliance inspections were completed for low risk
food premises and several seasonal moderate-risk food premises. Overall,
the compliance inspection rate for moderate risk food premises was 92%
and the compliance inspection rate for low risk food premises was 67%.
Unfortunately, in 2019 a spike in rabies investigations took priority and
required greater than normal hours of staff time to investigate animal bites.
There was a 48% increase in the number of investigations required in 2019
compared to 2018. This had a substantial impact on the time available for
Public Health Inspectors to complete food safety inspections. The decision
was made to prioritize and complete inspections of all high and non-
seasonal moderate risk premises.

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Healthy Environments
Julie Ingram, Manager, Environmental Health
Hallie Atter/Carolyn Doris, Managers, Family and Community Health

Program Compliance:
Requirement 3: Work on the Climate Change Health Vulnerability and Adaptation Plan is
advancing. In Q4, a lot of progress was made with the collection and analysis
of data and stakeholder engagement. Analysis of Rapid Risk Factor
Surveillance System data for climate was completed. The analysis of health
data is underway. Informant interviews have been conducted and the
External Advisory Committee was formed and met in October and
November. All internal focus groups were completed in December, 2019.
Vulnerable populations have been identified and data has been collected.
This data includes historical temperature and precipitation data for
projections for 2050 and 2080. It also includes hospitalization and
emergency room visits related to weather and temperature. Overall, the
vulnerability assessment and adaptation plan should be completed for two
hazards (extreme weather and extreme temperatures) close to the end of
Q1 2020.

Requirement 4 to 7: A comprehensive approach to creating health-promoting built and natural

blue and green spaces has been prioritized. Priorities for 2019 were to a)
complete a Theory of Change (TOC) Results Chain (which has been
completed) and b) engage in activities to contribute to Blue and Green Space
content in built and natural environment policies i.e. City/County OP, City
Parks Open Space Study, Township Parks and Recreation Plans,
Transportation Master plans, Food Charter. These priorities were
determined based on commitment to finalizing the Theory of Change,
selection of health promotion strategies that promote health equity and
current policy opportunities. Priorities for 2020 are to continue with
activities that support the both the Blue and Green Space and PPH TOC
Results Chain, including determining barriers to accessing blue and green
space. We will also continue to engage in policy development activities.

School Health
Hallie Atter/Carolyn Doris, Managers, Family and Community Health

Program Compliance:
Requirement 2 to 4: Due to staff capacity and school climate, with the exception of Challenges,
Beliefs Changes, Cessation Support and Healthy Sexuality, curriculum
supports to schools were limited to resources upon request. Completion of a
District School Board – local Public Health Agency Memorandum of
Understanding focusing on working relationships was delayed due to
modernization of public health discussions and labour relation priorities in
schools. In Q4, support was provided to schools working towards Ophea
BOH Agenda - Feb 12 2020
Page 122 of 149
 Healthy School designation. Internal coordination of staff supporting
comprehensive school health activities was reinstated in Q4.

Requirement 9: Due to school climate and identification of alternative evidence based

approaches, plans for a 130th Anniversary vaccination campaign and
competition were not completed. The alternative approaches identified are
included in operational plans for 2020.

Substance Use and Injury Prevention

Hallie Atter/Carolyn Doris, Managers, Family and Community Health

Program Compliance:
Requirement 2: Due to limited staffing capacity (resignation of staff in Cannabis role; staff
being assigned to other areas i.e. Emergency Management, Climate Change,
Planet Youth; surge in Opioid response required increase in staff time)
interventions were mainly focused on our local opioid response, Smoke Free
Ontario Act activities, and responses to the implementation of the cannabis
legalization and off road safety legislation.

Foundational Standards
Jane Hoffmeyer, Manager, Foundational Standards

Program Compliance – Effective Public Health Practice:

Requirement #2: A temporary staffing gap within the team affected achievement of 2019
objectives related to planning and evaluation. Delivery of learning
opportunities for program evaluation and evidence-informed decision
making were affected as was progress on evaluation planning on our
implementation of the Community Engagement framework. Also, there
was reduced support for managers as they entered into the 2020 planning
cycle.

Recruitment to replace the Health Promoter role within the team was
successful. Unmet objectives for 2019 will be revisited during operational
planning for 2020 and reprioritized with new or emerging needs.

Program Compliance – Health Equity

*Note: While minimal compliance was maintained in Q4, staff FTE’s were reduced due to the need
to temporarily shift some staffing to assist with the local start-up phase of the Ontario Seniors
Dental Care Program.

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 Communications – Q4 2019
Brittany Cadence, Manager, Communications & IT Services

Media Relations
Activity Q4 comparison

2019 2018
Total media products produced (news releases, audio files, letters to the
editor, monthly Examiner and PTW columns, op eds, BOH meeting 31 44
summaries, etc.)
Number of media interviews 23 19
Number of media stories captured directly covering PPH activities 96 84

Activity Yearly Totals

2019 (YTD) 2018 2017 2016 2015
Press releases/media products issued 163 131 181 158 165
Media interviews 122 77 86 92 82
Number of media stories directly covering PPH
546 465 329 340 540
activities
Communications tickets 574 649 680 n/a n/a

Communications Highlights:
- First frostbite alert of the season
- Radio ads on six local stations ran campaigns on child literacy, smoke-free arenas, and cannabis
edibles.

Information Technology - 2019 Q4

Note: this report is provided from the Information Technology (IT) team and is intended to
summarize major projects and provide a snapshot of the overall health of PPH systems.

System Status This Quarter:

Planned Outage -
Unplanned Outage -
Service Description % downtime of Total Uptime
% downtime of total
total
MS Exchange Email server 0% 0% 100%
Phone server 0% 0% 100%
File server 0% 0% 100%
Backup server 0% 0% 100%

Total Number of Helpdesk Tickets Served:

Activity Yearly Totals
2019 (YTD) 2018 2017 2016 2015
IT Tickets 1303 1696 1426 1277 945

IT Highlights:
 Human firewall cybersecurity presentation to ALL STAFF
 Quarterly maintenance to upgrade firewall and troubleshoot code white intercom

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 SOCIAL MEDIA
Follow us @Ptbohealth
Q4 REPORT October 1 –
December 31/19

www
www
Twitter: In Q4 our Instagram Facebook
followers grew
webpage views
-26.97%
to 2380 *due to spike in Q3 due to
Kawartha Endodontics lapse

Direct Engagement… How did people interact with us on social media?

123 157 167 501

0 2 67

Depth… How are people reaching us and what are they looking for?

Clickthroughs from
pages: peterboroughpublichealth.ca tweet/post to our website
Homepage: 9,257
Employment: 4,508
Flu Clinics: 2,707 Traffic
Sexual Health Clinic: 2,096
Contact Us: 1,951
Clinics and Classes: 1,704 Desktop
For Professionals: 1,477 49.56%
Food Handler Course: 1,288 Mobile
Your Health: 1,143 44.85% Tablet BOH Agenda - Feb 12 2020
Reports and Data: 876
5.58% Page 125 of 149
 Loyalty… How effectively are we keeping visitors engaged?

866 impressions, 4.3% engagement rate

www.peterboroughpublichealth.ca

Customer Experience… What are people saying about us on social media?

@MENTIONS

Glossary… What do these social media terms mean?

Engagements Total number of times a user interacted with a Tweet. Impression: Times a user is served a Tweet in a timeline or search
results.
Engagement rate: Number of engagements divided by impressions.
Handle: Another word for username specific to Twitter and
Impression: Times a user is served a Tweet in timeline or search represented by an @ symbol (e.g. @Ptbohealth).
results.
Mention: A Tweet that contains another user's @handle anywhere
Promoted Tweet: Ordinary Tweets purchased by advertisers who in the body of the Tweet. Used to “call out” to someone and will
want to reach a wider group of users to spark engagement. land in their notifications timeline.

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Financial Update Q4 2019 (Finance: Dale Bolton)
Programs Funded January 1 to December 31, 2019
YTD Budget $ Comments
Based on
2019 Year To Date Year to Date Year to Date
Funding 2019 Approved Approved Submission Expenditures % of Budget Variance
Type Submission by Board by Province (100%) to Dec. 31 Submission Under/(Over)
Mandatory Public MOHLTC 8,137,186 14-Nov-18 20-Aug-19 8,137,186 8,042,319 98.8% 94,867 Operated within budget submission.
Health Programs Cost Underspending due some staff gapping
Shared through year. In final quarter, some additional
(CS) staff hired to address program vacancies and
purchase of program resources aquired
reducing previously reported underspending.
Portion of underspending to offset overage in
Small Drinking Water. Planned reduction in
spending based on 3rd quarter to maintain
budgetted transfer from reserve.

Small Drinking CS 90,800 08-Nov-17 20-Aug-19 90,800 104,258 114.8% (13,458) Operated above budget due to legal fees
Water Systems incurred. Overage partially offset by savings in
Vector Borne Diseases and in Mandatory
Programs.

Vector- Borne CS 76,133 14-Nov-18 19-Aug-19 76,133 71,487 93.9% 4,646 Operated within budget. Underspending to
Disease (West Nile fund overage in Small Drinking Water.
Virus)

Infectious Disease 100% 222,300 14-Nov-18 20-Aug-19 222,300 222,300 100.0% - Operated within budget submission.
Control

Infection Prev. & 100% 90,100 14-Nov-18 20-Aug-19 90,100 90,100 100.0% - Operated within budget submission.
Control Nurses

Healthy Smiles 100% 763,100 14-Nov-18 20-Aug-19 763,100 726,786 95.2% 36,314 Operated within budget submission. Program
Ontario (HSO) dental billings in excess of budget resulting in
reduced overall net expenditures. Historically
program over has been underspent as staffing
not at full complement.

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 YTD Budget $
Based on
2019 Year To Date Year to Date Year to Date
Funding 2019 Approved Approved Submission Expenditures % of Budget Variance
Type Submission by Board by Province (100%) to Dec. 31 Submission Under/(Over) Comments
Enhanced Food 100% 25,000 14-Nov-18 20-Aug-19 25,000 25,000 100.0% - Operated within budget approval.
Safety

Enhanced Safe 100% 15,500 14-Nov-18 20-Aug-19 15,500 15,500 100.0% - Operated within budget approval.
Water

Needle Exchange 100% 57,000 14-Nov-18 20-Aug-19 57,000 53,902 94.6% 3,098 Operated within budget. Underspending of
Initiative base funding due to additional one time
funding in the first quarter of 2019.

Harm Reduction 100% 150,000 14-Nov-18 20-Aug-19 150,000 148,545 99.0% 1,455 Operated just below budget approval.
Enhancement

Social 100% 180,500 14-Nov-18 20-Aug-19 180,500 180,500 100.0% - Operated within budget approval.
Determinants of
Health Nurses
Initiative - Nurses
Commitment

Chief Nursing 100% 121,500 14-Nov-18 20-Aug-19 121,500 121,500 100.0% - Operated within budget approval.
Officer Initiative

Smoke Free 100% 100,000 14-Nov-18 20-Aug-19 100,000 100,000 100.0% - Operated within budget approval.
Ontario (SFO) -
Control

SFO - Enforcement 100% 202,100 14-Nov-18 20-Aug-19 202,100 212,162 105.0% (10,062) Operated above budget approval. Program
resources purchased in Q4 offset by
underspening in Youth Engagement.

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 YTD Budget $
Based on
2019 Year To Date Year to Date Year to Date
Funding 2019 Approved Approved Submission Expenditures % of Budget Variance
Type Submission by Board by Province (100%) to Dec. 31 Submission Under/(Over) Comments
SFO - Youth 100% 80,000 14-Nov-18 20-Aug-19 80,000 49,417 61.8% 30,583 Operated well below budget due to staff
Prevention gapping since early in 2nd quarter.
Underspending will offset overage in
Enforcement.

SFO - Prosecution 100% 6,700 14-Nov-18 20-Aug-19 6,700 1,920 28.7% 4,780 Operating within budget based on program
demand. Historically underspending in
program.

Electronic 100% 29,300 14-Nov-18 20-Aug-19 29,300 29,300 100.0% - Operated within budget approval.
Cigarettes Act -
Protection &
Enforcement

Medical Officer of 100% 59,187 NA 20-Dec-19 59,187 59,187 100.0% - Operated within budget approval.
Health
Compensation

Ontario Seniors 100% 245,005 NA 20-Aug-19 245,005 55,473 22.6% 189,532 Prorated funding approved of $525,075 for
Dental 2019 based on annual funding of $700,100.
Program activity commenced November 1,
2019 resulting in reduced spending as some
staffing postions not filled and no specialist
dental service in 2019. Staffing and specialists
will be in place for 2020 and anticipate utilizing
approved budget.

Total - Ministry 10,651,411 10,651,411 10,309,656 96.79% 341,755

Funded - 2019

One-Time Programs Funded April 1, 2019 to March 31, 2020

YTD Budget $
Based on
2019 Year To Date Year to Date Year to Date
Funding 2019 Approved Approved Submission Expenditures % of Budget Variance
Type Submission by Board by Province (100%) to Dec. 31 Submission Under/(Over) Comments

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PHI Practicum 100% 20,000 NA 20-Aug-19 15,000 - 34.3% 15,000 Funding for 2 practicum PHI student for 12
weeks during January - March 2020.

Programs funded April 1, 2019 to March 31, 2020

Approved
by Year To Date Year to Date
Funding Approved Province/Ot YTD Budget $ Expenditures Variance
Type 2019 - 2020 by Board her (100%) to Dec. 31 % of Budget Under/(Over) Comments
Infant Toddler and 100% 253,817 6-Mar-19 27-Jan-20 190,363 193,288 76.2% (2,925) Operating just above approved budget due
Development MCCSS some additional staffing costs in Q3. Anticipate
Program being within budget by end of year.

Healthy Babies, 100% 928,413 06-Mar-19 19-Aug-19 696,310 674,058 72.6% 22,252 Program operating well within budget due to
Healthy Children MCCSS savings in salary and benefits due to staffing
changes during 3rd quarter. Anticipate
spending budget by end of March as new
program manager to be hired in final quarter
and purchase of program resources.

Speech 100% 12,670 Annual 12,670 9,503 9,503 75.0% - Operating within budget.
FCCC Approval

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Funded Entirely by User Fees January 1 to December 31, 2019
YTD Revenue Year To Date Year to Date
Funding Approved 2019 $ Expenditures Variance
Type 2019 By Board Budget (100%) to Dec. 31 % of Budget Under/(Over) Comments
Safe Sewage Fee for 402,775 NA 402,775 332,769 363,023 90.1% (30,254) Program funded entirely by user fees.
Program Service Expenditures are within budget, however
revenue from User Fees are below budget
resulting in a deficit of $30,254. Anticipated
reduced revenue during year due to two
townships no longer having service provided by
program. Program reserve will be used to
offset defict based on final audit.

Mandatory and Fee for 97,500 NA 97,500 94,900 94,426 96.8% 474 Program funded entirely by fees. Program
Non-Mandatory Re- Service activity based on number of properties
inspection inspected during the period of May through
Program November. Operated within budget.

Total - All 11,418,173

12,366,586 11,990,255 11,643,954 94.16% 346,302
Programs

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PETERBOROUGH PUBLIC HEALTH
BOARD OF HEALTH – STAFF REPORT

TITLE: Audit Letter of Engagement, 2019

DATE: February 12, 2020
PREPARED BY: Dale Bolton, Manager, Finance and Property
APPROVED BY: Larry Stinson, Director, Operations
Dr. Rosana Salvaterra, Medical Officer of Health

PROPOSED RECOMMENDATIONS

That the Board of Health for Peterborough Public Health:

 Receive the staff report, Audit Letter of Engagement, 2019, for information;
 Engage the audit services of Baker Tilly Kawarthas LLP, formerly Collins Barrow
Chartered Accountants LLP; and
 Authorize the Chair and Vice-Chair to sign the Letter of Engagement.

FINANCIAL IMPLICATIONS AND IMPACT

Agreement will result in the annual audit fees which are part of the approved budget.
If the Letter of Engagement is not signed, the auditor will not be able to carry out the audit.

DECISION HISTORY

An annual audit by external auditors is required by legislation and under Board Policy 2-130.
Audit expenses are part of the approved budget. Agreement to the terms of services outlined in
the letter will result in the annual audit fees. If the Letter of Engagement is not signed, the
auditor will not be able to carry out the audit.

BACKGROUND

The Letter of Engagement is a standard letter required by the Canadian Institute of Chartered
Accountants (CICA). Approval of the Letter of Engagement is required annually by the Board of
Health.

RATIONALE

Auditors require their clients to sign a “Letter of Engagement” appointing the auditor, directing
the auditor to audit the books of account and committing the organization to pay for the audit
services upon completion of the work. Over time, the audit societies increased the
responsibilities and requirements of auditors, including reporting to the Board any relationships
they may have with the Board.

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These relationships include:
 Holding a financial interest, directly or indirectly, in the Board;
 Holding a position, directly or indirectly, that gives the right or responsibility to exert
 significant influence over the financial or accounting policies of the Board;
 A personal or business relationship with immediate family, close relatives, partners or
retired partners of the Board;
 Having an economic dependence on the work of the Board; and
 Providing services to the Board other than auditing (for example: consulting services).

The auditors have not identified any relationship.

The auditors have committed to expressing an opinion on whether our Financial Statements
fairly represent, in a material way, the financial position of the Board.

The auditors note that their obligation is to obtain reasonable, but not absolute assurance that
the financial statements are free of material misstatement. That is: the auditor will examine our
records but will not guarantee they will find a misstatement, if one is present. This also means
that there may be small misstatements but the misstatement will not have a significant bearing
on our Financial Statements.

The auditors will:

 Assess the risk that the financial statements contain misstatement(s) that are material
to the Financial Statements;
 Examine on a test basis the evidence supporting amounts and disclosures to the
financial statements (for example: compare invoices to cheque amounts, lease
commitments, etc.);
 Assess the accounting principles used and their application;
 Assess the estimates made; and
 Examine internal controls in place.

The Board or delegated committee is required to:

 Meet with the auditors prior to the release and approval of the financial statements to
review audit, disclosure and compliance issues;
 If necessary, review matters raised by the auditors with management, and if necessary
report back to the auditors on the Board’s findings;
 Make known to the auditors any issues of fraud or illegal acts or non-compliance with
any laws or regulatory requirements known to the Board that may affect the financial
statements;
 Provide direction to the auditor on any additional work the auditor feels should be
undertaken in response to issued raised or concerns expressed;
 Make enquiries into the findings of the auditor with respect to corporate governance,
management conduct, management cooperation, information flow and systems of
internal control;

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  Review the draft financial statements; and
 Pre-approve all professional and consulting services to be provided by the auditors. In
our case, there are none for the current year.

STRATEGIC DIRECTION

This report applies to the following strategic direction:

 Quality and Performance

APPENDICES

Attachment A – PPH Audit Planning Report

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 Audit
planning
report

Peterborough Public Health

2019 Audit

Prepared by Baker Tilly KDN LLP

January 28, 2020

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 Purpose of the report

To Members of the Board of Health:

We have been engaged to express an audit opinion on the consolidated financial statements of
Peterborough Public Health ("the Health Unit") in accordance with Canadian Public Sector
Accounting Standards for the year ended December 31, 2019, as outlined in our engagement letter
dated January 28, 2020.

The purpose of this report is to communicate certain matters related to the planning of our audit
that we believe to be of interest to you.

This report is confidential and is intended solely for the information and use of the Board of Health.
No responsibility for loss or damages, if any, to any third party is accepted as this report has not
been prepared for, and is not intended for, and should not be used by, any third party or for any
other purposes.

Yours very truly,

Baker Tilly KDN LLP

Chartered Professional Accountants, Licensed Public Accountants

Per: Richard Steiginga, CPA, CA

We look forward to discussing the contents of this report

and answering any questions you may have.

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Table of contents

4 Overview and audit approach

6 Materiality

7 Data analytics

8 Other matters

Appendices

Appendix A – Responsibilities

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 Overview and audit approach

Key audit dates

Interim testing – December 3-4, 2019
Year end testing – February 18-21, 2020

Audit approach
Our audit of the consolidated financial statements will be conducted under generally accepted
Canadian auditing standards and is designed to obtain reasonable, rather than absolute, assurance
as to whether the consolidated financial statements are free of material misstatement. We develop
our audit approach based on the risk assessment and understanding of control systems design and
implementation. Our risk assessment is based on our understanding of the Health Unit, industry,
ratepayer and supplier relationships, and analysis of financial information provided prior to the start
of the audit.

Engagement team
The key individuals involved in the audit:

Richard Steiginga, Engagement Partner – [email protected], (705) 742-3418 ext. 248

Colin Heffernan, Engagement Senior – [email protected], (705) 742-3418 ext. 259

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 Audit plan
Our risk-based approach focuses on obtaining sufficient appropriate audit evidence to reduce the
risk of material misstatement in the consolidated financial statements to an appropriately low level.
This means that we will focus our audit work on areas that have a higher risk of being materially
misstated.

Management is responsible for the accounting estimates included in the consolidated financial
statements. Estimates and the related judgements and assumptions are based on management's
knowledge of the business and past experience about current and future events.

Based on our knowledge of the Health Unit's business and our past experience, we have identified
the following areas that have a potentially higher risk of a material misstatement.

Area of audit emphasis Planned procedures

Revenue / deferred revenue Testing to ensure deferred revenue recorded meets recognition
criteria and does not result in an overstatement deferred revenue
and an understatement of revenue.

Long term debt Testing to ensure the Health Unit is meeting the debt service
coverage ratio required in the loan agreement.

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 Materiality

Materiality is the term used to describe the significance of financial statement information to
decision makers. An item of information, or an aggregate of items, is material if it is probable that its
omission or misstatement would influence or change a decision. Materiality is a matter of
professional judgement in the particular circumstances.

Materiality will be used throughout the audit and in particular when:

• Identifying and assessing risk of material misstatement;
• Determining the nature, timing and extent of further audit procedures; and
• Evaluating the effect of uncorrected misstatements, if any, on the consolidated financial
statements and in forming an opinion in the auditor’s report.

We set our materiality at $370,000 (2018 - $370,000).

Materiality was calculated as a percentage of total revenue.

The base and percentage applied in the current year are

consistent with those used in the prior audit.

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 Data analytics

We may integrate various automated tools and techniques throughout our audit, owing to our
continuing dedication to enhancing the relevance and value of the audit process. By incorporating
data analytics into our audit process, we are better able to identify potential risks around financial
reporting, including fraud and error. Through the use of analytics, we are able to enhance the
quality of our audits by relying less on sampling while reviewing complete data sets.

We’re always looking for innovative ways to evolve our current practices to better equip our staff,
improve your experience through the various audit phases and help support your business
success.

Specific areas where we may choose to use these tools:

We may leverage data analytics tools to identify risk areas, unusual

Planning and risk transactions and trends through an improved understanding of your
assessment operations and associated risks, including the risk of fraud. This allows us to
more effectively design procedures to specifically target the identified risks.

We may leverage data analytics tools to identify transactions more

Journal entry
susceptible to management override of controls by applying processes
testing
designed to analyze multiple criteria at once.

Identification of By examining 100% of the items in certain populations, where deemed

misstatements relevant, we are able to lower the risk of missing possible misstatements.

Two-way By gaining insight through our ability to analyze greater volume of

communication transactions, we engage your team in focused discussions about your
with your team operations.

Where deemed relevant, we will provide a summary of results obtained

Reporting
through application of various data analytics tools to you.

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 Other matters

Independence
We advise you that we are not aware of any relationships between the Health Unit and our firm that,
in our professional judgement, may reasonably be thought to bear on our independence.

We confirm we are independent of the Health Unit.

Fraud Discussion
Our procedures with respect to fraud and illegal acts are outlined in Appendix A.

If you have any knowledge of actual, suspected or alleged fraud or illegal acts, we ask that you
inform us.

Responsibilities
Refer to Appendix A for discussion on responsibilities.

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 Conclusion

Should any member of the Board of Health wish to discuss or review any matter addressed in this report or any
other matters related to financial reporting, please do not hesitate to contact us at any time.

Are you aware of any frauds, illegal acts or management override of internal controls at the Health Unit?

Yes / No (please circle one)

If yes, please contact our office immediately.

Acknowledgement of the Board of Health:

We have read this report.

Name, Position Signature

Name, Position Signature

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Appendices

Appendix A – Responsibilities

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 Appendix A – Responsibilities

Our responsibilities as auditor

As stated in the engagement letter, our responsibility as auditor of the Health Unit is to express an
opinion on whether the consolidated financial statements present fairly, in all material respects, the
financial position, results of operations and cash flows of the Health Unit in accordance with
Canadian Public Sector Accounting Standards.

An audit is performed to obtain reasonable but not absolute assurance as to whether the
consolidated financial statements are free of material misstatement. Due to the inherent limitations
of an audit, there is an unavoidable risk that some misstatements of the consolidated financial
statements will not be detected (particularly intentional misstatements concealed through
collusion), even though the audit is properly planned and performed.

Our audit includes:

• Assessing the risk that the consolidated financial statements may contain material
misstatements that, individually or in the aggregate, are material to the consolidated financial
statements taken as a whole;
• Examining, on a test basis, evidence supporting the amounts and disclosures in the
consolidated financial statements;
• Assessing the accounting principles used, and their application;
• Assessing the significant estimates made by management;
• Concluding on the appropriateness of management's use of the going concern basis of
accounting and, based on the audit evidence obtained, whether a material uncertainty exists
related to events or conditions that may cast significant doubt on the Health Unit's ability to
continue as a going concern;
• Evaluating the overall presentation, structure and content of the consolidated financial
statements, including the disclosures, and whether the consolidated financial statements
represent the underlying transactions and events in a manner that achieves fair presentation.

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 Our responsibilities as auditor (continued)
As part of our audit, we obtain a sufficient understanding of the operations and internal control
structure of the Health Unit to plan the audit. This includes management's assessment of:

• The risk that the consolidated financial statements may be materially misstated as a result of
fraud and error;
• The internal controls put in place by management to address such risks.

The engagement team undertakes a documented planning process prior to commencement of the
audit to identify concerns, addresses independence considerations, assesses the engagement
team requirements, and plans the audit work and timing.

An audit does not relieve management or those responsible for governance of their responsibilities
for the preparation of the Health Unit's consolidated financial statements.

Illegal acts, fraud, intentional misstatements and errors

Our auditing procedures, including tests of your accounting records, are limited to those considered
necessary in the circumstances and will not necessarily disclose all illegal acts should any exist.
Under CAS, we consider the Health Unit's control environment, governance structure,
circumstances encountered during the audit and the potential likelihood of fraud and illegal acts
occurring.

These procedures are not designed to test for fraudulent or illegal acts, nor will they necessarily
detect such acts or recognize them as such, even if the effect on the consolidated financial
statements is material. However, should we become aware that an illegal or possibly illegal act or
act of fraud may have occurred, other than one considered clearly inconsequential, we will
communicate directly to the Board of Health.

It is management's responsibility to detect and prevent illegal action. If such acts are discovered
or the Board of Health members become aware of circumstances under which the Health Unit
may have been involved in fraudulent, illegal or regulatory non-compliance situations, such
circumstances must be disclosed to us.

Related party transactions

During our audit, we conduct various tests and procedures to identify transactions considered to
involve related parties. Related parties exist when one party has the ability to exercise, directly
or indirectly, control, joint control or significant influence over the other. Two or more parties are
related when they are subject to common control, joint control or common significant influence.
Related parties also include management, directors and their immediate family members and
companies with which these individuals have an economic interest.

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 Board of Health member responsibilities
The Board of Health's role is to act in an objective, independent capacity as a liaison between the
auditor and management to ensure the auditors have a facility to consider and discuss governance
and audit issues with parties not directly responsible for operations. The Board of Health's
responsibilities include:

• Being available to assist and provide direction in the audit planning process when and
where appropriate;
• Meeting with the auditors as necessary and prior to release and approval of the consolidated
financial statements to review audit, disclosure and compliance issues;
• Where necessary, reviewing matters raised by the auditor with appropriate levels of management,
and reporting back to the auditors their findings;
• Making known to the auditor any issues of disclosure, corporate governance, fraud or illegal acts,
non-compliance with laws or regulatory requirements that are known to them, where such matters
may impact the consolidated financial statements or Independent Auditor's Report;
• Providing guidance and direction to the auditor on any additional work the auditor feels should be
undertaken in response to issues raised or concerns expressed;
• Making such enquiries as appropriate into the findings of the auditor with respect to corporate
governance, management conduct, cooperation, information flow and systems of internal controls;
• Reviewing the draft consolidated financial statements, including the presentation, disclosures and
supporting notes and schedules for accuracy, completeness and appropriateness, and approving
same.

Management’s responsibilities
Management is responsible for:

• The preparation and fair presentation of the consolidated financial statements;

• Establishing and maintaining an adequate internal control structure and procedures for financial
reporting, including the design and maintenance of accounting records, recording transactions,
selecting and applying accounting policies, safeguarding of assets and preventing and detecting
fraud and error;
• Ensuring completeness of information with regards to financial records and data and providing us
with information on non-compliance, illegal acts, related party transactions;
• Ensuring proper recognition, measurement and disclosure with respect to selection of accounting
policies, significant assumptions, future plans, related party transactions, any claims and possible
claims, contingent gains and losses and subsequent events;
• Providing to us a written confirmation of significant representations.

Management’s responsibilities are outlined in detail in our engagement letter.

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 Baker Tilly KDN LLP

Tax Assurance
Our tax services are designed to meet your business When you’re facing a changing global economy,
tax compliance and consulting needs. it’s important to have someone next to you who will help
navigate through the evolving accounting standards and
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Across our advisory service lines, we get to the essence
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4 offices | 20 partners | 120 professionals

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BOH Agenda - Feb 12 2020

Page 148 of 149
Thank you

BOH Agenda - Feb 12 2020

Page 149 of 149