Chief Medical Officer of Health Public Health Update

1. Chief Medical Officer of Health Public Health Update Presentation to alPHa Dr Arlene King, MD, MHSc, FRCPC June 22, 2010

2. Role of the Chief Medical Officer of Health Most of you will already be aware of my role, but as Chief Medical Officer of Health: Appointed by the Lieutenant Governor in Council Legislated obligations as outlined in the HPPA Duty to report annually to the legislature on the status of public health and to issue reports as needed Reports to Deputies of MOHLTC and MHP Ability to communicate directly with the public regarding public health Primary liaison with the Ontario Agency for Health Protection and Promotion Provides public health leadership in recommending policy, legislation and programs that cut across government jurisdictions and are consistent with Ontario�s priorities for public health  Represents Ontario Public Health System by leading the public health engagement at federal/provincial/territorial levels (Next Slide)Most of you will already be aware of my role, but as Chief Medical Officer of Health: Appointed by the Lieutenant Governor in Council Legislated obligations as outlined in the HPPA Duty to report annually to the legislature on the status of public health and to issue reports as needed Reports to Deputies of MOHLTC and MHP Ability to communicate directly with the public regarding public health Primary liaison with the Ontario Agency for Health Protection and Promotion Provides public health leadership in recommending policy, legislation and programs that cut across government jurisdictions and are consistent with Ontario�s priorities for public health Represents Ontario Public Health System by leading the public health engagement at federal/provincial/territorial levels (Next Slide)

3. CMOHO Structure Progress continues on the office structure. The reviews have been completed and are now awaiting final approvals. In the interim, the following key staff are in place to support the Chief Medical Officer of Health: Dr David Williams, ACMOH Health Protection Dr Francoise Bouchard, ACMOH Health Promotion Liz Walker, Interim Director Jason Stanley, Executive Assistant Benjamin Lim, Issues Management Coordinator* Gillian MacDonald, Issues Management Coordinator Laura Seeds, Executive Support Coordinator Nika Karapetova, Administrative Assistant Medical Group, including: Dr Beth Henning, Senior Medical Consultant � Health Promotion (Interim) Dr George Samuel, Senior Medical Consultant � Health Protection Dr Rose Bilotta, Senior Medical Consultant � Health Protection Dr Valerie Krym, Senior Medical Consultant � Health Protection Further updates will be provided in the near future. * Returning to home position mid-July 2010. Progress continues on the office structure. The reviews have been completed and are now awaiting final approvals. In the interim, the following key staff are in place to support the Chief Medical Officer of Health: Dr David Williams, ACMOH Health Protection Dr Francoise Bouchard, ACMOH Health Promotion Liz Walker, Interim Director Jason Stanley, Executive Assistant Benjamin Lim, Issues Management Coordinator* Gillian MacDonald, Issues Management Coordinator Laura Seeds, Executive Support Coordinator Nika Karapetova, Administrative Assistant Medical Group, including: Dr Beth Henning, Senior Medical Consultant � Health Promotion (Interim) Dr George Samuel, Senior Medical Consultant � Health Protection Dr Rose Bilotta, Senior Medical Consultant � Health Protection Dr Valerie Krym, Senior Medical Consultant � Health Protection Further updates will be provided in the near future. (Next Slide) Progress continues on the office structure. The reviews have been completed and are now awaiting final approvals. In the interim, the following key staff are in place to support the Chief Medical Officer of Health: Dr David Williams, ACMOH Health Protection Dr Francoise Bouchard, ACMOH Health Promotion Liz Walker, Interim Director Jason Stanley, Executive Assistant Benjamin Lim, Issues Management Coordinator* Gillian MacDonald, Issues Management Coordinator Laura Seeds, Executive Support Coordinator Nika Karapetova, Administrative Assistant Medical Group, including: Dr Beth Henning, Senior Medical Consultant � Health Promotion (Interim) Dr George Samuel, Senior Medical Consultant � Health Protection Dr Rose Bilotta, Senior Medical Consultant � Health Protection Dr Valerie Krym, Senior Medical Consultant � Health Protection Further updates will be provided in the near future. (Next Slide)

4. CMOH Pandemic H1N1 Report Report on Ontario�s response to pH1N1 entitled, The H1N1 Pandemic � How Ontario Fared was released June 2, 2010.  An initial look at our collective response informed by: My personal reflections The ministry review and audit The ministry is also undertaking its own review with oversight by the Ontario Internal Audit Division, which will be shared with stakeholders in the summer This review will also include a Communications and Information component. From a national and international context: National Review of pH1N1 response by Public Health Network Council. A Federal government review is also expected. International Review by the World Health Organization�s International Health Regulation Review Committee. Report on Ontario�s response to pH1N1 entitled, The H1N1 Pandemic � How Ontario Fared was released June 2, 2010.  CMOH Report an initial look at our collective response informed by: Personal reflections Ministry review and audit Ministry is also undertaking its own review with oversight by the Ontario Internal Audit Division, which will be shared with stakeholders in the summer This review will also include a Communications and Information component. From a national and international context: National Review of pH1N1 response by Public Health Network Council. A Federal government review is also expected. International Review by the World Health Organization�s International Health Regulation Review Committee. (Next Slide) Report on Ontario�s response to pH1N1 entitled, The H1N1 Pandemic � How Ontario Fared was released June 2, 2010. CMOH Report an initial look at our collective response informed by: Personal reflections Ministry review and audit Ministry is also undertaking its own review with oversight by the Ontario Internal Audit Division, which will be shared with stakeholders in the summer This review will also include a Communications and Information component. From a national and international context: National Review of pH1N1 response by Public Health Network Council. A Federal government review is also expected. International Review by the World Health Organization�s International Health Regulation Review Committee. (Next Slide)

5. What Went Right We got through it  Unprecedented collaboration First Nations Communities Schools Stayed Open What Went Right We got through it Hospitalizations, ICU admissions and death rates were lower than the national rates Excellent collaboration with Critical Care Secretariat Immunization coverage higher than most other countries Dominance over the seasonal flu strain; H1N1 deaths lower than reported annual deaths from seasonal flu Unprecedented collaboration Internationally, nationally, provincially, and locally Among governments and within the health care system First Nations Communities Collaboration on planning, advice, anti-virals and vaccines, especially in northern/remote areas One of the first provinces to develop a Chapter on First Nations within their pandemic plans Schools Stayed Open Boards, teachers and public health worked together to keep schools open (Next Slide) What Went Right We got through it Hospitalizations, ICU admissions and death rates were lower than the national rates Excellent collaboration with Critical Care Secretariat Immunization coverage higher than most other countries Dominance over the seasonal flu strain; H1N1 deaths lower than reported annual deaths from seasonal flu Unprecedented collaboration Internationally, nationally, provincially, and locally Among governments and within the health care system First Nations Communities Collaboration on planning, advice, anti-virals and vaccines, especially in northern/remote areas One of the first provinces to develop a Chapter on First Nations within their pandemic plans Schools Stayed Open Boards, teachers and public health worked together to keep schools open (Next Slide)

6. What Went Wrong Supply What Went Wrong: Supply: Demand (heightened by highly publicized deaths) exceeded supply, leading to line-ups Production of unadjuvanted vaccine (specifically for pregnant women) created delays Large 500-dose boxes caused storage and administration difficulties (Next Slide) What Went Wrong: Supply: Demand (heightened by highly publicized deaths) exceeded supply, leading to line-ups Production of unadjuvanted vaccine (specifically for pregnant women) created delays Large 500-dose boxes caused storage and administration difficulties (Next Slide)

7. What Went Wrong Capacity This was the largest and most rapidly executed immunization program in Ontario�s history We underestimated the logistics of organizing and delivering a mass campaign We underestimated line-ups and demand surges We didn�t have the details we needed about how the immunization program was unfolding What Went Wrong: Capacity This was the largest and most rapidly executed immunization program in Ontario�s history We underestimated the logistics of organizing and delivering a mass campaign We underestimated line-ups and demand surges We didn�t have the details we needed about how the immunization program was unfolding (Next Slide) What Went Wrong: Capacity This was the largest and most rapidly executed immunization program in Ontario�s history We underestimated the logistics of organizing and delivering a mass campaign We underestimated line-ups and demand surges We didn�t have the details we needed about how the immunization program was unfolding (Next Slide)

8. What Went Wrong Health System Challenges While collaboration was unprecedented, local system integration was challenging, e.g. no defined role for LHINs CMOH does not have the ability to issue directives to boards of health to ensure coordination and standardization of public health programs and services such as immunization What Went Wrong: Health System Challenges While collaboration was unprecedented, local system integration was challenging, e.g. no defined role for LHINs CMOH does not have the ability to issue directives to boards of health to ensure coordination and standardization of public health programs and services such as immunization (Next Slide) What Went Wrong: Health System Challenges While collaboration was unprecedented, local system integration was challenging, e.g. no defined role for LHINs CMOH does not have the ability to issue directives to boards of health to ensure coordination and standardization of public health programs and services such as immunization (Next Slide)

9. Recommendations We need better tools to manage our immunization system, including the capacity to electronically manage and track our immunization programs Need a review of the provincial immunization system Establish a much clearer chain of command and extend that chain of command to the local level Consideration should be given to better integrate the components of our health care system so that our response to the next pandemic, or other public health emergency, will be better integrated at the local level, and more closely linked to the overall provincial response Recommendations We need better tools to manage our immunization system, including the capacity to electronically manage and track our immunization programs Need a review of the provincial immunization system Establish a much clearer chain of command and extend that chain of command to the local level Consideration should be given to better integrate the components of our health care system so that our response to the next pandemic, or other public health emergency, will be better integrated at the local level, and more closely linked to the overall provincial response (Next Slide) Recommendations We need better tools to manage our immunization system, including the capacity to electronically manage and track our immunization programs Need a review of the provincial immunization system Establish a much clearer chain of command and extend that chain of command to the local level Consideration should be given to better integrate the components of our health care system so that our response to the next pandemic, or other public health emergency, will be better integrated at the local level, and more closely linked to the overall provincial response (Next Slide)

10. H1N1 Conclusions We were ready My recommendations are not to fix something that didn�t work, but to improve something that did, in order to ensure that it always will Conclusions: We were ready My recommendations are not to fix something that didn�t work, but to improve something that did, in order to ensure that it always will I am very proud of the way this province responded to the pandemic I am very proud of our public health units and how they rose to the challenge of our first pandemic in over 40 years Our success is a direct result of your efforts � thank you for your continued dedication to public health. (Next Slide) Conclusions: We were ready My recommendations are not to fix something that didn�t work, but to improve something that did, in order to ensure that it always will I am very proud of the way this province responded to the pandemic I am very proud of our public health units and how they rose to the challenge of our first pandemic in over 40 years Our success is a direct result of your efforts � thank you for your continued dedication to public health. (Next Slide)

11. Wind Turbines Report Another recent priority was recent review of existing scientific evidence on the potential health impact of wind turbines Conducted in response to public health concerns about wind turbines, particularly related to noise The report, �The Potential Health Impacts of Wind Turbines,� which summarized the review findings was released on May 20, 2010 (Next Slide) Another recent priority was recent review of existing scientific evidence on the potential health impact of wind turbines Conducted in response to public health concerns about wind turbines, particularly related to noise The report, �The Potential Health Impacts of Wind Turbines,� which summarized the review findings was released on May 20, 2010 (Next Slide)

12. Wind Turbines Report Conclusions Scientific evidence available to date does not demonstrate any direct causal link between wind turbine noise and adverse health effects Community engagement in consultation is important and may alleviate health concerns about wind farms Lack of data on noise measurements around wind turbines and comparison with other rural and urban areas is a key data gap. Better assessment of noise levels is necessary for making an informed decision on need for health studies Scientific evidence available to date does not demonstrate any direct causal link between wind turbine noise and adverse health effects Community engagement in consultation is important and may alleviate health concerns about wind farms Lack of data on noise measurements around wind turbines and comparison with other rural and urban areas is a key data gap. Better assessment of noise levels is necessary for making an informed decision on need for health studies (Next Slide) Scientific evidence available to date does not demonstrate any direct causal link between wind turbine noise and adverse health effects Community engagement in consultation is important and may alleviate health concerns about wind farms Lack of data on noise measurements around wind turbines and comparison with other rural and urban areas is a key data gap. Better assessment of noise levels is necessary for making an informed decision on need for health studies (Next Slide)

13. Looking Forward Tobacco Control Review of the Provincial Immunization System 5 year Strategic Plan for Public Health in the Province of Ontario. Tobacco Control There is a process underway to renew the government�s tobacco control strategy for the next five years. Government is doing this for a number of reasons: Tobacco use is the number one cause of preventable disease and death in Ontario, killing over 13,000 Ontarians every year. Tobacco-related diseases cost the Ontario economy $1.6 billion in direct health care costs, resulting in $4.4 billion in productivity losses and accounting for at least 500,000 hospital days each year. Reducing tobacco use makes a measurable impact on related chronic conditions, such as diabetes, asthma and heart disease. Although the government has exceeded its targets to reduce smoking consumption, without appropriate new objectives and a plan, Ontario risks loosing the ground we have achieved. Review of the Provincial Immunization System MOHLTC plans to undertake a comprehensive review of its publicly-funded vaccine program including: Vaccine identification Delivery methods Improving coverage Cost-effectiveness Procurement Partnerships Mandate will be developed through a Brainstorming session on July 14th; participants include representatives of MOHLTC, OAHPP, PIDAC and health units. 5 year Strategic Plan for Public Health in the Province of Ontario that will: Acknowledge and build on accomplishments in revitalizing public health in Ontario since the release of �Operation Health Protection� (2004) and �Revitalizing Ontario�s Public Health Capacity� (2006) Set a vision and direction for 2010 and beyond for the broader public health �system� Involve participation of OAHPP on Steering Committee (Next Slide) Tobacco Control There is a process underway to renew the government�s tobacco control strategy for the next five years. Government is doing this for a number of reasons: Tobacco use is the number one cause of preventable disease and death in Ontario, killing over 13,000 Ontarians every year. Tobacco-related diseases cost the Ontario economy $1.6 billion in direct health care costs, resulting in $4.4 billion in productivity losses and accounting for at least 500,000 hospital days each year. Reducing tobacco use makes a measurable impact on related chronic conditions, such as diabetes, asthma and heart disease. Although the government has exceeded its targets to reduce smoking consumption, without appropriate new objectives and a plan, Ontario risks loosing the ground we have achieved. Review of the Provincial Immunization System MOHLTC plans to undertake a comprehensive review of its publicly-funded vaccine program including: Vaccine identification Delivery methods Improving coverage Cost-effectiveness Procurement Partnerships Mandate will be developed through a Brainstorming session on July 14th; participants include representatives of MOHLTC, OAHPP, PIDAC and health units. 5 year Strategic Plan for Public Health in the Province of Ontario that will: Acknowledge and build on accomplishments in revitalizing public health in Ontario since the release of �Operation Health Protection� (2004) and �Revitalizing Ontario�s Public Health Capacity� (2006) Set a vision and direction for 2010 and beyond for the broader public health �system� Involve participation of OAHPP on Steering Committee (Next Slide)

14. Questions and Answers