2022 Annual Report

Climate change continues to influence the frequency and severity of weather events that may affect our health. Extreme weather events including extreme heat and cold, poor air quality events, severe storms such as wind storms, freezing rain, blizzards, and flooding often cause damage to infrastructure including the power grid and our homes. These events disrupt our lives and can have negative impacts on our physical and mental health. Members of our communities can better cope with these situations when they are aware of the risks and prepare ahead of time as much as possible to protect themselves, their families and their properties. On the larger scale, residents can advocate for community-level changes that can help make our region more resilient to the effects of climate change.

One way we can manage the public health effects of climate change is by working with municipalities, social services, childcare centres, Long-Term-Care/retirement homes, and shelters. We work with our partner municipalities to encourage policies and procedures that reduce the effects of climate change locally. We work with local school boards to spread the message about best practices for students on days of extreme heat, days of extreme cold, and air quality events. The media and other outreach partners like social services help spread the message to the public and provide outreach to vulnerable clients during these weather events.

“We continue to educate the public on the local effects of climate change,” says Kim McCann, Senior Public Health Inspector. “We can all contribute to a better understanding and better preparedness for climate change.”

From a prevention standpoint, we advocate for healthy built and natural environment interventions that can help make our communities more resilient to extreme heat. For example, through commenting on municipal plans, we encourage the planting of more trees, and the preservation of existing natural areas (e.g., forests, wetlands), which help keep the surrounding area cooler; the building of more public water features (e.g., splash pads, wading pools), which provide more options for cooling down, especially for people who don’t have air conditioning.

Moving forward Health Unit staff are working together to view our activities through the lens of climate change. In 2023, we added a section to our website that outlines climate change mitigation, adaptation, effects on health and climate change data. More information will be added in the coming years.

The pandemic brought uncertainty to our communities and responding to the crisis was the day to day work of many of the staff of the Health Unit for a few years. During 2022, we were able to look for opportunities to be creative and find ways to reach the equity deserving population with vaccines as well as expand the awareness of all respiratory illnesses. The future will see us living well alongside COVID-19 and immersing the precautions and messaging into our various programs.

Community partnerships helped deliver more than 500,000 COVID-19 vaccines in Leeds, Grenville and Lanark (#1 in the province).

Creative ways of holding vaccine clinics, such as at the Brockville Speedway and vaccinating residents from an RV mobile clinic were fun for staff and the clients; they also allowed us to reach those on the outer limits of our geography, where access to the vaccine had been limited. Many of our community members voiced their appreciation in ‘being remembered’. We also made it ‘easy’ by going to where the people are most comfortable, in their own neighbourhoods or community events.

The fall of 2022 saw the resurgence of COVID-19 infections as well as influenza and RSV (Respiratory Syncytial Virus). The new buzzword “Triple Threat” was in the news and on our minds. These non-COVID-19 respiratory infections, which are followed up by the Health Unit, increased from 20 cases in 2021 to 572 cases in 2022. This resurgence of non-COVID-19 respiratory infections relates to several years without exposure and the re-openings of 2022. COVID-19 vaccines had shifted to an in-house clinic model but we still offered 152 clinics.

Language is now shifting from “COVID-19” and “pandemic” focus to “respiratory illness” and “respiratory season”. This paradigm shift reflects the increase seen in non-COVID-19 respiratory illnesses in 2022, in combination with decreased testing criteria aimed at determining anti-viral treatment eligibility and identifying cases linked to high risk settings such as Long-Term-Care and acute care. The result is the Health Unit promoting “Living Well alongside COVID-19” and encouraging people to stay home when sick in hopes of decreasing the transmission of all respiratory illness (COVID-19 included). This respiratory prevention messaging has become embedded into many of our programs.

Looking towards recovery planning, the participation of pharmacies and health care providers in annual vaccination campaigns will be critical to support the Health Unit returning to non-pandemic vaccination programs. In 2023, the focus will be on school school/student vaccinations and routine vaccination catch up.

For more information about respiratory infections, visit this section of our website.

Dental Screening in schools results in timely and effective detection and identification of children and youth at risk of poor oral health outcomes. It also identifies associated risk factors and emerging trends. Children and youth from low income families have improved access to dental care as a result of providing screening in schools. Access to dental care is important because in 2017-2018, the Canadian Community Health Survey showed about 36% of the Leeds, Grenville and Lanark population aged eighteen years and over reported not having dental insurance.

Screening was suspended during the pandemic when schools were closed and many students participated in at home learning. The restart of this program for the 2022/23 school year was intended to end with a completed cycle of screening in all schools, and updated risk ratings for each. This supports efforts to review and re-establish the school fluoride varnish program and provide Healthy Smiles Ontario (HSO) preventive services to eligible children through public health preventive dental clinics. Our goal is to continue to promote the Healthy Smiles Ontario program to all children and youth 0-17. The school screening program will focus on surveillance activities in order to monitor the oral health status of children living in Leeds, Grenville and Lanark. Our dental team can help get kids enrolled in the program and support the parents through the processes to obtain services through local dental offices or our public health preventive dental clinics.

If this program was not in place, some children and youth may not be identified as being in need of treatment and have the opportunity to access dental care to address both urgent and preventive needs. As approximately 70% of our population does not have access to municipal fluoridated water, we also resumed our school-based fluoride varnish program. As part of our gradual return to this service, we offered 1 fluoride varnish application to all JK/SK students in schools identified as high risk through screening program outcomes in the 2022-2023 school year. To discuss future eligibility and preventive services at a public health dental clinic, families were encouraged to contact the health unit for more information.

Effective partnerships between our staff (Dental Hygienists, Dental Assistants, Administrative Assistants, School Health Nurses, Healthy Growth and Development Program) and Local Dental Offices, School Boards, School Administrators and Teachers, Ministry of Health, Family and Children’s Services, and Municipalities (water fluoridation) all help to round out the Health Unit’s Oral Health Program. These professionals work together to support the school screening process, refer children in need, and follow up with families to help ensure urgent dental needs are addressed in a timely manner.

“With the right prevention, early detection, treatment and maintenance, a healthy smile can last a lifetime,” quotes Registered Dental Hygienist, Jill Hicks of the Health Unit’s Oral Health Team.

For more information about oral health, visit this section of our website.

One of the roles of Public Health under the Health Protection and Promotion Act is to respond to new and emerging infectious diseases. On June 16, 2022 MPOX (“monkeypox”) was designated a Disease of Public Health Significance. This meant that any MPOX cases have to be reported to the local Medical Officer of Health in accordance with the reporting requirements under The Act.

The MPOX virus is related to the virus that causes Smallpox. Typically it is found in parts of central and West Africa. This disease of public health significance was new in 2022, but transferrable lessons learned from the Health Unit’s COVID-19 response applied. Public Health is always monitoring emerging infections and the work to address these is ongoing, not just during a pandemic. Since May 1, 2022, a total of 722 confirmed cases of MPOX have been reported in Ontario. 1500+ cases were seen in 9 provinces, with 45 hospitalizations.

The response to these new and emerging infectious diseases requires the work of key partners along with public health.

The Health Unit follows up reports of MPOX virus with case and contact management. The primary goal of MPOX case management is to control cases and prevent transmission.

Case Management isn’t the only role that public health plays in emerging infections, we also provide some testing and immunization services when available and raise awareness of prevention and identification of reportable diseases.

Testing of genital lesions for MPOX can be accessed at our sexual health clinics, but testing and diagnosis related to other symptoms are referred to Health care providers or the emergency department.

Other partners that may be needed in the fight against emerging infections are the Paramedics who administer vaccine to contacts under a Medical Directive of the Medical Officer of Health after hours/on weekends, primary and acute care help with testing and diagnosis related to other symptoms are referred to their healthcare provider or the emergency department. The Ministry of Health provides guidance documents and distributes vaccine, and there may be a need for regional public health units to share follow up information about cases when they cross jurisdictions.

“New and re-emerging infections and diseases continue to be a part of the work of public health,” says Yves Decoste, Infection Control Specialist at the Health Unit. “When we act quickly and work together, we can reduce the chances of these diseases causing harm or even death.”

For more information about reportable diseases, visit this section of our website.

Special events add vibrancy to our communities and can provide an opportunity to learn and enjoy a diversity of experiences and foods. When outdoor events offer food to our residents, the Health Unit is part of the planning to help prevent illness.

The International Plowing Match was one such event. This event brings the agricultural community to the urban and rural setting. More than 67,000 people attended during the five day event which ran from September 20 to 24 in 2022 including more than one thousand volunteers. An event of this size is no small feat as a temporary community is basically created with infrastructure such as roads, water and sewage systems being installed to service the event.

The Health Unit worked collaboratively with organizers and the municipality of North Grenville to ensure a successful event and minimize the risks to the public. The Ontario Clean Water Agency and the Ministry of Environment Conservation and Parks were also part of the partnerships needed for this event.

Public Health Inspectors inspected food vendors to ensure safe food preparation and service at the event. They monitored the water system to ensure safe drinking water was provided, as well as monitoring for health hazards including management of solid and liquid waste and sanitary conditions at the venue. There was also an RV park on the property that accommodated thousands of campers which also required inspections of the setup.

Providing clear expectations during the planning stages resulted in very few issues during opening and while inspections were being carried out.

During the Pandemic many special events were cancelled or scaled back. The plowing match was one of the first large events in our area to resume so additional outreach to ensure vendors were aware of their responsibilities under the various regulations took additional time and creativity. Many in this segment of the population had experienced challenges during the pandemic including financial challenges and looked forward to resuming their business operations.

Food safety continues to be important especially following the pandemic where the effects continue to be challenging for these types of special events where public health interventions including education and inspection are needed.

For more information about special event inspections, visit this section of our website.

The Health Unit’s role in reviewing municipal plans is a great example of an upstream intervention that is intended to help create/foster healthier built and natural environments that induce healthy behaviour. There are 22 municipalities and 2 counties in the Leeds, Grenville and Lanark District Health Unit region, all of which develop various municipal plans (e.g., Official Plan; Transportation Master Plan; Parks, Recreation and Culture Master Plan; proposed subdivision; etc.) that can affect population health.

Our goal is to collaborate with our municipal partners to include robust healthy public policy in these planning documents. The public benefits from this program by having the communities in which they live be more health-promoting and health-protecting due to municipal planning policies that: consider land use compatibility; create a more accessible and equitable transportation network; create better access to more health-promoting and health-protecting recreation spaces; preserve and protect the local food system; control access and exposure to tobacco, alcohol, and cannabis products; foster social interaction and sense of community; and plan for climate change mitigation and adaptation. The built and natural environments have a significant impact on people’s health, even if it goes unnoticed. We advocate for policies and action that protect the public from the negative effects of climate change; air pollution; extreme heat; incompatible land use as well as for policies and action that: induce physical activity; create multimodal transportation options; create better recreation options; reduce greenhouse gas (GHG) emissions.

Partnerships with Municipalities are very important in planning. Municipal staff lead a project, and do the majority of the work, usually in partnership with a consultant planning company hired by the municipality. The Health Unit consults on these projects either directly or indirectly. For most of these projects, we submit evidence informed letters that suggest healthy public policy to be considered for inclusion in the plans. We also communicate directly with municipal staff on various aspects of the projects, sit on stakeholder working groups and attend public meetings about these projects.

During 2022, we were still very much focused on COVID-19 work and so we did not work on as many municipal plans as we would have in pre-COVID-19 times. In 2023, capacity has increased, we have commented on more plans and strengthened the evidence behind our suggestions. Our work on municipal plans helps us move forward after the pandemic by reconnecting with different municipal staff and promoting public engagement to show residents the value of getting involved with municipal planning and the significant impact that can have on their lives.

One of the main actions to take is to get involved in the municipal planning process and advocate for healthy public policy. We continue to improve our public communication and are looking forward to strengthening our partnerships with municipal staff and Councils as well as continuing to improve our evidence based healthy public policy suggestions.

“Social progress is often slow,” explains Danielle Shewfelt, Public Health Nurse and Municipal Team Lead. “It has ups and downs and may even go backwards sometimes. But it’s the passionate people that persevere and chip away slowly who are often most successful at effecting positive change, over years and years, that prove that equitable social change and progress is worthwhile and important.”

Creating and fostering healthy built and natural environments that are resilient to climate change is a type of social progress that requires consistent and steady effort. The Health Unit intends to continue to provide this effort to help promote and protect population health. For more information about the Health Unit’s role municipal planning, visit this section of our website.

The pandemic saw an increase in people adopting pets or taking rescue animals into their care which contributed to an increase in animal bites. Some of these bites posed a risk of exposure to rabies. Given that rabies is a fatal disease, a risk assessment and appropriate treatment when needed remains necessary.

Preventing animal bites is the best way to reduce the chance of humans contracting rabies from animals that may be infected with rabies. Our bite prevention campaigns provide tips to help people identify the reasons animals may bite humans so they can be more aware when approaching domestic animals, and to avoid contact with wild animals.

Another way to prevent the spread of rabies is for animals to be vaccinated. It is also required by law (O. Reg. 567 (Rabies Immunization) under the HPPA has required rabies vaccination of dogs, cats and certain classes of livestock in Ontario since 1986). Having pets vaccinated against rabies protects family members, should their pet be exposed to rabies.

The Health Unit has seen an increase in animal exposure reports over the last few years. Some of these required post exposure treatment for rabies. To assist with non-emergent hospital visits, the Health Unit partnered with our community paramedicine program to facilitate the completion of rabies post exposure treatment for clients who were exposed to an animal where there was a risk of rabies. Although wound care and initial administration of post exposure prophylaxis (PEP) must still be provided by their health care provider or in the emergency department, clients now have the option to receive the remaining doses of rabies vaccine on day 3, 7 and 14 from paramedics.

This pilot project was timely during the later stages of the pandemic as many clients were still concerned about visiting emergency departments. With COVID-19 still in our communities and people visiting the emergency department for treatment this increased the volume of emergency department visits and wait times. This pilot demonstrated that emergency department visits in some cases can be diverted with positive outcomes for the clients.

PEP is important to administer when a person has been bitten by an animal and the risk of exposure to rabies cannot be ruled out. Completing the required series ensures a person that has been exposed will not develop rabies.   

“Working with the paramedics to provide this treatment is an important alternative and helps reduce the pressure on the extremely busy emergency rooms,” says Teresa Clow, Manager of Community Health Protection at the Health Unit. “Any diversion of visits to the emergency department while still getting the necessary treatment is beneficial for clients/patients seeking medical attention and for the hospital staff. We are also seeing an increase in clients who do not have a health care provider so when injuries occur they must go to the emergency department.”

This pilot project has seen benefits for both clients and the hospitals. Since this option works around the schedule of the client, we are seeing that clients are completing the full dose as per the schedule, resulting in complete protection from rabies and a reduction in wasted vaccine. Other Ontario Health Units have showed interest in this model.

Using prevention and intervention programs and partnering with paramedics and veterinarians, public health has helped in reducing human exposure to the rabies virus.

For more information about rabies prevention, visit this section of our website.

Public health has been providing support to schools almost since the beginning of its existence. Over the years, the role of the School Nurse has gone through many changes. During the pandemic, that role was identified as key for providing support to help reduce the spread of the virus amongst children.

Additional funding from the Ministry to hire more school focused nurses during the pandemic and throughout 2022 provided greater capacity for Public Health Nurses (PHNs) to build relationships with schools and assist them through the transition post COVID-19. Being present more frequently in schools allowed for more appreciation and recognition of the school PHN role and the supports that they could provide.

“I was pleasantly surprised to discover that the Health Unit was still very much active at the school level,” said one school representative. Another added; “this position was fantastic and allowed for a partnership between the school and the Health Unit – which has been difficult in the past.”

The goal of the school health program is “to achieve optimal health of school-aged children and youth through partnership and collaboration with school boards and schools” (Ontario Public Health Standards/OPHS). Effective partnerships between Health Unit staff and school communities (i.e., school boards, schools, principals, educators, parent groups, students, and the broader community) is fundamental to promoting and implementing school health. These partnerships, particularly with our schools, school board partners and neighbouring health unit (Eastern Ontario Health Unit), were strengthened during the pandemic and continued to remain strong throughout 2022.

While the focus of early 2022 continued to be on COVID-19, the latter part of the year allowed us to focus on priority topics from the OPHS (e.g., mental health promotion, vaping, human development & sexual health). These priority topics were identified through surveys and informal conversations with our school partners.

The Health Unit’s school team supported schools with these topics by providing curriculum consultations, in-person workshops, and resources; in-servicing principals, teachers, and parents; promoting and normalizing parenting support; fostering student engagement & leadership (e.g., largely around the topic of vaping); supporting existing and emerging healthy school committees, policies & practices; navigating the Health Unit’s resources and services for schools and connecting the school community to services & programs offered by partners in the greater community; facilitating consultations with other Health Unit internal partners such as Registered Dietitians, Health Promoters, the Immunization team, Smoke Free Ontario Inspectors and Public Health Inspectors.

Post COVID-19, our school board partners have indicated increases in attendance concerns, mental health referrals, self-reported anxiety and depressive symptoms, behaviour and safety concerns, eating disorders and substance abuse. Looking forward, we plan to focus on our OPHS work to help mitigate some of these identified issues along with maintaining and strengthening the level of collaboration with our schools, school boards and the neighbouring Health Unit that was developed throughout the pandemic. The emphasis on mental health promotion provincially (School Mental Health Ontario), in schools (social emotional learning workers) and school boards (mental health leads) has created opportunities for public health to partner and work more comprehensively, efficiently and effectively to support student well-being.

A recent journal article stated that: “health and education are interdependent: healthy students are better learners, and better-educated individuals are healthier.” We believe that our efforts in the schools has illustrated this statement.

For more information about school health, visit this section of our website.

The Health Unit participated in the Substance Use and Additional Program Grant from Health Canada from 2019 to 2022. We received the grant right before the pandemic hit but were still able to work with Peer Navigators to improve the navigation of local resources and to improve access to services by those who use substances. The Peer Navigators also supported the Lanark County Situation Table, where many community partners from multiple sectors (law enforcement, health care, addictions and mental health, child welfare, Public Health, Education, Social Services etc.) collaborate to review complex client situations and plan for interventions.

In 2021, we were able to promote surveys to help us gain some knowledge about the issue of stigma and access to services. The surveys were meant to assist with gaining a better understanding of the experiences of current and past substance users and their family and friends in accessing services in the area. There was also a survey for front line workers and organizations about their services. From these results, we have been able to develop training material to help decrease community stigma and discrimination towards people who use substances. Training materials included presentations to promote stigma free communication methods and provide training on assessing an organization to find changes organizations can make to provide stigma free services.

Within the Substance Use Program, the Health Unit provides clean equipment under the Ontario Harm Reduction Program. We also distribute Naloxone kits and training through Ontario Naloxone Program, as well as providing support to local Methadone clinics, and participating in community response/alerts related to drug overdoses. We work with a variety of community and provincial partners to reduce the harm and stigma associated with substance use and to re-orient health services to meet population needs. Because of this grant, we were able to work with new agencies to help with distribution of Naloxone.

We are continuing this work by partnering with the Upper Canada District School Board and R&J Youth Services to expand the reach of harm reduction supports to youth, and to facilitate the voice of youth being included in program decision-making.

“We were pleased with the program enhancements we were able to achieve with this grant money,” says Lucia Taggart, Public Health Nursing Co-ordinator at the Health Unit. “Harm reduction is an important part of keeping people in our communities safe.”

The Health Unit has always made an effort to increase awareness around the harmful effects of substance use when it comes to youth. We use a comprehensive tobacco control approach. This means we implement a number of programs and initiatives that include preventing the initiation of tobacco through education around the harms related to tobacco and limiting access to tobacco products, promoting quitting, eliminating exposure to environmental tobacco smoke and identifying and eliminating disparities related to tobacco use and its societal outcomes among different population groups.

Our Smoke Free Ontario Inspectors perform regular inspections of schools and premises that sell tobacco and vapour products to ensure compliance with the Smoke-Free Ontario Act (SFOA). Making sure these premises follow the laws helps keep tobacco products out of the hands of youth. Education and strong partnerships result in high levels of compliance in these premises. SFOA enforcement activities were put on hold during COVID-19. As we move back to our regular activities, Inspectors are making sure the schools and vendors have the information they need to comply with the Act, as well as, re-establishing relationships with new vendors and re-starting the test shopper inspections.

Increasing awareness around the harm caused by substance use can be challenging. Our website has taken a comprehensive approach to all facets of substance use. But the information is only good if it is being accessed and understood.

“One of the best ways to help young people make informed decisions about substances and their health is by meaningfully engaging with them to find out what they want to know and what will resonate with them,” says Rebecca Shams, Health Promoter for the Health Unit and member of Planet Youth Lanark County.

Focus groups and workshops have helped gain better understanding of the issues and how to get information to our local youth as well as through the surveys and sessions that were done in partnership with Planet Youth Lanark County (PYLC). 

The Health Unit is one of many partners that make up the PYLC Advisory Committee. Planet Youth partners include organizations like Open Doors, School Boards, and many dedicated community volunteers from all sectors. The Health Unit is taking the lead on the youth engagement portion of the project – and working as a partner for the other aspects of the project helping to provide resources and evidence for the chosen topics. Plant Youth Lanark County lost much momentum during the pandemic but staff still made time to stay connected with the key players while deployed to COVID-19 work. PYLC is a community engagement initiative so it needs many community players to be involved for success. Find out more about this project here; Planet Youth Lanark – A community-based prevention model. While Planet Youth is specific to Lanark County – the ideas and initiatives have the potential to be expanded even without formally adopting the project in Leeds/Grenville.

From the Planet Youth surveys we learned that a safe space was high on the list of what youth were asking for from their community. Working in partnership and supporting initiatives like Municipal Drug Strategy groups allows engagement with other community partners to identify local issues related to substance use prevention and to develop projects that meet the needs of that specific community. A good example is the Berm Out project that provided safe space for youth in Gananoque in the summer of 2022 with connection to services, competent adult ally leaders, food and access to Wi-Fi. This initiative saw Health Unit staff working alongside Police, Addictions and Mental Health, Justice Agencies and School boards.

The reality is that even with prevention information and limiting access, there are some youth who do smoke and vape for a number of reasons. Because of this, we offer cessation consultation which refers to motivating, encouraging and supporting efforts to quit tobacco use. Evidence suggests that for individuals who smoke, it may take numerous attempts to quit. Therefore, cessation support may be needed repeatedly and at different points on their quit journey. Cessation interventions are focused at both the population level and at the individual level.

Moving forward, the Health Unit has an opportunity to develop new partnerships and review how we can build healthy environments that prevent substance use and support cessation and mental well-being through healthy policy development as well as sharing of information and working together for a common outcome.

For more information about any of our programs related to smoking and vaping, visit this section of our website.