June 2010 Annual Conference

 

JUNE 20 - 23 2010, CORNWALL, ONTARIO

alPHa and the Eastern Ontario Health Unit hosted alPHa's Annual General Meeting in Cornwall, Ontario this year, to learn about The New Essentials - Public Health Communications Today. Participants heard from speakers from a variety of backgrounds as they shared their expertise on a range of topics related to the rapidly evolving ways that people use, communicate and understand information, in order to enhance the key function of communications in a public health context. Regular business meetings of the Board of Directors and its Sections (Board of Health and Council of Ontario Medical Officers of Health), the Annual Business Meeting and Resolutions Session were also held.

PLEASE CLICK HERE FOR THE COMPLETE PROGRAM INFORMATION 

PHOTO GALLERY OUT AND ABOUT IN CORNWALL

Business Meeting 4:00 PM - 7:00 PM - St. Lawrence East Room Final meeting of the 2008-2009 alPHa Board of Directors. Agenda, Background Materials and Minutes to be distributed to BOD members via e-mail. GALLERY

Welcoming Reception for Delegates and  Guests - 7:30 - 9:30 PM - Adirondack Room and Patio     Following the final meeting of the 2009-2010 alPHa Board of Directors, delegates and guests were invited to a reception where they were welcomed by Cornwall Mayor and Board of Health Chair Bob Kilger and entertained by violinist Veronika Cherniak and pianist Gilles Levac. Sponsored in part by the Royal Bank of Canada. GALLERY

 

DAY 2 - MONDAY JUNE 21

Business Meetings - 8:00 - 10:00 - Simon Fraser Ballroom       GALLERY ANNUAL REPORT alPHa Annual Business Meeting Members assembled to confirm the business of the year, receiving reports from the President and Executive Director, each of alPHa's Sections and Affiliates, and the alPHa Advocacy Committee. Members of the 2009-2010 alPHa Board of Directors and alPHa Staff were also recognized for their service. AGENDA AND WRITTEN REPORTS     DRAFT MINUTES   Resolutions Session alPHa's members discussed and passed 10 resolutions for action in the coming year, covering swimming pool safety, information privacy, board governance, contraband tobacco, AQHI, food literacy, LHINs, dental health, active living and knowledge-to-action.  DISPOSITION OF RESOLUTIONS - 2010

Plenary Sessions - 10:30 - 12:00 - Simon Fraser Ballroom   Opening Remarks - Jim Brownell, MPP, Stormont-Dundas-South Glengarry Biography     Jim Brownell welcomed delegates to the Eastern Ontario Health Unit, the first one established in Ontario, reflecting on the accomplishments of the past and plans for the future. He congratulated all in attendance for the outstanding service to public health in each of their communities, thanking each on behalf of the Ministers of Health and Long Term Care and Health Promotion. He also congratulated the EOHU for celebrating its 75 years of service and expressed hope that delegates would find time to enjoy the attractions, fresh air and sunshine currently on offer in the Cornwall area. Referring to the theme of communications, he also commended the EOHU for its innovations in video and its use of the multiple means that are available to communicate in different ways. He closed by introducing “A Pioneering Spirit”, a video produced by EOHU on its history, and wished everyone a productive conference.      Dr. Paul Roumeliotis - The Evolution of New Media   Biography   Dr. Roumeliotis introduced the session (“The Evolution of New Media”) as an illustration of the necessity of learning to do things differently in the various practices of public health communications, as the means of communication themselves are constantly evolving. He pointed out that every sector is looking at new means of communicating with and understanding audiences, which are also constantly evolving, in order to successfully get their messages out and ensure that they are properly understood. Multiple formats and multiple vehicles that didn’t exist before are providing new opportunities - and they may actually save money.   He outlined the notion of convergence, which sees even traditional single-source outlets like TV, Radio and Newspapers enhancing their reach by establishing online and social media content. The transmission of information is thus increasingly instantaneous and decreasingly centralized as intended audiences have more control over when and how they choose to receive information. The message, the medium and the audience must therefore be keenly examined before implementing a communications plan.   He added that this new reality requires a whole new set of expertise, as the technology to create and transmit messages has changed dramatically, although it has become much less expensive, more accessible and of higher quality. He indicated that he has saved hundreds of thousands of dollars at the EOHU with in-house Web and broadcasting infrastructure. He warned that if public health ignores the new reality of convergence and changing audiences (i.e. the way that information is sent and received) it will lose its ability to be heard. Public health practitioners should however never lose sight of the fact that regardless of the chosen medium, the communication must be accompanied by and reinforced with personal contact. SLIDE DECK  Tracy Keleher - Social Media in Action  Biography                                 Tracy Keleher gave an overview of her early success in using the new media to disseminate parenting and health information, with a history of the founding of "Canadian Parents" dot com, which was motivated solely by the idea of making it possible for parents to communicate instantly among each other, with concerns, fears, seeking advice, or feelings of isolation, by making connections with each other online. It was inspired by something she found from California, that she believed would be valuable to Canadian parents if it could be replicated with Canadian content. She shared that most of her collaborators were younger than she is, reiterating the still-significant age divide between those who "get it" (Web-mediated communication) and those who do not.  She also summarized the extremely rapid evolution of the World Wide Web from a traditional  model of producing and transmitting information for consumption to a model that is more dynamic, interactive, collaborative and conversational. She used the following video to illustrate the importance of social media in the way people communicate and the way they use the information to make choices: During the early years of CanadianParents.com (“Canada’s Parenting Community”), message boards were used to connect users to a huge number of topics under various categories. Over 50,000 of these were related to public health, and the moderators were passionate about their topic threads. As available technology changed, different approaches could be built into what she referred to as an evolving digital strategy.    She defined “digital strategy” as a constantly evolving ecosystem, where a Web site may be the hub, but it should be connected to various other branches such as Wikipedia, YouTube, Twitter, Facebook - and even print media. The aim is to do whatever it takes to attract traffic, where each branch is part of the overall social media strategy. Each one attracts traffic, each reinforces the brand or personality and each is interconnected with the others. She demonstrated this using a YouTube video about how the Salt Lake Health Department used Facebook and Twitter to manage its H1N1 response.     She then summarized the approach that she believes public health needs to take in this new communications landscape in four words: “Preach less. Engage more”.   SLIDE DECK

LUNCH     MORE DAY 1 PHOTOS

Plenary Sessions - 1:00 - 4:45 - Simon Fraser Ballroom Mark Federman - Audiences Today   Biography  Thanks to social media and advances in communications technologies, today’s audiences have changed dramatically in recent years. This dynamic, PowerPoint-free talk examined the impact of the new generation of audiences and their pervasive connectivity on current communications plans and activities. Dr. Mark Federman opened with an illustration of the central roles of communication on the audience perceptions of the manufactured crises of Y2K at the beginning of the new millennium and the H1N1 pandemic of the past year. He provocatively labeled each an “elaborate hoax”, where billions of dollars were spent on responses to worst-case scenarios that never materialized.   He pointed out that in both cases, the intended tone of the public communications didn’t exactly match the tone of what people heard. The disconnect between the two revealed a fundamental and ongoing communications challenge, which is the inability to control what happens to a message between its sender and receivers. This has become more pronounced as the traditional modes of one way, authoritative communications are subsumed by emerging collaborative ones.   He suggested that this disconnect can only get worse if those with “legitimated authority” attempt to co-opt these new media and treat them as if they can be used in the same way as traditional, one-way broadcast media - a means used by central authorities to send instructions with which users are expected to comply. This reveals a fundamental gap in the understanding of what he called the “fogey generation” – which is that audiences in the traditional sense no longer exist.   He then introduced the theory posited by the Toronto School of Communications (of which Marshall McLuhan was a notable scholar), that the dominant mode of communication is the foundation for all of the structural institutions of society.   To explain this concept, he summarized 3,000 years of history in five minutes, beginning in Ancient Greece, where illiteracy was rampant – because the alphabet hadn’t yet been invented. When the Phoenicians arrived with a system of symbols that represented commodities, messages could then be transmitted and transported in an entirely different way. Symbolic coding of language allowed not only the encoding, transportation and exact reproduction of messages far removed from their source without ever having heard them, but also the proxy authority to carry out whatever instruction was contained within them.     This, he suggested, is what laid the foundations of the rise of the power and bureacracy of the Catholic Church. The clergy were literate - in words as well as The Word. Controlling both allowed them to maintain their authority over a largely illiterate laity, as they alone controlled the interpretation of the messages. This disappeared when Gutenberg took the Word away from the bureaucracy by mass-producing printed bibles, putting it in the hands and minds of people, who began to develop their own ideas. This was followed by a period of religious wars, more churches, the Enlightenment, Universities, secularism and the dawn of the industrial age.     Electric communication appeared in 1844 with Morse’s telegraph, setting in motion another gradual but fundamental shift in the way we do things and what society institutions looks like. Such shifts are said to take approximately 300 years, during which (usually near the mid-point) there is a “break boundary”, where people notice that something seems suddenly different. The appearance of Netscape in 1995 – which brought the World Wide Web to the public at large – could be seen as the break boundary of the cycle in which we currently find ourselves.     He pointed out that the above story contains the three major phases in how humans have communicated – phonetic, movable type and electronic. The transitions from one to the next have been accompanied by major parallel generation gaps, the latest of which we are seeing today, as the newest generation lives in a world where the things that we see as new – the Web, Google, instant messaging - never didn’t exist. The newest generation has not had to adapt to a new way of communicating. They have just learned to communicate, the same way we learned to read, write and speak.   Whatever one may call social media (Twitter, Facebook etc.), they are all the same thing – enablers of ubiquitous connectivity and pervasive proximity. He suggested that the “fogey generation” has simplistically concluded that these modes of communication are driven solely by exhibitionism, which leads to attention, celebrity, fame money and power. But this is the broadcast mentality being imposed on the completely altered definition of Mass Media, which is now closer to its original meaning – media by the masses rather than for the masses.     Today’s communication landscape starts with a collection of artifacts, which are constantly being edited and mashed up in a process of “collaborative construction”. WikiPedia was given as the prime example of this, a collaborative cultural construction of knowledge. Collaborative construction of identity was a term that he applied to President Obama, whose image has been built by the public more than campaign managers. Collaborative construction of cultural reference points is best represented by YouTube.   This underscores that we can no longer look at people as passive consumers of stuff. We must reflect carefully upon how we come to know what we know, while accepting that one can rarely answer that question completely. Information has become much more part of the environment, which affects our understanding of “truth”, which is increasingly understood as something that is never absolute and must always be understood as highly contextualized. Knowledge and truth in other words, can now only be expressed in relative terms, informed by our disparate concepts of human systems.   Individuals are less likely than ever to respond to the old model of one-way authoritative transmission. This is especially true if social media are treated simply as new ways to use the old model – such an approach will not only fail to achieve the behavioural changes that are often the goal of what we communicate, but will also damage our credibility.   Instead, social media must be viewed as a series of entry points to the existing networks that generate, contribute to and use environmental knowledge, where huge numbers of people can be persuaded to take personal responsibility to do the right things. Because together, we're smarter.                         David Jones - Evaluating Your Communications Plan Biography                      David Jones brought a different perspective on the use of social media, speaking about the innovations that are required for the measurement and evaluation functions of communications and marketing plans that make use of them.  He reiterated that creating, managing and sharing content is now done through through conversation. This has brought a new dimension to the idea of accuracy when carrying out evaluations of outcomes: everyone is talking, and they all have ideas that should probably be looked at. He pointed out that every time a novel medium has appeared - print, radio, television, the Internet, and now social media - it has been initially criticized as a threat to the older media and by extension, society itself. In all cases so far, the negative societal consequences that were predicted did not materialize, and the older media that newer ones were expected to replace continue to exist. Each new medium has added to the available range, and new technologies have, little by little, made them all more accessible to public, as consumers as well as producers. All of this must inform the components of a social media plan – setting objectives, identifying and characterizing the audience, defining the approach, selecting the tools and finally, measurement of outcomes. He suggested that a good social media plan would be developed and overseen by four key "personalities": Reconnaissance (always on the cutting edge of what's new and what's happening); the Mad Scientist (constantly experimenting, not constrained by tradition or habit); Communications General (the realist who keeps the mad scientist in check and integrates the best ideas from the Reconnaissance); Community Manager (interface with the public – human face of the content). He characterized this fourth personality as critical, as this is where the responsibility for making content come alive, draw people to it, learn from it, and build on it. He outlined a series of questions that should be asked as part of any social media campaign, explained the importance of knowing the difference between measuring and monitoring (and of using both in evaluating outcomes in real-time), the broader menu of social media metrics that are difficult to measure but need to be considered, and a number of tools that are available to measure simple usage statistics (see the slide deck for more details). He reinforced the importance of embracing social media strategies as an important complement to existing communications tools by indicating that people are always searching for new content, and one of the most common is health information. There is a wealth of it in cyberspace and not all of it is accurate, so it is in the best interests of public health experts to make sure that their content is found, passed around, and discussed.   He also acknowledged that this does present a new set of challenges for evaluating success - the real-time nature of social media requires different strategies for benchmarking, establishing "listening posts", the ability to make quick course-corrections, and measuring results of each along the way. More careful evaluation may therefore require reverting to traditional modes of information gathering, such as focus groups, phone polls etc. to allow more in-depth measurements.                     SLIDE DECK              Panel Discussion - Provincial Communications Landscape    Marysia Szymczak Manager, Public Education  Ministry of Health Promotion Kevin Finnerty Executive Director, MOHLTC Communications & Information Branch), Cindy Baker-Barill TCAN Coordinator Central East Region         Bringing the discussion of social media into a practical public health context was next on the agenda, as we heard about some of the ways that the Ministry of Health Promotion, Ministry of Health and Long-Term Care and the Tobacco Control Area Networks have applied some of the above ideas. Marysia Szymczak opened with her presentation, “Engaging Ontarians – Adventures in Technology”, to begin a discussion about health-related social marketing. She made the distinction between social marketing and social media, where the latter is a tool among many that can be used to achieve success with the former. She indicated that a greater understanding of this within the Ministry of Health promotion has led to revisions in its online presence. Web sites are more attractive and interactive, lighter on text and heavier on accessibility. This includes greater integration with existing modes of communication as well as novel ones (e.g. social media). This kind of integration enables multi-pronged approaches to health-related social marketing, which can include print, a central online site, banner links on other Web pages, ad placements in video games, and television, as well as out-of-home marketing. The Stupid.Ca anti-smoking campaign was used to illustrate this. She characterized this apporach as one of involvement and engagement of staff, partners and the public in the creation of communities that can grow around specific interests and topics. An interesting outcome of this is the increasing use of social media as an alternative to traditional "help-lines" were one-on-one consultation with an expert is replaced by multi-faceted conversations with both experts and peers. She used the HSFO Smoking Cessation Facebook page as an example:     Cindy Baker-Barill continued by sharing her experiences with using communication and technology to support the very successful Youth Action Alliance (YAA) project, where youth engagement by Tobacco Control Area Networks became one of the most important elements of the Smoke Free Ontario Strategy.     The importance of new technologies and ways of communicating were noted early, because the youth had better tech than most of the health units and are familiar with how people their own age actually use it to talk to each other. This familiarity makes their creative ideas considerably more valuable than those that might come from health promotion experts, who might know what they want to say but have no idea how to say it. She summed this up thusly:  “If it looks like it was made by a health unit, it’s probably not the right look”.   She gave extensive examples of the amazing work that the YAAs did using the various platforms that they use to stay in touch with each other and the common cultural references that they share to get messages out about tobacco that were going to resonate with their peers. At the end of the day, YAA pages got more hits than all other pages on the Ministry of Health Promotion's Web site combined. Several video clips are available here:     Despite the considerable success of the YAAs, the Provincial Government opted to discontinue funding for them at the end of 2009.     Kevin Finnerty followed with his ideas on Leveraging the Social Media, summarizing the steps in formulating a communications strategy:    1. Set Clear Objectives before you choose or use the tools. Experiments are now public and permanently available. 2. Choose the Channels that match your strategy. Not all messages fit all media. 3. Listen. There are ways of monitoring responses, learning where people are going for information and what they do with it. 4. Stay committed. Technology is fast, but uptake is slow. Timelines are therefore unpredictable. 5. Measure and evaluate. Usage metrics can be done with software.   He illustrated this process using specific examples of recent public health campaigns, whose aims were to raise awareness and persuade the public to take precautions. Each was the product of multi-faceted strategies that included pitching stories to media, paid advertising, Web sites, sponsored liks in Google, posters, and more. He added that this approach creates buzz in an age where old media are reporting on the content of new media if it is generating sufficient interest ("going viral" as the kids might say).        Panel Discussion: Leveraging New Technology for Public Health Communications    Paul Roumeliotis invited Tracy Keleher, Mark Federman and David Jones back to the stage for a final discussion of some of the ideas that have been presented throughout the day by providing their perspectives on a series of questions on how to use new media and technologies in public health communication plans. What are the right questions? Mark suggested that the most important one to ask is, how do we know and fully understand what we’re doing? This requires a more careful look at the full range of indicators, both qualitative and quantitative. He suggested that governments have a track record of failing very badly to assess their own programs properly because they rely too heavily on quantitative measures and are very slow to adapt to new ways of doing things. David added that it is important to ask if the team has the capacity to properly execute the plan. It is a resource issue, but not necessarily a monetary one – he reiterated that success depends on time and commitment, which includes figuring out what resources are required to gain an appropriate understanding of the new processes themselves before a plan that uses them is even formulated. Tracy emphasized the importance of asking what to do if something goes wrong. This question needs to be built into the plan not only as a contingency measure, but also to demonstrate transparency. It makes everyone involved in the plan aware of the expectations should a problem arise. Paul suggested that public health needs to consider these answers to evaluate its own readiness from the top down to integrate and implement new communications opportunities, and to make plans to ensure that the required skills and resources are available throughout the organization to do it properly. As the outside world changes, how do we change ourselves?   Mark offered his opinion that anyone who thinks they should be controlling things should no longer be allowed to control things. One can be in charge, but not in control, because the world does not allow itself to be controlled. He also suggested that there is an over-reliance on the "best practices" approach, which has become a well-worn shortcut that is assumed to lead to success. Instead, we need to get used to trying new things and get comfortable with the possibility of failing often and spectacularly. This, he said, is the best way to learn and the only way to innovate. David agreed, adding that there is a much greater acceptance of failure if the approach that resulted in it is an innovative or novel one.   David urged knowing the difference between a plan and an unalterable script. People are not comfortable with the idea of too much flexibility in a plan, because it builds in too much uncertainty about the desired result. Focus thus needs to turn back to the real value of being engaged in the process given the natural difficulty in defining its end point before it is actually reached. One way of doing this is to be part of the community rather than trying to influence it. At the end of the day, people trust people more than they trust institutions - so institutions need to put more emphasis on the fact that they are made up of people.   Mark elaborated on this idea, stating that there is an inherent dissonance between what a person says and what that person’s role says. The authenticity that is too often lacking in the latter is very obvious to people, and it damages credibility.   Tracy added that relationships are more critical than ever in a mediated social environment. She agreed that failures need to become more acceptable as they are much more likely in such a fluid communications world.   How do we adapt communications to the changing notion of authority?     Mark responded that what’s important is to create an environment of tactility, where there is a keen understanding of whom you are going to touch and how you are going to touch them. In other words, it is critical to understand how our local communities interact in order to engage them in a way that will make sense to them.   He characterized the idea of the “clear and consistent message” as obsolete and one that never worked anyway. He believes that too much energy remains devoted to careful crafting and delivery of "the message" without any regard for what happens to it before it gets to the user. Messages and media are agents of change, and he argued that the user IS the content, because the idea is usually to change behaviour. To do this, more thought needs to be paid to a clearer separation of the message and its effect. To illustrate this, he returned to H1N1 messaging, suggesting that the message was "get the flu shot", but the desired effect was "we want people to be healthy".    David then characterized today's communications landscape as one with multiple injection points for information – it doesn’t matter where it starts – because the information system is so complex, information gets around fast - and for every injection point there is also an outlet. Quick systemic changes are therefore much more likely now.    Each then suggested a starting point for any delegates not yet well versed in social media - find someone much younger, have a conversation with them about it (Mark); try to understand information in a different way, and participate rather than lurk (Tracy); and finally - try it, you’ll like it (David).    RECEPTION AND ANNUAL AWARDS DINNER CORNWALL CIVIC COMPLEX After a full day of business, delegates and their guests assembled to enjoy refreshments and conversation at the President's Reception, followed by dinner, musical entertainment by students from the St. Joseph's Catholic Secondary School Music Department and the presentation of the 2010 Distiguished Service Awards. PHOTO GALLERY  DAY 3 - TUESDAY JUNE 22 Joint Session with Allison Stuart (Assistant Deputy Minister of Health and Long-Term Care) and Arlene King (Chief Medical Officer of Health)   Allison Stuart joined alPHa's members from the Board of Health Section, Council of Medical Officers of Health and Affiliates to offer updates on some of the things that are happening at the policy level of the Provincial Government.   1) Policy and Programs The Ministry is currently developing a "map of priorities". Many items will be of limited interest, but there is a number of initiatives that will involve the public health field that will be communicated soon. Work is underway to respond to the expectations itemized in the June 3 French Language Services Commissioner's Report, based in part on feedback already received from local public health agencies. Further consultation is expected.   G8 and G20 preparations have been a significant focus for the Emergency Management Branch, and she characterized Ontario's health system as fully prepared. An Information and Privacy Work Group has been jointly established with alPHa, which will be addressing the role of public health and how it uses personal health information. A Performance Management Framework work group continues its work as frequent reference is made within the Ministry to the systemic data that was gathered in the Initial Report on Public Health In Ontario. Accountability agreements, performance standards and organizational standards are being developed, with organizational standards expected to be the subject of consultation in early July. An E-learning module on the OPHS is due this fall. As part of the accountability agreements, a set of indicators is being developed to measure the health of Ontarians and the contribution of publc health to the health system overall. These should come into effect in January 2011. Performance indicators will be folded into a package of expectations that will apply to the Ministry as well as the BOH. This will be an evergreen document subject to a comprehensive review every 3 years. A Ministry-Boards of Health committee will look at the transition from program –based grants to the Accountability system for funding.   2) Fiscal The Provincial Government has a 5-year post recession recovery plan aimed at deficit cutting and reinvigorating the economy. This includes the compensation restraint measures that apply to all boards of health. A Funding Review Working Group has been established that includes members from across the public health field. Jointly chaired by David Mowat (MOH - Peel), Paulina Salamo (MOHLTC) and Penny Nelligan (MHP), the group will examine current practices in this and other jurisdictions, and consider appropriate factors of a new model.  Future meetings will start to look at recommendations, but also consideration of the best process for broader consultation. The main goal is to ensure that the new framework is fair, consistent and transparent. The current funding arrangement will remain in place, but new funding is expected to underwrite the outcomes of the new systems. The approvals for the 2010 program based funding are forthcoming, and will in no case exceed the 3% commitment. The Public Sector Compensation Restraint Act was summarized, with an acknowledgement of the difficulties that it poses with regards to the timing of collective agreements and the integration of many health units within municipal structures. Nevertheless, it applies to all boards of health and the aim is to eliminate net increases over the two years beginning March 25 2010 or the start date of new collective agreements, whichever is later. More advice on dealing with confounding circumstances is expected to be available from the Ministry of Finance in the coming weeks.   Dr. Arlene King then joined the session, pointing out to delegates that it was almost exactly one year ago that she first introduced herself as Ontario's new CMOH at alPHa's 2009 AGM in Timmins, on the day after she was appointed.   Referring to her presentation , she summarized the role of the CMOH and how a current restructuring and reinforcement of her office is expected to support it.   She then turned to her June 2010 Report (The H1N1 Pandemic - How Ontario Fared), summarizing its content and recommendations, which include enhancing health system integration, improvinc electronic information systems and reinforcing the provincial chain of command. She confirmed that the Minister is considering opening the Health Protection and Promotion Act to amendments that strengthen CMOH authority over local MOHs and Boards, and assured that Health Units and we will be consulted.   Discussion followed with members raising points about the impact of media reports on the response, to which she responded that there is no way to control that, so public health needs to find ways of speaking with a consistent voice that is capable of "distracting people back to the truth".   She was congratulated for committing to improvement to the immunization program as well as for expressing the importance of articulating the role of LHINs. She indicated that the Ontario Health Plan for Influenza Pandemic(OHPIP) is an evergreen document that will reflect such forward thinking.    She was also encouraged by members to look at critical infrastructure at the local level, for example the examination of how local MOH powers and duties might be reinforced to improve access to (for example) local facilities where immunization programs could be carried out.      Concerns were raised about the idea of exercising CMOH powers and responsibilities at the local level, and about the potential for uniform central direction not necessarily being in the best interests of all local communities. Dr. King clarified that she sees the benefit in extending her authority to issue directives to other parts of the health system to boards of health, and that the scope and the triggers for such directives will be discussed over the summer. The intent is that such authority would only be used during an emergency, which will also require clear definition. Initial conversations will be taking place about this with the COMOH Executive, but wider consultation is expected before the legislation is finalized. She reiterated the need for a balance between local autonomy and the need for consistent application of central decisions.      Dr. King then briefly referred to her May 2010 report, The Potential Impacts of Wind Turbines, which was the product of a unique mechanism (like the one she is wanting for the above) of collaboration whose net result is public health speaking with a unified voice on an issue that needs to be collectively managed.   A suggestion from the floor was to consider a similar undertaking that addresses the complexities of waste management, and to look at the pros and cons of certain options. The relative envirnonmental and public health impacts of Incinerators vs. the thousands of trucks driving thousands of miles to bring garbage somewhere else was used as an example of an important area of inquiry. Dr. King agreed that a public health perspective is also required to inform discussion on this issue.