2010 Winter Symposium

Day One:   Thursday, February 25 2010
07:00 - 07:30: Morning walk   Meet at Hotel Registration Desk at 6:50 am 07:00 - 08:30: Registration ond Breakfast 07:30 - 08:30: Ontario Medical Association Public Health Physician Section AGM - Stage Door Room
08:30-09:00 - GIBSON BALLROOM alPHa President's Welcome  alPHa President Valerie Sterling, Deputy Minister of Health Promotion (A) Bob Stark Introductory Remarks: Bob Stark, Deputy Minister of Health Promotion Deputy Minister of Health Promotion Bob Stark	Following words of welcome from alPHa President Valerie Sterling, Bob Stark opened the symposium, taking advantage of the opportunity to introduce himself and provide his perspective as the new Acting Deputy Minister of Health Promotion. His primary experience is in the private sector, but has learned much since stepping into the post for an ailing Angela Longo.  He gave a summary of the health promotion agenda, including reference to the strategic partnerships that have led to their attendance here today.  He characterized the MHP as an organization that leverages health promoting capabilities across government, and welcomed suggestions on how to do that, emphasizing in particular the importance of making the economic case for health promotion strategies and programs. He stated that he wants to work more effectively and more openly with the health units as their key delivery channel - one that accounts for over 70% of the MHP budget. He believes that the Ministry is more nimble and responsive now, and this will be helpful as opportunities to move the health promotion agenda forward present themselves while the Government refocuses its priorities by going back to the fundamentals.
09:00 - 10:00 - GIBSON BALLROOM Plenary Session: Ministry of Health Promotion Panel presentation from senior Ministry of Health Promotion staff describing the Ministry’s new directions, their roles and key initiatives   l-r: Penny Nelligan, Rick Beaver, Janie Romoff, Domenica Ozarko, Cindy Greeniaus, Dr. Françoise Bouchard	Penny Nelligan, Director of the Standards, Programs and Community Development Branch Summarized the origins of the MHP and its narrow focus on behaviours and isolated public health issues, mentioning the Smoke Free Ontario strategy and sports and recreation programs. While these remain important programs, she referred to the MHP's new Strategic Directions, Organizational Structure  and Mission, explaining that these will strongly inform a new approach for the Ministry that allows it to focus on the mulitiple factors that influence health and address them across government and with the public health units that deliver the programs and services. Regional advisors, accountability frameworks, and content experts are among the ideas that MHP is considering under this new approach, but the method and format of working together is up for discussion among all stakeholders. She added that MHP also has a close relationship with the Public Health Division (MOHLTC) on program strategies, which is also a significant source of MHP funds. The aim, through the various relationships is to create a strong and collaborative network for Health Promotion in Ontario.    Rick Beaver, Director of Sport and Recreation and Community Programs   He briefly described his role in overseeing the sports and recreation files, such as amateur sport (through municipal partnerships), high-performance sport, and the Pan Am Games (including ensuring that they leave a lasting and positive legacy for the GTA).  He also oversees the Healthy Communities Fund and After School initiatives, which are a major focus and the subject of more detailed presentations below. Responding to questions from the moderator, he indicated that the best way to ensure a strong partnership between his branch and public health in the field will be open communication. Another question was posed about the role of schools, where recreational opportunities are most important – he responsed that he will be examining the curriculum with MCYS and Ministry of Education to ensure that they are seized.   Domenica Ozarko Strategic Policy, Partnership and Research Branch   She summarized her main focus on partnerships with Ministries and stakeholders (both private and public), and creating partnerships with non-traditional partners. She echoed the importance of childhood recreation opportunities in schools and other avenues to promote healthy public policy, giving the example of their demonstrated contribution to the Ministry of Education's goal of improving educational success.  Research resources in Ministry have been moved to the Policy Branch, which will be used to set and refocus priorities, strengthen linkages with OAHPP and examine emerging interventions that have demonstrated early success. She reiterated that local Public Healh is the key partner, and that relationship will be essential to reaching MHP goals and influencing other partners, especially at the community level.   Janie Romoff - Strategic Initiatives Branch   Janie is responsible for bringing the various components within the Ministry together to move its overall agenda forward, and linking it with the larger directions of Government as a whole. She used Smoke Free Ontario as an example, where cross-government teams are brought together to meet the overall policy directions in health promotion. This is the only initiative currently in the branch, but it will look at all of the new ones and develop plans for collaborative work on each. It will also be responsible for developing a program evaluation framework in order to track progress and share information. She also singled out the importance of the community level in program design, which may see formal linkages in the form of secondments, formalized feedback and standing committees.   Cindy Greeniaus Communications Director   Cindy is a new member of the MHP team and a specialist in communications. She spoke of the importance of changing behavior through effective social marketing at all ages and stages, as well as the importance of sharing best practices to make the central functions of MHP and its messages relevant at the community level. Her main role is to support her other colleagues, to turn the policy directions of the Ministry into stories that resonate with the public.   Francoise Bouchard – Associate Chief Medical Officer of Health, Health Promotion.   Dr. Bouchard summarized her role as ACMOH of the MHP, and its origin in the same rationale that led to the creation of MHP five years ago, namely the critical role that health promotion plays in serving the overall goals of public health. She also cited the Tobacco Strategy as a good example of a novel approach to collaborative work on effective and far-reaching public health strategy. The presence of such a position within this Ministry adds an important element of influence as it links with the structures within the Ministry of Health and Long-Term Care. While she acknowledged that the MHP has been refocusing and rebuilding and is reasonalbly small, she expressed confidence that it could have a significant impact on healthy public policy with the right mix of communication, collaboration and influence.    Q&A   During the discussion that followed, alPHa members echoed the value of collaboration, especially considering the web of responsibilities involved. It will therefore be critical to take use existing research and partnerships to target specific outcomes. Because implementation of policy decisions always impacts capacity, it is essential to examine the delivery mechanisms, in this case making sure that the school boards, volunteer agencies and parks and recreation workers can handle the work. Related to this, it will be very important to ensure that the application process for Ministry grants to support local programs is not in itself a barrier to receiving them, as many deserving local organizations simply do not have the capacity to go through it.   In addition to this, it will be important to consider the resources of municipalities that provide facilities and programs. Janie Romoff assured that the municipalities are in the partnership mix, and close attention is being paid to the body of research that demonstrates the significant return on investment for open recreation programs, which will shape the eventual policy.     Members also reminded the Ministry representatives that the research on the importance of sport and exercise is clear, and that it is time to act on improving inadequate physical education programs in schools. One suggested that the school day should be extended with 30 minutes of mandatory physical activity.     In the end, there appeared to be mutual recognition that public health units are the key MHP partner at the community level, and that this partnership must be fully utilized to ensure that the translation of policy into practice will be a successful one.     PRESENTATION: Ministry of Health Promotion Strategic Directions
10:00 - 10:30 Break
10:30 - 12:00 - GIBSON BALLROOM Plenary Session:  Ministry of Health Promotion Updates and discussion of MHP programs such as Healthy Communities Ontario, New Directions in Tobacco Control and After School Programs   Rick Beaver   Vito Chiefari   Denis Gertler Pegeen Walsh	Rick Beaver, Director of Sport and Recreation and Community Programs returned to give an overview of the $10M MHP After School Initiative, which was announced in 2008. After that announcement, MHP determined that it was necessary to address multiple risk factors rather than simply focus on the mechanisms of obesity. It was determined that the best window for this was in the after school hours, leading to a rebranding of the initiative as a Child and Youth Health and Wellness Strategy. He also linked this to the Poverty Reduction agenda, as it addresses multiple social determinants of health and focuses delivery in high-priority neighborhoods. The three core program components are physical activity (30%), healthy eating (20%) and personal health and wellness (20%), with the remaining 30% allocation left available to other activities that would best serve local needs (cultural activities, homework supports, free play, targeted teen programs etc.).  Communities were asked to define what they wanted their programs to look like, and proposals were submitted to MHP on how they would leverage local partnerships, ensure supports for the greatest number of children, and define the specific features of their approach. The delivery requirement was for a minimum of 9 hours per week over a minimum of three days. The programs are currently serving over 15, 000 children and youth, and a new focus is being considered for on-reserve services.   Q&A   Members were very supportive of the vision of this program, but several points were raised for consideration by the MHP as it formulates next steps for expansion and improvements. One voiced concerns about ongoing difficulties in partnering with local schools, which often throw up barriers to some of the facility uses that are central to the idea. Mr. Beaver suggested that this will become less problematic as community use of schools is an increasing focus in Provincial policy.   It was also made clear that the 36 public health units are keen to help deliver these programs, but that they are not as involved as they would like to be. Mr. Beaver responded that this program is a three-year pilot, after which feedback will be invited in order to author a report, which will include outcome indicators, to make the case for program expansion, including consideration of new partners.     A question was also asked about the relationship with the Pascal Report, as it also envisions schools as key community hubs for families and children. Pegeen Walsh reported that she and the ADM has already planned a meeting with Jim Grieve (Deputy Minister of Education – Early Years Branch) to discuss this.     PRESENTATION: Ontario's After School Initiative       Vito Chiefari, Executive Lead, Tobacco Control Strategic Initiatives Branch  reported that the team that was brought together to refocus the New Directions in Tobacco Control is working very well, and remains extremely important, considering the continued prevalence in smoking and its measurable negative health impacts. He summarized what is known about the demographic realities of the smoking problem, referring to the preventable cases of lung cancer, the leveling off of smoking rates, the increase in uptake of young adults, aboriginal and marginalized groups, cheap and contraband tobacco availability that are all threatening the steady gains that have been made in recent years.   The New Directions in Tobacco Control is a 5-year, government – wide strategy to engage partners, coordinate interventions and leverage new investments to address this threat. The Scientific Advisory Group will review the evidence, the Tobacco Strategy Advisory Group will receive input from stakeholders and working groups, and the Inter-Ministerial Committee on Tobacco Control will work on coordinating the strategy across the provincial government.  All of this input will be used as the foundation of a new Tobacco Control Strategy, which will be presented to government in June 2010.   Denis Gertler, Director Smoke-Free Ontario Branch gave a summary of what to expect in the short-term, indicating that investments are expected to be the same for this coming fiscal year, with no change in priority. Further, the Ontario Tobacco Research Unit (OTRU) has been asked to develop a model for a more strategic enforcement approach than the current one that focuses almost exclusively on vendors. The Ministry is continuing to implement the final phase of the tobacco inspection program with state-of-the art systems in the field and better data on enforcement trends. It will continue to fund the Leave the Pack Behind initiative for young adults, as well as pilots targeting other priority populations. It will also link tobacco control activities to the broader ministry initiative on Youth Engagement, which covers all of programming in health promotion and chronic disease prevention. A framework with principles (including specifics on tobacco) for this initiative is expected to be released on March 31   Q&A   Delegates reiterated the importance of maintaining the focus on tobacco control, and expressed support for a renewal of the strategy, indicating that it will only be successful with sustained political commitment.   PRESENTATION: New Directions in Tobacco Control    Pegeen Walsh, Project Lead - Healthy Communities reported that a productive meeting with the COMOH Executive earlier this year was a catalyst for the extensive dialogue that is occurring here, referring to the very clear message from COMOH that local public health agencies are very eager to partner with MHP to move Health Promotion in Ontario effectively forward. Her purpose today is to explore this opportunity to formally partner with Medical Officers and Boards of Health to design and implement the Healthy Communities Ontario initiative.   The intent of the initiative is to examine the partnerships, evidence and best practices required to establish permanent and effective strategies for healthy communities, with a goal of creating a culture where healthy communities are a common interest and a primary driver for public policy. The MHP has established a set of initial priorities and three key components.   One of these is the Healthy Communities Fund, which provides financial assistance to provincial and local organizations to address multiple risk factors through a single Ministry funding window. It is program-based, and awarded according to the alignment of the proposal with the six priority areas.  Following consultation, some difficulties have been ironed out, including funding timelines, clarifying the role of public health, and reclassification of risk factors. These are included in the updated 2010-2011 HCF, which rolls out tomorrow (February 26 2010).   She concluded her presentation with an acknowledgement that local public health agencies have a lead role in identifying and working with community partners, and invited feedback on the challenges, opportunities and required supports to put this role to use in the development of Healthy Communities Partnerships (the second of the three key components). In addition to opening the floor for comment, input sheets were made available at each table, which alPHa will collate and return to the MHP.   Q&A   Significant concerns were expressed about the difficulties and disorder that the MHP’s new direction has been causing at the local level. Many expressed that the Healthy Communities Fund in particular is creating more problems than it is solving, and that its approach bypasses traditional communication through MOHs and management structures of health units, effectively cutting them off as the operational arm of creating healthy communities on the front line.   This is in turn creating a great deal of confusion about roles and responsibilities, especially as local public health agencies are ineligible as a "lead agency" for funding proposals. The onus for filling out applications, contracts and other Government forms is therefore transferred directly to small local organizations that have little experience with this type of process, and less capacity to complete it. Pegeen clarified that public health units can still do this work during the proposal process, enabled by its “partnerships” pillar. She also added that there are some areas with dedicated funding (e.g. the Heart Health Networks) for which local public health agencies are still welcome to retain lead-agency status.   It was also suggested that specific language around “collaboration and partnerships” be incorporated, using the core-competency definitions that already exist for public health. Another member expressed concern about the overreliance on volunteers at a time when the volunteer sector in Canada is experiencing significant decline.   It was acknowledged that further work is required to improve clarity of process and to clearly define the MHP - Public Health Unit - Local Community Organization relationship that will be required to realize the vision of Healthy Communities Ontario.   PRESENTATION: Healthy Communities Ontario
12:00 - 13:00: Lunch
13:00 - 13:30 - GIBSON BALLROOM Plenary Session: Hon. Deb Matthews, Minister of Health and Long-term Care Deb Matthews, Minister of Health and Long-Term Care, Deb Matthews, Minister of Health and Long-Term Care, Dr. Arlene King, Chief Medical Officer of Health	Minister Matthews eagerly accepted alPHa’s invitation to speak, as an opportunity for her to thank Ontario’s medical officers of health, boards of health and staff for their efforts, not only during the H1N1 pandemic, but each day, as they do the work that is so critical to keeping Ontario healthy.  She reassured delegates that the Government commitment to health care remains strong, even as its growth outpaces that of the Province’s revenues in the face of a very difficult economic situation.   She also thanked alPHa’s members for their advocacy and input into the Ontario Poverty Reduction Strategy, which she characterized as the first among many, with an initial focus on children, referring to the moral and economic responsibility to make investments that ensure that those most vulnerable are taken care of. She made special mention of the annual Cost of a Nutritious Food Basket data, which she hopes will inform future strategies to make healthy foods more accessible.   Responding to a question about the MOHLTC role in the ongoing poverty reduction strategy, she referred to the Social Assistance Review Advisory Council, which will present recommendations for short-term changes to the Social Assistance system. As Minister of Health and Long-Term Care, she continues to sit at the Results Table. She acknowledged that the system does not treat people with respect and dignity, does not help lift people out of poverty, and spends too much on administration. She expressed hope that this will be the start of significant change.   She reminded delegates that public health has demonstrated its importance to Government, which has responded with a 159% increase in Provincial funding since being elected. She added that it has also demonstrated its effectiveness, suggesting that Ontario’s response to H1N1 - especially in vaccinating so many people in such a short period of time - was unmatched. The primary care system was largely unaffected in the ways that the pandemic plan suggested it would be, and more people are coughing into their sleeves, a small but significant demonstration of successful efforts to change individual behaviours.     She closed by encouraging members to continue to demonstrate the enormous value of public health by reaching out to their local MPPs, to educate them and reinforce its importance.
13:30 - 13:35 - GIBSON BALLROOM Invitation to alPHa's June Conference in Cornwall Ontario by Bob Kilger, Chair, Eastern Ontario Board of Health  Bob Kilger, Mayor of Cornwall and Chair of the Eastern Ontario Board of Health Minister Matthews draws a name of the winner of the print held by Mayor Bob Kilger
13:35 - 15:00 - GIBSON BALLROOM Plenary Session: Updates from Allison Stuart, Monika Turner & Dianne Alexander, Public Health Division, MOHLTC: Performance Management and Public Health Funding Review; Low Income Dental Program Update     Monika Turner, Dianne Alexander, Donna Dupont Allison Stuart, Monika Turner	Allison Stuart, Assistant Deputy Minister of Health and Long-Term Care introduced the afternoon engagement with MOHLTC staff by giving a number of updates, beginning with two changes at the senior level - Rafi, Saäd is the new Deputy Minister, and David Hallett is the new Associate Deputy Minister   She continued by reiterating the Minister’s comments about Ontario’s excellent response to H1N1, and reported that the applications that were made by local public health agencies for related reimbursements are being reviewed, and pledged that responses will be sent out before the end of March.   The evolving relationship of the MOHLTC with the Ontario Agency for Health Protection and Promotion was also put to the test by H1N1, and despite growing pains and lack of clarity over who does what, she characterized the cooperation between the two as superb. The experience will be used to identify areas that still need work and roles and responsibilities that need clarification, to ensure the intended service to the public health sector. She added that the OAHPP has already absorbed the laboratories, and is in the process of doing likewise with the Regional Infection Control Networks (RICNs) and the Public Health Research and Education and Development (PHRED) program. Work is also being done to formulate a clear contact list so that stakeholders know exactly whom to call on a given issue.  Switching to IT infrastructure, she reported that the Panorama project went on hiatus for the e-health review. Because it is linked to the larger national Panorama project - which has continued - this has caused some tension in other jurisdictions. While approval still needs to be received from the Central Agencies to continue the process, the commitment to moving it forward remains strong.   She also stated that the Province has appealed the recent Ontario Court of Justice decision on the sale and distribution of Raw Milk, and that they clearly heard the message that this should be used as an opportunity to promote healthy eating while emphasizing the significant risks  of certain choices.   She closed by urging members to listen to upcoming Provincial Throne Speech for clues about what to expect in the 2010 Budget, speculating that the Government will likely narrow its focus on its original agenda. She also reminded that the initial Budget speech and documentation does not contain exact details about dollar amounts, and assured that consideration continues to be given to the difficulties presented by the misalignment of Ministry and Health Unit fiscal years. The current goal is to have health unit grants settled and communicated by late June / early July.     Monika Turner, Director, Public Health Practice Branch followed to give updates on the Public Health Funding Review and Performance Management initiatives.   The goal of the first is to fully examine the present model for funding local public health agencies, which will involve an accurate and detailed accounting of diverse sources of funding, current expenses (including administrative and capital costs) and areas of pressure in order to have a clearer picture of how Public Health dollars are being spent. It will also examine funding inequities that reflect factors such as urban, rural, and population characteristics, as well as funding transparency and stability (she reassured that this will not result in cuts to some to underwrite increases to others). This review is expected to be completed in October 2010, around the time that Accountability Agreements are being negotiated. MHP is also very involved in this.   On the Performance Management front, organizational Standards have been developed, which are aimed at providing the framework for assessing the success of the public health system in meeting its mandated objectives and its capacity for continuous quality improvement, and for demonstrating its contribution to the overall health system in more quantitative terms. PRESENTATION: Public Health Funding Review and Performance Management Initiatives  Dianne Alexander, Manager of Implementation and Support summarized the origins of the Low-Income Dental Program and its current status as a key initiative of the Province’s poverty reduction strategy. She gave an overview of the program’s scope and goals, including improved community dental infrastructure, an improved model for service delivery and enhanced opportunities for community health promotion initiatives related to good oral health. All are expected to be supported by local partnerships and local approaches to program development and are criteria for the business case packages submitted to the MOHLTC for funding consideration.   These business cases have been received and are in the final review stages. The pre-operational and operational stages will be supported by 100% Provincial dollars for start-up (one-time) and service provision (ongoing, starting in 2010) respectively.     In the meantime, the Dental Stakeholder Advisory Group (which includes alPHa and OAPHD representatives) continues to meet. It was acknowledged that further work will be required on partnerships and operational funding details. Allison Stuart added that the total amount of funding requested from public health units exceeds the amount available for the program. This and other details will be worked on in collaboration with all stakeholders. PRESENTATION: Low Income Dental Program  Q&A   Panorama: Members expressed appreciation for the renewed commitment to this project, but urged that the Ministry make further commitments to improving information technology for the public health sector in general, as it continues to work through a patchwork of outdated platforms such as fax machines. Allison Stuart replied that there is a desire to formulate a vision on the reform of the public health environment as it interacts through technology and indicated that dialogue on this is planned for June of this year.   PH Funding Review:  Clarification was sought about coverage for capital costs in the funding review. Allison Stuart responded that this will be carefully examined in the context of the review of the sources of variation among health units.  A follow up question was asked about the possibility of eventual 100% provincial funding for public health. Allison Stuart replied that it is challenging for public health to transpose models (e.g. 100% for hospitals) from elsewhere in the HC system. She also pointed out that the Hospital model is in fact cost shared between MOHLTC and fundraising organizations. Monika Turner added that this is the reason that the funding review is being done, and a discussion about the funding model can’t take place until its results are known.   Accountability agreements: Clarification was sought about what these agreements are going to look like – Allison Stuart indicated that there will be 36 agreements that are in part exactly the same for everyone (to inform accountability of the sector as a whole) and in part tailored to local circumstance (to ensure accountability of individual public health units to the communities that they serve).   LIDP: A question was asked about the role of Community Health Centres as ideal delivery agents for the LIDP, as some have expressed concerns about why they are not more directly involved. Donna Dupont replied that the Ministry has not been extremely prescriptive about how this program rolls out – although money will be flowed through PHUs (which will in turn be accountable to the Ministry), they will be responsible for drafting their own accountability agreements if they are not providing the services directly. Responding to a further question about the compensation model for dentists providing these services (i.e. the potential for per-diem model to draw dentists away from the CINOT program, which is fee-for-service), she clarified that the LIDP model allows for different compensation strategies to maximize program delivery. Clarification was also provided that unused CINOT dollars from the recently expanded service areas can in fact be reallocated to offset shortfalls in the original ones. This will be reinforced during an upcoming meeting with the HU business administrators.
15:00 - 15:30: Break 15:30 - 17:00: Concurrent Business Meetings of COMOH and Affiliates & Board of Health Sections 17:00 - 20:00 Reception, Sponsored by the Eastern Ontario Health Unit 2nd Floor Foyer
Day Two:  Friday, February 26 2010
07:00 - 07:30: Morning walk - meet at Hotel Registration Desk at 6:50 am 07:00 - 08:30: Registration ond Breakfast 08:30 - 12:00: Concurrent Business Meetings of COMOH and Affiliates & Board of Health Sections (Continued) 12:00-13:00: Lunch 13:00 - 15:30: COMOH Business Meeting (Continued) PRESENTATIONS: BOARD OF HEALTH AND AFFILIATES  PRESENTATION: Revised Health and Physical Education Curriculum (Grades 1 - 8) PRESENTATION: Chief Medical Officer of Health Updates  PRESENTATION: Wind Turbines: Hazard or Outrage?