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					        CMOH Presentation
Council of Medical Officers of Health
          Boards of Health

                   Friday February 26, 2010

Arlene King, MD, MHSc, FRCPC
Chief Medical Officer of Health
Overview of Presentation
• CMOH Office Review

• Current Issues:
  – H1N1 Lessons Learned Review
  – Raw Milk
  – Wind Turbines

• Interactive Q&A Period

CMOH Office Review
•   A review of the scope and role of the CMOH office is currently underway.
    The review is occurring in two phases:

     – Phase 1 will look at what the CMOH Office requires to get work done, including
       strategy, policy development, key processes and customer/client coordination.

     – Phase 2 will examine the governance, leadership relationships, processes and
       intersections between the CMOH, the Public Health Division, OAHPP and the
       Ministry of Health Promotion.

•   Work on Phase 1 was completed at end of January 2010 and
    implementation has started; Phase 2 is slated for completion by the end of
    April 2010 and implementation will continue into the summer.

•   Findings and recommendations of this review, along with other inputs, will
    help to shape the vision for the future of Public Health in Ontario.

New CMOH Team Members

• Elizabeth Walker – Interim Director of the CMOH

• Ben Lim – Issues Management

• Jason Stanley – Special Advisor

• Laura Seeds – Stakeholder Relations and
  Information Management

Current Issues
pH1N1 - Review Process
• pH1N1 review and lessons learned process is underway

• Four strategic objectives of the review have been identified:

   1. To critically examine and report on key lessons learned: what
      worked well, what requires improvement.

   2. To enable application of lessons learned to future events.

   3. To inform key reports from the CMOH to the provincial

   4. To inform potential 3rd party reviews that may take place, such
      as a review at a later date by the Auditor General of Ontario.

pH1N1 - Review Methodology
• Engagement of the Ontario Internal Audit Division
   – Helps validate methodology and objectivity.
   – Provides baseline of information for on-going process
     improvements and the 2009 CMOH Report.

• Review will include all the relevant stakeholders including:
   – Internal to MOHLTC.
   – Internal to Ontario Public Service.
   – Health external stakeholders.
   – Non-health external stakeholders.
   – Public, front-line workers and media.

pH1N1 - Review Methodology
Methodologies include:

    – Surveys and facilitated discussions with health and non-health
      stakeholder associations, labour unions and provincial ministries.

    – Focus groups with the general public, targeting the demographics most
      affected, in addition to front-line workers in the acute care, community
      health and public health sectors.

    – Interviews with media outlets, including editorial boards and in-
      province/out-of-province reporters of major dailies.

    – Lessons learned from other debriefs (e.g., COMOH H1N1 Debrief) will
      also be valuable in informing the review process, final report and
      subsequent changes to emergency plans.

Wind Turbines
•   The position of the CMOH continues to be that given the existing
    literature, there has not been an association found between adverse
    health effects and wind turbines.

•   In response to continued public concerns about wind turbines and its
    potential health effects, and to the need to have a consistent provincial
    position on the topic, the CMOH committed to review the literature and
    research to determine whether there had been any changes, whether
    there were any areas that required further research, and to develop a
    common view across the province.

•   A working group was struck between the Ministry, the Ontario Agency
    for Health Protection and Promotion, and COMOH to guide this work.

•   Results of the review and consultation will be summarized in a report to
    the CMOH expected in the near future.

Raw Milk
• The issue of raw milk sales was the focus of intense media interest
  in the fall of 2006.

• Individual cases and outbreaks of illness have been associated
  with consumption of raw milk and raw milk products.

• People with compromised immune systems, including the very
  young and elderly, are at greater risk of serious illness from raw

• 145 cases of illness associated with exposure to raw milk were
  reported in Ontario from 2005 to 2009.

Raw Milk
• Advocates for unpasteurized milk take the position that raw milk
  provides significant health benefits while the pasteurization process
  destroys the nutritional and therapeutic benefits of milk.

• The pasteurization of milk is one of the greatest public health
  achievements in Ontario.
    –   From 1929 – 1938 (the year in which it became legally compulsory to pasteurize milk before
        sale and consumption), there were almost 9000 documents cases of milk-borne illnesses
        and over 700 deaths.
    –   Milk-borne disease outbreaks accounted for 25% of all food and water-borne outbreaks in
        North America prior to pasteurization and over 10% of all childhood tuberculosis was caused
        by drinking T.B contaminated milk.
    –   Now, pasteurization has made bovine tuberculosis all but unknown to the general public.
    –   However, from Campylobacteriosis to Salmonellosis, consumption of unpasteurized milk still
        causes many instances of illnesses a year in Ontario.

Raw Milk - Recent Decision
• On December 21, 2009, a Justice of the Peace in Newmarket
  issued a decision dismissing 19 charges that had been brought
  against a farmer who distributed raw milk through his “cow-share”

• The charges were laid and prosecuted by the Grey Bruce Health
  Unit and the Ministry of Natural Resources (acting on behalf of

• Section 18 of the Health Protection and Promotion Act (HPPA)
  prohibits the sale and distribution of raw milk and raw milk products.

• The defendant was charged with numerous offences under section
  18 of the HPPA.

Raw Milk
• Other charges were laid under section 100 of the HPPA (relating to
  the defendant’s violation of a 1994 “health hazard” order), and under
  OMAFRA’s Milk Act, which sets out a licencing scheme for milk
  processing and distribution.

• The Ministry of the Attorney General has filed a notice of appeal –
  numerous substantive and procedural grounds for appeal cited in

• Decision will now be reviewed by an Ontario Court of Justice judge.

• Grey Bruce Health Unit has also filed notice of appeal.