Ottawa Public Health 2014 Budget Briefing Note DRAFT 2014 OTTAWA BOARD OF HEALTH OPERATING BUDGET 1

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2 Ottawa Public Health 2014 Budget Briefing Note Description The Ottawa Board of Health has a legislative responsibility for delivering public health services. Ottawa Public Health (OPH) provides programs and services based on the four broad areas of protection, promotion, surveillance and prevention to individuals and communities while advocating for public policies that make Ottawa and its residents healthier. In 2011, a new governance structure was established. The Board of Health is governed by the Ontario Health Protection and Promotion Act (R.S.O 1990, c.h.7,s.2) and is accountable for compliance with the Ontario Public Health Standards (2008), and the Ontario Public Health Organizational Standards (2011). The current funding arrangement, which is standard across the province, involves the City of Ottawa funding approximately 25% of OPH s programs and services, while the province funds the remaining 75%. The current funding profile is: 1. Cost Shared Funding: The majority of OPH programs and services which are legislated under the Ontario Public Health Standards (2008) % Provincial Funding: Programs include Healthy Smiles Ontario, Healthy Babies Healthy Children, Infection Control and Smoke-Free Ontario % City of Ottawa Funding: Programs include Mental Health, Brain Injury and School-based Outreach. 4. Cost Shared One-time Funding: Projects include Vaccine Room Retrofit, Peer-based HIV Testing Blitz and Increasing Access to Adolescent Vaccinations for % Provincial One-time Funding: Projects include Panorama, Healthy Communities Fund Partnership Stream and French-Language Services Community of Practice for Cost recovery: Some programs include a fee for services model, including Dental Health, Sexual Health, and Food Handler Training. DRAFT 2014 OTTAWA BOARD OF HEALTH OPERATING BUDGET 1

3 Ottawa Public Health 2014 Budget Briefing Note Programs, Services & 2013 Accomplishments Infectious Diseases The infectious disease program aims to prevent or reduce the burden of infectious diseases of public health importance through timely and effective surveillance detection and identification of infectious diseases and by working closely with community partners, health care providers, hospitals, long term care homes and other settings to reduce the health burden of infectious disease in the community. Program areas include: healthy sexuality; Tuberculosis case management; immunization surveillance; vaccine distribution and vaccination clinics; and, education and promotion of infection control practices Achievements Conducted 80 community and school immunization clinics, providing vaccines for hepatitis B, meningococcal, Human papillomavirus (HPV) and influenza and achieving the highest coverage rates among Ontario health units for HPV. Distributed influenza vaccine to 60 pharmacies delivering 42,360 doses. Completed surveillance of 52,585 high school student immunization records for the school year Notice of incomplete immunization sent to 18,179 parents of high school students resulting in 5,345 suspension orders. Reduced the spread of communicable diseases within the City of Ottawa through effective management of 68 respiratory and 61 enteric outbreaks in 120 institutions (retirement homes, long term care facilities and acute care settings). Responded to and managed four community outbreaks of measles and Hepatitis A clusters. Provided services to over 10,000 clients visiting sexual health centre including satellite clinics. Launched sex it smart campaign and distributed 568,000 promotional condoms in the first five months of the campaign potentially reducing sexually transmitted infectious (STIs) and communicable disease. Launched PROUD study a peer-based HIV testing blitz to perform HIV point-of-care testing including pre- and post-test counselling, reaching 1,200 people. Chronic Diseases and Injury Prevention The Chronic Diseases and Injury Prevention program aims to reduce the burden of preventable chronic diseases of public health importance and the frequency, severity, and impact of preventable injury and substance misuse, through coordinated activities to enhance healthy behaviour and reduce risks related to poor diet, obesity, tobacco use, physical inactivity, alcohol misuse, and exposure to ultraviolet radiation. Program areas include: Healthy Eating and Active Living (HEAL); tobacco prevention and control; substance misuse; seniors; and, suicide prevention and mental health. DRAFT 2014 OTTAWA BOARD OF HEALTH OPERATING BUDGET 2

4 Ottawa Public Health 2014 Budget Briefing Note 2013 Achievements Engaged 80% of elementary schools to implement over 300 school-based active transportation activities. Hosted a HEAL Forum with more than 100 stakeholders and partners attending. With partners, expanded Good Food Markets to 20 events reaching approximately 1,500 residents in neighbourhoods with limited access to healthy foods. Developed 24 lessons plans on food skills for English as a Second Language schools in collaboration with the Ottawa Carleton District School Board. Supported over 1,700 in the first 6 months of 2013 with cessation support and implemented a new cessation outreach program with construction companies. Increased compliance (over 90%) with tobacco retailers resulting in reduced youth access to tobacco. Provided falls prevention education and awareness session to over 4,000 seniors and screened over 500 seniors for their risk of falls Launched Community Connect, a program to train people across the community to identify isolated seniors and help them access supports intended to stay safe and independent in their homes. Partnered with Canadian Mental Health Association (Ottawa branch) and the Ottawa Suicide Prevention Coalition to deliver eight community safetalks. Family Health The Family Health program promotes healthy behaviours and environments to people in their childbearing age to achieve optimal conception health, maintain a healthy pregnancy, support postpartum health of the parents and children, and healthy development of the children. The program also supports proper oral health by providing screening of school aged children, preventive dental services, basic dental treatment for low income children and seniors, and dental services for seniors in collective living centres Achievements OPH achieved Baby Friendly Initiative status including training of 900 staff, students, and volunteers to promote, protect and support breastfeeding. Screened over 1,300 children for healthy growth and development indicators in community settings. Delivered a mental health promotion program, Healthy Transitions, enhancing positive coping and resiliency skills for 3,275 adolescent students across 120 classrooms. Served 730 new families (2,725 visits) at Baby Express drop-ins and provided breastfeeding support 7 days a week. DRAFT 2014 OTTAWA BOARD OF HEALTH OPERATING BUDGET 3

5 Ottawa Public Health 2014 Budget Briefing Note Provided preventive dental treatments to 3,654 children and youth. Enrolled/renewed 431 children in Healthy Smiles Ontario program. Increased community outreach services to over 200 English as a Second Language classes, daycares, Headstart programs and Welcome to Kindergarten events. Environmental Health The Environmental Health program is focussed on protecting the community, through quick mobilization of OPH staff to public health issues, inspections, as well as prompt and effective surveillance, education and intervention. Program areas include: food safety; outbreak management; health hazard investigation; vector-borne diseases; recreational water and small drinking water systems; extreme weather; and, a 24hour/7day emergency response commitment Achievements Health assessment and counselling to over 3,750 residents regarding various health hazards, including ~850 food safetyrelated concerns, ~890 inquiries related to rabies and ~120 related to environmental health hazards. Conducted ~7,500 inspections at food establishments to ensure proper food handling and general food safety surveillance, 538 pool inspections and more than 600 food safety inspections conducted at special events. Performed ~600 inspections at long-term care facilities, retirement homes, hospitals and high risk personal services settings. Educated over 1,200 food handlers to help increase their food safety knowledge and encourage increased attention to food safety practices in their premises. Issued notifications regarding 17 days of frostbite advisory (-25C wind chill) and 3 days of frostbite warning (-35C wind chill). As of August 31, 2013, a total of 21 days of heat advisory and heat warnings were issued, resulting in a healthier community during extreme weather advisories. Emergency Preparedness OPH aims to protect the health of its residents by working at various levels to ensure safety of the community from natural events and disaster such as floods, earthquakes, fires and highly dangerous infectious diseases; and accidents or criminal and terrorist acts involving explosives, chemicals, radioactive substances or biological threats. OPH works closely with the City of Ottawa enhanced and co-ordinated Emergency Management Plan to meet the needs of the community during a major emergency. DRAFT 2014 OTTAWA BOARD OF HEALTH OPERATING BUDGET 4

6 Ottawa Public Health 2014 Budget Briefing Note 2013 Achievements Implemented a Health Emergency Plan for Priority Populations, with health, municipal and social sector partners. Developed new health emergency response protocol at the request of the City Office of Emergency Management for collaboration between partners (all hospitals, Community Care Access Centre, Office of Emergency Management, and Ottawa Paramedic Services) during emergencies. Foundational Standards: OPH follows the Ontario Public Health Foundational Standard to support evidence-informed public health programs. The programs and services include but are not limited to: population health assessment, surveillance, research, and program evaluation. These elements contribute to identifying public health priorities, including emerging public health issues, and planning and implementing programs and services to address the health needs of the community Achievements Produced a cutting edge epidemiological report on Substance Misuse in Ottawa. Conducted epidemiological analyses to support program decision making in areas such as gambling, falls prevention in seniors, active transportation, heat and HIV. Shared fact sheets and infographics on the Ottawa results of the 2011 Ontario Student Drug Use and Health Survey with stakeholders. Designed and implemented a breastfeeding surveillance system essential to achieving the Baby-Friendly Initiative Designation. Played important role in guiding the Community Suicide Prevention Network through the provision of local surveillance data on mental health, self-harm and suicide and work with the Research Action Area. Initiated participation in Public Health Ontario s Locally Driven Collaborative Projects research program Falls Across the Lifespan to define the role of public health in adult falls prevention using emerging and existing evidence. Continued working on and became co-principal Investigator on E-Track second generation HIV surveillance system in collaboration with the University of Ottawa and the Public Health Agency of Canada. Analyzed and shared results of the Enjoy the Skin You re In indoor tanning study of grade 11 and 12 students in the Champlain LHIN. Conducted enhanced influenza surveillance. DRAFT 2014 OTTAWA BOARD OF HEALTH OPERATING BUDGET 5

7 Ottawa Public Health 2014 Budget Briefing Note Organizational Standards and Performance OPH follows the Ontario Public Health Organizational Standards to establish the management and governance requirements through effective management of resources and continuous quality improvements Achievements Expanded social media outreach by adding new Pinterest platform. Outreach through Twitter on track to reach 60% growth rate. Created 24 videos to promote health messaging and highlight OPH involvement in the local community. Preparation, launch and implementation of OPH-wide continuous quality improvement program through Accreditation Canada; achievement of increased client safety and improved client service delivery through development of policies, education and implementation of Accreditation Primer. Developed new partnerships to improve efficiencies related to program delivery, including: o Expanding services delivered through libraries to increased geographical access to Baby Express and prenatal classes. o Working with Ottawa Community Housing, Community Care Access Centre and local Community Health and Resource Centres to provide services for seniors o Establish a health emergency plan to communicate with and support priority population during an emergency response with 75 community agencies. DRAFT 2014 OTTAWA BOARD OF HEALTH OPERATING BUDGET 6

8 Ottawa Public Health 2014 Budget Briefing Note Priority Service Areas for Reinvestment ($391K) Food Safety, and School-based Active Transportation (HEAL Strategy) For 2014 OPH will reinvest efficiencies from the Mobile Workforce Strategy to support the continuation of the multi-year food safety strategy to meet the need associated with growth in outdoor food vendors through increasing the number of Public Health Inspectors available to conduct inspections at restaurants, outdoor food vendors and special events in order to maintain compliance with the Ontario Public Health Standards and Public Health Accountability Agreement. This reinvestment will also support continuation of the multi-year Healthy Eating, Active Living (HEAL) strategy to meet the need identified for school active transportation that will help increase physical activity levels of school-age children. This aligns with the Board of Health strategic priorities to increase active transportation (priority B4) and reduce health risks related to preventable infectious and non infectious diseases (priority B5). This also aligns with Ottawa City Council s strategic priority to create healthy and caring communities One-time investment (City) ($200K) Personal Service Settings The City will provide one-time seed funding to address an emerging public safety issue related to infection prevention and control practices in personal service settings (i.e. body piercing, branding, scarification) with the aim to reduce blood-borne illnesses. Given the current absence of provincial regulations outlining minimum training standards for operators who perform these services, an Infection Prevention and Control measures program for PSS operators on safety procedures as well as increasing public awareness of infection prevention and control measures is required. This aligns with the Board of Health strategic priority to reduce the health risks related to preventable infectious and non infectious diseases (priority B5) and Ottawa City Council s strategic priority to create healthy and caring communities. DRAFT 2014 OTTAWA BOARD OF HEALTH OPERATING BUDGET 7

9 Ottawa Public Health 2014 Budget Briefing Note 2014 One-time investment (Cost-shared) ($200K) Local community public health needs The city will provide 25% of funding for several one-time projects. Through the Ministry of Health and Long-Term Care s Program-Based Grant Application Process, OPH is seeking funding for projects that may include: increasing surveillance of immunization coverage of school-aged students; expanding community awareness of low risk alcohol drinking guidelines; promoting active transportation; providing outreach to parents supporting mental health in children; offering infant health services for aboriginal populations; and improving food environments in childcare facilities, restaurants and recreation facilities. Transfer of funds for these projects from the City of Ottawa (25%) will only occur when approval of the Provincial share (75%) is received. These projects align with Board of Health strategic priorities to explore alternate funding models (priority F1) and align with provincial and municipal long-range strategic plans (priority F4). This also aligns with Ottawa City Council s strategic priority to create healthy and caring communities. DRAFT 2014 OTTAWA BOARD OF HEALTH OPERATING BUDGET 8

10 Ottawa Public Health 2014 Budget Briefing Note Organizational Chart Ottawa Public Health Department Medical Officer of Health Strategic Support Integration, Quality and Standards Health Promotion and Disease Prevention Environment & Health Protection Clinical Programs DRAFT 2014 OTTAWA BOARD OF HEALTH OPERATING BUDGET 9

11 City of Ottawa Ottawa Public Health - Operating Resource Requirement In Thousands ($000) Actual Forecast Budget Estimate $ Change over 2013 Budget Expenditures by Program Cost Shared Programs 42,674 43,186 43,060 43, Public Health City Funded Programs , Provincially funded Programs 9,891 10,372 10,314 9, Cost Shared One-time Projects Gross Expenditure 53,601 54,811 54,627 54, Recoveries & Allocations -2,373-2,417-2,417-2,417 0 Revenue -51,228-52,394-52,210-52, Net Requirement Expenditures by Type Salaries, Wages & Benefits 45,676 46,638 46,502 46, Overtime Material & Services 5,489 5,933 5,933 6, Transfers/Grants/Financial Charges Fleet Costs Program Facility Costs Other Internal Costs Gross Expenditures 53,601 54,811 54,627 54, Recoveries & Allocations -2,373-2,417-2,417-2,417 0 Net Expenditure 51,228 52,394 52,210 52, Revenues By Type Federal Provincial -39,073-40,377-40,193-39, Municipal -11,906-11,865-11,865-12, Fees and Services Total Revenue -51,228-52,394-52,210-52, Net Requirement Full Time Equivalents DRAFT 2014 OTTAWA BOARD OF HEALTH OPERATING BUDGET 10

12 City of Ottawa Ottawa Public Health - Operating Resource Requirement Analysis In Thousands ($000) 2013 Baseline 2014 Adjustments Forecast Budget Adj. to Base Budget Maintain Services Provincial Legislated Growth Efficiencies User Fees & Revenues 2014 Estimate $ Change over 2013 Budget Expenditures by Program Cost Shared Programs Infectious Diseases 10,963 10, , Chronic Diseases & Injuries 11,467 11, , Family Health 10,038 10, , Foundational Standards 5,623 5, , Environmental Health 4,834 4, , Emergency Preparedness Public Health City Funded Programs Needle Abatement School Based Outreach Mental Health Brain Injury H. Risk PSS Infection Cont.-1-Time Provincially funded Programs Infection Control 1,533 1, ,533 0 Healthy Smiles Ontario 1,964 1, ,964 0 Healthy Babies Healthy Children 4,562 4, ,562 0 H. Babies H. Children - 1-Time AIDS Hotline SITE Expansion Smoke Free Ontario Enhance Food Safety Enhanced Safe Water Clean Needle Distribution Social Determinants of Health Priority Populations Chief Nursing Officer Initiative Healthy Com. Ontario - 1-Time Health Promotion Campaigns French Language Services Vaccine Refrigerators 1-Time Panorama - 1-Time W.P. Smoking Cessation - 1-Time DRAFT 2014 OTTAWA BOARD OF HEALTH OPERATING BUDGET 11

13 City of Ottawa Ottawa Public Health - Operating Resource Requirement Analysis In Thousands ($000) 2013 Baseline 2014 Adjustments Forecast Budget Adj. to Base Budget Maintain Services Provincial Legislated Growth Efficiencies User Fees & Revenues 2014 Estimate $ Change over 2013 Budget Cost Shared One-time Projects Vaccine Room Retrofit Infectious Disease Projects Vector Borne City Share of 1-Time Prov Requests Gross Expenditure 54,811 54, , , Recoveries & Allocations -2,417-2, ,417 0 Revenue -52,394-52, , Net Requirement Expenditures by Type Salaries, Wages & Benefits 46,638 46, , , Overtime Material & Services 5,933 5, , Transfers/Grants/Financial Charges Fleet Costs Program Facility Costs Other Internal Costs Gross Expenditures 54,811 54, , , Recoveries & Allocations -2,417-2, ,417 0 Net Expenditure 52,394 52, , , Percent of 2013 Net Expenditure Budget -1.7% 1.9% 0.7% 0.8% -1.1% 0.0% 0.7% Revenues By Type Provincial -40,377-40, , Municipal -11,865-11, , Fees and Services Total Revenue -52,394-52, , Percent of 2013 Revenue Budget -1.7% 0.5% 1.1% 0.8% 0.0% 0.0% 0.7% Net Requirement Percent of 2013 Net Requirement Budget 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% Full Time Equivalents (FTE's) Percent of 2013 FTE's 0.0% 0.0% 0.0% 0.0% -0.6% 0.0% -0.6% DRAFT 2014 OTTAWA BOARD OF HEALTH OPERATING BUDGET 12

14 City of Ottawa Ottawa Public Health - Operating Resource Requirement Explanatory Notes In Thousands ($000) Surplus / (Deficit) 2013 Forecast vs. Budget Variance Explanation Expense Revenue Net OPH is projecting a balanced financial position for the 2013 fiscal year Total Surplus / (Deficit) Increase / (Decrease) 2013 Baseline Adjustment / Explanation Net 2013 Expense Revenue Changes FTE Impact Completion of one-time funded Infectious Disease projects (Peer-based HIV testing blitz $82K and Increasing access to adolescent vaccinations $50K) Completion of the one-time funded Vector Borne risk mapping tool Completion of the Vaccine Room Retrofit project Completion of the one-time funded Healthy Babies Healthy Children Postpartum Screening project Completion of the one-time funded purchase of 3 tablets for the Smoke Free Ontario program Completion of the one-time funded Healthy Community Ontario program Adjustment of French Language Services program from one-time to base funding Completion of the one-time funded purchase of 4 vaccine refrigerators Annualization of the one-time funded Panorama program Annualization of the one-time funded Workplace Smoking Cessation project Completion of Health Promotion Campaigns (Sexually Transmitted Infections Week and World Tuberculosis Day) Total Adjustments to Base Budget Pressure Category / Explanation Expense Increase / (Decrease) Net 2014 Revenue Changes FTE Impact Maintain Services All programs include an adjustment for 2014 contract settlement, increments and benefit adjustments. 1, , Tax and Growth increase from the City of Ottawa for Cost Shared Programs as outlined in report (ACS2013-CMR-FIN-0028) Reduced leasing requirements (Sexual Health Center) and annual facilities inflationary increase Inflationary insurance costs Total Maintain Services 1, DRAFT 2014 OTTAWA BOARD OF HEALTH OPERATING BUDGET 13

15 City of Ottawa Ottawa Public Health - Operating Resource Requirement Explanatory Notes In Thousands ($000) Increase / (Decrease) Net 2014 Revenue Changes FTE Impact 2014 Pressure Category / Explanation Expense Provincial Legislated Reinvestment to support the continuation of the multi-year food safety strategy to meet the need associated with growth in outdoor food vendors through increasing the number of Public Health Inspectors available to conduct inspections at restaurants, outdoor food vendors and special events in order to maintain compliance with the Ontario Public Health Standards and Public Health Accountability Agreement. Continuation of the multiyear Healthy Eating, Active Living (HEAL) strategy to meet the need identified for school active transportation that will help increase physical activity levels of school-age children Estimated increase (2.0%) to grant funding from the Province of Ontario for Cost Shared Programs Total Provincial Legislated Increase / (Decrease) 2014 Pressure Category / Explanation Net 2014 FTE Expense Revenue Changes Impact Growth City one-time funding to address an emerging public safety issue related to infection prevention and control practices in personal service settings (ie body piercing, branding, scarification) with the aim to reduce blood-borne illnesses. Given the current absence of provincial regulations outlining minimum training standards for operators who perform these services, an Infection Prevention and Control measures program for PSS operators on safety procedures as well as increasing public awareness of infection prevention and control measures is required City share (25%) of one-time projects (e.g. immunization coverage surveillance for school aged children; expanding community awareness of Low Risk Alcohol Drinking Guidelines; promotion of active transportation; outreach to parents supporting mental health in children; infant health services for aboriginal populations; and improved food environments (childcare, restaurants, recreation facilities)). Transfer of funds will only occur when Provincial approval of the 75% share is received Total Growth DRAFT 2014 OTTAWA BOARD OF HEALTH OPERATING BUDGET 14

16 City of Ottawa Ottawa Public Health - Operating Resource Requirement Explanatory Notes In Thousands ($000) 2014 Pressure Category / Explanation Expense Increase / (Decrease) Net 2014 Revenue Changes FTE Impact Efficiencies Productivity Improvements from Corporate Service Ottawa Initiatives and other efficiencies Total Service Ottawa User Fees & Revenues See following user fee schedule for details on the specific rates Total User Fees & Revenues Total Budget Changes DRAFT 2014 OTTAWA BOARD OF HEALTH OPERATING BUDGET 15

17 City of Ottawa Ottawa Public Health - User Fees 2012 Rate $ 2013 Rate $ 2014 Rate $ % Change Over 2013 % Change Over 2012 Effective Date Prenatal classes % % 01-Jan-14 Health Inspection Searches % 0.0% 01-Jan-14 Radon Kits % 0.0% 01-Jan-14 Thermometers % 0.0% 01-Jan-14 Food Handler Course % 0.0% 01-Jan-14 Sale of contraceptives - various prices % 0.0% 01-Jan-14 OHIP Revenue Various Various Various 0.0% 0.0% 01-Jan-14 Total Departmental DRAFT 2014 OTTAWA BOARD OF HEALTH OPERATING BUDGET 16

18 City of Ottawa Ottawa Public Health - Revenues By Type In Thousands ($000) Actual Forecast Budget Estimate $ Change Over 2013 Budget $ Change Over 2012 Actual Revenues by Type Provincial - Cost Shared Programs -28,383-29,303-29,177-29, , % Funded Programs -10,112-10,372-10,314-9, OHIP Immunization Municipal - Cost Shared Programs -10,485-11,065-11,065-11, % Funded Programs , Cost Shared 1-Time Projects Fees and Services - Prenatal Classes Health Inspection Searches Radon Kits Thermometers Food Handler Courses Sale of contraceptives Federal Total Revenue -51,228-52,394-52,210-52, ,345 DRAFT 2014 OTTAWA BOARD OF HEALTH OPERATING BUDGET 17