October 12/04 Report
Meeting of the combined "Public Health and Community Services Committee"
Adjournment at 11:45 am

Present: Merulla, Bruckler, Jackson, Kelly (left at 9:55), McCarthy (out 1x for 10 min; left at 10:55), Mitchell (out 2x for 4 min), Morelli (arrived at 10 am, out 2x for 25 min), Bratina (out 1x for 12 min), Samson, Whitehead (arrived at 11:40 am?).

Changes to the Agenda:

Added delegation item 6.1 from the Seniors Advisory Committee; and item 7.3, a presentation which will be made by Community Services staff which was report HCS4077 which is a reciprocal agreement between the HWDSB and the city of Hamilton.

Merulla : Moved to approve agenda as amended. Moved Kelly, 2 Mitchell . Carried.

Approval minutes Sept 24 Moved Bratina 2 Bruckler.Carried.

Item 6 moved ? Kelly 2

Motion to waive rules to allow delegation from Seniors. advisory comm. Moved Kelly 2 Bruckler. Carried.

5. CONSENT ITEMS

5.1 Canada's Healthy Workplace Week (City Wide) HCS04068
http://www.city.hamilton.on.ca/clerk/agendas-minutes-reports/
public-health-com-serv/2004/Oct12/HCS04068.pdf
Report for information only. Mayor DiIanni will participate in the kick-off on October 25. The program promotes healthier workplaces.

Item 5.1 -report re Canada Healthy Workplace Week. Moved Mitchell. 2 Samson Carried.

Item 6.1 - Delegation from Hamilton Seniors Advisory Committee

Shirley Glosser : I'm chair of the Hamilton Seniors Advisory Committee I was administrator of Ancaster Seniors Achievement Centre for 17 ½ years, retiring in 2001. I'm president of the Ontario Older Adults Centres Association. We feel this is a very important issue and we'd like to educate some of our councillors and other residents as to how important the de-listing of OHIP is. Mr Al Gordon, a member of the committee, is the author of this report and will be the presenter.

Al Gordon : We're not experts. We don't profess to be medical people. We don't profess to have any great expertise in this except that we're all seniors. Our sources for today's presentation are the provincial press releases by the government, from MPP McMeekin's office We used city reports -much of the material in a marvellous group of documents that probably don't get read. as much as they should be. There's tremendous statistics - tremendous work has been put in by your staff to develop a lot of good concepts and a lot of good information that could be better used. We used press reports.

We're talking about the Ontario Health de-listing and the premium program. that the province has introduced. The goals of the de-listing program were very noble.- to reduce waiting time , improve access to health facilities , enhance preventative services and of course generate $1.6 billion in 2004-2005. The deleted services will give you an idea of what their goals were to improve cancer, cardiac, home and long-term care and some less critical services that no longer will be funded by the Ministry are chiropractic, optometry and physiotherapy.

Chiropractic. The late fall [ something that means ? implemenation date? ] has now been changed to March so it matches the end of the fiscal year. There are no exceptions in the de-listing so it is complete. The current OHIP patient subsidy of $150 yr. is gone. Starting April 1 next year, anyone getting chiropractic services will pay the full price.

Optometry. As of November 2004 OHIP will no longer provide optometry services for adults between 20 and 64. We'll come to how that affects seniors. There is a de-listing exception for seniors 65+, youths up to age 20 and they're planning on producing a low income program so that low income earners will have some coverage for optometry.

Physiotherapy. 86 physiotherapy clinics were sponsored by OHIP. From here on in, they will bill the patients directly. [..?..] of these clinics were in Hamilton and it strikes us rather severely. The de-listing of service for [?people?] who are in long-term care, the home care program - and those who are in hospital - they will still get their physio. but those outside these programs are on their own, and you will pay the full shot for physio. Some of the physio folks in town who run clinics tell us what was free will now run about $40 a visit. The physio thing is rather big.

I want to point out we're not experts or medical folk. We don't know the value of chiropractic care , but we do know people who say they get a lot of pain relief from chiropractic care and they improve mobility. There is a body of strong, good evidence that says that physiotherapy is very good. and it does help people recover quickly. For those of us who have been in athletics, we probably have shared some of the physiotherapy practices together. We're not pushing the idea of of chiropractic or physiotherapy - we just want you to know what's happening.

The premiums. Premiums are based on taxable income, and it's progressive from $21000 up. It's going to be collected through the tax system, either right off your pay cheques, your pension cheques or it will be part of your quarterly instalments. At $21,000 of taxable income, a person will pay $60 a year. At 24,000 you're going to pay $240. Between 25,000 and 36,000 people will pay $300 a year. 52% of seniors will pay health premiums. That's impressive - perhaps a little less impressive when we find that 48% of those will not pay premiums. That's largely because their taxable income is below $20,000.

That's comforting not to know that 48% of seniors have an income of less than $20,000. Here in Hamilton we have an aging population. Some excerpts from your documents: people that are 55 to 64 by 2001 will number 48,740. The people between 65 and 85 will be 73,000. By 2021 there'll be 132,500 people in Hamilton between 55 and their demise. That's 23% of the population in Hamilton will be over 55 by 2021.

The health issues for seniors is going to be clearly a reduction in independence. Physio is important and those who have great response from chiropractic - they feel it's important. There will be a slower recovery from injuries, especially falls. The early death of many seniors is a direct result of falls. They fall, break a hip, go to a hospital and they just never get over it. Arthritic and muscular problems will be remedied rather than treated. Increased waiting time is bound to occur as people line up to see their family physicians. There's going to be overcrowding at the emergency depts. As folks get older and less mobile, if there's no easy way for them to improve their mobility, they become isolated and that's where we see them last. They're wheeled out followed by their wheelchairs

Aging at home is clearly the best way to go, becomes aging in a home. There's tremendous difference between those 2 things. Coping and controlling becomes the issue. The issue is how do I get through the day.

Over the counter drugs will be the first step for seniors searching for a remedy for pain. How would you like to be living on 8-10Tylenol or 12 to 14 Tylenol a day. My doctor calls them Tylenol Twinkies. That's just what happens. Tylenol becomes the first. choice. Many seniors will seek prescriptions from their physicians. There are a lot of people in Hamilton , not just seniors who do not have a physician. In Ontario, according to the [?OMN?] there's something like 600,000 people who haven't got a physician. It's going to get worse because in Hamilton we're short something like 22% short of the number of family physicians we should have. Other seniors are going to go to the emergency rooms. Some will seek alternative pain killers. A good number of seniors will simply retreat to their homes, their walkers and to their wheelchairs. There's going to be new problems as a result of this. Alcohol may very well become the choice. People will start using other people's drugs. Mediation may lead to overdose, and soft drugs may actually become a factor and part of the diet of many seniors. Care cost - 52% of the seniors will pay premiums - 100% of chiropractic cost, and those not home care clients or in long term care will pay 100% of their cost.

It means reduced earning capacity and productivity of working seniors and a lot are working. There'll probably be increases in health insurance premiums for those who have their own self insurance and there will be caps. We know this- there will be caps on services for retirees who have benefit packages. The cost of this program will push seniors into the hospital or early long-term care. In our new city of Hamilton we have 300, 984 home care beds. They are 95% full despite the fact that a lot of new facilities have come on line in the last few years. A ward cost is $1480 a month. A semi - $1724 - a private $2022. To stay in a ward $17,760 a year. a private $24,264. 48% of seniors are making less than $20,000. Their personal allowance just went up $4- it's now $120 a month. The people in long term care are largely widows , so they have enough money to get their hair done, buy gifts for their grandchildren. After 20 years, our fearless leaders raised the personal allowance last week by $4.

You might be surprised if you've been in a home lately. You might not be happy with what you see. You may be damned uncomfortable. The first thing will be the odour. Transportation is going to become an issue and it's on that you folks are going to have to deal with . There's going to be loss of mobility earlier and licensing is going to become a problem. There's going to be an increased need for formal and informal support. That's going to pull people away from their jobs. There's going to be greater isolation.

Let's look at the early seniors- 55 to 64. A lot of people here in this room are in or will soon be in this group. I think it's important they be included in optometry. They are not with this plan. Undetected cataracts and eye disorders lead to all sorts of problems . Eye disorder like cancer, by the time you realize you've got it as a result of pain it's too late. It has to be observed by a qualified person. Doctors used to do this work - now they ask, do you go to your optometrist annually? Yes. Well, they'll take good care of your eyes. That's not going to happen for people 55-64. physio and chiropractic - that's not going to happen to those at all. There's going to be unnecessary work loss. productivity is going to fail, and there's going to be more personal injury. Arthritic disease and age-related muscular and skeletal problems ,degenerative disorders will go untreated. 23% of Hamilton population is going to fall in the group 55+.

The impact on the city. We see increased demand for DARTS, demands for increases in urban and rural housing subsidies, more applying for taxi scrip. The demand for accessible and affordable housing will increase. We were briefed by your excellent staff re a project called Keys to the City. It's an excellent report and we received an excellent briefing from I believe Keith Extant. It pointed out how much more affordable housing folks are going to need. There'll be increased demand for home renovations and there's a federal program that will help that but it will impact back on the city in some way.

Pressures on Macassa and Wentworth to expand. You're going to have to decide to stay in this business or get out of this business , but with the numbers coming on board, with the loss of these services, you can expect there's going to be demands on Macassa and Wentworth. There's going to be a decline in the quality of life for seniors, increased demands for family physicians , hospital and clinics . We know that social assistance will become a more costly issue and home and elder care clearly is going to become a major problem.

The impact of the changes on the city is going to be - the new OHIP programs are going to erode your city base. In this city of about 400,00 people we divide that by 4 - 100,000 people that are paying OHIP premiums. If they're earning around $30,000 on average, that's $30 million that's coming out of the Hamilton economy. How many industries do we need to replace that $30 million. We've just had our economic base eroded. We'll have reduced productivity for the non-insured folk. Earlier elder and home care needs are going to impact on the productivity of the informal care givers. Probability of negotiating premium costs , employee contracts - only go back to when we had OHIP premiums before. If I were in a bargaining unit one of the first things I would attempt to do would be to get those OHIP premiums included in my benefit package. That's the way it was in many provincial organization 15-20 years ago. What happens there is that your costs go up as they start to negotiate. Then you're going to be searching for an improved tax base.

For seniors, the quality of life is going to decline. Some will choose to avoid the cost of these services regardless of the consequences. They won't take bread off the table. The cost of the city services for seniors will increase , personal spending on the local economy will decline as $millions flow to the province and the cost of good and services are going to increase as firms add in their cost of premiums into their products.

Fixed income seniors face prescription deductibles if you've earned more that $29,000 a year , prescription fees, premiums , physio and chiropractic costs, a push to low cost drugs, deadly delays and increase in taxes. Golden years - freedom 65 - how about freedom 75? It may never happen. Higher taxes, new premiums, increased cost for electricity, heating, gas, transportation , the overall cost of living. The options are to live less or live cheaper. About 15 years ago take 70% of your salary 15 years ago if you had a pension that paid 70% , could you live on it today?

We believe many seniors 55+ have a problem. the city will have problems as a result of the OHIP changes. Hamilton cannot prosper unless the province harmonizes legislation with the cities. We know there is only 1 taxpayer.

An action Plan. we leave you with 2 resolutions which your staff have prepared for us.

We ask you to support a rollback for de-listed services. we've asked you to put pressure on the province to eliminate the OHIP for seniors . We've asked ( and this is critical ), that you build a case for provincial funding to cover the cost of these extra services that the city's going to face.

You excellent staff can build a research paper quickly and say to the government - one of things they are going to address is Bill 100 which is the OHIP health premiums.

We on the seniors advisory committee are not doing this for oursleves. Our intention is to be helpful, not hurtful and enure that you understand. Thank you.

Merulla : Thank you. There are some questions or comments. Jackson, Morelli , McCarthy

I have a motion from Morelli and Bratina.

Jackson : [ long thank you and praise for presentation ] . What was on 2 nd last slide slightly different from letter signed by Glosser to chair Smitherman. Letter says rolling back premiums for all seniors re-instating the de-listed chiro/physio services ,expanding definition of seniors to include 55- 64 for optometry. It's slightly different on the slide. Please clarify the exact points you're recommending, so we know exactly what we're voting on.

Gordon : I would definitely include the bullet pt. you're reading in the letter . It was looked over in the size of the slide and the length of the presentation. What's in the letter is true and that's what we would like -rolling back health dues for all seniors , re-instating the de-listed chiro/physio services , expanding definition 55-64 age for optometry.

Jackson: I full support the recommendatins here from our Seniors. Advisory Comm. They're reasonable. When the McGuinty govt announced on its first budget de-listing these free health services and charging additional taxes and premiums for them, I was shocked. All of us know somebody or of somebody who needs one of those 3 services. I use 2 of them myself Why those 3 were discriminated against by the McGuinty Govt. - it could go to the larger issue of those medical professionals in those 3 industries maybe aren't as strong a lobby group as some of the more powerful in the health services system. This is something that will impact the most vulnerable in our community - being seniors. I know we'll hear from some commuinity member that not all seniors are that badly off. But the others ( long list of frail etc . ) $5-10-!5 a month is just a hardship for them. They can't afford it and it will cause them to be more reclusive The McGuinty proposals will force more people to use pharmaceuticals... which is not the proper way to go.

...I don't see the Seniors Advisory Comm being overtly political at all. I'm pleased to see they are stepping out and saying what services within the municipality and beyond are affecting our seniors and not in a positive way I commend them for coming forward like this

Morelli : [ much praise to presenters and the report ]. I don't think there's anything here that you've missed. I think this is something that's been subject to amalgamation when we brought together the various communities , I salute the effort as one that responds to contemporary needs.

I will move re the sense of urgency with that these recommendations that we move forward to strongly reinforce not only acceptance but conveyance to the province. I would like to know what some of the implications are from a cost perspective. I think we need to move very quickly. I'm involved with seniors and I'm exposed to it every day with my family.I want to refer to psychological terrorizing of seniors What we're failing to recognize - there's reference there to those that will be visible and those that will be invisible. When you talk to seniors along with these new premiums .taxes, gas, oil going up, you look at fixed incomes stabilizing of being reduced one of the deaths of a spouse. It doesn't just occur in the inner city. When you talk about the quality of life seniors in our community is already very much a challenge for those , especially for those that are very impoverished. I want to reinforce all the pts. that have been made here .

Seniors not only will face fees here where you can see but they also are trying to stay in their homes. Add that to the list. Some of the bureaucrats come through with increases that maybe represent as much or as little as $30-50 a month. And I'm not just taking a run at bureaucrats since we approve it, we have to accept some responsibility and govt. has to accept some of that responsibility, but obviously not all. When you see $30-50 added to their income and the decision makers are probably making in excess of $100,000 a year, maybe we should step back and relate a little more closely to those that are living on incomes of $1000 a month. That's the psychological terror I referred to and if we continue along this path it will continue to occur.

[repeat of making motion and aggressively pursuing the matter with provincial govt.] Our staff should be working with the VON and some of the north end clinics that are dealing with chiro and physio services and already are seeing some of the fear and are anticipating some of the major difficulties that are going to exist. Those that are least equipped will be the most impacted and they are quite concerned.

Merulla : I assume C. Jackson will be seconding that motion.

McCarthy : I want to know what the financial implications could be to Hamilton. following this recommendation. I'm pleased that we've removed the burden on the municipality by having us bear the cost of the fallout os the issues. Am I right in that?

Merulla: Could we direct that question to Mr. Rinaldo to respond to e-mail to all of us?

McCarthy : Yes. I think that would be wise. the problem is we're moving forward today on supporting the recommendation ...

Merulla : But it will be ratified at council. so we have a day to review the e-mail response

McCarthy : To clarify one issue that to provide additional funding to offset the impact has been removed - the first bullet on page 3. On the last page, the one suggests providing additional funding to offset the impact of these changes on the city of Hamilton I'm reading that bullet to say we urge city council to demand the province to provide the additional funding. I'm not sure if it's being read a different way.

Bratina : [ personal story of starting distance running at age 44 , running about 25,000 miles only been to doctor once, but used chiro and physio services]. I can endorse those services absolutely. I'd like to know how carefully this was studied by the govt. So you have an idea how thorough the consultation process was that led to the govt. decision or do you know anything about that background, because it seems to me it came out of the blue for everyone. Are you aware of how the govt. decided this?

Gordon . I'm not aware how they decided, but the indications are that there was precious little consultation and it came out of the blue.

Bratina : I full endorse this.

MOTION: (Morelli/Jackson)

That a letter be forwarded to the Ministry of Health and Long Term Care advising them that Hamilton City Council strongly supports, endorses and fully concurs with the following recommendations of the City of Hamilton's Senior's Advisory Committee:

That the Province be requested to: (a) Roll back health premiums for all Seniors. (b) Reinstate the de-listed chiropractic and physiotherapy services. (c) Expand their definition of Seniors to include the 55 - 64 age cohort for optometry care.

Merulla: We do have a motion on the floor. Moved Morelli. 2 Jackson . Carried.

Gordon : [More thanks] the Sr. Advisory Committee does do things that are different from other committees. We actually try to improve things for seniors in the future. [ info and invitation to variety show at Ancaster Sr. Achievement Centre]

7. STAFF PRESENTATIONS

7.1 Ontario Tobacco Free Network - Presentation to HCAAT respecting their 2004 "Nip it in the Butt" award
http://www.city.hamilton.on.ca/clerk/agendas-minutes-reports/
public-health-com-serv/2004/Oct12/Item%207.1.pdf

Presentation to Jay Irvine and Cameron Tulloch

Merulla: Moving on. Item 7.1. Stacey [?Van dow?] , Barney Barron from the Ontario Tobacco Free Network who will present a plaque to members of HCAAT .

Bonnie Barron : The Ont. Tobacco Free Network is an inter-agency organizaion representing the Onto. division, Ont. Cancer Society , the H&Stroke Foundation of Ont. and the Lung Association. We work with community groups across the province, to reduce the harmful effects of tobacco use. Last May we participated in the organizing of the Ont. Tobacco control conference sponsored by the Ministry of Health and Long Term Care A decision was made to recognize our colleagues who have gone above and beyond in their tobacco control work at the community level. We honour today's award recipients ...[ end of tape ]

They now have about 30 members and this group stands out as the leading youth group in this province, as well as probably recognized on the national and international level. We're pleased to be here today and also pleased to work sometimes with some of the Hamilton youth.The chair, Cameron Tulloch is here today and the executive Jay Irvine to receive the award.

[applause]

?One of the members Tulloch ?: [Thanks given] We're very innovative and different in the way we deliver our messages, by not talking about health message specifically or attacking smokers directly, but by talking about the tobacco industry and how it markets and hooks them to become smokers. Through things like making the community aware of the practices and empowering youth to deliver the message that they want to. We thank the city for supporting us and look forward to it in the future.

Jackson: I want to salute these young people who have embarked on this wonderful initiative . [long speech re these all knew who smoked in younger years who deplore the habit 30-40 years later. It's a drug -elixir. Started to be cool, do the in thing etc. etc.] This type of grass roots thing done by young people better than govt. throwing money. Hope the movement has a domino effect. Statistics of 250,000 youth becoming new customers yearly is disgusting. etc. etc.

Samson : As a former high school principal, the smoking issue was one of the key issues in the school. We tried everything. Since that time the school board has moved the smokers off the property. That moves them on to the roadside which leaves a very bad impression for people going by schools to see students outside smoking. I'm thrilled to hear these young people talking abou positive ways which they can use peer influence - because that's the only way that's going to do it.

Merulla: Dr. Richardson re item 7.2. Health Promotion/ Children's Services.

Dr. Eliz. Richardson : This is the 3rd in the presentation on what we do in the health and community services dept. and Hamilton Emergency Services.

re the health protection program. I 'd be happy to forward copies of this presentation to our 2 new councillors. Parent and child and healthy lifestyles program, set up by Rebecca [?Barrels?] and Dorothy Elliott

The [..?..] that I'm going to talk about hosts a range of programs from the early years to seniors. They give children their best start in life - their parents and teachers the tools of support to guide kids through childhood and adolescence and for people of all ages, the information they need for healthy lifefstyles. The program suggests many major factors that leads to successful and resilient kids as well as major causes of death and disability - chronic diseases such as diabetes, stoke, heart disease etc.

The mandate and funding for this program comes from both federal and city levels and from a wide range of provincial depts. This is somethng we've chosen to draw together across our dept. I'm talking about the two branches on the right of the organizational chart for public health and children's services. I'm talking about the 2 branches on the right. - the parent/child branch and the healthy lifestyles and youth branch - their programs not the organizational charts.

The parent/child branch provides both public health and social services programs for families and children from 0 to 6 yrs. of age. It's a multi-disciplinary integrated group of public health nurses, early childhood educators, social services workers, dietitians and nutritionists. The pre-natal education and support program supports women and their partners with additional services particularly targeted to teens, single women and multi-cultural women.

New choices is a program that provides one stop services to women on substance abuse issues, and one of the federal programs - the Canadian pre-natal nutrition program provides food vouchers, nutrition and pre-natal information for 11 groups in the city.

Pre-conceptional health [..?..] how people do once they're pregnant but being healthy while they are trying to get pregnant or thinking about getting pregnant and we work in collaboration with other groups to promote a healthy lifestyle before pregnancy.

Workplaces. We are also working in partnership across healthy lifestyles in the parent/child branch to support healthy workplaces that support health and pregnancy. We go from age 0 to the healthy baby/healthy children program. All families are offered follow-up after they are discharged from hospital. We supply key supports in those first 12 months in breast feeding, post partum adjustment, fathering and access to community resources. Our health connections phone line refers people to many programs including the Sears breast feeding clinic, the breast feed support network and the post partum depression referrals that are necessary for a large number of mums, home visiting for high risk families, parent link which is a parenting program at the Ont. [? earlier ?] centres inter-preventive initiatives such as [..?..] safety and home safety.

The first 6 years are critical for early childhood development. It is best supported through an integrated program that involved learning initiatives, employment support, social integration and family support. These programs give parents the education tools to access free resources they need to foster their kids own healthy development. So we have the learning, earning and parenting programs [or LEAP?] which are support progams for teen parents. We have the Red Hill family centre which is an early childhood and care centre we provide directly and it is integrated program with public health. We have the injury prevention initiatives including [..?..] safety and moving on to bike helmet safety and literacy initiatives. We know that learning to read is so key for kids' success later on.

Through the Ont. early years centres provide a place for children 0 -6 to play and learn with their parents and caregivers. We provide services directly in those centres as well.- public health and home management services. We're responsible for child care systems management to create an environment and level of service that will provide all Hamilton kids from pre-natal to adolescence up to 12 with the best opportunities to become well adjusted and healthy adults.

Two other programs are the homemakers program that provides in-home support to elderly persons in need to keep them living in their own homews and the home management program which promotes independence by teaching life skills and offering support to to individuals and families.

Healthy[..?..] youth branch and child and adolescent services which is a Ministry of Children and Youth services funded program provides mental health treatment for children. It has led the way particularly in providing services our community needs around e.g. mental trauma.

The school program provides a range of services in elementary and secondary schools. Public health nurses deliver classroom services and group sessions and provide consultation to schools on growth and development, substance abuse, mental health self esteem, body image and vilence prevention.

We've had community-based initiatives such as that of the Sexual Health Network called our Worth the Weight campaign and the public health nurse in the bottom right corner is holding a hand held device which we've used in those programs to allow them to directly document in the school where they are and to access network resources that are tied in [..?..] that resulted in budget reductions 2 years ago of about $105,000. - efficiencies found by using that [..?..] computing.

The dental program screens kids in schools to find kids who have not had access to and are in need of dental care, to see that they receive dental care and prevention. The administrative claims for both the children in need of treatment program and the Ontario Wo... program and provide clinical services through the north Hamilton community health centre through the community health[..?..] in our upper Ottawa [,,?..].

We have 2 chronic disease prevention teams that used community-based strategies to address chronic diseases which are a leading cause of illness and death in our community. They work with community coalitions and partners such as the school boards, provide health education programs such as the cooking club, supermarket safari and demonstrations at the Hamilton market. We provide community wide field events such as Feel the power to Feel Fit and the annual Festival of Hearts which promotes healthy activities to our multi-cultural community. The group also works on the development of policies and initiatives to support environmental changes. We know a significant number of Hamilton residents are at risk of developing chronic conditions such as diabetes, heart disease and stroke because of physical inactivity, unhealthy eating habits or tobacco use. It's estimated that if everyone ate the 5 or more servings of vegetables and fruit each day it would of itself decrease the overall instances of cancer by at least 20%. The injury, substance abuse and violence prevention program targets all age groups the innoative [..?..] approaches they've used such as the Autumn Leaf players which is a seniors as well as this year's My turn, My time campaign that is used to prevent falls among seniors.

Bicycle helmets are promoted and through the work we do with a community partner are provided directly to children with financial needs. seniors. Active and safe routes to school is a new program that promotes clean air as well by working with school communities to address safety concerns ' the community health fest operates primarily in downtown Hamilton provides mobile health services for those who have economic and [..?..] to health care. The clients are seen first come, first serve and they receive dental treatment. That's one of our largest volume services provided through the bus as well as immunizations and health education.

School who have the best [..?..] to their parking lot on a regular basis - we've seen a marked decrease in the number of kids suspended. The kids can just walk across the parking lot and get their shots.

Key service level indicators. Among child and adolescent services the minimum increases in budget that they've had that they've managed to maintain high levels of service with 5000 clinical sessions provided each year, and more than 630 referrals each year. Our child health program. We feel that 8100 calls to the health connections phone line in 2003 saw7300 mums and babies at the Sears breast feeding clinic. 90% of the families with children in this community are contacted in less than 48 hrs post partum - that represents 4100 families - and 50% of those go on to receive a post partum home visit.

Our in depth referrals are at 2 times their target, that we're supposed to meet under the Ministry contract. 90% of those referrals are referred on for home visiting.

Child care subsidy program serves almost 3200 families with subsidies allowing them to access child care. Our learning, earning and parenting program serves about 319 parents and our homemaking program has 383 which is up from last year.

We are monitored re our compliance with the manager of programs by the Ministry of Health and long term care. and over the last 3 years (2003 is an estimate) we see an improvement in most program areas. We had earlier in 2003 chosen not to duplicate under the child health programs some of the programs being provided elsewhere. That's part of the reason for the non-compliance in that year. Also we've had difficulties getting our web page up and running and staff changes in 2003 with the loss of a manager. Those should be rectified for this year.

In chronic disease prevention, we were not confined to the area of smoking cessation program and found the approaches we were using were ineffective and so we developed new approaches working with pharmacists and with Cancer Care Ontario, The Cancer Centre and the north Hamilton Community health centre. The agreement with secondary schools around policies and inspections re smoking on school property at school have had legitimate concerns re those policies and we have worked with them to best implement the requirements of the tobacco control act that we have to.

Injury prevention. There are some educational campaigns that haven't been undertaken that are scheduled to occur this year. We anticipate 2004 being 100% compliance.

Child poverty is a significant issue. We have a higher % of families with low incomes than Ontario does as a whole. 42% of social assistance recipients are children between 0 -18 years. This represents 16.5% of all children in Hamilton and when you add in the working poor we are at 19.1% in 2001. Lone parent families are more than 3 times as likely to have low incomes than couples with kids....

The slide from a report by a Wisconsin economist illustrates the return on human development across all ages. It goes to show the importance of early childhood development in terms of human development. It's benefits carry on into adult life affecting helath, learning and behaviour. Children with better quality pre-school experience have more advanced language [..?..] and spocial skills. This shows a return on investment of anywhere from 2 to 1 to 8 to 1. Every dollar spent yields a 2 to 8-fold return in terms of reduction in school dropouts or grade repetition rates, improved academic performance, increased employment and incomes and lower cost for social assistance programs. Ensuring that every child gets a good start in life is necessary condiditon for breaking the vicious cyles of poverty and [?apathy?}. Children of the poorest and most disadvantaged families benefit from these pre-school [?families?] most, but we do know that every child from the poorest to the richest is not meeting their potential. These investments help them reach that potential.

The issue of teens and tobacco. Tobacco remains the most preventable cause of death and disease, and the work for which the award was presented today and some of the work that we support shows we work with community partners to present a successful model for youth empowerment for tobacco control. The traditional methods have not worked. The [?de-normalization?] approach you've heard today is what we've been taking, for a decline in smoking among kids.

Physical activity and obesity cannot be underscored too much. It tripled from 1981 to 96. Only 45% of Hamilton adults are a healthy weight. The rest are overweight or obese. Obesity is now challenging smoking as being the #1 preventable cause of death. It's a significan risk factor for diabetes, heart disese, hypertension and we're now seeing type 2 diabetes, something usual only seen in older adults - we're seeing it in kids.

There are worrying nutritional trends, 1/3 of students, grades 4-8 drink soft drinks daily. Grade 6 and 8 consume decreasing amounts of vegetables and fruits between 1990-98. and 30% grade 6 and 60% of grade 10 girls do not eat breakfast daily. Obestiy is not only related to diet but to physical activity. 75% girls and 60% boys ages 12-17 are physicall inactive. Canadian kids watch TV an average of 15.5 hrs. a week. which doesn't count the computer and video game time on top of that. There are other benefits. We know that high levels of fitness are associated with lower rates of smoking and drinking, healthier eating habits and increased self esteem. Girls who participate in sports are 90% less likely to use drugs and 80% less likely to have an unwanted pregancy. Physically active seniors experience less falls and less injury resulting from falls.

Re opportunities. Many initiatives are coming forward today or in future committees. One is the child care plan which the committee will be reviewing in November. Its purpose is to highlight the plan on which the city will base its decisions re determining the appropriate mix and level of health care services. It reflects an extensive communication with parents, care givers and key stakeholders, and an environmental scan along with a review of the current literature and research on child care has helped to frame the context of the plan.

The Red Hill Family Centre is an integrated centre with both public health and social services and we're beginning to see the benefits from that integetration, in which the various workers from different services can support those families. The early child care funding with a new funding of $2.3 million which is coming forward for the city will make real headway into better supporting the system, and strengthen the quality of service here. We're anticipating in the next few months the announcement of an initiative by the province Best Start, which will start to knit together the child care and school initiatives.

We're focusing on increased physical activity. The Hamilton Walk campaign is a comprehensive strategy we're working on with Culture and Rec. as well as Planning to promote walking as a physical activity and for transportation. It takes advantage of our waterfront and trail system.

A Cult of Action we hope will be successful in implementing across Hamilton with our partners. We view the local health integration network as an opportunity to work across the system and better co-ordinate our [..?..] and prevention initiatives around e.g. diabetes. There'll be a mandatory program review and that's away to see that those mandatory programs are updated and are addressing what are the most effective methods.

We can't afford to postpone investing in children before they become adults, nor can we wait until they reach school age. It may be too late to intervene. The critical time is the 0-6 years time when we have the most impact.

Our children are the first generation that will not live as long as their parents. Life expectancy for 4 year olds is reduced by 3 years. because of overweight and 6 to 7 years because of being obese. Trends we're seeing in terms of physical inactivity and obesity are very concerning because of the impact on longevity.

Morelli: I wonder how to reconcile the fact that life spans are increasing. At what point does ....

Dr. Richardson: You can measure life expectancy from different peopole and different characteristics and there's a different life expectancy for people who are overweight. More and more people are entering that category. Statisticians think you're going to see that life expectancy will start to decline.

Morelli: I'm one who has been exposed to one and a good many of these services. It would be helpful to know if there is a connect between area and ward in using these services? You see a great deal of this in our end of town. Is there a connect between such things as the health bus I know a great deal about.

Dr. Richardson: the services we provide are provided city wide. Some of them may be more targeted to certain areas like the community Health Fest targets mostly inner city areas.

Morelli: I know they are city wide but it would be helpful to me and this council to know where the connects area. There's probably some in the south west mountain using the dental program but I would speculate that there are a lot more in wards 2, 3 and 4 using it. That connect would be helpful for me. - to understand where we're focused and why we're focused and dealing with the futuristic issues where we want to go and where we want to e.g. Is there a connect between programs like City Kids and these programs? City Kids in the playhouse Theatre services 600 underprivileged kids each Saturday as well as something like Kids Fest. Is there a connect there as well?

Dr. Richardson : There are connections we make with community groups so there are ones in every part of the city that we're working with. e.g. Rebekah's Branch Parent and child Support centres across the city and a lot of our programs do get focused based on needs that arise or other program initiatives that target greatest need. So there are connections in each city area that the programs builds on. We don't analyze our data to the ward level. So I can't tell you ward by ward what services are delivered in that ward and how much is delivered there.

Merulla: I think it's a valid point. You analysed the seniors services ward by ward. Could we not apply similar initiatives with the youth services as well?

Dr. Richardson: Many of the services take place at a level that is not determined by those boundaries. It is very difficult to map all of that down to that level.

Morelli: I wouldn't be opposed to some sort of a quadrant approach. Clearly there are distinctions geographically on how the population is distributed. It's a connect I think might be helpful. All of us understand where it's been and where it' going but we may want to make adjustments. Maybe we're not getting into areas where we should be. This will help as we move forward. The message re postponing investing in children until they become adults - that would help determine where you'd spend the money, how you'd spend and where it's spent now.

Merulla: Councillors Bruckler and Mitchell and Johnson.

Bruckler: re the key level service indicators and the estimates and trends in compliance. How does that figure in with trends and demands for service within each of those categories?

Dr. Richardson: I give the key service levels primarily for services that are not part of the mandatory program. The exception is the child health staff - initiatives that are both a mandatory program as well as what the demand for those services is. Some of our services are increasing in demand and some are services that are more determined at a community level that we are required to give. They may fluctuate for e.g. the birth rate. So there's changes in demand.

Bruckler: If we were to track any of those trends or demands and service levels whether or not we could even approach the province as to where they might be allocating their funds if there's an area we seem to be underservicing. Other municipalities might find similar and there's a need to escalate funding in a particular area to address a certain need.

Dr. Richardson: That's been the case with mental health programs around child and adolescence The biggest issue we faced is that budget has been flatlined for a number of years. and demand remains the same as cost of service goes up. We do do that through our associations to advocate for those investments where we need them but we can bring forward further initiatives as they come up.

[Tape 3]

Dr. Richardson : We're addressing these issues in our Planning and Development to develop more active play sites, more trailways as well as look at health information, more greenspace , I hope we're better able to support in that decision making

Samson; I hope that last slide doesn't just refer to Hamilton. If it does it's not very good for our city. Do we relay this information to people who come into contact with our children starting now about age 3 in some case age 2? I've always wondered why we don't have compulsory physical activity every day as a country like Finland has. I don't see why our children couldn't be in exercise situations every day. I know it's not on a localized basis, but I wonder if there's a mandate saying this is something that must happen. That slide isn't saying much for our society if our children aren't going to live as long as we are. Are these kinds of things shared with the educational facilities?

Dr. Richardson : Our messages goes to all parts of the system. There's no real system for early childhood education in that it's not universal. We give that message across all our program areas- in the early child centres and with the school boards we work with. It may improve with Best Start. The key thing is to get them to understand those facts so they will make those changes themselves.

Merulla: It reads "our children'' - could we have a more definitive age? I'm 37. Does that mean my daughter of 13 or me compared to my father of 72? It's general. What age category are we talking about?

Dr. Richardson : It's young children and early teens.

Merulla : Moved Jackson, 2 Bratina. Carried.

Item 7.3 the HWDSB and City of Hamilton in a reciprocal agreement.
http://www.city.hamilton.on.ca/clerk/agendas-minutes-reports/
public-health-com-serv/2004/Oct12/HCS4077.added.pdf
Report by Gary Nathan

Nathan : I'll give some of the highlights of the reciprocal agreement . The old city of Hamilton and surrounding municipalites had reciprocal agreements with the school boards themselves. With amalgamation we got together and had one new reciprocal agreement with the new city of Hamilton and the new school board. The city has the right to use the gymnasiums in the schools from 6 to 10 p.m. and it does mean exclusive use - We''ll work with the school board to facilitate our needs and we'll meet with them to determine what types of things we want to use in the school board - and the board has the right to use our [..?..] municipal facilities during the school hours from 8a.m. to 6 p.m. We have to understand that is a reciprocal agreement where we meet with them to set out what we need, so they are not taking our time. The city puts their programs in first and the school board comes after that. The same things happen with the school board. They put in their programs first and we work around them. It works quite well.

The way the agreement works is 3 board gym hours to 1 city facility like a pool or gymnasium. We worked out what it costs to run a pool , an arena and what it cost s the school board to run their gymnasiums. At that time it worked out about 3 to 1 It costs 3 times as much to run a pool and arena as it does to run a gymnasium. We also use some of the school board's cafeterias, some auditoriums and some of the classrooms and we work that with the school board. It does say gymnasiums but it does include these others. The use of the facilities in the new agreement will be capped at 15,000 gym hours to 5000 pool/arena hours. There was no cap in the old agreement. If either partner needed more than that, they would have to request that from the other partner. But because of the cap they would have to pay for the cost of that service

Currently the culture and recreation and our[..?..] groups use about 13,000 gym hours. - about 2000 under the hard cap. When one party does not use all the hours available to them no credit is given, so If each party stays within our maximum hours of use. there is no dollar exchange. the terms of the agreement is to be one year dated to Dec. 1 of this year to 31 August 2005. The Minister of Tourism announced that this year they're going to put some funding back into the board of education to make their facilities more accessible to the general public. They're getting just over $½ million and each school board must have an agreement with its municipality so they can access that funding. That will make the gyms more available for the recreation programs but also for groups like the Cubs , Scouts, Girl Guides - those types of things that could not afford to pay the normal Board rates. So renting when the caretakers are in it's a very reasonable cost. Using it after hours it becomes very cost prohibitive because you're paying the cost of caretaking overtime . The funds can be used for 2 things - one is for utilities cost or the increase in staffing cost.

That kind of funding is available and the school board has indicated to us that they'd like to access that fund from the Ministry of Tourism so they've asked us to look at the reciprocal agreement . If we agree, get it signed and it has to be back to the board of education for October 15. If it's passed by council they can let the Ministry know that and get this agreement in place for future years.

Merulla: I commend you on this initiative Many of us have been working for a number of years to have this as inclusive as possible with both parties

Jackson : We embarked on this journey several years ago We had a former liase with Culture and Recreation and sub-committee of the last term of city council . I sense that in spite of all the cordiality that occurred between both public entities and the representatives, there was some reservation and some reluctance re making total accessibility for ourselves and our community groups that need to access their facilities. That was part of my frustration. The province, being the parent of the school board and the municipalities strongly pushed the board in this direction and that's what was needed to make sure this is occurring. We had some success the last few years but not in totality. My understanding when I book a gymnasium for a community group that I may be hosting, the normal channels of going through their admin. to book it , to rent it, to pay it through my office budget - that still will occur?

Nathan : You can book some of the school board facilities through us through the reciprocal agreement and you won't have to pay for that if it's a community event. If it's a Catholic School board , we have no agreement with them, so you have to book through the Catholic Board. or the Wentworth Board or you can book our facilities at Recreation centres through us.

Jackson : I'm thinking of things like Neighbourhood Watch, Community meetings town hall that would encompass parks, playgrounds , safety and traffic issues - things like that, Would you quarterback such things if we come through you, or some of you r staff?"

Nathan : Just now we're into a restructuring . When that' done It will be clearly defined for each councillor who your liaison is. We'll keep it simple.

Jackso n: Why is this only for a year? It is something we may look at renewing after a year?

Nathan: We're looking at renewing it again. The school board was a little reluctant at the time because they were not sure how long the Ministry funding was going to last, so they didn't want to sign a long-term agreement if the funding was only for a year. We'd love to sign it again for a longer term.

Bruckle r: Is provincial funding only extended to public school boards and not to separate school boards?

Nathan : I don't know that offhand.

Bruckler : That would be good to know. As the Separate school board could have pursued that initiative on their own. As they and the community lose by not being able to participate.

Merull a: Would like to provide direction for the school board to be contacted for a response? Moved by yourself. 2 Morelli. Carried.

Jackson : Schools are community resources and should be accessible by everyone. Re the timing. You said the community programs start at 6 p.m., but many of the pools , arenas start at 5. Will those not be interfered with?

Nathan : That is correct. It's the city programs first . And we work with the school boards to meet their needs as best we can.

Jackson: I notice within the agreement that we provide 2 life guards, I suppose we only supply one if the class were smaller- but the maximum we would provide is 2 at the cost exchange.

Nathan : That's correct - and if they require a third life guard, they would pay for that as that's a direct cost to us.

Jackson : As we're into a one year agreement, I assume there's some opportunity of reviewing and some flexibility in making alterations. At the end of the year one might be that if the school and the municipalities would have the need for an increase in the cap above 15and 5 - that would be an option we would pursue.

Nathan : correct. We'd look at the agreement and also the school board is building new facilities , so as both they and we build new facilities, they would be added to that schedule A and B because as they build a new school we'd like to access it -. The new Dr. Davey School we need that type of program in the inner city.

Jackson : Is this agreement largely intended to deal with indoor facilities? The schedule mentions Ivor Wynn and Mohawk, - so are those also on the 3 to 1 ratio?

Nathan : That's correct now. We are trying to get some type of formal agreement for the use of school board facilities because e.g. we're short on soccer pitches , so we'd like to move forward on the use of fields.

Jackson : So the caveat is that we're moving forward and trying to make some rationalization of outdoor facility exchange . We need further clarification in that funding from the province - whether it only included funding for the school facility proper or other of the facilities.

Nathan : I think it was just for the schools.- just the buildings.

Merulla : C. Mitchell and a motion from Jackson 2

Mitchel l: Not all parks and schools are listed in this document. Formerly a hand shake agreement was all that was needed. My concern is capping, If there's a large uptake in the larger urban areas and the capping is met and some rural area comes to the need to have this take place and it hasn't happened out there and it has not been totally recorded . That community gets told ' no' because our capping is up- it won't go over very well. ( story of using Glanbrook arena by Bellstone and BellmooreSchools and they're not there) . That's fine as long as they continue out there and are left separate , they're probably a lot happier, but my concern is bureaucratic red tape in the future and they begin told ' no'.

Nathan: We'll go through the list again before it goes forward in its entirety and make sure it's updated.

Samson : I'd like to see some reference that it's going to be looked at by the end of May, if you're going to have effective planning by a school . I think there's a willingness by the School board because of the funding. We're interested and have been after it for years . Could a statement go in there that it would be reviewed?

Merulla : We'll put that in as an amendment 2 Jackson.

We have a motion by Jackson. 2 Morelli with the amendment.

C?[Jackson, I think?]- One question re the geogrphical issue. Can it be incorporated back into this thing - as far as the capping and the use in different areas?

Nathan : Yes. No problem.

MOTION: (Jackson/Morelli) (a) That the Reciprocal Use Agreement between the Hamilton- Wentworth District School Board and the City of Hamilton be approved and implemented according to the terms and conditions listed in the Agreement. (b) That staff be directed to meet with the Hamilton District School Board no later than May 31, 2005 in order to negotiate a renewal option and to report back to the Public Health & Community Services Committee. (c) That staff be directed to contact the Hamilton Separate School Board to inquire if they are eligible to receive provincial funding for community use of schools and to inquire about the feasibility of entering into a Reciprocal Agreement with their Board.

Merulla : All in favour? Carried. Item [8.2?] item 8.3 by the acting GM of Public Health and Community Services, Dr. Eliz. Richardson. Is there any discussion on item 8.1?

8. DISCUSSION ITEMS

8.1 Call to Action: Creating a Healthy School Nutrition Environment (City Wide) (HCS04070)
http://www.city.hamilton.on.ca/clerk/agendas-minutes-reports/
public-health-com-serv/2004/Oct12/HCS04070.pdf
Recommendation that Council endorse the Call issued by Ontario Society of Nutrition Professionals in Public Health and that the mayor write a letter to Premier McGuinty expressing Council's endorsement of the Call. The Call includes asking that "all foods available in the school setting are consistent with classroom teaching, reinforce healthy eating messages and are culturally acceptable". The staff report says that "Official endorsement of the Call to Action by Council will reinforce the significance of a healthy school nutrition environment to promoting the health and academic achievement of students, thereby facilitating enhanced collaboration between Public Health and Community Services staff and local school boards to act on its recommendations."

Bruckle r: This is a healthy initiative. In our recreation centres we have youth in those centres that are centres of health and activity. I would hope some of the initiatives we are working with the school board with , that some of those principles would apply to our own facilities . We should be serving healthy food and drinks in our own facilities if it is truly a concern across the community. How do we deal with healthy food and drink?

Merulla : Would you like to provide that as a direction and report back ot us?

Jackson: Yes

Nathan: we're currently doing that anyway but that's good direction.

Merulla : Moved Bruckler, 2 Bratina. All in favour? Carried.

8.2 Federal Initiative - Supporting Communities Partnership Initiative (HCS04072)
http://www.city.hamilton.on.ca/clerk/agendas-minutes-reports/
public-health-com-serv/2004/Oct12/HCS04072.pdf
An update for information only on steps taken over the past year. The Supporting Communities Partnership Initiative is a federally sponsored program to address homelessness. $12.3 million was provided in the first three years of the program and SCPI has now been extended to 2006. The staff report notes that a number of proposals have been accepted for funding, and these are listed in Appendix B, but that appendix is not included in the material posted on the city website.

Item 8.2 . Motion Jackson, 2 Morelli.. All in favour? Carried.

Bruckle r: The time frame March 22 nd 2004 to March 31 st 2006 . Is that 2 years or 3 years?

Merulla : Kathy? That would be 3 years would it not - inclusive?

Kathy : I believe that's correct. But the agreement was onlys sgned in March of this year. .There was a delay - it was supposed to be a 3-year program. We kept the planning going, but the actual agreement was only signed last March.

8.3 Public Health Programs 2005 Accreditation Process (HCS04069)
http://www.city.hamilton.on.ca/clerk/agendas-minutes-reports/
public-health-com-serv/2004/Oct12/HCS04069.pdf
A report for information only on the accreditation renewal process.

Merulla. Item 8.3 . Moved Mitchell. 2 Samson . All in favour? Carried.

Dr. Richardson : That report asks for the appointment of a second representative . Do you need to do that now or...?

Merulla : I believe we should probably survey people's interest -then determine at that point. Moved Morelli. 2 Jackson. Al in favaour? Carried.

Morelli: Don't we have to go through this accreditation program anyway? Don't we have to do this? It sounds like we'll do it if we can get support.

Dr. Richardson : Under the agreement we have with the province we do have to go through this

Merulla : Are there any motions? Are there any notices of motions? Is there any general information that I have..?

Whitehead: The announcement last week re long-term care funding. Can I ask staff to if they can break down their understanding of how that is going to be proportioned across the province - specific to Hamilton? And do we have a handle on what we perceive to be the needs in this community re long term care?

Dr. Richardson : We could e-mail the issue re long-term care funding . I'm not familiar with the announcement that C. Whitehead is referring to. We could address the long-term funding in this community as well. We do know we have an increased number of beds over current utilization . That's driving the issues within our own lodges,

Merulla : C. Whitehead, could you receive this through e-mail and share it with the rest of the committee?

Whitehead . Great. There were 2 shooting in ward 8 on the weekend. From the discussions I've had with the community - is there a breakdown in these social issues that is contributing to the types of crime? What kind of relationship do our social services have with the police and do we understand what those breakdowns might be?

Merulla: Could Dr. Richadrson take note of that question and answer it in a reasonable time.

Morelli: There's s programs like COAST, dealing with social problems in the streets. You could also meet with the chief. . It will be an eye opener. There's a relationship there.

Mitchell : The figures that came out at the Hamilton& District Health Council's conference showed that in California 14% of its population was still smoking . Canada had 20. Hamilton has 29. It's also been proven it relates to the economics. of the family wealth. . If you can increase the economic factor , jobs etc. in a city you can lower that health hazard. That has a big bearing on the decision making we have to make in this city. We're coming into budget and it's proven that increase in smoking does relate to family wealth. Coming into budget, w have to work on economic development.

Meeting adjourned.