Ottawa Public Health – Annual Report 2008

Message from the Chair of the Community and Protective Services Committee

Ottawa Public Health (OPH) plays a central role in the health and well being of our city. Through various public health programs and services, OPH has an incredible impact on the lives of the many individuals, families and entire communities residing in our city.

As Chair of the Community and Protective Services Committee, which oversees public health in Ottawa, I am privy to the work that the dedicated staff at OPH accomplishes for our city. From health promotion activities to disease prevention programs, OPH staff work hard to ensure our communities remain safe, vibrant and healthy places to live.

In the pages that follow - or in the bytes that follow, if you are reading this online - we have provided a snapshot of the many ways in which OPH has touched the lives of Ottawa residents in 2008.

Diane Deans, Chair of the Community and Protective Services Committee
City Councillor, Ward 10 Gloucester-Southgate

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Message from the Medical Officer of Health (MOH)

When you are responsible for public health in a city as diverse as Ottawa, it is exciting to describe what the job entails, because the work done by the excellent staff at Ottawa Public Health (OPH) is so broad, impactful and immediately relevant to the people of our city.

Restaurant inspections. Prenatal health. Smoking prevention. Tracking reportable diseases. Working to help all of our citizens as well as numerous populations with unique needs and challenges, from immigrants to Aboriginal residents to the economically deprived to those who face barriers to services because of their sexual orientation. And so much more.

Our jobs are like few others, because when we do them well you seldom hear about us. Disease outbreaks are prevented. Your food and water are safe. Your children have a healthy start in life. There is someone helping to look out for the health interests of the citizens who need help the most.

In the coming year, I expect our jobs to become more difficult as we continue to manage the health impacts of the H1N1 pandemic and Canada's strained economy. Like health professionals around the world, we have seen our resources stretched and strained by the immediate needs of the community in dealing with H1N1 and planning for its second wave. We remain focused on meeting the challenges of the pandemic, and together with the community and our partners in the health sector, we will continue to do our best to protect the health and safety of Ottawa residents.

The health of a community is inevitably tied to the health of its economy. Canada's economy has been under stress. Our city is more insulated than most because of its fortunate position as Canada's capital, but we will not be free from the many impacts of the recession. As the city's early-warning system for all public health issues, OPH will be on the frontlines in dealing with the effects of these stresses and, where possible, working to ease them.

Ottawa Public Health protects and promotes the health of almost 900,000 people. We see an Ottawa where residents live in a strong and vibrant community and are maximally healthy and safe. We are able to do this work because of funding and direction provided by the provincial and municipal governments, which set our public health standards, and with the support of the Mayor and members of City Council, who form our Board of Health, as well as with the assistance and support of innumerable community partners and volunteers. My job has been made easier by the work of my predecessors, who built a robust service over the years, including most recently my immediate predecessor Dr. David Salisbury.

In the end, OPH does the same thing as so many other city departments: it keeps Ottawa healthy and safe. What follows are a few examples of the work we do and the way we do it.

Isra Levy, MB BCh, MSc, FRCPC, FACPM
613-580-6744, ext. 23681

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Ottawa Public Health: A day in the life

For Ottawa's public health staff, no two days are the same. Issues change with the seasons — for instance, influenza is usually much more common in winter than summer.

New public health threats can appear any time, as with the August 2008 listeriosis outbreak following contamination at a Toronto meat-packing plant. In our modern world, the next threat may be only an airline flight away, as we learned in 2003 when SARS — a previously unknown respiratory disease that arrived on a flight from the other side of the world — killed more than 40 Canadians.

Still, day-to-day work continues every day of the year. Here is what a typical day, seven days a week, looked like in 2008.

• Our inspectors visited 33 restaurants and stores to protect the safety of our food. By year's end, they had made 12,150 visits. Twenty-eight recall visits involving the listeriosis outbreak were made each day during this six-week outbreak in 2008. In total, 1,051 such visits were made.
• At our supervised beaches, 35 water samples were collected every day throughout the summer.
• 25 people made emergency visits to our dental clinics, and 130 children received dental screenings in schools.
• 175 young mothers were visited and their questions about their children's growth and development and other family health issues were answered by a Public Health Nurse (PHN) or Family Visitor.
• Forty mothers and babies were seen at two Well Baby Drop In clinics, for an annual total of 8,600 consultations.
• Healthy Baby Healthy Children Nurses made 45 postpartum screening calls.
• Public Health nurses met with over 90 school staff and offered services to schools ranging from curriculum support and policy development to teacher training.

• Our public health nurses provided more than 100 flu shots, for an annual total of 37,000.
• A “Fall Prevention” education session was offered to a group of 30 seniors.
• Public Health Nurses responded to over 100 calls per day on a wide range of health issues from baby care to community resources to quitting smoking.
• Fifteen calls related to reportable communicable disease issues were handled by specialized Communicable Disease staff, generating the need for an additional 75 follow-up calls by public health nurses to manage these cases.
• In a day, 50 couples received prenatal education. Thirty young single pregnant women and their partners as well as 12 pregnant women from vulnerable circumstances met with a public health nurse to discuss their issues and concerns and to learn more about having a healthy pregnancy and a healthy baby.
• Twenty-five working parents attended a lunch and learn sessions offered by a PHN at their workplace on positive parenting.
• HealthyOttawa@work ebulletin was distributed to 700 workplaces.

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Putting the Public in Ottawa Public Health

Ottawa Public Health exists to protect and promote the health of all city residents. The Board of Health is responsible for upholding provincial standards under the Health Protection and Promotion Act and other provincial legislation and for establishing our overall objectives and priorities.

In 2008, after consulting with the public, early steps toward revitalizing Ottawa's Board of Health were taken as Ottawa City Council adopted recommendations related to the board's structure. City Council currently comprises the Board of Health, but during a governance review conducted last year, Council accepted changes suggested by the public. These changes would result in an 11-member board that includes six city councillors and five members of the public.

This suggestion, along with several others, was approved in principle after the input from almost 450 people during focus groups; a public opinion survey and other opinion-gathering efforts had been received. This input pointed unanimously toward the need for a more autonomous Board of Health, and that is a direction City Council supported. The final result will be an improved focus on public health stewardship and increased responsiveness in meeting community health needs.

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Taking safety to the streets and beaches

Ottawa Public Health has many priorities, and one of the most important is the protection of public safety. In fact, safety is the key message delivered in many OPH programs. Here are some of the things we did in 2008.

Working in partnership with the Summer Parks Program operated by the Recreation and Community Services Department, we distributed more than 500 bike helmets provided by the Ontario Ministry of Health Promotion to Ottawa children and youth.

The Injury Prevention Program hosted the Party Smart Forum event, which attracted students from more than 20 High Schools and several community partners including Mothers Against Drunk Driving Canada. The goal was to engage students in proactive leadership to increase substance abuse awareness in Ottawa schools.

In collaboration with the Ottawa Police Service, the Department of Public Works and Services and community partners, the Integrated Road Safety Program implemented the "Speeding Costs You " and the "Back Off!" tailgating Campaign, which highlighted how to apply the two seconds between vehicle rule.

We worked to increase awareness in the community about shaken baby syndrome – “Never Shake a Baby” and Public Health Nurses provided information sessions on a weekly basis to parents, childcare providers, hospitals, and Community Health Centres on child safety issues.

We reminded Ottawa residents when spending time outdoors could put them at risk by issuing one Heat Alert (which lasted five days), 11 Frostbite Alerts (covering 16 days) and one Smog Advisory.

We helped expand membership in the Ottawa Drowning Prevention Coalition and funded radio advertisements that delivered water safety messages.

With the help of the Ottawa Police, we completed roadside checks involving 300 car booster seats, and our booster seat fitting stations in area schools reached another 300 parents.

By stressing safety and taking steps to improve it, we reduce the stress on our health care system and we also make Ottawa a better place to live.

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Ottawa gets a checkup – How healthy is our city?

Quite healthy, according to the City of Ottawa's last Health Status Report, which was completed in 2006. It determined that there had been encouraging improvements over the past decade and that Ottawa's results compare favourably with those in the rest of the province.

When that report was prepared, life expectancy at birth had reached 82.3 years for women and 78.6 years for men.

There is a lot of good news in that report. It showed that daily smoking by adults had declined to 11% of the population. By comparison, 50 years ago more than half of Canadian adults smoked. As well, more than 50% of residents aged between 18 and 65 were engaging in high or moderate levels of physical activity, and there was growing public recognition of the need to prevent injuries — a “very high proportion” of drivers always wore seat belts while in a motor vehicle.

On the negative side, almost half of Ottawa residents were either overweight or obese in 2006, with males significantly more likely to be in those categories. The leading cause of death for both sexes was ischemic heart disease — heart failure caused by blockages in blood vessels. As well, even though the overall age-standardized suicide mortality rate had declined significantly since the mid-1980s, suicide remained the leading cause of death among males aged 20 to 44 years.

As that report concluded, there are promising trends in most areas but “many public health challenges remain.” Meeting these challenges will be the main task facing Ottawa Public Health in the years ahead.

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Clearing the air...

Because disease prevention is at the top of the to-do list at Ottawa Public Health, it should come as no surprise that tobacco use is one of the subjects on our prevention hit list.

As a city we have already accomplished a great deal — it is becoming harder to remember a time when people smoked on OC Transpo buses, in restaurants, in arenas and other public places. But even though much has been done and the smoking rate has been cut by more than 50% in the past 30 years, there is still much to do. And we're doing it.

One example is our exposé Smoke-Free Youth Project that in 2008 provided training and support to 22,000 high school students and staff and saw 150 students lead activities to increase awareness about tobacco.

We tackled growing concerns about tobacco's depiction on the movie screen by holding an all-night movie screening for 150 young people at the Rainbow Cinemas. The event concluded with a discussion of the ways the tobacco industry uses movies and actors to encourage young people to smoke.

Ottawa Public Health also sponsored a student film festival — exposé Uncut: It's Our Turn to Target Big Tobacco — in which students' short films exposed attempts to market tobacco to young people. The Ottawa 67's also helped out, with OPH smoke-free messaging reaching 45,000 fans during five of their home games.

At the retail level, City staff visited 1,200 outlets to ensure compliance with the province-wide ban on point-of-sale tobacco displays, removing daily tobacco industry advertising exposure to our community.

Last year also saw the implementation of a tobacco prevention program for the thousands of young adults attending Ottawa's universities and colleges. The outreach is for a simple reason— they have the highest smoking rate of any age group.

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On the street: needles

It is estimated that more than 500,000 used needles were collected throughout Ottawa in 2008 thanks to a series of programs operated by Ottawa Public Health (OPH).

More than half of them — an estimated 273,415 needles — were retrieved via a harm reduction program that allows individuals who use needles to exchange their used needles for clean ones. This service, which has been operating since 1991, does more than help to keep Ottawa streets clean and safe. It allows OPH staff to promote safety and help minimize the risks associated with intravenous drug use in the face-to-face encounters with clients that occur as sterile needles are distributed. The 372,136 sterile needles supplied during these encounters in 2008 also helped to reduce the threat posed by communicable diseases that are spread when used needles are shared. Decreasing the risk of Hepatitis B and C and HIV/AIDS among people using needles reduces the whole population's risk of acquiring these infections.

The remaining 235,000 (approximately) needles, 46% of the total, were gathered through a series of proactive collection efforts. Leading this list are the more than 20 needle drop-box sites spread throughout the city, which were responsible for the safe collection of about 229,400 used needles in 2008.

A smaller number of needles were retrieved via:

• The OPH Needle Hotline that was launched in July 2008 and resulted in 27 requests from the public and the collection of 247 needles;
• The Needle Hunters in the Needle Retrieval Program, which operates in the Byward Market/Lowertown, Centretown, Hintonburg and Vanier (3,350 needles);
• Retrieval by other city services (1,270 needles)
• Proactive monitoring (10 needles).

The goal of all these efforts is simple — harm reduction, for both the public and the people who use needles.

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The things we do: Operation Hairspray

Operation Hairspray is an Ottawa Public Health initiative involving work with community members to provide health information to populations at risk. With this innovative program, we train African and Caribbean hairdressers and barbers to deliver culturally appropriate information about HIV/AIDS prevention to their customers and to members of local African/ Caribbean communities.

Operation Hairspray's volunteers are trained as peer educators – volunteers are provided with the knowledge and skills they need to discuss the prevention of HIV/AIDS and other sexually transmitted infections with clients.

We are pleased with the results. Over the course of 12 months, 19 peer volunteers were recruited and trained across Ottawa. They made more than 14,000 contacts with clients and members of the community, sharing both information and a variety of written publications on basic HIV/AIDS prevention, and distributing more than 24,000 condoms.

To help learn from the process, South East Ottawa Centre Healthy Communities also created a database to house information collected by the peer volunteers. In 2008, Ottawa Public Health also developed a successful partnership with Somerset West Community Health Centre that helped to expand the reach of the project by recruiting and training an additional 20 peer volunteers. The AIDS Community Action Program provided time-limited funding for Operation Hairspray, Phase Two: Spray the Word.

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À votre santé

Ottawa has a vibrant francophone community that represents over 16% of the population. Ottawa Public Health strives to increase access to culturally and linguistically appropriate French language services to improve the health of the Francophone population. The program was created because certain disparities persist in the health status of the francophone population and the recognition that there are unique cultural and socio-demographic realities that must be considered in the delivery of public health services.

As one Ottawa physician noted in a recent newspaper column, communication is a crucial part of the health equation. “They [francophones] have to be able to express their needs, and language plays a major role in this,” she wrote.

At OPH, we couldn't agree more.

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From the archives – Dr. Robert Law

A long list of people have helped protect the health of Ottawa residents, but few of them faced as many challenges as Dr. Robert Law. While he was acting medical officer of health in 1911, he had to deal with a typhoid epidemic that killed 52 people. Seven years later, as World War I ended, he devised the city's response to the devastating Spanish influenza epidemic that would claim more than 500 lives in Ottawa and millions more around the world. One of his major goals was to teach Ottawa residents about the relationship between clean living conditions and good health. “To teach people to dwell sanitarily in their home is a matter for education by the press, the schools and through the advice of the tactful visiting of a district nurse,” he wrote.

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Taking aim at diabetes

When it comes to public health, Ottawa has several priority populations that face specific health risks. One such group is our strong urban Aboriginal community, which is at increased risk for diabetes, a disease that affects more than two million Canadians, and is one of the top 5 diagnosed chronic conditions in Ottawa. However, among members of Ontario's Aboriginal population the disease is three times more common than it is in the general population.

This helps explain why Ottawa Public Health and Aboriginal serving organizations in Ottawa initiated the formation of the First Nations, Métis and Inuit Diabetes Network. The Network has been successful in creating a partnership of members that work together to prevent and raise awareness about type 2 diabetes in the Ottawa Urban Aboriginal community. Included in the Network membership are The Canadian Diabetes Association, The Diabetes Education Program of Ottawa, and Heart and Stroke Foundation of Ontario The strength of this network comes from its Aboriginal membership, which is committed to honouring and recognizing the needs of First Nations, Métis & Inuit that they serve, and developing culturally relevant resources, training and approaches to preventing diabetes.

The First Nations, Métis and Inuit Diabetes Network has been recognized by the Ministry of Health and Long Term Care as an innovative approach to community partnership building.

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Biting back at bed bugs

One of the most important roles at Ottawa Public Health is to identify emerging problems, and it has become clear in recent years that bed bug infestations are one such problem. And Ottawa's not alone — a Google search provides more than three million results for “bed bugs” and proves that these pests are a problem around the world.

As recent media reports have indicated, the problem is getting worse across North America because bed bugs often accompany travellers. Infestations occur most often in buildings that have a high turnover in tenants, but the problem can affect anyone and any home. Though not a significant public health risk, anyone who has been affected by bed bugs knows that it is an extreme nuisance and bites can be very unpleasant!

In 2008, we responded with four seminars on bed bugs that provided information on ways to prevent the problem, to detect it, and to deal with infestations. The best solution is to take the simple precautions that will keep bed bugs out of your home — give all luggage and clothing a thorough inspection when returning from a trip, for example.

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Did you know? We’ve come a long way baby...

A century ago, the infant mortality rate in Ottawa was 250 deaths per 1,000 live births. This meant that of every four children born, one had died before their first birthday! In 2008, the infant mortality rate in Ottawa is less than one death per 200 live births.

Ottawa's public health nurses provide advice and support to more than 2,000 expectant parents every year via early pregnancy education classes and 8,600 consultations with parents occur annually during Well Baby Drop In clinics. Public Health Nurses and Family Visitors provided 13,900 home visits to families in 2008.

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From the archives: Promoting Sexual Health

As Catherine (Katie) Keys can attest, changes in the law can sometimes lead to changes in our approach to public health.

Ms. Keys, a registered nurse with a degree in nursing education from McGill University, was asked to open Ottawa's first Family Planning Clinic in 1971. The move followed the federal government's decision to change the Criminal Code and allow public health officials to discuss sexual health issues with members of the public.

She approached the task with an idea that was all but unknown at the time — customer-friendly hours. Her clinic was open from 3 p.m. to 11 p.m. — in those days banks closed at 3 p.m.! — and enjoyed remarkable success as clinic staff discussed issues with clients such as birth control, breast self-examination and sexually transmitted disease.

But the innovations introduced by Katie Keys did not stop there. She also had public health nurses who worked in the city's high schools spend time in her clinic, and this encouraged students to raise issues of a sexual nature with them. “I think it was our biggest breakthrough,” she said.

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On the lookout for rabies

If you are driving along Richmond Road in the rural part of West Ottawa and are approaching the village of Richmond, keep your eyes open for a plaque commemorating the death of the Duke of Richmond in 1819.

The duke, who was serving as Governor General for British North America, is thought to have been infected with the rabies virus after being bitten by a soldier's pet fox in July 1819. A month later, while visiting the military settlement at Richmond, he began showing rabies-like symptoms, particularly fear of water (hydrophobia). He died near Twin Elm, which is just outside Richmond, on August 28, 1819.

Even though 190 years have passed since his death, rabies remains a serious public health concern in Ottawa, particularly in its rural areas. Rabies remains universally fatal to those who contract it, and so it must be prevented by pre- or post-exposure immunizations. In 2008, for example, Ottawa Public Health received 853 rabies-related calls following human-animal contact. As a result, 474 animals were quarantined, of these animals 434 were vaccinated and cleared, while another 225 animals that were not suitable for quarantine were tested to ensure that they were negative for the disease.

As a precaution, Ottawa Public Health provided post-exposure protective vaccinations to 115 people during the year.

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Meeting the needs of rural Ottawa

Ottawa is a huge city, and the fact that it is home to Canada's Parliament Buildings, many federal government departments and the headquarters of major businesses makes it easy to forget that roughly 90% of our city’s geographical area is considered to be rural.

Ottawa Public Health (OPH) operates a Rural Health Program that works with community organizations, businesses and individuals to meet the special public health needs of residents of Cumberland, Goulbourn, Osgoode, Rideau and West Carleton wards.

Here's an example of what gets done: Most residents of rural Ottawa rely on wells to supply their water needs, and this means their drinking water is not subject to the same rigorous testing as that supplied to urban residents by the City. To help ensure safety, OPH conducted 2,500 tests of rural well water in 2008 by organizing spring and fall collections of water samples.

The Rural Health Program also organizes cardiopulmonary resuscitation (CPR) training in the rural wards; supports exercise classes and provides advice on healthy living at the city's numerous agricultural fall fairs.

The goal is to help ensure that all residents of rural Ottawa receive the services available from OPH.

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The fastest growing population

Twenty years from now, Ottawa is going to be a much different city.

Not only will it have more residents and a different skyline, but it will also be a greyer city. That's because the number of Ottawa residents aged 65 or older — roughly 90,000 people and 10% of the population today — will have grown to 267,000 people and 22% of the population by 2031.

We must start preparing for this change today, and for the fact that the most rapid growth in the senior's population will take place among those aged 85 and older. So how do we do that?

People are never too old to benefit from adopting a healthy lifestyle, avoiding known health risks and living in a healthy environment.

This is why Ottawa Public Health, produced “Get Moving”, a DVD and manual which guides groups through a blend of exercises designed to improve balance, muscular strength, stability and flexibility.

We also have programs to support the “informal caregivers” of seniors who provide care and assistance for their loved ones who have lost a degree of independence.

Which brings us back to preparation. Staying active and being involved with others will set the stage for a healthier, involved seniors population.

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Sex in the city: protecting sexual health

One of the most crucial jobs done by Ottawa Public Health involves the promotion of sexual health. The reason is simple: sexual health is important for overall health. For example, by increasing our testing and education surrounding sexually transmitted infections (STIs), we can decrease the complications resulting from them, such as pelvic inflammatory disease and neurological complications of syphilis. Also, when people are prepared for pregnancy, the mom and baby can be as healthy as possible.

Providing this service is also part of our early-warning role, because better health outcomes are possible if infections are detected and treated quickly.

Our work in the field of sexual health takes many forms:

• Healthy sexuality information presentations in high schools
• Providing free screening of and treatment for STIs;
• Making available low- or no-cost access to contraception and emergency contraception;
• Offering anonymous or confidential HIV testing, including rapid “point of care” testing;
• Providing Pap testing and vaccinations for hepatitis A and hepatitis B;
• Offering counselling on subjects such as contraception, safer sex and healthy relationships.

In 2008, we provided these services to 15,704 clients. This involved the provision of more than 20,000 tests to detect chlamydia, syphilis and gonorrhea, and more than 5,000 tests for HIV.

By year's end, more than 2,700 STIs and blood-borne illnesses had been reported to Ottawa Public Health and investigated by our nurses.

On the “reaching-out” side of the ledger, a Gay Zone Gaie clinic was established in collaboration with six community organizations (Centretown Community Health Centre, AIDS Committee of Ottawa, Pink Triangle Services, Somerset West Community Health Centre, Youth Services Bureau and the Gay Men's Wellness Initiative) to help improve and increase our health promotion activities and interactions with members of Ottawa's gay community.

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It's what we do – Ottawa Public Health is about people

It is about the almost 900,000 people who live in our city, from the tiniest newborn to the most elderly senior. And it is about the more than 700 nurses, public health inspectors, dentists, dental assistants, dieticians, family visitors, epidemiologists, physicians and others who work to protect the public health in our community.

Ottawa Public Health and members of its Executive Team, Dr. Isra Levy, Dr. Vera Etches, Dr. Nadine Sicard, Siobhan Kearns, Esther Moghadam and Sherry Nigro, would like to acknowledge the generous contributions of our non-government sponsors, who provided funding and in-kind contributions to promote and implement OPH initiatives. We would also like to recognize the contributions of our volunteers, community partners and donors who generously provided space, refreshments, personal time and prizes. Together, we provide effective and efficient services to protect and promote the health of Ottawa residents.

We would also like to express our gratitude to members of our Board of Health, Mayor Larry O'Brien and Councillors Georges Bédard, Michel Bellemare, Rainer Bloess, Glenn Brooks, Rick Chiarelli, Alex Cullen, Diane Deans, Steve Desroches, Clive Doucet, Eli El-Chantiry, Peggy Feltmate, Jan Harder, Diane Holmes, Peter Hume, Gord Hunter,

Rob Jellett, Christine Leadman, Jacques Legendre, Maria McRae, Bob Monette, Shad Qadri, Doug Thompson and Marianne Wilkinson; and the City of Ottawa Senior Management for their steadfast support of our programs and services.

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Ottawa Public Health funding

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How to contact us

This report outlines only part of this work and just some of the services we provide. Additional information is available by phoning Ottawa Public Health at 613-580-6744, by e-mailing healthsante@ottawa.ca or by visiting our website, ottawa.ca/health

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