• Statutory Basis
• Perspective
• Principles for Setting Strategic Directions for Minimum Standards for Public Health
• Function
• Format
• Implementation

• Equal Access
• Health Hazard Investigation
• Program Planning and Evaluation

• Chronic Diseases and Injuries
• Chronic Disease Prevention
• Early Detection of Cancer
• Injury Prevention Including Substance Abuse Prevention

• Family Health
• Sexual Health
• Reproductive Health
• Child Health

• Infectious Diseases
• Control of Infectious Diseases
• Infection Control
• Rabies Control
• Safe Water
• Sexually Transmitted Diseases (STDs) Including HIV/AIDS
• Tuberculosis (TB) Control
• Vaccine Preventable Diseases

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INTRODUCTION TO THE STANDARDS

Statutory Basis

The standards contained in this document obtain their legal authority under provisions of the Health Protection and Promotion Act. Part II, Section 5, of the Health Protection and Promotion Act specifies that boards of health (as defined in the Health Protection and Promotion Act) must provide or ensure the provision of a minimum level of public health programs and services in specified areas. Section 7 of the Health Protection and Promotion Act authorizes the Minister of Health to develop and publish guidelines that represent minimum standards for these programs and services.

It is expected that boards of health will deliver additional programs and services in response to local needs, as acknowledged in Section 9 of the Health Protection and Promotion Act. This standards document, however, specifies only those programs which all boards of health are required to provide and is not intended to cover the total potential scope of public health programming.

Perspective

The purpose of the standards is to set out the minimum requirements for fundamental public health programs and services targeted at prevention of disease, health promotion and health protection. These standards reflect broad aspirations for the health of all Ontarians and the important role of boards of health in providing and/or ensuring relevant programs and services.

Through these standards, boards of health seek to enable residents of the community to realize their fullest health potential. They do this by promoting improved health, preventing disease and injury, controlling threats to human life and function, and facilitating social conditions to ensure equal opportunity in attaining health for all.

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The role of boards of health is to promote and protect the health of the population. To identify minimum standards for public health programs and services, we must have an understanding of health needs, of what interventions can impact positively on these needs, and which roles are most appropriate for and within the achievable capacity of Ontario's boards of health.

The proper locus of responsibility and accountability of program delivery should be local, not individual, provincial or federal. These programs are mandatory for all boards of health because they address health needs that exist in all health units across the province. The standards have been developed around four key principles implicit in the mission and goals of boards of health.

1. Need: How big is the problem?

   Assessing need requires the identification of opportunities that will improve the health of Ontarians. It also requires establishing the relative importance of these needs to facilitate priority setting. Furthermore, we must understand the context of the needs so that wherever possible, we are addressing the best opportunity to improve health or the root cause of problems.

   Knowledge of provincial epidemiology (i.e., the distribution, dimensions and significance of health and disease are important in assessing need). This must include traditional epidemiological markers of disease mortality and morbidity and also include measures of behaviours, health and well-being respecting the context of community values. The ability to measure various attributes of need is a critical consideration in planning and program assessment.

   Understanding the determinants of health - social, economic, behavioural, educational, biological, genetic, the physical environment and the workplace - is an important component of assessing need.

2. Impact: How much can we fix?

   After identifying a health need, we must determine how we can best address the requirement. There are several key components in assessing impact.

   We must have reasonable evidence that an intervention can and would work in Ontario as a necessary starting point.

   The health impact of an intervention is very important. This impact should be measured at a population level. Interventions with a major population health impact (i.e., impact on population attributable risk) should receive priority, regardless of whether they have a population-wide, high-risk group or individual focus.

   Interventions should also reflect an understanding of the determinants of health, as described above. Wherever possible, the intervention should address and affect the underlying determinants of a health need as a means of achieving the greatest long term benefits.

3. Appropriateness: Are we the best people to do it?

   Even if a health need has been identified and there is an intervention that could have an important positive impact, we must still decide if the delivery of a particular program is appropriate for all boards of health in Ontario.

   The program should be compatible with Ontario's health goals. The traditional focus of public health on primary prevention (i.e., eliminating the underlying causes of ill-health), and particularly those interventions directed to the entire population, is a useful guide but does not exclude other strategies.

   he program should, in general, be compatible with the established role of public health. This incorporates a broad range of programs and services directed at health promotion and health protection. The existence of a statutory requirement to provide a program is obviously important, as is the presence or absence of legal authority to do the same.

4. Capacity: Are we able to do it?

   It should be within the capacity of the local board of health, working with the community, to provide the program (i.e., reasonably compatible with the current or achievable resources and skills of the organization).

   The cost of an intervention must be considered. This should include an assessment of the costs and benefits of a program as well as its impact, both positive and negative, on other programs in terms of monetary costs, opportunity costs and other effects.

Function

Boards of health plan for and deliver a variety of health programs and services pertinent to local circumstances and needs. However, only the minimum standards for public health programs and services that all boards of health must meet are included in this document.

General Standards

The general standards are directed toward achievement of all health goals by outlining considerations or activities to be undertaken in the planning and delivery of all programs and services.

Program Standards

Individual program standards specify the minimum requirements to be carried out by each board of health for each program in order to contribute to the achievement of stated, province-wide public health goals. These programs translate broad goal directions into objectives and targets and outline the activities that boards of health are required to undertake to achieve the stated objectives.

Format

The following components have been specified for each standard: goal, objectives, requirements and standards.

Goal:

The program goal provides a broad statement about the program's direction.

Objectives:

Objectives specify desired results of the program for the Province of Ontario (i.e., they are provincial objectives). Where adequate baseline data exist, the objectives are measurable targets for achievement within a specific time frame. In the absence of such data, objectives are directional in character. It is expected that boards of health will vary in their achievement of the provincial objectives. However, from a population health perspective, all boards of health are required to work toward these objectives.

For some of the objectives, target dates have been provided. The targets vary from the year 2000 to 2010, as appropriate, to allow for the length of time within which they might reasonably be expected to be achieved.

Local objectives are to be established by each board of health in its annual planning process and should indicate either movement toward or beyond the desired provincial outcome.

Requirements and Standards:

Some standards require that boards of health provide a program or service directly, while others require that boards ensure the provision of a program. This means that a board does not have to provide the service itself if it is already adequately being provided by another community agency. However, in this event, the board is not precluded from also providing the service if it is necessary to meet local needs. Standards have been prepared to achieve balance between flexibility in order to accommodate differences in situations facing local boards of health, and the need to give clear program direction for the achievement of province-wide objectives.

Boards must meet the requirements and standards, or their provincially approved equivalent. Equivalency applies only where mentioned in the program requirements and standards as an option, and will require approval by the Ministry of Health and Long-Term Care. Boards will be required to support their request for the use of an equivalent option by indicating how their proposed strategy meets the four key principles: need, impact, appropriateness and capacity.

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Implementation

While the goals and objectives formulated for these standards fall within the sphere of public health activities, their achievement will depend largely on broad community participation and support. It is, therefore, expected that programs and services will involve extensive community partnership with other sectors and agencies. It is also expected that implementation will include intersectoral cooperation and coordination.

Boards shall develop their programs and services within the context of the community as a whole. Boards will create and deliver public health programs in partnership with other sectors, agencies and volunteer community groups/coalitions. They will provide leadership in identifying issues and developing services, integrating those services with other services in the community and advocating for those which fall outside their mandate. Boards will foster the creation of a supportive environment for health, including active participation by citizens in decisions which affect their own health. Through their knowledge of community health and community participation, and with the use of ongoing planning, program evaluation, priority setting and needs assessment, boards will ensure that programs are adapted to effectively address local needs.

Boards of health should bear in mind that in keeping with the French Language Services Act, services in French should be made available to French-speaking Ontarians located in designated areas.

Staffing

Boards of health are required to employ the services of appropriately trained professionals. This should be consistent with any qualification requirements of the Health Protection and Promotion Act and Ontario Regulation 600/91, Qualifications of Boards of Health Staff, in respect of: medical officers of health, public health dentists, dental hygienists, public health inspectors, public health nurses and public health nutritionists. Also, boards of health will employ staff with training in epidemiology, health promotion, speech pathology, toxicology and other backgrounds that are appropriate for interdisciplinary program planning and effective program delivery.

The services provided by boards of health are expected to be planned and delivered by staff with both the required technical/professional skills (acquired through the qualifications listed above) as well as skills in the following areas :

• community needs assessment
• program planning
• program evaluation
• data management
• data analysis
• negotiation and mediation
• health promotion
  • community development
  • social marketing
  • mass communication and media
  • health education
  • adult education
  • peer education
  • behaviour change education
• case management
• counselling
• immunization practices
• infection control
• health hazard investigation and assessment
• enforcement
• emergency planning
• advocacyrisk assessment and communication
• policy development/analysis

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GENERAL STANDARDS

Equal Access

Goal:

To ensure that all Ontarians have access to public health programs.

Objective:

To reduce educational, social and environmental barriers to accessing mandatory public health programs.

Requirements and Standards:

1. The board of health shall provide mandatory public health programs and services, whenever practical and appropriate, which are accessible to people in special groups for whom barriers* exist. Broadening access may require adjusting existing programs, promoting accessibility and developing special programs including special educational materials, tailored service delivery and active outreach.

2. When planning to use facilities and sites for mandatory public health programs, the board of health shall select those which are barrier-free and have suitable access for special groups.

3. The board of health shall establish ongoing community processes to identify needs, recommend approaches and monitor progress toward achieving access to the mandatory public health programs and services.

* Barriers can include, but are not limited to: literacy level, language, culture, geography, social factors, education, economic circumstance, and mental and physical ability.

Health Hazard Investigation

Goal:

To prevent or reduce adverse health outcomes resulting from exposure to health hazards* as defined in the Health Protection and Promotion Act and including biological, physical, and chemical agents, natural or manmade.

Objectives:

1. To identify health hazards and take appropriate action.

2. To ensure community health protection and continued public health services delivery in the event of a health hazard.

1. The board of health shall provide an initial response or investigation when occurrence of a disease or mortality appears to be significantly higher than expected.

2. In accordance with the Health Protection and Promotion Act, the board of health shall identify, investigate, and manage health hazards.

3. The board of health shall monitor health hazard management strategies annually or more frequently as required to ensure effectiveness.

4. The board of health shall consult with and provide advice to the community about health hazards when such hazards are identified.

5. The board of health shall provide educational materials to raise public awareness of health hazards.

6. The board of health shall ensure timely response to reports of health hazards through the provision of :

   • an on-call system that ensures 24-hour availability of board of health staff to respond;

   • same-day assessment and initiation of action within 24 hours if a health hazard is identified; and

   • a written response plan which is updated annually or more frequently as required.

7. The board of health shall report on health hazards in the community as outlined in Program Planning and Evaluation, requirements 2(f) and 3.

* Health hazard means :   a) a condition of a premises;  b) a substance, thing, plant or animal other than man;  c) a solid, liquid, gas or combination of any of them, that has or that is likely to have an adverse effect on the health of any person. (Health Protection and Promotion Act)

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Program Planning and Evaluation

Goal:

To ensure that local programs address the health needs of the community, with cost-effective, efficient, evidence-based approaches.

Objectives:

1. To ensure that programs and services are based on community health status information.

2. To ensure program development and design is based on evidence of effectiveness and efficiency.

1. The board of health shall liaise with district health councils, social service and municipal organizations, educational institutions, law enforcement agencies, social planning bodies and other health professions, in order to access all data relevant for local health planning.

2. The board of health shall assess annually the community health status in the health unit using as a minimum, data on :

   • demographics;

   • mortality rate;

   • morbidity rates;

   • reproductive outcomes;

   • risk factor prevalence;

   • health conditions that are known or suspected to be associated with exposure to health hazards; and

   • dental health indices.

3. The board of health shall produce an annual report covering current key public health issue(s) that is communicated to the community.

4. The board of health shall ensure the use of community health status information in assessing local health needs and in the planning and evaluating of programs.

5. The board of health shall, in collaboration with researchers and practitioners:

   • ensure the development of innovative, cost-effective, evidence-based programs and services that are consistent with mandatory health programs and services;

   • ensure evaluation is undertaken in areas directly related to mandatory health programs and services; and

   • ensure the dissemination of the knowledge gained from program development and evaluation.

6. The board of health shall encourage continuing education for public health practitioners in order that they develop and maintain the knowledge and skills for the most effective delivery of mandatory health programs and services.

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PROGRAM STANDARDS

CHRONIC DISEASES AND INJURIES

Chronic diseases are the leading causes of death in Ontario. They are a modern epidemic in terms of premature death, disability and health care costs. Common chronic diseases include heart disease, stroke, cancer, chronic lung diseases such as emphysema, diabetes, osteoporosis and many others. The control of chronic diseases has three main components: prevention, early detection, and treatment.

Although there has been considerable progress in the treatment of cardiovascular and many other chronic diseases, it has shown only limited potential for reducing the incidence and overall burden of these diseases.

Early detection of disease is an important means of reducing morbidity and mortality. In order to be worthwhile, however, a screening test should meet the following criteria:

• the burden of illness should warrant widespread implementation;

• the natural history of the condition should be understood;

• a test must accurately distinguish between those with and without disease;

• effective treatment for the early detected stage of the disease should be available and accessible; and

• the benefits of screening should outweigh the risks.

While many screening tests are available for chronic diseases, few meet all of these criteria. Public health has an important role in promoting screening utilization that meet the above criteria and the additional principles of appropriateness and capacity. Accordingly, the Early Detection of Cancer section includes requirements for the promotion of screening for both breast cancer and cervical cancer.

While treatment and early detection efforts are important, it is prevention which has the greatest potential to reduce the significant burden of chronic diseases and increase the overall level of the population's health. In Ontario, three-quarters of the population have one or more risk factors for cardiovascular disease and these risk factors overlap with other chronic diseases. To address this challenge, it is necessary to implement comprehensive multiple risk factor strategies to reduce the risk of heart disease, lung cancer, stroke, diabetes, osteoporosis, and many other chronic diseases.

The Chronic Disease Prevention section contains strategies for all ages to increase awareness and education, build skills, and improve the social and physical environment to support tobacco-free living, healthy eating*, healthy weights and regular physical activity through work with schools and other education facilities, workplaces, health professionals, community agencies and groups, restaurants and grocery stores, recreational facilities and the community at large. This approach will contribute to a reduction in chronic disease morbidity and mortality. Additional strategies are included in the Chronic Disease Prevention section to reduce exposure to ultraviolet radiation to prevent the rising incidence of skin cancers.

* Healthy eating, within the context of a total diet as defined by the Nutrition Recommendations for Canadians and Canada's Food Guide to Healthy Eating.

Alcohol use also contributes to the development of chronic diseases. Strategies to reduce the misuse of alcohol and other substances are located in the Injury Prevention Including Substance Abuse Prevention section.

Injuries are the leading cause of death in children, youth and young adults. While often referred to as "accidents", injuries occur due to specific reasons and can be prevented. The Injury Prevention Including Substance Abuse Prevention section describes multiple strategies aimed at reducing disability, morbidity and mortality among the general population from injuries caused by motorized vehicles, bicycle crashes, falls in the elderly and drownings.

Through this combination of strategies, public health will contribute to the prevention of the leading causes of death and disability for the people of Ontario.

Goal:

To increase the length and quality of life by reducing the mortality and morbidity associated with chronic diseases, injuries and substance abuse.

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Chronic Disease Prevention

Goal:

To reduce the premature mortality and morbidity from preventable chronic diseases.

Disease Objectives:

1. To reduce the mortality from ischemic heart diseases by 25 per cent by the year 2010.

2. To reduce the mortality from stroke by 10 per cent by the year 2010.

3. To slow the rise in incidence of lung cancer.

4. To slow the rise in mortality from chronic obstructive lung disease

5. To reduce the morbidity from diabetes and hypertension.

6. To reduce the incidence of oral cancer by 10 per cent by the year 2010.

7. To reduce the morbidity of osteoporosis.

8. To slow the rise in incidence of skin cancers.

The following behavioural and policy objectives are aimed at achieving the above-stated disease objectives :

• to reduce the proportion of 12-to-19 year-olds who smoke daily to 10 per cent by the year 2005;

• to reduce the proportion of adult women and men who smoke daily to 15 per cent by the year 2005;

• to increase the proportion of smoke-free public places and workplaces to 100 per cent by the year 2005;

• to reduce tobacco vendor non-compliance with sale of tobacco to minors legislation to 10 per cent by the year 2000;

• to increase the proportion of smoke-free homes by the year 2010;

• * to reduce dietary fat intake to an average of 30 per cent of calories or less among people age 18 and older by the year 2010;

• * to increase to 75 per cent the proportion of the population age four and older consuming five or more servings of vegetables and fruit daily by the year 2010;

* These sub-objectives should be achieved within the context of a total diet as defined by Nutrition Recommendations for Canadians and Canada's Food Guide to Healthy Eating.

• * to increase to 75 per cent the proportion of youth ages 10-16 years consuming three or more servings of milk products daily, and to increase to 65 per cent the proportion of adults consuming two or more servings of milk products daily by the year 2010;

• * to increase to 50 per cent the proportion of the population age four and older consuming five or more servings of grain products daily by the year 2010;

• to slow the decrease in the proportion of adults ages 20-64 with healthy weight status (Body Mass Index 20-27) by the year 2010;

• to increase to 40 per cent the proportion of all adults who include at least 30 minutes of accumulated, moderate physical activity on most if not all days of the week by the year 2010;

• to increase to 60 per cent the proportion of youth who include at least 30 minutes of accumulated, moderate physical activity on most if not all days of the week by the year 2010;

• to increase the proportion of children who are active; and

• to increase the proportion of the population of all ages who limit sun exposure, use protective clothing and sunscreens when exposed to sunlight, and avoid artificial sources of ultraviolet light (i.e., sun lamps, tanning booths).

Requirements and Standards:

1. The board of health shall work with community agencies and groups to provide the public with information and opportunities for skill development to facilitate the adoption of health-related behaviours for the prevention of chronic diseases. Topics that must be included are: tobacco-free living, healthy eating, healthy weights and regular physical activity. This shall include as a minimum :

   • provide at least one community-wide education campaign annually involving one of the above topics. The campaign must include the use of three of the following: television, radio, newspaper, posters/pamphlets, transit/billboard ads, community forums and contests;

   • promote and provide community events, on each of the above-mentioned topics, annually. Community events are open to the general public and/or specifically-targeted groups. They must involve public interaction and participation, and provide information and/or skill building;

   • develop, maintain an annual membership and participate in coalition(s) of community agencies and groups to coordinate community activities to address all of the above-mentioned topics;

   • promote and provide a telephone advice line and use the Internet to offer information on all of the above-mentioned topics and information on board of health and community programs; and

   • promote and provide information on the above topics through ongoing use of the community mass media including television, radio and print (newspaper, pamphlets).

2. The board of health shall support the development of peer educators as appropriate to participate in, and support chronic disease prevention by promoting one or more of the following topics: tobacco-free living, healthy eating, healthy weights and regular physical activity. This shall include recruiting peer educators; and providing orientation, initial and ongoing training, ongoing consultation and support, ongoing coordination and monitoring of the activities, and a system of recognition.

3. The board of health shall provide education for staff in social service and seniors' agencies, recreation departments and child care facilities to promote chronic disease prevention in their work environment. Topics that must be included are: tobacco-free living, healthy eating, healthy weights and physical activity. This shall include as a minimum :

   • promote and provide a two-hour education event on each of the above topics annually; and

   • provide, every three months, communication to inform and update on all the above topics using a newsletter or the Internet.

4. The board of health shall work with community agencies and groups, and health professionals to provide information and education on the benefits and methods for quitting smoking including community smoking cessation programs. This shall include as a minimum :

   • provide, on an ongoing basis, information on self-help materials and other resources through community media information services; and

   • provide smoking cessation programs and brief contact interventions giving emphasis to populations and areas not covered by existing programs.

5. The board of health shall contribute to the reduction of second-hand smoke exposure to the public, particularly pregnant women, children and youth. This shall include as a minimum :

   • provide, on an ongoing basis, information to parents, caregivers and the community on the risks of second-hand smoke and strategies for attaining smoke-free homes, home day cares, and cars; and

   • support and encourage municipal policy development, including the consideration of appropriate by-laws and their enforcement to reduce smoking in public places and workplaces.

6. The board of health shall enforce the Tobacco Control Act, including the sale or provision of tobacco, its promotion and distribution and smoking at prohibited sites. This shall include as a minimum :

   • annual inspections of all tobacco vendors believed to be in compliance with the Tobacco Control Act to ensure continued compliance with sections 3, 5, 6, 7, 9 and 10 of the Tobacco Control Act;

   • a semi-annual inspection of each tobacco vendor who has been warned of non-compliance under the Tobacco Control Act or charged with an offence under the Tobacco Control Act in the previous two years to ensure continued compliance with sections 3, 5, 6, 7, 9 and 10 of the Tobacco Control Act, and sections 16, 17 and 18 of the Tobacco Control Act, if applicable;

   • in addition to the above-mentioned inspections, such additional inspections as are necessary to ensure correction of non-compliance observed during previous inspection(s) and to investigate all complaints under the Tobacco Control Act;

   • annual compliance checks" encompassing at least 10 per cent of all tobacco vendors within the board of health's jurisdiction. The checks will be conducted in accordance with the Ministry of Health and Long-Term Care Determination of Tobacco Vendor Compliance Protocol (January 1, 1998). These checks may be conducted in conjunction with the inspections outlined in subsections a., b., and c. above;

   • the issuing of Provincial Offence Notices and laying of charges when infractions occur, particularly with respect to section 3 of the Tobacco Control Act, according to the Ministry of Health and Long-Term Care Routine Inspections, Follow-up of Complaints and Inspection of Problem Tobacco Vendors Protocol, (January 1, 1998);

   • the compilation of a list of all tobacco vendors within the board of health's jurisdiction. The list shall be updated annually;

   • the annual inspection of all secondary schools for compliance with sections 9 and 10 of the Tobacco Control Act; inspections every two years of all elementary schools and places as referred to under paragraphs 1 and 2 of subsection 9(1) of the Tobacco Control Act, for compliance with sections 9 and 10 of the Tobacco Control Act; inspection of all places referred to under subsection 9(1) of the Tobacco Control Act on a complaint basis to ensure compliance with the Tobacco Control Act;

   • ensure that an agreement is in place at every secondary school within the jurisdiction of the board of health outlining the roles and responsibilities of the board of health and of school officials, and the procedures to be followed for assuring compliance with subsection 9(1) of the Tobacco Control Act;

   • ensure the ongoing use of community media to increase awareness of the Tobacco Control Act and its purpose and to facilitate awareness of the rationale and scope of the board of health's enforcement efforts; and

   • ensure that there are sufficient board of health staff trained in inspection and enforcement duties as they relate to the responsibilities listed above.

7. The board of health shall work with municipal recreation departments and other community partners to promote and increase access to regular physical activity for people of all ages. This shall include as a minimum :

   • provide, on an ongoing basis, information to the public through the use of television, radio, pamphlets, posters, presentations on the health benefits of regular physical activity;

   • promote, on an ongoing basis, the availability of opportunities for physical activities;

   • assist community partners to increase the availability of safe and accessible recreation opportunities such as walking trails and cycling routes; and

   • promote and assist in the development of policies that increase access to regular physical activity in the community.

8. The board of health shall work with community agencies and groups to promote access to sufficient, safe, nutritious and personally acceptable food for people of all ages. This shall include as a minimum :

   • monitor, annually, the cost of a nutritious food basket according to the Ministry of Health and Long-Term Care Monitoring the Cost of a Nutritious Food Basket Protocol (June 1, 1998). Information about the cost of a nutritious food basket is to be used on an ongoing basis to promote and support policy development to increase access to healthy foods;

   • develop and disseminate an inventory of local programs and services which increase access to healthy foods. The inventory shall be updated annually;

   • work with community agencies and groups to improve access to healthy foods on an ongoing basis; and

   • promote and provide consultation and training sessions to community agencies and groups that are involved in increasing access to healthy foods on an ongoing basis.

9. The board of health shall work with all schools and school boards to implement health promotion programming. Topics that must be included are: tobacco-free living, healthy eating, healthy weights and regular physical activity. This shall include as a minimum :

   • provide assistance and consultation to school boards, school advisory councils and principals/teachers to review and implement health-related curricula on all the above topics as requested;

   • promote and provide teachers from all schools an opportunity to attend two hours of continuing education annually on one or more of the above-mentioned topics;

   • provide ongoing consultation and development and review of learning materials for school boards, student advisory councils and school staff throughout the year on all of the above-mentioned topics; and

   • support the implementation of a variety of activities in schools on an ongoing basis. This will include: student-led school wide initiatives, peer education, peer support groups and annual awareness events on any of the above topics.

10. The board of health shall work with school boards, school advisory councils, principals/teachers and parents to develop and implement guidelines that support healthy eating and regular physical activity. This shall include as a minimum :

    • promote the need for guidelines for healthy eating and daily physical activity with all school boards and all schools on an annual basis;

    • provide information, consultation and support to establish healthy eating guidelines consistent with Canada's Food Guide to Healthy Eating and relevant to foods available within the school including school nourishment programs, cafeterias, tuck shops/snack bars, vending machines, foods sold or distributed at special events and sports days, and foods used for fund-raising; and

    • provide information, consultation and support to establish guidelines which encourage daily physical activity for all students through balanced instructional programs, intramural activities, and interschool athletics, and skill development for lifelong active living.

11. The board of health shall work with workplace personnel and local trade and business associations to improve awareness, skills development and the work environment to reduce the risk of chronic diseases. Topics must include one or more of the following: tobacco-free living, healthy eating, healthy weights and regular physical activity. This shall include as a minimum :

    • provide consultation, assistance and health promotion resources to workplaces on all the above topics on an ongoing basis including any combination of workshops, print materials, and displays; and

    • promote and provide a two-hour education event on one or more of the above topics once a year to occupational health practitioners and others who may influence employee health.

12. The board of health shall work with workplace personnel and local trade and business associations to develop and implement guidelines that will reduce the risk of chronic diseases. This shall include as a minimum :

    • promote the need for smoke-free workplaces, healthy eating guidelines and higher levels of regular physical activity in workplaces through the use of the Internet and mass media;

    • provide consultation and assistance to establish smoke-free workplaces including provision of smoking cessation material and programs either directly or by linking with available and appropriate community cessation programs;

    • provide consultation and assistance to establish healthy eating guidelines consistent with Canada's Food Guide to Healthy Eating and relevant to foods available in cafeterias, vending machines and at business functions; and

    • provide consultation and assistance to support higher levels of regular physical activity by increasing employees' access to physical activity opportunities (e.g., on-site showers, locker rooms/equipment, incentives for community fitness club memberships, bicycle racks, walking clubs).

13. The board of health shall work with health professionals to enhance their knowledge and skills that will assist their patients/clients to stop smoking, eat a healthy diet, maintain or attain a healthy weight and engage in regular physical activity. This shall include one or more of the following :

    • promote use of in-office reminders for health professionals for preventive interventions on all the above topics;

    • provide patient educational materials on all the above topics;

    • perform outreach visits to health professionals' offices to encourage preventive interventions on all the above topics;

    • use health opinion leaders to encourage and model preventive interventions on all the above topics; and

    • participate in skill building workshops on the above topics.

14. The board of health shall work with restaurants, grocery stores, other food purchase outlets, and community partners to promote and provide information for, offer education and skills development programs, and improve physical and social environments for people to adopt healthy eating practices. This shall include as a minimum :

    • promote and provide information on an ongoing basis about healthy food choices in grocery stores, restaurants and cafeterias including displays, posters and point-of-purchase information;

    • promote and provide information and skills development for the public and particular target groups through group sessions on choosing, purchasing and preparing healthy foods at a frequency of 20 group sessions per 100,000 population or 20 group sessions per year, whichever is greater;

    • provide consultation to restaurants and cafeterias to enable them to offer and promote healthy food choices to their customers on an ongoing basis;

    • provide a healthy eating education component in Food Handler Training Courses in collaboration with Food Safety Requirement 4 on an ongoing basis; and

    • provide healthy eating education programs for food service industry personnel annually including workshops, newsletter inserts and food demonstrations.

15. The board of health shall work with local groups and individuals to provide education and promote policies which reduce the risk of skin cancers. This shall include as a minimum :

    • ensure the provision of community-wide education using a variety of strategies that addresses reducing exposure to ultraviolet radiation from the sun and artificial sources (e.g., tanning beds, lights);

    • assist schools, child care facilities, and work sites to develop and implement policies which reduce the risk of skin cancers; and

    • work with community partners to encourage public policy decisions that increase shade for public and school outdoor recreation areas.

     

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Goal:

To reduce mortality from breast cancer and cervical cancer by increasing early detection.

Objectives:

1. To reduce female breast cancer mortality by 10 per cent by the year 2010.

2. To increase to 70 per cent the proportion of women ages 50-69 who receive screening mammography through the Ontario Breast Screening Program (OBSP) by the year 2010.

3. To reduce the mortality from cervical cancer by 50 per cent by the year 2005.

4. To increase the proportion of women screened according to the guidelines of the Ontario Cervical Screening Collaborative Group to 85 per cent and to increase the proportion of ever-screened to 95 per cent by the year 2010.

Requirements and Standards:

1. The board of health shall work with and assist regional OBSP centres to increase recruitment to the OBSP. This shall include as a minimum :

   • work with community groups, women and health professionals to coordinate services, identify gaps and barriers to screening, and develop and implement strategies to reduce barriers and increase the level of use of OBSP;

   • ensure that a community-wide education campaign using a variety of strategies such as television, radio, newspapers, posters/pamphlets occurs not less than once a year aimed at increasing awareness and knowledge of effectiveness and availability of screening through OBSP;

   • provision of group education sessions for women and their family members at a frequency of one per 100,000 population or two group sessions per year, whichever is greater; and

   • provision of continuing education and resource materials to health professionals to promote awareness of OBSP.

2. The board of health shall work with community groups, women and health professionals to coordinate services, identify gaps and barriers to screening, and develop and implement strategies to increase recruitment for cervical cancer screening, particularly those in hard-to-reach groups.

Injury Prevention Including Substance Abuse Prevention

Goal:

To reduce disability, morbidity and mortality caused by motorized vehicles, bicycle crashes, alcohol and other substances, falls in the elderly and to prevent drowning in specific recreational water facilities.

Objectives:

1. To reduce the rate of injuries caused by cycling crashes and motorized vehicle crashes including, boats, snowmobiles and all terrain vehicles that lead to hospitalization or death by 20 per cent by the year 2010.

2. To reduce the rate of alcohol and other substance-related injuries or deaths by 20 per cent by the year 2010.

3. To reduce the percentage of the adult population who drink more than two drinks per day by 20 per cent by the year 2010.

4. To reduce the rate of illicit substance use and the non-medical use of drugs and of other psychoactive substances by 20 per cent by the year 2010.

5. To reduce the rate of fall-related injuries in the elderly (aged 65+ years) that lead to hospitalization or death by 20 per cent by the year 2010.

6. To eliminate drowning in waters used for specified recreational purposes.

Requirements and Standards:

1. The board of health shall work with municipal police, the Ontario Provincial Police, other traffic enforcement agencies and community groups to prevent injuries caused by motorized vehicles and bicycles by supporting policies and educating the public and targeted groups. As a minimum, the following topics are to be addressed :

   • road and motorized vehicle safety;

   • the correct use of car restraints and airbags;

   • bicycling injury prevention and bicycle helmet use;

   • impaired driving and riding with an impaired driver.

2. The board of health shall use the following means to address the topics listed in 1. above. This shall include as a minimum :

   • develop, maintain membership on and actively participate in a community injury prevention coalition and a substance abuse prevention coalition; and

   • promote and provide, on an annual basis, educational information and activities on three of the topics identified in 1. above. This shall include as a minimum:

     • provide at least one community-wide education campaign annually. The campaign must include the use of three of the following :   television, radio, newspapers, posters/pamphlets and the Internet; and

     • provide one community event (community or board of health led), per 100,000 population or two community events per year, whichever is greater. Community events are open to the general public and/or specifically-targeted groups. They must involve public interaction and participation, and provide information and/or skill building.

3. The board of health shall work with community agencies and groups to support policies and educate the public and targeted groups about low-risk drinking, illicit substance use and the non-medical use of drugs and of other psychoactive substances. As a minimum, the following topics are to be addressed :

   • alcohol use and health status;

   • drinking levels associated with a low risk of alcohol-related problems;

   • circumstances and populations where a person should limit use;

   • countermeasure initiatives; and

   • the risks associated with illicit substance use and the non-medical use of drugs and of other psychoactive substances.

4. The board of health shall use the following means to address the topics identified in 3. above. This shall include as a minimum :

   • develop and maintain an annual membership on and actively participate in a substance-abuse prevention coalition;

   • ensure to the best of the board of health's ability that a functioning alcohol risk management policy is in place in every municipality, university, college, and recreation centre within the board of health's jurisdiction;

   • ensure that there is annual provision of server intervention training to the public, staff and volunteers at recreational and other targeted facilities; and

   • on an annual basis, promote and provide educational information and activities on three of the topics listed in 3. above. This shall include as a minimum:

     • provide at least one community-wide education campaign annually. The campaign must include the use of three of the following :   television, radio, newspapers, posters/pamphlets and the Internet, and

     • one community event (community or board of health-led), per 100,000 population or two community events per year, whichever is greater. Community events may be open to the general public and/or specifically targeted groups. They must involve public interaction and participation, and provide information and/or skill building.

5. The board of health shall work with school boards, school advisory councils, principals/teachers and parents to promote and provide information and skill development programs on the topics listed in requirements 1. and 3. above. This shall include at a minimum :

   • one annual student education event on at least two of the topics listed in each of requirements 1. and 3. above, with the consent of the school (student or teacher or board of health led), in 50 per cent of the schools in the jurisdiction of the board of health. Of these schools, a minimum of 25 per cent of students must be reached. An equivalent option may be delivered with the approval of the Ministry;

   • promote and provide teachers from all schools an opportunity to attend two hours of continuing education annually on one or more of the topics in each of requirements 1. and 3. above;

   • provide ongoing consultation and development and review of learning materials; and

   • support the development of injury prevention and substance abuse prevention policies, as appropriate.

6. The board of health, in partnership with other health care providers and community groups shall support policies and educate the elderly and other targeted groups to prevent fall-related injuries in the elderly. Topics addressed must include the risk factors associated with fall-related injuries and strategies to prevent these injuries.

   As a minimum, the following should be utilized to address the risk factors :

   • develop, maintain membership on and actively participate in a fall-related injury prevention coalition; and

   • promote and provide, on an annual basis, educational information and activities regarding the risk factors. This shall include as a minimum:

     • provide at least one community-wide education campaign annually. The campaign must include the use of three of the following :   television, radio, newspapers, posters/pamphlets and the Internet, and

     • provide at least one community event (community or board of health led), per 200,000 population or two community events per year, whichever is greater. Community events may be open to the general public and/or specifically targeted groups. They must involve public interaction and participation, and provide information and/or skill building.

7. The board of health shall work with workplace personnel and local trade and business associations to improve awareness, skills development and the work environment to prevent alcohol and other substance abuse. This shall include as a minimum :

   • provide consultation, assistance and health promotion resources to workplaces; and

   • promote and provide a two-hour educational event once a year to occupational practitioners and others who may influence employee health.

8. The board of health shall work with health professionals to enhance their knowledge and skills about injury prevention and substance abuse prevention. This shall include one or more of the following:

   • promote use of in-office reminders for health professionals for preventive interventions;

   • provide patient educational materials;

   • perform outreach visits to health professionals' offices to encourage preventive interventions;

   • use health opinion leaders to encourage and model preventive interventions; and

   • participate in skill building workshops.

9. The board of health shall :

   • inspect public pools at least two times per year and no less than once every three months while operating to ensure compliance with Ontario Regulation, Public Pools;

   • inspect public wading pools, at least two times per year and no less than once every three months while operating to ensure compliance with the Ministry of Health and Long-Term Care Standards for Public Wading Pools Protocol (January 1, 1998);

   • inspect public spas once per year while operating to ensure compliance with the Ministry of Health and Long-Term Care Operation of Public Spas Protocol (January 1, 1998);

   • make additional inspections of public pools, public wading pools and public spas as necessary to ensure correction of non-compliance with Ontario Regulation, Public Pools, or the appropriate Ministry of Health and Long-Term Care Standards for Public Wading Pools Protocol (January 1, 1998) and Ministry of Health and Long-Term Care Operation of Public Spas Protocol (January 1, 1998) observed during previous inspection(s), and to investigate bather complaints; and

   • ensure the availability of information regarding the health and safety-related operational procedures applicable to public pools, public wading pools and public spas.

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PROGRAM STANDARDS

FAMILY HEALTH

Prenatal and early childhood experiences have a profound effect on health and well-being in later life. The Family Health program is directed at children, youth, parents, caregivers and people in their reproductive years who are making choices about future family life. The program is intended to protect and promote the health of families, prevent disease and assist in the attainment of an optimal level of health.

The components of the program are: Sexual Health, Reproductive Health, and Child Health. The primary focus of Sexual Health is on the establishment of healthy sexual relationships and personal responsibility. The focus of Reproductive Health is on planning for a healthy pregnancy and promoting healthy behaviours and environments before and during pregnancy. Child Health is focused on promoting healthy development through parenting practices and supportive environments.

Goal:

To promote the health of children, youth and families.

Goal:

To promote healthy sexuality.

Objectives:

1. To decrease the rate of pregnancy in women 15-19 years of age to 40 per 1,000 population by the year 2005.

2. To increase access to contraception for individuals in need to decrease unplanned pregnancy.

3. To increase the awareness and knowledge about personal responsibility and life skills required to deal with sexual relationships and behaviours including the impact of alcohol and other drugs.

Requirements and Standards:

1. The board of health shall work with community partners to ensure the provision of programs to the public that promote appropriate individual reproductive and sexual health choices. Content of programs shall include: knowledge, attitudes and the development of behaviours appropriate to the individual's reproductive age and maturity.

   Programs shall include, as a minimum, the following topics :

   • sexual behaviour, personal responsibility and decision-making;

   • relationships and assertiveness, including techniques for negotiating safer sex;

   • methods of contraception, including abstinence;

   • prevention of sexually transmitted diseases;

   • sexual orientation;

   • sexuality and aging; and

   • sexual assault and abuse.

   These programs shall include as a minimum :

   • three hours of sexual health education annually to all students in grades 7-9 by the person or organization that operates the school. The board of health shall assist in school curriculum development and implementation. In schools where this education is not provided, the board of health will report this to the Ministry of Health and Long-Term Care, and a program of equivalent activities targeted to school-aged children shall be delivered through other community settings;

   • provision of information for parents on an ongoing basis that will assist them in their role as the primary sexuality educators of their children;

   • health promotion strategies, including an annual workshop for individuals such as educators, health professionals and community workers involved in education and counselling; and

   • activities that promote awareness about sexuality to the targeted population, including those with special needs.

2. The board of health shall provide clinical services, at a minimum of four hours per week per 150,000 or less population, and such additional services as are required to meet local needs.

   Activities associated with these clinical services shall include as a minimum :

   • client's health assessment;

   • contraception counselling, provision of prescription and other contraceptives at cost and/or free for clients in financial need;

   • preventive counselling and screening for cancers of the cervix and additional physical and laboratory examinations as appropriate;

   • pregnancy tests and comprehensive pregnancy counselling;

   • post-abortion counselling;

   • education and counselling on reproductive and sexual health choices, with appropriate client referral to: smoking cessation programs, nutrition counselling, assertiveness training groups, alcohol and drug abuse programs and other health and social service agencies and groups;

   • provision of hepatitis B vaccine at no cost, according to Ministry of Health and Long-Term Care eligibility criteria; and

   • development of a management plan appropriate to client needs, including discharge planning and referral where necessary to health care and/or social agencies.

3. The board of health shall work with coalitions/networks of community groups and health and social services partners to coordinate and address gaps in sexual health programs in the community.

Reproductive Health

Goal:

To support healthy pregnancies.

Objectives:

1. To reduce the low birth weight rate (under 2500g) to 4 per cent by the year 2010.

2. To decrease the prevalence of neural tube defects by 25 per cent by the year 2010.

The attainment of these objectives will be assisted by behavioural and policy objectives. Refer to the Chronic Disease Prevention program objectives regarding healthy eating, healthy weights, physical activity promotion, tobacco use prevention and smoke-free public places and workplaces. Refer to the Injury Prevention Including Substance Abuse Prevention program regarding alcohol and other substance use and abuse.

Requirements and Standards:

1. The board of health shall provide a reproductive health program that contains the following topics :

   • folic acid supplementation before conception and in early pregnancy;

   • adequate nutrition including optimal weight gain in pregnancy;

   • smoking cessation and exposure to second-hand smoke;

   • physical activity;

   • avoidance of alcohol and other substance use in pregnancy;

   • benefits of support systems;

   • stress reduction and management;

   • access to prenatal care; and

   • early recognition and appropriate response to pre-term labour.

2. The board of health shall use the following means to address the topics listed in 1. above :

   • provide annual consultation to school boards, teachers and student councils on the implementation of a reproductive health curriculum on the topics listed in 1. above for grades 7 and above with the consent of the school. This shall consist of a half-day meeting with each school to review and advise on current content and resources;

   • promote and provide public education through group sessions on the topics listed in 1. above, at a frequency of 20 group sessions per 100,000 population; or 20 group sessions per year, whichever is greater. Education shall be targeted to all of the following: youth groups, pregnant women and their partners, and people planning pregnancies; and

   • distribute, on an ongoing basis, information on the topics listed in 1. above through the mass media including a combination of television, newspapers, radio, pamphlets and the Internet.

3. The board of health shall work with health professionals to enhance their knowledge and skills about reproductive health in order to support their counselling efforts. This shall include one or more of the following:

   • promote the use of in-office reminders for health professionals;

   • provide patient/client educational materials and reminders;

   • perform outreach visits to health professionals' offices;

   • use opinion leaders for the promotion of new programs and development of new protocols; and

   • participate in skill building workshops.

4. The board of health shall work with coalitions/networks of community agencies and groups and health and social service providers to coordinate services for pregnant women and people in their reproductive years. These services shall include as a minimum :

   • develop and distribute a community inventory of preconception and prenatal services for women and people in their reproductive years. The inventory shall be updated annually and distributed through a mass mailing to community agencies and groups and health and social service providers. The inventory shall also be made available to the general public on request;

   • conduct and document a needs assessment for service needs and update the assessment annually;

   • assist in the development and implementation of new services as identified in the needs assessment, and the coordination of existing services. Assistance shall include:

     • provision of public health expertise to the coalition/network such as epidemiological data, relevant research data and advice on effective program strategies and approaches,

     • annual one-day training of health and social service providers on the topics listed in 1. above,

     • ongoing provision of program materials, and

     • direct service delivery, when appropriate; and

   • distribute a written update on coalition activities every six months to coalition members, their parent organizations and the public.

5. The board of health shall assist workplaces and workplace personnel in supporting healthy pregnancies. This shall include as a minimum :

   • prepare information on risk factors related to reproductive health and distribute annually to management and employee groups. Content shall include information regarding the following :

     • the impact of type and hours of work,

     • established chemical, physical and biological hazards, and

     • workplace programs and policies demonstrated to have a positive impact on reproductive outcomes; and

   • assist in the development and implementation of workplace programs and policies to promote and protect the health of pregnant workers. Assistance shall include :

     • offer presentations to employers every six months, and

     • provide ongoing advice and consultation to employers, as requested.

Child Health

Goal:

To promote the health of children and youth.

Objectives:

1. To increase the percentage of children and youth who meet physical, cognitive, communicative and psychosocial developmental milestones.

2. To increase to 50 per cent the percentage of infants breast-fed up to six months by the year 2010.

3. To reduce the prevalence of dental diseases in children and youth.

4. To increase access to and the use of needs-based services and supports for children who are at risk of poor physical, cognitive, communicative, and psychosocial development, and their families.

5. To increase effective parenting ability in high-risk families.

The attainment of these objectives will be assisted by behavioural and policy objectives. Refer to the Chronic Disease Prevention program objectives related to healthy eating, physical activity promotion, tobacco use prevention and smoke-free public places and workplaces. Refer to the Injury Prevention Including Substance Abuse Prevention programs for alcohol and other substance use/abuse. Refer also to the Reproductive Health, Sexual Health, Sexually Transmitted Diseases and Vaccine Preventable Diseases programs.

Requirements and Standards:

1. The board of health shall provide a child health program that contains the following topics :

   • developmental milestones including, but not limited to :

     • speech and language,

     • hearing,

     • vision,

     • growth,

     • motor skills,

     • social interaction, and

     • behaviour; and

   • factors contributing to the achievement of milestones including, but not limited to :

     • immunization,

     • injury prevention and safety,

     • nutrition,

     • preventive dental health practices,

     • physical activity,

     • communication, and

     • stimulation and play;

     • parenting ability,

     • family functioning,

     • social supports, and

     • coping skills.

2. The board of health shall use the following means to address the topics listed in 1. above :

   • promote and provide information and skills development for child care providers and health and social service providers through group sessions on the topics listed in 1. above. These shall be offered annually to each of the above-mentioned groups;

   • provide at least one community-wide education campaign annually involving one of the topics listed in 1. above. The campaign must include the use of three of the following: television, radio, newspaper, posters/pamphlets, transit/billboard ads, community forums and contests;

   • promote and provide a telephone line for information and consultation services on the topics listed in 1. above;

   • distribute on an ongoing basis information on the topics listed in 1. above through the mass media including a combination of television, newspapers, radio, pamphlets and the Internet;

   • promote and provide information and skills development for parents through group parenting sessions on the topics listed in 1. above at a frequency of 20 group sessions per 100,000 population, or 20 group sessions per year, whichever is greater; and

   • promote and support the development of peer educators, as appropriate to support parents and assist with skills development. This shall include recruiting peer educators; and providing orientation, initial and ongoing training, ongoing consultation and support, ongoing coordination and monitoring of activities, and a system of recognition.

3. The board of health shall work with coalitions/networks of youth, parents, child care providers and health and social service providers to coordinate services for children, youth and parents. This shall include as a minimum :

   • provide ongoing consultation to the network/coalition through the provision of public health expertise such as epidemiological data, relevant research data and advice on effective program strategies and approaches; and

   • foster the development of peer support groups for parents and for youth. This shall include assisting in bringing individuals together, working with groups to identify needs and providing information and materials as requested.

4. The board of health shall promote and support breastfeeding. This shall include as a minimum :

   • distribute, on an ongoing basis, information regarding the benefits of breastfeeding through the mass media including a combination of television, newspapers, radio, pamphlets and the Internet;

   • work with health professionals to enhance their knowledge and skills about breastfeeding in order to support their counselling efforts. Activities shall include any combination of :

     • patient/client educational materials,

     • outreach visits to physicians' offices,

     • use of opinion leaders for the promotion of breastfeeding, and

     • participation in skill-building workshops;

   • advocate for and assist in the development of policies to support breastfeeding in the workplace, restaurants, shopping malls and other public places;

   • provide telephone consultation to breastfeeding mothers; and

   • ensure the provision of services to breastfeeding mothers, including :

     • assistance to other health and social service organizations and community groups in the establishment of telephone lines, centres/clinics, drop-ins and peer support groups,

     • recruitment and training of peer educators to act as breastfeeding advocates and to provide in-home support. This shall include initial and ongoing training and ongoing consultation, support and monitoring of activities, and a system of recognition, and

     • ongoing membership and active participation in a coalition/network of community agencies and groups to coordinate services. This shall include provision of public health expertise to the coalition/network such as relevant research data, program materials and advice on effective program strategies and approaches.

5. The board of health shall plan and implement the Healthy Babies, Healthy Children Program in accordance with the Ministry of Health and Long-Term Care/Ministry of Community and Social Services Implementation Guidelines for The Healthy Babies, Healthy Children Program (August, 1997). This shall include as a minimum :

   • coordinate services for at-risk and high-risk children ages 0-2 years. This shall include as a minimum :

     • collaborate with the Ministry of Community and Social Services and community providers in the development of an inventory of prevention, early intervention and treatment services for children,

     • develop protocols with providers and agencies for screening and referral of children and families to appropriate services,

     • monitor and support appropriate use of protocols,

     • link families and children to appropriate community supports, and

     • ensure identification of a case manager for high-risk children receiving services.

   • ensure the delivery of a lay home visiting program for high-risk families prenatally and with newborns. This program shall include as a minimum :

     • conduct a brief assessment of referred at-risk families,

     • conduct in-depth home assessment of referred high-risk families,

     • develop and implement a home visiting program tailored to the needs of individual families,

     • link at-risk and high-risk families to alternate and/or additional community supports; where these are inadequate or unavailable, and the family could benefit from home visiting by a nurse or other health professional, these services must be provided,

     • ongoing training of lay home visitors on child development,

     • monitor the program delivered by lay home visitors, and

     • coordinate the home visiting program with other community family supports and services.

   • lay home visitors will provide information and skills development regarding the following :

     • developmental milestones and how to promote healthy child development,

     • factors contributing to achievement of milestones, and

     • community supports.

6. The board of health shall provide the Children In Need Of Treatment (CINOT) Program in accordance with the Ministry of Health and Long-Term Care Children in Need of Treatment Program Protocol (August 29, 1997). For CINOT-eligible children, the board of health shall provide referrals to oral health care providers and monitor the action taken.

7. The board of health shall provide, or ensure the provision of, monitoring of the fluoridation of the local municipal or regional water supply in accordance with the Ministry of Health and Long-Term CareMonitoring the Fluoridation of Local Municipal or Regional Water Supply Protocol (August 29, 1997).

8. The board of health shall identify, on an annual basis, high-risk schools and high-risk individuals in other schools. The board of health shall :

   • conduct the Dental Indices Survey (DIS), annually according to Ministry of Health and Long-Term Care Dental Indices Survey Protocol (August 29, 1997) at school entry, in every school, annually; and

   • based on the current year's DIS results, conduct oral health screening in accordance with the Ministry of Health and Long-Term Care Dental Indices Survey Protocol (August 29, 1997).

9. The board of health shall :

   • provide dental health education resources, on an annual basis, to all high-risk schools, schools with English as a Second Language (ESL) classes and other schools who request such materials. Dental education resources are defined as informational pamphlets and other written material, computer programs and oral health aids that are targeted to the school-aged population; and

   • conduct at least one teacher in-service session per school, per year, for teachers in high-risk schools and teachers of English as a Second Language (ESL) classes; when in-service is declined, an equivalent option, approved by the Ministry, must be delivered.

10. The board of health shall provide, or ensure the provision of, clinical preventive services, on an annual basis, as defined in the Ministry of Health and Long-Term Care Dental Indices Survey Protocol (August 29, 1997). For the purposes of this document, clinical preventive services are defined as topical fluoride application and fissure sealant(s). These shall be provided to :

    • children identified through the DIS;

    • children identified through screening in high-risk schools; and

    • children referred to the board of health who meet the eligibility criteria listed in the Ministry of Health and Long-Term Care Determining Eligibility for Preventive Oral Health Services Provided Through Ontario's Boards of Health Protocol (August 29, 1997).

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PROGRAM STANDARDS

INFECTIOUS DISEASES

Infectious diseases remain an important cause of both morbidity and death in the community. Infectious diseases represent constant new challenges to public health's role as new organisms emerge as causes of disease. Others, not previously a public health problem, develop increased virulence or antibiotic resistance and become a new burden for public health infectious disease control programs. Surveillance, case-finding, contact tracing, immunization, infection control and risk assessment all work together to assure effective control of infectious diseases by public health. Public health professionals must remain vigilant to ensure that systems are in place that are capable of controlling all infectious diseases.

he programs defined are both general and specific in nature. The Control of Infectious Diseases outlines the general requirements for all Reportable and Communicable Diseases, as well as the emergency response structures which should be in place to deal with outbreaks. Specific programs are directed at controlling the potential for infectious disease in food and water. In addition, programs are directed at specific disease control requirements for sexually transmitted diseases including AIDS, tuberculosis, rabies and vaccine preventable diseases for which there are Ministry of Health and Long-Term Care immunization programs. Infection Control defines requirements for assuring that effective infection control techniques are in place in institutions, day care centres and personal service settings.

Goal:

Infectious diseases will be reduced or eliminated.

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Control of Infectious Diseases

Goal:

To reduce the incidence of infectious diseases of public health importance.

Objective:

To reduce morbidity and mortality associated with infectious diseases.

Requirements and Standards:

1. The board of health shall provide :

   • an on-call system that ensures 24-hour availability of appropriately trained and qualified board of health staff to respond;

   • assessment of a reported incident and a first response within 24 hours;

   • written outbreak response plans which include coordination with the public health laboratory;

   • identification and appropriate response to outbreaks; and

   • an infectious disease policy and procedure manual with current relevant information on all reportable diseases under the Health Protection and Promotion Act.

2. With respect to cases of Reportable Diseases and amendments, as outlined in Ontario Regulation 559/91 and Ontario Regulation 569/90, the board of health shall :

   • receive and investigate reports, in accordance with the Health Protection and Promotion Act;

   • apply provincial case definitions to reported cases as defined in the Reportable Diseases Information System manual;

   • provide on-going monitoring, including computerized data collection and analysis and application of results; and

   • forward reports to the Ministry of Health and Long-Term Care, including weekly transmission of data through the Reportable Diseases Information System.

3. With respect to cases of Communicable Diseases, as outlined in Ontario Regulation 558/91, the board of health shall :

   • receive and investigate reports in accordance with the provisions of the Health Protection and Promotion Act;

   • apply provincial case definitions to persons reported to be infected with an agent of a Communicable Disease as outlined in the Reportable Diseases Information System manual;

   • ensure public health management of persons found to be infected with an agent of a Communicable Disease in accordance with the infectious disease policy and procedure manual of the board of health; and

   • ensure the identification and appropriate management of contacts of persons found to be infected with an agent of a Communicable Disease in accordance with the infectious disease policy and procedure manual of the board of health.

4. The board of health shall provide information regarding infectious diseases to health care professionals, institutions and the community. This information shall be provided a minimum of once per year, through written material and/or presentations.

5. The board of health shall ensure implementation of the Ministry of Health and Long-Term Care Notification of Emergency Service Workers Protocol (August 23, 1994).

6. The board of health shall provide or ensure the availability of travel health advice and immunizations for travelers.

Food Safety

Goal:

To improve the health of the population by reducing the incidence of food-borne illness.

Objectives:

1. To ensure that food is stored, prepared, served and distributed in a manner consistent with accepted public health practices.

2. To stop the sale or distribution of food that is unfit for human consumption by reason of disease, adulteration, impurity or other cause.

Requirements and Standards:

1. The board of health shall provide food safety information annually :

   • to the community, by displaying readily available printed educational material to visitors to board of health offices and by providing the information through the media;

   • to all non-profit community groups such as school nourishment programs, food banks, and community meal programs; and

   • to teachers responsible for teaching food-related subjects to students in grades 7 and 8 and/or other teachers as deemed appropriate. Board of health staff will assist if requested.

2. The board of health shall assess all food premises annually and shall determine their risk status (high, medium or low) according to the Ministry of Health and Long-Term Care Hazard Analysis Critical Control Point Protocol (January 1, 1998);

3. The board of health shall provide public health inspection of all food premises, to ensure compliance with Ontario Regulation 562 under the Health Protection and Promotion Act, according to the following schedule :

   • not less than once every four months for high-risk food premises and in accordance with the Ministry of Health and Long-Term Care Hazard Analysis Critical Control Point Protocol (January 1, 1998);

   • not less than once every six months for medium-risk food premises;

   • not less than once every 12 months for low-risk food premises; and

   • additional inspections as necessary to ensure :

     • correction of non-compliance with the Regulation,

     • investigation of food-borne illnesses and food-borne outbreaks,

     • investigation of consumer complaints, and

     • action on a food recall.

4. The board of health shall ensure that food handler training courses are provided in accordance with the Ministry of Health and Long-Term Care Food Handler Training Protocol (January 1, 1998) to food handlers in high and medium risk food premises.

5. The board of health shall undertake food recalls in accordance with the Ministry of Health and Long-Term Care Food Recall Protocol (January 1, 1998).

6. In accordance with the provisions of the Health Protection and Promotion Act, the board of health shall provide to the Minister of Health semi-annual and annual food safety data. The January 1 to June 30 semi-annual food safety report shall be sent to the Minister of Health prior to July 31 of that reporting year. The January 1 to December 31 annual food safety report shall be sent to the Minister prior to January 31 of the year following the annual report period.

7. The board of health shall have a written protocol for responding to food-related complaints, based on a risk-assessment approach, and shall take appropriate action within 24 hours of notification of the food-related complaint.

Infection Control

Goal:

To reduce transmission of infectious diseases.

Objective:

To reduce morbidity and mortality associated with infectious diseases in institutions, day care centres and personal service settings.

Requirements and Standards:

1. The board of health shall ensure appropriate input to hospital infection control programs in the health unit. This shall include as a minimum :

   • representation of the medical officer of health or designate on each hospital infection control committee;

   • reporting of designated communicable diseases from hospitals, including emergency rooms and outpatient clinics, to the medical officer of health as required under the provisions of the Health Protection and Promotion Act;

   • consultation with the hospital infection control committee on the development and revision of infection control policies and procedures and an outbreak contingency plan;

   • providing advice when requested or when needed for the appropriate management of communicable diseases and infection control;

   • providing epidemiological information as needed regarding communicable diseases existing within the community and other institutions; and

   • collaboration or assistance in annual in-service education for hospital staff about communicable diseases.

2. The board of health shall ensure that infection control programs are in place in all nursing homes and homes for the aged. Activities shall include as a minimum :

   • representation on infection control committees;

   • ensuring that all nursing homes and homes for the aged designate a registered nurse or registered medical laboratory technologist to be responsible for infection control programs in the facility, in accordance with the Long Term Care Facility Program Manual;

   • ongoing consultation about a surveillance program to include the collection, analysis and appropriate management of nosocomial infections;

   • consultation on the development and revision of infection control policies;

   • development, in collaboration with the institution, an outbreak contingency plan consistent with good public health practices;

   • informing the institution about required reporting of designated communicable diseases and outbreaks of diseases to the medical officer of health as required under the provisions of the Health Protection and Promotion Act;

   • annual promotion of influenza vaccination to staff; and

   • ensuring the provision of annual in-service education for staff on infectious diseases.

3. The board of health shall ensure an annual inspection of :

   • boarding houses and lodging houses with five or more residents;

   • migrant farm workers' housing;

   • residential facilities for the aged;

   • homes for retarded persons; and

   • homes for special care,

   to ensure the existence of safe drinking water, safe food and sanitary facilities. Additional inspections shall be conducted when the requirements in Ontario Regulation 562 are not met.

4. The board of health shall ensure that infection control programs are in place in day nurseries. Activities shall include as a minimum :

   • consultation on the development of infection control policies and procedures such as hand washing, daily observation of children, immunization, health evaluation of children and staff and communication with parents;

   • inspection of premises at least twice a year to include diaper routines and general housekeeping practices and to ensure existence of safe drinking water, safe food and sanitary facilities;

   • ensuring the creation of a written policy on the management of infectious communicable diseases, exclusion of sick children and the reporting of designated diseases to the medical officer of health as required under the provisions of the Health Protection and Promotion Act; and

   • provision of annual in-service education in basic infection control for all staff providing direct care, consistent with generally-accepted infection control standards.

5. The board of health shall ensure that infection prevention practices as defined in the Ministry of Health and Long-Term Care Infection Control in Personal Services Settings Protocol (January, 1998) are in place in settings where there is a risk of exposure to blood, such as, but not limited to, hairdresser and barber shops, tattoo and body piercing studios, electrolysis and aesthetic clinics.

Rabies Control

Goal:

To prevent the occurrence of rabies in humans.

Objective:

To maintain the incidence of rabies at zero in the human population.

Requirements and Standards:

1. The board of health shall provide rabies information on an ongoing basis, and promote the vaccination of cats and dogs against rabies to the community. These shall be done by :

   • displaying readily available printed educational material to visitors to board of health offices;

   • providing sufficient information for client display or distribution to operators of veterinary practices and humane society offices; and

   • providing the information through the media.

2. The board of health shall provide rabies information annually to each elementary school. Board of health staff will assist in the presentation if requested.

3. The board of health shall have a written protocol for the investigation of exposures in accordance with Ontario Regulation 557 (Communicable Diseases - General) under the Health Protection and Promotion Act within 24 hours of notification where there is a potential for rabies transmission.

4. The board of health shall ensure that animals which are confined in accordance with Ontario Regulation 557 (Communicable Diseases - General) under the Health Protection and Promotion Act are visually inspected by qualified board of health staff or a veterinarian after notification and at the end of the isolation period. Further, that the person having care or custody of the animal is provided rabies information and advised regarding how to contact a board of health rabies investigator should the isolated animal become ill during the isolation period.

5. The board of health shall ensure access to post-exposure anti-rabies treatment in the event of human exposure to rabies.

6. The board of health shall keep themselves informed about local rabies prevalence in animal species.

7. The board of health shall develop and maintain a Raccoon Rabies Contingency Plan and provide a copy to the Minister of Health when requested.

8. The board of health of a health unit named in Ontario Regulation 567 (Rabies - Immunization) under the Health Protection and Promotion Act, shall :

   • provide rabies information to the public promoting compulsory rabies vaccination of cats and dogs; and

   • report to the Minister on its promotion activities annually.

Safe Water

Goal:

To reduce the incidence of water-borne illness in the population.

Objectives:

1. To ensure that community drinking water systems meet the health-related chemical, physical, microbiological and radionuclide objectives as published in the Ontario Drinking Water Objectives (revised 1994) and the Guidelines for Canadian Drinking Water Quality (sixth edition).

2. To reduce communicable disease transmission from waters used for bathing at public beaches.

Requirements and Standards:

1. For all drinking water systems that fall under the jurisdiction of the Ontario Water Resources Act, the board of health shall :

   • maintain an ongoing list of all drinking water systems;

   • receive all reports of adverse drinking water test results from the drinking water systems listed in 1a. above;

   • have a written protocol for dealing with adverse drinking water test results from the drinking water systems listed in 1a. above; and

   • act immediately in accordance with the Ontario Drinking Water Objectives (revised 1994) to protect the health of the public whenever an adverse drinking water test result is received.

2. With respect to owner/occupier inquiries of private water systems, the board of health shall :

   • interpret water analysis reports;

   • provide information regarding the potential health effects; and

   • provide information about the health-related parameters as published in the Ontario Drinking Water Objectives (revised 1994).

3. The board of health shall inspect bathing beaches, including the taking of water quality samples for testing at a minimum of one sample per week from each sample site and a minimum of five sample sites per beach. The inspections shall begin prior to and continue over the entire bathing season, in accordance with the requirements of the Ministry of Health and Long-Term Care Beach Management Protocol (January 1, 1998).

Sexually Transmitted Diseases (STDs) Including HIV / AIDS

Goal:

To reduce the incidence of and complications from all sexually transmitted diseases (STDs) including HIV / AIDS.

Objectives:

1. To reduce the incidence rate of gonorrhea to 15 per 100,000 population by the year 2005.

2. To reduce the incidence rate of genital chlamydia to 500 per 100,000 women ages 15-24 years by the year 2005.

3. To maintain the incidence rate of primary and secondary syphilis at less than one per 100,000 population by the year 2005.

4. To maintain the incidence of congenitally acquired syphilis at zero.

5. To reduce the number of newly diagnosed human immunodeficiency virus (HIV) infections to less than 800 per year by the year 2005.

6. To reduce the incidence of perinatal HIV infection.

Requirements and Standards:

1. The board of health shall provide clinical services, at a minimum of four hours per week per 150,000 or less population, and such additional services as are required to meet local needs. These clinical services shall include as a minimum :

   • provision of diagnosis, treatment and management of STDs including HIV testing;

   • provision of hepatitis B vaccine at no cost according to Ministry eligibility criteria; and

   • provision of individual counselling and referral to other agencies as necessary.

2. The board of health shall provide or ensure the provision of appropriate case management. This shall be accomplished, at a minimum, through :

   • distribution of procedures and protocols for the management and treatment of cases that are consistent with the Ministry of Health and Long-Term Care STD Control Protocol (December, 1997);

   • ensuring that STD patients are managed and treated according to the Ministry of Health and Long-Term Care STD Control Protocol (December, 1997);

   • identification of contacts and partner notification and referral according to the Ministry of Health and Long-Term Care STD Control Protocol (December, 1997);

   • provision of provincially approved drugs as required at no cost to the client, according to the Ministry of Health and Long-Term Care STD Control Protocol (December, 1997); and

   • provision of condoms.

3. The board of health shall ensure the provision of a liaison and referral system for individuals with HIV infections, their families and support network to access medical care and/or social agencies.

4. The board of health, in conjunction with community partners, shall ensure the provision of health promotion activities, including the provision of condoms, aimed at preventing STDs, including HIV/AIDS. The activities shall, as a priority, be targeted at the following groups :

   • school-aged children in grades 7-9 as a minimum. The board of health shall assist the person or organization that operates the school to ensure the provision of three hours annually of education about AIDS and about other STDs to students. In schools where this education is not provided, the board of health will report this to the Ministry of Health and Long-Term Care and an equivalent strategy targeted to school-aged children shall be delivered through other community settings;

   • those in post-secondary education, workplace settings and parent groups;

   • people engaging in high-risk behaviours; and

   • health care workers, in order that they be effective in case finding and management.

5. The board of health shall ensure that injection drug users can have access to sterile injection equipment by the provision of needle and syringe exchange programs as a harm reduction strategy to prevent transmission of HIV, hepatitis B, hepatitis C and other blood-borne infections and associated diseases in areas where drug use is recognized as a problem in the community. The strategy shall also include counselling and education and referral to primary health services and addiction/treatment services. The board of health shall produce an annual report of program activities and forward a copy to the Minister of Health.

6. The board of health shall provide consultation and assist in the development of policies related to sexual health, STDs and HIV/AIDS, when requested by local agencies.

Tuberculosis (TB) Control

Goal:

To reduce the incidence of tuberculosis (TB).

Objectives:

1. To reduce the annual incidence rate of active and reactivated TB to 3.5 per 100,000 population by the year 2005.

2. To reduce the progression of latent TB infection to active TB.

3. To reduce secondary drug-resistance by the year 2005.

4. To achieve the following completion rates by the year 2005 :

   • 95 per cent of active TB cases will complete treatment as prescribed;

   • 90 per cent of individuals on chemoprophylaxis will complete therapy; and

   • 90 per cent of contacts of active cases of TB will be assessed.

Requirements and Standards:

1. The board of health shall have in place an effective program for TB control for persons with active tuberculosis which shall include case finding, case holding, treatment, and follow-up, and be consistent with the Ministry of Health and Long-Term Care Tuberculosis Control Protocol (January, 1998).

   Such programs will, at a minimum :

   • ensure that all cases/suspected cases are fully investigated according to the Ministry of Health and Long-Term Care Tuberculosis Control Protocol (January, 1998);

   • ensure the provision of provincially-approved anti-tuberculosis drugs as required, at no cost to the client;

   • review drug regimens and sensitivity results for each case to ensure their appropriateness and adequacy;

   • monitor patient adherence with prescribed drug regimens, including the completion and outcome of therapy, according to the Ministry of Health and Long-Term Care Tuberculosis Control Protocol (January, 1998);

   • ensure that all persons with active tuberculosis complete the prescribed course of chemotherapy through the provision of Directly Observed Therapy (DOT) or another appropriate intervention according to the Ministry of Health and Long-Term Care Tuberculosis Control Protocol (January, 1998);

   • notify the Ministry of Health and Long-Term Care immediately in the event of non-completion of the above therapy;

   • provide, or ensure the provision of, annual updates to physicians and other health professionals in the form of written materials and/or presentations on signs and symptoms, risk factors and reporting requirements to achieve the early identification and early reporting of active cases; and

   • provide to the community on an ongoing basis, in collaboration with community organizations and local agencies and institutions, written materials and educational sessions on the signs and symptoms, epidemiology, risk factors and the benefit of treatment to promote the early identification and treatment of persons with active tuberculosis.

2. The board of health shall have in place an effective program for TB prevention, consistent with the Ministry of Health and Long-Term Care Tuberculosis Control Protocol (January, 1998). Such a program will, at a minimum :

   • trace and investigate contacts of cases according to the Ministry of Health and Long-Term Care Tuberculosis Control Protocol (January, 1998);

   • trace and monitor individuals placed on medical surveillance for inactive tuberculosis according to the Ministry of Health and Long-Term Care Tuberculosis Control Protocol (January, 1998);

   • promote through education and selective group screening programs, the screening of all persons in high-risk groups and assessment of those testing positive to rule out active tuberculosis;

   • recommend the prescribing of anti-tuberculosis chemoprophylaxis to those testing positive, unless medically contraindicated;

   • ensure the provision of provincially-approved anti-tuberculosis chemoprophylaxis drugs at no cost to the client;

   • review the required drug regimens for each person on chemoprophylaxis to ensure their adequacy and appropriateness;

   • monitor patient adherence to prescribed drug regimens and completion of therapy according to the Ministry of Health and Long-Term Care Tuberculosis Control Protocol (January, 1998);

   • monitor the completion rate of the prescribed course of chemoprophylaxis for the purpose of achieving the above-stated objectives;

   • provide, or ensure the provision of, annual updates in the form of presentations and/or written materials to health professionals on risk factors for tuberculosis infection, administration and interpretation of skin tests, indications for and benefits of chemoprophylaxis and reporting of positive skin test results; and

   • provide to the community on an ongoing basis, in collaboration with community organizations and local agencies and institutions, written materials and educational sessions regarding risk factors for tuberculosis infection and benefits of chemoprophylaxis.

Vaccine Preventable Diseases

Goal:

To reduce the incidence of vaccine preventable diseases.

Objectives:

1. To eliminate indigenous measles by the year 2000.

2. To maintain at zero the incidence of tetanus and diphtheria and indigenous polio.

3. To reduce to zero the incidence of invasive Haemophilus influenzae type b (Hib) among children under five years of age.

4. To reduce to zero the incidence of indigenous congenital rubella.

5. To reduce the annual incidence rate of mumps to 1.0 per 100,000 and pertussis to 2.5 per 100,000 population by the year 2005.

6. To reduce the annual incidence rate of acute hepatitis B to 1.5 per 100,000 population by the year 2000.

7. To reduce the age-adjusted mortality rate for pneumonia and influenza (using a five-year moving average).

8. To achieve the following vaccine coverage targets by the year 2000 :

   • 95 per cent coverage for up-to-date vaccination against diphtheria, pertussis, polio, tetanus, Haemophilus influenzae type b (Hib), measles, mumps and rubella by the second birthday;

   • 95 per cent coverage for up-to-date vaccination against diphtheria, pertussis, polio, tetanus, and measles, mumps, rubella and second dose measles by the seventh birthday;

   • 95 per cent coverage for hepatitis B vaccination by the end of grade 7;

   • 100 per cent coverage for hepatitis B vaccination of infants born to mothers who are hepatitis B carriers;

   • 95 per cent coverage for pneumococcal and annual influenza vaccination of residents of long term care facilities;

   • 70 per cent coverage for pneumococcal and annual influenza vaccination for persons age 65 years and older and persons with high-risk conditions; and

   • 70 per cent coverage for annual influenza vaccination of health care workers in contact with high-risk individuals.

9. To minimize wastage of provincially-funded vaccines to five per cent or less.

10. To monitor adverse events associated with provincially-funded vaccines.

Requirements and Standards:

1. The board of health shall ensure that any eligible person residing in the health unit has access to immunization for the administration of provincially-funded vaccine. If immunization services are not otherwise available, the board of health shall provide immunization clinics.

2. The board of health, annually, shall assess and maintain records of the immunization status of children in all licenced child care programs as defined in the Day Nurseries Act and ensure that all those enrolled are immunized against: diphtheria, pertussis, tetanus, polio, measles, mumps, rubella and Haemophilus influenzae type b, unless exempted by the medical officer of health. The board of health shall report on the immunization status of such children weekly and annually to the Ministry of Health and Long-Term Care.

3. The board of health, annually, shall assess and maintain records of the immunization status of children attending all schools in accordance with the Immunization of School Pupils Act. The board of health shall report on the immunization status of such children weekly and annually to the Ministry of Health and Long-Term Care.

4. The board of health shall promote the use of and provide or ensure the provision of hepatitis B vaccine to eligible school-aged children and to high-risk groups as identified by the Ministry of Health and Long-Term Care.

5. The board of health shall promote immunization for children and adults through :

   • education (such as individual counselling, presentations and/or written materials) targeted at the community and individuals, health care providers, settings for high-risk individuals, educational facilities and institutions; and

   • policy and procedure development in institutions and to health care providers.

6. The board of health shall promote by at least one campaign, annually (in the form of individual counselling, presentations and written materials) pneumococcal and influenza vaccination to high-risk persons and seniors in senior citizens' buildings, retirement and rest homes, specialty health care clinics and other appropriate settings in the community, and to all eligible residents and staff in all nursing homes, homes for the aged and chronic care hospitals or units.

7. The board of health shall ensure the availability of influenza and pneumococcal vaccine in all nursing homes, homes for the aged and chronic care hospitals or units for vaccination of all eligible residents and staff.

8. The board of health shall ensure that provincially-funded vaccines are available to physicians practicing within the health unit. The board of health shall optimize vaccine use by :

   • education (such as individual counselling in cases of suspected vaccine mishandling, presentations and /or written materials) of health care providers in procedures for proper vaccine usage, storage and handling in accordance with the Ministry of Health and Long-Term Care Vaccine Storage and Handling Protocol (January 1, 1998);

   • ensuring cold chain maintenance in premises where vaccine is stored by inspecting at least once annually, all such premises for adherence to the minimum requirements according to the Ministry of Health and Long-Term Care Vaccine Storage and Handling Protocol (January 1, 1998) and shall report annually the results of such inspections;

   • investigating all cases of suspected vaccine wastage due to mishandling in accordance with the Ministry of Health and Long-Term Care Vaccine Storage and Handling Protocol (January 1, 1998). A report of these inspections shall be submitted to the Ministry of Health and Long-Term Care annually, and all instances of vaccine wastage occurring in health facilities located in the health unit shall be reported to the Ministry of Health and Long-Term Care within 48 hours; and

   • meeting data requirements for the Ministry of Health and Long-Term Care Bioinventory System Protocol (January 1, 1998).

9. The board of health shall investigate all reported cases of adverse vaccine events to gather the epidemiologic information required for appropriate management and for case reporting to the Ministry of Health and Long-Term Care in accordance with the Reportable Diseases Information System.

10. The board of health shall enter routine immunization records into the Immunization Record Information System and shall analyze local vaccine coverage rates and report to the Ministry of Health and Long-Term Care at least annually to identify emerging trends and high-risk populations.

Government of Ontario