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Annual Report for 2016

Message from Dr. Miriam Klassen, Medical Officer of Health

I am pleased to share the 2016 Annual Report for the Perth District Health Unit (PDHU).

2016 marked the 50th anniversary for our health unit, and it was an opportunity to reflect on the achievements of the last half-century, while we also continue our focus on future directions. Public health work is ever evolving to meet the challenges of current public health issues.

For example, climate change is now recognized as a global issue that is impacting public health at the local level.  PDHU activities that prepare for and respond to climate change include the Extreme Heat Warning system (aiming to help residents and visitors protect themselves against extreme heat) and Emergency Response Plans (which include severe weather events).

The social determinants of health provide another example of increased priority across the healthcare and public health sectors. Accordingly, PDHU programs and services are planned while considering the health impacts of social factors such as income, education and culture. For example, Healthy Smiles Ontario ensures that all children have access to dental services including preventive care, regardless of income, and our Healthy Babies Healthy Children team provides family support that is mindful of culture and language.

I invite you to read the full report and see the many ways, old and new, that PDHU is working to create opportunities for the best health for all.

Thank you to the Board of Health and to all staff for your ongoing dedication to the people of this community.


Miriam Klassen,

Medical Officer of Health


Message from Teresa Barresi, Board of Health Chair

I am pleased to share with you the Perth District Health Unit’s 2016 Annual Report. The report provides some important highlights of this past year, outlining the health unit’s efforts to protect and improve the health and well-being of Perth County. Public health plays a role to promote health by educating the public on healthy lifestyles, and by advocating for public policy that promotes a healthy population. Public health also protects health by doing regulatory inspections to control infectious diseases, and reduce exposure to environmental hazards. Finally, public health works to prevent disease and injury by conducting surveillance of outbreaks, providing immunizations, and performing research on injury prevention and other risks to the public’s health. The Perth District Health Unit has many things to offer to help support healthy living. Make them a partner in your health!

Check out their website

On behalf of the Board of Health, I wish to congratulate the Perth District Health Unit on achieving 50 years of providing excellence in the delivery of public health programs and services to all the communities of Perth County. As a Board we look forward to working with the dedicated staff, over this next year to continue to support all your efforts to build healthy communities.

Kind Regards,

Teresa Barresi

Provincial Appointee/Board of Health Chair



The mission of the Perth District Health Unit (PDHU) is to work in partnership with our community to foster conditions in which people can be healthy. We promote health, protect health, and prevent disease by providing community health programs and services for all the people of Perth County.

Health For All

PDHU has a commitment to diversity and inclusiveness and ensuring equitable access to information and services for everyone who lives in Perth County.


PDHU is governed by an autonomous Board of Health, which is made up of six elected municipal representatives and three provincial representatives.  A Management Team of 11 (see page 2), which includes the Medical Officer of Health and a three-person Executive Committee, oversees public health services and provides direction to more than 100 full and part-time staff members.

PDHU is guided by our mission and values and our Strategic Plan. We use a Balanced Score Card approach based on the Strategic Plan to measure the effectiveness of our programs and services. Our program mandate is described in the Ontario Public Health Standards (2008). Organizational and governance standards for the agency are detailed in the Ontario Public Health Organizational Standards.

As part of the funding agreement with the Ministry of Health and Long Term Care, the Board measures and reports its performance on a variety of indicators and also strives to meet several Accountability Agreements with the Ministry. A complete list is available at


Board of Health Chair Receives Award

On May 17, 2016, the Huron Perth Health Human Resources Committee presented the 7th Healthcare Inspiration Event. Our very own Board of Health Chair Teresa Barresi was honoured for exemplary quality of service and inspiration through innovation, collaboration and cooperation in the “Quality in Service” category. Congratulations Teresa!


PDHU Celebrates 50 Years

The Health Unit has been promoting health, protecting health and preventing disease in Perth County since 1966.  We celebrated our 50th Anniversary in 2016 and there were events and activities to highlight our history, honour our staff, celebrate community partners and mark this significant event.

Highlighting our History:

We went back in time and searched the archives to highlight and display some of the public health issues since 1966. Three displays illustrated how over the years our partnerships, staff, Board of Health, the community in general, communications and volunteers have contributed to the health of Perth County. Vaccinations, harm reduction activities, vector-borne disease monitoring, public health inspections, and sexual health clinics have significantly reduced or eradicated disease, reduced absenteeism in workplaces, and created safe drinking water and food premises. Since 1965, the number of Ontarians using tobacco products has decreased from 50% to 20%. We are now able to live in a smoke free environment. Over the years, expectant women have received prenatal education, families with new babies have received home visiting and support for breastfeeding. Sun safety, injury prevention, healthy eating, and heart health are more recent efforts to reduce the burden of disease and injury. Clinical services are available to increase health equity and include dental and sexual health, and primary health care for Amish, Mennonite and Low German Speaking families. All services have evolved in response to the needs of the community.

Honouring Our Staff:

June 16th was the PDHU Staff Conference filled with special activities to honour those who are still making history. The staff at PDHU came together for music, food and to celebrate who we are and what we do. A live Celtic Folk band performed as a video depicted health unit staff and events over the years. Dr. Tamblyn, who was the Medical Officer of Health (1974-2004), shared the many accomplishments over the 50 years and noted that the Avonton Women’s Institute lobbied County Council to form a county health unit. In 1966 there were 19 staff. Fifty years later there are 105 staff including  the Medical Officer of Health, inspectors, nurses, home visitors, promoters, dental hygienists, dietitians, tobacco enforcement officers, youth peer leaders, administrative assistants, an epidemiologist, a communications team and IT staff.

Celebrating Community Partners:

Sunday, June 26th was a beautiful day. Present and past staff, community partners, board of health members, dignitaries, families and friends came together to enjoy an afternoon of festivities. Kids played in the bouncy castle, used sidewalk chalk, jumped rope and ate watermelon. Others participated in a scavenger hunt to identify five relevant facts from the archives. Music, food, greetings from community leaders and lots of fun marked the 50 years and acknowledged not only the work of the health unit, but the importance of all those in our community.

Marking History:

We opened a Time Capsule from 1991 that provided greetings and highlights from staff of 25 years ago. As such, we have placed a new Time Capsule in the vault to be opened in 2041. The Capsule marks significant events and public health projects of 2016. It also includes a photograph of all members of the present staff and a few comments about their hopes for 2041. A large, local rock with the 50th anniversary logo has been placed in the front garden of our main office to commemorate this achievement.


Community Health Department Highlights:

Oral Health News

In January 2016 the new Healthy Smiles Ontario (HSO) program was officially launched. The new program integrates six children’s dental programs including Children in Need of Treatment (CINOT), CINOT Expansion and Healthy Smiles Ontario previously administered by the Health Unit. ACCERTA, a new third party provider began paying claims for dental services provided to eligible children and youth. Navigation of the new program kept our Oral Health Team busy, as clients were transitioned to the new system.

When it comes to the Oral Health Status of adults, there is no provincially funded program to support those in need of preventive or emergency treatment. In 2016, we examined the oral health status of Perth County residents aged 12 and older, over a 10-year period. The report was intended to identify health inequalities and community needs to direct the planning and implementation of local programs and services.

A summary of the results indicated:

  •  The percentage of Perth County residents who brushed their teeth at least twice daily was lower than their Ontario counterparts.
  •  A lower percentage of Perth County males visited a dentist and had access to insurance compared to Ontario males.
  •  Significant inequalities are experienced by Perth County’s older adults, lower income earners, and residents with less than high school education. These groups struggle to access dental care and bear a disproportionate burden of dental disease.

Work is continuing in this area as we advocate for increased access to dental services for adults.


Sunscreen Pilot Project Received Award

A sunscreen dispenser pilot project was chosen by the Canadian Dermatology Association to receive a Public Education Award in the not for profit category. Funding for the project was provided by the Stratford Leisure Activity Council. Twelve dispensers were strategically placed at community sites with high foot traffic throughout Stratford to provide free and easily accessible sunscreen. The novel project garnered excellent media attention and residents and visitors utilized 27 litres of sunscreen from June 1 to September 10.


Rethink Your Drinking

A campaign created by the nine Southwest public health units to increase awareness of Canada’s Low-Risk Alcohol Drinking Guidelines garnered provincial attention in 2016. As a result, 29 of 36 public health units across Ontario joined together to promote the “Size Matters” message about standard drink sizes and moderate alcohol consumption. PDHU was a leader in this project and worked collaboratively with partners to create new campaign websites, translate the campaign into French, and spread the message at the local, regional and provincial level. To learn more about the campaign, visit


Reducing Tobacco Use Among Youth

On January 1, 2016 Ontario’s new policy measures to ban flavoured tobacco products, increase fines for tobacco sales to youth, and establish the minimum age of 19 years for the sale or supply of e-cigarettes came into effect.

One hundred per cent of eligible tobacco vendors received two rounds of the required test shopping with the mid-year compliance rate of 100% (55/55 vendors) and 94% (49/52) at year end.

Healthy Babies Healthy Children

  • 751 live births.
  • 44 (11%) of the 406 expectant families screened, participated in HBHC home visiting program.
  • PDHU received HBHC screens for 95% of the 751 postpartum families and successfully contacted 503 families for further follow-up.
  • 113 (79%) postpartum families were further assessed with 33% confirmed to experience risk factors.
  • 34 families with a new baby participated in the home visiting program.
  • 38 families with preschool children also sought support for parenting, growth/development, nutrition and other concerns.
  • 116 families benefited from the blended home visiting program.

Health Protection Department Highlights:

Extreme Heat Warning System for Perth County

The Health Unit started issuing expected heat event warnings in the summer to prevent heat-related illnesses based on the following criteria:

Heat Warnings are issued when one or more of the following criteria are met:

  •  Environment Canada issues a forecast calling for a daytime high of 31°C or higher with a minimum daytime low of 20°C or higher for two consecutive days; or
  •  Environment Canada issues a forecast calling for a Humidex of 40 or higher for two consecutive days.

Extended Heat Warnings are issued when one or more of these criteria are met:

  • Environment Canada issues a forecast calling for a daytime high of 31°C or higher with a minimum daytime low of 20°C or higher for three consecutive days or longer; or
  • Environment Canada issues a forecast calling for a Humidex of 40 or higher for three consecutive days or longer.

A total of five heat event warnings were issued between July 11 and September 6.


Preparing for Emergencies

Every year the Health Unit reminds residents that it’s important to be prepared. Past events like ice storms, flooding and severe weather are reminders that emergencies can strike at any time. Preparing for emergency situations will help lessen the impact and stress these events have. Our message for 2016 was “Are you prepared?” and residents were encouraged to consider how they would manage in an extended power outage, or if there was a flood in their home, or damage to their house and property from a severe storm. In addition, a mock exercise that originally began in 2015 was concluded. It involved a case of Hepatitis A in a fictitious popular Stratford restaurant and brought together the Health Unit’s Emergency Control Group. Case/Contact Management training was completed and staff were given the opportunity to practice their skills.


Infection Prevention and Control

PDHU highly values Infection Prevention and Control (IPAC). In 2016 our internal IPAC program underwent improvements and a peer to peer audit model was adopted. This model supports our ongoing commitment to Continuous Quality Improvement and Quality Assurance. Audits of our Health Connections and travel immunization clinics were completed and one for our dental clinic began. They looked at things like hand hygiene, sharps (needle) safety, and the disinfection of equipment, and identified ways that IPAC could be improved.

Also, new requirements in the Ontario Public Health Standards related to public reporting of IPAC lapses in the following settings were implemented:

  •  personal services settings (spas, hair salons, tattoo parlours, etc.);
  •  settings not routinely inspected by the Health Unit; and
  •  settings in which the lapse is linked to the conduct of a regulated health professional.

Public Health Units are now required to publicly disclose any IPAC lapses which the Medical Officer of Health (MOH) becomes aware of through:

  •  a complaint,
  •  communicable disease surveillance, or
  •  a referral from a regulatory college, another MOH or the Ministry of Health and Long-Term Care.

There were no IPAC lapses to disclose in 2016.


Flu Shot Season (2015/2016)

For the fourth year in a row, pharmacies were given the opportunity to provide influenza vaccine to Perth County residents. A total of 19 pharmacies participated during the 2015/16 season (10 in Stratford, three in St. Marys, three in Listowel, two in Mitchell and one in Milverton). The pharmacists were available during business hours to provide immunizations to adults and children over the age of 5.

A total of five community clinics and two by-appointment clinics were hosted by the Health Unit. Local statistics show that there has been a decrease in the number of flu shots given at Health Unit-run clinics. This corresponds with the number of people receiving their flu shots through Perth County pharmacies (which has been rising annually since 2012, when pharmacists began to immunize). It is expected that this trend will continue as people become more familiar with pharmacist-provided clinics, and recognize the flexibility offered in the clinic hours and locations throughout the county.


Vaccine Preventable Disease Activities

During the 2016-17 school year, the human papillomavirus (HPV) immunization program expanded to include boys in Grade 7, who are now eligible to receive the vaccine free of charge through school-based clinics.

At school clinics in the 2015/16 school year:

  • 90% of eligible grade 7 students received meningococcal vaccine
  • 81% of eligible grade 7 students received hepatitis B vaccine
  • 64% of eligible grade 8 females received HPV vaccine

Immunization Records Review

Each spring, the immunization team ensures that we have up-to-date records for students in Perth County. If students’ immunization records are not current, they can be suspended from school. In 2016, the team reviewed 12,731 records and 208 suspension notices were issued, with 18 students being suspended from school on May 17, 2016 (significantly less than the 66 that were suspended in 2015).


Public Health On-Call

Under the Ontario Public Health Standards, the Health Unit must have a 24 hour, seven days a week on-call system. All Public Health Inspectors and the Communicable Disease Team Public Health Nurses participated in this service. There were 145 calls, up from 109 in 2015, completed after hours. It took 172 hours to complete these calls. The majority of the calls were related to communicable diseases (41.4%), rabies (33.1%), water (9.0%) and other (7.6%). Dr. Klassen is always available, for consultation and direction, to the on-call staff.



A recent examination of trends in Perth County potential rabies exposures was completed in 2016. Suspect rabies investigation reports (which are completed by a Public Health Inspector), from 2010-2015 were analyzed. The findings showed that:

The majority of incidences (when looking at the rate per 100,000) involve:

  • children aged 0-4
  • domestic dogs (the majority of the dogs were unfamiliar to the victim and unprovoked)

The majority of the dogs involved were vaccinated for rabies, although this rate has been decreasing steadily since 2010. The Health Unit encourages all cat and dog owners to keep their animal’s rabies vaccinations up to date; particularly in light of recent animal rabies in the area and the ongoing raccoon rabies outbreak in the Hamilton area.

The percent of suspected rabies exposures reported with investigation initiated within one day of public health unit notification, was 94% (out of a 97.5% target).


PDHU Activities across Perth County

  • Listowel, St Marys: Suicide prevention program called iMatter was implemented with all grade 9 students at the two high schools.
  • Milverton: 294 clients screened and treated at PDHU dental clinic
  • Stratford: 476 drop-in harm reduction client visits (with 78,072 needles and 119 safer inhalation kits distributed) to our Festival Square office
  • Listowel, Stratford: Prenatal classes offered: 5 weekend series in Listowel; 5 weeknight series and 14 Saturday classes in Stratford
  • Stratford: Seven series of Loving Spoonfuls (a free cooking program for women of all ages after pregnancy) held in partnership with the Local Community Food Centre and the Ontario Early Years Centre
  • Stratford, Listowel: Nurse Connect outreach for parents of children ages 0-6 at House of Blessing, Salvation Army and Crossing Bridges
  • Newton, Milverton, Listowel (just outside): Seven parochial schools (approximately 260 scholars) tracked their steps using pedometers and in most cases, surpassed the daily step goals.
  • Stratford, St Marys: 182 clients received quit smoking support; this includes a partnership with STAR and Happy Valley Family Health Teams
  • Stratford: A senior’s fall prevention pilot project was launched in partnership with OneCare
  • Stratford: 14 food safety courses conducted. 275 certificates were issued
  • Wildwood, Galbraith Camp, Hidden Acres Camp, St. Marys Quarry, Woodland Lake: 5 beaches monitored for bacteriological safety of the water
  • Ellice Ward: cow and skunk tested positive for rabies
  • Stratford: Infection Prevention and Control workshop held for staff of retirement and long-term care homes on October 12 at River Gardens
  • Listowel, Mitchell, Stratford, St. Marys: Mosquito traps hung from May to August to monitor for West Nile virus
  • Milverton, Listowel, Hesson, Millbank: 1529 visits to Mother and Young Child Clinics, which focus on mothers with young children, prenatal and postpartum among the Anabaptist cultural communities
  • Schools across Perth (Avon Public, Jeanne Sauvé, St. Ambrose, Stratford Central, St. Joseph’s, Downie Central, St. Marys DCVI, Little Falls, Sprucedale, St. Patrick’s (Kinkora), Listowel Central): Teen Esteem and Elements volunteer programs offered for girls and boys in grades 7 and 8
  • Blanshard, Downie, Ellice, Elma, Fullarton, Hibbert, Mornington, North East Hope, South East Hope, and Wallace: 21 inspections and reassessments of Small Drinking Water Systems conducted
  • Stratford, Listowel, St Marys, Mitchell: 2169 visits to our sexual health clinics
  • Stratford: 2930 contacts made with Public Health Nurses on Health Line