CIPHI Conference, October 2017Paul Callanan & Monali Varia

Peel Public Health

Region of Peel

Are we making a difference?A local health unit approach to improving health outcomes

Objectives

• To describe Peel Public Health’s strategic priority, End-to-End Public Health Practice - an approach to identifying and addressing public health problems

• To demonstrate how an ‘End-to-End’ approach is being applied using the example of foodborne illness in Peel

• To provide participants an opportunity to ask questions and share their approaches to complex public health problems

What are the top health issues

facing the Peel population?

Is our work improving the

health of people in Peel?

End-to-End

Public Health Practice

(E2EPHP)= Effective Public Health

Practice

6

OPHS and Public Health Transformation

What are we trying to achieve through

E2EPHP?

1. Strong understanding of health outcomes among Peel

residents

2. Deliberate action where we have a public health mandate,

and where there is an effective intervention

3. Activities/interventions that drive towards health outcomes

End–to–end public health practice

9

Mandate Effective intervention

Health outcome/issue

Current practice questions

• What interventions should a local health unit be implementing to prevent foodborne illness?

• Where can Peel Public Health have the greatest impact in reducing the negative health effects of poor air quality?

• What range of actions will reduce the exposure to second-hand smoke in Peel?

• 2016 hepatitis A outbreak

• 2 Peel cases

• Linked to frozen food: 4 berries sourced from 4 different countries

• Local actions: case management, enforcement of food recall and post-exposure prophylaxis

Is there an upstream local role in preventing

or reducing foodborne illness?

What are we trying to achieve through

E2EPHP?

1. Strong understanding of health outcomes among Peel

residents

2. Deliberate action where we have a public health mandate,

and where there is an effective intervention

3. Activities/interventions that drive towards health outcomes

13

Defining the problem

What we knew

• Incidence of

reportable diseases

– Peel has a high

proportion of illness

associated with travel

• Outcomes of food

premises inspections

0

5

10

15

20

25

30

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Non-typhoidal Salmonellosis

0

5

10

15

20

25

30

35

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Age-

Stan

dard

iuze

d In

ciden

ce R

ate

(cas

es p

er 10

0,00

0 po

pula

tion)

Campylobacteriosis

Peel

Ontario

0

2

4

6

8

10

12

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Age-

Stan

dard

ized

Incid

ence

Rat

e

(cas

es p

er 10

0,00

0 po

pula

tion)

Amebiasis

0

1

2

3

4

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Typhoid Fever

The new Ontario Public Health Standards

Goal: To prevent or reduce the burden of foodborne illness (FBI)

Board of health outcomes- Mitigate FBI risks

- Use epidemiology to influence development of policy and programs to reduce FBI

- Food handlers/premises manage food in safe, sanitary manner

- Community partners and public are aware of safe food handling practices and food safety issues

Team Activities

Program Outputs

Program Outcomes

Health outcomesReduced foodborne illness

(and associated sequelae)

Inspections, enforcement and

education tactics with food

premises

Food premises in compliance

Reduced exposure of Peel

residents to foodborne illness

pathogens

Foodborne illness & associated

sequelaeEvidence-informed approaches/activities

• Legislation and regulation

• Restaurant inspections

• Case/contact management

• Food handler training

• Consumer education

• …Interv'n 1 Interv'n 2 Interv'n 3 Interv'n 4

17

Defining the problem

What we knew

• Incidence of reportable

diseases

• Outcomes of food premises

inspections

What we didn’t know

• The true burden of foodborne illness in Peel

• Incidence

• Severity

• Economic burden

• How much illness is associated with a food premises vs home prep

• What are the risk factors for foodborne illness in Peel

• From 2007-2016, there were ~939 lab-confirmed cases annually in Peel associated with 14 pathogens. 523 domestically-acquired.

• Using modelled estimates, there are over 150,000 annual cases in Peel per year of which 52,000 are foodborne (range 36,000-69,000)

Sources:

integrated Public Health Information System (iPHIS) 2007-2016, Ministry of Health and Long-Term Care.

Thomas, M. K., et al. (2015). Estimates of foodborne illness-related hospitalizations and deaths in Canada for 30 specified pathogens

and unspecified agents. Foodborne Pathogens and Disease, 12(10), 820-827. doi: 10.1089/fpd.2015.1966.

Source:

Butler A.J., et al. (2015). Expert elicitation as a means to attribute 28 enteric pathogens to foodborne, waterborne, animal contact,

and person-to-person transmission routes in Canada. Foodborne Pathogens and Disease, 12(4), 335-344. doi: 10.1089/fpd.2014.1856.

Pathogen Foodborne

% (90% CI)

Waterborne

% (90% CI)

Animal Contact

% (90% CI)

Person-to-Person

% (90% CI)

Other

% (90% CI)

Campylobacter spp. 62.3 (33.0-81.0) 9.3 (2.3-28.1) 15.9 (3.5-42.8) 7.7 (1.1-27.9) 4.8 (0.4-26.6)

Hepatitis A virus 29.5 (4.8-71.9) 6.2 (0.5-26.6) 4.4 (0.1-26.1) 50.3 (12.6-75.9) 9.6 (0.8-31.9)

Salmonella spp., 62.9 (31.7-79.6) 8.0 (0.6-35.0) 12.7 (3.0-37.9) 10.0 (1.7-36.0) 6.4 (0.5-34.6)

Shigella spp. 25.9 (8.6-50.9) 12.2 (1.0-39.0) 4.1 (0.0-24.9) 52.4 (22.2-74.0) 5.5 (0.4-24.7)

VTEC 61.4 (38.5-79.8) 13.3 (3.0-32.1) 9.6 (3.6-17.5) 13.2 (3.0-32.3) 2.5 (0.2-8.3)

• In 2016, 64% of domestically-acquired campylobacteriosis and non-typhoidalsalmonellosis cases did not report eating at a food premise during their incubation period.

• Between 2007-2016, ~60% of community enteric outbreaks in Peel occurred in settings that receive inspections

Next steps

• Food premises are a risk setting for Peel

– Identify performance measures that quantify true risk in Peel food premises; CQI in food premises inspections

• Surveillance data gaps were identified

– Enhance data standards and collection of data through case/contact management

• Evaluate and modify approach to case and contact management based on mode of pathogen transmission

• Enhance health promotion regarding home food preparation

Ongoing E2EPH practice journey

• Understanding impact of cultural food practices on food

safety

• Interventions to address travel-related illness

• Understanding the relative contribution of interventions

(e.g., enforcement, education) to reducing foodborne

illness in Peel region

Workforce Development

• Change management

• Knowledge translation of report data to staff

Practice questions

• What interventions should a local health unit be implementing to prevent foodborne illness?

• Where can Peel Public Health have the greatest impact in reducing the negative health effects of poor air quality?

• What range of actions will reduce the exposure to second-hand smoke in Peel?

End–to–End public health practice

26

Mandate Effective intervention

Health outcome/issue

Questions?

Region of Peel, Public Health 905-791-7800

Paul Callanan, Director, Health Protection: paul.callanan@peelregion.ca

Monali Varia, Manager, Surveillance: monali.varia@peelregion.ca