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1Report No. 3 of the Health and Emergency Medical Services Committee

THE REGIONAL MUNICIPALITY OF YORK

REPORT NO. 3OF THE REGIONAL

HEALTH AND EMERGENCY MEDICAL SERVICES COMMITTEEMEETING HELD ON MARCH 21, 2002

For Consideration byThe Council of The Regional Municipality of York

on March 28, 2002

Chair: Regional Councillor J. Frustaglio

Members: Mayor M. Black, Vice-ChairMayor J. HolecRegional Councillor D. HumeniukRegional Councillor T. WongMayor J. YoungRegional Chair B. Fisch, ex officio

Also Present: Mayor W. Emmerson

Staff Present: D. Bladek-Willett, H. Brown, S. Cartwright, B. Meekin, M. Di Re,Dr. T. Herrick, Dr. K.H. Jaczek, S. Turner, M. Woolhead

The Health and Emergency Medical Services Committee began its meeting at 11:08 a.m. onMarch 21, 2002.

1THE YORK REGION NO-SMOKING BY-LAW IMPLEMENTATION

A REVIEW OF PHASE II: AUGUST TO DECEMBER 2001

The Health and Emergency Medical Services Committee recommends:

1. The receipt of the following deputations:

i) Irv Riopelle, Crow’s Nest Pub


ii) Graham Hoad, The Lion of Stouffville Restaurantiii) Tim Rombos. Purple Pig Restaurantiv) Lou Innocente, Bingo Countryv) Doug Needham, Canadian Restaurant & Food Services Association

2. The receipt of the presentation of Soo Wong, Project Manager, No-SmokingBy-law Enforcement Division regarding ‘The York Region No-Smoking By-law Implementation – A Review of Phase II: August to December2001’(Overhead slides used in the presentation are on file with the RegionalClerk.)

3. The adoption of the recommendations contained in the following report,March 6, 2002, from the Commissioner of Health Services subject to addingan additional recommendation as follows:

4. Regional staff to meet with representatives of the CanadianRestaurant & Food Services Association to assess variousproposals to determine a resolution to accommodate theinterests of the parties.

1. RECOMMENDATIONSIt is recommended that:1. The Health and Emergency Medical Services Committee and Regional Council receive

this report for information.

2. The Health and Emergency Medical Services Committee and Regional Council notchange the Phase III implementation date.

3. The Regional Clerk circulate this report to the area municipalities, the City of Toronto,Simcoe County and the Regions of Peel, Halton and Durham for their information.

2. PURPOSEThe primary purpose of this report is to provide the Health and Emergency Medical ServicesCommittee and Regional Council with a review of Phase II of the York Region No-Smoking By-law which required all restaurants, banquet facilities, retail stores, foodcourts, theatres, shopping malls, recreation facilities, and bowling alleys to become smokefree or construct a separately ventilated designated smoking room (DSR) by June 1, 2001.

This report was also prepared to outline the degree of support in the Region with respect tochanging the Phase III implementation date which requires all bars, taverns, casinos, billiardhalls, bingo halls, race tracks, adult entertainment establishments and night clubs to besmoke-free or construct a separately ventilated DSR by June 1, 2004.


3. BACKGROUNDOn October 26, 2000, Regional Council adopted a three-phase, region-wide No-SmokingBy-law. Effective January 26, 2001, all workplaces in York Region became smoke-free(Phase I).

On June 1, 2001, all restaurants, banquet facilities, retail stores, food courts, theatres,shopping malls, recreation facilities, and bowling alleys became either smoke-free or erecteda separately ventilated DSR that did not exceed more than 25% of the occupiable publicspace (Phase II).

Currently, all bars, taverns, casinos, billiard halls, bingo halls, race tracks, adult entertainmentlounges and nightclubs must either create an unenclosed smoking area or construct aseparately ventilated DSR no greater than 25% of the occupiable public space.

Phase III takes effect on June 1, 2004 and will require all bars, taverns, casinos, billiard halls,bingo halls, race tracks, adult entertainment lounges and nightclubs to either become smokefree or construct a separately ventilated DSR that does not exceed 25% of the occupiablepublic space.

The scheme of the York Region No-Smoking By-law is to create a "level playing field" forestablishments within York Region by ensuring that smoking is not permitted in more than25% of the occupiable public space whether these establishments are restaurants, bars, bingohalls or other establishments.

Further, the implementation dates in the York Region No-Smoking By-law are consistentwith implementation dates adopted by the City of Toronto and area municipalities in theRegion of Peel.

At present, the Region of Durham does not have a No-Smoking By-law in place, but isinvestigating the development of one.

3.1 Phase II Implementation ActivitiesActivities in this phase of implementation have focused on maintaining public awareness ofthe York Region No-Smoking By-law, ongoing education of Regional staff and fortifyinglinks with Area Municipal staff. Extensive communication with the public and variouspartners and community agencies continued to be a priority for Phase II implementation.

3.1.1 Communications PlanHealth Services Department staff have collaborated with area municipalities, the City ofToronto, the Region of Peel and other health units in the implementation of the YorkRegion No-Smoking By-law.

In October and November 2001, Health Services Department staff hosted two DSRworkshops with Area Municipal staff (Building and By-law Enforcement). An educationinformation package, which contained a York Region No-Smoking Fact Sheet and DSR


Requirements Fact Sheet was also distributed to area municipalities, local Chambers ofCommerce and Boards of Trade.

On October 4, 2001, Health Services Department staff hosted the Greater Toronto AreaDSR workshop and collaborated with the Region of Peel and the City of Toronto in creatingthe fall booster communications campaign. The fall booster campaign included the revisionof the various educational materials and the development of a Chinese Public EducationCampaign.

Health Services Department staff have provided their expertise to health units from acrossOntario (Simcoe County, Regional Municipality of Durham, County of Brant, Municipalityof Chatham-Kent, Regional Municipality of Niagara and City of Hamilton) in order to assistthese health units in developing their own No-Smoking By-laws.

The Health Services Department also developed the first ethno-cultural public educationcampaign focused on York Region No-Smoking By-law compliance and enforcement. In an effort to address the needs of the growing Chinese Community, a Chinese publiceducation campaign was developed. York Region Health Services launched this campaign inDecember 2001 in collaboration with Corporate Communications and the Towns ofMarkham and Richmond Hill. Advertisements were placed in all local Chinese newspapersand three educational fact sheets and two promotional items were developed and distributed.

Finally, a display to promote smoke-free dining in York Region was developed by HealthServices Department staff consisting of a fine dining table setting, two “Smoke-Free YorkRegion” banners and promotional materials. This display was staffed by the York RegionNo-Smoking Enforcement Officers and appeared at the Vaughan Health Fair, York RegionYouth Forum, Father McGivney Catholic High School, York Region Open House and theChinese Public Education Campaign kick-off.

3.1.2 Communications DataSince the inception of Phase II of the York Region No-Smoking By-law, Health Connectionhas received 163 telephone calls related to the by-law. The breakdown is as follows:� Requests for information: 103� Complaints regarding smoking in facilities covered in the by-law: 38� Calls forwarded to the enforcement team: 20 (the enforcement team reported that none

of these callers expressed an opinion about the by-law itself)� Complaints about the by-law: 2

During the same time period, 17 letters related to the York Region No-Smoking have beenreceived. The breakdown is as follows:� By-law having negative impact on business: 1� Restaurateur complaining that the by-law should be amended because it is neither

effective or fair: 1


� Restaurateur complaining about spending money to comply with the old VaughanNo-Smoking By-law is now needing to spend more to comply with the York RegionBy-law: 1

� Support for 50% of occupiable space in Bingo Halls for smoking: 4� Information related to DSR construction and approval: 5� Request for a list of York Region restaurants with smoking areas: 1� Letters pertaining to dual designation status for restaurants: 4

The Metroland York Region Newspaper Group printed 13 Letters to the Editor (9 pro,4 con) pertaining to the York Region No-Smoking By-law. Furthermore, the MetrolandYork Region Newspaper Group and the Toronto Star printed 12 articles (4 pro, 8 con)pertaining to the York Region No-Smoking By-law.

There have also been 2 deputations heard by Health and Emergency Medical ServicesCommittee and Regional Council during this time period. On October 18, 2001, Health andEmergency Medical Services Committee heard a deputation from Esther Mitchell(Evergreen Hospice, Markham) outlining the negative impact of the York RegionNo-Smoking By-law on charity revenues generated from Bingo facilities.

On November 8, 2001, Regional Council received a deputation from John Hastings, Ward 5Councillor, Town of Georgina, who expressed support for the size of Bingo Hall DSRsbeing limited to no more than 25% of the occupiable floor space.

3.1.3 By-law Enforcement DataBetween August 1 and December 31, 2001, the By-law Enforcement Team visited 2,390establishments, distributed 16,793 educational/promotional materials, issued 268 letters ofwarning to which no penalty is attached and laid 120 Part III tickets (see Attachment 1).

A letter of warning issued for a first offence (i.e. when a premises is visited for the first timeand violations/infractions are noted). A proprietor is given 14 days to comply, andsubsequent visits or complaints within those 14 days may result in charges.

Part III tickets may be issued against both people and corporations. Multipleinfractions/violations may be listed on a Part III ticket, and the offending party must appearin Court to answer the charges. There is a maximum fine of $5,000 under the ProvincialOffences Act. Part III charges require a summons to be served, a second trial date to be set,and the offending parties to be provided with a copy of the appropriate files. The timebetween first appearance in court to trial is about 7 months. Of the 120 Part III tickets:� 17 resulted in guilty pleas.� 23 charges were withdrawn.� 19 are pending and have to appear in court for the first time.� 61 have received a court date and are awaiting trial.


3.1.4 DSR DataThe No-Smoking By-law Enforcement Division has developed one of the mostcomprehensive DSR review and approval processes in Ontario. A number of health unitsfrom across Ontario (Grey Bruce County, Regional Municipality of Niagara, City ofHamilton, Regional Municipality of Peel, Simcoe County, Regional Municipality of Durham,City of Ottawa, Municipalities of Muskoka and Parry Sound, and Windsor-Essex County)have consulted with Health Services staff on the development and implementation of asimilar DSR inspection and approval process.

There are two parts to the DSR approval process. Part I involves the review of theengineering drawings and approval of the DSR occupancy load (see Attachment 2). Part IIrequires an on-site inspection and review of the air balance report (see Attachment 3). Thetimeline for each of the two parts of the approval process takes approximately 10 days tocomplete. From August to December 2001, a total of 44 DSRs were approved under thePart I DSR approval process and 9 were approved under the Part II DSR approval process(see Attachment 4).

4. ANALYSIS AND OPTIONSIn order to determine the impact of the No-Smoking By-law on York Region, an analysis ofone of the more controversial aspects of the by-law, bingo operations, was conducted.Furthermore, surveys of both residents and business operators were also conducted.

4.1 Bingo OperationsAt present, there is tremendous competition among gambling facilities for business. Duringthe past few years, the Ontario government has expanded the gaming industry byintroducing a variety of gaming activities such as slot machines, instant win games andcasinos. These competing activities, along with the restrictive regulations imposed by boththe Alcohol and Gaming Commission of Ontario and the Ontario Lottery and GamingCorporation, have reduced both the attendance and revenue in the bingo industry.

Local registered charities that have been affected by the bingo industry can seek additionalfunding from the Ontario Trillium Foundation. The Foundation was established in 1982and is an agency of the Ministry of Tourism, Culture and Recreation. Its primary objective isto ensure that a portion of the proceeds from the Ontario Lottery and Gaming Corporationis directed toward social issues in Ontario.

The York Region No-Smoking By-law provides that until June 1, 2004, smoking in a bingoestablishment is either permitted in an unenclosed area no greater than 25% of theoccupiable public space or in a completely enclosed and separately ventilated DSR no greaterthan 25% of the occupiable public space. Thereafter, smoking will only be permitted in aDSR no greater than 25% of the occupiable public space.


The City of Toronto No-Smoking By-law provides that until June 1, 2004, smoking in abingo establishment is either permitted in an unenclosed area no greater than 25% of theoccupiable public space or in a completely enclosed and separately ventilated DSR no greaterthan 50% of the occupiable public space. Thereafter, smoking will only be permitted in aDSR no greater than 50% of the occupiable public space.

The No-Smoking By-laws of the area municipalities of the Region of Peel provide that untilJune 1, 2004, smoking in a bingo establishment is permitted in either an unenclosed area orin a completely enclosed and separately ventilated DSR no greater than 50% of theoccupiable public space. Thereafter, smoking will only be permitted in a DSR no greaterthan 50% of the occupiable public space.

Currently, there are five bingo facilities in the City of Toronto and Region of Peel that mayprovide competition to York Region bingo operations. Like the four York Region bingoestablishments (Newmarket, Aurora, Richmond Hill, and Woodbridge), they attempt toattract players to their facilities by using a variety of promotional strategies.

Bingo Country Corporation operates the Newmarket and Woodbridge facilities while DeltaMayfair Bingo operates the Richmond Hill bingo. Aurora Bingo is run by an independentbingo operator.

In early June 2001, Markham Bingo, owned by Bingo Country Corporation, closed itsfacility. At the time of this report, Markham Bingo remains closed. Prior to its closure,Markham Bingo held 28 sessions per week in 2001 as opposed to 35 sessions per week in2000. Despite the lower attendance in 2001, Markham Bingo continued to have a $5,500prize jackpot per session. Since June 1, 2001, Markham Bingo has consistently reported thatits closure was caused by the York Region No-Smoking By-law. However, the other fourbingo operators in York Region are not only meeting all the requirements outlined in the by-law, but their attendance does not appear to be greatly affected by the implementation of theYork Region No-Smoking By-law as evidenced by the number of bingo players noted ininspections by York Region No-Smoking By-law Enforcement Officers in November 2001,set out in the report to Regional Council on January 24, 2002 entitled “Bingo Operations inYork Region.”

Markham Bingo is located in close proximity to two bingo facilities in the City of Toronto. After numerous requests for attendance data from the two bingo facilities located inScarborough, only Delta Mayfair Bingo which operates the Scarborough Delta Club Bingoprovided data for 2001. At this facility, there was a slight increase of attendance after June 1,2001, even though the City of Toronto No-Smoking By-law also required bingo operators toestablish and designate an unenclosed smoking area no greater than 25% of the occupiablepublic space in the premises or construct a DSR no greater than 50% of the occupiablepublic space.


4.2 Part I: Residents’ Evaluation FindingsIn the fall of 2001, the Health Services Department retained Environics Research Group toconduct a survey of York Region residents’ attitudes towards the No-Smoking By-law. Theresults of the survey, completed in December 2001, are based on the telephone responses of632 York Region residents aged 18 years or older between November 29 to December 10,2001.

The residents who responded to this survey indicated support for the York RegionNo-Smoking By-law (see Table 1). It appears that there were no major discrepancies betweenmunicipalities with respect to the outcomes of the survey.

Table 1Support for Smoke-free Public Places

Type ofEstablishment

Regional Average(% Residents Surveyed

in Support)

Restaurants 87%Bars 72%Bingo Halls 75%Billiard Halls 68%

4.2.1 Smoke-Free RestaurantsEighty-seven percent (87%) of the York Region residents surveyed supported therequirement of the York Region No-Smoking By-law that restaurants be entirely smoke-freeor build a separately ventilated DSR. Of note, 71% of those polled have not changed thefrequency in which they frequent restaurants as a result of the conditions imposed by theYork Region No-Smoking By-law. In fact, 20% of those surveyed have increased thefrequency of eating out, while only 7% go less often (see Figure 1).


Figure 1

Figure 1 Frequency of attendance at York Region Restaurants since June 1, 2001

71% No Change

2% Don't know 20% More Often

7% LessOften

4.2.2 Smoke-Free BarsSeventy-two percent (72%) of the York Region residents polled supported bars beingsmoke-free or constructing a separately ventilated DSR. Sixty-three percent (63%) of thosesurveyed have not changed the frequency in which they visit bars as a result of theconditions imposed by the York Region No-Smoking By-law. Seven percent (7%) of thoseresidents responded that they went more frequently, while 10% went less frequently (seeFigure 2).

Figure 2

Figure 2 Attendance at Bars in York Region since June 1, 2001

63% No Change

20% Don't go to bars

7% More Often

10% Less Often


4.2.3 Smoke-Free Bingo and Billiard HallsSmoke-free bingo halls are supported by 75% of the York Region residents surveyed andsmoke-free billiard halls are supported by 68% of residents surveyed.

4.2.3.1 Smoke Free Bingo HallsForty-one percent (41%) of those surveyed never frequent bingo halls. Approximately 2%of respondents reported going to bingo facilities more often since June 1, 2001, and 4%reported that they go to bingo halls less frequently. The remaining 53% of bingo patronshave not changed their frequency of attendance (see Figure 3).

Figure 3

Figure 3 Reported Attendance at Bingo Halls in York Region since June 1, 2001

53%No

Change

41% Never go to Bingo Halls

2% More Often4% Less Often

4.2.3.2 Smoke-Free Billiard HallsThirty-eight percent (38%) of those surveyed never frequent billiard halls, while 54% ofbilliard hall patrons have not changed their frequency of attendance. Three percent (3%) ofpatrons have visited billiard halls more frequently and 5% visited billiard halls less frequentlysince June, 2001 (see Figure 4).


Figure 4

Figure 4 Reported Attendance at Billiard Halls in York Region since June 1, 2001

54%No

Change

38% Never go to Billiard

Halls

3% More Often

5% Less Often

4.2.4 Phase III Implementation TimelineResults indicated that 44% of those surveyed support maintaining the current Phase IIIimplementation date of June 1, 2004, at which time all bars, taverns, casinos, billiard halls,bingo halls, race tracks, adult entertainment establishments and night clubs must eitherbecome smoke-free or construct a separately ventilated DSR that does not exceed 25% ofthe occupiable public space. An additional 9% of respondents indicated that they would liketo see the Phase III implementation date delayed to a date later than June 2004.

Forty-two percent (42%) of those surveyed supported moving the Phase III implementationdate forward. Of this group:� 53% support Phase III implementation by June 2002.� 30% support Phase III implementation by January 2003.� 6% support Phase III implementation by June 2003.� 8% support Phase III implementation immediately.� 2% don’t know.

Four percent (4%) of those surveyed feel that smoking should not be restricted in theseplaces and 1% were unsure of a response.

4.3 Part II: Operators’ Evaluation FindingsIn January 2002, Environics Research Group was hired to conduct a telephone survey ofapproximately 200 establishments in York Region affected by the York Region No-SmokingBy-law. The results of the survey are based on the telephone responses of the owners ormanagers of establishments in York Region affected by the York Region No-SmokingBy-law between January 14 and 18, 2002.


4.3.1 Classification Prior to June 1, 2001Some 88% of the establishments surveyed indicated that they did not change theirclassification under the by-law (e.g. from a restaurant to a bar) since June 1, 2001, whereas4% reported changing their classification after June 1, 2001.

This finding is significant as it demonstrated that restaurants, banquet facilities, retail stores,food courts, theatres, shopping malls, recreation facilities, and bowling alleys which wererequired to become smoke free or construct a separately ventilated DSR by June 1, 2001, didnot change their classification to a bar, tavern, billiard hall, bingo hall, adult entertainmentestablishment or night club to take advantage of the June 1, 2004 implementation date.

4.3.2 Support for Smoke-free Status and DSRsFifty-four percent (54%) of the establishments surveyed indicated they supported aby-law requiring bingo halls to be smoke free or construct a separately ventilated DSR,71% supported a by-law requiring restaurants to be smoke-free or construct a DSR and50% supported such a by-law for bars and billiard halls.

4.3.3 Phase III Implementation DateWhen establishments were asked about advancing the Phase III implementation date ofJune 1, 2004, 42% of them supported no change; 29% indicated support for the date to beadvanced prior to June 1, 2004; and 21% supported the implementation date being delayedto a date after June 1, 2004; and only 5% of the respondents indicated that the Regionshould never restrict smoking in public places (see Figure 5).

Figure 5

Figure 5 Operators' Opinions of the Implementation Timeline

29% Sooner than June 2004

21% Some time after June 2004

42% Should leave date at June 2004

5% Smoking should never be restricted in these places

3% Don't know


4.3.4 Support for Regional No-Smoking By-lawRespondents were asked for their opinion about whether or not their customers supportedor opposed the York Region No-Smoking By-law. Fifty-four percent (54%) reported thattheir customers supported the York Region No-Smoking By-law; 35% indicated that theircustomers were opposed and another 11% did not answer or did not know the answer (seeFigure 6).

Figure 6

Figure 6 Operators' Perception of Customer Suport of the York Region No-Smoking By-law

54%Support

11% Don't know/Not responded

35%Oppose

4.3.5 Planned Construction of DSRsWhen questioned about DSRs, the majority of establishments (88%) indicated that they donot have a DSR at this time. Approximately 91% of them reported that they do not plan tobuild a DSR in the next 3 years.

4.4 Impact of By-law on York Region BusinessesAt this time, it is not possible to independently determine the overall impact of theNo-Smoking By-law on the business community in York Region.

4.5 Phase III Implementation TimelineAt the time of this writing, the City of Toronto and the Region of Peel have already decidednot to advance the Phase III implementation date of June 1, 2004, for bars, taverns, casinos,billiard halls, bingo halls, race tracks, adult entertainment lounges and night clubs. If YorkRegion unilaterally advanced the Phase III implementation date an uneven playing field inthis part of the GTA would be the result. Therefore, it would be best to leave the currentPhase III implementation date as planned.


5. FINANCIAL IMPLICATIONSThe Health Services’ 2001 gross budget included $763,734 for the implementation of theNo-Smoking By-law. The 2001 unaudited actual expenditures were approximately $673,000gross or $336,500 net. These expenditures included the salaries and benefits for 1 Manager,1 Health Educator, 1 Clerk and 5 Enforcement Officers. The majority of the remainingexpenditures were dedicated to education campaigns, which targeted both the public andbusiness owners as well as all costs associated with the implementation of Phases I and II.

The Health Services’ 2002 approved gross budget included $861,261 for the No-SmokingBy-law Division. The budget increase over 2001 is directly related to the hiring of anadditional 2.0FTE required to address increased program needs in addition to annualizationcosts that related to the Enforcement Officers. Some of these costs were partially offset bya reduction in printing and special promotion costs. The 2002 approved budget did notinclude any additional costs that may have been required if the implementation of Phase IIIwere to be advanced.

It is estimated that the financial impact of advancing the implementation of Phase III wouldtotal approximately $475,000 for a net increase of $237,500, as outlined in the table below.The implementation of Phase III will require additional resources. However, if this timelineis advanced, Health Services will also need to advance the hiring of additional staff to notonly educate the operators (billiards/bingo halls, bars, taverns, adult entertainment lounges,and night clubs) in Phase III about the by-law but also to review and conduct ongoingmonitoring of all existing and newly approved DSRs. An additional 4.0 EnforcementOfficers and a 0.5 clerk would be required to address the impact of advancing Phase III. Afurther 2.0 FTE, dedicated to reviewing the resolving issues related to Designated SmokingRooms would also be required. A reduction in contracted services for the approval ofDesignated Smoking Rooms would partially offset the costs of the additional FTE.Increased program costs would be incurred in addition to printing and promotion costs foran educational component that would ensure that both the public and businesses were madeaware of any new implementation date.

Table 2Estimated Additional Costs of Moving Up 2004 Deadline

Gross Cost Net CostSalaries/Benefits $385,543 $192,772Printing/Special Promotions 108,000 54,000Program Costs (mileage,training, etc.)

46,900 23,450

Sub-total $540,443 $270,222Less: Reduction in contractedservices for DSRs (65,000) (32,500)Total $475,443 $237,722


6. LOCAL MUNICIPAL IMPACTThere will be ongoing communication with area municipalities on the implementation of theYork Region No-Smoking By-law.

7. CONCLUSIONAt present, Phase II implementation is well underway. Successful communication with otherhealth units, with area municipalities and within regional departments has resulted in a goodunderstanding of the York Region No-Smoking By-law.

A majority of York Region residents and businesses surveyed by Environics Group Inc.support the York Region No-Smoking By-law and a majority of these residents have notadjusted the frequency with which they visit restaurants, bars, billiard and bingo halls sinceJune 1, 2001, when Phase II of the No-Smoking By-law came into effect. In fact 20% ofresidents surveyed reported going to restaurants more frequently since June 1, 2001.

There is evidence that the implementation of Phases I and II has been well accepted bythose surveyed and does not appear to have adversely affected the regional economy fromthe consumer’s perspective. The same evidence also suggests that York Region should staythe course with its planned implementation of the No-Smoking By-law in order to protectresidents from the harmful effects of second-hand smoke.

This report has been reviewed by the Senior Management Group.

(A copy of the attachments referred to in the foregoing is included with this report and is also on file in the Office of theRegional Clerk.)

(Regional Council at its meeting on March 28, 2002 amended the foregoingClause to include the following:

That the No-Smoking By-law be amended to increase the designatedsmoking area in bingo halls from 25% to 50% and staff report back to theCommittee on the by-law’s application to restaurants.)

2EARLY CHILD DEVELOPMENT—NEW INITIATIVES

The Health and Emergency Medical Services Committee recommends theadoption of the recommendation contained in the following report, February 20,2002, from the Commissioner of Health Services:


1. RECOMMENDATIONIt is recommended that:1. Health and Emergency Medical Services Committee and Regional Council receive this

report regarding Early Child Development initiatives for information purposes.

2. PURPOSEThe purpose of this report is to outline Early Child Development initiatives recentlyannounced by the Ontario Ministry of Health and Long-Term Care and to describe the stepsthat will be taken by the Health Services Department, Public Health Branch, to access EarlyChild Development funding.

3. BACKGROUND In December 2001, the Health Services Department, Public Health Branch, receivedcorrespondence from the Ontario Ministry of Health and Long-Term Care announcing thatEarly Child Development funding would be made available to Public Health unitsthroughout the province to be used to support children ages 0–6 years of age, their parentsand caregivers through the development of three community-based initiatives. The threeinitiatives are:� Injury and Family Abuse Prevention� Promotion of Healthy Pregnancy and Child Development� Perinatal and Child Health Survey Strategies

These initiatives are part of the Government of Ontario’s Early Years Plan, which is basedon Ontario’s vision for children and the thinking outlined in the Early Years Study,April 1999, co-chaired by Dr. Fraser Mustard and the Honourable Margaret McCain. TheEarly Years Plan has a two-pronged approach:

1. Fund a blend of targeted and universal programs to address existing pressures, orexpand/enhance those programs; and

2. Establish a Provincial system of local Ontario Early Years Centres that is accessible to allyoung children 0–6 years of age, and their families.

The Public Health Branch is integrally involved in all aspects of the Early Years Planimplementation in York Region, including the Early Years Steering Committee and theestablishment of local Early Years Centres. Furthermore, the Healthy Babies, HealthyChildren components of the Child Health Mandatory Core Program (December 1997) aredirectly linked to the Provincial Early Years Plan.

These new projects are not intended to duplicate requirements outlined in the provincialMandatory Health Programs and Services Guidelines (December 1997), but rather to provide 100%


funding for additional programs relevant to the target group which are not addressed in thecurrent legislation.

Phase 1 of these initiatives is a planning process which is to take place between January 1,2002 and March 31, 2002. The tight timeline set by the Ministry of Health and Long-TermCare for Phase 1 did not allow for the preparation of a detailed business plan and budget tooutline how these funds would be expended and the program implemented until theMarch 7, 2002 meeting of Health and Emergency Medical Services Committee. At thispoint in time, it will prove impossible to utilize the funds by the March 31, 2002 deadlineimposed by the Ministry. It is our intent to complete the 4-year plans by April 20, 2002 foreach initiative in order to access the funds for Phase 2.

3.1 Program Descriptions

3.1.1 Injury and Family Abuse PreventionThe goal of this initiative is to create safer environments for young children by identifyingand addressing risk factors associated with infant and childhood injuries and family abuse.Actions are required to ensure safer homes, childcare settings and communities in order toreduce deaths and disabilities due to suffocation, burns, poisoning, drowning and falls. Acomprehensive, population-based approach will be used to develop collaborative, multi-sectoral community injury prevention projects.

It is also the intent of this initiative that the public health sector play a key leadership role inaddressing family abuse prevention by developing partnerships with other sectors to addressboth risk and protective factors in order to raise awareness and increase knowledge. Primaryprevention strategies will target children 0–6 years, their families and caregivers and/orpregnant women.

The proposed annual funding in each of the four years for this initiative is $174,000.

3.1.2 Promotion of Healthy Pregnancy and Child DevelopmentThis initiative will address key factors associated with one or more of the following threeareas:� Healthy Pregnancy� Child Growth and Development� Parenting Capacity

Healthy Pregnancy outcomes, nutrition, nurturing and responsive caregiving in the first yearsof life improve the outcomes for all children’s learning, behaviour and physical and mentalhealth throughout life. This initiative is intended to develop population-based strategies toaddress those planning pregnancies, expectant parents, and families and caregivers ofchildren aged 0–6 years and to benefit all families in all socioeconomic groups.

The proposed annual funding in each of the four years for this initiative is $86,200.


3.1.3 Perinatal and Child Health Survey StrategiesThis initiative is a one-time funded project that is to be implemented prior to March 31,2002. Due to the restrictive time constraints for deliverables required by the Ministry ofHealth and Long-Term Care, the Public Health Branch has not been able to take advantageof this opportunity. Had we been able to do so, the Public Health Branch would haverecommended the implementation of the Early Development Instrument (EDI).

As noted previously, there have been many recent initiatives targeted to the prenatal to sixpopulation in response to The Early Years Report. In addition, there are numerous otherprograms and services which have been supporting young children, including those offeredby the Public Health Branch. Although each of these programs has an evaluationcomponent, there has been no mechanism to measure the total impact of the eventscollectively, on the well being of our children. The EDI is a tool which could provide thatmeasurement.

The EDI is a teacher-completed checklist that assesses children’s readiness to learn at schoolin five domains: physical health and well being, social competence, emotional maturity,language and cognitive development, and communication skills and general knowledge. Theinstrument is designed to be interpreted at the group level. It has not been set up to give acomplete picture of an individual child. By implementing the EDI across the Region, asnapshot would be provided of how well our children are doing at school entry. In addition,it would provide a baseline upon which to measure the impact of present and futureinitiatives.

This initiative requires collaboration of multiple community partners including York RegionHealth Services, Community Services and Housing, York Region District School Board,York Region Catholic District School Board, Early Years Steering Committee (ChallengeFund) and McMaster University (Canadian Centre for Studies of Children at Risk).

The EDI is a valuable tool that would be of benefit to the Region of York in planning forthe delivery of services for young children and their families.

4. ANALYSIS AND OPTIONS

By April 20, 2002, a report detailing a comprehensive four-year plan for each of theinitiatives is to be submitted to the Ministry of Health and Long Term Care. This report isto include:� Community needs assessment tools and results� Community inventory tools and results� Community priorities� Project vision� Identified key partners/stakeholders and their roles� Four-year program logic model, including timeline


� Draft evaluation plan� Training/education needs

These plans will clearly note that they are contingent upon approval by Health andEmergency Medical Services Committee and Regional Council, at the earliest time possible.

As previously mentioned, Public Health Branch staff are already collaborating with the EarlyYears Steering Committee, along with the York Region Advisory Forum for Children, Youthand Families—Prenatal to 6 Working Group, in the development of a comprehensive EarlyYears Action Plan for the children of York Region.

5. FINANCIAL IMPLICATIONSStaff costs of $6,000 associated with the preparation of the multiyear plans are not abudgeted item, but will be accommodated within the 2002 Health Services Departmentbudget. As soon as the multiyear plans are approved and funding is committed by theMinistry of Health and Long-Term Care, staff will present a further report to Health andEmergency Medical Services Committee and Regional Council to outline the details and seekauthorization to receive and expend the funds.

6. LOCAL MUNICIPAL IMPACTThe development and implementation of these two initiatives will have a direct bearing onthe wellbeing of all young children and their families in all municipalities in York Region.The immediate impact will be on the enhanced coordination of the planning and delivery ofprograms and services. The greater impact will be on the children and families themselves,who will benefit from access to improved early childhood development and parentinginformation and experiences, within safer and more supportive community environments.

7. CONCLUSIONThe 100% Early Child Development funding which is being made available to the PublicHealth Branch has the potential to build upon and enhance currently delivered programs inYork Region for children age 0–6 and their families. The Public Health Branch welcomesthe opportunity to access these additional dollars in order to achieve this objective.


3EARLY CHILD DEVELOPMENT—NEW INITIATIVES UPDATE

The Health and Emergency Medical Services Committee recommends theadoption of the recommendation contained in the following report, March 20,2002, from the Commissioner of Health Services:


1. RECOMMENDATIONSIt is recommended that:1. Health and Emergency Medical Services Committee and Regional Council authorize the

receipt and expenditure of $350,676 for the implementation of Phase I of the three EarlyChild Development Initiatives. The initiatives are 100% provincially funded.

2. PURPOSEThe purpose of this report is to update Health and Emergency Medical Services Committeeand Regional Council regarding the new deadlines for the Early Child DevelopmentInitiatives recently established by the Ministry of Health and Long-Term Care (MOHLTC).

3. BACKGROUND In a report to Health and Emergency Medical Services Committee dated March 21, 2002,entitled Early Child Development—New Initiatives, staff detailed the Early Child Initiativesset out by the MOHLTC. The report explained that, due to the tight timelines involved withthe planning and implementation of Phase I of these programs, the Public Health Branchwould not be able to expend these funds prior to the Ministry imposed deadline ofMarch 31, 2002.

On March 12, 2002, the MOHLTC sent a letter to all Medical Officers of Health (seeAttachment 1) informing all Public Health Units of an extension of Phase I funds fromMarch 31, 2002 to December 31, 2002.

3.1 Program DescriptionsAll areas detailed in the Early Child Development—New Initiatives report will now becompleted due to the extension granted by the MOHLTC, with the exception of the EarlyDevelopment Instrument (EDI). Unfortunately, the extension of the funding came after thedeadline set by McMaster University for the survey to be completed. The Public HealthBranch will be working with McMaster University in the fall on the pre-work for EDI,ensuring that the tool will ready for use in 2003 (provided ongoing funding is approved).The MOHLTC has agreed that the pre-work expenditures for EDI are acceptable, under thecircumstances, for 2002.

4. ANALYSIS AND OPTIONSThe extension of deadlines for expenditures for Early Child Development Initiatives is awelcome move by the MOHLTC. Staff are anxious to proceed with these programs andrecommend acceptance of funding for this purpose.


5. FINANCIAL IMPLICATIONSDirect costs related to the Early Child Development Initiatives will have no net impact tothe taxpayers of York Region. The cost of $174,000 for the Injury & Family AbusePrevention program, $86,200 for the Promotion of Healthy Pregnancy & ChildDevelopment, and $90,476 for Perinatal & Child Health Survey Strategies are 100% fundedby the MOHLTC (see Attachment 2).

However, costs related to corporate support for these programs (i.e. human resources, legal,payroll/accounting) are not funded through this initiative but do create significant pressureson corporate support areas funded through the tax levy.

In conjunction with the amended deadline for Phase I of the Early Child DevelopmentInitiatives, the Public Health Branch will have until December 3, 2002, to expend the above-noted funds, with a settlement process to recover any unspent funds at the end of our fiscalyear.

6. LOCAL MUNICIPAL IMPACTThe development and implementation of these two initiatives will have a direct bearing onthe wellbeing of all young children and their families in all municipalities in York Region.The immediate impact will be on the enhanced coordination of the planning and delivery ofprograms and services. The greater impact will be on the children and families themselves,who will benefit from access to improved early Child development and parentinginformation and experiences, within safer and more supportive community environments.

7. CONCLUSIONThe MOHLTC has acknowledged the difficulty in achieving the original deadlines associatedwith the Early Child Development Initiatives. Staff recommends that Health andEmergency Medical Services Committee and Regional Council authorize the receipt andexpenditure of $350,676 for the implementation of Phase I of the three Early ChildDevelopment Initiatives.

(A copy of the attachments referred to in the foregoing is included with this report and is also on file in the Office of theRegional Clerk.)

4

LONG TERM CARE FACILITY PROGRAMLEGISLATIVE COMPLIANCE REPORTS 2001

FIRE SAFETY AND OCCUPATIONAL HEALTH & SAFETY

The Health and Emergency Medical Services Committee recommends theadoption of the recommendations contained in the following report, February 1,2002, from the Commissioner of Health Services:


1. RECOMMENDATIONSIt is recommended that:1. The Health and Emergency Medical Services Committee and Regional Council receive

for information the appended report (Attachment 1A & 1B) regarding compliance withlegislated Fire Protection & Safety requirements in the Regional Long Term Care FacilityProgram.

2. The Health and Emergency Medical Services Committee and Regional Council receivefor information the appended report (Attachment 2) regarding compliance with theregulations made under the Occupational Health and Safety Act legislating and governingsafety standards in health care facilities.

2. PURPOSEThese reports are provided to the Health and Emergency Medical Services Committee andRegional Council, as the Governing Body of the Regional LTC Facility Program, to facilitatetheir legislated responsibility for ensuring that the Newmarket and Maple Health Centres arein compliance with applicable Fire Protection & Safety and Occupational Health & Safetylegislation.

3. BACKGROUND In accordance with applicable LTC legislation, the Governing Body of a Municipal LTCFacility is responsible for, among other things, ensuring that the facility is operating incompliance with the legislation and regulations governing Fire Protection & Safety andOccupational Health & Safety.

4. ANALYSIS AND OPTIONSThe attached reports identify the status of compliance at the Newmarket and Maple HealthCentres with the criteria and requirements for Life Safety and Occupational Health & Safetyestablished in the Long-Term Care Act, the Homes for the Aged and Rest Homes Act and theOccupational Health and Safety Act, including the regulation governing Health Care andResidential Facilities. The reports also identify corrective action (where applicable) that hasbeen initiated to address previous areas of non-compliance. The inspections identified inthese reports were compiled both internally by the appropriate Regional staff and externallythrough agencies such as Ontario Hydro, Fire Marshall Office, etc.

With respect to the Life Safety Compliance Reports, it should be noted that compliance withexisting long term care legislation does not necessarily construe compliance with therequirements of the current Fire Code (being a regulation to the Fire Protection and PreventionAct) or Building Code (being a regulation to the Building Code Act, 1992). This is particularlyevident at older facilities such as the Newmarket Health Centre where current codes providefor certain interim exemptions for existing facilities.


For example, whereas a new or renovated facility with this type of institutional health careoccupancy must be fully equipped with sprinklers, codes do not currently require that anexisting facility meet this same standard for Fire Protection & Safety. These differences inLife Safety standards will, however, be fully addressed at completion of the Phase IIIredevelopment of the Newmarket Health Centre that was previously approved by RegionalCouncil.

Accordingly, the Regional Long Term Care Centres continue to operate in full compliancewith all applicable legislation governing Fire Protection & Safety and Occupational Health& Safety.

5. FINANCIAL IMPLICATIONSAny improvements or charges were accommodated within existing budget allocations.

6. LOCAL MUNICIPAL IMPACTThere is no local municipal impact associated with these reports.

7. CONCLUSIONFor the year 2001, the Regional Long Term Care Centres continued to operate in fullcompliance with all applicable legislation governing Fire Protection & Safety and OccupationalHealth & Safety.


5UPDATE - COMMITTEE PROCEEDINGS

The Health and Emergency Medical Services Committee advises Council of thefollowing matters having been considered by the Health and Emergency MedicalServices Committee with the corresponding action as noted:

DEPUTATIONS

1. Requests to make a deputation have been received from the following regardingthe 'No-Smoking By-law':

Irv Riopelle, Crow's Nest Pub. Graham Hoad, The Lion of Stouffville Restaurant.

Tim Rombos, Purple Pig Restaurant.


Lou Innocente, Bingo Country.

Doug Needham, Canadian Restaurant & Food Services Association

(Please refer to Clause No 1 of this Report)

PRESENTATIONS

2. Presentations of the 'Award of Accreditation Certificates to Maple Health Centre,Newmarket Health Centre, Day Program (Keswick) and Day Program (Maple).'Received.

3. Soo Wong, Project Manager, No-Smoking By-law Enforcement Division, made apresentation regarding 'The York Region No-Smoking By-law Implementation - AReview of Phase II: August to December 2001.' (Please refer to Clause No 1 ofthis Report) Received.

COMMUNICATIONS

4. Janet Williams, Committee Co-ordinator, Health and Emergency MedicalServices Committee, February 21, 2002, to Dr. K. Helena Jaczek, Commissionerof Health Services & Medical Officer of Health, regarding 'Andy Elder of ShoelessJoe's Restaurants notification of withdrawal of deputation request and request forany further communications regarding the No-Smoking By-law.' Received.

5. Colleen Clarke, Licensing Officer, Town of Whitchurch-Stouffville, January 30,2002, regarding 'Bingo Operations.' Received.

6. Chris Somerville, Clerk, Township of King, February 14, 2002, regarding 'BingoOperations in York Region.' Received.

7. Carolyn Lance, Committee Secretary, Town of Georgina, February 15, 2002,regarding 'Bingo Operations in York Region.' Received.

8. Lou Innocente, Operations Manager and Rick Schwan, Operations Manager,Bingo Country, February 13, 2002, 'Response to Clause No. 6, Report No. 1 ofthe Health and Emergency Medical Services Committee/Changes to theRegional Smoking By-law.' Received.

9. B. Panizza, Director of Corporate Services/Town Clerk, Town of Aurora,February 27, 2002, regarding 'Bingo Operations in York Region.' Received.

10. Stephen McDonald, Director of Corporate Services/Municipal Clerk, Town of


East Gwillimbury, undated, regarding 'Bingo Operations in York Region.'Received.

11. Sheila Birrell, Town Clerk, Town of Markham, February 27, 2002, regarding'Bingo Operations in York Region.' Received.

12. Carolyn Lance, Committee Secretary, Town of Georgina, March 5, 2002,forwarding a motion adopted at its Council meeting held on February 25, 2002,regarding 'Bingo Operations in York Region.' Received.

13. Nancy Wright-Laking, Town Clerk, Town of Newmarket, March 4, 2002,regarding 'Proposed Regional Smoking Regulations Impacting Bingo Halls.'Received.

14. Carolyn Lance, Committee Secretary, Town of Georgina, February 4, 2002,forwarding a motion adopted at its Council meeting held on January 28, 2002,regarding 'Licensing of Food Handlers.' Received.

15. Chris Somerville, Clerk, Township of King, February 19, 2002, forwarding aresolution passed at its Council meeting held on February 4, 2002, regarding'Food Premises Inspection and Disclosure Update.' Received.

16. J.D. Leach, City Clerk, City of Vaughan, February 1, 2002, forwarding aresolution passed at its Council meeting held on January 28, 2002, regarding'Bathurst Clark Fire Station #71 - Regional Approval for Enhanced AmbulanceService.' Received.

17. Shawn D. Turner, Administrator and Director, Long Term Care & Seniors Branch,York Region, February 13, 2002, response letter to Deborah Egan, ExecutiveDirector, CHATS, request to make a deputation at the Health and EmergencyMedical Services Committee meeting scheduled for April 4, 2002. Received.

18. Regional Councillor Joyce Frustaglio, Chair, Health and Emergency MedicalServices Committee, February 11, 2002, to The Honourable Gordon Campbell,Premier of British Columbia, regarding 'Revised Smoking Regulations in BritishColumbia.' Received.

19. Joan Andrew, Assistant Deputy Minister, Environmental Sciences and StandardsDivision, Ministry of the Environment, February 21, 2002, regarding 'TestingPractices at Fine Analysis Laboratories Limited (FAL) of Hamilton.' Received.

20. The Honourable Tony Clement, Minister, Ministry of Health and Long-Term Care,February 14, 2002, regarding the 'Ministry's Support for Hadley Grange, Town ofAurora.' Received with thanks.


20. The Honourable Tony Clement, Minister, Ministry of Health and Long-Term Care,February 22, 2002, regarding 'Transition Costs and Land Ambulance Funding.'Received.

21. Nancy M. Merrow, M.D., C.C.F.P., Family Physician, Sharon, Ontario, March 4,2002, regarding ''Primary Care Medical Clinic at the Newmarket Health Centre.'Received and referred to staff.

22. Graham L. Pollett, Secretary-Treasurer, Middlesex-London Board of Health,January 28, 2002, regarding 'Advocacy for Public Funding for Four Vaccines.'Received and endorsed.

23. Malcolm Bates, Director, Emergency Health Services Branch, Ministry of Healthand Long-Term Care, March 6, 2002, regarding 'Year 2000 Post AssumptionVehicles and Equipment Costs.' Received and referred to the Regional Chair tosend correspondence to the Provincial Government expressing concerns of TheRegional Municipality of York.

24. A Summary of Responses by Area Municipalities and Bingo Operators as ofMarch 20, 2002. Received and was noted that one bingo operator responded.

The Health and Emergency Medical Services Committee adjourned at 12:48 PM.

Respectfully submitted,

March 21, 2002 J. Frustaglio

Newmarket, Ontario Chair

(Report No. 3 of the Health and Emergency Medical Services Committee wasadopted, as amended, by Regional Council at its meeting on March 28, 2002.)

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