Ontario\u27s Small Non-Community Drinking Water Systems: How to Ensure Provision of Safe Drinking

Waterborne disease outbreaks associated with drinking water systems occur in Canada and elsewhere. Previous research has shown that the small non-community drinking water system (SDWS) users are at increased risk of becoming ill compared to the community drinking water system users. Although public awareness surrounding access to safe drinking water has been increased considerably since the Walkerton tragedy in 2000, the provision of safe drinking water in Ontario’s SDWSs is relatively understudied. Furthermore, a key initiative to safeguard drinking water sources in Ontario, the planning for source water protection, does not include SDWSs. Our research consists of three manuscripts addressing the following objectives: a) to examine contributing factors to adverse water quality incidents in SDWSs, b) to investigate risk awareness and perceptions of the SDWS owners in the provision of safe drinking water and protecting their water sources, c) to develop a sustainable operation model for Ontario’s SDWSs. We use a mixed methods approach by analyzing quantitative and qualitative data in different phases of the research. The study region, Wellington-Dufferin-Guelph, is situated in the heart of southern Ontario. Our research investigates the relationship between operational characteristics of SDWSs and adverse water quality incidents and concludes that the presence of operator training, an upstream behavioural determinant, significantly reduces the incidence of adverse water quality incidents in SDWSs. The interviews with SDWS owners reveal the need for low-cost and easily accessible training opportunities, and financial support for some SDWS owners. Although the current literature on Ontario’s SDWSs is limited, the review of the current water management strategies in Canada and across the world provides fruitful results to create of a unique model for Ontario’s SDWSs using the Multiple-Barrier Approach framework. Our sustainable operation model consists of five main components: Commitment to providing safe drinking water; assessment of the system and source water; system operation and operator training; management of incidents and emergencies; and communication and raising awareness. Our model addresses the areas that need more attention for today, and in the future, such as protecting source water, financial stability, enhanced communication, and increased awareness

Case 11 : Knowledge Dissemination and Private Well Water Testing in Middlesex County, Ontario

The Middlesex-London Health Unit (MLHU) is challenged with regards to influencing health behaviours of private well water users. Private well owners are responsible for the testing of their water, and it is recommended by Public Health Ontario to do so three times per year. However, testing rates are either declining or at best, remaining stagnant across Middlesex County. It appears that well owners are unaware of the risks of not testing their drinking water, or if they are, they have become complacent. In short, the health unit is lacking an appropriate knowledge and education dissemination strategy that is suitable and well-adjusted for the target population. The unique characteristics of the target population made this group especially challenging to engage with. Such features are associated with the agriculture industry: seasonal work patterns, limited visits to town, distrust in government, varying education and literacy levels, resilient and “tough” attitudes towards health, remote residential areas, and more. The case introduces the steps taken by the protagonist and his summer student in order to determine the knowledge level of well water testing information, attitudes towards the program, and needs of local community members around this issue. Background information on well water testing services provided by the MLHU and Province of Ontario, history from the Walkerton Tragedy, and importance of well water testing are provided. The reader is left with the challenge of developing strategic ways to engage in knowledge exchange with the community, design and deliver appropriate communication tools, and work with the community to address health behaviour change

Case 7 : Local Climate Change Adaptation: Developing a Communication Strategy for Rural Populations

Climate change is expected to increase the frequency and intensity of extreme weather events and extreme temperatures (heat and cold) in Southern Ontario. Climate change-related impacts (i.e., flooding, heat, storms, tornados, etc.) may increase the risk of heat-related illness, respiratory disease, food-, water-, and vector-borne disease, and injuries in the Middlesex- London community. The Ontario Public Health Standards mandate local public health units to increase awareness of environmental health hazards, to prevent or reduce exposure to health hazards, and to work to create healthy environments. The Middlesex-London Health Unit (MLHU) conducts surveillance for vector-borne disease, disseminates heat warnings to community partners, and prepares for emergency planning in the community. The MLHU has identified a need to increase communication and awareness of climate change-related health impacts in the rural population of Middlesex County, focusing on extreme heat. There is currently no strategy in place for reaching the rural population with heat-related health messaging. To fill this gap, the health unit needs a comprehensive communication strategy targeted at the rural population

Case 13 : Preparing for the Tickpocalypse

The blacklegged tick population is increasing within the Realike region, and this has been associated with the emergence and increase of Lyme disease cases in the area. Zachary Smith, the Manager of the Safe Water and Rabies Prevention & Control, and Vector-Borne Disease team at the Realike Health Unit’s Environmental Health Department, has been notified by Public Health Ontario of a potential Lyme disease outbreak in the area. Lyme disease is a vector-borne disease caused by bites from blacklegged ticks, also known as deer ticks, that are infected with Borrelia burgdorferi bacteria. The disease was once mostly endemic to the United States, Europe, and parts of Asia. However, due to the uncertainty and negative impacts induced by climate change, the Realike region is now an endemic Lyme disease risk area. As per Ontario’s Emergency Management and Civil Protection Act, all municipalities should be prepared for emergencies such as disease outbreaks and, therefore should develop an emergency management program (Government of Ontario, 1990b). Further, the latest amendment of the Ontario Public Health Standards includes the addition of emergency management as one of the four foundational standards (MOHLTC, 2018a). This mandates that public health programs and services delivered by Ontario public health units incorporate all four of these foundational standards. The province’s public health standards state that emergency management plays a critical role in public health programming as it enables boards of health to ensure that they possess the capacity to respond to emerging and re-emerging threats within the community. Compliance with the standards also ensures that health units maintain adaptability and are resilient during times of high stress and in the presence of disruption. Currently, Ontario does not have any guidelines or emergency management plans for Lyme disease. Zachary must consider all elements of the problem and apply a systems-thinking approach to develop an efficient emergency preparedness plan for Lyme disease. This plan will provide a safe and healthy environment for the residents of the Realike region by ensuring that they are aware of the increased level of Lyme disease within the region

Ready-to-eat Meat Plant Characteristics Associated with Food Safety Deficiencies During Regulatory Compliance Audits, Ontario, Canada

Food safety deficiencies in ready-to-eat (RTE) meat processing plants can increase foodborne disease risks. The purpose of this study was to identify common deficiencies and factors related to improved food safety performance in RTE meat plants in Ontario. Routine food safety audit records for licensed provincial free-standing meat processing plants (FSMPs) and abattoirs that process RTE meats were obtained and analyzed in Ontario, Canada, from 2015 to 2019. A Bayesian regression analysis was conducted to examine the association between selected plant characteristics and two outcomes: overall audit rating (pass vs. conditional pass or fail) and individual audit item fail rate. The audit rating was examined in a logistic model, while the audit item fail rate was evaluated in a negative binomial model. The majority (87.7%, n = 800/912) of audits resulted in a pass rating (compared to conditional pass or fail). The mean number of employees per plant, among 200/204 plants with employee data available, was 11.6 (SD = 20.6, range = 1–200). For the logistic regression model, FSMPs were predicted to have a much higher probability of passing audits than abattoirs (32.0% on average, with a 95% credible interval [CI] of 13.8–52.8%). The number of plant employees, water source (municipal vs. private), and types of RTE meat products produced had little to no consistent association with this outcome. The negative binomial model predicted a −0.009 points lower fail rate, on average, for audit items among FSMPs than abattoirs (95% CI: −0.001, −0.018). Meat plants producing jerky had a higher audit item fail rate compared to those that did not produce such products. The other investigated variables had little to no association with this outcome. The results found in this study can support and guide future inspection, audit and outreach efforts to reduce foodborne illness risks associated with RTE meats

Food Safety & Characteristics of Meat Plants

Researchers identified key factors related to improved food safety performance in ready-to-eat meat plants in Ontario through an analysis of historical audit records from 2015 to 2019. </p

Global Health Impacts for Economic Models of Climate Change: A Systematic Review and Meta-Analysis

RATIONALE: Avoiding excess health damages attributable to climate change is a primary motivator for policy interventions to reduce greenhouse gas emissions. However, the health benefits of climate mitigation, as included in the policy assessment process, have been estimated without much input from health experts. OBJECTIVES: In accordance with recommendations from the National Academies in a 2017 report on approaches to update the social cost of greenhouse gases (SC-GHG), an expert panel of 26 health researchers and climate economists gathered for a virtual technical workshop in May 2021 to conduct a systematic review and meta-analysis and recommend improvements to the estimation of health impacts in economic-climate models. METHODS: Regionally-resolved effect estimates of unit increases in temperature on net all-cause mortality risk were generated through random-effects pooling of studies identified through a systematic review. RESULTS: Effect estimates, and associated uncertainties, varied by global region, but net increases in mortality risk associated with increased average annual temperatures (ranging from 0.1-1.1% per 1 degree C) was estimated for all global regions. Key recommendations for the development and utilization of health damage modules were provided by the expert panel, and include: not relying on individual methodologies in estimating health damages; incorporating a broader range of cause-specific mortality impacts; improving the climate parameters available in economic models; accounting for socio-economic trajectories and adaptation factors when estimating health damages; and carefully considering how air pollution impacts should be incorporated in economic-climate models. CONCLUSIONS: This work provides an example for how subject-matter experts can work alongside climate economists in making continued improvements to SC-GHG estimates

Global Health Impacts for Economic Models of Climate Change: A Systematic Review and Meta-Analysis.

Rationale: Avoiding excess health damages attributable to climate change is a primary motivator for policy interventions to reduce greenhouse gas emissions. However, the health benefits of climate mitigation, as included in the policy assessment process, have been estimated without much input from health experts. Objectives: In accordance with recommendations from the National Academies in a 2017 report on approaches to update the social cost of greenhouse gases (SC-GHG), an expert panel of 26 health researchers and climate economists gathered for a virtual technical workshop in May 2021 to conduct a systematic review and meta-analysis and recommend improvements to the estimation of health impacts in economic-climate models. Methods: Regionally resolved effect estimates of unit increases in temperature on net&nbsp;all-cause mortality risk were generated through random-effects pooling of studies identified through a systematic review. Results: Effect estimates and associated uncertainties varied by global region, but net increases in mortality risk associated with increased average annual temperatures (ranging from 0.1% to 1.1% per 1°C) were estimated for all global regions. Key recommendations for the development and utilization of health damage modules were provided by the expert panel and included the following: not relying on individual methodologies in estimating health damages; incorporating a broader range of cause-specific mortality impacts; improving the climate parameters available in economic models; accounting for socioeconomic trajectories and adaptation factors when estimating health damages; and carefully considering how air pollution impacts should be incorporated in economic-climate models. Conclusions: This work provides an example of how subject-matter experts can work alongside climate economists in making continued improvements to SC-GHG estimates