a local health unit approach to improving health outcomes ...paul callanan & monali varia peel...
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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
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