Public Health Regulations Quiz

Health Law - ENH 121 - Unit 9 - HPPA -1

• Course name: Health Law
• Unit number: 9
• Topic: HPPA -1
• Author: Daniel Huynh
• Year: 2024
• Source: Dr. Peter Strahlendorf's slides

Health Protection and Promotion Act

• Act name: Health Protection and Promotion Act
• Act reference: R.S.O. 1990, Chapter H.7 (Parts 1-3)
• Last revised: September 2023

Main Changes (2009, c.33)

• Amendment to the Chief Medical Officer of Health's powers regarding personal information and health information
• Clarification of when certain class orders are considered made under section 106
• Amendment to the Ministry of Health Appeal and Review Boards Act, 1998; renaming it to the Ministry of Health and Long-Term Care Appeal and Review Boards Act, 1998, and updating related acts correspondingly

Unit 9 - Contents

• History/Purpose/Scope of HPPA
• Health Units, Boards of Health, MOH, PHI Definitions
• HPPA Programs and Services
• Public Health Standards
• Community Health Protection (sections 13 Order/14 Direction, Duties, Seizure Power)

HPPA: History

• Formerly known as the "Public Health Act"
• Public Health Involvement in Occupational Health and Safety
• Nuisance vs. Health Hazard
• New HPPA passed in 1983
• Few amendments since then

HPPA: Structure

• Interpretation (Definitions)
• Health Programs and Services
• Community Health Protection
• Communicable Diseases
• Rights of Entry and Appeals from Orders
• Health Units and Boards of Health
• Administration
• Regulations
• Enforcement
• Transition

Purpose (Section 2)

• Organize and deliver public health programs and services
• Prevent the spread of disease
• Promote and protect the health of Ontarians

Purpose: Clarification

• Focuses on public health issues, not individual problems
• Issues must concern a significant portion of the public

Jurisdiction

• Public health is a multifaceted topic, with shared responsibility between federal and provincial governments
• Often, overlapping laws exist at both levels of government (e.g. food safety, water quality, quarantine)
• Paramountcy doctrine applies: Federal law overrides conflicting provincial law

Provincial Jurisdiction (Constitution Act, section 92)

• Municipal institutions
• Licenses for shops, taverns, etc
• Local works and undertakings
• Property and civil rights
• Matters purely local or private

Administrative Jurisdiction

• Ministry of Health and Long-Term Care: HPPA
• Ministry of Labour: OHSA
• Ministry of Environment and Climate Change: EPA, OWRA

What is Public Health: General Rule

• HPPA covers public places or parts of the public
• Overlaps with Ministry of Labour (MOL) when workers are involved
• Overlaps with Ministry of Environment (MOE) for hazards outside of built structures

Peculiarity

• OHSA inspectors are employees of MOL
• EPA inspectors are employees of the Ministry of Environment
• Public Health Inspectors, Local Medical Officers of Health, and Public Health Nurses are employees of local Boards of Health
• In Northern Ontario, Chief Medical Officers of Health are employees of MOHLTC

Boards of Health

• Southern Ontario is divided geographically into local health units
• Each local health unit has a board of health headed by a local Medical Officer of Health
• Jurisdictions are confined to their health unit, except for emergencies
• Guidance to boards of health in regards to health programs is provided by MOHLTC
• Boards structured by MOHLTC, MOH, Inspectors

Definitions (Part I)

• Board: Health Services Appeal and Review Board(under 1998 Ministry of Health Appeal and Review Boards Act)
• Board of Health: Regional municipalities of Durham, Halton, Niagara, Peel, Waterloo, York, and the County of Oxford, a single-tier municipality having the local board of health powers
• Chief Medical Officer of Health
• Communicable diseases: Specified diseases by regulation
• Disease of public health significance: Specified diseases by regulation
• Dwelling unit: Real property used as a home
• Food: Food or drink for human consumption, including ingredients
• Food premise: Premises where food or milk is processed, prepared, stored etc.
• Health hazard: Conditions, substances, plants/animals outside of a human affecting health

Definitions

• Further details on the definitions, including terms like "health unit," "mandatory," "medical officer of health," "milk," "minister," "municipality member," "obligated municipality," "occupier," "operator," "person," "personal service setting," "premises," "public health inspector," "public health nurse," "public health standard," "public pool," and "regulations."

Definitions (cont.)

• Reportable disease: Diseases specified by regulation as reportable
• Residential building: Structure containing one or more dwelling units
• Sanitary facilities: Rooms/spaces with toilets and washbasins.
• School: A private school or one as defined in the Education Act, and school board as defined in the Education Act.
• Sexually transmitted disease: Infections spread during sexual contact
• Small drinking water system: Small drinking water systems as specified by regulation

Diseases

• Disease of public health significance (formerly 'reportable disease')
• Communicable diseases
• Virulent diseases

HPPA: Diseases of Public Health Significance

• O.Reg. 432/01 (and amended to 135/18) outlines these diseases, specifically those detailed within Column 1 of the relevant table

Communicable Diseases

• Two related regulations cover all communicable diseases, including General Communicable Diseases regulation (R.R.O. 1990, Regulation 557, and most recent amendment O.Reg. 68/23, then further, Designation of Diseases - O. Reg. 135/18 with a recent amendment, O. Reg 171/23)

Communicable Diseases; Designation

• A disease set out in the designated column 1 of the referenced table's column is designated as a public health significance and (a) it is a communicable disease if identified in column 2 of the referenced table,
  (including further disease types that are communicable, with their status noted in the referenced table).

Virulent Diseases

• Diseases specifically designated as virulent by regulation.

Back to HPPA: Closing of Premises (section 13 subsections)

• Orders under this act require premise closure
• Shut down premises to halt entrance or access
• Halt any enterprise or activity on the premises
• Exceptions are specified in the order

Act Binds Crown

• This regulation has binding effect on the Crown.

Part II - Health Programs & Services

• Every board of health is required to provide the health programs and services prescribed by MOHLTC and Public Health Standards.
• Boards may develop additional programs contingent on needs within the unit.

Part III - Programs relevant to schools

• Immunization services, oral hygiene and fluoride treatment programs for children
• Preschool and school health care services
• Nutrition services and public health education programs.

Programs (Section 4 subsections)

• Every board oversees health programs and services
• Responsibilities include sanitation, maintaining hazards, and safe drinking water for the area's residents
• Additional duties as outlined in other regulations

Mandatory Programs & Services (Section 5)

• Community sanitation (safe drinking water by small drinking water systems)
• Infectious diseases and public health significance (immunization for children/adults)
• Health promotion, protection, and disease/injury prevention (cardiovascular disease, cancer, AIDS, etc.)
• Family health (counseling services, family planning services for high-risk groups like infants, pregnant women, and the elderly; preschool and school health services, including dental care; screening programs to reduce disease morbidity/mortality).
• Data collection on epidemiological data
• Additional health programs/services according to regulations

Part III - School Pupils (section 6)

• Boards of health provide regulated health programs/services to pupils
• Exemptions apply to schools that have already agreed to provide these services/programs.
• Regulations specify pupil classification according to services/programs.
• Further prohibitions on health program provision without board approval

MHLTC Public Health Standards (Section 7)

• Standards established by the minister are required for mandatory health program/service compliance by boards of health
• Public health standards are transmitted to health boards/accessible to the public in the Ministry
• Regulations override conflicting health standards
• Health standards can adopt codes, formulas, protocols, or procedures by reference (with necessary changes/modifications)
• Amendment of health standards goes into effect upon notice from the ministry to all boards of health

Extent of Programs & Services (Section 8)

• Boards of health are not required to provide/ensure services except for those specified by the regulation/public health standards.

Optional Programs & Services (Section 9)

• Boards of health may provide additional programs and services if approved and desired in accordance with the needs/desires of the community and by the municipality councils in the area

Part III - Community Health – Duty to Inspect (Section 10)

• Medical officer of health inspects conditions relevant to health risks in their health unit
• Includes responsibility for food premises, equipment, boarding, and lodging houses, food handling, restaurants/daycare centres etc
• Responsibility for food premises, equipment, inspection of boarding, lodging houses, etc, also included

Part III – Community Health: Complaint (Section 11)

• Reporting mechanisms when a complaint is filed about a health hazard in the health unit
• Ministry notification to determine if the hazard exists

Part III – Community Health - Report (Section 11 subsections):

• Reports on health hazards
• Exclusion of personal health information unless there's consent (under the Personal Health Information Protection Act).

Part III - Community Health – Conflict (Section 11 subsection):

• Prioritization of HPPA in case of conflicting issues with other legislation.

Duty of M.O.H. re occupational and environmental health (Section 12 subsections)

• Keeping informed about occupational and environmental health issues
• Obtaining info from related branches of government/municipalities regarding relevant risks to health.
• Authorizing to vary/establish interim requirements for small water systems if necessary.
• Restrictions on variation/establishment of interim requirements concerning risk to users

Section 13 Orders (including subsections 1, 2, 3):

• Medical officers of health and public health inspectors can issue written orders for actions regarding health hazards
• Specific criteria are required before issuing orders (probable grounds, need to diminish/eliminate the hazard, etc.)
• Timeframes in which the orders must be complied with are specified
• Contingent on health hazards (not breaches of regulation)
• Including specific actions that may be included in written orders

Section 14 Direction (including subsections 1, 2, 3, 4)

• Medical officer of health provides direction for health hazards to those who have agreed to cooperation in accordance to applicable guidelines (other staff, etc)
• Situations in which orders in section 13 are to be implemented

Recovery of Expenses by Action (Section 15 subsections)

• Recovery of expenses from owners/occupiers (including statements to the clerk, collection from taxes)

Duty - Food Premises (Section 16)

• Food premise operators' duties to maintain facilities according, including notice of intent requirement to the medical officer, and regulations for their employees.

General Duty – Food (Section 17)

• Selling unfit food is prohibited
• Not contingent on specific regulation

Unpasteurized or unsterilized milk (Sections 18(1), 18(2), 18(3), 18(4))

• Regulations regarding the sale of unpasteurized/unsterilized milk

Seizure Power (Section 19 subsections):

• Medical officer or public health inspector can seize substances causing health hazards.
• Further detailing of the process of examination, return of items if not hazardous, destruction of items if hazardous.

Facilities Required in Residential Buildings (Section 20)

• Owners of residential buildings must provide potable water and sanitary facilities for residents.

Test your knowledge on public health responsibilities, laws, and practices in Ontario. This quiz covers topics such as the Ministry of Health, Occupational Health and Safety Act, and jurisdiction of health units. Perfect for students and professionals in the field of health care and policy.