Promoting evidence-based food handler legislation in York region (February 2020)
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Learn more about how the Regional Municipality of York explored and implemented a bylaw in their region mandating food handler certification for food premises.
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Promoting evidence-based food handler legislation in York region (February 2020)
- 1. Peer-to-Peer Webinar: Success Stories in EIDM Featuring: Promoting evidence-based food handler legislation in York region Chetna Pandya & Caitlyn Paget February 26, 2020 1:00-2:00 PM EST Funded by the Public Health Agency of Canada | Affiliated with McMaster University Production of this presentation has been made possible through a financial contribution from the Public Health Agency of Canada. The views expressed here do not necessarily reflect the views of the Public Health Agency of Canada.
- 2. Housekeeping • Use Chat to post comments and/or questions during the webinar – ‘Send’ questions to All (not privately to ‘Host’) • Connection issues – Recommend using a wired Internet connection (vs. wireless), • WebEx 24/7 help line – 1-866-229-3239 2 Chat
- 3. After Today The PowerPoint presentation (in English and French) and English audio recording will be made available. These resources are available at: • PowerPoint: https://www.slideshare.net/NCCMT/presentations • Audio Recording: https://www.youtube.com/user/nccmt/videos 3
- 4. How many people are watching today’s session with you? A. Just me B. 1-3 C. 4-5 D. 6-10 E. >10 4 Poll Question #1
- 5. Have you visited the NCCMT website or used its resources before? A. Yes B. No 5 Poll Question #2
- 6. If you stated YES on the previous question, how many times have you used the NCCMT’s resources? A. Once B. 2-3 times C. 4-10 times D. 10+ times 6 Poll Question #3
- 7. 7
- 9. Registry of Methods and Tools Online Learning Opportunities WorkshopsMultimedia Public Health+ Networking and Outreach NCCMT Products and Services 9
- 10. The EIDM Casebook • Collection of stories in public health • Available at http://www.nccmt.ca/impact/ eidm-casebook 10
- 11. Presenters 11 Chetna Pandya Senior Public Health Inspector Caitlyn Paget Epidemiologist
- 12. YORK REGION CASEBOOK STORY NCCMT PEER-TO- PEER WEBINAR SERIES
- 13. What is Food Handler Certification (FHC) and why offer it? Mandates: The Ontario Public Health Standards (2014) and Food Safety Protocol (2013) Promote: that at least one certified food handler be present at the premises during all hours of operation for all high and moderate risk food premises Haines Report 2002
- 14. There is no I in Team – Various disciplines made up the team Multiple disciplines and stakeholders took part in undertaking the FHC bylaw. Food safety manager Epidemiologist Senior public health inspector (PHI) FHC committee Food owner/operators Health educators
- 15. Creation and implementation of a bylaw is a complex project, which can be broken down into multiple decision points. To pursue bylaw Bylaw criteria Unintended consequences Bylaw implementation Adapt to new regulations
- 16. Each decision was informed by the most relevant evidence; overall the project synthesized all types of information. Public Health Expertise Public Health Resources Community Health Issues, Local Context Community and Political Preferences and Actions Research Evidence
- 17. DECISION TO PERSUE A MANDATORY FHC BYLAW
- 18. Started by looking for all available evidence about the impact of FHC on food safety outcomes. Public Health Expertise Public Health Resources Community Health Issues, Local Context Community and Political Preferences and Actions Research Evidence
- 19. There was no conclusive best practice about mandatory FHC, based on the available research. Academic Literature: Systematic search No evidence available about a mandatory bylaw Three strong review articles about food safety training to improve knowledge and practices Grey Literature: Peel Public Health conducted a rapid review, concluding a lack of evidence NCCEH had an excellent summary of the evidence around inspection programs, not FHC Environmental Scan: 8 Ontario Public Health Units had mandatory bylaws No evaluations yet (bylaws were new)
- 20. A retrospective study of York Region inspection data was done to explore the local context of food handler certification. 2011-14 Compare available food safety outcomes. Categorize premises by food handler status. Summarize inspections for each premises. Extract four years of inspection data. Record FHC presence during inspections.
- 21. FHC was consistently associated with better food safety inspection outcomes, throughout the four years of data. % Premises with Enforcement Activities Assessed multiple types of inspection outcomes: Presence of infractions Average # of infractions Critical infractions Enforcement activities Due to small sample size, could not study food borne illness rates or outbreaks.
- 22. A limitation of the retrospective cross-sectional study design is that it cannot determine if there is a causal relationship. Although FHC is correlated with better food safety outcomes, we cannot conclude whether or not FHC is the cause. OUTCOME Food Safety Outcomes EXPOSURE Food Handler Certification CONFOUNDER ? Premises Culture ?
- 23. Mandatory food handler certification had strong support from both York Region residents and public health inspectors. 97% of York Region PHIs supported mandatory food handler certification. In 2015, surveyed our Public Health Inspectors (PHIs) to understand their perception of certification. 88% of York Region residents supported mandatory food handler certification. Estimated community support using 2014 Rapid Risk Factor Surveillance System (RRFSS) telephone survey.
- 25. The specific bylaw criteria were informed by looking at both our inspection evidence and bylaws from other jurisdictions. Public Health Expertise Public Health Resources Community Health Issues, Local Context Community and Political Preferences and Actions Research Evidence
- 26. During the four study period, infractions were less common at premises with a certified manager, and consistent presence. Premises with Infractions Premises with Critical Infractions Average # of Infractions Both certified manager and handler on staff. Certified staff present at all inspections. 20% 8% 1.7 Certified staff present at all inspections. 29% 15% 1.9 Both certified manager and handler on staff. 40% 16% 2.0 At least 1 certified staff member (in any role). 46% 19% 2.2 No certified staff. 49% 22% 2.2
- 27. Making the most of the eight bylaws – what criteria to use to best fit York Region’s needs, and our local evidence. Eight health units with variances in each of their bylaws Niagara and Toronto Public Health were the most stringent in their requirements Niagara best aligned with York Region Only high and moderate risk premises were to be impacted Transition period for implementation Brant Halton Hamilton Lambton Middlesex - London Niagara Peterborough Toronto
- 28. A Report to Council summarized the evidence and implications; the bylaw was enacted and passed on September 24, 2015. Link or navigate to: york.ca > About York Region > Bylaws
- 30. Bylaw implementation required coordination support for the community of food handlers and premises owner/operators. Public Health Expertise Public Health Resources Community Health Issues, Local Context Community and Political Preferences and Actions Research Evidence
- 31. Prior to bylaw implementation, the FHC program was enhanced based on consultations with food premises. Feedback from Food Premises Owners/Operators: Providing Selection in Course Modalities Workshops Online Self-Study Improving Scheduling Evenings Weekends
- 32. Phased in approach by food premises risk categorization, to focus resources where they would have the highest impact. Preparation 2014 and earlier - Assessing Evidence - FHC Enhancement 2015 - Report to council High Risk Premises 2016 (Year 1) - Education 2017 (Year 2) - Enforcement Moderate Risk Premises 2017 (Year 1) - Education 2018 (Year 2) - Enforcement
- 33. Targeted communication campaign with multiple components to inform and support food premises owners/operators. Stakeholder meetings with owner/operators to inform and for questions Emails, letters and postcards to all premises Local advertisements One-on-one education during inspections Reminders in advance of bylaw enforcement
- 34. Most high-risk premises were in compliance with the bylaw partway through 2016, with moderates following in 2017.
- 35. ADAPTING FHC
- 36. FHC was adapted for adults with intellectual disabilities, to support a vulnerable population as the bylaw impacted jobs. Public Health Expertise Public Health Resources Community Health Issues, Local Context Community and Political Preferences and Actions Research Evidence
- 37. By implementing a bylaw, was York Region creating an unintended consequence? HEIA is a flexible and practical assessment tool that can be used to identify and address potential unintended health impacts (positive or negative) of a policy, program, or initiative on specific population groups. NOTE: The HEIA Template is designed to be used alongside the accompanying HEIA Workbook, which provides definitions, examples, and more detailed instructions to help you complete this template. Date: Workgroup meetings: July 21, 2015, August 26, 2015, September 2, 2015, September 17, 2015 Organization: York Region Public Health Branch Contact: Becky Hester, Manager, Health Protection (905) 762-1282 x74689 becky.hester@york.ca Project Name: Adaptation of Food Handler’s Certification Training for Adults with Intellectual Disabilities • Health equity • Community interest • Accessible program • Meet population needs • Evidence from research
- 38. New team working together to pilot an adapted FHC program for York Region community partner Addition to team included public health nurses, health equity research specialist, community agencies, and the participants Engagement with community partners Consider different learning styles, meet Ministry requirements of food safety content and get participants certified
- 39. FHC AND NEW FOOD PREMISES REGULATION
- 40. Minimal impact from transitioning to the Regulation from the bylaw Bylaw advantage Bylaw not rescinded Communication and education provided on Regulatory requirement
- 41. THANK YOU
- 42. Share your story! • Are you using EIDM in your practice?We want to hear about it! – Email us: nccmt@mcmaster.ca • Need support for EIDM? Contact us for help! – Email us: nccmt@mcmaster.ca – We typically respond within 24 business hours 42
- 43. Your Comments / Questions • Use Chat to post comments and/or questions – ‘Send’ questions to All (not privately to ‘Host’) 43 Chat Participant Side Panel in WebEx
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- 45. Webinar Series from NCCMT http://www.nccmt.ca/capacity-development/webinars • Spotlight on Methods andTools • Topic-Specific Methods andTools • Online Journal Club • Peer-to-peerWebinars 45
- 46. Thank you! For more information about the NationalCollaborating Centre for Methods andTools: NCCMT website: www.nccmt.ca Contact: nccmt@mcmaster.ca 46 Funded by the Public Health Agency of Canada | Hosted by McMaster University Production of this presentation has been made possible through a financial contribution from the Public Health Agency of Canada. The views expressed here do not necessarily reflect the views of the Public Health Agency of Canada.
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- FYI: Presentation Guidelines 8 minutes + 2 minutes for discussion Max. 10 slides including introduction, conflict of interest and end slide
- NCCs are a unique structure in Canada – government-funded but apolitical Collective goal to improve the health of all Canadians by sharing knowledge, providing training, identifying gaps in knowledge and practice Each NCC focuses on a different theme in public health and hosted by different organization, but all national in scope At NCCMT we champion the use of evidence in public health decision making We help to compile the latest research and evidence for what is working in public health practice (e.g. Health Evidence) We work with practitioners to help develop more knowledge and skills for using different types of evidence when making decisions in their own work We support and help build confidence in the public health workforce so that practitioners know they are making informed decisions
- NCCMT offers a products and services to help apply research evidence in decision making This presentation today is going to provide an overview of the Online Learning Opportunities that NCCMT offers.
- 5 slide intro
- Requires health units to ensure food handlers in food premises have access to training in safe food-handling practices and principles The OPHS also requires that we promote certification In addition, Haines Report also recommended that the FPR adopt a mandatory FH training/certification Some background information on YR’s Food Handler Certification. Approximately 8 years ago, the Ministry standardized the food handler certification content based on a gold standard. From this, York Region took the new material and put a York Region flair on it. Minimum content was to be covered in the in person, or workshop, training: role of the board of health; public health legislation; food safety management principles (HACCP); safe handling, preparation and storage of food; food handler hygiene; food premises sanitation, design and maintenance; and prevention of food allergies, incidents and response. Working with the Ministry, a standardized 50 multiple choice exam was created, to ensure consistency amongst the province. Our FHC course trains people working or wanting to work in the food industry on how to safely prepare food. In 2018, we had more than 5000 participants go through the program. With language gaps and knowing the restaurant population, our manual has translated into Chinese and Tamil, in addition to having the Ministry’s French manual. With the Ministry French exam, we went one step further and translated our exams in Chinese, Farsi, Korean, Tamil and Russian. From staff resources, we were fortunate to provide Cantonese and Mandarin workshops on a yearly basis. This year with staff help, we held a Russian and Tamil workshop. We have also accommodated people by adding afternoon, evening exam session, weekend workshops and online learning modules, by using our online registration system and having our internal call centre, Access York register as well. Prior to the bylaw, York Region had been addressing a health equity gap with low income participants and those that are newcomers to the Region and partnering with agencies that service these areas by providing our course for free. Where those identified if there was a language barrier or required an accommodation (e.g., more time), our PHIs did their best to meet those needs. Requires health units to ensure food handlers in food premises have access to training in safe food-handling practices and principles The OPHS also requires that we promote certification Food premises Various means of learning Different languages for tests Availability to public Online registration Low-cost options
- Chetna to speak to this Our story is best told sequentially, talking about the different decisions throughout the larger project. For each decision, we considered different evidence to best suit the stage of the project…
- Caitlyn speaks to this This is a large project where we used a lot of different sources of evidence to inform our decisions. For this presentation, we’re using the NCCMT’s model for Evidence-Informed Decision Making, and we will return to this diagram repeatedly to talk about the balance of evidence for different stages of the project.
- 10 slides
- Community Health PHACTS study – study of inspection results Environmental scan at the time, Toronto had conducted an evaluation and that Hamilton was planning on doing one. After a period of adjustment when the bylaws were initially implemented, including communications and consultations with food premise operators and the public, the bylaws in these jurisdictions have been well received with minimal ongoing complaints. Many jurisdictions and operators have said these bylaws have been a positive change within the industry.
- [Blue = Research] Research bubble Lit search Conducted in 2013, where 3 strong systematic review articles were used These documents concluded that interventions such as inspections and food safety training may lead to improved knowledge and practices of FH; enhanced food safety knowledge and behaviour among FH. An environmental scan was conducted and found that eight health units were successful in implementing a mandatory FHC bylaw: Toronto, Halton, Hamilton, Niagara, Brant, Middlesex-London, Lambton, and Peterborough Each bylaw varied in requirements, but the goal was that food premises were to have a certified food handler at all times while in operation.
- [Lime = Community Health Issues, Local Context] Create a
- [Lime = Community Health Issues, Local Context] Our approach was to use the data that we had available. Different available outcomes Results were consistent!
- [Lime = Community Health Issues, Local Context] Correlation does not imply causation. A possible confounder is the culture of the food premises, as those that care for food safety would be more likely to Images: Images may be added to any body slide at the discretion of the creator Images should be high quality and in focus Images should bleed colour on all sides so that they do not appear to ‘float’ on the slide
- RRFSS It was lucky that that we had the right questions asked at the right time Very simple statistic, but also very powerful for our Report to Council to make the case for the bylaw.
- 5 slideds
- Research: The 8 health unit bylaws was used as a guide – choosing criteria that would be similar, yet meet the needs of YR Toronto and Niagara: At least one Certified FH is present at the Food Premises to supervise the processing, preparation , storage, handling, display, distribution, transportation, sale service, or offering for sale of food at all times during operation Niagara required that at a minimum, one operator and FH each have a valid certificate, where the FH would be onsite at all times of the operation. Toronto required that all owner/operators be certified Community and Political Preferences: Reviewed bylaws and deemed that YR was to use Niagara’s as a guide
- 10 slides
- Adapting our resources to support the implementation…
- #6035530 In tangent and anticipation of the bylaw, a telephone survey was conducted to operators that didn’t have a certified food handler at their inspection in 2013. Goal was to register them over the phone and if they said no, what was the barrier Location doesn’t work Time doesn’t work Too busy Already use safe food handling practices If the location didn’t work, operators preferred to have: Weekend workshops Evening workshops Morning, afternoon or evening exam sessions Online course Resources: Promotion was large part Once bylaw passed, stakeholder meetings were conducted in the various municipalities to answer questions about the bylaw and to provide guidance on the criteria and where to become certified Notification on our website, local newspaper, during PHI inspections, email and letters sent to all food premises Increased number of exam sessions and one-day workshops to accommodate the influx of those needing to be certified Afternoon and evening exam sessions offered at three of the five locations Weekend workshops offered at three of the five locations Online learning module created, making it easier for those that could not attend a one-day workshop Developed online registration – no need to call in Workshops offered in Cantonese and Mandarin – as resources were available Translated Ministry exams into multiple languages – top four languages spoken in York Region: Chinese, Tamil, Russian and Farsi. Chinese and Tamil were identified as top 2 languages spoken in restaurants
- Community and Political Focus was to have high risk premises certified first (NEED TO EXPLAIN WHAT HIGH RISK MEANS!!! FIRST time mentioning high/mod in the slides.) 2016, year 1 was education 2017, year 2 was enforcement Moderate risk premises had an additional year of education as there were more of these premises in the Region 2016-2017 was education 2018 was enforcement Focus was on high and moderate risk food premises as they are more likely to have a foodborne illness, compared to a low risk food premises. Risk is determined on the MOHLTC’s risk categorization, based on profile and performance factors The Operational Approaches for Food Safety Guideline, 2019 details what the risk categorization is. The purpose of Ontario’s risk categorization of food premises approach is to prevent or reduce food-borne illness attributed to food premises. Food premises do not all present the same potential risk of causing food-borne illness, so a standard approach to risk categorization (high, moderate, or low) is necessary so PHIs can appropriately focus on premises that pose the highest levels of risk. Levels of risk are attributable to a number of factors including: • Profile factors such as those that consider the type of operation, population served, and the complexity and extent of food handling; and • Performance factors such as those that are attributable to the operators’ performance and commitment to food safety practices (i.e., compliance with regulations, commitment to training of food handlers, and the extent to which they incorporate food safety plans into their operations). It is important to note that being a high risk premises does not necessarily mean it is a bad place to eat, it just means that there are factors that are weighted more. When in doubt check out the disclosure website for a recent inspection.
- Resources: Promotion was large part Once bylaw passed, stakeholder meetings were conducted in the various municipalities to answer questions about the bylaw and to provide guidance on the criteria and where to become certified Notification on our website, local newspaper, during PHI inspections, email and letters sent to all food premises Increased number of exam sessions and one-day workshops to accommodate the influx of those needing to be certified Afternoon and evening exam sessions offered at three of the five locations Weekend workshops offered at three of the five locations Online learning module created, making it easier for those that could not attend a one-day workshop Developed online registration – no need to call in Workshops offered in Cantonese and Mandarin – as resources were available Translated Ministry exams into multiple languages – top four languages spoken in York Region: Chinese, Tamil, Russian and Farsi. Chinese and Tamil were identified as top 2 languages spoken in restaurants
- Chetna only allowed 5 slides including title
- YR had an internal health equity team of nurses looking to work with other departments to apply the HEIA tool Interest from community partner to adapt FHC for those with ID arose simultaneously as YR went towards the bylaw Going for a bylaw would hinder those looking for employment in the food industry Research: A lit search found working gave individuals a sense of community and able to provide financially Health equity impact assessment (HEIA) tool was applied to this project, which assisted in our decision to go ahead with adaptation Community Health Issues We were approached by a few not-for-profit groups asking if we had an adapted program Great opportunity to do a pilot project and work with our external partners on this venture Community & Political FHC was already providing the workshop for free to new comers and low income individuals, exams translated into many languages Logical step was to provide program to those with ID Resources Did we have what it took to adapt the program when not have worked with this population
- public health nurses (PHNs) that specialize in the social determinants of health in the Health Equity Program an evaluation specialist and a health equity research specialist, Dr. Ingrid Tyler from Public Health Ontario Worked with community partner to better understand need of group – some could not read, write or have ever written a test Needed to incorporate different learning styles Taking a one day WS and breaking into smaller learning modules – feedback from participant More interaction Different ways to do a test and not calling it that Using clickers to obtain answers for the exam Additional staff resources from public health and the community partner Needed to ensure needs of the group were being met and still meet the Ministry requirements (Guidance Document for the Provincial Food Handler Training Plan) in providing the minimum required content for food safety We knew there was a gap for those with disabilities, specifically intellectual disabilities, wanting to do our course, but the struggle was how to accommodate them in our workshop and ensure that they could pass the exam. This was all set up in preparation for when the bylaw passed. Have worked with high schools, as it was easier to incorporate our program into their school day and schools could see the benefit. Each group is unique and the program is modified to meet each one No on shoe fits all I personally met one of the original participants working at a McDonald’s booth at a SE.
- Chetna only allowed 5 slides including title
- As Bylaw was implemented in 2015, YR had a head start and the majority of our premises had a CFH, therefore it was a relative smooth transition YR bylaw is more stringent that the Reg and was not rescinded Can still issue a ticket under the bylaw if needed Other health units are not planning on rescinding their bylaws Additional communication was sent to our operators, educating on the Reg requirements Email, letters, by PHIs during inspection Every operator of a food service premise shall ensure that there is at least one food handler or supervisor on the premise who has completed food handler training during every hour in which the premise is operating. Changes: Not based on risk of a premises, but definition of a food service premises any food premise where meals or meal portions are prepared for immediate consumption or sold or served in a form that will permit immediate consumption on the premises or elsewhere Education on this was required as some premises under the bylaw did not require a CFH, now did under the Regulation