Board of Health
The full agenda, as filed
All 9 items in the clerk’s order. Each carries the city’s own words: the staff recommendation, what the body decided, and its status. Nothing below is written by us.
HL13.1amended
Election of Chair for 2020 - Board of Health
Election of the Chair of the Board of Health under Part H, Section 22, of the Board of Health Procedures By-law for a term of office ending December 31, 2020, and until a successor is appointed.
The Board of Health: 1. Elected Director Joe Cressy as Chair of the Board of Health for a term of office starting January 13, 2020 and ending December 31, 2020, and until a successor is appointed.
HL13.2amended
Election of Vice Chair for 2020 - Board of Health
Election of the Vice Chair of the Board of Health under Part H, Section 22, of the Board of Health Procedures By-law for a term of office ending December 31, 2020, and until a successor is appointed.
The Board of Health: 1. Elected Director Kristyn Wong-Tam as Vice Chair of the Board of Health for a term of office starting January 13, 2020 and ending December 31, 2020, and until a successor is appointed.
HL13.3adopted
Promoting and Ensuring Accountability at Toronto Public Health
This report responds to the Board of Health's request to report on the current audits that have been conducted at Toronto Public Health, including details on promoting and ensuring accountability.
The Board of Health: 1. Received the report (December 18, 2019) from the Medical Officer of Health for information.
Staff recommendation as filed
The Medical Officer of Health recommends that: 1. The Board of Health receive this report for information.
HL13.4adopted
2019: A-Year-in-Review of Toronto Public Health
As per the Ontario Public Health Standards on Accountability, this report satisfies the requirement for the Board of Health to publicly report on Toronto Public Health's (TPH) main accomplishments and programs provided to City of Toronto residents during 2019. It also reviews changes and opportunities that TPH has experienced in the broader public health system. Finally, it highlights some of the innovative strategies and program achievements, as well as TPH's key priorities for Toronto in 2020.
The Board of Health: 1. Received the report (December 19, 2019) from the Medical Officer of Health for information.
Staff recommendation as filed
The Medical Officer of Health recommends that: 1. The Board of Health receive this report for information.
HL13.5amended
Housing Approaches that Support Health
Housing is an important determinant of health that has complex and multi-faceted relationships to health and health equity. At the intersection of health and housing, several populations are particularly at risk, including seniors and people with mental health and/or substance use issues. Supportive housing that matches housing need with the service needs of vulnerable subgroups is a key consideration in addressing Toronto's housing challenges. For example, integrating a harm reduction approach across housing types is a critical component of the response to the opioid crisis. Making progress requires a cooperative, multi-sectoral approach and investments from all levels of government. Toronto Public Health strongly supports the efforts of the City of Toronto's Housing Secretariat to work across sectors and City divisions and agencies to provide a coordinated response to the range of housing needs for Toronto residents, as outlined in the HousingTO 2020-2030 Action Plan. This report responds to direction from the Board of Health and summarizes approaches from Toronto and other jurisdictions with a focus on actions that can support the health needs of vulnerable Toronto residents. Recommendations reinforce the need for federal and provincial funding to allow the City of Toronto to act on its commitment to increasing housing options for Torontonians, in particular, housing for vulnerable populations.
The Board of Health: 1. Expressed its support for the themes reflected in the HousingTO 2020-2030 Action Plan. 2. Urged the federal and provincial governments to increase funding to community-based organizations and health care providers to support tenants with substance use and/or mental health issues through the following services: case management, peer support, harm reduction (including overdose prevention and response), crisis support, withdrawal management and other drug treatment, mental health services, and supports for daily living. 3. Urged the federal and provincial governments to provide capital and ongoing operating funding to support the creation and delivery of 18,000 supportive housing units in the City of Toronto over the next 10 years. 4. Requested the Medical Officer of Health, in consultation with the Deputy City Manager, Community and Social Services, the General Manager, Shelter, Support and Housing Administration, and the Executive Director, Housing Secretariat, to report to the Board of Health at its meeting on April 20, 2020 with details on the City of Toronto's plan to create 600 new supportive housing units every year, starting in 2020. 5. Requested the Medical Officer of Health to provide ongoing consultation and feedback during the implementation of the HousingTO 2020-2030 Action Plan and the updated Housing Stability Service Planning Framework. 6. Requested the Medical Officer of Health to forward the report (December 19, 2019) from the Medical Officer of Health to the Executive Director, Housing Secretariat, for consideration in the implementation of the HousingTO 2020-2030 Action Plan. 7. Requested the Medical Officer of Health to forward the report (December 19, 2019) from the Medical Officer of Health to the General Manager, Shelter, Support and Housing Administration, for consideration as part of the updated Housing Stability Service Planning Framework.
Staff recommendation as filed
The Medical Officer of Health recommends that: 1. The Board of Health express its support for the themes reflected in the HousingTO 2020-2030 Action Plan. 2. The Board of Health urge the federal and provincial governments to increase funding to community-based organizations and health care providers to support tenants with substance use and/or mental health issues through the following services: case management, peer support, harm reduction (including overdose prevention and response), crisis support, withdrawal management and other drug treatment, mental health services, and supports for daily living. 3. The Board of Health urge the federal and provincial governments to provide capital and ongoing operating funding to support the creation and delivery of 18,000 supportive housing units in the City of Toronto over the next 10 years. 4. The Board of Health request the Medical Officer of Health to forward this report to the Executive Director, Housing Secretariat, for consideration in the implementation of the HousingTO 2020-2030 Action Plan. 5. The Board of Health request the Medical Officer of Health to forward this report to the General Manager, Shelter, Support and Housing Administration, for consideration as part of the updated Housing Stability Service Planning Framework. 6. The Board of Health request the Medical Officer of Health to provide ongoing consultation and feedback during the implementation of the HousingTO 2020-2030 Action Plan and the updated Housing Stability Service Planning Framework.
HL13.6amended
Ministry of Health's Consultation on Changes to Public Health in Ontario
In November 2019, the Ministry of Health launched a public consultation process to inform their efforts in modernizing public health. This consultation includes a request for input on specific key issues in public health that are outlined in the Public Health Modernization discussion paper. This report responds to a request from the Board of Health to provide an update on these consultations by the Ministry of Health and to provide information for consideration with respect to the recently-released Public Health Modernization discussion paper.
The Board of Health: 1. Reaffirmed and endorsed the following principles with respect to the changes to public health in Ontario: a. Integration with local municipalities: Maintaining an integrated relationship with municipalities, including the current model for the majority of Board of Health members to come directly from municipalities and for Chairs to be elected by Boards; b. Core funding model: Maintaining 100 percent provincial funding to support key health protection functions and maintaining the 75 percent/25 percent cost-sharing funding formula for other public health functions; and c. Support for the health protection, health promotion, and health equity mandates. 2. Requested the Chair to transmit the principles in Part 1 above to the Ministry of Health on behalf of the Board. 3. Reiterated its request for the Ministry of Health to meet specifically with the Toronto Board of Health and Toronto Public Health as part of the consultations on the changes to public health in Ontario.
Staff recommendation as filed
The Medical Officer of Health recommends that: 1. The Board of Health receive this report for information.
HL13.7amended
Mobile Dental Clinic Program - Three-Month Pilot of Alternate Service Delivery Model
The Mobile Dental Clinic (MDC) program has been in operation since August 2012. The objective of the program is to provide dental services to marginalized clients, in particular, individuals accessing services at City of Toronto-run shelters, employment centres, and newcomer centres. In order to operate the MDC, the vehicle requires the Commercial Vehicle Operator's Registration to be renewed by passing an inspection. On November 22, 2019, during a routine maintenance inspection of the vehicle, it was identified that the MDC needs considerable repairs due to rusting of the vehicle's framework. The MDC has been deemed inoperable until such time as the repairs are completed and the vehicle passes inspection. The inoperability of the MDC presents an opportunity for Toronto Public Health (TPH) to run a three-month pilot of an alternate service delivery model that will maintain the dental service for clients. Under this model, Street Outreach Workers would accompany MDC clients to a fixed address clinic through a designated visit. The model would also be designed to reduce dental anxiety, be convenient for the clients, and minimize the potential social stigma and the associated anxiety of sitting in waiting rooms with other clients. This approach would help allow TPH to test the effectiveness of these features while ensuring marginalized clients continue to receive dental services.
The Board of Health: 1. Authorized the Medical Officer of Health to undertake a three-month pilot of an alternate service delivery model for Toronto Public Health's Mobile Dental Clinic program, effective February 1, 2020, to prevent a disruption in dental services for marginalized clients. 2. Requested the Medical Officer of Health to report at the end of the three-month pilot of an alternate service delivery model for Toronto Public Health's Mobile Dental Clinic program in Part 1 above with: a. a review of its performance, including the demand for the service, client experience, treatments given, and the oral health status of clients; and b. information on any additional funds required to sustain the Mobile Dental Clinic program.
Staff recommendation as filed
The Medical Officer of Health recommends that: 1. The Board of Health authorize the Medical Officer of Health to undertake a three-month pilot of an alternate service delivery model for Toronto Public Health's Mobile Dental Clinic program, effective February 1, 2020, to prevent a disruption in dental services for marginalized clients.
HL13.8amended
In 2017, the Board of Health requested an independent study of the health impacts of air quality for passengers in the subway system, particularly in relation to mitigation measures that could be implemented. To understand the overall impact of the Toronto subway on the health of Torontonians, Toronto Public Health carried out a Health Impact Assessment, including a Human Health Risk Assessment of air quality. The Health Impact Assessment concluded that taking the subway is associated with benefits to people's health and wellbeing and is a health-supportive way to travel, especially as an alternative to personal vehicle use. Promoting the use of transit is important because it provides a safer alternative to driving, reduces outdoor air pollution and greenhouse gases, promotes physical activity, and provides access to employment, education, and social/community services. The Health Impact Assessment also identified that improving air quality in the Toronto subway system is expected to be associated with health benefits for passengers. Air quality data collected in the Toronto subway system shows that, as is the case for other similar subway systems, levels of fine particulate matter air pollution (PM2.5) are elevated and contain high levels of some metals. The Human Health Risk Assessment, which considered subway PM2.5 overall and individual metal components, concluded that levels of subway PM2.5 warrant mitigation, particularly on Line 2. Other cities with similar systems are also identifying elevated levels of subway PM2.5 and information has been gathered on mitigation options. While a high-level jurisdictional scan shows that Toronto is demonstrating leadership in addressing subway air quality, a continuous improvement approach should be adopted by the Toronto Transit Commission Board to ensure ongoing assessment and improvement of subway air pollution levels in Toronto. In combination with mitigation actions that can be undertaken in the short-term, developing, implementing, and funding medium- and long-term PM2.5 mitigation measures will improve air quality in the subway and further enhance the health promoting aspects of using public transit. Continued research and collaboration among health, science, transportation, and engineering agencies will fill knowledge gaps within the field of public transit. In particular, a deeper understanding about the relationship between subway PM2.5 and the health of passengers and identification of the most effective mitigation strategies are priority areas of study.
The Board of Health recommends that: 1. City Council request the Toronto Transit Commission Board to implement PM2.5 mitigation measures that can be delivered in the short-term, including actions related to employee awareness and training programs, state of good repair (materials, equipment, procurement, and procedures), and engineering reviews, as described in the report (December 19, 2019) from the Medical Officer of Health. 2. City Council request the Toronto Transit Commission Board to identify medium- and long-term mitigation measures, with a priority on Line 2, that can be implemented to further improve air quality in the Toronto Transit Commission subway system, as described in the report (December 19, 2019) from the Medical Officer of Health, including: a. reviewing operational systems and procedures, such as automatic train control, train frequency, and ventilation systems; b. reviewing procurement specification and deployment plans for replacement trains for future line modernization; c. including consideration of the potential improvements to air quality in the Toronto Transit Commission's study of platform edge doors; and d. monitoring levels of subway PM2.5 and evaluating the PM2.5 mitigation strategies that are implemented. 3. City Council request the Toronto Transit Commission Board to request the Toronto Transit Commission staff to report to City Council on opportunities for air quality improvement in the Toronto Transit Commission subway system, including a review of emerging information and technology. 4. City Council request the Toronto Transit Commission Board to identify funding requirements through future budget processes to develop and implement further PM2.5 mitigation measures. 5. City Council request Metrolinx to proactively address air quality in future initiatives through consideration of air quality in future station/system design or redesign projects as well as station construction or renovation/reconstruction projects.
Staff recommendation as filed
The Medical Officer of Health recommends that: 1. City Council request the Toronto Transit Commission Board to implement PM2.5 mitigation measures that can be delivered in the short-term, including actions related to employee awareness and training programs, state of good repair (materials, equipment, procurement, and procedures), and engineering reviews, as described in this report. 2. City Council request the Toronto Transit Commission Board to identify medium- and long-term mitigation measures that can be implemented to further improve air quality in the Toronto Transit Commission subway system, as described in this report, including: a. reviewing operational systems and procedures such as automatic train control, train frequency, and ventilation systems; b. reviewing procurement specification and deployment plans for replacement trains for future line modernization; c. including consideration of the potential improvements to air quality in the Toronto Transit Commission's study of platform edge doors; and d. monitoring levels of subway PM2.5 and evaluating the PM2.5 mitigation strategies that are implemented. 3. City Council request the Toronto Transit Commission Board to request the Toronto Transit Commission staff to report to City Council on opportunities for air quality improvement in the Toronto Transit Commission subway system, including a review of emerging information and technology. 4. City Council request the Toronto Transit Commission Board to identify funding requirements through future budget processes to develop and implement further PM2.5 mitigation measures. 5. City Council request Metrolinx to proactively address air quality in future initiatives through consideration of air quality in future station/system design or redesign projects as well as station construction or renovation/reconstruction projects. 6. The Board of Health encourage Health Canada to continue its research on air quality issues in the Toronto Transit Commission subway system. 7. The Board of Health encourage the Canadian Institutes of Health Research, the Natural Sciences and Engineering Research Council of Canada, the Medical Council of Canada, the Public Health Agency of Canada, and the Transportation Association of Canada to support research into the potential health impacts of exposure to subway particulate matter, with a view to informing subway air quality standards and best practices for supporting passenger health and improving subway air quality. 8. The Board of Health forward this report to the Ontario Ministry of Labour, Training and Skills Development for consideration in any future occupational health standards development. 9. The Board of Health forward this report to the Ontario Ministry of Health, the Ontario Ministry of the Environment, Conservation and Parks, and the Ontario Ministry of Transportation.
HL13.9adopted
Assessing the Impact of Expanded Gambling in Toronto
City Council formally approved expanded gambling at Casino Woodbine (formerly OLG Slots at Woodbine) over a year ago. The Board of Health raised concerns about the potential health impacts of this expansion and reiterated support for City Council's May 21, 2013 decision which opposed gambling expansion in Toronto. Gambling expansion has also occurred (or is planned to occur) in a number of municipalities in the Greater Toronto Area (GTA), including Ajax and Pickering. Residents remain concerned about the potential social and health impacts due to the rapid pace of expanded gambling in the GTA on our neighbours. The Board of Health and Toronto City Council must be sure we are prepared and able to respond to impacts of expanded and more accessible gambling venues across the GTA.
The Board of Health: 1. Requested the Medical Officer of Health, in collaboration with other public health units and relevant City divisions, to consult with the Centre for Addiction and Mental Health and other responsible gambling experts on the feasibility and related costs of using the existing tools to monitor the social and health impacts on Toronto residents due to the broader expansion of gambling in the Greater Toronto Area and to report to the Board of Health.
Staff recommendation as filed
Councillor Mike Layton recommends that: 1. The Board of Health request the Medical Officer of Health, in collaboration with other public health units and relevant City divisions, to consult with the Centre for Addiction and Mental Health and other responsible gambling experts, and to report on the feasibility and related costs of using the existing tools to monitor the social and health impacts on Toronto residents due to the broader expansion of gambling in the Greater Toronto Area.