Board of Health
The full agenda, as filed
All 7 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.
HL23.1amended
Response to COVID-19: Persevering Through Resurgence
On November 3, 2020, the Ontario Government, in consultation with the Chief Medical Officer of Health and other health experts, released the Keeping Ontario Safe and Open Framework . It ensures that public health measures are targeted, incremental and responsive to help limit the spread of COVID-19, while keeping schools and businesses open, maintaining health system capacity and protecting vulnerable people, including those in long-term care. An updated report on COVID-19 will be provided prior to the November 16, 2020 Board of Health meeting. This report will provide an update on the Province's new framework, highlight Toronto's COVID-19 activity, including vaccination campaigns, and highlight key research findings about mental health and COVID-19.
The Board of Health recommends that: 1. City Council call on the Federal and Provincial Governments to provide financial resources to support increased community outreach in high transmission neighbourhoods to support access to COVID-19 testing, the promotion of voluntary self-isolation facilities, and access to health and social services. 2. City Council urge the Federal and Provincial Governments to immediately accelerate the distribution, expand the reach, and make completely accessible and transparent all financial supports directed toward people, including populations that have been disproportionately impacted by COVID-19 such as women, racialized individuals, low-income individuals, and those living with disabilities. 3. City Council urge the Federal and Provincial Governments and the National Advisory Committee on Immunization to consider the following when promoting and distributing future approved COVID-19 vaccines: a. prioritizing populations so that vaccination has the greatest impact on disease burden and transmission at the time of the availability of the vaccine; b. this prioritization should include patient care staff to ensure that the health system remains available to respond to the needs of the population and those at highest risk of more serious complications of COVID-19 once infected; and c. early distribution based on the geographic burden of disease, including disadvantaged populations. 4. City Council call on the Provincial Government to urgently take all necessary steps, in coordination with the Government of Canada where appropriate, to ensure that supplies of the influenza vaccine are readily available, especially for vulnerable and priority populations. 5. City Council call on the Provincial Government to provide adequate paid sick days and income supports for those who need to isolate but cannot afford to do and for workers and businesses affected by public health restrictions. 6. City Council urge the Ontario Ministry of Health to undertake a comprehensive assessment of the impact of the pandemic on mental health and well-being to inform the need for additional supports or programs required to mitigate the associated harms. 7. City Council urge the Ontario Ministry of Health to ensure that flu vaccine promotion and distribution is targeted across Toronto, with a particular focus on those at higher risk such as racialized and low-income populations.
Staff recommendation as filed
The Medical Officer of Health recommends that: 1. The Board of Health receive this report for information.
HL23.2amended
Opioid Poisoning Crisis in Toronto - Update
The COVID-19 pandemic is worsening the opioid poisoning crisis in Toronto and across Canada. Multiple jurisdictions, including Toronto, have reported spikes in fatal and non-fatal overdoses during the pandemic, which may reflect changes in the unregulated drug supply, as well as service reductions and physical distancing requirements. While there has been a decrease in calls to Toronto Paramedic Services during the pandemic, there has been an overall increase in calls resulting in fatalities. Paramedic data reveals that 132 people died of suspected opioid overdoses between April 1 and September 30, 2020, a near doubling of deaths compared to a two-year average of 67 fatal suspected opioid overdoses for the same period in 2018/2019. July and September 2020 also both saw the highest monthly number of fatal calls (27) attended by paramedics since September 2017. This staff report provides an update on the opioid poisoning crisis and identifies key actions needed urgently to help address the crisis. Crucial to the response is an expansion of the safer supply of regulated drugs in order to provide an alternative to the increasingly toxic unregulated drug supply and the decriminalization of the simple possession of drugs for personal use. Increased access to lifesaving harm reduction, treatment and other services that protect and promote the health and well-being of people who use drugs is also needed, as are grief and trauma supports for people impacted by the opioid poisoning crisis.
The Board of Health: 1. Reiterated its call urging the Federal Minister of Health to use the authority under the Controlled Drugs and Substances Act to permit the simple possession of all drugs for personal use, the need for which has become critical as the opioid poisoning crisis continues to worsen during the COVID-19 pandemic and, further, to support the immediate scale up of prevention, harm reduction, and treatment services. 2. Urged the Federal Minister of Health to provide additional funding for longer-term safer supply programs, injectable medications, and other safer supply options, including for stimulants. 3. Reiterated its request urging the Provincial Minister of Health to: a. convene a multi-sectoral opioid overdose task force comprised of public health officials, community-based service providers, people with lived and living experience of drug use, and family members; b. support and fund the implementation of a spectrum of safer supply options, including listing high-dose injectable formulations of hydromorphone on the Ontario Drug Benefit Formulary; and c. dedicate funding for overdose-related grief and trauma supports for frontline workers, people who use drugs, and family members. 4. Urged the Provincial Minister of Health to: a. create and fund an Urgent Public Health Need Site (UPHNS) program for Ontario to facilitate the implementation of these lifesaving services in a variety of settings; b. provide funding to pilot and evaluate virtual and/or telephone-based supervised consumption services as well as in-person peer supervision in congregate or residential settings to complement the current service options; c. allocate some of the new treatment funding recently announced to evidence-based, on-demand treatment services in Toronto; and d. designate harm reduction and treatment services as essential services and provide funding to ensure that these services can effectively operate and meet the needs of people who use drugs during the COVID-19 pandemic. 5. Requested the Provincial Minister of Health to reinstate funding for the Overdose Prevention Sites operated by Street Health and St. Stephen's Community House given the urgent and ongoing need for these lifesaving health services. 6. Requested the Provincial Minister of Health to expand the criteria for naloxone distribution to allow service providers to administer naloxone to clients in their programs. 7. Requested the Provincial Minister of Health to collect and provide socio-demographic data, such as sexual orientation, Indigenous identity, race or ethnicity, and income status, on fatal and non-fatal overdoses in Toronto to better understand who is being impacted to inform overdose responses. 8. Urged the Health Professions Regulatory Advisory Council to review the regulatory changes in British Columbia, consult with current safer supply prescribers about the regulatory issues they are facing, and advise the Provincial Ministry of Health and the relevant regulatory colleges on how to address regulatory uncertainties to support the expansion of safer supply initiatives in Ontario. 9. Requested the Medical Officer of Health to report on the status of conversations with the City of Toronto, enforcement agencies, and the Federal and Provincial Governments on decriminalizing the simple possession of drugs for personal use. 10. Requested the Medical Officer of Health to work with the Executive Director, Social Development, Finance and Administration, to include the decriminalization of the simple possession of all drugs for personal use as a key plank in the City of Toronto's Community Safety and Wellbeing Plan in recognition of the differential and negative impacts that this criminal law has on equity-seeking groups in Toronto such as Black and Indigenous peoples. 11. Requested the Medical Officer of Health, in consultation with the General Manager, Shelter, Support and Housing Administration, to continue to work with community partners toward urgently expanding the overdose prevention response and other harm reduction measures in shelters. 12. Requested the Medical Officer of Health to work with community partners and City divisions on options to expand grief and trauma supports for people who use drugs, family members, and service providers who are impacted by the opioid poisoning crisis. 13. Directed that the report (November 5, 2020) from the Medical Officer of Health be forwarded for information and consideration to all Boards of Health in Ontario, the Council of Medical Officers of Health, the Urban Public Health Network, the Canadian Public Health Association, the Ontario Public Health Association, the Ontario Medical Association, the Registered Nurses' Association of Ontario, the Canadian Association of Chiefs of Police, the Ontario Association of Chiefs of Police, the Federation of Canadian Municipalities, and the Association of Municipalities of Ontario.
Staff recommendation as filed
The Medical Officer of Health recommends that: 1. The Board of Health reiterate its call urging the Federal Minister of Health to use the authority under the Controlled Drugs and Substances Act to permit the simple possession of all drugs for personal use, the need for which has become critical as the opioid poisoning crisis continues to worsen during the COVID-19 pandemic, and further, to support the immediate scale up of prevention, harm reduction, and treatment services. 2. The Board of Health urge the Federal Minister of Health to provide additional funding for longer-term safer supply programs, injectable medications, and other safer supply options, including for stimulants. 3. The Board of Health reiterate its request urging the Provincial Minister of Health to: a. convene a multi-sectoral opioid overdose task force comprised of public health officials, community-based service providers, people with lived and living experience of drug use, and family members; b. support and fund the implementation of a spectrum of safer supply options, including listing high- dose injectable formulations of hydromorphone on the Ontario Drug Benefit Formulary; and c. dedicate funding for overdose-related grief and trauma supports for frontline workers, people who use drugs, and family members. 4. The Board of Health urge the Provincial Minister of Health to: a. create and fund an Urgent Public Health Need Site (UPHNS) program for Ontario to facilitate the implementation of these lifesaving services in a variety of settings; b. provide funding to pilot and evaluate virtual and/or telephone-based supervised consumption services as well as in-person peer supervision in congregate or residential settings to complement the current service options; c. allocate some of the new treatment funding recently announced to evidence-based, on-demand treatment services in Toronto; and d. designate harm reduction and treatment services as essential services and provide funding to ensure that these services can effectively operate and meet the needs of people who use drugs during the COVID-19 pandemic. 5. The Board of Health request the Medical Officer of Health to work with the Executive Director, Social Development, Finance and Administration, to include the decriminalization of the simple possession of all drugs for personal use as a key plank in the City of Toronto's Community Safety and Wellbeing Plan in recognition of the differential and negative impacts that this criminal law has on equity-seeking groups in Toronto such as Black and Indigenous peoples. 6. The Board of Health urge the Health Professions Regulatory Advisory Council to review the regulatory changes in British Columbia, consult with current safer supply prescribers about the regulatory issues they are facing, and advise the Ministry of Health and the relevant regulatory colleges on how to address regulatory uncertainties to support the expansion of safer supply initiatives in Ontario. 7. The Board of Health forward this report for information and consideration to all Boards of Health in Ontario, the Council of Medical Officers of Health, the Urban Public Health Network, the Canadian Public Health Association, the Ontario Public Health Association, the Ontario Medical Association, the Registered Nurses' Association of Ontario, the Canadian Association of Chiefs of Police, the Ontario Association of Chiefs of Police, the Federation of Canadian Municipalities, and the Association of Municipalities of Ontario.
HL23.3amended
Toronto Public Health 2021 Operating Budget Request
This report outlines the Toronto Public Health (TPH) 2021 Operating Budget Submission for consideration by the Board of Health. TPH's 2021 Operating Budget Submission totals $344,596.4 thousand gross, $127,383.9 thousand net, and 2,486.3 positions. This submission is $64,173.5 thousand gross and $56,554.8 thousand net higher than the Restated 2020 Operating Budget. This submission also reflects an increase of 460.4 positions above the Restated 2020 Operating Budget. The increases to the 2021 Operating Budget Submission is predominately related to the additional staffing and resources for TPH's COVID-19 response to be funded by the Ministry of Health. The 2021 Operating Budget Submission includes 2020 in-year changes, 2021 base changes, pending Council approval, and a 2021 service enhancement as detailed in the recommendations included in this report.
The Board of Health recommends to the Budget Committee that: 1. City Council approve the Toronto Public Health 2021 Operating Budget Request of $344,596.4 thousand gross, $127,383.9 thousand net, and 2,486.3 positions, as summarized in Table 1, Overview of the Toronto Public Health 2021 Operating Budget Submission, in the report (November 5, 2020) from the Medical Officer of Health, which includes the following: a. an increase from the Toronto Public Health 2020 Operating Budget of $3,897.0 thousand gross and $0 net for the annualization of the COVID-19 Volunteer Isolation Centre funded 100 percent by the Public Health Agency of Canada; b. an increase from the Toronto Public Health 2020 Operating Budget of $1,818.3 thousand gross and $0 net for the annualization of School Focussed Nursing COVID-19 service enhancements funded 100 percent by the Ontario Ministry of Health; c. an increase from the Toronto Public Health 2020 Operating Budget of $57,580.1 thousand gross, $57,580.1 thousand net, and 467 positions for Toronto Public Health's COVID-19 response; d. an increase from the Toronto Public Health 2020 Operating Budget of $1,349.8 thousand gross and net and a decrease of 1.6 positions related to increases in 2021 salaries and benefits for Cost of Living Adjustments (COLA) for union staff members; e. an increase from the Toronto Public Health 2020 Operating Budget of $409.8 thousand gross and net for inflationary cost increases in the Student Nutrition Program; f. a decrease from the Toronto Public Health 2020 Operating Budget of $199.5 thousand gross and $0 net for the annualization of the Infant Hearing program funded 100 percent by the Ontario Ministry of Children, Community and Social Services; g. a decrease from the Toronto Public Health 2020 Operating Budget of $652.1 thousand gross, an increase of $319.2 thousand net, and a reduction of 5 positions for 2021 Administrative Adjustments; h. a decrease from the Toronto Public Health 2020 Operating Budget of $165.0 thousand gross and $0 net for the Supervised Injection Service funded by the Ontario Ministry of Health in 2020 on a one-time basis; i. an increase in revenue of $4,836.9 thousand from the Toronto Public Health 2020 Operating Budget to reflect the Ontario Ministry of Health's extended and increased one-time mitigation funding to December 31, 2021; j. a decrease in revenue from the Toronto Public Health 2020 Operating Budget of $1,461.0 thousand as a result of a reduction in the collection of user fees and other revenues due to COVID-19; k. a decrease in revenue from the Toronto Public Health 2020 Operating Budget of $136.6 thousand to reflect the Ontario Ministry of Health's grant capped at the forecast reported to the Ministry in the 2018 third-quarter financial report; and l. a new and enhanced service request of $135.1 thousand gross and net related to increased capacity for the Hassle Free Clinic. 2. City Council request the Ontario Ministry of Health to provide funding to reimburse the City of Toronto for all extraordinary costs incurred by Toronto Public Health in 2021 for additional staffing and resources for Toronto Public Health's COVID-19 response.
Staff recommendation as filed
The Medical Officer of Health recommends that: 1. The Board of Health request City Council to approve the Toronto Public Health 2021 Operating Budget Request of $344,596.4 thousand gross, $127,383.9 thousand net, and 2,486.3 positions, as summarized in Table 1, Overview of the Toronto Public Health 2021 Operating Budget Submission, which includes the following: a. an increase from the Toronto Public Health 2020 Operating Budget of $3,897.0 thousand gross and $0 net for the annualization of the COVID-19 Volunteer Isolation Centre funded 100 percent by the Public Health Agency of Canada; b. an increase from the Toronto Public Health 2020 Operating Budget of $1,818.3 thousand gross and $0 net for the annualization of School Focussed Nursing COVID-19 service enhancements funded 100 percent by the Ministry of Health; c. a decrease from the Toronto Public Health 2020 Operating Budget of $199.5 thousand gross and $0 net for the annualization of the Infant Hearing program funded 100 percent by the Ministry of Children, Community and Social Services; d. an increase from the Toronto Public Health 2020 Operating Budget of $57,580.1 thousand gross, $57,580.1 thousand net, and 467 positions for Toronto Public Health's COVID-19 response; e. a decrease in revenue from the Toronto Public Health 2020 Operating Budget of $1,461.0 thousand as a result of a reduction in the collection of user fees and other revenues due to COVID-19; f. a decrease from the Toronto Public Health 2020 Operating Budget of $652.1 thousand gross, an increase of $319.2 thousand net, and a reduction of 5 positions for 2021 Administrative Adjustments; g. a decrease in revenue from the Toronto Public Health 2020 Operating Budget of $136.6 thousand to reflect the Ministry of Health's grant capped at the forecast reported to the Ministry in the 2018 third-quarter financial report; h. an increase from the Toronto Public Health 2020 Operating Budget of $1,349.8 thousand gross and net and a decrease of 1.6 positions related to increases in 2021 salaries and benefits for Cost of Living Adjustments (COLA) for union staff members; i. an increase in revenue of $4,836.9 thousand from the Toronto Public Health 2020 Operating Budget to reflect the Ministry of Health's extended and increased one-time mitigation funding to December 31, 2021; j. a decrease from the Toronto Public Health 2020 Operating Budget of $165.0 thousand gross and $0 net for the Supervised Injection Service funded by the Ministry of Health in 2020 on a one-time basis; k. an increase from the Toronto Public Health 2020 Operating Budget of $409.8 thousand gross and net for inflationary cost increases in the Student Nutrition Program; and l. a new and enhanced service request of $135.1 thousand gross and net related to increased capacity for the Hassle Free Clinic. 2. The Board of Health request City Council to request the Ministry of Health to provide funding to reimburse the City of Toronto for all extraordinary costs incurred by Toronto Public Health in 2021 for additional staffing and resources for Toronto Public Health's COVID-19 response. 3. The Board of Health refer this report to the Budget Committee for consideration during the 2021 Budget process. 4. The Board of Health forward this report to the Ministry of Health.
HL23.4adopted
Toronto Public Health 2021-2030 Capital Budget and Plan Request
This report provides an overview of the Toronto Public Health 2021 Capital Budget and 2022-2030 Plan Request. Toronto Public Health is recommending a 2021-2030 Capital Budget and Plan of $31.792 million, including a 2021 Capital Budget of $3.065 million with future year commitments of $5.982 million and future year estimates of $22.745 million. This 10-Year Capital Budget and Plan Request will provide funding for eighteen projects.
The Board of Health recommends to the Budget Committee that: 1. City Council approve a 2021 Recommended Capital Budget for Toronto Public Health with a total project cost of $9.047 million, including a 2021 cash flow of $3.065 million and future year commitments of $5.982 million. 2. City Council approve the 2021-2030 Capital Plan for Toronto Public Health totalling $22.745 million in project estimates, comprised of $1.016 million in 2022, $2.060 million in 2023, $3.148 million in 2024, $4.415 million in 2025, $2.890 million in 2026, $3.425 million in 2027, $2.166 million in 2028, $2.006 million in 2029, and $1.619 million in 2030.
Staff recommendation as filed
The Medical Officer of Health recommends that: 1. The Board of Health request City Council to approve a 2021 Recommended Capital Budget for Toronto Public Health with a total project cost of $9.047 million, including a 2021 cash flow of $3.065 million and future year commitments of $5.982 million. 2. The Board of Health request City Council to approve the 2021-2030 Capital Plan for Toronto Public Health totalling $22.745 million in project estimates, comprised of $1.016 million in 2022, $2.060 million in 2023, $3.148 million in 2024, $4.415 million in 2025, $2.890 million in 2026, $3.425 million in 2027, $2.166 million in 2028, $2.006 million in 2029, and $1.619 million in 2030. 3. The Board of Health refer this report to the Budget Committee for consideration during the 2021 Budget process.
HL23.5adopted
Toronto Public Health Operating Budget Variance - Nine Months Ended September 2020
This report provides an update to the Board of Health on the Toronto Public Health (TPH) Operating Budget Variance for the nine months ended on September 30, 2020. As of September 30, 2020, in comparison to the 2020 Operating Budget approved by Council, TPH's net expenditure is over budget by $0.1 million net (0.2 percent). As of December 31, 2020, TPH is projecting that the Operating Budget will be over budget by $20.4 million net (28.8 percent) which is expected to be fully recovered from the Province.
The Board of Health: 1. Received the report (October 26, 2020) 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.
HL23.6adopted
Toronto Public Health Capital Budget Variance - Nine Months Ended September 2020
This report provides an update to the Board of Health on the Toronto Public Health Capital Budget Variance for the nine months ended on September 30, 2020. As of September 30, 2020, Toronto Public Health spent $1,119.7 thousand representing 18.0 percent of the 2020 Approved Capital Budget of $6,217.3 thousand. The majority of planned 2020 capital projects have been deferred as resources have been deployed to support Toronto Public Health's COVID-19 response.
The Board of Health: 1. Received the report (October 26, 2020) 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.
HL23.7adopted
2020 Board of Health Self-Evaluation
The Minister of Health publishes the Ontario Public Health Standards: Requirements for Programs, Services and Accountability as per Section 7 of the Health Protection and Promotion Act. The Standards identify the minimum expectations for public health programs and services to be delivered by Ontario's 34 boards of health. Boards of health are accountable for implementing the Standards, including the requirement to have a self-evaluation process of its governance practices and outcomes. This report contains the results of the self-evaluation of Toronto's Board of Health (BOH), conducted in February 2020. Overall, the BOH self-evaluation survey results were positive, including: - Verifying that there is strong governance on the BOH; - Highlighting effective relationships and informed decision-making; and - Identifying that the BOH is responsive to the immediate and long-term public health needs of the community. In addition to the positive results, some opportunities and next steps were identified, including: - Providing board members with learning opportunities regarding the BOH's contribution to governance and leadership as well as its legal liabilities; - Taking steps to improve board members' comfort in raising issues; - Providing board members with materials and presentations in advance and allocating more time for discussion at meetings; and - Facilitating more opportunities for board members to identify key priorities. Responding to the COVID-19 pandemic has refocussed the work of Toronto Public Health and the BOH. Given this significant change, this report recommends another self-evaluation of the BOH in 2021.
The Board of Health: 1. Requested the Medical Officer of Health to conduct the next Board of Health self-evaluation in 2021 and report by the end of 2021 with the results of the self-evaluation.
Staff recommendation as filed
The Medical Officer of Health recommends that: 1. The Board of Health request the Medical Officer of Health to conduct the next Board of Health self-evaluation in 2021 and report to the Board of Health by the end of 2021 with the results of the self-evaluation.