Board of Health
The full agenda, as filed
All 6 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.
HL29.1amended
Response to COVID-19 - June 2021 Update
The COVID-19 pandemic continues to have a significant impact on our city, with variants of concern requiring continued public health measures to decrease the risk of transmission and the risk of serious illness or death. While COVID-19 cases and hospitalization rates are trending downward, it is imperative that all people in Toronto adhere to the recommended public health measures and draw on lessons learned in waves 1, 2, and 3 of the COVID-19 pandemic. The City's vaccination campaign throughout the month of May has continued to be a critical strategy to mitigate the COVID-19 pandemic. In particular, the expansion of pop-up and mobile vaccine clinics has been especially successful in facilitating vaccine delivery and ensuring those at greatest risk have access to vaccines. This report provides an update on the Toronto Public Health response to the COVID-19 pandemic, in partnership with City divisions, health system partners, and community stakeholders. In addition, this report includes an update on COVID-19 equity indicators, as requested by the Board of Health in October 2020, and an overview of the status and trends in workplace COVID-19 outbreaks, as directed by the Board of Health in January 2021.
The Board of Health recommends that: 1. City Council acknowledge and thank the Black Scientists' Task Force on Vaccine Equity for their work and report and: a. fully support the recommendations in the report from the Black Scientists' Task Force on Vaccine Equity; b. request the City Manager, in consultation with the Medical Officer of Health, to advance the recommendations in the report from the Black Scientists' Task Force on Vaccine Equity; c. request the City Manager, in consultation with the Medical Officer of Health, to report to the Board of Health in the fourth quarter of 2021 on the status of each recommendation in the report from the Black Scientists' Task Force on Vaccine Equity, including actions by the Federal, Provincial and Municipal Governments; d. request the Executive Director, Social Development, Finance and Administration, in consultation with the Medical Officer of Health, to use the report from the Black Scientists' Task Force on Vaccine Equity to inform the ongoing development of the Toronto Black Health Plan; and e. direct that the report (May 31, 2021) from the Medical Officer of Health, including the report from the Black Scientists' Task Force on Vaccine Equity, be forwarded to Toronto Members of Parliament and Members of Provincial Parliament, the Prime Minister of Canada, the Premier of Ontario, the Federal and Provincial Ministers of Health and all Boards of Health in Ontario.
Staff recommendation as filed
The Medical Officer of Health recommends that: 1. The Board of Health request the Ontario Ministry of Health, as it implements the COVID-19 Roadmap to Reopen, to continue working closely with local Public Health Units and to proceed with caution given the learnings that other jurisdictions have had with reopening and emerging evidence on variants of concern.
HL29.2amended
Toronto Overdose Action Plan: Status Report 2021
The opioid crisis in Toronto continues to intensify during the COVID-19 pandemic - a record number of overdose deaths have occurred. This may be due to the unintended consequences of the measures required to mitigate the spread of COVID-19 resulting in service reductions, and changes to the increasingly toxic unregulated drug supply. In Toronto, deaths involving all substances, including opioids, have increased to record highs. There was a 71 percent increase in suspected drug-related overdoses and a 78 percent increase in the number of confirmed opioid toxicity deaths in Toronto in 2020 compared to 2019. These alarming increases are unprecedented. Fatal suspected opioid overdose calls attended by paramedics have also increased to record highs. In the first three months of 2021, paramedics responded to 1,173 suspected opioid overdose calls, including 93 calls involving death; this is a 102 percent increase in calls involving death compared to the first three months of 2020. In January 2021, paramedics responded to the highest number of fatal suspected opioid overdose calls (38 deaths) ever recorded in Toronto. On May 5th, paramedics responded to the highest number of fatal suspected opioid overdose calls (5 deaths) in one day ever recorded in Toronto. Across Ontario, the number of opioid-related deaths among people experiencing homelessness more than doubled during the COVID-19 pandemic in 2020 compared to before the COVID-19 pandemic. The increased involvement of stimulants alongside opioids directly contributing to the cause of death in overdoses in Toronto means that what we are facing goes beyond an opioid poisoning crisis and is now most accurately described as a drug poisoning crisis. The drug poisoning crisis is also reflected in results from Toronto's drug checking services, which continue to identify larger quantities of unexpected substances of concern in the unregulated drug supply. This staff report highlights actions taken to implement the Toronto Overdose Action Plan (TOAP) since the last status report, and makes recommendations for actions that are urgently needed to mitigate the harms from drugs that are worsening during the COVID-19 pandemic. While some actions have been taken to respond to the drug poisoning crisis, they have not stemmed the tide of the crisis; the situation remains urgent and continues to worsen. There is much more to do in order to respond effectively to this crisis, including the decriminalization of the possession of all drugs for personal use, scaling up overdose prevention and harm reduction, and supporting the expansion of treatment services.
The Board of Health: 1. Recognized the drug poisoning crisis as a public health crisis in the City of Toronto and committed to supporting the actions that are urgently needed to respond to the crisis and stem the tide of overdose deaths. 2. Urged the Federal and Provincial Governments to provide a long-term financial commitment to assist the City of Toronto in creating and operating more affordable and supportive homes for people in need, including people who use drugs. 3. Reiterated its call urging the Federal Minister of Health to: a. use the authority under the Controlled Drugs and Substances Act to permit the simple possession of all drugs for personal use, and further, to support the immediate scale up of prevention, harm reduction and treatment services; and b. support evidence-based knowledge exchange and the development of innovative responses to reducing the harms of stimulant use. 4. Urged the Federal Minister of Health to: a. declare the drug poisoning crisis to be a national public health emergency and develop a coordinated Canada-wide plan; and b. support the domestic production of diacetylmorphine to increase the accessibility of this medication and build on previous support provided that promotes the scale up of safer supply programs to meet the needs of people at high risk of overdose in Toronto. 5. Reiterated its requests urging the Provincial Minister of Health to: a. recognize the urgency of the drug poisoning crisis and the critical need to scale up actions in response by convening a multi-sectoral 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. remove the current cap of 21 Consumption and Treatment Services permitted in Ontario; c. 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; d. create and fund an Urgent Public Health Need Site program for Ontario to facilitate the implementation of these lifesaving services in a variety of settings; e. increase the availability of services for people using methamphetamine and other stimulants and fund enhanced training for service providers on supporting people who use stimulants alone or with other drugs; f. support and fund the implementation of a spectrum of safer supply options, including listing injectable opioid agonist treatment (iOAT) medication on the Ontario Drug Benefit Formulary; and g. provide consistent and ongoing funding for grief and trauma supports for frontline workers responding to the drug poisoning crisis, people who use drugs and family members. 6. Urged the Provincial Minister of Health to: a. expand funding for supervised consumption and other harm reduction services to better address the needs of specific groups (such as Black, Indigenous and People of Colour, Lesbian, Gay, Bisexual, Transgender, Queer or Questioning, Two-Spirit, etc. communities), expand services across Toronto, support the provision of supervised inhalation and smoking services and allow for consumption services to remain open for longer hours; b. improve employment standards for frontline harm reduction workers, including adequate pay and benefits coverage, by increasing funding for supervised consumption and other harm reduction services; c. expand funding for harm reduction services urgently needed to stem the tide of increasing overdose deaths in the shelter system; d. fund longer-term implementation of vital drug checking services and provide additional funding to create more locations in diverse settings to meet local needs; e. fund proposals that include a system-level approach to addressing the drug poisoning crisis across the continuum of health care in Toronto to increase the capacity of several organizations that are part of the Toronto Academic Health Science Network/Toronto Public Health Opioid Task Force to offer expanded harm reduction and treatment services that respond to the intensifying crisis; f. expand funding for evidence-based harm reduction, including supervised consumption services, treatment and social support services that meet the needs of women, gender-diverse people and parents who use substances; and g. fund a comprehensive Substance Use Crisis Centre in Toronto. 7. Requested the Medical Officer of Health to convene a meeting with construction sector stakeholders, including the Ontario Construction Consortium and the Carpenters' District Council of Ontario, and the Chair, Toronto Board of Health, to discuss opioid use and overdoses among construction workers and how Toronto Public Health's comprehensive Toronto Overdose Action Plan can assist in addressing these issues and to report to the Board of Health in the fall of 2021 on the outcomes and further recommendations. 8. Requested the Medical Officer of Health, in consultation with the Executive Director, Social Development, Finance and Administration and other relevant City divisions, to convene a working group to develop a health- and social equity-based alternative approach to criminal sanctions for the possession of all drugs for personal use within the city environs, as a step towards requesting an exemption under the Controlled Drugs and Substances Act, with such working group to be comprised of the following: a. people with lived and living experience of drug use and family members; b. community-based service providers, including Black- and Indigenous-led agencies; c. relevant City divisions and agencies, including law enforcement; and d. policy and research experts in relevant areas, including substance use, human rights and mental health. 9. Requested the Medical Officer of Health, in consultation with the General Manager, Shelter, Support and Housing Administration, to continue to work toward urgently expanding the overdose prevention response and other harm reduction measures in shelters.
Staff recommendation as filed
The Medical Officer of Health recommends that: 1. The Board of Health recognize the drug poisoning crisis as a public health crisis in the City of Toronto and commit to supporting the actions that are urgently needed to respond to the crisis and stem the tide of overdose deaths. 2. The Board of Health request the Medical Officer of Health, in consultation with the Executive Director, Social Development, Finance and Administration and other relevant City divisions, to convene a working group to develop a health- and social equity-based alternative approach to criminal sanctions for the possession of all drugs for personal use within the city environs, as a step towards requesting an exemption under the Controlled Drugs and Substances Act, with such working group to be comprised of the following: a. people with lived and living experience of drug use and family members; b. community-based service providers, including Black- and Indigenous-led agencies; c. relevant City divisions and agencies, including law enforcement; and d. policy and research experts in relevant areas, including substance use, human rights, and mental health. 3. The Board of Health reiterate its call urging the Federal Minister of Health to: a. use the authority under the Controlled Drugs and Substances Act to permit the simple possession of all drugs for personal use, and further, to support the immediate scale up of prevention, harm reduction, and treatment services; and b. support evidence-based knowledge exchange and the development of innovative responses to reducing the harms of stimulant use. 4. The Board of Health urge the Federal Minister of Health to: a. declare the drug poisoning crisis to be a national public health emergency and develop a coordinated Canada-wide plan; and b. support the domestic production of diacetylmorphine to increase the accessibility of this medication and build on previous support provided that promotes the scale up of safer supply programs to meet the needs of people at high risk of overdose in Toronto. 5. The Board of Health reiterate its requests urging the Provincial Minister of Health to: a. recognize the urgency of the drug poisoning crisis and the critical need to scale up actions in response by convening a multi-sectoral 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. remove the current cap of 21 Consumption and Treatment Services permitted in Ontario; c. 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; d. create and fund an Urgent Public Health Need Site program for Ontario to facilitate the implementation of these lifesaving services in a variety of settings; e. increase the availability of services for people using methamphetamine and other stimulants and fund enhanced training for service providers on supporting people who use stimulants alone or with other drugs; f. support and fund the implementation of a spectrum of safer supply options, including listing injectable opioid agonist treatment (iOAT) medication on the Ontario Drug Benefit Formulary; and g. provide consistent and ongoing funding for grief and trauma supports for frontline workers responding to the drug poisoning crisis, people who use drugs, and family members. 6. The Board of Health urge the Provincial Minister of Health to: a. expand funding for supervised consumption and other harm reduction services to better address the needs of specific groups (such as Black, Indigenous and People of Colour, Lesbian, Gay, Bisexual, Transgender, Queer or Questioning, Two-Spirit, etc. communities), expand services across Toronto, support the provision of supervised inhalation and smoking services, and allow for consumption services to remain open for longer hours; b. improve employment standards for frontline harm reduction workers, including adequate pay and benefits coverage, by increasing funding for supervised consumption and other harm reduction services; c. expand funding for harm reduction services urgently needed to stem the tide of increasing overdose deaths in the shelter system; d. fund longer-term implementation of vital drug checking services and provide additional funding to create more locations in diverse settings to meet local needs; e. fund proposals that include a system-level approach to addressing the drug poisoning crisis across the continuum of health care in Toronto to increase the capacity of several organizations that are part of the Toronto Academic Health Science Network/Toronto Public Health Opioid Task Force to offer expanded harm reduction and treatment services that respond to the intensifying crisis; f. expand funding for evidence-based harm reduction, including supervised consumption services, treatment, and social support services that meet the needs of women, gender-diverse people, and parents who use substances; and g. fund a comprehensive Substance Use Crisis Centre in Toronto. 7. The Board of Health urge the Federal and Provincial Governments to provide a long-term financial commitment to assist the City of Toronto in creating and operating more affordable and supportive homes for people in need, including people who use drugs.
HL29.3adopted
2021 Toronto Urban Health Fund Allocations and Review Process
This report outlines the funding priorities, application review process, and funding allocation recommendations for the 2021 Toronto Urban Health Fund (TUHF). The TUHF provides funding for community-based non-profit organizations to deliver some of these programs and services because they build individual and community capacity to support HIV prevention, harm reduction, and child and youth resiliency. Based on the recommendations from the 2021 TUHF Review Panel and the TUHF Indigenous Review Panel, this report recommends a total allocation of $557,725 for eight one-year projects in 2021. This consists of $518,243 for seven one-year mainstream projects and $39,482 for one Indigenous one-year project. This report also recommends a total allocation of $2,786,318 for second-year funding for 39 projects the Board of Health approved in 2020. The recommended combined total allocation of $3,344,043 for eight one-year projects and 39 three-year projects is to be used between July 1, 2021 and June 30, 2022. Recommended projects focus on HIV prevention through sexual transmission, harm reduction, child and youth resiliency, and Indigenous health promotion.
The Board of Health: 1. Authorized the Medical Officer of Health to allocate $557,725 from the 2021 Approved Operating Budget for Toronto Public Health for eight one-year projects, as outlined in Tables 1 and 2 and Attachment 2 to the report (June 3, 2021) from the Medical Officer of Health. 2. Authorized the Medical Officer of Health to allocate $2,786,318 from the 2021 Approved Operating Budget for Toronto Public Health to carry out second-year activities for 39 three-year projects, as outlined in Tables 1 and 2 and Attachment 2 to the report (June 3, 2021) from the Medical Officer of Health. 3. Authorized the Medical Officer of Health to execute Funding Agreements with the approved applicants in Parts 1 and 2 above.
Staff recommendation as filed
The Medical Officer of Health recommends that: 1. The Board of Health authorize the Medical Officer of Health to allocate $557,725 from the 2021 Approved Operating Budget for Toronto Public Health for eight one-year projects, as outlined in Tables 1 and 2 and Attachment 2 to this report. 2. The Board of Health authorize the Medical Officer of Health to allocate $2,786,318 from the 2021 Approved Operating Budget for Toronto Public Health to carry out second-year activities for 39 three-year projects, as outlined in Tables 1 and 2 and Attachment 2 to this report. 3. The Board of Health authorize the Medical Officer of Health to execute Funding Agreements with the approved applicants in Recommendations 1 and 2 above.
HL29.4adopted
2021 Board of Health Procedures By-law Review
The Ontario Public Health Organizational Standards: Requirements for Programs, Services, and Accountability (Standards) requires that local boards of health review and revise their by-laws, policies, and procedures as necessary, and at least every two years. The Board of Health Procedures By-law was reviewed most recently in 2018, with the adoption of a new Procedures By-law in February 2019. This report recommends that the Board of Health Procedures By-law review begin in the fall of 2021 with a final report in January 2022. As part of this review, staff will be soliciting feedback from directors of the Board of Health. Pending adoption of the recommendation in this report, Board directors will be contacted in the fall of 2021, inviting each director to provide their ideas and/or proposed by-law amendments.
The Board of Health: 1. Directed the Medical Officer of Health, in consultation with the City Clerk, the City Solicitor, and the Board of Health, to review the Board of Health Procedures By-law and to report on any proposed amendments in January 2022.
Staff recommendation as filed
The Medical Officer of Health recommends that: 1. The Board of Health direct the Medical Officer of Health, in consultation with the City Clerk, the City Solicitor, and the Board of Health, to review the Board of Health Procedures By-law and to report on any proposed amendments in January 2022.
HL29.5adopted
Service Agreements Awarded and Executed by the Medical Officer of Health for 2021
The purpose of this report is to provide information on the purchase of service contracts awarded and executed by the Medical Officer of Health for 2021, according to the delegation of authority by City Council. This report also requests approval for the Medical Officer of Health to award, execute and amend, on an ongoing basis, a purchase of service contract with Parkdale Activity Recreation Centre (PARC) to support the service delivery of the Creating Health Plus Program. The Creating Health Plus (CHP) Program is a partnership program between Shelter, Support and Housing Administration, North York Harvest Food Bank, PARC, and Toronto Public Health in response to research that identified nutritional gaps in meals served at Toronto drop-ins. This program serves the City's most vulnerable people, many of whom are homeless or under-housed, have mental health or substance use issues and/or are street involved. Creating Health Plus provides regular and reliable access to five fresh foods at Toronto drop-ins on a weekly basis, including fruits, vegetables, milk, yoghurt and eggs.
The Board of Health recommends that: 1. City Council authorize the Medical Officer of Health to award, execute and amend, on an ongoing basis, a purchase of service contract for the Creating Health Plus Program with Parkdale Activity Recreation Centre, in a form approved by the City Solicitor.
Staff recommendation as filed
The Medical Officer of Health recommends that: 1. City Council authorize the Medical Officer of Health to award, execute and amend, on an ongoing basis, a purchase of service contract for the Creating Health Plus Program with Parkdale Activity Recreation Centre, in a form approved by the City Solicitor.
HL29.6received
Association of Local Public Health Agencies (alPHa) - June 2021 Update
Director Kate Mulligan, the Board of Health's appointee to the Association of Local Public Health Agencies (alPHa) Board of Directors and Board of Health Section, will provide a verbal update.
The Board of Health: 1. Received the letter (May 31, 2021) from Councillor Joe Cressy for information.