Minutes Confirmed on November 12, 2019

The Board of Health recommends that:

1.  City Council direct all City Divisions, in consultation with the Medical Officer of Health and subject matter experts, to:

a.  review the Toronto Food Policy Council 2019 Annual Report and other Toronto Food Policy Council reports; and

b.  develop a "food lens" for their respective work by the end of 2020 to leverage divisional work to support the objectives of eliminating food insecurity and addressing the climate emergency across the City of Toronto;

and request the Deputy City Manager, Community and Social Services, the Deputy City Manager, Corporate Services, and the Deputy City Manager, Infrastructure and Development Services, in consultation with the Medical Officer of Health, to report to the Board of Health in the first quarter of 2021.

The Board of Health:

1.  Directed the Medical Officer of Health to continue staffing levels to support the Toronto Food Policy Council, including coordination and associated administration positions.

Rachel Gray, Co-Chair, Toronto Food Policy Council, gave a presentation on Toronto Food Policy Council 2019 Annual Report.

The Toronto Food Policy Council (TFPC) was established in 1990 as a Subcommittee of the Board of Health to address growing food insecurity and food bank use in Toronto that accompanied globalization and the loss of industrial jobs.

The TFPC promotes the concept that food should be regarded as a public good, much like education, health care, or public transit, and that the City should be encouraged to use food policy as a lever to create healthier, more equitable, and more sustainable communities. The TFPC has long advocated for a broad definition of food security that includes health, social, economic, and environmental determinants and acknowledges that we are all food insecure when we face a crisis of the proportions of climate change. The TFPC has been at the forefront of this expansion of the definition of food security and continues to provide critical food guidance to the Board of Health for integrated policies that take a food system perspective and recognize the connection between public health and the health of the planet.

This report provides an overview of the work undertaken by the TFPC since its last annual report to the Board of Health in July 2018. 

The Board of Health recommends that:

1.  City Council direct the City Manager to report in the second quarter of 2020 with a plan and timelines for the City of Toronto to implement the short-term and long-term goals of the 2015 Milan Urban Food Policy Pact, to which the City is a signatory city, and the C40 Good Food Cities Declaration, which was signed by Mayor John Tory on October 10, 2019 in Copenhagen, Denmark, including those pertaining to food procurement, consumption, and food loss and waste.

2.  City Council commit to achieving the World Resources Institute's Cool Food Pledge to reduce the greenhouse gas emissions associated with the food the City of Toronto procures by 25 percent by 2030 relative to 2015 and request the City Manager to report in the second quarter of 2020 on a plan and timelines to implement the goals of the Pledge.

The Board of Health:

1.  Requested the Medical Officer of Health, in consultation with appropriate City Divisions, residents, the private sector, and community and institutional partners, to implement the following actions as a signatory city to the C40 Good Food Cities Declaration:

a.  Procurement - Align food procurement in the City of Toronto to the Planetary Health Diet and the 2019 Canada's Food Guide, which includes healthier, plant-based, and sustainable food options;

b.  Consumption - Support an overall increase in the consumption of healthy, plant-based foods by shifting away from unsustainable, unhealthy diets; and

c.  Food Loss and Waste - Reduce food loss and waste and create a circular economy for food.

The Manager, Food Strategy, Toronto Public Health, gave a presentation on Food Systems Transformation - Toronto Food Strategy.

The World Health Organization and The Lancet have called climate change the greatest threat and opportunity for global health in the 21st century. The dynamic relationship between food and climate change, and the resulting impact on human health, is a key dimension of this work and global and local calls to action.

There is growing evidence that food systems must change to combat the current climate crisis and promote food security. Cities can make impactful changes by changing how they procure food and by influencing the public's dietary behaviours. They can also take steps to reduce food loss and waste from the food they procure and prepare and set an example for the food service and hospitality industry. This staff report outlines strategic opportunities and recommended areas of action for Toronto Public Health and the City of Toronto to support both food systems transformation and climate change action to improve the health of our communities, as outlined in the attached Food Systems Transformation and Toronto Food Strategy 2019 Update report. The recommendations below reflect the intent and commitments outlined in the C40 Good Food Cities Declaration signed by the Mayor of Toronto and released at the C40 Mayoral Summit in Copenhagen in October 2019 and are supported by the scientific evidence regarding the need for food systems transformation to mitigate and adapt to climate change.

The Board of Health recommends that:

1.  City Council request the Government of Canada to:

a.  update the list of foods included in the National Nutritious Food Basket to reflect the recommendations from the 2019 Canada's Food Guide;

b.  develop a national food costing protocol to standardize the annual monitoring of food affordability by provincial/territorial and local governments; and

 
c.  mandate the annual measurement of food insecurity using the Household Food Security Survey Module.

The Board of Health:

1.  Restated its support for the passing of provincial Bill 60, An Act to amend the Ministry of Community and Social Services Act to establish the Social Assistance Research Commission.

Consistent monitoring of food affordability and food insecurity is necessary to assess the health of the population, to evaluate policy change, and to develop evidence-based recommendations for public health interventions. Based on this year's assessment, Toronto Public Health is reporting that the cost of nutritious food in Toronto has risen 7.6 percent between 2018 and 2019, the largest year-over-year increase in a decade. Ongoing surveillance will determine if there is evidence of a trend and what changes, if any, should be made to current programs and policies, particularly those targeting food insecurity.

Household food insecurity is defined as inadequate access to food due to financial constraints. Healthy eating can be particularly challenging for individuals and families experiencing food insecurity. Initiatives that target income insufficiency have been shown to reduce household food insecurity, suggesting that efforts should be made to ensure income support programs and policies accurately account for basic living expenses, including the cost of healthy eating.

When revising Canada's Food Guide, Health Canada made significant changes to its format that make it easier to follow. However, the changes create challenges related to calculating the cost of healthy eating. This report recommends adjustments the federal government can make to ensure important population health data continues to be collected and analyzed.

The Board of Health recommends that:

1.  City Council request the Medical Officer of Health, the Deputy City Manager, Corporate Services, and the Deputy City Manager, Infrastructure and Development Services, to collaborate on the continued implementation of the City-Wide Heat Relief Strategy through the Resilience Strategy and the Heat Relief Working Group.
 

2.  City Council request all City Divisions, including City Planning, Corporate Real Estate Management, Environment and Energy, Information and Technology, Municipal Licensing and Standards, Parks, Forestry and Recreation, Shelter, Support and Housing Administration, Social Development, Finance and Administration, and Strategic Communications, to continue to incorporate hot weather response activities as part of their divisional mandates.

3.  City Council request the General Manager, Shelter, Support and Housing Administration, in consultation with the Medical Officer of Health, to:

a.  identify and implement increased access to cool spaces that meet the needs of vulnerable individuals for the summer of 2020; and

b.  report on an implementation and communications plan in February 2020.

4.  City Council request staff to report in 2020 on the progress of incorporating the City-Wide Heat Relief Strategy through the Resilience Strategy.

The Director, Strategy and Preventive Health, Toronto Public Health, gave a presentation on Strengthening Heat Resilience in the City of Toronto.

Evidence demonstrates that temperatures are rising and heat waves are more frequent and longer in duration due to climate change. The resulting exposure to extreme heat is a health risk that needs to be managed in a coordinated manner across City Divisions who are also mitigating other climate change-related risks. Over time, it is important for the City and its residents to continue to evolve the response to heat through strategies that build the City's resilience to extreme weather.

In 2018 and 2019, the Board of Health and City Council directed Toronto Public Health (TPH), along with other City Divisions, to review the City's hot weather response. An interdivisional Heat Relief Working Group, co-chaired by the Deputy City Manager, Corporate Services, and TPH, was convened in the fall of 2018 to develop a Heat Relief Strategy for the City.  

This report describes the results of the collaboration among City Divisions to implement a coordinated Heat Relief Strategy in 2019. The report also makes recommendations for the City to continue to strengthen its response to hot weather. As mitigating the impacts of heat is a key aspect of the City's efforts to build resilience to climate change, incorporating the Heat Relief Strategy into planning for resilience is recommended as an effective long-term approach.

The Board of Health recommends that:

1.  City Council request the General Manager, Transportation Services, to include environmental noise mitigation as a priority in transportation planning and operations through:

a.  incorporating noise mitigation measures in upcoming projects, including the Freight and Goods Movement Strategy, the Congestion Management Plan, and the Vision Zero 2.0 Road Safety Plan;

b.  considering noise mitigation as a factor when reviewing road projects for state of good repair work; and

c.  determining the feasibility and approach for monitoring road traffic noise, associated costs, and budget considerations.

2.  City Council request the General Manager, Fleet Services, to include noise mitigation as a goal of the ongoing prioritization of electric vehicles, as defined in Fleet Services' Procurement Strategy and Green Fleet Plan.

3.  City Council request the Deputy City Manager, Corporate Services, to include noise mitigation as a goal in the forthcoming TransformTO Electric Vehicle Strategy.

4.  City Council request the Executive Director, Municipal Licensing and Standards, to consider the Noise Action Plan, as outlined in the report (October 9, 2019) from the Medical Officer of Health, to identify additional opportunities to mitigate noise.

5.  City Council request the General Manager, Economic Development and Culture, to consider the Noise Action Plan, as outlined in the report (October 9, 2019) from the Medical Officer of Health, for their programs and policies.

The Board of Health:

1.  Requested the federal Minster of Transport to update the Motor Vehicle Safety Act to further restrict the use of air brakes by freight and transport trucks in urban centres.

2.  Directed that the report (October 9, 2019) from the Medical Officer of Health be forwarded to the Toronto Transit Commission (TTC) for consideration in noise mitigation activities for TTC operations.

3.  Directed that the report (October 9, 2019) from the Medical Officer of Health be forwarded to the Ontario Ministry of Transportation and Metrolinx for consideration.

Noise from sources such as road traffic and rail contribute to ambient environmental noise in the City. Cities around the world are exploring mitigation measures for environmental noise in recognition of the impacts that noise can have on health. Research from the World Health Organization and other bodies has identified a range of health impacts associated with various levels of environmental noise, such as hearing loss, sleep disturbance, annoyance, and some cardiovascular impacts.

In June 2017, the Board of Health requested the Medical Officer of Health to develop a Noise Action Plan aimed at reducing exposure to ambient environmental noise over time. Experience from other jurisdictions indicates that, because noise occurs from multiple sources across the City, the most effective noise mitigation plans involve collaborative strategies across the jurisdiction.

This report describes a Noise Action Plan for Toronto, with recommendations for several City Divisions and provincial and federal partners. Given that road traffic is a major source of environmental noise in the City, the Noise Action Plan focuses on noise from transportation sources. The Plan identifies noise mitigation measures, such as traffic management, road surface improvements, structural noise attenuation, the promotion of alternate forms of transportation, building design, neighbourhood approaches, and noise monitoring. Toronto Public Health has developed recommendations with Municipal Licensing and Standards, Transportation Services, and other City partners to leverage environmental noise mitigation activities underway and will continue to work with partners to identify additional measures.

The Board of Health:

1.  Approved the following meeting dates for 2020:

-  Monday January 13
-  Monday March 2
-  Monday April 20
-  Monday May 11
-  Monday June 15
-  Monday July 13
-  Monday September 21
-  Monday October 19
-  Monday November 9
-  Monday December 7

In accordance with Section 25 of the Board of Health Procedures By-law, regular meetings of the Board are determined by the Board and a schedule of those meetings shall be publicly available by the first meeting of the Board in each calendar year.

On July 16, 17, and 18, 2019, City Council adopted the 2020 annual schedule of meetings for City Council and its Committees. The schedule included proposed regular meeting dates for the Board of Health. Please note that the meeting schedule is accessible on the City of Toronto's website at www.toronto.ca/council.

Traditionally, the Board of Health's meetings begin at 9:30 a.m. and are held in Committee Room 1, which is located on the second floor, of Toronto City Hall, 100 Queen Street West.

The Board of Health:

1.  Requested the Medical Officer of Health to report to the Board of Health at its meeting on December 9, 2019 with a report and presentation providing an update on the Toronto Public Health internal reorganization.

Since amalgamation in 1998, Toronto Public Health (TPH) has experienced changes, growth, and evolving priorities as an organization.

In 2017, Toronto City Council directed that TPH conduct an organizational review to assess effectiveness of the organization and identify possible opportunities for improvements.

The goal of TPH’s organizational review is to identify how to enhance the organization's ability to improve the health status of Toronto residents through prevention efforts that are focused at the population level. It is also designed to strengthen TPH's capacity to deliver programs and services that meet the province's new 2018 Public Health Standards.

As the re-organization has progressed and with a new Board of Health, it is important that the Board receive an update on the status.

The Board of Health:

1.  Requested the Medical Officer of Health, in consultation with the Executive Director, Municipal Licensing and Standards, and other City Divisions and stakeholders, as needed, to report in the spring of 2020 on:

a.  the effectiveness of the City of Toronto's current approach for addressing the public health risks from hookah use by prohibiting its use in establishments licensed by the City; and

b.  recommendations to close the regulatory gaps that continue to present public health risks from hookah use in establishments, including consideration of revisions to the current By-law.

In November 2015, Toronto City Council, on the recommendation of the Board of Health, took action to address the public health risk of hookah-use by prohibiting its use in business establishments that are licensed by the City of Toronto.

The prohibition came into force on April 1, 2016. However, the City delayed its enforcement pending the outcome of a legal challenge by some hookah establishment owners. On July 1, 2017, the Ontario Superior Court of Justice upheld the City's hookah-use prohibition and enforcement began.

Preliminary data and analysis from Toronto Public Health (TPH) suggests that the current approach to address the public health risk of hookah-use is not meeting Council's intention.

Toronto Public Health estimates that there are approximately 44 establishments in the City that continue to allow patrons to use hookah. This includes 24 establishments that have or are required to have a City of Toronto business license and are thus, in contravention of the City's hookah-use prohibition. These non-compliant premises continue to operate despite multiple charges, penalties, and in some cases, temporary closing orders. Since July 2017, TPH has conducted 287 inspections that have resulted in 102 convictions. A number of charges remain before the courts.

In addition, at least 20 establishments are operating without a City of Toronto business license. These business are not technically violating the City's hookah-use prohibition because they are not licensed by the City. This regulatory gap enables the continuation of the public health risk from hookah-use, which is contradictory to City Council's intentions on this issue. Existing enforcement powers under the Smoke-Free Ontario Act are not well suited to address the public health risk from hookah-use.

In light of the issues highlighted above, I am recommending that the Medical Officer of Health revisit the City's current approach to addressing the public health risk from hookah-use.

Announcements

The Chair acknowledged that the Board of Health was meeting on the traditional territory of many nations including the Mississaugas of the Credit, the Anishnabeg, the Chippewa, the Haudenosaunee and the Wendat peoples and is now home to many diverse First Nations, Inuit and Métis peoples. The Chair also acknowledged that Toronto is covered by Treaty 13 with the Mississaugas of the Credit.

The Chair acknowledged Joe Mihevc, former Chair, Board of Health, who was in attendance at the meeting with his students from York University.