Minutes Confirmed on November 8, 2022

This meeting of the Board of Health was conducted with members participating in person and remotely.

The Board of Health:

1.  Elected Director Joe Mihevc as Chair of the Board of Health for a term of office starting June 20, 2022 and ending November 14, 2022, and until a successor is appointed.

There was one nomination. The Board Secretary declared Director Joe Mihevc the Chair of the 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, as amended, for a term of office starting June 20, 2022 and ending November 14, 2022, and until a successor is appointed.

The Board of Health:

1.  Requested the Medical Officer of Health to report back to the Board of Health in 2023 with an update on new, resumed, and enhanced public health functions, as well as a process for the development of a new strategic plan to guide Toronto Public Health's long-term priorities.

The Medical Officer of Health gave a presentation on Update on COVID-19 Response and Other Public Health Functions.

This report provides an update on Toronto Public Health's (TPH) response to the COVID-19 pandemic, and addresses direction from the Board of Health to provide an update on the resumption of programs that were paused or scaled-back due to the response to the COVID-19 pandemic, as well as planning to address emerging public health priorities.

With key indicators showing that the sixth wave of the COVID-19 is subsiding, TPH is developing and implementing plans to resume or expand non-COVID-19 related public health functions, as resources permit. However, there remains an ongoing need to respond to the COVID-19 pandemic, including potential future surges. In the short-term, TPH is planning to maintain capacity to respond to COVID-19, while also focusing on other major health issues that affect Torontonians.

Toronto Public Health has identified three key goals that will guide this work: 1) to maintain and improve the health status of Toronto's population, 2) to reduce inequities in health status, and 3) to prepare for and respond to outbreaks of disease and public health emergencies. The pursuit of these goals will be informed by evidence-informed decision-making, centered on equity considerations, and premised on the understanding that public health is a public good that benefits the whole community.

With this in mind, TPH has identified the following as priorities for action for the remainder of 2022 and into 2023:

- continuing COVID-19 response and incorporating lessons learned from the COVID-19 response to support TPH's readiness for other emerging public health issues;

- responding to the drug poisoning epidemic;

- promoting mental health; and

- rebuilding public health functions.

Each of these priorities encompasses a range of actions that aim to maximize the impact and benefit to the overall health of Torontonians, such as restoring routine public health programming, reducing service backlogs, and collaborating with partners to expand access to resources, programs, and services.

In working to achieve these short-term priorities, TPH will continue to collaborate with other orders of government and partner organizations, especially in relation to the development of policies that support the social determinants of health. This work must also be accompanied by efforts to acknowledge and support the staff that have worked tirelessly to respond to the COVID-19 pandemic, invest in their well-being and resilience, and provide the tools and infrastructure to assist them in serving the public as TPH embarks on this next phase in working towards a healthier Toronto.

The Board of Health:

1.  Continued to recognize the drug poisoning crisis as a public health crisis in the City of Toronto and continue to commit to supporting actions that are urgently needed. 

2.  Reiterated its call requesting the Federal government to:

a.  develop a national framework to permit the simple possession of all drugs for personal use;

b.  support the immediate scale up of prevention, harm reduction and treatment services; and 

c.  support and fund additional safer supply options in Toronto.

3. Reiterated requests for the following actions from the Province of Ontario:

a.  expand funding for harm reduction and treatment services for disproportionately impacted communities, including African, Caribbean, Black, and Indigenous people to allow additional hours of operation, expand supervised consumption services to include supervised inhalation and smoking, and hire additional peer workers;

b.  expand funding for a comprehensive continuum of harm reduction and treatment services that respect the diverse needs of people who use drugs; 

c.  remove the cap of 21 Consumption and Treatment Services Sites in Ontario; 

d.  fund the proposal submitted to Ontario Health for the Substance Use Crisis Centre – Toronto; 

e.  integrate long-term and sustainable program funding for injectable Opioid Agonist Treatment and other safer supply tablet programs to ensure a seamless transition for clients on this medication once Health Canada's Substance Use and Addictions Program funding expires in March 2023;

f.  support safer supply options, including listing high dose hydromorphone on the Ontario Drug Benefit Formulary and exploring other evidence-informed options;

g.  identify and remove barriers to safe inhalation and smoking at Consumption and Treatment Service sites;

h.  formally integrate drug checking into harm reduction services in Ontario by extending funding for the only drug checking service currently operating in Ontario, and expanding drug checking services to all supervised consumption services in Ontario; and

i.  provide sustainable funding for the Integrated Prevention and Harm Reduction initiative, and expand funding for harm reduction services in the shelter system.

4.  Requested the Medical Officer of Health to continue working with Health Canada on the conditions that would allow for an exemption approval under Section 56(1) of the Controlled Drugs and Substances Act within the City of Toronto.  

5.  Requested the Medical Officer of Health to conduct community consultations throughout 2022 to inform a refreshed Toronto Drug Strategy for consideration by the Board of Health in 2023.

The Medical Officer of Health gave a presentation on Toronto Overdose Action Plan: Status Report 2022.

The drug poisoning crisis has continued to intensify since 2015 and has been exacerbated by the COVID-19 pandemic. Toronto Public Health (TPH) continues to implement the Toronto Overdose Action Plan (TOAP), initially launched in 2017 and updated in 2019.

The Office of the Chief Coroner for Ontario estimates 511 confirmed and 54 probable opioid toxicity deaths occurred in Toronto, in 2021. This level of opioid poisoning deaths is in line with trends observed in 2020, but represents a 71 percent increase from 2019 and a 273 percent increase from 2015. Alarming trends are also being observed at the provincial level. Across Ontario, 2,819 people died due to confirmed or probable opioid overdoses in 2021. 

This significant loss of life is reverberating throughout Toronto communities, impacting the families, chosen families, friends, and co-workers of people who use drugs. First-responders and frontline shelter, health, and social support workers are also grieving these losses.

Overdose deaths are preventable and are due in large part to the unregulated drug supply, where the use of highly-potent opioids combined with more unexpected and concerning substances are significantly increasing the risk of overdose.

This staff report highlights actions taken by TPH and City Divisions towards the continued implementation of the TOAP and provides an update on Board of Health direction for the Medical Officer of Health to submit a request to Health Canada for an exemption under Section 56(1) of the Controlled Drugs and Substances Act. This report also recommends further actions that are urgently needed by the Provincial and Federal governments to prevent additional drug poisoning deaths.

Shelter Support and Housing Division (SSHA), Social Development, Finance and Administration (SDFA), Toronto Community Housing Corporation (TCHC), and community partners were consulted in the development of this report.

The Board of Health recommends that:

1.  City Council authorize the Medical Officer of Health to award, execute and amend, on an ongoing basis, purchase of service contracts for the Ontario Seniors Dental Care Program with the Parkdale Queen West Community Health Centre, on such terms and conditions that are satisfactory to the Medical Officer of Health and in a form approved by the City Solicitor.

2.  City Council authorize the Medical Officer of Health to enter into capital funding agreements for the Ontario Seniors Dental Care Program with Scarborough Centre for Healthy Communities for the receipt and expenditure of funding on such terms and conditions that are satisfactory to the Medical Officer of Health and in a form approved by the City Solicitor.

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 2022, according to the delegation of authority by City Council, and request City Council authority for the Medical Officer of Health to award, execute and amend purchase of services contracts and capital funding agreements with organizations to deliver dental health programming and services that contribute to the health and well-being of Torontonians.

The Board of Health:

1.  Authorized the Medical Officer of Health to allocate $483,677 from the 2022 Approved Operating Budget for Toronto Public Health for seven one-year projects and to execute Funding Agreements with the approved applicants, as outlined in Tables 1 and 2 and Appendix 2 to this report.

2.  Authorized the Medical Officer of Health to allocate $2,852,659 from the 2022 approved Toronto Public Health Operating Budget for Toronto Public Health to carry out third-year activities for 35 three-year projects and to execute Funding Agreements with the approved applicants, as outlined in Tables 1 and 2 and Appendix 2 to this report.

This report outlines the funding priorities, application review process, and funding allocation recommendations for the 2022 Toronto Urban Health Fund (TUHF). The 2022 TUHF Review Panel recommends the total allocation of $483,677 for seven one-year projects and $2,852,659 for thirty-five third-year projects previously approved by the Board of Health in 2020. The combined total allocation of $3,336,336 for the forty-two projects is to be used between July 1, 2022 and June 30, 2023. Recommended projects focus on HIV prevention through sexual transmission, harm reduction, child and youth resiliency, and Indigenous health promotion.

The Board of Health:

1.  Appointed Director Joe Mihevc to the Board of Health Performance Appraisal of the Medical Officer of Health Committee for a term of office ending on November 14, 2022, and until a successor is appointed.

2.  Appointed Director Stephanie Donaldson as Chair of the Board of Health Performance Appraisal of the Medical Officer of Health Committee

3.  Appointed Director Joe Mihevc as Chair of the Board of Health Budget Committee for a term of office ending on November 14, 2022, and until a successor is appointed.

The resignation of Director Joe Cressy has resulted in a vacancy on the Board of Health Performance Appraisal of the Medical Officer of Health Committee as well as a vacancy on the Board of Health Budget Committee.

I am writing to recommend that Director Joe Mihevc be appointed to fill these positions. I am also recommending appointing the Chair of these two Committees.

The Board of Health:

1.  Requested the Medical Officer of Health, in consultation with the City Manager to report back on the recommendations outlined in Motion 2021.MM37.17 to its next meeting, as follows:

a.  City Council request the Medical Officer of Health, in consultation with the City Manager, to investigate options to better coordinate mental health and addictions services in Toronto, including the necessity and feasibility of a dedicated office, and to report to the Board of Health in early 2022; and

b.  City Council request the City Manager to develop an advocacy strategy, including using elected officials, to lobby the Provincial and Federal Governments for increased support for community-based agencies delivering mental health services in Toronto.

At the November 9th, 2021 City Council Meeting, then Ward 13 Councillor Kristyn Wong-Tam requested that the Medical Officer of Health, in consultation with the City Manager, to report back to the Board of Health by “early 2022” on the following items:

-  Investigate options to better coordinate mental health and addictions services in Toronto, including the necessity and feasibility of a dedicated office, and to report to the Board of Health in early 2022.

-  To develop an advocacy strategy, including using elected officials, to lobby the Provincial and Federal Governments for increased support for community-based agencies delivering mental health services in Toronto.

The intention of these recommendations was to explore ways to create a Mental Health and Addictions strategy for the City of Toronto. The early 2022 deadline has now passed and no report has been submitted to the Board of Health.

Announcements

The Vice 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, Councillor Joe Mihevc addressed the Board following his election as Chair and acknowledged that he would fill this role with a strong sense of civic duty.

Where the Directors of the Board of Health listed in the attendance for this meeting participated remotely, they were counted for quorum as permitted by Section 189(4.2) of the City of Toronto Act, 2006, and the Board's Procedures, as amended.