Decisions

The Board of Health:

1. Endorsed Our Health, Our City: A Mental Health, Substance Use, Harm Reduction and Treatment Strategy for Toronto attached as Attachment 1 to the report (November 13, 2023).

2. Directed the Medical Officer of Health to establish an implementation panel for Our Health, Our City: A Mental Health, Substance Use, Harm Reduction and Treatment Strategy for Toronto, and report back to the Board of Health in the first quarter of 2024 with recommendations on the panel terms of reference and membership selection criteria.

3. Directed the Medical Officer of Health to provide dedicated staffing resources from Toronto Public Health to support the implementation of Our Health, Our City: A Mental Health, Substance Use, Harm Reduction and Treatment Strategy for Toronto, responsible for convening stakeholders, advocating with appropriate levels of government, and monitoring progress on implementation.

4. Directed the Medical Officer of Health to report to the Board of Health with annual progress reports on the implementation of Our Health, Our City: A Mental Health, Substance Use, Harm Reduction and Treatment Strategy for Toronto.

5. Requested the Province of Ontario and Government of Canada to provide increased, ongoing and sustainable funding for shelter services, affordable housing and supportive housing, including supportive housing for people experiencing homelessness, complex mental health and/or substance use related challenges. 

6. Requested the Province of Ontario to fund low-barrier crisis stabilization spaces for people with mental health and/or substance use related issues that operate 24 hours per day, seven days per week across the city as part of a full continuum of evidence-based services, treatment and wrap around supports.

7. Requested the Medical Officer of Health to collaborate with first responders and hospitals to implement a coordination protocol that enhances the seamless transfer of individuals experiencing mental health and/or substance use crises to the most appropriate services.

8. Endorsed the expansion of the Toronto Community Crisis Service to be city-wide, as Toronto's fourth emergency service.

9. Forwarded Our Health, Our City: A Mental Health, Substance Use, Harm Reduction and Treatment Strategy for Toronto attached as Attachment 1 to the report (November 13, 2023) from the Medical Officer of Health, to the following Federal Ministers: Minister of Mental Health and Addictions, Minister of Health, Minister of Employment, Workforce and Official Languages, Minister of Housing, Infrastructure and Communities, Minister for Women and Gender Equality and Youth, and Minister of Families, Children and Social Development.

10. Forwarded Our Health, Our City: A Mental Health, Substance Use, Harm Reduction and Treatment Strategy for Toronto attached as Attachment 1 to the report (November 13, 2023) from the Medical Officer of Health, to the following Provincial Ministers for their information and consideration: Minister of Health, Minister of Children, Community and Social Services, Minister for Seniors and Accessibility, Minister of Municipal Affairs and Housing, Minister of Economic Development, Job Creation and Trade, Associate Minister of Mental Health and Addictions, Associate Minister of Housing, and Associate Minister of Women’s Social and Economic Opportunity.

11. Directed the Medical Officer of Health to develop a public dashboard that will track the progress of the implementation for Our Health, Our City: A Mental Health, Substance Use, Harm Reduction and Treatment Strategy for Toronto.

12. Directed the Medical Officer of Health to provide an update, including an implementation plan and outcomes measured, to the Board of Health as soon as a Health Canada decision is granted in response to the City of Toronto's application for decriminalization.

The Director, Public Health, Strategy and Clinical Services, Toronto Public Health, together with Dr. Kwame McKenzie, Chief Executive Officer, Wellesley Institute, and Susan Davis, Executive Director, Gerstein Crisis Centre, gave a presentation on Our Health, Our City: A Mental Health, Substance Use, Harm Reduction and Treatment Strategy for Toronto.

With a diverse and growing population, the City of Toronto offers an extraordinary wealth of cultural, social, and economic opportunities, making it one of the most livable cities in the world. To keep Toronto vibrant and welcoming, individuals and communities in the city must have equitable access to opportunities to optimize their health and achieve their full potential.

In June 2022, the Board of Health requested the Medical Officer of Health to develop a Mental Health and Addictions Strategy for Toronto. At the same time, the Board of Health directed the Medical Officer of Health to engage with stakeholders throughout summer and fall 2022 to refresh the Toronto Drug Strategy. This staff report presents Our Health, Our City: A Mental Health, Substance Use, Harm Reduction and Treatment Strategy for Toronto.

The strategy was developed through extensive consultation over the last 18 months with many stakeholders and partners, including people with lived and living experience of mental health and/or substance use issues. The strategy presents a city-wide, comprehensive population-level approach with recommendations for all levels of government, City divisions, and community partners to help address mental health and substance use related issues across the lifespan. This report outlines the proposed vision, mission, guiding principles, strategic goals and recommended actions to guide the city for the next five years.

Multiple City divisions were consulted in the development of this strategy.

The Board of Health:

1. Requested the Ministry of Health to provide $3.8 million in funding for Toronto Public Health to:

a. Address pandemic-induced immunization gaps in the Student Immunization Program (SIP) and the Immunization of School Pupils Act (ISPA) programs through clinics; and

b. Promote immunization catch-up to increase population-level protection for the communicable and chronic diseases addressed in these programs.

2. Requested the Medical Officer of Health to post online immunization rates for public schools for hepatitis B, human papillomavirus, and meningococcal vaccines.

The Deputy Medical Officer of Health gave a presentation on Enhancing Immunization Coverage for Toronto’s School-Aged Population.

Toronto Public Health will give a presentation on Enhancing Immunization Coverage for Toronto’s School-Aged Population.

The Board of Health:

1. Requested the Medical Officer of Health:

a. Develop a dedicated surveillance framework for systematically and routinely monitoring climate change health impacts for Toronto;

b. Collaborate with Public Health Ontario, public health units and other partners to identify consistent climate change health indicators for use across the province;

c. Use new and improved data and evidence to inform future priority actions for climate change and health for the City of Toronto; and 

d. Consider both the outdoor and indoor contexts of areas of impact, such as air quality, extreme heat, extreme cold and others as outlined in Attachment 2 to the report (November 13, 2023) from the Medical Officer of Health, when developing the dedicated surveillance framework.

2. Requested the Medical Officer of Health actively champion the application of a public health perspective to climate-related projects and decisions through collaborating with relevant City Divisions, including Environment and Climate and Social Development, Finance and Administration.

3. Requested the Medical Officer of Health engage with partners outside the City, including academic partners, the provincial and federal governments and community stakeholders, and contribute to action addressing emerging climate change and public health issues.

4. Requested the Medical Officer of Health report back on progress on the surveillance framework, collaboration efforts and climate change health indicators in the first quarter of 2025.

The Associate Medical Officer of Health gave a presentation on Public Health Impacts of Climate Change in Toronto: A Path Forward for Responding to the Climate Crisis

Climate change is not only an environmental problem – it is one of the most pressing health issues of the 21st century¹. In 2021, the United Nations Secretary-General called the International Panel on Climate Change report a “code red for humanity”. In Toronto, each of the last four decades has been increasingly warmer than any decade that preceded it since 1850². Toronto is susceptible to the impacts of national climate events as experienced by the 2023 Canadian wildfires that had smoke and particulate matter crossing municipal, provincial, and national boundaries. Residents are increasingly feeling these effects, with 89 percent of Torontonians believing climate change threatens their personal health and well-being³.

Direct and indirect health impacts of climate change include:

- Increased incidence of heat-related illness and premature death

- Increases in cardiovascular and respiratory illness from poor air quality

- Health effects from severe weather events such as injuries

- Increased incidence of water-borne diseases from contaminated water sources

- Food system impacts, including risks to food access and security, and increased food-borne illness

- Increases in vector-borne diseases from expanded vector habitats, and

- Worsening mental health.

Toronto Public Health (TPH) is an important partner in the City of Toronto’s (the "City") work on climate change by incorporating human health impacts into the City’s climate mitigation, adaptation, and resilience actions. Understanding current and future climate change health impacts for Toronto residents relies on timely monitoring of surveillance data. This information is required to identify and drive priority actions for the City. A surveillance framework can help the City better monitor and assess how resident health is affected by climate change, including any changes or developments of inequities. This evidence can inform actions taken by the City of Toronto and partners to promote climate change mitigation, adaptation, and resilience.

The Board of Health:

1. Requested the Province of Ontario provide an update on the status of the allocation of Federal Cannabis Excise Duty to municipalities and include public health prevention, promotion, policy and enforcement as allowable expenditures in any future municipal allocation of Federal Cannabis Excise Duty.

2. Requested the Province of Ontario expand evidence-based substance use treatment programs in the healthcare system, such as case management programs, Rapid Access Addiction Medicine Clinics (RAAM), long term care, as well as in-patient hospital and community-based programming, for both regulated and unregulated substance including opioids, alcohol, stimulants and cannabis.

3. Requested the Mayor to consider allocating future funds from the Federal Cannabis Excise Duty revenue sharing from the Provincial Government to Toronto Public Health’s Mental Health, Substance Use, Harm Reduction and Treatment Strategy.

City Council on October 11 and 12, 2023, referred Administrative Inquiry IA11.3 from Councillor James Pasternak, Ward 6, York Centre, regarding Cannabis Stores and Revenue Sharing and Answer IA11.3a from the City Manager to the Board of Health for consideration.

The Board of Health:

1. Approved the following 2024 meeting dates:

- Monday, January 15 at 9:30 a.m.

- Monday, February 12 at 9:30 a.m.

- Monday, March 25 at 9:30 a.m.

- Monday, April 29 at 9:30 a.m.

- Monday, May 27 at 9:30 a.m.

- Monday, July 8 at 9:30 a.m.

- Monday, September 9 at 9:30 a.m.

- Monday, October 21 at 9:30 a.m.

- Monday, November 18 at 9:30 a.m.

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 October 11 and 12, 2023, City Council considered Item ST3.1, 2024 Schedule of Meetings, and approved the 2024 schedule of meetings for City Council and its Committees. The schedule also included proposed 2024 meeting dates for the Board of Health. The updated meeting schedule can be viewed on the City of Toronto's website at www.toronto.ca/council.