Decisions

The Board of Health:

1. Received the letter (August 23, 2024) from Councillor Chris Moise for information.

As invited by the Chair, Board of Health, Jayson Phelps, Partner, Phelps Group and Fareed Amin, Senior Consultant, Diversity Practice, Phelps Group, gave a presentation on Update from the Medical Officer of Health Hiring Committee.

I would like to provide an update on the hiring process for the next Medical Officer of Health.

At our meeting on May 24, 2024, we struck a hiring committee to lead the hiring process. The committee convened for the first time on July 22 to discuss the requirements of the Medical Officer of Health position, select an executive search firm to support the hiring process and outline in more detail the hiring timeline. Phelps Group was selected to assist with the hiring process and they have since been working to engage key stakeholders and prepare the job profile for posting.

The following timeline outlines the next steps in the hiring process:

- September 26 - October 10: Preliminary Interviews

- October 15 - October 18: First Round Interviews

- October 22: Second Round Interviews

- November 6: Special Board of Health Meeting to Recommend Medical Officer of Health Appointment (date to be confirmed)

- November 18: Medical Officer of Health Appointment at Board of Health

- December 17: Medical Officer of Health Appointment Approval at City Council

- December 19: Transmittal of Medical Officer of Health Appointment to the Minister

I will continue to provide updates at our Board of Health meetings as the hiring process unfolds.

The Board of Health:

1. Requested the Mayor to propose a 2025 Operating Budget to City Council for Toronto Public Health of $285,898.1 thousand gross, $82,868.7 thousand net, and 1,908.0 positions, which includes the following incremental changes from the Toronto Public Health 2024 Operating Budget:
 

a. an increase in revenue of $1,957.1 thousand to accept additional funds from the provincial government to support the delivery of Ontario Public Health Standards programs and services;

b. an increase in budget of $327.3 thousand to accept additional funds from the provincial government's Ministry of Children, Community and Social Services to support the delivery of the Healthy Babies Healthy Children Program;

c. an increase of $886.3 thousand gross and $886.3 thousand net for inflationary cost of food increases and projected growth in student participation in the Student Nutrition Program;

d. an increase of $1,621.7 thousand gross and $1,621.7 thousand net and 17.0 positions for salaries and benefits;

e. a decrease of $406.2 thousand gross, $453.0 thousand net and 3.0 positions for 2025 administrative and technical adjustments; and

f. a decrease of $68.0 thousand gross, $0.0 net for the Partnership for Healthy Cities one-time grant.

2. Requested the Medical Officer of Health to prioritize working towards increasing the municipal contribution of the Student Nutrition Program to 20 percent.

3. Reiterated its request in Item HL13.4, 2024 Student Nutrition Program Service Subsidies, that the Government of Canada expand the National School Food Program to urgently provide funding for a universal program which would provide nutritious meals for every school-aged child, and that the federal funding allocated for 2025 be brought forward so that the implementation of the school food program can begin in January 2025. 

4. Requested the Province of Ontario to increase its grant funding investment to the Student Nutrition Program proportionally to match the increased City of Toronto investment and further request the Province of Ontario provide increased funding to address the inflationary cost of food.

5. Directed the Medical Officer of Health, in coordination with the City Manager, to engage the Government of Canada on the 2024 Federal Budget commitment of $79 million for 2024 and the $220 million for 2025 for student nutrition programs, which has not flowed, and negotiate with the Provincial and Federal Governments for Toronto's allocation of this funding.

6. Requested the Government of Ontario to protect community health, well-being and safety by continuing to fund, and permit the operation of, all currently operating Supervised Consumption Services and Consumption and Treatment Services Sites beyond March 31, 2025.

7. Requested the Government of Ontario to permit the co-location of Homelessness and Addiction Recovery Treatment Hubs (HART Hubs) and Supervised Consumption Services and Consumption and Treatment Services sites to provide for live-saving medical services, primary care, and increased pathways to treatment services.

8. Directed that this report be forwarded to the Budget Committee for consideration during the 2025 Budget process.

The Board of Health considered Items HL16.2 and HL16.3 together.

The Manager, Finance Services, Toronto Public Health gave a presentation on the Item.

This report outlines the Toronto Public Health 2025 Operating Budget Submission for consideration by the Board of Health. Toronto Public Health's 2025 Operating Budget Submission is $282,833.0 thousand gross, $79,803.6 thousand net and 1,887.0 positions.

This 2025 Operating Budget Submission is higher than the 2024 Operating Budget by $3.0 thousand gross, $98.0 thousand net with 1.0 fewer positions, due to the end of federal funding for the Injectable Opioid Agonist Treatment Program and the termination of provincial funding for Supervised Consumption Sites in 2025.  Additional information on the change between the 2025 Operating Budget Submission and the 2024 Operating Budget is available in Table 1 in this report.

The 2025 Operating Budget Submission includes in-year changes, and base changes as detailed in the recommendations in this report.

At its meeting on July 23, 2024, the Board of Health - Budget Committee considered Item HU3.1, Preliminary Toronto Public Health 2025 Operating Budget and 2025-2034 Capital Budget and Plan.

The Board of Health:

1. Requested the Mayor to propose a 2025 Capital Budget to City Council for Toronto Public Health with total cash flows and future year commitments of $7.780 million, including a 2025 cash flow of $3.996 million.

2. Requested the Mayor to propose a 2026-2034 Capital Plan to City Council for Toronto Public Health with total project estimates of $16.189 million, comprised of $0.449 million in 2027, $0.667 million in 2028 and $0.732 million in 2029, $2.868 million in 2030, $2.868 million in 2031, $2.868 million in 2032, $2.868 million in 2033 and $2.869 million in 2034.

3. Directed that this report be forwarded to the Budget Committee for consideration during the 2025 Budget process.

The Board of Health considered Items HL16.2 and HL16.3 together.

The Manager, Finance Services, Toronto Public Health gave a presentation on the Item.

This report provides an overview of Toronto Public Health's 2025 Capital Budget and 2026-2034 Plan Request.

Toronto Public Health is recommending a 2025-2034 Capital Budget and Plan of $23.969 million, including a 2025 Capital Budget of $3.996 million with future year commitments of $3.784 million and future year estimates of $16.189 million. The 10 Year Capital Budget and Plan Request will provide funding for seven projects.

At its meeting on July 23, 2024, the Board of Health - Budget Committee considered Item HU3.1, Preliminary Toronto Public Health 2025 Operating Budget and 2025-2034 Capital Budget and Plan.

The Board of Health recommends that:  

1. City Council authorize the Medical Officer of Health to enter into agreements and other suitable arrangements, on behalf of the City of Toronto, for the transfer of funds to the Angel Foundation for Learning ($50,000) and the Toronto Foundation for Student Success ($100,000) for the purpose of replacing refrigeration equipment for existing student nutrition programs across the City of Toronto on terms satisfactory to the Medical Officer of Health and in a form satisfactory to the City Solicitor.

This report provides an update to the Board of Health on the Toronto Public Health Operating Budget Variance for the six months ended on June 30, 2024.

As of June 30, 2024, Toronto Public Health gross expenditure was underspent by $17.8 million and revenue was underachieved by $12.0 million, resulting in a net favourable variance of $5.8 million.

At year end, gross expenditure is expected to be underspent by $22.7 million and revenue will be unachieved by $13.6 million, resulting in net expenditure being under budget by $9.1 million.

This report also recommends that City Council authorize the Medical Officer of Health to enter into agreements with the Angel Foundation for Learning and the Toronto Foundation for Student Success to transfer funds, in the amount of $50,000 and $100,000 respectively, for the purpose of replacing aging refrigeration equipment, at no net cost to the City of Toronto. This equipment is used in the delivery of student nutrition programs across the City of Toronto.

The Board of Health:  

1. Received the report (August 23, 2024) from the Medical Officer of Health for information.

This report provides an update to the Board of Health on the Toronto Public Health Capital Budget Variance for the six months ended on June 30, 2024.

The Board of Health:

1. Directed the Medical Officer of Health to decommission the mobile dental bus and work with the Fleet Services Division to initiate a process to auction the bus and return any recovered funds from the auction after netting associated costs to the provincial Ministry of Health.

2. Directed the Medical Officer of Health to include $460 thousand, fully funded by the discretionary Reserve Fund for Public Health, in the 2025-2034 Capital Budget and Plan Submission for Toronto Public Health to purchase a new mobile dental van.

3. Requested the provincial Ministry of Health to allow the proceeds of the auction of Toronto Public Health’s dental bus, estimated at between $40,000 to $50,000, to be retained by Toronto Public Health and applied towards the purchase of a new mobile dental van.

The Dental and Oral Health Services program at Toronto Public Health provides integral dental and oral health care to vulnerable populations in Toronto. The Ontario Public Health Standards and the Oral Health Screening Protocol, 2021 specify the mandatory oral health services to be offered by local public health units.

As part of achieving its plan to promote health and well-being across the lifespan and advance health equity, Toronto Public Health offers a mobile dental program that currently includes two mobile dental vans and a mobile dental bus focused on supporting harder to reach populations. The mobile dental bus has been in operation since 2012, and the interior and exterior of the bus has significantly declined over the past year.

This report makes recommendations to decommission and auction the mobile dental bus and return funds collected to the provincial Ministry of Health. The Ministry of Health provided the funds for the bus in 2011 through the Healthy Smiles Ontario program. A parallel request to City Council for capital funding to purchase a new mobile dental van to replace the bus is coming forward through the 2025 Budget process.

The report has been reviewed by the Fleet Services Division and Finance and Treasury Services.

The Board of Health:

1. Appointed the twelve candidates listed in Attachment 1 to the report (August 26, 2024) from the Medical Officer of Health to the Our Health, Our City Implementation Panel, for a 2.5-year term beginning on September 9, 2024, and ending on March 9, 2027, and until successors are appointed.

In November 2023, the Board of Health adopted Our Health, Our City: A Mental Health, Substance Use, Harm Reduction and Treatment Strategy for Toronto, which is a comprehensive five-year and city-wide strategy to address both mental health and substance use related issues in Toronto.

In March 2024, the Board of Health directed the Medical Officer of Health to initiate an open process to recruit candidates for a new Our Health, Our City Implementation Panel in consultation with the Chair of the Implementation Panel, and to report back to the Board of Health in the third quarter of 2024 with the recommended candidates for appointment.

This report outlines the recruitment process and recommends twelve candidates for appointment to the Our Health, Our City Implementation Panel.

The Board of Health:

1. Requested the Ministry of Health and Health Canada to explore opportunities to increase access and reduce barriers to health care providers providing the mpox vaccine to their patients.

Since 2022, mpox has been circulating in Toronto and globally. It is spread person to person through direct or indirect contact with infected lesions or blisters or with bodily fluids, or respiratory secretions.  In Toronto, it is mostly transmitted between people who have had close, intimate, or sexual contact, and it has been disproportionately impacting men who have sex with men. The strain circulating in Toronto,  known as clade II mpox, is rarely associated with serious illness.

TPH has a comprehensive mpox response that focuses on collaboration across the organization and in the community. This response includes:

- monitoring trends and data to identify and report changes in risk and local epidemiology,

- investigating transmission pathways through case and contact management to quickly
identify cases to reduce transmission and helping people who have been exposed obtain post-exposure vaccination,

- working with community partners and through our own communications channels to reduce stigma and increase awareness of the risks of mpox, the importance of getting two vaccine doses among priority populations, and channels for accessing vaccines, and 

- supporting our health care partners by training health care providers to administer and report mpox vaccinations as required, coordinating and distributing orders of vaccine for healthcare providers, and supplementing their efforts by providing mpox vaccine in TPH clinics.

On August 14, the World Health Organization declared a public health emergency of international concern (PHEIC) due to a clade I outbreak in Africa. Clade I mpox may cause more severe illness and death than clade II. There have been no cases of clade I mpox in Toronto and the risk remains low.

Despite the risk remaining low for clade I, and remaining the same for the ongoing clade II outbreak, since the World Health Organization declaration of a PHEIC, Toronto is experiencing increased demand for the mpox vaccine. In response to this increased demand for vaccination TPH has:

- increased mpox vaccination appointments at TPH clinics,

- ramped up outreach to healthcare providers to increase accessibility in the healthcare system, which is the primary channel for vaccine access in Toronto, and

- onboarded 5 new healthcare providers, with more expected to be onboarded soon.

Given increased demand for the vaccine, and because mpox vaccination is a multi-level governmental effort, I recommend that the Ministry of Health and Health Canada review current processes for accessing the vaccine and look for opportunities to increase access for eligible people, similar to other publicly-funded vaccines.

The Board of Health forwards this item to City Council without recommendation.

The Board of Health:

1. Requested the Medical Officer of Health to report directly to the October 9, 2024 meeting of City Council with a phased in plan to implement a universal school food program in January 2025 if federal funds flow by November 2024, including prioritization of the more than forty school communities that recently applied for a program and were denied due to lack of funding.

In Toronto, 28% of food bank users are children and youth, leading to more kids going to school on an empty stomach. Hunger impedes learning, making it difficult for students to concentrate on their education. Student nutrition programs play a crucial role by providing meals at school, allowing children to focus on their lessons rather than their hunger. As grocery prices rise and more families rely on food banks, it is imperative that funding flow to address student nutrition immediately.