Agenda

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

Directors of the Board and participating City Officials will be provided with the video conference details closer to the meeting date.

To provide comments or make a presentation to the Board of Health:

The public may submit written comments or register to speak to the Board on any item on the agenda.

Written comments may be submitted by writing to boh@toronto.ca.

To speak to the Board, please register by e-mail to boh@toronto.ca or by phone at 416-397-4592. Registered speakers will be provided with instructions on how to participate in the meeting.

Special Assistance for Members of the Public: City staff can arrange for special assistance with some advance notice. If you need special assistance, please call 416-397-4592, TTY 416-338-0889 or e-mail boh@toronto.ca.

Closed Meeting Requirements: If the Board of Health wants to meet in closed session (privately), a director of the Board must make a motion to do so and give the reason why the Board has to meet privately (City of Toronto Act, 2006).

Notice to People Writing or Making Presentations to the Board of Health: The City of Toronto Act, 2006 and the City of Toronto Municipal Code authorize the City of Toronto to collect any personal information in your communication or presentation to City Council or its Committees and Boards. The City collects this information to enable it to make informed decisions on the relevant issue(s). If you are submitting letters, faxes, e-mails, presentations or other communications to the City, you should be aware that your name and the fact that you communicated with the City will become part of the public record and will appear on the City's website. The City will also make your communication and any personal information in it - such as your postal address, telephone number or e-mail address - available to the public, unless you expressly request the City to remove it.

Many Committee, Board, and Advisory Body meetings are broadcast live over the internet for the public to view. If you speak at the meeting you will appear in the video broadcast. Video broadcasts are archived and continue to be publicly available.

If you want to learn more about why and how the City collects your information, write to the City Clerk's Office, City Hall, 100 Queen Street West, Toronto ON M5H 2N2 or call 416-397-4592.

toronto.ca/council

This agenda and any supplementary materials submitted to the City Clerk can be found online at toronto.ca/council. Visit the website for access to all agendas, reports, decisions, and minutes of City Council and its Committees and Boards.

Declarations of Interest under the Municipal Conflict of Interest Act

Confirmation of Minutes - October 21, 2024

Speakers/Presentations - The speakers list will be posted online at 8:30 a.m. on November 18, 2024

Communications/Reports

Over the past several months, the Medical Officer of Health Hiring Committee has been working alongside Phelps Group to find Toronto’s next Medical Officer of Health in preparation for Dr. Eileen de Villa’s departure at the end of this year. After an extensive search and interview process, we are bringing forward a recommendation to appoint the new Medical Officer of Health.

A report on the appointment of the recommended Medical Officer of Health will be submitted for consideration to the November 18th meeting of the Board of Health.

The Medical Officer of Health Hiring Committee recommends to the Board of Health that:

1.    City Council appoint the candidate identified in the Confidential Attachment 1 to the position of Medical Officer of Health for the City of Toronto Health Unit effective on January 1, 2025 or on the date the appointment is approved by the Minister of Health, whichever is later.

2.    City Council transmit the appointment of the Medical Officer of Health to the provincial Minister of Health for approval.

3.    In the event that the Minister of Health has not approved the appointment of the Medical Officer of Health by January 1, 2025, City Council appoint the candidate identified in the Confidential Attachment 1 to the position of Acting Medical Officer of Health for the City of Toronto Health Unit effective January 1, 2025, until such time that the Medical Officer of Health appointment is approved by the Minister of Health.

4.    City Council authorize the appropriate City officials to take the necessary action to give effect thereto, including the introduction in Council of the necessary bills to appoint the approved candidate as the Medical Officer of Health and to appoint the Acting Medical Officer of Health under the Health Protection and Promotion Act, R.S.O. 1990, c H.7 (“HPPA”).

5.    City Council authorize the public release of the name and Curriculum Vitae summary of the Medical Officer of Health contained in Confidential Attachment 1 upon City Council's approval of the appointment.

The purpose of this report is to recommend to the Board of Health an appointment to the position of Medical Officer of Health (MOH).

There are no financial implications resulting from the adoption of the recommendations in this report beyond what has already been included in the 2025 operating budget. 

The Medical Officer of Health recommends that:

1.  The Board of Health continue to recognize the drug toxicity epidemic as a public health crisis and continue to commit to actions that are evidence-based and urgently needed to promote wellbeing and community safety and aligned with the Our Health, Our City strategy.

2. The Board of Health reiterate its request to the Government of Ontario to:

a.  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.

b.  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 life-saving medical services, primary care, and increased pathways to treatment services.

3. The Board of Health reiterate City Council's request to the Government of Ontario to consider the inclusion of Supervised Consumption Services in their new Homelessness and Addiction Recovery Treatment program proposals that demonstrate outcomes for life-saving medical services, primary care, and increased pathways to treatment services and that include mandatory neighbourhood and operational safety plans.

4. The Board of Health requests the Our Health, Our City Implementation Panel to provide advice on the next set of priority actions, and to especially consider recommendations related to alcohol and tobacco.

5. The Board of Health reiterate its request to the Government of Ontario to fund the proposal submitted to Ontario Health for the Substance Use Crisis Centre - Toronto (SCC-T).

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. The Board of Health also directed the Medical Officer of Health to report back to the Board with annual progress reports on the implementation of Our Health, Our City.

This staff report provides an update on the current landscape, including the ongoing drug toxicity epidemic, as well as an overview of progress made in 2024 towards the implementation of the strategy, such as establishing the Our Health, Our City Implementation Panel, which includes representatives with lived and living experience of substance use and/or mental health challenges and a range of community partners.  

Over the last year, significant progress has been made towards the first-year priorities identified in the strategy. For example, the City has made advances on affordable and supportive housing, partners are taking steps to increase access to 24-7 crisis support services, and the Toronto Police Service has established a new pilot project to improve hospital transitions. Most notably, the Toronto Community Crisis Service has been expanded city-wide, which improves access to appropriate services and support for people in crisis.

Partners across the City have demonstrated action in areas that are well-aligned with Our Health, Our City recommendations, as well as continued partnership and collaboration to advance the strategy. Some examples of divisional initiatives are highlighted in this report, and a comprehensive status overview is provided in Attachment 1: Our Health, Our City Status Overview 2024. The Our Health, Our City Implementation Panel was also established in September 2024 following a public application process, and this panel will provide ongoing advice to further implement the strategy, including exploring priority areas of action for the following years.

Finally, this report also provides an update on recent actions to reduce harms specifically associated with cannabis, vaping, and smoking for youth. Toronto Public Health continues to provide an inspection and enforcement function, as well as health promotion, prevention, and education to reduce the harms associated with youth vaping.

Children's Services, Economic, Development and Culture, Toronto Employment and Social Services, Fire Services, Municipal Licensing and Standards, Parks, Forestry and Recreation, Senior Services and Long-Term Care, Social Development, Finance and Administration, Toronto Paramedic Services, Toronto Police Services, Toronto Public Library, Toronto Shelter and Support Services, and Toronto Transit Commission were consulted in the development of this report.

Parallel work on a co-developed Indigenous Wellness strategy is also underway at Toronto Public Health. An Indigenous Wellness Table and Indigenous Harm Reduction Circle with Indigenous-led service providers in the city were established and both groups continue to convene to advance Indigenous wellness, with a particular focus on harm reduction and promoting mental health and wellness.

There are no financial impacts associated with the adoption of the recommendations in current and future years. The Chief Financial Officer and Treasurer has reviewed this report and agrees with the information as presented in the Financial Impact Section.

The Medical Officer of Health recommends that:

1. The Board of Health recommend the Ministry of Health implement the recommendation from the Ontario Immunization Advisory Committee to create a provincial immunization registry that provides real-time information access to individuals and their health care providers and includes sociodemographic data linkage capabilities to support interventions to address inequities in vaccine access.

2. The Board of Health request the Minister of Health to:

a. Increase eligibility for publicly funded vaccine and access to Human Papillomavirus (HPV) vaccination for all people under 26 years of age; and as part of expanded public funding for HPV vaccination to all people under 26 years of age, the Ministry of Health request the Ontario Ministry of Colleges and Universities to promote HPV vaccination access with postsecondary institutions.

b. Develop a comprehensive campaign to increase the uptake of Human Papillomavirus (HPV), hepatitis B, and meningococcal vaccinations, especially among communities with lower coverage of these vaccines.

Toronto Public Health (TPH) works to facilitate high vaccination rates among elementary and secondary school-aged students and prevent vaccine-preventable disease outbreaks in schools and communities. Vaccinating children and youth protect them against vaccine-preventable diseases and some cancers and can prevent children and youth from passing on an infection to other people in their family or school.

Ontario's Immunization of School Pupils Act (ISPA) requires students who attend elementary and secondary school to be vaccinated against nine designated diseases or to have a valid exemption. It is the responsibility of parents and caregivers of students to report their immunizations to Toronto Public Health. Under the requirements of the Immunization of School Pupils Act, students who do not submit the required vaccination records or a valid exemption form to Toronto Public Health may be suspended from school.

Following a pause in student suspensions during the pandemic, Toronto Public Health resumed the full Immunization of School Pupils Act assessment and enforcement process for the 2023-2024 school year. This included suspensions from school for students who did not provide Toronto Public Health with complete Immunization of School Pupils Act vaccine records or a valid exemption. Toronto Public Health reminds and assists families and schools to promote Immunization of School Pupils Act compliance through informational and vaccination initiatives so that students can avoid suspension or return to school as quickly as possible. Toronto Public Health includes equity-focused initiatives in their student immunization programs, including working with other health and community partners to share messages about vaccines and assigning Public Health Nurses to schools with lower rates of coverage and Aanse-focused schools that have the highest numbers of self-identified Indigenous students.

Through the School Immunization Program (SIP), Toronto Public Health offers three vaccines to grade seven and eight students at clinics in schools. These vaccines are meningococcal, Human Papillomavirus (HPV), and the hepatitis B vaccines. Vaccine clinics in schools were paused during the pandemic response. The resumption of school-based clinics for adolescents promotes vaccine uptake.

There are no financial impacts associated with this initiative in current and future years. The Chief Financial Officer and Treasurer has reviewed this report and agrees with the information as presented in the Financial Impact Section.

The Medical Officer of Health recommends that:

1. City Council delegate authority to the Medical Officer of Health to enter into agreements, with any government, agency, community organization, private entity or individual for the purpose of receiving and using funds for the provision of Toronto Public Health programs and services in the amount of $500,000 or less on such terms and conditions that are satisfactory to the Medical Officer of Health and in a form approved by the City Solicitor provided that the cumulative amount received from any individual order of government, agency, community organization, private entity or individual shall not exceed $500,000 in any calendar year.

On occasion, Toronto Public Health (TPH) can apply for grants from third parties, including community organizations and agencies reporting to other orders of government. The purpose of a grant can range from providing additional public health services for community benefits, to engaging in research and projects that support topics of public health significance.

A recent example of this is a partnership with the Urban Public Health Network (UPHN), where Urban Public Health Network will provide Toronto Public Health with a one-time transfer of $100,000 CAD to enhance human papillomavirus (HPV) vaccination rates among high school students for the 2024/2025 and 2025/2026 school years. Funding will be used to initiate a project that will enhance communications and youth engagement to increase HPV vaccination.

This report seeks City Council authority for the Medical Officer of Health to accept grants, and to enter into contractual agreements for the purpose of accepting grants in the amount of $500,000 or less. If approved, this increase in delegated authority will enable Toronto Public Health to accept the Urban Public Health Network one-time funding, as well as access funds received from any future grants more quickly. Grants and funding above this amount would be reported to Council. Both the Board of Health and City Council will continue to be informed of all grant amounts received by Toronto Public Health through the annual budget process.

Toronto Public Health (TPH) is partnering with the Urban Public Health Network (UPHN) to enhance HPV vaccination rates among high school students for the 2024/2025 and 2025/2026 school years through enhanced communications and youth engagement to increase vaccination. As part of this project, Urban Public Health Network will provide Toronto Public Health with a one-time transfer of $100.0 thousand.

Toronto Public Health will request to adjust the 2025 Operating Budget through the in-year adjustment process by $100.0 thousand gross, $0 net once funding is received.

The Chief Financial Officer and Treasurer has reviewed this report and agrees with the financial impact information.

The Medical Officer of Health recommends that:  

1. City Council authorize the Medical Officer of Health to enter into agreements, on an ongoing basis, with the Toronto school boards (Toronto District School Board, Toronto Catholic District School Board, Mon Avenir and Conseil scolaire Viamonde) for the transfer of funds in the total amount of $300,000 or less per year as part of the Into Kids' Health program within the approved Toronto Public Health budget, on such terms and conditions as are satisfactory to the Medical Officer of Health and in a form approved by the City Solicitor. 

The Ontario Public Health Standards' School Health Guideline, 2018, indicates that the board of health shall develop and implement a program of public health interventions to improve the health of school-aged children and youth. The Toronto Healthy Schools Strategy formalizes the commitment of Toronto Public Health and the Toronto school boards to support student well-being through the creation of healthy school environments.

The Into Kids’ Health program, is an evidence informed collaboration between Toronto Public Health and Toronto schools serving equity deserving communities that aims to create healthy school environments. Participating schools receive up to $7500 to be spent over two years, as well as additional Toronto Public Health initiatives and resources. A wide range of school initiatives have been implemented through the Into Kids' Health program, including revitalizing outdoor spaces, improving student mental health and strengthening ties to the community.

To expand the reach of the Into Kids' Health program to more equity deserving schools and streamline the administrative process for issuing funds to individual schools, this report seeks City Council authority for Toronto Public Health to transfer funds of $300,000 or less annually beginning in the 2024-2025 school year to participating school boards (Toronto District School Board, Toronto Catholic District School Board, Mon Avenir, Conseil scolaire Viamonde).

This report recommends that Toronto Public Health (TPH) provide a lump sum schedule A payment to each of the participating school boards (Toronto District School Board, Toronto Catholic District School Board, Mon Avenir, Conseil scolaire Viamonde) for a total annual limit of $300,000 or less starting from the 2024-2025 school year.

Funding for the recommended program is included in the 2024 base operating budget of Toronto Public Health.

The Chief Financial Officer and Treasurer has been advised of the financial impacts associated with the program to be considered along with other priorities in future budget.

The Board Secretary, Board of Health, in consultation with the Chair, recommends that:

1.  The Board of Health approve the following 2025 meeting dates:

• Monday, January 20 at 9:30 a.m.
• Monday, February 10 at 9:30 a.m.
• Tuesday, April 1 at 9:30 a.m.
• Monday, May 5 at 9:30 a.m.
• Monday, June 2 at 9:30 a.m.
• Monday, July 7 at 9:30 a.m.
• Monday, September 15 at 9:30 a.m.
• Monday, October 27 at 9:30 a.m.
• Monday, November 24 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 July 24 and 25, 2024, City Council considered Item CC20.11, 2025 Schedule of Meetings, and approved the 2025 schedule of meetings for City Council and its Committees. The schedule also included proposed 2025 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.