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 - November 18, 2024, December 9, 2024, December 19, 2024

Speakers/Presentations - The speakers list will be posted online at 8:30 a.m. on January 20, 2025

Communications/Reports

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 January 20, 2025 and ending December 31, 2025, and until a successor is appointed.

Election of the Vice 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 January 20, 2025 and ending December 31, 2025, and until a successor is appointed.

The Medical Officer of Health recommends that: 

1.  The Board of Health review the current directorship of the Board of Health - Budget Committee and appoint Board of Health directors for a term of office ending December 31, 2025, and until successors are appointed.

2.  The Board of Health review the current directorship of the Board of Health - Performance Appraisal of the Medical Officer of Health Committee and appoint Board of Health directors for a term of office ending December 31, 2025, and until successors are appointed.

3. The Board of Health appoint a Board of Health director to be the Chair of the Our Health, Our City Implementation Panel for the remainder of the 2022-2026 Toronto City Council term, and until a successor is appointed.

4.  The Board of Health appoint a Board of Health director to the Association of Local Public Health Agencies' (alPHa) Board of Directors and Board of Health Section for a term of office ending December 31, 2025, and until a successor is appointed and pay expenses for attending alPHa's 2025 meetings and semi-annual meetings/conferences within Toronto Public Health's 2025 Approved Operating Budget.

5.  The Board of Health encourage all Board of Health directors to attend the Association of Local Public Health Agencies' (alPHa) Board of Health Section meeting and semi-annual meetings/conferences in Toronto and pay expenses for attending alPHa's 2025 meetings and conferences in Toronto within Toronto Public Heath's 2025 Approved Operating Budget.

This report outlines the need for appointments of Board of Health members to three Committees of the Board of Health and one external Board for 2025:

• The Board of Health - Budget Committee;
• The Board of Health - Performance Appraisal of the Medical Officer of Health Committee;
• Our Health, Our City Implementation Panel Chair; and
• The Association of Local Public Health Agencies' (alPHa) Board of Directors and Board of Health Section.

In addition, this report provides an update on the Strategic Plan Development Committee and the Medical Officer of Health Hiring Committee.

There is no financial impact resulting from the adoption of the recommendations in the report. 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 receive this report for information.

This report provides an overview of Toronto Public Health's accomplishments and achievements in 2024. The provision of a year-end annual report is a requirement in the Ontario Public Health Standards, 2021, as set by the Ontario Minster of Health.

This past year, Toronto Public Health entered a new chapter, emerging as a post-pandemic organization with a renewed commitment to adapting and improving to best serve the diverse needs of our city. Some highlights of achievements in 2024 include:

• Creating Toronto Public Health's Strategic Plan 2024 - 2028;
• Providing vaccination to more than 42,000 children and youth, continuing to close the gap in vaccination rates that developed over the pandemic;
• Launching online vaping prevention resources, an Integrated Respiratory Diseases Dashboard, and a refreshed Population Health Status Indicators Dashboard;
• Hosting the Hastings Lecture Series event, Diverse Dialogues: Stigma and Breaking Barriers;
• Establishing the Indigenous Wellness Committee in partnership with the Toronto Aboriginal Support Services Council; and
• Enhancing partnerships with City divisions and the community, including to recommend a maximum indoor temperature for tenants, and to expand breastfeeding services.

Looking to 2025, Toronto Public Health will continue to advance our strategic priorities, protecting and promoting the health of the more than three million residents of Toronto.

There is no financial impact resulting from the adoption of the recommendation in this report.

The Medical Officer of Health recommends that:

1. The Board of Health recognize that access to affordable, well-supported, and appropriate housing, alongside equitable income supports, is essential for improving population health and well-being.

2. The Board of Health request that the Medical Officer of Health:

a. Assess Toronto Public Health services for accessibility and the use of trauma-informed approaches as discussed in the Health and Homelessness Working Table (Attachment 3) to advance these practices across the organization;

b. Share the report from the Health and Homelessness Working Table (Attachment 3) with relevant City of Toronto divisions and agencies, and propose collaborative interventions to support implementation of the recommended actions; and

c. Share the report from the Health and Homelessness Working Table (Attachment 3) with relevant local health care partners and Ontario Health - Toronto Region, to propose collaborative interventions such as peer support navigator programs to navigate the health care system and establish pathways to bring health care to meet people where they are.

3. The Board of Health urge the Government of Ontario and the Government of Canada to collaborate with the City of Toronto to provide the necessary policy, funding, and intergovernmental support to sustain and strengthen the health, mental health and harm reduction services under the Homelessness Health Services Framework.

4. The Board of Health request that the Medical Officer of Health collaborate with Toronto Shelter and Support Services (TSSS) to support the continued delivery and advancement of the Homelessness Health Services Framework (HHSF) by:

a. Collaborating with the HHSF Steering Committee to provide public health expertise, align Toronto Public Health services, and foster intersectoral collaboration to advance the health and well-being of people experiencing homelessness;

b. Working with partners to increase equitable access to health care, including the full continuum of evidence-based prevention, harm reduction, and treatment supports for people experiencing homelessness; and

c. Advocating for sustainable funding from Ontario Health and the Ministry of Health to enhance prevention-focused mental health and crisis intervention services, expand supports for individuals with complex mental health and social needs, address systemic barriers, strengthen shelter safety, and ensure equitable access to care for people experiencing homelessness.

5. The Board of Health request the Government of Canada and Government of Ontario partner with the City of Toronto to establish an intergovernmental collaborative group to advance actions to address the health and well-being of people experiencing homelessness in Toronto that:

a. Includes representation from people with lived and living experience of homelessness, organizations serving people experiencing homelessness, healthcare and social service providers, and municipalities; and

b. Is informed by the expert advice in the report from the Health and Homelessness Working Table, as outlined in Attachment 3 to this report.

6. The Board of Health request that the Medical Officer of Health engage in ongoing advocacy with all orders of government for an increase in affordable, well-supported, and appropriate housing options, as a key determinant of population health and well-being.

In January 2023 the Board of Health requested that the Medical Officer of Health develop a working table to review the intersection of health and homelessness. In response, Toronto Public Health convened a group of experts and individuals with lived and living experience, including representatives from healthcare, academia, frontline services, and various City of Toronto divisions to create the Health and Homelessness Working Table. This group participated in a series of eight meetings from August 2023 to May 2024.

The primary objective of the Health and Homelessness Working Table was to provide input on and share recommendations addressing health-related issues affecting individuals experiencing homelessness in Toronto. Each meeting focused on specific health issues or populations, such as healthy environments, chronic disease management, refugees and asylum claimants, safety and injury prevention, mental health and substance use, and health across the lifespan.

Throughout the series of meetings, participants emphasized the need for enhanced multi-sector collaboration involving all levels of government. They identified gaps and opportunities for improving access to and coordination of services between healthcare and social services, as well as for better communication and resource sharing with individuals experiencing homelessness. The overarching recommendation was the establishment of an intergovernmental collaborative group to address the needs of people experiencing homelessness, with consideration of the feedback provided by this group.

Children's Services, Senior Services and Long-Term Care, Social Development, Finance and Administration, Toronto Shelter and Support Services, and Housing Secretariat were consulted in the development of this report.

Any financial impacts resulting from the adoption of the recommendations in this report can be  accommodated within approved operating or capital budgets.

The Acting Medical Officer of Health recommends that:

1. The Board of Health urge the Government of Ontario to:

a. Increase access to Supervised Consumption Services and Consumption and Treatment Services Sites consistent with the location requirements within the Community Care and Recovery Act, 2024 to prevent overdose deaths and facilitate pathways to substance use treatment; and

b. Permit needle exchange services within Homelessness and Addictions Recovery Treatment (HART) Hubs to reduce the transmission of communicable diseases.

c. Share provincial plans for mitigating healthcare system impacts due to the closures of Supervised Consumption Services and Consumption and Treatment Services Sites, as part of implementation planning for Homelessness and Addictions Recovery Treatment (HART) Hubs.

On December 4, 2024, the Government of Ontario passed the Community Care and Recovery Act, 2024. This legislation introduces new requirements for operating supervised consumption service sites in Ontario and will lead to a reduction in supervised consumption services available in Toronto by March 31, 2025.  

On November 18, 2024, the Board of Health requested the Medical Officer of Health, in consultation with the Toronto Police Service, Toronto Fire Services, and Toronto Paramedic Services to provide a summary of likely service impacts related to the anticipated closure of supervised consumption sites in Toronto. This staff report provides an overview of anticipated service impacts to Toronto Public Health's clinical service and emergency services in the city as a result of this provincial policy change.

The Board of Health also requested the Medical Officer of Health, in consultation with the City Solicitor, to provide a summary of any legal issues related to the Provincial decision to close supervised consumption sites in Toronto. An overview of the legal implications and advice related to the closures of the supervised consumption sites is provided in the supplementary report from legal services.

Supervised consumption sites are healthcare facilities that allow people to bring their own drugs to use in the presence of trained healthcare professionals. These facilities save lives, connect people to social services and are pathways to treatment. The new legislation will reduce access to an evidence-based clinical healthcare service leading to an anticipated increase in preventable fatal and non-fatal overdoses.

Toronto Fire Services, Toronto Paramedic Services and Toronto Police Service were consulted in the development of this report.

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

The City Solicitor recommends that:

1.  The Board of Health direct that the confidential information contained in Confidential Attachment 1 remain confidential in its entirety as it contains advice which is subject to solicitor-client privilege and information about litigation or potential litigation that affects the Board of Health.

The Community Care and Recovery Act, 2024 (the “CCRA”) received Royal Assent on December 4, 2024. The CCRA creates new restrictions on harm reduction services in Ontario, including a prohibition on the operation of a supervised consumption site within 200m of a school, private school, child care centre, and EarlyON child and family centre. It also limits the power of boards of health and municipalities to apply for new exemptions under the Controlled Drugs and Substances Act, to apply for funding from Health Canada for safer supply services, and to support applications that relate to the aforementioned.

Confidential Attachment 1 provides further information and advice regarding the Community Care and Recovery Act, 2024.

The financial impacts are identified in Confidential Attachment 1.

The Chief Financial Officer and Treasurer has reviewed this report and agrees with the financial implications as identified in the Financial Impact section.

The City Solicitor recommends that:

1.  The Board of Health consider the confidential recommendations in Confidential Attachment 1 from the City Solicitor and instruct staff accordingly.

2. The Board of Health authorize the public release of the confidential recommendations contained in Confidential Attachment 1 at the discretion of the City Solicitor, but that the remainder of Confidential Attachment 1 remain confidential in its entirety as it contains advice which is subject to solicitor-client privilege and information about litigation or potential litigation that affects the Board of Health.

The Community Care and Recovery Act, 2024 (the "CCRA") received Royal Assent on December 4, 2024. On December 9, 2024, a Notice of Application was issued in the Ontario Superior Court of Justice which challenges the constitutionality of the CCRA (the "TNG Application").

A supplementary report to Item HL21.6 was submitted by the City Solicitor on legal issues related to the CCRA and TNG Application on January 7, 2025. This second supplementary report provides an update on the TNG Application and seeks instructions from the Board of Health regarding participating as an intervenor.

The financial impacts are identified in Confidential Attachment 1.

The Medical Officer of Health recommends that: 

1. The Board of Health direct the Medical Officer of Health to implement the voluntary Food Safety Management Plan tool as outlined in this report in time for the summer 2025 special event season.

2. The Board of Health direct the Medical Officer of Health to collect feedback and data from special event organizers on the implementation of the Food Safety Management Plan tool and report back to the Board of Health in Q2 of 2026 on next steps, including exploring the feasibility of requiring special event organizers submit a Food Safety Management Plan as part of the special event permitting processes.

There are hundreds of special events in Toronto throughout the year and especially during the summer adding to the vibrancy of the city. Toronto Public Health (TPH) protects health at special events by providing guidance for water and food safety. Food safety rules can be complex, and food vendors at special events are held to the same standard as permanent food premises, but must achieve these standards while outside in crowded areas with limited infrastructure.

The number of special events is expected to increase as the City takes steps to grow the number of non-permanent food locations by creating new spaces for events like farmers markets. While these are welcomed changes that support the city's vibrancy, they also significantly increase the workload for public health inspectors (PHIs). As special events are clustered in the summer months, concurrently with peak times for other work, TPH PHIs cannot inspect all special event food vendors. To reduce risks for food safety issues while managing operational constraints, TPH is introducing The Food Safety Management Plan (FSMP), a new, voluntary, tool for event organizers which promotes proactive and preventative approaches to special event food safety. The introduction of the FSMP tool is supported by additional educational resources for both organizers and vendors of special events.

There are no financial impacts associated with the recommendations of this report.